Lorenza Mattei

Biotribology of artificial hip joints

Hip arthroplasty can be considered one of the major successes of orthopedic surgery, with more than 350000 replacements performed every year in the United States with a constantly increasing rate. The main limitations to the lifespan of these devices are due to tribological aspects, in particular the wear of mating surfaces, which implies a loss of matter and modification of surface geometry. However, wear is a complex phenomenon, also involving lubrication and friction. The present paper deals with the tribological performance of hip implants and is organized in to three main sections. Firstly, the basic elements of tribology are presented, from contact mechanics of ball-in-socket joints to ultra high molecular weight polyethylene wear laws. Some fundamental equations are also reported, with the aim of providing the reader with some simple tools for tribological investigations. In the second section, the focus moves to artificial hip joints, defining materials and geometrical properties and discussing their friction, lubrication and wear characteristics. In particular, the features of different couplings, from metal-on-plastic to metal-on-metal and ceramic-on-ceramic, are discussed as well as the role of the head radius and clearance. How friction, lubrication and wear are interconnected and most of all how they are specific for each loading and kinematic condition is highlighted. Thus, the significant differences in patients and their lifestyles account for the high dispersion of clinical data. Furthermore, such consideration has raised a new discussion on the most suitable in vitro tests for hip implants as simplified gait cycles can be too far from effective implant working conditions. In the third section, the trends of hip implants in the years from 2003 to 2012 provided by the National Joint Registry of England, Wales and Northern Ireland are summarized and commented on in a discussion.

Wear Simulation of Metal-on-Metal Hip Replacements With Frictional Contact

Preclinical wear evaluation is extremely important in hip replacements, wear being one of the main causes of failure. Experimental tests are attractive but highly cost demanding; thus predictive models have been proposed in the literature, mainly based on finite element simulations. In such simulations, the effect of friction is usually disregarded, as it is considered not to affect the contact pressure distribution. However, a frictional contact could also result in a shift of the location of the nominal contact area, which can thus modify the wear maps. The aim of this study is to investigate this effect in wear prediction for metal-on-metal implants. Wear assessment was based on a purpose-developed mathematical model, extension of a previous one proposed by the same authors for metal-on-plastic implants. The innovative aspect of the present study consists in the implementation of a modified location of the nominal contact point due to friction, which takes advantage of the analytical formulation of the wear model. Simulations were carried out aimed at comparing total and resurfacing hip replacements under several gait conditions. The results highlighted that the adoption of a frictional contact yields lower linear wear rates and wider worn areas, while for the adopted friction coefficient (f=0.2), the total wear volume remains almost unchanged. The comparison between total and resurfacing replacements showed higher scaled wear volumes (wear volume divided by wear factor) for the latter, in agreement with the literature. The effect of the boundary conditions (in vivo versus in vitro) was also investigated remarking their influence on implant wear and the need to apply more physiological-like conditions in hip simulators. In conclusion although friction is usually neglected in numerical wear predictions, as it does not affect markedly the contact pressure distribution, its effect in the location of the theoretical contact point was observed to influence wear maps. This achievement could be useful for increasing the correlation between numerical and experimental simulations, usually based on the total wear volume. In order to improve the model reliability, future studies will be devoted to implement the geometry update by combining the present model to finite element analyses. On the other hand, further experimental investigations are required to get out from the wide dispersion of wear factors reported in the literature.

Anthropomorphic ultrasound elastography phantoms — Characterization of silicone materials to build breast elastography phantoms

In this paper a mechanical characterization of low cost and simply available materials to build efficient anthropomorphic ultrasound elastography phantoms is described. The class of silicone materials was selected because of their deformability, durability and the possibility of reproducing specific tissue properties and shapes. Innovative formulations of silicone mixtures with echogenic and/or softening additives were tested. The proposed models have good acoustic properties and tactile feedback; moreover they are durable and do not require special storage since they do not dehydrate or decompose over time.

