1
|
Khan AZ, Maxwell MJ, Parrott RM, Bowler AR, Glass EA, Miller D, Vasconcellos D, Brownhill JR, Austin LS, Cuff DJ, Murthi AM, Smith MJ, Wiater JM, Jawa A. Effect of vitamin E-enhanced highly cross-linked polyethylene on wear rate and particle debris in anatomic total shoulder arthroplasty: a biomechanical comparison to ultrahigh-molecular-weight polyethylene. J Shoulder Elbow Surg 2024; 33:1465-1472. [PMID: 38182025 DOI: 10.1016/j.jse.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Particle-induced osteolysis resulting from polyethylene wear remains a source of implant failure in anatomic total shoulder designs. Modern polyethylene components are irradiated in an oxygen-free environment to induce cross-linking, but reducing the resulting free radicals with melting or heat annealing can compromise the component's mechanical properties. Vitamin E has been introduced as an adjuvant to thermal treatments. Anatomic shoulder arthroplasty models with a ceramic head component have demonstrated that vitamin E-enhanced polyethylene show improved wear compared with highly cross-linked polyethylene (HXLPE). This study aimed to assess the biomechanical wear properties and particle size characteristics of a novel vitamin E-enhanced highly cross-linked polyethylene (VEXPE) glenoid compared to a conventional ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid against a cobalt chromium molybdenum (CoCrMo) head component. METHODS Biomechanical wear testing was performed to compare the VEXPE glenoid to UHMWPE glenoid with regard to pristine polyethylene wear and abrasive endurance against a polished CoCrMo alloy humeral head in an anatomic shoulder wear-simulation model. Cumulative mass loss (milligrams) was recorded, and wear rate calculated (milligrams per megacycle [Mc]). Under pristine wear conditions, particle analysis was performed, and functional biologic activity (FBA) was calculated to estimate particle debris osteolytic potential. In addition, 95% confidence intervals for all testing conditions were calculated. RESULTS The average pristine wear rate was statistically significantly lower for the VEXPE glenoid compared with the HXLPE glenoid (0.81 ± 0.64 mg/Mc vs. 7.00 ± 0.45 mg/Mc) (P < .05). Under abrasive wear conditions, the VEXPE glenoid had a statistically significant lower average wear rate compared with the UHMWPE glenoid comparator device (18.93 ± 5.80 mg/Mc vs. 40.47 ± 2.63 mg/Mc) (P < .05). The VEXPE glenoid demonstrated a statistically significant improvement in FBA compared with the HXLPE glenoid (0.21 ± 0.21 vs. 1.54 ± 0.49 (P < .05). CONCLUSIONS A new anatomic glenoid component with VEXPE demonstrated significantly improved pristine and abrasive wear properties with lower osteolytic particle debris potential compared with a conventional UHMWPE glenoid component. Vitamin E-enhanced polyethylene shows early promise in shoulder arthroplasty components. Long-term clinical and radiographic investigation needs to be performed to verify if these biomechanical wear properties translate to diminished long-term wear, osteolysis, and loosening.
Collapse
Affiliation(s)
- Adam Z Khan
- Northwest Permanente P.C., Portland, OR, USA
| | | | | | | | | | | | | | | | - Luke S Austin
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
| | - Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports Medicine, Venice, FL, USA
| | | | - Matthew J Smith
- Department of Orthopedic Surgery, University of Missouri, Columbia, MO, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Andrew Jawa
- New England Baptist Hospital, Boston, MA, USA.
| |
Collapse
|
2
|
Panez-Toro I, Heymann D, Gouin F, Amiaud J, Heymann MF, Córdova LA. Roles of inflammatory cell infiltrate in periprosthetic osteolysis. Front Immunol 2023; 14:1310262. [PMID: 38106424 PMCID: PMC10722268 DOI: 10.3389/fimmu.2023.1310262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Classically, particle-induced periprosthetic osteolysis at the implant-bone interface has explained the aseptic loosening of joint replacement. This response is preceded by triggering both the innate and acquired immune response with subsequent activation of osteoclasts, the bone-resorbing cells. Although particle-induced periprosthetic osteolysis has been considered a foreign body chronic inflammation mediated by myelomonocytic-derived cells, current reports describe wide heterogeneous inflammatory cells infiltrating the periprosthetic tissues. This review aims to discuss the role of those non-myelomonocytic cells in periprosthetic tissues exposed to wear particles by showing original data. Specifically, we discuss the role of T cells (CD3+, CD4+, and CD8+) and B cells (CD20+) coexisting with CD68+/TRAP- multinucleated giant cells associated with both polyethylene and metallic particles infiltrating retrieved periprosthetic membranes. This review contributes valuable insight to support the complex cell and molecular mechanisms behind the aseptic loosening theories of orthopedic implants.
Collapse
Affiliation(s)
- Isidora Panez-Toro
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Independencia, Santiago, Chile
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
| | - Dominique Heymann
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
- Nantes Université, Laboratory of Histology and Embryology, Medical School, Nantes, France
- The University of Sheffield, Dept of Oncology and Metabolism, Sheffield, United Kingdom
| | - François Gouin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Jérôme Amiaud
- Nantes Université, Laboratory of Histology and Embryology, Medical School, Nantes, France
| | - Marie-Françoise Heymann
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
| | - Luis A. Córdova
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Independencia, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
- Oral and Maxillofacial Surgery, Clínica MEDS, Santiago, Chile
| |
Collapse
|
3
|
Cowie RM, Briscoe A, Jennings LM. The influence of cross shear and contact pressure on the wear of UHMWPE-on-PEEK-OPTIMA™ for use in total knee replacement. J Mech Behav Biomed Mater 2023; 148:106196. [PMID: 37875039 DOI: 10.1016/j.jmbbm.2023.106196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
PEEK-OPTIMA™ polymer is being considered as an alternative material to cobalt chrome in the femoral component of total knee arthroplasty to give a metal-free knee replacement system. Simple geometry pin-on-plate wear simulation can be used to systematically investigate and understand the wear of materials under many different conditions. The aim of this study was to investigate the wear of UHMWPE-on-PEEK-OPTIMA™ under a range of contact pressure (2.1-80 MPa) and cross-shear ratio (0-0.18) conditions. With increasing contact pressure, there was a trend of decreasing UHMWPE wear factor with a significant difference (p<0.001) in the wear factor of UHMWPE under the different contact pressure conditions of interest. Under uniaxial motion (cross-shear ratio = 0), the wear of UHMWPE was low, introducing multi-axial motion increased the wear of the UHMWPE. There was a significant difference (p<0.01) in the wear factor at different cross-shear ratios however, post hoc analysis showed only the study carried out under unidirectional motion to be significantly different from the other conditions. With varying contact pressure and cross-shear ratio, the wear of UHMWPE against PEEK-OPTIMA™ polymer showed similar trends to previous studies of UHMWPE-on-cobalt chrome.
Collapse
Affiliation(s)
- Raelene M Cowie
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Adam Briscoe
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK; Invibio ltd., Thornton Cleveleys, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| |
Collapse
|
4
|
Kandel S, Su S, Hall RM, Tipper JL. An automated system for polymer wear debris analysis in total disc arthroplasty using convolution neural network. Front Bioeng Biotechnol 2023; 11:1108021. [PMID: 37362220 PMCID: PMC10285289 DOI: 10.3389/fbioe.2023.1108021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction: Polymer wear debris is one of the major concerns in total joint replacements due to wear-induced biological reactions which can lead to osteolysis and joint failure. The wear-induced biological reactions depend on the wear volume, shape and size of the wear debris and their volumetric concentration. The study of wear particles is crucial in analysing the failure modes of the total joint replacements to ensure improved designs and materials are introduced for the next generation of devices. Existing methods of wear debris analysis follow a traditional approach of computer-aided manual identification and segmentation of wear debris which encounters problems such as significant manual effort, time consumption, low accuracy due to user errors and biases, and overall lack of insight into the wear regime. Methods: This study proposes an automatic particle segmentation algorithm using adaptive thresholding followed by classification using Convolution Neural Network (CNN) to classify ultra-high molecular weight polyethylene polymer wear debris generated from total disc replacements tested in a spine simulator. A CNN takes object pixels as numeric input and uses convolution operations to create feature maps which are used to classify objects. Results: Classification accuracies of up to 96.49% were achieved for the identification of wear particles. Particle characteristics such as shape, size and area were estimated to generate size and volumetric distribution graphs. Discussion: The use of computer algorithms and CNN facilitates the analysis of a wider range of wear debris with complex characteristics with significantly fewer resources which results in robust size and volume distribution graphs for the estimation of the osteolytic potential of devices using functional biological activity estimates.
