Bilateral neck fracture in bimodular femoral stem after primary total hip arthroplasty: a case report.

BACKGROUND: Bi-modular stems were introduced in primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. Despite numerous reports on modular femoral neck fractures, some designs are still marketed worldwide. While the risk factors for the sudden failure are multifactorial and mostly known, the timing of this new THA complication is not predictable by any means. CASE PRESENTATION: In this report, the literature regarding one of the most popular bi-modular stems with specific neck-stem coupling (oval Morse taper) is reviewed and illustrated with a case of bilateral modular neck fracture in a patient with idiopathic aseptic necrosis of femoral heads treated with primary bi-modular THA. Because of bilateral modular femoral neck fracture, which occurred 3 years on the left side and 20 years after implantation on the right side, the patient required a total of 6 revisions and 208 days of hospitalized care. CONCLUSION: To our knowledge, this is the first report of bilateral modular neck fracture in a single patient. Even though the same surgeon performed both operations and used the same neck length and orientation, fractures occurred with a 17-year time difference after implantation. This shows that we cannot predict with certainty when a fracture might occur. Orthopaedic surgeons should use bi-modular stem designs for primary THA very cautiously.

Modular femoral neck failure after revision of a total hip arthroplasty: a finite element analysis.

The authors report on a case of modular femoral neck fracture which appeared 21 months after revision of acetabular component. The revision surgery was performed 8 years after the primary total hip arthroplasty due to aseptic loosening of the acetabular component. During acetabular revision, the primary implanted short (S, - 3.5 mm) femoral head was also exchanged with extra-long (XL, + 7.0 mm) femoral head fitting the modular femoral neck with a longer lever arm. Numerical analysis has shown that this has resulted in a 19.9% increase in tensile stress at the neck-stem coupling during normal walking cycle. This could result in microcrack initiation and propagation and finally lead to modular neck failure of the otherwise well-fixed stem. Surgeons should avoid excessive loading of the exchangeable neck (dual-modular) femoral stem designs as the stem-neck couplings are subject to corrosion and are not as reliable as monoblock stems.

The Effects of Ozone Sterilization on the Chemical and Mechanical Properties of 3D-Printed Biocompatible PMMA.

Since ozone is highly corrosive, it can substantially affect the mechanical and chemical properties of the materials; consequently, it could affect the applicability of those materials in medical applications. The effect of ozone sterilization on the chemical and mechanical properties of additively manufactured specimens of biocompatible poly(methyl-methacrylate) was observed. FDM 3D-printed specimens of biocompatible PMMA in groups of five were exposed to high concentrations of ozone generated by corona discharge for different durations and at different ozone concentrations inside an enclosed chamber with embedded and calibrated ozone, temperature, and humidity sensors. A novel approach using laser-induced fluorescence (LIF) and spark-discharge optical emission spectrometry (SD-OES) was used to determine an eventual change in the chemical composition of specimens. Mechanical properties were determined by testing the tensile strength and Young's modulus. A calibrated digital microscope was used to observe the eventual degradation of material on the surface of the specimens. SD-OES and LIF analysis results do not show any detectable sterilization-caused chemical degradation, and no substantial difference in mechanical properties was detected. There was no detectable surface degradation observed under the digital microscope. The results obtained suggest that ozone sterilization appears to be a suitable technique for sterilizing PMMA medical devices.

Intrinsic Fatigue Limit and the Minimum Fatigue Crack Growth Threshold.

In the field of long-life fatigue, predicting fatigue lives and limits for mechanical components is crucial for ensuring reliability and safety. Fracture mechanics tools have enabled the estimation of fatigue lives for components with small cracks or defects. However, when dealing with defects larger than the microstructural characteristic size, estimating the fatigue resistance of a material requires determining the cyclic resistance curve for the defect-free matrix, which depends on knowledge of the material's intrinsic fatigue limit. This study focuses on the experimental evidence regarding the intrinsic fatigue limit and its correlation with naturally nucleated non-propagating cracks. Fracture mechanics models for small crack propagation are introduced, and their disparities and limitations are analyzed. The concept of intrinsic fatigue limit is then introduced and applied to reanalyze a recent publication. Methods for estimating the intrinsic fatigue limit are explored and applied to experimental results reported in the literature. The need to clarify and accurately predict the intrinsic fatigue limit is highlighted in alloys where the processing generates defects larger than the microstructural size of the matrix, as often observed in materials and components produced using additive manufacturing.

