Wear and damage of articular cartilage with friction against orthopedic implant materials

Failure in articular cartilage: Finite element predictions of stress, strain, and pressure under micro-indentation induced fracture

Articular cartilage is found at the distal end of long bones and is responsible for assisting in joint articulation. While articular cartilage has remarkable resistance to failure, once initially damaged, degeneration is nearly irreversible. Thus, understanding damage initiation is important. There are a few proposed mechanisms for articular cartilage failure initiation: (A) a single collagen fibril stress-based regime; (B) a rate-dependent regime captured by brittle failure at slow displacement rates (SDR) and ductile failure at fast displacement rates (FDR); and (C) a rate-dependent regime where failure is governed by pressurization fragmentation at SDR and governed by strain at FDR. The objective of this study was to use finite element (FE) models to provide evidence to support or refute these proposed failure mechanisms. Models were developed of microfracture experiments that investigated osmolarity (hypo-osmolar, normal osmolarity, and hyper-osmolar) and displacement rate (FDR and SDR) effects. Cartilage was modeled with a neo-Hookean ground matrix, strain-dependent permeability, nonlinear fibril reinforcement with viscoelastic fibril terms, and Donnan equilibrium swelling. Total stress, solid matrix stress, Lagrange strain, and fluid pressure were determined under the indenter tip at the moment of microfracture. Results indicated significant rate dependence across multiple outputs, which does not support (A) a single failure regime. Larger solid and fluid pressures at FDR than SDR did not support (C) a rate-dependent regime split by pressurization at SDR and strain at FDR. Consistent solid shear stresses at SDR and consistent third principal solid stresses at FDR support (B) the ductile-brittle failure regime. These findings help to shed light on the underlying mechanisms of articular cartilage failure, which have implications for the development of osteoarthritis.

Immature bovine cartilage wear is due to fatigue failure from repetitive compressive forces and not reciprocating frictional forces

OBJECTIVE

Wear of articular cartilage is not well understood. We hypothesize that cartilage wears due to fatigue failure in repetitive compression instead of reciprocating friction.

DESIGN

This study compares reciprocating sliding of immature bovine articular cartilage against glass in two testing configurations: (1) a stationary contact area configuration (SCA), which results in static compression, interstitial fluid depressurization, and increasing friction coefficient during reciprocating sliding, and (2) a migrating contact area configuration (MCA), which maintains pressurization and low friction while producing repetitive compressive loading in addition to reciprocating sliding. Contact pressure, sliding duration, and sliding distance were controlled to be similar between test groups.

RESULTS

SCA tests exhibited an average friction coefficient of μ=0.084±0.032, while MCA tests exhibited a lower average friction coefficient of μ=0.020±0.008 (p<10-4). Despite the lower friction, MCA cartilage samples exhibited clear surface damage with a significantly greater average surface deviation from a fitted plane after wear testing (Rq=0.125±0.095 mm) than cartilage samples slid in a SCA configuration (Rq=0.044±0.017 mm, p=0.002), which showed minimal signs of wear. Polarized light microscopy confirmed that delamination damage occurred between the superficial and middle zones of the articular cartilage in MCA samples.

CONCLUSIONS

The greatest wear was observed in the group with lowest friction coefficient, subjected to cyclical instead of static compression, implying that friction is not the primary driver of cartilage wear. Delamination between superficial and middle zones implies the main mode of wear is fatigue failure under cyclical compression, not fatigue or abrasion due to reciprocating frictional sliding.

Comparison of wear on articular cartilage by titanium alloy, ultra-high-molecular-weight polyethylene, and carbon fibre reinforced polyether-ether-ketone: A pilot study

Artificial implant materials may articulate against native articular cartilage in certain clinical scenarios and the selection of an implant material that results in the least wear on articular cartilage is preferred to maintain normal joint architecture and function. This project compared the wear on porcine femoral condyles induced by articulation against porcine patellae, titanium alloy (Ti6Al4V), ultra high molecular weight polyethylene (UHMWPE), and carbon fibre reinforced polyether-ether-ketone (CFR-PEEK) through an ex vivo experimental setup. A sinusoidal compressive load of 30-160 N, representing an approximate joint pressure of 0.19-1 MPa at a frequency of 3 Hz coupled with a rotational displacement of +/- 10⁰ at 3 Hz was used to simulate physiological joint motion. Wear was characterized via gross examination and histologically using the OARSI scoring system after 43,200 cycles. CFR-PEEK resulted in the most significant wear on articular cartilage compared to titanium alloy and UHMWPE whereas titanium alloy and UHMWPE resulted in similar levels of wear. All materials caused more wear compared to cartilage-on-cartilage testing. The wear mechanism was characterized by progressive loss of proteoglycan content in cartilage in histology samples.

Topographical Characterization of the Young, Healthy Human Femoral Medial Condyle

OBJECTIVE

The medial femoral condyle of the knee exhibits some of the highest incidences of chondral degeneration. However, a dearth of healthy human tissues has rendered it difficult to ascertain whether cartilage in this compartment possesses properties that predispose it to injuries. Assessment of young, healthy tissue would be most representative of the tissue's intrinsic properties.

DESIGN

This work examined the topographical differences in tribological, tensile, and compressive properties of young (n = 5, 26.2 ± 5.6 years old), healthy, human medial femoral condyles, obtained from viable allograft specimens. Corresponding to clinical incidences of pathology, it was hypothesized that the lowest mechanical properties would be found in the posterior region of the medial condyle, and that tissue composition would correspond to the established structure-function relationships of cartilage.

RESULTS

Young's modulus, ultimate tensile strength, aggregate modulus, and shear modulus in the posterior region were 1.0-, 2.8-, 1.1-, and 1.0-fold less than the values in the anterior region, respectively. Surprisingly, although glycosaminoglycan content is thought to correlate with compressive properties, in this study, the aggregate and shear moduli correlated more robustly to the amount of pyridinoline crosslinks per collagen. Also, the coefficient of friction was anisotropic and ranged 0.22-0.26 throughout the condyle.

CONCLUSION

This work showed that the posteromedial condyle displays lower tensile and compressive properties, which correlate to collagen crosslinks and may play a role in this region's predisposition to injuries. Furthermore, new structure-function relationships may need to be developed to account for the role of collagen crosslinks in compressive properties.

Superficial zone chondrocytes can get compacted under physiological loading: A multiscale finite element analysis

Recent in vivo and in vitro studies have demonstrated that superficial zone (SZ) chondrocytes within articular layers of diarthrodial joints die under normal physiologic loading conditions. In order to further explore the implications of this observation in future investigations, we first needed to understand the mechanical environment of SZ chondrocytes that might cause them to die under physiological sliding contact conditions. In this study we performed a multiscale finite element analysis of articular contact to track the temporal evolution of a SZ chondrocyte's interstitial fluid pressure, hydraulic permeability, and volume under physiologic loading conditions. The effect of the pericellular matrix modulus and permeability was parametrically investigated. Results showed that SZ chondrocytes can lose ninety percent of their intracellular fluid after several hours of intermittent or continuous contact loading, resulting in a reduction of intracellular hydraulic permeability by more than three orders of magnitude. These findings are consistent with loss of cell viability due to the impediment of cellular metabolic pathways induced by the loss of fluid. They suggest that there is a simple mechanical explanation for the vulnerability of SZ chondrocytes to sustained physiological loading conditions. Future studies will focus on validating these specific findings experimentally. STATEMENT OF SIGNIFICANCE: As with any mechanical system, normal 'wear and tear' of cartilage tissue lining joints is expected. Yet incidences of osteoarthritis are uncommon in individuals younger than 45. This counter-intuitive observation suggests there must be an intrinsic repair mechanism compensating for this wear and tear over many decades of life. Recent experimental studies have shown superficial zone chondrocytes die under physiologic loading conditions, suggesting that this repair mechanism may involve cell replenishment. To better understand the mechanical environment of these cells, we performed a multiscale computational analysis of articular contact under loading. Results indicated that normal activities like walking or standing can induce significant loss of intracellular fluid volume, potentially hindering metabolic activity and fluid transport properties, and causing cell death.

