Berna Richter

A rolling-gliding wear simulator for the investigation of tribological material pairings for application in total knee arthroplasty

BackgroundMaterial wear testing is an important technique in the development and evaluation of materials for use in implant for total knee arthroplasty. Since a knee joint induces a complex rolling-gliding movement, standardised material wear testing devices such as Pin-on-Disc or Ring-on-Disc testers are suitable to only a limited extent because they generate pure gliding motion only.MethodsA rolling-gliding wear simulator was thus designed, constructed and implemented, which simulates and reproduces the rolling-gliding movement and loading of the knee joint on specimens of simplified geometry. The technical concept was to run a base-plate, representing the tibia plateau, against a pivoted cylindrical counter-body, representing one femur condyle under an axial load. A rolling movement occurs as a result of the friction and pure gliding is induced by limiting the rotation of the cylindrical counter-body. The set up also enables simplified specimens handling and removal for gravimetrical wear measurements. Long-term wear tests and gravimetrical wear measurements were carried out on the well known material pairings: cobalt chrome-polyethylene, ceramic-polyethylene and ceramic-ceramic, over three million motion cycles to allow material comparisons to be made.ResultsThe observed differences in wear rates between cobalt-chrome on polyethylene and ceramic on polyethylene pairings were similar to the differences of published data for existing material-pairings. Test results on ceramic-ceramic pairings of different frontal-plane geometry and surface roughness displayed low wear rates and no fracture failures.ConclusionsThe presented set up is able to simulate the rolling-gliding movement of the knee joint, is easy to use, and requires a minimum of user intervention or monitoring. It is suitable for long-term testing, and therefore a useful tool for the investigation of new and promising materials which are of interest for application in knee joint replacement implants.

In vitro-analysis of kinematics and intradiscal pressures in cervical arthroplasty versus fusion – A biomechanical study in a sheep model with two semi-constrained prosthesis

BackgroundAs an alternative technique to arthrodesis of the cervical spine, total disc replacement (TDR) has increasingly been used with the aim of restoration of the physiological function of the treated and adjacent motions segments. The purpose of this experimental study was to analyze the kinematics of the target level as well as of the adjacent segments, and to measure the pressures in the proximal and distal disc after arthrodesis as well as after arthroplasty with two different semi-constrained types of prosthesis.MethodsTwelve cadaveric ovine cervical spines underwent polysegmental (C2-5) multidirectional flexibility testing with a sensor-guided industrial serial robot. Additionally, pressures were recorded in the proximal and distal disc. The following three conditions were tested: (1) intact specimen, (2) single-level arthrodesis C3/4, (3) single-level TDR C3/4 using the Discover® in the first six specimens and the activ® C in the other six cadavers. Statistical analysis was performed for the total range of motion (ROM), the intervertebral ROM (iROM) and the intradiscal pressures (IDP) to compare both the three different conditions as well as the two disc prosthesis among each other.ResultsThe relative iROM in the target level was always lowered after fusion in the three directions of motion. In almost all cases, the relative iROM of the adjacent segments was almost always higher compared to the physiologic condition. After arthroplasty, we found increased relative iROM in the treated level in comparison to intact state in almost all cases, with relative iROM in the adjacent segments observed to be lower in almost all situations. The IDP in both adjacent discs always increased in flexion and extension after arthrodesis. In all but five cases, the IDP in each of the adjacent level was decreased below the values of the intact specimens after TDR. Overall, in none of the analyzed parameters were statistically significantly differences between both types of prostheses investigated.ConclusionThe results of this biomechanical study indicate that single-level implantation of semi-constrained TDR lead to a certain hypermobility in the treated segments with lowering the ROM in the adjacent levels in almost all situations.

Quadriceps force during knee extension in different replacement scenarios with a modular partial prosthesis

BACKGROUND Previous biomechanical studies have shown that bi-cruciate retaining knee replacement does not significantly alter normal knee kinematics, however, there are no data on the influence of a combined medial and patellofemoral bi-compartimental arthroplasty. The purpose of this in vitro study was to evaluate the effect of different replacement scenarios with a modular partial knee replacement system on the amount of quadriceps force required to extend the knee during an isokinetic extension cycle. METHODS Ten human knee specimens were tested in a kinematic knee simulator under (1) physiologic condition and after subsequent implantation of (2) a medial unicondylar and (3) a trochlear replacement. An isokinetic extension cycle of the knee with a constant extension moment of 31 Nm was simulated. The resulting quadriceps extension force was measured from 120° to full knee extension. FINDINGS The quadriceps force curve described a typically sinusoidal characteristic before and after each replacement scenario. The isolated medial replacement resulted in a slightly, but significantly higher maximum quadriceps force (1510 N vs. 1585 N, P = 0.006) as well as the subsequent trochlear replacement showed an additional increase (1801 N, P = 0.008). However, for both replacements no significant difference to the untreated condition could be detected in mid-flexion (10-50°). INTERPRETATION When considering a bi-compartimental replacement an increase of required maximum quadriceps force needed to extend the knee has to keep in mind. However, the close to physiological movement in mid-flexion suggests that patients with a bi-crutiate retaining arthroplasty might have an advantage in knee stability compared to total knee arthroplasty.

Belt Machining and Testing of Ceramic Knee Implants

Currently about five million people are diseased by arthrosis. This painful inflammation is often attended by an artificial joint replacement.