Femoral strain adaptation after total hip replacement: a comparison of cemented and porous ingrowth components in canines

The purpose of this study was to investigate if experimental strain analysis is predictive of femoral adaptation after total hip replacement (THR). Ten large adult dogs underwent unilateral THR with identical implants. Five implants were press fit for porous ingrowth fixation, and five were cemented. Four months after surgery femora were harvested. Strain gauge rosettes were applied to the femora at eight proximal locations. Femora were compressively loaded on the head of the femur or femoral component. Strain data represented three conditions: preoperative, acutely postoperative, and four-month postoperative. The unoperated femur of each dog was used to simulate preoperative and acutely postoperative behavior of the contralateral implanted femur. Strains from each condition were compared. Transverse femoral sections were obtained through the levels of the strain gauges. Fine detailed radiographs were used to quantify morphological changes. Results showed cemented and uncemented implantations produce similar trends but different amounts of bone adaptation. Adaptations were generally consistent in direction with strain perturbations caused by implantation, but the extent of adaptation did not strongly correlate with the magnitude of perturbations. Also, there was no consistent trend towards normalization of altered strains. Results suggest that strain perturbations after THR may be mechanical triggers for morphological changes, but caution is required when predicting the extent of these changes or the autoregulatory role of strain.     

Understanding initiation and propagation of fretting wear on the femoral stem in total hip replacement

The femoral stem–bone cement interface in total hip replacement is supposed to experience low amplitude oscillatory micromotion under physiological loading, consequently leading to fretting wear on the stem surface, which nowadays is considered to play an important part in the overall wear of cemented prosthesis. However, initiation and propagation of fretting wear has been poorly documented and a better understanding concerning this issue has not been established as yet. This present study, on the basis of a profound surface investigation of a polished Exeter V40? femoral stem and Simplex P bone cement obtained from an in vitro wear simulation, demonstrated that the edges of the micropores in the cement surface matched pretty well to the boundaries of the worn areas on the stem surface. This would indicate that these micropores contributed significantly to the fretting process at the stem–cement interface.     

Reproduction of fretting wear at the stem-cement interface in total hip replacement

The stem-cement interface experiences fretting wear in vivo due to low-amplitude oscillatory micromotion under physiological loading, as a consequence it is considered to play an important part in the overall wear of cemented total hip replacement. Despite its potential significance, in-vitro simulation to reproduce fretting wear has seldom been attempted and even then with only limited success. In the present study, fretting wear was successfully reproduced at the stem-cement interface through an in-vitro wear simulation, which was performed in part with reference to ISO 7206-4: 2002. The wear locations compared well with the results of retrieval studies. There was no evidence of bone cement transfer films on the stem surface and no fatigue cracks in the cement mantle. The cement surface was severely damaged in those areas in contact with the fretting zones on the stem surface, with retention of cement debris in the micropores. Furthermore, it was suggested that these micropores contributed to initiation and propagation of fretting wear. This study gave scope for further comparative study of the influence of stem geometry, stem surface finish, and bone cement brand on generation of fretting wear.     

The contribution of the micropores in bone cement surface to generation of femoral stem wear in total hip replacement

Although cemented total hip replacement has long been recognized as a situation that can lead to wear, the wear generated on the femoral stem has not been well documented, especially with regard to how this wear is initiated and propagated. This present work aimed to further investigate this issue based on a comprehensive study on surface morphology of the femoral stem and the bone cement, which were collected from seven in vitro wear simulations. It was shown that the wear locations on the stem surface compared well with the results of retrieval studies, and the boundaries of the worn areas matched well the edges of the micropores present in the bone cement surface. This indicated that the micropores could potentially contribute to the generation of femoral stem wear. In addition, metallic debris was detected around the micropores from the simulation with increased loading cycles. However, no evidence of macro-cracks was observed across the cement mantle in spite of the presence of micro-cracks initiated at the edge of the micropores. This study demonstrated a possible cause for progression of femoral stem wear and it may have an important bearing on the long term durability of cemented hip prosthesis.     

