Surfactants identified in synovial fluid and their ability to act as boundary lubricants

Interactions between adsorbed hydrogenated soy phosphatidylcholine (HSPC) vesicles at physiologically high pressures and salt concentrations

Using a surface force balance, we measured normal and shear interactions as a function of surface separation between layers of hydrogenated soy phosphatidylcholine (HSPC) small unilamellar vesicles (SUVs) adsorbed from dispersion at physiologically high salt concentrations (0.15 M NaNO₃). Cryo-scanning electron microscopy shows that each surface is coated by a close-packed HSPC-SUV layer with an overlayer of liposomes on top. A clear attractive interaction between the liposome layers is seen upon approach and separation, followed by a steric repulsion upon further compression. The shear forces reveal low friction coefficients (μ = 0.008-0.0006) up to contact pressures of at least 6 MPa, comparable to those observed in the major joints. The spread in μ-values may be qualitatively accounted for by different local liposome structure at different contact points, suggesting that the intrinsic friction of the HSPC-SUV layers at this salt concentration is closer to the lower limit (μ = ~0.0006). This low friction is attributed to the hydration lubrication mechanism arising from rubbing of the hydrated phosphocholine-headgroup layers exposed at the outer surface of each liposome, and provides support for the conjecture that phospholipids may play a significant role in biological lubrication.

Challenges associated with using bovine serum in wear testing orthopaedic biopolymers

For appropriate in vitro wear testing of prostheses and their biomaterials, the choice of lubricant is critical. Bovine serum is the lubricant recommended by several international standards for wear testing artificial joints and their biomaterials because the wear rate and wear mechanisms closely match clinical results of polyethylene bearings. The main problem with the use of bovine serum as a lubricant is protein degradation and precipitation formation, effects that are recognized as having a direct impact on wear processes. Hence, some researchers have questioned the validity of using bovine serum in simulator testing. This paper reviews the various lubricants used in laboratory wear studies and also the properties of the synovial fluid that the lubricant is trying to replicate. It is clear from the literature survey that the composition of bovine-serum-based lubricants does not match that of synovial fluid. In view of this conclusion, it is suggested that there is a need to develop an alternative lubricant that can replace bovine serum.

Tear analysis and lens-tear interactions: part II. Ocular lipids-nature and fate of meibomian gland phospholipids

PURPOSE

Published data indicate that the polar lipid content of human meibomian gland secretions (MGS) could be anything between 0.5% and 13% of the total lipid. The tear film phospholipid composition has not been studied in great detail and it has been understood that the relative proportions of lipids in MGS would be maintained in the tear film. The purpose of this work was to determine the concentration of phospholipids in the human tear film.

METHODS

Liquid chromatography mass spectrometry (LCMS) and thin layer chromatography (TLC) were used to determine the concentration of phospholipid in the tear film. Additionally, an Amplex Red phosphatidylcholine-specific phospholipase C (PLC) assay kit was used for determination of the activity of PLC in the tear film.

RESULTS

Phospholipids were not detected in any of the tested human tear samples with the low limit of detection being 1.3 μg/mL for TLC and 4 μg/mL for liquid chromatography mass spectrometry. TLC indicated that diacylglycerol (DAG) may be present in the tear film. PLC was in the tear film with an activity determined at approximately 15 mU/mL, equivalent to the removal of head groups from phosphatidylcholine at a rate of approximately 15 μM/min.

CONCLUSIONS

This work shows that phospholipid was not detected in any of the tested human tear samples (above the lower limits of detection as described) and suggests the presence of DAG in the tear film. DAG is known to be at low concentrations in MGS. These observations indicate that PLC may play a role in modulating the tear film phospholipid concentration.

Liposomes act as effective biolubricants for friction reduction in human synovial joints

Phospholipids (PL) form the matrix of biological membranes and of the lipoprotein envelope monolayer, and are responsible for many of the unique physicochemical, biochemical, and biological properties of these supermolecular bioassemblies. It was suggested that phospholipids present in the synovial fluid (SF) and on the surface of articular cartilage have major involvement in the low friction of cartilage, which is essential for proper mobility of synovial joints. In pathologies, such as impaired biolubrication (leading to common joint disorders such as osteoarthritis), the level of phospholipids in the SF is reduced. Using a human-sourced cartilage-on-cartilage setup, we studied to what extent and how phospholipids act as highly effective cartilage biolubricants. We found that large multilamellar vesicles (MLV), >800 nm in diameter, composed of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) or of a mixture of DMPC and 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) are superior lubricants in comparison to MLV composed of other phosphatidylcholines. Introducing cholesterol into liposomes resulted in less effective lubricants. DMPC-MLV was also superior to small unilamellar vesicles (SUV), <100 nm in diameter, composed of DMPC. MLV are superior to SUV due to MLV retention at and near (<200 microm below) the cartilage surface, while SUV penetrate deeper into the cartilage (450-730 microm). Superiority of specific PL compositions is explained by the thermotropic behavior (including compressibility) of the lipid bilayer. Correlating physicochemical properties of the MLV with the friction results suggests that MLV having lipid bilayers in the liquid-disordered phase and having a solid-ordered to liquid-disordered phase transition temperature slightly below physiological temperature are optimal for lubrication. High phospholipid headgroup hydration, high compressibility, and softness are the common denominators of all efficient PL compositions. The high efficiency of DMPC-MLV and DMPC/DPPC-MLV as cartilage lubricants combined with their resistance to degradation at 37 degrees C supports further evaluation of these MLV for treatment of joint impairments related to poor lubrication. This work also demonstrates the relevance of basic physicochemical properties of phospholipids to their activities in biological systems.

