Introduction and Aims. A recent submission to ASTM, WK28778 entitled “Standard test method for determination of friction torque and friction factor for hip implants using an anatomical motion hip simulator”, describes a proposal for determining the friction factor of hip implant devices. Determination of a friction factor in an implant bearing couple using a full kinematic walking cycle as described in ISO14242-1 may offer designers and engineers valuable input to improve wear characteristics, minimize torque and improve long term performance of hip implants. The aim of this study was to investigate differences in friction factors between two commercially available polyethylene materials using the procedure proposed. Methods. Two polyethylene acetabular liner material test groups were chosen for this study: commercially available Marathon. ®. (A) and AltrX. ®. (B). All liners were machined to current production specifications with an inner diameter of 36mm and an outer diameter of 56mm. Surface roughness (Ra) of the liner inner diameters were measured using contact profilometry in the head-liner contact area, before and after 3Mcyc of wear testing. Liners were soaked in bovine serum for 48 hours prior to testing. Friction factor measurements were taken per ASTM WK28778 prior to, and after wear testing using an external six degrees of freedom load cell (ATI Industrial Automation) and a reduced maximum vertical load of 1900N. Friction factor and wear testing was conducted in bovine serum (18mg/mL total protein concentration) supplemented with 0.056% sodium azide (preservative) and 5.56mM EDTA (calcium stabilizer) on a 12-station AMTI (Watertown, MA) ADL hip simulator with load soak controls per ISO 14242-1:2014(E). The liners were removed from the machine, cleaned and gravimetric wear determined per ISO 14242-2:2000(E) every 0.5 million cycles (MCyc) through a total of 3Mcyc to evaluate wear. Results. It was observed that although measured wear rates were significantly different between the Marathon. ®. (10.3 ± 2.2mg/Mcyc) and AltrX. ®. (1.7 ± 0.2mg/Mcyc) test groups, the measured friction factors were not significantly different between groups; 0.094 ± 0.015 Marathon. ®. and 0.095 ± 0.007 AltrX. ®. pre wear, and 0.103 ± 0.001 Marathon. ®. and 0.106 ± 0.006 AltrX. ®. post wear. The increase in friction factor observed following wear in of the polyethylene liners is expected. Average friction factors were calculated from data measured in the region from heel strike through toe-off of the gait cycle (the 1. st. 60% of the kinematics cycle described in ISO 14242). It is observed that the resultant friction curves for untested bearing couples had a larger spread across the 4 measured samples than those following 3Mcyc of standard wear, most likely due to variations in polyethylene roughness, contact area and clearances between the bearing couples in the as received state. Conclusions. It is concluded from this study that the draft ASTM protocol proposed is capable of measuring frictional effects in MoP hip bearing couples, and for the polyethylene materials tested herein there is no significant difference between the average measured friction factors when all other parameters (i.e. design and gait cycle) are controlled

To improve the longevity of total hip replacements (THR), it is necessary to prevent wear of the ultra-high molecular weight polyethylene (UHMWPE) bearing, as wear debris can cause osteolysis and aseptic loosening. Highly cross-linked UHMWPE reduces wear, sometimes stabilized with vitamin E to preserve its mechanical properties and prevent oxidative degeneration. An extra novel solution has been grafting the surface of UHMWPE with poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC). This treatment uses a hydrophilic (wettable) phospholipid polymer to improve lubrication and reduce friction and wear of the bearing material. We set out to test the wear and friction of ceramic-on-polyethylene (COP) THRs that had the PMPC surface treatment, or left untreated for control. Four groups of UHMWPE bearings were tested against identical 40mm ceramic heads (zirconia-toughened alumina). The UHMWPE bearings were highly cross-linked with/without vitamin E (HXL Vit. E: 125 kGy radiation dose / HXL: 75 kGy). In each group, half underwent the PMPC treatment (n = 3 for all four groups). Testing was conducted on an AMTI hip simulator for 10 million walking cycles of ISO-14242-1, at 1 Hz, with diluted bovine serum (30 g/L protein concentration) as lubricant, at 37ºC, and with fluid absorption errors corrected with active soak controls. Using a previously published method, frictional torques and a frictional factor around three orthogonal axes about the femoral head were measured/computed, by data processing of the measurements of a 6-DOF load cell on each station of the hip simulator. Such friction measurements and stops for specimen weighing were carried out at regular intervals throughout the wear test. The HXL liners without and with the PMPC treatment wore at 5.86±0.402 mg/Mc and 1.70±1.36 mg/Mc, respectively (p=0.013) (Fig. 1). The HXL Vit. E liners without and with the PMPC treatment wore at 2.14±0.269 mg/Mc and 0.736±0.750 mg/Mc, respectively (p=0.035). The wear rates of the untreated HXL and HXL Vit. E liners were significantly different (p=0.0002) but no difference in wear rate was found between the two PMPC treated groups (p=0.179), although, as mentioned above, the PMPC treatment very significantly reduced wear in each case. The ceramic femoral heads showed little wear (weight loss) themselves. In general, the THRs showed decreasing friction over the 10 Mc, with the PMPC types showing a slight increase in friction towards the end of the test (Fig. 2). PMPC HXL liners showed the lowest friction factor (0.022±0.001) which was significantly lower (p<0.001) than the friction of the untreated liners (0.028±0.002) (Fig. 3). The PMPC HXL Vit. E liners showed lower friction factors than the untreated HXL Vit. E liners (0.034±0.002, 0.036±0.004, respectively), although this difference was not significant (p=0.116). Overall, the liners with the PMPC treatment displayed statistically significantly lower friction factors (p=0.003) than those untreated. The coincidence of some reduction of surface friction with larger wear reduction obviously suggests some but not necessarily full causality. PMPC successfully reduced both the friction and the wear in these COP THRs during this extended 10 Mc test. This likely would translate to improved implant longevity in patients. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Introduction. Modularity allows surgeons to use femoral heads of various materials, diameters and offsets to achieve the best possible outcome, nevertheless the fretting corrosion behaviour of modular junctions can be significantly affected. The aim of this study was to assess physiological friction moment and lubrication ratio in order to compare various tribological materials against different bearing sizes. This data is important as lubrication will affect the friction, wear and torque generated which may lead directly to the production of debris or to enhanced corrosion at modular junctions. Materials and methods. Hip joints were tested in lubricant condition on a hip simulator following the ISO14242-3 configuration. Three samples for each combinations were examined: 1) 36mm metal-on-metal made in CoCrMo 2) 36mm ceramic-on-ceramic made in ZTA 3) 58mm resurfacing metal-on-metal made in CoCrMo 4) 57mm resurfacing ceramic-on-ceramic made in ZTA. Preconditioning and dynamic loading steps were spaced out by rest periods (Fig. 1) and the entire series was repeated three times for each combination. Strains were measured on the Ti6Al4V neck's femoral stem with three couples of biaxial strain gauges and were converted into friction moments by means of analytical formulas. Mean maximum moment M and lubrication ratio λ were calculated. M. START-UP. and M. TURN-OFF. were respectively the first three and last three peak moment sampled for each consecutive step. Results. Fig. 2 reports the obtained results. It can be observed that MoM large bearings showed a mean maximum friction moment lower than MoM smaller bearings (p=0,001), whereas no effect of bearing diameter on friction moment was observed for CoC (p=0,162). There is no statistically significant difference on friction moment between Ø57mm ceramic-on-ceramic resurfacing bearing and Ø58mm metal-on-metal resurfacing (p=0,805). However the CoC Ø36 friction moment was significantly lower than with MoM Ø36 (p=0,001). The calculated lubrication ratio λ gave information on lubrication regime: in the case of standard bearings mixed lubrication (1≤λ≤3) occurred, while resurfacing bearings were in full film lubrication (λ>3). Correlating lubrication ratio λ with M. START-UP. and M. TURN-OFF. (Fig. 2) it can be observed that the peak friction moment increased during the dynamic step for bearing in mixed lubrication, while a decrease was observed for bearing in full film lubrication. The breaking point cycle between downward and flat peak friction moment trend decreased more than half with longer dynamic steps (Fig. 3), leading to a stable maximum friction moment. Discussion. Ceramic bearing friction moment monotonically increased with bearing diameter, this trend being not observed on metal couplings because the tested standard diameter was in mixed lubrication lower limit. Mixed lubrication regime energized the bearing by increasing the friction moment during the dynamic step such as a self-powered system, on the other side full film lubrication reduced friction moment to a lower asymptote, such as a self-stabilized system. Conclusion. Modern ceramic hip resurfacing was designed in full film lubrication and its friction moment was equivalent to metal-on-metal hip resurfacing. Modern ceramic resurfacing may reduce fretting corrosion compared to traditional metal resurfacing while keeping the same biomechanical advantages. For figures/tables, please contact authors directly.

