Isolation and morphological characterisation of UHMWPE wear debris generated in vitro

Characterization of hardness and elastic modulus using nanoindentation and correlation with wear behavior of UHMWPE during uniaxial tension

UHMWPE is the material of choice for bearing surfaces in total joint arthroplasty making its wear and mechanical properties important factors of contribution in longevity of prosthetic hip/knee implants. In this study, the variation of hardness and elastic modulus with applied load in textured UHMWPE has been investigated. Texture has been induced through uniaxial tension of UHMWPE modifying its microstructure which in turn influences the wear resistance and hence the mechanical properties of the material. Previous studies have shown hardness to be a major factor influencing wear resistance. However, recently, the ratio of hardness (H) to elastic modulus (E) has been recognized as a more influential parameter of wear resistance. The validity of predicting wear resistance using H/E ratio has been examined in this work. Power law variation with load for the bioimplant material UHMWPE has been investigated at different strain levels. It has been observed that power law exponent of 2 can only be achieved at higher load levels. Overall, this work provides an insight into influencing the properties of bioimplant material UHMWPE by modifying the microstructure of the material through inducing texture which ultimately affects the longevity of the prosthetic implants.

Quantitative analysis and degradation mechanisms of different protein degradation methods

The abrasive debris produced by wear test of artificial joints in vitro is encapsulated by proteins in serum lubricants, which hinder the characterization of debris analysis. One of the key issues of isolating wear debris from serum is degrading the proteins wrapping the wear debris. In this article, the proteins in calf serum were degraded by a strong alkali, a strong acid, and an enzyme. The residual concentration of proteins in calf serum was detected by UV absorption. Quantitative analysis of protein degradation and the protein degradation rate was proposed, following treatment with different degradation reagents and different incubation times. The results showed that when 10 mL of 25% volume calf serum was added with 40 mL of NaOH and incubated at 65°C for 24 h, the protein degradation rate reached a maximum of 95.52%. The protein degradation rate in the solution ranged from 31.86% to 71.64% when a different volume of 37% HCl was added and incubated at 60°C. The highest protein degradation rate was 94.98% in the protease degradation solution. When the protein degradation rate is less than 70%, the particles were coated by protein. When the protein degradation rate was more than 95%, there was no protein coating around the particles. The three protein degradation methods have different processes and protein degradation rates. A suitable method for protein degradation can be selected according to these practical applications.

Treating orthopedic prosthesis with diamond-like carbon: minimizing debris in Ti6Al4V

Prostheses are subject to various forms of failing mechanisms, including wear from ordinary patient motion. Superficial treatments can improve tribological properties of the contact pair, minimizing wear and increasing prostheses lifetime. One possibility is the diamond-like carbon (DLC) coating, where Carbon is deposited with variable ratio of sp(2)/sp(3) structures, leading to an increase in surface hardness. So in this research Ti6Al4V samples were coated with DLC using sputtering process to evaluate the debris release. The Ti6Al4V and Ti6Al4V plus DLC coating surfaces were analyzed using Raman spectroscopy and instrumented indentation (hardness). The wear behavior was tested using a reciprocating linear tribometer. The wear rate was smaller in the coated samples, producing less debris than the untreated Ti6Al4V alloy. Debris morphology was also evaluated, using scanning electronic microscopy, and it was observed that debris size from the coated samples were bigger than those observed from the uncoated Ti6Al4V alloy, above the size that generally triggers biological response from the host.

Biotribology of a new bearing material combination in a rotating hinge knee articulation