Friction Force Microscopy of Lubricin and Hyaluronic Acid between Hydrophobic and Hydrophilic Surfaces

Lubricin and hyaluronic acid (HA), molecular constituents of synovial fluid, have long been theorized to play a role in joint lubrication and wear protection. While lubricin has been shown to function as a boundary lubricant, conflicting evidence exists as to the boundary lubricating ability of hyaluronic acid. Here, we use colloidal force microscopy to explore the friction behavior of these two molecules on the microscale between chemically uniform hydrophilic (hydroxyl-terminated) and hydrophobic (methyl-terminated) surfaces in physiological buffer solution. Behaviors on both surfaces are physiologically relevant since the heterogeneous articular cartilage surface contains both hydrophilic and hydrophobic elements. Friction between hydrophobic surfaces was initially high (μ=1.1, at 100nN of applied normal load) and was significantly reduced by lubricin addition while friction between hydrophilic surfaces was initially low (μ=0.1) and was slightly increased by lubricin addition. At lubricin concentrations above 200 µg/ml, friction behavior on the two surfaces was similar (μ=0.2) indicating that nearly all interaction between the two surfaces was between adsorbed lubricin molecules rather than between the surfaces themselves. In contrast, addition of HA did not appreciably alter the frictional behavior between the model surfaces. No synergistic effect on friction behavior was seen in a physiological mixture of lubricin and HA. Lubricin can equally mediate the frictional response between both hydrophilic and hydrophobic surfaces, likely fully preventing direct surface-to-surface contact at sufficient concentrations, whereas HA provides considerably less boundary lubrication.

Effects of sustained interstitial fluid pressurization under migrating contact area, and boundary lubrication by synovial fluid, on cartilage friction

OBJECTIVE

This experimental study tests two hypotheses which address outstanding questions in cartilage lubrication: can the friction coefficient remain low under sustained physiological loading conditions? How effective is synovial fluid (SF) in the lubrication of articular cartilage? Based on theory, it is hypothesized that migrating contact areas can maintain elevated cartilage interstitial fluid pressurization, thus a low friction coefficient, indefinitely. It is also hypothesized that the beneficial effects of SF stem from boundary lubrication rather than fluid-film lubrication.

DESIGN

Five experiments were conducted on immature bovine femoro-tibial joints, to compare the frictional response under migrating vs stationary contact areas; the frictional response in SF vs saline; the role of sliding velocity and the role of congruence on the friction coefficient.

RESULTS

Migrating contact area could maintain a low friction coefficient under sustained physiological conditions of loading for at least 1 h. SF reduced the friction coefficient by a factor of approximately 1.5 relative to saline. However, interstitial fluid pressurization was far more effective, reducing the friction coefficient by a factor of approximately 60 relative to equilibrium (zero-pressure) conditions. It was confirmed that SF acts as a boundary lubricant.

CONCLUSIONS

These results emphasize the importance of interstitial fluid pressurization on the frictional response of cartilage. They imply that the mechanical integrity of cartilage must be maintained to produce low friction in articular joints. The more limited effectiveness of SF implies that intra-articular injections of lubricants in degenerated joints may have only limited effectiveness on their tribological properties.

The interface of functional biotribology and regenerative medicine in synovial joints

Biotribology is the science of biological surfaces in sliding contact encompassing the concepts of friction, wear, and lubrication of interacting surfaces. This bioscience field has emerged from the classical field of tribology and is of paramount importance to the normal function of numerous tissues, including articular cartilage, blood vessels, heart, tendons, ligaments, and skin. Surprisingly, relatively little attention has been given to the restoration of surface characteristics in the fields of tissue engineering and regenerative medicine-the science of design and manufacture of new tissues for the functional restoration of impaired or diseased organs that depend on inductive signals, responding stem cells, and extracellular matrix scaffolding. Analogous to ancient civilizations (c. 3000 B.C.) that introduced wheeled vehicles, sledges for transporting heavy blocks, and lubricants, modern biotribologists must aim to restore surface characteristics to regenerated tissues and develop novel biomaterials with optimal tribological properties. The objective of this article is to highlight the significance of functional biotribology in the physiology of body surfaces and provide a comprehensive overview of unresolved issues and controversies as it relates to regenerative medicine. Specific attention is placed on the molecular basis of lubrication, mechanical and biochemical regulation of lubricating molecules, and the need to study wear processes in articular cartilage, especially in light of degenerative diseases, such as osteoarthritis. Surface engineering of replacement tissues exhibiting low friction and high wear resistance is examined using articular cartilage as an illustrative model system.

Cell response in mixtures of surfactant-culture medium--towards a systemic approach to cell-based treatments for focal osteoarthritis

Osteoarthritis (OA), the most common form of arthritis is a degenerative joint disease, which causes severe long-term pain and physical disability. It is becoming more important to improve diagnosis and understanding of the disease process and subsequently develop new intervention to delay or even reverse the disease progress. Our study was designed to combine two relatively novel treatment techniques, autologous chondrocyte transplantation (ACT) and proposed application of medical remedies based on surface-active phospholipids. To this end we exposed chondrocyte to culture environments with mixtures of culture medium and phospholipid solutions. Following various culture periods, cell survival and well-being were determined by measuring proliferation and assessing morphological features, and comparing these with the behaviour of cells grown in classical which were not mixed with surfactant, i.e., control culture medium. Scanning electron microscopy and light microscopy demonstrate that the cells exposed to mixtures with surfactant were as healthy as those in the control environment with polygonal morphology, while proliferation assay indicated a noticeably higher level of proliferation over similar periods, for cells cultured in media that was mixed with surfactants. Also, the cells in media with unsaturated surfactants responded better than those cultured in mixtures containing saturated surfactant.

