Evaluation of Surface Finish and Dimensional Control of Tribological Metal-Ultra High Molecular Weight Polyethylene Pair of Commercially Available Hip Implants

Contact stress and sliding wear damage tolerance of hydroxyapatite and carbon nanotube reinforced polyethylene cup liner against zirconia femoral head

A finite element modeling (FEM) approach is carried out to estimate the contact stresses such as von-Mises and shear stress on the acetabular cup liner, made up of ultra-high molecular weight polyethylene (UHMWPE)-hydroxyapatite (HAp)-carbon nanotubes (CNT) based composites. The highlights of this work include the effects of liners' material (UHMWPE-HAp-CNT composites), radial clearance (0.05 to 1 mm), and liners' wall thickness (3 to 8 mm) on contact stresses. The thick liner (thickness: 8 mm) with conformal geometry (radial clearance 0.05 mm) produced the lowest contact stresses (von-Mises: 13.8-17.5 MPa and shear stress: 2.3-3.3 MPa). In contrast, the thin liner (thickness: 3 mm) with higher radial clearance (1 mm) showed the highest von-Mises stress (78.6-131.0 MPa) and shear stress (17.0-23.3 MPa). According to ISO 7206-1, nearly 6-7 times reduced contact stresses were observed because of the wider articulating contact area provided by thick cup liner and its conformity with respect to the femoral head. The UHMWPE-2 wt % CNT composite (UC) showed low von-Mises stress (16.1 MPa) and lowest shear stress (2.3 MPa); thus, it is the most damage tolerant material (wear rate: 2.6 × 10-7 mm3/Nm). The excellent mechanical properties such as hardness (165 MPa), elastic modulus (2.28 GPa), and tensile strength (36.7 MPa) are reasoned to elicit an increased sliding-wear resistance of UC. Thus, CNT-based UHMWPE composite can be the potential acetabular cup liner with a thickness of 8 mm and clearance of 0.05 mm without plastic deformation.

High Revision Rates of a Cementless Beta-Titanium Alloy Stem with Contamination-Free Roughened Surface in Primary Total Hip Arthroplasty

Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival. The purpose of this follow-up study was to evaluate the clinical and radiological outcome, the complications, and survival rates of a beta-titanium alloy stem with a specific grit-blasted-free surface. In 192 patients (mean age of 64.4 years), 202 consecutive primary total hip arthroplasties were performed using a cementless Hipstar^® stem (Stryker, Duisburg, DE). The Harris Hip Score (HHS) was assessed pre-operatively and post-operatively. Radiolucent lines were evaluated and the implant survival rate was calculated using Kaplan-Meier analysis. The mean follow-up was 7.71 years (range of 5.0–14.0 years). Overall, 15 revisions were performed. Early aseptic stem loosening was observed in six cases (2.97%). Radiolucent-lines adjacent to the stem were detected in 73 cases (83.02%), especially (70.46%) in the Gruen zones 1, 7, 8, and 14. The mean postoperative HHS was 92.65 points (range 42–100). The cumulative survival probability of the stem was 94.4% (95% CI 90.3 to 98.5%). Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% (95% CI 0.914 to 0.992) at six years of follow-up. Overall, an inferior mid-term implant survival was observed in comparison to well-established cementless stem designs.