The objective of the present study was to evaluate the biotribological behaviour, in terms of wear and particle release, of bushings and flanges made of carbon fibre reinforced poly-ether-ether-ketone (CFR-PEEK) in articulation with a zirconium nitride (ZrN) multilayer surface coating in a rotating hinge knee system. For the bushings of the rotational and flexion axles and the medial and lateral flanges, a CFR-PEEK with 30% polyacrylonitrile fibre content was used in a new bearing combination with ZrN. In vitro wear simulation was performed for patients with metal ion hypersensitivity, using a new rotating hinge knee design with a ZrN surface articulation in comparison with the clinically established cobalt-chromium version. For the bushings and flanges made of CFR-PEEK subjected to wear simulation, the volumetric wear rates were 2.3±0.48mm(3)million(-1) cycles in articulation to cobalt-chromium as reference and 0.21±0.02mm(3)million(-1) cycles in the coupling with ZrN, a 10.9-fold decrease. The released CFR-PEEK particles were comparable in size and shape for the coupling to cobalt-chromium and ZrN with most of the particles in a size range between 0.1 and 2μm. The study reveals comparable low wear and no macroscopic surface fatigue in a new rotating hinge knee design with highly congruent flanges and axles bushings made of CFR-PEEK articulating to a ZrN multilayer surface coating. Favourable wear behaviour of the newly introduced CFR-PEEK/ZrN coupling in comparison with the clinically established CFR-PEEK/cobalt-chromium articulation was found.

Periprosthetic aseptic osteolysis in total ankle replacement: cause and management

Osteolysis is the loss of bone secondary to a pathologic process and remains the most common cause of failure of total ankle replacement. Friction at the bearing surface results in the generation of abraded wear debris of polyethylene. These activate a biologic cascade that may result in significant bone loss and subsequent loss of fixation of the prosthesis. Revision surgery must address this loss of bone and may be achieved through either bone grafting or use of appropriate revision prosthesis components.

Effect of anterior-posterior and internal-external motion restraint during knee wear simulation on a posterior stabilised knee design

The objective of our study was to examine the effect of biphaseal AP translation and IE rotation restraint, using a system defined specifically for posterior stabilised knee designs, on wear, kinematics and particle release in comparison to linear motion restraint as required by the established ISO 14243-1:2002(E) protocol. In the ISOlinear groups, an AP motion restraint of 30 N/mm and an IE rotation restraint of 0.6 Nm/° were applied in the knee wear simulation. In the ISOgap biphaseal groups with PCL sacrificing implants, the restraining AP force was zero in a ±2.5mm range with, externally, a constant of 9.3N/mm applied proportionally to the AP translation of the tibia plateau, whereas the restraining IE torque was zero in a ±6° range with, externally, a constant of 0.13 Nm/° applied proportionally to the IE rotation of the tibia plateau. Using the ISOgap biphaseal protocol on a posterior stabilised knee design, we found an increase of 41% in AP translation and of 131% in IE rotation, resulting in a 3.2-fold higher wear rate compared to the results obtained using the ISOlinear protocol. Changes in AP translation and IE rotation ligament motion restraints have a high impact on knee joint kinematics and wear behaviour of a fixed bearing posterior stabilised knee design.

Current concepts in osteolysis

The most frequent cause of failure after total hip replacement in all reported arthroplasty registries is peri-prosthetic osteolysis. Osteolysis is an active biological process initiated in response to wear debris. The eventual response to this process is the activation of macrophages and loss of bone. Activation of macrophages initiates a complex biological cascade resulting in the final common pathway of an increase in osteolytic activity. The biological initiators, mechanisms for and regulation of this process are beginning to be understood. This article explores current concepts in the causes of, and underlying biological mechanism resulting in peri-prosthetic osteolysis, reviewing the current basic science and clinical literature surrounding the topic.

Cold atmospheric pressure gas plasma enhances the wear performance of ultra-high molecular weight polyethylene

Ultra-high molecular weight polyethylene (UHMWPE) is frequently employed in joint replacements because of its high biocompatibility; however, this material does not exhibit particularly strong wear performance, thus potentially reducing the longevity of such devices. Numerous techniques have been investigated to increase the resistance to wear of UHMWPE, but they are all based on expensive machinery and require a high level of safety precautions. Cold atmospheric pressure gas plasma treatment is an inexpensive process that has been used as a surface modification method and as a sterilization technique. We demonstrate for the first time that a helium/oxygen cold atmospheric pressure gas plasma can be used to enhance the wear performance of UHMWPE without affecting the cytocompatibility of the material. The exposure to a cold atmospheric pressure gas plasma results in a greater level of crosslinking of the polyethylene chains. As a consequence of the higher crosslinking, the material stiffness of the treated surface is increased.

