Contact mechanics analysis of metal-on-metal hip resurfacing prostheses

Finite-element method was employed to study the contact mechanics in metal-on-metal hip resurfacing prostheses, with particular reference to the effects of bone quality, the fixation condition between the acetabular cup and bone, and the clearance between the femoral head and the acetabular cup. Simple finite-element bone models were developed to simulate the contact between the articulating surfaces of the femoral head and the acetabular cup. The stresses within the bone structure were also studied. It was shown that a decrease in the clearance between the acetabular cup and femoral head had the largest effect on reducing the predicted contact-pressure distribution among all the factors considered in this study. It was found that as the clearance was reduced, the influence of the underlying materials, such as bone and cement, became increasingly important. Stress shielding was determined to occur in the bone tissue surrounding the hip resurfacing prosthesis considered in this study. However, the stress-shielding effects predicted were less than those observed in conventional total hip replacements. Both the effects of bone quality (reduction in elastic modulus) and the fixation condition between the cup and the bone were found to have a negligible effect on the predicted contact mechanics at the bearing surface. The loading was found to have a relatively small effect on the predicted maximum contact pressure at the bearing surface; this was attributed to an increase in contact area as the load was increased.     

A comparison of structural and mechanical properties in cancellous bone from the femoral head and acetabulum

Mechanical interlock obtained by penetration of bone cement into cancellous bone is critical to the success of cemented total hip replacement (THR). Although acetabular component loosening is an important mode of THR failure, the properties of acetabular cancellous bone relevant to cement penetration are not well characterized. Bone biopsies (9 mm diameter, 10 mm long) were taken from the articular surfaces of the acetabulum and femoral head during total hip replacement. After mechanical and chemical defatting the two groups of bone specimens were characterized using flow measurement, mechanical testing and finally serial sectioning and three-dimensional computer reconstruction. The mean permeabilities of the acetabular group (1.064 x 10(-10) m2) and femoral group (1.155 x 10(-10) m2) were calculated from the flow measurements, which used saline solution and a static pressure of 9.8 kPa. The mean Young's modulus, measured non-destructively, was 47.4 MPa for the femoral group and 116.4 MPa for the acetabular group. Three-dimensional computer reconstruction of the specimens showed no significant differences in connectivity and porosity between the groups. Results obtained using femoral head cancellous bone to investigate bone cement penetration and fixation are directly relevant to fixation in the acetabulum.     

Pre-clinical evaluation of ceramic femoral head resurfacing prostheses using computational models and mechanical testing

Ceramic-on-ceramic hip resurfacing can potentially offer the bone-conserving advantages of resurfacing while eliminating metal ion release. Thin-walled ceramic resurfacing heads are conceivable following developments in the strength and reliability of ceramic materials, but verification of new designs is required. The present study aimed to develop a mechanical pre-clinical analysis verification process for ceramic resurfacing heads, using the DeltaSurf prosthesis design as a case study. Finite element analysis of a range of in vivo scenarios was used to design a series of physiologically representative mechanical tests, which were conducted to verify the strength of the prosthesis. Tests were designed to simulate ideal and worst-case in vivo loading and support, or to allow comparison with a clinically successful metallic device. In tests simulating ideal loading and support, the prosthesis sustained a minimum load of 39 kN before fracture, and survived 10 000 000 fatigue cycles of 0.534 kN to 5.34 kN. In worst-case tests representing a complete lack of superior femoral head bone support or pure cantilever loading of the prosthesis stem, the design demonstrated strength comparable to that of the equivalent metal device. The developed mechanical verification test programme represents an improvement in the state of the art where international test standards refer largely to total hip replacement prostheses. The case study's novel prosthesis design performed with considerable safety margins compared with extreme in vivo loads, providing evidence that the proposed ceramic resurfacing heads should have sufficient strength to perform safely in vivo. Similar verification tests should be designed and conducted for novel ceramic prosthesis designs in the future, leading the way to clinical evaluation.     

