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Basiouny M, Lambert S, Kuenfoo C, Taylor S. Fatigue test evaluation of a customised humeral component for an instrumented total elbow prosthesis and strain validation study. Med Eng Phys 2025; 138:104311. [PMID: 40180540 DOI: 10.1016/j.medengphy.2025.104311] [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] [Received: 05/13/2024] [Revised: 02/06/2025] [Accepted: 02/24/2025] [Indexed: 04/05/2025]
Abstract
The survival rate of total elbow arthroplasty (TEA) is negatively impacted by the lack of available data on elbow biomechanics. This study developed a modified humeral component for TEA that is purposed to be instrumented to generate real-time 6 degrees of freedom (d.o.f) force and moment data during activities of daily living (ADL). The objectives are twofold: (1) to assess the safety of the modified humeral component under peak anticipated loads in fatigue, and (2) verify the strains measured under physiological loads with strains modelled using finite element analysis (FEA). Four modified titanium alloy humeral components were welded, and fatigue tested at 5 Hz for 5 million cycles under a compressive load of 700 N corresponding to moderate ADL. The strains were measured using triaxial 350 Ω rectangular rosette (45°) strain gauges bonded to three specific locations on the humeral component confirmed through an FE study. The four welded humeral components successfully withstood fatigue conditions and did not deform. The measured and modelled principal strains were confirmed to be highest at the external wall of the lateral cavity, with a percentage difference of <10 %.
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Affiliation(s)
- Marim Basiouny
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, Stanmore, United Kingdom.
| | | | - Chin Kuenfoo
- Barking, Havering and Redbridge University Hospitals, United Kingdom
| | - Stephen Taylor
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, Stanmore, United Kingdom
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Nelson BK, Nazzal EM, Moody D, Jakucki M, Kaufmann RA. Polyethylene wear testing of a nonmechanically linked total elbow replacement. J Shoulder Elbow Surg 2025; 34:1088-1097. [PMID: 39214494 DOI: 10.1016/j.jse.2024.07.015] [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: 01/21/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The objective of this study was to perform a polyethylene wear test on a nonmechanically linked total elbow arthroplasty implant using a clinically relevant in-vitro elbow wear test methodology that simulated 10 years of use in the light to moderate activity of daily living range. MATERIALS AND METHODS The test protocol applied an 80° arc of ulnohumeral motion beginning at 30° shy of full extension and progressing to 110° of flexion. Force was applied at 7° to recreate a valgus load on the elbow. A variable joint load profile at a frequency of 0.5 Hz was employed. The implants were tested for 5 million cycles (mc) in a bovine serum lubricant. Implant component failure was characterized and polyethylene wear was determined gravimetrically. RESULTS After 5 mc, the small polyethylene bushing wear rate was 0.56 mg/mc. The medium size wear rate was 0.28 mg/mc. Three large sizes were tested and the average wear rate was 0.39 ± 0.07 mg/mc. No implant failure was identified. CONCLUSION The test recreated an in vivo loading environment and measured polyethylene wear rates at specified cycle counts. The test demonstrated less wear than other joint replacements. Further clinical evaluation is necessary to determine if this translates into reduced complications of total elbow replacement associated with wear.
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Affiliation(s)
| | - Ehab M Nazzal
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, USA
| | - Devon Moody
- Design Engineer, Arrch Orthopedics, Pittsburgh, PA, USA
| | | | - Robert A Kaufmann
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, USA.
