Contact Fatigue Failure of Ultra-High Molecular Weight Polyethylene Bearing Components of Knee Prostheses

The objective of this work has been to study the origin of surface failures in UHMWPE tibial bearings of total knee replacements. Earlier examination of hundreds of retrieved prostheses, along with analysis of the properties of UHMWPE material from retrieved bearings, had shown that a large number of the bearings suffered from subsurface oxidation. This oxidation was related to the gamma irradiation used to sterilize the tibial bearings. Mechanical properties of the polymer were significantly deteriorated in the oxidized region, with the most severe reduction of strength and ductility occurring about 1 mm beneath the contact surface. In this work the contact stress distribution in the bearings was analyzed, and tribotesting of the bearing materials was carried out under simulated service conditions. Fatigue cracks and delamination developed in bearings tested in a knee simulator and in rolling/sliding test specimens, and the damage was similar to that found in retrieved tibial bearings. The fatigue cracks invariably initiated in the embrittled oxidized layer, and the depth of that layer determined the depth at which the cracks began. The stress analysis showed that the maximum shear stress and von Mises equivalent stress reached high levels in the subsurface oxidized zone where the delamination and contact fatigue failures initiated. [S0742-4787(00)04401-5]