Crosslinked polyethylene in knee arthroplasty: a simulator study evaluating the positive influence on the tribocontact area in the fixed-bearing knee

Background Crosslinked polyethylene (XPE) was developed to reduce the wear rate in hip as well as knee arthroplasty. The crosslinking process reduces the mechanical properties of ultra-high-molecular-weight polyethylene (UHMWPE), particularly its fatigue strength. UHMWPE fatigue occurs more frequently in the knee than in the hip joint due to its changing tribocontact areas (TCAs) combined with high weight bearing. This is why XPE is still controversially discussed for use in total knee arthroplasty. Therefore, the potential advantage of using XPE in the knee was analysed in a simulator study with a focus on potential fatigue wear mechanisms. Methods Three different kinds of XPE and one conventional UHMWPE were tested over 5 million cycles in fixed-bearing knee designs. The TCAs were examined by replicas, and their extent was measured. The wear mechanism was analysed by scanning electron microscopy. Results The extent of the TCAs was less than 5% for all XPEs, whereas 35% for the conventional UHMWPE. Fatigue wear mechanisms were not observed. Conclusion The measured small extent of the TCAs as a predictor of a low wear rate without any fatigue wear mechanism shows a possible advantage for the use of XPE even in knee arthroplasty.