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Duijn RGA, Meijering D, Vegter RJK, Albers F, Boerboom AL, Eygendaal D, van den Bekerom MPJ, Stevens M, Schelhaas R, Lamoth CJC, Murgia A. Elbow joint loads during simulated activities of daily living: implications for formulating recommendations after total elbow arthroplasty. J Shoulder Elbow Surg 2024; 33:145-155. [PMID: 37689102 DOI: 10.1016/j.jse.2023.07.042] [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: 05/22/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Overloading of the elbow joint prosthesis following total elbow arthroplasty can lead to implant failure. Joint moments during daily activities are not well contextualized for a prosthesis's failure limits, and the effect of the current postoperative instruction on elbow joint loading is unclear. This study investigates the difference in elbow joint moments between simulated daily tasks and between flexion-extension, pronation-supination, and varus-valgus movement directions. Additionally, the effect of the current postoperative instruction on elbow joint load is examined. METHODS Nine healthy participants (age 45.8 ± 17 years, 3 males) performed 8 tasks; driving a car, opening a door, rising from a chair, lifting, sliding, combing hair, drinking, emptying cup, without and with the instruction "not lifting more than 1 kg." Upper limb kinematics and hand contact forces were measured. Elbow joint angles and net moments were analyzed using inverse dynamic analysis, where the net moments are estimated from movement data and external forces. RESULTS Peak elbow joint moments differed significantly between tasks (P < .01) and movement directions (P < .01). The most and least demanding tasks were, rising from a chair (13.4 Nm extension, 5.0 Nm supination, and 15.2 Nm valgus) and sliding (4.3 Nm flexion, 1.7 Nm supination, and 2.6 Nm varus). Net moments were significantly reduced after instruction only in the chair task (P < .01). CONCLUSION This study analyzed elbow joint moments in different directions during daily tasks. The outcomes question whether postoperative instruction can lead to decreasing elbow loads. Future research might focus on reducing elbow loads in the flexion-extension and varus-valgus directions.
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Affiliation(s)
- Roos G A Duijn
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Daniëlle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Friederike Albers
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG Hospital, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reslin Schelhaas
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Claudine J C Lamoth
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alessio Murgia
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Siala M, Callamand G, Delclaux S, Bonnevialle N, Mansat P. Short-term outcomes of the Nexel total elbow arthroplasty. J Shoulder Elbow Surg 2021; 30:2105-2112. [PMID: 33675969 DOI: 10.1016/j.jse.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Third-generation total elbow arthroplasties (TEAs) have shown better mechanical characteristics than older designs. However, these results remain purely mechanical and lack clinical evidence. The purpose of this study was to evaluate clinical and radiographic outcomes of the new-generation semiconstrained Nexel TEA performed at our center. MATERIALS AND METHODS Between 2015 and 2017, 9 Nexel TEAs were implanted in 9 patients (mean age 61 years, range 38-71). Indication for further surgery, range of motion, mean Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), radiolucency lines, outcome measures that included implant survival, complications, and revisions were assessed. RESULTS The mean follow-up was 28 months (5-46 months). Average range of motion significantly improved from pre- to postoperation, with flexion from 120° (70°-140°) to 140° (130°-155°) and supination from 60° (0°-80°) to 80° (80°). Average MEPS improved from 33 (5-45) to 85 points (30-95). During the study period, 5 elbows (56%) experienced complications and 2 (22%) underwent revision. Aseptic humeral loosening was the main indication for revision. The survivorship rate without revision was 75% at 45 months. CONCLUSIONS The short-term clinical results of the Nexel TEA are satisfactory. However, an unusually high rate of complications and revisions was observed, mainly at the humeral component. Further research with longer follow-up and more patients included are needed to validate this new prosthesis.
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Affiliation(s)
- Mahdi Siala
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.
