Semi-quantitative assessment methods for backside polyethylene damage in modular total knee replacements

Two semi-quantitative grading methods (referred to as the Hood/Wasielewski-method and the Modified-method) were described and then applied to 52 retrieved tibial polyethylene inserts from modular total knee replacements. Their ability to assess backside surface damage was compared. The damage score correlation with the implantation period greater than 24 months was better using the Modified-method (R=0.524, p=0.006) than using the Hood/Wasielewski-method (R=0.328, p=0.102). Also, the Modified-method gave significantly higher damage scores for males with gamma-in-air irradiated polyethylene inserts whereas the Hood/Wasielewski-method did not. Thus, the damage score obtained using the Modified-method seemed to provide a better representation of clinical surface damage and possibly PE wear.     

Prediction of backside micromotion in total knee replacements by finite element simulation

The micromotion at the interface between the polyethylene tibial insert and metal tibial tray [corrected] in modular total knee replacements [corrected] has been shown to contribute to wear particle-induced osteolysis and may [corrected] cause implant failure. Therefore, studying the design parameters that are involved in the backside wear process is an important task that may lead to improvement in new total knee replacements. In the present study, a finite element model was developed to predict the backside micromotion along the entire modular interface. Both the linear elastic constitutive model and non-linear J2-plasticity constitutive model were considered in the finite element model for polyethylene and were corroborated against published results obtained from displacement controlled knee simulator wear tests. The finite element simulation with the non-linear J2-plasticity constitutive model was able to predict backside micromotion [corrected] more accurately than the simulation with the linear elastic constitutive model. [corrected] The developed finite element model (including the non-linear J2-plasticity constitutive model) was then applied to assess the effects of the tibial tray locking mechanism design (dovetails versus fullperipheral [corrected] design) and different levels of interference fit on insert micromotion. The developed finite element model, implementing the non-linear J2-plasticity constitutive model, was shown to successfully predict clinical amounts of backside micromotion and could be used for the design and development of total knee replacements for the reduction of backside micromotion and polyethylene [corrected] wear.     

Wear of moderately cross-linked polyethylene in fixed-bearing total knee replacements

Cross-linked polyethylene has been introduced into total joint replacement to improve wear resistance. Although the performance of highly cross-linked polyethylene is well documented clinically and experimentally for total hip replacements, the reduction in mechanical properties with increasing irradiation is of concern for application to total knee replacement. The aim of this study was to investigate the wear performance of a moderately cross-linked polyethylene material in a fixed-bearing total knee replacement. The study was conducted using two femoral geometries, a conventional cruciate-retaining femoral and a high-flexion femoral geometry. The femoral geometry appeared to have no effect on the wear of the knee replacement under standard gait conditions. A significant reduction in wear volume was measured with the moderately cross-linked polyethylene compared with the conventional polyethylene over a six-million-cycle wear study. This study indicates the use of a moderately cross-linked polyethylene in a fixed-bearing total knee replacement may provide a low wearing option for total knee replacement.     

Computational model of asperity contact for the prediction of UHMWPE mechanical and wear behaviour in total hip joint replacements

The effect of sliding friction on the size of yielding region in the ultra high molecular weight polyethylene asperity in contact with metal was investigated. The main objective of this work was to gain an understanding of wear particle generation mechanism from the two-dimensional finite element model. To assess the influence of the parameters of interest, different friction coefficients and loading conditions were used in the numerical simulations. Results from the finite element analysis show that the increase of the yielding region is strongly influenced by the friction coefficient and the rise in the tangential force, which is related to the generation of wear particles. Finite element wear particle generation model, based on strain discontinuities, was therefore proposed. The results obtained in this study can lead to the development of an accurate finite element particle generation model that would be of use in the assessment of an artificial implant performance and their development.     