Wear Behaviour and Wear Debris Characterization of UHMWPE on Alumina Ceramic, Stainless Steel, CoCrMo and Ti6Al4V Hip Prostheses in a Hip Joint Simulator

Ultra-high molecular-weight polyethylene (UHMWPE) has been used in total hip replacement for the last three decades. Despite the advancements in prosthesis design, the wear of UHMWPE remains a serious clinical problem; the release of wear debris may induce osteolysis and implant loosening. Understanding of wear behavior and wear debris morphology of the polyethylene is essential to improve the reliability of hip joint implants. The investigation in this paper carried out wear simulation tests of UHMWPE on Al2O3, 316L stainless steel, CoCrMo alloy and Ti6Al4V alloy, respectively. The lubrication of plasma solution and bovine serum solution was presented in wear tests. The effect of motion and loading on the wear behavior and wear debris morphology, and the influence of femoral head material and assembly style were studied in order to obtain a better understanding of the morphology of ultra-high molecular weight polyethylene wear particles. It is shown that the wear of UHMWPE acetabular cups against metal femoral heads was significantly higher than that against ceramic heads. The presence of protein in lubricant increases the wear of UHMWPE acetabular cups on Al2O3 heads. The wear rates of UHMWPE in multi-directional motion are approximately 2.5 times of those in uni-directional motion. The size distribution range of the UHMWPE debris particles for all head materials varies from submicron particles up to several hundreds micron. The size distribution range of wear debris particles is not directly related to wear resistance of UHMWPE, but significantly influenced by wear mechanisms. The UHMWPE debris particles produced in hip wear simulation tests are classified as round debris, flake-like debris and stick debris, which are closely related to the primary mechanisms of abrasive wear, adhesive wear and fatigue wear.

Biotribology of alternative bearing materials for unicompartmental knee arthroplasty

The objective of our wear simulator study was to evaluate the suitability of two different carbon fibre-reinforced poly-ether-ether-ketone (CFR-PEEK) materials for fixed bearing unicompartmental knee articulations with low congruency. In vitro wear simulation was performed according to ISO 14243-1:2002 (E) with the clinically introduced Univation F fixed bearing unicompartmental knee design (Aesculap AG, Tuttlingen, Germany) made of UHMWPE/CoCr29Mo6 in a direct comparison to experimental gliding surfaces made of CFR-PEEK pitch and CFR-PEEK PAN. Gliding surfaces of each bearing material (n=6+2) were gamma-irradiated, artificially aged and tested for 5 million cycles with a customized four-station knee wear simulator (EndoLab, Thansau, Germany). Volumetric wear assessment, optical surface characterization and an estimation of particle size and morphology were performed. The volumetric wear rate of the reference PE1-6 was 8.6 +/- 2.17 mm(3) per million cycles, compared to 5.1+/-2.29 mm(3) per million cycles for PITCH1-6 and 5.2 +/- 6.92 mm(3) per million cycles for PAN1-6; these differences were not statistically significant. From our observations, we conclude that CFR-PEEK PAN is obviously unsuitable as a bearing material for fixed bearing knee articulations with low congruency, and CFR-PEEK pitch also cannot be recommended as it remains doubtful wether it reduces wear compared to polyethylene. In the fixed bearing unicompartmental knee arthroplasty examined, application threshold conditions for the biotribiological behaviour of CFR-PEEK bearing materials have been established. Further in vitro wear simulations are necessary to establish knee design criteria in order to take advantage of the biotribiological properties of CFR-PEEK pitch for its beneficial use to patients.

Fixed and mobile bearing total knee arthroplasty--influence on wear generation, corresponding wear areas, knee kinematics and particle composition

BACKGROUND

Several studies in literature are dealing with a direct comparison between fixed and mobile bearing knee replacements, but to our knowledge there is no published data comparing the wear behaviour of the two design principles based on the same femur and superior gliding surface geometry. The objective of our study was to investigate a fixed and mobile bearing knee design with identical femoral articulation in regard to wear, tibio-femoral kinematics and particle size distribution.

METHODS

In vitro wear simulation according to ISO 14243-1 has been performed with the Columbus knee system (Aesculap, Tuttlingen) in the configurations fixed and mobile bearing for five million cycles on a customized four station knee wear simulator. The tests were running under force control and the tibio-femoral kinematics were assessed. A particle analysis has been undergone after each inspection interval when the lubricant was replaced.

