Alloy Femoral Components Research Articles

MECHANICAL PROPERTIES AND WEAR RESISTANCE OF A VITAMIN E-BLENDED AND MODERATELY CROSSLINKED POLYETHYLENE FOR TOTAL KNEE ARTHROPLASTY

The purpose of the study was to compare the mechanical properties, oxidation and wear resistance of a vitamin E blended and moderately crosslinked polyethylene for total knee arthroplasty (MXE) in comparison with clinically established polyethylene materials.The following polyethylene materials were tested: CPE (30 kGy e-beam sterilized), XLPE (75 kGy gamma crosslinked @ 100°C), ViXLPE (0.1 % vitamin E blended, 80 kGy e-beam crosslinked @ 100°C), and MXE (0.1 % vitamin E blended polyethylene, 30 kGy gamma sterilized). For the different tests, the polyethylene materials were either unaged or artificially aged for two or six weeks according to ASTM F2003-02.The oxidation index was measured based on ASTM F2102 at a 1 mm depth. Small punch testing was performed based on ASTM F2977. Mechanical properties were measured on unaged materials according to ASTM D638.Wear simulation was performed on a load controlled 3 + 1 station knee wear simulator (EndoLab GmbH, Thansau, Germany) capable of reproducing loads and movement of highly demanding activities (HDA) as well as ISO 14243-1 load profiles. The load profiles were applied for 5 million cycles (mc) or delamination of the polyethylene components. Medium size AS e.motion® PS Pro (Aesculap AG, Tuttlingen, Germany) femoral and tibial components with a ZrN-multilayer surface, as well as Columbus® CR cobalt-chrome alloy femoral and tibial components were tested. Particle analysis was performed on the serum samples of the ISO 14243-1 wear simulations based on ISO 17853:2011 and ASTM F1877.The analysis of the mechanical properties show that moderately crosslinked polyethylene (MXE) might be a superior material for total knee arthroplasty applications [Schwiesau et al. 2021]. The addition of vitamin E in a moderately crosslinked polyethylene prevented its oxidation, kept its mechanical characteristics, and maintained a low wear, even under a HDA knee wear simulation.

Amorphous Carbon Coatings for Total Knee Replacements-Part I: Deposition, Cytocompatibility, Chemical and Mechanical Properties.

Diamond-like carbon (DLC) coatings have the potential to reduce implant wear and thus to contribute to avoiding premature failure and increase service life of total knee replacements (TKAs). This two-part study addresses the development of such coatings for ultrahigh molecular weight polyethylene (UHMWPE) tibial inlays as well as cobalt–chromium–molybdenum (CoCr) and titanium (Ti64) alloy femoral components. While a detailed characterization of the tribological behavior is the subject of part II, part I focusses on the deposition of pure (a-C:H) and tungsten-doped hydrogen-containing amorphous carbon coatings (a-C:H:W) and the detailed characterization of their chemical, cytological, mechanical and adhesion behavior. The coatings are fabricated by physical vapor deposition (PVD) and display typical DLC morphology and composition, as verified by focused ion beam scanning electron microscopy and Raman spectroscopy. Their roughness is higher than that of the plain substrates. Initial screening with contact angle and surface tension as well as in vitro testing by indirect and direct application indicate favorable cytocompatibility. The DLC coatings feature excellent mechanical properties with a substantial enhancement of indentation hardness and elastic modulus ratios. The adhesion of the coatings as determined in modified scratch tests can be considered as sufficient for the use in TKAs.

Amorphous Carbon Coatings for Total Knee Replacements-Part II: Tribological Behavior.

Diamond-like carbon coatings may decrease implant wear, therefore, they are helping to reduce aseptic loosening and increase service life of total knee arthroplasties (TKAs). This two-part study addresses the development of such coatings for ultrahigh molecular weight polyethylene (UHMWPE) tibial inlays as well as cobalt-chromium-molybdenum (CoCr) and titanium (Ti64) alloy femoral components. While the deposition of a pure (a-C:H) and tungsten-doped hydrogen-containing amorphous carbon coating (a-C:H:W) as well as the detailed characterization of mechanical and adhesion properties were the subject of Part I, the tribological behavior is studied in Part II. Pin-on-disk tests are performed under artificial synovial fluid lubrication. Numerical elastohydrodynamic lubrication modeling is used to show the representability of contact conditions for TKAs and to assess the influence of coatings on lubrication conditions. The wear behavior is characterized by means of light and laser scanning microscopy, Raman spectroscopy, scanning electron microscopy and particle analyses. Although the coating leads to an increase in friction due to the considerably higher roughness, especially the UHMWPE wear is significantly reduced up to a factor of 49% (CoCr) and 77% (Ti64). Thereby, the coating shows continuous wear and no sudden failure or spallation of larger wear particles. This demonstrated the great potential of amorphous carbon coatings for knee replacements.

