Constituents and pH changes in protein rich hyaluronan solution affect the biotribological properties of artificial articular joints

Nanoparticle-Containing Hyaluronate Solution for Improved Lubrication of Orthopedic Ceramics

Premature failure caused by inadequate lubrication of an artificial joint is a major problem. Inspired by engine lubrication, in which various additives are used to enforce the oil lubricant, here, a bench test of a biomimetic lubricating fluid containing different substances was carried out. Bovine serum albumin (BSA), in the form of both molecules and nanoparticles, was used as a functional additive. Compared with BSA molecules, BSA nanoparticles dispersed in HA solution served as more effective additives in the biomimetic lubrication fluid to minimize the friction and wear of ceramic orthopedic materials made of zirconium dioxide (ZrO₂). Meanwhile, a tribo-acoustic study indicated that the “squeaking” problem associated with ZrO₂ could be suppressed by the biomimetic fluid. Together with a cytotoxicity assessment, the BSA nanoparticle-incorporated biomimetic fluid was confirmed as a potential reagent for use in the clinic to maintain an even longer service life of artificial joints.

Lipid Anchoring Improves Lubrication and Wear Resistance of the Collagen I Matrix

Osteoarthritis is a prevalent degenerative joint disease characterized by progressive articular cartilage loss and destruction. The resultant increase in friction causes severe pain. The collagen I matrix (COL I) has been used clinically for cartilage repair; however, how COL I acts at cartilage surfaces is unclear. Here, we studied adsorption and lubrication of synovial fluid components, albumin, γ-globulin, and the phospholipid DPPC, on COL I under physiological conditions using surface plasmon resonance and an in situ sensing surface force apparatus. Our results revealed COL I had poor lubrication ability, a fairly high coefficient of friction (COF, μ = 0.651 ± 0.013), and surface damage under a 7 mN load. DPPC formed an improved lubricating layer on COL I (μ = 0.072 ± 0.016). In sharp contrast, albumin and γ-globulin exhibited poor lubrication with an order of magnitude higher COF but still provided benefits by protecting COL I from wear. Hence, DPPC on COL I may help optimize COL I implantation design.

Exploring the lubrication mechanisms of synovial fluids for joint longevity - A perspective

Synovial fluids are complex fluids responsible for the exceptional lubrication present in synovial joints. These fluids consist of various constituents, including hyaluronic acid, surface-active proteins (i.e., lubricin), surface-active phospholipids, as well as various other proteins such as human serum albumin and γ -globulin seric proteins, each of them playing an essential role in lubrication. Being the key to the most efficient biotribological systems, this article is intended to review the current understanding of the underlying lubrication mechanisms of the synovial fluids enables prospective usage in numerous applications, especially as a lubricant for hip and knee prosthetics in combatting osteoarthritis. Current research focuses on the determination of the role of proteins in prosthetic lubrication, optimal material combinations for prosthesis, and the effects of relevant physical variables in prosthetic lubrication. The characterization of prosthetic lubrication and wear mechanisms by synovial fluids represents a prominent challenge in tribological research, yet also an important hurdle to overcome towards optimal lubrication of articular prosthetics.

The efficacy and safety of intra-articular injection of hyaluronic acid in the knee and physical therapy agents to treat Kashin-Beck disease: A prospective interventional study

The aim of the present study was to determine whether hyaluronic acid (HA) or physical therapy agents (PTA) can improve functional parameters in patients with knee Kashin-Beck disease (KBD). For 2 years, patients (n=55) were treated with HA weekly for 5 weeks, then received 6th and 7th injections on the 3rd and 6th month, respectively, for 7 injections in total. Patients (n=53) were treated with PTA five times a week for 3 weeks every month for 6 months. The patients were evaluated with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the visual analog pain scale (VAS). Trial registration, ChiCTR-TRC-12002189 (http://www.chictr.org/). During the study, following treatment interruption, pain increased in the PTA group (from a mean value of 85.7±83.8 mm at month 12 to 145.2±128.8 mm at month 18 and 201.3±150.5 mm at month 24), while it remained stable in the HA group (from a mean value of 80.7±70.6 mm at month 12 to 90.1±95.2 mm at month 18 and 82.6±85.3 mm at month 24), with a statistically significant difference in favor of HA at month 18 (P<0.05) and month 24 (P<0.05). Joint stiffness, physical function and total WOMAC showed the same trend as pain. The global efficacy judgments by the patients and the investigators showed a statistically significant difference in favor of HA at month 18 (P<0.05) and month 24 (P<0.05). In conclusion, although all the patients improved in terms of pain and function, HA was superior to PTA alone for pain relief and lasting effect.

