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Damm P, Bender A, Waldheim V, Winkler T, Duda GN. Surgical cup placement affects the heating up of total joint hip replacements. Sci Rep 2021; 11:15851. [PMID: 34349160 PMCID: PMC8338953 DOI: 10.1038/s41598-021-95387-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
The long-term success of highly effective total hip arthroplasty (THA) is mainly restricted by aseptic loosening, which is widely associated with friction between the head and cup liner. However, knowledge of the in vivo joint friction and resulting temperature increase is limited. Employing a novel combination of in vivo and in silico technologies, we analyzed the hypothesis that the intraoperatively defined implant orientation defines the individual joint roofing, friction and its associated temperature increase. A total of 38,000 in vivo activity trials from a special group of 10 subjects with instrumented THA implants with an identical material combination were analyzed and showed a significant link between implant orientation, joint kinematics, joint roofing and friction-induced temperature increase but surprisingly not with acting joint contact force magnitude. This combined in vivo and in silico analysis revealed that cup placement in relation to the stem is key to the in vivo joint friction and heating-up of THA. Thus, intraoperative placement, and not only articulating materials, should be the focus of further improvements, especially for young and more active patients.
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Affiliation(s)
- Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
| | - Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Vivian Waldheim
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Tobias Winkler
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Current Preclinical Testing of New Hip Arthroplasty Technologies Does Not Reflect Real-World Loadings: Capturing Patient-Specific and Activity-Related Variation in Hip Contact Forces. J Arthroplasty 2020; 35:877-885. [PMID: 31699529 DOI: 10.1016/j.arth.2019.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) implants are routinely tested for their tribological performance through regulatory preclinical wear testing (eg, ISO-14242). The standardized loading conditions defined in these tests consist of simplified waveforms, which do not specifically represent in vivo loads in different groups of patients. The aim of this study is to investigate, through musculoskeletal modeling, patient-specific and activity-related variation in hip contact forces (HCFs) in a large cohort of THA patients during common activities of daily living (ADLs). METHODS A total of 132 THA patients participated in a motion-capture analysis while performing different ADLs, including walk, fast walk, stair ascent, and descent (locomotor); sit to stand, stand to sit, squat, and lunge (nonlocomotor). HCFs were then calculated using the AnyBody Modeling System and qualitatively compared across all activities. The influence of gender on HCFs was analyzed through statistical parametric mapping analysis. RESULTS Systematic differences were found in HCF magnitudes and individual components in both locomotor and nonlocomotor ADLs. The qualitative analysis of the ADLs revealed a large range and a large variability in forces experienced at the hip during different activities. Significant differences in the 3-dimensional loading patterns were observed between males and females across most activities. CONCLUSION THA patients present a large variability in the forces experienced at the hip joint during their daily life. The interpatient variation might partially explain the heterogeneity observed in implant survival rates. A more extensive preclinical implant testing standard under clinically relevant loading conditions has been advocated to better predict and avoid clinical wear problems.
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Damm P, Bender A, Duda G, Bergmann G. In vivo measured joint friction in hip implants during walking after a short rest. PLoS One 2017; 12:e0174788. [PMID: 28350858 PMCID: PMC5370152 DOI: 10.1371/journal.pone.0174788] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/15/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction It has been suspected that friction in hip implants is higher when walking is initiated after a resting period than during continuous movement. It cannot be excluded that such increased initial moments endanger the cup fixation in the acetabulum, overstress the taper connections in the implant or increase wear. To assess these risks, the contact forces, friction moments and friction coefficients in the joint were measured in vivo in ten subjects. Instrumented hip joint implants with telemetric data transmission were used to access the contact loads between the cup and head during the first steps of walking after a short rest. Results The analysis demonstrated that the contact force is not increased during the first step. The friction moment in the joint, however, is much higher during the first step than during continuous walking. The moment increases throughout the gait cycle were 32% to 143% on average and up to 621% individually. The high initial moments will probably not increase wear by much in the joint. However, comparisons with literature data on the fixation resistance of the cup against moments made clear that the stability can be endangered. This risk is highest during the first postoperative months for cementless cups with insufficient under-reaming. The high moments after a break can also put taper connections between the head and neck and neck and shaft at a higher risk. Discussion During continuous walking, the friction moments individually were extremely varied by factors of 4 to 10. Much of this difference is presumably caused by the varying lubrication properties of the synovia. These large moment variations can possibly lead to friction-induced temperature increases during walking, which are higher than the 43.1°C which have previously been observed in a group of only five subjects.