A finite element model of an idealized diarthrodial joint to investigate the effects of variation in the mechanical properties of the tissues

The stiffness of articular cartilage increases dramatically with increasing rate of loading, and it has been hypothesized that increasing the stiffness of the subchondral bone may result in damaging stresses being generated in the articular cartilage. Despite the interdependence of these tissues in a joint, little is understood of the effect of such changes in one tissue on stresses generated in another. To investigate this, a parametric finite element model of an idealized joint was developed. The model incorporated layers representing articular cartilage, calcified cartilage, the subchondral bone plate and cancellous bone. Taguchi factorial design techniques, employing a two-level full-factorial and a four-level fractional factorial design, were used to vary the material properties and thicknesses of the layers over the wide range of values found in the literature. The effects on the maximum values of von Mises stress in each of the tissues are reported here. The stiffness of the cartilage was the main factor that determined the stress in the articular cartilage. This, and the thickness of the cartilage, also had the largest effect on the stresses in all the other tissues with the exception of the subchondral bone plate, in which stresses were dominated by its own stiffness. The stiffness of the underlying subchondral bone had no effect on the stresses generated in the cartilage. This study shows how stresses in the various tissues are affected by changes in their mechanical properties and thicknesses. It also demonstrates the benefits of a structured, systematic approach to investigating parameter variation in finite element models.     

Development of a computer model to predict pressure generation around hip replacement stems

Cemented fixation of hip replacements is the elective choice of many orthopaedic surgeons. The cement is an acrylic polymer which grouts the prostheses into the medullary cavity of the femur. Cement pressure is accepted as a significant parameter in determining the strength of cement/bone interfaces and hence preventing loosening of the prostheses. The aim of this work was to allow optimal design of the intramedullary stem of a hip prosthesis through knowledge of the flow characteristics of curing bone cement which can be used to predict pressures achieved during insertion of the femoral stem. The viscosity of the cement is a vital property determining the cement flow and hence cement interdigitation into bone. The apparent viscosities, nu(a), of three commercial bone cements were determined with respect to time by extrusion of the curing cement through a parallel die of known geometry under selected pressures. Theoretical models were developed and implemented in a computer program to describe cement flow in three models each of increasing complexity: (a) a simple parallel cylinder, (b) a tapered conical mandrel and (c) an actual femoral prosthesis, the latter models being complicated by extensional effects as annular areas increase. Predicted pressures were close to those measured experimentally, maximum pressures being in the range 10-160 kPa which may be compared with a threshold of 76 kPa proposed for effective interdigitation with cancellous bone. The theoretical model allows the prosthesis/bone geometry of an individual patient to be evaluated in terms of probable pressure distributions in the medullary cavity during cemented fixation and can guide stem design with reference to preparation of the medullary canal. It is proposed that these models may assist retrospective studies of failed components and contribute to implant selection, or to making informed selection from options in custom hip prosthesis designs to achieve optimum cement pressurization.     

Effect of bone material properties on the initial stability of a cementless hip stem: a finite element study

In previous finite element studies of cementless hip stems reported in the literature, the effect of bone quality on the initial micromotion and interface bone strain has been rarely reported. In this study, the effect of varying cortical and cancellous bone modulus on initial stem micromotion and interface bone strain was examined and the potential consequence of these changes on bone ingrowth and implant migration was reported. A finite element (FE) model of a total hip replacement (THR) was created and the Young's moduli of cortical and cancellous bone were systematically varied to study the relative effect of the quality of both types of bone on the initial stability of a cementless THR. It was found that the initial micromotion and interface bone strain in a THR was significantly affected by the overall stiffness of the femur. In other words, both the reduction of the modulus of cortical and cancellous bone caused an increase in the initial micromotion and interface bone strain. This suggests that for FE studies to be truly predictive, a range of bone quality must be examined to study the performance envelope of a particular stem and to allow comparison with clinical results.     

A comparison of various loading configurations of the proximal femur for the evaluation of reconstructive surgical procedures.

The study was designed to evaluate the effect of different loading configurations on stem and bone stresses in simulated total hip arthroplasty. The traditional experiment design of loading the model through the head of the prosthesis by the resultant joint force was compared with a more realistic model which included an abductor strap to simulate the abductor muscle force. In addition, an alternative experiment design was evaluated in which a loading arm was clamped directly on to the head of the prosthesis. The results show that loading the model by the resultant joint force not only changes the magnitude of the stresses but also the stress distribution compared to the abductor muscle model. The new experiment design closely approximates stresses seen in the abductor muscle model below the lesser trochanter. In the proximal region, the stresses are increased on the medial side and decreased on the lateral side. The advantages of the proposed loading model are: (a) easy and reproducible set-up and alignment is facilitated, (b) different positions of the femur (flexion, extension) can be simulated and (c) a more realistic stress distribution and magnitude is achieved.     