New joints for the Millennium: wear control in total replacement hip joints

Hip joint replacement is described as the greatest achievement in orthopaedic surgery in the twentieth century. The field has been dominated for some forty years by implants based upon metallic femoral heads and stems and polymeric acetabular cups. At the dawn of the new Millennium, many alternative materials and designs are now being proposed or evaluated. The reasons for these developments and the current contributions of engineering science and tribology to advances in hip replacement are discussed. Illustrations are presented of the significant changes being proposed or introduced. While the new designs of total hip replacements offer exciting engineering contributions to the future of joint replacement, the long-term benefits to patients will depend upon the biological response to the new devices.     

A study of the wear of some materials in connection with total hip replacement

Failure of total hip prostheses due to wear is examined. It is concluded that wearing out of these devices should not be a problem. However, it is desirable to look for materials of improved wear resistance due to possibilities of long-term response to wear debris.A series of experiments is described to evaluate the wear resistance of candidate materials on an annular wear tester. The results indicate that the wear resistance of ultra high molecular weight polyethylene may be improved by increase in molecular weight, by irradiation or by the use of fillers. Pyrolytic carbon containing silicon is also a good candidate.     

Validation of ion level analysis as method to assess in vitro total hip replacement wear

Abstract

Currently in vitro hip simulator wear of metal on metal hip replacements is carried out by gravimetric means. However, this is time consuming and cannot be used to assess wear between measurement intervals. Measuring ion levels (Co and Cr) by inductively coupled plasma mass spectroscopy has been proposed as an alternative method. A standard hip simulator test was conducted using clinically available parts and wear assessed by gravimetric means; additionally, the serum lubricant was assessed for Co and Cr ion levels. A strong correlation in the ion levels and gravimetric was observed, indicating that this method would provide an appropriate alternative wear measurement technique in hip simulator testing.     

Design revision of a partially cemented hip stem.

In a previous preclinical study the prototype version of a partially cemented hip stem, cement-locked uncemented (CLU) prosthesis, showed optimal primary stability and moderate stress shielding. However, numerical analysis suggested that the prototype design would induce relatively high stresses in the cement and a significant relative motion between cement and metal. The present study aimed to verify if these problems could be eliminated once the CLU design is improved. The revised design was analysed using a complete finite element model of an implanted human femur. To further strengthen the predictions of the finite element analysis, the cement damage induced by a severe load history was assessed experimentally in synthetic femurs implanted with the improved CLU stem or with a clinically successful fully cemented stem. The modifications made to the CLU stem design did not reduce its good primary stability but decreased the metal-cement relative micromotion. The same load induced stresses in the cement mantle of the improved CLU stem that were significantly lower than those predicted for the prototype design. Although the presence of modelling artefacts produced a highly localized stress peak of 13 MPa. 99 per cent of the cement volume was subjected to a principal tensile stress lower then 4 MPa. These levels of stress compare favourably with the tensile fatigue limit of the acrylic cement used in this study (9.7 MPa). The experimental results further supported these findings. The cemented stem showed a number of cracks per volume unit approximately ten times higher than the partially cemented stem under investigation.     

Effect of contact stress on friction and wear of ultra-high molecular weight polyethylene in total hip replacement

This paper studies the effect of contact stress on friction and wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups by means of friction and wear joint simulator testing under serum lubrication. For a given applied load, increasing the contact stress by increasing the ball/socket radial clearance decreased both the coefficient of friction and the wear rate. Friction and wear were highly correlated. The dependence of friction on contact stress for the UHMWPE socket under serum lubrication was similar to that of semi-crystalline polymers under dry sliding. This finding indicates the occurrence of partial dry contact at asperity levels for the metal-polyethylene ball-in-socket joint under serum lubrication.     

