Polyethylene wear in total hip and knee arthroplasties

Influence of surface termination of ultrananocrystalline diamond films coated on titanium on response of human osteoblast cells: A proteome study

Successful osseointegration, i.e. the fully functional connection of patient's bone and artificial implant depends on the response of the cells to the direct contact with the surface of the implant. The surface properties of the implant which trigger cell responses leading to its integration into the surrounding bone can be tailored by surface modifications or coating with thin layers. One potential material for such applications is ultrananocrystalline diamond (UNCD). It combines the exceptional mechanical properties of diamond with good biocompatibility and possibility of coating as thin uniform films on different substrates of biological interest. In the current work we firstly deposited UNCD films on titanium-coated substrates and applied oxygen or ammonia plasma to modify their surface properties. The as-grown and modified UNCD exhibited relatively smooth surfaces with topography dominated by rounded features. The modifications induced oxygen- or amino-terminated surfaces with increased hydrophilicity. In addition, the UNCD coatings exhibited very low coefficient of friction when diamond was used as a counterpart. As-grown and modified UNCD samples were applied to study the responses of human osteoblast MG63 cells triggered by surfaces with various terminations assessed by proteomic analysis. The results revealed that the coating of Ti with UNCD as well as the plasma modifications resulting in O- or NH₂-terminated UNCD induced upregulation of proteins specific for cytoskeleton, cell membrane, and extracellular matrix (ECM) involved in the cell-ECM-surface interactions. Proteins from each of these groups, namely, vimentin, cadherin and fibronectin were further studied immunocytochemically and the results confirmed their increased abundance leading to improved cell-to-surface adhesion and cell-to-cell interactions. These findings demonstrate the potential of implant coating with UNCD and its surface modifications for better osseointegration and bone formation.

Biotribology of Synovial Cartilage: A New Method for Visualization of Lubricating Film and Simultaneous Measurement of the Friction Coefficient

A healthy natural synovial joint is very important for painless active movement of the natural musculoskeletal system. The right functioning of natural synovial joints ensures well lubricated contact surfaces with a very low friction coefficient and wear of cartilage tissue. The present paper deals with a new method for visualization of lubricating film with simultaneous measurements of the friction coefficient. This can contribute to better understanding of lubricating film formation in a natural synovial joint. A newly developed device, a reciprocating tribometer, is used to allow for simultaneous measurement of friction forces with contact visualization by fluorescence microscopy. The software allowing for snaps processing and subsequent evaluation of fluorescence records is developed. The evaluation software and the follow-up evaluation procedure are also described. The experiments with cartilage samples and model synovial fluid are carried out, and the new software is applied to provide their evaluation. The primary results explaining a connection between lubrication and friction are presented. The results show a more significant impact of albumin proteins on the lubrication process, whereas its clusters create a more stable lubrication layer. A decreasing trend of protein cluster count, which corresponds to a decrease in the thickness of the lubrication film, is found in all experiments. The results highlight a deeper connection between the cartilage friction and the lubrication film formation, which allows for better understanding of the cartilage lubrication mechanism.

Polyethylene in total knee arthroplasty: Where are we now?

Polyethylene (PE) remains the gold standard for the articulating surface in hip and knee arthroplasty. To increase arthroplasty longevity and improve wear resistance, newer versions of PE have been designed with resultantly different wear properties. Highly cross-linked polyethylene (HXLPE) is used in total hip arthroplasty with excellent outcomes; however, its use in total knee arthroplasty (TKA) remains conflicting. This review summarizes biomechanical and wear properties, clinical outcomes, and cost of polyethylene inserts in TKA. Simulation studies have convincingly shown decreased wear and oxidation rates with HXLPE when compared to conventional polyethylene (CPE). Registry results have been conflicting, and short- to midterm clinical studies have not demonstrated a significant difference between HXLPE and CPE. The cost of HXLPE inserts is higher than CPE. Long-term clinical data are lacking and further studies are warranted to evaluate the role of HXLPE in TKA.

Materials for Hip Prostheses: A Review of Wear and Loading Considerations

Replacement surgery of hip joint consists of the substitution of the joint with an implant able to recreate the articulation functionality. This article aims to review the current state of the art of the biomaterials used for hip implants. Hip implants can be realized with different combination of materials, such as metals, ceramics and polymers. In this review, we analyze, from international literature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e., being biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a low wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We analyzed the scientific literature, collecting information on the material behavior and the human-body response to it. Particular attention has been given to the tribological behavior of the biomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After more than 50 years of evolution, in term of designs and materials, the actual wear rate of the most common implants is low, allowing us to sensibly reduce the risk related to the widespread debris distribution in the human body.

Mechanical tests, wear simulation and wear particle analysis of carbon-based nanomultilayer coatings on Ti6Al4V alloys as hip prostheses

Carbon-based nanomultilayer coatings were deposited on medical-grade Ti₆Al₄V alloy using a magnetron sputtering technique under a graded bias voltage.