| | - Gabriel Callamand
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Stephanie Delclaux
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
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Quantitative ultrahigh-molecular-weight polyethylene wear in total elbow retrievals. J Shoulder Elbow Surg 2020; 29:2364-2374. [PMID: 32666923 DOI: 10.1016/j.jse.2020.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate ultrahigh-molecular-weight polyethylene (UHMWPE) wear and damage from retrieved total elbow arthroplasty components and compare in vivo wear with wear produced in vitro. METHODS Explanted total elbow components were collected at revision surgery. UHMWPE damage was characterized visually, whereas penetration and wear were quantified using micro-computed tomography and gas pycnometry. Volumetric wear rates were compared with historical hip data, and wear data were compared with reported in vitro wear test data. RESULTS Humeral bushing damage primarily occurred in the form of burnishing, scratching, and pitting at the articular face in the region of contact with the ulnar component. Wear of the ulnar bushings was concentrated on the edge of the component at the point of contact with the axis pin. Pitting and embedded debris were dominant damage modes, in addition to burnishing and delamination. Backside wear was negligible. The median linear penetration rates of the lateral, medial, and ulnar bushings were 0.14 mm/yr (range, 0.01-0.78 mm/yr), 0.12 mm/yr (range, 0.03-0.55 mm/yr), and 0.11 mm/yr (range, 0.01-0.69 mm/yr), respectively. The volumetric wear rates of the lateral, medial, and ulnar bushings were 5.5 mm3/yr (range, 0.7-37.2 mm3/yr), 5.9 mm3/yr (range, 0.6-25.5 mm3/yr), and 5.5 mm3/yr (range, 1.2-51.2 mm3/yr), respectively. CONCLUSIONS The observed wear rates were similar to those reported in well-functioning total hip replacement patients with conventional UHMWPE bearings. We found limitations in reported in vitro testing resulting in wear that was not consistent with our retrieval data. We recommend further investigation to clinically validate in vitro simulation to provide appropriate loading protocols for elbow wear simulation.
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How does lubricant viscosity affect the wear behaviour of VitE-XLPE articulated against CoCr? J Mech Behav Biomed Mater 2020; 112:104067. [PMID: 32905920 DOI: 10.1016/j.jmbbm.2020.104067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022]
Abstract
Using a 50-station pin-on-disc (SuperCTPOD) machine, the influence of lubricant viscosity on the wear of vitamin E blended crosslinked polyethylene was investigated. Five different test lubricants were prepared by mixing different concentrations of carboxymethyl cellulose powder with deionised water. The viscosity range of the lubricants was 0.002-0.155 Pa, a range that represents the viscosities of diseased and healthy synovial fluids. Five groups of pins (10 pins in each group) were articulated against cobalt chromium discs. Wear was measured in terms of weight loss from each pin and disc for every group. Every 500,000 cycles the experiment was stopped to take gravimetric measurements along with roughness measurements of the articulating surfaces. The test discs did not show a significant change in weight after 2.5 million cycles of testing (p > 0.05). For the pins, the group tested with the lowest viscosity (0.002 Pa) produced the highest wear rate, namely 0.931 mg/million cycles, and the wear rates of the other groups were 0.074, 0.027, 0.034 and 0.021 mg/million cycles respectively. The wear rates calculated for the five groups were all lower than the wear rates recorded for ultrahigh molecular weight polyethylene and not significantly different to crosslinked polyethylene. In addition, apart from group 1 pins (tested with the lowest lubricant viscosity (0.002 Pa)), the machining marks on the other pins were still present after 2.5 million cycles of testing, indicating low wear.
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Cui W, Bian Y, Zeng H, Zhang X, Zhang Y, Weng X, Xin S, Jin Z. Structural and tribological characteristics of ultra-low-wear polyethylene as artificial joint materials. J Mech Behav Biomed Mater 2020; 104:103629. [PMID: 32174389 DOI: 10.1016/j.jmbbm.2020.103629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/11/2019] [Accepted: 01/07/2020] [Indexed: 12/28/2022]
Abstract
Ultra-low-wear polyethylene (ULWPE) is a new metallocene catalyzed high density polyethylene (HDPE)material. Previous studies have demonstrated that it has excellent biocompatibility and wear resistance, whereupon indicating great potential in the applications to artificial joints. However, as a newly developed material, its tribological behavior and wear resistance mechanism has not been well understood. In the current study, we experimentally evaluated the tribological behavior of ULWPE, and investigated its high wear resistance mechanism in terms of microstructure, crystallization properties, mechanical, physical, and chemical properties. ULWPE manifested the best tribological performance on pin-on-disc (POD) wear tests compared with the most widely used artificial joints materials, with a wear volume of 0.720 ± 0.032 mm3/million cycles (Mc) and 0.600 ± 0.027 mm3/Mc against cobalt-chromium (CoCr) alloy disc and zirconia toughened alumina (ZTA) ceramic disc, respectively. The results of the wear morphology analysis showed that the surface of ULWPE was the slightest, with no obvious surface damage, debris shedding and wear pits. We reveal that three major factors mainly contributed to its high wear resistance. First, ULWPE demonstrated a high crystallinity and a compact crystalline morphology comprised of long linear molecular chains, which contributed to its good mechanical performance. As confirmed by the mechanical test, ULWPE had a very high density, hardness, and tensile elongation at break. The high hardness and strength laid a solid foundation to a low wear volume, and its high ductility and hardness helped to endure abrasive and adhesive wear, resulting in excellent wear resistance. Second, the results of wettability analysis showed that the contact angle formed on the surface of ULWPE was the lowest and the surface energy was the highest. The hydrophilicity of ULWPE provided good lubrication conditions in body fluid. Third, it also had a lower oxidation index. The high hardness, high strength, high ductility and good wetting of ULWPE materials reduced the damage of the material to adhesion and abrasive wear, resulting in excellent wear resistance.
