In vitro simulation of fretting-corrosion in hip implant modular junctions: The influence of pH

Investigation of cell-accelerated corrosion (CAC) on the CoCrMo alloy with segregation banding: Hip implant applications

Metal alloy microstructure plays a crucial role in corrosion associated with total hip replacement (THR). THR is a prominent strategy that uses metal implants such as cobalt-chromium-molybdenum (CoCrMo) alloys due to their advantageous biological and mechanical properties. Despite all benefits, these implants undergo corrosion and wear processes in-vivo in a synergistic manner called tribocorrosion. Also, the implant retrieval findings reported that fretting corrosion occurred in-vivo, evidenced by the damage patterns that appeared on the THR junction interfaces. There is no scientific data on the studies reporting the fretting corrosion patterns of CoCrMo microstructures in the presence of specific biological treatments to date. In the current study, Flat-on-flat fretting corrosion set-up was customized and used to study the tribocorrosion patterns of fretting corrosion to understand the role of alloy microstructure. Alloy microstructural differences were created with the implant stock metal's longitudinal and transverse cutting orientations. As a result, the transverse created the non-banded, homogenous microstructure, whereas the longitudinal cut resulted in the banded, non-homogenous microstructure on the surface of the alloy (in this manuscript, the terms homogenous and banded were used). The induced currents were monitored using a three-electrode system. Three different types of electrolytes were utilized to study the fretting corrosion patterns with both homogeneous and banded microstructures: 1. Control media 2. Spent media (the macrophage cell cultured media) 3. Challenged media (media collected after the macrophage was treated with CoCrMo particles). From the electrochemical results, in the potentiostat conditions, the banded group exhibited a higher induced current in both challenged and spent electrolyte environments than in control due to the synergistic activity of CoCrMo particles and macrophage demonstrating more corrosion loss. Additionally, both Bode and Nyquist plots reported a clear difference between the banded and homogeneous microstructure, especially with challenged electrolytes becoming more corrosion-resistant post-fretting than pre-fretting results. The banded microstructure showed a unique shape of the fretting loop, which may be due to tribochemical reactions. Therefore, from the electrochemical, mechanical, and surface analysis data results, the transverse/homogenous/non-banded alloy microstructure groups show a higher resistance to fretting-corrosion damage.

Do Patients With Hypoallergenic Total Knee Arthroplasty Implants for Metal Allergy Do Worse? An Analysis of Health Care Utilizations and Patient-Reported Outcome Measures

BACKGROUND

Metal allergy is a rare and controversial cause of implant failure and poor outcomes following total knee arthroplasty (TKA). Few studies have investigated clinical and patient-reported outcome measures (PROMs) in patients treated with hypoallergenic implants. This investigation aimed to compare: (1) health care utilizations (eg, hospital length of stay, 90-day readmission rate, and incidence of nonhome discharge) and (2) 1-year PROMs between patients who received hypoallergenic and standard TKA implants.

METHODS

This was a retrospective review of prospectively collected data from patients who underwent primary TKA between 2018 and 2019. Propensity score matching (3:1) was used to compare standard TKA patients with those who received hypoallergenic TKA implants, respectively. Knee injury and Osteoarthritis Outcome Score (KOOS) pain, KOOS Physical function Shortform (PS), and Veterans RAND 12-Item Health Survey Mental Component Score were collected preoperatively and at 1-year. After matching, 190 hypoallergenic and 570 standard TKAs were analyzed.

RESULTS

No differences were observed in length of stay (P = .98), 90-day readmission (P = .89), and nonhome discharge (P = .82). Additionally, there was no significant difference in change from preoperative to 1-year PROMs (KOOS pain, P = .97; KOOS PS, P = .88; Veterans RAND 12-Item Health Survey Mental Component Score, P = .28). Patient-reported satisfaction was similar at 1-year (P = .23). Patients achieved similar rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for KOOS pain (PASS, P = .77; MCID, P = .33) and KOOS PS (PASS, P = .44; MCID, P = .65).

CONCLUSION

Patients treated with hypoallergenic TKA implants for suspected metal allergy had similar outcomes compared to patients who had standard implants and no metal allergy.

