Alternative Damping Layer in Total Knee Replacement

Using Self-Healing Hydrogel

Kidthiphat Tejakumpuj 5613344, Nattawat Kingsuvangul 5613352 and Tanawat Chansophonkul 5613356
Background and Significance
Osteoarthritis is a bone degenerative, wear-and-tear" type of arthritis that occurs most in the knee. As the
cartilage wears away, the protective space between the bones decreases. This can result in bone rubbing together
during articulation of joint, and produce pain, swelling, and stiffness of knee joint. Common causes of osteoarthritis
of the knee is older age, body weight pressure on the joints, heredity, and injury. There are three treatments for
knee Osteoarthritis: medication, physical therapy, and the most effective way is prosthetic joint implant surgery.
The first generation of knee prosthetic joint implant began in 1880, material used is ivory attached to bone
with the help of colophony cement. Acrylic hinge was made in 1951 and replaced by Cobalt Chromium in 1958, but
it caused toxicity in some patients. In 1960s, Polyethylene tibial tray was used, but high notch sensitivity could lead
to fracture. COP alloy (Co, Cr, Ni, Mo, C, and P) and Vitallium metal then was used in 1970s, and was coated with
porous substance in 1986. After that, Titanium Aluminum and Vanadium alloy (Ti6Al4V) was developed for Total
knee replacement and Polyethylene was used for allowing better ligamentous tension. In 1998, Ultrahigh Molecular
Weight Polyethylene had been applied as an answer to toxicity and biocompatibility, and is still in used as of today.
After development of Ultra High Molecular Weight Polyethylene, toxicity due to degradation of metallic
debris was solved, but UHMW Polyethylene degradation, caused by friction, contacting fatigue and oxidative
reaction still appeared as a main problem that lead to the failure of the artificial joint. There are many factors that
lead to the failure of the joint replacement, most of the factors depend on patient activity and material free particle
in synovial fluids, other factor is caused by inaccuracy of the doctor which result in false alignment of the joint.
The most serious issue that cause joint failure is free particle of material. UHMPE free particle have an
impact on the incidence of osteolysis and aseptic loosening, Polyethylene wear particles are generated at the
articulation and dispersed into synovial fluid. Some particles captured in the capsule but other migrate in interface
of the tissue. Macrophage in immune system target all these free particle and affect the bone tissue, causing change
of the bone structure and immunological response. As a result osteolysis loosen the artificial joint and increase the
risk of bone breakage.

Method
We suggest a method to solve the osteolysis problem due to the free particle of UHMWPE. We insert a
layer of self-healing hydrogel into prosthesis knee joint. It acts like a damper between metallic part of femur and
UHMW polyethylene tibial tray. With high stretchability and toughness of hydrogel, the friction at the surface of both
metallic part and polyethylene part is decreased, furthermore load impact during the activity of joint can be
absorbed. Finally, it should be able to reduce the debris caused by friction of articulating joint.

Self-healing Hydrogel
A hydrogel is a macromolecular polymer gel formed by crosslinking polymer chains through ionic
or covalent bonding. A net-like structure give hydrogel's the ability to absorb great amount of water. As a result,
hydrogels is a homogeneous material which contain over 90% water and develop characteristics of firm and elastic
mechanical properties.
With high compatibility, hydrogels are commonly used in medical field as scaffolds for tissue engineering,
vehicles for drug delivery and extracellular matrices model for biological studies. Most hydrogels does not show
high stretchability, or load bearing property, therefore the scope of hydrogel applications is often limited by their
mechanical property.
The material we took an interest in is Self-healing hydrogels developed by a team from Harvard University.
It is synthesized by mixing two types of crosslinked polymer: ionically crosslinked alginate, and covalently
crosslinked polyacrylamide show high stretchability and toughness. It can be stretched to over 20 times its initial
length, and have fracture energies of 9,000 Jm-2, as compared with 10,000 Jm-2 for cartilage.

References
[1] Jeong-Yun Sun, Highly stretchable and tough hydrogels, Nature: International Journal of Science Vol. 489, 2012.
[2] Raphael Guillin, Polyethylene Wear in Knee Arthroplasty, University of Montreal Hospital Center, 2007
[3] Yukihide Minoda, Polyethylene Wear Particles in Synovial Fluid after Total Knee Replacement, p 165-172, 2003
[4] Wear and Osteolysis around Total Knee Arthroplasty, Douglas D.R. Naudie, Volume 15, January 2007