Importance of head diameter, clearance, and cup wall thickness in elastohydrodynamic lubrication analysis of metal-on-metal hip resurfacing prostheses

The main design features of metal-on-metal (MOM) hip resurfacing prostheses in promoting elastohydrodynamic lubrication were investigated in the present study, including the femoral head diameter, the clearance, and the cup wall thickness. Simplified conceptual models were developed, based on equivalent uniform wall thicknesses for both the cup and the head as well as the support materials representing bone and cement, and subsequently used for elastohydrodynamic lubrication analysis. Both typical first- and second-generation MOM hip resurfacing prostheses with different clearances and cup wall thicknesses were considered with a fixed large bearing diameter of 50 mm, as well as a 28 mm diameter MOM total hip replacement bearing for the purpose of comparison. The importance of the head diameter and the clearance in promoting elastohydrodynamic lubrication was confirmed. Furthermore, it was also predicted that a relatively thin acetabular cup in the more recently introduced second-generation MOM hip resurfacing prostheses would be capable of improving elastohydrodynamic lubrication even further.     

Could the intraosseous fluid in cancellous bone bear external load significantly within the elastic range?

Cancellous bone is a two-phase material comprising a porous solid and a fluid. The intraosseous fluid fills the voids of the porous solid and occupies more than 85 per cent of the volume of cancellous bone. Cancellous bone undergoes various loadings; therefore could the intraosseous fluid in cancellous bone bear external load significantly? To answer this question, a specific experimental setup representing the most restrictive fluid flow boundaries around a bovine vertebral cancellous bone sample was designed. Then, a quasi-static loading was applied up to the strain of 0.6 per cent as the measured intraosseous pressure changed in the undrained and drained conditions. A significant intraosseous pressure was generated in the undrained condition, but no intraosseous pressure generation was generated in the drained condition. The maximum external load-bearing capability of the intraosseous fluid in bovine vertebral cancellous bone at the strain of 0.6 per cent was about 66 per cent of the total load in the experimental setup used in this study.     

Non-linear three-dimensional finite element analysis of a cementless hip endoprosthesis

In this finite element study the stresses between a stem component of a cementless hip endoprosthesis (Young modulus of Co-Cr-Mo) and the human femur were calculated for two different loading types. Linear and non-linear models were used to simulate the interface implant bone. Two models, a stem with a porous coated surface over the entire length and a stem with a porous coated surface in the proximal region were compared regarding the load transmission to the femur. An additional calculation of an 'isoelastic' stem (Young modulus of cortical bone) was done to show the influence of the stem stiffness. A porous coated surface over the entire length causes principal shear stresses up to 2.75 MPa in the distal-medial region during level walking. The highest compressive stresses were calculated in the proximal-lateral region as 1.5 MPa in cancellous bone. A more physiological load transmission is obtained by limiting the coated area to the proximal region. All stresses in the two models are lower than experimentally evaluated strengths in the interface between implant and bone. A strong influence of the Young modulus of the stem material on the interface stresses was found. An 'isoelastic' stem causes compressive stresses in the proximal-lateral region whose values exceed the experimental strength of cancellous bone.     

An investigation into the effect of cyclic loading and frequency on the temperature of PMMA bone cement in hip prostheses

A titanium alloy hip prosthesis was inserted in a Tufnol tube representing the upper part of the femur. The prosthesis was cemented in the model femur using PMMA bone cement. Five thermocouples were embedded in the bone cement and the assembly was subjected to cyclic loading with a range of 0.3-4.5 kN at a frequency of 6 Hz. Temperature measurements over a 48 hour period indicated that the temperature rise in the bone cement was less than 4 degrees C. It is concluded that such tests can be carried out at 6 Hz without significantly affecting the mechanical properties of PMMA bone cement.     

Temperature prediction in a finite element model for sliding contact analysis of total hip prosthesis

A finite-element model for sliding contact in total hip joint prosthesis is presented in this paper. The hip prosthesis studied consists of an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup articulating against cobalt-chrome and alumina-ceramic femoral heads. Various aspects of prosthesis operation were analysed using the finite-element model. For example, bulk material and surface stresses were analysed under varying conditions of elastic modulus, friction coefficient, sliding speed, and radial clearance. The resulting variations of temperature were also recorded. The results obtained from the model are useful in understanding the operating conditions and the causes of wear in the hip prosthesis.     