Tribo-biological deposits on the articulating surfaces of metal-on-polyethylene total hip implants retrieved from patients

Artificial total hip arthroplasty (THA) is one of the most effective orthopaedic surgeries that has been used for decades. However, wear of the articulating surfaces is one of the key failure causes limiting the lifetime of total hip implant. In this paper, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) were employed to explore the composition and formation mechanism of the tribo-layer on the articulating surfaces of metal-on-polyethylene (MoPE) implants retrieved from patients. Results showed that, in contrast to conventional understanding, the attached tribo-layer contained not only denatured proteins but also a fraction of polymer particles. The formation of the tribo-layer was believed to relate to lubrication regime, which was supposed to be largely affected by the nature of the ultra-high-molecule-weight-polyethylene (UHMWPE). Wear and formation of tribo-layer could be minimized in elasto-hydrodynamic lubrication (EHL) regime when the UHMWPE was less stiff and have a morphology containing micro-pits; whereas the wear was more severe and tribo-layer formed in boundary lubrication. Our results and analyses suggest that enhancing interface lubrication may be more effective on reducing wear than increasing the hardness of material. This finding may shed light on the design strategy of artificial hip joints.

High efficiency fabrication of ultrahigh molecular weight polyethylene submicron filaments/sheets by flash-spinning

In this study, we propose a novel method for preparing continuous ultrahigh molecular weight polyethylene (UHMWPE) filaments by flash-spinning. The filaments were processed by calendaring to obtain the sheets. The morphology of the filaments and the sheets, the forming process, the optimal fabrication conditions, mechanical properties, spinning speed, and the rate of spinning of the filaments were investigated. The results showed that the filaments were composed of bunches of microfibers and the diameter of the filaments and the microfibers ranged from 0.15 mm to 0.22 mm and 0.2 μm to 5 μm, respectively. For a given concentration of 5 wt% of the UHMWPE, optimal specimens were obtained only when the temperature was in the range 150–210°C and the pressure was in the range 8–20 MPa. The spinning speed and the polymer consumption increased with enhancement in the pressure and the value reached as high as 47.2 m/s and 116.7 g/min, respectively. The properties and the spinning efficiency of the filaments revealed that flash-spinning is a potential method for manufacturing commercial products in various fields of application.

[Possibilities and limits of modern polyethylenes. With respect to the application profile]

BACKGROUND

Polyethylene is still one of the most important materials in the field of hip and knee arthroplasty. The clinical results of the last decades have helped to further develop polyethylene into a high-tech material. Progress in the development of new materials must be compared with the tried and tested ones to provide optimal and most individual patient care.

OBJECTIVES

This article gives an overview of the history and current application profile of the material ultra-high molecular weight polyethylene (UHMWPE) in hip and knee arthroplasty.

MATERIAL AND METHODS

With the aid of the current literature, new developments in the field of the material UHMWPE, also with respect to the biological activity of wear, the particular biomechanics of the knee joint as well as alternative hard-hard bearing surfaces in the hip, are represented in terms of implant safety.

RESULTS

The problems concerning polyethylene are now well recognized. The disadvantages of the material UHMWPE could be consistently reduced based on material research so that modern polyethylenes have gradually been shown in clinical trials that they can be reliably used.

CONCLUSION

Despite this the potential for improvement has still not yet been fully exploited. Any further development must be extensively tested both biomechanically and biologically before the material can be used in vivo. Long-term results are still necessary before a material can be accepted as being clinically safe.

Wear characteristics of WSU total ankle replacement devices under shear and torsion loads

BACKGROUND

There are several factors that contribute to the failure of total ankle replacement (TAR). Aseptic loosening is one of the primary mechanisms of failure in TAR. Since a cross-linked ultrahigh molecular weight polyethylene (UHMWPE) is used as liner material, there is a need to quantify and develop methods to estimate the wear rates of the liners. High contact stresses develop during the gait generates wear debris resulting in osteolysis and early loosening of the prostheses.

METHODS

In this paper wear characteristics of Wright State University (WSU) TARs were determined by applying shear and torsion loads. Viscoelastic properties were used to model the liner component. Finite element analysis was conducted to determine the wear rate by deriving Von Mises and contact stresses generated in the liner and wear rate equation was used to predict the wear rate.

RESULTS

Titanium alloy has shown less resistance towards shear forces when compared with other metal alloys. Under torsion, rotation angle plays a significant role in affecting the peak stress values. The maximum average contact stress was 14.46 MPa under torsion load which contributes to a wear rate of 0.67 (mm(3)/year) for one of the mobile bearing models. The maximum average contact stress and wear rate obtained from the analytical study were 10.55 MPa and 0.33 (mm(3)/year), respectively for mobile bearing models. When compared with mobile bearing model, fixed bearing model has shown higher stresses at different degrees of rotation.

CONCLUSION

Both shear and torsion loads cause significantly lower contact stresses and wear when compared to the axial load. Further studies are necessary to accurately determine the wear behavior of fixed bearing TAR models.

On the roughness measurement on knee prostheses

The majority of total knee replacements currently implanted present an articulation composed of two metal parts, femoral and tibial components, between which there is a polyethylene insert serving as a bearing surface. The finishing surface of the metal components is a very important factor in minimizing the polyethylene wear rate and, later, the gradual production of metal and plastic debris. Considering the role of surface roughness on volumetric wear rates, the purpose of this study is to develop a protocol for the roughness characterization of total knee prosthesis (TKP) metal components, taking into consideration a limited number of points on each surface. Six mobile TKP of different sizes (three size 2 and three size 6) were tested on a knee joint simulator to compare the wear behavior of each group. After 2 million cycles the weight loss by the polyethylene inserts was measured with gravimetric method and the surface roughness of the metallic components was assessed in terms of average surface roughness, Ra, skewness, Rsk, and total roughness, Rt. Roughness measurement involved 29 points on each femoral condyle and 26 points on each metal tibial plate. The data collected has shown an increased roughness upon wear testing for both the investigated TKP sizes. No statistical differences were observed between the two groups for both the parameters Ra, Rsk, and Rt. The surface of all metallic components became more negatively skewed, indicating diminishing peaks. The various parameters were correlated to the volumetric loss using a linear regression analysis.