Tribological performance of the biological components of synovial fluid in artificial joint implants

The concentration of biological components of synovial fluid (such as albumin, globulin, hyaluronic acid, and lubricin) varies between healthy persons and osteoarthritis (OA) patients. The aim of the present study is to compare the effects of such variation on tribological performance in a simulated hip joint model. The study was carried out experimentally by utilizing a pin-on-disk simulator on ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) hip joint implants. The experimental results show that both friction and wear of artificial joints fluctuate with the concentration level of biological components. Moreover, the performance also varies between material combinations. Wear debris sizes and shapes produced by ceramic and polyethylene were diverse. We conclude that the biological components of synovial fluid and their concentrations should be considered in order to select an artificial hip joint to best suit that patient.

Role of hyaluronic acid and phospholipid in the lubrication of a cobalt-chromium head for total hip arthroplasty

The tribological performance of total hip arthroplasty has an important influence on its success rate. This study examined the concentration-dependent role of hyaluronic acid (HA) and phospholipid (dipalmitoylphosphatidylcholine, DPPC) in the boundary lubricating ability of retrieved cobalt-chromium femoral heads. The microscale frictional coefficients (μ) were measured by atomic force microscopy using a rectangular silicon cantilever integrated with sharp silicon tips. In the case of HA lubricant, the frictional coefficients decreased significantly at concentrations of 2.0 (0.16 ± 0.03) and 3.5 mg/ml (0.11 ± 0.01) while increased at 5.0 mg/ml (0.15 ± 0.01), compared to that with phosphate buffer saline (0.25 ± 0.03). The concentration-dependent lubrication behavior of DPPC was most effective when DPPC was in the physiological concentration range, showing μ = 0.16 ± 0.01 in polypropylene glycol, and 0.05 ± 0.01, 0.02 ± 0.01, and 0.03 ± 0.01 at a DPPC concentration of 0.05, 0.2, and 3.0 mg/ml, respectively. Results obtained show significant differences between the DPPC concentration groups. Conclusively, the microscale frictional response of the retrieved CoCr femoral head has a significant dependence on the concentrations of HA and DPPC. Moreover, observed optimal concentration of HA and DPPC for effective lubrication is similar to that observed in normal human synovial fluid. Therefore, a retrieval of the synovia may be considered during total hip replacement surgeries in an effort for reduction of friction between head and liner of total hip replacement implants.

On the matter of synovial fluid lubrication: implications for Metal-on-Metal hip tribology

Artificial articular joints present an interesting, and difficult, tribological problem. These bearing contacts undergo complex transient loading and multi axes kinematic cycles, over extremely long periods of time (>10 years). Despite extensive research, wear of the bearing surfaces, particularly metal-metal hips, remains a major problem. Comparatively little is known about the prevailing lubrication mechanism in artificial joints which is a serious gap in our knowledge as this determines film formation and hence wear. In this paper we review the accepted lubrication models for artificial hips and present a new concept to explain film formation with synovial fluid. This model, recently proposed by the authors, suggests that interfacial film formation is determined by rheological changes local to the contact and is driven by aggregation of synovial fluid proteins. The implications of this new mechanism for the tribological performance of new implant designs and the effect of patient synovial fluid properties are discussed.

Synovial fluid lubrication of artificial joints: protein film formation and composition

Despite design improvements, wear of artificial implants remains a serious health issue particularly for Metal-on-Metal (MoM) hips where the formation of metallic wear debris has been linked to adverse tissue response. Clearly it is important to understand the fundamental lubrication mechanisms which control the wear process. It is usually assumed that MoM hips operate in the ElastoHydrodynamic Lubrication (EHL) regime where film formation is governed by the bulk fluid viscosity; however there is little experimental evidence of this. The current paper critically examines synovial fluid lubrication mechanisms and the effect of synovial fluid chemistry. Two composition parameters were chosen; protein content and pH, both of which are known to change in diseased or post-operative synovial fluid. Film thickness and wear tests were carried out for a series of model synovial fluid solutions. Two distinct film formation mechanisms were identified; an adsorbed surface film and a high-viscosity gel. The entrainment of this gel controls film formation particularly at low speeds. However wear of the femoral head still occurs and this is thought to be due primarily to a tribo-corrosion mechanisms. The implications of this new lubrication mechanism and the effect of different synovial fluid chemistries are examined. One important conclusion is that patient synovial fluid chemistry plays an important role in determining implant wear and the likelihood of failure.