Experimental and Numerical Analysis of Fracture Mechanics Behavior of Heterogeneous Zones in S690QL1 Grade High Strength Steel (HSS) Welded Joint.

The heterogeneity of welded joints' microstructure affects their mechanical properties, which can vary significantly in relation to specific weld zones. Given the dimensional limitations of the available test volumes of such material zones, the determination of mechanical properties presents a certain challenge. The paper investigates X welded joint of S690QL1 grade high strength steel (HSS), welded with slightly overmatching filler metal. The experimental work is focused on tensile testing to obtain stress-strain properties, as well as fracture mechanics testing. Considering the aforementioned limitations of the material test volume, tensile testing is carried out with mini tensile specimens (MTS), determining stress-strain curves for each characteristic weld zone. Fracture mechanical testing is carried out to determine the fracture toughness using the characteristic parameters. The experimental investigation is carried out using the single edge notch bend (SENB) specimens located in several characteristic welded joint zones: base metal (BM), heat affected zone (HAZ), and weld metal (WM). Fractographic analysis provides deeper insight into crack behavior in relation to specific weld zones. The numerical simulations are carried out in order to describe the fracture behavior of SENB specimens. Damage initiation and evolution is simulated using the ductile damage material behavior. This paper demonstrates the possibility of experimental and numerical determination of fracture mechanics behavior of characteristic heterogeneous welded joint zones and their influence on crack path growth.

Modelling of Fatigue Microfracture in Porous Sintered Steel Using a Phase-Field Method.

Porosity in sintered materials negatively affects its fatigue properties. In investigating its influence, the application of numerical simulations reduces experimental testing, but they are computationally very expensive. In this work, the application of a relatively simple numerical phase-field (PF) model for fatigue fracture is proposed for estimation of the fatigue life of sintered steels by analysis of microcrack evolution. A model for brittle fracture and a new cycle skipping algorithm are used to reduce computational costs. A multiphase sintered steel, consisting of bainite and ferrite, is examined. Detailed finite element models of the microstructure are generated from high-resolution metallography images. Microstructural elastic material parameters are obtained using instrumented indentation, while fracture model parameters are estimated from experimental S-N curves. Numerical results obtained for monotonous and fatigue fracture are compared with data from experimental measurements. The proposed methodology is able to capture some important fracture phenomena in the considered material, such as the initiation of the first damage in the microstructure, the forming of larger cracks at the macroscopic level, and the total life in a high cycle fatigue regime. However, due to the adopted simplifications, the model is not suitable for predicting accurate and realistic crack patterns of microcracks.

Effects of Fixture Configurations and Weld Strength Mismatch on J-Integral Calculation Procedure for SE(B) Specimens.

This work presents the development of a J-integral estimation procedure for deep and shallow cracked bend specimens based upon plastic ηpl factors for a butt weld made in an S690 QL high strength low alloyed steel. Experimental procedures include the characterization of average material properties by tensile testing and evaluation of base and weld metal resistance to stable tearing by fracture testing of square SE(B) specimens containing a weld centerline notch. J-integral has been estimated from plastic work using a single specimen approach and the normalization data reduction technique. A comprehensive parametric finite element study has been conducted to calibrate plastic factor ηpl and geometry factor λ for various fixture and weld configurations, while a corresponding plastic factor γpl was computed on the basis of the former two. The modified ηpl and γpl factors were then incorporated in the J computation procedure given by the ASTM E1820 standard, for evaluation of the plastic component of J and its corresponding correction due to crack growth, respectively. Two kinds of J-R curves were computed on the basis of modified and standard ηpl and γpl factors, where the latter are given by ASTM E1820. A comparison of produced J-R curves for the base material revealed that variations in specimen fixtures can lead to ≈10% overestimation of computed fracture toughness JIc. Furthermore, a comparison of J-R curves for overmatched single-material idealized welds revealed that the application of standard ηpl and γpl factors can lead to the overestimation of computed fracture toughness JIc by more than 10%. Similar observations are made for undermatched single material idealized welds, where fracture toughness JIc is overestimated by ≈5%.

