Wear Stripes Research Articles

Is Surface Metastability of Today’s Ceramic Bearings a Clinical Issue?

Recent studies on zirconia-toughened alumina (ZTA) evidenced that in vivo aged implants display a much higher monoclinic zirconia content than expected from in vitro simulations by autoclaving. At the moment, there is no agreement on the source of this discrepancy: Some research groups ascribe it to the effect of mechanical impact shocks, which are generally not implemented in standard in vitro aging or hip walking simulators. Others invoke the effect of metal transfer, which should trigger an autocatalytic reaction in the body fluid environment, accelerating the kinetics of tetragonal-to-monoclinic transformation in vivo. Extrapolations of the aging kinetics from high (autoclave) to in vivo temperature are also often disputed. Last, Raman spectroscopy is by far the preferred method to quantify the amount of monoclinically transformed zirconia. There are, however, many sources of errors that may negatively affect Raman results, meaning that the final interpretation might be flawed. In this work, we applied Raman spectroscopy to determine the monoclinic content in as-received and in vitro aged ZTA hip joint implants, and in one long-term retrieval study. We calculated the monoclinic content with the most used equations in the literature and compared it with the results of X-ray diffraction obtained on a similar probe depth. Our results show, contrary to many previous studies, that the long-term surface stability of ZTA ceramics is preserved. This suggests that the Raman technique does not offer consistent and unique results for the analysis of surface degradation. Moreover, we discuss here that tetragonal-to-monoclinic transformation is also necessary to limit contact damage and wear stripe extension. Thus, the surface metastability of zirconia-containing ceramics may be a non-issue.

Prosthetic Impingement in Total Hip Arthroplasty—The Trigger for Adverse Wear

Development of total hip arthroplasty (THA) now spans more than 5 decades encompassing combinations of metal-on-metal (MOM), ceramic-on-metal (COM), metal-on-plastic (MOP), ceramic-on-plastic (COM), and ceramic-on-ceramic (COC). In every arena of extensive technical development, there exists a data set that when viewed in isolation seemed of little import, but when assembled in-toto may produce a generational shift in perception. Our review focused on two such THA events. Firstly, COC retrieval studies (1999-2001) noted habitual wear patterns on heads and peripheral wear stripes, along with femoral-neck impingement, and ceramic surfaces stained gray by metal debris. These COC data indicated THA risks included, 1) cup edge-loading (E/L) on heads producing “stripe wear”, 2) component impingement releasing metal particles resulting in 3) tissues contaminated by metal debris. A corresponding MOM impingement-debris mechanism was only perceived by Howie (2005) in a McKee-Farrar retrieval study. Our anticipation at LLUMC was that MOM retrievals would provide superior wear details to those seen on COC retrievals. We noted stripe wear in the polar zone of CoCr heads and basal stripes in the non-wear areas. The basal-polar stripe combinations were found in all MOM retrievals. Basal-polar stripe combinations followed cup-rim profiles in our LLUMC simulations of prosthetic impingement. LPUH videos demonstrated the formation of stripe wear in functional-standing and functional-sitting postures for both impingement and subluxation episodes using THA and RA designs. The stripes on CoCr heads revealed the large scratches we now term “microgrooves”. Microgroove width varied from 40 - 400 um with 100 um being typical. The longitudinal striations in microgrooves, the raised jagged lips, scratches with shallow entry and exit termini, were all indicative of a classic 3rd-body wear mechanism. The THA impingement simulations denoted four sites of edge-loading, i.e. neck-E/L, inferior cup-E/L, superior cup-E/l and head-E/L, and ingress of Ti64 particles as a contaminating-roughness effect. Individual MOM cases referred to LLUMC demonstrated dramatic evidence of neck notching. At one end of the debris spectrum, a Ti64-notch model predicting a 6 mm3 annual wear-rate represented the release of 5700 particles of 126 um-size (approximating daily release of 16 particles). At the other end of the spectrum, if metal particles were crushed between MOM surfaces to the equivalent nanometer size found in tissues, our notch model represented approximately 22-trillion Ti64 particles annually deposited in tissues. The anatomical THA models represented in LPUH videos demonstrated that even 1-degree of head subluxation from a rigid cup created a cup “lift-off” scenario (CLO) that would open a gap of 250 - 400 microns between femoral head and cup. This would void all lubrication potential and focus the total hip-joint force along the beveled cup rim, i.e. stripe wear. It is therefore interesting that MOM impingement/debris predictions by Howie et al. have not been confirmed until now or discussed in contemporary literature. Therefore, this review of 50 years of THA data demonstrated that hip impingement was always the trigger for adverse wear and that metal-backed cups represent the potential for release of metal debris at extremes of functional standing and sitting postures.

