Wear Of Implants Research Articles

Histological Features of Pseudotumor-like Tissues From Metal-on-Metal Hips

BackgroundPseudotumor-like periprosthetic tissue reactions around metal-on-metal (M-M) hip replacements can cause pain and lead to revision surgery. The cause of these reactions is not well understood but could be due to excessive wear, or metal hypersensitivity or an as-yet unknown cause. The tissue features may help distinguish reactions to high wear from those with suspected metal hypersensitivity.Questions/purposesWe therefore examined the synovial lining integrity, inflammatory cell infiltrates, tissue organization, necrosis and metal wear particles of pseudotumor-like tissues from M-M hips revised for suspected high wear related and suspected metal hypersensitivity causes.MethodsTissue samples from 32 revised hip replacements with pseudotumor-like reactions were studied. A 10-point histological score was used to rank the degree of aseptic lymphocytic vasculitis-associated lesions (ALVAL) by examination of synovial lining integrity, inflammatory cell infiltrates, and tissue organization. Lymphocytes, macrophages, plasma cells, giant cells, necrosis and metal wear particles were semiquantitatively rated. Implant wear was measured with a coordinate measuring machine. The cases were divided into those suspected of having high wear and those suspected of having metal hypersensitivity based on clinical, radiographic and retrieval findings. The Mann-Whitney test was used to compare the histological features in these two groups.ResultsThe tissues from patients revised for suspected high wear had a lower ALVAL score, fewer lymphocytes, but more macrophages and metal particles than those tissues from hips revised for pain and suspected metal hypersensitivity. The highest ALVAL scores occurred in patients who were revised for pain and suspected metal hypersensitivity. Component wear was lower in that group.ConclusionsPseudotumor-like reactions can be caused by high wear, but may also occur around implants with low wear, likely because of a metal hypersensitivity reaction. Histologic features including synovial integrity, inflammatory cell infiltrates, tissue organization, and metal particles may help differentiate these causes.Clinical RelevancePainful hips with periprosthetic masses may be caused by high wear, but if this can be ruled out, metal hypersensitivity should be considered.

Cross-shear implementation in sliding-distance-coupled finite element analysis of wear in metal-on-polyethylene total joint arthroplasty: Intervertebral total disc replacement as an illustrative application

Computational simulations of wear of orthopaedic total joint replacement implants have proven to valuably complement laboratory physical simulators, for pre-clinical estimation of abrasive/adhesive wear propensity. This class of numerical formulations has primarily involved implementation of the Archard/Lancaster relationship, with local wear computed as the product of (finite element) contact stress, sliding speed, and a bearing-couple-dependent wear factor. The present study introduces an augmentation, whereby the influence of interface cross-shearing motion transverse to the prevailing molecular orientation of the polyethylene articular surface is taken into account in assigning the instantaneous local wear factor. The formulation augment is implemented within a widely utilized commercial finite element software environment (ABAQUS). Using a contemporary metal-on-polyethylene total disc replacement (ProDisc-L) as an illustrative implant, physically validated computational results are presented to document the role of cross-shearing effects in alternative laboratory consensus testing protocols. Going forward, this formulation permits systematically accounting for cross-shear effects in parametric computational wear studies of metal-on-polyethylene joint replacements, heretofore a substantial limitation of such analyses.

Measurement of protein denaturation in human synovial fluid and its analogs using differential scanning calorimetry

Differential scanning calorimetry (DSC) was used to evaluate the thermal transitions associated with protein constituents of synovial fluid samples from three individuals with osteoarthritis. Analysis of the multi-component DSC curves revealed that major endothermic transitions of synovial fluid occur between 60 and 80 °C and can be resolved into three peaks, likely due to the unfolding of human serum albumin and immunoglobulins, and that the enthalpies of these transitions can be quantified in terms of their relative contribution to the total system enthalpy. DSC was also used to analyze a solution of bovine calf serum, a lubricant used in simulator wear testing of joint replacement implants, and the resulting endothermic transitions occurred in a temperature range relevant to that produced by frictional heat during such wear simulator testing. Results of this study indicate a new application for DSC as a direct method for studying thermal stabilities of both bovine calf serum and synovial fluid. The use of DSC is proposed as a diagnostic tool to detect altered thermal properties or protein concentrations indicative of a diseased or injured state, and as a development tool to test the efficacy of additives in controlling protein denaturation associated with increased wear in joint replacement implants.