Correlation analysis of cartilage wear with biochemical composition, viscoelastic properties and friction

Healthy articular cartilage exhibits remarkable resistance to wear, sustaining mechanical loads and relative motion for decades. However, tissues that replace or repair cartilage defects are much less long lasting. Better information on the compositional and material characteristics that contribute to the wear resistance of healthy cartilage could help guide strategies to replace and repair degenerated tissue. The main objective of this study was to assess the relationship between wear of healthy articular cartilage, its biochemical composition, and its viscoelastic material properties. The correlation of these factors with the coefficient of friction during the wear test was also evaluated. Viscoelastic properties of healthy bovine cartilage were determined via stress relaxation indentation. The same specimens underwent an accelerated, in vitro wear test, and the amount of glycosaminoglycans (GAGs) and collagen released during the wear test were considered measures of wear. The frictional response during the wear test was also recorded. The GAG, collagen and water content and the concentration of the enzymatic collagen crosslink pyridinoline were quantified in tissue that was adjacent to each wear test specimen. Finally, correlation analysis was performed to identify potential relationships between wear characteristics of healthy articular cartilage with its composition, viscoelastic material properties and friction. The findings suggest that stiffer cartilage with higher GAG, collagen and water content has a higher wear resistance. Enzymatic collagen crosslinks also enhance the wear resistance of the collagen network. The parameters of wear, composition, and mechanical stiffness of cartilage were all correlated with one another, suggesting that they are interrelated. However, friction was largely independent of these in this study. The results identify characteristics of healthy articular cartilage that contribute to its remarkable wear resistance. These data may be useful for guiding techniques to restore, regenerate, and stabilize cartilage tissue.

Investigation of the Friction Properties of a New Artificial Imitation Cartilage Material: PHEMA/Glycerol Gel

The absence of artificial articular cartilage could cause the failure of artificial joints due to excessive material wear. There has been limited research on alternative materials for articular cartilage in joint prostheses, with few reducing the friction coefficient of artificial cartilage prostheses to the range of the natural cartilage friction coefficient (0.001-0.03). This work aimed to obtain and characterize mechanically and tribologically a new gel for potential application in articular replacement. Therefore, poly(hydroxyethyl methacrylate) (PHEMA)/glycerol synthetic gel was developed as a new type of artificial joint cartilage with a low friction coefficient, especially in calf serum. This glycerol material was developed via mixing HEMA and glycerin at a mass ratio of 1:1. The mechanical properties were studied, and it was found that the hardness of the synthetic gel was close to that of natural cartilage. The tribological performance of the synthetic gel was investigated using a reciprocating ball-on-plate rig. The ball samples were made of a cobalt-chromium-molybdenum (Co-Cr-Mo) alloy, and the plates were synthetic glycerol gel and two additional materials for comparison, which were ultra-high molecular polyethylene (UHMWPE) and 316L stainless steel. It was found that synthetic gel exhibited the lowest friction coefficient in both calf serum (0.018) and deionized water (0.039) compared to the other two conventional materials for knee prostheses. The surface roughness of the gel was found to be 4-5 μm through morphological analysis of wear. This newly proposed material provided a possible solution as a type of cartilage composite coating with hardness and tribological performance close to the nature of use in wear couples with artificial joints.

Patella non-resurfacing in primary total knee arthroplasty provides good functional results-a retrospective review of nine thousand three hundred forty six knees

PURPOSE

Patellar resurfacing has long been a contentious subject in TKA with no consensus and the literature yielding disparate results. The aim of this study was to evaluate the long-term functional outcomes and complications of patients undergoing primary TKA without patellar resurfacing (non-resurfacing).

METHODS

This study retrospectively analysed 9346 patients who underwent primary manual jig-based TKA without patellar resurfacing at a single high-volume arthroplasty centre between 2010 and 2018. Patients with a minimum three year follow-up irrespective of disease etiology and implant manufacturer were included in the study. Primary outcome was measured using Oxford knee score and patellofemoral Feller score. Secondary outcomes included determining the incidence of patellofemoral complications and re-operation rates following TKA.

RESULTS

A total of 8695 knees were eligible for final evaluation having a mean follow-up of 6.6 years. Mean age of the patients was 62.6 (SD-7.5) years with female predominance of (N-6619, 70.8%). The majority of the patients had primary OA (N-8792, 94.1%) with varus deformity (N-8642, 92.46%). Depuy was the most used manufacturer (n = 2592, 26.4%) with the posterior stabilised (N-4127, 44.2%) design being the most predominant. The mean Feller score of the study population was 24.5 (SD = 3) with a majority of patients having good to excellent outcomes (86.95%, N-8424) and mean Oxford knee score was 36.9 (SD-6.9) with a majority of the patients having an OKS greater than 30 (87.1%, N-8133) with anterior knee pain (AKP) reported in only 4.8% patients (N-418). Most common complications included patellar clunk (N-56, 0.7%), traumatic patellar fractures (N-62, 0.8%), quadriceps tendon tear (N-54, 0.7%) and patellar dislocation (N-4, 0.05%) CONCLUSION: Patellar non-resurfacing has no detrimental impact on functional outcomes and incidence of AKP. We conclude that it is a safe, cost-effective and satisfactory approach in primary TKA with no significant complications.

Calcium phosphate bone cements as local drug delivery systems for bone cancer treatment

Bone cancer is usually a metastatic disease, affecting people of all ages. Its effective therapy requires a targeted drug administration locally at the cancer site so that the surrounding healthy organs and tissues stay unharmed. Upon a thorough literature search, a tremendous number of published articles are reporting on development of calcium phosphate cements (CPCs) for the treatment of a variety of diseases, such as osteoporosis, osteoarthritis, osteomyelitis, and other musculoskeletal disorders. However, just a limited number of research employs CPCs specifically for bone cancer treatment. In this review article, we study the factors influencing the local drug release from CPCs and particularly focus on bone cancer therapy. Finally, we locate the deficiencies in the literature regarding this specific topic and propose which other perspectives should be considered and discussed in future articles.

Toward defining the role of the synovium in mitigating normal articular cartilage wear and tear

Cartilage repair has been studied extensively in the context of injury and disease, but the joint's management of regular sub-injurious damage to cartilage, or 'wear and tear,' which occurs due to normal activity, is poorly understood. We hypothesize that this cartilage maintenance is mediated in part by cells derived from the synovium that migrate to the worn articular surface. Here, we demonstrate in vitro that the early steps required for such a process can occur. First, we show that under physiologic mechanical loads, chondrocyte death occurs in the cartilage superficial zone along with changes to the cartilage surface topography. Second, we show that synoviocytes are released from the synovial lining under physiologic loads and attach to worn cartilage. Third, we show that synoviocytes parachuted onto a simulated or native cartilage surface will modify their behavior. Specifically, we show that synoviocyte interactions with chondrocytes lead to changes in synoviocyte mechanosensitivity, and we demonstrate that cartilage-attached synoviocytes can express COL2A1, a hallmark of the chondrogenic phenotype. Our findings suggest that synoviocyte-mediated repair of cartilage 'wear and tear' as a component of joint homeostasis is feasible and is deserving of future study.

The effect of HydroSpacer implant placement on the wear of opposing and adjacent cartilage

A HydroSpacer implant, that is, a swelling hydrogel confined by a spacer fabric, was developed to repair focal cartilage defects and to prevent progression into osteoarthritis. The present study evaluated the effect of implant placement height in an osteochondral (OC) plug on wear of the opposing and adjacent cartilage. Three-dimensional warp-knitted spacer fabrics, polycaprolactone with poly(4-hydroxybutyrate) pile yarns, were filled with a hyaluronic acid methacrylate and chondroitin sulfate methacrylate hydrogel. After polymerization of the hydrogel, these HydroSpacers were implanted in OC defects (ø 6 mm) created in bovine OC plugs (ø 10 mm) and allowed to swell to equilibrium. A custom-made pin-on-plate wear apparatus was used to apply simultaneous compression and sliding against bovine cartilage. Cartilage damage, visualized with Indian ink, was only seen for the group in which the HydroSpacer was placed flush with the surrounding cartilage. A significant increase on average surface roughness of the sliding path compared to the adjacent cartilage confirmed surface damage for this group. When the implants were recessed (with and without extra hydrogel layer on top of the implant), this damage was not observed, but the cartilage surrounding the implants was compressed (without damage) indicating substantial load sharing with the implant. Furthermore, it was shown that all defects treated with a HydroSpacer implant resulted in shear forces comparable to intact cartilage. Clinical significance: The present study suggests that placing a HydroSpacer implant recessed into the surrounding cartilage would decrease wear of the opposing cartilage. Altogether, this study supports the development of textile-constraining hydrogels for cartilage replacement.