Fretting-corrosion Apparatus with Low Magnitude Micro-motion (≤5 μm): Development and Preliminary Outcome

Fretting-corrosion is one of the failure processes in many applications, including biomedical implants. For example, the modern design of hip implants with multiple components offers better flexibility and inventory storage. However, it will trigger the fretting at the implant interfaces with a small displacement amplitude (< 5 µm) and usually in a partial slip region. Although many studies have been reported on the fretting, they have high displacement amplitude and are in the gross slip region. It is imperative to have an apparatus to overcome such limitations, specifically for hip implant applications. Therefore, this study describes the development of a fretting-corrosion apparatus with low micro-motion (≤ 5 µm) that can simultaneously monitor the corrosion process. Initial experiments with Ti6Al4V-Ti6Al4V in 0.9% saline, Ti6Al4V-Ti6Al4V in bovine calf serum (BCS), and ZrO2-Ti6Al4V in BCS were conducted to validate the system. As a result, the fretting regime of all groups remained partially slip region throughout the 3600 cycles, and the possible failure mechanisms are proposed in this manuscript.

In Vitro Tribocorrosion Evaluation of Carbide-derived Carbon (CDC) for Hip Implants

Carbide-derived carbon (CDC) was previously proposed as a surface modification method for hip implant applications since it showed excellent tribocorrosion performance under open-circuit potential (OCP) conditions. Nonetheless, a systematic evaluation of CDC's tribocorrosion properties was still missing. Therefore, our objective is to test CDC's tribocorrosion performance under various electrochemical conditions and to identify the synergism between wear and corrosion. Based on the findings, the variations in OCP for CDC (0.626 mV) is smaller than Ti6Al4V (1.91 mV), and CDC showed lower induced current than T6Al4V for all potentials, suggesting CDC is more stable than Ti6Al4V under tribocorrosive conditions. Eventually, the weight loss of Ti6Al4V (50.662±5.19 μg) was found to be significantly higher than that of CDC (4.965±5.19 μg), which agrees with the electrochemical results. In summary, CDC showed better tribocorrosion performance than Ti6Al4V and was determined as an Antagonism regime.

The Progress in Tribocorrosion Research (2010-21): Focused on the Orthopedics and Dental Implants

Tribocorrosion is an integration of two areas-tribology and corrosion. It can be defined as the material degradation caused by the combined effect of corrosion and tribological process at the material interfaces. Significant development has occurred in the field of tribocorrosion over the past years. This development is due to its applications in various fields, such as aerospace, marine, biomedical, and space. Focusing on biomedical applications, tribocorrosion finds its applications in the implants used in cardiovascular, spine, orthopedics, trauma, and dental areas. It was reported that around 7.2 million Americans are living with joint implants. Implant surgery is a traumatic and expensive procedure. Tribocorrosion can affect the lifespan of the implants, thus leading to implant failure and a potential cause of revision surgery. Hence, it is essential to understand how tribocorrosion works, its interaction with the implants, and what procedures can be implemented to protect materials from tribocorrosion. This paper discusses how tribocorrosion research has evolved over the past 11 years (2010-2021). This is a comprehensive overview of tribocorrosion research in biomedical applications.

Hip implant modular junction: The role of CoCrMo alloy microstructure on fretting-corrosion