Characterisation of DLC Films Deposited Using Titanium Isopropoxide (TIPOT) at Different Flow Rates

In recent years, there has been growing interest in the search for advanced biomaterials for biomedical applications, such as human implants and surgical cutting tools. It is known that both carbon and titanium exhibit good biocompatibility and have been used as implants in the human body. It is highly desirable to deposit biocompatible thin films onto a range of components in order to impart biocompatibility and to minimise wear in implants. Diamond like carbon (DLC) is a good candidate material for achieving biocompatibility and low wear rates. In this study, thin films of diamond-like-carbon DLC were deposited onto stainless steel (316) substrates using C2H2, argon and titanium isopropoxide (TIPOT) precursors. Argon was used to generate the plasma in the plasma enhanced vapour deposition (PECVD) system. A critical coating feature governing the performance of the component during service is film thickness. The as-grown films were in the thickness range 90-100 nm and were found to be dependent on TIPOT flow rate. Atomic force microscopy (AFM) was used to characterise the surface roughness of the samples. As the flow rate of TIPOT increased the average roughness was found to increase in conjunction with the film thickness. Raman spectroscopy was used to investigate the chemical structure of amorphous carbon matrix. Surface tension values were calculated using contact angle measurements. In general, the trend of the surface tension results exhibited an opposite trend to that of the contact angle. The elemental composition of the samples was characterised using a VG ToF SIMS (IX23LS) instrument and X-ray photoelectron spectroscopy (XPS). Surprisingly, SIMS and XPS results showed that the DLC samples did not show evidence of titanium since no peaks representing to titanium appeared on the SIMS/XPS spectra.

A Wireless, Passive Strain Sensor: Application to In Vivo Monitoring of Compressive Forces at Knee Implants

This study describes the design of a new wireless and passive sensor for in vivo strain monitoring at knee replacements. In a total knee arthroplasty, the proximal end of the tibia and the two femoral condyles are replaced with artificial components, and a high-density polyethylene insert is placed between the two components. The wear and tear of the polyethylene insert is considered a threat to the long-term survival of many knee implants. We have designed a wireless, implantable strain sensor to study the stresses experienced by the polyethylene insert. The sensor, which is embedded within the insert, is comprised of a magnetically soft material (sensing element) and a magnetically hard material (biasing element) separated by a deformable∕flexible layer. Under AC magnetic field, the sensing element generates a secondary, higher-order mode magnetic flux that can be measured with a magnetic inductive coil. Additional stresses to the sensor deform the flexible layer, altering the higher-order magnetic flux and thus allowing remote measurement of compressive forces. The advantages of this sensor are, its wireless and passive nature, small size, and cost effectiveness. The remote query nature of this sensor allows long-term implantation and real-time monitoring of human body. Experimental results have shown that the sensor responded linearly with applied stress and demonstrated good repeatability and stability. We believe that the outcome of this project will greatly improve public health by leading to a better implant design and providing a convenient way to detect wear and tear of knee implants.

