Friction of ceramic and metal hip hemi-endoprostheses against cadaveric acetabula

Risk factors for radiological changes after bipolar hemiarthroplasty for osteonecrosis of the femoral head

OBJECTIVES

This study aimed to report the mid-term radiological outcomes of patients with bipolar hemiarthroplasty (BHA) for stage 3 osteonecrosis of the femoral head (ONFH), and to identify the risk factors for postoperative radiological changes.

METHODS

We retrospectively investigated 62 patients (38 men and 24 women; mean age, 50.1 years) aged <70 years who underwent primary BHA for Association Research Circulation Osseous stage 3 ONFH between 1998 and 2010. The mean follow-up period after BHA was 12.8 years. The following changes were assessed on follow-up radiographs: outer head migration, polyethylene wear, and femoral osteolysis. The association between demographic data and the development of postoperative radiological changes was evaluated.

RESULTS

Radiological changes were found in 20 hips (32.3%) at a mean of 8.1 years after BHA; of these, three hips (4.8%) underwent total hip arthroplasty conversion at a mean of 10.9 years after BHA. Both univariate and multivariate analysis revealed that younger age and female sex were independent risk factors for the development of postoperative radiological changes.

CONCLUSION

The current results suggest that the indication of BHA should be carefully determined in young or female patients with ONFH, even when the disease is in the early stage.

Hemiarthroplasties: the choice of prosthetic material causes different levels of damage in the articular cartilage

BACKGROUND

Hemiarthroplasty has clear advantages over alternative procedures and is used in 20% of all shoulder joint replacements. Because of cartilage wear, the clinical outcome of hemiarthroplasty is unreliable and controversial. This paper suggests that the optimal choice of prosthetic material may reduce cartilage degeneration and improve the reliability of the procedure. The specific objectives were to assess 3 materials and assess how the severity of arthritis might affect the choice of prosthetic material.

METHODS

A CoCr alloy, an AL₂O₃ ceramic, and a polycarbonate urethane polymer (PCU) were mechanically tested against 5 levels of human osteoarthritic cartilage (from intact to severely arthritic, n = 45). A high friction coefficient, a decrease in Young's modulus, an increase in permeability, a decrease in relaxation time, an increase in surface roughness, and a disrupted appearance of the cartilage after testing were used as measures of cartilage damage. The biomaterial that caused minimal cartilage damage was defined as superior.

RESULTS

The CoCr caused the most damage. This was followed by the AL₂O₃ ceramic, whereas the PCU caused the least amount of damage. Although the degree of arthritis had an effect on the results, it did not change the trend that CoCr performed worst and PCU the best.

DISCUSSION AND CONCLUSION

This study indicates that ceramic implants may be a better choice than metals, and the articulating surface should be as smooth as possible. Although our results indicate that the degree of arthritis should not affect the choice of prosthetic material, this suggestion needs to be further investigated.

Effects of Endoprosthesis Head Material on Acetabular Cartilage Metabolism: An Animal Study Using Crossbred Pigs

BACKGROUND

Hip endoprosthesis is one option for the treatment of displaced femoral neck fractures and avascular necrosis of the femoral head. Few reports are available describing acetabular cartilage metabolism after endoprosthesis surgery of the hip. The purpose of this study was to compare the biological effects on cartilage between cobalt-chrome (Co-Cr) and alumina ceramic heads wherein the cartilage articulates directly.

METHODS

We used the acetabular cartilage from six hips of three immature crossbred pigs to examine the effects on cytokines, the amount of hyaluronic acid (HA), and cartilage mRNA expression of ceramic head and Co-Cr head endoprosthesis. Mechanical loading of materials of Co-Cr and ceramic heads was performed on the acetabular cartilage in culture media as an organ culture model. Thereafter, protein levels of cytokines (MMP-1, 3, TNF-alpha (α), Interleukin (IL)-1 alpha (α), and IL-1 beta (β)) and the amount of HA were measured from the culture media. Cartilage RNA extraction was performed, and quantitative reverse transcriptase-polymerase chain reaction was performed with primer sets for type I, II, and III collagens; aggrecan; MMP-1, 3, 13; TNF-α; and IL-1 α, IL-1 β.

