The effect of contact load on CoCrMo wear and the formation and retention of tribofilms

Translational Characterization of Macrophage Responses to Stable and Non-Stable CoCrMo Wear and Corrosion Debris Generated In-Situ for Total Hip Replacement

Metal wear and corrosion debris remain a limiting factor for long-term durability of total hip replacement (THR). Common wear particle production techniques for research differ from the actual tribocorrosion processes at the implant site, potentially causing loss of valuable information. The aim of this study was to investigate reactions to freshly generated and time-stabilized particles and ions released from CoCrMo-alloy using a bio-tribometer, which mimics conditions of the periprosthetic environment. THP-1 macrophages were challenged with freshly produced or time-stabilized wear debris. Wear generation took place in a custom-built bio-tribometer inside a CO2 incubator operating with a reciprocating rotation of an Al2O3 ball against a CoCrMo disc. Two different electrochemical conditions with increasingly forced corrosion rates were tested: +0.45 V (passive domain) and +0.67 V (transition to transpassive domain). Cell viability, proinflammatory cytokines, electrochemical measurements and ICP-MS metal ion content analyses were performed. Cobalt/ chromium concentrations were 6.6/ 1.6 ppm in the passive domain and almost doubled to 11.4/ 3.0 ppm in the passive-transpassive domain. Under those electrochemical conditions, freshly produced and time-stabilized CoCrMo wear decreased cell viability to the same extent. Secretion of proinflammatory cytokines were not significantly different for freshly produced and time-stabilized debris. This study suggests that freshly generated and time-stabilized metal particles/ions cause similar toxicity and inflammatory reactions in macrophages, indicating that standard practices for generating wear debris are valid methods to evaluate wear particle disease. Other cell types, materials, and corrosion potentials need to be studied in the future to solidify the conclusion.

Retrieval Analysis of the Essure® Micro Insert Female Sterilization Implant: Methods for Metal Ion and Microscopic Analysis

The Essure® Device is a female sterilization implant comprised of four alloys (Ni-Ti, 316L SS, Pt-Ir and Sn-Ag) and Dacron fibers. As part of the mandated 522 post-market surveillance study, implant retrieval and metal-ion analysis methods were developed separate from patient clinical data, to quantify trace metal ions found in tissue and to assess implant degradation present. Three segments of tissue (proximal implant, distal implant, and tissue distal from the implant) stored in neutral buffered formalin, were retrieved. Tissue was prepared for metal ion analysis using inductively coupled mass spectrometry (ICP-MS). Implant sections from four patients, were analyzed using digital optical microscopy (DOM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). Image analysis showed Sn-Ag solder corroded and elevated Sn ion levels in tissue proximal to the solder compared to tissues more remote in all cases observed. The 316L SS exhibited signs of degradation with high surface concentrations of molybdenum and chromium and low iron compared to the parent alloy. Evidence of elevated iron, chromium and nickel within the tissues and storage solutions combined with precipitation of an iron-calcium-phosphorous material on some implants indicate evidence of SS corrosion. Ni-Ti, Pt-Ir and Dacron appear to have no major damage. This study includes preliminary results as part of the ongoing 522 study and therefore no final conclusions regarding the device or patient data can be drawn from this present study until the entire 522 study is complete. STATEMENT OF SIGNIFICANCE: The Essure Device is a female sterilization implant that was implanted into approximately 750,000 women. The device is composed of polyethylene terephthalate fibers and 4 metal alloys, 316L stainless steel, Nickel-Titanium, Tin-Silver and Platinum-Iridium. Following an increase in patient reported adverse events, the FDA required a 522-post market surveillance study. As part of this study, implants are retrieved from patients via salpingectomy or hysterectomy. This study focuses on the development of the implant retrieval methods following surgery, with focus on measuring local tissue metal ions, their distribution and assessing the degradation of the implant without correlation to patient clinical condition.

Insights into tribofilm formation on Ti-6V-4Al in a bioactive environment: Correlation between surface modification and micro-mechanical properties

