Probabilistic analysis of the influence of the bonding degree of the stem-cement interface in the performance of cemented hip prostheses

The long-term behavior of the stem-cement interface is one of the most frequent topics of discussion in the design of cemented total hip replacements, especially with regards to the process of damage accumulation in the cement layer. This effect is analyzed here comparing two different situations of the interface: completely bonded and debonded with friction. This comparative analysis is performed using a probabilistic computational approach that considers the variability and uncertainty of determinant factors that directly compromise the damage accumulation in the cement mantle. This stochastic technique is based on the combination of probabilistic finite elements (PFEM) and a cumulative damage approach known as B-model. Three random variables were considered: muscle and joint contact forces at the hip (both for walking and stair climbing), cement damage and fatigue properties of the cement. The results predicted that the regions with higher failure probability in the bulk cement are completely different depending on the stem-cement interface characteristics. In a bonded interface, critical sites appeared at the distal and medial parts of the cement, while for debonded interfaces, the critical regions were found distally and proximally. In bonded interfaces, the failure probability was higher than in debonded ones. The same conclusion may be established for stair climbing in comparison with walking activity.     

Effects of idealized joint geometry on finite element predictions of cartilage contact stresses in the hip

Computational models may have the ability to quantify the relationship between hip morphology, cartilage mechanics and osteoarthritis. Most models have assumed the hip joint to be a perfect ball and socket joint and have neglected deformation at the bone-cartilage interface. The objective of this study was to analyze finite element (FE) models of hip cartilage mechanics with varying degrees of simplified geometry and a model with a rigid bone material assumption to elucidate the effects on predictions of cartilage stress. A previously validated subject-specific FE model of a cadaveric hip joint was used as the basis for the models. Geometry for the bone-cartilage interface was either: (1) subject-specific (i.e. irregular), (2) spherical, or (3) a rotational conchoid. Cartilage was assigned either a varying (irregular) or constant thickness (smoothed). Loading conditions simulated walking, stair-climbing and descending stairs. FE predictions of contact stress for the simplified models were compared with predictions from the subject-specific model. Both spheres and conchoids provided a good approximation of native hip joint geometry (average fitting error ～0.5 mm). However, models with spherical/conchoid bone geometry and smoothed articulating cartilage surfaces grossly underestimated peak and average contact pressures (50% and 25% lower, respectively) and overestimated contact area when compared to the subject-specific FE model. Models incorporating subject-specific bone geometry with smoothed articulating cartilage also underestimated pressures and predicted evenly distributed patterns of contact. The model with rigid bones predicted much higher pressures than the subject-specific model with deformable bones. The results demonstrate that simplifications to the geometry of the bone-cartilage interface, cartilage surface and bone material properties can have a dramatic effect on the predicted magnitude and distribution of cartilage contact pressures in the hip joint.     

Fatigue fracture of the stem-cement interface with a clamped cantilever beam test

A clamped cantilever beam test was developed to determine the fatigue crack propagation rate of the CoCr alloy/PMMA cement interface at high crack tip phase angles. A combination of finite element and experimental methods was used to determine the fatigue crack growth rates of two different CoCr alloy/PMMA cement surfaces. A crack tip phase angle of 69 deg was found, indicating that loading at the crack tip was mixed-mode with a large degree of in-plane shear loading. The energy required to propagate a crack at the interface was much greater for the plasma-sprayed CoCr surface when compared to the PMMA-precoated satin finish (p < 0.001). Both interface surfaces could be modeled using a Paris fatigue crack growth law over crack propagation rates of 10(-4) to 10(-9) m/cycle.     

Measurement of transient and residual stresses during polymerization of bone cement for cemented hip implants

The initial fixation of a cemented hip implant relies on the strength of the interface between the stem, bone cement and adjacent bone. Bone cement is used as grouting material to fix the prosthesis to the bone. The curing process of bone cement is an exothermic reaction where bone cement undergoes volumetric changes that will generate transient stresses resulting in residual stresses once polymerization is completed. However, the precise magnitude of these stresses is still not well documented in the literature. The objective of this study is to develop an experiment for the direct measurement of the transient and residual radial stresses at the stem-cement interface generated during cement polymerization. The idealized femoral-cemented implant consists of a stem placed inside a hollow cylindrical bone filled with bone cement. A sub-miniature load cell is inserted inside the stem to make a direct measurement of the radial compressive forces at the stem-cement interface, which are then converted to radial stresses. A thermocouple measures the temperature evolution during the polymerization process. The results show the evolution of stress generation corresponding to volumetric changes in the cement. The effect of initial temperature of the stem and bone as well as the cement-bone interface condition (adhesion or no adhesion) on residual radial stresses is investigated. A maximum peak temperature of 70 degrees C corresponds to a peak in transient stress during cement curing. Maximum radial residual stresses of 0.6MPa in compression are measured for the preheated stem.     

