非球面人工髋关节接触力学

目的由于受制造技术的局限性、可能的设计优化考虑以及临床应用的磨损等因素影响,人工髋关节轴承表面表现为非球面几何特征,可以利用有限元分析方法对非球面人工髋关节的接触力学行为进行研究。方法对球面网格数据模型进行非球关节面重建,研究不同取向椭球面股骨头对球面髋臼几何特征的非球面金属对金属人工髋关节的接触力学表现。结果非球面股骨头接触区域中心位置的平均曲率半径在一定范围内增大时,能有效降低相应关节接触面上的最大接触压力,同时接触面积有所增加;在同样载荷下,髋臼相对股骨头不同倾斜状态对非球面股骨头的接触压力峰值和面积影响较小,但压力分布有所不同。结论良好地控制人工髋关节的非球表面特征,有利于改善人工髋关节最大接触压力幅值大小和接触区域分布。所发展的非球面人工髋关节接触模型及数值模拟过程能够有效地运行,这为非球面关节动态接触及磨损预测问题研究提供了条件。     

Effect of 3D physiological loading and motion on elastohydrodynamic lubrication of metal-on-metal total hip replacements

An elastohydrodynamic lubrication (EHL) simulation of a metal-on-metal (MOM) total hip implant was presented, considering both steady state and transient physiological loading and motion gait cycle in all three directions. The governing equations were solved numerically by the multi-grid method and fast Fourier transform in spherical coordinates, and full numerical solutions were presented included the pressure and film thickness distribution. Despite small variations in the magnitude of 3D resultant load, the horizontal anterior–posterior (AP) and medial–lateral (ML) load components were found to translate the contact area substantially in the corresponding direction and consequently to result in significant squeeze-film actions. For a cup positioned anatomically at 45°, the variation of the resultant load was shown unlikely to cause the edge contact. The contact area was found within the cup dimensions of 70–130° and 90–150° in the AP and ML direction respectively even under the largest translations. Under walking conditions, the horizontal load components had a significant impact on the lubrication film due to the squeeze-film effect. The time-dependent film thickness was increased by the horizontal translation and decreased during the reverse of this translation caused by the multi-direction of the AP load during walking. The minimum film thickness of 12–20 nm was found at 0.4 s and around the location at (95, 125)°. During the whole walking cycle both the average and centre film thickness were found obviously increased to a range of 40–65 nm, compared with the range of 25–55 nm under one load (vertical) and one motion (flexion–extension) condition, which suggested the lubrication in the current MOM hip implant was improved under 3D physiological loading and motion. This study suggested the lubrication performance especially the film thickness distribution should vary greatly under different operating conditions and the time and location that potential wear may occur was very sensitive to specific loading and motion conditions. This may provide some explanation to the large variations in wear from hip simulators and clinical studies, and also stress the importance of using more realistic loading and motion conditions in the tribological study of MOM hip prostheses.     

金属对金属人工髋关节的磨损预测

目的发展复杂动态载荷与瞬态运动条件下的球面共型接触硬对硬人工髋关节的磨损预测模型,并用于典型的金属对金属人工髋关节在复杂三维生理运动条件下的磨损预测研究。方法建立有限元模型用于接触力学问题求解,采用固定-跟踪法(fixed-tracked method)完成具有三维欧拉运动的人工髋关节双侧界面动态磨损几何再现及相应的接触与磨损问题模拟的数值交换。结果磨损预测表明,磨损导致金属对金属人工髋关节接触界面几何由球面向非球面过渡,接触区域随磨损周期而增大,接触压力变化趋于平缓、最大接触压力逐渐减小。结论本研究所发展的三维复杂动态、具有双侧界面几何磨损变化的人工髋关节磨损预测模型,能够很好地进行金属对金属髋关节磨损数值预测模拟实验,为认识人工髋关节磨损机理提供了新的方法。     

Comparison of stress on knee cartilage during kneeling and standing using finite element models

Kneeling is a common activity required for both occupational and cultural reasons and has been shown to be associated with an increased risk of knee disorders. While excessive contact pressure is considered to be a possible aggressor, it is not clear whether and to what extent stress on the cartilage during kneeling is different from that while standing. In this study, finite element models of the knee joint for both kneeling and standing positions were constructed. The results indicated differences in high-stress regions between kneeling and standing. And both the peak von-Mises stress and contact pressure on the cartilage were larger in kneeling. During kneeling, the contact pressure reached 4.25 MPa under a 300 N compressive load. It then increased to 4.66 MPa at 600 N and 5.15 MPa at 1000 N. Changing the Poisson's ratio of the cartilage, which represents changes in compressibility caused by different loading rates, was found to have an influence on the magnitude of stress.     