The effect of polyethylene thickness in fixed- and mobile-bearing total knee replacements

In this paper fixed- and mobile-bearing implants were simulated using a multibody dynamic model and a finite element model to investigate the contact pressure distribution in the ultra high molecular weight polyethylene tibial bearing component. The thickness of polyethylene varied from 6.8 to 12.3 mm and the polyethylene was modelled as a non-linear material. It was found that the contact pressure on the polyethylene decreased in the fixed-bearing implant when the thickness of polyethylene increased from 6.8 to 8 and 9.6 mm, but there was little further decrease in pressure with the increase of polyethylene thickness from 9.6 to 11.0 and 12.3 mm. In the mobile-bearing implant, no increase in contact pressure on the superior surface was found with the increase in the thickness of the polyethylene; however, the contact pressures on the inferior contact surface of the thicker designs were higher than those in the 6.8 mm design. The numerical results obtained in this paper are in good agreement with published experimental test results. Moreover, the paper presents a detailed pressure distribution on the tibial bearing component during a full gait cycle.     

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 1.5x 10(6) 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.     

Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements

With the increased clinical interest in metal-on-metal and ceramic-on-ceramic total-hip replacements (THRs), the objective of this hip simulator study was to identify the relative wear ranking of three bearing systems, namely CoCr-polyethylene (M-PE), CoCr-CoCr (M-M) and ceramic-on-ceramic (C-C). Volumetric wear rates were used as the method of comparison. The seven THR groupings included one M-PE study, two M-M studies and four C-C studies. Special emphasis was given to defining the 'run-in' phase of accelerated wear that rigid-on-rigid bearings generally exhibit. The hypothesis was that characterization of the run-in and steady state wear phases would clarify not only the tribological performance in vitro but also help correlate these in vitro wear rates with the 'average' wear rates measured on retrieved implants. The implant systems were studied on multichannel hip simulators using the Paul gait cycle and bovine serum as the lubricant. With 28 mm CoCr heads, the PE (2.5 Mrad/N2) wear rates averaged 13 mm3/10(6) cycles duration. This was considered a low value compared with the clinical model of 74 mm3/year (for 28 mm heads). Our later studies established that this low laboratory value was a consequence of the serum parameters then in use. The mating CoCr heads (with PE cups) wore at the steady state rate of 0.028 mm3/10(6) cycles. The concurrently run Metasul M-M THRs wore at the steady state rate of 0.119 mm3/10(6) cycles with high-protein serum. In the second Metasul M-M study with low-protein serum, the THR run-in rate was 2.681 mm3/10(6) cycles and steady state was 0.977 mm3/10(6) cycles. At 10 years, these data would predict a 70-fold reduction in M-M wear debris compared with the clinical PE wear model. All M-M implants exhibited biphasic wear trends, with the transition point at 0.5 x 10(6) cycles between run-in and steady state phases, the latter averaging a 3-fold decrease in wear rate. White surface coatings on implants (coming from the serum solution) were a confounding factor but did not obscure the two orders of magnitude wear performance improvement for CoCr over PE cups. The liners in the alumina head-alumina cup combination wore at the steady state rate of 0.004 mm3/10(6) cycles over 14 x 10(6) cycles duration (high-protein serum). The zirconia head-alumina cup THR combination wore at 0.174 and 0.014 mm3/10(6) cycles for run-in and steady state rates respectively (low-protein serum). The zirconia head and cup THR combination wore slightly higher initially with 0.342 and 0.013 mm3/10(6) cycles for run-in and steady state rates respectively. Other wear studies have generally predicted catastrophic wear for such zirconia-ceramic combinations. It was noted that the zirconia wear trends were frequently masked by the effects of tenacious white surface coatings. It was possible that these coatings protected the zirconia surfaces somewhat in this simulator study. The experimental ceramic Crystaloy THR had the highest ceramic run-in wear at 0.681 mm3/10(6) cycles and typical 0.016 mm3/10(6) cycles for steady state. Since these implants represented the first Crystaloy THR sets made, it was likely that the surface conditions of this high-strength ceramic could be improved in the future. Overall, the ceramic THRs demonstrated three orders of magnitude wear performance improvement over PE cups. With zirconia implants, while the cup wear was sometimes measurable, head wear was seldom discernible. Therefore, we have to be cautious in interpreting such zirconia wear data. Identifying the run-in and steady state wear rates was a valuable step in processing the ceramic wear data and assessing its reliability. Thus, the M-M and C-C THRs have demonstrated two to three orders of reduction in volumetric wear in the laboratory compared with the PE wear standard, which helps to explain the excellent wear performance and minimal osteolysis seen with such implants at retrieval operations.     