Effects of Non-Conventional Sterilisation Methods on PBO-Reinforced PVA Hydrogels for Cartilage Replacement

Articular cartilage (AC) degradation is a recurrent pathology that affects millions of people worldwide. Polyvinyl alcohol (PVA) hydrogels have been widely explored for AC replacement. However, their mechanical performance is generally inadequate, and these materials need to be reinforced. Moreover, to be used in a clinical setting, such materials must undergo effective sterilisation. In this work, a PVA hydrogel reinforced with poly(p-phenylene-2,6-benzobisoxazole) (PBO) nanofibres was submitted to three non-conventional sterilisation methods: microwave (MW), high hydrostatic pressure (HHP), and plasma (PM), in order to evaluate their impact on the properties of the material. Sterilisation was achieved in all cases. Properties such as water content and hydrophilicity were not affected. FTIR analysis indicated some changes in crystallinity and/or crosslinking in all cases. MW was revealed to be the most suitable method, since, unlike to PM and HHP, it led to a general improvement of the materials’ properties: increasing the hardness, stiffness (both in tensile and compression), and shear modulus, and also leading to a decrease in the coefficient of friction against porcine cartilage. Furthermore, the samples remained non-irritant and non-cytotoxic. Moreover, this method allows terminal sterilisation in a short time (3 min) and using accessible equipment.

Sliding Corrosion Fatigue of Metallic Joint Implants: A Comparative Study of CoCrMo and Ti6Al4V in Simulated Synovial Environments

Mechanical contact in a corrosive synovial environment leads to progressive surface damage at the modular interface of the joint implants. The wear debris and corrosion products degrade the synovial fluids and change the lubrication mechanisms at the joints. Consequently, the unstable joint lubrication and corrosion products will further induce the undesirable performance of the joint implants. In this study, the two major joint materials, CoCrMo and Ti6Al4V, were tested during the course of reciprocal sliding contact in simulated synovial liquids. Open circuit potential and coefficient of friction were monitored to describe electrochemical and mechanical responses. Potentiostatic test results illustrated electrochemical damage on both surfaces that modified oxidation chemistry on both surfaces. However, more significant modification of the CoCrMo surface was detected during wear in the simulated joint liquid. Even with a reduced coefficient of friction on the CoCrMo surface in sodium lactate environments, fretting current density drastically increased in corrosive sodium lactate with pH 2. However, the test results from the Ti6Al4V surface presented less coefficient of friction values, and moderate change in fretting current. Therefore, the experimental study concluded that the biocompatibility of Ti6Al4V is superior to that of CoCrMo in the combined effect of mechanical loadings and an electrochemical environment.

PVA-Based Hydrogels Loaded with Diclofenac for Cartilage Replacement

Polyvinyl alcohol (PVA) hydrogels have been widely studied for cartilage replacement due to their biocompatibility, chemical stability, and ability to be modified such that they approximate natural tissue behavior. Additionally, they may also be used with advantages as local drug delivery systems. However, their properties are not yet the most adequate for such applications. This work aimed to develop new PVA-based hydrogels for this purpose, displaying improved tribomechanical properties with the ability to control the release of diclofenac (DFN). Four types of PVA-based hydrogels were prepared via freeze-thawing: PVA, PVA/PAA (by polyacrylic acid (PAA) addition), PVA/PAA+PEG (by polyethylene glycol (PEG) immersion), and PVA/PAA+PEG+A (by annealing). Their morphology, water uptake, mechanical and rheological properties, wettability, friction coefficient, and drug release behavior were accessed. The irritability of the best-performing material was investigated. The results showed that the PAA addition increased the swelling and drug release amount. PEG immersion led to a more compact structure and significantly improved the material’s tribomechanical performance. The annealing treatment led to the material with the most suitable properties: besides presenting a low friction coefficient, it further enhanced the mechanical properties and ensured a controlled DFN release for at least 3 days. Moreover, it did not reveal irritability potential for biological tissues.

Arbitrary Prestrain Values for Ligaments Cause Numerical Issues in a Multibody Model of an Ankle Joint

Experimental studies report that ligaments of the ankle joint are prestrained. The prestrain is an important aspect of modern biomechanical analysis, which can be included in the models by: applying symmetrical, arbitrary prestrains to the ligaments, assuming a strain-free location for the joint or by using experimental prestrain data. The aim of the study was to comparatively analyze these approaches. In total, 4 prestraining methods were considered. In order to do so, a symmetrical model of the ankle with six nonlinear cables and two sphere–sphere contact pairs was assumed. The model was solved in statics under moment loads up to 5 Nm. The obtained results showed that the arbitrary prestrains caused an unbalanced load for the model at rest, and in turn modified its rest location in an unpredictable way. Due to the imbalance, it was impossible to enforce the assumed prestrains and thus cartilage prestrain was required to stabilize the model. The prestraining had a significant effect on the angular displacements and the load state of the model. The findings suggest that the prestrain values are patient specific and arbitrary prestrains will not be valid for most models.

The effect of hemiarthroplasty implant modulus on contact mechanics: an experimental investigation

BACKGROUND

Hemiarthroplasties cause damage to the cartilage that they articulate against, which is a major limitation to their use. This study investigated the use of lower-stiffness materials to determine whether they improve hemiarthroplasty contact mechanics and thus reduce the risk of cartilage damage.

METHODS

Eleven fresh-frozen cadaveric upper extremities were disarticulated and fixed in a custom-built jig that applied a static load of 50 N to the radiocapitellar joint. Flexion angles of 0°, 45°, 90°, and 135° were tested with radial head implants made of cobalt-chrome (CoCr) and ultrahigh-molecular-weight polyethylene (UHMWPE) compared with the native radial head. A Tekscan thin-film sensor was used to measure the contact area and contact pressure between the radius and capitellum.

RESULTS

UHMWPE and CoCr were too stiff in the application of hemiarthroplasty, resulting in lower contact areas and higher contact pressures relative to the native joint. The native contact area was, on average, 42 ± 20 mm² larger than that of UHMWPE (P < .001) and 55 ± 24 mm² larger than that of CoCr (P < .001). UHMWPE had a contact area 13 ± 10 mm² greater than that of CoCr (P = .014).

DISCUSSION AND CONCLUSION

This study shows that even though UHMWPE has a stiffness several times lower than CoCr, the use of this material in hemiarthroplasty led to only a minor improvement in contact mechanics. Neither implant restored contact similar to the native articulation. Investigations into new materials to improve the contact mechanics of hemiarthroplasty should focus on materials with a lower stiffness than UHMWPE.

Analysis of the Crystallization Kinetics and Thermal Stability of the Amorphous Mg72Zn24Ca4 Alloy

The aim of this study was to analyze the crystallization of the Mg₇₂Zn₂₄Ca₄ metallic glass alloy. The crystallization process of metallic glass Mg₇₂Zn₂₄Ca₄ was investigated by means of the differential scanning calorimetry. The glass-forming ability and crystallization are both strongly dependent on the heating rate. The crystallization kinetics, during the isothermal annealing, were modelled by the Johnson–Mehl–Avrami equation. Avrami exponents were from 2.7 to 3.51, which indicates diffusion-controlled grain growth. Local exponents of the Johnson–Mehl–Avrami equation were also calculated. In addition, the Mg phase—being the isothermal crystallization product—was found, and the diagram of the time–temperature phase transformation was developed. This diagram enables the reading of the start and end times of the crystallization process, occurring in amorphous ribbons of the Mg₇₂Zn₂₄Ca₄ alloy on the isothermal annealing temperature. The research showed high stability of the amorphous structure of Mg₇₂Zn₂₄Ca₄ alloy at human body temperature.