Combined wear and ageing of ceramic-on-ceramic bearings in total hip replacement under edge loading conditions

Ceramic-on-ceramic bearings in total hip replacement have shown the potential to provide low wear solutions in hip replacement. Assessing the tribological performance of these materials is important to predict their long-term performance in patients. In this study, a methodology was devised to assess the tribological in vitro behaviour of composite ceramics under combined adverse edge loading conditions and accelerated ageing. Two commercial ceramic composites were considered, namely Alumina-Toughened Zirconia (ATZ, ceramys®) and Zirconia-Toughened Alumina (ZTA, symarec®). The bearing couples were studied using the Leeds Mark II hip joint simulator for a total of eight million cycles, the first two million under normal gait (no edge loading) and the following six million cycles with the addition of edge loading conditions driven by medial-lateral separation. The bearing couples underwent hydrothermal ageing using an accelerated protocol in autoclave every million cycles.The influence of edge loading combined with ageing was significant for ATZ bearings, resulting in a slower overall ageing kinetics over the wear stripe than on the control heads. During the autoclave ageing steps, the monoclinic fraction increased more over the wear stripe area than over the unworn area. Both results thus indicated that the monoclinic phase was removed during shocks induced by edge loading. The wear performance of the two materials were similar exhibiting relatively low wear rates and low level of microstructural damage for these clinically relevant adverse conditions.

Ageing, Shocks and Wear Mechanisms in ZTA and the Long-Term Performance of Hip Joint Materials.

The surface morphologies and microstructures of Zirconia Toughened Alumina (ZTA) femoral heads were analyzed following in vitro tests aiming to simulate in vivo degradation. Three phenomena potentially leading to degradation were investigated: shocks, friction and hydrothermal ageing. Shocks due to micro-separation created the main damage with the formation of wear stripes on the femoral head surfaces. Atomic Force Microscopy (AFM) images suggested the release of wear debris of various shapes and sizes through inter- and intra-granular cracks; some debris may have a size lower than 100 nm. A decrease in hardness and Young’s modulus was measured within the wear stripes by nanoindentation technique and was attributed to the presence of surface and sub-surface micro-cracks. Such micro-cracks mechanically triggered the zirconia phase transformation in those worn areas, which in return presumably reduced further crack propagation. In comparison with shocks, friction caused little wear degradation as observed from AFM images by scarce pullout of grains. The long-term resistance of the ZTA composite material against hydrothermal ageing is confirmed by the present observations.

Effects of in vitro shocks and hydrothermal degradation on wear of ceramic hip joints: Towards better experimental simulation of in vivo ageing

In an ageing world population, increasing the lifetime of orthopedic devices is of vital importance for reducing surgical risks for patients and reducing medical costs. Ceramic materials are gaining interest because of their hardness and chemical inertia with respect to metal prosthesis. Wear of the prosthetic couple (femoral head and cup) is one of the main rationales for using ceramic hip implants, because they induce much lower wear debris. The present study investigates the combined effects of shocks due to microseparation and hydrothermal ageing on the wear of Zirconia Toughened Alumina (ZTA) bearings, which have been under strong development these past ten years. Wear stripe patterns are formed on femoral heads tested on a shock device. 3D profilometry is used to evaluate the volume of worn material released from the head that averages at 0.46mm3/year during simulation mimicking about 15 years of ageing. This volume is larger than formerly estimated with hip walking simulators with microseparation, an effect that we tentatively attribute to a larger force (9000N) applied here than on hip simulators where the force was not specified. The present experiment should allow refining the effect of force on the wear of ceramic femoral head, hence to simulate different patient conditions (weight, activity, accidents,…). Micro Raman spectroscopy reveals significant zirconia phase transformation within wear stripes. ZTA components show minor phase transformation during hydrothermal degradation in an autoclave when compared to changes induced by shocks. Finally, five clinically retrieved bearings are characterized for in vivo comparison, and also reveal phase transformation within wear track areas. The association of phase transformation enhancement with wear areas on in vivo samples indicates that wear is induced by shocks, rather than by hydrothermal ageing. Shock simulations are therefore essential for in vitro experimentation aiming at reproducing wear of ceramic implants and in vivo environment. On a material׳s point of view, it is shown that the ZTA ceramics can exhibit a beneficial phase transformation under stress, which may limit wear stripes, without suffering from significant ageing.

Shock machine for the mechanical behaviour of hip prostheses: a description of performance capabilities

ABSTRACTThe aim of this study was to describe the behaviour of a shock machine designed for testing hip prostheses. A microseparation between head and cup occurs inducing a shock of several times the body weight, leading to fracture of ceramic femoral components. Femoral heads and cups of diameter 32 mm manufactured from alumina were tested in dry and wet conditions. Implants were subjected to shocks with a load profile of 9 kN load at 2 Hz and various microseparations. Position is monitored and force is measured with two acquisition systems. The working range and the device capabilities were investigated. Only cups tested in dry conditions failed. Observations by scanning electron microscopy revealed intergranular and transgranular fractures. Two wear stripes were observed on the heads. Three‐dimensional roughness of wear stripes was measured. Since experimental results are in good agreement with retrieved femoral heads, the shocks machine reproduces the in vivo degradations. Copyright © 2011 John Wiley & Sons, Ltd.