Development rationale for an articular surface replacement: a science-based evolution

Hip resurfacing has an enduring appeal because of the advantages of bone conservation and maximal joint stability. However, a far from satisfactory experience with earlier resurfacing designs led to its virtual disappearance in the 1980s. The concept was reintroduced in the late 1990s. The current generation of resurfacing devices generally consisted of a large-diameter metal-on-metal articulation, the femoral components being cemented and the acetabular components utilizing various forms of cementless fixation. The encouraging medium-term results, with a follow-up of up to 8 years using the current generation of surface replacement joints, combined with favourable reports related to long-term performance of some metal bearings have led to a rapid increase in the use of such components with these devices. This trend is most marked in younger, more active patients who have expectations of restoration of lifestyle in addition to improved mobility and pain relief and in whom failure with conventional total hip replacement is much higher than previously reported with more sedentary patients. The aim of this paper is, firstly, to highlight a number of areas of improvement and, secondly, to explain how these may be addressed by making modifications to the design of both implants and instrumentation and to the surgical technique. The areas identified for improvement were tissue preservation (thinner components, and reduced steps between sizes), acetabular cup issues (fixation, insertion, and positioning), femoral component issues (design, loading, and cementation), improved bearing surface characteristics, and simplified precise instrumentation with a low-trauma surgical technique.     

Optimizing the configuration of cement keyholes for acetabular fixation in total hip replacement using Taguchi experimental design

Cement fixation of the acetabular component is increasingly recognized as a common site of loosening when hip replacements fail. Cement keyholes drilled into the acetabulum have been recommended to improve this fixation but little is known of the optimum positions or sizes of these holes. This study investigates the diameter, depth and number of keyholes to be drilled to maximize the failure torque in a model system. A Taguchi experimental design was used to identify the most significant factors and to predict the best configuration of keyholes within the constraints of the experimental test rig. One hole at each of the pubic, iliac and ischial sites, of 12 mm diameter and 6 mm depth, was found to be the optimum configuration. The failure torque was most strongly dependent on the hole diameter in the pubic region, decreased with increasing hole depth and was not sensitive to the number of holes.     

The effect of primary stability on load transfer and bone remodelling within the uncemented resurfaced femur

One of the major causes of aseptic loosening in an uncemented implant is the lack of any attachment between the implant and the bone. The implant's stability depends on a combination of primary stability (mechanical stability) and secondary stability (biological stability). The primary stability may affect the implant-bone interface condition and thus influence the load transfer and mechanical stimuli for bone remodelling in the resurfaced femur. This paper reports the results of a study into the affect of primary stability on load transfer and bone adaptation for an uncemented resurfaced femur. Three-dimensional finite element models were used to simulate the intact and resurfaced femurs and the bone remodelling. As a first step towards assessing the immediate post-operative condition, a debonded interfacial contact condition with varying levels of the friction coefficient (0.4, 0.5, and 0.6) was simulated at the implant-bone interface. Then, using a threshold value of micromotion of 50 microm, the implant-bone interfacial condition was varied along the implant-bone boundary to mechanically represent non-osseointegrated or osseointegrated regions of the interface. The considered applied loading conditions included normal walking and stair climbing. Resurfacing leads to strain shielding in the femoral head (20-75 per cent strain reductions). In immediate post-operative conditions, there was no occurrence of elevated strains in the cancellous bone around the proximal femoral neck-component junction resulting in a lower risk of neck fracture. Predominantly, the micromotions were observed to remain below 50 microm at the implant-bone interface, which represents 97-99 per cent of the interfacial surface area. The predicted micromotions at the implant-bone interface strongly suggest the likelihood of bone ingrowth onto the coated surface of the implant, thereby enhancing implant fixation. For the osseointegrated implant-bone interface, the effect of strain shielding was observed in a considerably greater bone volume in the femoral head as compared to the initial debonded interfacial condition. A 50-80 per cent peri-prosthetic bone density reduction was predicted as compared to the value of the intact femur, indicating bone resorption within the superior resurfaced head. Although primary fixation of the resurfacing component may be achieved, the presence of high strain shielding and peri-prosthetic bone resorption are a major concern.     

