Contact mechanics of metal-on-metal hip implants employing a metallic cup with a UHMWPE backing

Estimation of the effects of inset heights and slit configurations in an acetabular cup on the pull-out behavior of an artificial hip joint with a structure for preventing dislocation using finite element analysis

Joint dislocation is a critical problem of total hip replacement. We have newly proposed an artificial hip joint with a structure that prevents dislocation. The proposed joint has a simple form with a femoral head partially covered with an acetabular cup. In the present study, the effects of inset heights and slit configurations of the cup on the pull-out forces of the joint were evaluated using finite element analysis. Joint models with different inset heights and those with or without a slit in the cup were used for the analyses to estimate the pull-out forces of the joint. In the case without the slit, the maximum pull-out force of the joint with 1.0 and 1.5 mm of the inset height was approximately 12 and 40 N, respectively. In the case of 1.0-mm inset height, the maximum force of the joint with and without the slit was approximately 9 and 12 N, respectively. These results reveal that the maximum force is markedly changed by the inset height and is moderately affected by the slit. Thus, we can gain insights into a strategy to optimally design an artificial joint in which dislocation does not occur easily. Graphical abstract.

The effect of femoral head size on edge loading in metal-on-metal hip joint replacement under dynamic separation conditions

Edge loading that occurs in hip joint replacements due to dynamic separation of the joint bearings has been shown to cause severe wear for meal-on-metal bearings. In the present study, the multibody dynamics model for metal-on-metal (MoM) hip joints with a medial-lateral translational mismatch in the centers of rotation of the cup and head has been developed to predict the dynamic separation and contact force of edge loading under gait loading conditions. The effects of larger head diameters (28-55 mm), in combination with the translational mismatch (0-4 mm) and varied cup inclination angles (45°-65°), on edge loading of MoM bearings have been computationally investigated. For the given translational mismatch, increasing head diameters results in negligible effects on the dynamic separation, contact force and severity of edge loading. Increasing head size also leads to increased offset loading torque which has been found to reach at the level that may cause cup loosening under larger translational mismatch at 4 mm. The result highlights the importance of the cup inclination angle of 45° and a lower translational mismatch to avoid severe edge loading.

A computational parametric study on edge loading in ceramic-on-ceramic total hip joint replacements

Edge loading in ceramic-on-ceramic total hip joint replacement is an adverse condition that occurs as the result of a direct contact between the head and the cup rim. It has been associated with translational mismatch in the centres of rotation of the cup and head, and found to cause severe wear and early failure of the implants. Edge loading has been considered in particular in relation to dynamic separation of the cup and head centres during a gait cycle. Research has been carried out both experimentally and computationally to understand the mechanism including the influence of bearing component positioning on the occurrence and severity of edge loading. However, it is experimentally difficult to measure both the load magnitude and duration of edge loading as it occurs as a short impact within the tight space of hip joints. Computationally, a dynamic contact model, for example, developed using the MSC ADAMS software for a multi-body dynamics simulation can be particularly useful for calculating the loads and characterising the edge loading. The aim of the present study was to further develop the computational model, and improve the predictions of contact force and the understanding of mechanism in order to provide guidance on design and surgical factors to avoid or to reduce edge loading and wear. The results have shown that edge loading can be avoided for a low range of translational mismatch in the centres of rotation of the cup and head during gait at the level of approximately 1.0 mm for a cup at 45° inclination, keeping a correct cup inclination at 45° is important to reduce the edge loading severity, and edge loading can be avoided for a certain range of translational mismatch of the cup and head centres with an increased swing phase load.

