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In Vivo Biological Response to Vitamin E and Vitamin-E-Doped Polyethylene
Bryan T. Jarrett, BS1; Jennifer Cofske, BS1; Andrew E. Rosenberg, MD2; Ebru Oral, PhD1; Orhun Muratoglu, PhD1; Henrik Malchau, MD1
1 Harris Orthopaedic Biomechanics and Biomaterials Laboratory, Massachusetts General Hospital, 1125 Gray/Jackson, 55 Fruit Street, Boston, MA 02115. E-mail address for B.T. Jarrett: bjarrett@partners.org
2 Department of Pathology, Massachusetts General Hospital, Warren 2, 55 Fruit Street, Boston, MA 02115
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet).

Investigation performed at the Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Nov 17;92(16):2672-2681. doi: 10.2106/JBJS.I.00068
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Cross-linking has decreased the wear of ultra-high molecular weight polyethylene, a cause of osteolysis leading to total joint replacement failure. Compared with melting or annealing, doping cross-linked ultra-high molecular weight polyethylene with vitamin E stabilizes free radicals from irradiation while maintaining mechanical properties and wear resistance. This study was done to determine the local tissue effects of free vitamin E and vitamin E eluted from ultra-high molecular weight polyethylene implants in the joint space.


Three studies were performed. First, pure vitamin E and solubilized vitamin E were injected into rabbit knees to simulate vitamin-E elution from radiation cross-linked ultra-high molecular weight polyethylene; second, vitamin-E-doped, irradiated ultra-high molecular weight polyethylene plugs were implanted into dorsal subcutaneous pouches of rabbits to determine the local effects of vitamin-E elution from radiation cross-linked ultra-high molecular weight polyethylene; and, third, two groups of vitamin-E-doped, irradiated acetabular liners (high surface and uniform vitamin-E concentration profiles) were compared with undoped, control ultra-high molecular weight polyethylene liners in a canine model of total hip replacement to determine the effect of possible vitamin-E elution on bone ingrowth and the local tissue response to it in a load-bearing environment.


Injection of solubilized vitamin E resulted in histologically normal surrounding soft tissue at both two and twelve-week follow-up intervals, while injection of pure vitamin E resulted in acute and chronic inflammation at the time of the two-week follow-up. Both control and vitamin-E-doped subcutaneous plugs showed inflammation associated with surgery at two weeks of follow-up, but showed stable fibrous encapsulation without inflammation at twelve weeks of follow-up. In the canine total hip replacement model, there was no qualitative difference in local tissue appearance and no significant difference in the percent bone ingrowth and the percent bone density between the control and vitamin-E groups.


These investigations showed that vitamin-E-doped ultra-high molecular weight polyethylene plugs and total hip replacement components are well tolerated in both a small and a large-animal model with no observed adverse effects on the surrounding tissues at twelve weeks of follow-up.

Clinical Relevance: 

A lack of adverse effects of vitamin E eluted from ultra-high molecular weight polyethylene components on surrounding joint tissues and bone ingrowth suggests that vitamin-E elution from these components would not cause clinical complications.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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