Effect of microseparation on contact mechanics in ceramic-on-ceramic hip joint replacements

The contact mechanics in ceramic-on-ceramic hip implants are investigated in this study under the microseparation condition where the edge contact occurs between the superolateral rim of the acetabular cup and the femoral head. A three-dimensional finite element model is developed to examine the effect of the microseparation distance between the femoral head and the acetabular cup on the contact area and contact stresses between the bearing surfaces. It is shown that microseparation leads to edge contact and elevated contact stresses, and these are mainly dependent on the magnitude of separation, the radial clearance between the femoral head and the acetabular cup, and the cup inclination angle. For a small microseparation distance (less than the diametrical clearance), the contact occurs within the acetabular cup, and consequently an excellent agreement of the predicted contact pressure distribution is obtained between the present three-dimensional anatomical model and a simple two-dimensional axisymmetric model adopted in a previous study [5]. However, as microsegregation is increased further, edge contact between the superolateral rim and the femoral head occurs. Consequently, the predicted contact pressure is significantly increased. The corresponding contact area resembles closely the stripe wear pattern observed on both clinically retrieved and simulator-tested ceramic femoral heads [8, 9, 11]. Furthermore, introducing a fillet radius of 2.5 mm at the mouth of the acetabular cup is shown to reduce the contact stress due to edge contact, but only under relatively large microseparation distances.     

A general axisymmetric contact mechanics model for layered surfaces, with particular reference to artificial hip joint replacements

A general axisymmetric contact mechanics model for layered surfaces is considered in this study, with particular reference to artificial hip joint replacements. The indenting surface, which represents the femoral head, was modelled as an elastic solid with or without coating, while the other contacting surface, which represents the acetabular cup, was modelled as a two-layered solid. It is shown that this model is applicable to current total hip joint prostheses employing ultra-high molecular weight polyethylene (UHMWPE) acetabular cups against metallic, metallic with coating or ceramic femoral heads as well as metal-on-metal combinations. The effect of cement is also investigated for these prostheses using this model. The use of a metallic bearing surface bonded to a UHMWPE substrate for acetabular cups is particularly examined for metal-on-metal hip joint replacements. Both the contact radius and the contact pressure distribution are predicted for examples of these total hip joint replacements, under typical conditions. Application of contact mechanics to the design of artificial hip joint replacements employing various material combinations is discussed.     

Analysis of mixed lubrication mechanism in metal-on-metal hip joint replacements

A simple mixed lubrication model has been developed to predict the asperity contact and wear for the metal-on-metal bearing couple for total hip joint replacements. It has been shown that the femoral head radius has a large effect on the predicted asperity contact and wear depending on the lubrication regime. An increase in the femoral head radius can lead to an increase in wear under a predominantly boundary lubrication regime, but this trend can be reversed under a mixed lubrication regime towards fluid film lubrication. These observations are consistent with the recent experimental findings from hip simulator studies by Smith and co-workers.     

Analysis of contact mechanics in McKee-farrar metal-on-metal hip implants

Contact mechanics analysis for a typical McKee-Farrar metal-on-metal hip implant was carried out in this study. The finite element method was used to predict the contact area and the contact pressure distribution at the bearing surfaces. The study investigated the effects of the cement and underlying bone, the geometrical parameters such as the radial clearance between the acetabular cup and the femoral head, and the acetabular cup thickness, as well as other geometrical features on the acetabular cup such as lip and studs. For all the cases considered, the predicted contact pressure distribution was found to be significantly different from that based upon the classical Hertz contact theory, with the maximum value being away from the centre of the contact region. The lip on the cup was found to have a negligible effect on the predicted contact pressure distribution. The presence of the studs on the outside of the cup caused a significant increase in the local contact pressure distribution, and a slight decrease in the contact region. Reasonably good agreement of the predicted contact pressure distribution was found between a three-dimensional anatomical model and a simple two-dimensional axisymmetric model. The interfacial boundary condition between the acetabular cup and the underlying cement, modelled as perfectly fixed or perfectly unbonded, had a negligible effect on the predicted contact parameters. For a given radial clearance of 0.079 mm, the decrease in the thickness of the acetabular cup from 4.5 to 1.5 mm resulted in an increase in the contact half angle from 15 degrees to 26 degrees, and a decrease in the maximum contact pressure from 55 to 20 MPa. For a given acetabular cup thickness of 1.5 mm, a decrease in the radial clearance from 0.158 to 0.0395 mm led to an increase in the contact half-angle from 20 degrees to 30 degrees, and a decrease in the maximum contact pressure from 30 to 10 MPa. For zero clearance, although the contact pressure was significantly reduced over most of the contact area, the whole acetabular cup came into contact with the femoral head, leading to stress concentration at the edge of the cup. Design optimization of the geometrical parameters, in terms of the acetabular cup thickness and the radial clearance, is important, not only to minimize the contact stress at the bearing surfaces, but also to avoid equatorial and edge contact.     