Numerical and experimental investigations for the evaluation of the wear coefficient of reverse total shoulder prostheses

In the present study, numerical and experimental wear investigations on reverse total shoulder arthroplasties (RTSAs) were combined in order to estimate specific wear coefficients, currently not available in the literature. A wear model previously developed by the authors for metal-on-plastic hip implants was adapted to RTSAs and applied in a double direction: firstly, to evaluate specific wear coefficients for RTSAs from experimental results and secondly, to predict wear distribution. In both cases, the Archard wear law (AR) and the wear law of UHMWPE (PE) were considered, assuming four different k functions. The results indicated that both the wear laws predict higher wear coefficients for RTSA with respect to hip implants, particularly the AR law, with k values higher than twofold the hip ones. Such differences can significantly affect predictive wear model results for RTSA, when non-specific wear coefficients are used. Moreover, the wear maps simulated with the two laws are markedly different, although providing the same wear volume. A higher wear depth (+51%) is obtained with the AR law, located at the dome of the cup, while with the PE law the most worn region is close to the edge. Taking advantage of the linear trend of experimental volume losses, the wear coefficients obtained with the AR law should be valid despite having neglected the geometry update in the model.

Prediction of contact mechanics in metal-on-metal Total Hip Replacement for parametrically comprehensive designs and loads

Manufacturers and investigators of Total Hip Replacement (THR) bearings require tools to predict the contact mechanics resulting from diverse design and loading parameters. This study provides contact mechanics solutions for metal-on-metal (MoM) bearings that encompass the current design space and could aid pre-clinical design optimization and evaluation. Stochastic finite element (FE) simulation was used to calculate the head-on-cup contact mechanics for five thousand combinations of design and loading parameters. FE results were used to train a Random Forest (RF) surrogate model to rapidly predict the contact patch dimensions, contact area, pressures and plastic deformations for arbitrary designs and loading. In addition to widely observed polar and edge contact, FE results included ring-polar, asymmetric-polar, and transitional categories which have previously received limited attention. Combinations of design and load parameters associated with each contact category were identified. Polar contact pressures were predicted in the range of 0-200 MPa with no permanent deformation. Edge loading (with subluxation) was associated with pressures greater than 500 MPa and induced permanent deformation in 83% of cases. Transitional-edge contact (with little subluxation) was associated with intermediate pressures and permanent deformation in most cases, indicating that, even with ideal anatomical alignment, bearings may face extreme wear challenges. Surrogate models were able to accurately predict contact mechanics 18,000 times faster than FE analyses. The developed surrogate models enable rapid prediction of MoM bearing contact mechanics across the most comprehensive range of loading and designs to date, and may be useful to those performing bearing design optimization or evaluation.

Effect of microseparation on contact mechanics in metal-on-metal hip replacements-A finite element analysis

Some early failures of metal‐on‐metal (MoM) hip replacements associated with elevated wear have caused concerns for the use of this bearing combination. Simulator studies have shown that microseparation and its associated rim contact and edge loading may produce the most severe wear in MoM bearings. It is generally recognized that this high wear can be attributed to the high contact stress of the head on the rim of the cup. In this study, an improved finite element contact model that incorporates an elastic‐perfectly plastic material property for cobalt‐chrome alloy of the metal bearing was developed in an attempt to provide an accurate prediction of the stress and strain for the rim contact. The effects of the microseparation displacement (0.1−2 mm), cup inclination angle (25−65°) and cup rim radius (0.5−4 mm) on the contact stress/strain were investigated. The results show that a translational displacement >0.1 mm under a load >0.5 kN can produce a highly concentrated contact stress at the surface of the cup rim which can lead to plastic deformation. This study also suggests that the magnitude of translational displacement was the major factor that determined the severity of the contact conditions and level of stress and strain under microseparation conditions. Future studies will address the effect of surgical translational and rotational malposition and component design on the magnitude of microseparation, contact stress and strain and severity of wear. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 1312–1319, 2015.

[Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient]

The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery.

