Multidirectional wear and impact-to-wear tests of phospholipid-polymer-grafted and vitamin E-blended crosslinked polyethylene: a pilot study

Highly lubricious SPMK-g-PEEK implant surfaces to facilitate rehydration of articular cartilage

To enable long lasting osteochondral defect repairs which preserve the native function of synovial joint counter-face, it is essential to develop surfaces which are optimised to support healthy cartilage function by providing a hydrated, low friction and compliant sliding interface. PEEK surfaces were modified using a biocompatible 3-sulfopropyl methacrylate potassium salt (SPMK) through UV photo-polymerisation, resulting in a ∼350 nm thick hydrophilic coating rich in hydrophilic anionic sulfonic acid groups. Characterisation was done through Fourier Transformed Infrared Spectroscopy, Focused Ion Beam Scanning Electron Microscopy, and Water Contact Angle measurements. Using a Bruker UMT TriboLab, bovine cartilage sliding tests were conducted with real-time strain and shear force measurements, comparing untreated PEEK, SPMK functionalised PEEK (SPMK-g-PEEK), and Cobalt Chrome Molybdenum alloy. Tribological tests over 2.5 h at physiological loads (0.75 MPa) revealed that SPMK-g-PEEK maintains low friction (μ< 0.024) and minimises equilibrium strain, significantly reducing forces on the cartilage interface. Post-test analysis showed no notable damage to the cartilage interfacing against the SPMK functionalised surfaces. The application of a constitutive biphasic cartilage model to the experimental strain data reveals that SPMK surfaces increase the interfacial permeability of cartilage in sliding, facilitating fluid and strain recovery. Unlike previous demonstrations of sliding-induced tribological rehydration requiring specific hydrodynamic conditions, the SPMK-g-PEEK introduces a novel mode of tribological rehydration operating at low speeds and in a stationary contact area. SPMK-g-PEEK surfaces provide an enhanced cartilage counter-surface, which provides a highly hydrated and lubricious boundary layer along with supporting biphasic lubrication. Soft polymer surface functionalisation of orthopaedic implant surfaces are a promising approach for minimally invasive synovial joint repair with an enhanced bioinspired polyelectrolyte interface for sliding against cartilage. These hydrophilic surface coatings offer an enabling technology for the next generation of focal cartilage repair and hemiarthroplasty implant surfaces.

Multiwall Carbon Nanotube Composites as Artificial Joint Materials

Because ultrahigh-molecular-weight polyethylene (UHMWPE) is susceptible to frictional wear when used in sliding members of artificial joints, it is common practice to use cross-linked UHMWPE instead. However, cross-linked UHMWPE has low impact resistance; implant breakage has been reported in some cases. Hence, sliding members of artificial joints pose a major trade-off between wear resistance and impact resistance, which has not been resolved by any UHMWPE. On the other hand, multiwall carbon nanotubes (MWCNTs) are used in industrial products for reinforcement of polymeric materials but not used as biomaterials because of their unclear safety. In the present study, we attempted to solve this trade-off issue by complexing UHMWPE with MWCNTs. In addition, we assessed the safety of these composites for use in sliding members of artificial joints. The results showed the equivalence of MWCNT/UHMWPE composites to cross-linked UHMWPE in terms of wear resistance and to non-cross-linked UHMWPE in terms of impact resistance. In addition, all MWCNT/UHMWPE composites examined complied with the requirements of biosafety testing in accordance with the ISO10993-series specifications for implantable medical devices. Furthermore, because MWCNTs can occur alone in wear dust, MWCNTs in an amount of about 1.5 times that contained in the dust produced from 50 years of wear (in the worst case) were injected into rat knees, which were monitored for 26 weeks. Although mild inflammatory reactions occurred in the joints, the reactions soon became quiescent. In addition, the MWCNTs did not migrate to other organs. Furthermore, MWCNTs did not exhibit carcinogenicity when injected into the knees of mice genetically modified to spontaneously develop cancer. The MWCNT/UHMWPE composite is a new biomaterial expected to be safe for clinical applications in both total hip arthroplasty and total knee arthroplasty as the first sliding member of artificial joints to have both high wear resistance and high impact resistance.

