Aims

Biofilm formation is intrinsic to prosthetic joint infection (PJI). In the current study, we evaluated the effects of silver-containing hydroxyapatite (Ag-HA) coating and vancomycin (VCM) on methicillin-resistant Staphylococcus aureus (MRSA) biofilm formation.

Although the pre- or intraoperative flexion angle in TKA has been commonly considered as a predictor of the postoperative flexion angle, patients with well flexion intraoperatively cannot necessarily obtain deep flexion angle postoperatively. The reason why inconsistencies remains has been unsolved. The intraoperative compressive force between femoral and tibial components has the advantage of the sequential changes during knee motion. However, the relationship between the compressive force and the postoperative ROM has not yet been clarified. We aimed to evaluate the intraoperative femorotibial compressive force during passive knee motion, and determine the relationship between the compressive force and the postoperative flexion angle.

A total of 11 knees in 10 patients who underwent primary cruciate-retaining (CR) TKA (The FINE Total Knee System; Teijin Nakashima Medical Co., Ltd., Okayama, Japan) for osteoarthritis were studied retrospectively, with a mean age of 76 years via a measured resection technique. We developed a customized measurement device mimicking the tibial component with this platform of six load sensors arranged in two rows (medial and lateral) by three tandem sets (anterior, center and posterior): anteromedial (AM), anterolateral (AL); centromedial (CM), centrolateral (CL); and posteromedial (PM), posterolateral compartment (PL) (Fig. 1). At the step of the implant trial, this device was placed on the tibia with compressive force recorded three times, while the knee was subsequently taken from 0° to full flexion manually in 15 seconds with the flexion angle of the knee recorded simultaneously by using an electric goniometer (Fig. 2). Eligibility were evaluated for ROM using a long-armed goniometer preoperatively and at 6 months postoperatively. A p value of < 0.05 was considered significant.

The mean compressive force at AM, AL, CM, CL, PM and PL was 0.7, 0.5, 1.3, 1.2, 3.4 and 2.6 kgf, with the peak force of 4.2, 2.5, 4.1, 2.5, 7.3 and 4.7 kgf, respectively. The mean pre- and postoperative extension and flexion angles were −11° and −6°; and 115° and 113°, respectively. There were no significant correlations between the mean force in any region of interest (AM to PL) and the postoperative flexion angle. The peak force in PM showed little correlation with the postoperative flexion angle (r = −0.17, p = 0.54), however, that in PL was strongly negatively correlated with the postoperative flexion (r = −0.86, p < 0.01).

The current results suggest the presence of less force on the lateral side in flexion. We speculate that lower compressive force at the lateral side is essential for deep flexion as it has been reported that the lateral structure has more laxity than the medial side during flexion in healthy knees. Measurement between the femoral and tibial compressive force can contribute an achievement of more flexion angle following CR-TKA.

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.

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 9.2×10⁵. 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: 9.2×10⁵), 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.

One of the main concerns about the currently available simulators is that the TKA is driven in a “passive way” for assessment. For the simulators for the wear assessment, the tibio-femoral relative motion is automatically made by using the knee kinematics and loading profile of a normal gait. As for the simulators for the kinematics and kinetics assessment of TKA, also the predicted loading profiles introduced from the theoretical model are applied as the input data to drive the simulator. It should be noted that the human joints are driven by the muscles' forces and external loads, and their kinematics and kinetics are the “outcome”. This being so, the knee simulator should be driven by the muscles' forces and upon these conditions the TKA performance is to be assessed. Some other concerns about the current simulations are as follows. The effects of hip joint motion are not taken into account. The upper body weight is applied along a vertical rod in such a way as a crank-slider. Furthermore, few simulators are capable of knee flexion greater than about 110°.

Considering the above, we have developed a novel knee simulator which makes it possible to reproduce the active and natural knee motion to assess kinematics and kinetics of TKA. In the experiment, the custom-designed PS type TKA was attached and the simulator was operated so as to reproduce the sit-to-stand features, thereby introducing the tibio-femoral loading profiles during the motion.