Ti-6Al-4V has been used as a surgical implant material for a long time because of its combination of strength, corrosion resistance and biocompatibility. However, there remains much that is not understood about how the surface reacts with the environment under tribocorrosion conditions. In particular, the conditions under which tribofilms form and their role on friction and wear are not clear. To evaluate the complicated nature of the dynamic surface microstructural changes on the wear track, high resolution transmission electron microscopy (TEM), scanning transmission electron microscope (STEM) and electron energy loss spectroscopy (EELS) have been used to characterise the structure and chemical composition of the tribofilm. Detailed analysis of the formation and structure of the tribofilm and the metal surface deformation behaviour were studied as a function of applied potential and the role of proteins in the lubricant. For the first time, graphitic and onion-like carbon structures from wear debris were found in the testing solution. The presence of carbon nanostructures in the tribocorrosion process and the formation of the tribofilm leads to an improved tribocorrosion behaviour of the system, in particular a reduction in wear and friction. A detailed, quantitative, analysis of surface deformation was undertaken, in particular, the geometrically necessary dislocation (GND) density was quantified using precession electron diffraction (PET). A clear correlation between applied potential, tribofilm formation and the surface strain was established. STATEMENT OF SIGNIFICANCE: The formation of tribofilm and microstructure modification of the Ti-6Al-4V surface during tribocorrosion in a physiological environment is not fully understood. In particular, the correlation between microstructural changes and electrochemical conditions is not clear. This study presents a detailed investigation of the structure and chemical composition of tribofilms at the nanoscale during tribocorrosion tests in simulated body fluid and gives a detailed and quantitative description of the evolved surface structure. A clear correlation between applied potential, tribofilm formation and the surface strain was established. Moreover, particular attention is paid to the wear debris particles captured from the lubricating solution, including nanocarbon onion structures. The implications for tribocorrosion of the alloy in its performance as an implant are discussed.

Dynamic microfluidic bioreactor-Hip simulator (DMBH) system for implant toxicity monitoring

The generation of degradation products (DPs) like ions and organo-metallic particles from corroding metallic implants is an important healthcare concern. These DPs generate local and systemic toxicity. The impact on local toxicity is well documented, however, little is known about systemic toxicity. This is mainly due to the limited scope of the current microtiter plate-based (static) toxicity assay techniques. These methods do not mimic the systemic (dynamic) conditions. In this study, it is hypothesized that DPs incubated with cells in static conditions might provide improper systemic toxicity results, as there is no movement mimicking the blood circulation around cells. This study reports the development of a three-chambered prototype microfluidic system connected to the operational hip implant simulator to test the cellular response induced by the DPs. This setup is called a dynamic microfluidic bioreactor-hip simulator system. We hypothesize that a dynamic microfluidic system will provide a realistic toxicology response induced by DPs than a static cell culture plate. To prove the hypothesis, Neuro2a (N2a) cells were used as representative cells to study systemic neurotoxicity by the implant DPs. The microfluidic bioreactor system was validated by comparing the cell toxicity against the traditional static system and using COMSOL modeling for media flow with DPs. The hip implant simulator used in this study was a state-of-the-art sliding hip simulator developed in our lab. The results suggested that static toxicity was significantly more compared to dynamic microfluidic-based toxicity. The newly developed DMBH system tested for in situ systemic toxicity on N2a cells and demonstrated very minimum toxicity level (5.23%) compared to static systems (31.16%). Thus, the new DMBH system is an efficient tool for in situ implant metal systemic toxicity testing.

Hueter Anterior Approach for Metal-on-Metal Hip Resurfacing Arthroplasty: 555 Cases at a Minimum Five-Year Follow-Up

BACKGROUND

Purpose of this study was to determine implant survivorship and resultant outcomes, including modes of failure, for metal-on-metal hip resurfacing through the Hueter anterior approach (HAA).

METHODS

Retrospective review of cases from 2006 to 2015, resulted in 555 metal-on-metal hip resurfacing via HAA, mean age 49.4 ± 6.9 years and mean BMI 28.1 ± 5.3. Kaplan-Meier curves were used to assess implant survivorship. Evaluation of technique was based on radiographic assessment of component position at 6 weeks. Patient-reported outcome measures were assessed using 12-Item Short Form Survey 12, University of California Los Angeles activity, Western Ontario and McMaster Universities Osteoarthritis Index, and hip disability osteoarthritis outcome scores.

RESULTS

At a mean follow-up of 9.18 years, survivorship was 95.0% at 5 years (95% CI: 93.2-96.8 years) and 92.5% at 10 years (95% CI: 90.0-95.0 years); men at 96.1% (95% CI: 94.3-97.9) and 93.8% (95% CI: 91.1-96.5), and women at 88.8% (95% CI: 81.9-95.7) and 85.6% (95% CI: 77.6-93.6), 5 and 10 years, respectively (P = .033). There were 37 revisions to total hips (7%) at a mean time of 3.3 years (SD 2.7). Indications for revision were aseptic loosening of acetabular (n = 12) and femoral component (n = 7) and pseudotumor (n = 6). Radiographic parameters were respectable and consistent, median acetabular inclination angle 41.2° and femoral stem shaft angle 137.7°. Patient-reported outcome measure scores significantly improved and remained stable at 2 and 5 years postoperatively.

CONCLUSION

Although choice of surgical approach should always be based on surgeon's technical expertise, this study has shown that HAA is safe and effective for hip resurfacing. Mindful attention to long-term metal ion exposure must still be considered.

