Materials For Total Hip Arthroplasty Research Articles

Advancements in ceramic-on-ceramic bearing materials for total hip arthroplasty: Properties, challenges, and future directions

Total hip arthroplasty (THA) is a vital procedure for addressing hip injuries and end-stage arthritis, offering relief to millions annually. However, long-term issues like femoral headwear and osteolysis persist, with 25-year survival rates of around 77.6%. Material selection significantly influences THA outcomes. This article investigated five typical ceramic-on-ceramic (CoC) bearing materials, including alumina, zirconia, zirconia-toughened alumina (ZTA), delta ceramic, and sapphire. Alumina, known for hardness and wear resistance, improved with lower fracture rates, and some squeaking and zirconia ceramics addressed fractures but require impurity reduction. ZTA combines alumina and zirconia, excelling in mechanical properties but also exhibiting squeaking. Optimized with nanostructures, delta ceramic shows fracture resistance despite occasional squeaking. Sapphire offers excellent biocompatibility but requires complex manufacturing and more clinical trials. The quest for optimal THA-bearing surfaces is ongoing, demanding rigorous research and collaboration.

Role of femoral head material on readmission and mortality rates following elective primary total hip arthroplasty in Medicare patients.

The role of different femoral head materials for total hip arthroplasty (THA) has been widely studied in the context of wear properties and corrosion. Cobalt chrome (CoCr) femoral heads are commonly used as a standard of comparison to other materials such as ceramic and oxidized zirconium (OxZi). This study aims to evaluate the impact of femoral head material on clinical outcomes in elective primary THA patients. Retrospective analysis of THA patients within the Medicare claims database between October 2017 and September 2020 using diagnosis-related group codes was conducted. Information collected included sex, age, Charlson Comorbidity Index, and femoral head type. Patients with CoCr femoral heads were compared against patients with either OxZi or ceramic femoral heads using 1:1 propensity score matching. Z-testing and Chi-square analysis were used to determine between-group significance. In total, 112,960 elective THA patients were included, with 56,480 in OxZi or ceramic and 56,480 in CoCr. Readmission rates were lower in patients that received OxZi or ceramic femoral heads at 30-day (p < 0.0001), 60-day (p < 0.0001), and 90-day postoperatively (p < 0.0001) compared to CoCr. Mortality rates were also lower in patients that received OxZi or ceramic femoral heads at 30-day (p = 0.004), 60-day (p = 0.018), and 90-day postoperatively (p = 0.009) compared to CoCr. CoCr femoral heads had higher rates of readmissions and mortality compared to OxZi or ceramic. Further analysis of bearing surface combinations and sub-group analyses to determine significance between-group differences is needed. Retrospective analysis.

Analysis of Heat Treatment Results of Ti6Al7Nb for Application as Total Hip Arthroplasty Component Material

This research is a literature study on Ti-6Al-7Nb material after having heat treatment. This study aims to analyze the results of selected articles reporting the effect of Ti-6Al-7Nb heat treatment. The research method used in this literature study is a qualitative descriptive method. Only several article results from analyses were reviewed that meet the requirement for implementation for future research topics related to materials for total hip arthroplasty. Data sources are obtained through library research techniques (literature study), which refers mainly to online sources, such as scientific journals, websites, and news from trusted sources. The results concluded that materials preparation techniques, heat treatment methods, and results analysis reported in those articles should be appropriate in this paper review. It was suggested from the literature that we need to anticipate that the martensitic phase does not cause significant changes in the Titanium alloys' properties. Moreover, the heat treatment method for α-type Titanium alloys is ineffective; namely, the heat treatment of Titanium alloys is mainly used for α+β-type Titanium alloys. The heat treatment should avoid the formation of the ω phase because constructing the ω phase will make Titanium alloys brittle.

Highly cross‐linked polyethylene is the new ‘gold standard’ bearing material for total hip arthroplasty

AbstractConventional polyethylene is not used much in total hip arthroplasty (THA); it has been supplanted by oxidation‐resistant cross‐linked polyethylene (≥50 kGy irradiation). However, studies persist that de‐emphasize or ignore cross‐linked polyethylene. A selective literature review is used briefly to present the early use of conventional polyethylene and its implication in wear particle‐induced osteolysis leading to premature revision surgeries. The current situation is established based on Australian registry data and other studies that advocate the use of cross‐linked polyethylene in preference to conventional polyethylene. Although some studies suggest caution in using cross‐linked polyethylene, overall it is strongly supported. In the author’s opinion, cross‐linked polyethylene is the new reference standard bearing material in THA.