The Role of Stripe Wear in Causing Acoustic Emissions From Alumina Ceramic-On-Ceramic Bearings

Noise from ceramic-on-ceramic hip bearings has been reported during specific patient activities. Wear stripes, which have been seen in some clinical retrievals, may be associated with bearing noise. We produced wear stripes on ceramic bearings in the laboratory and determined that, under certain conditions, noise could occur during either edge loading or joint simulation. Squeaking was not observed with bearings in their pristine condition. We concluded that wear stripes caused by edge loading may be associated with bearing noise, during either edge loading alone or during normal articulation.

Edge loading in third generation alumina ceramic-on-ceramic bearings: Stripe wear

Alumina ceramic-on-ceramic bearings perform exceptionally well under standard hip simulator conditions, but in vivo some retrieved bearings have shown an unusual stripe pattern of wear. We studied 16 bearings retrieved from a series of 1,588 cementless hip arthroplasties with third generation alumina ceramic-on-ceramic bearings to characterize the mechanism of stripe wear formation. None of these bearings were retrieved for bearing failure. The average wear volume was 0.4 mm 3 per year in the heads and 0.3 mm 3 per year in the liners. Mapping of wear stripes on the heads and liners showed that the majority do not occur with normal walking; instead they probably occur with edge loading when the hip is flexed, such as with rising from a chair or with climbing a high step.

Alumina–alumina artificial hip joints. Part II: Characterisation of the wear debris from in vitro hip joint simulations

Until recently it was not possible to reproduce clinically relevant wear rates and wear patterns in in vitro hip joint simulators for alumina ceramic-on-ceramic hip prostheses. The introduction of microseparation of the prosthesis components into in vitro wear simulations produced clinically relevant wear rates and wear patterns for the first time. The aim of this study was to characterise the wear particles generated from standard simulator testing and microseparation simulator testing of hot isostatically pressed (HIPed) and non-HIPed alumina ceramic-on-ceramic hip prostheses, and compare these particles to those generated in vivo.Standard simulation conditions produced wear rates of ≈0.1mm3 per million cycles for both material types. No change in surface roughness was detected and very few wear features were observed. In contrast, when microseparation was introduced into the wear simulation, wear rates of between 1.24 (HIPed) and 1.74mm3 per million cycles (non-HIPed) were produced. Surface roughness increased and a wear stripe often observed clinically on retrieved femoral heads was also reproduced. Under standard simulation conditions only nanometre-sized wear particles (2–27.5nm) were observed by TEM, and it was thought likely that these particles resulted from relief polishing of the alumina ceramic. However, when microseparation of the prosthesis components was introduced into the simulation, a bi-modal distribution of particle sizes was observed. The nanometre-sized particles produced by relief polishing were present (1–35nm), however, larger micrometre-sized particles were also observed by both transmission electron microscopy (TEM) (0.02–1μm) and scanning electron microscopy (SEM) (0.05–>10μm). These larger particles were thought to originate from the wear stripe and were produced by trans-granular fracture of the alumina ceramic.In Part I of this study, alumina ceramic wear particles were isolated from the periprosthetic tissues from around Mittelmeier ceramic-on-ceramic hip prostheses. Characterisation of the particles by TEM and SEM revealed a bi-modal size distribution. SEM analysis revealed particles in the 0.05–3.2μm size range, and TEM revealed particles in the 5–90nm size range, indicating that microseparation of the prosthesis components may be a common event in vivo. This study (Part II) has revealed that the introduction of microseparation of the prosthesis components during the swing phase of the wear simulation reproduced clinically relevant wear rates, wear patterns and wear particles in in vitro hip joint simulators.

Comparative analysis of two different types of alumina-alumina hip prosthesis retrieved for aseptic loosening

We compared and quantified the modes of failure and patterns of wear of 11 Mittelmeier and 11 Ceraver-Ostal retrieved alumina-alumina hip prostheses with reference to the corresponding clinical and radiological histories. Macroscopic wear was assessed using a three-dimensional co-ordinate measuring machine. Talysurf contacting profilometry was used to measure surface roughness on a microscopic scale and SEM to determine mechanisms of wear at the submicron level. The components were classified into one of three categories of wear: low (no visible/measurable wear), stripe (elliptical wear stripe on the heads and larger worn areas on the cups) and severe (macroscopic wear, large volumes of material lost). Overall, the volumetric wear of the alumina-alumina prostheses was substantially less than the widely used metal and ceramic-on-polyethylene combinations. By identifying and eliminating the factors which accelerate wear, it is expected that the lifetime of these devices can be further increased.