Poly (vinyl alcohol) (PVA) hydrogel with high water content is one of the potential materials for artificial cartilage. In the previous study, the wear behavior of PVA hydrogel prepared by freeze-thawing (FT) method (PVA-FT gel) showed the excellent friction and wear property in simulated biological environment. However, the improvement of mechanical strength and wear resistance would be also needed for clinical application of PVA hydrogel as artificial cartilage. The different kind of physically-crosslinked PVA hydrogels prepared by cast-drying (CD) method (PVA-CD gel) and hybrid method of FT and CD (PVA-CD on FT hybrid gel) were also developed, and these two hydrogels have different mechanical properties and showed low friction compared with PVA-FT gel in saline. In this study, PVA hydrogel prepared by CD and hybrid methods were newly developed and friction and wear behavior of PVA-CD gel and PVA-CD on FT hybrid gel were evaluated in simulated biological environment. A sliding pair of an ellipsoidal reciprocating upper specimen of hydrogel and a flat stationary lower specimen of hydrogel was tested in reciprocating friction test. The thicknesses of PVA-CD gel and PVA-CD on FT hybrid gel were 2.0mm and 1.7mm, respectively. The applied load was 2.94 N. The sliding velocity was 20 mm/s and the total sliding distance was 1.5 km. In this study, solutions that contain hyaluronic acid, phospholipid and proteins were prepared as simulated synovial fluid and used as a lubricant for friction test. Molecular weight of sodium hyaluronate was 9.2×10. 5. L-alpha dipalmitoylphosphatidylcholine (DPPC) was selected as phospholipid constituent and was dispersed in saline as liposome. This liposomal solution was used as a base lubricant. Albumin and gamma-globulin, which are main protein constituents in natural synovial fluid, were used as additives as protein constituents. As shown in Fig.1, PVA-CD gel showed low friction such as below 0.02 at initial state of friction test. However, friction coefficient of PVA-CD gel rapidly increased and reached to about 0.5. In contrast, PVA-CD on FT hybrid gel kept low friction within the friction test. After friction test, many deep scratches were observed on the worn surface of PVA-CD gel (Figs. 2(a)-(c)). In contrast, the original surface structure of PVA-CD on FT hybrid gel almost remained while some scratches were observed (Figs. 2(d)-(f)). These results indicated that PVA-CD gel could show low friction but low wear resistance. The hybridization of FT and CD improved the wear resistance of PVA-CD gel. Therefore, the hybridization of FT and CD method is one of the prospective preparation methods of artificial cartilage with low friction and low wear. It is important to elucidate the mechanism of excellent lubricating property of PVA-CD on FT hybrid gel and develop the highly-functioned artificial hydrogel cartilage with low friction and high wear resistance

