The effects of polyethylene cup thickness on wear of total hip prostheses

The wear rate of the ultrahigh molecular weight polyethylene cups in combination with a 28 mm alumina femoral head was measured on the radiographs of patients without any complications, and on cups retrieved due to slight loosening of the prosthesis or due to late infection between bone and components. The wear rate on the radiographs did not include the initial wear, but the wear rate on the retrieved cups did include the initial wear. The wear rate on the retrieved cups was higher, by 50%, than that measured on the radiographs. In both cases, the thicker the polyethylene cups, the lower was the wear rate measured. The average wear rate of the 7 and 8 mm thick cups was about twice that of cups 10 and 11 mm thick. From these results, we conclude that polyethylene cups more than 11 mm thick should be used.     

Observations of residual sub-surface shear strain in the ultrahigh molecular weight polyethylene acetabular cups of hip prostheses

Analysis of bearing surfaces of explanted cups can help to determine the wear mechanisms that are responsible for generation of wear debris. In this study a microscope polariscope was used to detect residual subsurface shear strains, deformation and subsurface cracks in explanted Charnley acetabular cups. The wear surfaces were compared to an acetabular cup from a hip joint simulator test. The six explanted cups that were studied had all failed after long periods of implantation, with penetrations ranging from 2.1 to 3.8 mm. The explanted and simulator cups both had a smooth, high-wear region. High residual subsurface shear strains were found in the high-wear region of most cups, with certain cups possessing subsurface cracks running parallel with the surface 5–10 m deep, close to the areas of high residual subsurface shear strain. This was caused by plastic deformation and subsurface fatigue of the polymer surface.     

Effect of cross-linkage by gamma radiation in heavy doses to low wear polyethylene in total hip prostheses

Wear, frictional torque and creep deformity of UHMWPE sockets crosslinked by gamma radiation of 100, 500 and 1000 Mrad in combination with 28 mm alumina heads, were measured using a hip simulator (under constant load 250 kgf with lubrication of saline solution). Hardness and hydrophilic increased and creep deformity decreased as a result of gamma radiation. The initial wear (decrement of the thickness) of the socket with radiation of 0, 100, 500 and 1000 Mrad was, 150 m, 100 m, 70 m and 50 m, respectively. The time to steady-state wear at 0, 100, 5000 and 1000 Mrad was about 0.15 million, 0.15 million, 0.1 million, and 0.05 million cycles, respectively. The steady-state wear (decrement of the thickness) of the socket without and with radiation was 200 m/million cycles and less than 20 m/million cycles, respectively. Rotational torque was under 0.65 Nm in every case. Swing frictional torque at radiation levels of 0, 100, 500 and 1000 MRad were 1.60–2.84 Nm, 3.24–9.02 Nm, 5.23–8.78 Nm, and 2.51–6.79 Nm, respectively.     

The prediction of polyethylene wear rate and debris morphology produced by microscopic asperities on femoral heads

Counterface damage in the form of scratches, caused by bone cement, bone or metallic particles, has been cited as a cause of increased wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups. It is known that high levels of particulate wear debris lead to osteolysis. Surface damage was characterized in a series of explanted Charnley femoral heads. The heads had a mean scratch height of 1 m with a mean aspect ratio (defined as height divided by half width) of 0.1. Wear discs were artificially scratched using these scratch geometries as a guide. In addition, the scratch geometries were incorporated into a finite element model of a stainless steel asperity repeatedly sliding over UHMWPE under conditions similar to those in an artificial hip joint. Wear tests showed a strong correlation between the average cross-sectional area of the scratch lip above the mean zero line and the measured wear factor. The finite element model predicted increases in the area of UHMWPE suffering plastic strain with increases in the cross-sectional area of the asperity above the mean line. Analysis of the wear debris showed the mode of the particle size was 0.01–0.5 m for all cases. The morphology of the particles varied with aspect ratio of the asperity, with an increased percentage mass of submicrometer-sized debris with increased scratch lip aspect ratio. The finite element results predicted that the maximum surface strains would increase with increasing asperity aspect ratio. Examination of the worn UHMWPE pin surfaces showed an association between increased surface damage, probably due to high surface strains, and increased aspect ratio. The large areas of surface plastic strain predicted for asperities with high cross-sectional areas above the mean line offer an explanation for the positive correlation between wear rate and the average cross-sectional area of the scratch lip material. The higher surface strains predicted for the higher aspect ratios may explain the increased percentage mass of biologically active submicrometer-sized wear particles found for scratch lips with higher aspect ratios. ©©2000 Kluwer Academic Publishers     