Effect of simplifications of bone and components inclination on the elastohydrodynamic lubrication modeling of metal-on-metal hip resurfacing prosthesis

It is important to study the lubrication mechanism of metal-on-metal hip resurfacing prosthesis in order to understand its overall tribological performance, thereby minimize the wear particles. Previous elastohydrodynamic lubrication studies of metal-on-metal hip resurfacing prosthesis neglected the effects of the orientations of the cup and head. Simplified pelvic and femoral bone models were also adopted for the previous studies. These simplifications may lead to unrealistic predictions. For the first time, an elastohydrodynamic lubrication model was developed and solved for a full metal-on-metal hip resurfacing arthroplasty. The effects of the orientations of components and the realistic bones on the lubrication performance of metal-on-metal hip resurfacing prosthesis were investigated by comparing the full model with simplified models. It was found that the orientation of the head played a very important role in the prediction of pressure distributions and film profiles of the metal-on-metal hip resurfacing prosthesis. The inclination of the hemispherical cup up to 45° had no appreciable effect on the lubrication performance of the metal-on-metal hip resurfacing prosthesis. Moreover, the combined effect of material properties and structures of bones was negligible. Future studies should focus on higher inclination angles, smaller coverage angle and microseparation related to the occurrences of edge loading.

Contact mechanics and elastohydrodynamic lubrication in a novel metal-on-metal hip implant with an aspherical bearing surface

Diameter and diametral clearance of the bearing surfaces of metal-on-metal hip implants and structural supports have been recognised as key factors to reduce the dry contact and hydrodynamic pressures and improve lubrication performance. On the other hand, application of aspherical bearing surfaces can also significantly affect the contact mechanics and lubrication performance by changing the radius of the curvature of a bearing surface and consequently improving the conformity between the head and the cup. In this study, a novel metal-on-metal hip implant employing a specific aspherical bearing surface, Alpharabola, as the acetabular surface was investigated for both contact mechanics and elastohydrodynamic lubrication under steady-state conditions. When compared with conventional spherical bearing surfaces, a more uniform pressure distribution and a thicker lubricant film thickness within the loaded conjunction were predicted for this novel Alpharabola hip implant. The effects of the geometric parameters of this novel acetabular surface on the pressure distribution and lubricant thickness were investigated. A significant increase in the predicted lubricant film thickness and a significant decrease in the dry contact and hydrodynamic pressures were found with appropriate combinations of these geometric parameters, compared with the spherical bearing surface.

Multi-body simulation of a canine hind limb: model development, experimental validation and calculation of ground reaction forces

BACKGROUND

Among other causes the long-term result of hip prostheses in dogs is determined by aseptic loosening. A prevention of prosthesis complications can be achieved by an optimization of the tribological system which finally results in improved implant duration. In this context a computerized model for the calculation of hip joint loadings during different motions would be of benefit. In a first step in the development of such an inverse dynamic multi-body simulation (MBS-) model we here present the setup of a canine hind limb model applicable for the calculation of ground reaction forces.

METHODS

The anatomical geometries of the MBS-model have been established using computer tomography- (CT-) and magnetic resonance imaging- (MRI-) data. The CT-data were collected from the pelvis, femora, tibiae and pads of a mixed-breed adult dog. Geometric information about 22 muscles of the pelvic extremity of 4 mixed-breed adult dogs was determined using MRI. Kinematic and kinetic data obtained by motion analysis of a clinically healthy dog during a gait cycle (1 m/s) on an instrumented treadmill were used to drive the model in the multi-body simulation.

RESULTS AND DISCUSSION

As a result the vertical ground reaction forces (z-direction) calculated by the MBS-system show a maximum deviation of 1.75%BW for the left and 4.65%BW for the right hind limb from the treadmill measurements. The calculated peak ground reaction forces in z- and y-direction were found to be comparable to the treadmill measurements, whereas the curve characteristics of the forces in y-direction were not in complete alignment.

CONCLUSION

In conclusion, it could be demonstrated that the developed MBS-model is suitable for simulating ground reaction forces of dogs during walking. In forthcoming investigations the model will be developed further for the calculation of forces and moments acting on the hip joint during different movements, which can be of help in context with the in silico development and testing of hip prostheses.