Role of stem design and material on stress distributions in cemented total hip replacement

The risk of fatigue fractures of the femoral stem in a cemented total hip arthroplasty can be minimized by either increasing the stem cross-section and/or using a very high strength alloy. The object of this study was to compare important mechanical characteristics of five selected stem designs, differing in configuration and material (stainless steel, cast chrome cobalt alloy, nickel based alloy and titanium alloy). The strain pattern on the stem was analysed in a 3-point-bending jig and also after cementing it into cadaver femurs. Regardless of stem type or test method, the typical tensile stress distribution on the lateral stem was a bell shaped curve. For the cobalt-chrome and stainless steel stems, the larger the stem the lower were the stem stresses and the stress gradient, and the higher was the factor of safety. However, the factor of safety was increased even further by the use of super alloys such as MP35N and Ti₆Al₄V. In addition, Ti₆Al₄V alloy allowed the use of larger and stronger stems without the extra penalty of rigidity, which was enforced by either the steel or cobalt based alloy.     

Sensitivity analysis of a cemented hip stem to implant position and cement mantle thickness

Patient-specific finite element models of the implanted proximal femur can be built from pre-operative computed tomography scans and post-operative X-rays. However, estimating three-dimensional positioning from two-dimensional radiographs introduces uncertainty in the implant position. Further, accurately measuring the thin cement mantle and the degree of cement–bone interdigitation from imaging data is challenging. To quantify the effect of these uncertainties in stem position and cement thickness, a sensitivity study was performed. A design-of-experiment study was implemented, simulating both gait and stair ascent. Cement mantle stresses and bone–implant interface strains were monitored. The results show that small variations in alignment affect the implant biomechanics, especially around the most proximal and most distal ends of the stem. The results suggest that implant position is more influential than cement thickness. Rotation around the medial–lateral axis is the dominant factor in the proximal zones and stem translations are the dominant factors around the distal tip.     

Finite element analysis of shear stresses at the implant-bone interface of an acetabular press-fit cup during impingement.

After total hip replacement (THR) impingement of the implant components causes shear stresses at the acetabular implant-bone interface. In the current study the finite element method (FEM) was applied to analyse the shear stresses at a fully bonded implant-bone interface assuming total ingrowth of the cup. The FE model of a press-fit acetabular component and the proximal part of the femoral component incorporates non-linear material and large sliding contact. The model was loaded with a superior-medial joint load of 435 N simulating a two-legged stance. Starting at initial impingement, the femoral component was medially rotated by 20 degrees . The peak tilting shear stress of -2.6 MPa at the impingement site takes effect towards the pole of the cup. The torsional shear stress at the impingement site is zero. On each side of the impingement site, there are extrema of torsional shear stress reaching -1.8 and 1.8 MPa, respectively. The global peak shear stress during impingement may indicate a possible starting point for cup loosening. The pattern of the torsional shear stresses suggests that besides the symmetric lever-out, an additional asymmetrical tilting of the cup occurs that can be explained by the orientation of the applied joint load.     

The endocytic machinery at an interface with the actin cytoskeleton: a dynamic,hip intersection

Clathrin-mediated endocytosis is the major mechanism by which proteins and membrane lipids gain access into cells. Over the past several years, an array of proteins has been identified that define the molecular machinery regulating the formation of clathrin-coated pits and vesicles. This article focuses on how the identification of this machinery has begun to reveal a molecular basis for a link between endocytosis and the actin cytoskeleton--a link that had long been suspected to exist in mammalian cells but which had remained elusive. In particular, I discuss the relationship between actin and three components of the endocytic machinery--dynamin, HIPs (huntingtin-interacting proteins) and intersectin.     