Quantitative analysis of polyethylene wear debris, wear rate and head damage in retrieved Charnley hip prostheses

Submicrometer- and micrometer-sized ultra-high molecular weight polyethylene (UHMWPE) wear particles have been associated with osteolysis and failure of total artificial joints. Previous studies have isolated predominantly submicrometer-sized particles at the expense of larger particles (>10 m). This study aimed to isolate and characterize quantitatively all sizes of UHMWPE wear particles generated in 18 Charnley hip prostheses. In addition, to analyze the wear debris with respect to the total volumetric wear of the cup and damage to the femoral head. Particle size distributions ranged from 0.1 to ->1000 m. A significant proportion (3–82%) of the mass of the wear debris isolated was>10 m. The mode of the frequency distribution of the particles was in the range 0.1–0.5 m for all patients. However, analysis of the mass of wear debris as a function of its size allowed differentiation of the wear debris from different patients. Femoral head damage was associated with high volumetric wear and increased numbers of biologically active submicrometer-sized particles.     

A combined XPS-SEM/EDX investigation on explanted UHMW polyethylene acetabular cups: possible role of silicon traces in the wear debris

An investigation was started aimed at a better understanding of the complex phenomena leading to chemical degradation and morphological deterioration of UHMW polyethylene cups in total hip prostheses. Analysis was performed on retrieved implants which needed revision due to inflammation and pain problems. Preliminary results obtained by parallel XPS and SEM/EDX experiments gave evidence, for the first time, that silicon traces are involved in the process of particle formation and segregation onto the surface of the cups. The extent of modification of the surface chemical composition of cups and the process of particle segregation seem to be correlated to both the implant time and to some particular features of patient (age, activity, style of life, etc.). Investigation on a large number of samples is in progress in order to test this hypothesis. The results obtained so far confirmed the potential of surface spectroscopies (XPS) in biomaterial investigations.     

Application of a stereometric structural analysis for an evaluation of surface and for a forecast of the wear of endoprothesis acetabular cups

To improve the resistance to wear and permanent deformation of polyethylene operating in a polymer/metal friction couple, initial plastic deformation of the polyethylene and its electron irradiation was applied. This contributed to a change of the polymer structure, visible already while machining when the sample surfaces were being prepared for a tribological test. The study shows that the interactions that shape the structure of polyethylene, at the same time cause adequate changes to the stereometric structure of its surface. The parameters of surface microgeometry characterize the future tribological behavior of polyethylene during its operation in a friction couple. It has been shown that an analysis of stereometric parameters may constitute the first projection of polymer wear resistance.     

Investigations into the mechanical reliability of ceramic femoral heads for hip joints

This paper reports the findings of a finite element analysis applied to the study of ceramic femoral ball heads. The objective of carrying out these analyses was to assess the shape design and loading conditions applied to specific femoral heads and to capture the stress fields developed when they are subjected to idealized test conditions. Two designs were considered, these being the existing Biolox keyhole shape, manufactured by Cerasiv, Medical Products Division and an alternative design with a flat top internal hole. For each of these designs, three load cases and two types of frictional contact were considered. It is shown that the key hole shape with full taper contact conditions together with the higher value of surface friction produce the lowest tensile stress fields in the ball head hence increasing mechanical reliability.     

