Synthetic PVA Osteochondral Implants for the Knee Joint: Mechanical Characteristics During Simulated Gait

BACKGROUND

Although polyvinyl alcohol (PVA) implants have been developed and used for the treatment of femoral osteochondral defects, their effect on joint contact mechanics during gait has not been assessed.

PURPOSE/HYPOTHESIS

The purpose was to quantify the contact mechanics during simulated gait of focal osteochondral femoral defects and synthetic PVA implants (10% and 20% by volume of PVA), with and without porous titanium (pTi) bases. It was hypothesized that PVA implants with a higher polymer content (and thus a higher modulus) combined with a pTi base would significantly improve defect-related knee joint contact mechanics.

STUDY DESIGN

Controlled laboratory study.

METHODS

Four cylindrical implants were manufactured: 10% PVA, 20% PVA, and 10% and 20% PVA disks mounted on a pTi base. Devices were implanted into 8 mm-diameter osteochondral defects created on the medial femoral condyles of 7 human cadaveric knees. Knees underwent simulated gait and contact stresses across the tibial plateau were recorded. Contact area, peak contact stress, the sum of stress in 3 regions of interest across the tibial plateau, and the distribution of stresses, as quantified by tracking the weighted center of contact stress throughout gait, were computed for all conditions.

RESULTS

An osteochondral defect caused a redistribution of contact stress across the plateau during simulated gait. Solid PVA implants did not improve contact mechanics, while the addition of a porous metal base led to significantly improved joint contact mechanics. Implants consisting of a 20% PVA disk mounted on a pTi base significantly improved the majority of contact mechanics parameters relative to the empty defect condition.

CONCLUSION

The information obtained using our cadaveric test system demonstrated the mechanical consequences of femoral focal osteochondral defects and provides biomechanical support to further pursue the efficacy of high-polymer-content PVA disks attached to a pTi base to improve contact mechanics.

CLINICAL RELEVANCE

As a range of solutions are explored for the treatment of osteochondral defects, our preclinical cadaveric testing model provides unique biomechanical evidence for the continued investigation of novel solutions for osteochondral defects.

Self-regenerating compliance and lubrication of polyacrylamide hydrogels

Pristine hydrogel surfaces typically have low friction, which is controlled by composition, slip speeds, and immediate slip history. The stiffness of such samples is typically measured with bulk techniques, and is assumed to be homogeneous at the surface. While the surface properties of homogeneous hydrogel samples are generally controlled by composition, the surface also interfaces with the open bath, which distinguishes it from the bulk. In this work, we disrupt as-molded polyacrylamide surfaces with abrasive wear and connect the effects on the surface stiffness and lubrication to the wear events. At both the nanoscale and the microscale, quasistatic indentations reveal a stiffer surface by up to two times following wear events, even considering roughness. Longitudinal experiments with a series of wear episodes interposed with periods of re-equilibration show that increased stiffness is reversible: more compliant surfaces regenerate within 24 hours. The timescale suggests an osmotic swelling mechanism, and we postulate that abrasive wear removes a swollen surface layer, revealing the stiffer bulk. The newly-revealed bulk becomes the surface, which re-swells over time. We quantify the effects on the self-lubricating ability of these surfaces following abrasive wear using micro-tribometry. The lubrication curve shows that robust low friction is maintained, and that the friction becomes less dependent upon the sliding speed. The unique ability of these materials to regenerate swollen surfaces and maintain robust low friction following abrasive wear is promising for designing their slip behavior into aqueous soft robotics components or biomedicine applications.

THE EFFECT OF THE FORMATION OF POLYMER /SURFACTANT COMPLEXES ON SELECTED TRIBOLOGICAL PROPERTIES OF THEIR AQUEOUS SOLUTIONS

Aqueous solutions of sodium alkyl sulphate (surfactant) and polyvinylpyrrolidone (polymer) whose physicochemical properties, including complexing ability, have been widely described in the literature were proposed as a model lubricant. It has been assumed that aqueous solutions of these compounds will favourably modify lubricating properties of water under high load conditions. For this purpose, measurements were made on a four-ball apparatus (T-02 Tester) for aqueous solutions of these compounds. Two kinds of tests were carried out: at constant loads (2, 3, and 4 kN) and variable loads within the range of 0 to 7.2 kN. Unexpectedly, high decreases in motion resistance and wear as well as an increase in antiseizure properties were found in relation to water as a base. The results obtained are so promising that solutions with an optimized composition can find practical applications. The surprisingly high effectiveness of the additives used results from the formation of surfactant/polymer complexes. These adducts adsorb at the interface, and, under friction conditions, they form a lubricant film capable of carrying high loads.

