Slide track analysis of the relative motion between femoral head and acetabular cup in walking and in hip simulators

Joint simulators are important tools in wear studies of prosthetic joint materials. The type of motion in a joint simulator is crucial with respect to the wear produced. It is widely accepted that only multidirectional motion yields realistic wear for polyethylene acetabular cups. Multidirectionality, however, is a wide concept. The type of multidirectional motion varies considerably between simulators, which may explain the large differences in observed wear rates. At present, little is known about the relationship between the type of multidirectional motion and wear. One illustrative way to compare the motions of various hip simulators is to compute tracks made on the counterface by selected points of the surface of the femoral head and acetabular cup due to the cyclic relative motion. A new computation method, based on Euler angles, was developed, and used to compute slide tracks for the three-axis motion of the hip joint in walking, and for two hip simulators, the HUT-3 and the biaxial rocking motion. The slide track patterns resulting from the gait waveforms were found to be similar to those produced by the HUT-3 simulator. This paper is the first to include a verification of the computed simulator tracks. The tracks were verified in the two simulators using sharp pins, embedded in acetabular cups, engraving distinct grooves onto the femoral heads. The engravings were identical to the computed tracks. The results clearly differed from earlier computations by another research group. This study is intended to start a thorough investigation of the relationship between the type of multidirectional motion and wear.     

Force track analysis of contemporary hip simulators

In an earlier paper, the authors presented the first verified method of computation of slide tracks in the relative motion between femoral head and acetabular cup of total hip prostheses. The method was applied for gait and for two hip simulator designs, and in a subsequent paper, for another eight designs. In the present paper, the track drawn by the resultant contact force, the so-called force track, was studied in depth. The variations of sliding distance, sliding velocity and direction of sliding during a cycle, all of which are important with respect to wear, were computed for gait and for 11 hip simulator designs. Moreover, the product of the instantaneous load and increment of sliding distance was numerically integrated over a cycle. This integral makes it possible to compare clinical wear rates with those produced by hip simulators in terms of a wear factor. For the majority of contemporary hip simulators, the integral has so far been unknown. The computations revealed considerable differences, which are likely to explain the substantial differences in wear produced by the simulators. With the most common head diameter, 28 mm, the ranges for sliding distance per cycle, mean sliding velocity, total change of direction of sliding and integral were: 19.7-34.3 mm, 19.7-49.0 mm/s, 360-1513 degrees, and 17.4-43.5 Nm, respectively.     

Surface slide track mapping of implants for total disc arthroplasty

Total disc arthroplasty has recently become a potential alternative to spinal arthrodesis. Until recently, there has been no standardized method for evaluating the wear of an artificial disc and myriad testing conditions have been used. The American Society for Testing and Materials (ASTM) and International Organization of Standardization (ISO) recently published guidance documents for the wear assessment of intervertebral spinal disc prostheses; however, various kinematic profiles are suggested, leading to different wear paths between the articulating surfaces of the implants. Since the wear between materials is influenced by the type of relative motion, it is important to select test conditions that lead to clinically realistic results. The purpose of this study was to characterize the slide tracks generated by 7 test conditions allowed for by the ISO and ASTM guidance documents and in Euler sequences consistent with 4 commercially available spine wear simulators. The analysis was performed for a ball-in-socket articulation under both lumbar and cervical motion test conditions. Results were generated analytically using a mathematical algorithm and then validated experimentally. Four tests resulted in elliptical sliding tracks of similar geometries for both the lumbar and cervical conditions. Curvilinear and ribbon-shaped wear paths were generated for 3 tests. With the data normalized for implant diameter, the sliding distance was similar between the lumbar and cervical conditions allowed for in the ASTM guidance. This distance differed compared with the results for the ISO guidance document where the lengths of cervical slide tracks were twice those for the lumbar conditions. Slide tracks were also found to be insensitive to the type of simulator under all testing conditions.     

RandomPOD--a new method and device for advanced wear simulation of orthopaedic biomaterials

A 16-station wear simulator of the pin-on-disc type, called RandomPOD, was designed, built, and validated. The primary area of application of the RandomPOD is wear studies of orthopaedic biomaterials. The type of relative motion between the bearing surfaces, generally illustrated as shapes of slide tracks, has been found to have a strong effect on the type and amount of wear produced. The computer-controlled RandomPOD can be programmed to produce virtually any slide track shape and load profile. In the present study, the focus is on the biomechanically realistic random variation in the track shape and load. In the reference test, the established combination of circular translation and static load was used. In addition, the combinations of random motion/static load, and circular translation/random load were included. The pins were conventional ultra-high molecular weight polyethylene (UHMWPE), the discs were polished CoCr, and the lubricant was diluted calf serum. The UHMWPE wear factor resulting from random motion was significantly higher than that resulting from circular translation. This was probably caused by the fact that in the random motion the direction of sliding changed more than in circular translation with the same sliding distance. The type of load, random vs. static, was unimportant with respect to the wear factor produced. The principal advantage of using the present random track is that possible unrealistic wear phenomena related to the use of fixed track shapes can be avoided.     