Figure 1 illustrates the external appearances of the simulator and a close view of the knee joint compartment. Since our simulator is composed of a multiple inverted pendulum, the knee part bears the upper body weight in a physiological way. The holder bracket is set to prevent the simulator from collapsing for security. The dimension and weight of each link were set as close as those of each segment of a normal male subject. Our simulator is driven by the wire pull mechanism which substitutes the human musculo-skeletal system of lower limb. Figure 2 shows close views of tibial tray with load cells. In Fig.2a, cell FR, FC and FL are to measure the tangential components of tibio-femoral contact force, i.e., the Anterio-Posterior force (AP force). The rest five cells are to measure the normal components of tibio-femoral contact force (normal force). As shown in Fig.2c, the tibial insert of TKA is mounted on the lid of the tibial tray box.

In the experiment, a PS type TKA whose maximum flexion angle of 150° was attached to the simulator for evaluation. The simulator was operated so as to reproduce the sit-to-stand features and the data concerning about the AP force, F_t, and the normal force, F_n were recorded.

Figure 3 shows the variations of knee flexion angles and knee contact forces respectively as a function of normalized time. Our knee simulator may have a potential for substituting the in vivo measurement.

Ultra-high molecular weight polyethylene (UHMWPE) is the sole polymeric material currently used for weight-bearing surfaces in total joint arthroplasty. However, the wear phenomenon of UHMWPE components in knee and hip prostheses after total joint arthroplasty is one of the major restriction factors on the longevity of these implants. In order to minimize the wear of UHMWPE and to improve the longevity of artificial joints, it is necessary to clarify the factors influencing the wear mechanism of UHMWPE. In the microscopic surface observation of the virgin knee prosthesis with anatomical design, various grades of microscopic surface scratches and defects caused by machining and surface finishing processes during manufacture of the component were observed on the surface of the metallic femoral component [Fig. 1] (C. Cho et al, 2009), although the overall surface were finished at smoother level. It is thought that certain levels of the microscopic surface asperities caused by these surface damages in the metallic femoral component might contribute to increasing and/or accelerating wear of the UHMWPE tibial insert. Therefore, it is necessary to clarify quantitatively the influence of the microscopic surface asperities of the metallic components in virgin artificial joints on the wear of UHMWPE components.

The primary purpose of this study was to investigate the influence of the microscopic surface asperities of the virgin metallic femoral component on the wear of the UHMWPE tibial insert in the virgin knee prosthesis. In this study, the authors focused on the three-dimensional shape of the microscopic surface asperities as a factor influencing the wear mechanism of the UHMWPE tibial insert. The 3D microscopic surface profile measurement of the virgin metallic femoral component using a laser microscope and reproduction of the femoral component surface using 3D CAD software were performed [Fig. 2] in order to produce idealized 3D finite element models of the microscopic surface asperity of the femoral component based on actual measurement data. Elasto-plastic finite element contact analyses between idealized microscopic surface asperities and UHMWPE were also performed in order to investigate the influence of the three-dimensional shape of the microscopic surface asperities of the virgin metallic femoral component on the wear of the UHMWPE tibial insert. The analytical findings of this study suggest that the aspect ratio and shape ratio [Fig. 3] of the microscopic surface asperity of the virgin metallic femoral component have an important influence on increasing and/or accelerating wear of the UHMWPE tibial insert.

It is reported that more than 10 million Japanese suffer from arthrosis. To cure these cartilage defects, total joint replacements, which are the most popular treatment methods for severe disease situation, have been operated as about two hundred thousand cases a year in Japan. Although the implants made of either ceramics, metals or plastics have high wear resistance quality, it becomes apparent that the endurance life of the artificial joints in considerable cases is limited by aseptic loosening to between 10–15 years. Here we focused on a poly(vinyl alcohol) (PVA) hydrogel as an artificial cartilage tissue to make an improvement of friction surface of the artificial joints. In this paper, we observed morphology of wear particles and assessed immune responses of wear particles from the hydrogel for confirming the validity of the gel as a biotribological material.