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Affiliation(s)
- Wen Cui
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Yanyan Bian
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hongkai Zeng
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Xiaogang Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Yali Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China.
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Shixuan Xin
- PetroChina Petrochemical Research Institute, PetroChina Synthetic Resin Key Laboratory, Beijing, 100195, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China; School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
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Spece H, Schachtner JT, MacDonald DW, Klein GR, Mont MA, Lee GC, Kurtz SM. Reasons for Revision, Oxidation, and Damage Mechanisms of Retrieved Vitamin E-Stabilized Highly Crosslinked Polyethylene in Total Knee Arthroplasty. J Arthroplasty 2019; 34:3088-3093. [PMID: 31416742 PMCID: PMC6864268 DOI: 10.1016/j.arth.2019.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In order to improve oxidation resistance, antioxidants such as vitamin-E are added to polyethylene used in the bearing surfaces of orthopedic components. Currently, little is known about the efficacy of this treatment in vivo. This study therefore reports on the reasons for revision, surface damage mechanisms, and oxidation of retrieved vitamin E-stabilized highly crosslinked polyethylene (HXLPE) for total knee arthroplasty. METHODS We examined 103 retrieved knee inserts fabricated from vitamin E (VE)-stabilized HXLPE and 67 fabricated from remelted HXLPE as a control. The implantation times were 1.2 ± 1.3 and 1.5 ± 1.3 years for the VE and control cohorts, respectively. The inserts were evaluated for 7 surface damage mechanisms using a semiquantitative scoring method and analyzed for oxidation using Fourier-transform infrared spectroscopy. Reasons for revision were also assessed using operative notes created at time of retrieval. RESULTS Both groups were revised primarily for instability, infection, and loosening. Burnishing, pitting, and scratching were the most common damage mechanisms observed, with the VE cohort demonstrating less surface damage than the control. Measured oxidation for the cohort was low, with a median oxidation index of 0.09 ± .05 for the articulating surface, 0.05 ± 0.06 for the backside, 0.08 ± 0.06 for the anterior/posterior surfaces, and 0.08 ± 0.05 for the stabilizing post. As compared to the control cohort, oxidation tended to be less for the VE group at the articulating (P < .001) and backside (P = .003) surfaces, although the median differences were minimal and may not be clinically significant. CONCLUSION The results indicate positive fatigue damage resistance and oxidation resistance for the retrieved VE-stabilized total knee arthroplasty inserts.