An improved method of computing the wear factor for total hip prostheses involving the variation of relative motion and contact pressure with location on the bearing surface

A new method of computing the wear factor for total hip prostheses is presented. In the conventional method, only the resultant contact force and the track drawn by the point of its application are considered so that the product of the instantaneous force and sliding increment is integrated over one motion cycle. In the present, improved, method the contact pressure distribution is discretized by a large number of smaller normal forces, and the contribution of each is summed. This is important because the relative motion and contact pressure vary strongly with location, and because the transverse pressure component is substantial. Hence, the present surface integral represents the large contact surface better than the conventional line integral. A prerequisite for the surface integral was the method of computing the relative motion correctly anywhere on the contact surface, developed and published earlier by the present authors. For the pressure discretization, the contact surface was divided into nearly equal-sized surface elements. The contact pressure was modelled with ellipsoidal, paraboloidal and sinusoidal distributions. Two load cases were studied, double-peak and static. When an ellipsoidal contact pressure distribution extending over a hemisphere was discretized by 1000 element forces, the computed wear factor for double-peak load in a biaxial hip wear simulator was 30% lower than in the conventional resultant force case. The present method can be later developed further to involve the temporal variation of size and location of the contact surface.     

Meniscal wear at a three-component total ankle prosthesis by a knee joint simulator

Despite the fundamental value of wear simulation studies to assess wear resistance of total joint replacements, neither specialised simulators nor established external conditions are available for the human ankle joint. The aim of the present study was to verify the suitability of a knee wear simulator to assess wear rates in ankle prostheses, and to report preliminary this rate for a novel three-component total ankle replacement design. Four intact 'small' size specimens of the Box ankle were analysed in a four-station knee wear simulator. Special component-to-actuator holders were manufactured and starting spatial alignment of the three-components was sought. Consistent load and motion cycles representing conditions at the ankle joint replaced exactly with the prosthesis design under analysis were taken from a corresponding mechanical model of the stance phase of walking. The weight loss for the three specimens, after two million cycles, was 32.68, 14.78, and 62.28mg which correspond to a linear penetration of 0.018, 0.008, and 0.034mm per million-cycle, respectively for the specimens #1, #2, and #3. The knee wear simulator was able to reproduce load-motion patterns typical of a replaced ankle. Motion of the meniscal bearing in between the tibial and talar components was smooth, this component remaining in place and in complete congruence with the metal components throughout the test.     

Improved single- and multi-contact life-time testing of dental restorative materials using key characteristics of the human masticatory system and a force/position-controlled robotic dental wear simulator

This paper presents a new in vitro wear simulator based on spatial parallel kinematics and a biologically inspired implicit force/position hybrid controller to replicate chewing movements and dental wear formations on dental components, such as crowns, bridges or a full set of teeth. The human mandible, guided by passive structures such as posterior teeth and the two temporomandibular joints, moves with up to 6 degrees of freedom (DOF) in Cartesian space. The currently available wear simulators lack the ability to perform these chewing movements. In many cases, their lack of sufficient DOF enables them only to replicate the sliding motion of a single occlusal contact point by neglecting rotational movements and the motion along one Cartesian axis. The motion and forces of more than one occlusal contact points cannot accurately be replicated by these instruments. Furthermore, the majority of wear simulators are unable to control simultaneously the main wear-affecting parameters, considering abrasive mechanical wear, which are the occlusal sliding motion and bite forces in the constraint contact phase of the human chewing cycle. It has been shown that such discrepancies between the true in vivo and the simulated in vitro condition influence the outcome and the quality of wear studies. This can be improved by implementing biological features of the human masticatory system such as tooth compliance realized through the passive action of the periodontal ligament and active bite force control realized though the central nervous system using feedback from periodontal preceptors. The simulator described in this paper can be used for single- and multi-occlusal contact testing due to its kinematics and ability to exactly replicate human translational and rotational mandibular movements with up to 6 DOF without neglecting movements along or around the three Cartesian axes. Recorded human mandibular motion and occlusal force data are the reference inputs of the simulator. Experimental studies of wear using this simulator demonstrate that integrating the biological feature of combined force/position hybrid control in dental material testing improves the linearity and reduces the variability of results. In addition, it has been shown that present biaxially operated dental wear simulators are likely to provide misleading results in comparative in vitro/in vivo one-contact studies due to neglecting the occlusal sliding motion in one plane which could introduce an error of up to 49% since occlusal sliding motion D and volumetric wear loss V(loss) are proportional.     