Contact mechanics and lubrication analyses of ceramic-on-metal total hip replacements

Ceramic-on-metal (CoM) total hip replacements have shown reduced wear and friction. Lubrication and contact mechanics analyses play an important role in providing an overall understanding for the tribological performance of CoM bearings. In the present study, the steady-state contact mechanics and elastohydrodynamic lubrication (EHL) and transient EHL of CoM bearings were analyzed. The dry and lubricated contact pressures of CoM bearings showed typical characteristics of hard-on-hard hip bearings. The effects of head radius and radial clearance on the lubrication performance were predicted. CoC and CoM bearings are more likely to benefit full fluid film lubrication than MoM bearings.     

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.     

An axisymmetric contact model of ultra high molecular weight polyethylene cups against metallic femoral heads for artificial hip joint replacements.

Contact mechanics of ultra high molecular weight polyethylene (UHMWPE) cups against metallic femoral heads for artificial hip joints is considered in this study. Both the experimental measurement of the contact area and the finite element prediction of the contact radius, maximum contact pressure and maximum Von Mises stress have been carried out for a wide range of contemporary artificial hip joints. Good agreement of the contact radius has been found between the experimental measurements and the finite element predictions based upon an elastic modulus of 1000 MPa and a Poisson's ratio of 0.4 for UHMWPE material under various loads up to 2.5 kN. It has been shown that the half contact angle for all the cup/head combinations considered in this study is between 40 degrees and 50 degrees under a load of 2.5 kN. The importance of this result has been discussed with respect to the anatomical position of the cup when placed in the body and the selection of a simple wear-screening test for artificial hip joints. The predicted contact radius and maximum contact pressure from the finite element model have also been compared with a simple elasticity analysis. It has been shown that the difference in the predicted contact radius between the two methods is reduced for more conforming contacts between the femoral head and the acetabular cup and smaller UHMWPE cup thickness. However, good agreement of the predicted maximum contact pressure has been found for all the combinations of the femoral head and the acetabular cup considered in this study. The importance of contact mechanics on the clinical performance of artificial hip joint replacements has also been discussed.     

Elastohydrodynamic lubrication analysis of ultra-high molecular weight polyethylene hip joint replacements under squeeze-film motion

Elastohydrodynamic lubrication was analysed under squeeze-film or normal approach motion for artificial hip joint replacements consisting of an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup and a metallic or ceramic femoral head. A simple ball-in-socket configuration was adopted to represent the hip prosthesis for the lubrication analysis. Both the Reynolds equation and the elasticity equations were solved simultaneously for the lubricant film thickness and hydrodynamic pressure distribution as a function of the squeeze-film time was solved using the Newton-Raphson method. The elastic deformation of the UHMWPE cup was calculated by both the finite element method and a simple equation based upon the constrained column model. Good agreement of the predicted film thickness and pressure distribution was found between these two methods. A simple analytical method based upon the Grubin-Ertel-type approximation developed by Higginson in 1978 [1] was also applied to the present squeeze-film lubrication problem. The predicted squeeze-film thickness from this simple method was found to be remarkably close to that from the full numerical solution. The main design parameters were the femoral head radius, the radial clearance between the femoral head and the acetabular cup, and the thickness and elastic modulus for the UHMWPE cup; the effects of these parameters on the squeeze-film thickness generated in current hip prostheses were investigated.     

Numerical study of squeaking suppresses for ceramic-on-ceramic hip endoprosthesis

A finite element model of a ceramic hip endoprosthesis system is established with ABAQUS 6.7 and the motion stability of the model is studied using the complex eigenvalue method. Numerical results reveal that a torsional vibration and a flexural vibration of the femoral component are responsible for squeaking. Increasing Young's modulus of the stem, adding CoCrMo alloy as well as 316 L stainless steel in the stem and adding a whole damping layer of UHMWPE to the acetabular component can improve the vibrant stability of the system, then, suppress the squeaking.     