Effect of protein concentrations of bovine serum albumin and γ-globulin on the frictional response of a cobalt-chromium femoral head

The study aims to identify the concentration-dependent role of bovine serum albumin (BSA) and γ-globulin in the lubricating ability of a cobalt-chromium femoral head. The frictional coefficients of the cobalt-chromium femoral head decreased with increasing BSA concentrations from 10 to 40 mg/ml and showed statistical differences between any of the BSA concentration groups, except between the 30 and 40 mg/ml concentration groups. In γ-globulin, the frictional coefficients significantly decreased at concentrations of 2.5 and 5.0 mg/ml as compared with the PBS control group, but significant increases were observed at 7.5 and 12.5 mg/ml. These results suggest that the friction of the cobalt-chromium femoral head is dependent on the concentration of both BSA and γ-globulin. However, there is a maximum concentration for BSA to act as an effective boundary lubricant, while the lubricating ability of γ-globulin is most effective in the physiological concentration range within human synovial fluid.

Inlet protein aggregation: a new mechanism for lubricating film formation with model synovial fluids

This paper reports a fundamental study of lubricant film formation with model synovial fluid components (proteins) and bovine serum (BS). The objective was to investigate the role of proteins in the lubrication process. Film thickness was measured by optical interferometry in a ball-on-disc device (mean speed range of 2-60 mm/s). A commercial cobalt-chromium (CoCrMo) metal femoral head was used as the stationary component. The results for BS showed complex time-dependent behaviour, which was not representative of a simple fluid. After a few minutes sliding BS formed a thin adherent film of 10-20 nm, which was attributed to protein absorbance at the surface. This layer was augmented by a hydrodynamic film, which often increased at slow speeds. At the end of the test deposited surface layers of 20-50 nm were measured. Imaging of the contact showed that at slow speeds an apparent 'phase boundary' formed in the inlet just in front of the Hertzian zone. This was associated with the formation of a reservoir of high-viscosity material that periodically moved through the contact forming a much thicker film. The study shows that proteins play an important role in the film-forming process and current lubrication models do not capture these mechanisms.

Adsorption of albumin and sodium hyaluronate on UHMWPE: a QCM-D and AFM study

The biotribological properties of artificial joints, in particular the efficiency of the lubrication, strongly determine their lifetime. The most commonly used artificial joints combine a metallic or ceramic part articulating against a ultra high molecular weight polyethylene (UHMWPE) counterface, and are lubricated by the periprosthetic fluid. This fluid contains several macromolecules, namely albumin and sodium hyaluronate (NaHA), that are known to be involved in the lubrication process. There are several studies in the literature concerning the interaction of the referred macromolecules with ceramic or metallic prosthetic materials. However, to our knowledge, information about their binding to the polymeric surface is practically inexistent. The objective of this work is to contribute to clarify the role played by albumin and NaHA on the biolubrication process, through the investigation of their interaction with the UHMWPE surface. The study involves adsorption measurements using a quartz crystal microbalance with dissipation (QCM-D), the characterization of the adsorbed films by atomic force microscopy (AFM) and wettability determinations. Albumin was found to adsorb strongly and extensively to the polymer, while NaHA led to a very low adsorption. In both cases rigid films were obtained, but with different morphology and porosity. The high binding affinity of the protein to the polymer was demonstrated both by the results of the fittings to Langmuir and Freundlich models and by the values of the adhesion forces determined by AFM. In the simultaneous adsorption of albumin and NaHA, protein adsorption is predominant and determines the surface properties.

Evaluation of J-initiation fracture toughness of ultra high molecular weight polyethylene used in total joint replacements

Fracture of ultra high molecular weight polyethylene (UHMWPE) total joint replacement components is a clinical concern. Thus, it is important to characterize the fracture resistance of UHMWPE. To determine J-initiation fracture toughness (J(Q)) for metals and metallic alloys, ASTM E1820 recommends a procedure based on an empirical crack blunting line. This approach has been found to overestimate the initiation toughness of tough polymers like UHMWPE. Therefore, in this study, a novel experimental approach based on crack tip opening displacement (CTOD) was utilized to evaluate J(Q) of UHMWPE materials. J-initiation fracture toughness was experimentally measured in ambient air and a physiologically-relevant 37°C PBS environment for three different formulations of UHMWPE and compared to the blunting line approach. The CTOD method was found to provide J(Q) values comparable to the blunting line approach for the UHMWPE materials and environments examined in this study. The CTOD method used in this study is based on experimental observation and, thus, does not rely on an empirical relationship or fracture surface measurements. Therefore, determining J(Q) using the experimentally based CTOD method proposed in this study may be a more reliable approach for UHMWPE and other tough polymers than the blunting line approach.