We prepared 20 w/w% of PVA hydrogel by repeated freezing-thawing method. The number of the freezing-thawing cycles was five times. Polymerization degree and saponification degree of PVA (Kishida Chemical Co. Ltd., Japan) were 2000 and 98.4–99.8 mol%, respectively. To collect the wear particles of PVA hydrogel, we processed wear testing by using a purpose-build wear test machine of reciprocating pin-on-plate tribometer as shown in figure 1. We installed a Co-Cr-Mo ball of 26 mm in diameter as a stationary upper specimen and a PVA hydrogel plate of 2 mm in thickness as reciprocating lower specimen in a water bath. The lubricant was a distilled water containing eluted PVA which PVA-FT gel had been soaked in, filtered by 0.22 μm and autoclaved, subsequently. Siding speed was 50 mm/s and the total sliding distance was 3 km. We observed the wear particles which had been dried in a desiccator, by scanning electron microscope (SEM; SU8000, Hitachi High-Technologies). Additionally, to investigate the effect of the wear particles on response of phagocytosis of macrophages, here we used THP-1 cell line from Human acute monocytic leukemia as a macrophage, which was purchased from JCRB Cell Bank, and attached the macrophages on a dish after stimulating THP-1 by phorbol 12-myristate 13-acetate (PMA; Wako). After the wear test, we harvested the lubricant in aseptic clean hood and applied the particles to the macrophages to clarify the effect of wear particles of PVA hydrogel on immune response of the cell. To assess cytokine biosynthesis as immune responses, we assayed IL-1β and TNF-α biosynthesis in culture medium by ELISA (Thermo scientific), respectively.

Figure 2 shows an SEM image of PVA hydrogel after wear test under 4.9 N loading. We observed the wear particles of varied sizes. When applying the wear particles to the macrophages in RPMI-1640 supplement with 10 v/v% fetal bovine serum, it seemed that there were not enough change on cytokine synthesis in culture medium between with/without the particles.

In joint prostheses using ultra-high molecular weight polyethylene (UHMWPE) as bearing material, wear problems are not yet completely solved under severe conditions in various daily activities, although efficacious treatments such as crosslinking, addition of vitamin E and the grafting of phospholipid polymer improved the wear properties. In contrast, in healthy natural synovial joints possessing articular cartilage as biphasic bearing material lubricated with synovial fluid, minimal wear with extremely low friction has been maintained for a whole life. Therefore, the joint prosthesis with artificial hydrogel cartilage with similar properties to articular cartilage is expected to show superior tribological functions with very low friction and infinitesimal wear if the appropriate lubrication mechanism is actualized. In this study, the effectiveness of biphasic lubrication mechanism in hydrogel through significant load support by fluid phase is evaluated in finite element (FE) analysis for reciprocating motion.

As biocompatible artificial hydrogel cartilage materials, two kinds of poly (vinyl alcohol) (PVA) hydrogels were prepared by the repeated freezing-thawing method and the cast-drying method, which are physically crosslinked with hydrogen bonding but different in structure and mechanical properties. To evaluate these time dependent behaviors of load-support ratio of fluid/solid phases and friction, two-dimensional biphasic FE analysis for cylindrical PVA hydrogel cartilage as 1.5 mm thick soft layer and radius of 5 mm was conducted under continuous loading of 0.2 N/mm by impermeable rigid plate in reciprocating motion in Fig. 1. The sliding speed is 4 mm/s for stroke of 8 mm at period of 4 s. A commercial package ABAQUS (6.8–4), which was appropriately evaluated for the biphasic FE analyses, was used in this study. The biphasic tissue was modeled by CPE4RP (four-node bilinear displacement and pore pressure, reduced integration with hour glass control) elements. The mechanical properties such as permeability, Young's modulus and Poisson ratio were estimated by curve fitting to stress relaxation behaviors in compression test.

As indicated in Fig. 2, it is worth noting that the cast-drying PVA shows significant interstitial fluid pressurization compared with a repeated freezing-thawing PVA hydrogel at 292 s after start-up, where coefficient of friction for solid-to-solid was assumed as 0.2. Changes in friction for PVA hydrogels in reciprocating motion were estimated as shown in Fig. 3. In spite of high friction (0.2) for solid-to-solid, cast-drying PVA brought the gradual decreasing in friction, probably due to rising of load-support ratio by fluid phase from initial 74% to 80%.

In human body, lubricating constituents in synovial fluids such as hyaluronic acid, proteins, glycoproteins and phospholipids can reduce the coefficient of friction for solid-to-solid. As suggested for low coefficient of friction for solid-to-solid as 0.01 in Fig. 3, rubbing friction is expected to be reduced to significantly low level.

As described above, the effective biphasic lubrication can sustain low friction level and minimal wear in synergistic action with soft-elastohydrodynamic lubrication, hydration lubrication and boundary lubrication as a similar mechanism to natural cartilage in various daily activities. These results indicate the usefulness of artificial hydrogel cartilage for longer durability in joint prostheses for clinical application.