Characterisation of wear debris from UHMWPE on zirconia ceramic, metal-on-metal and alumina ceramic-on-ceramic hip prostheses generated in a physiological anatomical hip joint simulator

There is currently much interest in the characterisation of wear debris from different types of artificial hip joints. There have been numerous studies on the wear of UHMWPE in hip joint simulators, but relatively few studies on the wear of alternative materials such as metal-on-metal (MOM) and ceramic-on-ceramic (COC). The aim of this study was to compare the wear volumes and wear debris generated from zirconia ceramic-on-UHMWPE, MOM and COC hip joints under identical conditions in the same hip joint simulator.

All prostheses showed an initial higher ‘bedding in’ wear rate, which was followed by a lower steady state wear rate. The zirconia ceramic-on UHMWPE prostheses showed the highest wear rates (31±4.0 mm³/million cycles), followed by the MOM (1.23±0.5 mm/million cycles), with the COC prostheses showing significantly (P<0.01) lower wear rates at 0.05±0.02 mm³/million cycles. The mode (±95% confidence limits) of the size distribution of the UHMWPE wear debris was 300±200, 30±2.25 nm for the metal particles, and 9±0.5 nm for the ceramic wear particles. The UHMWPE particles were significantly larger (P<0.05) than the metal and ceramic wear particles, and the metal particles were significantly larger (P<0.05) than the ceramic wear particles. A variety of morphologies and sizes were observed for the UHMWPE wear particles, including submicrometer granules and large flakes in excess of 50 μm. However, the wear particles generated in both the MOM and COC articulations were very uniform in size and oval or round in shape.

This investigation has demonstrated substantial differences in volumetric wear. The in vitro wear rates for the zirconia-on-UHMWPE and MOM are comparable with clinical studies and the UHMWPE and metal wear particles were similar to the wear debris isolated from retrieved tissues. However, the alumina/alumina wear rate was lower than some clinical retrieval studies, and the severe wear patterns and micrometer-sized particles described in vivo were not reproduced here.

This study revealed significant differences in the wear volumes and particle sizes from the three different prostheses. In addition, this study has shown that the alternative bearing materials such as MOM and COC may offer a considerable advantage over the more traditional articulations which utilise UHMWPE as a bearing material, both in terms of wear volume and osteolytic potential.     

Biological effects of metal-on-metal hip replacements

The advantages seen by patients receiving total hip arthroplasties and the implications of the release of both metal particles and soluble metal ions are discussed. This paper describes some of the early changes that have been observed in metal-on-metal hip arthroplasties, in terms of both changes in metal levels in blood and chromosome changes.     

Coupling of dynamics and contact mechanics of artificial hip joints in a pendulum model

To date, fully coupled dynamics and contact mechanics analysis is still limited by expensive computational cost and long computing time and has not been addressed comprehensively, particularly in the hip joint. To understand the influence of different parameters on the biomechanics of the total hip replacement (THR) and improve its design, two numerical approaches were developed and implemented in finite element models to investigate the coupling between the dynamics response and the contact mechanics for three different THR configurations, metal-on-polyethylene (MOP), metal-on-metal (MOM), and ceramic-on-ceramic (COC). The dynamic force and the contact pressure distribution at the bearing surfaces from the two methods were predicted and compared. The influences of various parameters (motion angle, load applied in the pendulum, friction coefficient, geometry, and material properties) were subsequently investigated. From the comparisons, the decoupled method, based on the rigid-body dynamics and the quasi-static elastic contact mechanics, was adequate to predict the performance of the THRs efficiently. The load had the greatest influence on the dynamics/contact mechanics among other factors.     

Wear and deformation of ceramic-on-polyethylene total hip replacements with joint laxity and swing phase microseparation