Anatomization of wear behaviour of materials for total hip arthroplasty bearing surfaces: A review

Considered as the weight bearer body, the hip joint is one of the major joints in the human body. The proper functioning of this joint is very important without which the body will cease to function normally. When the hip joint is damaged completely, replacement surgery of the whole joint needs to be done in order to restore its functioning, which is known as total hip arthroplasty (THA). THA is done with the help of implants designed for the purpose with different biomaterials such as polymers, metals and ceramics. Biomaterials have evolved through the generations to ensure the proper requirements are met. The main concerns regarding the use of different biomaterials are the response of the body’s mechanism to the wear debris. In this review the different biomaterials used in THA till date and the biomaterials that are evolving is discussed along with the wear behaviour and mechanism. Also, the different properties of the biomaterials are discussed along with the potential advantages and disadvantages of their use. Further the combinations of different biomaterials in the articulating surfaces are analysed and the problems concerning their use are evaluated.

Progress in Wear Resistant Materials for Total Hip Arthroplasty

Current trends in total hip arthroplasty (THA) are to develop novel artificial hip joints with high wear resistance and mechanical reliability with a potential to last for at least 25–30 years for both young and old active patients. Currently used artificial hip joints are mainly composed of femoral head of monolithic alumina or alumina-zirconia composites articulating against cross-linked polyethylene liner of acetabular cup or Co-Cr alloy in a self-mated configuration. However, the possibility of fracture of ceramics or its composites, PE wear debris-induced osteolysis, and hypersensitivity issue due to metal ion release cannot be eliminated. In some cases, thin ultra-hard diamond-based, TiN coatings on Ti-6A-4V or thin zirconia layer on the Zr-Nb alloy have been fabricated to develop high wear resistant bearing surfaces. However, these coatings showed poor adhesion in tribological testing. To provide high wear resistance and mechanical reliability to femoral head, a new kind of ceramic/metal artificial hip joint hybrid was recently proposed in which 10–15 μm thick dense layer of pure α-alumina was formed onto Ti-6Al-4V alloy by deposition of Al metal layer by cold spraying or cold metal transfer methods with 1–2 μm thick Al3Ti reaction layer formed at their interface to improve adhesion. An optimal micro-arc oxidation treatment transformed Al to dense α-alumina layer, which showed high Vickers hardness 1900 HV and good adhesion to the substrate. Further tribological and cytotoxicity analyses of these hybrids will determine their efficacy for potential use in THA.

Choosing a Femoral Head: A Survey Study of Academic Adult Reconstructive Surgeons

BackgroundOur aim was to examine how academic adult reconstructive surgeons have interpreted evidence on femoral head material in total hip arthroplasty (THA). MethodsA 16-question survey to evaluate attitudes toward ceramic and cobalt-chrome head use was emailed to 274 faculty at 42 US adult reconstruction fellowship programs. ResultsWith 116 respondents, the response rate was 42.2%. Faculty use ceramic heads 72.9% of the time. The most common reason why respondents do not use ceramic heads is cost (44.8%). Ninety-four percent of faculty have observed head-neck taper corrosion in cobalt-chrome on polyethylene THA, while 9.5% of faculty have observed head-neck taper corrosion in ceramic on polyethylene THA. Only 6.0% of surgeons have seen Biolox Delta ceramic fracture. ConclusionAdult reconstruction thought leaders are guided by evidence suggesting that with ceramic heads, taper corrosion and fracture are rare. Cost and personal experience also strongly influence their implant selection. Efforts to equalize cost of ceramic and cobalt-chrome heads may free surgeons to practice in a purely evidence-based fashion.

Mid term results of total hip arthroplasty using polyethylene-ceramic composite (Sandwich) liner.