An Overview on the Tribological Performance of Titanium Alloys with Surface Modifications for Biomedical Applications

The need for metallic biomaterials will always remain high with their growing demand in joint replacement in the aging population. This creates need for the market and researchers to focus on the development and advancement of the biometals. Desirable characteristics such as excellent biocompatibility, high strength, comparable elastic modulus with bones, good corrosion resistance, and high wear resistance are the significant issues to address for medical implants, particularly load-bearing orthopedic implants. The widespread use of titanium alloys in biomedical implants create a big demand to identify and assess the behavior and performance of these alloys when used in the human body. Being the most commonly used metal alloy in the fabrication of medical implants, mainly because of its good biocompatibility and corrosion resistance together with its high strength to weight ratio, the tribological behavior of these alloys have always been an important subject for study. Titanium alloys with improved wear resistance will of course enhance the longevity of implants in the body. In this paper, tribological performance of titanium alloys (medical grades) is reviewed. Various methods of surface modifications employed for titanium alloys are also discussed in the context of wear behavior.

Hydrated Phospholipid Polymer Gel-Like Layer for Increased Durability of Orthopedic Bearing Surfaces

Recently, traditional strategies for manipulating orthopedic bearing substrates have attempted to improve their wear resistance by adjusting polyethylene substrate through cross-linking and antioxidant blending. However, further research is required on the substrate, as well as the surface focused on the structure and role of articular cartilage. We therefore develop an orthopedic bearing surface comprising a nanometer-scale hydrated gel-like layer by grafting highly hydrophilic poly(2-methacryloyloxyethyl phosphorylcholine), with the aim of mimicking the lubrication mechanism of articular cartilage, and investigate its surface characteristics, bulk characteristics, and behavior under load bearing conditions upon accelerated aging. Neither the hydrophilicity nor lubricity of the gel-like surface was influenced by accelerated aging; instead, high stability was revealed, even under strong oxidation conditions. The characteristics of the hydrated gel-like surface potentiated the wear resistance of the cross-linked polyethylene liner, irrespective of accelerated aging. These results suggest that the hydrated gel-like surface enhances the longevity of cross-linked polyethylene bearings even under load-bearing conditions. Furthermore, the inflection point on the time series of wear can be a suitable indicator of the durability of the life-long protectant. In conclusion, the hydrated gel-like surface can positively increase orthopedic implant durability.

Construction of lubricant composite coating on Ti6Al4V alloy using micro-arc oxidation and grafting hydrophilic polymer

To improve the tribological properties of Ti6Al4V alloy to realize the application in artificial joints, a novel composite coating was designed and fabricated on its surface through the combination of two different surface modification techniques-micro-arc oxidation (MAO) and grafting hydrophilic polymer. The characterizations of morphologies and composition of MAO layer were examined using scanning electron microscopy (SEM), energy dispersive spectroscope (EDS) and X-ray diffraction (XRD). It was found that a TiO₂ layer displaying uniform porous structure formed on the surface based on the optimal MAO parameters of an oxidation voltage of 450 V and an oxidation time of 60 min. After grafting 3-dimethyl(3-(N-methacrylamido)propyl) ammonium propane sulfonate (MPDSAH), Fourier-transform infrared spectroscopy with attenuated total reflection (FT-IR/ATR) and wettability test demonstrated the successful modification. Tribological performance of composite coating-modified Ti6Al4V alloy in water exhibited the low friction coefficient of 0.13 and favorable wear resistance.