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Affiliation(s)
- Hannah Spece
- Implant Research Center at Drexel University, Philadelphia, PA
| | | | | | - Gregg R. Klein
- Hartzband Center for Hip and Knee Replacement, Paramus, NJ
| | | | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA
| | - Steven M. Kurtz
- Implant Research Center at Drexel University, Philadelphia, PA,Exponent, Inc, Philadelphia, PA
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Meijering D, Boerboom AL, Breukelman F, Eygendaal D, Bulstra SK, Stevens M. Long-term results of the iBP elbow prosthesis: beware of destructive metallosis! BMC Musculoskelet Disord 2019; 20:415. [PMID: 31488129 PMCID: PMC6729027 DOI: 10.1186/s12891-019-2781-z] [Citation(s) in RCA: 2] [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: 01/14/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to review the long-term results of the instrumented Bone Preserving (iBP) elbow prosthesis. Methods Thirty-one patients (10 M, 21F, 28-77 year) were retrospectively evaluated using the Oxford Elbow Score (OES), Disabilities of Arm, Shoulder and Hand Outcome Measure (DASH), Mayo Elbow Performance (MEPS), physical examination and standard radiographs. Kaplan-Meier survival analysis was used. Results Thirty-seven primary iBPs have been placed in 31 patients between 2000 and 2007. Six patients (8 prostheses) had died, 10 elbows had been revised and three patients (4 prostheses) were lost to follow-up. Fourteen patients (15 prostheses) were available for follow-up. The main indication for surgery was rheumatoid arthritis. Mean follow-up was 11 years (8–15). Kaplan-Meier survival analysis showed a survival of 81% at 10 years after surgery. Main reason for revision was particle disease and loosening due to instability and malalignment. Eleven of 14 patients were satisfied, although radiographs showed radiolucencies in 11 patients. Conclusion The iBP elbow prosthesis gives a survival rate of 81% 10 years after surgery with a progressive decline beyond 10 years. However, many patients have radiolucencies. Discrepancy between clinical signs and radiological results warrants structural follow-up, to assure quality of bone stock in case revision surgery is indicated. The study was reviewed and approved by the Medical Ethical Committee of University Medical Center Groningen (METc2016/038). Level of evidence Level IV, Case series.
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Affiliation(s)
- Daniëlle Meijering
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Fred Breukelman
- Orthopedic Department, Wilhelmina Hospital, Assen, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands.,Orthopedic Surgery Department, Amphia Hospital, Breda, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Developing a thermal grafting process for zwitterionic polymers on cross-linked polyethylene with geometry-independent grafting thickness. Acta Biomater 2019; 85:180-191. [PMID: 30583111 DOI: 10.1016/j.actbio.2018.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/27/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
To overcome the drawbacks of the UV grafting method, an alternative, thermal grafting process is suggested. The uniform and geometry-independent grafting of zwitterionic polymers on curved cross-linked polyethylene (CLPE), which is used in artificial hip joints, surface was successfully achieved. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) and poly(2-(methacryloyloxy)ethyl)dimethyl(3-sulfopropyl)ammonium hydroxide) (PMEDSAH) were grafted on the CLPE by two methods: a UV-based process and a thermal process. The thermal method yielded zwitterionic surfaces with similar hydrophilicities and graft layer thicknesses to those prepared via the UV grafting method. The X-ray photoelectron spectra and surface zeta potential results showed that the PMPC and PMEDSAH layers were successfully grafted onto the CLPE surface. In addition, 3-D confocal microscopy, as well as friction and wear volume tests, confirmed that there was a significant decrease in the friction coefficient and wear, which indicates that the thermal grafting method can successfully substitute the UV grafting method. The thermally grafted polymer showed uniform graft layer thickness on the curved CLPE surface, whereas the UV-grafted polymer showed a geometry-dependent heterogeneous graft layer thickness. Thus, we confirmed that the thermal grafting method is advantageous for the preparation of uniform grafting layers on artificial joint surfaces with complicated shapes. STATEMENT OF SIGNIFICANCE: Formation of uniform grafting thickness of the zwitterionic polymers on the implant materials is a very important issue in the field of biomaterials. In this study, a thermal grafting process was developed for the formation of the uniform grafting thickness of the zwitterionic polymers on the curved cross-linked polyethylene (CLPE) surface used in artificial hip-joint. This method yielded zwitterionized CLPE surfaces with similar hydrophilicities and friction coefficient to those prepared via the UV grafting method which has been widely used process to modify the implant surfaces. Furthermore, the thermally grafted CLPE surface showed geometry-independent uniform grafting thickness on the curved CLPE surface while UV-grafted one showed uneven grafting thickness. This grafting method could help the development of complex, personalized, and biocompatible artificial liner surfaces.