The translocation of fullerenic nanoparticles into lysosome via the pathway of clathrin-mediated endocytosis

Manufactured fullerene nanoparticles easily enter into cells and hence have been rapidly developed for biomedical uses. However, it is generally unknown which route the nanoparticles undergo when crossing cell membranes and where they localize to the intracellular compartments. Herein we have used both microscopic imaging and biological techniques to explore the processes of [C(60)(C(COOH)(2))(2)](n) nanoparticles across cellular membranes and their intracellular translocation in 3T3 L1 and RH-35 living cells. The fullerene nanoparticles are quickly internalized by the cells and then routed to the cytoplasm with punctate localization. Upon entering the cell, they are synchronized to lysosome-like vesicles. The [C(60)(C(COOH)(2))(2)](n) nanoparticles entering cells are mainly via endocytosis with time-, temperature- and energy-dependent manners. The cellular uptake of [C(60)(C(COOH)(2))(2)](n) nanoparticles was found to be clathrin-mediated but not caveolae-mediated endocytosis. The endocytosis mechanism and the subcellular target location provide key information for the better understanding and predicting of the biomedical function of fullerene nanoparticles inside cells.

Differential tissue-on-tissue lubrication by ophthalmic formulations

Tissue-on-tissue friction testing was used to determine how instillation of hydrophilic polymer-containing formulations between the "blinking" tissues would compare with lubrication by saline, alone, or an oil-emulsion preparation. Best results were obtained for a formulation that contained active demulcents polyethylene glycol (PEG 400) and propylene glycol (PG), as well as a gellable polymer hydroxypropyl guar (HP-Guar) in a borate-buffered solution, in comparison with hydroxypropylcellulose-containing and carboxymethylcellulose-containing formulations. Superior performance of all the formulations was found for lubricating tissue-on-tissue couples, compared with metal-oxide-to-metal oxide interfaces, or metal oxide-to-tissue interfaces. A reciprocating pin-on-disc type friction/wear test device articulated the intimal faces of preserved human umbilical cord vein segments under increasing loads during simulated continuous "eye-blinking" with addition of increasing weights up to 60 g/cm2, simulating maximal eyelid force on the orbital globe. The tissue-on-tissue couples moved from liquid phase lubrication to boundary lubrication. After residual formulations were rinsed away with saline, persistence of low friction at the highest loads was indicative of formulation substantivity. Human umbilical cord vein segments were utilized in saline-wetted tissue-on-tissue couples that showed variable starting coefficients of friction in the range 0.2-0.4, producing moderate tearing and disruption of the interfacial layers above the medial collagen zone. The best-performing formulations instilled to the tissues pre-wetted with saline apparently reacted separately with each tissue face to produce a lower final and persistent coefficient of friction of about 0.05. Scanning electron microscopy and light microscopy of these guar-modified tissue specimens showed only a few superficial tissue disruptions, and some interphase swelling consistent with polymer uptake. The frictional values for lubricated couples having non-tissue members were considerably higher than the coefficients of friction measured for the similarly lubricated tissue-on-tissue couples, emphasizing the requirement that appropriate simulations are critical to obtaining clinically predictive data.

Zeta‐potentials of alginate‐PLL capsules: A predictive measure for biocompatibility?

Alginate-poly-L-lysine (PLL) microencapsulation of cells is a promising approach to prevent rejection in the absence of immunosuppression. Clinical application, however, is hampered by insufficient insight in factors influencing biocompatibility of the capsules. By now, it has been accepted that not only the chemical composition of the materials applied but also other factors contribute to bioincompatibility. The zeta-potential serves as a measure for the electrical charge of the surface and has been shown to be a predictive value for the interfacial reactions between the biomaterial and the surrounding tissue in other applications. In the present study, we have assessed the streaming potential of alginate-PLL capsules composed of either low-, intermediate-, or high-guluronic (G) alginate to calculate the zeta-potential. The zeta-potentials of the capsules were compared to the biological response against the capsules at 4 weeks after implantation in the rat. We show that high-G and low-G alginates provoke a more severe response in the rat than capsules prepared of intermediate-G alginate. This correlates with a higher zeta-potential of the high-G and low-G alginates and by a change in zeta-potential at lower pH. These lower pH-levels are common directly after implantation as the consequence of a host-response associated with mandatory surgery. Our results suggest that we should not only consider the capsule properties under physiological circumstances to explain bioincompatibility but also the capsule features during common pathophysiological situations.