A phospholipid polymer graft layer affords high resistance for wear and oxidation under load bearing conditions

Manipulating the surface and substrate of cross-linked polyethylene (CLPE) is an essential approach for obtaining life-long orthopedic bearings. We therefore proposed a bearing material comprised of an antioxidative substrate generated by vitamin E blending (HD-CLPE[VE]) with a poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted surface, and investigated its wear resistance and oxidative stability under accelerated aging and load bearing conditions. Neither the hydration nor friction kinetics of the molecular network structure of the PMPC-grafted surface or the HD-CLPE(VE) substrate were influenced by accelerated aging but rather exhibited high stability even under high oxidation conditions. The characteristics of the PMPC-grafted surface improved the wear and impact fatigue resistance of the HD-CLPE(VE) liner regardless of accelerated aging. Notably, the PMPC-grafted surface was found to affect the potential oxidative stability at the rim part of the acetabular liner. PMPC chains serve several important functions on the surface regardless of load bearing, such as high lubricity or low lipophilicity attributed to phosphorylcholine groups and/or surrounding water-fluid film, and suppression of lipid diffusion attributed to methacrylate main chains on the surface. Together, these results provide preliminary evidence that the PMPC graft layer and vitamin E-blended substrate might positively affect the extent of orthopedic implant durability.

Patient-Specific Contact Stress Does Not Predict Polyethylene Wear Rate in a Specific Pressfit Cup

BACKGROUND

The most common reason for revision total hip arthroplasty remains polyethylene wear. Development dysplasia of the hip and revision situations requires a conscious compromise of implant position. The surgeon should know about the consequence on wear via a possible change in hip contact force. The objective of this study is to investigate whether annual wear is dependent on hip contact force.

METHODS

Forty-five inserts (DuraLoc, DePuy) that were explanted in our department were included. Three-dimensional gravimetric determination of the wear was performed by fluid displacement. Then, the hip contact force was determined using radiographs according to the Blumentritt model.

RESULTS

No correlation was found between patient-specific factors and the annual wear. The hip contact force estimated by the Blumentritt model also showed no correlation between hip contact force and annual wear. Two single model parameters correlated significantly with wear: VRECAB as a ratio of the lever length of the spinocrural and the pelvitrochanteric muscles and the angle Alpha as a measure of the position of the center of rotation in relation to the greater trochanter. The greater the ratio spinocrural/pelvitrochanteric lever arm (R = 0.408, P = .005) and the greater the Alpha angle (more valgus the femoral neck) (R = 0.377, P = .011) were, the greater was the wear.

CONCLUSION

These results lead to the conclusion that neither patient-specific factors nor the estimated hip contact force have a major influence on annual wear in the case of DuraLoc cups. Only a coxa valga and a small femoral offset contribute in a limited amount to an increase in wear.

Laser textured Co-Cr-Mo alloy stored chitosan/poly(ethylene glycol) composite applied on artificial joints lubrication

Arthroplasty brings the wear problems because of body fluid has poor performance as lubricant. Lubricant which is used in artificial joints will rapidly degrade and be absorbed by human body after injecting. To prolong the lubricant's effectiveness, this study prepared chitosan/poly(ethylene glycol) (CS/PEG) and textures to play a role in joint lubrication and wear protection. Chitosan (CS) and poly(ethylene glycol) which have biocompatibility and biodegradability properties can be used in human body. The tribological results shown that CS/PEG sol has excellent performance when this sol was composed by 2wt% CS and 30wt% PEG, the average friction coefficient below 0.016 under the condition of 30-90N load (pressure 4.2-12.6MPa). In this study, CS/PEG was added in the texture of artificial joints, then the surfaces of the CS/PEG formed gel via NaOH solidification effect. The CS/PEG gel film could prevent the CS/PEG sol from diluting in body fluid. Meanwhile, FT-IR, XRD, UV/vis and Raman spectra revealed that CS associated with PEG via hydrogen bond effect may form a particular structure, which leaded the good tribological performance. This study provides a new, simple and green approach to enhance tribological performances of artificial joints.