Cobalt-chromium-molybdenum (CoCrMo) alloy is one of the most used metals in total hip replacement (THR) due to the alloy's superior corrosion qualities and biocompatibility. Over time these prostheses may undergo wear and corrosion processes in a synergistic process known as tribocorrosion. Implant retrieval studies have shown that damage patterns on THR modular junction surfaces indicating specifically in vivo fretting-corrosion to take place. To date, there have been no studies on the fretting-corrosion behaviors of CoCrMo alloy under the consideration of specific microstructural features. A custom-built flat-on-flat fretting-corrosion setup was utilized to test the synergistic tribocorrosion behavior of fretting-corrosion. The difference in microstructure was generated through the cutting orientations of the transverse and the longitudinal direction of the bar stock material, where the longitudinal cut exhibits a characteristic banded microstructure (banded group) and the transverse cut a homogenous microstructure (unbanded group). A three-electrode system was employed to monitor the induced currents. Two different types of electrolytes were used in the current study: 1. Bovine calf serum (BCS-30 g/L protein) (normal conditions) 2. BCS with Lipopolysaccharide (LPS, 0.15 μg/ml) (simulated infectious conditions). In the free potential mode, banded samples showed an increased potential compared to the unbanded samples. In potentiostatic conditions, the banded group also exhibited a higher induced current in both electrolyte environments, indicating more corrosion loss. Both Nyquist and Bode plots showed both orientations of metal becoming more corrosion resistant post-fretting when compared to pre-fretting data. The longitudinal group at OCP demonstrated a unique shape of the fretting-loop, which might be related to tribochemical reactions. Based on the mechanical, electrochemical, and surface characterization data, the transverse group (unbanded) microstructures demonstrates a higher resistance to fretting-corrosion damage.

Influence of FeCl3 and H2O2 in corrosion testing of modular taper connections in total hip arthroplasty: An in vitro study

Corrosion at the modular taper junctions in total hip arthroplasty is clinically relevant because wear particles and ions generated at this interface can lead to adverse local tissue reactions or even implant failure. In vitro tribo-corrosion tests are usually accomplished in saline solutions or calf serum (CS), but the addition of H₂O₂ and FeCl₃ have been suggested to mimic inflammatory conditions in the joint. Inflammatory conditions may aggravate corrosive processes and, therefore, should lead in vitro to a more severe and realistic tribo-corrosive material attack. Corrosion testing at 12/14 tapers comprising a CoCrMo head taper and a Ti6Al4V trunnion was accomplished in five electrolytes (Ringer's solution (RS), RS with 30 mM H₂O₂ and/or 0.7 mM FeCl₃ and CS) under dynamical loading for five million cycles. Resulting material loss was determined gravimetrically and by ion analysis. The tribo-corrosive material degradation was investigated by light and electron microscopy. FeCl₃ enhanced the material loss from taper connections while H₂O₂ did not lead to a significant alteration of total material loss. In comparison to pure RS, corrosion testing in CS decreased material loss at the head taper while it increased material loss at the trunnion. The combination of FeCl₃ and H₂O₂ led to an enhanced occurrence of micro cracks at the trunnion surface. Adding FeCl₃ and optionally also H₂O₂ aggravates material loss in in vitro corrosion testing of taper junctions and leads to harsher and probably more realistic testing conditions. STATEMENT OF SIGNIFICANCE: Tribo-corrosive processes at taper connections in hip implants are complex and can lead to major clinical implications. Joint inflammation is assumed to aggravate taper corrosion in vivo, why FeCl₃ and H₂O₂ have been proposed as additives to electrolytes to simulate inflammatory conditions in vitro. Often used fretting test setups, however, do not involve real taper geometries. Besides, testing is often accomplished in saline solutions or calf serum, which do not induce a clinically significant amount of corrosive material degradation. This study presents an approach to increase tribo-corrosive processes at realistic taper connections by adding FeCl₃ and/or H₂O₂. Unlike H₂O₂, FeCl₃ increased material loss from taper connections. The combination of both additives enhanced micro crack formation at the trunnion surfaces.

Driving electrochemical corrosion of implanted CoCrMo metal via oscillatory electric fields without mechanical wear

Decades of research have been dedicated to understanding the corrosion mechanisms of metal based implanted prosthetics utilized in modern surgical procedures. Focused primarily on mechanically driven wear, current fretting and crevice corrosion investigations have yet to precisely replicate the complex chemical composition of corrosion products recovered from patients' periprosthetic tissue. This work specifically targets the creation of corrosion products at the metal on metal junction utilized in modular hip prosthetics. Moreover, this manuscript serves as an initial investigation into the potential interaction between implanted CoCrMo metal alloy and low amplitude electrical oscillation, similar in magnitude to those which may develop from ambient electromagnetic radiation. It is believed that introduction of such an electrical oscillation may be able to initiate electrochemical reactions between the metal and surrounding fluid, forming the precursor to secondary wear particles, without mechanically eroding the metal's natural passivation layer. Here, we show that a low magnitude electrical oscillation (≤ 200 mV) in the megahertz frequency (10⁶ Hz) range is capable of initiating corrosion on implanted CoCrMo without the addition of mechanical wear. Specifically, a 50 MHz, 200 mVpp sine wave generates corrosion products comprising of Cr, P, Ca, O, and C, which is consistent with previous literature on the analysis of failed hip prosthetics. These findings demonstrate that mechanical wear may not be required to initiate the production of chemically complex corrosion products.