In joint prostheses where ultra-high molecular weight polyethylene (UHMWPE) is used as bearing material, efficacious treatments such as crosslinking, addition of vitamin E and the grafting of phospholipid polymer are known to improve wear resistance. Under severe conditions of various daily activities, however, friction and wear problems in such prostheses have not yet been completely solved. In contrast, extremely low friction and minimum wear have been maintained for a lifetime in healthy natural synovial joints containing articular cartilage with superior lubricity. Accordingly, joint prostheses containing artificial hydrogel cartilage with properties similar to those of articular cartilage are expected to show superior tribological functions. In establishing the function of artificial hydrogel cartilage as a novel material for joint prostheses, the tribological properties of hydrogel materials used and synergistic performance with synovia constituents are both important. In this study, the influence of synovia constituents on friction and wear in artificial hydrogels was examined in reciprocating test and compared with that for articular cartilage. As biocompatible artificial hydrogel cartilage materials, three poly(vinyl alcohol) (PVA) hydrogels were prepared using the repeated freeze-thawing (FT) method, the cast-drying (CD) method and hybrid method for CD on FT, which are physically crosslinked with hydrogen bonding but differ in terms of structure and mechanical properties. First the frictional behavior of the PVA hydrogels and articular cartilage as ellipsoidal specimens was examined in reciprocating tests against a glass plate with a sliding speed of 20 mm/s under constant continuous loading. As shown in Fig.1, the three hydrogels exhibited different frictional behaviors in a saline solution. It is noteworthy that the hybrid gel maintained very low friction until the end of test. The CD gel showed slightly higher friction and a gradual increase. Meanwhile, the FT gel showed initial medium friction and a gradual increase echoing the time-dependent behavior of natural articular cartilage. Based on these observations, focus was placed on FT gel and articular cartilage to examine how synovia constituents influence friction and wear in these hydrogel materials. In human body, lubricating constituents in synovial fluids such as hyaluronic acid, proteins, glycoproteins and phospholipids are considered to reduce the coefficient of friction in solid-to-solid interaction. Here, the effects of hyaluronic acid (HA, molecular weight: 9.2×10. 5. ), serum proteins and phospholipid were examined. Dipalmitoylphosphatidylcholine (DPPC) was used as a typical phospholipid. As indicated in Fig.2 for repeated reciprocating tests, addition of HA alone was effective particularly for PVA-FT hydrogel. The combination of HA and DPPC was more effective in reduction of friction. The simulated synovial fluid (composed of HA 0.5 wt%, DPPC 0.01 wt%, albumin(Alb) 1.4 wt% and gamma-globulin (g-glob) 0.7 wt%) exhibited both low friction and minimum wear. The rubbing surfaces of articular cartilage and FT gel after tests are shown in Fig.3. On the articular cartilage surface, gel-like surface layer existed. On the FT gel surface, the original texture was observed without damage. These results indicate the importance of synovia constituents for the clinical application of artificial hydrogel cartilage in joint prostheses

Introduction. Wear plays a key role in the clinical outcome of total hip replacements (THR). In addition, increased frictional moment can stress the implant interfaces which may lead to high torsional loadings in the intermodular taper junction (fretting) and cup loosening and to the development of noise (squeaking). Against the background of larger head diameters (increased range of motion and decreased risk of dislocation), the friction induced by the joint articulation is of particular interest. As of now, the investigation of friction with the use of relevant joint kinematics and loadings are limited to numerical studies. Experimental approaches use simplified models which do not take into consideration complex activities. Thus, with the aim of this study is the identification of articular frictional moments that consider critical in vivo loading conditions and kinematics as well as the clinical cup inclination, head size and clearance of ceramic-on-ceramic hip bearings. Materials and Methods. A standard hip simulator (Minibionix 852 with 4 DOF Hip setup, MTS, Eden Prairie, USA) was modified in order to allow for high-precision friction measurements during head-insert articulation in all 6 DOF (MC2.5D-500, AMTI, Boston, USA). Disturbing systemic effects have been minimized by using quasi frictionless aerostatic lateral force compensation (Eitzenberger, Wessobrunn, Germany) and cross talk compensation. Beside the standard protocoll for in vitro wear assessment (ISO 14242-1), more complex profiles from in vivo patient data (Heidelberg Motion Lab and Orthoload database) have been used: normal walking with different walking speeds and patient's weights, stairs up/down and start-stop conditions. All-ceramic bearings (Biolox delta, Ceramtec, Plochingen, Germany) have been orientated in clinically relevant cup inclinations (30, 45, 60 and 75 deg). For each head diameter (28, 36 and 48 mm) n=8 specimens have been devided in two groups: small and large clearance according to the manufacturer's specification. All tests were run at 37°C in diluted bovine serum (20 g/l protein content). Results and Discussion. For all continuously running activities (normal walking, stairs up/down and ISO standard), increased resulting frictional moments have been measured with larger head diameters and smaller clearances in a range of less than 6 Nm. This data corresponds well to the results of a well-lubricated ceramic-on-ceramic bearing from numerical studies. In addition, the initial breakaway torque after a short resting period (start-stop initiation) was increased, where the highest maximal moments have been measured with increasing resting durations and larger head diameters (large clearance: up to 11 Nm, small clearance: up to 20 Nm). Interestingly enough, not in all cases a negative effect on the resulting moment was seen with increasing cup inclination, even though no subluxation was induced. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Damage to metallic femoral heads can occur in vivo. Testing of hip prostheses under abrasive conditions is one among various efforts needed towards more realistic and harsher testing. Abrasion likely increases both wear and friction at the head/liner interface. This study investigates if our novel friction measurement technique can detect damage to femoral heads during extended wear testing of metal-on-plastic (MOP) THRs of various material combinations using both scratched and as-new femoral heads. Friction was measured based on equilibrium of forces and moments measured by a 6-DOF load cell on each test station of an AMTI hip simulator. The force and moment data from the load cells was utilized to calculate the frictional torque about each of three rotational axes (flexion/extension, abduction/adduction and internal/external rotation). The frictional torques were transformed to account for the offset in load cell position from the hip center and were then vector summed to yield an overall frictional torque about the femoral head. The friction factor was then computed by dividing the overall frictional torque by the applied compressive load and the femoral head radius. The waveforms specified in ISO-14242-1 were used. Diluted bovine serum at 37°C with 30 g/L protein concentration lubricated the specimens. Twelve UHMWPE liners (40 mm I.D.) were tested against CoCrMo femoral heads. Liners were of three materials: a) Three conventional (GUR1020, gamma-sterilized 3.5 Mrad), b) Three highly cross-linked (HXL) (GUR 1020, 10 Mrad, annealed, EtO-sterilized, artificially aged), and c) Six HXL w/vitamin-E (GUR 1020, 12 Mrad, annealed, EtO-sterilized, aged). The test consisted of three phases were as follows: . –. Phase-I: Standard clean (non-abrasive) test for 5 Mc. –. Phase-II: Pulverized PMMA was added to serum at 700 mg/L (to introduce abrasive conditions); however, effects were minimal after 2 Mc (7 Mc total). –. Phase-III: Femoral heads were scratched using a technique developed in house to create latitudinal and longitudinal scratches similar to what is seen on retrievals. Phase-III lasted for 1 Mc, for a total of 8 Mc. The friction results are shown in Fig. 1. Friction factors of the three THR types tested were similar for the first 5 Mc (0.062 ± 0.0084) and increased only marginally after the PMMA powder was added (0.066 ± 0.0066). The PMMA powder did not appear to damage the heads much visually, and therefore the insignificant increase was not surprising. However, once heads were intentionally scratched at 7 Mc, the friction factor rose on all three THR types: a) 0.11 ± 0.0077, b) 0.082 ± 0.0049, c) 0.087 ± 0.022. This friction technique successfully detected when femoral head damage had occurred. Higher friction was clearly observed after femoral heads had been scratched

