Redesigning Metal Interference Screws Can Improve Ease of Insertion While Maintaining Fixation of Soft-Tissue Anterior Cruciate Ligament Reconstruction Grafts.

PURPOSE: To compare the fixation strength and loads on insertion of a titanium alloy interference screw with a modified tip against a conventional titanium interference screw. METHODS: Slippage of bovine digital extensor tendons (as substitutes for human tendon grafts) under cyclic loading and interference fixation strength under a pullout test were recorded in 10 cadaveric knees, with 2 tunnels drilled in each femur and tibia to provide pair-wise comparisons between the modified-tip screw (MS) and conventional screw (CS). To analyze screw insertion, 10 surgeons blindly inserted pairs of the MS and CS into bone-substitute blocks (with polyester shoelaces as graft substitutes), with insertion loads measured using a force/torque sensor. RESULTS: No differences were found between the MS and CS either in graft slippage from the femur (P = .661) or tibia (P = .950) or in ultimate load to failure from the femur (P = .952) or tibia (P = .126). On insertion, the MS required less axial force application (78 ± 38 N, P = .001) and fewer attempted turns (2 ± 1, P < .001) to engage with the bone tunnel than the CS (99 ± 43 N and 4 ± 4, respectively). In 90% of the paired insertion tests, the screw identified by the surgeon as being easier to initially insert was the MS. CONCLUSIONS: The MS was found to be easier to engage with the bone tunnel and initially insert than the CS while still achieving similar immediate postsurgical fixation strength. CLINICAL RELEVANCE: The study shows that screw designs can be improved to ease insertion into a bone tunnel, which should reduce any likelihood of ligament reconstruction graft damage.

Tribological evaluation of biomedical polycarbonate urethanes against articular cartilage.

This research investigated the in-vitro wear and friction performance of polycarbonate urethane (PCU) 80A as they interact with articular cartilage, using a customised multidirectional pin-on-plate tester. Condyles were articulated against PCU 80A discs (Bionate® I and Bionate® II) (configuration 1) and the results arising from these tests were compared to those recorded during the sliding of PCU pins against cartilage plates (configuration 2). Configuration 1 produced steadily increasing coefficient of friction (COF) (up to 0.64 ±â€¯0.05) and had the same trend as the cartilage-on-stainless steel articulation (positive control). When synovial fluid rather than bovine calf serum was used as lubricant, average COF significantly decreased from 0.50 ±â€¯0.02-0.38 ±â€¯0.06 for condyle-on-Bionate® I (80AI) and from 0.41 ±â€¯0.02-0.24 ±â€¯0.04 for condyle-on-Bionate® II (80AII) test configurations (p < 0.05). After 15 h testing, the cartilage-on-cartilage articulation (negative control) tests showed no cartilage degeneration. However, different levels of cartilage volume loss were found on the condyles from the positive control (12.5 ±â€¯4.2 mm3) and the PCUs (20.1 ±â€¯3.6 mm3 for 80 AI and 19.0 ±â€¯2.3 mm3 for 80AII) (p > 0.05). A good correlation (R2 =0.84) was found between the levels of average COF and the volume of cartilage lost during testing; increasing wear was found at higher levels of COF. Configuration 2 showed low and constant COF values (0.04 ±â€¯0.01), which were closer to the negative control (0.03 ±â€¯0.01) and significantly lower than configuration 1 (p < 0.05). The investigation showed that PCU is a good candidate for use in hemiarthroplasty components, where only one of the two articulating surfaces is replaced, as long as the synthetic material is implanted in a region where migrating cartilage contact is achieved. Bionate® II showed better tribological performance, which suggests it is more favourable for use in hemiarthroplasty design.

Additive manufactured push-fit implant fixation with screw-strength pull out.

