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Sathishkumar S, Paulraj J, Chakraborti P, Muthuraj M. Comprehensive Review on Biomaterials and Their Inherent Behaviors for Hip Repair Applications. ACS APPLIED BIO MATERIALS 2023; 6:4439-4464. [PMID: 37871169 DOI: 10.1021/acsabm.3c00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Developing biomaterials for hip prostheses is challenging and requires dedicated attention from researchers. Hip replacement is an inevitable and remarkable orthopedic therapy for enhancing the quality of patient life for those who have arthritis as well as trauma. Generally, five types of hip replacement procedures are successfully performed in the current medical market: total hip replacements, hip resurfacing, hemiarthroplasty, bipolar, and dual mobility systems. The average life span of artificial hip joints is about 15 years, and several studies have been conducted over the last 60 years to improve the performance and thereby increase the lifespan of artificial hip joints. Present-day prosthetic hip joints are linked to the wide availability of biomaterials. Metals, ceramics, and polymers are some of the most promising types of biomaterials; nevertheless, each biomaterial has advantages and disadvantages. Metals and ceramics fail in most applications owing to stress shielding and the emission of wear debris; ongoing research is being carried out to find a remedy to these unfavorable responses. Recent research found that polymers and composites based on polymers are significant alternative materials for artificial joints. With growing research and several biomaterials, recent reviews lag in effectively addressing hip implant materials' individual mechanical, tribological, and physiological behaviors. This Review comprehensively investigates the historical evolution of artificial hip replacement procedures and related biomaterials' mechanical, tribological, and biological characteristics. In addition, the most recent advances are also discussed to stimulate and guide future researchers as they seek more effective methods and synthesis of innovative biomaterials for hip arthroplasty application.
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Xu J, Oni T, Shen D, Chai Y, Walter WK, Walter WL. Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up. J Arthroplasty 2022; 37:549-553. [PMID: 34843912 DOI: 10.1016/j.arth.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Alumina ceramic-on-ceramic bearings are used in total hip arthroplasty (THA) because of their wear-resistant and inert properties. In this study, we assessed the clinical and radiographic outcomes of patients undergoing primary cementless ceramic-on-ceramic THA at a minimum follow-up of 20 years. METHODS A series of 301 consecutive primary THAs in 283 patients were assessed. Clinically, patients were assessed with the modified Harris Hip Score (HHS) and pain questionnaires. Anteroposterior radiographs of the pelvis and lateral radiographs of the hip were used to radiologically assess the implant. Patients were classified as lost to follow-up if they could not be contacted on multiple occasions or did not wish to participate further in this study. RESULTS At twenty years after operation, 60 patients had died of a cause unrelated to surgery, 16 had experienced complications requiring reoperation, and 100 hips had both clinical assessments and radiographs at a minimum of 20 years of follow-up. The average HHS improved from 56.1 (range: 17-89) before THA to 92.5 (range: 63-100) at the latest follow-up. The classification of the HHS was good or excellent in 96.4% of patients. Only 1.8% of patients still had moderate residual pain at the thigh or groin. Radiographically, all patients demonstrated bony ingrowth but no clinical symptoms of loosening. The overall survival rate of the implants was 94.2% at 20 years with revision for any reason as the end point. CONCLUSION Long-Term follow-up in our series showed excellent implant survival, excellent functional outcomes, and minimal late complications. There was no significant radiographic evidence of failure at a minimum of 20 years after THA. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Joshua Xu
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia; Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
| | - Tofunmi Oni
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - David Shen
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Yuan Chai
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
| | - William K Walter
- Department of Orthopaedic Surgery, Mater Hospital, Sydney, Australia
| | - William L Walter
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia; Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
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Abstract
AbstractThe success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.
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Oxide Bioceramic Composites in Orthopedics and Dentistry. JOURNAL OF COMPOSITES SCIENCE 2021. [DOI: 10.3390/jcs5080206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ceramic composites based on alumina and zirconia have found a wide field of application in the present century in orthopedic joint replacements, and their use in dentistry is spreading. The development of this class of bioceramic composites was started in the 1980s, but the first clinical applications of the total hip replacement joint were introduced in the market only in the early 2000s. Since then, several composite systems were introduced in joint replacements. These materials are classified as Zirconia-Toughened Alumina if alumina is the main component or as Alumina-Toughened Zirconia when zirconia is the main component. In addition, some of them may contain a third phase based on strontium exa-aluminate. The flexibility in device design due to the excellent mechanical behavior of this class of bioceramics results in a number of innovative devices for joint replacements in the hip, the knee, and the shoulder, as well in dental implants. This paper gives an overview of the different materials available and on orthopedic and dental devices made out of oxide bioceramic composites today on the market or under development.