The wear of fixed and mobile bearing unicompartmental knee replacements

Unicompartmental knee replacements (UKR) are an option for surgical intervention for the treatment of single-compartment osteoarthritis. The aim of this study was to compare the wear of a low-conformity fixed-bearing UKR with a conforming mobile bearing UKR under two kinematic conditions, to investigate the effect of implant design and kinematics on wear performance in a physiological knee wear simulator. Under both sets of kinematic conditions, the relatively low-conforming fixed UKR showed lower wear, compared with the more conforming anterior-posterior sliding mobile bearing. However, it should be noted that differences in materials between the two designs also contribute to the relative wear performance of the bearings. The combined wear of the medial and lateral bearings of the fixed-bearing UKR as a 'total knee' were significantly reduced compared with a fixed-bearing total knee replacement studied under the same kinematic conditions.     

A model for the lubrication mechanism in knee joint replacements

Analytical studies are presented of the lubrication mechanism occurring in knee-joint replacements under restricted motion. The idealized model is shown to produce results consistent with those in normal situations. The effects of increasing the viscoelastic parameter of the lubricant are similar to those produced by an increase in the concentration of hyaluronic acid molecules in synovial fluid. Slip velocity occurring at the porous boundary aids the normal functioning of the joints. The load capacity of the replaced tibia has been shown to increase as the gap closes and/or the femoro-tibial angle decreases from π/20 to ?π/20 rad.     

Comparison of gas plasma and gamma irradiation in air sterilization on the delamination wear of the ultra-high molecular weight polyethylene used in knee replacements

Early failure of knee replacements is thought to be due to the combination of sterilization by gamma irradiation in air and the high cyclic stresses that they endure during use. Such failures are shown through delamination and permanent deformation of the ultra-high molecular weight polyethylene (UHMWPE) component. This study investigated whether gas plasma sterilization, as an alternative to gamma irradiation in air, would give better performance after ageing in a knee replacement using a metal pin on polymer plate wear test. Fourier transform infrared (FTIR) analysis was performed on the components to assess oxidation levels and a finite element stress analysis model is presented to estimate strain at failure in the UHMWPE. Delamination occurred in the majority of the gamma-irradiated plates but did not occur in any of the gas-plasma-sterilized plates. The FTIR analysis showed that the plates gamma irradiated in air were highly oxidized when compared with the gas-plasma-sterilized plates. Plastic strain at failure was determined for the gamma-irradiated plates and found to be less than 2.4-14 per cent.     

Increased total knee arthroplasty ultra-high molecular weight polyethylene wear using a clinically relevant hyaluronic acid simulator lubricant

In this study, osteoarthritic and periprosthetic synovial fluid samples were rheologically and biochemically compared to develop a hyaluronic acid (HA) supplemented bovine serum (BS) lubricant that mimicked the properties of human joint synovial fluid. The effect of this BS + HA lubricant (50 per cent bovine calf serum + 1.5 g/l HA) on the wear rate of ultra-high molecular weight polyethylene (UHMWPE) during a total knee replacement wear test was then investigated. In conjunction with biochemical similarities, the rheological analysis showed that the BS + HA lubricant viscosity was not statistically different to aspirated total knee arthroplasty (TKA) revision joint fluid viscosity over a range of physiologic shear rates. Gravimetric results at 5 million wear testing cycles showed that the BS + HA lubricant produced an average of 6.88 times more UHMWPE wear than 50 per cent bovine serum lubricant alone. The BS + HA lubricated CoCr femoral component surfaces revealed pitting and surface roughening that was not observed using standard bovine serum only lubricants, but that was similar to the metallic surface corrosion observed on in vivo CoCr femoral component retrievals. These findings support the hypothesis that the addition of HA to simulator lubricant is capable of producing CoCr femoral component surface damage similar to that observed in vivo.     

Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements

Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt-chromium (Co-Cr) pins against Co-Cr plates; secondly, Co-Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co-Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion-wear interactions between the tribological pair.     

Reduction of total knee replacement wear with vitamin E blended highly cross-linked ultra-high molecular weight polyethylene

Ultra-high molecular weight polyethylene (UHMWPE) is a common bearing component in total knee replacement (TKR) implants, and its susceptibility to wear continues to be the long-term limiting factor in the life of these implants. This study hypothesized that in TKR systems, a highly cross-linked (HXL) UHMWPE blended with vitamin E will result in reduced wear as compared to a direct compression-moulded (DCM) UHMWPE. A wear simulation study was conducted using an asymmetric lateral pivoting '3D Knee' design to compare the two inserts. The highly cross-linked UHMWPE was aged prior to the testing and force-controlled wear testing was carried out for 5 million cycles using a load-controlled ISO-14243 standard at a frequency of 1 Hz on both groups. Gravimetric measurements of DCM UHMWPE (4.4 +/- 3.0 mg/million cycles) and HXL UHMWPE with vitamin E (1.9 +/- 1.9 mg/million cycles) showed significant statistical differences (p < 0.01) between the wear rates. Wear modes and surface roughness for both groups revealed no significant dissimilarities.     

In vitro analysis of the wear,wear debris and biological activity of surface-engineered coatings for use in metal-on-metal total hip replacements

Extremely low wear rates have been reported for metal-on-metal total hip replacements, but concerns remain about the effects of metal ion release, dissolution rates and toxicity. Surface-engineered coatings have the potential to improve wear resistance and reduce the biological activity of the wear debris produced. The aim of this study was to examine the wear and wear debris generation from surface-engineered coatings: titanium nitride (TiN), chromium nitride (CrN) and chromium carbon nitride (CrCN) applied to a cobalt-chrome alloy (CoCr) substrate. The coatings were articulated against themselves in a simple geometry model. The wear particles generated were characterized and the cytotoxic effect on U937 macrophages and L929 fibroblasts assessed. The CrN and CrCN coatings showed a decrease in wear compared to the CoCr bearings and produced small (less than 40 nm in length) wear particles. The wear particles released from the surface engineered bearings also showed a decreased cytotoxic effect on cells compared to the CoCr alloy debris. The reduced wear volumes coupled with the reduced cytotoxicity per unit volume of wear indicate the potential for the clinical application of this technology.     

Dynamic simulation of a displacement-controlled total knee replacement wear tester

This paper presents a dynamic finite element method (FEM) model of a commercial displacement-controlled total knee replacement (TKR) wear tester. The first goal of the study was to validate the model, which included both the wear tester and the TKR components. Convergence simulations and experimental testing were performed. These included a novel experimental determination of the coefficient of friction and an evaluation of predicted joint contact areas by comparing simulation results with experimental data collected using pressure-sensitive film. The second goal of this study was to develop a procedure for implementing force-based testing protocols on a displacement-controlled TKR wear tester. A standard force-based cyclic wear-testing protocol was simulated using the FEM model and resulting displacement waveforms were extracted. These were used as control inputs to the physical wear tester and an experimental wear test was performed. Reaction loads on the tibial components were measured and compared with the simulated results. The model was capable of accurately predicting the tibial loads throughout the test cycle, verifying the model's contact mechanics. The study demonstrated the use of computational modelling to convert a force-based testing protocol into displacement-based control parameters for use in a displacement-controlled mechanical testing system.     