Tissue engineered autologous cartilage-bone grafts for temporomandibular joint regeneration

Joint disorders can be detrimental to quality of life. There is an unmet need for precise functional reconstruction of native-like cartilage and bone tissues in the craniofacial space and particularly for the temporomandibular joint (TMJ). Current surgical methods suffer from lack of precision and comorbidities and frequently involve multiple operations. Studies have sought to improve craniofacial bone grafts without addressing the cartilage, which is essential to TMJ function. For the human-sized TMJ in the Yucatan minipig model, we engineered autologous, biologically, and anatomically matched cartilage-bone grafts for repairing the ramus-condyle unit (RCU), a geometrically intricate structure subjected to complex loading forces. Using image-guided micromilling, anatomically precise scaffolds were created from decellularized bone matrix and infused with autologous adipose-derived chondrogenic and osteogenic progenitor cells. The resulting constructs were cultured in a dual perfusion bioreactor for 5 weeks before implantation. Six months after implantation, the bioengineered RCUs maintained their predefined anatomical structure and regenerated full-thickness, stratified, and mechanically robust cartilage over the underlying bone, to a greater extent than either autologous bone-only engineered grafts or acellular scaffolds. Tracking of implanted cells and parallel bioreactor studies enabled additional insights into the progression of cartilage and bone regeneration. This study demonstrates the feasibility of TMJ regeneration using anatomically precise, autologous, living cartilage-bone grafts for functional, personalized total joint replacement. Inclusion of the adjacent tissues such as soft connective tissues and the TMJ disc could further extend the functional integration of engineered RCUs with the host.

Proteoglycan 4 reduces friction more than other synovial fluid components for both cartilage-cartilage and cartilage-metal articulation

OBJECTIVE

The clinical success of focal metallic resurfacing implants depends largely on the friction between implant and opposing cartilage. Therefore, the present study determines the lubricating ability of the synovial fluid components hyaluronic acid (HA), proteoglycan 4 (PRG4) and a surface-active phospholipid (1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine, POPC), on the articulation between cartilage and a Cobalt Chromium Molybdenum (CoCrMo) implant surface, compared with two cartilage surfaces.

METHODS

A ring-on-disk geometry was used to perform repeated friction measurements at physiologically relevant velocities (6 and 60 mm/s) using lubricants with an increasing number of components present. Shear measurements were performed in order to evaluate the viscosity. To ensure that it is clinically relevant to explore the effect of these components, the presence of PRG4 in synovial fluid obtained from primary and revision knee and hip implant surgeries was examined.

RESULTS

PRG4 in the presence of HA was found to significantly reduce the coefficient of friction for both cartilage-cartilage and cartilage-CoCrMo interface. This is relevant, as it was also demonstrated that PRG4 is still present at the time of revision surgeries. The addition of POPC had no effect for either configurations. HA increased the viscosity of the lubricating fluid by one order of magnitude, while PRG4 and POPC had no effect.

CONCLUSION

The present study demonstrates the importance of selecting the appropriate lubrication solution to evaluate implant materials with biotribology tests. Because PRG4 is a key component for reducing friction between cartilage and an opposing surface, developing coatings which bind PRG4 is recommended for cartilage resurfacing implants.

Resilience to height loss of articular cartilage of osteoarthritic stifle joints of old pigs, compared with healthy cartilage from young pigs in a tribological pin-on-plate exposure, revealing similar friction forces

Introduction

We saw a lack of data on the biomechanical behavior of degenerated articular cartilage (OA) compared with that of healthy cartilage, even though the susceptibility to wear and tear of articular cartilage plays a key role in the progression of osteoarthritis (OA). Therefore, we performed a comparison between naturally occurring OA and healthy cartilage from pigs, before and after tribological stress.

Aim

The aim of the study was to compare OA-cartilage with healthy cartilage and to analyze the resilience to tribological shear stress, which will be measured as height loss (HL), and to friction forces of the cartilage layers. The findings will be substantiated in macro- and microscopical evaluations before and after tribological exposure.

Methods

We assessed stifle joints of fifteen old and sixteen young pigs from the local abattoir radiologically, macroscopically and histologically to determine possible OA alterations. We put pins from the femoral part of the joints and plates from the corresponding tibial plateaus in a pin-on-plate tribometer under stress for about two hours with about 1108 reciprocating cycles under a pressure of approximately 1 MPa. As a surrogate criterion of wear and tear, the HL was recorded in the tribometer. The heights of the cartilage layers measured before and after the tribological exposure were compared histologically. The condition of the cartilage before and after the tribological exposure was analyzed both macroscopically with an adapted ICRS score and microscopically according to Little et al. (2010). We assessed the friction forces acting between the surfaces of the cartilage pair–specimens.

Results

Articular cartilage taken from old pigs showed significant degenerative changes compared to that taken from the young animals. The macroscopic and microscopic scores showed strong alterations of the cartilage after the tribological exposure. There was a noticeable HL of the cartilage specimens after the first 100 to 300 cycles. The HL after tribological exposure was lower in the group of the old animals with 0.52 mm ± 0.23 mm than in the group of the young animals with 0.86 mm ± 0.26 mm (p < 0.0001). The data for the HL was validated by the histological height measurements with 0.50 mm ± 0.82 mm for the old and 0.79 mm ±0.53 mm for the young animals (p = 0.133). The friction forces measured at the cartilage of the old animals were 2.25 N ± 1.15 N and 1.89 N ± 1.45 N of the young animals (p = 0.3225).

Conclusion

Unlike articular cartilage from young pigs, articular cartilage from old pigs showed OA alterations. Tribological shear stress exposure revealed that OA cartilage showed less HL than healthy articular cartilage. Tribological stress exposure in a pin–on–plate tribometer seemed to be an appropriate way to analyze the mechanical stability of articular cartilage, and the applied protocol could reveal weaknesses of the assessed cartilage tissue. Friction and HL seemed to be independent parameters when degenerated and healthy articular cartilage were assessed under tribological exposure in a pin–on- plate tribometer.

Cartilage Assessment Requires a Surface Characterization Protocol: Roughness, Friction, and Function

The surface of articular cartilage is integral to smooth, low-friction joint articulation. However, the majority of cartilage literature rarely includes measurements of surface characteristics and function. This may, in part, be due to a shortage of or unfamiliarity with fast, nondestructive, and, preferably, noncontact methods that can be applied to large cartilage surfaces for evaluating cartilage surface characteristics. A comprehensive methodology for characterizing cartilage surfaces is useful in determining changes in tissue function, as for example, in cases where the quality of cartilage grafts needs to be assessed. With cartilage storage conditions being an area of ongoing and active research, this study used interferometry and tribology methods as efficient and nondestructive ways of evaluating changes in cartilage surface topography, roughness, and coefficient of friction (CoF) resulting from various storage temperatures and durations. Standard, destructive testing for bulk mechanical and biochemical properties, as well as immunohistochemistry, were also performed. For the first time, interferometry was used to show cartilage topographical anisotropy through an anterior-posterior striated pattern in the same direction as joint articulation. Another novel observation enabled by tribology was frictional anisotropy, illustrated by a 53% increase in CoF in the medial-lateral direction compared to the anterior-posterior direction. Of the storage conditions examined, 37°C, 4°C, -20°C, and -80°C for 1 day, 1 week, and 1 month, a 49% decrease in CoF was observed at 1 week in -80°C. Interestingly, prolonged storage at 37°C resulted in up to an 83% increase in the compressive aggregate modulus by 1 month, with a corresponding increase in the glycosaminoglycan (GAG) bulk content. This study illustrates the differential effects of storage conditions on cartilage: freezing tends to target surface properties, while nonfreezing storage impacts the tissue bulk. These data show that a bulk-only analysis of cartilage function is not sufficient or representative. The nondestructive surface characterization assays described here enable improvement in cartilage functionality assessment by considering both surface and bulk cartilage properties; this methodology may thus provide a new angle to explore in future cartilage research and tissue engineering endeavors.

The quantitative influence of current treatment options on patellofemoral stability in patients with trochlear dysplasia and symptomatic patellofemoral instability - a finite element simulation

BACKGROUND

Trochlear dysplasia is highly associated with patellofemoral instability. The goal of conservative and surgical treatment is to stabilize the patella while minimizing adverse effects. However, there is no literature investigating the quantitative influence of different treatment options on patellofemoral stability in knees with trochlear dysplasia. We created and exploited a range of finite element models to address this gap in knowledge.

METHODS

MRI data of 5 knees with trochlear dysplasia and symptomatic patellofemoral instability were adapted into this previously established model. Vastus medialis obliquus strengthening as well as double-bundle medial patellofemoral ligament reconstruction and the combination of medial patellofemoral ligament reconstruction and trochleoplasty were simulated. The force necessary to dislocate the patella by 10 mm and fully dislocate the patella was calculated in different flexion angles.