Collapse
Affiliation(s)
- Sushil Kandel
- Faculty of Engineering and IT, University of Technology, Sydney, NSW, Australia
| | - Steven Su
- Faculty of Engineering and IT, University of Technology, Sydney, NSW, Australia
- College of Artificial Intelligence and Big Data for Medical Science, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Richard M. Hall
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - Joanne L. Tipper
- Faculty of Engineering and IT, University of Technology, Sydney, NSW, Australia
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
5
|
Su J, Wang J, Yan S, Zhang M, Zhang N, Luan Y, Cheng CK. Wear Analysis of Tibial Inserts Made of Highly Cross-Linked Polyethylene Supplemented with Dodecyl Gallate before and after Accelerated Aging. Polymers (Basel) 2022; 14:polym14235281. [PMID: 36501675 PMCID: PMC9737456 DOI: 10.3390/polym14235281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The wear of the tibial insert is one of the primary factors leading to the failure of total knee arthroplasty. As materials age, their wear performance often degrades. Supplementing highly cross-linked polyethylene (HXLPE) with dodecyl gallate (DG) can improve the oxidation stability of tibial inserts for use in total knee arthroplasty (TKA). This study aimed to evaluate the wear resistance of HXLPE supplemented with DG (HXLPE-DG) tibial inserts before and after accelerated aging. HXLPE-DG tibial inserts were subjected to wear testing of up to 5 million loading cycles according to ISO 14243, and the resulting wear particles were analyzed according to ISO 17853. The wear rate, number, size, and shape of the wear particles were analyzed. The average wear rate of the unaged samples was 4.39 ± 0.75 mg/million cycles and was 3.22 ± 1.49 mg/million cycles for the aged samples. The unaged tibial inserts generated about 2.80 × 107 particles/mL following the wear test, but this was considerably lower for the aged samples at about 1.35 × 107 particles/mL. The average equivalent circle diameter (ECD) of the wear particles from the unaged samples was 0.13 μm (max: 0.80 μm; min: 0.04 μm), and it was 0.14 μm (max: 0.66 μm; min: 0.06 μm) from the aged samples. Moreover, 22.1% of the wear particles from the unaged samples had an aspect ratio (AR) of >4 (slender shape), while this was 15.4% for the aged samples. HXLPE-DG improves the wear performance of the material over time. HXLPE-DG is a novel material that has been demonstrated to have antiaging properties and high wear resistance, making it a promising candidate for use in TKA. Nevertheless, the results are preliminary and will be clarified in further studies.
Collapse
Affiliation(s)
- Jian Su
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
- Beijing Institute of Medical Device Testing, Beijing 101111, China
| | - Jianjun Wang
- Beijing Institute of Medical Device Testing, Beijing 101111, China
| | - Shitong Yan
- Beijing Institute of Medical Device Testing, Beijing 101111, China
| | - Min Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Ningze Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Yichao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Correspondence:
| |
Collapse
|
6
|
Dammer RH, Zietz C, Bader R. A Comparison of Wear Patterns on Retrieved and Simulator-Tested Total Knee Replacements. J Funct Biomater 2022; 13:256. [PMID: 36412896 PMCID: PMC9680524 DOI: 10.3390/jfb13040256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Aseptic implant loosening is the most common reason for revision surgery after total knee replacement. This is associated with adverse biological reactions to wear debris from the articulating implant components. To predict the amount of wear debris generated in situ, standard wear testing of total knee replacement (TKR) is carried out before its clinical use. However, wear data reported on retrievals of total knee replacement (TKR) revealed significant discrepancies compared with standard wear simulator studies. Therefore, the aim of the present study was to compare the wear patterns on identical posterior-cruciate-retaining TKR designs by analyzing retrieved and experimentally tested implants. The identification and classification of wear patterns were performed using 21 retrieved ultra-high-molecular-weight-polyethylene (UHMW-PE) inserts and four sets of inserts of identical design and material tested in a knee wear simulator. These four sets had undergone different worst-case conditions and a standard test in a wear simulator according to ISO 14243-1. Macroscopic and microscopic examinations of the polyethylene inserts were performed, including the determination of seven modes of wear that correspond to specific wear patterns, the calculation of wear areas, and the classification of the damage over the whole articulating area. Retrieved and standard wear simulator-tested UHMW-PE inserts showed significant differences in wear area and patterns. The total wear areas and the damage score were significantly larger on the retrievals (52.3% versus 23.9%, 32.7 versus 22.7). Furthermore, the range of wear patterns found on the retrievals was not reproducible in the simulator-tested inserts. However, good correspondence was found with the simulator-tested polyethylene inserts under worst-case conditions (third body wear), i.e., deep wear areas could be replicated according to the in vivo situation compared with other wear test scenarios. Based on the findings presented here, standard simulator testing can be used to directly compare different TKR designs but is limited in the prediction of their in situ wear. Preclinical wear testing may be adjusted by worst-case conditions to improve the prediction of in situ performance of total knee implants in the future.
Collapse
Affiliation(s)
- Rebecca H. Dammer
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057 Rostock, Germany
| | | | | |
Collapse
|
7
|
Goodman SB, Gallo J. Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment. J Clin Med 2019; 8:E2091. [PMID: 31805704 PMCID: PMC6947309 DOI: 10.3390/jcm8122091] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone-implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.
Collapse
Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St. M/C 6342, Redwood City, CA 94063, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic;
| |
Collapse
|
8
|
The effect of vitamin E-enhanced cross-linked polyethylene on wear in shoulder arthroplasty-a wear simulator study. J Shoulder Elbow Surg 2019; 28:1771-1778. [PMID: 31029519 DOI: 10.1016/j.jse.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wear of the polyethylene glenoid component and subsequent particle-induced osteolysis remains one of the most important modes of failure of total shoulder arthroplasty. Vitamin E is added to polyethylene to act as an antioxidant to stabilize free radicals that exist as a byproduct of irradiation used to induce cross-linking. This study was performed to assess the in vitro performance of vitamin E-enhanced polyethylene compared with conventional polyethylene in a shoulder simulator model. METHODS Vitamin E-enhanced, highly cross-linked glenoid components were compared with conventional ultrahigh-molecular-weight polyethylene glenoids, both articulating with a ceramic humeral head component using a shoulder joint simulator over 500,000 cycles. Unaged and artificially aged comparisons were performed. Volumetric wear was assessed by gravimetric measurement, and wear particle analysis was also subsequently performed. RESULTS Vitamin E-enhanced polyethylene glenoid components were found to have significantly reduced wear rates compared with conventional polyethylene in both unaged (36% reduction) and artificially aged (49% reduction) comparisons. There were no differences detected in wear particle analysis between the 2 groups. CONCLUSION Vitamin E-enhanced polyethylene demonstrates improved wear compared with conventional polyethylene in both unaged and artificially aged comparisons and may have clinically relevant benefits.
Collapse
|
9
|
Biomechanics and Biotribology of UHMWPE Artificial Hip Joints. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2019. [DOI: 10.1007/978-981-13-6924-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
10
|
Shen W, Tomita N, Niikura M, Sugino T. Amount of TNF‐α released from macrophages reacting with polyethylene particles showed dose‐dependent relationship to the total surface area of added particles. BIOSURFACE AND BIOTRIBOLOGY 2018. [DOI: 10.1049/bsbt.2018.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Weiqi Shen
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Naohide Tomita
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Miho Niikura
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Takuma Sugino
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| |
Collapse
|
11
|
Wear and Friction of UHMWPE-on-PEEK OPTIMA™. J Mech Behav Biomed Mater 2018; 89:65-71. [PMID: 30265867 PMCID: PMC6195677 DOI: 10.1016/j.jmbbm.2018.09.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022]
Abstract
PEEK-OPTIMA™ is being considered as an alternative bearing material to cobalt chrome in the femoral component of total knee replacement to provide a metal-free implant. The aim of this study was to investigate the influence of lubricant temperature (standard rig running and elevated temperature (~36 °C)) on the wear of a UHMWPE-on-PEEK OPTIMA™ bearing couple using different lubricant protein concentrations (0%, 2%, 5%, 25% and 90% bovine serum) in a simple geometry pin-on-plate configuration. Friction was also investigated under a single temperature condition for different lubricant protein concentrations. The studies were repeated for UHMWPE-on-cobalt chrome in order to compare relationships with temperature (wear only) and lubricant protein concentration (wear and friction). In low lubricant protein concentrations (≤ 5%) there was no influence of temperature on the wear factors of UHMWPE-on-PEEK. With 25% bovine serum, the wear factor of UHMWPE-on-PEEK reduced by half at elevated temperature. When tested in high protein concentration (90% serum), there was no influence of temperature on the wear factor of UHMWPE-on-PEEK. These temperature dependencies were not the same for UHMWPE-on-cobalt chrome. For both material combinations, there was a trend of decreasing friction with increasing protein concentration once protein was present in the lubricant. This study has shown the importance of the selection of appropriate test conditions when investigating the wear and friction of different materials, in order to minimise test artefacts such as polymer transfer, and protein precipitation and deposition.
Collapse
|
12
|
Perino G, Sunitsch S, Huber M, Ramirez D, Gallo J, Vaculova J, Natu S, Kretzer JP, Müller S, Thomas P, Thomsen M, Krukemeyer MG, Resch H, Hügle T, Waldstein W, Böettner F, Gehrke T, Sesselmann S, Rüther W, Xia Z, Purdue E, Krenn V. Diagnostic guidelines for the histological particle algorithm in the periprosthetic neo-synovial tissue. BMC Clin Pathol 2018; 18:7. [PMID: 30158837 PMCID: PMC6109269 DOI: 10.1186/s12907-018-0074-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 08/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The identification of implant wear particles and non-implant related particles and the characterization of the inflammatory responses in the periprosthetic neo-synovial membrane, bone, and the synovial-like interface membrane (SLIM) play an important role for the evaluation of clinical outcome, correlation with radiological and implant retrieval studies, and understanding of the biological pathways contributing to implant failures in joint arthroplasty. The purpose of this study is to present a comprehensive histological particle algorithm (HPA) as a practical guide to particle identification at routine light microscopy examination. METHODS The cases used for particle analysis were selected retrospectively from the archives of two institutions and were representative of the implant wear and non-implant related particle spectrum. All particle categories were described according to their size, shape, colour and properties observed at light microscopy, under polarized light, and after histochemical stains when necessary. A unified range of particle size, defined as a measure of length only, is proposed for the wear particles with five classes for polyethylene (PE) particles and four classes for conventional and corrosion metallic particles and ceramic particles. RESULTS All implant wear and non-implant related particles were described and illustrated in detail by category. A particle scoring system for the periprosthetic tissue/SLIM is proposed as follows: 1) Wear particle identification at light microscopy with a two-step analysis at low (× 25, × 40, and × 100) and high magnification (× 200 and × 400); 2) Identification of the predominant wear particle type with size determination; 3) The presence of non-implant related endogenous and/or foreign particles. A guide for a comprehensive pathology report is also provided with sections for macroscopic and microscopic description, and diagnosis. CONCLUSIONS The HPA should be considered a standard for the histological analysis of periprosthetic neo-synovial membrane, bone, and SLIM. It provides a basic, standardized tool for the identification of implant wear and non-implant related particles at routine light microscopy examination and aims at reducing intra-observer and inter-observer variability to provide a common platform for multicentric implant retrieval/radiological/histological studies and valuable data for the risk assessment of implant performance for regional and national implant registries and government agencies.