Comparative study on the wear behaviour of different conventional and cross-linked polyethylenes for total hip replacement

In this study, five different types of conventional and cross-linked polyethylene (XLPE) (γ-sterilised PE GUR1020, EtO-sterilised PE GUR1020, γ-sterilised PE GUR1050, EtO-sterilised XLPE GUR1020, EtO-sterilised XLPE GUR1050) acetabular cups were tested on a hip joint simulator run for 5 million cycles in order to compare the relative long-term wear resistance in relation to material properties (PE grade, conventional or cross-linked) and sterilisation method (EtO treatment or γ-irradiation).Gravimetric measurements revealed significant differences between the wear behaviours of the five sets of acetabular cups. Weight loss was found to decrease along the series: γ-sterilised PE GUR1020>EtO-sterilised PE GUR1020>γ-sterilised PE GUR1050>EtO-sterilised XLPE GUR1050>EtO-sterilised XLPE GUR1020. The wear results were discussed in relation to the crystallinity degree of the cups which was determined by micro-Raman spectroscopy coupled to partial least-squares analysis. Within both conventional and cross-linked PE series, it appeared that higher crystallinity samples (i.e. γ-sterilised PE GUR1020 and EtO-sterilised XLPE GUR1050, respectively) were characterised by higher wear rates. The higher weight loss observed for PE GUR1020 was explained in relation to its lower molecular weight with respect to PE GUR1050. Raman analysis showed that wear testing did not significantly modify the crystallinity degree of any of the tested acetabular cups. The most worn cup, i.e. γ-sterilised PE GUR1020, appeared the most homogeneously polished upon wear testing, as confirmed by the lowest standard deviation associated to the crystallinity value recorded in the centre of the cup. The results of this investigation have clearly shown a dramatic wear reduction in favour of the cross-linked polyethylene.     

The wear of metal-on-metal total hip prostheses measured in a hip simulator

New generation metal-on-metal prostheses have been introduced to try and overcome the problem of osteolysis often attributed to the wear particles of the polyethylene component of conventional metal-on-ultra-high molecular weight polyethylene (UHMWPE) joints. The wear rates of four metal-on-metal joints (two different clearances) were assessed along with that of a conventional metal-on-UHMWPE joint. Friction measurements of the metal-on-metal joints were taken before and after the wear test and compared. Two distinct wear phases were discernible for all the metal-on-metal joints: an initial wear phase up to 0.5 x 10(6) cycles and then a lower steady state wear phase. The steady state wear rate of the 22 microm radial clearance metal-on-metal joint was lower than that for the 40 microm radial clearance joint, although this difference was not found to be significant (p > 0.15). The wear rates for all the joints tested were consistent with other simulator studies. The friction factors produced by each joint were found to decrease significantly after wear testing (p < 0.05).     

Biological reactions to wear debris in total joint replacement

The vast majority of total hip prostheses currently implanted consist of a hard metal or ceramic femoral head articulating against an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Over the last 10 years, evidence has accumulated to show that these prostheses are prone to failure due to late aseptic loosening and few survive beyond 25 years. With an increasing need to implant hip prostheses in the younger, more active patient the need to understand the mechanisms of failure and to develop artificial hip joints using alternative materials have become major issues in the orthopaedic community. This review focuses initially on our current understanding of the biological reactions to UHMWPE prosthetic wear debris in vivo and in vitro since this is believed to be the main cause of late aseptic loosening. While the precise mechanisms of osteolysis induced by UHMWPE wear debris have not been elucidated, the major message to emerge is that it is not the wear volume that determines the biological response to the debris, but the concentration of the wear volume that is within the critical size range (0.2-0.8 micron) for macrophage activation. The review then considers whether the problem of wear-debris-induced osteolysis may be overcome with the use of new generation metal-on-metal or ceramic-on-ceramic prostheses. For metal-on-metal prostheses, the prospects for increasing the osteolysis free life of the implant are good but additional biological problems associated with the nanometre size and reactivity of the wear particles in vivo may emerge. For the ceramic-on-ceramic prostheses, although initial prospects are encouraging, more data are needed on the characteristics of the wear particles generated in vivo before predictions can be made. It is concluded that the pre-clinical testing of any new materials for joint replacement must include an analysis of the wear particle characteristics and their biological reactivity in addition to the usual assessment of wear.     