There are several concerns about the current simulators for TKA. First, the knee is flexed in a “passive way” under the condition of applying constant muscular tension forces. Second, the effects of hip joint motion are not taken into account. Thirdly, the external load for example, upper body weight is not applied in a natural way. Finally, few simulators are capable of knee flexion greater than about 100°.

To this end, we have developed a novel knee simulator system that reproduces the active and natural knee motion to evaluate kinematics and joint forces of TKA. Our simulator system has the following advantages and innovative features. First, it is driven directly by muscles' tension forces, and the knee is capable of active flexion. Secondly, a hip joint is incorporated into it and the lower limb motion is achieved in a synergistic way between the hip and knee joints. Thirdly, it is capable of complete deep knee flexion up to 180°.

Figure 1 shows the structure of the system. Both the hip and knee joints are moved by the tension forces of four wires that simulate the functions of the mono-articular muscles ((1), (3)) and the bi-articular muscles ((2), (4)) by means of a multiple pulley system (Fig 2). The femoral and tibial components of TKA are secured in the distal end of the upper link (thigh) and the proximal end of the lower link (shank) respectively. The ankle assembly has three sets of rotary bearings whose axes intersect at a fixed point, the center of the ankle, allowing spherical movement of the tibia about the ankle center. Springs were stretched around the ankle center to substitute the muscles around the ankle. Weights I and II are counterweights so as to duplicate the weights of the human upper body, thigh and shank respectively. The wires are pulled to produce the hip and knee motions. The linear bearings running along vertical rods also prevent the system from collapsing.

In the experiment, a custom-designed posterior stabilized type TKA was attached to the simulator system for evaluation. The system was operated so as to reproduce the sit-to-stand features in a quasi-static manner in order to study the kinematics of TKA. Beyond 130°, the knee proceeded to flex passively because of upper body weight. Conspicuous internal/external rotation or valgus/varus motion of the tibia relative to the femur was not observed as the knee flexed. When our simulator system was driven in a quasi-static manner, it was able to measure the kinematics of TKA however, when the system was driven in a dynamic manner, it oscillated because the springs around the ankle were not stiff enough to hold the inverted pendulum-like system upright and the ratios of the tension force exerted by the four wires simulating muscles could not be determined appropriately.

Various treatments for ultra-high molecular polyethylene (UHMWPE) such as cross-linking, addition of vitamin E and the grafting of phospholipid polymer improved the wear properties. However, wear problems still occur in joint prostheses in mixed or boundary lubrication modes under severe conditions. As an alternate method, the joint prosthesis with artificial hydrogel cartilage with similar properties to articular cartilage is expected to show superior tribological functions with very low friction and low wear if the adaptive multimode lubrication mechanism is actualized. In this study, the effectiveness of hydrogel structure and adsorbed film formed on artificial cartilage surfaces is examined in reciprocating tests in related to biphasic, hydration and boundary lubrication modes.

The frictional behaviors of artificial cartilage materials against flat glass plate in the reciprocating test were observed. As upper specimens, poly(vinyl alcohol) (PVA) hydrogel ellipsoidal specimen as 2 mm soft layer were prepared. PVA hydrogel specimens were prepared by the repeated freezing-thawing method and the cast-drying method. The sliding speed and stroke length were 20 mm/s and 35 mm, respectively. Applied load was 2.94 N or 9.8 N. The lubricants are saline or saline solutions containing L-α-Dipalmitoyl phosphatidyl-choline (DPPC), serum protein and/or hyaluronate(HA).

As shown in Fig. 1, the repeated freezing-thawing PVA shows gradual increase in friction from initial medium value immediately after loading of 2.94 N to high level. For the same test condition, the articular cartilage exhibited similar time-dependent frictional behavior from initial lower friction to high level as estimated by biphasic lubrication theory. On the contrary, it is noticed that a low friction is maintained for cast-drying PVA hydrogel, particularly two-layer laminated PVA hydrogel until 140 m sliding. The improvement of frictional behaviors in cast-drying PVA hydrogel is considered to have been brought about by the improvement of water retention ability of the hydrogel with uniform microstructure controlled by hydrogen bond.