The influence of contact conditions and micromotions on the fretting behavior of modular titanium alloy taper connections

Modularity of femoral stems and neck components has become a more frequently used tool for an optimized restoration of the hip joint center and improvement of patient biomechanics. The additional taper interface increases the risk of mechanical failure due to fretting and crevice corrosion. Several failures of titanium alloy neck adapters have been documented in case-reports.An experimental fretting device was developed in this study to systematically investigate the effect of micromotion and contact pressure on fretting damage in contact situations similar to taper interfaces of modular hip prostheses under cyclic loading representative of in vivo load conditions. As a first application, the fretting behavior of Ti–6Al–4V titanium alloy components was investigated. Micromotions were varied between 10 μm and 50 μm, maximum contact pressures between 400 and 860 N/mm². All modes of fretting damage were observed: Fretting wear was found for high micromotions in combination with low contact pressures. Fretting fatigue occurred with reduced movement or increased contact pressures. With small micromotions or high normal pressures, low fretting damage was observed. The developed device can be used to evaluate taper design (and especially contact geometry) as well as different materials prior to clinical use.     

Effects of molecular weight of grafted hyaluronic acid on wear initiation

Hyaluronic acid (HA) of different molecular weights (M_w) was grafted onto mica surfaces to study the effects of M_w on the conformation and wear protection properties of a grafted HA (gHA) layer in lubricin (LUB) and bovine synovial fluid (BSF) using a surface forces apparatus. The M_w of gHA had significant effects on the wear pressure (P_w), at which point the wear initiates. Increasing the gHA M_w from 51 to 2590 kDa increased P_w from 4 to 8 MPa in LUB and from 15 to 31 MPa in BSF. The 2590 kDa gHA in BSF had the best wear protection (P_w ∼ 31 MPa), even though it exhibited the highest friction coefficient (μ ∼ 0.35), indicating that a low μ does not necessarily result in good wear protection, as is often assumed. The normal force profile indicated that BSF confines the gHA structure, making it polymer brush-like, commonly considered as an excellent structure for boundary lubrication.     

Biotribology of alternative bearing materials for unicompartmental knee arthroplasty

The objective of our wear simulator study was to evaluate the suitability of two different carbon fibre-reinforced poly-ether-ether-ketone (CFR-PEEK) materials for fixed bearing unicompartmental knee articulations with low congruency. In vitro wear simulation was performed according to ISO 14243-1:2002 (E) with the clinically introduced Univation® F fixed bearing unicompartmental knee design (Aesculap AG, Tuttlingen, Germany) made of UHMWPE/CoCr29Mo6 in a direct comparison to experimental gliding surfaces made of CFR-PEEK pitch and CFR-PEEK PAN. Gliding surfaces of each bearing material (n = 6 + 2) were γ-irradiated, artificially aged and tested for 5 million cycles with a customized four-station knee wear simulator (EndoLab, Thansau, Germany). Volumetric wear assessment, optical surface characterization and an estimation of particle size and morphology were performed.The volumetric wear rate of the reference PE1–6 was 8.6 ± 2.17 mm³ per million cycles, compared to 5.1 ± 2.29 mm³ per million cycles for PITCH1–6 and 5.2 ± 6.92 mm³ per million cycles for PAN1–6; these differences were not statistically significant. From our observations, we conclude that CFR-PEEK PAN is obviously unsuitable as a bearing material for fixed bearing knee articulations with low congruency, and CFR-PEEK pitch also cannot be recommended as it remains doubtful wether it reduces wear compared to polyethylene. In the fixed bearing unicompartmental knee arthroplasty examined, application threshold conditions for the biotribological behaviour of CFR-PEEK bearing materials have been established. Further in vitro wear simulations are necessary to establish knee design criteria in order to take advantage of the biotribological properties of CFR-PEEK pitch for its beneficial use to patients.     