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Microstructure and Young’s modulus evolution during re-sintering of partially sintered alumina-zirconia composites (ATZ ceramics). Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2021.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Busch A, Wassenaar D, Zinser W, Jäger M. A bicentric approach evaluating the combination of a hemispheric cup with a novel ceramic head in total hip arthroplasty. Orthop Rev (Pavia) 2021; 13:8794. [PMID: 33953887 PMCID: PMC8077281 DOI: 10.4081/or.2021.8794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/24/2020] [Indexed: 12/27/2022] Open
Abstract
Medical ceramics are frequently used biomaterials as a liner in total hip arthroplasty. Strong efforts have been made to improve material properties over the last decades. Alumina toughened zirconia ceramics seem to be promising alternatives to further reduce fracture rates and squeaking phenomena. To answer the question if alumina toughened zirconia ceramic liners in combination with a cementless, hemispheric cup are able to reduce squeaking phenomena and fracture rates, we initiated a bicentric, mid-term trial. Noise phenomena will be recorded using MONA Score (Melbourne Orthopaedic Noise Assessment). Functional outcome (Harris Hip Score, University of California-Los Angeles, Forgotten Joint Score, EQ-5D Score, Visual Analogue Scale) and radiographic parameters will serve as secondary parameters. The study has been set up for 5 years, with follow-ups after 6-14 weeks, 12, 24 and 60 months.
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Affiliation(s)
- André Busch
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an der Ruhr, University of Duisburg-Essen
| | - Dennis Wassenaar
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an der Ruhr, University of Duisburg-Essen
| | - Wolfgang Zinser
- Department of Orthopaedics and Trauma Surgery, St. Vinzenz Hospital Dinslaken, Germany
| | - Marcus Jäger
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an der Ruhr, University of Duisburg-Essen
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Hua X, Li J. CMM‐based method for assessing the volume change of retrieved polyethylene cups in MoP total hip replacements. BIOSURFACE AND BIOTRIBOLOGY 2020. [DOI: 10.1049/bsbt.2019.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Xijin Hua
- Department of Health Sciences and TechnologyInstitute for BiomechanicsETH ZurichZurichSwitzerland
| | - Junyan Li
- School of Science & TechnologyDepartment of Design Engineering & MathsMiddlesex University LondonLondonUK
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Al-Hajjar M, Gremillard L, Begand S, Oberbach T, Hans K, Delfosse D, Chevalier J, Jennings LM. Combined wear and ageing of ceramic-on-ceramic bearings in total hip replacement under edge loading conditions. J Mech Behav Biomed Mater 2019; 98:40-47. [PMID: 31185443 DOI: 10.1016/j.jmbbm.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/15/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
Ceramic-on-ceramic bearings in total hip replacement have shown the potential to provide low wear solutions in hip replacement. Assessing the tribological performance of these materials is important to predict their long-term performance in patients. In this study, a methodology was devised to assess the tribological in vitro behaviour of composite ceramics under combined adverse edge loading conditions and accelerated ageing. Two commercial ceramic composites were considered, namely Alumina-Toughened Zirconia (ATZ, ceramys®) and Zirconia-Toughened Alumina (ZTA, symarec®). The bearing couples were studied using the Leeds Mark II hip joint simulator for a total of eight million cycles, the first two million under normal gait (no edge loading) and the following six million cycles with the addition of edge loading conditions driven by medial-lateral separation. The bearing couples underwent hydrothermal ageing using an accelerated protocol in autoclave every million cycles. The influence of edge loading combined with ageing was significant for ATZ bearings, resulting in a slower overall ageing kinetics over the wear stripe than on the control heads. During the autoclave ageing steps, the monoclinic fraction increased more over the wear stripe area than over the unworn area. Both results thus indicated that the monoclinic phase was removed during shocks induced by edge loading. The wear performance of the two materials were similar exhibiting relatively low wear rates and low level of microstructural damage for these clinically relevant adverse conditions.