Introduction

Introduction

Seppo Santavirta: The Life and Work of an Orthopaedic Surgeon and Scientist. A Tribute From His Friends

Seppo Santavirta: The Life and Work of an Orthopaedic Surgeon and Scientist. A Tribute From His Friends

Investigation of Aged Dispersion Ceramics by Means of Hip Simulator

Wear of hip implants is a significant problem for the life expectancy of artificial joints. By using alumina ceramic on ceramic couplings the wear can be decreased. But for further improvement of the safety of THR the aim is the development of new ceramic materials. For orthopaedic applications an Alumina Toughened Zirconia Ceramic ATZ (80% ZrO2-20%Al2O3) and a Zirconia Toughened Alumina ZTA (25% ZrO2-75%Al2O3) were tested regarding their tribological behaviour by means of hip simulator testing after hydrothermal treatment. The absolute wear amount for the aged samples after 5 million cycles is slightly increased on a very low level, but even less wear than for common alumina pairings. In consideration of these excellent results both dispersion ceramics are highly suitable for long term applications.

Microstimulation at the bone–implant interface upregulates osteoclast activation pathways

Peri-implant bone resorption after total joint arthroplasty is a key parameter in aseptic loosening. Implant wear debris and biomechanical aspects have both been demonstrated to be part of the bone resorption process. However, neither of these two parameters has been clearly identified as the primary initiator of peri-implant bone resorption. For the biomechanical parameters, micromotions were measured at the bone–implant interface during normal gait cycles. The amplitude of the micromotions was shown to trigger differentiation of bone tissues. So far no data exists directly quantifying the effect of micromotion and compression on human bone. We hypothesize that micromotion and compression at the bone–implant interface may induce direct activation of bone resorption around the implant through osteoblasts–osteoclasts cell signaling in human bone. This hypothesis was tested with an ex vivo loading system developed to stimulate trabecular bone cores and mimic the micromotions arising at the bone–implant interface. Gene expression of RANKL, OPG, TGFB2, IFNG and CSF-1 was analyzed after no mechanical stimulation (control), exposure to compression or exposure to micromotions. We observed an 8-fold upregulation of RANKL after exposure to micromotions, and downregulation of OPG, IFNG and TGFB2. The RANKL:OPG ratio was upregulated 24-fold after micromotions. This suggests that the micromotions arising at the bone–implant interface during normal gait cycles induce a bone resorption response after only 1 h, which occurs before any wear debris particles enter the system.

Wear and Osteolysis Around Total Knee Arthroplasty

Osteolysis induced by wear debris of ultra-high-molecular-weight polyethylene has emerged as a significant problem after total knee arthroplasty. The generation of polyethylene wear and the development of osteolysis around total knee arthroplasty are caused by a combination of patient, implant, and surgical factors. Activity level over time may be the most important patient factor affecting the loads placed on a total knee replacement, but it is the most difficult to manage. Multiple factors related to the manufacturing of the polyethylene implant influence the extent of wear, and surgeons should be cautious in considering enhanced polyethylenes pending results of further investigations. The optimal design of the articular bearing surface remains controversial but needs to be considered with respect to the stresses imparted on component-bone and modular tibial backside interfaces. Surgical factors, including restoration of alignment and ligament balance, are important for long-term durability of the implant. Methods of measuring the wear of total knee implants are still evolving. Thus, when confronted with a worn total knee implant and developing osteolysis, the surgeon should consider each of these factors in selecting the best management option to eliminate the source of debris and minimize the potential for wear and osteolysis following revision.

The entrapment of corrosion products from CoCr implant alloys in the deposits of calcium phosphate: A comparison of serum, synovial fluid, albumin, EDTA, and water

Physical wear of orthopedic implants is inevitable. CoCr alloy samples, typically used in joint reconstruction, corrode rapidly after removal of the protective oxide layer. The behavior of CoCr pellets immersed in human serum, foetal bovine serum (FBS), synovial fluid, albumin in phosphate-buffered saline (PBS), EDTA in PBS, and water were studied using X-ray Photoelectron Spectroscopy (XPS) and Time-of-Flight Secondary Ion Mass Spectroscopy (ToF-SIMS). The difference in the corrosive nature of human serum, water, albumin in PBS and synovial fluid after 5 days of immersion was highlighted by the oxide layer, which was respectively 15, 3.5, 1.5, and 1.5 nm thick. The thickness of an additional calcium phosphate deposit from human serum and synovial fluid was 40 and 2 nm, respectively. Co and Cr ions migrated from the bulk metal surface and were trapped in this deposit by the phosphate anion. This may account for the composition of wear debris from CoCr orthopedic implants, which is known to consist predominantly of hydroxy-phosphate compounds. Known components of synovial fluid including proteoglycans, pyrophosphates, phospholipids, lubricin, and superficial zone protein (SZP), have been identified as possible causes for the lack of significant calcium phosphate deposition in this environment. Circulation of these compounds around the whole implant may inhibit calcium phosphate deposition.

Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK–/– mice

Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.

The effects of calcium phosphate deposition upon corrosion of CoCr alloys and the potential for implant failure

Physical wear of orthopedic implants is inevitable. CoCr metal samples, typically used in joint reconstruction, corrode rapidly after removal of the protective oxide layer. The behavior of CoCr pellets immersed in human serum, fetal bovine serum (FBS), synovial fluid, and water were studied using time-of-flight secondary ion mass spectroscopy (ToF-SIMS). The differences in the corrosive nature of human serum, FBS, synovial fluid, and water after 5 days immersion were highlighted by the oxide/hydroxide layer, which was, respectively, 25, 10, 1.5, and 3-3.5 nm thick. The thickness of calcium phosphate deposit from human serum, FBS, and synovial fluid was, respectively, 30, 20, and 2 nm. Co and Cr ions migrated from the bulk metal surface and were trapped in the serum deposits, where chromium existed as oxides, hydroxides, and phosphates, whereas the cobalt chemistry was dominated only by phosphates and hydroxides. This may account for the composition of wear debris from CoCr orthopedic implants, which are predominantly hydroxyphosphate compounds. From the literature, proteoglycans, pyrophosphates, phospholipids, lubricin, and superficial zone protein (SZP) have been identified as possible causes for the insignificant deposit of calcium phosphate from synovial fluid. Circulation of these compounds around the whole implant may inhibit calcium phosphate deposition and therefore contribute to osteolysis.

Total Hip Replacement: A Successful Interaction of Biology, Mechanics, and Materials Science

Low friction and decreased wear rates are desirable characteristics of materials for articulating surfaces of prostheses for total hip replacement (THR). The Charnley low-friction hip arthroplasty has shown good pain relief and clinical function as well as reasonable longevity and wear characteristics. Continued research successfully has improved the mechanical properties as well as the biocompatibility of THR prostheses. However, a hip prosthesis represents a large foreign body, which is not fully incorporated with the surrounding biologic environment. One of the relevant problems is the difference between the modulus of elasticity of the materials used for THR and the surrounding bone. The deformation characteristics of bone are anisotropic and the elastic moduli vary from one site to the next. Therefore, complete fixation between the prosthesis surface and the surrounding bone is difficult without ongoing deformation and remodeling of the interface surfaces. Stress-induced adaptive remodelling of bone is one of the key properties that makes long-lasting fixation and compatability between the implant and bone possible. Implant wear and the generation of particulate debris are related directly to periprosthetic osteolysis. Reduction of wear of the articulation, and ultimately all implant surfaces, currently is one of the technological challenges in THR. Improvement of the tribologic and other physical properties of the materials, as well as improved implant designs will undoubtedly extend implant longevity. Many unsolved problems remain-for example, the optimal diameter and shape of the bearings still are unsolved issues. Because loosening of THRs seems to depend to a great extent on biologic factors, pharmacologic modulation of periprosthetic osteolysis has become timely. Inhibition of osteoclastic activity and pro-inflammatory cytokines as well the potential use of growth factors and other bioactive molecules to enhance osseointegration and prevent implant loosening currently are being studied. An improvement in the tribology of bearing surfaces is an effective means of increasing the longevity of THRs. To this end, testing of new bearing materials using a hip simulator is a valuable method of evaluation. The introduction of highly crosslinked polyethylenes to improve tribology of the bearing surfaces seems very promising. Ceramic bearings and metal-on-metal THRs recently have become more popular. Traditional materials such as stainless steel and Co-Cr alloy have been improved with new technologies such as surface coatings and other manufacturing processes. Implant longevity can be further improved with combined strategies related to implant design, material properties, and the biomechanical environment. The ultimate outcome of new innovations must be documented clearly with long-term clinical survivorship analysis, exemplified by the Scandinavian total joint registers. Seppo Santavirta, MD, PhD Helsinki University Central Hospital, Department of Orthopaedics Stuart B. Goodman, MD, PhD Stanford University Medical Center, Division of Orthopaedic Surgery