Conceptualisation of articular cartilage as a giant reverse micelle: a hypothetical mechanism for joint biocushioning and lubrication

Phospholipid (PL) molecules form the main structure of the membrane that prevents the direct contact of opposing articular cartilage layers. In this paper we conceptualise articular cartilage as a giant reverse micelle (GRM) in which the highly hydrated three-dimensional network of phospholipids is electrically charged and able to resist compressive forces during joint movement, and hence loading. Using this hypothetical base, we describe a hydrophilic-hydrophilic (HL-HL) biopair model of joint lubrication by contacting cartilages, whose mechanism is reliant on lamellar cushioning. To demonstrate the viability of our concept, the electrokinetic properties of the membranous layer on the articular surface were determined by measuring via microelectrophoresis, the adsorption of ions H, OH, Na and Cl on phospholipid membrane of liposomes, leading to the calculation of the effective surface charge density. The surface charge density was found to be -0.08+/-0.002cm(-2) (mean+/-S.D.) for phospholipid membranes, in 0.155M NaCl solution and physiological pH. This value was approximately five times less than that measured in 0.01M NaCl. The addition of synovial fluid (SF) to the 0.155M NaCl solution reduced the surface charge density by 30% which was attributed to the binding of synovial fluid macromolecules to the phospholipid membrane. Our experiments show that particles charge and interact strongly with the polar core of RM. We demonstrate that particles can have strong electrostatic interactions when ions and macromolecules are solubilized by reverse micelle (RM). Since ions are solubilized by reverse micelle, the surface entropy influences the change in the charge density of the phospholipid membrane on cartilage surfaces. Reverse micelles stabilize ions maintaining equilibrium, their surface charges contribute to the stability of particles, while providing additional screening for electrostatic processes.

Conformational mechanics, adsorption, and normal force interactions of lubricin and hyaluronic acid on model surfaces

Glycoproteins, such as lubricin, and hyaluronic acid (HA) play a prominent role in the boundary lubrication mechanism in diarthrodial joints. Although many studies have tried to elucidate the lubrication mechanisms of articular cartilage, the molecular details of how lubricin and HA interact with cartilage surfaces and mediate their interaction still remain poorly understood. Here we used model substrates, functionalized with self-assembled monolayers terminating in hydroxyl or methyl groups, (1) to determine the effect of surface chemistry on lubricin and HA adsorption using surface plasmon resonance (SPR) and (2) to study normal force interactions between these surfaces as a function of lubricin and HA concentration using colloidal probe microscopy. We found that lubricin is amphiphilic and adsorbed strongly onto both methyl- and hydroxyl-terminated surfaces. On hydrophobic surfaces, lubricin likely adopts a compact, looplike conformation in which its hydrophobic domains at the N and C termini serve as surface anchors. On hydrophilic surfaces, lubricin likely adsorbs anywhere along its hydrophilic central domain and adopts, with increasing solution concentration, an extended tail-like conformation. Overall, lubricin develops strong repulsive interactions when compressing two surfaces into contact. Furthermore, upon surface separation, adhesion occurs between the surfaces as a result of molecular bridging and chain disentanglement. This behavior is in contrast to that of HA, which does not adsorb appreciably on either of the model surfaces and does not develop significant repulsive interactions. Adhesive forces, particularly between the hydrophobic surfaces, are large and not appreciably affected by HA. For a mixture of lubricin and HA, we observed slightly larger adsorptions and repulsions than those found for lubricin alone. Our experiments suggest that this interaction depends on unspecific physical rather than chemical interactions between lubricin and HA. We speculate that in mediating interactions at the cartilage surface, an important role of lubricin, possibly in conjunction with HA, is one of providing a protective coating on cartilage surfaces that maintains the contacting surfaces in a sterically repulsive state.

Lubrication of the temporomandibular joint

Although tissue engineering of the temporomandibular joint (TMJ) structures is in its infancy, tissue engineering provides the revolutionary possibility for treatment of temporomandibular disorders (TMDs). Recently, several reviews have provided a summary of knowledge of TMJ structure and function at the biochemical, cellular, or mechanical level for tissue engineering of mandibular cartilage, bone and the TMJ disc. As the TMJ enables large relative movements, joint lubrication can be considered of great importance for an understanding of the dynamics of the TMJ. The tribological characteristics of the TMJ are essential for reconstruction and tissue engineering of the joint. The purpose of this review is to provide a summary of advances relevant to the tribological characteristics of the TMJ and to serve as a reference for future research in this field. This review consists of four parts. Part 1 is a brief review of the anatomy and function of the TMJ articular components. In Part 2, the biomechanical and biochemical factors associated with joint lubrication are described: the articular surface topology with microscopic surface roughness and the biomechanical loading during jaw movements. Part 3 includes lubrication theories and possible mechanisms for breakdown of joint lubrication. Finally, in Part 4, the requirement and possibility of tissue engineering for treatment of TMDs with degenerative changes as a future treatment regimen will be discussed in a tribological context.

Boundary lubrication of joints: characterization of surface-active phospholipids found on retrieved implants

BACKGROUND

The identity of the vital active ingredient within synovial fluid (SF)--to which we owe the near frictionless performance of diarthrodial joints--has been the quest of researchers for many years. Initially, hyaluronic acid (HA) was thought to be the lubricant, but it has been shown not to possess the load-bearing ability required within the physiological joint. The glycoprotein fraction of synovial fluid (lubricin) has been shown to have the same lubricating ability as synovial fluid. All or part of this is thought to be due to the surface-active phospholipids (SAPLs) present in lubricin. We characterized the SAPLs adsorbed on the surface of retrieved prostheses which have been implicated as the boundary lubricant.

MATERIAL AND METHODS

Rinsing fluids collected from the bearing surfaces of 40 prostheses removed from hip and knee revision operations were analyzed using high-performance liquid chromatography (HPLC).

RESULTS

SAPLs were detected on all retrieved implants. During the study, 8 different species of phosphatidylcholines were identified. We also determined the relative concentration of each species, which suggested that the unsaturated SAPL species predominate.

INTERPRETATION

It is of value to know the identity of the lubricating constituents of SF, not only for the future development of artificial joints, but also in developing cures for several disease processes in which lubrication plays a role.