Effects of fine microstructures and precipitates of laser-sintered Co–28Cr–6Mo alloy femoral components on wear rate of UHMWPE inserts in a knee joint simulator

To develop a new manufacturing process for total knee arthroplasty (TKA) femoral components, we investigated the effects of fine microstructures and precipitates on the wear rate of ultrahigh-molecular-weight polyethylene (UHMWPE) inserts against a laser-sintered Co–28Cr–6Mo alloy femoral component measured using a knee joint simulator. The tensile and fatigue strengths of the laser-sintered Co–28Cr–6Mo alloy were higher than those of cast Co–28Cr–6Mo and aged Zr-2.5Nb alloys. The laser-sintered Co–28Cr–6Mo alloy had finer microstructures and precipitates of the pi (π)-phase [(Cr, Mo)12Co8(C, N)4; lattice constants: a = b = c = 0.636 nm] in the grains and grain boundaries. The volumetric wear rate (7.16 ± 1.9 mm3/million cycles) of conventional UHMWPE (CPE, non-highly crosslinked) against a laser-sintered Co–28Cr–6Mo femoral component was lower than that of previously reported CPE inserts with Genesis Ⅱ TKA devices. Since the effect of precipitates of the π-phase on the increase in the wear rate was negligible, laser sintering is a promising new manufacturing technology for femoral components.

Effect of Cryogenic and Coating treatments on Wear and Friction between Titanium Alloy and UHMWPE for Knee Implants

Abstract Knee implant are mostly made of titanium alloy femoral component and ultra-high molecular weight polyethylene (UHMWPE) tibial insert. Wear and friction are the main problems of knee implant. Surface treatments, such as cryogenic and coating influence friction and wear of contacting parts. The aim of this paper is to investigate the effect of coating materials and cryogenic process on surface hardness, friction and wear characteristics between titanium alloy femoral component and UHMWPE tibial insert. It is also desirable to achieve the lowest friction and wear of the knee joint components. The friction and wear experiments were carried out on a pin-on-disc testing machine according to G99 standard under dry condition using the speed of 120 rpm and total sliding distance of 250 m. In this study, titanium alloy pins were treated with cryogenic process for 24 hours and coated with diamond-like carbon (DLC) and titanium-nitride(TiN). The disc material was medical grade UHMWPE GUR1020 produced by extrusion mixer and hot-press process. Hardness and surface roughness testing and morphological observations were performed on specimens before and after the wear testing experiments. Friction coefficient and wear volume were measured at regular intervals. DLC coating exhibited the highest friction coefficient of all treatments. The results indicated that the TiN coating on titanium alloy exhibited lower friction coefficient and wear volume of both titanium alloy pins and UHMWPE + 2% CNT disc than that of the uncoated, 24 hr-cryogenic and DLC coating.

A comparative surface topographical analysis of explanted total knee replacement prostheses: Oxidised zirconium vs cobalt chromium femoral components