FINDINGS

Our model predicts a significant increase of patellofemoral stability at the investigated flexion angles (0°-45°) for a dislocation of 10 mm and a full dislocation after medial patellofemoral ligament reconstruction and the combination of medial patellofemoral ligament reconstruction and trochleoplasty compared to trochleodysplastic (P = 0.01) and healthy knees (P = 0.01-0.02). Vastus medialis obliquus strengthening has a negligible effect on patellofemoral stability.

INTERPRETATIONS

This is the first objective quantitative biomechanical evidence supporting the place of medial patellofemoral ligament reconstruction and medial patellofemoral ligament reconstruction combined with trochleoplasty in patients with symptomatic patellofemoral instability and trochlear dysplasia type B. Vastus medialis obliquus strengthening has a negligible effect on patellar stability at a low total quadriceps load of 175 N.

Direct Osmotic Pressure Measurements in Articular Cartilage Demonstrate Nonideal and Concentration-Dependent Phenomena

The osmotic pressure in articular cartilage serves an important mechanical function in healthy tissue. Its magnitude is thought to play a role in advancing osteoarthritis. The aims of this study were to: (1) isolate and quantify the magnitude of cartilage swelling pressure in situ; and (2) identify the effect of salt concentration on material parameters. Confined compression stress-relaxation testing was performed on 18 immature bovine and six mature human cartilage samples in solutions of varying osmolarities. Direct measurements of osmotic pressure revealed nonideal and concentration-dependent osmotic behavior, with magnitudes approximately 1/3 those predicted by ideal Donnan law. A modified Donnan constitutive behavior was able to capture the aggregate behavior of all samples with a single adjustable parameter. Results of curve-fitting transient stress-relaxation data with triphasic theory in febio demonstrated concentration-dependent material properties. The aggregate modulus HA increased threefold as the external concentration decreased from hypertonic 2 M to hypotonic 0.001 M NaCl (bovine: HA=0.420±0.109 MPa to 1.266±0.438 MPa; human: HA=0.499±0.208 MPa to 1.597±0.455 MPa), within a triphasic theory inclusive of osmotic effects. This study provides a novel and simple analytical model for cartilage osmotic pressure which may be used in computational simulations, validated with direct in situ measurements. A key finding is the simultaneous existence of Donnan osmotic and Poisson-Boltzmann electrostatic interactions within cartilage.

The role of synovial fluid constituents in the lubrication of collagen-glycosaminoglycan scaffolds for cartilage repair

Extracellular matrix (ECM)-derived scaffolds have shown promise as tissue-engineered grafts for promoting cartilage repair. However, there has been a lack of focus on fine-tuning the frictional properties of scaffolds for cartilage tissue engineering as well as understanding their interactions with synovial fluid constituents. Proteoglycan-4 (PRG4) and hyaluronan (HA) are macromolecules within synovial fluid that play key roles as boundary mode lubricants during cartilage surface interactions. The overall objective of this study was to characterize the role PRG4 and HA play in the lubricating function of collagen-glycosaminoglycan (GAG) scaffolds for cartilage repair. As a first step towards this goal, we aimed to develop a suitable in vitro friction test to establish the boundary mode lubrication parameters for collagen-GAG scaffolds articulated against glass in a phosphate buffered saline (PBS) bath. Subsequently, we sought to leverage this system to determine the effect of physiological synovial fluid lubricants, PRG4 and HA, on the frictional properties of collagen-GAG scaffolds, with scaffolds hydrated in PBS and bovine synovial fluid (bSF) serving as negative and positive controls, respectively. At all compressive strains examined (ε = 0.1-0.5), fluid depressurization within hydrated collagen-GAG scaffolds was >99% complete at ½ minute. The coefficient of friction was stable at all compressive strains (ranging from a low 0.103 ± 0.010 at ε = 0.3 up to 0.121 ± 0.015 at ε = 0.4) and indicative of boundary-mode conditions. Immunohistochemistry demonstrated that PRG4 from recombinant human (rh) and bovine sources adsorbed to collagen-GAG scaffolds and the coefficient of friction for scaffolds immersed in rhPRG4 (0.067 ± 0.027) and normal bSF (0.056 ± 0.020) solution decreased compared to PBS (0.118 ± 0.21, both p < 0.05, at ε = 0.2). The ability of the adsorbed rhPRG4 to reduce friction on the scaffolds indicates that its incorporation within collagen-GAG biomaterials may enhance their lubricating ability as potential tissue-engineered cartilage replacements. To conclude, this study reports the development of an in vitro friction test capable of characterizing the coefficient of friction of ECM-derived scaffolds tested in a range of synovial fluid lubricants and demonstrates frictional properties as a potential design parameter for implants and materials for soft tissue replacement.

Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing

BACKGROUND

The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively.

AIMS

To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty.

METHOD

A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae.

RESULTS

Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors.

CONCLUSION

Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.

Sub-toxic levels of cobalt ions impair chondrocyte mechanostranduction via HDAC6-dependent primary cilia shortening

Cobalt ions are the main wear particles associated with orthopaedic implants, causing adverse complications due to cytotoxicity and inflammatory mediators. Recent studies have shown that sub-toxic levels of cobalt ions regulate matrix synthesis and inflammation, but the influence of cobalt ions on mechanotransduction remains unclear. Previously, we reported that sub-toxic levels of cobalt ions modulated primary cilia, which are crucial for mechanotransduction. This study therefore aimed to investigate the effect of cobalt ions on chondrocyte mechanosensation in response to cyclic tensile strain and the association with primary cilia. Sub-toxic levels of cobalt ions impaired chondrocyte mechanosensation and affected the gene expression of aggrecan, collagen II and MMP-13. Moreover, cobalt ions induced HDAC6-dependent primary cilia disassembly, which was associated with either cytoplasmic or ciliary α-tubulin deacetylation. Pharmaceutical HDAC6 inhibition with tubacin restored primary cilia length and mechanotransduction, whereas chemical depletion of primary cilia by chloral hydrate prevented mechanosignalling. Thus, sub-toxic levels of cobalt ions impaired chondrocyte mechanotransduction via HDAC6 activation, which was associated with tubulin deacetylation and primary cilia shortening.

Patellofemoral instability in trochleodysplastic knee joints and the quantitative influence of simulated trochleoplasty - A finite element simulation

BACKGROUND

Patellofemoral instability is a debilitating condition mainly affecting young patients and has been correlated with trochlear dysplasia. It can occur when the patella is insufficiently guided through its range of motion. Currently, there is no literature describing patellofemoral stability in trochleodysplastic knees and the effect of isolated trochleoplasty on patellofemoral stability.

METHODS

The effect of isolated trochleoplasty in trochleodysplastic knees of patients with symptomatic patellofemoral instability was investigated using a quasi-static finite element model. MRI data of five healthy knees were segmented, meshed and a finite element analysis was performed in order to validate the model. A second validation was performed by comparing simulated patellofemoral kinematics to in-vivo values obtained from upright- weight bearing CT scans. Subsequently, five trochleodysplastic knees were modelled before and after simulated trochleoplasty. The force necessary to dislocate the patella by 10 mm and to fully dislocate the patella was calculated in various knee flexion angles between 0 and 45°.

FINDINGS

The developed models successfully predicted outcome values within the range of reference values from literature. Lateral stability was significantly lower in trochleodysplastic knees compared to healthy knees. Trochleoplasty was determined to significantly increase the force necessary to dislocate the patella in trochleodysplastic knees to comparable values as in healthy knees.

INTERPRETATION

This is the first study to investigate lateral patellofemoral stability in patients with symptomatic patellofemoral instability and dysplasia of the trochlear groove. We confirm that patellofemoral stability is significantly lower in trochleodysplastic knees than in healthy knees. Trochleoplasty increases patellofemoral stability to levels similar to healthy.

The tribology of cartilage: Mechanisms, experimental techniques, and relevance to translational tissue engineering

Diarthrodial joints, found at the ends of long bones, function to dissipate load and allow for effortless articulation. Essential to these functions are cartilages, soft hydrated tissues such as hyaline articular cartilage and the knee meniscus, as well as lubricating synovial fluid. Maintaining adequate lubrication protects cartilages from wear, but a decrease in this function leads to tissue degeneration and pathologies such as osteoarthritis. To study cartilage physiology, articular cartilage researchers have employed tribology, the study of lubrication and wear between two opposing surfaces, to characterize both native and engineered tissues. The biochemical components of synovial fluid allow it to function as an effective lubricant that exhibits shear-thinning behavior. Although tribological properties are recognized to be essential to native tissue function and a critical characteristic for translational tissue engineering, tribology is vastly understudied when compared to other mechanical properties such as compressive moduli. Further, tribometer configurations and testing modalities vary greatly across laboratories. This review aims to define commonly examined tribological characteristics and discuss the structure-function relationships of biochemical constituents known to contribute to tribological properties in native tissue, address the variations in experimental set-ups by suggesting a move toward standard testing practices, and describe how tissue-engineered cartilages may be augmented to improve their tribological properties.