Friction between bearing surfaces in Total Hip Arthroplasty has been a main target of applied tribology. MPC (2-Methacryloyloxyethyl phosphorylcholine) has a similar properties to those of cell membranes, and can reduce friction with fluid lubrication in wet environment. We have used crosslink polyethylene with MPC polymer coating for primary and revision THA since 2011. We have examined 19 cases which were followed for more than two years. Sixteen cases for primary THA and three for revision THA, and 3 were male and 16 were female. Sixteen cases were osteoarthritis, one osteonecrosis of femoral head and two rheumatoid arthritis. Average age of patients at THA was 60.1 years old. In the OR, we have experienced a very wet and slippery feeling on the bearing surface of polyethylene liner. Surface touch is similar to hard surface with oil or lotions. No PE wear were measured on the X-ray display and no infections and no fractures were occurred during follow up. MPC polymer coating in THA can be useful for reduction of friction and generation of wear debris

Introduction. It has been speculated that impact deformation of thin 1-piece cups used for modern metal-on-metal hip replacement may contribute to early failure. The purpose of this study was to reproduce typical impact deformation and quantify the effect of this on the frictional torque generated at the hip. Methods. We tested nine hip couples of three designs (the ASR, BHR and Durom) and three sizes (42mm, 46mm and 50mm). A custom compression device was designed to replicate the in vivo forces and impact deformation of 1-piece metal cups reported in the literature. Each cup was mounted in the device, which itself was mounted on a mechanical testing machine. The cups were compressed with incremental loads up to a maximum of 2000N. At each increment we measured cup deformation, and then the head component was seated into the cup. The hip was lubricated and the head component rotated 60 degrees axially within the cup and the axial torque was measured. Results. Maximum deformation occurred at the rim for all cups, and was not associated with cup diameter (p = 0.42). However, at all applied loads the BHR cups were deformed significantly less than both the ASR and Durom cups (all p < 0.05). We observed deformation that exceeded the diametric clearance for both the ASR and Durom. Deformation resulted in increased axial torque up to eight times higher than those measured at zero deformation. The maximum torques generated for the BHR cups were significantly lower than those observed for both the ASR and Durom cups. Discussion. Deformation of 1-piece cups, equatorial bearing and subsequent increased frictional torque is likely to have widespread consequences for the performance of metal-on-metal hip replacement. This may include loosening of the cup, mechanical damage at the taper junction and increased early wear of the bearing surface

Introduction. Frictional behavior and, therefore, the coefficient of friction (CoF) play an important role in the evolution of fretting wear. Several studies investigated fretting at the ball head-taper junction with a remarkable variation in the CoF (0.15 to 0.55). This may be due to different material couplings, surface topographies or macro-geometries. Since the results of Finite Element (FE) models are strongly dependent on the choice of CoF it is crucial to determine the correct CoF for a speci?c system. Therefore, this study aimed to determine the CoF for the interface between ceramic ball heads and metal tapers. Materials and Methods. Three groups of taper-ball head couplings were investigated (n=18 titanium (Ti), n=18 cobalt chromium (CoCr), n=18 steel tapers (SS)). Line profiles of the taper surfaces were measured and tapers and ball heads were assembled using different loads (2, 4, 6 kN). Tapers were disassembled from ball heads by using liquid nitrogen, surface topography was remeasured and the effective contact area was determined. Another set of measurements was conducted (n=5 tapers per taper material) to measure the contact pressure. Here, pressure sensitive films were placed between tapers and ball heads during assembly. Using the effective contact area and contact pressure the CoF was calculated. Results. Effective contact area increased logarithmically with increasing assembly load with maximum values around 100 mm² for SS and Ti tapers at 6 kN. Contact pressure also increased with increasing load. Maximum contact pressures were found at the proximal end of the tapers and decreased linearly towards the distal end. Highest values were found for SS and CoCr (138 and 126 MPa). CoF increased with increasing load and varied from 0.44 to 0.68, while a decrease of the CoF between 4 and 6 kN for SS tapers was found. Largest values were found for Ti and CoCr tapers. Discussion. Since contact pressure increases with increasing load it seems plausible that the CoF also increases. Absolute pressure values are within the range of literature data (25–280 MPa). At first sight, the CoF seem to be independent from the material coupling, but looking at taper subsidence there are distinct differences between materials with SS showing the lowest and Ti the highest subsidence. Therefore, the different deformation behavior of the materials and, thus, the different evolution of effective contact area have also an effect on CoF. Ti shows largest deformation and SS shows lowest deformation. This effect seems plausible since Ti has the lowest Young's Modulus of the three taper materials examined. Some of the CoF determined here are larger than literature values. This may be due to different surface specifications and geometrical parameters (e.g. angular mismatch), different material couplings and loading conditions. Here surface roughness and angular mismatch was kept constant for all couplings tested. The results of this study will be used to develop friction laws to be implemented in FE models examining fretting and wear processes