Assessing Taper Geometry, Head Size, Head Material, and Their Interactions in Taper Fretting Corrosion of Retrieved Total Hip Arthroplasty Implants

BACKGROUND

Decreased fretting and corrosion damage at the taper interface of retrieved ceramic-on-polyethylene total hip arthroplasty (THA) implants has been consistently reported; however, resultant fretting corrosion as a function of femoral head size and taper geometry has not been definitively explained.

METHODS

Eight cohorts were defined from 157 retrieved THA implants based on femoral head composition (n = 95, zirconia-toughened alumina, ZTA vs n = 62, cobalt-chromium alloy, CoCr), head size (n = 56, 32mm vs n = 101, 36mm), and taper geometry (n = 84, 12/14 vs n = 73, V40). THA implants were evaluated and graded for taper fretting and corrosion. Data were statistically analyzed, including via a 2³ factorial modeling.

RESULTS

Factorial-based analysis indicated the significant factors related to both resultant (summed) fretting and corrosion damage were head material and taper geometry; head material-taper geometry interaction was also a significant factor in resultant corrosion damage. Lower rates of moderate-to-severe fretting and corrosion damage were exhibited on ZTA heads (ZTA = 13%, CoCr = 38%), smaller heads (32mm = 18%, 36mm = 26%), and 12/14 tapers (12/14 = 13%, V40 = 35%). ZTA+32mm heads demonstrated the lowest rates of moderate-to-severe fretting and corrosion damage (12/14 = 2%, V40 = 7%), whereas CoCr heads with V40 tapers demonstrated the greatest rates of moderate-to-severe damage (32mm = 47%, 36mm = 59%).

CONCLUSION

In this series, retrieved implants with ZTA, 32-mm heads paired with 12/14 tapers exhibited lower rates of moderate-to-severe damage. Factorial analysis showed head material, taper geometry, and their interactions were the most significant factors associated with resultant damage grades. Isolating implant features may provide additional information regarding factors leading to fretting and corrosion damage in THA.

LEVEL OF EVIDENCE

IV (case series).

Investigation of the effects of electrochemical reactions on complex metal tribocorrosion within the human body

Although total hip arthroplasty (THA) is considered to be the most successful orthopedic operation in restoring mobility and relieving pain, common Metal-on-Metal (MoM) implants developed in the past decade suffer from severe inflammatory reactions of the surrounding tissue caused by the premature corrosion and degradation of the implant. A substantial amount of research has been dedicated to the investigation of mechanically driven fretting and crevice corrosion as the primary mechanism of implant failure. However, the exact mechanism by which hip implant breakdown occurs remains unknown, as current in vitro fretting and crevice corrosion studies have failed to completely replicate the corrosion characteristics of recovered implants. Here, we show that minor electric potential oscillations on a model hip implant replicate the corrosion of failed implants without the introduction of mechanical wear. We found in a controlled lab setting that small electrical oscillations, of similar frequency and magnitude as those resulting from ambient electromagnetic waves interacting with the metal of the implant, can force electrochemical reactions within a simulated synovial fluid environment that have not been previously predicted. In lab testing we have shown the replication of titanium, phosphorous, and oxygen deposition onto the surface of ASTM astm:F75 CoCrMo metal alloy test specimens, matching the chemical composition of previously retrieved wear particles from failed patient prosthetics. Our results demonstrate that the electrical activity and ensuing electrochemical activity excites two corrosion failure modes: direct dissolution of the medically implantable alloy, leaching metal ions into the body, and surface deposition growth, forming the precursor of secondary wear particles. We anticipate our findings to be the foundation for the future development and testing of electrochemically resistant implantable material.