The performance of resurfacing implants for focal cartilage defects depends on the degenerative condition of the opposing cartilage

BACKGROUND

Non-degradable resurfacing implants are being developed for treatment of focal cartilage defects. Performance of these implants has been investigated opposing intact cartilage. This study investigates whether implants would perform equally well when the opposing cartilage is fibrillated.

METHODS

Human osteochondral strips (~2x1x1 cm) with a smooth (n = 9) or fibrillated (n = 17) cartilage surface were obtained from human tibial plateaus excised during total knee arthroscopy. A custom-made pin-on-plate sliding indenter was used to apply simultaneous compression (0.75-3 MPa) and movement (4 mm/s over 6 mm). Either metal implants, polycarbonate-urethane or healthy porcine osteochondral plugs with a diameter of 6 mm were used as indenter.

FINDINGS

Cartilage roughness of the osteochondral strips was significantly higher for the fibrillated than the smooth group prior to sliding-indentation. Roughness of the indenters was not significantly altered by sliding indentation using either smooth or fibrillated cartilage. For all but one sample, sliding of smooth cartilage against any of the indenter surfaces did not cause damage. However, samples with fibrillated cartilage showed varied responses from seemingly unaffected to severe tissue wear as quantified by analysis of Indian ink staining and histology.

INTERPRETATION

This study demonstrates that the opposing cartilage quality is relevant for the clinical success of implanting an artificial implant in a focal cartilage defect. Therefore it is essential to test the efficacy of newly developed implants against arthritic joint surfaces, and care should be taken when interpreting in vivo studies in which implants are inserted in healthy joints.

Immature bovine cartilage wear by fatigue failure and delamination

This study investigated wear damage of immature bovine articular cartilage using reciprocal sliding of tibial cartilage strips against glass or cartilage. Experiments were conducted in physiological buffered saline (PBS) or mature bovine synovial fluid (SF). A total of 63 samples were tested, of which 47 exhibited wear damage due to delamination of the cartilage surface initiated in the middle zone, with no evidence of abrasive wear. There was no difference between the friction coefficient of damaged and undamaged samples, showing that delamination wear occurs even when friction remains low under a migrating contact area configuration. No difference was observed in the onset of damage or in the friction coefficient between samples tested in PBS or SF. The onset of damage occurred earlier when testing cartilage against glass versus cartilage against cartilage, supporting the hypothesis that delamination occurs due to fatigue failure of the collagen in the middle zone, since stiffer glass produces higher strains and tensile stresses under comparable loads. The findings of this study are novel because they establish that delamination of the articular surface, starting in the middle zone, may represent a primary mechanism of failure. Based on preliminary data, it is reasonable to hypothesize that delamination wear via subsurface fatigue failure is similarly the primary mechanism of human cartilage wear under normal loading conditions, albeit requiring far more cycles of loading than in immature bovine cartilage.

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.

A Century of Cartilage Tribology Research Is Informing Lubrication Therapies

Articular cartilage is one of the most unique materials found in nature. This tissue's ability to provide low friction and low wear over decades of constant use is not surpassed, as of yet, by any synthetic materials. Lubrication of the body's joints is essential to mammalian locomotion, but breakdown and degeneration of cartilage is the leading cause of severe disability in the industrialized world. In this paper, we review how theories of cartilage lubrication have evolved over the past decades and connect how theories of cartilage lubrication have been translated to lubrication-based therapies. Here, we call upon these historical perspectives and highlight the open questions in cartilage lubrication research. Additionally, these open questions within the field's understanding of natural lubrication mechanisms reveal strategic directions for lubrication therapy.

Histological evaluation of the acetabular labrum after bipolar hip hemiarthroplasty: a case report

We report herein the microstructure of the acetabular labrum obtained from a patient with stem loosening but without bipolar cup migration who had undergone hemiarthroplasty for femoral neck fracture 18 years ago. We used light and scanning electron microscopy to investigate the influence of bipolar cup on acetabular labrum in vivo. Deparaffinized blocks were treated with 2 N NaOH to digest the cell matrix, allowing the collagen fibers, constituting the acetabular labrum, to be observed under scanning electron microscopy. Although chondrocyte atrophy was seen, the basic structure was not different from the normal tissue images of the elderly. However, in the deep part of the acetabular labrum, there was an area that was not stained with Alcian blue observed with light microscopy, and there was an amorphous tissue without type II collagen fibrils observed with scanning electron microscopy. These findings proved that the acetabular labrum has partially degenerated over the long term after bipolar hemiarthroplasty, and that the acetabular labrum can survive in vivo in such a condition. Given that hemiarthroplasty has a possibility to preserve the face-to-face tissue in the long term in vivo, it may be one of the valuable options for modern or future joint reconstruction surgery.

Effects of Loading Conditions on Articular Cartilage in a Metal-on-Cartilage Pairing

The aim of this in vitro study was to investigate the response of articular cartilage to frictional load when sliding against a metal implant, and identify potential mechanisms of damage to articular cartilage in a metal-on-cartilage pairing. Bovine osteochondral cylinders were reciprocally slid against metal cylinders (cobalt-chromium-molybdenum alloy) with several variations of load and sliding velocity using a microtribometer. The effects of different loads and velocities, and the resulting friction coefficients on articular cartilage, were evaluated by measuring histological and metabolic outcomes. Moreover, the biotribocorrosion of the metal was determined. Chondrocytes stimulated with high load and velocity showed increased metabolic activity and cartilage-specific gene expression. In addition, higher load and velocity resulted in biotribocorrosion of the metal implant and damage to the surface of the articular cartilage, whereas low velocity and a high coefficient of friction increased the expression of catabolic genes. Articular cartilage showed particular responses to load and velocity when sliding against a metal implant. Moreover, metal implants showed tribocorrosion. Therefore, corrosion particles may play a role in the mechano-biochemical wear of articular cartilage after implantation of a metal implant. These findings may be useful to surgeons performing resurfacing procedures and total knee arthroplasty. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 37:2531-2539, 2019.

A Systematic Review and Guide to Mechanical Testing for Articular Cartilage Tissue Engineering

Articular cartilage is integral to the mechanical function of many joints in the body. When injured, cartilage lacks the capacity to self-heal, and thus, therapies and replacements have been developed in recent decades to treat damaged cartilage. Given that the primary function of articular cartilage is mechanical in nature, rigorous physical evaluation of cartilage tissues undergoing treatment and cartilage constructs intended for replacement is an absolute necessity. With the large number of groups developing cartilage tissue engineering strategies, however, a variety of mechanical testing protocols have been reported in the literature. This lack of consensus in testing methods makes comparison between studies difficult at times, and can lead to misinterpretation of data relative to native tissue. Therefore, the purpose of this study was to systematically review mechanical testing of articular cartilage and cartilage repair constructs over the past 10 years (January 2009-December 2018), to highlight the most common testing configurations, and to identify key testing parameters. For the most common tests, key parameters identified in this systematic review were validated by characterizing both cartilage tissue and hydrogels commonly used in cartilage tissue engineering. Our findings show that compression testing was the most common test performed (80.2%; 158/197), followed by evaluation of frictional properties (18.8%; 37/197). Upon further review of those studies performing compression testing, the various modes (ramp, stress relaxation, creep, dynamic) and testing configurations (unconfined, confined, in situ) are described and systematically reviewed for parameters, including strain rate, equilibrium time, and maximum strain. This systematic analysis revealed considerable variability in testing methods. Our validation testing studies showed that such variations in testing criteria could have large implications on reported outcome parameters (e.g., modulus) and the interpretation of findings from these studies. This analysis is carried out for all common testing methods, followed by a discussion of less common trends and directions in the mechanical evaluation of cartilage tissues and constructs. Overall, this work may serve as a guide for cartilage tissue engineers seeking to rigorously evaluate the physical properties of their novel treatment strategies. Impact Statement Articular cartilage tissue engineering has made significant strides with regard to treatments and replacements for injured tissue. The evaluation of these approaches typically involves mechanical testing, yet the plethora of testing techniques makes comparisons between studies difficult, and often leads to misinterpretation of data compared with native tissue. This study serves as a guide for the mechanical testing of cartilage tissues and constructs, highlighting recent trends in test conditions and validating these common procedures. Cartilage tissue engineers, especially those unfamiliar with mechanical testing protocols, will benefit from this study in their quest to physically evaluate novel treatment and regeneration approaches.