RESULTS

Protein level of IL-1 β and amount of HA in the Co-Cr group were significantly higher than those of the Ceramic group. Type II collagen mRNA expression in the Ceramic group was significantly higher than in the Co-Cr group. IL-1 β mRNA expression was significantly higher in the Co-Cr group than in the Ceramic group.

CONCLUSIONS

The present study showed that ceramic bipolar produces smaller adverse effects on cartilage cells compared to Co-Cr bipolar. These results could have significant implications for implant usage not only in hip joints, but also in other joints, including the shoulder, talus and radial head.

Sliding behavior of zirconia porous implant surfaces against bone

Different zirconia porous layers were produced on zirconia dense zirconia substrates by slip casting using powder with different mean sizes: 40 μm (Z40), 70 μm (Z70), and 100 μm (Z100). The dynamic and static coefficients of friction against bovine femoral bone, mimicking the implantation process, were conducted using a ball-on-flat reciprocating sliding tribometer under 3 N of normal load. Additionally, the porous layers were assessed with regard to their low temperature degradation (aging). Results revealed that the porous layers were able to keep their integrity during the sliding testes against bone, with no zirconia particles being transferred to the bone. Results did not show significant differences (p > 0.05) in kinetic and static COF values for Z40, Z70, Z100, and GRAD specimens, ranging from 0.53 to 0.77 and 0.65 to 0.90, respectively. The aging tests revealed that all surfaces were prone to low temperature degradation (~49% of monoclinic content after 18 h). In conclusion, the cohesive integrity of the layers and relatively high COF observed reveled that zirconia porous layers may be considered for replacing the current implant surfaces, and are expected to improve their primary stability. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1113-1121, 2019.

In-vivo postoperative motion analysis of metal and ceramic bipolar hip hemiarthroplasty

BACKGROUND

We hypothesized that ceramic bipolar shows less impingement between stem neck and outer head compared to metal bipolar, because of its low coefficient of friction with the acetabulum cartilage. In this paper, a three dimensional (3D) postoperative motion analysis has been used to assess the different motion characteristics of metal and ceramic bipolar hip hemiarthroplasty systems.

METHODS

This study was conducted on 40 patients divided in two matched cohorts: 20 patients with metal bipolar and 20 patients with the ceramic bipolar. We obtained motion pictures from standing position to maximum abduction in flexion by fluoroscopy then analyzed by 2D-3D image matching method. The motion range of the "Outer head angle", "Stem neck angle" and the "Stem neck and outer head angle" was compared between the metal bipolar group and the ceramic bipolar group.

RESULTS

The metal bipolar group's inner head's range of movement was greater than the ceramic bipolar group. Impingement between stem neck and outer head occurred in 30% of metal group patients. There were no impingement cases for the ceramic bipolar group.

CONCLUSIONS

The ceramic bipolar shows less impingement between stem neck and outer head compared to the metal bipolar. Ceramic bipolar may reduce the typical bipolar related complication and exert less effect on the acetabular cartilage due to less surface coefficient of friction.

Articulation of Native Cartilage Against Different Femoral Component Materials. Oxidized Zirconium Damages Cartilage Less Than Cobalt-Chrome

BACKGROUND

Oxidized zirconium (OxZr) is produced by thermally driven oxidization creating an oxidized surface with the properties of a ceramic at the top of the Zr metal substrate. OxZr is much harder and has a lower coefficient of friction than cobalt-chrome (CoCr), both leading to better wear characteristics. We evaluated and compared damage to the cartilage of porcine patella plugs, articulating against OxZr vs CoCr. Our hypothesis was that, owing to its better wear properties, OxZr would damage cartilage less than CoCr. If this is true, OxZr might be a better material for the femoral component during total knee arthroplasty if the patella is not resurfaced.