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Affiliation(s)
- Philipp Damm
- Julius Wolff Institute, Charité–Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Alwina Bender
- Julius Wolff Institute, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Duda
- Julius Wolff Institute, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Bergmann
- Julius Wolff Institute, Charité–Universitätsmedizin Berlin, Berlin, Germany
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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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5
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Haider H, Weisenburger JN, Garvin KL. Simultaneous measurement of friction and wear in hip simulators. Proc Inst Mech Eng H 2016; 230:373-88. [DOI: 10.1177/0954411916644476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/02/2016] [Indexed: 11/15/2022]
Abstract
We propose and have evaluated a method to measure hip friction during wear testing on a popular multi-station hip simulator. A 6-degree-of-freedom load cell underneath the specimen sensed forces and torques during implant wear testing of simulated walking. This included internal–external and adduction–abduction rotations which are often neglected during friction testing on pendulum-type machines. Robust mathematical analysis and data processing provided friction estimates in three simultaneous orthogonal rotations, over extended multi-million cycle wear tests. We tested various bearing couples including metal-on-plastic, ceramic-on-plastic, and metal-on-metal material couples. In one test series, new and intentionally scratched CoCrMo 40-mm-diameter femoral heads were tested against conventional ultrahigh-molecular-weight polyethylene, highly cross-linked, and highly cross-linked with vitamin E versions. The scratching significantly increased friction and doubled the wear of all groups. Before scratching, friction levels for the aforementioned plastic groups were 0.056 ± 0.0060, 0.062 ± 0.0080, and 0.070 ± 0.0045, respectively, but after scratching increased to 0.088 ± 0.018, 0.076 ± 0.0066, and 0.082 ± 0.0049, respectively, all statistically significant increases (p = 0.00059, 0.00005, 0.0115, respectively). In another test series of 44-mm femoral head diameter hips, metal-on-plastic hips with conventional ultrahigh-molecular-weight polyethylene showed the lowest friction at 0.045 ± 0.0085, followed by highly cross-linked with 0.046 ± 0.0035 (not significantly different). In a ceramic-on-plastic design with conventional ultrahigh-molecular-weight polyethylene, higher friction 0.079 ± 0.0070 was measured likely due to that ceramic surface being rougher than usual. Metal-on-metal hips were compared without and with a TiN coating, resulting in 0.049 ± 0.014 and 0.097 ± 0.020 friction factors, respectively (statistically significant, p < 0.001), and the coating wore away on all coated hips eventually. Higher friction mostly correlated with higher wear or damage to femoral heads or implant coatings, except for the highly cross-linked wear resistant ultrahigh-molecular-weight polyethylene which had slightly higher friction, confirming the same finding in other independent studies. This type of friction measurements can help screen for clamping and elevated wear of metal-on-metal and resurfacing total hip replacements, surgical malpositioning, and abraded and otherwise damaged surfaces.
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Affiliation(s)
- Hani Haider
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joel N Weisenburger
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kevin L Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
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Toxicology of wear particles of cobalt-chromium alloy metal-on-metal hip implants Part I: Physicochemical properties in patient and simulator studies. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:1201-15. [DOI: 10.1016/j.nano.2014.12.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 12/27/2022]
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Zietz C, Fabry C, Reinders J, Dammer R, Kretzer JP, Bader R, Sonntag R. Wear testing of total hip replacements under severe conditions. Expert Rev Med Devices 2015; 12:393-410. [PMID: 26048088 DOI: 10.1586/17434440.2015.1050378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Controlled wear testing of total hip replacements in hip joint simulators is a well-established and powerful method, giving an extensive prediction of the long-term clinical performance. To understand the wear behavior of a bearing and its limits under in vivo conditions, testing scenarios should be designed as physiologically as possible. Currently, the ISO standard protocol 14242 is the most common preclinical testing procedure for total hip replacements, based on a simplified gait cycle for normal walking conditions. However, in recent years, wear patterns have increasingly been observed on retrievals that cannot be replicated by the current standard. The purpose of this study is to review the severe testing conditions that enable the generation of clinically relevant wear rates and phenomena. These conditions include changes in loading and activity, third-body wear, surface topography, edge wear and the role of aging of the bearing materials.
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Affiliation(s)
- Carmen Zietz
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany
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Li J, McWilliams AB, Jin Z, Fisher J, Stone MH, Redmond AC, Stewart TD. Unilateral total hip replacement patients with symptomatic leg length inequality have abnormal hip biomechanics during walking. Clin Biomech (Bristol, Avon) 2015; 30:513-9. [PMID: 25900447 PMCID: PMC4441097 DOI: 10.1016/j.clinbiomech.2015.02.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Symptomatic leg length inequality accounts for 8.7% of total hip replacement related claims made against the UK National Health Service Litigation authority. It has not been established whether symptomatic leg length inequality patients following total hip replacement have abnormal hip kinetics during gait. METHODS Hip kinetics in 15 unilateral total hip replacement patients with symptomatic leg length inequality during gait was determined through multibody dynamics and compared to 15 native hip healthy controls and 15 'successful' asymptomatic unilateral total hip replacement patients. FINDING More significant differences from normal were found in symptomatic leg length inequality patients than in asymptomatic total hip replacement patients. The leg length inequality patients had altered functions defined by lower gait velocity, reduced stride length, reduced ground reaction force, decreased hip range of motion, reduced hip moment and less dynamic hip force with a 24% lower heel-strike peak, 66% higher mid-stance trough and 37% lower toe-off peak. Greater asymmetry in hip contact force was also observed in leg length inequality patients. INTERPRETATION These gait adaptions may affect the function of the implant and other healthy joints in symptomatic leg length inequality patients. This study provides important information for the musculoskeletal function and rehabilitation of symptomatic leg length inequality patients.