Physical stresses at the air-wall interface of the human nasal cavity during breathing.

The nose is the front line defender of the respiratory system and is rich with mechanoreceptors, thermoreceptors, and nerve endings. A time-dependent computational model of transport through nasal models of a healthy human has been used to analyze the fields of physical stresses that may develop at the air-wall interface of the nasal mucosa. Simulations during quiet breathing revealed wall shear stresses as high as 0.3 Pa in the noselike model and 1.5 Pa in the anatomical model. These values are of the same order of those known to exist in uniform large arteries. The distribution of temperature near the nasal wall at peak inspiration is similar to that of wall shear stresses. The lowest temperatures occur in the vicinity of high stresses due to the narrow passageway in these locations. Time and spatial gradients of these stresses may have functional effects on nasal sensation of airflow and may play a role in the well-being of nasal breathing.     

Shape optimal design of the stem of a cemented hip prosthesis to minimize stress concentration in the cement layer

An optimal shape of the metal stem of a cemented total hip prosthesis minimizing stress concentration in the cement layer was searched for. A gradient projection method of numerical optimization and a finite element method of stress analysis were employed. A two-dimensional model of the femoral part of a total hip prosthesis was derived equivalent to a simplified three-dimensional axisymmetric model. The result of the stress analysis of the two-dimensional model compared favorably with that of the three-dimensional axisymmetric model. Using this two-dimensional model, an optimal shape of the stem, minimizing stress concentration in the cement layer, was obtained by a gradient projection method and the shape was checked again by the three-dimensional finite element analysis. The resulting optimal shape of the stem profile was in good agreement with conventional ones, except in the proximal region where a significant amount of stress reduction in the cement layer was achieved by tapering the stem to the limit that the stem still could withstand the increased stem stress.     

Shape optimization of a cementless hip stem for a minimum of interface stress and displacement

The primary stem stability is an essential factor for success of cementless hip stems. A correct choice of the stem geometry can improve the stem stability and, consequently, increase the life time of a hip implant. In this work, it is proposed a computational model for shape optimization of cementless hip stems. The optimization problem is formulated by the minimization of relative displacement and stress on bone/stem interface using a multi-criteria objective function. Also multiple loads are considered to incorporate several daily life activities. Design variables are parameters that characterize the geometry of selected cross sections, which are subject to geometric constraints to ensure a clinically admissible shape. The stem/bone set is considered a structure in equilibrium with contact conditions on interface. The contact formulation allows us to analyze different lengths of porous coating. The optimization problem is solved numerically by a steepest descent method. The interface stress and relative displacement are obtained solving the contact problem by the finite element method. Numerical examples are presented for a two-dimensional model of a hip stem, however, the formulation is general and can be applied to the three-dimensional case. The model gives indications about the relation between shape, porous coating and prosthesis stability.     

Simulations of the dynamics at an RNA-protein interface.

Molecular dynamics simulations of the RNA-binding domain of the U1A spliceosomal protein in complex with its cognate RNA hairpin, performed at low and high ionic strength in aqueous solution, suggest a pathway for complex dissociation. First, cations condense around the RNA and compete with the protein for binding sites. Then solvated ions specifically destabilize residues at the RNA-protein interface. For a discrete cluster of residues at the complex interface, the simulations reveal an increased deviation from the crystal structure at high salt concentrations while the remaining protein scaffold is stabilized under these conditions. The microscopic picture of salt influence on the complex suggests guidelines for rational design of interface inhibitors targeted at RNA-protein complexes.     

Aseptic loosening of the femoral component in cemented total hip replacement

The purpose of this study was to identify factors which predispose to aseptic loosening of the femoral component in cemented total hip replacement. Its design was based on rigid selection critria, so that successful and loose replacements which employed the same surgical technique were compared. Measurements of patient anatomy and of the insertion of the femoral component were made, by an accurate computer technique, on initial post-operative radiographs. Loosening was associated with heavier patients with a wider medullary canal which was flared proximally. This difference in anatomy led to differing distributions of cement in the successful and loose replacements. Medial cement-bone demarcation, at the mid-stem level, was also associated with loosening. These findings indicate the importance of optimizing the size of the prosthesis with respect to the femoral morphology.     