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Affiliation(s)
- Mazen Al-Hajjar
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Laurent Gremillard
- Univ Lyon, INSA Lyon, CNRS, MATEIS UMR, 5510, Bât. Blaise Pascal, 7 Avenue Jean Capelle, Villeurbanne, France
| | - Sabine Begand
- Mathys Orthopädie GmbH, Moersdorf, Germany; Fraunhofer IKTS, Hermsdorf, Germany
| | | | - Karen Hans
- Mathys Orthopädie GmbH, Moersdorf, Germany
| | | | - Jérôme Chevalier
- Univ Lyon, INSA Lyon, CNRS, MATEIS UMR, 5510, Bât. Blaise Pascal, 7 Avenue Jean Capelle, Villeurbanne, France
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
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Materials for Hip Prostheses: A Review of Wear and Loading Considerations. MATERIALS 2019; 12:ma12030495. [PMID: 30764574 PMCID: PMC6384837 DOI: 10.3390/ma12030495] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/15/2022]
Abstract
Replacement surgery of hip joint consists of the substitution of the joint with an implant able to recreate the articulation functionality. This article aims to review the current state of the art of the biomaterials used for hip implants. Hip implants can be realized with different combination of materials, such as metals, ceramics and polymers. In this review, we analyze, from international literature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e., being biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a low wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We analyzed the scientific literature, collecting information on the material behavior and the human-body response to it. Particular attention has been given to the tribological behavior of the biomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After more than 50 years of evolution, in term of designs and materials, the actual wear rate of the most common implants is low, allowing us to sensibly reduce the risk related to the widespread debris distribution in the human body.
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Hu CY, Yoon TR. Recent updates for biomaterials used in total hip arthroplasty. Biomater Res 2018; 22:33. [PMID: 30534414 PMCID: PMC6280401 DOI: 10.1186/s40824-018-0144-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022] Open
Abstract
Background Total hip arthroplasty (THA) is probably one of the most successful surgical interventions performed in medicine. Through the revolution of hip arthroplasty by principles of low friction arthroplasty was introduced by Sir John Charnley in 1960s. Thereafter, new bearing materials, fixation methods, and new designs has been improved. The main concern regarding failure of THA has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. To resolve these problems, the materials of the modern THA were developed since then. Methods A literature search strategy was conducted using various search terms in PUBMED. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included ‘total hip arthroplasty’, ‘biomaterials’, ‘stainless steel’, ‘cobalt-chromium’, ‘titanium’, ‘polyethylene’, and ‘ceramic’. Results The initial search retrieved 6921 articles. Thirty-two articles were selected and used in the review. Conclusion This article introduces biomaterials used in THA and discusses various bearing materials in currentclinical use in THA as well as the newer biomaterials which may even further decrease wear and improve THA survivorship.
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Affiliation(s)
- Chang Yong Hu
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809 South Korea
| | - Taek-Rim Yoon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809 South Korea
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Partridge S, Buckley P, de Boer G, Williams S. A novel method to measure rim deformation in UHMWPE acetabular liners. Med Eng Phys 2018; 59:56-62. [PMID: 30057256 DOI: 10.1016/j.medengphy.2018.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/27/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
Fluoroscopy studies of total hip replacement (THR) have shown that the femoral head and acetabular cup can separate in vivo, causing edge loading on the rim of the cup. Pre-clinical testing of THR involves ISO standard motion and loading parameters that are representative of a standard walking gait. However, a requirement for more robust testing of THR has been identified and protocols for edge loading in hip simulators have been developed. This technical note describes a method to measure rim wear and deformation on ultra-high molecular weight polyethylene acetabular liners using 2D contacting profilometry and Matlab® analysis. The method is demonstrated on liners that have been subjected to edge loading in hip simulator tests and that have been retrieved at revision surgery. A quantitative and qualitative evaluation of the rim deformation was performed with good repeatability using the method.