It has been proposed that an increased surface roughness of the femoral components of Total Knee Replacements (TKRs) may be a contributing factor to the accelerated wear of the polyethylene (PE) bearing and ultimately prosthesis failure. Oxidised Zirconium was introduced to the orthopaedic market in an attempt to reduce PE wear associated failures and increase the longevity of the prosthesis.In this study, non-contacting profilometry was used to measure the surface roughness of the femoral components of 6 retrieved TKRs (3 Oxidised Zirconium (OxZr) and 3 Cobalt Chromium alloy (CoCr) femoral components) and 2 as-manufactured femoral components (1 OxZr and 1 CoCr). A semi-quantitative method was used to analyse the damage on the retrieved PE components.The Sa values for the retrieved OxZr femoral components (Sa = 0.093 µm ± 0.014) and for the retrieved CoCr femoral components (Sa = 0.065 µm ± 0.005) were significantly greater (p < .05) than the roughness values for the as-manufactured femoral components (OxZr Sa = 0.061 µm ± 0.004 and CoCr Sa = 0.042 µm ± 0.003). No significant difference was seen between the surface roughness parameters of the retrieved OxZr and retrieved CoCr femoral components. There was no difference between the PE component damage scores for the retrieved OxZr TKRs compared to the retrieved CoCr TKRs.These results agree with other studies that both OxZr and CoCr femoral components roughen during time in vivo but the lack of difference between the surface roughness measurements of the two materials is in contrast to previous topographical reports. Further analysis of retrieved OxZr TKRs is recommended so that a fuller appreciation of their benefits and limitations be obtained.

Surface and Subsurface Analyses of Metal-on-Polyethylene Total Hip Replacement Retrievals.

Metal-on-polyethylene (MoP) articulations are one of the most reliable implanted hip prostheses. Unfortunately, long-term failure remains an obstacle to the service life. There is a lack of higher resolution research investigating the metallic surface component of MoP hip implants. This study investigates the surface and subsurface features of metallic cobalt chromium molybdenum alloy (CoCrMo) femoral head components from failed MoP retrievals. Unused prostheses were used for comparison to differentiate between wear-induced defects and imperfections incurred during implant manufacturing. The predominant scratch morphology observed on the non-implanted references was shallow and linear, whereas the scratches on the retrievals consisted of largely nonlinear, irregular scratches of varying depth (up to 150 nm in retrievals and up to 60 nm in reference samples). Characteristic hard phases were observed on the surface and subsurface material of the cast samples. Across all samples, a 100-400 nm thick nanocrystalline layer was visible in the immediate subsurface microstructure. Although observation of the nanocrystalline layer has been reported in metal-on-metal articulations, its presence in MoP retrievals and unimplanted prostheses has not been extensively examined. The results suggest that manufacturing-induced surface and subsurface microstructural features are present in MoP hip prostheses prior to implantation and naturally, these imperfections may influence the in vivo wear processes after implantation.

Biomechanical comparison of the strength of adhesion of polymethylmethacrylate cement to zirconia ceramic and cobalt–chromium alloy components in a total knee arthroplasty

Purpose The purpose of this study was to clarify the biomechanical characteristics of cement–material interfaces for the zirconia ceramic and cobalt–chromium (Co–Cr) alloy femoral components used for total knee arthroplasty.Methods In the first sub-study, we compared the strength of adhesion of the cement to flat plates, by tensile testing under dry and moistened conditions. In the second sub-study, we compared the maximum load of the cement–component complex by tensile testing. In the third sub-study, we compared the fatigue characteristics of the cement–component complex by use of a dynamic tensile testing machine.Results Under dry conditions, the maximum strength of adhesion to the zirconia ceramic plate was the same as that to the Co–Cr alloy plate. Under moistened conditions, however, the strength of adhesion to the zirconia ceramic plate was significantly lower (p = 0.0017) whereas the strength of adhesion to the Co–Cr alloy plate was not reduced. Maximum load for the cement–component complexes for zirconia ceramic and Co–Cr alloy was no different under both dry and moistened conditions. Fatigue testing showed that cement–zirconia adhesion was stronger than cement–Co–Cr alloy adhesion (p = 0.0161).Conclusions The strength of adhesion of cement to zirconia ceramic is substantially weaker under wet conditions than under dry conditions. The mechanical properties of cement–zirconia ceramic component complexes and cement–Co–Cr alloy component complexes are equivalent.

Research on rapid manufacturing of CoCrMo alloy femoral component based on selective laser melting

In order to meet the high suitability requirements of a femoral component in total knee arthroplasty (TKA), direct and rapid manufacturing of customized CoCrMo alloy femoral components by selective laser melting (SLM) was studied in this paper. When directly manufacturing CoCrMo alloy femoral component by SLM, the processability of CoCrMo alloy is an important factor in successful manufacturing and was firstly analysed in this paper, including the optimizing process for high density and high mechanical properties. Then the femoral component designed to meet the requirement of customized, the display and corresponding supports were discussed to achieve less production time and cost. At last, accuracy of femoral components directly manufactured by SLM was obtained by a contrastive detection method between a 3D scan model of manufactured customized femoral component and designed digital 3D model. The results show that a customized total knee replacement femoral component can be processed with high efficiency and high quality by the direct SLM manufacturing method. This study provides an important method for customized implant rapidly manufactured by SLM.