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Physiological Loading of the Coonrad/Morrey, Nexel, and Discovery Elbow Systems: Evaluation by Finite Element Analysis. J Hand Surg Am 2019; 44:61.e1-61.e9. [PMID: 29908927 DOI: 10.1016/j.jhsa.2018.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/15/2018] [Accepted: 04/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Wear of polyethylene bearings represents a limiting factor in the long-term success of total elbow prostheses. Bearing stress is 1 factor contributing to accelerated wear. Physiological loading of total elbow prostheses and implant design influence upon bearing stresses have not been well described. This study evaluates bearing stresses in 3 commercially available implant designs under loads associated with daily living. METHODS Motion tracking from a healthy volunteer helped establish a musculoskeletal model to simulate flexor and extensor muscle activation at 0°, 45°, and 90° of shoulder abduction with a 2.3-kg weight in hand-forces and moments were measured at the elbow. Resulting physiological joint reaction forces and moments were applied to finite element models of 3 total elbow bearing designs (Coonrad/Morrey, Nexel, and Discovery) to evaluate contact area and polyethylene stresses. RESULTS Increasing shoulder abduction resulted in minimal changes to the elbow joint reaction force but greater joint moments. All implants showed greater peak stresses with increasing shoulder abduction-elbow varus. Discovery and Nexel achieved greater contact area (23% vs > 100%) and demonstrated up to 39% lower peak polyethylene stresses compared with the Coonrad/Morrey design. CONCLUSIONS Shoulder abduction results in a varus moment at the elbow. Newer bearing designs (Nexel and Discovery) provide a combination of higher contact area, improved load sharing, reduced edge loading, and lower stresses through elbow range of motion when compared with a cylindrical hinge-bearing design (Coonrad/Morrey). CLINICAL RELEVANCE Although the Coonrad/Morrey is a clinically successful prosthesis, our physiological loading model shows that Discovery and Nexel provide greater contact area, better load sharing and lower peak stresses. This may lead to a decrease in polyethylene wear rates and the eventual risks of osteolysis and aseptic loosening. Further studies are needed to determine how these findings translate clinically.
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Ponzio DY, Weitzler L, deMeireles A, Esposito CI, Wright TM, Padgett DE. Antioxidant-stabilized highly crosslinked polyethylene in total knee arthroplasty. Bone Joint J 2018; 100-B:1330-1335. [DOI: 10.1302/0301-620x.100b10.bjj-2018-0061.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to evaluate the surface damage, the density of crosslinking, and oxidation in retrieved antioxidant-stabilized highly crosslinked polyethylene (A-XLPE) tibial inserts from total knee arthroplasty (TKA), and to compare the results with a matched cohort of standard remelted highly crosslinked polyethylene (XLPE) inserts. Materials and Methods A total of 19 A-XLPE tibial inserts were retrieved during revision TKA and matched to 18 retrieved XLPE inserts according to the demographics of the patients, with a mean length of implantation of 15 months (1 to 42). The percentage areas of PE damage on the articular surfaces and the modes of damage were measured. The density of crosslinking of the PE and oxidation were measured at loaded and unloaded regions on these surfaces. Results A-XLPE inserts had higher rates of burnishing and lower rates of pitting and scratching compared with XLPE. There were no differences in the density of crosslinking at loaded and unloaded regions. A-XLPE showed higher oxidation indices in the unloaded surface region compared with XLPE. There were no differences in the levels of oxidation in the loaded regions. Conclusion Retrieval analysis of A-XLPE did not reflect a clinically relevant difference in surface damage, density of crosslinking, or oxidation compared with XLPE tibial inserts at short-term evaluation. Cite this article: Bone Joint J 2018;100-B:1330–5.