A new ISO/FDIS 14242-1 compatible hip prosthesis simulator: E-SIM]

The continuing development of new, highly sophisticated materials for the articulating surfaces of total hip endoprostheses involves the need for testing, not only of biocompatibility and dynamic loadability, but also of tribological properties (friction, wear, lubrication). For decades, the wear resistance of these materials has been tested in wear simulators. In consequence of the currently often widely differing test methods, the technical committee (TC 150) of the ISO (International Organization for Standardization) has been concerned to develop an International Standard (ISO/FDIS 14242 1 and 2: Implants for Surgery--wear of total hip joint prostheses--on the basis of kinetic and kinematic data from gait analysis. This new standard will be the basis for ensuring the comparability of scientific data obtained from tribological testing of total hip endoprothesis. The new hip simulator, E-SIM, presented in this paper, complies with the currently published FDIS (Final Draft International Standard), and enables testing in accordance with these specifications.     

Development of computational wear simulation of metal-on-metal hip resurfacing replacements

As one of the alternatives to traditional metal-on-polyethylene total hip replacements, metal-on-metal hip resurfacing prostheses demonstrating lower wear have been introduced for younger and more active patients during the past decade. However, in vitro hip simulator testing for the predicted increased lifetime of these surface replacements is time-consuming and costly. Computational wear modelling based on the Archard wear equation and finite element contact analysis was developed in this study for artificial hip joints and particularly applied to metal-on-metal resurfacing bearings under simulator testing conditions to address this issue. Wear factors associated with the Archard wear equation were experimentally determined and based on the short-term hip simulator wear results. The computational wear simulation was further extended to a long-term evaluation up to 50 million cycles assuming that the wear rate stays constant. The prediction from the computational model shows good agreement with the corresponding simulator study in terms of volumetric wear and the wear geometry. The simulation shows the progression of linear wear penetrations, and the complexity of contact stress distribution on the worn bearing surfaces. After 50 million cycles, the maximum linear wear was predicted to be approximately 6 and 8 microm for the cup and head, respectively, and no edge contact was found.     

The influence of design, materials and kinematics on the in vitro wear of total knee replacements

Debris-induced osteolysis due to surface wear of ultra high molecular weight polyethylene (UHMWPE) bearings is a potential long-term failure mechanism of total knee replacements (TKR). This study investigated the effect of prosthesis design, kinematics and bearing material on the wear of UHMWPE bearings using a physiological knee simulator. The use of a curved fixed bearing design with stabilised polyethylene bearings reduced wear in comparison to more flat-on-flat components which were sterilised by gamma irradiation in air. Medium levels of crosslinking further improved the wear resistance of fixed bearing TKR due to resistance to strain softening when subjected to multidirectional motion at the femoral-insert articulating interface. Backside motion was shown to be a contributing factor to the overall rate of UHMWPE wear in fixed bearing components. Wear of fixed bearing prostheses was reduced significantly when anterior-posterior displacement and internal-external rotation kinematics were reduced due to decreased cross shear on the articulating surface and a reduction in AP displacement. Rotating platform mobile bearing prostheses exhibited reduced wear rates in comparison to fixed bearing components in these simulator studies due to redistribution of knee motion to two articulating interfaces with more linear motions at each interface. This was observed in two rotating platform designs with different UHMWPE bearing materials. In knee simulator studies, wear of TKR bearings was dependent on kinematics at the articulating surfaces and the prosthesis design, as well as the type of material.     

Wear paths produced by individual hip-replacement patients--a large-scale, long-term follow-up study

Wear particle accumulation is one of the main contributors to osteolysis and implant failure in hip replacements. Altered kinematics produce significant differences in wear rates of hip replacements in simulator studies due to varying degrees of multidirectional motion. Gait analysis data from 153 hip-replacement patients 10-years post-operation were used to model two- and three-dimensional wear paths for each patient. Wear paths were quantified in two dimensions using aspect ratios and in three dimensions using the surface areas of the wear paths, with wear-path surface area correlating poorly with aspect ratio. The average aspect ratio of the patients wear paths was 3.97 (standard deviation=1.38), ranging from 2.13 to 10.86. Sixty percent of patients displayed aspect ratios between 2.50 and 3.99. However, 13% of patients displayed wear paths with aspect ratios >5.5, which indicates reduced multidirectional motion. The majority of total hip replacement (THR) patients display gait kinematics which produce multidirectional wear paths, but a significant minority display more linear paths.     