Use of silicone hydrogel material for daily wear

Silicone hydrogel contact lenses were initially developed to optimise oxygen transmissibility for extended wear use. The concerns with such contact lenses have been their higher elastomeric and hydrophobic characteristics associated with the incorporation of silicone type monomers. The use of silicone hydrogel has most recently been suggested for daily wear to eliminate all hypoxic related problems. The primary aim of the investigation was to test in vivo wetting performance and subjective acceptance of the first silicone hydrogel contact lens developed for daily wear, ACUVUE ADVANCE with HYDRACLEAR (galyfilcon A), compared to a conventional hydrogel contact lens for the same application SofLens 66 (alphafilcon A). The investigation was a randomised, subject masked bilateral cross over investigation testing of the two contact lens materials over their approved replacement periods (galyfilcon A 2 weeks and alphafilcon A 2 weeks (USA) and 4 weeks (Europe)). In all cases ReNu Multiplus lens care system was used. The investigation carried out on 24 contact lens wearers showed that: (i) in vivo wettability was superior for galyfilcon A which had a thicker lipid layer (thin layer incidence: galyfilcon A 54%; alphafilcon A 70-86%, p<0.05), a thicker aqueous layer (thick layer incidence: galyfilcon A 88%; alphafilcon A 35-64%, p<0.05) and a more stable tear film (galyfilcon A 7.8s; alphafilcon A 2 weeks 5.6s, p=0.022; 4 weeks 7.4s, p=0.276); (ii) for the intended replacement period, comfort was better with galyfilcon A (2 weeks) compared to alphafilcon A (4 weeks) at insertion (p=0.001) and, throughout the day (daytime and evening p=0.008). Contact lenses made from galyfilcon A and replaced two weekly achieved better in vivo wettability than contact lenses made from alphafilcon A and replaced either two and four weekly; the better wettability was associated with an overall better comfort for galyfilcon A.

Boundary lubrication of articular cartilage: Role of synovial fluid constituents

OBJECTIVE

To determine whether the synovial fluid (SF) constituents hyaluronan (HA), proteoglycan 4 (PRG4), and surface-active phospholipids (SAPL) contribute to boundary lubrication, either independently or additively, at an articular cartilage-cartilage interface.

METHODS

Cartilage boundary lubrication tests were performed with fresh bovine osteochondral samples. Tests were performed using graded concentrations of SF, HA, and PRG4 alone, a physiologic concentration of SAPL, and various combinations of HA, PRG4, and SAPL at physiologic concentrations. Static (mu(static, Neq)) and kinetic (<mu(kinetic, Neq)>) friction coefficients were calculated.

RESULTS

Normal SF functioned as an effective boundary lubricant both at a concentration of 100% (<mu(kinetic, Neq)> = 0.025) and at a 3-fold dilution (<mu(kinetic, Neq)> = 0.029). Both HA and PRG4 contributed independently to a low mu in a dose-dependent manner. Values of <mu(kinetic, Neq)> decreased from approximately 0.24 in phosphate buffered saline to 0.12 in 3,300 mug/ml HA and 0.11 in 450 mug/ml PRG4. HA and PRG4 in combination lowered mu further at the high concentrations, attaining a <mu(kinetic, Neq)> value of 0.066. SAPL at 200 mug/ml did not significantly lower mu, either independently or in combination with HA and PRG4.

CONCLUSION

The results described here indicate that SF constituents contribute, individually and in combination, both at physiologic and pathophysiologic concentrations, to the boundary lubrication of apposing articular cartilage surfaces. These results provide insight into the nature of the boundary lubrication of articular cartilage by SF and its constituents. They therefore provide insight regarding both the homeostatic maintenance of healthy joints and pathogenic processes in arthritic disease.

2006 Frank Stinchfield Award: grafting of biocompatible polymer for longevity of artificial hip joints

Aseptic loosening induced by wear particles from the polyethylene liner is likely the most common cause of long-term total hip arthroplasty failure. We developed a novel hip polyethylene liner with the surface graft of a biocompatible phospholipid polymer, 2-methacryloyloxyethyl phosphorylcholine (MPC), and previously reported the grafting decreased the short-term production of wear particles and the subsequent bone resorptive responses. For clinical application, we investigated the stability of the 2-methacryloyloxyethyl phosphorylcholine grafting during sterilization and the wear resistance of the sterilized liner during longer loading comparable to clinical usage. Radiographic spectroscopy confirmed the stability of the 2-methacryloyloxyethyl phosphorylcholine polymer on the liner surface after the gamma irradiation. We used a hip wear simulator up to 1 x 10(7) cycles to test sterilized cross-linked polyethylene liners with and without 2-methacryloyloxyethyl phosphorylcholine grafting. The 2-methacryloyloxyethyl phosphorylcholine grafting markedly decreased the friction, the production of wear particles, and the wear of the liner surface. These data suggest a marked improvement in the wear resistance of the polyethylene liner by the 2-methacryloyloxyethyl phosphorylcholine grafting for clinically relevant periods after sterilization, indicating 2-methacryloyloxyethyl phosphorylcholine grafting is a promising technology for extending longevity of artificial hips.

The role of the surface amorphous layer of articular cartilage in joint lubrication

Articular cartilage is a complex soft tissue that performs multiple functions in the joint. In particular, the amorphous layer that covers the surface of articular cartilage is thought to play some role in lubrication. This study aimed to characterize the surface amorphous layer (SAL) using a variety of techniques, including environmental scanning electron microscopy, transmission electron microscopy, white light interferometry, and biochemical analysis of its composition. Friction tests were conducted to investigate the role of the SAL in lubrication. A protocol to remove successfully the SAL without damaging the underlying cartilage was developed and the material removed from healthy cartilage was found to contain approximately equal quantities of glycosaminoglycan (GAG), protein, and lipid. Cartilage-on-cartilage friction tests were conducted on fresh, healthy cartilage with and without the SAL, under both dynamic and static operating conditions. Removal of the SAL was not found to change the friction coefficient. However, subsequent staining of specimens indicated that the SAL had replenished during the test following loading. The replenished SAL was characterized and found to contain lipids and sulphated GAGs with undetectable protein. This study revealed experimental evidence of surface layer replenishment in articular cartilage. It was postulated that the surface layer regeneration mechanism was purely mechanical and associated with movement of GAGs and lipids through the cartilage matrix during deformation, since the experimental set-up did not contain any means of biochemical activation.