Biological effects of wear particles generated in total joint replacements: trends and future prospects

Abstract

Joint replacements have considerably improved the quality of life of patients with joints damaged by disease or trauma. However, problems associated with wear particles generated due to the relative motion between the components of the bearing are still present and can lead to the eventual failure of the implant. The biological response to wear debris affects directly the longevity of the prosthesis. The identification of the mechanisms by which cells respond to wear debris and how particles distribute into the human body may provide valuable information for the long term success of artificial joints. During the last few decades, orthopaedic research has been focused on predicting the in vivo performance of joint replacements. However, the exact relationship between material physicochemical properties and inflammatory response has not been fully understood. Laboratory wear simulators provide an accurate prediction of implant wear performance. Though, particles generated from such wear simulators require validation to compare them with particles extracted from peri-implant tissues. This review focuses initially on the current status of total joint replacements (hard on soft and hard on hard bearings) as well as on the tribological behaviour of the potential materials currently under investigation. Then, the correspondence between particles observed in vivo and those generated in vitro to predict the cellular response to wear debris is discussed. Finally, the biological effects of the degradation products generated by wear and corrosion are described.     

The effect of femoral head diameter upon lubrication and wear of metal-on-metal total hip replacements

It has been found that a remarkable reduction in the wear of metal-on-metal hip joints can be achieved by simply increasing the diameter of the joint. A tribological evaluation of metal-on-metal joints of 16, 22.225, 28 and 36 mm diameter was conducted in 25 per cent bovine serum using a hip joint simulator. The joints were subject to dynamic motion and loading cycles simulating walking for both lubrication and wear studies. For each size of joint in the lubrication study, an electrical resistivity technique was used to detect the extent of surface separation through a complete walking cycle. Wear of each size of joint was measured gravimetrically in wear tests of at least 2 x 10(6) cycles duration. Joints of 16 and 22.225 mm diameter showed no surface separation in the lubrication study. This suggested that wear would be proportional to the sliding distance and hence joint size in this boundary lubrication regime. A 28 mm diameter joint showed only limited evidence of surface separation suggesting that these joints were operating in a mixed lubrication regime. A 36 mm diameter joint showed surface separation for considerable parts of each walking cycle and hence evidence of the formation of a protective lubricating film. Wear testing of 16 and 22.225 mm diameter metal-on-metal joints gave mean wear rates of 4.85 and 6.30 mm3/10(6) cycles respectively. The ratio of these wear rates, 0.77, is approximately the same as the joint diameters ratio, 16/22.225 or 0.72, as expected from simple wear theory for dry or boundary lubrication conditions. No bedding-in was observed with these smaller diameter joints. For the 28 mm diameter joint, from 0 to 2 x 10(6) cycles, the mean wear rate was 1.62 mm3/10(6) cycles as the joints bedded-in. Following bedding-in, from 2.0 x 10(6) to 4.7 x 10(6) cycles, the wear rate was 0.54 mm3/10(6) cycles. As reported previously by Goldsmith et al. in 2000 [1], the mean steady state wear rate of the 36 mm diameter joints was lower than those of all the other diameters at 0.07 mm3/10(6) cycles. For a range of joints of various diameters, subjected to identical test conditions, mean wear rates differed by almost two orders of magnitude. This study has demonstrated that the application of sound tribological principles to prosthetic design can reduce the wear of metal-on-metal joints, using currently available materials, to a negligible level.     

Effect of stair descent loading on ultra-high molecular weight polyethylene wear in a force-controlled knee simulator