The effects of presence of a backside screw hole on biotribological behavior of phospholipid polymer-grafted crosslinked polyethylene

One of the important factors in determining the success of joint replacement is the wear performance of polyethylene. Although highly crosslinked polyethylene (CLPE) is presently used, it is still not adequate. We have developed a surface modification technology using poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) in an attempt to improve wear performance. In this study, we evaluated the wear and creep deformation resistances of 3-mm and 6-mm thick PMPC-grafted CLPE disks, set on a metal back-plate, with and without a sham screw hole. The gravimetric wear and volumetric change of the disks were examined using a multidirectional pin-on-disk tester. PMPC grafting decreased the gravimetric wear of CLPE regardless of the presence of a screw hole, and did not affect the volumetric change. The volumetric change in the bearing and backside surfaces of the 3-mm thick disk with a screw hole was much larger than that of those without a screw hole or those of the 6-mm thick disk, which was caused by creep deformation. PMPC grafting on the bearing surface can be a material engineering approach to reduce the wear without changing the creep deformation resistance, and is a promising surface modification technology that can be used to increase the longevity of various artificial joints. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 610-618, 2018.

Laser-textured surface storing a carbon dots/poly(ethylene glycol)/chitosan gel with slow-release lubrication effect

Arthroplasty presents wear problems because body fluid, as the only lubricant, has poor performance.

Status of surface modification techniques for artificial hip implants

Surface modification techniques have been developed significantly in the last couple of decades for enhanced tribological performance of artificial hip implants. Surface modification techniques improve biological, chemical and mechanical properties of implant surfaces. Some of the most effective techniques, namely surface texturing, surface coating, and surface grafting, are applied to reduce the friction and wear of artificial implants. This article reviews the status of the developments of surface modification techniques and their effects on commonly used artificial joint implants. This study focused only on artificial hip joint prostheses research of the last 10 years. A total of 27 articles were critically reviewed and categorized according to surface modification technique. The literature reveals that modified surfaces exhibit reduced friction and enhanced wear resistance of the contact surfaces. However, the wear rates are still noticeable in case of surface texturing and surface coating. The associated vortex flow aids to release entrapped wear debris and thus increase the wear particles generation in case of textured surfaces. The earlier delamination of coating materials due to poor adhesion and graphitization transformation has limited the use of coating techniques. Moreover, the produced wear debris has adverse effects on biological fluid. Conversely, the surface grafting technique provides phospholipid like layer that exhibited lower friction and almost zero wear rates even after a longer period of friction and wear test. The findings suggest that further investigations are required to identify the role of surface grafting on film formation and heat resistance ability under physiological hip joint conditions for improved performance and longevity of hip implants.

A hydrated phospholipid polymer-grafted layer prevents lipid-related oxidative degradation of cross-linked polyethylene

The surface and substrate of a cross-linked polyethylene (CLPE) liner are designed to achieve resistance against oxidative degradation in the construction of hip joint replacements. In this study, we aimed to evaluate the oxidative degradation caused by lipid absorption of a highly hydrophilic nanometer-scaled thickness layer prepared by grafting a poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) layer and a high-dose gamma-ray irradiated CLPE with vitamin E blending (HD-CLPE[VE]). The HD-CLPE(VE) and PMPC-grafted HD-CLPE(VE) exhibited extremely high oxidation resistance regardless of lipid absorption, even though residual-free radical levels were detectable. The water wettability of the PMPC-grafted CLPE and PMPC-grafted HD-CLPE(VE) surfaces was considerably greater than that of untreated surfaces. The hydrated PMPC-grafted layer also exhibited extremely low solubility for squalene. Lipids such as squalene and cholesterol esters diminished the oxidation resistance of CLPE despite the vitamin E improvement. Notably, the PMPC-grafted surface was resistant to lipid absorption and diffusion as well as subsequent lipid-related oxidative degradation, likely because of the presence of the hydrated PMPC-grafted layer. Together, these results provide preliminary evidence that the resistance against lipid absorption and diffusion of a hydrated PMPC-grafted layer might positively affect the extent of resistance to the in vivo oxidation of orthopedic implants.