Patellofemoral joint biomechanics and tissue engineering

Recent advances in the study of patellofemoral joint biomechanics have provided promising diagnosis and treatment modalities for patellofemoral joint disorders, such as quantitative assessment of cartilage lesions from noninvasive imaging, computer simulations of surgical procedures for optimizing surgical parameters and potentially predicting outcomes, and cartilage tissue engineering for the treatment of advanced degenerative joint disease. These technologies are still in development and their clinical potentials remain an ongoing topic of investigation. We review some of our progress in addressing these issues, and the important role of cartilage mechanics and lubrication in understanding the challenges regarding patellofemoral surgery and cartilage tissue engineering.

Lubrication and wear properties of grafted polyelectrolytes, hyaluronan and hylan, measured in the surface forces apparatus

Hyaluronan is believed to have an important function in the boundary biolubrication of articular cartilage. Using a Surface Forces Apparatus, we tested the tribological properties of surface bound, rather than "free" hyaluronan. The grafting process of the polyelectrolyte included either a biological route via an HA-binding protein or a chemical reaction to covalently bind the polymer to a lipid bilayer coated surface. In another reaction, we constructed a surface with covalently grafted hylan (crosslinked hyaluronan). We studied the normal and shear forces between these surfaces. None of the systems demonstrated comparable lubrication to that found between cartilage surfaces except at very low loads. Both grafted hyaluronan and hylan generated coefficients of friction between 0.15 and 0.3. Thus, the polysaccharide, which is a constituent of the lamina splendens (outermost cartilage layer), is not expected to be the responsible molecule for the great lubricity of cartilage; however, it may contribute to the load bearing and wear protection of these surfaces. This was concluded from the results with hylan, where a thin gel layer was sufficient to shield the underlying surfaces from damage even at applied pressures of over 200 atmospheres during shear. Our study shows that a low coefficient of friction is not a requirement for, or necessarily a measure of, wear protection.

The John Charnley Award Paper. The role of joint fluid in the tribology of total joint arthroplasty

The effect of joint fluid on the tribology (ie, lubrication, friction, and wear) of total hip arthroplasty has not yet been investigated adequately. In the current study, a friction assay was used to assess four hypotheses relating to the effect of human joint fluid and its principal components on the articulation of metal-on-polyethylene. First, joint fluid was found to produce a widely varying amount of friction between cobalt-chromium and polyethylene; this range exceeded the range produced when the articulation was lubricated by water or bovine serum. Second, it was shown that hyaluronic acid, phospholipid, albumin, and gamma-globulin were not acting as boundary lubricants, but that one or more other proteins (as yet unidentified) were responsible for reducing friction in this couple. Third, lower friction was found when oxidized zirconium alloy replaced cobalt-chromium as a bearing surface on polyethylene. Finally, a pilot study suggested that lubricin, which contributes to cartilage-on-cartilage lubrication, is not a protein responsible for the tribological variabiation found among joint fluid samples. The current study showed that joint fluid is a patient factor that influences the tribology of metal-on-polyethylene arthroplasty.

Mechanical effects of the intraarticular administration of high molecular weight hyaluronic acid plus phospholipid on synovial joint lubrication and prevention of articular cartilage degeneration in experimental osteoarthritis

OBJECTIVE

To examine in vivo the effects of a mixture of high molecular weight hyaluronic acid (HA) plus phospholipids on joint lubrication and articular cartilage degeneration.

METHODS

Experimental osteoarthritis (OA) of the right knee was induced by anterior cruciate and medial collateral ligament transection in 40 rabbits. The animals were subjected to 8 consecutive weekly intraarticular administrations of high molecular weight HA (the HA200 group), conventional molecular weight HA (the HA80 group), or high molecular weight HA plus L-delta dipalmitoyl phosphatidylcholine liposomes (the PHA group) and were killed 1 week after the final injection. The remaining transected right knees (the OA group) and randomly selected nontransected contralateral left knees (the control group) were collected simultaneously. Each group (n = 10) was divided into 2 equal subgroups, one of which was evaluated histologically while the other was subjected to a lubricating ability test using a pendulum friction tester.

RESULTS

The injected knees had a tendency to demonstrate less damage to the articular cartilage compared with the OA group, and the histologic findings in all groups except for the PHA group differed significantly from the control group. There was a significant difference in the mean +/- SD friction coefficient between the control group (0.0100 +/- 0.00300) and the OA (0.0206 +/- 0.00649), HA200 (0.0190 +/- 0.00427), and HA80 (0.0177 +/- 0.00712) groups (P < 0.05 for each comparison), but not between the control group and the PHA group (0.0150 +/- 0.00330) (P = 0.15).

CONCLUSION

To our knowledge, this is the first in vivo study to examine whether intraarticular injections of phospholipids influence joint lubrication by acting as a boundary lubricant, thus protecting articular cartilage from degenerative changes.

Phospholipid composition of articular cartilage boundary lubricant

The mechanism of lubrication in normal human joints depends on loading and velocity conditions. Boundary lubrication, a mechanism in which layers of molecules separate opposing surfaces, occurs under severe loading. This study was aimed at characterizing the phospholipid composition of the adsorbed molecular layer on the surface of normal cartilage that performs as a boundary lubricant. The different types of phospholipid adsorbed onto the surface of cartilage were isolated by extraction and identified by chromatography on silica gel paper and mass spectroscopy. The main phospholipid classes identified were quantified by a phosphate assay. Gas chromatography and electrospray ionization mass spectrometry were used to further characterize the fatty acyl chains in each major phospholipid component and to identify the molecular species present. Phosphatidylcholine (41%), phosphatidylethanolamine (27%) and sphingomyelin (32%) were the major components of the lipid layer on the normal cartilage surface. For each lipid type, a mixture of fatty acids was detected, with a higher percentage of unsaturated species compared to saturated species. The most abundant fatty acid observed with all three lipid types was oleic acid (C18:1). Additional work to further quantify the molecular species using electrospray ionization mass spectrometry is recommended.