Next, the influence of lubricant constituents on tribological behaviors of freezing-thawing PVA hydrogel was examined in repeated reciprocating test including unloading-restarting process at each 36 m sliding at 9.8 N. The frictional behavior for the freezing-thawing PVA hydrogel could be improved with supplying appropriate lubricant constituents as shown in Fig. 2. In lubricated condition with HA solution containing 0.01 wt% DPPC, 1.4 wt% albumin and 0.7 wt% γ-globulin, low friction was maintained and very little visible wear was confirmed in micrograph. Adsorbed films appear to contribute to the effective synergistic lubrication even under high load of 9.8 N in reciprocating test.

As described above, the effectiveness of synergistic lubrication for PVA hydrogel specimens is shown for improvement of tribological behaviors of artificial cartilage as a superior mechanism to natural cartilage. These results indicate the possibility of artificial hydrogel cartilage for longer durability in joint prostheses for clinical application.

The reduction of both friction and wear is required in existing joint prostheses composed of ultra-high molecular weight polyethylene (UHMWPE) and metallic or ceramic components, or even in Hard-on-Hard joint prostheses. In contrast, the healthy natural synovial joints with rubbing surfaces of articular cartilage are likely to operate at very low friction and low wear for the entire lifetime in the adaptive multimode lubrication mechanism, in which various lubrication modes become effective in various daily activities. Therefore, to establish a similar lubrication mechanism in joint prostheses by the application of compliant artificial cartilage, we conduct various researches to improve lubrication modes resulting in reduction in both friction and wear. In this paper, the effectiveness of the hydrogel artificial cartilage of high water content is discussed from the viewpoint of bionic design to mimic natural synovial joints.

The aim of this paper is to facilitate a function based on multimode lubrication mechanism in joint prostheses similar to natural synovial joints. Firstly, the possibility of full elastohydrodynamic lubrication was evaluated by experimental methods in friction tester and joint simulator. The joint prostheses with compliant rubbing materials or polymer-on-hard joint with better geometrical congruity showed siginificant fluid film formation, but some local intimate contact occurred. Therefore, as the second viewpoint, the effectiveness of adsorbed film formation was examined. The noteworthy phenomena are remarkable reduction in friction for artificial joint with poly(vinyl alcohol) (PVA) hydrogel articular surfaces and a notable increase in friction for artificial joint with polyurethane surface in hyaluronate solutions containing serum proteins. These results indicated that adsorbed protein films can reduce or increase friction and wear depending on probably fluid film thickness.

Other findings of effectiveness of layered adsorbed film and negative effect of heterogeneous adsorbed film are described on the basis of various observation in friction tests.

As the third viewpoint, the importance of biphasic lubrication and hydration lubrication for hydrogel surface with high water content is discussed. In friction tests of natural articular cartilage against glass plate, it was observed that the unloading for 5 min after continuous 30 min rubbing reduced the friction at restarting probably due to biphasic lubrication and/or hydration lubrication after rehydration, where adsorbed films have some influences on friction and wear. For joint prostheses with compliant hydrogel artificial cartilage, similar mechanism is required for surface and bulk structure of artificial cartilage.

In this paper, several important essential points from the bionic design are indicated for development of the next generation for joint prostheses with higher function and better longevity.

Alumina and zirconia have been extensively used for orthopedic implants, such as hip and knee joint replacements. In 1982, Dr Hironobu Oonishi and Kyocera Corp. put the world’s first ceramic knee component, KOM, to practical use. This ceramic knee component shows excellent clinical results for long-time use. Now, the ceramic material of the knee component is changed from the alumina to the zirconia, and over 5000 ceramic components have been used in Japan so far.

The 3 mol% yttria stabilized polycrystalline zirconia (3Y-TZP) has been used as surgical grade zirconia. The 3Y-TZP possesses higher fracture strength and toughness as compared to monolithic alumina. However, it is generally known that spontaneous transformation may also occur at relatively low temperatures in hydrothermal environment as in the case of human body for the 3Y-TZP. Therefore, there is a concern of the degradation of mechanical and wear properties as a consequence of the transformation (low temperature degradation).

Our previous studies confirmed that low temperature degradation can be prevented by optimizing sintering temperature and adopting a Hot Isostatic Press process. In this study, we evaluated the effects of surface nature of ceramic material and heat treatment. Since grinding and polishing of the ceramic implants (e.g. femoral heads) might induce phase transformation, residual stress and microcracks, it is needed to examine the validity of the manufacturing process.