Retrieved total hip prostheses. Part I: The effects of cup thickness, head sizes and fusion defects on wear

The effects of polyethylene cup thickness, femoral head sizes (22, 28 and 32 mm) and fusion defects on wear were investigated on retrieved total hip prostheses. When the cup thickness was less than 9 mm, the larger the femoral head, the higher the linear wear rate; however, when the cup thickness was more than 9 mm, the larger the femoral head, the linear wear rate was lower. When the cup thickness was less than 11 mm, the volumetric wear rate increased with increasing size of the femoral head, and when it was more than 11 mm, the volumetric wear rate of the three kinds of the prosthetic cups approached the same values. The wear rate of the cross-linked cups irradiated by 100 Mrad were very low, with no correlation to cup thickness. When the cup thickness was less than 9 mm, the volumetric wear rate tended to increase with increasing number of fusion defects. Large diameter fusion defects diminished the tensile strength.     

The effects of peroxide content on the wear behavior, microstructure and mechanical properties of peroxide crosslinked ultra-high molecular weight polyethylene used in total hip replacement

The wear of the ultra-high molecular weight polyethylene (UHMWPE) acetabular components and wear debris induced osteolysis are the major causes of failure in total hip replacements. Crosslinking has been shown to improve the wear resistance of UHMWPE by producing a network structure, resisting the plastic deformation of the surface layer. In this study organic peroxides were used to crosslink two different types of UHMWPE resins, using hot isostatic pressing as the processing method. The effects of peroxide content on the different properties were investigated, along with the effect of the crosslink density on the wear behavior. An increase in peroxide content decreases the melting point and the degree of crystallinity, which results in a decrease in the yield strength. The ultimate tensile strength remains essentially unchanged. The molecular weight between crosslinks decreases with an increase in the peroxide content and reaches a saturation limit at around 0.3–0.5 weight percent peroxide, its value at the saturation limit is a function of the virgin resin used for processing. The wear rate decreases linearly with the increase in crosslink density.     

Microscale wear behavior and crosslinking of PEG-like coatings for total hip replacements

The predominant cause of late-state failure of total hip replacements is wear-mediated osteolysis caused by wear particles that originate from the ultrahigh molecular weight polyethylene (UHMWPE) acetabular cup surface. One strategy for reducing wear particle formation from UHMWPE is to modify the surface with a hydrophilic coating to increase lubrication from synovial fluid. This study focuses on the wear behavior of hydrophilic coatings similar to poly(ethylene glycol) (PEG). The coatings were produced by plasma-polymerizing tetraglyme on UHMWPE in a chamber heated to 40°C or 50°C. Both temperatures yielded coatings with PEG-like chemistry and increased hydrophilicity relative to uncoated UHMWPE; however, the 40°C coatings were significantly more resistant to damage induced by atomic force microscopy nanoscratching. The 40°C coatings exhibited only one damage mode (delamination) and often showed no signs of damage after repeated scratching. In contrast, the 50°C coatings exhibited three damage modes (roughening, thinning, and delamination), and always showed visible signs of damage after no more than two scratches. The greater wear resistance of the 40°C coatings could not be explained by coating chemistry or hydrophilicity, but it corresponded to an approximately 26–32% greater degree of crosslinking relative to the 50°C surfaces, suggesting that crosslinking should be a significant design consideration for hydrophilic coatings used for total hip replacements and other wear-dependent applications.     

Wear testing and particle characterisation of sequentially crosslinked polyethylene acetabular liners using different femoral head sizes

Larger femoral heads lead to a decreased risk of total hip dislocation and an improved range of motion. However, the larger diameter is associated with increased wear rates. The low wear rates of crosslinked polyethylene opens up the possibility of using larger heads. The aim of this experimental study was to evaluate the wear of conventional non-crosslinked versus sequentially crosslinked polyethylene liners in combination with different ceramic head sizes (28, 36, 44 mm). Wear testing was performed in a hip simulator according to ISO 14242. Wear particles from the polyethylene liners were characterized after wear testing. The wear measurements revealed a significant increase in the wear of crosslinked polyethylene liners with larger heads. By sequential crosslinking, however, the gravimetric wear using larger heads was reduced to a fractional amount of the wear using conventional polyethylene. Significant differences were observed for particle morphology but not for the number of particles when comparing non-crosslinked and crosslinked polyethylene.     