Total knee prosthesis polyethylene wear reduction by a new metal part finishing method

PURPOSE

The purpose of this study was to assess a new metal component finishing designed to improve total knee prosthesis durability. Wear of ultrahigh molecular-weight polyethylene (UHMWPE), with generation of submicrometer- and micrometer-sized particles, has been associated with osteolysis and artificial joint failure. Wear extent is influenced by several factors, some of which are related to manufacturing.

METHODS

UHMWPE wear was assessed in metal prosthesis components finished with the Microloy® technology and in traditionally finished components by wear simulation experiments (pin on disk and knee simulator tests) and analysis of wear debris.

RESULTS

Microloy®-finished prosthesis showed a 48.5% reduction in UHMWPE total weight loss compared with traditional components (P=0.002). A statistically significant (P<0.05) reduction of UHMWPE debris were detected from the Microloy®-finished compared with the traditionally finished components.

CONCLUSIONS

These findings suggest the Microloy® metal finishing may enhance the long-term performance of knee prostheses.

Oxidative properties and surface damage mechanisms of remelted highly crosslinked polyethylenes in total knee arthroplasty

PURPOSE

Remelted highly crosslinked polyethylenes (HXLPEs) were introduced in total knee replacement (TKR) starting in 2001 to reduce wear and particle-induced lysis. The purpose of this study was to investigate the damage mechanisms and oxidative stability of remelted HXLPEs used in TKR.

METHODS

A total of 186 posteriorly stabilised tibial components were retrieved at consecutive revision operations. Sixty nine components were identified as remelted HXLPE. The conventional inserts were implanted for 3.4 ± 2.7 years, while the remelted components were implanted 1.4 ± 1.2 years. Oxidation was assessed using Fourier transform infrared spectroscopy.

RESULTS

Remelted HXLPE inserts exhibited lower oxidation indices compared to conventional inserts. We were able to detect slight regional differences within the HXLPE cohort, specifically at the bearing surface.

CONCLUSION

Remelted HXLPE was effective at reducing oxidation in comparison to gamma inert sterilised controls. Additional long-term HXLPE retrievals are necessary to ascertain the long term in vivo stability of these materials in TKR.

In vivo oxidation and surface damage in retrieved ethylene oxide-sterilized total knee arthroplasties

BACKGROUND

Gas sterilization (eg, ethylene oxide [EtO] and gas plasma) was introduced for polyethylene to reduce oxidation due to free radicals occurring during radiation sterilization. Recently, oxidation has been observed in polyethylenes with undetectable levels of free radicals, which were expected to be oxidatively stable. It is unclear whether in vivo oxidation will occur in unirradiated inserts sterilized with EtO.

QUESTIONS/PURPOSES

We analyzed the oxidation, mechanical behavior, and surface damage mechanisms of tibial inserts of a single design sterilized using EtO.

METHODS

We collected 20 EtO-sterilized tibial inserts at revision surgeries. We assessed oxidative using Fourier transform infrared spectroscopy and mechanical properties using the small punch test. Surface damage was assessed using damage scoring techniques and micro-CT.

RESULTS

Oxidation indexes were low and uniform between the regions. The subtle changes did not affect the mechanical properties of the polymer. The dominant surface damage modes included burnishing, abrasion, and third-body wear. There was no evidence of delamination in the retrievals.

CONCLUSIONS

The retrieved EtO-sterilized UHMWPE retrievals remained stable with respect to both oxidative and mechanical properties for up to 10 years in vivo. We did observe slight measurable amounts of oxidation in the inserts; however, it was far below levels that would be expected to compromise the strength of the polymer.

CLINICAL RELEVANCE

Due to the stable oxidative and mechanical properties, EtO-sterilized tibial components appear to be an effective alternative to gamma-sterilized inserts, at least in short-term implantations.

HIGHLY CROSSLINKED POLYETHYLENE: A COMPARATIVE STUDY BETWEEN TWO UHMWPES WITH DISTINCT MOLECULAR WEIGHT

In the recent years, radiation-induced highly crosslinked polyethylenes have been introduced in arthroplasties as an alternative to conventional ultra high molecular weight polyethylene (UHMWPE) for their superior wear resistance. In the present study, the influence of the molecular weight of the raw on end-user properties of highly crosslinked polyethylenes (HXLPE) is investigated by means of a comparative study between two resins with distinct molecular weights. The main outcomes indicate that the differences in mechanical and wear properties between the row materials disappear after crosslinking; nevertheless the resin with the highest molecular weight is likely to retain a better resistance to short-term oxidation.

Cold atmospheric pressure gas plasma enhances the wear performance of ultra-high molecular weight polyethylene

Ultra-high molecular weight polyethylene (UHMWPE) is frequently employed in joint replacements because of its high biocompatibility; however, this material does not exhibit particularly strong wear performance, thus potentially reducing the longevity of such devices. Numerous techniques have been investigated to increase the resistance to wear of UHMWPE, but they are all based on expensive machinery and require a high level of safety precautions. Cold atmospheric pressure gas plasma treatment is an inexpensive process that has been used as a surface modification method and as a sterilization technique. We demonstrate for the first time that a helium/oxygen cold atmospheric pressure gas plasma can be used to enhance the wear performance of UHMWPE without affecting the cytocompatibility of the material. The exposure to a cold atmospheric pressure gas plasma results in a greater level of crosslinking of the polyethylene chains. As a consequence of the higher crosslinking, the material stiffness of the treated surface is increased.

