Sliding wear studies of selected nitride coatings and their potential for long-term use in orthopaedic applications

Bioactive coatings for orthopaedic implants-recent trends in development of implant coatings

Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants.

Laser processed TiN reinforced Ti6Al4V composite coatings

The purpose of this first generation investigation is to evaluate fabrication, in vitro cytotoxicity, cell-material interactions and tribological performance of TiN particle reinforced Ti6Al4V composite coatings for potential wear resistant load bearing implant applications. The microstructural analysis of the composites was performed using scanning electron microscope and phase analysis was done with X-ray diffraction. In vitro cell-material interactions, using human fetal osteoblast cell line, have been assessed on these composite coatings and compared with Ti6Al4V alloy control samples. The tribological performance of the coatings were evaluated, in simulated body fluids, up to 1000 m sliding distance under 10 N normal load. The results show that the composite coatings contain distinct TiN particles embedded in α+β phase matrix. The average top surface hardness of Ti6Al4V alloy increased from 394±8 HV to 1138±61 HV with 40 wt% TiN reinforcement. Among the composite coatings, the coatings reinforced with 40 wt% TiN exhibited the highest wear resistance of 3.74×10(-6) mm(3)/Nm, which is lower than the wear rate, 1.04×10(-5) mm(3)/Nm, of laser processed CoCrMo alloy tested under identical experimental conditions. In vitro biocompatibility study showed that these composite coatings were non-toxic and provides superior cell-material interactions compared to Ti6Al4V control, as a result of their high surface energy. In summary, excellent in vitro wear resistance and biocompatibility of present laser processed TiN reinforced Ti6Al4V alloy composite coatings clearly show their potential as wear resistant contact surfaces for load bearing implant applications.

Delamination wear on two retrieved polyethylene inserts after gamma sterilization in nitrogen

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.

Abrasion resistance of oxidized zirconium in comparison with CoCrMo and titanium nitride coatings for artificial knee joints

Most total knee replacement joints consist of a metal femoral component made from a cobalt-chromium- molybdenum (CoCrMo)-alloy and a tibial component with an ultrahigh molecular weight polyethylene (UHMWPE) bearing surface. Wear of the UHMWPE remains the primary disadvantage of these implants. The allergic potential ascribed to CoCrMo-alloys is a further concern. Other metallic alloys with and without ceramic coatings are clinically used to avoid these problems. This study compared the mechanical surface properties of an oxidized zirconium alloy with those of cast and wrought CoCrMo and TiAlV6-4. Additionally, the influence of a titanium nitride (TiN)-plasma coating on the surface properties was investigated. The composition of the oxidized zirconium layer was analyzed. Micro- and macrohardness tests as well as adhesion tests were used to reveal material differences in terms of their abrasive wear potential in artificial joints.

Potential for adhesive wear in friction couples of UHMWPE running against oxidized zirconium, titanium nitride coatings, and cobalt-chromium alloys

The classical wear mechanisms abrasion, fatigue, and adhesion are the most frequent causes of surface changes of ultra high molecular weight polyethylene (UHMWPE) in artificial joints. The counterpart material has a strong influence on the wear and friction behavior of artificial joints due to its abrasive properties and adhesive interaction with UHMWPE. The formation of a transfer layer on the counterpart in UHMWPE bearing systems is often described as being a clear indication of strong adhesive forces. The influence of using a cobalt-chromium-molybdenum (CoCrMo) alloy, a titanium nitride plasma coating or an oxidized zirconium alloy on adhesive wear was studied. The surface free energy and the bonding forces of these counterpart materials to UHMWPE were investigated. Catalytic effects on the degradation behavior of polyethylene, the micro friction behavior, and the build-up and constitution of a transfer layer deposited under loads, and relative velocities that are relevant in knee joints were analyzed.

Improvement in the assessment of wear of total knee replacements using coordinate-measuring machine techniques

Total joint replacement is one of the most common elective surgical procedures performed worldwide, with an estimate of 1.5×106 operations performed annually. Currently joint replacements are expected to function for 10–15 years; however, with an increase in life expectancy, and a greater call for knee replacement due to increased activity levels, there is a requirement to improve their function to offer longer-term improved quality of life for patients.

Wear analysis of total joint replacements has long been an important means in determining failure mechanisms and improving longevity of these devices. The effectiveness of the coordinate-measuring machine (CMM) technique for assessing volumetric material loss during simulated life testing of a replacement knee joint has been proved previously by the present authors. The purpose of the current work is to present an improvement to this method for situations where no pre-wear data are available.

To validate the method, simulator tests were run and gravimetric measurements taken throughout the test, such that the components measured had a known wear value. The implications of the results are then discussed in terms of assessment of joint functionality and development of standardized CMM-based product standards. The method was then expanded to allow assessment of clinically retrieved bearings so as to ascertain a measure of true clinical wear.