Surface finishing of cobalt chromium alloy femoral knee components

This paper describes the modification of surface roughness and lay of cobalt chromium alloy femoral knee components by magnetic abrasive finishing (MAF), including clarification of the MAF surface-processing mechanisms. The MAF process creates characteristic surfaces by micro-cutting of abrasive pressed by magnetic particles that nearly conform to the surface, removing large asperities and creating microasperities compared to hand-buffed surfaces. The process enables smoothing the surface on the nanometer scale with critical control of surface lay (e.g., crosshatch angle), altering the contact angle of water by a combination of kinematic behavior of magnetic particles over the freeform condyle surface.

Clinical and Radiographic Comparison of Oxidized Zirconium and Cobalt Chrome Femoral Components of a Single Design Primary Total Knee Arthroplasty: Is the Cost Difference Justified Based on Patient Outcomes?

A review of 120 consecutive total knee arthroplasty patient records was made comparing oxidized zirconium with traditional cobalt chrome alloy femoral components and assessing the clinical and radiographic outcomes of each. The direct hospital implant cost for each of these implant systems was obtained and assessed in the context of any difference in patient Knee Society Scores, knee flexion, pain, probability of metal allergy, and radiographic signs of pending implant failures. At an average of 5.6-year followup (1–11-year range in both groups), the data showed no clinical or radiological variance between the two groups, while the hospital direct implant cost with the oxidized zirconium femoral component was $1900 higher than the cobalt chrome implants. Considering the cost difference between the implants and the lack of a difference in outcomes at an average of 5-6 years of followup, this paper brings into question the ability to justify the use of oxidized zirconium femoral components based solely on improved patient outcomes.

Performance assessment of femoral knee components made from cobalt–chromium alloy and oxidized zirconium

BackgroundThe surface characteristics of the femoral component affect polyethylene wear in modular total knee replacements. In the present retrieval study, the surface characteristics of cobalt–chromium (CoCr) alloy and oxidized zirconium (OxZr) femoral components were assessed and compared. MethodsTwenty-six retrieved CoCr alloy femoral components were matched with twenty-six retrieved OxZr femoral components for implantation period, body-mass index, patient gender, implant type, and polyethylene insert thickness. The surface damage on the retrieved femoral components was evaluated using a semi-quantitative assessment method, scanning electron microscopy, and contact profilometry. ResultsThe retrieved CoCr alloy femoral components showed less posterior surface gouging than OxZr femoral components; however, at a higher magnification, the grooving damage features on the retrieved CoCr alloy femoral components confirmed an abrasive wear mechanism. The surface roughness values Rp, Rpm, and Rpk for the retrieved CoCr alloy femoral components were found to be significantly higher than those of the retrieved OxZr femoral components (p≤0.031). The surface roughness values were higher on the medial condyles than on the lateral condyles of the retrieved CoCr alloy femoral components; such a difference was not observed on the retrieved OxZr femoral components. ConclusionsThe surface roughness of CoCr alloy femoral components increased while the surface roughness of the OxZr femoral components remained unchanged after in vivo service. Therefore, the OxZr femoral components' resistance to abrasive wear may enable lower polyethylene wear and ensure long-term durability in vivo. Level of EvidenceLevel IV

Primary total hip replacement with a Furlong fully hydroxyapatite-coated titanium alloy femoral component

We present the extended follow-up (≥ 20 years) of a series of fully hydroxyapatite-coated femoral components used in 72 primary total hip replacements (THRs). Earlier results of this cohort have been previously published. All procedures were performed between 1986 and 1991. The series involved 45 women and 15 men with 12 bilateral procedures. Their mean age at the time of surgery was 60 years (46 to 80) and the mean duration of follow-up was 22.5 years (20 to 25). At final follow-up, the mean Merle d'Aubigné and Postel hip scores were 5.5 (4.5 to 6), 3.8 (3.5 to 5) and 3.3 (3.0 to 5.0) for pain, mobility and function, respectively. Of the patients 92% were very satisfied at the time of final follow-up. There were seven revisions: six of the acetabular component for aseptic loosening and one of both the stem and the acetabular component for loosening due to deep infection. The survival of this prosthesis at 22.5 years with revision for any reason as the endpoint was 91.7% (95% confidence interval (CI) 84 to 99). Survival with aseptic loosening of the stem as the endpoint was 100% (95% CI 90 to 100). This prosthesis provides pain relief in the long term. Survival of this component is comparable to the best results for primary THR with any means of fixation.

