Analysis of ultrahigh molecular weight polyethylene failure in artificial knee joints: thermal effect on long-term performance

Boron nitride-based nanocomposite hydrogels: preparation, properties and applications

Hexagonal boron nitride (h-BN) nanostructures are well-known for their good chemical stability, thermal conductivity and high elastic modulus. BN can be used as a filler in hydrogels to significantly improve their mechanical and thermal properties, to reinforce their biocompatibility and to provide self-healing capacity. Moreover, in contrast with their carbon equivalents, BN nanocomposites are transparent and electrically insulating. Herein, we present an overview of BN-based nanocomposite hydrogels. First, the properties of h-BN are described, as well as common exfoliation and functionalization techniques employed to obtain BN nanosheets. Then, methods for preparing BN-nanocomposite hydrogels are explained, followed by a specific overview of the relationship between the composition and structure of the nanocomposites and the functional properties. Finally, the main properties of these materials are discussed in view of the thermal, mechanical, and self-healing properties, along with the potential applications in tissue engineering, thermal management, drug delivery and water treatment.

The impact of variations in input directions according to ISO 14243 on wearing of knee prostheses

ISO 14243 is the governing standard for wear testing of knee prostheses, but there is controversy over the correct direction of anterior-posterior (AP) displacement and loading and the correct direction of tibial rotation (TR) angles and torque. This study aimed to analyze how altering the direction of AP and TR affected wear on the tibial insert. Modifications to the conditions specified in ISO 14243–1 and ISO 14243–3 were also proposed. As such, five loading conditions were applied to FEA models of a knee prosthesis: (1) Modified ISO 14243–3 with positive AP displacement and TR angle, (2) ISO 14243–3:2004 with negative AP displacement and positive TR angle, (3) ISO 14243–3:2014 with positive AP displacement and negative TR angle, (4) Modified ISO 14243–1 with positive AP load and TR torque, and (5) ISO 14243–1:2009 with negative AP load and positive TR torque. This study found that changing the input directions for AP and TR according to ISO 14243–1 and 14243–3 had an influence on the wear rate and wear contours on the tibial insert model. However, the extent of wear varies depending on the design features of the tibial insert and shape of the input curves. For displacement control according to ISO 14243–3, changing the direction of AP displacement had a marked influence on the wear rate (272.77%), but changing the direction of TR angle had a much lower impact (2.17%). For load control according to ISO 14243–1, reversing the AP load (ISO 14243–1:2009) only increased the wear rate by 6.73% in comparison to the modified ISO 14243–1 conditions. The clinical relevance of this study is that the results demonstrate that tibial wear is affected by the direction of application of AP and TR. Incorrect application of the loading conditions during the design stage may lead to an ineffective preclinical evaluation and could subsequently influence implant longevity in clinical use.

Biocompatible Hydroxylated Boron Nitride Nanosheets/Poly(vinyl alcohol) Interpenetrating Hydrogels with Enhanced Mechanical and Thermal Responses

Poly(vinyl alcohol) (PVA) hydrogels with tissue-like viscoelasticity, excellent biocompatibility, and high hydrophilicity have been considered as promising cartilage replacement materials. However, lack of sufficient mechanical properties is a critical barrier to their use as load-bearing cartilage substitutes. Herein, we report hydroxylated boron nitride nanosheets (OH-BNNS)/PVA interpenetrating hydrogels by cyclically freezing/thawing the aqueous mixture of PVA and highly hydrophilic OH-BNNS (up to 0.6 mg/mL, two times the highest reported so far). Encouragingly, the resulting OH-BNNS/PVA hydrogels exhibit controllable reinforcements in both mechanical and thermal responses by simply varying the OH-BNNS contents. Impressive 45, 43, and 63% increases in compressive, tensile strengths and Young's modulus, respectively, can be obtained even with only 0.12 wt% (OH-BNNS:PVA) OH-BNNS addition. Meanwhile, exciting improvements in the thermal diffusivity (15%) and conductivity (5%) can also be successfully achieved. These enhancements are attributed to the synergistic effect of intrinsic superior properties of the as-prepared OH-BNNS and strong hydrogen bonding interactions between the OH-BNNS and PVA chains. In addition, excellent cytocompatibility of the composite hydrogels was verified by cell proliferation and live/dead viability assays. These biocompatible OH-BNNS/PVA hydrogels are promising in addressing the mechanical failure and locally overheating issues as cartilage substitutes and may also have broad utility for biomedical applications, such as drug delivery, tissue engineering, biosensors, and actuators.