The role of fretting-frequency on the damage modes of THR modular junction: In-vitro study

According to the National Center for Health Statistics, currently, more than 250,000 total hip replacements annually in the US alone, with an estimated increase to 500,000 by the year 2030. The usage of tapered junctions between the femoral neck and head gives the surgeon flexibility in implant assembly. However, these modular junctions are subjected to micro-motion that may cause chemical and fretting-corrosion at the modular junction. Therefore, it is imperative to study these forces to mitigate their effects. The current study aims to understand the effects of fretting-corrosion as a function of fretting frequencies caused by common physical activities in an in-vitro model of hip modular junctions. The fretting system has a tribological contact condition of flat-on-flat, mounted to a load frame. CoCrMo pins were polished and immersed in a synovial fluid-like electrolyte solution (Bovine calf serum 30 g/l). Electrochemical measurements were made using a potentiostat. Samples then undergo 3600 cycles at 50 μm (to simulate gross slips), with a horizontal load at 200 N, and a frequency of 0.5 Hz, 0.7 Hz, 1 Hz, and 1.5 Hz to simulate Sit Down-Stand Up, Stair Climb, Walking, and Jogging, respectively. Worn surfaces were then examined under optical and scanning electron microscopy. The evolution of free potential as a function of time for tested frequencies shows the initial potential drop and stabilized trend in the potential evolution. The sample group at a higher frequency displays a higher tendency of corrosion than a lower frequency; however, the dissipation energy decreases as a function of fretting frequency. Both electrochemical and mechanical responses correlate to the variation in the fretting frequencies. Organometallic complexes were found on the surfaces of the samples that were subjected to a slower frequency of fretting, whereas mechanical grooving was noticed on samples with a faster frequency. Hence, these preliminary studies suggest that implant failure rates may be altered based on fretting-frequencies induced by physical activity. Further studies will be required to verify the findings and explore the potential role of fretting frequency in the damage modes of the modular junction.

Do SiNx coatings bear the potential to reduce the risk of micromotion in modular taper junctions?

Fretting corrosion is one contributor to the clinical failure of modular joint arthroplasty. It is initiated by micromotion in metal junctions exposed to fluids. Omitting metal-on-metal contacts could help to reduce the corrosion risk. The coating of one metal taper partner with a ceramic-based silicon nitride (SiNx) coating might provide this separation. The aim of the study was to identify whether a SiNx coating of the male taper component influences the micromotion within a taper junction. Hip prosthesis heads made of CoCr29Mo6 (Aesculap) and Ti6Al4V (Peter Brehm) were assembled (2000 N) to SiNx-coated and uncoated stem tapers made of Ti6Al4V and CoCr29Mo6 (2×2×2 combinations, each n = 4). Consecutive sinusoidal loading representing three daily activities was applied. Contactless relative motion in six degrees of freedom was measured using six eddy-current sensors. Micromotion in the junction was determined by compensating for the elastic deformation derived from additional monoblock measurements. After pull-off, the taper surfaces were microscopically inspected. Micromotion magnitude reached up to 8.4 ± 0.8 µm during loading that represented stumbling. Ti6Al4V stems showed significantly higher micromotion than those made of CoCr29Mo6, while taper coating had no influence. Statistical differences in pull-off forces were found for none of the taper junctions. Microscopy revealed CoCr29Mo6 abrasion from the head taper surface if combined with coated stem tapers. Higher micromotion of Ti6Al4V tapers was probably caused by the lower Young's modulus. Even in the contact areas, the coating was not damaged during loading. The mechanics of coated tapers was similar to uncoated prostheses. Thus, the separation of the two metal surfaces with the objective to reduce in vivo corrosion appears to be achievable if the coating is able to withstand in vivo conditions. However, the hard ceramic-based stem coating lead to undesirable debris from the CoCr29Mo6 heads during loading.

