[Residual particle free surfaces after shot peening in modular hip arthroplasty are feasible]. / Restpartikelfreie Oberflächen nach Stahlkugelstrahlen modularer Hüftendoprothesen sind erreichbar.

INTRODUCTION: Shot peening with steel balls is used for introduction of compressive stress in the production of morse taper junctions of modular hip endoprostheses. After this procedure, significant contamination with residual particles can be detected, which may lead to increased corrosion and third body wear. Additionally, the European norm EN 12010 requires surfaces free of residual particles. The aim of this study is to evaluate the effects of several cleaning procedures with regard to complying with EN 12010. MATERIAL AND METHOD: The surfaces of 12 Ti6Al7Nb rods with a diameter of 15 mm was shot peened with steel balls (GS VERA, Fa. Würth, Bad Friedrichshall, Germany). A field emission scanning electron microscopy (SEM, LEO 1525) was used for the detection of residual particles on the surface of the rods with a backscattered electron detector. After SEM examination, one sample each was cleaned using shot peening with sugar or dry ice and 10 rods using a pH dependent cleaning procedure. After these cleaning procedures, the samples were again analysed with the SEM for residual particle contamination. RESULTS: The surface of all rods showed a considerable contamination with steel particles after shot-peening with steel balls. After the cleaning procedure with dry ice or sugar steel contamination was lower, however, only the pH dependent cleaning procedure was able to achieve surfaces free of residual particles. DISCUSSION: For smooth shot-peened surfaces in modular hip arthroplasty Euro Norm EN 12010 can be fulfilled using shot peening with steel balls followed by a pH dependent cleaning procedure.

[The use of a thermomechanical cleaning procedure for removal of residual particles of corund blasted or glass bead peened implants in total hip arthoplasty]. / Die Anwendung eines thermomechanischen Reinigungsverfahrens zur Entfernung von Restpartikeln auf Oberflächen von korund- bzw. glasperlengestrahlten Hüftgelenkimplantaten.

INTRODUCTION: Shot peening and grit blasting techniques are used to modify surfaces of hip endoprostheses. Alumina blasting techniques using highly pure corund (Al (2)O (3)) particles create a rough surface of Titanium implants to achieve a better osteointegration in cementless total hip arthroplasty. An increasing number of publications in maxillo-facial-surgery and orthopedic surgery show that there is a significant contamination with remnants on corund blasted surfaces. To our knowledge no previous study analysed the effects of cleaning procedures of hip endoprostheses in respect to glass beads and Al (2)O (3) remnants. MATERIAL AND METHOD: The surface of the flexible anisotropic Vector cup and the stiff modular MRP-Titan stem (one implant each) were analysed with respect to Al (2)O (3) or glass particles before and after the cleaning procedure. The implants were cleaned using an ultrasound bath for 10 or 20 minutes under nitrogen cooling or simple ultrasound bath with water. A field emission scanning electron microscopy (LEO 1525) was used for the detection of the particles on the implant surface with a backscattered electron detector. The proportion of the surface covered with particles was determined with an imaging analyze software (analySIS, Soft Imaging System GmbH). RESULTS: A reduction of corund particles on the surface of the flexible anisotropic Vector cup of up to 5.2 % (from 40.0 % to 34.8 %) after 10 minutes nitrogen cooling was achieved. A reduction of corund particles on the surface of the stiff MRP-Titan stem of up to 2.2 % (from 38.8 % to 36.6 %) was observed after 20 minutes of non cooled ultrasound bath whereas a reduction up to 3.2 % (from 25.8 % to 22.6 %) of glass particles after 10 minutes of nitrogen cooled ultrasound bath was detected. CONCLUSION: With the cleaning procedure tested only incomplete removal of just the small glass and Al (2)O (3) particles is possible. Further research is needed to reduce or even avoid residual particles in total hip arthoplasty.

[Metallurgical differentiation of cobalt-chromium alloys for implants]. / Metallkundliche Differenzierung von Kobalt-Chrom-Legierungen für Implantate.