Collapse
Affiliation(s)
- G. Perino
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10023 USA
| | - S. Sunitsch
- Medizinische Universität Graz, Institut für Pathologie, Graz, Austria
| | - M. Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - D. Ramirez
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10023 USA
| | - J. Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Olomouc, Czech Republic
| | - J. Vaculova
- Department of Pathology, Fakultni Nemocnice Ostrava, Ostrava, Czech Republic
| | - S. Natu
- Department of Pathology, University hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - J. P. Kretzer
- Labor für Biomechanik und Implantat-Forschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - S. Müller
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| | - P. Thomas
- LMU Klinik, Klinik und Poliklinik für Dermatologie und Allergologie, Munich, Germany
| | - M. Thomsen
- Baden-Baden Klinik, Baden-Baden, Germany
| | | | - H. Resch
- Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Salzburg, Austria
| | - T. Hügle
- Hôpital Orthopédique, Lausanne, Switzerland
| | - W. Waldstein
- Medizinische Universität Wien, AKH-Wien, Universitätsklinik für Orthopädie, Wien, Austria
| | - F. Böettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - T. Gehrke
- Helios Endo-Klinik, Hamburg, Germany
| | - S. Sesselmann
- Orthopädische Universitätsklinik Erlangen, Erlangen, Germany
| | - W. Rüther
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Z. Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - E. Purdue
- Hospital for Special Surgery, Research Institute, New York, NY USA
| | - V. Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| |
Collapse
|
13
|
Li J, Wang K, Li Z, Tu JP, Jin G, Su J, Zhai B. Mechanical tests, wear simulation and wear particle analysis of carbon-based nanomultilayer coatings on Ti6Al4V alloys as hip prostheses. RSC Adv 2018; 8:6849-6857. [PMID: 35540330 PMCID: PMC9078386 DOI: 10.1039/c7ra12080j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 11/21/2022] Open
Abstract
Carbon-based nanomultilayer coatings were deposited on medical-grade Ti6Al4V alloy using a magnetron sputtering technique under a graded bias voltage.
Collapse
Affiliation(s)
- Ji Li
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - Ketao Wang
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - Zhongli Li
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - J. P. Tu
- State Key Laboratory of Materials and Department of Materials Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co
- Economic and Technological Development Zone
- Beijing 100176
- China
| | - Jian Su
- Beijing Institute of Medical Instruments
- Beijing 101111
- China
| | - Bao Zhai
- Beijing Institute of Medical Instruments
- Beijing 101111
- China
| |
Collapse
|
14
|
Maiti R, Cowie RM, Fisher J, Jennings LM. The influence of malalignment and ageing following sterilisation by gamma irradiation in an inert atmosphere on the wear of ultra-high-molecular-weight polyethylene in patellofemoral replacements. Proc Inst Mech Eng H 2017; 231:634-642. [PMID: 28661229 PMCID: PMC5495427 DOI: 10.1177/0954411917696112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complications of patellofemoral arthroplasty often occur soon after implantation and, as well as other factors, can be due to the design of the implant or its surgical positioning. A number of studies have previously considered the wear of ultra-high-molecular-weight polyethylene patellae following suboptimal implantation; however, studies have primarily been carried out under a limited number of degrees of freedom. The aim of this study was to develop a protocol to assess the wear of patellae under a malaligned condition in a six-axis patellofemoral joint simulator. The malalignment protocol hindered the tracking of the patella centrally in the trochlear groove and imparted a constant 5° external rotation (tilt) on the patella button. Following 3 million cycles of wear simulation, this condition had no influence on the wear of ultra-high-molecular-weight polyethylene patellae aged for 4 years compared to well-positioned non-aged implants (p > 0.05). However, under the malaligned condition, ultra-high-molecular-weight polyethylene patellae aged 8-10 years after unpacking (following sterilisation by gamma irradiation in an inert atmosphere) and worn ultra-high-molecular-weight polyethylene components also aged 4 years after unpacking (following the same sterilisation process) exhibited a high rate of wear. Fatigue failure due to elevated contact stress led to delamination of the ultra-high-molecular-weight polyethylene and in some cases complete failure of the patellae. The results suggest that suboptimal tracking of the patella in the trochlear groove and tilt of the patella button could have a significant effect on the wear of ultra-high-molecular-weight polyethylene and could lead to implant failure.
Collapse
Affiliation(s)
- Raman Maiti
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Raelene M Cowie
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| |
Collapse
|
15
|
Tsukamoto M, Ohnishi H, Mori T, Kawasaki M, Uchida S, Sakai A. Fifteen-Year Comparison of Wear and Osteolysis Analysis for Cross-Linked or Conventional Polyethylene in Cementless Total Hip Arthroplasty for Hip Dysplasia-A Retrospective Cohort Study. J Arthroplasty 2017; 32:161-165.e1. [PMID: 27444850 DOI: 10.1016/j.arth.2016.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/05/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cross-linked polyethylene (XLPE) acetabular liners used in cementless total hip arthroplasty (THA) have demonstrated better wear resistance at 10 years compared with conventional polyethylene (CPE) liners. No clinical studies have compared XPLE to CPE liners beyond 10 years. METHODS We performed a 15-year retrospective cohort study on cementless THA performed in patients with developmental hip dysplasia to measure the differences in polyethylene wear rates and the presence of osteolysis. Twenty-four THAs with XLPE and 17 THAs with CPE were evaluated. The mean age of patients was 55.9 years (41-68) in the XLPE group and 54.4 years (40-67) in the CPE group. The mean follow-up period was 15.1 years (13.9-16.1) in the XLPE group and 15.2 years (14.5-16.0) in the CPE group. RESULTS The XLPE group had a significantly lower wear rate at 5 and 10 years compared with the CPE group; however, no significant difference was found at 15 years (XLPE group, 0.040 mm/y; CPE group, 0.034 mm/y). In addition, the incidence of osteolysis did not differ significantly between the groups. However, the incidence of excessive wear between 10 and 15 years after surgery in the XLPE group was significantly higher than that in the CPE group. CONCLUSION XLPE demonstrated no advantage in the wear rate or the incidence of osteolysis at 15 years, despite having superior wear resistance up to 10 years. It is concerning that the incidence of excessive wear was higher in the XLPE group between 10 and 15 years, and this finding should alert the arthroplasty community to this possible problem with the more highly cross-linked polyethylene.
Collapse
Affiliation(s)
- Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hideo Ohnishi
- Department of Orthopaedic Surgery, Moji Medical Center, Kitakyushu, Japan
| | - Toshiharu Mori
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| |
Collapse
|
16
|
Berni M, Lopomo N, Marchiori G, Gambardella A, Boi M, Bianchi M, Visani A, Pavan P, Russo A, Marcacci M. Tribological characterization of zirconia coatings deposited on Ti6Al4V components for orthopedic applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 62:643-55. [PMID: 26952468 DOI: 10.1016/j.msec.2016.02.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/15/2016] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
One of the most important issues leading to the failure of total joint arthroplasty is related to the wear of the plastic components, which are generally made of ultra high molecular weight polyethylene (UHMWPE). Therefore, the reduction of joint wear represents one of the main challenges the research in orthopedics is called to address nowadays. Surface treatments and coatings have been recognized as innovative methods to improve tribological properties, also in the orthopedic field. This work investigated the possibility to realize hard ceramic coatings on the metal component of a prosthesis, by means of Pulsed Plasma Deposition, in order to reduce friction and wear in the standard coupling against UHMWPE. Ti6Al4V substrates were coated with a 2 μm thick yttria-stabilized zirconia (YSZ) layer. The mechanical properties of the YSZ coatings were assessed by nanoindentation tests performed on flat Ti6Al4V substrates. Tribological performance was evaluated using a ball-on-disk tribometer in dry and lubricated (i.e. with fetal bovine serum) highly-stressing conditions, up to an overall distance of 10 km. Tribology was characterized in terms of coefficient of friction (CoF) and wear rate of the UHMWPE disk. After testing, specimens were analyzed through optical microscopy and SEM images, in order to check the wear degradation mechanisms. Progressive loading scratch tests were also performed in dry and wet conditions to determine the effects of the environment on the adhesion of the coating. Our results supported the beneficial effect of YSZ coating on metal components. In particular, the proposed solution significantly reduced UHMWPE wear rate and friction. At 10 km of sliding distance, a wear rate reduction of about 18% in dry configuration and of 4% in presence of serum, was obtained by the coated group compared to the uncoated group. As far as friction in dry condition is concerned, the coating allowed to maintain low CoF values until the end of the tests, with an overall difference of about 40% compared to the uncoated balls. In wet conditions, the friction values were found to be comparable between coated and uncoated materials, mainly due to a premature delamination of the coating. Scratch tests in wet showed in fact a reduction of the critical load required to a complete delamination due to a formation of blister, although no change or damage occurred at the coating during the soaking period. Although conditions of high values of contact pressure were considered, further analyses are however required to fully understand the behavior of YSZ coatings in wet environment and additional research on the deposition process will be mandatory in order to improve the coating tribological performance at long distances addressing orthopedic applications.
