Background. When reversing the hard-soft articulation in inverse shoulder replacement, i.e. hard inlay and soft glenosphere, the tribological behaviour of such a pairing has to be tested thoroughly. Therefore, two hard materials for the inlay, CoCr alloy and alumina toughened zirconia ceramic (ATZ) articulating on two soft materials, conventional UHMWPE and vitamin E stabilised, highly cross-linked PE (E-XLPE) were tested. Methods. The simulator tests were performed analogue to standardised gravimetric wear tests for hip prosthesis (ISO 14242-1) with load and motion curves adapted to the shoulder. The test parameters differing from the standard were the maximum force (1.0 kN) and the range of motion. A servo-hydraulic six station joint simulator (EndoLab, Rosenheim) was used to run the tests up to 5 times 106 cycles with diluted calf serum at 37° C as lubricant. Results. The wear rates measured in the simulator when the CoCr alloy inlay articulated on UHMWPE and E-XLPE were respectively 32.50 +/− 3.48 mg/Mcycle and 10.65 +/− 2.36 mg/Mcycle. In comparison, when the ATZ inlay articulated on UHMWPE and E-XLPE the wear rates were 20.34 +/− 1.14 mg/Mcycle and 5.99 +/− 0.79 mg/Mcycle respectively. Conclusions. The simulator wear rate of the standard articulation CoCr – UHMWPE is similar to that found in the corresponding pairing for hip endoprosthesis. Replacing UHMWPE by E-XLPE, the wear rate is reduced to about 1/3 for both hard counterparts, CoCr and ZTA, respectively. Replacing the CoCr inlay by a part made from ZTA lowers wear by about 37 % in articulation against UHMWPE and about 44 % against E-XLPE. The lowest wear rate, with a reduction of about 80 % compared to the standard CoCr – UHMWPE, exhibits the pairing of both advanced materials, ZTA – E-XLPE. However, long-term clinical follow-up will confirm if this in-vitro wear reduction leads to longer in-vivo survival. Level of evidence. Laboratory test on sample implants. Study financed by Mathys Orthopaedie GmbH

Background. As the number of ceramic THR bearings used worldwide is increasing, the number of implants that experience off-normal working conditions, e.g. edge loading, third bodies in the joint, soft tissues laxity, dislocation/subluxation of the joint, increases too. Under all such conditions the bearing surfaces can be damaged, leading eventually to a limitation of the expected performances of the implant. Methods. We characterised the damage resistance of different bearing surfaces (alumina matrix composite BIOLOXdelta, alpha-alumina BIOLOXforte, zirconia 3Y-TZP, oxidized zirconium alloy Zr-2.5Nb, CoCr-alloy) by scratch tests performed following the European standard EN 1071–3:2005. Also the scratch hardness of same materials has been assessed. Results. The Lc1 value (i.e., the load for the onset of a scratch) measured for BIOLOXdelta is about fivefold the one measured for the oxidized zirconium alloy (OXZr) surface and about tenfold the Lc1 measured for the CoCr alloy. The height of ridges along the scratch edges due to plastic flow in the composite ceramic BIOLOXdelta are only 21% in height than in CoCr, and only a small fraction (0.04%) of the height of ridges measured on OXZr surfaces. The scratch hardness of the metal samples tested (CoCr, OXZr) results one order of magnitude lower than the ones of ceramics. This behavior is not influenced by of the presence of the coating on OXZr surface. Conclusions. The transformation toughened ceramics tested (BIOLOXdelta, 3Y-TZP) are the materials that exhibit the higher resistance to scratching. Ridges at scratch edges are lower in ceramics than in coated or uncoated metals. The result show the superior scratch resistance behavior of toughened ceramics for THR wear couples with respect to coated or bare alloys. Level of Evidence. Level 1

