bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of third body damage to the tibial counterface in mobile bearing knees
Authors: Jones V C , Williams I R , Auger D D , Walsh W , Barton D C , Stone M H , Fisher J
Published: October 2002

Fourteen pairs of explanted low contact stress (LCS) tibial interface components: six rotating platform (RP), six meniscal (MN) and two anterior-posterior (AP) glide designs, have been analysed with particular attention paid to the condition of the tibial counterfaces. The average surface roughness, Ra, for the tibial trays ranged from 0.01 to 0.087 μm, significantly greater than the unworn control measurement of 0.008 μm. The scratch geometry analysis showed that the scratch peaks were found to be consistently of a lower aspect ratio than the scratch valleys and under 1 μm in height (average asperity height - Rp = 0.52 μm, aspect ratio Δ p = 0.01, average asperity depth Rv = 1.10 μm, Δ v = 0.05). The largest scratches were 3-4 μm in both Rp and Rv

In vitro tests have shown that ultra-high molecular weight polyethylene (UHMWPE) wear increases in the presence of counterface scratches perpendicular to the direction of motion. In these explants, the unidirectional motion produced scratches parallel to the direction of sliding which is predicted to produce a smaller increase in UHMWPE wear. Other designs in mobile bearing knees have less constrained motion at the tibial counterface and this has been shown to accelerate wear; it may also lead to a further increase in wear in the presence of third body scratches. It may be possible in future knee designs to reduce this type of wear damage by introducing alternative materials or coatings which are more resistant to scratching and surface roughening.
Fabrication of porous polymeric matrix drug delivery devices using the selective laser sintering technique
Authors: Leong K F , Phua K K S , Chua C K , Du Z H , Teo K O M
Published: October 2002

New techniques in solid freeform fabrication (SFF) have prompted research into methods of manufacturing and controlling porosity. The strategy of this research is to integrate computer aided design (CAD) and the SFF technique of selective laser sintering (SLS) to fabricate porous polymeric matrix drug delivery devices (DDDs). This study focuses on the control of the porosity of a matrix by manipulating the SLS process parameters of laser beam power and scan speed. Methylene blue dye is used as a drug model to infiltrate the matrices via a degassing method; visual inspection of dye penetration into the matrices is carried out. Most notably, the laser power matrices show a two-stage penetration process. The matrices are sectioned along the XZ planes and viewed under scanning electron microscope (SEM). The morphologies of the samples reveal a general increase in channel widths as laser power decreases and scan speed increases. The fractional release profiles of the matrices are determined by allowing the dye to diffuse out in vitro within a controlled environment. The results show that laser power and scan speed matrices deliver the dye for 8-9 days and have an evenly distributed profile. Mercury porosimetry is used to analyse the porosity of the matrices. Laser power matrices show a linear relationship between porosity and variation in parameter values. However, the same relationship for scan speed matrices turns out to be rather inconsistent. Relationships between the SLS parameters and the experimental results are developed using the fractional release rate equation for the infinite slab porous matrix DDD as a basis for correlation.
A three-dimensional finite element model from computed tomography data: A semi-automated method
Authors: Cattaneo P M , Dalstra M , Frich L H
Published: October 2002

Three-dimensional finite element analysis is one of the best ways to assess stress and strain distributions in complex bone structures. However, accuracy in the results may be achieved only when accurate input information is given. A semi-automated method to generate a finite element (FE) model using data retrieved from computed tomography (CT) was developed. Due to its complex and irregular shape, the glenoid part of a left embalmed scapula bone was chosen as working material. CT data were retrieved using a standard clinical CT scanner (Siemens Somatom Plus 2, Siemens AG, Germany). This was done to produce a method that could later be utilized to generate a patient-specific FE model. Different methods of converting Hounsfield unit (HU) values to apparent densities and subsequently to Young's moduli were tested. All the models obtained were loaded using three-dimensional loading conditions taken from literature, corresponding to an arm abduction of 90°. Additional models with different amounts of elements were generated to verify convergence. Direct comparison between the models showed that the best method to convert HU values directly to apparent densities was to use different equations for cancellous and cortical bone. In this study, a reliable method of determining both geometrical data and bone properties from patient CT scans for the semi-automated generation of an FE model is presented.
Three-dimensional shoulder kinematics in individuals with C5-C6 spinal cord injury
Authors: Acosta A M , Kirsch R F , van der Helm F C T
Published: October 2002

The shoulder kinematics of five able-bodied subjects and those of five arms in three subjects with spinal cord injuries at C5 or C6 levels were measured as the subjects elevated their arms in three different planes: coronal, scapular and sagittal. The range of humeral elevation was significantly reduced in all spinal cord injury (SCI) subjects relative to able-bodied subjects. Over this restricted range of humeral motion, the scapula of SCI subjects tended to be medially rotated, relative to ablebodied subjects, and the protraction and spinal tilt angles of the scapula of the SCI subjects indicated scapular winging. These results are consistent with paralysis or at least with significant weakness of the serratus anterior muscle. If further study confirms this hypothesis, functional neuromuscular stimulation of the serratus anterior muscle via a nerve cuff electrode may be an effective intervention for improving shoulder function in C5-C6 SCI.
Learning motor control in the upright position: A mechanical engineering approach
Authors: Major R E , Johnson G R , Butler P B
Published: October 2002