The influence of phospholipid concentration in protein-containing lubricants on the wear of ultra-high molecular weight polyethylene in artificial hip joints

There is considerable interest in the wear of polyethylene and the resulting wear-debris-induced osteolysis in artificial hip joints. Proteins play an important role as boundary lubricants in vivo in the pseudosynovial fluid, and these are reproduced in in vitro tests through the use of bovine serum. Little is known, however, about the effect of phospholipid concentrations within proteinaceous solutions on the wear of ultra-high molecular weight polyethylene (UHMWPE). The effects of protein-containing lubricants with 0.05, 0.5 and 5 per cent (w/v) phosphatidyl choline concentrations on the wear of ultra-high molecular weight polyethylene (UHMWPE) were compared with 25 per cent (v/v) bovine serum which had 0.01 per cent (w/v) lipid; the effects were compared in a hip joint simulator with smooth (n = 4) and scratched (n = 3) femoral heads. The control bovine serum lubricant produced UHWMPE wear of 55 and 115 mm3/10(6) cycles on the smooth and rough heads respectively. The increased phospholipid concentration significantly reduced the wear rate. At the higher concentration (5% w/v phosphatidyl choline) the average wear was reduced to less than 2 mm3/10(6) cycles. Even with the relatively low concentrations of 0.05% w/v phosphatidyl choline the wear was reduced by at least threefold compared with the bovine serum tests for both the smooth and rough femoral heads. There may be considerable differences in the phospholipid concentrations in patients' synovial fluid and this is highly likely to produce considerable variation in wear rates. In vitro, differences in the phospholipid concentration of lubricants may also cause variation in wear rates between different simulator tests.

Evaluation of the frictional properties of an elastomer with enhanced lipid-adsorbing ability

Wear particle production in load-bearing orthopaedic implants is one of the major factors currently limiting the service life of the implant. Most of the research carried out to date in attempting to solve this problem has used the approach of finding more wear-resistant biocompatible material pairs. In contrast, other researchers have attempted to reduce wear by encouraging elastohydrodynamic film formation through the use of elastomeric bearing surfaces. Unfortunately, these elastomeric bearing surfaces have poor tribological properties when a fluid film is not present. Boundary lubrication of an elastomeric orthopaedic bearing may alleviate some of these difficulties. The purpose of this research was to fabricate and characterize an elastomeric material that had a surface capable of specifically adsorbing a naturally occurring boundary lubricant. Dipalmitoyl phosphatidylcholine (DPPC) has been previously shown to be able to act as a boundary lubricant at stresses that occur in human load-bearing joints such as the hip and knee; therefore, DPPC was chosen for use in this study. It was expected that in an aqueous liposome suspension the static coefficient of friction microseconds of such a material would be lower, and increase less quickly over time, than a similar material without an ability to adsorb specifically DPPC when articulated against a polished chrome steel ball bearing. The lipid-adsorbing elastomer did not possess the desired tribological properties. This result was attributed to the polymer adsorbing the DPPC in the liposome phase and not in the bilayer phase, and interaction among the polymeric surface, DPPC and water. This approach to lubricating orthopaedic bearings was shown to have some merit, but a great deal of work needs to be done before such an approach can be used on a clinically available material.

Effect of phospholipidic boundary lubrication in rigid and compliant hemiarthroplasty models

Hemiarthroplasty may benefit from materials which produce lower friction and improved boundary lubrication protection during start-up conditions. The purpose of this study was to evaluate the effect of phospholipidic boundary lubrication in both rigid and compliant hemiarthroplasty. An in vitro model was designed to dissociate the relative contribution of implant material compliance and the presence of phospholipid to the overall friction of a hemiarthroplasty contact using bovine articular cartilage. Normal bovine articular cartilage was articulated against four flat materials using reciprocating motion: (a) borosilicate glass: (b) borosilicate glass coated with dipalmitoylphosphatidylcholine (DPPC); (c) polyurethane (PU) elastomer (Tecoflex SG93A, a medical-grade aliphatic thermoplastic PU, Thermedics Incorporated. Woburn, Massachusetts); and (d) surface-coated PU (Tecoflex SG93A substrate coated with lipid-attracting copolymer poly[methacryloyloxyethyl phosphorylcholine (MPC)-co-butyl methacrylate (BMA)]. Tests were conducted in physiologically simulated tribological conditions for a non-conformal point contact. Friction and lubrication analysis was performed using both static and kinetic coefficients of friction mu measured for each group as a function of time for a sliding distance of up to 60 m. Results showed that the inclusion of supplemental phospholipid, DPPC, on a rigid substrate significantly decreased mu in comparison with the control (cartilage-glass). Additionally, removal of phospholipid components from the articular cartilage surface produced a significantly greater start-up mu in comparison with normal cartilage at the test onset. The use of a material with a lower modulus resulted in lower mu for the entire duration of the test. Polyurethane elastomer coated with the lipid-attracting copolymer, poly(MPC-co-BMA), resulted in the lowest frictional response. As seen in this study, the improvement of low-modulus hemiarthroplasty may involve the optimization of chemical modification and incorporation of lipid-attracting MPC copolymers onto compliant materials. However, further tests are warranted to determine whether lipid-attracting MPC copolymers perform as well during long-time, in vivo wear studies.