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Affiliation(s)
- Junyan Li
- Department of Design Engineering, School of Science and Technology, Middlesex University, UK
| | - Anthony B. McWilliams
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, UK,NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Zhongmin Jin
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK,School of Mechanical Engineering, Xi'an Jiaotong University, PR China
| | - John Fisher
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
| | - Martin H. Stone
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK,Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - Anthony C. Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, UK,NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Todd D. Stewart
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK,Corresponding author at: School of Mechanical Engineering, The University of Leeds, Woodhouse Lane, Leeds LS2 9JT, United Kingdom.
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9
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Damm P, Bender A, Bergmann G. Postoperative changes in in vivo measured friction in total hip joint prosthesis during walking. PLoS One 2015; 10:e0120438. [PMID: 25806805 PMCID: PMC4373913 DOI: 10.1371/journal.pone.0120438] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/22/2015] [Indexed: 12/02/2022] Open
Abstract
Loosening of the artificial cup and inlay is the most common reasons for total hip replacement failures. Polyethylene wear and aseptic loosening are frequent reasons. Furthermore, over the past few decades, the population of patients receiving total hip replacements has become younger and more active. Hence, a higher level of activity may include an increased risk of implant loosening as a result of friction-induced wear. In this study, an instrumented hip implant was used to measure the contact forces and friction moments in vivo during walking. Subsequently, the three-dimensional coefficient of friction in vivo was calculated over the whole gait cycle. Measurements were collected from ten subjects at several time points between three and twelve months postoperative. No significant change in the average resultant contact force was observed between three and twelve months postoperative. In contrast, a significant decrease of up to 47% was observed in the friction moment. The coefficient of friction also decreased over postoperative time on average. These changes may be caused by ‘running-in’ effects of the gliding components or by the improved lubricating properties of the synovia. Because the walking velocity and contact forces were found to be nearly constant during the observed period, the decrease in friction moment suggests an increase in fluid viscosity. The peak values of the contact force individually varied by 32%-44%. The friction moment individually differed much more, by 110%-129% at three and up to 451% at twelve months postoperative. The maximum coefficient of friction showed the highest individual variability, about 100% at three and up to 914% at twelve months after surgery. These individual variations in the friction parameters were most likely due to different ‘running-in’ effects that were influenced by the individual activity levels and synovia properties.
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Affiliation(s)
- Philipp Damm
- Julius Wolff Institute, Charité—Universitaetsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Alwina Bender
- Julius Wolff Institute, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Georg Bergmann
- Julius Wolff Institute, Charité—Universitaetsmedizin Berlin, Berlin, Germany
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10
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Maleki-Ghaleh H, Khalil-Allafi J, Sadeghpour-Motlagh M, Shakeri MS, Masoudfar S, Farrokhi A, Beygi Khosrowshahi Y, Nadernezhad A, Siadati MH, Javidi M, Shakiba M, Aghaie E. Effect of surface modification by nitrogen ion implantation on the electrochemical and cellular behaviors of super-elastic NiTi shape memory alloy. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:2605-2617. [PMID: 25064465 DOI: 10.1007/s10856-014-5283-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/17/2014] [Indexed: 06/03/2023]
Abstract
The aim of this investigation was to enhance the biological behavior of NiTi shape memory alloy while preserving its super-elastic behavior in order to facilitate its compatibility for application in human body. The surfaces of NiTi samples were bombarded by three different nitrogen doses. Small-angle X-ray diffraction was employed for evaluating the generated phases on the bombarded surfaces. The electrochemical behaviors of the bare and surface-modified NiTi samples were studied in simulated body fluid (SBF) using electrochemical impedance and potentio-dynamic polarization tests. Ni ion release during a 2-month period of service in the SBF environment was evaluated using atomic absorption spectrometry. The cellular behavior of nitrogen-modified samples was studied using fibroblast cells. Furthermore, the effect of surface modification on super-elasticity was investigated by tensile test. The results showed the improvement of both corrosion and biological behaviors of the modified NiTi samples. However, no significant change in the super-elasticity was observed. Samples modified at 1.4E18 ion cm(-2) showed the highest corrosion resistance and the lowest Ni ion release.