Oxidation and fusion defects synergistically accelerate polyethylene failure in knee replacement

We have previously reported upon a cohort of patients with premature failure of such material and postulated upon the impact of abnormally high concentrations of type 2 fusion defects whereby there is a lack of particle cohesion due to incomplete diffusion. In vivo oxidation has been purported to underscore the premature failure of polyethylene. The mechanism of such remains poorly delineated. New data has now been obtained by determining substrata oxidative profiles of 10 failed Kinemax Plus modular tibial insert analyses in conjunction with fusion defect detection. The full thickness of a series of cores was analysed using infra-red spectroscopy to identify higher levels of oxidation in loaded used material at both the articulating and non-articulating regions. A comparison was made to an unused control. Articulating, loaded, areas exhibited greater local concentrations of oxidised material and wider variation of such consistent with the higher presence of fusion defects. Subsurface analysis confirmed the presence of a major oxidative peak 2mm below the surface for all loaded areas irrespective of wear. Additionally we were able to identify a second major oxidative focus about halfway between the inferior (tibial baseplate) surface and the articulating area. We believe that the combination of high oxidation and fusion defects represents a second high stress zone consistent with the observation of tibial baseplate polyethylene dissociation and backside wear with resultant catastrophic material failure.

In vivo oxidation contributes to delamination but not pitting in polyethylene components for total knee arthroplasty

The aim of this study was to better understand how in vivo oxidation contributes to fatigue damage in total knee arthroplasty (TKA). A total of 119 tibial inserts were consecutively collected after revision surgery. Of the 119 polyethylene retrievals, 29 were gamma sterilized in air (historical), whereas the remaining 90 were gamma sterilized in nitrogen (conventional). Surface damage assessment and characterization of oxidation were performed on all the retrievals. Delamination was significantly more prevalent and extensive in the longer-term, highly oxidized, historical tibial inserts. Pitting damage, in contrast, seemed to be equally prevalent between both retrieval groups and was not correlated with in vivo oxidation. Our findings support our hypothesis that in vivo oxidation is a contributing factor to delamination, but not pitting, in TKA. Despite the lower oxidation displayed by conventional retrievals, this study provides strong evidence that delamination secondary to in vivo oxidation may occur during the second decade of implantation.

Plasma Surface Modification of Medical-Grade Ultra-High Molecular Weight Polyethylene for Improved Tribological Properties

Ultra-high molecular weight polyethylene (UHMWPE) is the principal material used to replace damaged cartilage in total joint replacement surgeries. This publication presents preliminary results from a new class of surface treatments to modify the surface chemistry and microstructure of UHMWPE under controlled processing conditions. Radio frequency plasmas were used to lightly crosslink the subsurface of UHMWPE and to modify the surface chemical state through the attachment of low-surface-energy fluorocarbon groups. A pin-on-disk apparatus was used to slide CoCrWNi pins with spherical tips on polished disks of plasma- treated and untreated UHMWPE immersed in a bath of preserved bovine serum. The wear resistance and surface chemical composition of tested specimens were characterized by surface profilometry and X-ray photoelectron spectroscopy (XPS), respectively. Changes in the surface hydrophobicity due to plasma treatment were evaluated using contact angle measurements. The prospect of surface plasma treatment in orthopedic applications is elucidated in the context of the obtained friction, wear, distilled water contact angle, and XPS results.

Biocompatibility and mechanical properties of diamond-like coatings on cobalt-chromium-molybdenum steel and titanium-aluminum-vanadium biomedical alloys

Diamond-like carbon (DLC) films are favored for wear components because of diamond-like hardness, low friction, low wear, and high corrosion resistance (Schultz et al., Mat-wiss u Werkstofftech 2004;35:924-928; Lappalainen et al., J Biomed Mater Res B Appl Biomater 2003;66B:410-413; Tiainen, Diam Relat Mater 2001;10:153-160). Several studies have demonstrated their inertness, nontoxicity, and the biocompatibility, which has led to interest among manufacturers of surgical implants (Allen et al., J Biomed Mater Res B Appl Biomater 2001;58:319-328; Uzumaki et al., Diam Relat Mater 2006;15:982-988; Hauert, Diam Relat Mater 2003;12:583-589; Grill, Diam Relat Mater 2003;12:166-170). In this study, hydrogen-free amorphous, tetrahedrally bonded DLC films (ta-C) were deposited at low temperatures by physical vapor deposition on medical grade Co28Cr6Mo steel and the titanium alloy Ti6Al4V (Scheibe et al., Surf Coat Tech 1996;85:209-214). The mechanical performance of the ta-C was characterized by measuring its surface roughness, contact angle, adhesion, and wear behavior, whereas the biocompatibility was assessed by osteoblast (OB) attachment and cell viability via Live/Dead assay. There was no statistical difference found in the wettability as measured by contact angle measurements for the ta-C coated and the uncoated samples of either Co28Cr6Mo or Ti6Al4V. Rockwell C indentation and dynamic scratch testing on 2-10 μm thick ta-C films on Co28Cr6Mo substrates showed excellent adhesion with HF1 grade and up to 48 N for the critical load L(C2) during scratch testing. The ta-C coating reduced the wear from 3.5 × 10(-5) mm(3)/Nm for an uncoated control sample (uncoated Co28Cr6Mo against uncoated stainless steel) to 1.1 × 10(-7) mm(3)/Nm (coated Co28Cr6Mo against uncoated stainless steel) in reciprocating pin-on-disk testing. The lowest wear factor of 3.9 × 10(-10) mm(3)/Nm was measured using a ta-C coated steel ball running against a ta-C coated and polished Co28Cr6Mo disk. Student's t-test found that the ta-C coating had no statistically significant (p < 0.05) effect on OB attachment, when compared with the uncoated control samples. There was no significant difference (p < 0.05) in the Live/Dead assay results in cell death between the ta-C coated Co28Cr6Mo and Ti6Al4V samples and the uncoated controls. Therefore, these ta-C coatings show improved wear and corrosion (Dorner-Reisel et al., Diam Relat Mater 2003;11:823-827; Affato et al., J Biomed Mater Res B Appl Biomater 2000;53:221-226; Dorner-Reisel et al., Surf Coat Tech 2004;177-178:830-837; Kim et al., Diam Relat Mater 2004;14:35-41) performance and excellent in vitro cyto-compatibility, when compared with currently used uncoated Co28Cr6Mo and Ti6Al4V implant materials.

