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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 91 - 91
1 Feb 2017
Baykal D Day J Underwood R
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In the retrieval analysis of explanted hip joints, the estimation of wear volume and visualization of wear pattern are commonly used to evaluate in-vivo performance. While many studies report wear volumes from explanted hips, it is important to understand the limitations of these estimates including the sources and magnitude of uncertainty of the reported results. This study builds on a previous uncertainty analysis by Carmignato et al. to quantify the magnitude of uncertainty caused by the assumption that the as-manufactured shape of an explanted hip component is a perfect sphere.

Synthetic data sets representing idealized measurements of spheroidal explants (prolate, oblate and pinched) with a nominal diameter of 50 mm were generated. These data sets represent the shape and magnitude of form deviations observed for explanted hip components (Figure 1). Data were simulated for either unworn components or those with a known volume and magnitude of wear simulated to represent 5 µm penetration of a 49.90 mm femoral head into an acetabular cup (Table 1). The volume of wear and wear pattern were estimated using a custom Matlab script developed for analysis of metrology data from explanted hip joints. This script fits a least squares sphere to data points in unworn, as manufactured regions of the surface to estimate the as-manufactured shape of the component. The diameter of the best fit sphere, and wear volume were compared to the known wear depths and volumes from the synthetic datasets.

The results showed that the Matlab script estimated a wear volume of up to 1.4 mm3 for an unworn cup with a radial deviation of 10 µm. The maximum error of 13.3 mm3 was for a pinched cup with wear at the pole. The complete results are shown in Table 2.

In some cases with aspherical form deviations, the least squares sphere fitted to the synthetic data was displaced in the Z direction with respect to the origin of the spheroid and the radius of the least squares sphere was outside the range of the principal radii of the spheroid. For instance, in case 5, the center was shifted 22 µm vertically from the mathematical center.

The results from this study show that the magnitude of uncertainty due to form deviations on wear volume varies depending on the shape and magnitude of the form deviations and in some cases was greater than 10 mm3. A further important finding is that in some instances, the diameter and center of the least squares sphere fitted to the unworn regions may not be consistent with the mathematical radius and center of the synthetic data. This may have important implications for the “reverse engineering” of the as-manufactured dimensions from worn explanted hip joints.

Please contact authors directly for the figure:

Figure 1 Graphical depiction of a) synthetic data set, b) deviation map of a hemispherical acetabular cup with simulated wear, c) deviation map of a prolate spheroid with simulated wear at rim with color bar set to ±5 microns, d) deviation map of pinched ellipsoid with simulated wear at 45 degrees from pole.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_4 | Pages 93 - 93
1 Feb 2017
Kurtz S MacDonald D Kocagoz S Arnholt C Underwood R Rimnac C Gilbert J
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Introduction

There is considerable interest in the orthopaedic community in understanding the multifactorial process of taper fretting corrosion in total hip arthroplasty (THA). Previous studies have identified some patient and device factors associated with taper damage, including length of implantation, stem flexural rigidity, and head offset. Due to the complexity of this phenomenon, we approached the topic by developing a series of matched cohort studies, each attempting to isolate a single implant design variable, while controlling for confounding factors to the extent possible. We also developed a validated method for measuring material loss in retrieved orthopaedic tapers, which contributed to the creation of a new international standard (ASTM F3129-16).

Methods

Based on our implant retrieval collection of over 3,000 THAs, we developed independent matched cohort studies to examine (1) the effect of femoral head material (metal vs. ceramic, n=50 per cohort) and (2) stem taper surface finish (smooth vs. microgrooved, n=60 per cohort). Within each individual study, we adjusted for confounding factors by balancing implantation time, stem taper flexural rigidity, offset, and, when possible, head size. We evaluated fretting and corrosion using a four-point semiquantitative score. We also used an out-of-roundness machine (Talyrond 585) to quantify the material loss from the tapers. This method was validated in a series of experiments of controlled material removal on never-implanted components.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 129 - 129
1 May 2016
Kurtz S Arnholt C MacDonald D Higgs G Underwood R Chen A Klein G Hamlin B Lee G Mont M Cates H Malkani A Kraay M Rimnac C
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Introduction

Previous studies of retrieved CoCr alloy femoral heads have identified imprinting of the stem taper surface features onto the interior head bore, leading researchers to hypothesize that stem taper microgrooves may influence taper corrosion. However, little is known about the role of stem taper surface morphology on the magnitude of in vivo corrosion damage. We designed a matched cohort retrieval study to examine this issue.