Reducion of friction between bearing surfaces in Total Hip Arthroplasty is a main target of biological tribology. MPC (2-Methacryloyloxyethyl phosphorylcholine) has a similar properties to those of cell membranes, and can reduce friction with fluid luburication. We have used crosslink polyethylene with MPC polymer coating for primary and revision THA since 2011. Eighty one cementless THA were performed with closslink polyethlene liner with MPC polymer in our hospital. We have examined 21 cases which were followed for more than one year. Eighteen cases for primary THA and three for revision THA, and 3 were male and 18 were female. Seventeen cases were osteoarthritis, two osteonecrosis of femoral head and two rheumatoid arthritis. Average age of patients at THA was 60.4 years old. In the OR, we have experienced a very wet and slippery feeling on the bearing surface of polyethylene liner every time. Surface touch is similar to skin with lotions. No wear were measured on the X-ray display and no infections and no fractures were occurred during follow up. MPC polymer coating in THA can be useful for reduction of friction and generation of wear debris

Introduction. Hip simulator studies show that metal-on-metal bearing wear can be reduced by reducing the diametral clearance of the bearing. We present the six-year follow-up results of a prospective clinico-radiological and metal ion study in patients with a low clearance metal-metal surface arthroplasty. The results are compared to published results of similar design bearings with conventional clearance. Methods. Twentysix male patients (mean age 55 years, mean BMI 26) who received a 50 mm bearing resurfacing (radial clearance 50μm) were included in an ongoing clinico-radiological and metal ion study. Urine/blood specimens were obtained before and periodically after hip resurfacing. Patients were also assessed with Oxford Hip Scores and Harris Hip Score questionnaires. Two hips were excluded during follow-up, one for revision and another for contralateral hip arthroplasty. Results. Twentyone patients have so far been reviewed at the six-year stage and had excellent hip function (Median Oxford score 13/60 and median Harris Hip Score 89/90). Metal ion data shows encouraging results with mean daily output of cobalt and chromium in urine at 6 years being 3.8 μg/24 hr and 2.2 μg/24 hr respectively. The mean whole blood concentrations for cobalt and chromium were 0.5 μg/l and 1.42 μg/l respectively. Three patients who we reported earlier had radiolucent lines in acetabular zones 1 and 2 continue to have these features, albeit asymptomatic. Discussion and Conclusion. Metal ion levels in this group are lower compared to earlier published reports with similar design bearings with conventional clearance. However the presence of radiolucencies raises the concern that reduced clearance affects early implant fixation possibly from increased friction. Further investigation is needed to assess the long-term outcomes of low clearance bearings

Polyimide (MP-1, MMATech, Haifa, Israel), is a high performance aerospace thermoplastic used for its lubricity, stability, inertness and radiation resistance. A wear resistant thin robust bearing is needed for total hip arthroplasty (THR). After independent laboratory testing, in 2006, the author used the material as a bearing in two Reflection (Smith and Nephew, USA) hip surgeries. The first, a revision for polyethylene wear, survives with no evidence of wear, noise, new osteolysis or complications related to the MP-1 bearing after 16 yrs. The second donated his asymptomatic MP-1 hip at 6.5yrs for post-mortem examination. There were no osteoclasts, cellular reaction bland in contrast to that of polyethylene. In 2013 a clinical study with ethical committee approval was started using a Biolox Delta (Ceramtec, Germany) head against a polyimide liner in 97 patients. MMATech sold all liners, irradiated: steam 52:45. Sixteen were re-machined in New Zealand. Acetabular shells were Delta PF (LIMA, Italy). The liner locked by taper. The cohort consisted of 46:51 M:F, and ages 43 to 85, mean 65. Ten received cemented stems. For contralateral surgery, a ceramic or polyethylene liner was used. Initial patients were lower demand, later, more active patients, mountain-biking and running. All patients have on-going follow up, including MP-1 liner revision cases. There has been no measurable wear, or osteolysis around the acetabular components using weight-bearing radiographs. Squeaking within the first 6 weeks was noted in 39 number of cases and subtle increase in palpable friction, (passive rotation at 50 degrees flexion), but then disappeared. There were 6 revisions, four of which were related to cementless Stemsys implants (Evolutis, Italy) fixed distally with proximal linear lucencies in Gruen zones 1 and 7, and 2 and 6. No shells were revised and MP-1 liners were routinely changed to ceramic or polyethylene. The liners showed no head contact at the apex, with highly polished contact areas. There were no deep or superficial infections, but one traumatic anterior dislocation at 7 years associated with 5 mm subsidence of a non-collared stem. The initial squeaking and increased friction was due to the engineering of the liner / shell composite as implanted, not allowing adequate clearance for fluid film lubrication and contributed to by shell distortion during impaction. The revised bearings were “equatorial” rather than polar, and with lack of wear or creep this never fully resolved. Where the clearance was better, function was normal. The “slow” utilization was due to my ongoing concern with clearances not being correct. The revision of 4 Stemsys stems, tribology issues may have contributed, but non “MP-1” / Stemsys combinations outside this study have shown the same response, thought to be due to de-bonding of the hydroxyapatite coating. With correct engineering and clearances, a 3.6 mm thick MP-1 bearing, a surface Ra<0.5, steam sterilized, shows no appreciable wear, and with confidence, can be used as a high performance THR bearing

