Wear of Artificial Joint Materials I

Hip simulator testing of the taper-trunnion junction and bearing surfaces of contemporary metal-on-cross-linked-polyethylene hip prostheses

Adverse reaction to metal debris released from the taper-trunnion junction of modular metal-on-polyethylene (MoP) total hip replacements (THRs) is an issue of contemporary concern. Therefore, a hip simulator was used to investigate material loss, if any, at both the articulating and taper-trunnion surfaces of five 32-mm metal-on-cross-linked-polyethylene THRs for 5 million cycles (Mc) with a sixth joint serving as a dynamically loaded soak control. Commercially available cobalt-chromium-molybdenum femoral heads articulating against cross-linked polyethylene (XLPE) acetabular liners were mounted on 12/14 titanium (Ti6Al4V) trunnions. Weight loss (mg) was measured gravimetrically and converted into volume loss (mm³ ) for heads, liners, and trunnions at regular intervals. Additionally, posttest volumetric wear measurements of the femoral tapers were obtained using a coordinate measuring machine (CMM). The surface roughness (Sa) of femoral tapers was measured posttest. After 5 Mc, the mean volumetric wear rate for XLPE liners was 2.74 ± 0.74 mm³ /Mc. The CMM measurements confirmed material loss from the femoral taper with the mean volumetric wear rate of 0.045 ± 0.024 mm³ /Mc. The Sa on the worn area of the femoral taper showed a significant increase (p < 0.001) compared with the unworn area. No other long-term hip simulator tests have investigated wear from the taper-trunnion junction of contemporary MoP THRs. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:156-166, 2020.

Wear of Artificial Joint Materials II

A twelve-channel wear machine was designed for the screening of candidate materials for use in prosthetic joints, and for investigating the influence of parameters such as load, cycling rate, surface finish, sterilization dosage, and others, on the wear of conventional materials. The rationale for the design of the machine is discussed In detail with respect to the practice of using data obtained with a simplified specimen geometry to predict wear under the widely varying contact geometries in actual prosthetic joints. Three sets of experiments are described:

(a) a comparison of polyethylene wear properties in the various lubricants used in previous studies, (b) tests of polyethylene against conventional prosthetic alloys to evaluate the accuracy and repeatability of the wear measurement method, and (c) a comparison of the wear properties of several polymers tested in the screening machine to the clinical performance of these materials, to evaluate the clinical significance of the laboratory test protocol.

The wear machine was found to be a very reliable apparatus for providing reproducible data. The simplicity of design and its inherent reliability enabled long-term, multi-specimen tests with a variety of materials to be conducted in a reasonably short time period. Of the lubricants tested, only bovine blood serum produced wear of the same type as that observed on removed prostheses. This was considered to be an essential factor in laboratory wear tests of prosthetic materials.

Wear was determined by direct weighing of the polymer specimens with correction for the effects of fluid absorption. The data thus obtained had a much higher repeatability than has been typical of previous studies of wear properties of prosthetic materials. Nevertheless, tests lasting two to three million cycles were necessary to establish accurately the very low wear rate of the polyethylene specimens, in the order of one micron per year's equivalent use of a prosthesis. This was in contrast to the range of 100-200 microns per year that has been commonly reported in the literature. However, consideration of the potential error, especially due to polymer creep, in previous wear measurement methods suggests that the value of one micron per year may in fact represent a minimum for prostheses under optimal conditions. Polyester, PTFE and Delrin polyacetal all exhibited significantly higher wear rates than polyethylene. A comparison of these results with the available data on prior clinical performance of these polymers strongly indicates that the laboratory wear model developed here provides a first-stage quantitative indication of the potential clinical performance of candidate materials.

Y-TZP zirconia run against highly crosslinked UHMWPE tibial inserts: knee simulator wear and phase-transformation studies

BACKGROUND

Zirconia (ZrO(2)) ceramics combined with highly cross-linked polyethylene appears to be a promising approach to minimize wear in artificial knee joints. The wear performance of yttria-stabilized zirconia (YZr) femoral condyles on 7-Mrad tibial inserts was compared in a knee simulator to CoCr bearing on 3.5-Mrad inserts.