Methods

From a multi-institutional retrieval collection of over 3,000 THAs, 120 femoral head-stem pairs were analyzed for evidence of fretting and corrosion using a visual scoring technique based on the severity and extent of fretting and corrosion damage observed at the taper. A matched cohort design was used in which 60 CoCr head-stem pairs with a smooth stem taper were matched with 60 CoCr head-stem pairs having a micro-grooved surface, based on implantation time, flexural rigidity, apparent length of taper engagement, and head size. This study was adequately powered to detect a difference of 0.5 in corrosion scores between the two cohorts, with a power of 82% and 95% confidence. Both cohorts included CoCr and Ti-6-4 alloy femoral stems. A high precision roundness machine (Talyrond 585, Taylor Hobson, UK) was used to measure surface morphology and categorize the stem tapers into smooth vs. micro-grooved categories. Fretting and corrosion damage at the head/neck junction was characterized using a modified semi-quantitative adapted from the Goldberg method by three independent observers. This method separated corrosion damage into four visually determined categories: minimal, mild, moderate and severe damage.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_3 | Pages 3 - 3
1 Jan 2016
MacDonald D Baykal D Underwood R Malkani AL Parvizi J Kurtz SM
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Introduction

First-generation annealed HXLPE has been clinically successful at reducing both clinical wear rates and the incidence of osteolysis in total hip arthroplasty. However, studies have observed oxidative and mechanical degradation occurring in annealed HXLPE. Thus, it is unclear whether the favorable clinical performance of 1st generation HXLPE is due to the preservation of bearing surface tribological properties or, at least partially, to the reduction in patient activity. The purpose of this study was to evaluate the in vitro wear performance (assessed using multidirectional pin-on-disk (POD) testing) of 1st-generation annealed HXLPE with respect to in vivo duration, clinical wear rates, oxidation, and mechanical properties.

Materials and Methods

103 1st-generation annealed HXLPE liners were collected at revision surgery. 39 annealed HXLPE liners were selected based on their implantation time and assigned to three equally sized cohorts (n=13 per group); short-term (1.4–2.7y), intermediate term (5.2–8.0y) and long-term (8.3–12.5y). From each retrieved liner, two 9-mm cores were obtained (one from the superior region and one from the inferior region). Sixteen cores were fabricated from unimplanted HXLPE liners that were removed from their packaging and six pins from unirradiated GUR 1050 resin served as positive controls. Multidirectional POD wear testing was conducted against wrought CoCr disks in a physiologically relevant lubricant (20 g/L protein concentration) using a 100-station SuperPOD (Phoenix Tribology, UK). Each pin had its own chamber with 15mL lubricant maintained at 37±1°C. An elliptical wear pattern with a static contact stress of 2.0 MPa was employed. Testing was carried out to 1.75 million cycles at 1.0 Hz and wear was assessed gravimetrically. POD wear rates were calculated using a linear regression of volumetric losses. In vivo penetration was measured directly using a calibrated micrometer. Oxidation was assessed on thin films obtained from superior and inferior regions of the liners (ASTM 2102). Mechanical properties were assessed using the small punch test (ASTM 2183).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 110 - 110
1 Dec 2013
MacDonald D Kurtz S Kocagoz S Hanzlik J Underwood R Gilbert J Lee G Mont M Kraay M Klein GR Parvizi J Rimnac C
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Background:

Previous studies regarding modular head-neck taper corrosion were largely based on cobalt chrome (CoCr) alloy femoral heads. Less is known about head-neck taper corrosion with ceramic femoral heads.

Questions/purposes:

We asked (1) whether ceramic heads resulted in less taper corrosion than CoCr heads; (2) what device and patient factors influence taper fretting corrosion; and (3) whether the mechanism of taper fretting corrosion in ceramic heads differs from that in CoCr heads.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 65 - 65
1 May 2012
Hart A Lloyd G Sabah S Sampson B Underwood R Cann P Henckel J Cobb PJ Lewis A Porter M Muirhead-Allwood S Skinner J
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SUMMARY

We report a prospective study of clinical data collected pre, intra and post operation to remove both cup and head components of 118 failed, current generation metal on metal (MOM) hips. Whilst component position was important, the majority were unexplained failures and of these the majority (63%) had cup inclination angles of less than 55 degrees. Poor biocompatibility of the wear debris may explain many of the failures.

BACKGROUND

Morlock et al reported a retrospective analysis of 267 MOM hips but only 34 head and cup couples (ie most were femoral neck fractures) and without data necessary to define cause of failure. The commonest cause of failure in the National Joint Registry (NJR) is unexplained.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 547 - 548
1 Nov 2011
Underwood R Cann P Ilo K Wagner C Skinner J Cobb J Porter M Muirhead-Allwood S Hart A
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Introduction: The London Implant Retrieval Centre (LIRC) was founded to investigate the high incidence of unexplained failures of Metal-on-Metal (MoM) hips. A multidisciplinary team analyse the failed hips, investigations include CT and MRI scans, blood and synovial fluid tests, wear measurements, X-rays and clinical data from the explanting surgeons.

Wear measurements of 100 explanted hips have been carried out on a Taylor Hobson 365 Roundness Machine using the LIRC Wear Protocol. It was found that 50% of explanted cups were wearing less than 5 μm/year and 60% of components were wearing less than 10 μm/year. Wear tests on hip joint simulators predict wear rates between 2 and 8 μm/year. However, 6% of cups are wearing faster than 100 μm/year, with 16% of cups have wear patches deeper than 100 μm and that 4% have a wear patch deeper than 300 μm.

Discussion: This paper considers the common characteristics of components in this very high wearing category. Engineering parameters such as head/cup clearance, surface finish, form errors and head cup contact conditions are investigated. This is correlated with clinical data and other results from the LIRC.

