Analysis of polyethylene wear of reverse shoulder components: A validated technique and initial clinical results.

One of the most prevalent phenomena associated with reverse total shoulder arthroplasty (rTSA) is scapular notching. Current methods examine only the damage to the scapula and no methods are available for quantifying the total wear volume of the polyethylene humeral bearing. Quantifying the polyethylene material loss may provide insight into the mechanism for scapular notching and into the particle dose delivered to the patient. A coordinate measurement machine (CMM) and custom computer algorithms were employed to quantify the volumetric wear of polyethylene humeral bearings. This technique was validated using two never-implanted polyethylene humeral liners with a controlled amount of wear in clinically relevant locations. The technique was determined to be accurate to within 10% of the known value and within 5 mm3 of the gravimetrically determined values. Following validation, ten retrieved polyethylene humeral liners were analyzed to determine a baseline for future clinical tests. Four of the ten polyethylene humeral liners showed visible and measureable wear volumes ranging from 40 to 90 mm3 total with a maximum wear rate as high as 470 mm3 /year in one short duration and significantly damaged humeral liner. This validated technique has the potential to relate patient outcomes such as scapular notching grades to polyethylene release into the body. While the total wear volumes are less than reported in literature for cases of osteolysis in knee and hip patients, dosages are well within the osteolytic thresholds that have been suggested, indicating that osteolysis may be a clinical concern in the shoulder. This work provides the basis for future studies that relate volumetric wear to patient outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:980-987, 2017.

Contribution of micro-motion to backside wear in a fixed bearing total knee arthroplasty.

This study seeks to identify important factors related to backside wear of tibial inserts in vivo and determine an appropriate wear model for backside wear. An IRB approved database was queried for tibial inserts of a single design from one manufacturer that exhibited evidence of rotatory motion on the backside of the polyethylene. These devices were measured for volumetric wear using a previously established protocol. Features including the change in locking lip width and measurement of micro-motion marks were used to describe the motion pattern. Volumetric wear and implant characteristics were compared using linear regressions by modeling wear theories suggested by Archard and Wang to determine the most appropriate model for backside wear. The Wang model showed that duration, adjusted sliding distance, and cross-shear index accounted for approximately 58% of the volumetric wear variation while adjusted sliding distance and duration in vivo accounted for approximately 35% of the volumetric wear variation in the Archard model. Patient weight (p = 0.750), patient BMI (p = 0.680), and backside area (p = 0.784) of the tibial insert were all found to be non-significant in the Wang model. Similarly, patient weight (p = 0.233), patient BMI (p = 0.162), and backside area (p = 0.796) were found to be non-significant in the Archard model. Multidirectional micro-motion appears to contribute significantly to the wear of these components, supporting the Wang theory of cross-shear for polyethylene wear. Cross-shear of polymers on an unpolished titanium tray can lead to an increase in wear debris in the body. Care should be taken when designing locking mechanisms and tray designs. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1933-1940, 2016.

Fatigue failure of reverse shoulder humeral tray components of a single design.

BACKGROUND: Modularity in shoulder arthroplasty provides surgical flexibility and facilitates less-complex revision surgery. Modular designs must fit in the glenohumeral joint space, necessitating minimal thickness and careful material selection. The potential for fatigue fracture is higher, and fatigue fracture has been experienced by patients. The purpose of this study was to determine the impact of geometry and materials used for modular humeral trays from a single manufacturer. METHODS: We consecutively retrieved 8 humeral trays of nearly identical designs: 4 Ti-6Al-4V (Ti) and 4 CoCrMo (CoCr). Optical microscopy and scanning electron microscopy were used, along with metallurgical techniques. Finite element and fatigue analyses of the stresses at the humeral tray taper informed observation interpretation. RESULTS: Two Ti devices were revised for in vivo fracture. Scanning electron microscopy showed cracking in the other 2 Ti trays and no evidence of cracking in the CoCr components. A geometric difference in the CoCr devices resulted in a 25% decreased stress under simulated activities of daily living. Accounting for the tray material properties, the fatigue failure envelope ranged from 1000 to 1 million cycles for Ti and from 30,000 to >10 million cycles for CoCr. CONCLUSIONS: All Ti humeral tray retrievals fractured in vivo or were cracked at the taper fillet. No CoCr retrievals showed signs of cracking. Finite element and fatigue analyses predict a 10-fold lifetime increase for the CoCr devices compared with the Ti devices. This study shows that fatigue failure is possible for some reverse shoulder components and is likely exacerbated by fillet radius, tray thickness, and material choice.

Creating physiologically realistic vertebral fractures in a cervine model.

Approximately 50% of women and 25% of men will have an osteoporosis-related fracture after the age of 50, yet the micromechanical origin of these fractures remains unclear. Preventing these fractures requires an understanding of compression fracture formation in vertebral cancellous bone. The immediate research goal was to create clinically relevant (midvertebral body and endplate) fractures in three-vertebrae motion segments subject to physiologically realistic compressional loading conditions. Six three-vertebrae motion segments (five cervine, one cadaver) were potted to ensure physiologic alignment with the compressive load. A 3D microcomputed tomography (microCT) image of each motion segment was generated. The motion segments were then preconditioned and monotonically compressed until failure, as identified by a notable load drop (48-66% of peak load in this study). A second microCT image was then generated. These three-dimensional images of the cancellous bone structure were inspected after loading to qualitatively identify fracture location and type. The microCT images show that the trabeculae in the cervine specimens are oriented similarly to those in the cadaver specimen. In the cervine specimens, the peak load prior to failure is highest for the L4-L6 motion segment, and decreases for each cranially adjacent motion segment. Three motion segments formed endplate fractures and three formed midvertebral body fractures; these two fracture types correspond to clinically observed fracture modes. Examination of normalized-load versus normalized-displacement curves suggests that the size (e.g., cross-sectional area) of a vertebra is not the only factor in the mechanical response in healthy vertebral specimens. Furthermore, these normalized-load versus normalized-displacement data appear to be grouped by the fracture type. Taken together, these results show that (1) the loading protocol creates fractures that appear physiologically realistic in vertebrae, (2) cervine vertebrae fracture similarly to the cadaver specimen under these loading conditions, and (3) that the prefracture load response may predict the impending fracture mode under the loading conditions used in this study.