Interpenetrating polymer networks in polyvinyl alcohol/cellulose nanocrystals hydrogels to develop absorbent materials

Polyvinyl alcohol/cellulose nanocrystals/poly(2-Hydroxyethyl methacrylate) (PVA/CNC/polyHEMA) and PVA/CNC/poly(N'-methylenebisacrylamide) (PVA/CNC/polyMBA) hydrogels were prepared by photo-crosslinking followed by freezing/thawing (F-T) cycle and this novel preparation method was reported. The formation of interpenetrating polymer networks (IPN) resulted from the addition of crosslinking HEMA or MBA monomers displayed improved interfacial adhesion. The produced hydrogels were measured by scanning electron microscopy (SEM), real-time fourier transform infrared (RTIR), thermogravimetric analysis (TGA), mechanical, swelling and adsorption tests. The results showed both PVA/CNC/polyHEMA with semi-IPN and PVA/CNC/polyMBA with dual network (DN) hydrogels had higher thermal stability, lower water loss rate and better swelling and reswelling and mechanical properties, comparing to PVA and PVA/CNC hydrogels. The adsorption behaviors of hydrogels using xylenol orange (XO) and methylene blue (MB) as model dyes were evaluated, indicating that PVA/CNC/polyHEMA and PVA/CNC/polyMBA hydrogels could hold some dyes. Overall, this work provided a good way for increasing mechanical, swelling, reswelling, thermal, and adsorption properties of PVA/CNC, which will be a promising water-manageable material for agriculture application and a candidate for dye carrier.

Propagation of Fatigue Cracks in Friction of Brittle Hydrogels

In order to understand fatigue crack propagation behavior in the friction of brittle hydrogels, we conducted reciprocating friction experiments between a hemi-cylindrical indenter and an agarose hydrogel block. We found that the fatigue life is greatly affected by the applied normal load as well as adhesion strength at the bottom of the gel⁻substrate interface. On the basis of in situ visualizations of the contact areas and observations of the fracture surfaces after the friction experiments, we suggest that the mechanical condition altered by the delamination of the hydrogel from the bottom substrate plays an essential role in determining the fatigue life of the hydrogel.

DN strategy constructed photo-crosslinked PVA/CNC/P(NIPPAm-co-AA) hydrogels with temperature-sensitive and pH-sensitive properties

The surface and cross-section morphologies of PVA/CNC/P(NIPPAm-co-AA) hydrogels exhibited double-network (DN) and uniform network structures due to the introduction of PNIPAAm and PAA through the photo-crosslinking technology.

Dynamic compression of human and ovine meniscal tissue compared with a potential thermoplastic elastomer hydrogel replacement

Understanding how human meniscal tissue responds to loading regimes mimetic of daily life as well as how it compares to larger animal models is critical in the development of a functionally accurate synthetic surrogate. Seven human and eight ovine cadaveric meniscal specimens were regionally sectioned into cylinders 5 mm in diameter and 3 mm thick along with 10 polystyrene-b-polyethylene oxide block copolymer-based thermoplastic elastomer (TPE) hydrogels. Samples were compressed to 12% strain at 1 Hz for 5000 cycles, unloaded for 24 h, and then retested. No differences were found within each group between test one and test two. Human and ovine tissue exhibited no regional dependency (p < 0.05). Human samples relaxed quicker than ovine tissue or the TPE hydrogel with modulus values at cycle 50 not significantly different from cycle 5000. Ovine menisci were found to be similar to human menisci in relaxation profile but had significantly higher modulus values (3.44 MPa instantaneous and 0.61 MPa after 5000 cycles compared with 1.97 and 0.11 MPa found for human tissue) and significantly different power law fit coefficients. The TPE hydrogel had an initial modulus of 0.58 MPa and experienced less than a 20% total relaxation over the 5000. Significant differences in the magnitude of compressive modulus between human and ovine menisci were observed, however the relaxation profiles were similar. Although statistically different than the native tissues, modulus values of the TPE hydrogel material were similar to those of the human and ovine menisci, making it a material worth further investigation for use as a synthetic replacement. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2722-2728, 2017.

Biphasic and boundary lubrication mechanisms in artificial hydrogel cartilage: A review

Various studies on the application of artificial hydrogel cartilage to cartilage substitutes and artificial joints have been conducted. It is expected in clinical application of artificial hydrogel cartilage that not only soft-elastohydrodynamic lubrication but biphasic, hydration, gel-film and boundary lubrication mechanisms will be effective to sustain extremely low friction and minimal wear in daily activities similar to healthy natural synovial joints with adaptive multimode lubrication. In this review article, the effectiveness of biphasic lubrication and boundary lubrication in hydrogels in thin film condition is focused in relation to the structures and properties of hydrogels. As examples, the tribological behaviors in three kinds of poly(vinyl alcohol) hydrogels with high water content are compared, and the importance of lubrication mechanism in biomimetic artificial hydrogel cartilage is discussed to extend the durability of cartilage substitute.