METHODS

Twenty-one plugs from porcine patellae were prepared and tested in a reciprocating pin-on-disk machine while lubricated with bovine serum and under a constant load. Three different configurations were tested: cartilage-cartilage as the control group, cartilage-OxZr, and cartilage-CoCr. Macroscopic appearance, cartilage thickness, and the modified Mankin score were evaluated after 400,000 wear cycles.

RESULTS

The control group showed statistically significant less damage than plugs articulating against both other materials. Cartilage plugs articulating against OxZr were statistically significantly less damaged than those articulating against CoCr.

CONCLUSION

Although replacing cartilage by an implant always leads to deterioration of the cartilage counterface, OxZr results in less damage than CoCr. The use of OxZr might thus be preferable to CoCr in case of total knee arthroplasty without patella resurfacing.

Superficial Zone Extracellular Matrix Extracts Enhance Boundary Lubrication of Self-Assembled Articular Cartilage

OBJECTIVE

Previous work has shown that increasing the production of boundary lubricant, superficial zone protein (SZP), did not reduce the friction coefficient of self-assembled articular cartilage constructs and was possibly due to poor retention of the lubricant. The aim of this investigation was to reduce the friction coefficient of self-assembled articular cartilage constructs through enhancing SZP retention by the exogenous addition of extracellular matrix (ECM) extracted from the superficial zone of native articular cartilage.

DESIGN

Superficial zone cartilage was shaved from juvenile bovine femoral condyles using a dermatome, minced finely with razor blades, extracted with 4 M guanidine-hydrochloride, buffer exchanged with culture medium, and added directly to the culture medium of self-assembled articular cartilage constructs at low (10 µg/mL) and high (100 µg/mL) concentrations for 4 weeks. Biochemical and biomechanical properties were determined at the conclusion of 4 weeks culture.

RESULTS

ECM treatment increased compressive and tensile stiffness of self-assembled articular cartilage constructs and decreased the friction coefficient. Glycosaminoglycan content decreased and collagen content increased significantly in self-assembled constructs by the ECM treatment.

CONCLUSIONS

Friction coefficients of self-assembled articular cartilage constructs were reduced by adding extracted superficial zone ECM into the culture medium of self-assembled articular cartilage constructs.

Rapid prototyping for in vitro knee rig investigations of prosthetized knee biomechanics: comparison with cobalt-chromium alloy implant material

Retropatellar complications after total knee arthroplasty (TKA) such as anterior knee pain and subluxations might be related to altered patellofemoral biomechanics, in particular to trochlear design and femorotibial joint positioning. A method was developed to test femorotibial and patellofemoral joint modifications separately with 3D-rapid prototyped components for in vitro tests, but material differences may further influence results. This pilot study aims at validating the use of prostheses made of photopolymerized rapid prototype material (RPM) by measuring the sliding friction with a ring-on-disc setup as well as knee kinematics and retropatellar pressure on a knee rig. Cobalt-chromium alloy (standard prosthesis material, SPM) prostheses served as validation standard. Friction coefficients between these materials and polytetrafluoroethylene (PTFE) were additionally tested as this latter material is commonly used to protect pressure sensors in experiments. No statistical differences were found between friction coefficients of both materials to PTFE. UHMWPE shows higher friction coefficient at low axial loads for RPM, a difference that disappears at higher load. No measurable statistical differences were found in knee kinematics and retropatellar pressure distribution. This suggests that using polymer prototypes may be a valid alternative to original components for in vitro TKA studies and future investigations on knee biomechanics.