Distribution of polyethylene wear particles and bone fragments in periprosthetic tissue around total hip joint replacements

Ultra-high molecular weight polyethylene (UHMWPE) wear particles play a significant role in failures of total joint replacements (TJRs). In this work, we investigated the distribution of these wear particles in periprosthetic tissues obtained from nine revisions of hip TJR. In the first step, all periprosthetic tissues were combined and mechanically separated into granuloma tissue (containing hard granules visible to the naked eye) and surrounding tissue (without visible granules). In the second step, the tissues were hydrolyzed by protease from Streptomyces griseus and granules were separated by filtration; this divided the sample into four groups: (i) lyzate and (ii) non-degraded large granules from the granuloma tissue plus (iii) lyzate and (iv) non-degraded small granules from the surrounding tissue. In the third step, the large as well as small granules were hydrolyzed by collagenase from Clostridium histolyticum. In the last step, the UHMWPE wear particles from all four groups were purified by HNO3 digestion and weighed. The purity of the isolated particles was verified by scanning electron microscopy, infrared spectroscopy and energy-dispersive X-ray analysis. Of the total amount of polyethylene particles in the whole granuloma tissue, 72% of particles in the size range 0.1-10 microm and 68% of those larger than 10 microm were found in granules. Therefore, the formation of granules significantly lowers the effective amount of wear particles available for interaction with reactive cells and seems to be a natural defense mechanism.

Influence of microscopic surface asperities on the wear of ultra-high molecular weight polyethylene in a knee prosthesis

The wear of ultra-high molecular weight polyethylene (UHMWPE) in knee and hip prostheses is one of the major factors restricting the longevity of these implants. A number of microscopic scratches caused by various factors were observed on the metallic femoral components of the retrieved knee prostheses with an anatomical design. It appears that microscopic surface asperities caused by this surface damage contribute to increasing and/or accelerating the wear of the UHMWPE tibial insert. In this study, in the first step, microscopic observations and surface roughness measurements of several retrieved metallic femoral components were performed in order to produce simplified two-dimensional (2D) finite-element method (FEM) models of a microscopic surface asperity using roughness parameters. Next, a three-dimensional (3D) microscopic surface profile measurement of the damaged surface of a retrieved metallic femoral component and the reproduction of the femoral component surface were performed in order to produce 3D FEM models of a microscopic surface asperity based on actual measurement data. 2D and 3D elastoplastic contact analyses between a metallic microscopic surface asperity and UHMWPE were also performed in order to investigate the mechanical state and microscopic wear of UHMWPE caused by a metallic microscopic surface asperity. The analytical findings of this study suggest that the aspect ratio, shape ratio, and indentation depth of the microscopic surface asperity have significant influence on increasing and/or accelerating the wear of UHMWPE. Higher aspect ratios, shape ratios, and indentation depths cause higher contact stresses and plastic strains in UHMWPE.

The effect of anterior-posterior shear load on the wear of ProDisc-L TDR

The current wear-testing standard (ISO18192-1) for total disc replacement (TDR) requires only four degrees of freedom (DOF) inputs: axial load, flexion-extension, lateral bending and axial rotation. The study aim was to assess the effect of an additional DOF, anterior-posterior (AP) shear on the wear of the ProDisc-L TDR. A 5DOF simulator was used to test ProDisc-L implants under 4DOF and 5DOF conditions. The 4DOF conditions were defined by ISO18192-1 whilst the 5DOF used ISO18192-1 conditions with the addition of an AP load of +175 and -140 N (anterior and posterior, respectively), extrapolated from in vivo data. The implants were mounted such that the polyethylene insert could be removed for gravimetric measurements. Tests were run using bovine serum (15 g/l protein concentration) as a lubricant for five million cycles (MC), with measurements repeated every 1 MC. The mean wear rate in the 4DOF test was 12.7 +/- 2.1 mg/MC compared to 11.6 +/- 1.2 mg/MC in the 5DOF test. There were marked differences in the wear scars between 4DOF and 5DOF simulations. With 4DOF, wear scars were centralised on the dome of the insert, whilst 5DOF scars were larger, breaching the anterior rim of the dome causing deformation at the edge. The 4DOF wear test showed similar gravimetric wear rates to previously published ISO-tested TDRs. The addition of AP load was found to have no significant effect on the overall wear rate. However, there were pronounced differences in the respective wear scars, which highlights the need for more research in order to understand the factors that influence wear of TDR.

