Initial stability of modular acetabular components. Comparative in-vitro study with polyethylene and ceramic liners.

Modular acetabular components with alumina ceramic liners are currently used in total hip arthroplasty, but concerns have emerged regarding their high stiffness, which could cause impairment of stability, stress-shielding phenomena, and loosening. The purpose of the present biomechanical investigation was to compare the in-vitro initial stability of a modular press-fit acetabular component using a polyethylene liner and using an alumina liner. The initial stability was investigated by measuring the micromotion between the implant and the acetabulum during the application of physiological load (2.39 kN). The micromotion of the acetabular component was investigated in 10 acetabuli using a polyethylene liner and in 10 acetabuli using an alumina liner. Micromotion was assessed at the level of the Os ilium, Os pubis, and Os ischium using 3 electromagnetic transducers. The transducers have a sensitivity of 1 micron and a range of measurement of 500 microns. All implants have been fixed on human pelves made of polyurethane. Measurement of implant micromotion showed stable conditions at the level of the three main sectors of the acetabulum during all tests. No statistically significant differences of results were observed between the group of specimens with polyethylene liner and the group of specimens with alumina liner. The mean micromotion values of the uncemented cups were similar to the mean micromotion values of 10 cemented cups investigated to achieve comparative data of stability. In conclusion, the modular acetabular components inserted using an alumina liner showed a satisfactory initial stability in-vitro. The results do not contrast with those achieved using the same cup inserted with a polyethylene liner.     

Investigation of explanted hip and acetabulum hip prostheses]

Retrieved ceramic femoral heads and acetabular cups were investigated. On the basis of the case studies, the reasons for revision are discussed. Wear patterns and wear rates were found to differ from those observed in hip simulating testing. Monolithic ceramic cups showed a high wear rate. Owing to their limited range of motion, ceramic "mushroom heads" are associated with impingement that leads to a high risk of cup loosening, high wear rates and in vivo fractures. The combination of ceramic "mushroom heads" and cups is not recommended. An evaluation of complications shows that some can be explained by patient behaviour--e.g. Japanese sitting position, horse riding. Designers need to develop new concepts offering a larger range of motion, for example, with head diameters of 32 and 36 mm that reduce the risk of impingement, subluxation and dislocation, while increasing the range of motion. The potential of ceramic/ceramic coupling has been known since the 70s, and ceramic concepts for total hip replacement are currently experiencing a renaissance, although further developments are still possible.     

Modification of form, material and modularity of threaded acetabulum cups]

The fixation principle of threaded cups ensures high primary stability. Inadequate results with first-generation threaded cups led to modifications of surface machining. 10 threaded cups of the first generation, and 27 of the second and third generations were systematically analysed and their shapes measured using a no-touch light section technique. In addition, measurements of surface roughness were performed. Implants of the first generation made of polyethylene, ceramic or cobalt-chrome have an average surface roughness (Ra) of 1.5 microns. Approximately one-half of these implants have a conical shape, and one-third a height that is greater than the radius. Threaded cups of the second generation are made either of CP-titanium or titanium alloy. The average corundum-blasted surface roughness is 4.5 microns. Hydroxyapatite-coated (HA) implants have a surface roughness of 5.0 microns. Approximately 45% of the implants have a conical, biconical or flattened-conical shape, while one-third are of hemispherical shape. Approximately 90% of the cups have a height that is up to 23% smaller than the radius. A few cups have a height that approximates the radius. Implants of the third generation with identical surface structure can be supplied with crosslinked-polyethylene inlays or, optionally, with metal/metal or ceramic/ceramic contact surfaces. Primary stability, biocompatible materials and a structured surface are essential for ensuring osseointegration over the long-term. Corundum-blasted pure titanium or titanium alloys with corundum-blasted or HA-coated implants can be considered standard for these cups.     