At first, the 3Y-TZP samples with grinded (#400) and mirror polished surfaces were prepared and exposed in saturated vapor in an autoclave at 121°C for 150 h (aging test). Some of the samples were subjected to a heat treatment and then to aging test. Before and after aging test, change in crystal structure was evaluated by X-ray diffraction. Then, for evaluation of the aging effects for microscopic area of the ceramic, a Vickers indentation was introduced on the surface before the aging test. Changes in crystal structure and residual stress were evaluated by a Raman spectroscopic technique.

In the results of the aging test, it was found that the degree of the increase in monoclinic fraction of both grinded and polished surfaces was lower in the samples with heat treatment than in those without heat treatment. These results indicate that the phase stability of the 3Y-TZP was improved by the heat treatment after machining.

Around the indentation, circular-like deformation zone and cracks extending from the four corners of the indentation were observed. After the aging test, the transformed area gradually spread towards neighborhood regions depending on the aging time. Besides, a distinct progress of phase transformation at around the crack was also observed. On the other hand, in the samples subjected to the heat treatment, no transformed area was observed around the indentation. These results suggest that low temperature degradation could be prevented by the heat treatment after the machining.

The residual stress fields induced in phase-transformed areas increased during aging test, and heat treatment after the machining was also able to prevent phase transformation even if surface damages, such as indentation or machining, were introduced on the samples.

The wear phenomenon of ultra-high molecular weight polyethylene (UHMWPE) in knee and hip prostheses is one of the major restriction factors on the longevity of theses implants. Despite quite a number of studies on the wear of UHMWPE, the wear mechanism is not clear yet. In order to minimize the wear of UHMWPE and to improve the longevity of artificial joints, it is necessary to clarify the factors influencing the wear mechanism of UHMWPE. Especially for the artificial knee joint with anatomical design, the contact stresses in the UHMWPE tibial insert are generally higher than the yield stress of the material during normal gait. In addition, the predominant types of wear on reported simulator-tested and retrieved UHMWPE tibial inserts are delamination and pitting. These facts suggest that the fatigue fracture that causes micro-cracks both on and below the surface of the UHMWPE tibial insert and the generation of wear particles as fatigue type are closely related to the repeated plastic deformation. On the metallic femoral components of the retrieved knee prostheses with anatomical design, a number of microscopic scratches caused by various factors were observed. It is thought that microscopic surface asperities caused by this surface damage contribute to increasing and/or accelerating wear of the UHMWPE tibial insert. The primary objective of this study was to investigate the factors influencing the wear mechanism of UHMWPE tibial insert in knee prosthesis.

In this study, macroscopic and microscopic elasto-plastic contact analyses of the UHMWPE tibial insert based on macroscopic and microscopic geometrical measurements from retrieved knee prosthesis were performed using finite element method (FEM) in order to investigate the mechanical state, plastic deformation behavior in the UHMWPE tibial insert and microscopic wear of the polyethylene caused by microscopic surface asperity. For this purpose, the determinative method of the contact position between the femoral component and the UHMWPE tibial insert for the retrieved knee prosthesis was developed. The three-dimensional FEM model of the retrieved knee prosthesis with worn contact surfaces was produced. Three-dimensional microscopic surface profile measurements of damaged surface of a retrieved metallic femoral component by using a laser microscope and reproduction of the femoral component surface by using 3D CAD software were performed in order to produce the 3D FEM models of the microscopic asperity based on actual measurement data.

The analytical findings of this study suggest that maximum plastic strain below the surface is closely related to subsurface crack initiation and delamination of the retrieved UHMWPE tibial insert. The worn surface whose macroscopic geometrical congruity had been improved due to wear after joint replacement showed lower contact stress at the macroscopic level. The aspect ratio, shape ratio and indentation depth of the microscopic asperity have a significant effect on increasing and/or accelerating wear on the UHMWPE. Higher aspect ratios, shape ratios and indentation depths cause higher contact stresses and plastic strains in the UHMWPE. These are therefore significant factors influencing the wear mechanism of UHMWPE.

We report the use of a new approach for elbow arthroplasty in 58 cases over a 20-year period. A wide exposure, obtained by elevating the triceps attachment and dividing the radial collateral ligament, allows the excision of diseased tissue, articular irregularities and osteophytes. Normal anatomy is restored and active mobilisation can be started 10 days after operation. Good or fair results, with over 70 degrees of joint movement, were achieved in 88% of cases.