Motor control problems that result from damage to the central nervous system can make it difficult to learn functional activities. Although several therapeutic approaches attempt to address such problems there is little evidence of their efficacy. Targeted Training is a new approach, based on a biomechanical analysis of the problem, which usually relies on specifically designed equipment. This paper describes the underlying theory, the development of functional specifications, the translation of these specifications into an engineering design and the clinical results of applying the equipment. The promotion of head and trunk control provides an example of the process.
Polymerization shrinkage of dental composite resins
Authors: Ensaff H , O'Doherty D M , Jacobsen P H
Published: October 2002

Aesthetic materials have always been a priority for the restoration of anterior teeth; increasingly, they have also gained prominence in the restoration of posterior teeth. This has been due to their advantages as an alternative to amalgam. Their drawbacks however, can include poor marginal adaptation, postoperative sensitivity and cuspal movement. These are particularly associated with the polymerization shrinkage accompanying the placement of composite resins. Consequently, a variety of methods have been used for determining the polymerization shrinkage. These range from dilatometer methods, specific gravity methods and deflecting disc systems to optical methods. In this work a unique method for the qualitative analysis of polymerization shrinkage was undertaken. This method utilized a miniature transducer and provided details of the shrinkage from within the material. The results indicated movement of material towards the initiating light, followed by a return movement away from it. The study was expanded to incorporate clinical aspects, whereby the composite resin was in direct contact with dental tissue, as in a restoration. Tests were performed with surfacetreated cavity moulds, as in restoration placement, and without surface treatment. Results indicated that the shrinkage was highly dependent upon the region under investigation, as well as on the state of the surface.
Improved mathematical model of the wear of the cup articular surface in hip joint prostheses and comparison with retrieved components
Authors: Raimondi M T , Santambrogio C , Pietrabissa R , Raffelini F , Molfetta L
Published: October 2002

This paper presents an analytical model of the cobalt-based alloy-ultra-high molecular weight polyethylene (UHMWPE) wear coupling. Based on a previous model in which the cup wear volume over a gait cycle (WG) was calculated under the simplifying assumption of an ideal rigid coupling, the current version proposes a more realistic wear simulation. All three components of the hip loading force were considered for the contact pressure calculation and all three components of the hip motion were taken into account for the sliding distance calculation. The contact pressure distribution was calculated on the basis of the Hertzian theory for the elastic contact of two bodies with non-conforming geometrical shapes. The wear factor was taken from hip simulator wear tests. The calculated WG is 67 × 10−6mm3 for a standard reference patient. The parametric model simulations show that WG increases linearly with the patient weight, femoral head diameter and surface roughness. It increases non-linearly to a maximum and decreases to an asymptotic value with increasing cup/head clearance and with cup isotropic elastic modulus. The cup orientation in the pelvis affects only slightly the total amount of WG whereas it is the dominant factor affecting the shape of the wear distribution. The iso-wear maps show paracentral patterns at low cup inclination angles and marginal patterns at higher inclination angles. The maximum wear depth is supero-posterior when the cup is in neutral alignment and supero-anterior at increasing anteversion angles. Complex patterns with a combination of paracentral and marginal wear were obtained at specific clearance values and cup orientations. The results of the simulations are discussed in relation to the wear distribution measured on the articular surface of 12 UHMWPE components retrieved from failed hip joint prostheses, after a period of in situ functioning.
A fracture movement monitoring system to aid in the assessment of fracture healing in humans
Authors: Ogrodnik P J , Moorcroft C I , Thomas P B M
Published: October 2002

This paper presents a new design for a device to monitor the motion of fracture fragments in diaphyseal tibial fractures. The device measures the motion that occurs at the fracture site when loaded by gait or by manipulation. It has undergone rigorous calibration and acceptance trials. The device has been used in ethically approved research clinics held at the North Staffordshire Hospital (40 patients). The paper presents a selection of results obtained using the new device. The results demonstrate several new ways of assessing fracture healing by examining fracture site motion. The following conclusions were drawn:

1. If fracture monitoring devices are to be attached to bone screws, it is essential to minimize bone screw errors. To do this, each patient must have similar bone screw lengths, orientations, alignment and siting. This is only achievable using a peroperative reduction device. 2. If fracture stiffness is to be used as a measure of fracture healing, load rate should be controlled; at the very least strain rate should be controlled. 3. It is imperative that fracture stiffness be measured in more than one plane by a biplanar device so that asymmetry may be accommodated. 4. Fracture stiffness, on its own, is probably not a sufficiently rigorous measure of healing end-point. The quantifiably viscoelastic properties of healing callus should be taken into account.
An in vitro wear study of alumina—alumina total hip prostheses
Authors: Smith S L , Unsworth A
Published: October 2002