Numerical and experimental investigations for the evaluation of the wear coefficient of reverse total shoulder prostheses

In the present study, numerical and experimental wear investigations on reverse total shoulder arthroplasties (RTSAs) were combined in order to estimate specific wear coefficients, currently not available in the literature. A wear model previously developed by the authors for metal-on-plastic hip implants was adapted to RTSAs and applied in a double direction: firstly, to evaluate specific wear coefficients for RTSAs from experimental results and secondly, to predict wear distribution. In both cases, the Archard wear law (AR) and the wear law of UHMWPE (PE) were considered, assuming four different k functions. The results indicated that both the wear laws predict higher wear coefficients for RTSA with respect to hip implants, particularly the AR law, with k values higher than twofold the hip ones. Such differences can significantly affect predictive wear model results for RTSA, when non-specific wear coefficients are used. Moreover, the wear maps simulated with the two laws are markedly different, although providing the same wear volume. A higher wear depth (+51%) is obtained with the AR law, located at the dome of the cup, while with the PE law the most worn region is close to the edge. Taking advantage of the linear trend of experimental volume losses, the wear coefficients obtained with the AR law should be valid despite having neglected the geometry update in the model.

Effect of size and dimensional tolerance of reverse total shoulder arthroplasty on wear: An in-silico study

Although huge research efforts have been devoted to wear analysis of ultra-high molecular weight polyethylene (UHMWPE) in hip and knee implants, shoulder prostheses have been studied only marginally. Recently, the authors presented a numerical wear model of reverse total shoulder arthroplasties (RTSAs), and its application for estimating the wear coefficient k from experimental data according to different wear laws. In this study, such model and k expressions are exploited to investigate the sensitivity of UHMWPE wear to implant size and dimensional tolerance. A set of 10 different geometries was analysed, considering nominal diameters in the range 36-42mm, available on the market, and a cup dimensional tolerance of +0.2, -0.0mm (resulting in a diametrical clearance ranging between 0.04-0.24mm), estimated from measurements on RTSAs. Since the most reliable wear law and wear coefficient k for UHMWPE are still controversial in the literature, both the Archard law (AR) and the wear law of UHMWPE (PE), as well as four different k expressions were considered, carrying out a total of 40 simulations. Results showed that the wear volume increases with the implant size and decreases with the dimensional tolerance for both the wear laws. Interestingly, different trends were obtained for the maximum wear depth vs. clearance: the best performing implants should have a high conformity according to the AR law but low conformity for the PE law. However, according to both laws, wear is highly affected by both implant size and dimensional tolerance, although it is much more sensitive to the latter, with up to a twofold variation of wear predicted. Indeed, dimensional tolerance directly alters the clearance, and therefore the lubrication and contact pressure distribution in the implant. Rather surprisingly the role of dimensional tolerance has been completely disregarded in the literature, as well as in the standards. Furthermore, this study notes some important issues for future work, such as the validation of wear laws and predictive wear models and the sensitivity of k to implant geometry.

Wear simulation of metal on metal hip replacements: an analytical approach

Hip replacement failure is mainly attributable to the implant wear. Consequently preclinical wear evaluations are extremely important. As experimental tests are attractive but highly cost/time demanding, several predictive models have been proposed mainly based on finite element simulations and for metal on plastic (MoP) implants. The aim of this study is to develop a mathematical wear model of metal on metal prostheses, revision of the previous one for MoP implants, developed by the same authors. The model, based on the Archard wear law and on the Hertzian theory, was applied to compare a total (THR) and a resurfacing (RHR) hip replacement under both in vivo and in vitro gait conditions. The results were in agreement with the literature predicting wear rates significantly higher for the RHR than for the THR. The effect of the boundary conditions on wear rates/maps was also investigated and the model limitations discussed.Copyright

Vibration Testing Procedures for Bone Stiffness Assessment in Fractures Treated with External Fixation