Background:Ceramic-on-ceramic (COC) couplings are an attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. However, the material in total hip arthroplasty (THA) remains one of the major concern regarding the risk of fracture. The present study aims at reporting the fracture rate of bearings in a series of COC THAs with the use of a sandwich liner and attempt to detect the relative risk factors, the possible cause and assess the clinical results.Materials and Methods:We retrospectively evaluated 153 patients (163 hips) using the sandwich liner COC THA between 2001 and 2009. Patient assessment was based on demographic factors, including age, weight, gender and body-mass index (BMI). All patients were evaluated clinically and radiographically or using computed tomography viz-a-viz dislocation, osteolysis, periprosthetic fracture, infection, loosening and implant fracture.Results:Three ceramic sandwich liners fracture (1.84%) were observed at an average of 7.3 years’ followup. The factors which were found to be non-significant to the ceramic liner fracture, included age (P = 0.205), weight (P = 0.241), gender (P = 0.553), BMI (P = 0.736), inclination (P = 0.199) and anteversion (P = 0.223). The overall survival was 91.4% at 12-year with revision as the endpoint. Other complications included osteolysis in 4 (2.45%), dislocation in one and periprosthetic fracture in one. In no hip aseptic loosening of the implants was seen.Conclusions:Our experience with the ceramic-polyethylene sandwich liner acetabular component has been disappointing because of the high rate of fracture and osteolyis. We have discontinued the use of this device and recommend the same.

High frequency circular translation pin-on-disk method for accelerated wear testing of ultrahigh molecular weight polyethylene as a bearing material in total hip arthroplasty

The temporal change of the direction of sliding relative to the ultrahigh molecular weight polyethylene (UHMWPE) component of prosthetic joints is known to be of crucial importance with respect to wear. One complete revolution of the resultant friction vector is commonly called a wear cycle. It was hypothesized that in order to accelerate the wear test, the cycle frequency may be substantially increased if the circumference of the slide track is reduced in proportion, and still the wear mechanisms remain realistic and no overheating takes place. This requires an additional slow motion mechanism with which the lubrication of the contact is maintained and wear particles are conveyed away from the contact. A three-station, dual motion high frequency circular translation pin-on-disk (HF-CTPOD) device with a relative cycle frequency of 25.3Hz and an average sliding velocity of 27.4mm/s was designed. The pins circularly translated at high frequency (1.0mm per cycle, 24.8Hz, clockwise), and the disks at low frequency (31.4mm per cycle, 0.5Hz, counter-clockwise). In a 22 million cycle (10 day) test, the wear rate of conventional gamma-sterilized UHMWPE pins against polished CoCr disks in diluted serum was 1.8mg per 24h, which was six times higher than that in the established 1Hz CTPOD device. The wear mechanisms were similar. Burnishing of the pin was the predominant feature. No overheating took place. With the dual motion HF-CTPOD method, the wear testing of UHMWPE as a bearing material in total hip arthroplasty can be substantially accelerated without concerns of the validity of the wear simulation.

Initial Misdiagnosis of a Traumatic Ceramic Femoral Head Fracture

A destructive ceramic head fracture was diagnosed 1 year after a serious motorcycle accident in a patient who had undergone primary THA 7 years earlier. Introduction In the 1970s, Boutin implemented ceramic in modern total hip arthroplasty (THA). Although initial fracture rates of 13.4 % for ceramic heads were described before the 1990s, the inferior rate of wear and friction when compared with metallic heads and the optimized tribology wre promising in THA [1-3]. Gradual improvements in processing of the material led to a significant reduction of the fracture rate to below 0.1 % [3]. Thus, alumina ceramic heads have currently become the standard material in THA with ceramic bearing surfaces.Nevertheless, multiple case reports have been published describing ceramic head fractures [4-11]. The causes of fractures are diverse and vary from traumatic events [5,9,12,13] to impingement between the neck and the liner rim [7]. Spontaneous fractures without any history of trauma have also been described [4,6,8,10,11]. However, only two reports describing delayed fractures of ceramic heads were found [12,13].In this report, we present a 24-year old patient who underwent primary THA at our institution and was a victim of high-energy trauma 7 years later. Initial radiographs were misinterpreted in a non-designated total joint clinic at the time of primary admission (after the accident). A destructive ceramic head fracture was diagnosed more than 1 year after initial trauma at our institution, with major destruction of the ceramic head and the remaining THA.This was followed by an extensive revision. Based on this experience, the general question of adequate radiographic diagnosis after trauma to a THA, especially one with partial or full ceramic bearing surfaces, will be further discussed in this report.