Four 28 mm diameter alumina-alumina hip prostheses were tested in the MkII Durham hip simulator for 5 × 106 cycles using 25 per cent bovine serum as lubricant. Wear of the heads and cups was measured gravimetrically. The mean and standard deviation of the wear rate for the alumina cups was 0.097 ± 0.039 mm3/106 cycles. The femoral heads produced such low wear that it could not be measured by weighing but could be detected by increased surface roughness measurements. Such low wear rates represent about one-five-hundredth of the wear of ultra-high molecular weight polyethylene (UHMWPE) against ceramic in a similar test and supports work which indicates that fluid film lubrication exists in these joints.
A CAD-CAM methodology to produce bone-remodelled composite femurs for preclinical investigations
Authors: Waide V , Cristofolini L , Toni A
Published: October 2002

Femoral bone remodelling, following total hip arthroplasty, is a clinically observed phenomenon attributed to the changed stress environment of the postoperative implanted hip. While this process cannot be avoided, there is concern as to its consequences on the long-term survival of hip joint replacements. Previous methods of studying remodelling, such as clinical or animal-based studies, or finite element analyses, have their limitations. The aim of this study is to develop experimental specimens incorporating bone resorption features typical of clinically successful implants. This work describes the use of computer aided design/manufacturing methods (CAD-CAM) to produce these specimens, based on modifying commercially available composite femurs. The procedures are investigated and verified for two different designs of cemented prostheses (Lubinus SPII and Müller Curved). Quantitative clinical data is used to define the remodelled geometry of a CAD model of the femur for each stem design. Composite femur specimens are machined using a three-axis milling machine, where each specimen can be accurately positioned using a custom-designed jig and a digitizer system. The accuracy of the process is assessed by analysing the deviation of the digitized premachined and postmachined surfaces of each specimen in relation to the CAD model. The results demonstrate that the procedure can be used for developing in vitro specimens with bone resorption features. These specimens are proposed as a useful tool for performing preclinical trials, such as load transfer or longevity/stability testing, with the advantage of modelling a long-term clinical situation, rather than solely analysing implanted femurs in an immediate postoperative state.
A novel three-dimensional tissue equivalent model to study the combined effects of cyclic mechanical strain and wear particles on the osteolytic potential of primary human macrophages in vitro
Authors: Matthews J B , Mitchell W , Stone M H , Fisher J , Ingham E
Published: October 2002

The effects of cyclic mechanical strain and challenge with physiologically relevant doses of submicrometre-size polyethylene (PE) particles on the osteolytic potential of primary human mononuclear phagocytes were investigated. Cells were seeded into a three-dimensional tissue matrix and co-cultured with particles (mean size 0.21 μ) at particle volume to cell number ratios of 7.5, 15, 30 and 100μm3/cell. Matrices were then either cultured statically or subjected to 20 per cent cyclic compressional strain in the ‘ComCell’ for 16 h prior to the assessment of cell viability and quantification of the pro-inflammatory cytokine tumour necrosis factor alpha (TNFα). The MTT (3-[5-5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazdium bromide) assay was shown to be too insensitive to detect changes in cell viability. However, when quantified by the adenosine triphosphate (ATP) assay, cell viability was demonstrated to be reduced following exposure to cyclic strain. Macrophages cultured in the static three-dimensional tissue equivalent model produced very high levels of TNFα in response to submicrometre PE particles at a ratio of 100 μm3/cell. Cyclic strain in the absence of particles gave only a small increase in TNFα production. However, the combined effects of strain and particle stimulation at a ratio of 30 μm3/cell resulted in the secretion of significantly more TNFα than was produced by macrophages subjected to strain alone, or the cells-only control. This synergy between cyclic strain and PE particle stimulation was only evident when the volume of particles was reduced below the volume that maximally stimulated cells. These results suggest that while cyclic strain may not be the primary factor responsible for macrophage activation and periprosthetic osteo-lysis, at low particle load, it may contribute significantly to the osteolytic potential of macrophages in vitro or in vivo.
Elastohydrodynamic lubrication analysis of metal-on-metal hip prostheses under steady state entraining motion
Authors: Jagatia M , Jin Z M
Published: October 2002

