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Döring J, Buchholz A, Herbster M, Gehring J, Betke U, Chodór P, Zabrzyński J, Bertrand J, Lohmann CH, Łapaj Ł. Damage analysis of retrieved Biolox Ⓡdelta components used in hard and soft bearings. Acta Biomater 2023; 158:827-842. [PMID: 36599400 DOI: 10.1016/j.actbio.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/02/2023]
Abstract
This retrieval study included 43 Biolox delta explants (18 CoC, 25 CoP). Implants were examined macroscopically, whereby damage was evaluated using a semi quantitative scoring system. Confocal microscopy was used to examine wear related damage patterns of the articulating surfaces. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) was used to analyze wear marks on the implant surface and wear debris in periprosthetic tissue samples. Raman spectroscopy and X-ray diffraction (XRD) were used to quantify monoclinic zirconia fractions. On all components, in vivo wear resulted predominantly in different damage patterns caused by metal transfer. In CoC bearings stripe wear was additionally detected, and some implants underwent severe damage due to component breakage. The wear scores were higher for CoC components, with no differences between the scores for CoC heads and liners. Wear features caused comparable roughening on implants from CoC and CoP bearings. SEM studies demonstrated that most wear marks were caused by metal debris released from implant components. Grain pull-out was observed in stripe wear regions. Monoclinic phase shift was observed in a similar quantity on components from CoP and CoC bearings. The increase of monoclinic zirconia content around metal deposits was minimal and was more pronounced in areas of stripe wear. The results of this study indicate, that ZTA components in general undergo minimal wear in both, CoC and CoP bearings, however, it is more pronounced in the former. Metal deposits, as the most common wear feature, have no significant effect on monoclinic phase transition. STATEMENT OF SIGNIFICANCE: In this paper, we classify all damage patterns macroscopically according to an established scoring system and assess them regarding surface roughness (confocal microscopy) and monoclinic phase content (Raman spectroscopy) in order to derive the severity for patients. We compare hard-hard and hard-soft bearings and relate damage patterns with metal transfer based on SEM/EDS examinations. Furthermore, we work out correlations between patient-specific data, cause of revision and the physical condition of each individual sample Our cohort consists of 43 Biolox delta retrievals, a comparatively large quantity. In addition, we address current topics such as metal transfer and, based on the classification of damage patterns, provide incentives and/or meaningful focal points for further research.
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Affiliation(s)
- Joachim Döring
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany.
| | - Adrian Buchholz
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Maria Herbster
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Jennifer Gehring
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ulf Betke
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Paweł Chodór
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań, Poland
| | - Jan Zabrzyński
- Faculty of Medicine, Nicolas Copernicus University, Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań, Poland
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Experimental Investigation of Material Transfer on Bearings for Total Hip Arthroplasty—A Retrieval Study on Ceramic and Metallic Femoral Heads. J Clin Med 2022; 11:jcm11143946. [PMID: 35887710 PMCID: PMC9318345 DOI: 10.3390/jcm11143946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Metallic deposition is a commonly observed phenomenon on the surface of revised femoral heads in total hip arthroplasty and can lead to increased wear due to third bodies. In order to find out the origin and composition of the transfer material, 98 retrieved femoral heads of different materials were examined with regard to the cause of revision, localization, pattern and composition of the transfer material by energy dispersive X-ray spectroscopy. We found that in 53.1%, the deposition was mostly in the region of the equator and the adjacent pole of the femoral heads. The most common cause for revision of heads with metallic deposition was polyethylene wear (43.9%). Random stripes (44.9%), random patches (41.8%) and solid patches (35.7%) were most prevalent on retrieved femoral heads. Random patches were a typical pattern in ceramic-on-ceramic bearing couples. The solid patch frequently occurred in association with dislocation of the femoral head (55%). The elemental analysis of the depositions showed a variety of different materials. In most cases, titanium was an element of the transferred material (76.5%). In addition to metallic components, several non-metallic components were also detected, such as carbon (49%) or sulfur (4.1%). Many of the determined elements could be assigned with regard to their origin with the help of the associated revision cause. Since the depositions lead to an introduction of third-body particles and thus to increased wear, the depositions on the bearing surfaces should be avoided in any case.