Design, construction and modularity of pressure-fit acetabular cups]

To enable a comparison of different pressfit acetabular cups objective criteria are essential. The aim of this study is to describe the design features of this type of cup and to analyse currently available cups. 30 implants were systematically measured and analysed. The mean surface roughness (Ra) was determined and configurations established with the light section technique. For further evaluation the cups were transversely sectioned. The cups are made of pure titanium, titanium alloy or polyethylene coated with titanium. Five implants take the form of monoblocks. The configuration is predominately (n = 25) flattened spherical. The size of eight cups corresponds to the outer diameter, 19 cups have a larger outer diameter (overdimensioning), 3 cups have a smaller outer diameter (underdimensioning). The magnitude of overdimensioning is, on average, 1.9%. 9 cups are provided with plugs, hollow cylinders, fins or rings as outer stabilizers. Surface roughness achieved with corundum blasting is 6.8 microns. Titanium porous-coated implants have a surface roughness of 21-32 microns. 24 cups have polyethylene inserts, most of which are snap-fixed with equatorial lips. For 16 cups, full-ceramic inserts are available. 4 cups have a metal insert. Titanium implants with structured or HAC-coated surfaces have become the accepted standard for cementless acetabular cup implantation. Together with ceramic, metal, or modified polyethylene inserts they meet the requirement for permanent osteo-integrative stability.     

Titanium serum levels may remain elevated despite hip revision surgery for wear-through of an acetabular component.

A 62-year-old female patient showed radiographic signs of severe linear wear of the acetabular component six years after cementless total hip arthroplasty. This suggested wear-through of the acetabular liner with secondary wear of the titanium shell. At revision surgery wear-through of both the inlay and the acetabular shell were confirmed. Despite meticulous debridement serum titanium levels remained elevated for more than 12 months. Wear-through of a polyethylene acetabular liner with secondary wear of the titanium shell can lead to increased titanium serum levels. Titanium serum levels can remain highly elevated despite revision surgery.     

Radiological evaluation of polyethyelene wear of cementless total hip endoprosthesis]

During the last years increasingly cementless hip endoprostheses have been implanted. Radiological wear measurement of cemented hip endoprostheses for the material couples polyethylene cup-ceramic- or metal head has been established in the literature. However, for cups encased by metal (screwing or pressfit cups), this method of measurement is not applicable. Therefore, a method has been developed to measure wear on radiographs on cementless spherical implants. The data were compared to those, obtained from conventional wear measurements on cemented hip cups. The results indicate that both techniques generate comparable results, thus validating the new technique as being suited for cementless cup implants.     

Dynamics of Heterogeneous Liners with Prolonged Plasma Creation

Prolonged plasma creation in heterogeneous liners, in which the liner substance is separated into two phase states (a hot plasma and a cold skeleton), is investigated both experimentally and theoretically. This situation is typical of multiwire, foam, and even gas liners in high-current high-voltage facilities. The main mechanisms governing the rate at which the plasma is created are investigated, and the simplest estimates of the creation rate are presented. It is found that, during prolonged plasma creation, the electric current flows through the entire cross section of the produced plasma shell, whose thickness is comparable with the liner radius; in other words, a current skin layer does not form. During compression, such a shell is fairly stable because of its relatively high resilience. It is shown that, under certain conditions, even a thick plasma shell can be highly compressed toward the discharge axis. A simplified numerical simulation of the compression of a plasma shell in a liner with prolonged plasma creation is employed in order to determine the conditions for achieving regimes of fairly compact and relatively stable radial compression of the shell.     

Head injury in facial impact--a finite element analysis of helmet chin bar performance

The chin bar of a motorcycle helmet protects the rider from facial and head injuries. To evaluate the protective performance of chin bars against head injuries from facial impacts, an explicit finite element method was used to simulate the Snell Memorial Foundation test and a proposed drop test. The maximum acceleration and Head Injury Criterion (HIC) were employed to assess the impact-absorbing capability of the chin bar. The results showed that the proposed approach should be more practical than the Snell test, and provided more information for improving the chin bar design to protect against head injuries. The shell stiffness was important in determining the protective ability of the chin bar, but a chin bar with only an outer shell and comfort foam offered inadequate protection. An energy-absorbing liner was essential to increase the protective performance of the chin bar and the liner density should be denser than that used in the cranial portion of the helmet. For the chin bar with energy-absorbing liner, a shell design that is less stiff would provide better protection.     

Fracture analysis of a ceramic liner. Is in hip endoprosthesis replacement of ceramic on ceramic components with only one of the corresponding partners justified?]