The elastohydrodynamic lubrication problem of metal-on-metal hip joint replacements was considered in this study. A simple ball-in-socket configuration was used to represent the hip prosthesis. The Reynolds equation in a spherical coordinate was adopted for the fluid-film lubrication analysis, to account for the ball-in-socket geometry. The corresponding elastic deformation was calculated by means of the finite element method in order to consider the complex ball-in-socket geometry as well as the backing materials underneath the acetabular cup. Both the Reynolds and the elasticity equations were solved simultaneously using the Newton-Raphson finite difference method. The general methodology developed was then applied to a recent experimental prototype metal-on-metal hip implant. It was shown that the backing materials underneath the acetabular cup had little influence on the predicted contact pressure and the elastic deformation at the bearing surfaces for this particular example. Both the film thickness and the hydrodynamic pressure distributions were obtained under various loads up to 2500 N. The predicted minimum lubricating film thickness from the present study was compared with a simple estimation using the Hamrock and Dowson formulae based upon an equivalent ball-on-plane model and excellent agreement was found. However, it was pointed out that for some forms of metal-on-metal hip prostheses with a thin acetabular cup, a polyethylene inlay underneath a metallic bearing insert or a taper connection between a bearing insert and a fixation shell, the general methodology developed in the present study should be used and this will be considered in future studies.
Interface biomechanics of the Anca Dual Fit hip stem: An in vitro experimental study
Authors: Monti L , Cristofolini L , Viceconti M
Published: October 2002

The Anca Dual Fit hip stem (Cremascoli Wright, Milan, Italy) is a partially cemented stem developed to overcome the drawbacks of both cemented and uncemented fixations. Its design was based on the hypothesis that partial cementing would ensure the primary stability necessary to allow bone ingrowth on the cement-free stem surfaces. At the same time, the limitation of the cement to the proximal regions would prevent stress-shielding by increasing proximal load transfer.

After finite element (FE) simulations and in vitro primary stability assessment, an analysis of the long-term stability of the Anca Dual Fit stem was necessary to conclude the preclinical testing. Three stems were implanted in composite femurs and subjected to testing for 1 × 106 cycles, each cycle reproducing the activity of stair climbing. The simulation was designed so as to replicate the physiological loading in a simplified, yet relevant way for this test. Various measurements were collected before, during and after the test in order to give exhaustive information on the response of the implant to long-term, cyclic loading. The present study confirmed the positive results of previous investigations, and proved that the Anca Dual Fit stem has excellent long-term stability; therefore successful clinical outcomes are predicted.
Effects of acetabular resurfacing component material and fixation on the strain distribution in the pelvis
Authors: Thompson M S , Northmore-Ball M D , Tanner K E
Published: October 2002

A 3D finite element (FE) model of an implanted pelvis was developed as part of a project investigating an all-polymer hip resurfacing design. The model was used to compare this novel design with a metal-on-metal design in current use and a metal-on-polymer design typical of early resurfacing implants. The model included forces representing the actions of 22 muscles as well as variable cancellous bone stiffness and variable cortical shell thickness. The hip joint reaction force was applied via contact modelled between the femoral and acetabular components of the resurfacing prosthesis. Five load cases representing time points through the gait cycle were analysed. The effect of varying fixation conditions was also investigated. The highest cancellous bone strain levels were found at mid-stance, not heel-strike. Remote from the acetabulum there was little effect of prosthesis material and fixation upon the von Mises stresses and maximum principal strains. Implant material appeared to have little effect upon cancellous bone strain failure with both bonded and unbonded bone-implant interfaces. The unbonded implants increased stresses in the subchondral bone at the centre of the acetabulum and increased cancellous bone loading, resembling behaviour obtained previously for the intact acetabulum.
Fracture mechanics analysis of the dentine-luting cement interface
Authors: Ryan A K , Mitchell C A , Orr J F
Published: October 2002

The objectives of this study were to determine the fracture toughness of adhesive interfaces between dentine and clinically relevant, thin layers of dental luting cements. Cements tested included a conventional glass-ionomer, F (Fuji I), a resin-modified glass-ionomer, FP (Fuji Plus) and a compomer cement, D (DyractCem). Ten miniature short-bar chevron notch specimens were manufactured for each cement, each comprising a 40 μm thick chevron of lute, between two 1.5 mm thick blocks of bovine dentine, encased in resin composite. The interfacial KIC results (MN/m3/2) were median (range): F; 0.152 (0.14-0.16), FP; 0.306 (0.27-0.37), D; 0.351 (0.31-0.37). Non-parametric statistical analysis showed that the fracture toughness of F was significantly lower ( p < 0.05) than those of FP or D, and all were significantly lower than values for monolithic cement specimens [26]. Scanning electron microscopy of the specimens suggested crack propagation along the interface. However, energy dispersive X-ray analysis indicated that failure was cohesive within the cement. It is concluded that the fracture toughness of luting cement was lowered by cement-dentine interactions.
A technique for measuring the compressive modulus of articular cartilage under physiological loading rates with preliminary results
Authors: Shepherd D E T , Seedhom B B
Published: October 2002

This paper describes a technique and apparatus for measuring the compressive modulus of articular cartilage under physiological loading rates. The compressive modulus is the most relevant property to the primary function of articular cartilage i.e. load carriage. It has been determined previously from measurement of cartilage deformation under slow or almost static loading conditions. The modulus was based on deformations occurring 2 s after the initial application of load which greatly reduces its relevance since in physiological conditions joint loading occurs within 10-150 ms.