A physical vapor deposition method for controlled evaluation of biological response to biomaterial chemistry and topography

The purpose of this study was to characterize a technique to effectively mask surface chemistry without modifying surface topography. A thin layer of titanium was deposited by physical vapor deposition (PVD) onto different biomaterial surfaces. Commercially pure titanium disks were equally divided into three groups. Disks were either polished to a mirror finish, grit blasted with alumina particles, or grit blasted and subsequently plasma sprayed with a commercial grade of hydroxyapatite (HA). A subgroup of each of these treatment types was further treated by masking the entire disk surface with a thin layer of commercially pure titanium deposited by PVD. A comparison of surface topography and chemical composition was carried out between disks within each treatment group. Canine marrow cells were seeded on all disk surfaces to determine the stability of the PVD Ti mask under culture conditions. The PVD process did not significantly alter the surface topography of any samples. The thin titanium layer completely masked the underlying chemistry of the plasma sprayed HA surface and the chemistry of the plasma vapor deposited titanium layer did not differ from that of the commercially pure titanium disks. Aliquots obtained from the media during culture did not indicate any significant differences in Ti concentration amongst the Ti and Ti-masked surfaces. The PVD application of a Ti layer on HA coatings formed a stable, durable, and homogenous layer that effectively masked the underlying surface chemistry without altering the surface topography.

Vascular graft infections:In vitro andin vivo investigations of a new vascular graft with long-term protection

We investigated a polyester vascular prosthesis (PET) coated with elemental silver (SC). Measurement of silver release over a period of 52 weeks by means of inductively coupled plasma atomic emission spectrometry of PET with (PET-G) and without (PET-N) gelatine impregnation revealed a silver release on the first day of 1.2 +/- 0.2 microg (PET-N) and 1.2 +/- 0.1 microg (PET-G) (calculated for 1 g of prosthesis); from the 90th day onward, it was between 0.22 +/- 0.14 microg (PET-N) and 0.18 +/- 0.12 microg (PET-G) per day. The prostheses were incubated with Staphylococcus aureus (S.a.), Staphylococcus epidermidis (S.e.), or Escherichia coli (E.c.) to investigate in vitro antibacterial efficacy. After 6 h of incubation, no colony-forming units were to be seen for any of the bacterial suspensions for PET with SC (p < 0.001). To investigate in vivo antibacterial efficacy, PET-G rings with and without SC contaminated with S.a., S.e., or E.c. were implanted in 18 albino rabbits and examined 7 days after agar culture for 48 h. The silver coating was associated with a significant reduction in bacterial growth (S.a., p = 0.001; S.e., p < 0.005; E.c., p < 0.001). The silver-coated prosthesis, with and without gelatine impregnation, had a significantly antibacterial effect with continuous release of silver.

Importance of pin geometry on pin-on-plate wear testing of hard-on-hard bearing materials for artificial hip joints

The contact mechanics between the pin and the plate used in simple wear screening tests were investigated in this study. Both soft-on-hard, such as ultra-high molecular weight polyethylene (UHMWPE)-on-metal or UHMWPE-on-ceramic, and hard-on-hard, such as metal-on-metal, bearing couples were considered. The effect of the pin geometry and the misalignment between the pin and the plate were investigated on the predicted contact pressure distribution at the bearing surfaces using the finite element method. It was demonstrated that in the case of soft-on-hard bearing couples, neither the geometrical discontinuity of the pin surface nor the misalignment could cause a significant increase in the contact stress. However, for hard-on-hard combinations, even with a very small misalignment of 0.5 degrees between the pin and the plate, the geometrical discontinuity could lead to a more than tenfold increase in the predicted contact stress. This elevated contact stress may lead to a large scatter in the wear data and, even more importantly, structural damage of the bearing surfaces.

The in-vivo wear performance of prosthetic femoral heads with titanium nitride coating

This paper reports the study performed on four titanium nitride (TiN) coated prosthetic femoral heads collected at revision surgery together with patient data. Surface topology has been examined using Scanning Electron Microscopy (SEM) and elemental analysis of both coating and substrate have been evaluated using energy-dispersive X-ray spectrometry. Quantitative assessment of the surface topography is achieved using contacting profilometry. The average Ra roughness value is calculated at five different locations for each femoral head. The UHMWPE counterface worn volume has been measured directly on the acetabular components. TiN fretting and coating breakthrough occurred in two of the four components examined. In the damaged coating areas the surface profile is macroscopically saw-toothed with average tooth height 1.5 microm. The average Ra value is 0.02 microm on the undamaged surfaces and 0.37 microm on the damaged ones. Failure of the coating adhesion resulted in the release of TiN fragments and of metallic particulate from the substrate fretting corrosion and in the increase of the head surface roughness affecting counterface debris production. Our results suggest that TiN-coated titanium alloy femoral heads are inadequate in the task of resisting third body wear mechanisms in vivo.