The effect of disc thickness and trauma on disc surface friction in the porcine temporomandibular joint

The pathomechanics of osteoarthritis in the human temporomandibular joint (TMJ) are unknown. Compromised lubrication is a potential factor, but, lubrication within even the normal TMJ is not understood completely. Weeping lubrication is a concept that may be applicable to the TMJ. A characteristic of weeping lubrication is a slow increase in friction during static loading. The rate of increase in friction is related to the rate of lateral movement of synovial fluid away from the loading area. The TMJ disc is expected to be the main source of TMJ lubrication. This study tested two variables, disc thickness and magnitude of trauma to the disc, as factors that can affect the rate of flow of synovial fluid and thus alter lubrication of the disc surfaces. To test these variables, TMJ disc surface friction was measured before and after an impulse load. Before the impulse load, all discs demonstrated a gradual increase in friction during light static loading. The rate of increase in friction was inversely related to the disc thickness (R(2)=0.75). After an impulse load of known magnitude and peak force, disc surface friction was higher. The magnitude of this surface friction was correlated with the magnitude of the impulsive blow (R(2)=0.89) and the area of surface damage (R(2)=0.85). Disc thickness was a significant factor in determining the minimal impulse needed to produce higher surface friction (R(2)=0.99). These results confirm that disc thickness and trauma to the disc affect surface friction in the TMJ, and therefore may be important factors in compromised lubrication and the development of osteoarthritis.

Mixture of hyaluronic acid and phospholipid prevents adhesion formation on the injured flexor tendon in rabbits

Dipalmitoyl phosphatidylcholine, a highly surface-active polar lipid, has been implicated as a potential boundary lubricant for synovial joints. We examined the effects of dipalmitoyl phosphatidylcholine on the flexor tendon and its protective effect against postoperative adhesion in two experimental steps. First, the flexor digitorum fibularis and the distal pulley of rabbits were set for a friction test. The test was performed with saline solution, sodium hyaluronate, or a mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate as the lubricant. The friction coefficient was significantly lower with the mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate than with saline solution or sodium hyaluronate. We concluded that the decreased friction coefficient indicates that dipalmitoyl phosphatidylcholine could complement the boundary-lubricating ability of the tendon. In the second experiment, we used an experimental adhesion model of the flexor digitorum fibularis in the rabbit. During the operation, either saline solution, sodium hyaluronate, or a mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate was injected into the tendon sheath. The specimen was sent to another tester, and the work required to tear off the adhesion was measured. The work required was significantly greater for the tendons that had been injected with saline solution than for those given injections of dipalmitoyl phosphatidylcholine and sodium hyaluronate. Our findings suggest that dipalmitoyl phosphatidylcholine plays an important role in the boundary lubrication of the tendon and that after tendon injury, the administration of a mixture of dipalmitoyl phosphatidylcholine and sodium hyaluronate may improve tendon lubrication and prevent adhesion formation.

The synovial response to exogenous phospholipid (synovial surfactant) injected into the equine radiocarpal joint compared with that to prilocaine, hyaluronan and propylene glycol

AIMS

To determine the effects of the intra-articular injection of surface-active phospholipid in a propylene glycol carrier on synovial fluid composition and joint function of horses, and to compare these effects with those observed after the intra-articular administration of prilocaine, hyaluronan and propylene glycol alone.

METHODS

Twenty-four horses were randomly allocated to four treatment groups: Group 1 100 mg of surface-active phospholipid in 1 ml of propylene glycol; Group 2 1 ml of propylene glycol; Group 3 10 ml of prilocaine; Group 4 2 ml of hyaluronan. Left radiocarpal joints were injected with the treatments and the right radiocarpal joints were injected with volume-matched saline as controls. Examinations for lameness, arthrocenteses and synovial fluid analyses were performed before and at 1, 3 and 7 days after injection.

RESULTS

No horses became lame but treated joints temporarily developed mild to moderate effusions. Synovial fluid analyses indicated significantly greater inflammation in treated compared to control joints and this difference was greatest 24 hours after injection. There were no differences between the four treatments based on synovial fluid analysis except for neutrophil counts and alkaline phosphatase activities, which were significantly higher in prilocaine-treated joints.

CONCLUSION

In horses, the intra-articular injection of surface-active phospholipid in a propylene glycol carrier induces clinically insignificant, temporary abnormalities in synovial fluid. Surface-active phospholipid was no more injurious to the synovium than prilocaine or hyaluronan. None of the agents used in this experiment caused lameness when injected into the joints of horses.

RELEVANCE

This dose and formulation appear suitable for use in future experiments investigating the efficacy of surface-active phospholipid in the treatment or prevention of osteoarthritis in horses.

The normal stress effect and equilibrium friction coefficient of articular cartilage under steady frictional shear

During creep or stress relaxation, articular cartilage exhibits a time-dependent friction coefficient which has been shown to reach an equilibrium value, mu eq, as the tissue deformation equilibrates. This study investigates the frictional properties of articular cartilage explants under steady frictional shear and constant compressive strain after the tissue reaches stress-relaxation equilibrium. The two parameters measured are the normal force and frictional torque, from which the friction coefficient was then calculated. It is shown in this experimental study that: (1) Under a prescribed infinitesimal compressive strain, cartilage supports higher compressive normal stress under steady shear than it does in the absence of frictional shear. Furthermore, the normal stress increases with increasing sliding velocity, resulting in a velocity-dependent value of mu eq. The observed normal stress effectively increases the compressive stiffness of cartilage by a factor up to 3.1. (2) Under a prescribed steady frictional shear both the normal stress and frictional shear stress increase, though not proportionally, with increasing compressive strain, producing a decreasing friction coefficient. (3) This velocity-dependent normal stress effect is also shown to result, at least partly, from intrinsic properties of cartilage. The normal stress effect has not been previously reported for articular cartilage, and represents an intriguing mechanical response not commonly encountered in solids, though common in non-Newtonian fluids.

