Alpha Lipoic Acid (L.A.) is an effective natural antioxidant discovered in the human body in 1951 from L.J. Reed and I.C. Gunslaus from liver. It is inside broccoli, spinach and red meats, especially liver and spleen. Actually it is largely used as antioxidant in antiaging products according to the low toxicity level of the product. The present study take into consideration the possibility to reduce oxidation of medical irradiated UHMWPE GUR 1050, mixing together polyethylene powder and Alpha Lipoic Acid powder. The study is composed of two parts. Part 1 Thermostability of alpha lipoic acid during polyethylene fusion Part 2 detection of oxygen level in artificially aged irradiated polyethylene Solid pieces were made with Gur 1050 powder (Ticona Inc., Bayport, Tex, USA) and mixed with Alpha Lipoic Acid (Talamonti, Italy, Stock 1050919074) 0, 1% and gamma ray irradiated with 30 kGy (Isomedix, Northborough, MA). An oven (80° Celsius) was used to produce an aging effect for 35 days in the doped and control samples (Conventional not doped polyethylene). This process simulate an aging effect of 10 years into the human body. THERMAL STABILITY: a Fourier Transfer Infra Red (FTIR) test was made in pieces molded in a cell at 150° and 200°Celsius and pressure of 200 MPa comparing to the UHMWPE powder mixed with alpha lipoic acid. The presence of Alpha Lipoic Acid in the polyethylene was found at any depth in the manufacts. figure 1: A Pure Lipoic Acid. B Lipoic Acid + UHMWPE melted 150° C. Lipoic Acid + UHMWPE melted 200° C° (A And B spectra subtracted UHMWPE) OXIDATION: After 5 weeks at 80° Celsius in a oven (ASTM standard F-2003-02)A FOURIER TRANSFER INFRA RED TEST (FTIR) was made in the superficial layer and deeper on the undersurface of doped 0.1% and conventional UHMWPE. The antioxidation limit is defined as the ratio of the area under 1740 cm/−1 carbonyl and 1370 cm/−1 Methylene absorbance peaks. In conventional UHMWPE oxidation is detected on the surface and decreases in the deeper layers down to zero under 1500 Micron Fig 2. figure 2 Pure polyethylene: A Surface, B 1500 Micron, C 3000 Micron In the doped UHMWPE, FTIR demonstrate a very low oxidation limit on the surface and at any depth, comparing to conventional UHMWPE Fig 3. figure 3 Doped UHMWPE A surface, B 700 micron deept, C 1700 micron deept The examples show that Lipoic Acid is effective as antioxidant in irradiated UHMWPE and it is stable with respect to thermal treatment.
Septic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction is a rare complication. In the literature, several different managements have been proposed. A total of 1232 ACL reconstruction procedures were performed from January 2001 and December 2008. Twelve patients (0.97%) had a post-operative infection. The average age at trauma was 24 years (range:16–43). Treatment included continuous irrigation of the knee (4 hour/day for 2 days) and parenteral and oral antibiotics subsequently for a mean of 7 weeks (range:4–12 weeks). The average time at follow-up was 38 months (range 6–54 months). Follow-up included International Knee Documentation Committee (IKDC) forms, radiographs, the Tegner and Lysholm scores and KT-1000 arthrometric evaluation. In all cases treatment of infection was successful. In no cases graft or hardware removal was needed. At final examination pivot shift was negative in 10/12 patients and 1+ in 2/12 patients. In all cases the Lachman was negative. The mean postoperative Tegner score was 7.2 (range 5–9), the mean Lysholm score was 98.3 (range 69–100). 10/12 patients were graded as Group A and 2/12 patients as group B using the IKDC. The mean postoperative manual maximum KT-1000 side to side difference was 2.3 (range1–4), with 10 patients between 0 and 3 mm and 2 between 3 and 5 mm. No significative bone tunnel enlargement was found. The described treatment gives reliable results. There were no recurrences of septic arthritis or bone infection. No further surgeries were required. The graft can be retained during treatment of septic arthritis after ACL reconstruction.
In all cases a specialized dedicated surgical instrumentation was used. Inclusion criteria to enter the study group (A-B-C Groups) were:BMI<
30, diagnosis of primary osteoarthritis, age<
75 years. Following parameters were evaluated: intra and post operative complications, total blood loss, time of surgery, component placement, length of hospital stay and functional outcomes (HHS, WOMAC) at six weeks.
In control group D (149 patients) the following complications were observed: one proximal femoral fracture, one case of cup malposition and one infection.
Polyethylene wear is the most important risk factor affecting the durability of total knee arthroplasty. We developed a new method of measuring wear of the tibial polyethylene insert in total knee arthroplasty (TKA) on standard standing radiographs.