Tribocorrosion of a CoCrMo alloy sliding against articular cartilage and the impact of metal ion release on chondrocytes

Partial knee replacement and hemiarthroplasty are some of the orthopedic procedures resulting in a metal on cartilage interface. As metal implant material, CoCrMo based alloys are commonly used. The aim of the present study is to assess the role of biotribocorrosion on the CoCrMo-cartilage interface with an emphasis on metal release during sliding contact. The biotribocorrosion experiments were performed under controlled electrochemical conditions using a floating cell with a three electrode set up coupled to a microtribometer. Throughout the experiment the coefficient of friction and the open circuit potential were monitored. Analyses of the electrolyte after the experiment show that metal release can occur during sliding contact of CoCrMo alloy against articular cartilage despite the extraordinary low coefficient of friction measured. Metal release is attributed to changes in passive layer caused at the onset of sliding. The released metal was found to be forming compounds with potential cytotoxicity. Since the presence of metal ions in the cartilage matrix can potentially lead to cell apoptosis, the metabolic activity of human osteoarthritic chondrocytes (2D-cultures) was investigated in the presence of phosphate buffered saline containing metal ions using XTT-assay. The experiments indicate that critical concentrations of Co ions lead to a significant decrease in chondrocyte metabolic activity. Therefore, biotribocorrosion is a mechanism that can occur in partial replacements and lead to chondrocyte apoptosis thus playing a role in the observed accelerated degradation of the remaining cartilage tissue after the mentioned orthopedic procedures. STATEMENT OF SIGNIFICANCE: Partial replacements provide an alternative to total joint replacements. This procedure is less invasive, allows a faster rehabilitation and provides a better function of the joint. However, the remaining native cartilage experiences accelerated degradation when in contact with metallic implant components. This work investigates the role of tribocorrosion at the metal-cartilage interface during sliding. Tribocorrosion is a degradation process that can alter significantly the wear rates experienced by metallic implants and lead to the release of metal ions and particles. The released metal can form compounds with potential cytotoxicity on cartilage tissue. The knowledge gained in this work will serve to understand the mechanisms behind the failure of partial replacements and develop future biomaterials with an enhanced lifetime.

Frictional characterization of injectable hyaluronic acids is more predictive of clinical outcomes than traditional rheological or viscoelastic characterization

Hyaluronic acid injections have been a mainstay of arthritis treatment for decades. However, much controversy remains about their clinical efficacy and their potential mechanism of action. This approach to arthritis therapy is often called viscosupplementation, a term which is rooted in the elevated viscosity of the injected solutions. This terminology also suggests a mechanical pathway of action and further implies that their efficacy is dependent on viscosity. Notably, previous studies of the relationship between viscous properties of hyaluronic acid solutions and their clinical efficacy have not been definitive. Recently we developed an experimental and analytical framework for studying cartilage lubrication that captures the Stribeck-like behavior of cartilage in an elastoviscous transition curve. Here we apply this framework to study the lubricating behavior of six hyaluronan products currently used for injectable arthritis therapy in the US. Despite the fact that the source and chemical modifications endow these products with a range of lubricating properties, we show that the lubricating effect of all of these materials can be described by this Stribeck-like elastoviscous transition. Fitting this data to the elastoviscous transition model enables the calculation of effective lubricating viscosities for each material, which differ substantially from the viscosities measured using standard rheometry. Further we show that while data from standard rheometry are poor predictors of clinical performance of these materials, measurements of friction coefficient and effective lubricating viscosity correlate well (R2 = 0.77; p < 0.005) with assessments of improved clinical function reported previously. This approach offers both a novel method that can be used to evaluate potential clinical efficacy of hyaluronic acid formulations and provide new insight on their mode of action.

Analysis of patellofemoral arthrokinematic motion quality in open and closed kinetic chains using vibroarthrography

Background

Knee movements performed in open (OKC) and closed (CKC) kinetic chains generate various patterns of muscle activities and especially distinct contact stresses in the patellofemoral joint (PFJ). In contrast to these features, the arthrokinematic motion quality (AMQ) of the PFJ has not been compared between mentioned conditions. In this study we performed vibroarthrographic analysis of AMQ in movements performed in OKC and CKC, in healthy subjects and individuals with chondromalacia patellae, to assess which of the test conditions is more efficient in differentiation between healthy and deteriorated joints. Moreover, our analysis will broaden the knowledge related to behavior of normal and pathological synovial joints during motion with and without weight bearing. It is an essential issue, due to the recently observed significant interest in comparing potential benefits and limitations of CKC and OKC exercises as they relate to lower extremity rehabilitation.

Methods

100 subjects (62 healthy controls and 38 subjects with PFJ chondromalacia) were enrolled. During repeated knee flexion/extension motions performed in OKC (in a sitting position) and CKC (sit-to-stand movements), the vibroarthrographic signals were collected using an accelerometer and described by variability (VMS), amplitude (R4), and spectral power in 50–250 Hz (P1) and 250–450 Hz (P2) bands.

Results

Significant differences in VMS [V], R4 [V], P1 [V²/Hz] and P2 [V²/Hz] between OKC and CKC were found (0.0001, 0.969. 0.800 0.041 vs 0.013, 3.973, 6.790, 0.768, respectively, P < 0.001). Moreover, in both analyzed load-related conditions the subjects with chondromalacia were characterized by significantly higher values of all parameters, when compared to controls (P < 0.001), with effect size values over 0.6.

Conclusions

We showed that motion of the physiological, unloaded PFJ articular surfaces in OKC is nearly vibrationless, which corresponds with optimal AMQ of PFJ, while loaded movements in CKC are characterized by a higher vibroacoustic emission level. Moreover, chondral lesions should be considered as an increased friction-related, aggravating factor of AMQ, which is critical in CKC movements under load. Nonetheless, OKC and CKC conditions are characterized by large effect sizes, and provide an efficient test frame for differentiating physiological knees and joints with chondral lesions.

Mechanically stimulated osteochondral organ culture for evaluation of biomaterials in cartilage repair studies

Surgical procedures such as microfracture or autologous chondrocyte implantation have been used to treat articular cartilage lesions; however, repair often fails in terms of matrix organization and mechanical behaviour. Advanced biomaterials and tissue engineered constructs have been developed to improve cartilage repair; nevertheless, their clinical translation has been hampered by the lack of reliable in vitro models suitable for pre-clinical screening of new implants and compounds. In this study, an osteochondral defect model in a bioreactor that mimics the multi-axial motion of an articulating joint, was developed. Osteochondral explants were obtained from bovine stifle joints, and cartilage defects of 4 mm diameter were created. The explants were used as an interface against a ceramic ball applying dynamic compressive and shear loading. Osteochondral defects were filled with chondrocytes-seeded fibrin-polyurethane constructs and subjected to mechanical stimulation. Cartilage viability, proteoglycan accumulation and gene expression of seeded chondrocytes were compared to free swelling controls. Cells within both cartilage and bone remained viable throughout the 10-day culture period. Loading did not wear the cartilage, as indicated by histological evaluation and glycosaminoglycan release. The gene expression of seeded chondrocytes indicated a chondrogenic response to the mechanical stimulation. Proteoglycan 4 and cartilage oligomeric matrix protein were markedly increased, while mRNA ratios of collagen type II to type I and aggrecan to versican were also enhanced. This mechanically stimulated osteochondral defect culture model provides a viable microenvironment and will be a useful pre-clinical tool to screen new biomaterials and biological regenerative therapies under relevant complex mechanical stimuli. STATEMENT OF SIGNIFICANCE: Articular cartilage lesions have a poor healing capacity and reflect one of the most challenging problems in orthopedic clinical practice. The aim of current research is to develop a testing system to assess biomaterials for implants, that can permanently replace damaged cartilage with the original hyaline structure and can withstand the mechanical forces long term. Here, we present an osteochondral ex vivo culture model within a cartilage bioreactor, which mimics the complex motion of an articulating joint in vivo. The implementation of mechanical forces is essential for pre-clinical testing of novel technologies in the field of cartilage repair, biomaterial engineering and regenerative medicine. Our model provides a unique opportunity to investigate healing of articular cartilage defects in a physiological joint-like environment.