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Affiliation(s)
- H Maleki-Ghaleh
- Research Center for Advanced Materials and Mineral Processing, Faculty of Materials Engineering, Sahand University of Technology, P.O. Box: 51335-11996, Tabriz, Iran,
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11
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Hua X, Li J, Wang L, Jin Z, Wilcox R, Fisher J. Contact mechanics of modular metal-on-polyethylene total hip replacement under adverse edge loading conditions. J Biomech 2014; 47:3303-9. [PMID: 25218504 PMCID: PMC4199141 DOI: 10.1016/j.jbiomech.2014.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 08/06/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Abstract
Edge loading can negatively impact the biomechanics and long-term performance of hip replacements. Although edge loading has been widely investigated for hard-on-hard articulations, limited work has been conducted for hard-on-soft combinations. The aim of the present study was to investigate edge loading and its effect on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR). A three-dimensional finite element model was developed based on a modular MoP bearing. Different cup inclination angles and head lateral microseparation were modelled and their effect on the contact mechanics of the modular MoP hip replacement were examined. The results showed that lateral microseparation caused loading of the head on the rim of the cup, which produced substantial increases in the maximum von Mises stress in the polyethylene liner and the maximum contact pressure on both the articulating surface and backside surface of the liner. Plastic deformation of the liner was observed under both standard conditions and microseparation conditions, however, the maximum equivalent plastic strain in the liner under microseparation conditions of 2000 µm was predicted to be approximately six times that under standard conditions. The study has indicated that correct positioning the components to avoid edge loading is likely to be important clinically even for hard-on-soft bearings for THR.
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Affiliation(s)
- Xijin Hua
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
| | - Junyan Li
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ling Wang
- State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK; State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Ruth Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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12
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Damm P, Dymke J, Ackermann R, Bender A, Graichen F, Halder A, Beier A, Bergmann G. Friction in total hip joint prosthesis measured in vivo during walking. PLoS One 2013; 8:e78373. [PMID: 24260114 PMCID: PMC3832636 DOI: 10.1371/journal.pone.0078373] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022] Open
Abstract
Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al2O3 ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06) at contralateral toe off to 0.06 (0.04 to 0.08) at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23) at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W). Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.
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Affiliation(s)
- Philipp Damm
- Julius Wolff Institute, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Joern Dymke
- Julius Wolff Institute, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Robert Ackermann
- Julius Wolff Institute, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Friedmar Graichen
- Julius Wolff Institute, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Andreas Halder
- Klinik für Endoprothetik, Sana Kliniken Sommerfeld, Sommerfeld, Germany
| | - Alexander Beier
- Klinik für Endoprothetik, Sana Kliniken Sommerfeld, Sommerfeld, Germany
| | - Georg Bergmann
- Julius Wolff Institute, Charité – Universitaetsmedizin Berlin, Berlin, Germany
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13
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Sonntag R, Reinders J, Rieger JS, Heitzmann DWW, Kretzer JP. Hard-on-hard lubrication in the artificial hip under dynamic loading conditions. PLoS One 2013; 8:e71622. [PMID: 23940772 PMCID: PMC3737097 DOI: 10.1371/journal.pone.0071622] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
The tribological performance of an artificial hip joint has a particularly strong influence on its success. The principle causes for failure are adverse short- and long-term reactions to wear debris and high frictional torque in the case of poor lubrication that may cause loosening of the implant. Therefore, using experimental and theoretical approaches models have been developed to evaluate lubrication under standardized conditions. A steady-state numerical model has been extended with dynamic experimental data for hard-on-hard bearings used in total hip replacements to verify the tribological relevance of the ISO 14242-1 gait cycle in comparison to experimental data from the Orthoload database and instrumented gait analysis for three additional loading conditions: normal walking, climbing stairs and descending stairs. Ceramic-on-ceramic bearing partners show superior lubrication potential compared to hard-on-hard bearings that work with at least one articulating metal component. Lubrication regimes during the investigated activities are shown to strongly depend on the kinematics and loading conditions. The outcome from the ISO gait is not fully confirmed by the normal walking data and more challenging conditions show evidence of inferior lubrication. These findings may help to explain the differences between the in vitro predictions using the ISO gait cycle and the clinical outcome of some hard-on-hard bearings, e.g., using metal-on-metal.
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Affiliation(s)
- Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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14
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Bishop NE, Hothan A, Morlock MM. High friction moments in large hard-on-hard hip replacement bearings in conditions of poor lubrication. J Orthop Res 2013; 31:807-13. [PMID: 23239536 DOI: 10.1002/jor.22255] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 10/05/2012] [Indexed: 02/06/2023]
Abstract
Disappointing clinical results for large diameter metal replacement bearings for the hip are related to compromised lubrication due to poor cup placement, which increases wear as well as friction moments. The latter can cause overload of the implant-bone interfaces and the taper junction between head and stem. We investigated the influence of lubrication conditions on friction moments in modern hip bearings. Friction moments for large diameter metal and ceramic bearings were measured in a hip simulator with cup angles varying from 0° to 60°. Two diameters were tested for each bearing material, and measurements were made in serum and in dry conditions, representing severely compromised lubrication. Moments were lower for the ceramic bearings than for the metal bearings in lubricated conditions, but approached those for metal bearings at high cup inclination. In dry conditions, friction moments increased twofold to 12 Nm for metal bearings. For ceramic bearings, the increase was more than fivefold to over 25 Nm. Although large diameter ceramic bearings demonstrate an improvement in friction characteristics in the lubricated condition, they could potentially replicate problems currently experienced due to high friction moments in metal bearings once lubrication is compromised.