Biomaterials in orthopaedics

At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field.

Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface

In total joint arthroplasty, third body particle access to the articulating surfaces results in accelerated wear. Hip joint subluxation is an under-recognized means by which third body particles could potentially enter the otherwise closely conforming articular bearing space. The present study was designed to test the hypothesis that, other factors being equal, even occasional events of femoral head subluxation greatly increase the number of third body particles that enter the bearing space and become embedded in the acetabular liner, as compared to level-walking cycles alone. Ten metal-on-polyethylene hip joint head-liner pairs were tested in a multi-axis joint motion simulator, with CoCrMo third body particles added to the synovial fluid analog. All component pairs were tested for 2h of level walking; half were also subjected to 20 intermittent subluxation events. The number and location of embedded particles on the acetabular liners were then determined. Subluxation dramatically increased the number of third body particles embedded in the acetabular liners, and it considerably increased the amount of scratch damage on the femoral heads. Since both third body particles and subluxation frequently occur in contemporary total hip arthroplasty, their potent synergy needs to be factored prominently into strategies to minimize wear.

Three-dimensional laser micrometry characterization of surface wear in total hip arthroplasty

Even after decades of clinical use, our ability to quantify wear across total hip replacement implant surfaces is largely limited to single value measurements. The influence of patient factors on wear remains enigmatic. This pilot study for the development of three-dimensional laser micrometry (3DLM) introduces an easy, accurate means of 'mapping' and quantifying material removal. A three-dimensional laser micrometer was constructed using a laser micrometer having an accuracy of 0.5 microm. A 3D surface map is triangulated from a point cloud consisting of approximately 140,000 individual points. Comparison to a reference sphere determines radial wear over the entire surface. 3DLM was able to map and quantify fine scale surface features. Even for zirconia on relatively soft ultra-high molecular weight polyethylene, this technique maps the contributions of localized wear at the macroscopic level. The 0.5 microm (or greater) accuracy of these lasers allows us to image surfaces with a high degree of confidence. This analysis lends itself well to automation, and we anticipate that this advance will prove valuable in establishing that each head and cup combination emerging from a given clinical environment has unique wear patterns as observed in this trial data set.

Abriebpartikel

The aseptic prosthetic loosening of hip and knee prosthesis is the most important cause of implant insufficiency. Bone loss as a result of the biological effect of wear particles is the main cause of such loosening. Wear particles develop their biological activity along different cellular pathways, above all via macrophages, foreign body giant cells as well as fibroblasts of the periprosthetic membrane. These cells induce particle-dependent bone resorption by means of proinflammatory cytokines, such as IL-1beta, TNF-alpha, IL-6 and PGE2. These factors induce the activation of osteoclasts as well as the suppression of osteoblasts. Neutrophil granulocytes and lymphocytes do not play an important role in the process of aseptic loosening. The different wear particles, such as ultra-high molecular weight polyethylene, metal particles, ceramic particles and polymethylmethacrylate can be morphologically recognized very easily. From the clinical point of view, the differentiation between acute or chronic implant infection and particle induced prosthetic loosening is very important, with the histomorphological differential diagnosis between septic and aseptic loosening and their combination being the key clinicopathological factor.

UHMWPE and vitamin E bioactivity: an emerging perspective

Ultra-high molecular weight polyethylene (UHMWPE) is a semicrystalline biomaterial widely used in the components for articular prosthesis for its excellent mechanical qualities. Two major problems limit the UHMWPE prosthesis life-wearing and delamination, both phenomena being mainly due to chemical oxidation of polymer. Wearing causes the release of generated particulate that triggers a macrophage reaction leading to chronic inflammation and osteolysis, while delamination, due to the mechanical stress, macroscopically alters the surfaces. The most diffused method to reduce wearing is UHMWPE molecular cross-linking by high-energy irradiation followed by melting that also reduces polymer fatigue strength. For this reason, the use of vitamin E (alpha-tocopherol), as an anti-oxidative and biocompatible additive for normal and cross-linked UHMWPE, has been suggested as an alternative method to improve polymer wearing resistance without altering its mechanical strength. This paper describes briefly the rationale of vitamin E as UHMWPE additive and its possible use as an emerging perspective in the orthopaedic field.

Elasto-plastic contact analysis of an ultra-high molecular weight polyethylene tibial component based on geometrical measurement from a retrieved knee prosthesis

The wear phenomenon of ultra-high molecular weight polyethylene (UHMWPE) in knee and hip prostheses is one of the major restriction factors on the longevity of these implants. Especially in retrieved knee prostheses with anatomical design, the predominant types of wear on UHMWPE tibial components are delamination and pitting. These fatigue wear patterns of UHMWPE are believed to result from repeated plastic deformation owing to high contact stresses. In this study, the elasto-plastic contact analysis of the UHWMPE tibial insert, based on geometrical measurement for retrieved knee prosthesis, was performed using the finite element method (FEM) to investigate the plastic deformation behaviour in the UHMWPE tibial component. The results suggest that the maximum plastic strain below the surface is closely related to subsurface crack initiation and delamination of the retrieved UHMWPE tibial component. The worn surface whose macroscopic geometrical congruity had been improved due to wear after joint replacement showed lower contact stress at macroscopic level.