A bone healing assessment is crucial for the successful treatment of fractures, particularly in terms of the timing of support devices. However, in clinical practice, this assessment is only made qualitatively through bone manipulation and X-rays, and hence cannot be repeated as often as might be required. The present study reconsiders the quantitative method of frequency response analysis for healing assessments, and specifically for fractures treated with an external fixator. The novelty consists in the fact that bone excitation and response are achieved through fixator pins, thus overcoming the problem of transmission through soft-tissues and their damping effect. The main objective was to develop and validate a test procedure in order to characterize the treated bone. More than 80 tests were performed on a tibia phantom alone, a phantom with pins, and a phantom with a complete fixator. Different excitation techniques and input–output combinations were compared. The results demonstrated the effectiveness of a procedure based on impact tests using a micro-hammer. Pins and fixator were demonstrated to influence the frequency response of the phantom by increasing the number of resonant frequencies. This procedure will be applied in future studies to monitor healing both in in vitro and in vivo conditions.

Experimental study on the chemico-physical interaction between a two-component cyanoacrylate glue and the material of PICCs

Introduction: The use of cyanoacrylate glue as sealant on the exit site of peripherally inserted central catheters (PICCs) may offer some important clinical advantages. However, concerns exist about the potential interaction between cyanoacrylate and the material of the catheter itself. The aim of this study was to investigate the possibility of damage to the catheter secondary to a long-term contact with a two-component skin glue (N-butyl + octyl cyanoacrylate). Methods: Twelve PICCs of different brands and types were selected (11 made of polyurethane and one made of silicon). PICCs were glued onto artificial skin pads, slightly wetted with Earle solution. The pads were kept in an egg incubator at 34°C and 60% humidity, for up to twelve weeks. Possible signs of degradation were monitored by surface analyses and mechanical tests. Scanning electron microscopy observations, surface roughness measurements, pressure strength and uniaxial tests were performed. Results: Samples were analyzed after 4, 8 and 12 weeks of contact with the glue. No chemical reaction between the glue and the material of the catheters was evident. The mechanical strength of PICCs was consistently within the ranges of ISO standards. An expected increase in the stiffness of the samples covered with glue was observed in uniaxial tests. The silicon catheter was weaker than the polyurethane catheters and was damaged while trying to remove it from the pad for tests. Conclusions: The long-term use of N-butyl + octyl cyanoacrylate glue on polyurethane PICCs is not expected to be associated to any damage to the catheter.

Fracture Healing Assessment Based on Impact Testing: In Vitro Simulation and Monitoring of the Healing Process of a Tibial Fracture with External Fixator

In clinical practice, bone healing is monitored with X-rays and manipulation. Its assessment is thus subjective, depending on the skills of the operator. Alternative and quantitative approaches hav...

In vivo impact testing on a lengthened femur with external fixation: a future option for the non-invasive monitoring of fracture healing?

Non-invasive methods for assessing fracture healing are crucial for biomedical engineers. An approach based on mechanical vibrations was tried out in the 1990s, but was soon abandoned due to insufficiently advanced technologies. The same approach is re-proposed in the present study in order to monitor the healing process of a lengthened femur with an external fixator. The pins screwed into the bone were exploited for the impact testing (IT) to excite the bone and capture its response. Transmission through the soft tissues was thus prevented, and the quality of the signals was improved. Impact tests were performed every three to four weeks for five months. Unfortunately, after seven weeks, some pins were removed due to infection, and thus, the system was modified. Two different configurations were considered: before and after pin removal. An additional configuration was examined in the last two sessions, when the fixator body was removed, while four pins were left in the femur. The evolution of the frequency response function and of the resonant frequencies of the system were analysed for the duration of the monitoring period. The IT results were compared to the indications provided by X-ray images. During the evolution of the callus from the soft phase to the woven bone, the resonant frequencies of the system were found to increase by approximately 2–3% per week. The largest increase (approx. 22%) was observed for the first resonant frequency. After formation of the woven bone, the vibratory response remained almost the same, suggesting that the healing assessment could be related to the relative variation in the resonant frequencies. The results presented support the application of the IT approach for fracture healing assessment.