Physical Activities That Cause High Friction Moments at the Cup in Hip Implants

BACKGROUND

High friction moments in hip implants contribute to the aseptic loosening of cementless cups, of which there are approximately 100,000 cases per year; sustained joint loading may cause such high moments. The most "critical" physical activities associated with sustained joint loading were identified in this study.

METHODS

Friction moments in the cup were telemetrically measured about 33,000 times in the endoprostheses of 9 subjects during >1,400 different activities. The highest moments were compared with the cup's fixation stability limit of approximately 4 Nm.

RESULTS

A total of 124 different activities caused friction moments meeting or exceeding the critical limit, with the highest value of 11.5 Nm. Most involved sustained high contact forces before or during the activity. The highest peak moments (6.3 to 11.5 Nm) occurred when moving the contralateral leg during 1-legged stance, during breaststroke swimming, muscle stretching, 2-legged stance with muscle contraction, and during static 1-legged stance. The median moments were highest (3.4 to 3.9 Nm) for unstable 1-legged stance, whole-body vibration training, 2-legged stance with an unexpected push at the upper body, 1-legged stance while exercising the contralateral leg, and running after 2-legged stance.

CONCLUSIONS

Frequent unloading plus simultaneous movement of the joint are required to maintain good joint lubrication and keep the friction moments low. Frequent, sustained high loads before or during an activity may cause or contribute to aseptic cup loosening. During the first months after hip arthroplasty, such activities should be avoided or reduced as much as possible. This especially applies during postoperative physiotherapy. Whether these guidelines also apply for subjects with knee implants or arthrotic hip or knee joints requires additional investigation.

CLINICAL RELEVANCE

The risk of aseptic cup loosening may be reduced by avoiding sustained loading of hip implants without periodic joint movement.

Microscale frictional strains determine chondrocyte fate in loaded cartilage

Mounting evidence suggests that altered lubricant levels within synovial fluid have acute biological consequences on chondrocyte homeostasis. While these responses have been connected to increased friction, the mechanisms behind this response remain unknown. Here, we combine a frictional bioreactor with confocal elastography and image-based cellular assays to establish the link between cartilage friction, microscale shear strain, and acute, adverse cellular responses. Our incorporation of cell-scale strain measurements reveals that elevated friction generates high shear strains localized near the tissue surface, and that these elevated strains are closely associated with mitochondrial dysfunction, apoptosis, and cell death. Collectively, our data establish two pathways by which chondrocytes negatively respond to friction: an immediate necrotic response and a longer term pathway involving mitochondrial dysfunction and apoptosis. Specifically, in the surface region, where shear strains can exceed 0.07, cells are predisposed to acute death; however, below this surface region, cells exhibit a pathway consistent with apoptosis in a manner predicted by local shear strains. These data reveal a mechanism through which cellular damage in cartilage arises from compromised lubrication and show that in addition to boundary lubricants, there are opportunities upstream of apoptosis to preserve chondrocyte health in arthritis therapy.

Detection of depth-depend changes in porcine cartilage after wear test using Raman spectroscopy

Cartilage damage and wear can lead to severe diseases, such as osteoarthritis, thus, many studies on the cartilage wear process have already been performed to better understand the cartilage wear mechanism. However, most characterization methods focus on the cartilage surface or the total wear extent. With the advantages of high spatial resolution and easy characterization, Raman microspectroscopy was employed for the first time to characterize full-depth changes in the cartilage extracellular matrix (ECM) after wear test. Sections from the cartilage samples after wear were compared with sections from the control group. Univariate and multivariate analyses both indicated that collagen content loss at certain depths (20%-30% relative to the cartilage surface) is possibly the dominating alteration during wear rather than changes in collagen fiber orientation or proteoglycan content. These findings are consistent with the observations obtained by scanning electron microscopy and histological staining. This study successfully used Raman microspectroscopy efficiently assess full-depth changes in cartilage ECM after wear test, thus providing new insight into cartilage damage and wear.

Phospholipid Vesicles in Media for Tribological Studies against Live Cartilage

Introduction

Pre-clinical testing of hemiarthroplasty devices requires that the tribological conditions present in vivo with live cartilage be closely duplicated. A current limitation in the tribological testing of live cartilage involves the use of cell-culture media as lubricant.

Study Aim

to develop and test a new hyaluronan-phospholipid based medium (HA-phospholipid medium) that combines the rheological and frictional properties of synovial fluid with the nourishing properties of culture media to keep cells alive.

Materials and Methods

The HA-phospholipid medium consisted of culture medium with added phospholipid dipalmitoylphosphatidylcholine (0.3 mg/mL), and hyaluronic acid (2.42 mg/mL). A standard cell culture medium was used as the control. The rheology of each medium was determined using a flat plate configuration. Bovine calf cartilage was used to assess cell viability and friction in each medium. For friction measurements, a cobalt-chrome alloy ball was articulated against cartilage disks immersed in medium.

Results

Lipid vesicles 0.1 to 50 μm in diameter were identified in the HA-phospholipid medium. Cartilage cell viability was significantly higher in the HA-phospholipid medium (62% ± 8%, 95% CI) than in control medium (49.5% ± 5%) (p = 0.009). The HA-phospholipid medium exhibited strong shear-thinning behavior, similar to synovial fluid, with viscosities ~100-fold higher at 10 s^-1 and 5-fold higher at 20,000 s^-1 than the approximately Newtonian control medium. The HA-phospholipid medium also yielded 20% lower friction values than the control medium after one hour of testing.

Conclusions

The rheological and friction results indicate that the HA-phospholipid medium is superior to the control cell culture medium in emulating the shear thinning and lubricative properties of natural synovial fluid, making it more clinically relevant for in vitro wear and friction testing with live cartilage.

Experimental Study on the Mechanical Properties of Porcine Cartilage with Microdefect under Rolling Load

Objectives

To investigate the mechanical responses of microdefect articular cartilage under rolling load and find out the failure rule.

Methods

Rolling load was applied to the porcine articular cartilage samples with rectangular notches of different depths. The displacement and strain near the notches were obtained by the noncontact digital image correlation technique.

Results

The strain value and peak frequency around the notch increased; the maximum equivalent strain value could be observed at both bottom corners of the notch; the equivalent strain value first increased and then decreased at the points in the superficial and middle layers with the increase of rolling velocity; the points in the deep layer were less affected by rolling velocity; the equivalent strain value of the points in the superficial layer declined after rising with the increase of defect depth, while a decreased trend could be found for the points in the middle and deep layers.

Conclusions

The shear strain, which rose with the increase in defect depth, was the main factor in cartilage destruction. The cartilage tended to be destructed firstly at the bottom corner of the defect. Rolling velocity showed significant effects on superficial and middle layers. Cartilage had the ability to resist destruction.

On mechanical mechanism of damage evolution in articular cartilage

Superficial lesions of cartilage are the direct indication of osteoarthritis. To investigate the mechanical mechanism of cartilage with micro-defect under external loading, a new plain strain numerical model with micro-defect was proposed and damage evolution progression in cartilage over time has been simulated, the parameter were studied including load style, velocity of load and degree of damage. The new model consists of the hierarchical structure of cartilage and depth-dependent arched fibers. The numerical results have shown that not only damage of the cartilage altered the distribution of the stress but also matrix and fiber had distinct roles in affecting cartilage damage, and damage in either matrix or fiber could promote each other. It has been found that the superficial cracks in cartilage spread preferentially along the tangent direction of the fibers. It is the arched distribution form of fibers that affects the crack spread of cartilage, which has been verified by experiment. During the process of damage evolution, its extension direction and velocity varied constantly with the damage degree. The rolling load could cause larger stress and strain than sliding load. Strain values of the matrix initially increased and then decreased gradually with the increase of velocity, and velocity had a greater effect on matrix than fibers. Damage increased steadily before reaching 50%, sharply within 50 to 85%, and smoothly and slowly after 85%. The finding of the paper may help to understand the mechanical mechanism why the cracks in cartilage spread preferentially along the tangent direction of the fibers.