Case reports: fractures of threaded cups: rare complications of a well-established implant

The use of cementless threaded cups in THA is a well-established treatment. Fractures of the cups are rare complications recorded in individual cases with material defects being discussed as the primary cause. We analyzed three cases of fractured cups. Although all three cups were well fixed to existing bone, we observed deficient osseous backing dorsocranially and abrasion particles. There were no signs of femoroacetabular impingement or infection. The cups showed corrosion debris. Scanning electron microscopic investigations showed characteristics of fretting and fretting-related corrosion. We concluded the fractures occurred because of fretting combined with inadequate bony support leading to fatigue of the material and subsequent fracture.

Development of computational wear simulation of metal-on-metal hip resurfacing replacements

As one of the alternatives to traditional metal-on-polyethylene total hip replacements, metal-on-metal hip resurfacing prostheses demonstrating lower wear have been introduced for younger and more active patients during the past decade. However, in vitro hip simulator testing for the predicted increased lifetime of these surface replacements is time-consuming and costly. Computational wear modelling based on the Archard wear equation and finite element contact analysis was developed in this study for artificial hip joints and particularly applied to metal-on-metal resurfacing bearings under simulator testing conditions to address this issue. Wear factors associated with the Archard wear equation were experimentally determined and based on the short-term hip simulator wear results. The computational wear simulation was further extended to a long-term evaluation up to 50 million cycles assuming that the wear rate stays constant. The prediction from the computational model shows good agreement with the corresponding simulator study in terms of volumetric wear and the wear geometry. The simulation shows the progression of linear wear penetrations, and the complexity of contact stress distribution on the worn bearing surfaces. After 50 million cycles, the maximum linear wear was predicted to be approximately 6 and 8 microm for the cup and head, respectively, and no edge contact was found.

[FE-analysis of surface stresses for the tribological system in total hip prostheses]

The implantation of a total hip prosthesis is an operation which is performed frequently due to advanced hip joint damage both in humans and in veterinary medicine in dogs. The long-term result of a hip prosthesis is mainly determined by aseptic loosening of the prosthesis; among other causes, abrasion particles of the tribological pairing are responsible for the loosening. For the analysis of the surface stresses with different tribological pairings, a finite element model was generated which was based on the CAD data of a commercial total hip prosthesis. After transmission of a physiological force in the components of the three tribological pairings ceramic/polyethylene, ceramic/ceramic and metal/polyethylene, stresses were calculated. Stresses in the ceramic/ceramic tribological pairings were conspicuously higher than in the other material pairings. In the future adapted prostheses have to be developed that ensure optimal friction and absorption characteristics of the components.

Transient elastohydrodynamic lubrication analysis of metal-on-metal hip implant under simulated walking conditions

The transient elastohydrodynamic lubrication (EHL) analysis was performed in this study for a typical metal-on-metal bearing employing a polyethylene backing underneath a metallic cup inlay under dynamic operating conditions of load and speed representative of normal walking. A ball-in-socket configuration was adopted to represent the articulation between the femoral head and the acetabular cup. The governing Reynolds and elasticity equations were solved simultaneously by using both finite difference and finite element methods. The predicted transient film thickness from the present study was compared with the estimation based on the quasi-static analysis. It was found that the polyethylene backing employed in the typical metal-on-metal hip bearing, combined with dynamic squeeze-film action, significantly improved the transient lubricant film thickness under cyclic walking and consequently a fluid film lubrication regime was possible for smooth bearing surfaces with an average roughness less than 0.005 microm.

Failure of an uncemented acetabular prosthesis - a case study

Severe wear and aseptic loosening in an uncemented acetabular prosthesis have been observed in a revision surgery carried out at King Edwards VII hospital by L. Taylor and P. Heaton-Adegbile, twelve years following the primary total hip replacement operation. The superior-lateral wall of the polyethylene liner and part of the titanium cup were found to be completely worn out, such that the ceramic head was in direct articulation with the titanium cup.A three-dimensional finite element model was developed. The polyethylene liner was modelled with the outer surface of the liner fully constrained to represent the much stiffer metal cup. Contact analyses were performed between the articulating surfaces under physiological loading conditions, including normal walking, climbing upstairs and downstairs, using the finite element software ANSYS. The results show high initial contact pressure along the periphery of the liner due to the oversize of the femoral head. The maximum contact pressure was found in the superior-posterior quadrant, which correlates well with the location and the direction of the wear. Both wear particles and stress shielding may have contributed to the periprosthetic bone loss and ultimately the late loosening. Reduction of the interference between the liner and the femoral head seems to be effective in the reduction of the initial contact pressure.

