Highly Cross-Linked Polyethylene in Total Knee Arthroplasty

Loosening and lysis related to wear are the most common reasons for total knee arthroplasty (TKA) revision. Knee simulator studies on the wear behavior of tibial knee inserts have looked at the effects of long-term testing, artificial aging, presence of third body particles, implant design, and malpositioning of implants. Analysis of synovial fluid aspirates of patients at one-year post TKA have shown significantly fewer polyethylene wear particles in knees with cross-linked polyethylene (XLPE) versus non-XLPE. The key factors of importance to a patient undergoing TKA are clinical outcomes and prosthesis survivorship. The rationale behind the development of XLPE with antioxidants was that the residual free radicals from the radiation cross-linking could be stabilized by the antioxidant, eliminating the need for postirradiation melting for oxidative resistance. Laboratory trials have demonstrated benefits to XLPE and antioxidant XLPE over non-XLPE. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.