Summary Statement. Fretting and corrosion has been identified as a clinical problem in modular metal-on-metal THA, but remains poorly understood in modern THA devices with polyethylene bearings. This study investigates taper damage and if this damage is associated with polyethylene wear. Introduction. Degradation of modular head-neck tapers was raised as a concern in the 1990s (Gilbert 1993). The incidence of fretting and corrosion among modern, metal-on-polyethylene and ceramic-on-polyethylene THA systems with 36+ mm femoral heads remains poorly understood. Additionally, it is unknown whether metal debris from modular tapers could increase wear rates of highly crosslinked PE (HXLPE) liners. The purpose of this study was to characterise the severity of fretting and corrosion at head-neck modular interfaces in retrieved conventional and HXLPE THA systems and its effect on penetration rates. Patients & Methods. 386 CoCr alloy heads from 5 manufacturers were analyzed along with 166 stems (38 with ceramic femoral heads). Metal and ceramic components were cleaned and examined at the head taper and stem taper by two investigators. Scores ranging from 1 (mild) to 4 (severe) were assigned in accordance with the semi-quantitative method adapted from a previously published technique. Linear penetration of liners was measured using a calibrated digital micrometer (accuracy: 0.001 mm). Devices implanted less than 1 year were excluded from this analysis because in the short-term, creep dominates penetration of the head into the liner. Results. The majority of the components were revised for instability, infection, and loosening. Mild to severe taper damage (score ≥2) was found in 77% of head tapers and 52% of stem tapers. The extent of damage was correlated to implantation time at the head taper (p=0.0004) and at the stem taper (p=0.0004). Damage scores were statistically elevated on CoCr heads than the matched stems (mean score difference=0.5; p<0.0001) and the two metrics were positively correlated with each other (ρ=0.41). No difference was observed between stem taper damage and head material (CoCr, ceramic) (p=0.56), nor was a correlation found between taper damage and head size (p=0.85). The penetration rate across different formulations of HXLPE was not found to be significantly different (p=0.07), and therefore grouped together for further analysis. Within this cohort, penetration rate was not found to be associated with head size (p=0.08) though a negative correlation with implantation time was noted (ρ=−0.35). When analyzed along with taper damage scores, a correlation was not observed between head taper damage scores and HXLPE penetration rates (p=0.51). Discussion. The results of this study do not support the hypothesis that 36+ mm ceramic or CoCr femoral heads articulating on HXLPE liners are associated with increased risk of corrosion among HXLPE liners when compared with smaller diameter heads. A limitation of this study is the semi-quantitative scoring technique, heterogeneity of the retrieval collection and short implantation time of the larger diameter heads. Because corrosion may increase over time in vivo, longer-term follow-up, coupled with quantitative taper wear measurement, will better assess the natural progression of taper degradation in modern THA bearings

Objectives

Mechanical wear and corrosion at the head-stem junction of total hip arthroplasties (THAs) (trunnionosis) have been implicated in their early revision, most commonly in metal-on-metal (MOM) hips. We can isolate the role of the head-stem junction as the predominant source of metal release by investigating non-MOM hips; this can help to identify clinically significant volumes of material loss and corrosion from these surfaces.

Objectives

Third-body wear is believed to be one trigger for adverse results with metal-on-metal (MOM) bearings. Impingement and subluxation may release metal particles from MOM replacements. We therefore challenged MOM bearings with relevant debris types of cobalt–chrome alloy (CoCr), titanium alloy (Ti6Al4V) and polymethylmethacrylate bone cement (PMMA).

Hip simulators have been used for ten years to determine the tribological performance of large-head metal-on-metal devices using traditional test conditions. However, the hip simulator protocols were originally developed to test metal-on-polyethylene devices. We have used patient activity data to develop a more physiologically relevant test protocol for metal-on-metal devices. This includes stop/start motion, a more appropriate walking frequency, and alternating kinetic and kinematic profiles.

There has been considerable discussion about the effect of heat treatments on the wear of metal-on-metal cobalt chromium molybdenum (CoCrMo) devices. Clinical studies have shown a higher rate of wear, levels of metal ions and rates of failure for the heat-treated metal compared to the as-cast metal CoCrMo devices. However, hip simulator studies in vitro under traditional testing conditions have thus far not been able to demonstrate a difference between the wear performance of these implants.

Using a physiologically relevant test protocol, we have shown that heat treatment of metal-on-metal CoCrMo devices adversely affects their wear performance and generates significantly higher wear rates and levels of metal ions than in as-cast metal implants.