Effect of clearance on cartilage tribology in hip hemi-arthroplasty

Hemi-arthroplasty of the hip (an artificial femoral head articulating against the natural acetabulum) is used to treat fractured necks of femur; however, there is evidence that articulation causes erosion of the cartilage, resulting in pain for the patient. Parameters that may influence this cartilage erosion include head material and roughness, clearance between the head and acetabulum and activity levels of the patient. This study has assessed the effect of clearance of hemi-arthroplasty articulations on the contact stress, friction and cartilage deformation in an in vitro tribological simulation of the hemi-arthroplasty joint that applied dynamic loads and motion. It has been demonstrated that peak contact stress increased from 5.6 to 10.6 MPa as radial clearance increased from small (<0.6 mm) to extra-large (>1.8 mm). In all samples, friction factor increased with time and was significantly less with extra-large clearances compared to small (<0.6 mm), medium (0.6–1.2 mm) and large (1.2–1.8 mm) clearances. The cartilage deformation observed was significantly greater in acetabulum samples paired to give small or extra-large clearances compared to those with medium or large clearances.

Analysis of frictional behavior and changes in morphology resulting from cartilage articulation with porous polyurethane foams

Porous polyurethane foams (PUR) have been extensively evaluated as meniscal replacement materials and show great promise enabling infiltration of cells and fibrocartilage formation in vivo. Similar to most materials, PUR demonstrates progressive degeneration of opposing cartilage; however, the damage mechanism is impossible to determine because no information exists on the frictional properties of PUR-cartilage interfaces. The goals of this study were to characterize the frictional behavior of a cartilage-PUR interface across a range of articulating conditions and assess the resulting morphological changes to the cartilage surface following articulation. Articular cartilage was oscillated against PUR or stainless steel using phosphate-buffered saline (PBS) and synovial fluid as lubricants. Following friction testing, cartilage and PUR samples were analyzed with environmental scanning electron microscopy and histological staining to determine changes in tissue morphology. Stribeck-surface analysis demonstrated distinct lubrication modes; however, boundary mode lubrication was dominant in cartilage-PUR interfaces and the low-friction pressure-borne lubrication mechanism present in native joints was absent. Microscopy noted obvious wear, with disruption of the collagen architecture and concomitant proteoglycan loss in cartilage articulated against PUR. These data collectively point to the importance of frictional properties as design parameters for implants and materials for soft tissue replacement.

Development of a finger biomechanical model and its considerations

The development of a biomechanical model for a human finger is faced with many challenges, such as extensor mechanism complexity, statistical indeterminacy and suitability of computational processes. Motivation for this work was to develop a computer model that is able to predict the internal loading patterns of tendons and joint surfaces experienced by the human finger, while mitigating these challenges. Proposed methodology was based on a non-linear optimising mathematical technique with a criterion of boundary conditions and equality equations, maximised against unknown parameters to reduce statistical indeterminacy. Initial validation was performed via the simulation of one dynamic and two static postures case studies. Past models and experiments were used, based on published literature, to verify the proposed model's methodology and results. The feasibility of the proposed methodology was deemed satisfactory as the simulated results were concordant with in-vivo results for the extrinsic flexors.

Biotribology of articular cartilage--a review of the recent advances

A brief review of the advances in the biotribology of articular cartilage in the last decade or so are presented. The review is limited to experimental friction and wear studies involving articular cartilage. The importance of developing in vitro models as tools not only to understand the cartilage tribological characteristics, but to evaluate current and future cartilage substitution and treatment therapies is discussed.

Use of oxidized zirconium hemiarthroplasty in hip fractures: clinical results and spectrum analysis

Oxidized zirconium may have improved wear characteristics against polyethylene, but its performance against native cartilage is unknown. Between 1996 and 1998, 52 patients received an oxidized zirconium hemiarthroplasty for the treatment of a hip fracture. Twelve patients (23%) died within 1 year of surgery, and 24 (46%) were surviving at 5 years. In 38 patients with minimum 2-years follow-up, clinical evaluation after surgery averaged 4.5 years with Harris hip scores averaging 78 (range, 55-92). Three patients radiographically showed acetabular protrusion or significant wear, with 2 undergoing revision surgery. An explanted prosthesis demonstrated no appreciable damage by spectrum analysis. Because of the high mortality rate after hip fracture, the clinical benefits of oxidized zirconium hemiarthroplasty in this population, if existent, are difficult to appreciate and currently show no benefits over standard prostheses.