Wear of polyethylene and the resulting wear debris-induced osteolysis remains a major cause of long-term failure in artificial hip joints. There is interest in understanding engineering and clinical conditions that influence wear rates. Fluoroscopic studies have shown separation of the head and the cup during the swing phase of walking due to joint laxity. In ceramic-on-ceramic hips, joint laxity and microseparation, which leads to contact of the head on the superior rim of the cup, has led to localized damage and increased wear in vivo and in vitro. The aim of this study was to investigate the influence of joint laxity and microseparation on the wear of ceramic on polyethylene artificial hip joints in an in vitro simulator. Microseparation during the swing phase of the walking cycle produced contact of the ceramic head on the rim of the polyethylene acetabular cup that deformed the softer polyethylene cup. No damage to the alumina ceramic femoral head was found. Under standard simulator conditions the volume change of the moderately crosslinked polyethylene cups was 25.6 +/- 5.3 mm3/million cycles and this reduced to 5.6 +/- 4.2 mm3/million cycles under microseparation conditions. Testing under microseparation conditions caused the rim of the polyethylene cup to deform locally, possibly due to creep, and the volume change of the polyethylene cup when the head relocated was substantially reduced, possibly due to improved lubrication. Joint laxity may be caused by poor soft tissue tension or migration and subsidence of components. In ceramic-on-polyethylene acetabular cups wear was decreased with a small degree of joint laxity, while in contrast in hard-on-hard alumina bearings, microseparation accelerated wear. These findings may have significant implications for the choice of fixation systems to be used for different types of bearing couples.     

A comparative joint simulator study of the wear of metal-on-metal and alternative material combinations in hip replacements

While total hip replacement represents the major success story in orthopaedic surgery in the twentieth century, there is much interest in extending even further, early in the twenty first century, the life of implants. Osteolysis has been identified as a major factor limiting the life of prostheses, with indications that fine polyethylene wear debris, generated primarily at the interface between the femoral head and the acetabular cup, promotes the process. There is therefore considerable interest in the introduction of alternative wear resistant systems to limit the deleterious effects of wear. These alternatives include ceramic-on-ceramic and metal-on-metal configurations and the present paper is primarily concerned with the latter. Some six pairs of new metal-on-metal implants of 36 mm diameter and four pairs of existing metal-on-metal implants of 28 mm diameter were tested in a ten-station hip joint simulator in the presence of a 25 per cent bovine serum solution. The implants were tested in the anatomical position to 5 x 10(6) cycles. The new heads and cups were manufactured from CoCrMo alloy with careful attention being paid to sphericity and surface finish of both components. The wear performance of the new and existing metal-on-metal total hip replacements have been evaluated and compared. The overall wear rates have then been compared with previously reported wear rates for a zirconia-on-polyethylene prosthesis of 22 mm diameter tested on the same simulator. The comparison is taken further by recalling published penetration data for metal-on-polyethylene implants of 22 and 28 mm diameter and converting these to volumetric wear rates. It was found that the heads and cups in metal-on-metal joints wore by almost equal amounts and that the opposing surfaces converged to similar surface roughness as the testing time increased. Steady state wear rates were generally achieved after 1-2 x 10(6) cycles. The mean long-term wear rates for the metal-on-metal prostheses were very low, being 0.36 mm3/10(6) cycles and 0.45 mm3/10(6) cycles for the new implants of 36 mm diameter and established implants of 28 mm diameter respectively. These wear rates compare with 6.3 mm3/10(6) cycles for zirconia-on-ultra-high molecular weight polyethylene tested on the same simulator and representative clinical values for metal-on-polyethylene of 36 mm3/year for heads of 22 mm diameter and a reported range of 60-180 mm3/year for 28 mm heads. These values do not translate directly into numbers of particles, since the metallic debris from metal-on-metal joints is very fine. The number of metallic particles may exceed the number of polyethylene wear particles from an otherwise similar metal-on-polyethylene joint by a factor of 10(3). A detailed discussion of the size and morphology of wear debris and tissue reaction to various forms of debris is beyond the scope of this paper, but the biological response to polymeric, metallic and ceramic wear debris forms a major subject for further study. The present investigation nevertheless confirms the potential of carefully designed and manufactured metal-on-metal total replacement joints for the treatment of diseased and damaged hips.     

The tribology of metal-on-metal total hip replacements

Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.     

The influence of stem insertion rate on the porosity of the cement mantle of hip joint replacements

This study investigates the effect of stem insertion rate on the porosity of the cement mantle. An experimental protocol was developed to simulate the surgical technique of cementing a prosthetic stem into the medullary canal of the femur. Cement mantle specimens were produced for three different stem insertion rates. The presence of porosity in the cement mantle was investigated. Additionally, the mechanical strength of the bone cement was assessed. Increasing the stem insertion rate did not have a significant effect on the porosity distribution within the bulk cement mantle. However, for all stem insertion rates investigated, the porosity concentration increased significantly moving from the cement/pseudofemur interface through to the stem/cement interface. In all cases, the presence of porosity significantly decreased the mechanical behaviour of the bone cement. High porosity concentration at the stem/cement interface seems to be attributed also to the rheology of the cement during implant insertion. Nevertheless, the surgeon cannot influence the formation of porosity by changing the stem insertion rate.     

