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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 80 - 80
1 Mar 2013
Iwade H Kawasaki T Tajima K Sakurai Y Uetsuki K Turner A Tomita N
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Background

dl-α-Tocopherol (vitamin E) blended ultra-high molecular weight Polyethylene (UHMWPE) was originally developed as a bearing material for use in knee prostheses (1). The reduced biological response observed for vitamin E (VE) blended UHMWPE wear particles in in vitro experimentation (2) has also demonstrated the materials potential for use in other orthopedic applications, especially total hip arthroplasty (THR). However, due to the excellent results achieved by highly crosslinked UHMWPE in hip simulator testing (3), the use of VE blended UHMWPE in THR would similarly require crosslinking. It was previously reported that VE radicals are formed during radiation crosslinking of VE blended UHMWPE (4), and it is hypothesized that these VE radicals may negatively impact the materials biological activity. In this study, ascorbic acid 6-palmitate (lipophilic vitamin C) was applied to electron-beam-irradiated VE blended UHMWPE in an attempt to oxidatively reduce the VE radicals. Electron Spin Resonance (ESR) was used to measure the number of VE radicals within the material and evaluate the regenerating effect of ascorbic acid 6-palmitate.

Materials & Methods

UHMWPE resin powder (GUR 1050, Ticona, USA) was mixed with dl-a-Tocopherol (vitamin E) at 0.3 wt% and molded under direct compression at 25 MPa and 220°C. Virgin samples were produced by the same process, but without the addition of vitamin E (VE). Cylindrical pins (length: 40 mm, diameter: 3.5 mm) were then machined from these samples, packaged in a vacuum, and irradiated by electron-beam at 300 kGy. Samples were subsequently doped with either ascorbic acid 6-palmitate (Sigma, Japan) or ethanol (Ethanol 99.5%, Kishida, Japan) and subjected to a hydrostatic pressure of 100 MPa for 7, 14, and 21 days at room temperature. Radical measurements were made using ESR at 9.44 GHz and room temperature. All ESR spectra were recorded at 0.1 mW microwave power and 0.1 mT modulation amplitude.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XL | Pages 90 - 90
1 Sep 2012
Kawasaki T Hamada D Tajima K Sakurai Y Uetsuki K Tomita N
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INTRODUCTION

Electron-beam-irradiated dl-α-Tocopherol (Vitamin E)-blended UHMWPE is now being considered as a potential new bearing surface material for hip prosthesis [1]. However, Vitamin E stabilizes some of the primary free-radicals required for crosslinking, thereby reducing the material's crosslink density [2]. Additionally, some biological-stabilization effects of Vitamin E may also be reduced by oxidation. In this study, Vitamin E radicals in electron-beam-irradiated UHMWPE were measured and identified using Electron Spin Resonance (ESR), and the effects of annealing on radical stabilization and crosslink density were examined.

MATERIALS & METHODS

Both pure UHMWPE and Vitamin E added (0.3% w/w) resin was used to produce bulk specimens via vacuum direct compression molding at 220°C under 25 MPa for 30 min. Cylindrical pins (3.5 mm diameter, 40 mm length) for ESR measurement were then machined and placed in vacuum packaging. The pins were irradiated at 300 kGy, with half of each test group annealed at 80°C for 24 hours. Free radical measurements were made using a high-sensitive X-band ESR operating at 9.44 GHz. Detection of Vitamin E radicals was performed by comparing the characteristic symmetrical spectrum of oxidized Vitamin E to the spectra observed for the pins using both g-value and linewidth as references. Crosslink density was measured via gel fraction analysis and was performed in accordance with ASTM D2765. Thin sections (20 × 40 mm2, 200 μm) were machined from the bulk specimens, which were then placed in vacuum packaging, irradiated and annealed at the same conditions as those for the ESR measurements. Two of these thin sections were then placed in a stainless-steel cage (200 µm pore diameter) and were immersed in decahydronaphtalene at 200°C for 24 hours. These specimens were then extracted using soxhlet extractor at 100°C for 24 hours and dried in vacuum at 150°C for 12 hours.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_II | Pages 46 - 46
1 Feb 2012
Tajima K Sasaki T Kono K Yamanaka K Nomoto S
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In February 2004, our institute began to perform routine cervical CT scans in addition to head CT examinations on patients with blunt head trauma who had received high energy injuries. We present the findings of 108 patients who underwent a routine cervical CT within the last year and the usefulness of routine cervical CT examinations is discussed. The present report is, to our knowledge, the only prospective study to examine the utility of routine cervical CT examinations.

Among the patients admitted to the emergency room of our institute after receiving high energy injuries, 108 patients had blunt head trauma and underwent a routine cervical CT examination in addition to the head CT examination specified by our original protocol for cervical clearance. The mechanism of injury and the presence of cervical bone lesions were noted in each case. 76 males and 32 females ranging in age from 13 to 77 years (average, 41.0 years) were included in the study. Among these 108 cases, cervical fractures or subluxation were visible in 5 cases on plain films. Although no fractures were seen on the plain films taken in the remaining 103 cases, the additional cervical CT examinations demonstrated 14 cervical fractures in 13 (12.6%) of these cases.

For patients with blunt head trauma, a cervical CT examination is not usually performed if no evidence of a cervical fracture is found on plain films and no neurological deficits are present. Nevertheless, the present findings suggest that many cervical fractures may have been missed on plain films in the past, and the routine inclusion of a cervical CT examination in addition to a head CT examination might be appropriate in the evaluation of patients with blunt head trauma who have been involved in a high energy injury.