过盈量对植入体与骨接触压力的影响

为了探讨植入体骨界面的应力特征,采用各向异性的三维有限元和接触单元法,建立一个立方体颌骨与圆柱体植入体的局部模型,研究过盈量对界面接触压力的影响。嵌合界面按100％骨结合率,计算不同过盈量下植入体骨界面、骨内各节点的应力。结果表明界面接触压力沿植入体中轴线非对称分布,接触压力大小与过盈量呈正比的关系,在近远中向达到最大,颊舌向的压力最小;在深度方向皮质骨层接触压力最大,在骨孔底部松质骨层接触压力最小;在半径方向上离界面越远应力越小;皮质骨对植入体的力学稳定性贡献较大。     

Primary and long-term stability of a short-stem hip implant

The new generation short-stem hip implants are designed to encourage physiological-like loading, to minimize stress-strain shielding and therefore implant loosening in the long term. As yet there are no long-term clinical studies available to prove the benefits of these short-stem implants. Owing to this lack of clinical data, numerical simulation may be used as a predictor of longer term behaviour. This finite element study predicted both the primary stability and long-term stability of a short-stem implant. The primary implant stability was evaluated in terms of interface micromotion. This study found primary stability to fall within the critical threshold for osseointegration to occur. Longer term stability was evaluated using a strain-adaptive bone remodelling algorithm to predict the long-term behaviour of the bone in terms of bone mineral density (BMD) changes. No BMD loss was observed in the classical Gruen zones 1 and 7 and bone remodelling patterns were comparable with hip resurfacing results in the literature.     

Hip resurfacing arthroplasty: the evolution of contemporary designs

Metal-on-metal hip resurfacing is considered by many as the most significant recent development in hip arthroplasty. It preserves proximal femoral bone stock, optimizes stress transfer to the proximal femur, and offers inherent stability and optimal range of movement. The early results of hip resurfacing in the 1970s and 1980s were poor and the procedure was largely abandoned by the mid-1980s. The expectation that these prostheses would be easy to revise was not often fulfilled. The large diameter of the articulation combined with thin polyethylene cups or liners resulted in accelerated wear and the production of large volumes of biologically active particulate debris, leading to bone loss and implant loosening. Failure has been attributed to other factors, mainly avascular necrosis of the femoral head. However, this concern has not been confirmed by retrieval studies. The failure of early hip resurfacings was essentially a consequence of the use of inappropriate materials, poor implant design, inadequate instrumentation, and crude surgical technique. It was not an inherent problem with the procedure itself. The renaissance of metal-on-metal articulations for total hip arthroplasty enabled the introduction of new hip resurfacings and most of the major implant manufacturers have already introduced such systems. Early results are encouraging and complications commonly seen in the 1970s and 1980s, such as early implant loosening and femoral neck fracture, now appear to be rare. Whilst early results should be regarded with caution, modern metal-on-metal hip resurfacing potentially offers the ultimate bone preservation and restoration of function in appropriately selected young patients.     

Investigating the effect of remodelling signal type on the finite element based predictions of bone remodelling around the thrust plate prosthesis: a patient-specific comparison

The resorption of bone in the human femur following total hip arthroplasty is recognized to be related to the loading in the bone surrounding the prosthesis. However, the precise nature of the mechanical signal that influences the biological remodelling activity of the bone is not completely understood. In this study, a validated finite element modelling methodology was combined with a numerical algorithm to simulate the biological changes over time. This was used to produce bone remodelling predictions for an implanted thrust plate prosthesis (Centerpulse Orthopedics Limited) in a patient specific bone model. The analysis was then repeated using different mechanical signals to drive the remodelling algorithm. The results of these simulations were then compared to the patient-specific clinical data, to distinguish which of the candidate signals produced predictions consistent with the clinical evidence. Good agreement was found for a range of strain energy based signals and also deviatoric remodelling signals. The results, however, did not support the use of compressive dilatational strain as a candidate remodelling signal.     

滚动摩擦:一种新的人工关节设计

针对人工关节磨损颗粒导致的骨吸收、骨溶解现象以及由此引起的假体远期松动问题,基于滚动摩擦原理,提出了一种新的无聚乙烯滚动式人工关节设计思想,并以滚动式人工髋关节和滚动式人工膝关节设计为例探讨其基本设计原理。滚动式人工髋关节通过滚动轴承将原有人工半髋关节与天然髋臼之间的滑动摩擦在屈伸运动方向变为滚动摩擦,滚动式人工膝关节则通过滚动轴承将膝关节在屈伸运动方向上的滑动摩擦变为滚动摩擦,从而能有效降低人工关节运动时的摩擦阻力和假体—骨界面间的应力,降低了金属假体的磨损。滚动式人工关节假体设计由于没有采用聚乙烯作为主要的摩擦件,从而完全避免了聚乙烯磨粒及其引起的生物毒性作用,为有效降低假体的远期松动提供了新思路。