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Willing R. Comparing damage on retrieved total elbow replacement bushings with lab worn specimens subjected to varied loading conditions. J Orthop Res 2018; 36:1998-2006. [PMID: 29315772 DOI: 10.1002/jor.23847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/24/2017] [Indexed: 02/04/2023]
Abstract
Complication rates following total elbow replacement (TER) with conventional implants are relatively high due to mechanical failure involving the UHMWPE bushings. Unfortunately, there are no standardized pre-clinical durability testing protocols for assessing the durability of TER components. This study examines the damage observed on retrieved humeral bushings, and then uses in vitro durability testing with two different loading protocols to compare resulting damage. Damage on 25 pairs of retrieved humeral bushings was characterized using micro-computed tomographic imaging techniques. The damage was compared with that of in vitro test specimens which were subjected to 200 K cycles of either high joint reaction force (high JRF) or high varus moment (high VM) loading. Material removal (mass loss) from bushing components was measured using gravimetric techniques. Thinning was less for retrieved bushings which were still assembled in their humeral component, versus bushings which were loose (0.3 ± 0.3 mm vs. 0.6 ± 0.3 mm, p = 0.02). Comparing in vitro test specimens, thinning due to high VM loading was 0.9 ± 0.3 mm, versus 0.2 ± 0.0 mm for high JRF loading (p = 0.08); however, the actual material removal rates from the humeral bushings were not different between the two protocols (48 ± 5 mm3 /Mc vs. 43 ± 2 mm3 /Mc, p = 1). Neither loading protocol could produce damage patterns fully representative of the spectrum of damage patterns observed on clinical retrievals. Pre-clinical testing should employ multiple loading protocols to characterize implant performance under a broader spectrum of usage. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1998-2006, 2018.
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Affiliation(s)
- Ryan Willing
- Department of Mechanical Engineering, Thomas J. Watson School of Engineering and Applied Science, State University of New York at Binghamton, Binghamton 13902-6000, New York.,Department of Mechanical and Materials Engineering, The University of Western Ontario, 1151 Richmond Street N. London, Ontario, Canada N6A 5B9
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Bian YY, Zhou L, Zhou G, Jin ZM, Xin SX, Hua ZK, Weng XS. Study on biocompatibility, tribological property and wear debris characterization of ultra-low-wear polyethylene as artificial joint materials. J Mech Behav Biomed Mater 2018; 82:87-94. [DOI: 10.1016/j.jmbbm.2018.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
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Development of a hybrid computational/experimental framework for evaluation of damage mechanisms of a linked semiconstrained total elbow system. J Shoulder Elbow Surg 2018; 27:614-623. [PMID: 29305101 DOI: 10.1016/j.jse.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/10/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term durability of total elbow arthroplasty (TEA) is a concern, and bearing wear or excessive deformations may necessitate early revision. The current study used experimental wear testing and computational finite element modeling to develop a hybrid computational and experimental framework for the evaluation of TEA damage mechanisms. METHODS Three Coonrad-Morrey (Zimmer-Biomet Inc., Warsaw, IN, USA) TEA implants were used for experimental wear testing for 200,000 cycles. Gravimetric measurements were performed before and after the tests to assess the weight change caused by wear. A finite element model of the implant was also developed to analyze ultrahigh-molecular-weight polyethylene (UHMWPE) damage. RESULTS High localized contact pressures caused visible creep and plastic flow, deforming bushings and creating unintended UHMWPE-on-UHMWPE contact surfaces where considerably high wear rates were observed. Average experimentally measured vs. model-predicted wear was 9.5 ± 1.0 vs. 14.1 mg for the of the medial bushing, 8.5 ± 1.0 vs. 13.9 mg for the lateral humeral bushing, and 34.1 ± 0.7 vs. 36.9 mg for the ulnar bushings, respectively. Model predicted contact stresses on the surfaces of bushings were substantially higher than the yield limit of conventional UHMWPE (87 MPa for the humeral bushings and 83 MPa for the ulnar bushing). CONCLUSIONS Our study discovered that unintended wear at UHMWPE-UHMWPE contact surfaces, "fed" by excessive plastic flow may, in fact, be of more concern than wear that occurs at the intended metal-UHMWPE contact interfaces. Furthermore, formation of high localized contact stresses much above the yield limit of UHMWPE is another likely contributor to bushing failure for this implant.
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