Proceedings of the Institution of Mechanical Engineers,Part H: Journal of Engineering in Medicine

The objective of this study was to investigate the effect of counterface roughness and lubricant on the morphology of ultra-high molecular weight polyethylene (UHMWPE) wear debris generated in laboratory wear tests, and to compare this with debris isolated from explanted tissue. Laboratory tests used UHMWPE pins sliding against stainless steel counterfaces. Both water and serum lubricants were used in conjunction with rough and smooth counterfaces. The lubricants and tissue from revision hip surgery were processed to digest the proteins and permit filtration. This involved denaturing the proteins with potassium hydroxide (KOH), sedimentation of any remaining proteins, and further digestion of these proteins with chromic acid. All fractions were then passed through a 0.2 μm membrane, and the debris examined using scanning electron microscopy.

The laboratory studies showed that the major variable influencing debris morphology was counterface roughness. The rougher counter-faces produced larger numbers of smaller particles, with a size range extending below 1 μm. For smooth counterfaces there were fewer of these small particles, and evidence of larger platelets, greater than 10 μm in diameter. Analysis of the debris from explanted tissues showed a wide variation in the particle size distribution, ranging from below 1 μm up to several millimetres in size. Of major clinical significance in relation to osteolysis and loosening is roughening of the femoral components, which may lead to greater numbers of the sub-micron-sized particles.

Cross-linked polyethylene (XLPE) may have an application as a material for an all-plastic surface replacement finger joint. It is inexpensive, biocompatible and can be injection-moulded into the complex shapes that are found on the ends of the finger bones. Further, the cross-linking of polyethylene has significantly improved its mechanical properties. Therefore, the opportunity exists for an all-XLPE joint, and so the wear characteristics of XLPE sliding against itself have been investigated. Wear tests were carried out on both reciprocating pin-on-plate machines and a finger function simulator.

The reciprocating pin-on-plate machines had pins loaded at 10 N and 40 N. All pin-on-plate tests show wear factors from the plates very much greater than those of the pins. After 349 km of sliding, a mean wear factor of 0.46 × 10⁻⁶ mm³/N m was found for the plates compared with 0.021 × 10⁻⁶ mm³/N m for the pins. A fatigue mechanism may be causing this phenomenon of greater plate wear. Tests using the finger function simulator give an average wear rate of 0.22 ×10⁻⁶ mm³/N m after 368 km. This sliding distance is equivalent to 12.5 years of use in vivo. The wear factors found were comparable with those of ultra-high molecular weight polyethylene (UHMWPE) against a metallic counterface and, therefore, as the loads across the finger joint are much less than those across the knee or the hip, it is probable that an all-XLPE finger joint will be viable from a wear point of view.

A triaxial flexible electrogoniometer has been developed to measure the three-dimensional angular motion of the shoulder joint during simulated activities of daily living. The motion of the elbow, forearm and wrist were also recorded and angle-angle diagrams were mathematically analysed to provide quantitative parameters regarding the control and co-ordination of the joints of the normal and the arthritic upper limb. Two parameters (slope and movement area quotient) were derived and used in the interpretation of joint motion during different activities.

An elastostatic model of rapidly loaded articular cartilage is presented. It is assumed that the cartilage experiences little volumetric change or interstitial fluid flow while loaded instantaneously. Subchondral bone compliance and articular surface friction are incorporated. Integral representations of the stress distributions within cartilage are derived using Fourier transform techniques and the integrals are solved numerically. Localized tensile stresses are found and occur in regions close to the cartilage-bone interface as well as at the articular surface, outside the embrace of the load. The qualitative similarity between the results and those of previous investigations is explained by an elementary equilibrium analysis. The stress distributions suggest that the splits and cracks observed in diseased cartilage may be initiated, or propagated, by tensile stress.

A model of articular cartilage suffering rapidly applied loads and containing splits and fissures is presented. The possibility of cracks propagating through the cartilage collagen network is analysed using elastic fracture mechanics. Cracks are modelled using the distributed dislocation technique and the crack tip stress intensity factors are thereby evaluated. The mode I (tensile) stress intensity factors are generally much larger than the mode II (shearing) factors for cracks at the articular surface and close to, and at oblique angles to, the cartilage-bone interface, two regions where cartilage cracks have been observed. This suggests an opening, tensile mode of failure. The mode II factors are larger for cracks running along the interface. The rapidly loaded cracked cartilage model may explain the splits observed in osteoarthrotic cartilage.

Finite element methods have been applied extensively and with much success in the analysis of orthopaedic hip and knee implants. Very recently a burgeoning interest has developed, in the finite element community, in how numerical models can be constructed for the solution of problems in contact mechanics. New developments in this area are of paramount importance in the design of implants for orthopaedic surgery. Modern techniques are described for finite element contact analysis and applied to two problems of stress analysis in a plastic tibial component. In the former, results are compared with a previous finite element analysis and with Hertzian solutions. In the latter, an estimate of the extent of convergence of the finite element solutions is provided.

A test device has been developed and validated to simulate physiologic loading of the hip during stair climbing. Forces about the hip joint were measured in static simulations of stair climbing using simulated extensor, abductor and adductor muscle groups to support the joint. Femoral flexion angle (to model step length and height) and applied hip flexion moment (to model trunk lean) were varied to examine the effects of different loading conditions on the hip. In stair climbing the maximum total joint force was six times body weight at 34° of femoral flexion and 60 N m of hip flexion moment. Joint forces increased with hip flexion moment and varied little with femoral flexion angle, except for the posteriorly directed force. This component, which twists implants about the femoral shaft, increased with femoral flexion angle but changed little with hip flexion moment.