Effect of surface deformation on biocompatibility of biomedical alloys

In this study, biocompatibility of Co-29Cr-5Mo (CCM), 316L steel (316L) and Ti-6Al-4V (TC4) alloys after surface plastic deformation under the condition comparable to the human ankle activities were investigated in details. Biocompatibility of all alloys decreases after surface deformation, while it is most significantly observed in CCM alloy. The different responses of biocompatibility are related to the corresponding microstructure evolution during surface deformation: martensitic phase transformation, dislocation slipping and mechanical twinning in CCM alloy result in the extremely localized microstructure, giving rise to the obviously decreased corrosion resistance or biocompatibility; quite homogenous microstructure after surface deformation leads to the slightly decreased corrosion resistance or biocompatibility in both 316L and TC4 alloys, since the surface deformation is dominated by slipping in 316L and by both slipping and a few mechanical twinning in TC4.

Influence of Bovine Serum Albumin (BSA) on the Tribocorrosion Behaviour of a Low Carbon CoCrMo Alloy in Simulated Body Fluids

Tribocorrosion, as the interaction between mechanical wear and electrochemical corrosion, has been found to be the main problem causing the failure and limiting the lifetime of metal-on-metal artificial hip joints. Better understanding of the tribocorrosion mechanisms of CoCrMo alloys is needed in order to reduce the degradation of this alloy, especially in the presence of proteins as one of the organic components present in synovial fluid. In this study, tribocorrosion tests of a low carbon CoCrMo alloy in phosphate buffer solution (PBS) with and without bovine serum albumin (BSA) in two different concentrations at different applied potentials (passive and cathodic) were carried out. The results show that the effect of proteins on wear and friction was concentration and potential dependent. In the cathodic domain (absence of very thin passive film), wear was very low in all solutions and the friction was significantly reduced by the addition of BSA to PBS even at low BSA concentrations. However, in the passive domain, the friction and wear were found not to be affected when the BSA concentration was 0.5 g/L, while they were reduced when increasing the BSA concentration to 36 g/L. The tribocorrosion results were rationalized through an existing tribocorrosion model and the effect of BSA on wear and friction was explained by the consideration of physical factors such as changes in viscosity and double layer structure, because in the present results no tribofilm formation was observed.

In Vitro Evidence for Cell-Accelerated Corrosion Within Modular Junctions of Total Hip Replacements

Corrosion at modular junctions of total hip replacement (THR) remains a major concern today. Multiple types of damage modes have been identified at modular junctions, correlated with different corrosion characteristics that may eventually lead to implant failure. Recently, within the head-taper region of the CoCrMo retrieval implants, cell-like features and trails of etching patterns were observed that could potentially be linked to the involvement of cells of the periprosthetic region. However, there is no experimental evidence to corroborate this phenomenon. Therefore, we aimed to study the potential role of periprosthetic cell types on corrosion of CoCrMo alloy under different culture conditions, including the presence of CoCrMo wear debris. Cells were incubated with and without CoCrMo wear debris (obtained from a hip simulator) with an average particle size of 119 ± 138 nm. Electrochemical impedance spectroscopy (EIS) was used to evaluate the corrosion tendency, corrosion rate, and corrosion kinetics using the media after 24 h of cell culture as the electrolyte. Results of the study showed that there was lower corrosion resistance (p < 0.02) and higher capacitance (p < 0.05) within cell media from macrophages challenged with particles when compared with the other media conditions studied. The potentiodynamic results were also in agreement with the EIS values, showing significantly higher corrosion tendency (low E_corr ) (p < 0.0001) and high I_corr (p < 0.05) in media from challenged macrophages compared with media with H₂ O₂ solution. Overall, the study provides in vitro experimental evidence for the possible role of macrophages in altering the chemical environment within the crevice and thereby accelerating corrosion of CoCrMo alloy. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:393-404, 2020.

Effects of Temperature on Wear Properties and Mechanisms of HVOF Sprayed CoCrAlYTa-10%Al2O3 Coatings and H13 Steel

In this study, the CoCrAlYTa-10%Al2O3 coatings were prepared by the high-velocity oxygen-fuel (HVOF) spraying. A series of ball-on-disk sliding wear tests were conducted to evaluate the tribological properties of the coatings at different temperatures (25 °C, 200 °C, 400 °C, and 600 °C). The results showed that the average coefficients of friction (COFs) of the CoCrAlYTa-10%Al2O3 coatings were lower than that of H13 steel at different temperatures. The average COFs of the CoCrAlYTa-10%Al2O3 coatings and H13 steel both decreased with increasing temperature. The wear rate of the CoCrAlYTa-10%Al2O3 coatings increased first and then decreased. The microhardness of worn surface of the CoCrAlYTa-10%Al2O3 coatings increased with increasing temperature, while the microhardness of worn surface of H13 steel at 25 °C and 200°C was higher than that at 400 °C and 600 °C. The wear mechanism of the two materials was mainly abrasive wear. The tribofilms were formed on the worn surface of the CoCrAlYTa-10%Al2O3 coatings, which had a good protective effect. Due to thermal softening and low binding strength of debris, it was difficult for H13 steel to form the tribofilms. The wear rate of H13 steel was much higher than that of the CoCrAlYTa-10%Al2O3 coatings at 400 °C and 600 °C, indicating that the high temperature wear resistance of the coatings was much better than that of H13 steel.