The good biomechanical and tribological properties, together with the excellent biocompatibility, of ceramic-on-ceramic components, make them a preferential choice for total hip replacement surgery, at least in Europe. We report on a man admitted as an outpatient with painless grating in the hip one year after replacement of a ceramic femoral head, but not of the ceramic inlay. Clinical and radiological findings were indicative of a broken liner. This was confirmed during revision surgery, during which it was replaced by a polyethylene inlay; although the ceramic head appeared intact, it was replaced by a metal head. Inspection of the surface of the broken liner in the scanning electron microscope (SEM) revealed signs of material failure. We recommend careful inspection of ceramic-on-ceramic articulating components during total hip revision surgery and if there is any uncertainty, replacement of both so as to avoid premature failure.     

Simulation of initial frontside and backside wear rates in a modular acetabular component with multiple screw holes.

A sliding distance-based finite element formulation was implemented to predict initial wear rates at the front and back surfaces of a commercially available modular polyethylene component during in vitro loading conditions. We found that contact area, contact stress, and wear at the back surface were more sensitive to the liner/shell conformity than the presence of multiple screw holes. Furthermore, backside linear and volumetric wear rates were at least three orders of magnitude less than respective wear estimates at the articulating surface. This discrepancy was primarily attributed to the difference in maximum sliding distances at the articulating surfaces (measured in mm) versus the back surface (measured in microm). This is the first study in which backside wear has been quantified and explicitly compared with frontside wear using clinically relevant metrics established for the articulating surface. The results of this study suggest that with a polished metal shell, the presence of screw holes does not substantially increase abrasive backside wear when compared with the effects of backside nonconformity.     

Frictional heating of total hip implants. Part 1: measurements in patients

Hip implants heat up due to friction during long lasting, high loading activities like walking. Thermal damage in the surrounding soft and hard tissues and deteriorated lubrication of synovial fluid could contribute to implant loosening. The goal of this study was to determine the implant temperatures in vivo under varying conditions. Temperatures and contact forces in the joints were measured in seven joints of five patients using instrumented prostheses with alumina ceramic heads and telemetry data transmission. The peak temperature in implants with polyethylene cups rose up to 43.1 degrees C after an hour of walking but varied considerably individually. Even higher temperatures at the joints are probable for patients with higher body weight or while jogging. The peak temperature was lower with a ceramic cup, showing the influence of friction in the joint. During cycling the peak temperatures were lower than during walking, proving the effect of force magnitudes on the produced heat. However, no positive correlation was found between force magnitude and maximum temperature during walking. Other individual parameters than just the joint force influence the implant temperatures. Based on the obtained data and the available literature about thermal damage of biological tissues a detrimental effect of friction induced heat on the stability of hip implants cannot be excluded. Because the potential risk for an individual patient cannot be foreseen, the use and improvement of low friction implant materials is important.     

Finite Element Analysis of the Contact Mechanics of Ceramic-on-Ceramic Hip Resurfacing Prostheses

<正> Ceramics are good alternative to metal as bearing couple materials because of their better wear resistance. A Finite Element(FE) study was performed to investigate the contact mechanics and stress distribution of Ceramic-on-Ceramic (COC) hip resurfacingprostheses. It was focused in particular on a parametric study to examine the effects of radial clearance, loading,alumina coating on the implants, bone quality, and fixation of cup-bone interface. It was found that a reduction in the radialclearance had the most significant effect on the predicted contact pressure distribution among all of the parameters considered inthis study. It was determined that there was a significant influence of non-metallic materials, such as the bone underneath thebearing components, on the predicted contact mechanics. Stress shielding within the bone tissue was found to be a major concernwhen regarding the use of ceramic as an alternative to metallic resurfacing prostheses. Therefore, using alumina implantswith a metal backing was found to be the best design for ceramic resurfacing prostheses in this study. The loading, bone quality,and acetabular cup fixation conditions were found to have only minor effects on the predicted contact pressure distribution alongthe bearing surfaces.     

Cation exchange properties of porous ceramic cups: Implications for field use

Porous ceramic cup soil-water samplers were treated with solutions containing Na, K, Ca, or Mg to examine any interactions between the cups and the extracted solutions. Acid-washed and non-acid washed cups were evaluated. Results demonstrated simple ion exchange between monovalent and divalent cations on charged sites, and that Na contamination of commercially available cups was effectively removed by acid-washing.     