METHODS

The knee design was the Bi-Surface type with a 9-year clinical history in Japan (JMM, Japan). A displacement-controlled knee simulator was used with kinematics that included 20 degrees flexion, +/-5 degrees rotation, and 6 mm anterior/posterior translation. Lubricant was alpha-calf serum, test duration was 10 million cycles (10 Mc), and wear was measured by weight-loss techniques. The wear zones were studied by laser interferometry, scanning electron microscopy, and Raman microprobe spectroscopy.

RESULTS

At 10 Mc the wear rates of the CoCr controls averaged 4.5 mm(3)/Mc. This was within 7% of the prior estimate at 5-Mc duration and comparable to Bi-Surface wear data from another laboratory. The CoCr condyles increased in roughness (R(a)) from <50 nm to average R(a) = 250 nm due to linear scratching. The ceramic condyles remained pristine throughout the wear study (R(a) <7 nm). With the YZr/7-Mrad combination, the weight change had a positive slope over at 10 Mc, which meant that the actual polyethylene wear was unmeasurable. Microscopic examinations at 10 Mc showed that the zirconia surfaces were intact and there was no detectable change from tetragonal to monoclinic phase.

INTERPRETATION

Our laboratory knee wear simulation appeared very supportive of the 9-year YZr/PE clinical results with Bi-Surface total knee replacements in Japan.

Laboratory studies on the tribology of hard bearing hip prostheses: Ceramic on ceramic and metal on metal

Total hip replacements offer relief to a great many patients every year around the world. With an expected service life of around 25 years on most devices, and with younger and younger patients undergoing this surgery, it is of great importance to understand the mechanisms of their function. Tribological testing of both conventional and hard bearing joint combinations have been conducted in many centres throughout the world, and, after being initially abandoned owing to premature failures, hard bearing combinations have been revisited as viable options for joint replacements. Improved design, manufacturing procedures, and material compositions have led to improved performance over first-generation designs in both metal-on-metal and ceramic-on-ceramic hip prostheses. This paper offers a review of the work conducted in an attempt to highlight the most important factors affecting joint performance and tribology of hard bearing combinations. The tribological performance of these joints is superior to that of conventional metal- or ceramic-on-polymer designs.

Micro-wear patterns on UHMWPE tibial inserts in total knee joint simulation

The objective of this study was to examine both simulator and retrieved total knee replacement polyethylene inserts to confirm, using scanning electron microscopy, whether similar micro-wear patterns to those seen on retrieved inserts were reproduced on simulator specimens. The simulator specimens consisted of samples subjected to sliding and rolling movement (Experiment 1) and to sliding movement only (Experiment 2). Samples from Experiment 1 demonstrated longitudinal patterns in the middle of the wear track and transverse patterns in the anterior and posterior ends, whereas in Experiment 2, only transverse patterns were observed. In the retrieved specimens, both longitudinal and transverse patterns were observed. The results showed that the simulator study reproduced similar patterns of micro-damage on polyethylene, and that the longitudinal micro-wear pattern was related to the rolling movement that is distinctive in knee kinematics.

Effects of A-P translation and rotation on the wear of UHMWPE in a total knee joint simulator

We developed a three-channel total knee joint simulator and studied the effect of tibial anterior-posterior translation and internal/external rotation on the wear of polyethylene tibial inserts in total knee replacements (Anatomic Graduated Component knees). The wear rate was the lowest in experiment (Exp.) 1, without translation and rotation [1.74 mg/million (mg/Mc) cycles]. In Exp. 2, with +/-5 degrees tibial rotation added, the wear rate increased to 10.6 mg/Mc. In Exp. 3, with rotation and -12 mm tibial translation added, the wear rate was 15.1 mg/Mc, whereas in Exp. 4, with rotation and +12 mm tibial translation, the wear rate was 18.7 mg/Mc. Internal/external rotation and anterior-posterior translation added a 6- to 11-fold increase in the wear rates of tibial knee inserts. The shapes of the tibial wear tracks were rectangular and the area of the track increased when rotation and translation were added.