Formation and Nature of Carbon-Containing Tribofilms

Minimizing friction and wear at a rubbing interface continues to be a challenge and has resulted in the recent surge toward the use of coatings such as diamond-like carbon (DLC) on machine components. The problem with the coating approach is the limitation of coating wear life. Here, we report a lubrication approach in which lubricious, wear-protective carbon-containing tribofilms can be self-generated and replenishable, without any surface pretreatment. Such carbon-containing films were formed under modest sliding conditions in a lubricant consisting of cyclopropanecarboxylic acid as an additive dissolved in polyalphaolefin base oil. These tribofilms show the same Raman D and G signatures that have been interpreted to be due to the presence of graphite- or DLC films. Our experimental measurements and reactive molecular dynamics simulations demonstrate that these tribofilms are in fact high-molecular weight hydrocarbons acting as a solid lubricant.

Investigation of CoCrMo material loss in a novel bio-tribometer designed to study direct cell reaction to wear and corrosion products

Wear and corrosion in total hip replacement negatively impact implant service-life and patient well-being. The aim of this study was to generate a statistical response surface of material loss using an apparatus, capable of testing the effect of wear and corrosion products in situ on cells, such as macrophages. The test chamber of a ball-on-flat tribometer operating inside a CO₂ incubator was integrated with an electrochemical setup and adapted for cell culture work. A 20-test series, following a 2-level 3-factor design of experiments, was performed with a ceramic head in reciprocating rotational motion against a CoCrMo-alloy disc, under constant load. The lubricant was cell culture medium (RPMI-1640+10vol% bovine serum). Response surfaces were generated, which statistically showed the influence of motion amplitude, load, and potential on the total mass loss and wear scar volume of the metallic discs. Potential had the highest impact on the total mass loss, while motion amplitude and load significantly influenced the wear scar volume. The concentrations of the alloy elements found in the lubricants reflected the bulk-alloy stoichiometry. The total concentration of Co released into the lubricant (2.3-63 ppm by total mass loss, 1.5 to 62 ppm by ICP-MS) corresponded well with the known range to trigger cell response. Tribocorrosion tests in the presence of cells and tissues, such as macrophages, lymphocytes and/or synovium, will be carried out in the future.

Biological effects of metal degradation in hip arthroplasties

Metals and metal alloys are the most used materials in orthopedic implants. The focus is on total hip arthroplasty (THA) that, though well tolerated, may be associated with local and remote adverse effects in the medium-long term. This review aims to summarize data on the biological consequences of the metal implant degradation that have been attributed predominantly to metal-on-metal (MoM) THA. Local responses to metals consist of a broad clinical spectrum ranging from small asymptomatic tissue lesions to severe destruction of bone and soft tissues, which are designated as metallosis, adverse reactions to metal debris (ARMD), aseptic lymphocytic vasculitis associated lesion (ALVAL), and pseudotumors. In addition, the dissemination of metal particles and ions throughout the body has been associated with systemic adverse effects, including organ toxicity, cancerogenesis, teratogenicity, and immunotoxicity. As proved by the multitude of studies in this field, metal degradation may increase safety issues associated with THA, especially with MoM hip systems. Data collection regarding local, systemic and long-term effects plays an essential role to better define any safety risks and to generate scientifically based recommendations.

Effects of surface friction treatment on the in vitro release of constituent metals from the biomedical Co-29Cr-6Mo-0.16N alloy

Due to the ignorance by many researchers on the influence of starting microstructure on the metal release of biomedical materials in human body after implant, in this study, the effect of surface friction treatment on the in vitro release of the constituent elements of the biomedical Co-29Cr-6Mo-0.16N (CCM) alloy is investigated for the first time by immersion test in lactic acid solution combined with electron backscatter diffraction, transmission electron microscope, X-ray diffraction, X-ray photoelectron spectroscopy, and inductively coupled plasma atomic emission spectroscopy (ICP-EOS). The results indicate that friction treatment on the as-annealed CCM alloy sample surface leads to a planar strain-induced martensitic transformation (SIMT) on sample surface; this greatly accelerates the release of all the constituent elements and, in particular, that of Co as indicated by the ICP-EOS analysis. This increase can be ascribed to a localized deformation that occurred over the entire sample surface, with the dislocation density being high within the SIMTed phase and low in the alloy matrix.