Five human knee joints have been used to test the apparatus before a major study is undertaken. The preliminary results from these joints showed that the compressive modulus of articular cartilage measured within physiological loading time intervals was much greater than previously reported. The compressive modulus at 20 ms was in the range 4.4-27 MPa and was between 32 and 75 per cent greater than its value obtained at 2 s after loading.
Intraoperative guidance in maxillofacial and craniofacial surgery
Authors: Hassfeld S , Muehling J , Wirtz C R , Knauth M , Lutze T , Schulz H-J
Published: October 2002

The authors' experiences with intraoperative computer assisted guidance in interventions in oromaxillofacial and craniofacial surgery are reported. The guidance system SPOCS® (Surgical Planning and Orientation Computer Systems, Aesculap, Germany) consists of an infrared light emitting system of diodes and camera, an imaging workstation and assorted freehand instruments. The software is an updated version of the well-known Viewing Wand® software (ISG Technologies, Canada). In tests on phantoms, the system proved a mean accuracy of less than 1.5 mm. Within the last 15 clinical tests, the system has achieved an accuracy better than 3 mm which, at the moment, the authors estimate to be sufficient to proceed with its clinical evaluation. Using bone screws to register the patient's position, an accuracy in the range of less than 2 mm in relation to bony reference points has been achieved. By visualizing the tip of the instrument in real time, this technique allows surgical interventions, even in anatomically complicated situations, without endangering vital neighbouring structures. The ‘offset’ function of the software, by which the surgeon can elongate the tip of the instrument virtually, allows the surgeon to analyse structures before they are penetrated by the instrument as in a ‘look ahead’ operation. The authors expect computer assisted simulation and guidance systems to improve surgical quality and reduce the risks associated with surgical interventions.
Active compliance in robotic surgery—the use of force control as a dynamic constraint
Authors: Davies B L , Harris S J , Lin W J , Hibberd R D , Middleton R , Cobb J C
Published: October 2002

Robotic surgery can be carried out automatically by using a robot to move the cutting tool under position control. However, although the surgeon can observe the procedure on a visual display and has the ability to stop the operation in an emergency, he has little direct contact with the task. An alternative approach is to involve the surgeon more directly, by his moving a robot using active force control. The robot is then used to allow motion in preprogrammed regions, by the surgeon back-driving the robot motors, while preventing motion in prohibited areas. This active constraint robot (or ACROBOT) is described in this paper applied to knee surgery, in which the knee bones are accurately machined to allow the fitting of prosthetic knee implants. The ACROBOT is, however, ideally suited to a range of surgical procedures, because it allows the surgeon to feel the forces exerted during cutting and take appropriate action. This ability to be in direct control, while being constrained to cut within a permitted region, enhances safety and makes the system more acceptable to the medical community. The system of programmable constraint also allows the ACROBOT to provide the traditional benefits of robot surgery, namely the ability to machine complex geometrical surfaces very accurately and to make repetitive motions tirelessly. The system also has a potential for minimally invasive procedures. In knee surgery, for example, the robot could operate through a small incision in the skin and excise a volume into which a small, specially designed, unicompartmental prosthesis could fit.
Computer simulation of the dynamics of a human arm and orthosis linkage mechanism
Authors: Buckley M A , Johnson G R
Published: October 2002

This paper describes the use of computer modelling and simulation during the design and development of a motorized upper limb orthotic system to be used to aid the dysfunctional human arm. The orthosis consisted of a three-degree-of-freedom shoulder module and a lower arm module providing movements at the elbow and wrist.

Simulation software has been used to model the mechanism created by the connection of the orthosis and the arm. With this model it has been possible to analyse the kinematics and kinetics of both the arm and orthosis during a variety of dynamic loading conditions. In particular, the power requirements of the orthotic joints during the execution of specific tasks have been determined and these data have been used to specify the motors of a working prototype. The effect of misalignment between real and orthotic shoulder joints has also been investigated and a potentially hazardous situation has been highlighted prior to testing of the prototype by a volunteer in the laboratory.
Evaluation of the frictional properties of an elastomer with enhanced lipid-adsorbing ability
Authors: Williams P F , Iwasaki Y , Ishihara K , Powell G L , Gilbert J A , Nakabayashi N , LaBerge M
Published: October 2002

Wear particle production in load-bearing orthopaedic implants is one of the major factors currently limiting the service life of the implant. Most of the research carried out to date in attempting to solve this problem has used the approach of finding more wear-resistant biocompatible material pairs. In contrast, other researchers have attempted to reduce wear by encouraging elastohydrodynamic film formation through the use of elastomeric bearing surfaces. Unfortunately, these elastomeric bearing surfaces have poor tribological properties when a fluid film is not present. Boundary lubrication of an elastomeric orthopaedic bearing may alleviate some of these difficulties.