A novel low wearing differential hardness, ceramic-on-metal hip joint prosthesis

Osteolysis and loosening of artificial joints caused by polyethylene wear debris has prompted renewed interest in alternative bearing materials for hip prosthesis designs. Lower wearing metal-on-metal (MOM) and ceramic-on-ceramic prostheses are being used more extensively, and there is considerable interest in further improving on their performance. This study investigated the wear properties and debris morphology of a novel differential hardness ceramic-on-metal (COM) prosthesis, in comparison with MOM articulations in a physiological anatomical hip joint simulator.The COM pairings were found to have wear rates approximately 100-fold lower than the MOM pairings. The MOM pairings showed a higher "bedding in" wear rate (3.09+/-0.46mm(3)/10(6) cycles) in the first million cycles, which then reduced to a steady state wear rate of 1.23+/-0.5mm(3)/10(6) cycles. The wear rate of the COM pairings over the duration of the test was approximately 0.01mm(3)/10(6) cycles with very little wear detected on the surface of the prosthesis components.The wear particles from both articulations were oval to round in shape and in the nanometer size range. After one million cycles the mean maximum diameter of the MOM and COM wear particles were 30+/-2.25 and 17.57+/-1.37nm, respectively. After five million cycles the wear particles were statistically significantly smaller than at one million cycles, 13.9+/-0.72nm for the MOM pairings and 6.11+/-0.40nm for the COM pairings.The wear rates of the MOM prostheses were representative of clinical values. The use of differential hardness COM pairings dramatically reduced the wear rate compared to MOM hip prostheses. The wear particles from the MOM articulation were similar to particles found in retrieved tissues from around MOM prostheses. The extremely low wearing differential hardness COM bearings presented in this study produced far smaller volumetric particle loads compared to MOM prostheses currently used clinically.     

Ceramic cups for hip endoprostheses. 5: Consideration of designs]

Using the combination ceramic on ceramic for hip prostheses, the wear rate can be reduced to less than 1 micron per million cycles. More than 20 years of experience are now available for various concepts involving alumina ceramics in THR. In the early days, monolithic ceramic cups were employed. However, since alumina ceramic has an unsatisfactory potential for bone integration, soft tissue forms at the interface, with the result that the sockets migrate and penetrate. To improve bony integration, monoblock cups surfaced with ceramic beads were introduced. For the past 10 years, there has been a trend towards the use of modular acetabular components comprising a metal shell and a liner made of Biolox forte ceramic. Two concepts for the fixation of the ceramic liners are employed: locking of the ceramic in the metal shell (CeraLock) and the sandwich concept with a polyethylene layer interposed between liner and shell. The basic design and important aspects such as diameter, range of motion, and the possibility for revision, clinical experience, and trends are discussed.     

High-tech hip implant for wireless temperature measurements in vivo

When walking long distances, hip prostheses heat up due to friction. The influence of articulating materials and lubricating properties of synovia on the final temperatures, as well as any potential biological consequences, are unknown. Such knowledge is essential for optimizing implant materials, identifying patients who are possibly at risk of implant loosening, and proving the concepts of current joint simulators. An instrumented hip implant with telemetric data transfer was developed to measure the implant temperatures in vivo. A clinical study with 100 patients is planned to measure the implant temperatures for different combinations of head and cup materials during walking. This study will answer the question of whether patients with synovia with poor lubricating properties may be at risk for thermally induced bone necrosis and subsequent implant failure. The study will also deliver the different friction properties of various implant materials and prove the significance of wear simulator tests. A clinically successful titanium hip endoprosthesis was modified to house the electronics inside its hollow neck. The electronics are powered by an external induction coil fixed around the joint. A temperature sensor inside the implant triggers a timer circuit, which produces an inductive pulse train with temperature-dependent intervals. This signal is detected by a giant magnetoresistive sensor fixed near the external energy coil. The implant temperature is measured with an accuracy of 0.1°C in a range between 20°C and 58°C and at a sampling rate of 2-10 Hz. This rate could be considerably increased for measuring other data, such as implant strain or vibration. The employed technique of transmitting data from inside of a closed titanium implant by low frequency magnetic pulses eliminates the need to use an electrical feedthrough and an antenna outside of the implant. It enables the design of mechanically safe and simple instrumented implants.     