Can Squeaking With Ceramic-On-Ceramic Hip Articulations In Total Hip Arthroplasty Be Avoided?

Squeaking is a recognized complication of total hip arthroplasty with ceramic on ceramic bearings but the etiology has not been well identified. We evaluated 183 hips in 148 patients who had undergone ceramic-on-ceramic noncemented total hip arthroplasties at one center between 1997–2007 by standardized telephone interviews and radiographic review. Audible squeaking was reported from 22 hips (12% of 183) of 19 patients. Prevalence of squeaking was associated with younger age; obesity; lateralized cup position; use of beta titanium alloy femoral components and shortened head length options; and higher reported activity level, greater pain, and decreased satisfaction at the time of the interview. Squeaking was described as having little personal significance by most patients. Squeaking might be preventable in part through medialization of the acetabular cup and avoidance of the use of shortened femoral necks.

MRI analysis for rotation of total knee components

PurposeThe aim of this study was to analyze rotation of total knee (TKA) implant components using magnetic resonance imaging (MRI) and to assess the reproducibility of results. It was hypothesized that rotation of both femoral and tibial implants would be reliably reproduced. MethodsA retrospective analysis of 55 MRI studies in subjects with painful TKA implants was conducted. There were 27 zirconium and 28 cobalt/chrome/molybdenum alloy (CoCrMo) femoral components in the group. The rotation angle of femoral and tibial components was measured and determined. Statistical analysis included tests for reliability, variance between implant groups, standard deviations and confidence intervals. ResultsThere was a sufficient inter- and intra-observer reliability determined for rotation in all implants. The inter-observer reliability was notably higher in the zirconium femur group with significant less variance and lower standard deviations than the CoCrMo femoral component comparison group. Standard deviations for femoral rotational analysis were within a clinically acceptable range. The standard deviations were considerably higher in the tibial component rotational analysis. ConclusionMRI analysis of the rotation of femoral implants after TKA allows good reproducibility, especially with review of zirconium implants. There is less reproducibility for tibial components related to the applied geometric method to quantify rotation and not to the MRI technique.

In-Vitro Wear and Radiographic Analyses of High Flexion Posterior Stabilized Mobile- and Fixed-Bearing Knee Implants

Abstract In vitro wear tests results and 2-year follow up radiographic analyses of implanted fixed- and mobile-bearing LPS Flex knees are compared. The two knee designs use gamma-sterilized GUR 1050 ultra high molecular weight polyethylene (UHMWPE) patellae and tibial inserts, and the same CoCrMo alloy (ASTM F 75) femoral components. The in vitro wear tests were performed on six fixed- and six mobile-bearing knee implants using modified ISO 14243-3 load and kinematic waveforms. Tests were conducted at a frequency of 1 Hz for 5 × 106 cycles (Mc) in bovine serum lubricant. Two year follow up radiographic analyses were performed on 341 patients implanted with 173 mobile- and 168 fixed-bearing implants. Average accumulative in vitro polyethylene wear rates of the mobile- and fixed-bearing knees were 19.9 ± 5.1 mg/Mc and 14.2 ± 2.1 mg/Mc, respectively. There is no statistically significant difference in the wear rates of both devices (p &amp;gt; 0.05, Mann–Whitney test). Overall survivorship at two years with revision for any reason as the endpoint was 99.3 % for the mobile group and 100 % in the fixed group. There was no evidence of tibial, femoral, or patella bone loss at the two year follow up. The mean active range of motion increased from 110.8° to 127.0° in the mobile- bearing group and from 110.7° to 127.2° in the fixed-bearing one. Overall, radiographic evaluation showed similar performance of both devices.