The purpose of this research was to fabricate and characterize an elastomeric material that had a surface capable of specifically adsorbing a naturally occurring boundary lubricant. Dipalmitoyl phosphatidylcholine (DPPC) has been previously shown to be able to act as a boundary lubricant at stresses that occur in human load-bearing joints such as the hip and knee; therefore, DPPC was chosen for use in this study. It was expected that in an aqueous liposome suspension the static coefficient of friction μs of such a material would be lower, and increase less quickly over time, than a similar material without an ability to adsorb specifically DPPC when articulated against a polished chrome steel ball bearing.

The lipid-adsorbing elastomer did not possess the desired tribological properties. This result was attributed to the polymer adsorbing the DPPC in the liposome phase and not in the bilayer phase, and interaction among the polymeric surface, DPPC and water. This approach to lubricating orthopaedic bearings was shown to have some merit, but a great deal of work needs to be done before such an approach can be used on a clinically available material.
Further studies into proximal interphalangeal joint dimensions for the design of a surface replacement prosthesis: Medullary cavities and transverse plane shapes
Authors: Ash H E , Unsworth A
Published: October 2002

The proximal and middle phalanges from 83 proximal interphalangeal joints (PIPJs) were set in clear plastic and sectioned in the transverse plane leaving the heads whole. The sections were cleaned, shadowgraphed and measured. The medullary canals were marked on sagittal and frontal plane shadowgraphs of the intact bones and analysed. The information was then used in the design of a surface replacement prosthesis for the PIPJs.

The main dorsal surface of the proximal phalanx (PP) was found to be angled to the longitudinal baseline of the bone by a mean of 5.19°. This angle increased just proximal to the phalangeal head to a mean of 11.84°. The mean ratio between these angles was 2.71. The phalangeal shaft bone was thicker laterally than dorsally and palmarly, and thicker dorsally than palmarly for the proximal and middle phalanges throughout the length of the bone. The shape and size of the transverse cross-section of the medullary canal changed throughout the length of the shaft.

The centreline of the PP medullary canal coincided with the midline of the bone in the frontal plane and was approximately a straight line along the length of the canal. In the sagittal plane the centreline was slightly palmar to the midline and the angle between it and the longitudinal baseline of the bone changed along the length of the canal. In the region of the shaft just proximal to the PP head (where the stem of a surface replacement prosthesis would fit) the mean angle was 10.63°. The centreline was offset dorsally from the centre of rotation of the PIPJ by a mean of 0.83 mm, 0.83 mm, 0.80 mm and 0.57 mm for the index, middle, ring and little fingers respectively, with an overall mean of 0.76 mm.

The mean PP head heights (transverse plane) were 9.17 mm, 9.33 mm, 8.73 mm and 7.40 mm and the mean PP widths (transverse plane) were 12.86 mm, 13.25 mm, 12.75 mm and 10.54 mm for the index, middle, ring and little fingers respectively. The mean angle between the lateral sides of the condyles to the transverse baseline was 78.35° and the mean distance from the centreline of the PP head (transverse plane) to the bases of the two condyles was 4.69 mm. The mean maximum depth of the PP head intercondylar sulcus in the frontal plane was 0.72 mm and in the transverse plane, the mean maximum depth of the intercondylar sulcus on the anterior face was 0.82 mm.
Contact stress analysis of the tibial component of prosthetic knee implants
Authors: McGloughlin T M , Monaghan J M
Published: October 2002

The engineering problems associated with implantation into the human body of prosthetic knee implants and some of the outstanding issues facing engineering designers in this growing sector of orthopaedic medicine are described. The contact behaviour of polymeric tibial components was modelled using a stainless steel indentor in contact with an Araldite CT200 block which contained embedded strain gauges. The block was subjected to normal and sliding loads and the stresses in the block were evaluated using the strain data; the results were compared with results obtained from finite element analysis. The results are considered in the light of recent experience with non-conforming knee implants.
Comparative dynamic evaluation of the sliding/characteristics of the Gamma nail: A biomechanical analysis
Authors: Haynes R C , Miles A W
Published: October 2002

This study was directed at establishing the influence of dynamic loading situations on the sliding characteristics of the Gamma locking nail (Howmedica). It was postulated that the changing regions of load contact area that occur within the sliding mechanism during flexion and extension would favourably modify the jamming behaviour observed under static test conditions. The forces required to initiate sliding of the lag screw in the intramedullary device were investigated under a range of conditions representing clinical situations. The optimum sliding performance of the Gamma nail was shown to occur during test conditions of dynamic loading, when the rate of application of the load was rapid and the cyclic angle of flexion was greatest. The size and weight of the patient also influence the sliding characteristics, as a shorter lag screw length protruding from the barrel and a reduced vertical static load (body weight) yielded a lower axial sliding force. The results under dynamic loading conditions suggest that static testing of sliding hip screws does not accurately represent their clinical performance.
The wear of ultra-high molecular weight polyethylene sliding on metallic and ceramic counterfaces representative of current femoral surfaces in joint replacement
Authors: Lancaster J G , Dowson D , Isaac G H , Fisher J
Published: October 2002