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Affiliation(s)
- Nicholas E Bishop
- Biomechanics Section, TUHH Hamburg University of Technology, Denickestrasse 15, D-21073 Hamburg, Germany.
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15
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Brockett CL, Williams S, Jin Z, Isaac GH, Fisher J. Squeaking hip arthroplasties: a tribological phenomenon. J Arthroplasty 2013; 28:90-7. [PMID: 22480525 DOI: 10.1016/j.arth.2012.01.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 10/20/2011] [Accepted: 01/19/2012] [Indexed: 02/01/2023] Open
Abstract
The clinical incidence of squeaking has been reported with increasing frequency, with ceramic-on-ceramic bearings seemingly most affected. This study investigated potential causes of squeaking in hard-on-hard hip bearings through 2 sets of experimental conditions. Bearing clearance appeared to affect the incidence of squeaking in metal-on-metal surface arthroplasties. The addition of third-body particles to the interface for total hip arthroplasties also affected the incidence of squeaking. In both studies, the incidence of squeaking correlated well with elevated friction. The findings of this study suggest that a likely cause of squeaking in the hip arthroplasty is adverse tribological conditions caused by suboptimal lubrication. There are numerous factors that may cause the suboptimal lubrication, and therefore, it is unlikely that an individual cause for squeaking will be identified.
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Affiliation(s)
- Claire L Brockett
- Institute of Medical and Biological Engineering, University of Leeds, School of Mechanical Engineering, Leeds, United Kingdom
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Fisher J, Al-Hajjar M, Williams S, Jennings LM, Ingham E. In Vitro Measurement of Wear in Joint Replacements: A Stratified Approach for Enhanced Reliability “SAFER” Pre-Clinical Simulation Testing. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2012.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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17
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Jennings LM, Al-Hajjar M, Brockett CL, Williams S, Tipper JL, Ingham E, Fisher J. (iv) Enhancing the safety and reliability of joint replacement implants. ACTA ACUST UNITED AC 2012; 26:246-252. [PMID: 23335949 PMCID: PMC3546063 DOI: 10.1016/j.mporth.2012.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A new Stratified Approach For Enhanced Reliability (SAFER) pre-clinical simulation testing of joint prostheses is presented in this article. The aim of this approach is preclinical systematic testing of wear performance in the much wider envelope of conditions found clinically rather than relying only on the standard testing conditions that are currently used. The approach includes variations in surgical delivery, variations in kinematics, variations in the patient population and degradation of the biomaterial properties. Clinical experience of existing prostheses has been used to validate the new in vitro methods.
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Affiliation(s)
- Louise M Jennings
- Principal Research and Innovation Fellow, Institute of Medical and Biological Engineering iMBE, University of Leeds, Leeds, UK and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital Trust, Leeds, UK. Conflict of interest: none
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Fisher J, Al Hajjar M, Williams S, Tipper J, Ingham E, Jennings L. (v) Simulation and measurement of wear in metal-on-metal bearings in vitro- understanding the reasons for increased wear. ACTA ACUST UNITED AC 2012; 26:253-258. [PMID: 23335950 PMCID: PMC3546064 DOI: 10.1016/j.mporth.2012.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A new Stratified Approach For Enhanced Reliability (SAFER) pre-clinical simulation testing of joint prostheses has been described in a preceding paper in this volume. The application of SAFER in vitro simulation and testing to metal-on-metal bearings is described in this review paper. The review aims to provide further understanding of the reasons for, and causes of, increased wear in metal-on-metal hips in a proportion of patients. Variation in positioning (mal-positioning) of the head and cup in hip prostheses results in the head contacting the rim of the cup and producing increased wear. Variation in both translational and rotational positioning has been investigated. Variation in translational positioning of the centres of the head and cup, which is not detected on radiographs, is a frequent occurrence clinically and can result in a substantial increase in wear rate. The variation in translational positioning acts synergistically with variation in rotational positioning to produce substantial increases in wear. These recent findings are consistent with the wear mechanisms and formation of stripe wear reported for ceramic-on-ceramic bearings over a decade ago, and provide insight into the reasons for the variation and increases in the wear rate found clinically in metal-on-metal hips in specific patients, which may cause premature failure.