Alginate-based microcapsules for immunoisolation of pancreatic islets

Transplantation of microencapsulated cells is proposed as a therapy for the treatment of a wide variety of diseases since it allows for transplantation of endocrine cells in the absence of undesired immunosuppression. The technology is based on the principle that foreign cells are protected from the host immune system by an artificial membrane. In spite of the simplicity of the concept, progress in the field of immunoisolation has been hampered for many years due to biocompatibility issues. During the last years important advances have been made in the knowledge of the characteristics and requirements capsules have to meet in order to provide optimal biocompatibility and survival of the enveloped tissue. Novel insight shows that not only the capsules material but also the enveloped cells should be hold responsible for loss of a significant portion of the immunoisolated cells and, thus, failure of the grafts on the long term. Microcapsules without cells can be produced as such that they remain free of any significant foreign body response for prolonged periods of time in both experimental animals and humans. New approaches in which newly discovered inflammatory responses are silenced bring the technology of transplantation of immunoisolated cells close to clinical application.

Adsorption of albumin on prosthetic materials: Implication for tribological behavior

The orthopedic prosthesis used to substitute damaged natural joints are lubricated by a pseudosynovial fluid that contains biological macromolecules with potential boundary lubrication properties. Proteins are some of those macromolecules whose role in the lubrication process is not yet completely understood. In a previous work, we investigated the influence of the presence of albumin, the major synovial protein, upon the tribological behavior of three of the most used pairs of artificial joint materials: ultra high molecular weight polyethylene (UHMWPE) against counterfaces of alumina, CoCrMo alloy, and 316L stainless steel. Albumin was found to cause a significant decrease in the friction coefficient when the counterfaces were metallic because transfer of UHMWPE was avoided, but this effect was much weaker in the case of alumina. The objective of the present work was to look for an explanation for these differences in tribological behavior in terms of albumin adsorption. With this goal, studies on adsorption of bovine serum albumin (BSA) on the counterface materials, from a biological model fluid (Hanks' balanced salt solution), were carried out using radiolabeled albumin ((125)I-BSA), X-ray photoelectron spectroscopy, and atomic force microscopy. The conclusion from all techniques is that the driving force for albumin adsorption is higher on the metals than on alumina. These results confirm that the greater the amount of protein adsorbed on the counterface, the more efficient is the protection against the transfer of polymeric film to the counterface.

The John Charnley Award Paper. The role of joint fluid in the tribology of total joint arthroplasty

The effect of joint fluid on the tribology (ie, lubrication, friction, and wear) of total hip arthroplasty has not yet been investigated adequately. In the current study, a friction assay was used to assess four hypotheses relating to the effect of human joint fluid and its principal components on the articulation of metal-on-polyethylene. First, joint fluid was found to produce a widely varying amount of friction between cobalt-chromium and polyethylene; this range exceeded the range produced when the articulation was lubricated by water or bovine serum. Second, it was shown that hyaluronic acid, phospholipid, albumin, and gamma-globulin were not acting as boundary lubricants, but that one or more other proteins (as yet unidentified) were responsible for reducing friction in this couple. Third, lower friction was found when oxidized zirconium alloy replaced cobalt-chromium as a bearing surface on polyethylene. Finally, a pilot study suggested that lubricin, which contributes to cartilage-on-cartilage lubrication, is not a protein responsible for the tribological variabiation found among joint fluid samples. The current study showed that joint fluid is a patient factor that influences the tribology of metal-on-polyethylene arthroplasty.

Theoretical investigation of an artificial joint with micro-pocket-covered component and biphasic cartilage on the opposite articulating surface

This paper presents a theoretical investigation of a geometrically idealized artificial joint with micro-pocket-covered component and biphasic cartilage on the opposite articulating surface. The fluid that exudes from the biphasic cartilage fills and pressurizes the micro-pockets. In this way, a poro-elasto-hydrodynamic regime of lubrication is developed. Assuming that lower friction would result in lower adhesive wear, and neglecting the fatigue as well as the abrasive wear, the proposed bearing system hypothetically could reduce the amount of wear debris. Equations of the linear biphasic theory are applied for the confined and unconfined compression of the cartilage. The fluid pressure and the elastic deformation of the biphasic cartilage are explicitly presented. The effective and equilibrium friction coefficients are obtained for the particular configuration of this bearing system. The micro-pockets geometrical parameters (depth, radius, surface distribution and edge radius) must be established to reduce the local contact stresses, to assure low friction forces and to minimize the biphasic cartilage damage. The influence of the applied pressure, porosity of the micro-pocket-covered component, filling time, cartilage elasticity, permeability and porosity upon the micro-pockets depth is illustrated. Our results are based upon the previously published data for a biphasic cartilage.