In situ sampling of small volumes of soil solution using modified micro-suction cups

Two modified designs of micro-pore-water samplers were tested for their capacity to collect unbiased soil solution samples containing zinc and citrate. The samplers had either ceramic or polyethersulfone (PES) suction cups. Laboratory tests of the micro-samplers were conducted using (a) standard solutions with zinc and citrate concentrations that can be found in the rhizosphere and (b) two soils with contrasting texture. The results showed that both suction cups were inert with respect to citrate and zinc: they did not affect the concentrations of the two ions in freshly prepared and directly sampled standard solutions. Both micro-suction cups removed most microorganisms by filtration, though the PES cups were more effective in this respect. This filtering by the suction cups allowed for relatively accurate analysis of citrate in solutions containing microorganisms. These capacities, together with their small size and small dead volume, make the two micro-pore-water samplers highly suitable for sampling of rhizosphere soil solutions although further testing with other organic acids and trace metals may be needed.     

Effects of clinically relevant alumina ceramic, zirconia ceramic and titanium particles of different sizes and concentrations on TNF-alpha release in a human macrophage cell line]

INTRODUCTION: Aseptic loosening is considered to be the main problem of modern endoprothesis. Tumor necrosis factor alpha (TNFalpha) seems to be the initiator protein of particle disease. The aim of our study was to investigate the TNFalpha response of macrophage like cells (MLC) after stimulation with periprosthetic particles, typically found during revision surgery. For this purpose alumina ceramic (Al2O3), zirconia ceramic (ZrO2) and titanium (Ti) particles of different sizes and concentrations were used. Important was to study the effects of different sizes due to TNFalpha secretion and the comparison of the biological effects of alumina ceramic and titanium. METHOD: To obtain an TNFalpha profile we used an established macrophage model (Rader et al.) with THP-1 cells (human monocytic cell line). Therefore 106 MLC were incubated with different particle concentrations and sizes for 6 h. The supernatant was then investigated for TNF using ELISA assay. RESULTS: Ti-particles provoked in both sizes (0.2 microm and 2.5 microm) the greatest TNFalpha response, 8 times and 17 times as high in comparison with control. But substantially more 0.2 microm sized Ti-particles were necessary to get the above mentioned results. Al2O3-particles were not as effective as Ti, but they released fourfold more TNFalpha compared to control. There was no difference in TNFalpha-secretion comparing Al2O3-particles of different sizes (0.6 microm and 2 microm), but a 1000 times greater concentration of the 0.6 microm sized particles were needed. Using Al2O3- and Ti-particles of the same size and concentration, Ti provoked a significant higher TNFalpha response. ZrO2 showed no effects on TNFalpha release. CONCLUSION: Because of our results we recommend ceramic articulating surfaces, which are superior to metal on metal matings ion term of biological reactions. Additionally bigger wear particles should be avoided. Revisionoperation should be done early to avoid huge amount of wear particles and to minimize local osteolysis.     

Reusable vs. disposable cups revisited: guidance in life cycle comparisons addressing scenario,model, and parameter uncertainties for the US consumer

Purpose

Despite interest in an environmentally conscious decision between disposable and reusable cups, a comprehensive and current study for US consumers is not yet available. Guidance in favor of single-use cups rely on outdated or non-ISO-compliant results with limited uncertainty information. Such claims are insufficiently generalizable. This article delivers an updated comparative life cycle impact assessment of reusable ceramic cups and single-use expanded polystyrene cups.

Methods

The ReCiPe midpoint model was selected. Scenario uncertainties are addressed by evaluating compliant standard dishwashing appliance models from 2004 to 2013 used in 26 US subregional utility grids. A utility snapshot from 2009 is applied with extension to recent shifts in generation from increased penetration of natural gas and renewable energy. Parameter uncertainty is quantified through statistical methods.

Results

Where there is statistical difference, results almost entirely favor reusable cups in the USA. For climate change, 16 % of users have higher impact for ceramic cups washed in 2013 by minimally compliant dishwashers. Higher climate change impacts for 32 % of reusable cup users is indicated with 2004 average dishwashers, though using a cup twice between washes shifts the impact in favor of the reusable cup.

Conclusions

Disposable cup scenarios do not account for film sleeves, lids, printing, and less conservative shipping weights and distances and therefore reflect a best case scenario. Impact for reusable cups is expected to decrease further as the electricity mix becomes less CO₂-intensive with replacement of coal-fired generators by natural gas, wind, and solar and as less efficient dishwashers are replaced with new units compliant to current laws.     