Posterior Condyle Surface Damage on Retrieved Femoral Knee Components

Twenty-two retrieved femoral knee components were identified with posterior condyle surface damage on average at 99° flexion (range, 43°-135° flexion). Titanium alloy material transfer and abrasive surface damage were evident on cobalt-chromium alloy femoral components that were in contact with titanium alloy tibial trays. Surface damage on the retrieved Oxinium femoral components (Smith and Nephew, Inc, Memphis, Tenn) that were in contact with titanium alloy tibial trays showed gouging, associated with the removal and cracking of the oxide and exposure of the zirconium-niobium alloy substrate. Cobalt-chromium alloy femoral components that were in contact with cobalt-chromium alloy tibial trays showed abrasive wear. Contact between the femoral component and tibial tray should be avoided to prevent surface damage to the femoral condyles, which could potentially accelerate polyethylene wear in vivo.

Microstructure and mechanical properties of open-cellular biomaterials prototypes for total knee replacement implants fabricated by electron beam melting

Total knee replacement implants consisting of a Co–29Cr–6Mo alloy femoral component and a Ti–6Al–4V tibial component are the basis for the additive manufacturing of novel solid, mesh, and foam monoliths using electron beam melting (EBM). Ti–6Al–4V solid prototype microstructures were primarily α -phase acicular platelets while the mesh and foam structures were characterized by α ′ -martensite with some residual α . The Co–29Cr–6Mo containing 0.22% C formed columnar (directional) Cr 23C 6 carbides spaced ∼2 μm in the build direction, while HIP-annealed Co–Cr alloy exhibited an intrinsic stacking fault microstructure. A log–log plot of relative stiffness versus relative density for Ti–6Al–4V and Co–29Cr–6Mo open-cellular mesh and foams resulted in a fitted line with a nearly ideal slope, n = 2.1 . A stress shielding design graph constructed from these data permitted mesh and foam implant prototypes to be fabricated for compatible bone stiffness.

Evaluation of the wear performance of a polycarbonate-urethane acetabular component in a hip joint simulator and comparison with UHMWPE and cross-linked UHMWPE

Acetabular hip joint components manufactured from gamma-sterilized ultra high molecular weight polyethylene (UHMWPE), gamma cross-linked UHMWPE, or polycarbonate-urethane (PCU) polymers were evaluated in a hip joint simulator, using cobalt alloy femoral components, for at least 5 million cycles. The volume of material losses due to wear was calculated for each type of sample, based upon mass loss measurements, every 500,000 cycles. The loss of material for the conventional UHMWPE was much higher than for the cross-linked UHMWPE, showing about a 70% reduction in wear due to cross-linking. The material loss for the PCU samples appears to have been at least 24% lower than for the cross-linked UHMWPE. Based upon these results, the PCU material seems to have potential for use as an alternative bearing material to UHMWPE for total hip replacement surgeries.

Can the method of fixation influence the wear behaviour of ZrN coated unicompartmental mobile knee prostheses?

Background Modern unicompartmental knee prostheses represent a valid alternative to total knee replacement. It is known that variations in clinical alignment lead to altered biomechanics and abnormal wear. The aim of this study was to assess the influence, on wear behaviour, of two different cementing interfaces of the femoral components tested on a knee joint wear simulator. Methods The wear tests were run in a knee wear simulator at a frequency of 1.1 Hz for 3 million cycles in accordance with ISO 14243-3. Twelve commercial mobile GUR 1020 UHMWPE meniscus specimens articulated in between 12 cobalt–chromium–molybdenum alloy femoral and tibial components covered by a multi-layer of chromium nitride and a final layer of zirconium nitride ceramic coating to prevent ion release from the substrate. Two wear tests were performed: in the first test, each femoral component was cemented into a custom made metallic-block shaped to perfectly host it. In the second test, synthetic composite femurs received the femoral components on the basis of guidelines used in current surgery. Findings The two cementing interfaces showed a significantly different wear behaviour, quantified as mean weight loss ( P < 0.001). Scanning electron microscope examinations of new and tested metallic components showed macro- and micro-pores of few microns on both configurations. Interpretation The wear pattern observed at 3 million cycles showed differences between the two methods of fixation for the meniscus femoral components.