Collapse
Affiliation(s)
- M Berni
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy.
| | - N Lopomo
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy; Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, via Branze 38, Brescia, Italy
| | - G Marchiori
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - A Gambardella
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - M Boi
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - M Bianchi
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - A Visani
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - P Pavan
- Dipartimento di Ingegneria Industriale, Centro Interdipartimentale di Ricerca di Meccanica dei Materiali Biologici - CMMB, Università di Padova, Via F. Marzolo 9, Padova 35131, Italy
| | - A Russo
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - M Marcacci
- Laboratorio di NanoBiotecnologie - NaBi, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy; Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| |
Collapse
|
17
|
de Villiers D, Shelton JC. Measurement outcomes from hip simulators. Proc Inst Mech Eng H 2016; 230:398-405. [DOI: 10.1177/0954411916628559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/15/2015] [Indexed: 11/15/2022]
Abstract
Simulation of wear in total hip replacements has been recognised as an important factor in determining the likelihood of clinical success. However, accurate measurement of wear can be problematic with factors such as number and morphology of wear particles produced as well as ion release proving more important in the biological response to hip replacements than wear volume or wear rate alone. In this study, hard-on-hard (CoCr alloy, AgCrN coating) and hard-on-soft (CoCr alloy and CrN coating on vitamin E blended highly cross-linked polyethylene) bearing combinations were tested in an orbital hip simulator under standard and some adverse conditions. Gravimetric wear rates were determined for all bearings, with cobalt and where applicable, silver release determined throughout testing. Isolation of wear particles from the lubricating fluid was used to determine the influence of different bearing combinations and wear conditions on particle morphology. It was found that cobalt and silver could be measured in the lubricating fluid even when volumetric wear was not detectable. In hard-on-hard bearings, Pearson’s correlation of 0.98 was established between metal release into the lubricating fluid and wear volume. In hard-on-soft bearings, coating the head did not influence the polyethylene wear rates measured under standard conditions but did influence the cobalt release; the diameter influenced both polyethylene wear and cobalt release, and the introduction of adverse testing generated smaller polyethylene particles. While hip simulators can be useful to assess the wear performance of a new material or design, measurement of other outcomes may yield greater insight into the clinical behaviour of the bearings in vivo.
Collapse
Affiliation(s)
- Danielle de Villiers
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Julia C Shelton
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| |
Collapse
|
18
|
Hyde PJ, Tipper J, Fisher J, Hall RM. Wear and biological effects of a semi-constrained total disc replacement subject to modified ISO standard test conditions. J Mech Behav Biomed Mater 2014; 44:43-52. [PMID: 25598071 DOI: 10.1016/j.jmbbm.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/21/2014] [Accepted: 12/02/2014] [Indexed: 12/28/2022]
Abstract
Development of pre-clinical testing methodologies is an important goal for improving prediction of artificial replacement joint performance and for guiding future device design. Total disc replacement wear and the potential for osteolysis is a growing concern, therefore a parametric study on the effects on wear of altered kinematics and loading was undertaken. A standard ISO testing protocol was modified in order to study the wear behaviour of lumbar total disc replacements when subject to low cross shear input kinematics, reduced axial loading and smaller flexion-extension magnitude. Volumetric wear, bearing surface topography, and wear debris biological reactivity were assessed. The ISO standard results were expected, however, the very low cross shear test produced a level of wear approximately two orders of magnitude higher than that reported for zero cross shear motions on UHMWPE bearings. When the osteolytic potential of the wear particles was calculated, all total disc replacement simulations had lower predicted osteolytic potential compared to total hip replacements, as a consequence of the generally lower wear rates found.
Collapse
Affiliation(s)
- P J Hyde
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK (Until 30 Oct 2014).
| | - J Tipper
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK (Until 30 Oct 2014)
| | - J Fisher
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK (Until 30 Oct 2014)
| | - R M Hall
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK (Until 30 Oct 2014)
| |
Collapse
|
19
|
In vivo compatibility of Dynesys® spinal implants: a case series of five retrieved periprosthetic tissue samples and corresponding implants. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1074-84. [DOI: 10.1007/s00586-014-3705-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 12/28/2022]
|
20
|
Utzschneider S, Lorber V, Dedic M, Paulus AC, Schröder C, Gottschalk O, Schmitt-Sody M, Jansson V. Biological activity and migration of wear particles in the knee joint: an in vivo comparison of six different polyethylene materials. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1599-1612. [PMID: 24562818 DOI: 10.1007/s10856-014-5176-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Abstract
Wear of polyethylene causes loosening of joint prostheses because of the particle mediated activity of the host tissue. It was hypothesized that conventional and crosslinked polyethylene particles lead to similar biological effects around the knee joint in vivo as well as to a similar particle distribution in the surrounding tissues. To verify these hypotheses, particle suspensions of six different polyethylene materials were injected into knee joints of Balb/C mice and intravital microscopic, histological and immunohistochemical evaluations were done after 1 week. Whereas the biological effects on the synovial layer and the subchondral bone of femur and tibia were similar for all the polyethylenes, two crosslinked materials showed an elevated cytokine expression in the articular cartilage. Furthermore, the distribution of particles around the joint was dependent on the injected polyethylene material. Those crosslinked particles, which remained mainly in the joint space, showed an increased expression of TNF-alpha in articular cartilage. The data of this study support the use of crosslinked polyethylene in total knee arthroplasty. In contrast, the presence of certain crosslinked wear particles in the joint space can lead to an elevated inflammatory reaction in the remaining cartilage, which challenges the potential use of those crosslinked polyethylenes for unicondylar knee prostheses.
Collapse
Affiliation(s)
- S Utzschneider
- Department of Orthopedic Surgery, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Piñol I, Torres A, Gil G, Prats E, Puig-Verdier L, Hinarejos P. Polyethylene particles in joint fluid and osteolysis in revision total knee arthroplasty. Knee 2014; 21:402-5. [PMID: 24238652 DOI: 10.1016/j.knee.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/06/2013] [Accepted: 10/22/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND One of the most frequent reasons for total knee arthroplasty late failure is osteolysis. It has been related to foreign body reaction to polyethylene particles. The aim of this study is to analyse the number, size and morphology of polyethylene particles in synovial fluid in total knee arthroplasty revision and correlate them to the pathology and the degree of osteolysis. METHODS Synovial fluid was obtained in 12 patients before the revision total knee arthroplasty. Polyethylene particles were isolated and analysed through scanning electron microscopy. Samples of synovial tissue were analysed with optical microscopy while considering the parameters of particles and histiocytic infiltration. Osteolysis was analysed with plain radiography and the macroscopic aspect during surgery. RESULTS The statistical analysis showed a significant correlation between a high concentration of polyethylene particles in synovial fluid and a high degree of osteolysis. The concentration of particles in synovial fluid also showed a significant correlation with a high degree of particles and histiocytes in the histological analysis. There was a relationship between the size of particles and the degree of osteolysis. No relationship was found between the shape of the particles and the histological findings or the degree of osteolysis. CONCLUSIONS In an "in vivo" TKA scenario, the presence of a high concentration of polyethylene particles in the synovial fluid seems to be the cause of a highly active foreign body histological reaction, with an increased number of histiocytes, which seems to be the cause of a significant degree of osteolysis around the implant.
Collapse
Affiliation(s)
- Ignasi Piñol
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
| | - Alberto Torres
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Gabriel Gil
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Eva Prats
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Lluis Puig-Verdier
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Pedro Hinarejos
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| |
Collapse
|
22
|
Abstract
We reviewed the literature on the currently available choices of bearing surface in total hip replacement (THR). We present a detailed description of the properties of articulating surfaces review the understanding of the advantages and disadvantages of existing bearing couples. Recent technological developments in the field of polyethylene and ceramics have altered the risk of fracture and the rate of wear, although the use of metal-on-metal bearings has largely fallen out of favour, owing to concerns about reactions to metal debris. As expected, all bearing surface combinations have advantages and disadvantages. A patient-based approach is recommended, balancing the risks of different options against an individual’s functional demands. Cite this article: Bone Joint J 2014;96-B:147–56.
Collapse
Affiliation(s)
- A. Rajpura
- Wrightington Hospital, The Centre
for Hip Surgery, Appley Bridge, Wigan
WN6 9EP, UK
| | - D. Kendoff
- Helios ENDO Klinik, Holstenstr. 2, 22767
Hamburg, Germany
| | - T. N. Board
- Wrightington Hospital, The Centre
for Hip Surgery, Appley Bridge, Wigan
WN6 9EP, UK
| |
Collapse
|
23
|
Maiti R, Fisher J, Rowley L, Jennings LM. The influence of kinematic conditions and design on the wear of patella-femoral replacements. Proc Inst Mech Eng H 2014; 228:175-81. [PMID: 24477888 PMCID: PMC4361355 DOI: 10.1177/0954411913518910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The success rate of patella-femoral arthroplasty varies between 44% and 90% in 17 years of follow-up. Several studies have been performed previously for assessing the surface wear in the patella-femoral joint. However, they have not included all six degrees of freedom. The aim of this study was to develop a six-axis patella-femoral joint simulator to assess the wear rate for two patellae designs (round and oval dome) at different kinematic conditions. An increase in patellar rotation from 1° to 4° led to a significantly (p<0.049) increased wear rate of round dome from 8.6 mm3/million cycles to 12.3 mm3/million cycles. The wear rate for oval dome increased from 6.3 mm3/million cycles to 14.5 mm3/million cycles. However, the increase was nonsignificant (p>0.08). The increase in wear rate was likely due to the higher cross shear. A decrease in patellar medial lateral displacement from passive to constrained resulted in a nonsignificant reduction in wear (p>0.06). There was no significant difference in wear rate between the two patellae designs (p>0.28). The volumetric wear under all conditions was positively correlated with the level of passive patellar tilt (rho>0.8). This is the first report of preclinical wear simulation of patella-femoral joint in a six-axis simulator under different kinematic conditions.