The future in the care of the cervical spine: interbody fusion and arthroplasty. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

The future in the care of the cervical spine: interbody fusion and arthroplasty

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

Computational wear prediction of a total knee replacement from in vivo kinematics

Wear of ultra-high molecular weight polyethylene bearings in total knee replacements remains a major limitation to the longevity of these clinically successful devices. Few design tools are currently available to predict mild wear in implants based on varying kinematics, loads, and material properties. This paper reports the implementation of a computer modeling approach that uses fluoroscopically measured motions as inputs and predicts patient-specific implant damage using computationally efficient dynamic contact and tribological analyses. Multibody dynamic simulations of two activities (gait and stair) with two loading conditions (70–30 and 50–50 medial–lateral load splits) were generated from fluoroscopic data to predict contact pressure and slip velocity time histories for individual elements on the tibial insert surface. These time histories were used in a computational wear analysis to predict the depth of damage due to wear and creep experienced by each element. Predicted damage areas, volumes, and maximum depths were evaluated against a tibial insert retrieved from the same patient who provided the in vivo motions. Overall, the predicted damage was in close agreement with damage observed on the retrieval. The gait and stair simulations separately predicted the correct location of maximum damage on the lateral side, whereas a combination of gait and stair was required to predict the correct location on the medial side. Predicted maximum damage depths were consistent with the retrieval as well. Total computation time for each damage prediction was less than 30 min. Continuing refinement of this approach will provide a robust tool for accurately predicting clinically relevant wear in total knee replacements.

Wear Mechanisms in Ceramic Hip Implants

The wear in hip implants is one of the main causes for premature hip replacements. The wear affects the potential life of the prosthesis and subsequent removals of in vivo implants. Therefore, the objective of this article is to review various joints that show lower wear rates and consequently higher life. Ceramics are used in hip implants and have been found to produce lower wear rates. This article discusses the advantages and disadvantages of ceramics compared to other implant materials. Different types of ceramics that are being used are reviewed in terms of the wear characteristics, debris released, and their size together with other biological factors. In general, the wear rates in ceramics were lower than that of metal-on-metal and metal-on-polyethylene combinations.

Implant wear and osteolysis with a hydroxylapatite-coated screw cup.

Radiographs of 72 uncemented hip implants with a mean follow-up of 6.5 years were analysed to measure wear of the implant. The wear rate was measured using the modified technique of Livermore and was found to be 0.13 mm per year (CI 95% 0.080-0.18). There was no statistical correlation between wear and age, gender and cup angle, but there was a correlation between wear and the number and size of cysts. This has not been previously published. In view of the risk of loosening and of a dramatic increase in the rate of wear when the femoral head articulates with the metal backing, it is important to plan revision of these cups in good time and to ensure regular radiographic surveillance of these patients.

Implant wear debris detection apparatus and method

A system for detecting wear debris particulate from a medical implant within the body of a living animal is provided. The system includes an acoustic transmitter for transmitting acoustinc energy from outside the body to a soft tissue region proximate the medical implant containing wear debris particles; an acoustic receiver located outside the body to detect resultant acoustic energy generated by the wear debris particles and produce a received signal indicative thereof; a processor for processing the received signal to evaluate at least one parameter associated with the wear debris particles; and an output for indicating the at least one parameter.