The effect of tranexamic acid on artificial joint materials: a biomechanical study (the bioTRANX study).

BACKGROUND: Tranexamic acid (TXA) has been successfully used to reduce bleeding in joint replacement. Recently local TXA has been advocated to reduce blood loss in total knee or hip replacement; however, this raised concerns about potential adverse effects of TXA upon the artificial joint replacement. MATERIALS AND METHODS: In this biomechanical study we compared the effects of TXA and saline upon the following biomechanical properties of artificial joint materials-(1) tensile properties (ultimate strength, stiffness and Young's modulus), (2) the wear rate using a multi-directional pin-on-plate machine, and (3) the surface topography of pins and plates before and after wear rate testing. RESULTS: There were no significant differences in tensile strength, wear rates or surface topography of either ultra-high-molecular-weight polyethylene pins or cobalt chromium molybdenum metal plates between specimens soaked in TXA and specimens soaked in saline. CONCLUSION: Biomechanical testing shows that there are no biomechanical adverse affects on the properties of common artificial joint materials from using topical TXA. LEVEL OF EVIDENCE: V.

Retrieval analysis of alumina ceramic-on-ceramic bearing couples.

BACKGROUND AND PURPOSE: Ceramic-on-ceramic (CoC) bearings have been in use in total hip replacement (THR) for more than 40 years, with excellent long-term survivorship. Although there have been several simulator studies describing the performance of these joints, there have only been a few retrieval analyses. The aim of this study was to investigate the wear patterns, the surface properties, and friction and lubrication regimes of explanted first-generation alumina bearings. MATERIALS AND METHODS: We studied 9 explanted CoC bearings from Autophor THRs that were revised for aseptic loosening after a mean of 16 (range 7-19) years. The 3D surface roughness profiles of the femoral heads and acetabular cups (Srms, Sa, and Ssk) were measured to determine the microscopic wear. The bearings were imaged using an atomic-force microscope in contact mode, to produce a topographical map of the surfaces of the femoral heads. Friction tests were performed on the bearing couples to determine the lubrication regime under which they were operating during the walking cycle. The diametral clearances were also measured. RESULTS: 3 femoral heads showed stripe wear and the remaining 6 bearings showed minimal wear. The femoral heads with stripe wear had significantly higher surface roughness than the minimally worn bearings (0.645 vs. 0.289, p = 0.04). High diametral clearances, higher than expected friction, and mixed/boundary lubrication regimes prevailed in these retrieved bearings. INTERPRETATION: Despite the less than ideal tribological factors, these first-generation CoC bearings still showed minimal wear in the long term compared to previous retrieval analyses.

Biotribological study of large diameter ceramic-on-CFR-PEEK hip joint including fluid uptake, wear and frictional heating.

A novel material combination of a large diameter Biolox(®) Delta zirconia-toughened-alumina (ZTA) head and a pitch-based carbon fibre reinforced poly ether-ether-ketone (CFR-PEEK) MOTIS(®) cup has been studied. The acetabular cups were inclined at three angles and tested using Durham Hip Simulators. The different inclination angles used did not have a significant effect on the wear rates (ANOVA, p = 0.646). Averaged over all cups, the wear rates were calculated to be 0.551 ± 0.115 mm(3)/10(6) cycles and 0.493 ± 0.107 mm(3)/10(6) cycles taking into account two types of soak controls; loaded at room temperature and unloaded at 37 °C respectively. Averaged across all femoral heads, the wear rate was 0.243 ± 0.031 mm(3)/10(6) cycles. The temperature change of the lubricant caused by the frictional heat was measured in situ. Friction factors measured using the Durham Friction Simulator were lower for the worn CFR-PEEK cups compared with unworn. This correlated with the decreased surface roughness. Even though relatively high friction was observed in these hemispherical hard-on-soft bearings, the wear rate is encouragingly low.

Some aspects of frictional measurements in hip joint simulators.

The measurement of friction in artificial hip joints can lead to the knowledge of the lubrication mechanisms occurring in the joints. However, the measurement of friction, particularly in spherical contacts, is not always straightforward. The important loading and kinematic features must be appropriate and the friction must be measured in the correct plane. Even defining a coefficient of friction is difficult with spherical contacts as friction acts at different moment arms throughout the contact area. Thus, the generated frictional torques depend on the pressure distribution of the contact and the moment arms at which this pressure acts. The pressure distribution depends on the material properties, the surface entraining velocities, the joint diameters, and the clearance between the two surfaces of the ball and socket joint. Equally measuring friction is very taxing for machines which are applying very high loads. Slight misalignments of the application of these loads can produce torques which are very much greater than the frictional torques that we are trying to measure. This article attempts to share the thoughts behind over 40 years of measuring friction in artificial joints using the Durham Friction Simulators. This has led to accrued consistency of measurement and a robust scientific design rationale to understand the nature of friction in these spherical contacts. It also impacts on how to obtain accurate measurements as well as on the understanding of where the difficult issues lie and how to overcome them.

Wear of PEEK-OPTIMA® and PEEK-OPTIMA®-Wear Performance articulating against highly cross-linked polyethylene.