Collapse
Affiliation(s)
- Raman Maiti
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | | | | |
Collapse
|
24
|
Nich C, Takakubo Y, Pajarinen J, Ainola M, Salem A, Sillat T, Rao AJ, Raska M, Tamaki Y, Takagi M, Konttinen YT, Goodman SB, Gallo J. Macrophages-Key cells in the response to wear debris from joint replacements. J Biomed Mater Res A 2013; 101:3033-45. [PMID: 23568608 PMCID: PMC3775910 DOI: 10.1002/jbm.a.34599] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/16/2012] [Accepted: 01/12/2013] [Indexed: 12/14/2022]
Abstract
The generation of wear debris is an inevitable result of normal usage of joint replacements. Wear debris particles stimulate local and systemic biological reactions resulting in chronic inflammation, periprosthetic bone destruction, and eventually, implant loosening, and revision surgery. The latter may be indicated in up to 15% patients in the decade following the arthroplasty using conventional polyethylene. Macrophages play multiple roles in both inflammation and in maintaining tissue homeostasis. As sentinels of the innate immune system, they are central to the initiation of this inflammatory cascade, characterized by the release of proinflammatory and pro-osteoclastic factors. Similar to the response to pathogens, wear particles elicit a macrophage response, based on the unique properties of the cells belonging to this lineage, including sensing, chemotaxis, phagocytosis, and adaptive stimulation. The biological processes involved are complex, redundant, both local and systemic, and highly adaptive. Cells of the monocyte/macrophage lineage are implicated in this phenomenon, ultimately resulting in differentiation and activation of bone resorbing osteoclasts. Simultaneously, other distinct macrophage populations inhibit inflammation and protect the bone-implant interface from osteolysis. Here, the current knowledge about the physiology of monocyte/macrophage lineage cells is reviewed. In addition, the pattern and consequences of their interaction with wear debris and the recent developments in this field are presented.
Collapse
Affiliation(s)
- Christophe Nich
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Laboratoire de Biomécanique et Biomatériaux Ostéo-Articulaires-UMR CNRS 7052, Faculté de Médecine-Université Paris 7, Paris, France; Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique-Hôpitaux de Paris-Université Paris 5, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Highly crosslinked polyethylene does not reduce the wear in total knee arthroplasty: in vivo study of particles in synovial fluid. J Arthroplasty 2013; 28:1333-7. [PMID: 23507066 DOI: 10.1016/j.arth.2013.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/05/2012] [Accepted: 01/21/2013] [Indexed: 02/01/2023] Open
Abstract
The aim was to assess if the reduction in polyethylene wear with highly crosslinked polyethylene suggested by studies with knee simulators is confirmed in patients with a knee arthroplasty. The use of a conventional or a highly crosslinked polyethylene was randomly assigned intraoperatively. Twelve months after surgery a knee arthrocentesis was performed and the synovial fluid of 17 patients in each group was studied analysing the number, size and shape of the polyethylene particles by scanning electron microscope. We found no significant differences in the concentration, size or morphology of polyethylene particles between groups. The great variability in the number of particles between individuals suggests that in vivo polyethylene wear depends on many factors and probably the type of polyethylene is not the most significant.
Collapse
|
26
|
Baxter RM, MacDonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am 2013; 95:e751-9. [PMID: 23780545 PMCID: PMC3748985 DOI: 10.2106/jbjs.k.00522] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wear, oxidation, and particularly rim impingement damage of ultra-high molecular weight polyethylene total disc replacement components have been observed following surgical revision. However, neither in vitro testing nor retrieval-based evidence has shown the effect(s) of impingement on the characteristics of polyethylene wear debris. Thus, we sought to determine (1) differences in polyethylene particle size, shape, number, or biological activity that correspond to mild or severe rim impingement and (2) in an analysis of all total disc replacements, regardless of impingement classification, whether there are correlations between the extent of regional damage and the characteristics of polyethylene wear debris. METHODS The extent of dome and rim damage was characterized for eleven retrieved polyethylene cores obtained at revision surgery after an average duration of implantation of 9.7 years (range, 4.6 to 16.1 years). Polyethylene wear debris was isolated from periprosthetic tissues with use of nitric acid and was imaged with use of environmental scanning electron microscopy. Subsequently, particle size, shape, number, biological activity, and chronic inflammation scores were determined. RESULTS Grouping of particles by size ranges that represented high biological relevance (<0.1 to 1-μm particles), intermediate biological relevance (1 to 10-μm particles), and low biological relevance (>10-μm particles) revealed an increased volume fraction of particles in the <0.1 to 1-μm and 1 to 10-μm size ranges in the mild-impingement cohort as compared with the severe-impingement cohort. The increased volume fractions resulted in a higher specific biological activity per unit particle volume in the mild-impingement cohort than in the severe-impingement cohort. However, functional biological activity, which is normalized by particle volume (mm3/g of tissue), was significantly higher in the severe-impingement cohort. This increase was due to a larger volume of particles in all three size ranges. In both cohorts, the functional biological activity correlated with the chronic inflammatory response, and the extent of rim penetration positively correlated with increasing particle size, number, and functional biological activity. CONCLUSIONS The results of this study suggest that severe rim impingement increases the production of biologically relevant particles from motion-preserving lumbar total disc replacement components. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ryan M. Baxter
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Daniel W. MacDonald
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Marla J. Steinbeck
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| |
Collapse
|
27
|
Baxter RM, MacDonald DW, Kurtz SM, Steinbeck MJ. Characteristics of highly cross-linked polyethylene wear debris in vivo. J Biomed Mater Res B Appl Biomater 2013; 101:467-75. [PMID: 23436587 PMCID: PMC3928672 DOI: 10.1002/jbm.b.32902] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 11/12/2012] [Accepted: 12/20/2012] [Indexed: 12/12/2022]
Abstract
Despite the widespread implementation of highly cross-linked polyethylene (HXLPE) liners to reduce the clinical incidence of osteolysis, it is not known if the improved wear resistance will outweigh the inflammatory potential of HXLPE wear debris generated in vivo. Thus, we asked: What are the differences in size, shape, number, and biological activity of polyethylene wear particles obtained from primary total hip arthroplasty revision surgery of conventional polyethylene (CPE) versus remelted or annealed HXLPE liners? Pseudocapsular tissue samples were collected from revision surgery of CPE and HXLPE (annealed and remelted) liners, and digested using nitric acid. The isolated polyethylene wear particles were evaluated using scanning electron microscopy. Tissues from both HXLPE cohorts contained an increased percentage of submicron particles compared to the CPE cohort. However, the total number of particles was lower for both HXLPE cohorts, as a result there was no significant difference in the volume fraction distribution and specific biological activity (SBA; the relative biological activity per unit volume) between cohorts. In contrast, based on the decreased size and number of HXLPE wear debris there was a significant decrease in total particle volume (mm(3)/g of tissue). Accordingly, when the SBA was normalized by total particle volume (mm(3)/gm tissue) or by component wear volume rate (mm(3)/year), functional biological activity of the HXLPE wear debris was significantly decreased compared to the CPE cohort. Indications for this study are that the osteolytic potential of wear debris generated by HXLPE liners in vivo is significantly reduced by improvements in polyethylene wear resistance.
Collapse
Affiliation(s)
- Ryan M Baxter
- School of Biomedical Engineering, Science & Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | | | | | | |
Collapse
|
28
|
Bladen CL, Teramura S, Russell SL, Fujiwara K, Fisher J, Ingham E, Tomita N, Tipper JL. Analysis of wear, wear particles, and reduced inflammatory potential of vitamin E ultrahigh-molecular-weight polyethylene for use in total joint replacement. J Biomed Mater Res B Appl Biomater 2013; 101:458-66. [PMID: 23436622 PMCID: PMC3798093 DOI: 10.1002/jbm.b.32904] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 11/27/2012] [Accepted: 01/10/2013] [Indexed: 11/12/2022]
Abstract
Vitamin E (VE) has been added to ultrahigh-molecular-weight polyethylene (UHMWPE) acetabular cups and tibial trays primarily to reduce oxidative damage to the polymer. The aim of this study was to investigate the relative wear rates of UHMWPE-containing VE compared with virgin UHMWPE. The ability of VE to reduce the amount of inflammatory cytokines produced from stimulated peripheral blood mononuclear cells (PBMNCs) was also investigated. Stimulation was achieved by exposure of PBMNCs to either lipoplysaccharide (LPS) or VE-containing UHMWPE (VE-UHMWPE). In the present study, results showed that the wear rates of UHMWPE with or without VE were not significantly different. Particles generated by UHMWPE with and without VE were not significantly different in size distribution. The production of osteolytic mediators, tumor necrosis factor-alpha, interleukin 1β (IL-β), IL-6, and IL-8 were significantly reduced in (PBMNCs) stimulated with either LPS + VE compared with LPS or VE-UHMWPE particles compared to virgin UHMWPE particles. This trend was also observed when VE was added as a liquid to UHMWPE wear particle-stimulated PBMNCs. The exact mechanism of how VE affects the release of inflammatory mediators from particle-stimulated macrophages is not yet understood. It is likely to involve the anti-inflammatory and/or antioxidant effects of VE.