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Affiliation(s)
- Susan Partridge
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK.
| | - Paige Buckley
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Greg de Boer
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Sophie Williams
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
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12
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Liu F, Feng L, Wang J. A computational parametric study on edge loading in ceramic-on-ceramic total hip joint replacements. J Mech Behav Biomed Mater 2018; 83:135-142. [PMID: 29704828 DOI: 10.1016/j.jmbbm.2018.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/24/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
Edge loading in ceramic-on-ceramic total hip joint replacement is an adverse condition that occurs as the result of a direct contact between the head and the cup rim. It has been associated with translational mismatch in the centres of rotation of the cup and head, and found to cause severe wear and early failure of the implants. Edge loading has been considered in particular in relation to dynamic separation of the cup and head centres during a gait cycle. Research has been carried out both experimentally and computationally to understand the mechanism including the influence of bearing component positioning on the occurrence and severity of edge loading. However, it is experimentally difficult to measure both the load magnitude and duration of edge loading as it occurs as a short impact within the tight space of hip joints. Computationally, a dynamic contact model, for example, developed using the MSC ADAMS software for a multi-body dynamics simulation can be particularly useful for calculating the loads and characterising the edge loading. The aim of the present study was to further develop the computational model, and improve the predictions of contact force and the understanding of mechanism in order to provide guidance on design and surgical factors to avoid or to reduce edge loading and wear. The results have shown that edge loading can be avoided for a low range of translational mismatch in the centres of rotation of the cup and head during gait at the level of approximately 1.0 mm for a cup at 45° inclination, keeping a correct cup inclination at 45° is important to reduce the edge loading severity, and edge loading can be avoided for a certain range of translational mismatch of the cup and head centres with an increased swing phase load.
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Affiliation(s)
- Feng Liu
- School of Mechanical Engineering, North University of China, PR China.
| | - Li Feng
- School of Mechanical Engineering, North University of China, PR China
| | - Junyuan Wang
- School of Mechanical Engineering, North University of China, PR China
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O'Dwyer Lancaster-Jones O, Williams S, Jennings LM, Thompson J, Isaac GH, Fisher J, Al-Hajjar M. An in vitro simulation model to assess the severity of edge loading and wear, due to variations in component positioning in hip joint replacements. J Biomed Mater Res B Appl Biomater 2017; 106:1897-1906. [PMID: 28941162 PMCID: PMC6088455 DOI: 10.1002/jbm.b.33991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/22/2017] [Accepted: 08/30/2017] [Indexed: 12/03/2022]
Abstract
The aim of this study was to develop a preclinical in vitro method to predict the occurrence and severity of edge loading condition associated with the dynamic separation of the centres of the head and cup (in the absence of impingement) for variations in surgical positioning of the cup. Specifically, this study investigated the effect of both the variations in the medial–lateral translational mismatch between the centres of the femoral head and acetabular cup and the variations in the cup inclination angles on the occurrence and magnitude of the dynamic separation, the severity of edge loading, and the wear rate of ceramic‐on‐ceramic hip replacement bearings in a multi‐station hip joint simulator during a walking gait cycle. An increased mismatch between the centres of rotation of the femoral head and acetabular cup resulted in an increased level of dynamic separation and an increase in the severity of edge loading condition which led to increased wear rate in ceramic‐on‐ceramic bearings. Additionally for a given translational mismatch, an increase in the cup inclination angle gave rise to increased dynamic separation, worst edge loading conditions, and increased wear. To reduce the occurrence and severity of edge loading, the relative positions (the mismatch) of the centres of rotation of the head and the cup should be considered alongside the rotational position of the acetabular cup. This study has considered the combination of mechanical and tribological factors for the first time in the medial–lateral axis only, involving one rotational angle (inclination) and one translational mismatch. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1897–1906, 2018.
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Affiliation(s)
- O O'Dwyer Lancaster-Jones
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - S Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - L M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - J Thompson
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.,DePuy Synthes Joint Reconstruction, Leeds, United Kingdom
| | - G H Isaac
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.,DePuy Synthes Joint Reconstruction, Leeds, United Kingdom
| | - J Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - M Al-Hajjar
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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Liu F, Fisher J. Effect of an edge at cup rim on contact stress during micro-separation in ceramic-on-ceramic hip joints. TRIBOLOGY INTERNATIONAL 2017; 113:323-329. [PMID: 28867870 PMCID: PMC5465945 DOI: 10.1016/j.triboint.2017.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 06/07/2023]
Abstract
Alumina ceramic total hip joint bearings have shown superior wear properties. The joint bearing may undergo adverse conditions such as micro-separation causing head contact on the cup rim. As a transition, an edge is formed between the cup bearing and the rim. The aim of this study was to predict the effect of the edge on contact stresses in order to better understand the mechanisms of wear. A finite element contact model was developed under the conditions of the head displacements 0.5-2 mm and vertical loads 0.5-3 kN. The edge contact produced the most severe stresses capable of causing elevated wear and damage to ceramic bearings. The study shows that the bearing design should be considered in association with clinical conditions to eliminate severe stress.
