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. 2024 Jan 5;25(1):27.
doi: 10.1186/s13063-023-07811-1.

Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial

Kristin Maier  1 , Marius Selig  2 , Andréa Haddouche  3 , Martin Haunschild  4 , Oliver Hauschild  5 , Iman Khalili  6 , Julia Kirschberg  7 , Christoph Lutter  8 , Michael Menges  9 , Patrice Mertl  10 , Andreas Niemeier  6 , Brice Rubens-Duval  3 , Wolfram Mittelmeier  8
Affiliations

Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial

Kristin Maier et al. Trials. .

Abstract

Background: The gliding surface of total knee endoprostheses is exposed to high loads due to patient weight and activity. These implant components are typically manufactured from ultra-high molecular weight polyethylene (UHMWPE). Crosslinking of UHMWPE by ionizing radiation results in higher wear resistance but induces the formation of free radicals which impair mechanical properties after contact with oxygen. Medium-crosslinked UHMWPE enriched with vitamin E (MXE) provides a balance between the parameters for a sustainable gliding surface, i.e., mechanical strength, wear resistance, particle size, and oxidation stability. Therefore, a gliding surface for knee endoprostheses made up from this material was developed, certified, and launched. The aim of this study is to compare this new gliding surface to the established predecessor in a non-inferiority design.

Methods: This multicenter, binational randomized controlled trial will enroll patients with knee osteoarthritis eligible for knee arthroplasty with the index device. Patients will be treated with a knee endoprosthesis with either MXE or a standard gliding surface. Patients will be blinded regarding their treatment. After implantation of the devices, patients will be followed up for 10 years. Besides clinical and patient-related outcomes, radiological data will be collected. In case of revision, the gliding surface will be analyzed biomechanically and regarding the oxidative profile.

Discussion: The comparison between MXE and the standard gliding surface in this study will provide clinical data to confirm preceding biomechanical results in vivo. It is assumed that material-related differences will be identified, i.e., that the new material will be less sensitive to wear and creep. This may become obvious in biomechanical analyses of retrieved implants from revised patients and in radiologic analyses.

Trial registration: ClinicalTrials.gov, NCT04618016. Registered 27 October 2020, https://clinicaltrials.gov/study/NCT04618016?term=vikep&checkSpell=false&rank=1 . All items from the World Health Organization Trial Registration Data Set can be found in Additional file 1.

Keywords: Clinical study; Gliding surface material; Total knee arthroplasty; UHMWPE.

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Conflict of interest statement

All authors filled and provided the ICMJE disclosure form. KM and MS are employees of Aesculap AG. AH declares that she has no conflict of interest. IK and MM declare that they received study grants from B.Braun/Aesculap AG for the conduction of this study and received support for attending/traveling to meetings from B.Braun/Aesculap AG. MH and OH declare that they received study grants from B.Braun/Aesculap AG for the conduction of this study and received honoraria for various lectures, workshops, and courses from B.Braun/Aesculap AG. JK declares that she received study grants from B.Braun/Aesculap AG for the conduction of this study and has an advisor contract for another study sponsored by B.Braun/Aesculap AG and received payments for a congress lecture and received support for attending/traveling to meetings from B.Braun/Aesculap AG. CL and WM declare that they received research grants from B.Braun/Aesculap AG and received support for attending/traveling to meetings from B.Braun/Aesculap AG. PM declares that he receives royalties/licenses from X.Nov and Adler. AN declares that he received study grants from B.Braun/Aesculap AG for the conduction of this study. BRD declares that he received study grants from B.Braun/Aesculap AG for the conduction of this study and received consulting fees from B.Braun/Aesculap AG and received support for attending/traveling to meetings from Leo Pharma.

Figures

Fig. 1
Fig. 1
Patient inclusion flowchart
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