A comparative study of the characteristics of femoral hip prosthesis heads--study and results ceramic-coated hip joint heads of titanium]

Today, only hard/soft cup and femoral head combinations are employed for hip joint prostheses. Highly polished ceramic is a material with very good tribological properties for femoral heads, being highly resistant to mechanical wear and tear, and highly resistant to chemical reactions in the biological environment. The advantage of metal heads, in contrast, undoubtedly lies in their resistance to breakage and the ease with which their geometry can be modified with respect, for example, to antirotation angle and neck length. The ideal material for femoral heads is a combination of the two materials. The new multi-layer combination of titanium-niobium oxide/nitride ceramic coating applied to a prehardened titanium head combines the positive material properties in an ideal manner. Femoral heads made of CoCrMo, oxide-hardened titanium, aluminium oxide or multilayer titanium-niobium ceramic were compared by means of friction an wear and tear tests. The TiNb-ceramic-metal heads showed similar abrasion at the surface as the ceramic heads. At the high loads of more than 400 kp, which may also be reached under physiological conditions, the specially coated titanium-ceramic heads proved to be superior in terms of resistance to fracture and tribological properties.     

氧化铝玻璃复合体强度及断裂韧性的研究

全瓷修复材料抗拉强度,脆性大且制作困难,限制了它在牙科临床上应用,随着ＣＡＤ／ＣＡＭ技术和Ｉｈ－Ｃｅｒａｍ技术的完美结合,使得牙科陶瓷强度和断裂韧性很大的提高,给临床全瓷修复体的制作提供了新的途径,本研究采用α型高纯度,超细氧化铝粉末,经等静压处理,在在１３５０℃下烧结成一定强度的多孔氧化铝坯体。最后在多孔氧化铝坯体的表面采用镧硅硼玻璃进行渗透,制作具有一定强度和半透明的氧化铝玻璃复合体。结果表明     

Early fracture of a plasma cup ceramic liner: a case report and surface analysis

Background: Ceramic surfaces offer excellent tribological properties and for this reason are frequently used in younger patients with osteoarthritis of the hip. However, they may fracture easily owing to low tolerance to tensile and impact stresses in particular. We report a case of early fracture of a currently available ceramic liner in a 44-year-old woman with revision total hip arthroplasty. Methods and Results: Scanning electron microscopy and macroscopic fractographic examination were done to elucidate the cause of failure. These showed the fracture started most probably at the inner surface of the cup. Several mechanisms of fracture initiation are discussed in the paper. Conclusion: This is the first report on early fracture of the Plasma cup ceramic liner in white man. The fracture occurred intraoperatively or early postoperatively while the diagnosis was determined much later despite the patient had experienced sensations of subluxations long time before.     

Ceramic acetabular cups for hip endoprostheses. 7: How do position of the center of rotation and the CCD angle of the shaft modify range of motion and impingement?]

The range of motion (ROM) of total hip prostheses is influenced by a number of parameters. An insufficient ROM may cause impingement, which may result in subluxation, dislocation or material failure of the prostheses. In a three-dimensional CAD simulation, the position of the centre of rotation and the CCD angle of the stem were investigated. Displacement of the centre of rotation of the femoral head may be due to wear (PE cups) or to the design of the prosthesis (ceramic cups). Stems of widely differing design have been developed and implanted. The results of the present study demonstrate that the ROM is clearly reduced by increasing penetration of the femoral head. At an inclination angle of 45 degrees, a depth of penetration of 2 mm restricts flexion by about 15 degrees, and a depth of penetration of 3 mm by about 30 degrees. At smaller angles of inclination the ROM is reduced and flexion and abduction are associated with an increased risk of impingement. With steeper acetabular cup inclinations, the risk of impingement decreases, but dislocation, the risk of rim fractures (ceramic cups), and wear and penetration rates (PE cups) increase. The CCD angle of the stem should be oriented to the anatomical situation. At high CCD angles (> 135 degrees), flexion is clearly limited, in particular when there is penetration of the femoral head. For modern total hip arthroplasty, prosthetic systems characterised by precise positioning of components, minimum wear, slightly recessed inserts, and appropriate CCD angles should be used.