BACKGROUND: Cobalt Chromium alloys are used in cemented total hip or knee arthroplasty as well as in metal-on-metal bearings in total hip arthroplasty. An increasing number of publications report about (allergic) reactions to wear particles of Cobalt Chromium alloys. Reactions to nickel are more frequent in comparison to Cobalt or Chromium particles. It is well known that different kinds of Cobalt Chromium alloys contain different amounts of alloying elements; nevertheless. The aim of the current work was to compare the different Cobalt Chromium alloys according to ASTM F or ISO standards in respect to the different alloying elements. MATERIAL AND METHODS: Co28Cr6Mo casting alloys according to ASTM F 75 or ISO 5832-4 as well as forging alloy types according to ASTM F 799 and ISO 5832 such as Co20Cr15W10Ni, Co35Ni20Cr, Fe40Co20Cr10Ni, Co20Cr20Ni, and Co28Cr6Mo were analyzed in respect to their element content of Co, Cr, Ni, Mo, Fe, W, and Mn. RESULTS: In 1935 the Cobalt based alloy "Vitallium" Co30Cr5Mo basically used in the aircraft industry was introduced into medicine. The chemical composition of this alloy based on Cobalt showed 30 wt.% Chromium and 5 wt.% Molybdenum. The differentiation using alloy names showed no Nickel information in single alloy names. CONCLUSION: The information given about different alloys can lead to an unprecise evaluation of histopathological findings in respect to alloys or alloying constituents. Therefore, implant manufacturers should give the exact information about the alloys used and adhere to European law, Euronorm 93/42/EWG.

[Allergic potential of titanium implants]. / Das Allergiepotenzial von Implantatwerkstoffen auf Titanbasis.

AIM: The aim of this investigation is to evaluate the allergic potential of titanium and titanium alloys for surgical implant applications. MATERIALS AND METHODS: Discs cut from rods supplied by five different titanium suppliers in several diameters were investigated. The samples were cp-Titanium as well as Ti6Al4 V and Ti6Al7Nb, 6 mm thick with a diameter of between 6 and 60 mm. The material was checked by optical spectral analysis. RESULTS: In all samples except iodidtitanium, a Nickel content of 0.012-0,034 wt% could be detected. CONCLUSION: The low nickel content in the implant material results from the production process. The nickel atoms are in solid solution in the titanium lattice. Nickel allergic patients may develop hypersensitivity reactions even due to this low nickel content. Hence, this reaction may be falsely attributed to the titanium material itself. Measurements of ion concentration in the body are helpful for quantifying the maximum content of nickel in titanium materials for surgical implant applications. In addition, technical questions related to the production of nickel free titanium materials for allergic patients have to be solved.

[Residual particle free rough surfaces after rough blasting with steel grit in total hip arthroplasty]. / Restpartikelfreie raue Oberflächen nach Stahldrahtkornstrahlen in der Hüftendoprothetik.

INTRODUCTION: Several shot peening and grit blasting techniques are used to modify the surface in the production of hip endoprostheses. A number of publications in maxillo- facial- surgery and orthopedic surgery demonstrated significant contamination on alumina blasted surfaces. Latest research studies suspected an association between surface contamination and early failure of endoprostheses associated with third body wear. Additionally, the European standard EN 12010 requires surfaces free of residual particles. The aim of this study is to evaluate the effects of rough blasting using steel grit followed by a pH dependent cleaning procedures with regard to complying with EN 12010. MATERIAL AND METHOD: Ti6Al7Nb rods were rough blasted 1 time using steel grit ("Stahldrahtkorn", hardness: 56 HRC; R+K Draht GmbH, Leisnig). All blasting procedures were carried out with a special grit blasting device with direct pressure. One Ti6Al7Nb rod each was grit blasted with 3 and 4 bar pressure and 10 rods with 5 bar pressure. Surface roughness was measured by means of Mitutoyo- Surftest 301 three times before and after grit blasting. The mean value was calculated. A field emission scanning electron microscopy (SEM, LEO 1525) was used for the detection of residual particles on the surface of the rods with a backscattered electron detector. RESULTS: By rough blasting using steel grit a mean roughness of 54,9 microm and a maximum roughness of 61,4 microm could be achieved. The surface of all rods showed a considerable contamination with steel particles after grit blasting. After the a pH- dependent cleaning procedure a residual particle free surface was detected in all samples. DISCUSSION: The European standard EN 12010 can be fulfilled using rough blasting with steel grit followed by a pH dependent cleaning procedure.

[Surface characterisation of shot peened implants with glas beads in total hip arthroplasty]. / Oberflächenuntersuchungen an Glaskugel-gestrahlten Titanimplantaten in der Hüftendoprothetik.

