Biological reactions to wear debris in total joint replacement

Chemical eluates from ultra-high molecular weight polyethylene and fibroblast proliferation

Although polyethylene wear particles have been implicated in osteolysis and implant loosening, this study is the first to test whether chemical eluates extracted from ultra-high molecular weight polyethylene (UHMWPE) could also be involved in this process. Eluates were prepared from UHMWPE bar stock and examined for their effects on (3)H-thymidine incorporation by human foreskin fibroblasts grown in 96-well culture plates. Low concentrations of eluates stimulated (3)H-thymidine uptake; whereas, high concentrations inhibited uptake in a dose-dependent manner. Maximum inhibition of proliferation for eluates (87+/-0.03% inhibition, n = 45 paired wells) was greater than that observed for particles (54+/-0.07% inhibition, n = 45 paired wells). Ethylene oxide sterilization of UHMWPE reduced (3)H-thymidine uptake at low eluate concentrations relative to sterilization by gamma-irradiation. It was concluded that leachable eluates from UHMWPE implantse contribute to the osteolytic process at the bone-implant interface.

Prediction of lubricating film thickness in UHMWPE hip joint replacements

An elastohydrodynamic lubrication model developed for a ball-in-socket configuration in a previous studies by the present authors (Jalali-Vahid et al., Thinning films and tribological interfaces, 26th Leeds-Lyon Symposium on Tribology, 2000, pp. 329-339) was applied to analyse the lubrication problem of a typical artificial hip joint replacement, consisting of an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup against a metallic or ceramic femoral head. The cup was assumed to be stationary whilst the ball was assumed to rotate at a steady angular velocity and under a constant load. A wide range of main design parameters were considered. It has been found that the predicted lubricating film thickness increases with a decrease in the radial clearance, an increase in the femoral head radius, an increase in UHMWPE thickness and a decrease in UHMWPE modulus. However, the predicted lubricating film thicknesses are not found to be sufficiently large in relation to the surface roughness of the cup and head to indicate separation of the two articulating surfaces. It should also be noted that if the design features are unable to secure full fluid film lubrication, it may be preferable to select them for minimum wear rather than maximum film thickness. For example, an increase in head radius will enhance the film thickness, but it will also increase the sliding distance and hence wear in mixed or boundary lubrication conditions. Furthermore, it is pointed out that an increase in the predicted lubricant film thickness is usually associated with an increase in the contact area, and this may cause lubricant starvation and stress concentration at the edge of the cup, and adversely affect the tribological performance of the implant. The effect of running-in process on the lubrication in UHMWPE hip joint replacements is also discussed.