Additive manufacturing offers exciting new possibilities for improving long-term metallic implant fixation in bone through enabling open porous structures for bony ingrowth. The aim of this research was to investigate how the technology could also improve initial fixation, a precursor to successful long-term fixation. A new barbed fixation mechanism, relying on flexible struts was proposed and manufactured as a push-fit peg. The technology was optimized using a synthetic bone model and compared with conventional press-fit peg controls tested over a range of interference fits. Optimum designs, achieving maximum pull-out force, were subsequently tested in a cadaveric femoral condyle model. The barbed fixation surface provided more than double the pull-out force for less than a third of the insertion force compared to the best performing conventional press-fit peg (p < 0.001). Indeed, it provided screw-strength pull out from a push-fit device (1,124 ± 146 N). This step change in implant fixation potential offers new capabilities for low profile, minimally invasive implant design, while providing new options to simplify surgery, allowing for one-piece push-fit components with high levels of initial stability. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:1508-1518, 2018.

Tribological properties of PVA/PVP blend hydrogels against articular cartilage.

This research investigated in-vitro tribological performance of the articulation of cartilage-on- polyvinyl alcohol (PVA) and polyvinyl pyrrolidone (PVP) blend hydrogels using a custom-designed multi-directional wear rig. The hydrogels were prepared by repeated freezing-thawing cycles at different concentrations and PVA to PVP fractions at a given concentration. PVA/PVP blend hydrogels showed low coefficient of friction (COF) values (between 0.12 ± 0.01 and 0.14 ± 0.02) which were closer to the cartilage-on-cartilage articulation (0.03 ± 0.01) compared to the cartilage-on-stainless steel articulation (0.46 ± 0.06). The COF increased with increasing hydrogel concentration (p = 0.03) and decreasing PVP content at a given concentration (p < 0.05). The cartilage-on-hydrogel tests showed only the surface layers of the cartilage being removed (average volume loss of the condyles was 12.5 ± 4.2mm3). However, the hydrogels were found to be worn/deformed. The hydrogels prepared at a higher concentration showed lower apparent volume loss. A strong correlation (R2 = 0.94) was found between the COF and compressive moduli of the hydrogel groups, resulting from decreasing contact congruency. It was concluded that the hydrogels were promising as hemiarthroplasty materials, but that improved mechanical behaviour was required for clinical use.

A low friction, biphasic and boundary lubricating hydrogel for cartilage replacement.

Partial joint repair is a surgical procedure where an artificial material is used to replace localised chondral damage. These artificial bearing surfaces must articulate against cartilage, but current materials do not replicate both the biphasic and boundary lubrication mechanisms of cartilage. A research challenge therefore exists to provide a material that mimics both boundary and biphasic lubrication mechanisms of cartilage. In this work a polymeric network of a biomimetic boundary lubricant, poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC), was incorporated into an ultra-tough double network (DN) biphasic (water phase + polymer phase) gel, to form a PMPC triple network (PMPC TN) hydrogel with boundary and biphasic lubrication capability. The presence of this third network of MPC was confirmed using ATR-FTIR. The PMPC TN hydrogel had a yield stress of 26 MPa, which is an order of magnitude higher than the peak stresses found in the native human knee. A preliminary pin on plate tribology study was performed where both the DN and PMPC TN hydrogels experienced a reduction in friction with increasing sliding speed which is consistent with biphasic lubrication. In the physiological sliding speed range, the PMPC TN hydrogel halved the friction compared to the DN hydrogel indicating the boundary lubricating PMPC network was working. A biocompatible, tough, strong and chondral lubrication imitating PMPC TN hydrogel was synthesised in this work. By complementing the biphasic and boundary lubrication mechanisms of cartilage, PMPC TN hydrogel could reduce the reported incidence of chondral damage opposite partial joint repair implants, and therefore increase the clinical efficacy of partial joint repair. STATEMENT OF SIGNIFICANCE: This paper presents the synthesis, characterisation and preliminary tribological testing of a new biomaterial that aims to recreate the primary chondral lubrication mechanisms: boundary and biphasic lubrication. This work has demonstrated that the introduction of an established zwitterionic, biomimetic boundary lubricant can improve the frictional properties of an ultra-tough hydrogel. This new biomaterial, when used as a partial joint replacement bearing material, may help avoid damage to the opposing chondral surface-which has been reported as an issue for other non-biomimetic partial joint replacement materials. Alongside the synthesis of a novel biomaterial focused on complementing the lubrication mechanisms of cartilage, your readership will gain insights into effective mechanical and tribological testing methods and materials characterisation methods for their own biomaterials.