Crosslinked polyethylene in knee arthroplasty: a simulator study evaluating the positive influence on the tribocontact area in the fixed-bearing knee

BACKGROUND

Crosslinked polyethylene (XPE) was developed to reduce the wear rate in hip as well as knee arthroplasty. The crosslinking process reduces the mechanical properties of ultra-high-molecular-weight polyethylene (UHMWPE), particularly its fatigue strength. UHMWPE fatigue occurs more frequently in the knee than in the hip joint due to its changing tribocontact areas (TCAs) combined with high weight bearing. This is why XPE is still controversially discussed for use in total knee arthroplasty. Therefore, the potential advantage of using XPE in the knee was analysed in a simulator study with a focus on potential fatigue wear mechanisms.

METHODS

Three different kinds of XPE and one conventional UHMWPE were tested over 5 million cycles in fixed-bearing knee designs. The TCAs were examined by replicas, and their extent was measured. The wear mechanism was analysed by scanning electron microscopy.

RESULTS

The extent of the TCAs was less than 5% for all XPEs, whereas 35% for the conventional UHMWPE. Fatigue wear mechanisms were not observed.

CONCLUSION

The measured small extent of the TCAs as a predictor of a low wear rate without any fatigue wear mechanism shows a possible advantage for the use of XPE even in knee arthroplasty.

Thermomechanical analysis of ultra-high molecular weight polyethylene-metal hip prostheses

In order to predict the frictional heating and the contact stresses between the polyethylene cup and the metallic ball-head forming the articulation of a hip prosthesis a three-dimensional finite element model was developed and calculated. The non-linear model includes a fully coupled thermomechanical formulation of the mechanical properties of the ultra-high-molecular-weight polyethylene, and a large-sliding Coulomb frictional contact between the two components. The model predicts the temperature of the polyethylene with an accuracy that was tested by comparing the model predictions with the temperature measurements. The temperature measurements were taken by thermocouples placed on the cup surface, the head surface and the inside of the thermostatic bath, during a complete test within a hip joint wear simulator. The model was found to be very accurate, predicting the measured temperatures with an accuracy better than 2 per cent. The temperature peak (51 degrees C) was predicted at the contact surface. The model results indicate that frictional heat is mostly dissipated through the metallic ball-head. The full coupling between the thermal and the mechanical conditions used in this study appears to be necessary if accurate predictions of the polyethylene deformation are required.

Determination of muscle loading at the hip joint for use in pre-clinical testing

The stability of joint endoprostheses depends on the loading conditions to which the implant-bone complex is exposed. Due to a lack of appropriate muscle force data, less complex loading conditions tend to be considered in vitro. The goal of this study was to develop a load profile that better simulates the in vivo loading conditions of a "typical" total hip replacement patient and considers the interdependence of muscle and joint forces. The development of the load profile was based on a computer model of the lower extremities that has been validated against in vivo data. This model was simplified by grouping functionally similar hip muscles. Muscle and joint contact forces were computed for an average data set of up to four patients throughout walking and stair climbing. The calculated hip contact forces were compared to the average of the in vivo measured forces. The final derived load profile included the forces of up to four muscles at the instances of maximum in vivo hip joint loading during both walking and stair climbing. The hip contact forces differed by less than 10% from the peak in vivo value for a "typical" patient. The derived load profile presented here is the first that is based on validated musculoskeletal analyses and seems achievable in an in vitro test set-up. It should therefore form the basis for further standardisation of pre-clinical testing by providing a more realistic approximation of physiological loading conditions.

Interaction of oxidation and crosslinking in gamma-irradiated ultrahigh molecular-weight polyethylene

The interaction between oxidation and crosslinking in gamma-irradiated ultrahigh molecular-weight polyethylene with and without artificial aging was studied. The effect of the atmosphere during irradiation (air vs. low oxygen) occurred primarily within about 0.5 mm of the surface, that is, the depth to which oxygen had diffused when the polyethylene specimen was machined and when it was irradiated. Irradiation in the presence of oxygen induced oxidation instead of crosslinking, so that the level of crosslinking achieved was lower than that which normally would occur at the same dose in the absence of oxygen. Subsequent artificial aging reduced the gel content (crosslinking) and had a maximal effect on the surface and subsurface regions for the gamma-air and gamma-low oxygen polyethylenes, respectively. Thus the storage environments and durations prior to irradiation and prior to artificial aging must be taken into account when attempting to duplicate the oxidation-crosslinking profiles that occur with actual implants in clinical use. In addition, the oxidation mechanisms initiated by the artificial aging method used in this study (i.e., heating in air to 80 degrees C) initiated somewhat different oxidative reactions from those that occur during prolonged shelf life at room temperature or in vivo. In particular, the formation of a peak of oxidation below the free surface of the polyethylene is due to the combined effects of the distribution of residual free radicals and the diffusion gradient of the oxygen. The interactive relationship between oxidation and crosslinking characterized in the present study provides a fundamental basis for understanding the wear behavior of gamma-sterilized components in past clinical use. It also provides guidelines for the development of polyethylenes with improved resistance to oxidation and wear, with particular relevance to estimation of the amount of crosslinking need- ed to potentially eliminate the clinical problem of osteolysis.