FINDINGS

Due to the additional wear in the tibial articulation of the mobile bearing design the mean gravimetric wear rates are not statistically different between the two groups. Apart of that there is a substantial reduction in the amount of wear per area unit for the mobile versus the fixed bearing gliding surfaces. Both groups show comparable tibio-femoral kinematics and a similar wear debris morphology.

INTERPRETATION

Our investigation of a fixed and mobile bearing knee design with identical femoral articulation demonstrates that there are no significant differences in wear rate, resulting kinematics and polyethylene particle release. Therefore it can be recommended that surgeons decision for one or the other design principle should be based on the individual patient profile.

Biotribological evaluation of artificial disc arthroplasty devices: influence of loading and kinematic patterns during in vitro wear simulation

Wear simulation is an essential pre-clinical method to predict the mid- and long-term clinical wear behavior of newly introduced devices for total disc arthroplasty. The main requirement of a suitable method for spinal wear simulation has to be the ability to distinguish between design concepts and allow for a direct comparison of predicate devices. The objective of our study was to investigate the influence of loading and kinematic patterns based on two different protocols for spinal wear simulation (ISO/FDIS 18192-1 (2006) and ASTM F2423-05). In vitro wear simulation was performed with six activ L lumbar artificial disc devices (Aesculap Tuttlingen, Germany). The applied kinematic pattern of movement was multidirectional for ISO (elliptic track) and unidirectional with a curvilinear shape for ASTM. Testing was done for 10 million cycles in the ISO loading mode and afterwards with the same specimens for 5 million cycles according to the ASTM protocol with a customized six-station servohydraulic spinal wear simulator (EndoLab Thansau, Germany). Gravimetrical and geometrical wear assessment, a slide track analysis correlated to an optical surface characterization, and an estimation of particle size and morphology were performed. The gravimetric wear rate for the first 10 million cycles was ISO(initial) = 2.7 +/- 0.3 mg/million cycles. During the ASTM test period (10-15 million cycles) a gravimetric wear rate of 0.14 +/- 0.06 mg/million cycles was estimated. The wear rates between the ISO and ASTM driven simulations differ substantially (approximately 20-fold) and statistical analysis demonstrates a significant difference (p < 0.001) between the test groups. The main explanation of divergency between ISO and ASTM driven wear simulations is the multidirectional pattern of movement described in the ISO document resulting in a cross-shear stress on the polyethylene material. Due to previous retrieval observations, it seems to be very unlikely that a lumbar artificial disc is loaded with a linear wear path.Testing according to ASTM F2423-05 with pure unidirectional motion does not reflect the kinematics of TDA patients' daily activities. Based on our findings it seems to be more reliable to predict the clinical wear behavior of an artificial disc replacement using the ISO/FDIS 18192-1 method.

Identification of nanometre-sized ultra-high molecular weight polyethylene wear particles in samples retrieved in vivo

Nanometre-sized particles of ultra-high molecular weight polyethylene have been identified in the lubricants retrieved from hip simulators. Tissue samples were taken from seven failed Charnley total hip replacements, digested using strong alkali and analysed using high-resolution field emission gun-scanning electron microscopy to determine whether nanometre-sized particles of polyethylene debris were generated in vivo. A randomised method of analysis was used to quantify and characterise all the polyethylene particles isolated. We isolated nanometre-sized particles from the retrieved tissue samples. The smallest identified was 30 nm and the majority were in the 0.1 microm to 0.99 microm size range. Particles in the 1.0 microm to 9.99 microm size range represented the highest proportion of the wear volume of the tissue samples, with 35% to 98% of the total wear volume comprised of particles of this size. The number of nanometre-sized particles isolated from the tissues accounted for only a small proportion of the total wear volume. Further work is required to assess the biological response to nanometre-sized polyethylene particles.

