The objective of our study was to test alternative polymer-on-polymer articulations for cervical total disc arthroplasty with favourable biotribological properties and the benefit of radiolucency in comparison to the clinically well established metal-on-polyethylene coupling. In vitro wear simulation was performed according to ISO 18192-1:2008 (E) with the clinically introduced activ C cervical artificial disc (Aesculap AG Tuttlingen, Germany) made of UHMWPE/CoCr29Mo6 in a direct comparison to experimental disc articulations made of PEEK, CFR-PEEK and PEK. Each material combination was tested for 10 million cycles with a customised 6 station spinal wear simulator (EndoLab Thansau, Germany). Gravimetric and geometric wear assessment, optical surface characterisation and an estimation of particle size and morphology were performed. The gravimetric wear rate of the clinical reference polyethylene-on-cobalt-chromium was 1.0+/-0.1 mg/million cycles, compared to 1.4+/-0.4 mg/million cycles for PEEK, to 0.02+/-0.02 mg/million cycles for CFR-PEEK and 0.8+/-0.1 mg/million cycles for PEK. In conclusion, a number of different candidate materials for total cervical disc arthroplasty were compared using the same disc design. Whereas the polymer-on-polymer articulation of PEK showed no substantial benefit in comparison to polyethylene-on-cobalt-chromium and whereas natural PEEK tends towards pitting and delamination, the carbon fibre reinforced PEEK demonstrated an excellent wear behaviour with a reduction in order of a magnitude. Therefore, the CFR-PEEK based polymer-on-polymer articulations may be an alternative to polyethylene-on-metal and have a high potential for next generation disc replacements.
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