金属对金属人工髋关节边缘接触效应

目的 研究金属对金属人工髋关节不同行走姿态下的接触力学行为,特别是大幅度运动可能导致的边缘接触效应。方法 建立球面共型接触的髋关节有限元模型,通过改变髋臼相对股骨头的倾斜状态和对股骨头施加恒定竖直方向载荷相结合,等效模拟分析人工髋关节不同行走姿态下的接触状态。结果 髋臼相对股骨头倾角在小于约60°范围内增加时,其对应的最大接触压力呈下降趋势,接触面积有所增大;当倾角超过80°范围时,关节接触区域因靠近髋臼边缘,最大接触压力位置由初始接触点向髋臼倾斜方向移动了约6°~9°的位置,用以满足压力分布合力与外载荷的平衡,接触压力和分布范围有所增加。结论 髋臼相对股骨头较大倾斜状态极易引起不同的边缘接触现象,置换人体髋关节产生的边缘接触问题需要引起临床外科和关节制造上的重视。     

Subject-specific evaluation of patellofemoral joint biomechanics during functional activity

Patellofemoral joint pain is a common problem experienced by active adults. However, relatively little is known about patellofemoral joint load and its distribution across the medial and lateral facets of the patella. In this study, biomechanical experiments and computational modeling were used to study patellofemoral contact mechanics in four healthy adults during stair ambulation. Subject-specific anatomical and gait data were recorded using magnetic resonance imaging, dynamic X-ray fluoroscopy, video motion capture, and multiple force platforms. From these data, in vivo tibiofemoral joint kinematics and knee muscle forces were computed and then applied to a deformable finite-element model of the patellofemoral joint. The contact force acting on the lateral facet of the patella was 4–6 times higher than that acting on the medial facet. The peak average patellofemoral contact stresses were 8.2 ± 1.0 MPa and 5.9 ± 1.3 MPa for the lateral and medial patellar facets, respectively. Peak normal compressive stress and peak octahedral shear stress occurred near toe-off of the contralateral leg and were higher on the lateral facet than the medial facet; furthermore, the peak compressive stress (11.5 ± 3.0 MPa) was higher than the peak octahedral shear stress (5.2 ± 0.9 MPa). The dominant stress pattern on the lateral patellar facet corresponded well to the location of maximum cartilage thickness. Higher loading of the lateral facet is also consistent with the clinical observation that the lateral compartment of the patellofemoral joint is more prone to osteoarthritis than the medial compartment. Predicted cartilage contact stress maps near contralateral toe-off showed three distinctly different patterns: peak stresses located on the lateral patellar facet; peak stresses located centrally between the medial and lateral patellar facets; and peak stresses located superiorly on both the medial and lateral patellar facets.     

Wear resistance of artificial hip joints with poly(2-methacryloyloxyethyl phosphorylcholine) grafted polyethylene: Comparisons with the effect of polyethylene cross-linking and ceramic femoral heads

Aseptic loosening of artificial hip joints induced by wear particles from the polyethylene (PE) liner remains the ruinous problem limiting their longevity. We reported here that grafting with a polymer, poly(2-methacryloyloxyethyl phosphorylcholine (MPC)) (PMPC), on the PE liner surface dramatically decreased the wear production under a hip joint simulator condition. We examined that the effect of properties of both PE by cross-linking and femoral head by changing the materials on wearing properties of PE. The PMPC grafting on the liners increased hydrophilicity and decreased friction torque, regardless of the cross-linking of the PE liner or the difference in the femoral head materials. During the hip joint simulator experiments (5 × 10⁶ cycles of loading), cross-linking caused a decrease of wear amount and a reduction of the particle size, while the femoral head materials did not affect it. The PMPC grafting abrogated the wear production, confirmed by almost no wear of the liner surface, independently of the liner cross-linking or the femoral head material. We concluded that the PMPC grafting on the PE liner surpasses the liner cross-linking or the change of femoral head materials for extending longevity of artificial hip joints.     

