Malpositioning still occurs in total hip arthroplasty (THA). As a result of mal-orientation, THA bearing can be subjected to edge loading. The main objective of the study was to assess if the wear rate of ceramic-on-ceramic and metal-on-polyethylene increases under edge loading conditions and to determine which of the most commonly used hip bearings is the most forgiving to implant mal-orientation. Two different polyethylenes (UHMWPE and vitamin E blended HXLPE) and ceramics (pure aluminum PAL and alumina-toughened zirconia ATZ) were tested with a hip simulator and compared to metal-on-metal results. The inclination angle was selected at 45°, 65° and 80°. In addition, the ceramic-on-ceramic barings were tested at conditions that produced microseparation. Contrary to metal-on-metal that is highly susceptible to edge loading, the wear rate of ceramic-on-ceramic and metal-on-polyethylene articulations does not increase with increasing cup inclination. In fact, the polyethylenes showed a contra-intuitive behaviour as its wear rate decreased slightly but significantly with increasing inclination angle. This behaviour can be explained when looking closely at the contact stresses and areas. (Figure 1 shows the wear area of the vitamin E blended HXLPE at 45° and figure 2 at 80° cup inclination). The newest biomaterials, vitamin E blended HXLPE and ATZ, showed markedly lower wear rates compared to their conventional counterparts, UHMWPE and PAL. The ATZ ceramic-on-ceramic articulation showed the lowest wear rate (even when microseparation is included) of all tested pairings, but the new vitamin-doped HXLPE seems to be the most forgiving materials when it comes to implant mal-orientation. It shows low wear rate even at an extremely high cup inclination angle. Therefore, a surgeon that discovers a mal-positioned polyethylene cup at the first post-op X-ray will not need to worry unduly about increased wear (but “only” about a potential dislocation).Materials and methods
Results
Ceramic composites have been developed to further improve the mechanical properties, reduce risk of fracture, and increase the survivorship of ceramic-on-ceramic bearings in total hip replacement1. The aim of this study was to evaluate the wear of two novel ceramic composite materials under edge loading conditions due to translational mal-positioning when used in both like-on-like and mixed pairing configurations; and to compare their performance to earlier generation ceramic-on-ceramic bearings. The head-on-cup configurations of three ceramic materials (see Figure 1), were ATZ-on-ATZ, ZTA-on-ZTA, Al2O3-on-Al2O3, ATZ-on-ZTA, ZTA-on-ATZ, Al2O3-on-ATZ, ATZ-on-Al2O3and Al2O3-on-ZTA. All combinations were size 28mm and were supplied by Mathys Orthopädie GmbH (Morsdorf, Germany). They were tested for four million cycles on the Leeds II hip simulator under microseparation2,3,4 conditions representing translational mal-positioning. The gait cycle comprised extension/flexion (−15º/+30º), internal external rotation (+/−10º) and a twin peak load with a maximum of 3kN. Microseparation was achieved by applying a 0.5mm dynamic medial/lateral displacement using a spring load resulting in edge loading at heel strike. New-born calf serum (25%) was used as a lubricant. Wear was assessed gravimetrically every million cycles. Statistical analysis was performed using one-way ANOVA (significance taken at p<0.05).Introduction
Materials and Methods