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Affiliation(s)
- John Fisher
- Professor, Institute of Medical and Biological Engineering iMBE, University of Leeds, Leeds, UK and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital Trust, Leeds, UK
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Fisher J. A stratified approach to pre-clinical tribological evaluation of joint replacements representing a wider range of clinical conditions advancing beyond the current standard. Faraday Discuss 2012; 156:59-68; discussion 87-103. [DOI: 10.1039/c2fd00001f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Fisher J. Bioengineering reasons for the failure of metal-on-metal hip prostheses. ACTA ACUST UNITED AC 2011; 93:1001-4. [DOI: 10.1302/0301-620x.93b8.26936] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bioengineering reasons for increased wear and failure of metal-on-metal (MoM) bearings in hip prostheses have been described. Low wear occurs in MoM hips when the centre of the femoral head is concentric with the centre of the acetabular component and the implants are correctly positioned. Translational or rotational malpositioning of the components can lead to the contact-patch of the femoral component being displaced to the rim of the acetabular component, resulting in a ten- to 100-fold increase in wear and metal ion levels. This may cause adverse tissue reactions, loosening of components and failure of the prosthesis.
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Affiliation(s)
- J. Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
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Al-Hajjar M, Leslie IJ, Tipper J, Williams S, Fisher J, Jennings LM. Effect of cup inclination angle during microseparation and rim loading on the wear of BIOLOX® delta ceramic-on-ceramic total hip replacement. J Biomed Mater Res B Appl Biomater 2010; 95:263-8. [DOI: 10.1002/jbm.b.31708] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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22
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Liu H, Ellison PJ, Xu H, Jin Z. Coupling of dynamics and contact mechanics of artificial hip joints in a pendulum model. Proc Inst Mech Eng H 2010; 224:989-1003. [DOI: 10.1243/09544119jeim687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To date, fully coupled dynamics and contact mechanics analysis is still limited by expensive computational cost and long computing time and has not been addressed comprehensively, particularly in the hip joint. To understand the influence of different parameters on the biomechanics of the total hip replacement (THR) and improve its design, two numerical approaches were developed and implemented in finite element models to investigate the coupling between the dynamics response and the contact mechanics for three different THR configurations, metal-on-polyethylene (MOP), metal-on-metal (MOM), and ceramic-on-ceramic (COC). The dynamic force and the contact pressure distribution at the bearing surfaces from the two methods were predicted and compared. The influences of various parameters (motion angle, load applied in the pendulum, friction coefficient, geometry, and material properties) were subsequently investigated. From the comparisons, the decoupled method, based on the rigid-body dynamics and the quasi-static elastic contact mechanics, was adequate to predict the performance of the THRs efficiently. The load had the greatest influence on the dynamics/contact mechanics among other factors.
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Affiliation(s)
- H Liu
- Theory of Lubrication and Bearing Institute, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - P J Ellison
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - H Xu
- Theory of Lubrication and Bearing Institute, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Z Jin
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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Isaac GH, Brockett C, Breckon A, van der Jagt D, Williams S, Hardaker C, Fisher J, Schepers A. Ceramic-on-metal bearings in total hip replacement: whole blood metal ion levels and analysis of retrieved components. ACTA ACUST UNITED AC 2009; 91:1134-41. [PMID: 19721036 DOI: 10.1302/0301-620x.91b9.22306] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study reports on ceramic-on-metal (CoM) bearings in total hip replacement. Whole blood metal ion levels were measured. The median increase in chromium and cobalt at 12 months was 0.08 microg/1 and 0.22 microg/1, respectively, in CoM bearings. Comparable values for metal-on-metal (MoM) were 0.48 microg/1 and 0.32 microg/1. The chromium levels were significantly lower in CoM than in MoM bearings (p = 0.02). The cobalt levels were lower, but the difference was not significant. Examination of two explanted ceramic heads revealed areas of thin metal transfer. CoM bearings (one explanted head and acetabular component, one explanted head and new acetabular component, and three new heads and acetabular components) were tested in a hip joint simulator. The explanted head and acetabular component had higher bedding-in. However, after one million cycles all the wear rates were the same and an order of magnitude less than that reported for MoM bearings. There were four outliers in each clinical group, primarily related to component malposition.
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Affiliation(s)
- G H Isaac
- DePuy International Ltd., Number 1 White Rose Office Park, Leeds LS11 0BG, UK.