In vitro testing of Al2O3–Nb composite for femoral head applications in total hip arthroplasty

Alumina (Al₂O₃) bearings in total hip arthroplasty lead to low wear rates, but catastrophic failure of Al₂O₃ femoral heads, while rare, remains a concern. In the present work, a composite of Al₂O₃ and niobium (Nb) was tested in vitro for potential use as an alternative femoral head material in vivo. Dense composite laminates of Al₂O₃ and Nb were fabricated by hot pressing, and their microstructure and mechanical properties were evaluated. The flexural strength of Al₂O₃–Nb laminates in four-point loading was 720 ± 40 MPa, compared with a value of 460 ± 110 MPa for Al₂O₃. Scanning electron microscopy and X-ray diffraction showed a well-bonded interface between the Al₂O₃ and Nb without measurable formation of an interfacial reaction phase. The interfacial shear strength between Al₂O₃ and Nb, measured by a double-notched specimen test, was 290 ± 15 MPa. The feasibility of fabricating prototype femoral heads (32 mm in diameter), consisting of an Al₂O₃ surface layer (2–3 mm thick) and a Nb core, by hot pressing was shown. The composite femoral head combined the low wear of an Al₂O₃ articulating surface with the safety of a ductile metal femoral head.     

活动式与固定式 UKA 衬垫的接触力学和磨损对比研究

目的 采用计算机模拟方法对比研究 ISO 14243 - 1 ∶ 2009 力控制标准测试条件下单髁膝关节置换术(unicompartmental knee arthroplasty,UKA)活动式与固定式衬垫的接触力学和磨损性能。 方法 采用有限元方法分析两种衬垫在测试条件下的接触应力和 von Mises 应力,并采用磨损预测模型模拟 5 MC(million cycles, 百万次循环)步态周期工况获得两种衬垫的线性磨损深度、磨损体积。 结果 磨损前活动式与固定式衬垫的最大接触应力分别为 15. 7、44. 3 MPa,最大 von Mises 应力分别为 11. 94、23. 33 MPa。 随着磨损加剧,活动式衬垫的最大接触应力和 von Mises 应力先减小后趋于稳定,而固定式衬垫的基本保持不变。 固定式衬垫的线性磨损深度为活动式的1. 5 倍,但活动式衬垫的磨损体积是固定式的 5. 4 倍,且活动式衬垫的背部磨损体积占其总磨损体积的 70% 。 结论 与固定式 UKA 衬垫相比,活动式 UKA 衬垫具有较低的接触应力与 von Mises 应力,但有较大的磨损体积。 活动式衬垫背部磨损是磨屑增加的另一个重要来源。     

Effect of tibial component varus on wear in total knee arthroplasty

IntroductionMalalignment can result in poor clinical outcomes and increased wear. However, component malalignment can occur even when overall limb mechanical axis is within the normal anatomic range. We studied the effect of component malalignment in the presence of acceptable knee alignment in knee arthroplasty.MethodsSixteen tibial inserts retrieved at revision surgery were laser-mapped to measure wear. Average implantation duration was 7.7 years (range, 1 to 13). Early (postprimary) and final (prerevision) radiographs were analyzed for overall alignment (limb, femoral and tibial components) and osteolysis.ResultsThe tibial components were initially aligned in a mean of 1.3 ± 1.7° varus (range, –1.5 to 4.5°), which increased to 3.2 ± 2.9° (range, –2.0 to 8.0°) at the time of revision (p = 0.05). Tibial components initially placed in greater than 3° varus were associated with almost twice the volumetric penetration rate. Anatomic knee angles were 5.4 ± 0.9° valgus (range, 4.0 to 7.0°) in the post-primary radiographs and decreased in prerevision radiographs to 3.8 ± 2.6° (range, –1.0 to 7.5°), (p = 0.04).DiscussionTibial varus was associated with increased medial compartment wear and total wear, thus affecting osteolysis in addition to local destruction of the bearing surface. Varus malalignment as low as 3° may result in accelerated wear, even if overall limb alignment is nearly ideal. These results indicate that tibial component alignment is an important factor associated with tibial tray subsidence and polyethylene wear even when limb alignment is neutral.     