Horseradish peroxidase-catalyzed formation of hydrogels from chitosan and poly(vinyl alcohol) derivatives both possessing phenolic hydroxyl groups

Horseradish peroxidase-catalyzed cross-linking was applied to prepare hydrogels from aqueous solutions containing chitosan and poly(vinyl alcohol) derivatives both possessing phenolic hydroxyl groups (denoted as Ph-chitosan and Ph-PVA, respectively). Comparing the hydrogels prepared from the solution of 1.0% (w/v) Ph-chitosan and 3.0% (w/v) Ph-PVA and that of 3.0% (w/v) Ph-chitosan and 1.0% (w/v) Ph-PVA, the gelation time of the former hydrogel was 47 s, while was 10s longer than that of the latter one. The breaking point for the former hydrogel under stretching (114% strain) was approximately twice larger than that for the latter one. The swelling ratio of the former hydrogel in saline was about half of the latter one. Fibroblastic cells did not adhere on the former hydrogel but adhered and spread on the latter one. The growth of Escherichia coli cells was fully suppressed on the latter hydrogel during 48 h cultivation.

A novel method for the accurate evaluation of Poisson's ratio of soft polymer materials

A new method with a simple algorithm was developed to accurately measure Poisson's ratio of soft materials such as polyvinyl alcohol hydrogel (PVA-H) with a custom experimental apparatus consisting of a tension device, a micro X-Y stage, an optical microscope, and a charge-coupled device camera. In the proposed method, the initial positions of the four vertices of an arbitrarily selected quadrilateral from the sample surface were first measured to generate a 2D 1st-order 4-node quadrilateral element for finite element numerical analysis. Next, minimum and maximum principal strains were calculated from differences between the initial and deformed shapes of the quadrilateral under tension. Finally, Poisson's ratio of PVA-H was determined by the ratio of minimum principal strain to maximum principal strain. This novel method has an advantage in the accurate evaluation of Poisson's ratio despite misalignment between specimens and experimental devices. In this study, Poisson's ratio of PVA-H was 0.44 ± 0.025 (n = 6) for 2.6–47.0% elongations with a tendency to decrease with increasing elongation. The current evaluation method of Poisson's ratio with a simple measurement system can be employed to a real-time automated vision-tracking system which is used to accurately evaluate the material properties of various soft materials.

Polyvinyl alcohol hydrogel irradiated and acetalized for osteochondral defect repair: mechanical, chemical, and histological evaluation after implantation in rat knees

Polyvinyl Alcohol (PVA) hydrogel plugs were implanted in artificial osteochondral defects on the trochlear groove of rat knees. After 0, 3, 6, 12, and 24 weeks of followup, samples containing the implants were mechanically evaluated by creep indentation test, chemically, and histologically by optical microscopy. The mechanical test pointed towards an increase of the implant creep modulus and the chemical analysis exhibited an increasing concentration of calcium and phosphorus within the implants over time. Optical microscopy showed no foreign body reaction and revealed formation, differentiation, and maintenance of new tissue at the defect/implant interface. The absence of implant wear indicated that the natural articular lubrication process was not disturbed by the implant. The performance of the irradiated and acetalized PVA was considered satisfactory for the proposed application.

A review of polyvinyl alcohol and its uses in cartilage and orthopedic applications

Polyvinyl alcohol (PVA) is a synthetic polymer derived from polyvinyl acetate through partial or full hydroxylation. PVA is commonly used in medical devices due to its low protein adsorption characteristics, biocompatibility, high water solubility, and chemical resistance. Some of the most common medical uses of PVA are in soft contact lenses, eye drops, embolization particles, tissue adhesion barriers, and as artificial cartilage and meniscus. The purpose of this review is to evaluate the available published information on PVA with respect to its safety as a medical device implant material for cartilage replacement. The review includes historical clinical use of PVA in orthopedics, and in vitro and in vivo biocompatibility studies. Finally, the safety recommendation involving the further development of PVA cryogels for cartilage replacement is addressed.