Femoral stem modularity

Femoral stem modularity in hip replacement was first developed to connect a ceramic head to the stem, then extended to metal heads using the Morse taper principle. Is it a good thing, or a necessary evil? It contributes to improving lower limb length and lateralization setting, at the cost of fairly rare complications such as dissociation and fretting corrosion, which can exceptionally lead to ARMD (Adverse Reaction to Metal Debris). Modular necks were later recommended, with a double Morse taper: cylindrical for the head junction, and more or less flattened for the stem. Is this one modularity too far? Dual modularity in theory perfectly reproduces the biomechanical parameters of the hip, but is unfortunately associated with fractures and severe corrosion, leading to ARMD and pseudotumor, especially in Cr-Co necks. Moreover, it provides no functional advantage, and no longer has a role outside dysplasia and other femoral deformities. Metaphyseal-diaphyseal modularity is not widespread in primary implants, and is it really necessary? Only one model has been widely studied: S-Rom™ (Depuy®). It features a metaphyseal sleeve adapting to the anatomy of the proximal femur, with a stem fitted via an inverse Morse taper. Its only interest is in case of congenital dislocation; like all metal connections, it incurs a risk of fracture and corrosion. On the other hand, modularity is widely employed in revision implants. Does it really help these procedures? The connection between a proximal femoral component of variable geometry and a diaphyseal stem with press-fit distal fixation provides a real solution to problems of length, lateralization and anteversion. Early models encountered high rates of fracture, but current implants and rigorous surgical technique have reduced this risk. Corrosion is a less serious problem, as the Morse taper undergoes only axial stress, without the friction undergone by other models subject to varus stress.

Fretting corrosion behaviour of Ti-6Al-4V reinforced with zirconia in foetal bovine serum

Fretting corrosion is a critical challenge in the design of hip prosthesis used in total hip arthroplasty (THA) surgeries. Currently, the design of hip implants includes a tapered junction which introduces additional interfaces that connect different parts of the hip implant such as the femoral neck and head or stem and neck interface. Micro motions that occur under the influence of load, together with chemical changes in the host environment, make these interfaces susceptible to tribocorrosion processes, particularly fretting corrosion. Commonly used metallic biomaterials are based on stainless steels, cobalt chrome-based alloys as well as titanium and titanium alloys. Each of these materials possess some degree of limitations, particularly where tribocorrosion events are concerned. Titanium alloy Ti-6Al-4V is widely used in biomedical applications for non-bearing components of total joint arthroplasty (TJA) surgeries. Its poor wear resistance continues to remain a challenge in load-bearing joints where parts articulate against one another as in the case of modular junctions. Some of the attempts made to improve the wear properties of Ti-6Al-4V is through the incorporation of second phase particles like ceramics in its matrix to produce metal matrix composites of Ti-6Al-4V. The aim of this work is to investigate the effect of zirconia reinforcement on spark plasma sintered Ti-6Al-4V composites (zirconium oxide particles incorporated into Ti-6Al-4V matrix) on the fretting corrosion properties of Ti-6Al-4V. Fretting corrosion tests were carried out on as-sintered Ti-6Al-4V and Ti-6Al-4V with 5 and 10 wt.% ZrO₂. The tests were carried out in foetal bovine serum under applied normal loads of 85 and 115 N using the cylinder-on-flat contact configuration. The evolution of OCP, dissipated energy and friction coefficient were recorded throughout the test. Microstructural analysis of the samples before fretting corrosion tests showed the presence of globular agglomerates throughout the Ti-6Al-4V matrix due to zirconia additions; the volume of the agglomerates was higher in the composites having 10 wt.% ZrO₂. Ti-6Al-4V composites having zirconia additions produced a nobler OCP during fretting in foetal bovine serum, compared to pure Ti-6Al-4V. Furthermore, the fretting corrosion results showed a significant improvement in the tribocorrosion resistance of Ti-6Al-4V with 10 wt.% ZrO₂ at all loads. This composition also produced the least amount of degradation. and metal ion release. Mechanical data showed that increasing the applied normal load promoted a transition from gross slip to partial slip conditions for all compositions. Partial slip was found to be prevalent at a higher normal load (drastic decrease of the dissipated energy and consequently the friction coefficient). This mechanical condition prevents a large amount of degradation.