Contact pressure on ACL hamstring grafts in the bone tunnel with interference screw fixation--dynamic adaptation under load

IntroductionInterference screws used in fixation of anterior cruciate ligament (ACL) hamstring grafts create mechanical hold by forcing the graft into frictional contact with the bone tunnel. We analyzed the resultant graft–tunnel contact pressure using an in vitro model of human cadaver 8 mm hamstring grafts.MethodsContact characteristics were assessed using both pressure sensitive films and a force sensor. Two screw sizes were investigated (8 and 9 mm in an 8 mm Sawbone tunnel), both with and without a bone wedge between graft and screw. Separately, time dependent relaxation of contact force was recorded over a one hour epoch and associated tendon water loss was measured. Pullout testing of 8 mm tendon grafts from 8 mm holes in Sawbone and porcine femora were performed after 1 min and 1 h.ResultsDuring screw insertion, measured peak pressures (> 40 MPa) exceeded the compressive failure stress of metaphyseal bone by more than an order of magnitude. Using a bone wedge between tendon and screw reduced local peak pressure by 85% but produced also inferior average contact pressure. In all approaches, initially achieved graft contact pressure rapidly decreased to approximately 25% within 30 min. Pullout strength was significantly reduced after 1 h in comparison to 1 min in porcine bone as well as Sawbone.ConclusionViscoelastic adaptation of the tendon is severe and critically reduces effective graft–bone contact pressure. Consideration of this newly recognized effect may open new and improved approaches for tendon graft fixation.     

Biotribology of a vitamin E-stabilized polyethylene for hip arthroplasty – Influence of artificial ageing and third-body particles on wear

The objective of our study was to evaluate the influence of prolonged artificial ageing on oxidation resistance and the subsequent wear behaviour of vitamin E-stabilized, in comparison to standard and highly cross-linked remelted polyethylene (XLPE), and the degradation effect of third-body particles on highly cross-linked remelted polyethylene inlays in total hip arthroplasty. Hip wear simulation was performed with three different polyethylene inlay materials (standard: γ-irradiation 30 kGy, N₂; highly cross-linked and remelted: γ-irradiation 75 kGy, EO; highly cross-linked and vitamin E (0.1%) blended: electron beam 80 kGy, EO) machined from GUR 1020 in articulation with ceramic and cobalt–chromium heads. All polyethylene inserts beneath the virgin references were subjected to prolonged artificial ageing (70 °C, pure oxygen at 5 bar) with a duration of 2, 4, 5 or 6 weeks. In conclusion, after 2 weeks of artificial ageing, standard polyethylene shows substantially increased wear due to oxidative degradation, whereas highly cross-linked remelted polyethylene has a higher oxidation resistance. However, after enhanced artificial ageing for 5 weeks, remelted XLPE also starts oxidate, in correlation with increased wear. Vitamin E-stabilized polyethylene is effective in preventing oxidation after irradiation cross-linking even under prolonged artificial ageing for up to 6 weeks, resulting in a constant wear behaviour.     

Biotribology of a new bearing material combination in a rotating hinge knee articulation

The objective of the present study was to evaluate the biotribological behaviour, in terms of wear and particle release, of bushings and flanges made of carbon fibre reinforced poly-ether-ether-ketone (CFR-PEEK) in articulation with a zirconium nitride (ZrN) multilayer surface coating in a rotating hinge knee system. For the bushings of the rotational and flexion axles and the medial and lateral flanges, a CFR-PEEK with 30% polyacrylonitrile fibre content was used in a new bearing combination with ZrN. In vitro wear simulation was performed for patients with metal ion hypersensitivity, using a new rotating hinge knee design with a ZrN surface articulation in comparison with the clinically established cobalt–chromium version. For the bushings and flanges made of CFR-PEEK subjected to wear simulation, the volumetric wear rates were 2.3 ± 0.48 mm³ million^?1 cycles in articulation to cobalt–chromium as reference and 0.21 ± 0.02 mm³ million^?1 cycles in the coupling with ZrN, a 10.9-fold decrease. The released CFR-PEEK particles were comparable in size and shape for the coupling to cobalt–chromium and ZrN with most of the particles in a size range between 0.1 and 2 μm. The study reveals comparable low wear and no macroscopic surface fatigue in a new rotating hinge knee design with highly congruent flanges and axles bushings made of CFR-PEEK articulating to a ZrN multilayer surface coating. Favourable wear behaviour of the newly introduced CFR-PEEK/ZrN coupling in comparison with the clinically established CFR-PEEK/cobalt–chromium articulation was found.     