UNLABELLED: Alumina-blasting is used to create a rougher surface of Titanium implants in cementless total hip arthroplasty to achieve a better bony ingrowth. An increasing number of publications in maxillofacial surgery and orthopaedic surgery show that there is a significant contamination in Alumina blasted surfaces. Latest research published an effect of contaminant particles on early loosening of endoprostheses associated with third body wear. Due to our knowledge no previous study analysed surface contamination of hip endoprostheses with glass beads. Aim of our work was to evaluate the percentage of contaminated surface of hip endoprostheses with glass beads. MATERIAL AND METHOD: The surface of 5 Ti-VPS sprayed Phoenix cups and 5 morse-taper-junctions of the MRP-Titan revision stem (Peter Brehm, Chirurgie Mechanik, Weisendorf) were analysed with respect to glass particles. Shot peening was performed with glass beads "BALLOTINI" MGL, Fa. Würth Strahlmittel. A field emission scanning electron microscopy (LEO 1525) was used for the detection of the glass-particles on the implant surface with a backscattered electron detector. The particle covering position was calculated by means of an imaging analyze software (analySIS, Soft Imaging System GmbH). RESULTS: The surface of the Ti-VPS sprayed Phoenix cups showed a contaminated area at a mean of 9.2 +/- 1.3 %, morse-taper-junctions of the MRP-Titan stem at a mean of 9.6 +/- 2.1 % with glass particle contact. DISCUSSION: The results of this study clearly show that there is a contamination of shot pinned Titanium surfaces with glass particles in a significant percentage. With respect to third body wear in total hip arthroplasty further studies are necessary to minimize contamination.

[Titanium deposits on the ceramic heads of dislocated total hip replacements]. / Titanauflagerungen auf Keramikköpfen bei luxierten Hüftendoprothesen.

INTRODUCTION: In cases of revision total hip replacement (THR) having acetabular titanium components with dislocations in the past, metallic deposits are frequently found on the ceramic heads. The aim of this study was to determine whether the metallic deposits increase surface roughness in definite areas. MATERIALS AND METHODS: Ten ceramic heads of revised THR which showed metallic deposits were investigated. The patients suffered from one to six dislocations. The prosthesis lifetime ranged from 2 weeks to 12 years. Surface structure was investigated in a scanning electron microscope (LEO 1525), and the metallic deposits characterised by means of energy dispersive x-ray analysis (EDX). RESULTS: In the area of the metallic deposits, titanium was detected by EDX. Edges with a significant increase in surface roughness were observed, partially accompanied by damage to the surface structure and loosening of Al(2)O(3) particles. DISCUSSION: Titanium deposits increase surface roughness in definite areas, which probably causes wear to the ceramic-ceramic or ceramic-polyethylene articulations due to different roughness values and surface properties. Further investigations are necessary in order to determine the importance of these findings with respect to wear and loosening of total hip arthroplasty.

[Surface characterization of Al2O3-blasted titanium implants in total hip arthroplasty]. / Oberflächenuntersuchungen an Al2O3-raugestrahlten Titanimplantaten in der Hüftendoprothetik.

INTRODUCTION: Shot peening and grit blasting techniques are used in several surface modifications for producing hip endoprostheses. Corund blasting techniques using highly pure Al2O3 particles to create a rough surface of titanium implants in cementless total hip arthroplasty achieve better osteointegration. An increasing number of publications in maxillofacial surgery and orthopedic surgery show that there is a significant contamination on corund-blasted surfaces. The latest research studies reported an effect of contaminant particles on early failure of endoprostheses associated with third body wear. The aim of our work was to evaluate the amount and particle size of Al2O3 on the implant surface. MATERIAL AND METHOD: The surface of four different geometries (five parts each, ARR titanium acetabular reinforcement ring, anisotropic Vektor cup, Vektor titanium stem and modular MRP Titan stem) were analyzed with respect to Al2O3 particles. Grit blasting was performed with Al2O3 particles, Alodur SWSK, Fa. Treibacher. Field emission scanning electron microscopy (LEO 1525) was used for the detection of the Al2O3 particles at the implant surface with a backscattered electron detector. The particle size distribution as well as the average area of the covered surface was calculated with image analyzing software (analySIS, Soft Imaging System GmbH). RESULTS: The surface of the anisotropic Vektor cup was contaminated at an average of 41.7+/-4.9%, the Vektor titanium stem at an average of 33.3+/-4.7%, the (MRP) Titan stem at an average of 30.6+/-4.2%, and the ARR titanium acetabular reinforcement ring at an average of 23.2+/-1.6 with Al2O3 particles over the whole surface orientated to the bone. DISCUSSION: The results of this study clearly show that there is contamination of rough titanium surfaces with Al2O3 particles at an unexpectedly high percentage. With respect to third body wear in total hip arthroplasty, further studies are necessary to minimize contamination of roughened surfaces and maintain sufficient roughness for osteointegration.

Granulocytopenia with marked lymphocytosis manifesting Sjogren syndrome.

Sjogren syndrome is a multi-system disease leading to diverse organ involvement during its course [1, 2]. Hematologic abnormalities described in Sjogren syndrome include anemia, mild leukopenia [3, 4], eosinophilia, elevated erythrocyte sedimentation rate, hypergammaglobulinemia, mixed cryoglobulinemia, and a variety of autoantibodies [5]. Marked lymphocytosis with granulocytopenia is distinctly unusual and has not been previously reported. We report a case of Sjogren syndrome who presented with constellation of the latter problems without prominent sicca manifestations.