The combined role of wear particles, macrophages and lymphocytes in the loosening of total joint prostheses

This review considers the causes of loosening of prosthetic joint replacement paying attention to the biological mechanisms rather than other effects that are physical, such as component fracture and other failure related to mechanical problems. Infection accounts for approximately 1.5 per cent of joint loosening and when it occurs it is a cause of serious concern to the surgeon. The loosening of prosthetic joints in the absence of infection is by far the most common reason for revision surgery and is known as aseptic loosening. While this may be multifactorial in terms of causation, and non-biological factors may contribute significantly in a particular individual, a significant part is undoubtedly played by the generation of wear debris, mainly from the bearing surfaces of the joint, and the cellular reaction to this in the implant bed. Phagocytic cells (macrophages and multinucleated giant cells) are the ones that remove foreign material from the tissues, and the ways in which these cells function in the interface between implant and bone are described. Mediators produced locally include numerous cytokines, enzymes and integrins. There is evidence for interactions between macrophages and locally recruited lymphocytes, which may or may not give rise to an immunologically mediated process.     

Characterisation of wear particles produced by metal on metal and ceramic on metal hip prostheses under standard and microseparation simulation

The failure of metal on polyethylene total hip replacements due to wear particle induced osteolysis and late aseptic loosening has focused interest upon alternative bearings, such as metal on metal implants. A recent advance in this field has been the development of a novel ceramic on metal implant. The characteristics of the wear particles generated in this low-wearing bearing have not been previously determined. The aims of this study were to characterise metal wear particles from metal on metal and ceramic on metal hips under standard and adverse (microseparation) wear conditions. Accurate characterisation of cobalt-chrome wear particles is difficult since the reactive nature of the particles prevents them from being isolated using acids and bases. A method was developed to isolate the metal wear particles using enzymes to digest serum containing lubricants from metal on metal and ceramic on metal hip simulations. High resolution scanning electron microscopy was then used to characterise the wear particles generated by both metal on metal and ceramic on metal implants under standard and microseparation wear conditions. The wear particles isolated from all simulations had a mean size of less than 50 nm with a rounded and irregular morphology. No significant difference was found between the size of wear particles generated under any conditions.     

Is 7206 ISO standard enough to prove the endurance of femoral components of hip prostheses?

The design of a cementless femoral stem that fractured at the neck–shoulder junction was analysed with reference to parts 4 and 8 of ISO standard 7206. The stresses in the section where fracturing occurred were calculated assuming the 2300 N loading specified in ISO 7206-8. The results show that the prosthesis met ISO standard requirements regarding fatigue behaviour. However, this feature does not occur when a load of 4000 N, corresponding to a patient with a body weight of 1000 N, is applied. It is therefore suggested that patient body weight should be taken into account when designing and choosing the appropriate stem size.     

Quantitative analysis of the wear and wear debris from low and high carbon content cobalt chrome alloys used in metal on metal total hip replacements

The biological reactions to polyethylene wear debris have been shown to result in osteolysis and loosening of total hip arthroplasties. This has led to renewed interest in the use of metal on metal bearings in hip prostheses. This study employed uniaxial and biaxial multistation pin on plate reciprocators to assess how the carbon content of the cobalt chrome alloy and the types of motion affected the wear performance of the bearing surfaces and the morphology of the wear debris generated.The low carbon specimens demonstrated higher wear factors than both the mixed carbon pairings and the high carbon pairings. The biaxial motion decreased the wear rates of all specimens. Plate wear was significantly reduced by the biaxial motion, compared to pin wear. The metal wear particles isolated were an order of magnitude smaller than polyethylene particles, at 60–90 nm, and consequently, 100-fold more particles were produced per unit volume of wear compared to polyethylene. The low carbon specimens produced significantly larger particles than the other material combinations, although it is thought unlikely that the difference would be biologically significant in vivo.The volumetric wear rates were affected by the carbon content of the cobalt chrome alloy, the material combination used and type of motion applied. However, particle morphology was not affected by the carbon content of the alloy or the type of motion applied. ©©1999©Kluwer Academic Publishers     

Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability against dislocation of total hip replacement

After total hip replacement an insufficient range of motion (ROM) can lead to contact between femoral neck and rim of the cup (= impingement) causing dislocation and consecutive material failure. The purpose of this study was to analyse the influence of different wear couples on the ROM and stability against dislocation. By means of a special testing device the ROM until impingement, the ROM until dislocation as well as the resisting moment against levering the head out of the cup were experimentally determined. Various total hip systems with cup inserts made of ceramic and polyethylene were comparatively examined in different implant positions. Maximum resisting moment as well as the ROM until impingement and dislocation were clearly influenced by the implant position. Furthermore, the stability against dislocation was affected by design parameters, whereas in the case of appropriate implant position differing wear couples (metal-on-polyethylene vs. ceramic-on-ceramic) had a minor impact. However, as shown by tests under lubricant conditions, ceramic-on-ceramic couples provided less dislocation stability in unfavourable implant position in comparison to metal-on-polyethylene. Therefore, ceramic-on-ceramic couples should only be applied in the case of optimised implant orientation preventing impingement and dislocation with subsequent material failure like chipping off or breakage.     

Influence of surface roughness on the calculation of optical constants of a metallic film by attenuated total reflection

The measured optical-constant errors that arise in the Kretschmann configuration from surface roughness have been analyzed. The broadening of the half-width and the change in the reflection minimum of the attenuated-total-reflection curve that are due to the surface roughness are described. Calculation of the correct optical constants and silver-film thickness is demonstrated.     

An evaluation of the tribological performance of zirconia and CoCrMo femoral heads

Five new zirconia, five new CoCrMo and three explanted CoCrMo femoral heads were wear-tested in bovine serum for five million cycles using the Durham Hip Joint Wear Simulator. Wear was measured gravimetrically and surface topography with a 3D non-contacting profilometer. This allowed an evaluation of the different head types on UHMWPE acetabular cup wear rates and the effect of roughening of the femoral head on acetabular cup wear. The mean acetabular cup wear rate against the five CoCrMo femoral heads was 40.8 mm³/10⁶ cycles which was significantly higher (p = 0.03) than against zirconia (33.3 mm³/10⁶ cycles). The initial surface roughness of the CoCrMo femoral heads (R_a = 4.6 nm) was statistically significantly higher than for the zirconia heads (R_a = 3.1 nm). Over the wear test the CoCrMo heads got statistically significantly rougher (R_a = 10.5 nm) whilst the zirconia heads showed no statistically signficant change. The three explanted CoCrMo femoral heads had initial mean surface roughness, R_a, values of 19, 24 and 55 nm with corresponding cup wear rates of 97.6, 131.2 and 148.4 mm³/10⁶ cycles respectively. The very high wear rates against the explanted heads highlight the need for scratch resistant femoral head surfaces.     

The effect of cooling rate on the wear performance of a ZrCuAlAg bulk metallic glass

In the present work, the local atomic ordering and the wear performance of ZrCuAlAg bulk metallic glass (BMG) samples with different diameters have been studied using transmission electron microscopy (TEM) plus autocorrelation function analysis, and pin-on-disc dry sliding wear experiments. Differential scanning calorimetry and TEM studies show that smaller diameter BMG sample has higher free volume and less local atomic ordering. The wear experiments demonstrate that with the same chemical composition, the smaller BMG sample exhibits higher coefficient of friction, higher wear rate, and rougher worn surface than those of the larger ones. Compared with larger BMG sample, the faster cooling rate of the smaller sample results in looser atomic configuration with more free volume, which facilitates the formation of the shear bands, and thus leads to larger plasticity and lower wear resistance. The results provide more quantitative understanding on the relationship among the cooling rate, the local atomic ordering, and the wear performance of BMGs.