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Lazennec JY, Boyer P, Poupon J, Rousseau MA, Roy C, Ravaud P, Catonné Y. Outcome and serum ion determination up to 11 years after implantation of a cemented metal-on-metal hip prosthesis. Acta Orthop 2009; 80:168-73. [PMID: 19404797 PMCID: PMC2823177 DOI: 10.3109/17453670902947408] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known about the long-term outcome of cemented metal-on-metal hip arthroplasties. We evaluated a consecutive series of metal-on-metal polyethylene-backed cemented hip arthroplasties implanted in patients under 60 years of age. METHODS 109 patients (134 joint replacements) were followed prospectively for mean 9 (7-11) years. The evaluation included clinical score, radiographic assessment, and blood sampling for ion level determination. RESULTS At the final review, 12 hips had been revised, mainly because of aseptic loosening of the socket. Using revision for aseptic loosening as the endpoint, the survival rate at 9 years was 91% for the cup and 99% for the stem. In addition, 35 hips showed radiolucent lines at the bone-cement interface of the acetabulum and some were associated with osteolysis. The median serum cobalt and chromium levels were relatively constant over time, and were much higher than the detection level throughout the study period. The cobalt level was 1.5 microg/L 1 year after implantation, and 1.44 microg/L 9 years after implantation. INTERPRETATION Revisions for aseptic loosening and radiographic findings in the sockets led us to halt metal-on-metal-backed polyethylene cemented hip arthroplasty procedures. If the rigidity of the cemented socket is a reason for loosening, excessive release of metal ions and particles may be involved. Further investigations are required to confirm this hypothesis and to determine whether subluxation, microseparation, and hypersensitivity also play a role.
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Affiliation(s)
- Jean-Yves Lazennec
- Department of Orthopaedic Surgery, Pitié-Salpétrière HospitalParisFrance
| | - Patrick Boyer
- Department of Orthopaedic Surgery, Bichat HospitalParisFrance
| | - Joel Poupon
- Laboratory of Toxicology, Lariboisière HospitalParisFrance
| | | | - Carine Roy
- Department of Statistics, Bichat Hospital, Université Paris Diderot, Asistance Publique-Hopitaux de ParisParisFrance
| | - Philippe Ravaud
- Department of Statistics, Bichat Hospital, Université Paris Diderot, Asistance Publique-Hopitaux de ParisParisFrance
| | - Yves Catonné
- Department of Orthopaedic Surgery, Pitié-Salpétrière HospitalParisFrance
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25
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Williams S, Leslie I, Isaac G, Jin Z, Ingham E, Fisher J. Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position. J Bone Joint Surg Am 2008; 90 Suppl 3:111-7. [PMID: 18676945 DOI: 10.2106/jbjs.h.00485] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical studies have indicated that the angular position of the acetabular cup may influence wear in metal-on-metal total hip bearings. A high cup angle in comparison to the anatomical position may lead to the head being constrained by the superior lateral surface and rim of the cup, thus potentially changing the location of the contact zone between the head and the cup. The aim of this study was to test the hypothesis that both a steep cup angle and a lateralized position of the head can increase head contact on the superior rim of the cup, with the consequence of increased wear. METHODS Hip-joint simulator studies of metal-on-metal bearings were undertaken with cup angles of 45 degrees and 55 degrees . The femoral head was either aligned to the center of the cup or placed in a position of microlateralization. Wear was measured gravimetrically over 5 million cycles. RESULTS A steep cup angle of 55 degrees showed significantly higher long-term steady-state wear than a standard cup angle of 45 degrees (p < 0.01). The difference was fivefold. Microlateralization of the head resulted in a fivefold increase in steady-state wear compared with a centralized head. The combination of a steep cup angle and a microlateralized head increased the steady-state wear rate by tenfold compared with a standard cup angle with a centralized head. CONCLUSIONS These studies support the hypothesis that both an increased cup angle and a lateral head position increase wear in metal-on-metal hip prostheses.
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Affiliation(s)
- Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
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26
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Cazenave A. [Dissociation of the acetabular metallic inlay of a metal-on-metal total hip arthroplasty]. ACTA ACUST UNITED AC 2008; 94:399-402. [PMID: 18555867 DOI: 10.1016/j.rco.2008.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
Total hip arthroplasty was performed in November 2001 in a 30-year-old active patient with degenerative hip disease. A metal-on-metal bearing was used. Follow-up was considered excellent until the development of pain and squeaking at hip mobilization, leading to revision in March 2006. The acetabular metallic inlay of the metal-on-metal insert was found detached from the polyethylene insert; half of the diameter of the neck of the femoral stem was sectioned. Complete revision was performed with an acetabular graft. At one year follow-up, anatomic and functional outcome has been excellent. To our knowledge, this is the first report of this kind of mechanical failure of a metal-on-metal total hip arthroplasty.
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Affiliation(s)
- A Cazenave
- Service de Chirurgie Orthopédique des Membres, Institut Calot, Berck-Sur-Mer, France.
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27
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Figueiredo-Pina CG, Yan Y, Neville A, Fisher J. Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements. Proc Inst Mech Eng H 2008; 222:285-96. [DOI: 10.1243/09544119jeim363] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt—chromium (Co—Cr) pins against Co—Cr plates; secondly, Co—Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co—Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion—wear interactions between the tribological pair.