Computational wear prediction of a total knee replacement from in vivo kinematics

Wear of ultra-high molecular weight polyethylene bearings in total knee replacements remains a major limitation to the longevity of these clinically successful devices. Few design tools are currently available to predict mild wear in implants based on varying kinematics, loads, and material properties. This paper reports the implementation of a computer modeling approach that uses fluoroscopically measured motions as inputs and predicts patient-specific implant damage using computationally efficient dynamic contact and tribological analyses. Multibody dynamic simulations of two activities (gait and stair) with two loading conditions (70-30 and 50-50 medial-lateral load splits) were generated from fluoroscopic data to predict contact pressure and slip velocity time histories for individual elements on the tibial insert surface. These time histories were used in a computational wear analysis to predict the depth of damage due to wear and creep experienced by each element. Predicted damage areas, volumes, and maximum depths were evaluated against a tibial insert retrieved from the same patient who provided the in vivo motions. Overall, the predicted damage was in close agreement with damage observed on the retrieval. The gait and stair simulations separately predicted the correct location of maximum damage on the lateral side, whereas a combination of gait and stair was required to predict the correct location on the medial side. Predicted maximum damage depths were consistent with the retrieval as well. Total computation time for each damage prediction was less than 30 min. Continuing refinement of this approach will provide a robust tool for accurately predicting clinically relevant wear in total knee replacements.

Protein-mediated boundary lubrication in arthroplasty

Wear of articulated surfaces can be a major lifetime-limiting factor in arthroplasty. In the natural joint, lubrication is effected by the body's natural synovial fluid. Following arthroplasty, and the subsequent reformation of the synovial membrane, a fluid of similar composition surrounds the artificial joint. Synovial fluid contains, among many other constituents, a substantial concentration of the readily adsorbing protein albumin. The ability of human serum albumin to act as a boundary lubricant in joint prostheses has been investigated using a pin-on-disc tribometer. Circular dichroism spectroscopy was employed to follow the temperature- and time-dependent conformational changes of human serum albumin in the model lubricant solution. Effects of protein conformation and polymer surface hydrophilicity on protein adsorption and the resulting friction in the boundary lubrication regime have been investigated. Unfolded proteins preferentially adsorb onto hydrophobic polymer surfaces, where they form a compact, passivating layer and increase sliding friction-an effect that can be largely suppressed by rendering the substrate more hydrophilic. A molecular model for protein-mediated boundary friction is proposed to consolidate the observations. The relevance of the results for in vivo performance and ex vivo hip-joint testing are discussed.

Biocompatibility of Carbon Layer on Polymer

Polymers with modified surface structure are useful for medicine applications. This study is focused on the surface properties of polymers with carbon layers and their biocompatibility. For experiments was used polyethyleneterephtalate (PET). We used magnetron sputtering for producing of the carbon layers. Raman spectroscopy, goniometry, AFM – microscopy, X-ray diffraction and infrared spectroscopy were used in our experiments to describe the physicochemical properties of modified polymers. Biocompatibility of structure polymer-carbon layers was studied with method in vitro. We investigated adhesion of mouse 3T3-fibroblasts. The carbon layers have positive influence on biocompatibility.

Stresses in Polyethylene Liners in a Semiconstrained Ankle Prosthesis

A finite element model of a semiconstrained ankle implant with the tibia and fibula was constructed so that the stresses in the polyethylene liner could be computed. Two different widths of talar components were studied and proximal boundary conditions were computed from an inverse process providing a load of five times body weight appropriately distributed across the osseous structures. von Mises stresses indicated small regions of localized yielding and contact stresses that were similar to those in acetabular cup liners. A wider talar component with 36% more surface area reduced contact stress and von Mises stresses at the center of the polyethylene component by 17%.

Nanoindentation properties of compression-moulded ultra-high molecular weight polyethylene

This paper investigates the elastic modulus and hardness of untreated and treated compression-moulded ultra-high molecular weight polyethylene (UHMWPE) tibial inserts of a total knee replacement (TKR) prosthesis. Investigations were carried out at a nanoscale using a Nanoindenter at penetration depths of 100,250 and 500 nm. The nanomechanical properties of surface and subsurface layers of the compression-moulded tibial inserts were studied using the untreated UHMWPE. The nanomechanical properties of intermediate and core layers of the compression-moulded tibial insert were studied using the cryoultrasectioned and etched UHMWPE treated samples. The cryoultrasectioning temperature (-150 degrees C) of the samples was below the glass transition temperature, Tg (-122 +/- 2 degrees C ), of UHMWPE. The measurement of the mechanical response of crystalline regions within the nanostructure of UHMWPE was accomplished by removing the amorphous regions using a time-varying permanganic-etching technique. The percentage crystallinity of UHMWPE was measured using differential scanning calorimetry (DSC) and the Tg of UHMWPE was determined by dynamic mechanical analysis (DMA). Atomic force microscopy (AFM) was used to assess the effect of surface preparation on the samples average surface roughness, Ra. In this study, it was demonstrated that the untreated UHMWPE samples had a significantly lower (p < 0.0001) elastic modulus and hardness relative to treated UHMWPE cryoultrasectioned and etched samples at all penetration depths. No significant difference (p > 0.05) in elastic modulus and hardness between the cryoultrasectioned and etched samples was observed. These results suggest that the surface nanomechanical response of an UHMWPE insert in a total joint replacement (TJR) prosthesis is significantly lower compared with the bulk of the material. Additionally, it was concluded that the nanomechanical response of material with higher percentage crystallinity (67 per cent) was predominantly determined by the crystalline regions within the semi-crystalline UHMWPE nanostructure.