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Affiliation(s)
- Feng Liu
- School of Mechanical and Power Engineering, North University of China, PR China
| | - John Fisher
- Institute of Medical and Biological Engineering School of Mechanical Engineering, University of Leeds,UK
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Al‐Hajjar M, Carbone S, Jennings LM, Begand S, Oberbach T, Delfosse D, Fisher J. Wear of composite ceramics in mixed-material combinations in total hip replacement under adverse edge loading conditions. J Biomed Mater Res B Appl Biomater 2017; 105:1361-1368. [PMID: 27062442 PMCID: PMC5516149 DOI: 10.1002/jbm.b.33671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 02/09/2016] [Accepted: 03/10/2016] [Indexed: 12/12/2022]
Abstract
Ceramic composites have performed very well under adverse edge loading conditions when used in like-on-like configurations, where the femoral head and acetabular cup are of the same material. The aim of this study was to determine the wear of pure alumina (Al2 O3 ), alumina toughened zirconia (ATZ) and zirconia toughened alumina (ZTA) when used in mixed bearing combinations, under edge loading conditions due to translational mal-positioning. The head-on-cup configurations of three ceramic materials were ATZ-on-ZTA, ZTA-on-ATZ, Al2 O3 -on-ATZ, ATZ-on-Al2 O3 , Al2 O3 -on-ZTA, and ZTA-on-Al2 O3 . They were tested on the Leeds II hip simulator under microseparation conditions. The bedding in and steady state wear rates of ATZ-on-ZTA were 1.16mm3 /million cycles and 0.18mm3 /million, respectively, and for ATZ-on-Al2 O3 were 0.66 mm3 /million cycles and 0.20 mm3 /million, respectively. The wear rates of the other bearing combinations under these adverse microseparation conditions, Al2 O3 -on-ATZ, Al2 O3 -on-ZTA, ZTA-on-ATZ and ZTA-on-Al2 O3 were very low with no clear bedding in and steady state phases, and with steady state wear rates lower than 0.11 mm3 /million. The mixed material combinations tested in this study have shown slightly higher wear rates when compared to ATZ in like-on-like configuration reported previously, but superior wear resistance when compared to alumina-on-alumina bearings tested previously under the same adverse microseparation conditions. © 2016 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1361-1368, 2017.
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Affiliation(s)
- Mazen Al‐Hajjar
- Institute of Medical and Biological Engineering, School of Mechanical EngineeringUniversity of LeedsLeedsUK
| | - Silvia Carbone
- Institute of Medical and Biological Engineering, School of Mechanical EngineeringUniversity of LeedsLeedsUK
| | - Louise M. Jennings
- Institute of Medical and Biological Engineering, School of Mechanical EngineeringUniversity of LeedsLeedsUK
| | | | | | | | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical EngineeringUniversity of LeedsLeedsUK
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17
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Partridge S, Tipper JL, Al-Hajjar M, Isaac GH, Fisher J, Williams S. Evaluation of a new methodology to simulate damage and wear of polyethylene hip replacements subjected to edge loading in hip simulator testing. J Biomed Mater Res B Appl Biomater 2017; 106:1456-1462. [DOI: 10.1002/jbm.b.33951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/24/2017] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Susan Partridge
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Joanne L. Tipper
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Mazen Al-Hajjar
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Graham H. Isaac
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
- DePuy Synthes Joint Reconstruction; Leeds United Kingdom
| | - John Fisher
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Sophie Williams
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
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Clinical outcomes of ceramicized ball heads in total hip replacement bearings: a literature review. J Appl Biomater Funct Mater 2017; 15:e1-e9. [PMID: 28009420 DOI: 10.5301/jabfm.5000330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Metallic ball heads for total hip replacement (THR) bearings with ceramicized surfaces were introduced in orthopedics during the second half of the 1980s, with the aim of decreasing the wear of polyethylene cups. METHODS An analysis was made of the literature regarding outcomes for metallic ball heads with ceramicized surfaces now in clinical use (TiN, TiNbN, ZrN, monoclinic ZrO2), as well as carbon coatings (pyrolytic carbon, diamond-like carbon) and silicon nitride as coatings in ball heads for THR bearings. RESULTS Notwithstanding the diffusion of ceramicized ball heads in THRs, there are few reports about their clinical outcomes in hip arthroplasty. In addition, several clinical studies and some registry data are putting under scrutiny the clinical advantages of ceramicized ball heads over cobalt chrome (CoCr) alloy and ceramic ball heads. CONCLUSIONS The wear of THR bearings with ceramicized ball heads looks like it depends more on the behavior of the polyethylene cups than on the treatment of the ball head surface. The risk of coating damage and of its consequences has to be taken into account in selecting this type of bearing.