SiC nanoparticle-reinforced Al2O3–Nb composite as a potential femoral head material in total hip arthroplasty

Abstract A ceramic–metal composite consisting of SiC nanoparticle-reinforced Al2O3 and Nb (referred to as SiC/Al2O3–Nb), was prepared and evaluated in vitro for potential application as a femoral head material in total hip arthroplasty. Dense bi-layer laminates of SiC nanoparticle-reinforced Al2O3 and Nb were fabricated by hot pressing of powders (1425 °C; 35 MPa), and evaluated using scanning electron microscopy, microchemical analysis, and mechanical testing. The flexural strength of the SiC/Al2O3–Nb laminate (960 ± 20 MPa) was higher than the value (720 ± 40 MPa) for an Al2O3–Nb laminate, and far higher than the value (620 ± 50 MPa) for SiC nanoparticle-reinforced Al2O3 (SiC/Al2O3). The Vickers hardness of SiC/Al2O3 was 17 ± 2 GPa, compared to 12 ± 1 GPa for Al2O3. A high interfacial shear strength of the SiC/Al2O3–Nb laminate (310 ± 100 MPa), coupled with SEM observation of the interfacial region, showed strong bonding between the SiC/Al2O3 and Nb layers. Composite femoral heads consisting of a SiC/Al2O3 surface layer and a Nb core could potentially lead to a reduction in the tendency for brittle failure as well as to lower wear, when compared to Al2O3 femoral heads.

Alumina–tantalum composite for femoral head applications in total hip arthroplasty

Dense composite laminates of alumina (Al 2O 3) and tantalum (Ta) were fabricated by hot pressing and tested in vitro for potential use as a femoral head material in total hip arthroplasty (THA). Al 2O 3–Ta composite laminates hot pressed at 1450 °C and 1650 °C had flexural strengths of 940 ± 180 MPa and 1090 ± 340 MPa, respectively, which were far larger than the values of 420 ± 140 MPa and 400 ± 130 MPa for Al 2O 3 hot pressed at 1450 °C and 1650 °C, respectively. The interfacial shear strength, determined by a double-notched specimen test, was 310 ± 80 MPa for the composite laminate hot pressed at 1650 °C, indicating strong interfacial bonding between Al 2O 3 and Ta. Scanning electron microscopy (SEM), energy dispersive X-ray (EDS) analysis, and X-ray mapping of polished sections of the hot-pressed laminates showed the presence of an interfacial region formed presumably by diffusion of O (at 1450 °C) or O and Al (1650 °C) from Al 2O 3 into Ta. Composite femoral heads of Al 2O 3 and Ta could combine the low wear of an Al 2O 3 articulating surface with the safety of a ductile metal femoral head.

Fracture of a ceramic liner in a total hip arthroplasty with a sandwich cup

Alumina ceramic-on-ceramic total hip arthroplasty (THA) has been widely used due to its advantages such as low wear, scratch resistance, wettable surface and relatively low biological reactivity of the wear particles. Nevertheless, this material in THA still persists to be one of the major concerns about the risk of fracture, due to its brittleness. Many authors have reported a fracture of the ceramic head but few reported a fracture of the ceramic acetabular insert. In order to reduce the rigidity of the ceramic-on-ceramic coupling and prevent an impingement between the rim of the ceramic liner and the metal neck of the femoral stem, a modular acetabular component with a sandwich insertion (alumina/polyethylene/titanium) was proposed. We report the fracture of the ceramic acetabular liner of such a ceramic sandwich cup due to a slightly retroverted position of the cup that causes an impingement between the femoral stem and the rim of the insert. The fracture occurred 3 years after the operation without trauma. At revision the entire cup was replaced using a polyethylene liner without inner ceramic liner.

Ist die Implantation von Titan-Schäften in der Hüftendoprothetik wirklich obsolet?

Due to several bad results of studies, titanium is no longer used as an implant material in cemented total hip arthroplasty. This study attempts figure out by means of a meta-analysis if the material titanium itself was responsible for the bad results of some studies or if specific implant characteristics contributed to implant failure, independent of titanium. Studies between 1960 and July 2002 were analysed concerning failure rates of cemented titanium total hip arthroplasties regarding their specific implant characteristics. Specific implant characteristics such as roughness of the surface and geometrical features led to significantly different failure rates. Stems of titanium with a dull surface and a wide proximal geometry could achieve such good results as those of the cobalt-chromium stems published in the study results of Malchau. Titanium is justified as a cementable material in total hip arthroplasty. By respecting specific implant characteristics, very good failure rates can be achieved. The high failure rates, published in several studies, are based upon implant characteristics which are not suitable for cementing techniques and not upon the implant material titanium itself.