Micromechanics of shelf-aged and retrieved UHMWPE tibial inserts: indentation testing, oxidative profiling, and thickness effects

Understanding the surface micromechanical properties of ultra-high-molecular-weight polyethylene (UHMWPE) may allow for improvement in its wear characteristics. Microtomed sections of two UHMWPE tibial bearings, one that had been irradiation sterilized and shelf-aged, and the other irradiation sterilized and used in a patient, were subjected to depth sensing indentation testing. The microtomed sections exhibited a white band in the subsurface region that is characteristic of oxidation, and the indentation testing, followed by FTIR analysis at the same testing locations, was performed across this region and into the bulk of the material. Indentation testing yielded data leading to hardness, modulus, and energy dissipation factor (EDF). FTIR profiling generated information about oxidation; oxidation indices were calculated by taking a ratio of peak heights at 1,716 cm(-1) (ketone) to 2,022 cm(-1) (methylene). The mechanical properties showed a strong linear correlation with oxidation index above a minimum thickness. Modulus, hardness, and EDF all increased with increasing oxidation. The appropriate thickness-to-indentation-depth ratio was determined by two methods and was found to be approximately 20:1. The mechanical properties through the oxidized region were seen to vary with depth into the sample in a profile similar to the oxidation profile. The differing aging environments of the tibial bearings are hypothesized to have had an effect on both the mechanical and oxidation profiles. The retrieved bearing exhibited a narrower oxidation profile with peaks closer to the surface, and oxidation indices of lower magnitude. The mechanical properties proved similar, with less intense and narrower readings for the retrieved sample. This research is consistent with much of the literature.

Wear behaviour of cross-linked polyethylene assessed in vitro under severe conditions

The polyethylene (PE) for hip implants presents serious clinical problems; the production of debris may induce adverse tissue reactions that may lead to extensive bone loss around the implant and consequently osteolysis and implant loosening. Several attempts have been made to improve the wear properties of ultra-high molecular weight polyethylene (UHMWPE). More recently the attention of various researchers has been focused on cross-linked polyethylene (XLPE), due to its improved wear resistance with respect to conventional UHMWPE. This study was aimed at comparing the wear performances of clinically available acetabular liners (Zimmer Inc.) made of electron beam XLPE and conventional UHMWPE. To evaluate the influence of the material properties on wear, conventional UHMWPE and XLPE acetabular cups were tested against deliberately scratched CoCrMo femoral heads (Ra = 0.12-0.14 microm) in a hip joint wear simulator run for 3 million cycles with bovine calf serum as lubricant. Gravimetric measurements revealed significant differences between the wear behaviours of the two sets of acetabular cups: XLPE exhibited a wear rate about 40 times lower than conventional UHMWPE. Raman spectroscopy coupled to partial least-squares analysis was used to evaluate the possible crystallinity changes induced by mechanical stress (and thus the material wear resistance): only the UHMWPE cup which showed the highest weight loss displayed significant crystallinity changes. These results were correlated to the thickness of the plasticity-induced damage layer. The wear debris produced during the tests were isolated according to a validated protocol and imaged by scanning electron microscopy . The wear particles produced by XLPE were smaller than those produced by UHMWPE; the latter were observed as fibrillar and agglomerated particles. The mean equivalent circle diameter was 0.71 and 0.26 microm for UHMWPE and XLPE, respectively.

An easy technique to digest and isolate UHMWPE wear particles from a hip joint simulator

The size and morphology of polyethylene wear particles isolated from in vitro tests were analysed in this study. There are some major controversies emerging in the literature that will only be resolved by careful particles analysis. Since it is difficult to identify the factors that affect size and morphology of the wear particles, the goal of this study was to compare four different polymer wear debris isolation techniques (base method and acid treatment) under identical conditions in a hip joint simulator to obtain polyethylene wear particles. We investigated achieving particulate isolation by using a different approach to the one reported in the literature that involved an easier and streamline method of particle debris isolation. The new method, compared to the previous one, used a strong base, normal centrifugation, and filtration to digest the serum constituents thus isolating the polyethylene particle debris from lubricant. In all four methods the isolation involved some or all of the following steps: density gradient separation, centrifugation or ultracentrifugation, and washing. However, a requirement for all these techniques was that the lubricant had to be devoid of organic compounds in order to effectively image and count the particle debris. The results from these studies clearly show that this new method of particle isolation is easier and more streamlined than the three methods analysed and reported in literature because it did not involve ultracentrifugation and is quicker.