Effects of Surface Modification and Bulk Geometry on the Biotribological Behavior of Cross-Linked Polyethylene: Wear Testing and Finite Element Analysis

The wear and creep deformation resistances of polymeric orthopedic bearing materials are both important for extending their longevity. In this study, we evaluated the wear and creep deformation resistances, including backside damage, of different polyethylene (PE) materials, namely, conventional PE, cross-linked PE (CLPE), and poly(2-methacryloyloxyethyl phosphorylcholine)- (PMPC-) grafted CLPE, through wear tests and finite element analysis. The gravimetric and volumetric degrees of wear of disks (3 or 6 mm in thickness) of these materials against a cobalt-chromium-molybdenum alloy pin were examined using a multidirectional pin-on-disk tester. Cross-linking and PMPC grafting decreased the gravimetric wear of the PE disks significantly. The volumetric wear at the bearing surface and the volumetric penetration in the backside of the 3-mm thick PE disk were higher than those of the 6-mm thick PE disk, regardless of the bearing material. The geometrical changes induced in the PE disks consisted of creep, because the calculated internal von Mises stress at the bearing side of all disks and that at the backside of the 3-mm thick disks exceeded their actual yield strengths. A highly hydrated bearing surface layer, formed by PMPC grafting, and a cross-linking-strengthened substrate of adequate thickness are essential for increasing the wear and creep deformation resistances.

Prevention of bacterial adhesion and biofilm formation on a vitamin E-blended, cross-linked polyethylene surface with a poly(2-methacryloyloxyethyl phosphorylcholine) layer

In the construction of artificial hip joint replacements, the surface and substrate of a cross-linked polyethylene (CLPE) liner are designed to achieve high wear resistance and prevent infection by bacteria. In this study, we fabricated a highly hydrophilic and antibiofouling poly(2-methacryloyloxyethyl phosphorylcholine [MPC]) (PMPC)-graft layer on the vitamin E-blended CLPE (HD-CLPE(VE)) surface. The 100-nm-thick, smooth, and electrically neutral PMPC layer was successfully fabricated on the HD-CLPE(VE) surface using photoinduced graft polymerization. The PMPC-grafted HD-CLPE(VE) was found to prevent bacterial adherence and biofilm formation on the surface because of the formation of a highly hydrophilic polyzwitterionic layer on the surface of HD-CLPE(VE), which can serve as an extremely efficient antibiofouling layer. The number of bacterial adhered on the PMPC-grafted HD-CLPE(VE) surface was reduced by 100-fold or more by PMPC grafting, regardless of the biofilm-production characteristics of the strains. In contrast, vitamin E blending did not affect bacterial adhesion. Moreover, the number of planktonic bacteria did not differ significantly, regardless of PMPC grafting and vitamin E blending. In conclusion, the PMPC-grafted HD-CLPE(VE) provided bacteriostatic effects associated with smooth, highly hydrophilic surfaces with a neutral electrostatic charge owing to the zwitterionic structure of the MPC unit. Thus, this modification may prove useful for the production of artificial hip joint replacement materials.

STATEMENT OF SIGNIFICANCE

Our preliminary in vitro findings suggest that improved bacteriostatic performance of the HD-CLPE(VE) surface in orthopedic implants is possible via PMPC grafting. The results also indicate that surface modifications affect the anti-infection properties of the orthopedic implants and demonstrate that the application of a PMPC-grafted HD-CLPE(VE) surface may be a promising approach to extend the longevity and clinical outcomes of total hip arthroplasty. Further research is needed to evaluate the resistance to infection of PMPC-grafted HD-CLPE(VE) in terms of the varieties of biofilm formation tests including fluid flow conditions and animal experiments, which may offer useful clues to the possible performance of these materials in vivo.