Step activity monitor: increased accuracy in quantifying ambulatory activity

This study compares the accuracy of a two-dimensional accelerometer worn on the ankle (a step activity monitor) with that of an electronic, digital pedometer worn on the belt line. Twenty-nine human subjects were evaluated while they briskly walked 400 M, slowly walked 10 M, and ascended and descended a flight of stairs. The step activity monitor had less error in all activities; its mean absolute error was 0.54%, whereas that of the pedometer was 2.82%. The difference was more pronounced in obese subjects (body mass index greater than 30), with an overall mean absolute error of 0.48% for the step activity monitor and 6.12% for the pedometer (nearly 13 times that of the step activity monitor). For subjects with a body mass index less than 30, the step activity monitor had an overall error of 0.56% and the pedometer had an overall error of 1.56% (less than 3 times that of the step activity monitor). The absolute error of the pedometer was positively correlated with body mass index (r = 0.792, p < 0.0001) and weight (r = 0.753, p < 0.0001), whereas the error of the step activity monitor was not significantly correlated with either. Neither device was significantly biased by age, gender, or the presence of a lower-extremity joint prosthesis. The accuracy and additional capabilities, including a real-time memory record of activity, of the step activity monitor make it well suited for objectively quantifying ambulatory activity, especially for obese subjects.

Wear testing of materials and surfaces for total knee replacement

A simple wear test was investigated for evaluating the wear and damage of material pairs when used in total knee replacement. The test consisted of an axially loaded metallic femoral indentor and a reciprocating ultrahigh molecular weight polyethylene (UHMWPE) flat disk that represented the tibial component. A number of variables were studied including the effect of conformity by varying the radii of the femoral surface, distilled water or serum as a lubricant, different femoral materials, and different types of UHMWPE. In general, the different morphologies of the surface wear of the UHMWPE were similar to those seen on retrieved total knee replacements. Increased conformity with a cylindrical indentor gave a reduced wear rate initially, compared with that of the lower conformity spherical indentor. However, the wear rates were similar subsequent to this initial wearing in phase. Transfer films of UHMWPE were observed on the cobalt-chrome indentors for both serum and distilled water lubrication, although this film was more extensive for distilled water. The lowest wear rate was observed when oxidized zirconium was used on the femoral side, which was attributed to greater wettability, surface hardness, and immunity to oxidative wear. Tests using cobalt-chrome femoral cylinders and different grades of UHMWPE showed different wear rates. Of these PEs, GUR 415 showed less wear than both RCH 1000 and UHMWPE containing numerous fusion defects. For the latter, wear was attributed to a fatigue mechanism, although in most cases it was associated with surface phenomena rather than subsurface cracking. However, in some specimens of UHMWPE subsurface crack propagations occurred with defects. The test method is discussed in relation to its applicability to the evaluation and comparison of bearing materials and surfaces, with particular application to total knee replacements.

Tribology of total artificial joints

The tribology of total artificial replacement joints is reviewed. The majority of prosthesis currently implanted comprise a hard metallic component which articulates on ultra high molecular weight polyethylene surface. These relatively hard bearing surfaces operate with a mixed or boundary lubrication regime, which results in wear and wear debris from the ultra high molecular weight polyethylene surface. This debris can contribute to loosening and ultimate failure of the prostheses. The tribological performance of these joints has been considered and a number of factors which may contribute to increased wear rates have been identified. Cushion bearing surfaces consisting of low elastic modulus materials which can articulate with full fluid film lubrication are also described. These bearing surfaces have shown the potential for greatly reducing wear debris.

Wear studies on prosthetic materials using the pin-on-disc machine

The wear of ultra high molecular weight polyethylene in combination with cobalt-chromium-molybdenum alloy was investigated by pin-on-disc experiments in which the alloy pin was loaded against the rotating polyethylene disc. In some experiments the pin was stationary, but in others it rotated about its axis. The effect of lubricant type, pin rotation, magnitude of the applied load, magnitude of the relative surface velocity, and disc storage in various environments was investigated. Wear of the polyethylene was assessed at 100 h intervals by both volumetric and gravimetric methods. Each experiment lasted 1000 h. It was concluded that of the lubricants tested bovine serum was the most suitable and that pin rotation produced more suitable polyethylene surfaces than did the stationary pin. The wear rate increased slightly with load (possibly owing to creep), was insensitive to speed, and was not affected by disc storage. The dynamic coefficient of friction increased with running tme. Results obtained by the two wear assessment methods were comparable and the reproducibility of the results was good.