A number of studies have investigated the influence of surface roughness on the wear of ultra-high molecular weight polyethylene (UHMWPE) in total joint replacement. The results of these studies have shown that the wear factor is proportional to the counterface roughness raised to a power greater than one. In this laboratory study, the effect of surface finish of several biomaterials on the wear of UHMWPE was studied. The study was conducted using reciprocating pin-on-plate wear tests with bovine serum as a lubricant. The biomaterials investigated as the counterface material included stainless steel, cast cobalt chrome (CoCr), CoCr (ASTM F799), alumina ceramic and zirconia ceramic. The counterface topographies of the wear plates were produced using techniques representative of current manufacturing methods. The surface roughness of the wear plates was varied in the range Ra, = 0.005-0.04 μm; this was representative of femoral heads and femoral knee components currently used clinically. Metals and ceramics with a similar surface roughness produced a similar wear rate of UHMWPE. For the limited range of smooth counterfaces used in this study only a moderate correlation was found between the surface roughness and the wear factors. For a change in counterface roughness Ra of 0.005 to 0.04 μm, the wear factor increased from 7.4 ± 1.6 to 16.5 ± 2.4 × 10−9mm3/N m (mean ± standard error). This variation in counterface roughness had much less effect in wear than previously reported for rougher counterfaces. For an extended range of counterface roughness, a stronger correlation was found using an exponential function for the regression fit. The exponential function shows the benefits of decreased wear with decreased surface roughness. Although the wear rate decreased less rapidly with decreased counterface roughness for Ra values below 0.05 μa, there were significant advantages to be gained from improved femoral head roughness to below 0.01 μm Ra
Factors contributing to the wear of polyethylene in clinical practice
Authors: Learmonth I D , Cunningham J L
Published: October 2002

Wear of polyethylene is a major contributor in the failure of total joint replacement. A number of different factors may predispose to increased wear of polyethylene. These can be broadly categorized as (i) material polymorphism, (ii) poor design features and (iii) three-body wear. Many of these factors contribute to the wear encountered in clinical practice. These mechanisms are reviewed and examples identified in which they have resulted in increased wear.
The pathogenesis of osteolysis in two different cementless hip replacements
Authors: Learmonth I D , Smith E J , Cunningham J L
Published: October 2002

Wear of ultra-high molecular weight polyethylene has been incriminated in the osteolysis associated with aseptic loosening of hip implants. A variety of different factors can contribute to accelerated patterns of polyethylene wear and subsequent osteolysis. This paper examines the incidence of osteolysis observed in two different well-matched cohorts of cementless total hip arthro-plasties. The patterns of osteolysis observed, which are ascribed to the generation of polyethylene debris, are interpreted with reference to the design of the individual prostheses.
The influence of articular surface incongruity on lubrication and contact pressure distribution of loaded synovial joints
Authors: Hlaváček M , Vokoun D
Published: October 2002

In the model intended for short-term loading (such as during the walking cycle) of a human synovial joint in the lower extremities, cartilage lubricated by Newtonian synovial fluid is considered to be incompressible elastic and subchondral bone is considered to be rigid. The model is non-diffusional, i.e. no interstitial fluid flow occurs across the articular surfaces. A simple plane strain case of the human ankle joint is considered. For high steady loading applied in the centre of the stationary tibial arc and for steady sliding of the talar arc, this model shows that individual physiological variations in the geometry of the articular surfaces have only a small effect on the contact stress distribution and the fluid film thickness. If this load is applied eccentrically in the tibial arc, the contact pressure distribution varies more with surface geometry, but the minimum fluid film thickness differs little from that for symmetric loading. The maximum contact pressure is placed eccentrically in this case, but its value is changed only little when compared to the central loading of the same value. In order to explain different distribution patterns of subchondral bone mineralization, it is anticipated that the total load peaks of periodic time-dependent loads are transmitted centrally in some incongruent joints and eccentrically in others.
Prediction of plastic strains in ultra-high molecular weight polyethylene due to microscopic asperity interactions during sliding wear
Authors: McNie C , Barton D C , Stone M H , Fisher J
Published: October 2002