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Pezzotti G, Zhu W, Zanocco M, Marin E, Sugano N, McEntire BJ, Bal BS. Reconciling in vivo and in vitro kinetics of the polymorphic transformation in zirconia-toughened alumina for hip joints: II. Theory. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 71:446-451. [DOI: 10.1016/j.msec.2016.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/05/2016] [Accepted: 10/16/2016] [Indexed: 11/28/2022]
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Boffelli M, Doimo A, Marin E, Puppulin L, Zhu W, Sugano N, Clarke IC, Pezzotti G. Chemically driven tetragonal-to-monoclinic polymorphic transformation in retrieved ZTA femoral heads from dual mobility hip implants. J Mech Behav Biomed Mater 2015; 56:195-204. [PMID: 26708254 DOI: 10.1016/j.jmbbm.2015.11.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 02/04/2023]
Abstract
Two short-term (two and nine months) retrieved zirconia-toughened alumina (ZTA) femoral heads and nine pristine femoral heads from the same manufacturer have been investigated with respect to their surface stability by means of confocal Raman spectroscopy. Quantitative estimations of monoclinic volume fraction have been carried out in both non-wear and main wear zones of the retrieved heads, which invariantly showed high volume fractions of monoclinic polymorph. In-depth (sub-surface) profiles, non-destructively collected in the main wear zones with the Raman probe in confocal configuration, indeed confirmed that polymorphic transformation was extended down to 100μm below the bearing surface of the femoral heads. Acceleration of tetragonal-to-monoclinic transformation rate leads to unexpectedly high fractions of monoclinic phase within very short-term in-vivo exposures. Phase transformation in-vivo is much more marked than what one could actually predict according to simply simulating a hydrothermal environment in-vitro and could not be simply ascribed to the mechanical stress fields generated during normal service at the bearing surface. Instead, the chemical consequences of metal contamination on the ZTA femoral head surface are shown to play the most detrimental role in phase destabilization.
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Affiliation(s)
- M Boffelli
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585 Kyoto, Japan
| | - A Doimo
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585 Kyoto, Japan; Materials Engineering and Applied Chemistry Department, University of Trieste, Via Valerio, 34127 Trieste, Italy
| | - E Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585 Kyoto, Japan
| | - L Puppulin
- Department of Molecular Cell Physiology, Kyoto Prefectural University of Medicine, Kamigyoku Hirokoji agaru, Kawaramachi-dori, 602-8566 Kyoto, Japan
| | - W Zhu
- Department of Medical Engineering for Treatment of Bone and Joint Disorders, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0854, Japan
| | - N Sugano
- Department of Medical Engineering for Treatment of Bone and Joint Disorders, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0854, Japan
| | - I C Clarke
- Loma Linda University Medical Center, Department of Orthopaedics, 11406 Loma Linda Drive, Suite 606, Loma Linda, CA, USA
| | - G Pezzotti
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585 Kyoto, Japan.
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Brandt JM, Gascoyne TC, Guenther LE, Allen A, Hedden DR, Turgeon TR, Bohm ER. Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Proc Inst Mech Eng H 2013; 227:833-46. [DOI: 10.1177/0954411913489803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present study investigates the performance of ceramic-on-ceramic total hip replacements by combining a retrieval analysis with a survivorship analysis to elucidate mechanisms that led to clinical failure. Semiquantitative surface damage assessment, contact profilometry, contour measurements, and scanning electron microscopy were performed to characterize the types and quantify the extent of surface damage on the retrieved ceramic components. The implantation period was positively correlated with both damage scores of the femoral heads (R = 0.573, p < 0.001) and the acetabular cups (R = 0.592, p < 0.001). Increased maximal out-of-roundness values of the femoral heads correlated with both increased metal transfer damage score (R = 0.384, p = 0.023) and increased stripe damage score (R = 0.729, p ≤ 0.001) of the acetabular liners. The damage rate (damage score/year) for both the retrieved heads and acetabular liners was at least 2.2-fold greater at inclination angles of >45° than the damage rate at inclination angles of ≤45°. For the retrieved femoral heads only, the linear wear rate of 25.5 ± 21.3 µm/year at inclination angles of >45° was 6-fold greater than the linear wear rate of 4.2 ± 2.3 µm/year at inclination angles of ≤45°. Metal transfer on the ceramic bearing surface could possibly contribute to fluid-film starvation and, in combination with an increased inclination angle, may facilitate an adhesive wear mechanism associated with stripe surface damage. At our institution, the clinical survivorship of ceramic-on-ceramic total hip replacements was 98.9% (a total of 9 out of 815 patients were revised within 10 years after total hip arthroplasty) with revision as the end point, suggesting their safe use in younger patients.
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Affiliation(s)
- Jan-M Brandt
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
| | | | | | - Andrew Allen
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | | | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
- Orthopaedic Innovation Centre, Inc., Winnipeg, MB, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
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