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.     

Enhanced computational prediction of polyethylene wear in hip joints by incorporating cross-shear and contact pressure in additional to load and sliding distance: Effect of head diameter

A new definition of the experimental wear factor was established and reported as a function of cross-shear motion and contact pressure using a multi-directional pin-on-plate wear testing machine for conventional polyethylene in the present study. An independent computational wear model was developed by incorporating the cross-shear motion and contact pressure-dependent wear factor into the Archard's law, in additional to load and sliding distance. The computational prediction of wear volume was directly compared with a simulator testing of a polyethylene hip joint with a 28 mm diameter. The effect of increasing the femoral head size was subsequently considered and was shown to increase wear, as a result of increased sliding distance and reduced contact pressure.     

Elbow helical axes of motion are not the same in physiologic and kinetic joint simulators

Physiologic and kinetic joint simulators have been widely used for investigations of joint mechanics. The two types of simulator differ in the way joint motion is achieved; through prescribed motions and/or forces in kinetic joint simulators and by tendon loads in physiologic joint simulators. These two testing modalities have produced important insights, as in elucidating the importance of soft tissue structures to joint stability. However, the equivalence of the modalities has not been tested. This study sequentially tested five cadaveric elbows using both a physiologic simulator and a robot/6DOF system. Using position data from markers on the humerus and ulna, we calculated and compared the helical axes of motion of the specimens as the elbows were flexed from full extension. Six step size increments were used in the helical axis calculation. Marker position data at each test's full extension and full flexion point were also used to calculate a datum (overall) helical axis. The angles between the datum axis and step-wise movements were computed and stored. Increasing step size monotonically decreased the variability and the average conical angle encompassing the helical axes; a repeated measures ANOVA using test type (robot or physiologic simulator) and step size found that both type and step caused statistically significant differences (p<0.001). The large changes in helical axis angle observed for small changes in elbow flexion angle, especially in the robot tests, are a caveat for investigators using similar control algorithms. Controllers may need to include increased joint compliance and/or C(1) continuity to reduce variability.     

The Importance of Stimulus Noise Analysis for Self-Motion Studies

Motion simulators are widely employed in basic and applied research to study the neural mechanisms of perception and action during inertial stimulation. In these studies, uncontrolled simulator-introduced noise inevitably leads to a disparity between the reproduced motion and the trajectories meticulously designed by the experimenter, possibly resulting in undesired motion cues to the investigated system. Understanding actual simulator responses to different motion commands is therefore a crucial yet often underestimated step towards the interpretation of experimental results. In this work, we developed analysis methods based on signal processing techniques to quantify the noise in the actual motion, and its deterministic and stochastic components. Our methods allow comparisons between commanded and actual motion as well as between different actual motion profiles. A specific practical example from one of our studies is used to illustrate the methodologies and their relevance, but this does not detract from its general applicability. Analyses of the simulator’s inertial recordings show direction-dependent noise and nonlinearity related to the command amplitude. The Signal-to-Noise Ratio is one order of magnitude higher for the larger motion amplitudes we tested, compared to the smaller motion amplitudes. Simulator-introduced noise is found to be primarily of deterministic nature, particularly for the stronger motion intensities. The effect of simulator noise on quantification of animal/human motion sensitivity is discussed. We conclude that accurate recording and characterization of executed simulator motion are a crucial prerequisite for the investigation of uncertainty in self-motion perception.     

Computational hip joint simulator for wear and heat generation

This paper presents a computational simulator for the hip to compute the wear and heat generation on artificial joints. The friction produced on artificial hip joints originates wear rates that can lead to failure of the implant. Furthermore, the frictional heating can increase the wear. The developed computational model calculates the wear in the joint and the temperature in the surrounding zone, allowing the use of different combinations of joint materials, daily activities and different individuals. The pressure distribution on the joint bearing surfaces is obtained with the solution of a contact model. The heat generation by friction and the volumetric wear is computed from the pressure distribution and the sliding distance. The temperature is obtained from the solution of a transient heat conduction problem that includes the time-dependent heat generated by friction. The contact and heat conduction problems are solved numerically with the Finite Element Method. The developed computational model performs a full simulation of the acetabular bearing surface behaviour, which is useful for acetabular cup design and material selection. The results obtained by the present model agree with experimental and clinical data, as well as other numerical studies.     

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.