The influence of loading time and lubricant on the friction of articular cartilage

Friction of cartilage on metal, metal on cartilage and cartilage on cartilage contact configurations, within a mixed lubrication regime, was measured using synovial fluid, Ringer's solution or with no lubricant present. The main test variable was the period of stationary loading which ranged from 5 s to 45 min, prior to sliding and consequently measuring friction. The coefficient of friction rose gradually with increasing stationary loading time, up to a value of approximately 0.3 at 45 min for all the contact configurations. Following the re-application of load, after short periods of load removal, friction was also found to drop sharply. The flow of liquid in the biphasic cartilage and load carriage by the fluid phase was highlighted as being an important factor in reducing friction within the mixed or boundary lubrication regime. Movement of the contact zone over the cartilage counterface ensured very low friction as the slider moved over fully hydrated cartilage. For the cartilage--cartilage contacts synovial fluid significantly reduced friction compared to Ringer's solution. This was attributed to an effective boundary lubrication action, which was not as effective for the cartilage--metal contacts.

Interactions of hyaluronan (hyaluronic acid) with phospholipids as determined by gel permeation chromatography, multi-angle laser-light-scattering photometry and 1H-NMR spectroscopy

The chain flexibility of solutions of hyaluronan (HA) of different molecular weights was determined by 1H-NMR spectroscopy in the absence and presence of the phospholipid dipalmitoyl-D,L-alpha-phosphatidylcholine (DPC). Sonication of high- or low-molecular-weight HA with DPC for periods of up to 120 min markedly increased HA chain flexibility as determined by observing the half-peak linewidths (delta V1/2) for the methyl protons of the acetamidodeoxyglucose residues of the HA molecules. Gel permeation chromatography of mixtures of purified high-molecular-weight HA (Healon) with 3H-DPC or 3H-platelet activating factor (PAF) showed exclusion of these radioactively labelled molecules from the gel in the presence of HA but not in its absence. Studies using multi-angle laser-light-scattering (MALLS) photometry of sonicates of DPC and Healon after Superose 6 chromatography revealed increases in HA Mw, Mn, Mz and their corresponding root mean square radii relative to control sonicates of HA without DPC. From these data, we have deduced that DPC binds to HA by competing for those hydrophobic centres along the HA chain which are normally responsible for the inter- and intra-chain interactions and which confer stiffness to the HA molecule. It is proposed that such interactions in arthritic joints could reduce synovial fluid viscoelasticity thereby diminishing the ability of this medium to protect articular cartilage from mechanical injury.

In vitro measurement of the frictional properties of the temporomandibular joint disc

The integrity of the articulating surfaces of the temporomandibular joint (TMJ) is likely to be promoted by the control of stresses due to frictional forces between moving joint surfaces. Using a pendulum designed to measure the friction on the surface of the pig TMJ disc, factors such as duration of loading and degree of hydration of the disc were found to influence the amount of friction and the time-dependent changes in friction on the disc surface. The tests provide evidence in support of the hypothesis of 'weeping lubrication' on the surface of the TMJ disc.

Sliding friction analysis of phosphatidylcholine as a boundary lubricant for articular cartilage

Dipalmitoyl phosphatidylcholine (DPPC), the major lipidic component of the synovial fluid (45 per cent), has been implicated in previous studies in synovial joint lubrication as a potential boundary lubricant for articular cartilage. The purpose of this study was to evaluate the effectiveness of DPPC as a boundary lubricant at physiological stresses experienced by weight-bearing joints (up to 7.5 MPa). The sliding coefficients of static and kinetic friction for glass surfaces coated with DPPC layers of physiological thickness (70 nm) were measured as a function of average contact stress, contact geometry (point and line), applied load and relative velocity (from 25 to 0 mm/s) and compared to the coefficient of friction for clean glass in the same conditions. The coefficient of friction for DPPC-lubricated surfaces was dependent on contact geometry, obeyed Amonton's law (not dependent on axial load or contact area), was dependent on relative velocity within the range stated and was an effective lubricant at physiological stresses. This study showed that dipalmitoyl phosphatidylcholine can be an effective boundary lubricant at stresses observed in load-bearing joints. Because of their surface-active nature, these adsorbed molecules might also act as a protective layer for the articular surfaces.

Phospholipids in inflammatory synovial effusions

The concentration of phospholipids and proteins was determined in 23 inflammatory synovial fluids obtained from human knee joints. The synovial fluid to plasma phospholipid ratio (0.48 and 0.37 at high and low inflammatory state) was lower than the value found for the total protein content (0.68 and 0.53, respectively) indicating that phospholipids were more discriminated than proteins in their transfer from plasma to the synovial space. Constant amounts of phosphatidylinositol were found in all synovial fluids, whereas trace amounts of lysophosphatidylethanolamine and phosphatidylserine were more frequent in the active inflammatory state. A decrease in the relative amounts of phosphatidylcholine and phosphatidylinositol with respect to plasma suggested the possibility of phospholipid hydrolysis in the synovial compartment. In agreement, determinations of phospholipase activity disclosed the presence of a phospholipase A2 in the fluid phase of synovial effusions. Phospholipid derivatives formed in the synovial space may thus contribute to the amplification of the inflammatory response.

Phospholipids identified on the pericardium and their ability to impart boundary lubrication

Phospholipids have been identified by thin-layer chromatography in appreciable quantities in pericardial fluid taken from 12 dogs and found to include sphingomyelin and phosphatidylcholines, -ethanolamines, -inositols and -serines--the cholines predominating. The extracts, the synthetic surfactants and a mixture of synthetics simulating the extracts were all found to be good lubricants when tested by a standard method. The phosphatidylcholines were capable of reducing friction between two otherwise hydrophilic surfaces by as much as 100- to 200-fold when deposited as an oriented monolayer. A goniometer was used to measure an average contact angle of 33 degrees for a drop of saline placed upon the internal wall of the pericardium, indicating an appreciably hydrophobic surface anticipated if surfactant were directly adsorbed. The results are consistent with the classical theory of "boundary" lubrication (17) as modified (21) to reflect the almost ideal molecular structure of the identified surfactants for adsorption, film cohesion and interaction of fatty-acid chains during sliding. This model is proposed as an alternative to hydrodynamic lubrication in the pericardium and one compatible with several practical aspects such as pericardial rub and the maintenance of normal heart action after pericardectomy.