Total Knee Replacement with an Uncemented Porous Tantalum Tibia Component: A Failure Analysis.

Porous tantalum has been extensively used in orthopaedic surgery, including uncemented total knee arthroplasty (TKA). Favourable results were reported with earlier monobloc tibial components and the design evolved to modular implants. We aimed to analyse possible causes for extensive medial tibia bone loss, resulting in modular porous tantalum tibia baseplate fracture after primary TKA. Retrieved tissue samples were scanned with 3 MeV focused proton beam for Proton-Induced X-ray Emission (micro-PIXE) elemental analysis. Fractographic and microstructural analysis were performed by stereomicroscopy. A full 3D finite-element model was made for numerical analysis of stress-strain conditions of the tibial baseplate. Histological examination of tissue underneath the broken part of the tibial baseplate revealed dark-stained metal debris, which was confirmed by micro-PIXE to consist of tantalum and titanium. Fractographic analysis and tensile testing showed that the failure of the tibial baseplate fulfilled the criteria of a typical fatigue fracture. Microstructural analysis of the contact surface revealed signs of bone ingrowth in 22.5% of the surface only and was even less pronounced in the medial half of the tibial baseplate. Further studies are needed to confirm the responsibility of metal debris for an increased bone absorption leading to catastrophic tibial tray failure.

Yield Load Solutions for SE(B) Fracture Toughness Specimen with I-Shaped Heterogeneous Weld.

The objective of this work was to investigate the fracture behavior of a heterogeneous I-shaped welded joint in the context of yield load solutions. The weld was divided into two equal parts, using the metal with the higher yield strength and the metal with the lower yield strength compared to base metal. For both configurations of the I-shaped weld, one with a crack in strength in the over-matched part of the weld and one for a crack in the under-matched part of the weld, a systematic study of fracture toughness SE(B) specimen was carried out in which the crack length, the width of the weld and the strength mismatch factor for both weld metals were varied, and the yield loads were determined. As a result of the study, two mathematical models for determination of yield loads are proposed. Both models were experimentally tested with one strength mismatch configuration, and the results showed good agreement and sufficiently conservative results compared to the experimental results.

The Numerical Modelling Approach with a Random Distribution of Mechanical Properties for a Mismatched Weld.

The aim of this work was to include a local variation in material properties to simulate the fracture behaviour in a multi-pass mis-matched X-weld joint. The base material was welded with an over and under-match strength material. The local variation was represented in a finite element model with five material groups in the weld and three layers in the heat-affected zone. The groups were assigned randomly to the elements within a region. A three-point single edge notch bending (SENB) fracture mechanics specimen was analysed for two different configurations where either the initial crack is in the over or under-matched material side to simulate experimentally obtained results. The used modelling approach shows comparable crack propagation and stiffness behaviour, as well as the expected, scatter and instabilities of measured fracture behaviour in inhomogeneous welds.

Succinylation of Polyallylamine: Influence on Biological Efficacy and the Formation of Electrospun Fibers.