Introduction. Friction between head and cup is a primary factor for survival of total hip joint replacement (THR) and its gliding surfaces. In up to 40% of all revisions, the cup or inlay must be replaced as result of friction-induced wear [1]. Aim of the study was to measure the friction-induced temperature increase in vivo in THR and to identify possible individual parameters of influence. Methods. For the in vivo measurement, an instrumented implant with an Al. 2. O. 3. /XPE-pairing and an integrated temperature sensor was used [Fig. 1] [2]. Ten patients were provided with such an instrumented implant. Up to now, long time measurements were performed on six of these patients (Ø63y, Ø89kg). During these measurements, the subjects walked Ø60min on a treadmill with 4km/h. The investigation was performed Ø61 (43–70) months post operatively. Short time (Ø3min) in vivo load measurements during walking on treadmill were already available from the other four patients. These data were used to calculate the peak temperatures after 60mins of walking by using a model, based on the long time measurements. Results. The peak values of the friction-induced temperature increase were achieved in vivo after 30min (H7R) to 70min (H2R), with peak temperatures between 1.5°C (H6R) to 4.8°C (H7R) [Fig. 2]. These maximum values were similar to those already observed in other patients [3]. The in vivo measured peak values of the friction-induced temperature increase after long time walking on a treadmill with respect to the implant orientation are shown in Fig. 3 as points and the calculated peak values as circles. First analyses have shown that the individual implant orientations seem to have an influence [Fig. 3] on the friction-induced increase of the joint temperature during walking, but also the patient's age. Discussion. The gliding partners and joint lubrication directly influence friction in artificial hip joint replacements and thus the friction- induced temperature increase. Analyses of the in vivo acting joint friction during walking have shown that there is an increase in friction over the course of each gait cycle after contralateral toe off [4]. This can be explained by a decrease in the lubricating film thickness due to the pressing out of the synovia from the joint space. During load reduction of the joint in the swing phase, the fluids are transported back into the joint space. Thus, the level of joint friction at the beginning of the next gait cycle depends on the return transport of the synovia. The influence of the sum anteversion angle (ΣAV) on friction-induced temperature increase (Fig. 3) can therefore be explained mechanically: The ΣAV determines the functional joint roofing and the position of the load-transferring zone into the joint socket. The larger the ΣAV, the more it shifts towards the edge of the socket, and the shorter the path for the return transport of the synovium

Introduction. Relative motion at the modular head-neck junction of hip prostheses can lead to severe surface damage through mechanically-assisted corrosion. One factor affecting the mechanical performance of modular junctions is the frictional resistance of the mating surfaces to relative motion. Low friction increasing forces normal to the head-neck interface, leading to a lower threshold for slipping during weight-bearing. Conversely, a high friction coefficient is expected to limit interface stresses but may also allow uncoupling of the interface in service. This study was performed to examine this trade-off using finite element models of the modular head-neck junction. Methods. A finite element model (FEM) of the trunnion/ head assembly of a total hip prosthesis was initially created and experimentally validated. CAD models of a stem trunnion (taper size: 12/14mm) and a prosthetic femoral head (diameter: 28mm) were discretized into elements for finite element analysis (FEA). The trunnion (Ti6Al4V) was modelled with a hexahedral mesh (33,648 elements) and the femoral head (CoCrMo) with a tetrahedral mesh (51,182 elements). A friction-based sliding contact interface was defined between the mating surfaces. The model was loaded in 2 stages: (i) an assembly load of 4000N applied along the trunnion axis, and (ii) 500N applied along the trunnion axis in combination with a torque of 10Nm. A linear static solution was set up using Siemens NX-Nastran solver. Multiple simulations were executed by modulating the frictional coefficient at the taper-bore interface from 0.05 to 0.15 in increments of 0.01, the coefficient of 0.1 serving as the control case (Swaminathan and Gilbert, 2012). Results. The vertical and tangential displacements of the nodes on the taper of the trunnion relative to the femoral head demonstrated a strong inverse dependence upon the coefficient of friction at the interface (Fig. 1). A similar trend was observed with respect to the peak interface pressure (Fig. 2). The peak von Mises stress, however, increases with increasing coefficient of friction (Fig. 2). A Fisher's R to Z correlation test was performed on each output variable to determine its correlation with coefficient of friction. The coefficient of friction correlated significantly (p<0.0001) with both tangential displacement (r = −0.990) and vertical displacement (r = −0.974). Peak von Mises stress (r = 0.995) and peak contact pressure (r = −0.984) were also found to be significantly (p<0.0001) correlated to the coefficient of friction. Discussion. A higher coefficient of friction at the taper-bore interface led to lower contact pressure and sliding at the modular junction. However, higher coefficients of friction also led to increased von Mises stresses within the bore and the trunnion increasing the risk of yielding and fatigue failure. The current results strongly indicate that factors affecting the frictional coefficient at the interface likely influence the occurrence of and severity of mechanically-assisted corrosion in THA. Significance. The results from this study will help us set tolerances for the interlocking mechanism, identifying the minimum frictional coefficient required to obtain stable implant mechanics