Cup position is an important factor, all of the high wearing components are outside the Lewinick’s Box, however it is shown that mal position is does not always lead to extreme wear. Further analysis is taking place to calculate the size of the contact patch between head and cup (based on patient data and biomechanics) and the proximity of the contact patch to the edge of the cup.

Conclusion: The study of explanted components shows that 6% exhibit extreme wear, and although several “risk” factors can be identified, it is not clear why only a proportion of these components show extremely high wear rates. This is the subject of current investigation.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 9 | Pages 1169 - 1177
1 Sep 2011
Underwood R Matthies A Cann P Skinner JA Hart AJ

The Articular Surface Replacement (ASR) hip resurfacing arthroplasty has a failure rate of 12.0% at five years, compared with 4.3% for the Birmingham Hip Resurfacing (BHR). We analysed 66 ASR and 64 BHR explanted metal-on-metal hip replacements with the aim of understanding their mechanisms of failure. We measured the linear wear rates of the acetabular and femoral components and analysed the clinical cause of failure, pre-revision blood metal ion levels and orientation of the acetabular component.

There was no significant difference in metal ion levels (chromium, p = 0.82; cobalt, p = 0.40) or head wear rate (p = 0.14) between the two groups. The ASR had a significantly increased rate of wear of the acetabular component (p = 0.03) and a significantly increased occurrence of edge loading (p < 0.005), which can be attributed to differences in design between the ASR and BHR. The effects of differences in design on the in vivo wear rates are discussed: these may provide an explanation as to why the ASR is more sensitive to suboptimal positioning than the BHR.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 3 | Pages 315 - 320
1 Mar 2011
Hart AJ Ilo K Underwood R Cann P Henckel J Lewis A Cobb J Skinner J

We measured the orientation of the acetabular and femoral components in 45 patients (33 men, 12 women) with a mean age of 53.4 years (30 to 74) who had undergone revision of metal-on-metal hip resurfacings. Three-dimensional CT was used to measure the inclination and version of the acetabular component, femoral version and the horizontal femoral offset, and the linear wear of the removed acetabular components was measured using a roundness machine.

We found that acetabular version and combined version of the acetabular and femoral components were weakly positively correlated with the rate of wear. The acetabular inclination angle was strongly positively correlated with the rate of wear. Femoral version was weakly negatively correlated with the rate of wear. Application of a threshold of > 5 μm/year for the rate of wear in order to separate the revisions into low or high wearing groups showed that more high wearing components were implanted outside Lewinnek’s safe zone, but that this was mainly due to the inclination of the acetabular component, which was the only parameter that significantly differed between the groups.

We were unable to show that excess version of the acetabular component alone or combined with femoral version was associated with an increase in the rate of wear based on our assessment of version using CT.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 3 | Pages 307 - 314
1 Mar 2011
Matthies A Underwood R Cann P Ilo K Nawaz Z Skinner J Hart AJ

This study compared component wear rates and pre-revision blood metal ions levels in two groups of failed metal-on-metal hip arthroplasties: hip resurfacing and modular total hip replacement (THR).

There was no significant difference in the median rate of linear wear between the groups for both acetabular (p = 0.4633) and femoral (p = 0.0872) components. There was also no significant difference in the median linear wear rates when failed hip resurfacing and modular THR hips of the same type (ASR and Birmingham hip resurfacing (BHR)) were compared.

Unlike other studies of well-functioning hips, there was no significant difference in pre-revision blood metal ion levels between hip resurfacing and modular THR.

Edge loading was common in both groups, but more common in the resurfacing group (67%) than in the modular group (57%). However, this was not significant (p = 0.3479). We attribute this difference to retention of the neck in resurfacing of the hip, leading to impingement-type edge loading. This was supported by visual evidence of impingement on the femur.

These findings show that failed metal-on-metal hip resurfacing and modular THRs have similar component wear rates and are both associated with raised pre-revision blood levels of metal ions.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 400 - 400
1 Jul 2010
Hart AJ Bandi A Maggiore P Skinner JA Underwood R Cann P
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Data on retrieval analysis of current generation metal on metal hip replacements is scarce. Such analysis may help to reduce the incidence of failure and revision procedures. Our aim was to investigate the wear characteristics of explanted (ie failed) metal on metal (MOM) acetabular components in terms of; 1) wear rate; and 2) distribution of the wear (specifically edge loading).

30 hips were collected from 20 centres. The types of prostheses were: 15 BHR; 10 Cormet and 5 ASR. Wear of the acetabular components of the prostheses was measured using an out of roundness (Rondcom 60A) machine. We recorded the implantation and removal date of each hip.

The median linear wear rate was 7.32μm/year; this is at least 3 times greater than steady state wear rates reported for similar components worn in hip simulator studies. For 24 out of 30 cups, the greatest linear wear was recorded at the cup edge.

Failed metal-on-metal acetabular components were associated with higher than expected wear rates. The highest wear was seen closest to the cup edge in the majority of patients suggesting edge loading had occurred and probably explained the high wear rates. Accurate cup placement (to avoid edge loading) may reduce the failure of MOM hips.