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Perrichon A, Reynard B, Gremillard L, Chevalier J, Farizon F, Geringer J. A testing protocol combining shocks, hydrothermal ageing and friction, applied to Zirconia Toughened Alumina (ZTA) hip implants. J Mech Behav Biomed Mater 2017; 65:600-608. [DOI: 10.1016/j.jmbbm.2016.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
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Marin E, Rondinella A, Zhu W, McEntire BJ, Bal BS, Pezzotti G. Wear and surface degradation of commercial ZTA femoral heads under boundary lubrication conditions. J Mech Behav Biomed Mater 2017; 65:616-626. [DOI: 10.1016/j.jmbbm.2016.09.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/19/2016] [Accepted: 09/28/2016] [Indexed: 11/26/2022]
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Khanna R, Kokubo T, Matsushita T, Takadama H. Fabrication of dense α-alumina layer on Ti-6Al-4V alloy hybrid for bearing surfaces of artificial hip joint. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:1229-39. [DOI: 10.1016/j.msec.2016.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities. Med Eng Phys 2016; 38:518-25. [DOI: 10.1016/j.medengphy.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/05/2016] [Accepted: 03/06/2016] [Indexed: 12/12/2022]
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Spear RL, Symeonidou A, Skepper JN, Brooks RA, Markaki AE. Fibrin affects short-term in vitro human mesenchymal stromal cell responses to magneto-active fibre networks. BIOMATERIALS AND BIOMECHANICS IN BIOENGINEERING 2015. [DOI: 10.12989/bme.2015.2.3.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Langton DJ, Sidaginamale RP, Holland JP, Deehan D, Joyce TJ, Nargol AVF, Meek RD, Lord JK. Practical considerations for volumetric wear analysis of explanted hip arthroplasties. Bone Joint Res 2014; 3:60-8. [PMID: 24627327 PMCID: PMC4182907 DOI: 10.1302/2046-3758.33.2000249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Wear debris released from bearing surfaces has been shown to provoke negative immune responses in the recipient. Excessive wear has been linked to early failure of prostheses. Analysis using coordinate measuring machines (CMMs) can provide estimates of total volumetric material loss of explanted prostheses and can help to understand device failure. The accuracy of volumetric testing has been debated, with some investigators stating that only protocols involving hundreds of thousands of measurement points are sufficient. We looked to examine this assumption and to apply the findings to the clinical arena. METHODS We examined the effects on the calculated material loss from a ceramic femoral head when different CMM scanning parameters were used. Calculated wear volumes were compared with gold standard gravimetric tests in a blinded study. RESULTS Various scanning parameters including point pitch, maximum point to point distance, the number of scanning contours or the total number of points had no clinically relevant effect on volumetric wear calculations. Gravimetric testing showed that material loss can be calculated to provide clinically relevant degrees of accuracy. CONCLUSIONS Prosthetic surfaces can be analysed accurately and rapidly with currently available technologies. Given these results, we believe that routine analysis of explanted hip components would be a feasible and logical extension to National Joint Registries. Cite this article: Bone Joint Res 2014;3:60-8.
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Affiliation(s)
- D J Langton
- North Tees Explant Centre (NTEC), FarndaleHouse, University Hospital of North Tees, TS19 8PE, UK
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