Defect initiation at subsurface grain boundary as a precursor of delamination in ultrahigh molecular weight polyethylene

In order to examine the initiation mechanism of delamination in ultrahigh molecular weight polyethylene (UHMWPE) knee components, a bi-directional sliding fatigue test was performed for three types of UHMWPE specimens: nonirradiated, gamma-irradiated (25 kGy) and gamma-irradiated (25 kGy) with 0.1% vitamin E added. Sliding surfaces of post-tested UHMWPE specimens were observed using an optical microscope and a scanning electron microscope. Also, surface roughness was measured at the sliding surfaces of UHMWPE specimens. Delamination was observed only in gamma-irradiated specimens. A networked structure of surface asperity that resembled grain boundary was observed prior to delamination in gamma-irradiated specimens. Surface roughness in the gamma-irradiated specimens, higher than in any other specimen, showed a rapid increase prior to delamination. Detailed observation using an optical microscope and a scanning electron microscope showed microscopic crack initiation along subsurface grain boundaries in gamma-irradiated specimens. These results suggest that subsurface crack initiation is a precursor of delamination and is accelerated by oxidative degradation due to gamma irradiation. Of the three types of specimens, UHMWPE with vitamin E added showed the lowest surface roughness values at all measuring points. The addition of vitamin E is effective in improving wear resistance and fatigue performance of UHMWPE.

Contact stresses in the glenoid component in total shoulder arthroplasty

Several studies of retrieved glenoid components from total shoulder arthroplasty show an erosion of the rim, surface irregularities, component fracture and wear resulting from polyethylene deformation in vivo. Particles resulting from polyethylene wear might be one of the reasons for the very high rate of glenoid component loosening found clinically. Because wear can be the result of high contact stresses, the aim of this study is to find out whether or not contact stresses are high enough to cause wear of the glenoid component and what influence the component type and geometry have on polyethylene contact stresses for different humerus abduction angles. Elasticity theory is used in a parametric study of contact stresses in several glenoid component designs. A finite element method is used to confirm the accuracy of the analytical solution. The analysis shows that the peak stress generated in glenoid components under conditions of normal living can be as high as 25 MPa; since this exceeds the polyethylene yield strength, wear and also cold flow of the components can be expected. It is predicted that more conforming components have lower contact stresses, which might result in lower wear rate and less cold flow. It is also found that a metal-backed component promotes higher contact stresses than an all-polyethylene component with the same total thickness, therefore it can be expected that metal-backed components have inferior wear properties.

Effects of the sample preparation temperature on the nanostructure of compression moulded ultrahigh molecular weight polyethylene

In this study, the effects of the sample sectioning temperature on the surface nanostructure and mechanical response of compression moulded ultrahigh molecular weight polyethylene (UHMWPE) at a nanometer scale (nanomechanical properties) have been characterized. The primary focus of this work was to determine if the sample sectioning temperature significantly changed the nanostructure of UHMWPE, while the secondary focus was to characterize the effect on the mechanical response due to the changes in the sectioned surface nanostructure. The goals of this study were: (a) to investigate the potential possibility of creating surface artefacts by the sample preparation technique by sectioning at different temperatures relative to the published range of glass transition temperatures, Tg, for PE (-12, -80 and -25 degrees C); (b) to determine the possibility of molecular orientation induced by plastic deformation of the UHMWPE sample during the process of sample preparation; (c) to measure the relative difference in nanomechanical properties owing to evolution of different nanostructures as a function of sample sectioning temperature. Field emission scanning electron microscopy (FESEM), atomic force microscopy (AFM) and nanoindentation were used to demonstrate that the sectioning temperature caused a change in nanostructure of the compression moulded UHMWPE sectioned surface, explaining the change in mechanical response to indentation at a nanoscale. In this study, it was demonstrated that significant plastic deformation occurs when a shear stress is applied between the glass or diamond blade and the UHMWPE during sample preparation under ambient conditions at a temperature of 22 degrees C. These results also suggest that an optimum sample sectioning temperature should definitely be below the measured Tg of the polymer.

Adhesion and proliferation of rat vascular smooth muscle cells (VSMC) on polyethylene implanted with O+ and C+ ions

Polyethylene was implanted with 30-keV oxygen (PE/O+) or 23-keV carbon ions (PE/C+) at 10(13) to 5 x 10(15) ions cm(-2) doses in order to improve the adhesion of vascular smooth muscle cell (VSMC) to the polymer surface in vitro because of its oxidation and carbon-enrichment. The concentration of -CO- groups in the PE/O+ and PE/C+ samples increased only up to doses of 3 x 10(14) and 10(15) ions cm(-2), respectively, and then declined. At the same time, the concentration of these groups, measured at a dose of 3 x 10(14) ions cm(-2), was higher in PE/O+ than in PE/C+ samples. Similarly, the number of initially-adhering rat VSMC (24 h after seeding) increased only up to a dose of 3 x 10(13) and 10(15) ions cm(-2) on PE/O+ and PE/C+ samples, respectively. In addition, between doses of 10(13) and 10(14) ions cm(-2), this number was about two to three times higher on PE/O+ samples. On the other hand, the surface wettability increased proportionally to the implanted ion dose, especially above a dose of 10(14) ions cm(-2). Thus, the number of initially-adhered cells appeared to be positively correlated with the amount of the oxygen group present at the polymer surface rather than with the surface wettability. The higher cell adhesion was accompanied by adsorption of fluorescent dye-conjugated collagen IV in larger amounts. The highest numbers of initially-adhered cells were usually associated with the lowest rates of subsequent proliferation (measured by the doubling time, BrdU labelling and M