Studies of explanted femoral heads have shown that scratches caused by bone cement, bone or metallic particles are present on the rubbing surface. This damage has been cited as a cause of increased wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups and it is known that the particulate wear debris produced leads to osteolysis. A series of explanted Charnley femoral heads have been surface characterized using a Talysurf 6 profilometer and found to have scratches with lip heights in the size range 0.1–3.25 μm with an average height of 1 μm giving an average aspect ratio (defined as height/half-width) of 0.1. These geometries were incorporated into a finite element model of a stainless steel asperity sliding over UHMWPE under conditions similar to those in an artificial hip system. It was found that as the aspect ratio of the asperity lip increased, the plastic strains both on and below the surface of the UHMWPE increased non-linearly, but that the magnitude of the strain was independent of the asperity height. The asperity aspect ratio was also found to affect the position of the maximum sub-surface strain, as the asperity aspect ratio was increased the maximum strain rose to the surface. The high plastic strains predicted offer an explanation for the highly elevated wear rates in scratched counterface tests and the aspect ratio of scratch lips is therefore a critical determinant of plastic strain.
Fibroblast responses to mechanical forces
Authors: Eastwood M , McGrouther D A , Brown R A
Published: October 2002

The repair and maintenance of connective tissues is performed predominately by a mesenchymal cell known as a fibroblast. The activity of this cell is regulated, in part, by changes in the mechanical environment in which it resides. The authors have addressed some of the questions related to the fibroblast and how it responds to mechanical stimulation. An in vitro model, the ‘culture force monitor’, and its derivative, the tensioning culture force monitor have been developed enabling quantitative investigations to be performed on fibroblasts in a collagen lattice. Results have shown that a fibroblast can generate a force of approximately 10−10 N, as a result of change in cell shape and attachment, while in a three-dimensional collagen lattice. Application of a physiologically similar mechanical load has shown that fibroblasts have the ability to maintain a tensional homeostasis of approximately 40–60×10−5 N per million cells, change cellular morphology in a predictable manner and biochemically modify their resident environment.
Bioactive bone cements
Authors: Harper E J
Published: October 2002

Poly (methylmethacrylate) (PMMA) bone cement, used to fix implants into the bone, produces good surgical results if used correctly. However, prostheses do eventually become loose and the breakdown of the cement mantle is a factor in this failure. Limitations of PMMA cement, which lead to problems with the fixation of the implant, include its mechanical characteristics and its influence upon surrounding bone, associated with the polymerization reaction. A bioactive bone cement is particularly designed to produce a better interface between the cement and bone. However, an improvement in mechanical properties, especially fatigue, creep and fracture toughness, are an added necessary requirement to increase the lifetime of a cemented implant. The development of a bioactive cement has been conducted mainly in two ways; firstly, to improve existing PMMA cement by the addition of various bioactive agents and secondly, to design an alternative matrix for the bioactive material to be combined with. The most promising investigations which have been conducted, along with their relative benefits and drawbacks, are discussed.
In vitro simulation of contact fatigue damage found in ultra-high molecular weight polyethylene components of knee prostheses
Authors: Currier J H , Duda J L , Sperling D K , Collier J P , Currier B H , Kennedy F E
Published: October 2002

An in vitro simulation of fatigue loading of ultra-high molecular weight polyethylene (UHMWPE) knee components was carried out on a knee simulator and on a rolling and sliding wear tester. Tibial components for the knee simulator were gamma-sterilized, implantable components taken from manufacturing inventory. The rolling/sliding UHMWPE discs were machined from bar stock and either gamma sterilized in air and accelerated aged, or left as non-sterilized (controls).

Cracking and delamination of samples that had been gamma sterilized in air and aged were observed in both types of tests. Contact fatigue damage was visible in as few as 150 000 cycles using the knee simulator at loads of 122 N (275 lb). The rolling/sliding samples showed signs of damage in as few as 130 000 cycles with an estimated stress of 15 MPa and 25 per cent sliding. However, cracking and delamination were not generated in the never-sterilized or recently sterilized controls. UHMWPE that has been gamma sterilized in air and aged is shown to be susceptible to contact fatigue damage. These results are important to the interpretation of in vitro total knee replacement simulations used to assess the performance of tibial bearings.
Sliding wear studies of selected nitride coatings and their potential for long-term use in orthopaedic applications
Authors: Ward L P , Subramanian C , Strafford K N , Wilks T P
Published: October 2002

In the area of orthopaedic implants, particularly total hip joint replacements, a metal-plastic combination is still the most popular choice consisting of a femoral head fabricated from 316L stainless steel, Ti alloy or Co-Cr alloy in contact with an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. It is recently considered that wear of the UHMWPE cup is of major concern. Generation of the wear debris can have adverse effects on the body, both localized and systemic. It is envisaged that wear of the prosthetic components, particularly those fabricated from UHMWPE can be reduced through the use of surface coatings.

The aim of this investigation was to deposit a selection of refractory element nitride-based coatings (TiN, TiAIN, ZrN) onto 316L stainless steel substrates, using physical vapour deposition (PVD) technology and to study their sliding wear behaviour in contact with both UHMWPE and 316L stainless steel pins, using a pin-on-plate testing rig. Tests were conducted in Ringers solution and Ringers solution plus bone cement particles. The volume of material removed from the pins served as an indication of their wear behaviour. Wear mechanisms were identified using scanning electron microscopy. The results of these findings and the potential for these coatings to be used in orthopaedic applications are discussed.