Succinylation of proteins is a commonly encountered reaction in biology and introduces negatively charged carboxylates on previously basic primary amine groups of amino acid residues. In analogy, this work investigates the succinylation of primary amines of the synthetic polyelectrolyte polyallylamine (PAA). It investigates the influence of the degree of succinylation on the cytotoxicity and antibacterial activity of the resulting polymers. Succinylation was performed in water with varying amounts of succinic anhydride and at different pH values. The PAA derivatives were analyzed in detail with respect to molecular structure using nuclear magnetic resonance and infrared absorbance spectroscopy. Polyelectrolyte and potentiometric charge titrations were used to elucidate charge ratios between primary amines and carboxylates in the polymers. The obtained materials were then evaluated with respect to their minimum inhibitory concentration against Staphylococcus aureus and Pseudomonas aeruginosa. The biocompatibility was assessed using mouse L929 fibroblasts. The degree of succinylation decreased cytotoxicity but more significantly reduced antibacterial efficacy, demonstrating the sensitivity of the fibroblast cells against this type of ampholytic polyelectrolytes. The obtained polymers were finally electrospun into microfiber webs in combination with neutral water-soluble polyvinyl alcohol. The resulting non-woven could have the potential to be used as wound dressing materials or coatings.

Preparation and Characterisation of Waste Poultry Feathers Composite Fibreboards.

The growth of poultry meat production is increasing industrial waste quantities every year. Feathers represent a huge part of the waste, and international directives and restrictions prevent landfilling of such biodegradable materials with high burning values. Furthermore, with their unique properties, poultry waste feathers are already a reliable resource for many byproducts, such as keratin extraction, fibres, hydrogel production, etc., all trying to achieve a high-added value. However, mass reduction of waste feathers into useful applications, such as development of alternative building materials, is also an important aspect. To take advantage of feathers' thermal insulation capabilities, sound damping, and biodegradability, we worked towards mixing waste feathers with wood residues (wood shavings, dust, and mixed residues) for production of composite fibreboards, comparable to the market's medium density fibreboards. The emphasis was to evaluate waste poultry feathers as the component of natural insulation composites, along with mixed waste wood residues, to improve their mechanical properties. Various composite fibreboards with different shares of wood and feathers were produced and tested for mechanical, thermal, and acoustic properties, and biodegradability, with comparison to typical particle boards on the market. The addition of waste feather fibres into the fibreboards' structure improved thermal insulation properties, and the biodegradability of fibreboards, but decreased their bending strength. The sound transition acoustic loss results of the presented combination fibreboards with added feathers improved at mid and high frequencies. Finally, production costs are estimated based on small scale laboratory experiments of feather processing (cleaning and drying), with the assumption of cost reduction in cases of large industrial application.

Why do some titanium-alloy total hip arthroplasty modular necks fail?

BACKGROUND: Increased modularity in total hip arthroplasty (THA) through extra junction between the neck and the femoral stem is gaining popularity among orthopaedic community. However, the advantage of the additional junction is shadowed by an increased risk of mechanical failure. The aim of this study was to describe the exact mechanism of fracture of the modular femoral neck in an uncemented stem. METHODS: Clinical, metallurgical, and mechanical analysis including finite-element modelling and elemental-sensitive tissue analysis with the micro-PIXE method was performed on two patients treated with fully modular primary THA made from Titanium alloy of the same oval taper-cone design. In patient A revision was performed 7.8 years after the unilateral primary procedure because of modular femoral neck fracture, while patient B was left-side revised 15 years after the bilateral primary procedure because of aseptic loosening of the femoral stem. RESULTS: Body weight was 30% higher and the arm of implanted modular femoral neck was 51% longer in patient A compared to patient B. Therefore, the stress ratio on the modular femoral neck of patient A was calculated to be 2.45 times higher than in patient B, preventing cold welding and producing taper damage and degradation at the neck-stem junction. Large clusters of metallic debris containing Titanium and Vanadium from the alloy were present in the periprosthetic soft tissues of patient A. CONCLUSIONS: Patients with higher body mass index treated with fully modular Ti-alloy THA may be at increased risk to experience catastrophic failure of the device. Orthopaedic surgeons should avoid using long necks whenever possible, as these are especially prone to develop a vicious circle starting with the fretting process and crevice corrosion at the taper-cone connection, leading to crack initiation and crack propagation, accelerated by the increased vulnerability of the Ti-alloy in biologic media, ultimately ending as fracture at the typical site. Serum Ti concentration may represent a rough estimation of taper degradation and patients with elevated levels should be warned and followed accordingly.