Analysis and modelling of wear of cobalt-chrome alloys in a pin-on-plate test for a metal-on-metal total hip replacement

The complex interaction between wear and bearing surfaces of two contacting solids was investigated in this study, with particular reference to the use of metal-on-metal material combinations for artificial hip joint replacements. The contact mechanics model was coupled with the wear model and solved simultaneously as a function of time for a simple case of a uniaxial pin-on-plate wear test. Both a spherical pin and a flat-ended spherical pin were considered. It was shown that the contact pressure between the pin and the plate was substantially reduced by the wear process, particularly during the initial running-in period and for the spherical pin. The theoretical prediction of the worn profiles of the pin and the plate was found to be in good agreement with previous experimental measurements by Tipper et al. in 1999.     

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.     

An in vitro wear study of alumina-alumina total hip prostheses.

Four 28 mm diameter alumina-alumina hip prostheses were tested in the Mkll Durham hip simulator for 5 x 10(6) cycles using 25 per cent bovine serum as lubricant. Wear of the heads and cups was measured gravimetrically. The mean and standard deviation of the wear rate for the alumina cups was 0.097 +/- 0.039 mm3/10(6) cycles. The femoral heads produced such low wear that it could not be measured by weighing but could be detected byincreased surface roughness measurements. Such low wear rates represent about one-five-hundredthof the wear of ultra-high molecular weight polyethylene (UHMWPE) against ceramic in a similar test and supports work which indicates that fluid film lubrication exists in these joints.     

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.     

Contact mechanics of a novel metal-on-metal total hip replacement

The contact mechanics of a novel metal-on-metal total hip replacement (THR) were investigated in this study. The metal-on-metal prosthesis considered consists of a cobalt-chrome acetabular insert connected to a titanium shell through a taper contact, articulating against a cobalt-chrome femoral head. Both the experimental measurement of the displacement of the acetabular insert and the contact area between the two bearing surfaces, and the corresponding numerical predictions using the finite element method have been conducted. Excellent agreement has been demonstrated between the experimental measurement and the finite element prediction under various loads up to 3 kN. The maximum contact pressure at the articulating surfaces has been predicted to be about 31 MPa from a simple axisymmetric finite element model, significantly lower than that of a similar cup but with a monoblock construct. This has been mainly attributed to the flexibility of the insert, leading to an increase in the conformity between the femoral head and the acetabular insert. In addition, the predicted maximum contact pressure is only slightly increased to 37 MPa, from a more realistic three-dimensional anatomical finite element model. The design features on metal-on-metal THRs have been shown to reduce contact stresses and may improve tribological performances of these hard-on-hard bearing couples.     

A simulator study of friction in total replacement hip joints.

Frictional behaviour of 22 different femoral head-acetabular cup combinations was studied on a new servo-hydraulic microcomputer-controlled hip joint simulator using various flexion-extension angle and superior-inferior load set value waveforms and using distilled water at 37 +/- 1 degrees C as lubricant. Six different head materials were included in the study, whereas all cups were ultra-high molecular weight polyethylene (UHMWPE). Most head-cup combinations studied are commercially available. No distinctly superior joint design can be pointed out, but the frictional behaviour of alumina ceramic against UHMWPE proved overall most favourable (mu min was 0.02), whereas that of non-ion-implanted titanium alloy Ti-6Al-4V against UHMWPE proved strikingly poor (mu max was 0.15). The lowest frictional torque was in 22 mm joints, but frictional torque did not always increase straightforwardly with increasing diameter of the femoral head. The measurements form an extensive comparison between a wide variety of head-cup combinations. The simulator is apparently a useful instrument in the study of frictional behaviour of new designs, materials, surface treatments and coatings that are frequently introduced.     

Axisymmetric mechanical analysis of ceramic heads for total hip replacement

An axisymmetric, mechanical analysis of conical press-fit ceramic heads is performed. The head strength and its fracture modes are assessed experimentally. The stress field is examined by finite element, strain gauge and photoelastic methods. An alternative head design, characterized by a cylindrical engagement with the stem, is analysed with the same techniques and its merits are explored.