Steady-state elastohydrodynamic lubrication analysis of a metal-on-metal hip implant employing a metallic cup with an ultra-high molecular weight polyethylene backing

The elastohydrodynamic lubrication (EHL) analysis was carried out in this study for a 28 mm diameter metal-on-metal hip prosthesis employing a metallic cup with an ultra-high molecular weight polyethylene (UHMWPE) backing under a simple steady state rotation representing the flexion/extension during walking. Both Reynolds and elasticity equations were coupled and solved numerically by the finite difference method. The elastic deformation was determined by means of the fast Fourier transform (FFT) technique using the displacement coefficients obtained from the finite element method. Excellent agreement of the predicted elastic deformation was obtained between the FFT technique and the conventional direct summation method. The number of grid points used in the lubrication analysis was found to be important in predicting accurate film thicknesses, particularly at low viscosities representative of physiological lubricants. The effect of the clearance between the femoral head and the acetabular cup on the predicted lubricant film thickness was shown to be significant, while the effect of load was found to be negligible. Overall, the UHMWPE backing was found not only to reduce the contact pressure as identified in a previous study by the authors (Liu et al., 2003) but also significantly to increase the lubricant film thickness for the 28mm diameter metal-on-metal hip implant, as compared with a metallic mono-block cup.

Effect of Wear of Bearing Surfaces on Elastohydrodynamic Lubrication of Metal-on-Metal Hip Implants

The effect of geometry change of the bearing surfaces owing to wear on the elastohydrodynamic lubrication (EHL) of metal-on-metal (MOM) hip bearings has been investigated theoretically in the present study. A particular MOM Metasul™ bearing (Zimmer GmbH) was considered, and was tested in a hip simulator using diluted bovine serum. The geometry of the worn bearing surface was measured using a coordinate measuring machine (CMM) and was modelled theoretically on the assumption of spherical geometries determined from the maximum linear wear depth and the angle of the worn region. Both the CMM measurement and the theoretical calculation were directly incorporated into the elastohydrodynamic lubrication analysis. It was found that the geometry of the original machined bearing surfaces, particularly of the femoral head with its out-of-roundness, could lead to a large reduction in the predicted lubricant film thickness and an increase in pressure. However, these non-spherical deviations can be expected to be smoothed out quickly during the initial running-in period. For a given worn bearing surface, the predicted lubricant film thickness and pressure distribution, based on CMM measurement, were found to be in good overall agreement with those obtained with the theoretical model based on the maximum linear wear depth and the angle of the worn region. The gradual increase in linear wear during the running-in period resulted in an improvement in the conformity and consequently an increase in the predicted lubricant film thickness and a decrease in the pressure. For the Metasul™ bearing tested in an AMTI hip simulator, a maximum total linear wear depth of approximately 13 μm was measured after 1 million cycles and remained unchanged up to 5 million cycles. This resulted in a threefold increase in the predicted average lubricant film thickness. Consequently, it was possible for the Metasul™ bearing to achieve a fluid film lubrication regime during this period, and this was consistent with the minimal wear observed between 1 and 5 million cycles. However, under adverse in vivo conditions associated with start-up and stopping and depleted lubrication, wear of the bearing surfaces can still occur. An increase in the wear depth beyond a certain limit was shown to lead to the constriction of the lubricant film around the edge of the contact conjunction and consequently to a decrease in the lubricant film thickness. Continuous cycles of a running-in wear period followed by a steady state wear period may be inevitable in MOM hip implants. This highlights the importance of minimizing the wear in these devices during the initial running-in period, particularly from design and manufacturing points of view.