Inflammatory response against different carbon fiber-reinforced PEEK wear particles compared with UHMWPE in vivo

Poly(ether ether ketone) (PEEK) and its composites are recognized as alternative bearing materials for use in arthroplasty because of their mechanical properties. The objective of this project was to evaluate the biological response of two different kinds of carbon fiber-reinforced (CFR) PEEK compared with ultra-high molecular weight polyethylene (UHMWPE) in vivo as a standard bearing material. Wear particles of the particulate biomaterials were injected into the left knee joint of female BALB/c mice. Assessment of the synovial microcirculation using intravital fluorescence microscopy as well as histological evaluation of the synovial layer were performed 7 days after particle injection. Enhanced leukocyte–endothelial cell interactions and an increase in functional capillary density as well as histological investigations revealed that all tested biomaterials caused significantly (P < 0.05) increased inflammatory reactions compared with control animals (injected with sterile phosphate-buffered saline), without any difference between the tested biomaterials (P > 0.05). These data suggest that wear debris of CFR-PEEK is comparable with UHMWPE in its biological activity. Therefore, CFR-PEEK represents an alternative bearing material because of its superior mechanical and chemical behavior without any increased biological activity of the wear particles, compared with a standard bearing material.     

Effect of femoral to tibial varus mismatch on the contact area of unicondylar knee prostheses

In unicondylar knee prostheses, the relative angle and congruency of the femoral against the tibial component is not mechanically constrained and may vary with the surgical implantation technique.The contact area between both components was measured with increasing varus (0–20°) and flexion angles (? 20° to 90°) in five prosthesis models in the laboratory.The contact area varied with the relative position of the components and was critically reduced up to 70% at a varus range between > 5° and < 25°.The importance of relative malpositioning of the femoral and tibial components may be underestimated and reduces the contact area of unicondylar prostheses decisively, independent from the limb axis. This increases local pressure and may thus importantly contribute to increased wear and early loosening.     

The effect of cup inclination and wear on the contact mechanics and cement fixation for ultra high molecular weight polyethylene total hip replacements

The present study aimed to investigate individual and combined influences of the cup inclination and wear on the contact mechanics and fixation of a Charnley hip replacement using finite element method. The effects of cup inclination and penetration on the contact mechanics of articulating bearings as well as the stress within the cement and at the bone-cement interface were examined. The maximum contact pressure and the von Mises stress on the cup were reduced by ~30% and ~20% respectively when even a small penetration occurred. However, no large differences were found between different cup penetration depths with regards to either the contact pressure or the von Mises stress. The von Mises stress at the bone-cement interface was predicted almost unaltered with an increased cup inclination angle to 55° for a cup penetration to 4mm. These predictions suggest that the contact mechanics and the cement stress are insensitive to the cup inclination and wear under these normal conditions investigated, therefore explaining the robustness of the Charnley hip implant. An increase in the cup inclination angle to 65°, coupled with a maximum penetration of 4mm, resulted in a large increase in the maximum von Mises stress at the bone-cement interface.     

Wear rate evaluation of a novel polycarbonate-urethane cushion form bearing for artificial hip joints

There is growing interest in the use of compliant materials as an alternative to hard bearing materials such as polyethylene, metal and ceramics in artificial joints. Cushion form bearings based on polycarbonate-urethane (PCU) mimic the natural synovial joint more closely by promoting fluid-film lubrication. In the current study, we used a physiological simulator to evaluate the wear characteristics of a compliant PCU acetabular buffer, coupled against a cobalt–chrome femoral head. The wear rate was evaluated over 8 million cycles gravimetrically, as well as by wear particle isolation using filtration and bio-ferrography (BF). The gravimetric and BF methods showed a wear rate of 9.9–12.5 mg per million cycles, whereas filtration resulted in a lower wear rate of 5.8 mg per million cycles. Bio-ferrography was proven to be an effective method for the determination of wear characteristics of the PCU acetabular buffer. Specifically, it was found to be more sensitive towards the detection of wear particles compared to the conventional filtration method, and less prone to environmental fluctuations than the gravimetric method. PCU demonstrated a low particle generation rate (1–5 × 10⁶ particles per million cycles), with the majority (96.6%) of wear particle mass lying above the biologically active range, 0.2–10 μm. Thus, PCU offers a substantial advantage over traditional bearing materials, not only in its low wear rate, but also in its osteolytic potential.