Influence of third-body particles originating from bone void fillers on the wear of ultra-high-molecular-weight polyethylene

Calcium sulfate bone void fillers are increasingly being used for dead space management in infected arthroplasty revision surgery. The presence of these materials as loose beads close to the bearing surfaces of joint replacements gives the potential for them to enter the joint becoming trapped between the articulating surfaces; the resulting damage to cobalt chrome counterfaces and the subsequent wear of ultra-high-molecular-weight polyethylene is unknown. In this study, third-body damage to cobalt chrome counterfaces was simulated using particles of the calcium sulfate bone void fillers Stimulan® (Biocomposites Ltd., Keele, UK) and Osteoset® (Wright Medical Technology, TN, USA) using a bespoke rig. Scratches on the cobalt chrome plates were quantified in terms of their density and mean lip height, and the damage caused by the bone void fillers was compared to that caused by particles of SmartSet GMV PMMA bone cement (DePuy Synthes, IN, USA). The surface damage from Stimulan® was below the resolution of the analysis technique used; SmartSet GMV caused 0.19 scratches/mm with a mean lip height of 0.03 µm; Osteoset® led to a significantly higher number (1.62 scratches/mm) of scratches with a higher mean lip height (0.04 µm). Wear tests of ultra-high-molecular-weight polyethylene were carried out in a six-station multi-axial pin on plate reciprocating rig against the damaged plates and compared to negative (highly polished) and positive control plates damaged with a diamond stylus (2 µm lip height). The wear of ultra-high-molecular-weight polyethylene was shown to be similar against the negative control plates and those damaged with third-body particles; there was a significantly higher (p < 0.001) rate of ultra-high-molecular-weight polyethylene wear against the positive control plates. This study showed that bone void fillers of similar composition can cause varying damage to cobalt chrome counterfaces. However, the lip heights of the scratches were not of sufficient magnitude to increase the wear of ultra-high-molecular-weight polyethylene above that of the negative controls.