Introduction. The metal-on-metal (MoM) total hip prosthesis is widely used. However, the adverse reactions such as pseudotumor around the total hip prosthesis are observed. This is considered the effect of the corrosion of alloy which includes metal ion release and the wear particle generation. As materials for total hip prostheses, cobalt chromium (Co-Cr) alloy is used because of the wear resistance and corrosion resistance. The passive film on the surface of alloy contributes to corrosion resistance. The passive film is removed easily with friction. Therefore, metal ion is released from bare metal. However, this removal of passive film can be restored because of oxidation reaction with neighboring environment. The modular MoM total hip prosthesis such as acetabular component-femoral head or taper junction which connect femoral head and stem have friction interfaces. The friction amplitudes must be different among these interfaces. However, how sliding amplitude affects on removal of a passive film is unclear. The main purpose of this study was to investigate the effect of the sliding amplitude of the reciplocating micromotion on removal and reformation of the passive film of Co-Cr alloy. Methods. The behavior of the passive film was observed by measuring the electric potential of the alloy. Co-Cr alloy (ASTM F75) pin specimen and common tablet specimen were immersed in simulated body fluid PBS(−) and abraded with friction testing machine. The electronic potential between the pin and the Ag/AgCl reference electrode (RE-1C, ALS, Tokyo, Japan) were measured using a high impedance electrometer (HE-104E, HOKUTO DENKO, Tokyo, Japan). The friction amplitude was chosen from 0.2–2 mm. The reciprocating cycle was 1 Hz. The load of 10 N applied on the pin by a weight. Results and discussion. The electric potential neared equilibrium before the friction, and the passive film was stable. Electric potential dropped with the onset of friction and gradually increased with the cessation of friction. The potential difference ΔV and a time constant τ of the rise in electric potential after the friction were estimated. Those ΔV and τ were used as the indicator of the passive film destruction and restoration, respectively. At the friction amplitude of 0.2 mm, ΔV was lowest among at the other amplitudes. On the other hand, τ tended to be longer (Fig. 2). It showed that the reformation of passive film was delayed. When the removal of the passive film was repeated on local area of the friction interfaces, it was presumed similar to a phenomenon of the crevice corrosion. To view tables/figures, please contact authors directly

Introduction. Geometric variations of the hip joint can give rise to abnormal joint loading causing increased stress on the articular cartilage, which may ultimately lead to degenerative joint disease. In-vitro simulations of total hip replacements (THRs) have been widely reported in the literature, however, investigations exploring the tribology of two contacting cartilage surfaces, and cartilage against metal surfaces using complete hip joint models are less well reported. The aim of this study was to develop an in-vitro simulation system for investigating and comparing the tribology of complete natural hip joints and hemiarthroplasties with THR tribology. The simulation system was used to assess natural porcine hip joints and porcine hemiarthroplasty hip joints. Mean friction factor was used as the primary outcome measure to make between-group comparisons, and comparisons with previously published tribological studies. Method. In-vitro simulations were conducted on harvested porcine tissue. A method was developed enabling natural acetabula to be orientated with varying angles of version and inclination, and natural femoral heads to be potted centrally with different orientations in all three planes. Acetabula were potted with 45° of inclination and in the complete joint studies, natural femoral heads were anatomically matched and aligned (n=5). Hemiarthroplasty studies (n=5) were conducted using cobalt chrome (CoCr) heads mounted on a spigot (Figure 1), size-matched to the natural head. Natural tissue was fixed using PMMA (polymethyl methacrylate) bone cement. A pendulum friction simulator (Simulator Solutions, UK), with a dynamic loading regime of 25–800N, ± 15° flexion-extension (FE) at 1 Hertz was used. The lubricant was a 25% (v/v) bovine serum. Axial loading and motion was applied through the femoral head and frictional torque was measured using a piezoelectric transducer, from which the friction factor was calculated. Results. The correct anatomical orientation and positioning was achieved enabling in-vitro simulation testing to be conducted on hemiarthroplasty and complete hip joint samples for two-hours. Mean friction increased rapidly followed by a continued gradual increase to ≈0.03 ± 0.00 in the complete joints, with the hemiarthroplasty group plateauing at ≈0.05 ± 0.01 (Figure 2). Mean friction factor was significantly lower (t-test; p < 0.05) in the complete natural joint group. Discussion. An in-vitro simulation system for the natural hip joint with controlled orientation of the femur and acetabulum was successfully developed and used to measure friction in complete porcine hip joints and porcine hip hemiarthroplasties. A non-linear increase in friction indicative of biphasic lubrication was observed in both groups with slower exudation of fluid from the complete joints compared to the hemiarthroplasties, inferring a quicker move towards solid-phase lubrication. Higher friction in the hemiarthroplasties, which was similar to that measured in-vitro in metal-on-polyethylene THRs, was most likely due to variable clearances between the non-conforming spherical metal head and aspherical acetabulum, causing poorer congruity and distribution of the load. This could in time lead to abrasive wear and cartilage degradation. This methodology could have an important role when investigating associations between hip geometric variations, interventions for hip disease/pathology, and risk factors for cartilage degeneration

Total hip and knee joint prostheses composed of ultra-high molecular weight polyethylene (UHMWPE) and metal or ceramics have been widely applied. Efficacious treatments such as crosslinking, addition of vitamin E and phospholipid coating to UHMWPE have reduced wear and extended the life of joint prostheses. However, wear problems have not yet been completely solved for cases involving severe conditions, where direct contact can occur in mixed or boundary lubrication. In contrast, extremely low friction and minimum wear are maintained for a lifetime in healthy natural synovial joints containing articular cartilage with superior lubricity. Accordingly, joint prostheses containing artificial hydrogel cartilage with properties similar to those of articular cartilage are expected to show superior tribological functions. In establishing the function of artificial hydrogel cartilage as a novel material for joint prostheses, the tribological properties of hydrogel materials used and synergistic performance with synovia constituents are both important. In this study, the lubrication ability and wear resistance properties of poly(vinyl alcohol) (PVA) hydrogels were evaluated by differences in friction and wear properties in reciprocating tests lubricated with saline and simulated synovial fluid. Biphasic finite element (FE) analysis was applied to elucidate the role of biphasic lubrication mechanism in hydrogels. As biocompatible artificial hydrogel cartilage materials, three PVA hydrogels were prepared using the repeated freeze-thawing (FT) method, the cast-drying (CD) method and the hybrid method for laminated gel of FT on CD, which are physically crosslinked with hydrogen bonding but differ in terms of structure and mechanical properties. First the frictional behavior of the ellipsoidal PVA hydrogel specimens was examined in reciprocating tests against a glass plate, which corresponds to simplified knee prosthesis model (Fig.1), with a sliding speed of 20 mm/s under constant continuous loading. As shown in Fig.1, the three hydrogels exhibited different frictional behaviors in a saline solution. It is noteworthy that the hybrid gel maintained very low friction until the end of test. The CD gel showed slightly higher friction and a gradual increase. Meanwhile, the FT gel showed initial medium friction and a gradual increase. Time-dependent frictional behavior was clarified with biphasic lubrication mechanism via biphasic FE analysis. Contact surface observation showed minimal wear without scratches for hybrid gel in saline. Next, simulated synovial fluid composed of 0.5 wt% hyaluronic acid (HA, molecular weight: 920,000 Da), 1.4 wt% albumin, 0.7 wt% gamma-globulin and 0.01 wt% L-alpha dipalmitoylphosphatidylcholine (DPPC), was used to evaluate tribological performance of these gels in physiological condition. As shown in Fig.2, PVA hydrogels in simulated synovial fluid exhibited very low friction, with hybrid gel showing an extremely low friction coefficient of 0.003 in the test. These friction differences were sustained by biphasic FE analysis. Hybrid gel further showed very little wear (Fig.3), which is favorable in terms of hydrogel durability. These results indicate the importance of superior lubricity and wear resistance of PVA hybrid gel for the clinical application of artificial hydrogel cartilage in joint prostheses