Collapse
Affiliation(s)
- C L Bladen
- Institute of Medical and Biological Engineering, University of Leeds, UK.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Fisher J, Al-Hajjar M, Williams S, Jennings LM, Ingham E. In Vitro Measurement of Wear in Joint Replacements: A Stratified Approach for Enhanced Reliability “SAFER” Pre-Clinical Simulation Testing. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2012.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
30
|
Gallo J, Goodman SB, Lostak J, Janout M. Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:204-12. [PMID: 23069885 DOI: 10.5507/bp.2012.063] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 06/13/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ceramic on ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris and accordingly, the occurrence of osteolysis and aseptic loosening especially in younger patients. Based on the excellent tribological behavior of current COC bearings and the relatively low biological activity of ceramic particles, significant improvement in survivorship of these implants is expected. METHODS We used manual search to identify all relevant studies reporting clinical data on COC THAs in PubMed. The objective was to determine whether current COC THA offers a better clinical outcome and survivorship than non-COC THA. RESULTS Studies with early generation ceramic bearings yielded 68% to 84% mean survivorship at 20 years follow-up which is comparable with the survivorship of non-COC THAs. Studies on current ceramic bearings report a 10-year revision-free interval of 92% to 99%. These outcomes are comparable to the survivorship of the best non-COC THAs. However, there are still concerns regarding fracture of sandwich ceramic liners, squeaking, and impingement of the femoral neck on the rim of the ceramic liner leading to chipping, especially in younger and physically active patients. CONCLUSION Current COC THA leads to equivalent but not improved survivorship at 10 years follow-up in comparison to the best non-COC THA. Based on this review, we recommend that surgeons weigh the potential advantages and disadvantages of current COC THA in comparison to other bearing surfaces when considering young very active patients who are candidates for THA.
Collapse
Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
| | | | | | | |
Collapse
|
31
|
Vaupel ZM, Baker KC, Kurdziel MD, Wiater JM. Wear simulation of reverse total shoulder arthroplasty systems: effect of glenosphere design. J Shoulder Elbow Surg 2012; 21:1422-9. [PMID: 22365559 DOI: 10.1016/j.jse.2011.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/08/2011] [Accepted: 10/23/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although early results with reverse total shoulder arthroplasty (rTSA) have been promising, concern exists about the high reported rates of scapular notching and the potential for catastrophic failure of glenoid component fixation. Generation of polyethylene wear debris may also contribute to notching and osteolysis of the scapula. A testing model for polyethylene wear is currently unavailable for reverse shoulder prostheses. The goal of this study was to develop a testing protocol using a commercially available hip simulator. Component design may also influence the generation of polyethylene debris. It is hypothesized that increased polyethylene wear occurs in glenospheres with holes in the articulating surface. MATERIALS AND METHODS Custom fixtures were fabricated to simulate both glenohumeral abduction and flexion on a 12-station hip wear simulator. Loading profiles for both abduction and flexion were alternated every 250,000 cycles for a total of 5 million cycles. Gravimetric analysis of humeral cups throughout the test was used to characterize wear. Lubricant fluid was collected throughout the test and digested for polyethylene particle analysis. RESULTS Comparisons of volumetric wear rates and total volume loss between glenospheres with and without holes and between flexion and abduction loading profiles showed similar results. Particle analysis displayed fibrillar particles with an equivalent circle diameter of 0.3 ± .1 μm and an aspect ratio of 2.5 ± 1.4. CONCLUSIONS This study represents the first wear simulation and particle characterization of reverse shoulder systems. No significant difference in wear was reported between glenospheres with and without holes.
Collapse
Affiliation(s)
- Zachary M Vaupel
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI 48073, USA
| | | | | | | |
Collapse
|
32
|
Brandt JM, MacDonald SJ, Bourne RB, Medley JB. Retrieval analysis of modular total knee replacements: factors influencing backside surface damage. Knee 2012; 19:306-15. [PMID: 21784646 DOI: 10.1016/j.knee.2011.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 05/13/2011] [Accepted: 06/05/2011] [Indexed: 02/02/2023]
Abstract
Retrieved knee implants were examined to investigate the influence of patient and implant related factors on backside damage. Fifty-two implants of three different models were examined that all had cemented tibial trays without screw holes. A semi-quantitative grading system supplied backside damage scores (BDS) for each polyethylene (PE) tibial insert. Evidence was obtained to support the use of a constraining partial-peripheral locking mechanism and polished tibial tray surface (particularly for male patients) to reduce backside damage. Overall, male patients in the present study were associated with higher body mass and higher BDS compared with female patients. Furthermore, PE inserts sterilized by gamma-in-air had higher BDS than PE inserts sterilized in inert environments (gas-plasma or ethylene-oxide). Also, the proximal surfaces of tibial trays that had been grit-blasted showed embedded particles that may have increased backside damage. While none of these overall findings was unexpected, the present study provided detailed supporting analysis based on data from clinical retrievals, which may further support the use of a polished tibial tray combined with partial-peripheral locking mechanism to reduce BDS.
Collapse
Affiliation(s)
- Jan-M Brandt
- Concordia Hip and Knee Institute, Suite 310-1155 Concordia Ave., Winnipeg, MB, Canada R2K 2M9.
| | | | | | | |
Collapse
|
33
|
Ellison P, Tipper JL, Jennings LM, Fisher J. Biological activity of polyethylene wear debris produced in the patellofemoral joint. Proc Inst Mech Eng H 2012; 226:377-83. [PMID: 22720390 DOI: 10.1177/0954411912441316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Polyethylene wear is considered a threat to the long-term survival of total knee replacements. The aim of this study was to investigate the contribution that resurfacing the patella makes to wear debris-induced osteolysis following total knee replacement. Ultra-high molecular-weight polyethylene wear particles were isolated from simulator lubricant. Particle shape, size, and volume distributions were recorded allowing the osteolytic potential of the wear debris produced in the patellofemoral joint to be estimated using the concept of specific biological activity and functional biological activity. Values were compared with those reported for the tibiofemoral joint. Specific biological activity for the patellofemoral joint was not significantly different from the values for the tibiofemoral joint of total knee replacement devices, and therefore, has a similar potential to stimulate osteolytic cytokine release from macrophages. Functional biological activity was significantly lower for the patellofemoral joint compared with the tibiofemoral joint. Functional biological activity was significantly lower for the patellofemoral joint compared with the fixed bearing and rotating platform total knee replacement devices. However, as patellar resurfacing is commonly fitted as part of a total knee replacement system, this results in a 20% increase in overall functional biological activity for the system. Therefore, implanting a patellar resurfacing will increase the potential for osteolysis in the knee.
Collapse
Affiliation(s)
- Peter Ellison
- Department of Surgical Sciences, University of Bergen, Norway.
| | | | | | | |
Collapse
|
34
|
Hinarejos P, Torres A, Piñol I, Valverde D, Prats E, Puig L. Polyethylene particles in synovial fluid after knee arthroplasty with a conventional or highly cross-linked polyethylene. Preliminary study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2011.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
35
|
The John Charnley Award: an accurate and sensitive method to separate, display, and characterize wear debris: part 1: polyethylene particles. Clin Orthop Relat Res 2012; 470:329-38. [PMID: 21997780 PMCID: PMC3254734 DOI: 10.1007/s11999-011-2057-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous studies indicate highly crosslinked polyethylenes reduce the wear debris volume generated by hip arthroplasty acetabular liners. This, in turns, requires new methods to isolate and characterize them. QUESTIONS/PURPOSES We describe a method for extracting polyethylene wear particles from bovine serum typically used in wear tests and for characterizing their size, distribution, and morphology. METHODS Serum proteins were completely digested using an optimized enzymatic digestion method that prevented the loss of the smallest particles and minimized their clumping. Density-gradient ultracentrifugation was designed to remove contaminants and recover the particles without filtration, depositing them directly onto a silicon wafer. This provided uniform distribution of the particles and high contrast against the background, facilitating accurate, automated, morphometric image analysis. The accuracy and precision of the new protocol were assessed by recovering and characterizing particles from wear tests of three types of polyethylene acetabular cups (no crosslinking and 5 Mrads and 7.5 Mrads of gamma irradiation crosslinking). RESULTS The new method demonstrated important differences in the particle size distributions and morphologic parameters among the three types of polyethylene that could not be detected using prior isolation methods. CONCLUSION The new protocol overcomes a number of limitations, such as loss of nanometer-sized particles and artifactual clumping, among others. CLINICAL RELEVANCE The analysis of polyethylene wear particles produced in joint simulator wear tests of prosthetic joints is a key tool to identify the wear mechanisms that produce the particles and predict and evaluate their effects on periprosthetic tissues.
Collapse
|
36
|
Hinarejos P, Torres A, Piñol I, Valverde D, Prats E, Puig L. [Polyethylene particles in synovial fluid after knee arthroplasty with a conventional or highly cross-linked polyethylene. Preliminary study]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 56:210-5. [PMID: 23594808 DOI: 10.1016/j.recot.2011.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022] Open
Abstract
AIM OF THE STUDY In recent years cross-linked polyethylenes have been developed in an attempt to reduce the wear, as has been demonstrated in knee simulators. The aim is to assess, by counting particles of polyethylene in synovial fluid, whether the reduction in wear is confirmed in patients with a highly crosslinked polyethylene prosthesis. MATERIAL AND METHODS A prospective randomised study was designed. During the implantation of a knee prosthesis, one group of patients was assigned the use of a conventional polyethylene (group A), and the other group a highly crosslinked polyethylene (X3, Stryker Orthopaedics) (group B). At 12 months after surgery a knee arthrocentesis was performed, and the number of polyethylene particles was counted in a scanning electron microscopy. Fourteen samples from each group were studied. RESULTS Both groups were comparable in all study variables. We found no significant differences in the concentration of polyethylene particles/ml (1.49 ± 0.85 million in group A vs 1.42 ± 0.91 million in group B, P=.60) or the total number of isolated particles. We found no differences either in size or morphology of particles between both groups. DISCUSSION AND CONCLUSIONS Although several in vitro studies in vitro using different types of highly crosslinked polyethylene found a significant reduction, we did not find that that wear was reduced in the knees of these patients. The great variability in the number of particles between individuals suggests that polyethylene wear in vivo depends on many factors, so perhaps the type of polyethylene is not the most significant factor.