A loading protocol approximating forces, torques and motions at the knee during stair descent was developed from previously published data for input into a force-controlled knee simulator. A set of total knee replacements (TKRs) was subjected to standard walking cycles and stair descent cycles at a ratio of 70: 1 for 5 million cycles. Another set of implants with similar articular geometry and the same ultra-high molecular weight polyethylene (UHMWPE) resin (GUR 415), sterilization and packaging was tested with standard walking cycles only. Implant kinematics, gravimetric wear and surface roughness of the UHMWPE inserts were analysed for both sets of implants. Contact stresses were calculated for both loading protocols using a Hertzian line contact model. Significantly greater weight loss (p < 0.05) and more severe surface damage of UHMWPE inserts resulted with the walking + stair descent loading protocol compared to walking cycles only. Anterior-posterior (AP) tibiofemoral contact point displacements were lower during stair descent than walking, but not significantly different (p = 0.05). Contact stresses were significantly higher during stair descent than walking, owing to higher axial loads and the smaller radius of curvature of the femoral components at higher flexion angles. High contact stresses on UHMWPE components are likely to accelerate the fatigue of the material, resulting in more severe wear, similar to what is observed in retrieved implants. Thus the inclusion of loading protocols for activities of daily living in addition to walking is warranted for more realistic in vitro testing of TKRs.     

Calf serum constituent fractions influence polyethylene wear and microbial growth in knee simulator testing

Calf serum lubricants consisting of various polypeptide constituent fractions are routinely used in knee wear simulators as part of the standardized test protocol. Three calf sera (bovine, new-born and alpha) were diluted as per the recommendation of ISO 14243-3 and used in displacement-controlled knee wear simulators to investigate their effects on polyethylene wear. Biochemical analyses included measuring total polypeptide degradation, electrophoretic profiles and low-molecular weight polypeptide concentrations to elucidate their involvement in the wear process. The effects of the various calf sera constituent fractions on microbial growth were also explored. The polyethylene wear rates and the results from the biochemical analyses for the three calf serum lubricants were all found to be statistically significantly different from each other. The lubricant derived from the alpha-calf serum was closest in constituent fractions to human synovial fluid. It also showed the lowest polyethylene wear rate (14.38 +/- 0.85 mm3/million cycles) and the lowest amount of polypeptide degradation (7.77 +/- 3.87%). Furthermore, the alpha-calf serum lubricant was associated with the least amount of change in the electrophoretic profile, the least change in low-molecular weight polypeptide concentration, and the lowest microbial growth in the presence of sodium azide (a microbial inhibitor conventionally used in implant wear testing). Replacing sodium azide with a broad spectrum antibiotic-antimycotic eradicated the microbial growth. Some speculation was entertained regarding the effect of alpha-calf serum on colloid-mediated boundary lubrication. Based on the results, it was recommended that ISO 14243-3 be modified to include guidelines on calf serum constituent fractions that would favour using alpha-calf serum in order to improve the fidelity of the simulation in knee implant wear testing.     

In vitro studies of the wear of articular cartilage II. Characteristics of the wear of articular cartilage when worn against stainless steel plates having characterized surfaces

As part of an attempt to elucidate the physical parameters that govern the wear of articular cartilage, its wear properties were studied with the tissue interfaced against stainless steel plates having characterized surface profiles. The studies were carried out in apparatus that was designed and constructed for these purposes. In addition measurements were made of (1) the geometric contact areas between the tissue and the plates as functions of time and load, (2) the changes with time and load of the average fluid contents of the cartilage, (3) the changes in dimension and profile of the surface of the tissue after it had been worn under various conditions and equilibrated for different times with dilute neutral buffered solutions, and (4) the fraction of the hexosamine and hydroxyproline contents of the debris that dissolved during the wear in the dilute neutral buffer used as a lubricant.Wear rates were found to be sensitive functions of the surface profile of the metal. The tissue initially wore against “smooth” surfaces at rates that decreased with time until a final rate, characteristic for a given surface and pressure, was attained. The extent of wear in this region of the wear-time curve could be described by linear functions of the pressure, plate speed and time. The data are interpreted as follows: (1) network breakdown and reorientation of the domains of the macromolecules and their aggregates towards the wear direction occur within a surface region of the tissue as it wears, and such reorientation is responsible for the initial decrease of the wear rates; (2) the rate of crack initiation governs the overall wear rate of the tissue in the linear region of the wear-time curve; (3) the formation of wear particles is accompanied by chain scission.