Introduction. Lipped liners have the potential to decrease the rate of revision for instability after total hip replacement since they increase the jumping distance in the direction of the lip. However, the elevated lip also may reduce the Range of Motion and may lead to early impingement of the femoral stem on the liner. It is unclear whether the use of a lipped liner has an impact on the level of lever-out moments or the contact stresses. Therefore, the aim of the current study was to calculate these values for lipped liners and compare these results to a conventional liner geometry. Materials and Methods. 3D Finite Element studies were conducted comparing a ceramic lipped liner prototype and a ceramic conventional liner both made from BIOLOX. ®. delta. The bearing diameter was 36 mm. To apply loading, a test taper made of titanium alloy was bonded to a femoral head, also made from BIOLOX. ®. delta. Titanium was modeled with a bilinear isotropic hardening law. For the bearing contact a coefficient of friction of both 0.09 or 0.3 was assumed to model a well and poorly lubricated system. Frictionless contact was modeled between taper and liner. Pre-load was varied between 500 N and 1500 N and applied along the taper axis. While keeping pre-load constant, lever-out force was applied perpendicular to the taper axis until subluxation occurred. Liners were fixed at the taper region. Lever-out moment, equivalent plastic strain and von Mises stress of the taper, bearing contact area and contact area between taper and liner was evaluated. Results. With increasing pre-load, larger lever-out moment, equivalent plastic strain, contact area between taper and liner and bearing contact area was found for both liner designs. However, von Mises stresses were nearly constant but slightly exceeded yield strength of titanium. For all evaluated parameters almost no differences were found between the liner designs. Lever-out moments were comparable for both designs ranging from 4.5–10.5 Nm for the lipped liner and 4.4–10.2 Nm for the conventional liner. The increase of the coefficient of friction strongly affected lever-out moments, equivalent plastic strain and contact area between taper and liner. The other parameters were not affected by varying the coefficient of friction. Discussion. This study did not find significant differences in the lever-out behavior of the lipped acetabular liner compared to the conventional liner design. The inner geometry of the lipped liner is comparable to the conventional liner inner geometry. Therefore, contact area showed no significant differences and contact mechanics are identical in the current setup leading to similar results of both liner designs. For both designs small plastic deformations in the contact point of the taper were found at the contact region between liner and taper. However, the investigated mechanical parameters did not differ between the two investigated liner types. For any figures or tables, please contact authors directly

INTRODUCTION. In theory, Finite Element Analysis (FEA) is an attractive method for elucidating the mechanics of modular implant junctions, including variations in materials, designs, and modes of loading. However, the credence of any computational model can only be established through validation using experimental data. In this study we examine the validity of such a simulation validated by comparing values of interface motion predicted using FEA with values measured during experimental simulation of stair-climbing. MATERIALS and METHODS. Two finite element models (FEM) of a modular implant assembly were created for use in this study, consisting of a 36mm CoCr femoral head attached to a TiAlV rod with a 14/12 trunnion. Two head materials were modelled: CoCr alloy (118,706 10-noded tetrahedral elements), and alumina ceramic (124,710 10-noded tetrahedral elements). The quasi-static coefficients of friction (µ. s. ) of the CoCr-TiAlV and Ceramic-TiAlV interfaces were calculated from uniaxial assembly (2000N) and dis-assembly experiments performed in a mechanical testing machine (Bionix, MTS). Interface displacements during taper assembly and disassembly were measured using digital image correlation (DIC; Dantec Dynamics). The assembly process was also simulated using the computational model with the friction coefficient set to µ. s. and solved using the Siemens Nastran NX 11.0 Solver. The frictional conditions were then varied iteratively to find the value of µ providing the closest estimate to the experimental value of head displacement during assembly. To validate the FEA model, the relative motion between the head and the trunnion was measured during dynamic loading simulating stair-climbing. Each modular junction was assembled in a drop tower apparatus and then cyclically loaded from 230–4300N at 1 Hz for a total of 2,000 cycles. The applied load was oriented at 25° to the trunnion axis in the frontal plane and 10° in the sagittal plane. The displacement of the head relative to the trunnion during cyclic loading was measured by a three-camera digital image correlation (DIC) system. The same loading conditions were simulated using the FEA model using the optimal value of µ derived from the initial head assembly trials. RESULTS. For both head materials, the predicted values of axial displacement of the head on the trunnion closely approximated the measured values derived from DIC measurements, with differences of −0.17% to +6.5%, respectively. Larger differences were calculated for individual components of motion for the stair climbing activity. However, the predicted magnitude of interface motion was still within 10% of the observed values, ranging from −7% to −5%. CONCLUSIONS. Our simulations closely approximated physical testing using complex loading, coming within 7% of the target values. By generating a validated computational model of a modular junctions with varying head materials, we will be able to simulate additional activities of daily living to determine micromotion and areas of peak pressure and contact stresses generated. For any figures or tables, please contact authors directly