Collapse
Affiliation(s)
- P Hinarejos
- Servicio de Cirugía Ortopédica y Traumatología, Parc de Salut Mar (Hospitales del Mar y Esperanza), Barcelona, España.
| | | | | | | | | | | |
Collapse
|
37
|
An in vitro assessment of wear particulate generated from NUBAC: a PEEK-on-PEEK articulating nucleus replacement device: methodology and results from a series of wear tests using different motion profiles, test frequencies, and environmental conditions. Spine (Phila Pa 1976) 2011; 36:E1675-85. [PMID: 21494194 DOI: 10.1097/brs.0b013e31821ac8a0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro biotribological wear particulate investigation. OBJECTIVE To characterize poly-ether-ether-ketone (PEEK)-OPTIMA wear particulate generated from a series of wear tests used to evaluate the wear resistance and long-term biodurability of NUBAC, a PEEK-on-PEEK articulating nucleus replacement device, and compare with wear particulate associated with hip and knee total joint arthroplasties. SUMMARY OF BACKGROUND DATA The use of PEEK in spinal arthroplasty represents a unique application of this material. Clinically, osteolysis, osteolytic changes, and adverse reactions to metal ions have been documented in spinal arthroplasty. Therefore, it is critically important to analyze the PEEK wear particulate to evaluate its resultant biologic reactivity. Historically, scanning electron microscopy (SEM) has been used for wear debris characterization. Light scattering, specifically laser diffraction, has also been successfully used. The combined use of both techniques may provide a more comprehensive analysis than either method alone. METHODS Proteinacious serum containing PEEK wear debris generated from four groups of devices from separate wear tests underwent enzymatic and acid digestion. The particulate was analyzed using laser diffraction in duplicate, followed by SEM analysis. RESULTS Laser diffraction analysis demonstrated a relatively large mean particle diameter on the basis of particle volume (16.5-40.0 µm) as compared with particle number (0.9-2.2 µm). For all groups, more than 50% of debris was larger than 5.0 µm. SEM analysis revealed a mean particle size consistent with the number-based laser diffraction results. The morphology of the wear particulate appeared to be similar for all the groups analyzed. CONCLUSION The analysis of the particles generated from an articulating PEEK-on-PEEK nucleus replacement device shows debris within size ranges typical of other total joint arthroplasty implants, with relatively round morphology, along with the results suggesting a reduced particle load. These attributes tend to diminish the potential of these PEEK particles to elicit an inflammatory response.
Collapse
|
38
|
Brandt JM, Medley JB, MacDonald SJ, Bourne RB. Delamination wear on two retrieved polyethylene inserts after gamma sterilization in nitrogen. Knee 2011; 18:125-9. [PMID: 20598549 DOI: 10.1016/j.knee.2010.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/16/2010] [Accepted: 03/19/2010] [Indexed: 02/02/2023]
Abstract
Two self-aligning mobile bearing knee replacements (SAL-1) with gamma-in-nitrogen sterilized polyethylene inserts were revised due to instability after 6.3 years and after 14.2 years in vivo in two patients. The predominant damage features were burnishing, cracking, and delamination and were observed on the proximal bearing surface of the retrieved polyethylene inserts. This suggested an association with sub-surface fatigue, perhaps initiated by in vivo oxidative degradation which was confirmed by developing a sub-surface white band in one insert. The damage features observed on the distal bearing surface of the polyethylene inserts suggested both an adhesive wear mechanism and an abrasive wear mechanism. The titanium-nitrite coated, titanium-alloy tibial tray was severely worn in one case and possibly contributed to third-body abrasive wear at the distal surface interface. We suggest to carefully follow-up patients who received this type of mobile bearing knee system.
Collapse
Affiliation(s)
- J-M Brandt
- Concordia Hip and Knee Institute, Suite 310 - 1155 Concordia Ave. Winnipeg, MB, Canada R2K 2M9.
| | | | | | | |
Collapse
|
39
|
Kretzer JP, Jakubowitz E, Reinders J, Lietz E, Moradi B, Hofmann K, Sonntag R. Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 2011; 7:710-5. [PMID: 20883831 DOI: 10.1016/j.actbio.2010.09.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/22/2010] [Accepted: 09/24/2010] [Indexed: 11/16/2022]
Abstract
Unicondylar knee arthroplasty is an attractive alternative to total knee arthroplasty for selected patients with osteoarthritis. Mobile bearing knee designs have been developed to improve knee kinematics, lower contact stresses and reduced wear of ultra-high molecular weight polyethylene compared with fixed bearing designs. This study compared in vitro wear behavior of fixed and mobile unicondylar bearing designs. Analysis was performed using a force-controlled AMTI knee simulator according to ISO 14243-1:2002(E). The wear volume of the implants was determined gravimetrically. Optical surface characterization and an estimation of wear particle size and morphology were performed. Implant kinematic data for both designs were determined. The wear rates averaged 10.7 ± 0.59 mg per 10(6) cycles for the medial and 5.38 ± 0.63 mg per 10(6) cycles for the lateral components of the mobile bearings, compared with 7.51 ± 0.29 mg per 10(6) cycles and 3.04 ± 0.35 mg per 10(6) cycles for the fixed bearings. The mobile bearings therefore exhibited higher wear rates (P<0.01) compared with the fixed bearings. The tibial polyethylene inserts of the mobile bearings showed pronounced backside wear at the inferior surface. The kinematics of both designs was similar. However, anterior-posterior translation was lower in the mobile bearings. The wear particles were mainly elongated and small in size for both designs (P=0.462). This study shows that wear may play an important role in unicondylar mobile bearing knee designs. Advantages of unicondylar mobile designs compared with fixed bearing designs, which have been proposed in terms of wear behavior and improved kinematics, could not be confirmed.
Collapse
Affiliation(s)
- J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopedics, Traumatology and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | | | | | | | | | | | | |
Collapse
|
40
|
Gallo J, Slouf M, Goodman SB. The relationship of polyethylene wear to particle size, distribution, and number: A possible factor explaining the risk of osteolysis after hip arthroplasty. J Biomed Mater Res B Appl Biomater 2010; 94:171-7. [PMID: 20524192 DOI: 10.1002/jbm.b.31638] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The most critical factor in the development of periprosthetic osteolysis (OL) in total hip arthroplasty (THA) is the biological reaction to wear debris. This reaction is dependent, in part, on the size and concentration of particles, which are determined predominantly by the polyethylene (PE) wear rate. This implies that the risk for developing OL and prosthesis failure can be estimated from wear measurements. We developed a computational algorithm for calculating the total number of PE particles for volumetric wear when particle size and distribution are known. We found that: (i) total number of PE wear particles decreases up to 5 orders of magnitude if the average size of particles increases and the total volumetric wear remains constant; (ii) total amount of PE wear particles decreases up to 4 orders of magnitude if the width of the distribution increases and total volumetric wear remains constant; (iii) for the same volumetric wear, the number of particles significantly decreases/increases with the increase/decrease in their average size and range. These findings suggest that the risk for the development of OL in THA cannot be simply estimated from the volumetric wear alone.
Collapse
Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, Teaching Hospital, Palacký University, Olomouc 77520, Czech Republic.
| | | | | |
Collapse
|
41
|
Fregly BJ, Marquez-Barrientos C, Banks SA, DesJardins JD. Increased Conformity Offers Diminishing Returns for Reducing Total Knee Replacement Wear. J Biomech Eng 2010; 132:021007. [DOI: 10.1115/1.4000868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Wear remains a significant problem limiting the lifespan of total knee replacements (TKRs). Though increased conformity between TKR components has the potential to decrease wear, the optimal amount and planes of conformity have not been investigated. Furthermore, differing conformities in the medial and lateral compartments may provide designers the opportunity to address both wear and kinematic design goals simultaneously. This study used a computational model of a Stanmore knee simulator machine and a previously validated wear model to investigate this issue for simulated gait. TKR geometries with different amounts and planes of conformity on the medial and lateral sides were created and tested in two phases. The first phase utilized a wide range of sagittal and coronal conformity combinations to blanket a physically realistic design space. The second phase performed a focused investigation of the conformity conditions from the first phase to which predicted wear volume was sensitive. For the first phase, sagittal but not coronal conformity was found to have a significant effect on predicted wear volume. For the second phase, increased sagittal conformity was found to decrease predicted wear volume in a nonlinear fashion, with reductions gradually diminishing as conformity increased. These results suggest that TKR geometric design efforts aimed at minimizing wear should focus on sagittal rather than coronal conformity and that at least moderate sagittal conformity is desirable in both compartments.