Friction properties of novel PVP/PVA blend hydrogels as artificial cartilage

In this work, novel polyvinylpyrrolidone (PVP)/polyvinylalcohol (PVA) blend hydrogels were prepared by repeated freezing-thawing cycles. The factors that influenced friction properties of blend hydrogels, such as PVP content, contact load, sliding speed, and lubrication condition, were mainly studied by sliding with stainless steel ball. The results showed that friction coefficients of the PVP/PVA blend hydrogels were definitely dependent on such influence factors. The friction system consisting of blend hydrogel and stainless steel ball nearly exhibited a mixed lubrication regime especially under bovine serum lubrication, and it can be proposed as a promising method to reduce wear of the prosthesis.

Comparison of Human Articular Cartilage and Polyvinyl Alcohol Hydrogel as Artificial Cartilage in Microstructure Analysis and Unconfined Compression

Many biomaterials have been developed to replace articular cartilage. One of these materials, polyvinyl alcohol (PVA) hydrogel is proposed to be used as artificial cartilage in joint replacement. To better understand the differences between human articular cartilage and PVA hydrogel, microstructure analysis and unconfined compression were developed. In microstructure analysis, the surface of articular cartilage was smooth and free from any significant morphological features. Some small holes were found in the surface and cross-section of PVA hydrogel. The porous structure of PVA hydrogel was observed clearly by Environmental scanning electron microscopy (ESEM). In unconfined compression tests, the compression modulus of articular cartilage was higher than that of PVA hydrogel. In the creep tests, the strain value of articular cartilage was lower than that of PVA hydrogel all the time. It is indicated that the microstructure of each material has a great influence on their biphasic property which related to their mechanical behavior.

Study on compressive mechanical properties of nanohydroxyapatite reinforced poly(vinyl alcohol) gel composites as biomaterial

Nanohydroxyapatite reinforced poly(vinyl alcohol) (nano-HA/PVA) gel composites has been proposed as a promising biomaterial to replace diseased or damaged articular cartilage. In this paper, nano-HA/PVA gel composites were prepared by in situ synthesis nano-HA particles in PVA solution and accompanied with freeze/thaw method. The influence of nano-HA content, PVA concentration and freeze/thaw cycle times on the compressive mechanical behavior of nano-HA/PVA gel composites were evaluated using mechanical test equipment. The results showed that the compressive mechanical behavior of nano-HA/PVA gel composites was similar to that of natural articular cartilage, which held special viscoelastic characteristics. Both the compressive strength and modulus of the composites improved correspondingly with the rise of freeze/thaw cycle times and PVA concentration. The compressive strength and modulus of nano-HA/PVA gel composites firstly increased and then presented decreasing trend with the rise of nano-HA content. Furthermore, the compressive modulus of the composites improved exponentially with the rise of compressive strain ratio.

Viscoelastic behavior of nano-hydroxyapatite reinforced poly(vinyl alcohol) gel biocomposites as an articular cartilage

Nanohydroxyapatite reinforced poly(vinyl alcohol) gel (nano-HA/PVA gel) composites has been proposed as an articular cartilage repair biomaterial. In this paper, nano-HA/PVA gel composites were prepared by in situ synthesis nano-HA particles in PVA solution and accompanied with freeze/thaw method. The influence of nano-HA content, PVA concentration, test frequency and freeze/thaw cycle times on the viscoelastic behavior of nano-HA/PVA gel composites were evaluated using dynamic mechanical thermal analysis (DMTA). The results showed that both storage modulus and loss modulus firstly increased and then presented decreasing trend with the rise of nano-HA content. Their maximum values were obtained while nano-HA content was 6%. Furthermore, the G' and G'' of the composites improve with the increase of PVA concentrations and freeze/thaw cycle times. This effect was more distinct at low freeze/thaw cycles. The phase angle (tan delta) of the pure PVA gel is larger than that of the nano-HA/PVA composites at the test frequency spectra, but all the phase angle values of the tested composites were close to that of nature bone.

Friction Characteristics of Poly(vinyl Alcohol) Hydrogel as an Articular Cartilage Biomaterial

Poly(vinyl alcohol) (PVA) hydrogel is a promising articular cartilage biomaterial. In this paper, the effects of different variable factors on the friction coefficient of Poly(vinyl alcohol) (PVA) hydrogel were investigated when sliding against stainless steel ball by ball-pan tribometer. Factors included lubrication condition, sliding speed, diameter of stainless steel ball, and load. It was shown that the free water in PVA hydrogel has an excellent lubrication on the counterparts. The friction coefficients have little difference between dry and lubricants lubrication condition at initial friction test. With the friction test time prolonged, friction coefficient of PVA hydrogel under dry condition increased rapidly. Friction coefficient decreased with the increase of sliding speed and the diameter of stainless steel ball, and increased with the increasing load. The rising rate of friction coefficient at low load region is obviously larger than that at high load region.