Enrichment of amyloidogenesis at an air-water interface

The aggregation of proteins or peptides into amyloid fibrils is a hallmark of protein misfolding diseases (e.g., Alzheimer's disease) and is under intense investigation. Many of the experiments performed are in vitro in nature and the samples under study are ordinarily exposed to diverse interfaces, e.g., the container wall and air. This naturally raises the question of how important interfacial effects are to amyloidogenesis. Indeed, it has already been recognized that many amyloid-forming peptides are surface-active. Moreover, it has recently been demonstrated that the presence of a hydrophobic interface can promote amyloid fibrillization, although the underlying mechanism is still unclear. Here, we combine theory, surface property measurements, and amyloid fibrillogenesis assays on islet amyloid polypeptide and amyloid-β peptide to demonstrate why, at experimentally relevant concentrations, the surface activity of the amyloid-forming peptides leads to enriched fibrillization at an air-water interface. Our findings indicate that the key that links these two seemingly different phenomena is the surface-active nature of the amyloid-forming species, which renders the surface concentration much higher than the corresponding critical fibrillar concentration. This subsequently leads to a substantial increase in fibrillization.     

The influence of cement mantle thickness and stem geometry on fatigue damage in two different cemented hip femoral prostheses

Experimental models can be used for pre-clinical testing of cemented and other type of hip replacements. Total hip replacement (THR) failure scenarios include, among others, cement damage accumulation and the assessment of accurate stress and strain magnitudes at the cement mantle interfaces (stem-cement and cement-bone) can be used to predict mechanical failure. The aseptic loosening scenario in cemented hip replacements is currently not fully understood, and methods of evaluating medical devices must be developed to improve clinical performance. Different results and conclusions concerning the cement micro-cracking mechanism have been reported.The aim of this study was to verify the in vitro behavior of two cemented femoral stems with respect to fatigue crack formation. Fatigue crack damage was assessed at the medial, lateral, anterior and posterior sides of the Lubinus SPII and Charnley stems. All stems were loaded and tested in stair climbing fatigue loading during one million cycles at 2 Hz. After the experiments each implanted synthetic femur was sectioned and analyzed. We observed more damage (cracks per area) for the Lubinus SPII stem, mainly on the proximal part of the cement mantle. The micro-cracking formation initiated in the stem–cement interface and grew towards the direction of cortical bone of the femur.Overall, the cement–bone interface seems to be crucial for the success of the hip replacement. The Charnley stem provoked more damage on the cement–bone interface. A failure index (maximum length of crack/maximum thickness of cement) considered was higher for the cement–stem interface of the Lubinus SPII stem. For a cement mantle thickness higher than 5 mm, cracking initiated at the cement–bone interface and depended on the opening canal process (reaming procedure and instrumentation). The analysis also showed that fatigue-induced damage on the cement mantle, increasing proximally, and depended on the axial position of the stem. The cement thickness is an important factor for the success of THR and this study evidenced that cement thickness higher than 2 mm apparently does not affect the mechanical behavior of the cement mantel and induce more crack formation on the cement–bone interface.     

Anchoring problems in cemented total hip endoprosthesis--a review of the literature]

The question as to what constitutes the most suitable material for the cemented total hip endoprosthesis has not yet been decided. Owing to the different modules of elasticity of titanium and CoCr alloy, the characteristics of force transmission into the proximal femur vary. Titanium alloys load the proximal femur earlier and more markedly, and therefore counteract possible bone degeneration; whereas the CoCr alloys are associated with less stressing of the bone cement in the critical region of the calcar femorale. This paper is a review of the various analytical, experimental and clinical publications on the subject. Besides the question of material, the problems of bone cement and its application are also discussed.     

Bending and fracture of the femoral component in cemented total hip replacement

A computer method was used to make 41 measurements on the geometry of insertion of the femoral component in 200 Charnley total hip replacements. Surgery had been performed at least 12 years before, giving results which were classified as: success (90); fracture (56); or loose (54), according to rigid selection criteria. Fracture was associated with heavier patients in which there was poor proximal fixation of the femoral component but adequate distal fixation. Stems with a medial disposition proximally were more common in the fracture group than in the successful or loose groups. Sequential measurements of bending and subsequent fracture were made on the follow-up radiographs of 24 of the 200 cases (6 fracture and 18 successful). These measurements allowed bending to be detected at an earlier stage than by simple inspection of the radiographs.