Biocompatible alumina ceramic for total hip replacements

Abstract

Their resistance to wear and biocompatibility make ceramics ideal materials for medical applications, such as implants. For over 30 years, pure alumina has been the dominant material for ceramic hip prostheses. Interest in alumina hip prostheses continues to grow, due to the relatively short life of polymer/metal prostheses, mainly resulting from osteolysis and aseptic loosening caused by polymer wear debris. Since its introduction by Boutin in the 1970s, substantial improvements have been achieved in the microstructure of medical grade alumina by improving purity and processing to give complete densification and fine, uniform grain sizes. A brief review is given of the types of alumina used in total hip replacement, the development of medical grade alumina, and methods of in vivo and in vitro investigation of alumina prostheses, with a focus on current knowledge of the damage observed on alumina prostheses. Particular attention is paid to wear mechanisms and the influence of materials properties on wear behaviour. A region of relatively severe wear, known as stripe wear, is widely observed on retrieved alumina hip prostheses. This type of wear can now be replicated in vitro in joint simulators by the introduction of a 'microseparation' motion during the test cycle. Finally, the future of ceramic hip prostheses and development of the next generation of ceramics for hip prostheses is discussed.     

A ‘3-body’ abrasion wear study of bioceramics for total hip joint replacements

The current study focuses on the effect of the material type and the lubricant on the abrasive wear behaviour of two important commercially available ceramic on ceramic prosthetic systems, namely, Biolox^® forte and Biolox^® delta (CeramTec AG, Germany). A standard microabrasion wear apparatus was used to produce ‘3-body’ abrasive wear scars with three different lubricants: ultrapure water, 25 vol% new-born calf serum solution and 1 wt% carboxymethyl cellulose sodium salt (CMC-Na) solution. 1 μm alumina particles were used as the abrasive. The morphology of the wear scar was examined in detail using Atomic Force Microscopy (AFM) and Scanning Electron Microscopy (SEM). Subsurface damage accumulation was investigated by Focused Ion Beam (FIB) cross-sectional milling and Transmission Electron Microscopy (TEM). The effect of the lubricant on the ‘3-body’ abrasive wear mechanisms is discussed and the effect of material properties compared.     

Analysis of elastohydrodynamic lubrication in McKee-Farrar metal-on-metal hip joint replacement

An elastohydrodynamic lubrication (EHL) analysis was carried out in this study for a typical McKee-Farrar metal-on-metal hip prosthesis under a simple steady state rotation. The finite element method was used initially to investigate the effect of the cement and bone on the predicted contact pressure distribution between the two articulating surfaces under dry conditions, and subsequently to determine the elastic deformation of both the femoral and the acetabular components required for the lubrication analysis. Both Reynolds equation and the elasticity equation were coupled and solved numerically using the finite difference method. Important features in reducing contact stresses and promoting fluid-film lubrication associated with the McKee-Farrar metal-on-metal hip implant were identified as the large femoral head and the thin acetabular cup. For the typical McKee-Farrar metal-on-metal hip prosthesis considered under typical walking conditions, an increase in the femoral head radius from 14 to 17.4 mm (for a fixed radial clearance of 79 microm) was shown to result in a 25 per cent decrease in the maximum dry contact pressure and a 60 per cent increase in the predicted minimum film thickness. Furthermore, the predicted maximum contact pressure considering both the cement and the bone was found to be decreased by about 80 per cent, while the minimum film thickness was predicted to be increased by 50 per cent. Despite a significant increase in the predicted minimum lubricating film thickness due to the large femoral head and the thin acetabular cup, a mixed lubrication regime was predicted for the McKee-Farrar metal-on-metal hip implant under estimated in vivo steady state walking conditions, depending on the surface roughness of the bearing surfaces. This clearly demonstrated the important influences of the material, design and manufacturing parameters on the tribological performance of these hard-on-hard hip prostheses. Furthermore, in the present contact mechanics analysis, the significant increase in the elasticity due to the relatively thin acetabular cup was not found to cause equatorial contact and gripping of the ball.