Collapse
Affiliation(s)
- Benjamin J. Fregly
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611-6250; Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611-6131; and Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32611-2727
| | | | - Scott A. Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611-6250; Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611-6131; and Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32611-2727
| | - John D. DesJardins
- Department of Bioengineering, Clemson University, Clemson, SC 29634-0905
| |
Collapse
|
42
|
Williams PA, Brown CM, Tsukamoto R, Clarke IC. Polyethylene wear debris produced in a knee simulator model: Effect of crosslinking and counterface material. J Biomed Mater Res B Appl Biomater 2010; 92:78-85. [DOI: 10.1002/jbm.b.31491] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
43
|
Wirth MA, Klotz C, Deffenbaugh DL, McNulty D, Richards L, Tipper JL. Cross-linked glenoid prosthesis: a wear comparison to conventional glenoid prosthesis with wear particulate analysis. J Shoulder Elbow Surg 2009; 18:130-7. [PMID: 19095186 DOI: 10.1016/j.jse.2008.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 06/25/2008] [Accepted: 06/28/2008] [Indexed: 02/01/2023]
Abstract
Wear debris has been observed in shoulder arthroplasties that use an ultrahigh-molecular weight polyethylene (UHMWPE) glenoid component, and the biologic response to this debris contributes to aseptic loosening of the implant. The objective of this study was to assess the wear and particle morphology of a cross-linked UHMWPE prosthetic glenoid. To our knowledge, this is the first time a simulator with kinematic considerations for assessing wear has been used in a shoulder model. Shoulder wear testing was conducted on 2 groups of glenoids (n = 3 in each group) by use of an orthopaedic joint simulator to create worst-case scenario motions. One group was manufactured from conventional UHMWPE. The second was manufactured from 50-kGy cross-linked UHMWPE. The resulting wear rates for the conventional and cross-linked glenoid components were 46.7 +/- 2.6 mg/million cycles and 7.0 +/- 0.4 mg/million cycles, respectively. Particles isolated from the 2 groups showed similar morphologies; however, the calculated osteolytic potential of the cross-linked glenoid was significantly lower. The results of this study support the use of cross-linked UHMWPE glenoids in clinical applications.
Collapse
Affiliation(s)
- Michael A Wirth
- Department of Orthopaedics, University of Texas, Health Science Center at San Antonio, San Antonio, TX 78284, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Bowsher JG, Williams PA, Clarke IC, Green DD, Donaldson TK. "Severe" wear challenge to 36 mm mechanically enhanced highly crosslinked polyethylene hip liners. J Biomed Mater Res B Appl Biomater 2008; 86:253-63. [PMID: 18412135 DOI: 10.1002/jbm.b.31013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Our purpose was to compare the wear performance of mechanically enhanced 5Mrad highly crosslinked polyethylene (MEP, ArComXL) hip liners to (control) 3Mrad UHMWPE liners (ArCom) in 36 mm head size. As a more severe synergy of clinically relevant test models, we contrasted wear with custom roughened Co-Cr surfaces (Ra 500 nm) to the standard pristine Co-Cr heads (Ra < 20 nm) using a severe microseparation test mode in our hip simulator. We adopted a previously published model to estimate potential biological activity. On new Co-Cr heads, the MEP liners showed a 47% reduction in volumetric wear a 13% reduction in wear particle size and a 27% reduction in Functional Biological Activity (FBA) compared to our control. On rough Co-Cr heads, the MEP liners showed little advantage in terms of volumetric wear compared with the control. However, the MEP liners overall showed a 38% reduction in FBA compared to the control owing to a larger volume fraction of larger particles. Thus overall the MEP liners appeared to offer advantages in terms of reduced FBA indices.
Collapse
Affiliation(s)
- J G Bowsher
- Department of Orthopaedics, Loma Linda University Medical Center, Loma Linda, California 92354, USA
| | | | | | | | | |
Collapse
|
45
|
Teramura S, Sakoda H, Terao T, Endo MM, Fujiwara K, Tomita N. Reduction of wear volume from ultrahigh molecular weight polyethylene knee components by the addition of vitamin E. J Orthop Res 2008; 26:460-4. [PMID: 17975842 DOI: 10.1002/jor.20514] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Wear performance and debris-size distribution of vitamin E (DL-alpha tocopherol, VE)-added ultrahigh molecular weight polyethylene (UHMWPE) was evaluated using a knee-simulator test. VE was mixed with GUR 1050 UHMWPE powder at 0.3 wt%, and the tibial components of the knee joint were made by direct compression molding. The VE-added UHMWPE showed consistently lower wear volume throughout the test.
Collapse
Affiliation(s)
- Satoshi Teramura
- Graduate School of Engineering, Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto, Kyoto 606-8501, Japan
| | | | | | | | | | | |
Collapse
|
46
|
How have wear testing and joint simulator studies helped to discriminate among materials and designs? J Am Acad Orthop Surg 2008; 16 Suppl 1:S111-9. [PMID: 18612005 DOI: 10.5435/00124635-200800001-00022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Historically, hip joint simulators most often have been used to model wear of a bearing surface against a bearing surface. These simulators have provided highly accurate predictions of the in vivo wear of a broad spectrum of bearing materials, including cross-linked polyethylenes, metal-on-metal, ceramic-on-ceramic, and others in development. In recent years, more severe conditions have been successfully modeled, including jogging, stair climbing, ball-cup micro separation, third-body abrasion, and neck-socket impingement. These tests have served to identify improved materials and to eliminate some with inadequate wear resistance prior to their clinical use. Simulation of the knee joint is inherently more complex than it is for the hip. It is more difficult to compare the results of laboratory tests with actual clinical performance, due to the lack of accurate in vivo measures of wear. Nevertheless, knee simulators, based on force control or motion control, have successfully reproduced the type of surface damage that occurs in vivo (eg, burnishing, scratching, pitting) as well as the size and shapes of the resultant wear particles. Knee simulators have been used to compare molded versus machined polyethylene components, highly cross-linked polyethylenes, fixed versus mobile bearings, and oxidized zirconia and other materials, under optimal conditions as well as more severe wear modes, such as malalignment, higher loading and activity levels, and third-body roughening.
Collapse
|
47
|
In vitro simulation and quantification of wear within the patellofemoral joint replacement. J Biomech 2008; 41:1407-16. [DOI: 10.1016/j.jbiomech.2008.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 02/17/2008] [Accepted: 02/19/2008] [Indexed: 12/28/2022]
|
48
|
Galvin AL, Tipper JL, Jennings LM, Stone MH, Jin ZM, Ingham E, Fisher I. Wear and biological activity of highly crosslinked polyethylene in the hip under low serum protein concentrations. Proc Inst Mech Eng H 2007; 221:1-10. [PMID: 17315763 DOI: 10.1243/09544119jeim99] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Crosslinked ultra-high molecular weight polyethylene (UHMWPE) has been developed and introduced into clinical practice in order to reduce wear in the hip. Zero wear of highly crosslinked UHMWPE in vitro has been reported by some groups using lubricants with high concentrations of serum proteins in hip simulators. In contrast, some clinical studies have reported finite wear rates. The aim of this study was to compare the wear rates, wear surfaces, and wear debris produced by UHMWPE with different levels of crosslinking in a hip joint simulator, with lower, more physiologically relevant concentrations of protein in the lubricant. The UHMWPEs were tested in the Leeds ProSim hip joint simulator against cobalt-chromium (CoCr) femoral heads. The wear particles were isolated and imaged using a field emission gun scanning electron microscope (FEGSEM) at high resolution. The highly crosslinked UHMWPEs had significantly lower wear volumes than the non-crosslinked UHMWPEs. No significant difference was found in the percentage number and percentage volume of the particles in different size ranges from any of the materials. They had similar values of specific biological activity. The functional biological activity (FBA), which takes into account the wear volume and specific biological activity, showed that the highly crosslinked UHMWPEs had lower FBAs due to their lower wear volume.
Collapse
Affiliation(s)
- A L Galvin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
The tribological performance and biological activity of the wear debris produced has been compared for highly cross-linked polyethylene, ceramic-on-ceramic, metal-on-metal, and modified metal bearings in a series of in vitro studies from a single laboratory. The functional lifetime demand of young and active patients is 10-fold greater than the estimated functional lifetime of traditional polyethylene. There is considerable interest in using larger diameter heads in these high demand patients. Highly cross-linked polyethylene show a four-fold reduction in functional biological activity. Ceramic-on-ceramic bearings have the lowest wear rates and least reactive wear debris. The functional biological activity is 20-fold lower than with highly cross-linked polyethylene. Hence, ceramic-on-ceramic bearings address the tribological lifetime demand of highly active patients. Metal-on-metal bearings have substantially lower wear rates than highly cross-linked polyethylene and wear decreases with head diameter. Bedding in wear is also lower with reduced radial clearance. Differential hardness ceramic-on-metal bearings and the application of ceramic-like coatings reduce metal wear and ion levels.
Collapse
Affiliation(s)
- John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK.
| | | | | | | | | |
Collapse
|
50
|
Visentin M, Stea S, Squarzoni S, Reggiani M, Fagnano C, Antonietti B, Toni A. Isolation and characterization of wear debris generated in patients wearing polyethylene Hylamer inserts, gamma irradiated in air. J Biomater Appl 2006; 20:103-21. [PMID: 16183672 DOI: 10.1177/0885328205049407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hylamer polyethylene was used in the early 1990s to make hip-joint components. Clinical experience has shown that these components, if sterilized by gamma rays in the presence of oxygen, are easily affected by wear, which then leads to osteolysis. The authors analyzed polyethylene wear particles in seven patients who had received Hylamer polyethylene implants sterilized by gamma rays in air and had suffered prosthetic loosening. The results were compared to those of six controls, who had received traditional polyethylene implants, sterilized by the same method. The frequency distribution of globular and fibrillar particles was similar in both groups (38.5% in Hylamer, 45.2% in controls). The globular particles in the Hylamer samples had a mean area of 0.12 microm2, which was significantly lesser than that of the controls (0.30 microm2). The width of fibrillar particles in the Hylamer samples was significantly lesser than that of the controls. Therefore, the two materials, despite undergoing the same type of sterilization, produced different types of wear, due to their different properties. In conclusion, the difference in the morphology of Hylamer polyethylene wear particles in comparison with PCA might have caused a more intensive biological response, early and massive osteolysis, and therefore, early loosening.
Collapse
Affiliation(s)
- M Visentin
- Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, Bologna 40136, Italy.
| | | | | | | | | | | | | |
Collapse
|