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Affiliation(s)
- C G Figueiredo-Pina
- Departamento de Engenharia Mecânica, EST Setúbal, Instituto Politecnico de Setúbal, Estefanilha, Setúbal, Portugal
| | - Y Yan
- Institute of Engineering Thermofluids, Surfaces and Interfaces (iETSI), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - A Neville
- Institute of Engineering Thermofluids, Surfaces and Interfaces (iETSI), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - J Fisher
- Institute of Medical and Biological Engineering (iMBE), School of Mechanical Engineering, University of Leeds, Leeds, UK
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28
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Wang FC, Brockett C, Williams S, Udofia I, Fisher J, Jin ZM. Lubrication and friction prediction in metal-on-metal hip implants. Phys Med Biol 2008; 53:1277-93. [DOI: 10.1088/0031-9155/53/5/008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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29
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The 2007 Otto Aufranc Award. Ceramic-on-metal hip arthroplasties: a comparative in vitro and in vivo study. Clin Orthop Relat Res 2007; 465:23-32. [PMID: 18090468 DOI: 10.1097/blo.0b013e31814da946] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The performance of novel ceramic-on-metal bearing couples has been compared with metal-on-metal and ceramic-on-ceramic bearing couples in laboratory and short-term clinical studies. Laboratory studies compared ceramic-on-metal with metal-on-metal and ceramic-on-ceramic bearings with diameters of 28 and 36 mm under standard conditions and under adverse conditions with head loading on the rim of the cup. Clinical studies compared metal ion levels in ceramic-on-metal with metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings in a randomized prospective study. In the laboratory studies, friction, wear, and ion levels were lower in ceramic-on-metal bearings compared with metal-on-metal, with results similar to ceramic-on-ceramic couples. Under adverse conditions and rim loading, all bearings showed increased wear with lower wear and absence of stripe wear in ceramic-on-metal compared with metal-on-metal bearings. Short-term studies in 31 patients at 6 months revealed lower metal ion levels (cobalt and chromium) in those with ceramic-on-metal compared with metal-on-metal bearings.
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Brockett C, Williams S, Jin Z, Isaac G, Fisher J. Friction of total hip replacements with different bearings and loading conditions. J Biomed Mater Res B Appl Biomater 2007; 81:508-15. [PMID: 17041924 DOI: 10.1002/jbm.b.30691] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Metal-on-ultra-high molecular weight polyethylene (UHMWPE) total hip replacements have been the most popular and clinically successful implants to date. However, it is well documented that the wear debris from these prostheses contributes to osteolysis and ultimate failure of the prosthesis, hence alternative materials have been sought. A range of 28 mm diameter bearings were investigated using a hip friction simulator, including conventional material combinations such as metal-on-UHWMPE, ceramic-on-ceramic (CoC), and metal-on-metal (MoM), as well as novel ceramic-on-metal (CoM) pairings. Studies were performed under different swing-phase load and lubricant conditions. The friction factors were lowest in the ceramic bearings, with the CoC bearing having the lowest friction factor in all conditions. CoM bearings also had low friction factors compared with MoM, and the trends were similar to CoC bearings for all test conditions. Increasing swing phase load was shown to cause an increase in friction factor in all tests. Increased serum concentration resulted in increased friction factor in all material combinations, except MoM, where increased serum concentration produced a significant reduction in friction factor.
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Affiliation(s)
- Claire Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom.
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31
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Northwood E, Fisher J, Kowalski R. Investigation of the friction and surface degradation of innovative chondroplasty materials against articular cartilage. Proc Inst Mech Eng H 2007; 221:263-79. [PMID: 17539582 DOI: 10.1243/09544119jeim178] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Understanding the wear of the biomaterial-cartilage interface is vital for the development of innovative chondroplasty. The aim of this study was to investigate a number of biphasic materials as potential chondroplasty biomaterials. Simple geometry friction and wear studies were conducted using bovine articular cartilage pins loaded against a range of single-phase and biphasic materials. The frictions of each biomaterial was compared within simple and protein-containing lubricants. Longer-term continuous sliding tests within a protein containing lubricant were also conducted at various loading conditions to evaluate the friction and degradation for each surface. All single-phase materials showed a steady rise in friction, which was dependent on the loss of interstitial fluid load support from the opposing cartilage pin. All biphasic materials demonstrated a marked reduction in friction when compared with the single-phase materials. It is postulated that the biphasic nature of each material allowed an element of fluid load support to be maintained by fluid rehydration and expulsion. In the longer-term study, significant differences in the articular cartilage pin (surface damage) between the positive control (stainless steel) and the negative control (articular cartilage) was found. The potential biphasic chondroplasty materials produced a reduction in articular cartilage pin damage when compared with the single-phase materials. The changes in surface topography of the cartilage pin were associated with increased levels of friction achieved during the continuous wear test. The study illustrated the importance of the biphasic properties of potential chondroplasty materials, and future work will focus on the optimization of biphasic properties as well as long-term durability, such that materials will more closely mimic the biotribology of natural articular cartilage.
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Affiliation(s)
- E Northwood
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK.
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