The idea of all polymer artificial joints, particularly for the knee and finger, has been raised several times in the past 20 years. This is partly because of weight but also to reduce stress shielding in the bone when stiffer materials such as metals or ceramics are used. With this in mind, pin-on-plate studies of various polyetheretherketone preparations against highly cross-linked polyethylene were conducted to investigate the possibility of using such a combination in the design of a new generation of artificial joints. PEEK-OPTIMA(®) (no fibre) against highly cross-linked polyethylene gave very low wear factors of 0.0384 × 10(-6) mm(3)/N m for the polyetheretherketone pins and -0.025 × 10(-6) mm(3)/N m for the highly cross-linked polyethylene plates. The carbon-fibre-reinforced polyetheretherketone (PEEK-OPTIMA(®)-Wear Performance) also produced very low wear rates in the polyetheretherketone pins but produced very high wear in the highly cross-linked polyethylene, as might have been predicted since the carbon fibres are quite abrasive. When the fibres were predominantly tangential to the sliding plane, the mean wear factor was 0.052 × 10(-6) mm(3)/N m for the pins and 49.3 × 10(-6) mm(3)/N m for the highly cross-linked polyethylene plates; a half of that when the fibres ran axially in the pins (0.138 × 10(-6) mm(3)/N m for the pins and 97.5 × 10(-6) mm/ N m for the cross-linked polyethylene plates). PEEK-OPTIMA(®) against highly cross-linked polyethylene merits further investigation.

In vitro wear testing of the PyroCarbon proximal interphalangeal joint replacement: Five million cycles of flexion and extension.

Clinical results of the PyroCarbon proximal interphalangeal joint replacement are inconsistent with various complications reported. To address this, in vitro testing was conducted using finger joint simulators. Two PyroCarbon proximal interphalangeal prostheses were tested in a lubricant of dilute bovine serum to 5 × 10(6) cycles of flexion-extension (90°-30°) with dynamic forces of 10 N applied. At intervals of 3000 cycles testing ceased and a static load of 100 N was applied to simulate gripping. In addition, two 'control' prostheses were immersed alongside the test prostheses to account for lubricant absorption. Wear and roughness averages (Ra) were measured every 1 × 10(6) cycles. Minimal wear for all of the components was measured with a negligible increase in Ra for most of the components. One condyle of one component increased in Ra over the 5 × 10(6) cycles with a value above the recommended 50 nm. Unidirectional marks were visible on the condyle from micrographs, consistent with an abrasive wear mode.

The nature and dissemination of UHMWPE wear debris retrieved from periprosthetic tissue of THR.

The role of wear debris in provoking joint replacement failure through bone resorption is now supported by much research. This study presents the analysis of 104 tissue samples using laser diffraction wear particle analysis in conjunction with standard histologic methods. The number and volume distributions were correlated to a range of joint and patient parameters. The median particle diameter by number was 0.69 microm. No particles smaller than 0.113 microm were resolved. No variation in terms of particle distribution was found among joint types. The ability of particles to migrate away from their point of origin was found to be inversely proportional to their size. The numbers of particles per gram of tissue found in various regions around the prosthesis varied little. Further, the numbers of particles in tissue samples shown to have a chronic foreign-body reaction was > 1 x 10(9) particles/gram.

The influence of nominal stress on wear factors of carbon fibre-reinforced polyetheretherketone (PEEK-OPTIMA® Wear Performance) against zirconia toughened alumina (Biolox® delta ceramic).

Carbon fibre-reinforced polyetheretherketone is an attractive alternative to ultra-high-molecular-weight polyethylene in artificial joints, but little has been published on the influence of stress on the wear factor. We know that in ultra-high-molecular-weight polyethylene, the wear factor reduces as the normal stress increases, which is counter-intuitive but very helpful in the case of non-conforming contacts. In this study, carbon fibre-reinforced polyetheretherketone (PEEK-OPTIMA® Wear Performance) has been investigated in a pin-on-plate machine under steady loads and under stresses typical of hip and knee joints. At stresses below about 6 MPa, wear factors are between 10 and a 100 times lower than for ultra-high-molecular-weight polyethylene but at higher stresses the wear factors increase substantially.

Does surface wettability influence the friction and wear of large-diameter CoCrMo alloy hip resurfacings?

The role of surface tension in the lubrication of metal-on-metal (CoCrMo alloy) hip resurfacings has been investigated to try to explain why all metal joints fail to be lubricated with simple water-based lubricants (sodium carboxymethyl cellulose), which have similar rheology to synovial fluid, but are lubricated with the same fluid with the addition of a proportion of bovine serum. As part of this study, surfactants, in the form of detergents, when added to carboxymethyl cellulose, have been shown to produce a predominantly fluid-film lubrication mechanism with friction even lower than the biological lubricant containing serum. Friction factors were reduced by 80% when a detergent was added to the lubricant. It is considered that the failure of the water-based fluids to generate fluid-film lubrication is due to the fact that 'boundary slip' takes place where the fluid does not fully attach to the bounding solid surfaces as assumed in Reynolds' equation, thereby drawing in less lubricant than predicted from hydrodynamic theory. The addition of surfactants either in the form of natural materials such as serum or in the form of detergent reduces surface tension and helps the water-based lubricant to attach more fully to the bounding surfaces resulting in more fluid entrainment and thicker fluid-film formation. This was confirmed by up to 70% lower wear being found when these joints were lubricated in a detergent solution rather than 25% bovine serum.