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Aterial selection and component design are important factors in the per! formance and dura"ility of total joint replacements# wear testing and joint simulator studies should "e used to de%elop an understand! ing of wear mechanisms and the influence of en%ironmental' design' and material parameters on wear "eha%ior# (eplicating the specific conditions occurring in a hip or )nee joint' simulator testing can then 'e used to test specific design and material com"inations
Aterial selection and component design are important factors in the per! formance and dura"ility of total joint replacements# wear testing and joint simulator studies should "e used to de%elop an understand! ing of wear mechanisms and the influence of en%ironmental' design' and material parameters on wear "eha%ior# (eplicating the specific conditions occurring in a hip or )nee joint' simulator testing can then 'e used to test specific design and material com"inations
Aterial selection and component design are important factors in the per! formance and dura"ility of total joint replacements# wear testing and joint simulator studies should "e used to de%elop an understand! ing of wear mechanisms and the influence of en%ironmental' design' and material parameters on wear "eha%ior# (eplicating the specific conditions occurring in a hip or )nee joint' simulator testing can then 'e used to test specific design and material com"inations
Copyright 2001 American Academy of Orthopaedic Surgeons
What is the role of wear testing
and joint simulator studies in discriminating among materials and designs? aterial selection and component design are important factors in the per! formance and dura"ility of total joint replacements# $oth la"oratory "ench tests and joint simulators ha%e "een used to e%aluate the influence of mate! rials and designs on wear# &he role of wear testing and joint simulation stud! ies is often unclear' howe%er' in terms of discriminating the effect of materials and design on performance# Controlled "ench wear testing should "e used to de%elop an understand! ing of wear mechanisms and the influence of en%ironmental' design' and material parameters on wear "eha%ior# (eplicating the specific conditions occurring in a hip or )nee joint' simulator testing can then "e used to test specific design and material com"inations# *sed properly' "ench wear test! ing can also ser%e as a screening tool to identify grossly unsuita"le materials# Wear is not an intrinsic property of the material "ut rather a function of the system# &he elements of a wear system include the contact surfaces' lu"ricant' load' articulating surface speeds' motions' surface roughnesses' and temperature# &he general conditions e+isting at the contact interface may not control wear as much as the specific load conditions e+isting at the asperities on the contact surfaces# *nfortunately' conditions at asperities are difficult to measure# Wear is also a function of history# An isolated e%ent at the "eginning of a wear test can significantly change all su"se,uent e%ents# -f a third!"ody parti! cle is caught "etween contact surfaces at the "eginning of a test' for e+ample' and produces a scratch on the metallic surface' the cumulati%e polyethylene wear at the end of the test may "e 2 to . times what would "e o"ser%ed in the a"sence of the third!"ody particle#1'2 A wear test is a mechanical test with mo%ing parts# Accordingly' factors such as alignment and %i"ration can influence the resulting wear measure! ment much more than other parameters# &he current practice of wear testing multiple specimens in each e+perimental group does not necessarily resol%e this issue# Only when all these factors are under reasona"le control can the difference attri"uta"le to materials "e measured accurately for a gi%en design# A different degree of wear measured "etween two materials in an in %itro wear test does not necessarily mean the materials will perform to the same degree of difference in %i%o# When the critical wear mechanisms are sufficiently simulated in %itro' then the wear test results can "e claimed clin! ically rele%ant# &herefore' understanding of the wear mechanisms and the 1/0 -mplant Wear in &otal 1oint (eplacement 2igure 1 A schematic diagram of the chain orientation of ultra!high molecular weight polyethylene# associated characteristics 3surface features' wear de"ris si4e and shape5 are )ey to successful discrimination of materials and designs# Wear mecha! nisms' in turn' depend on the relati%e material properties of the wear sur! faces' the contact geometry' speeds' loads' surface roughness' and lu"ricant#. 2or ultra!high molecular weight polyethylene materials' direction of motion and the fre,uency of motion directional changes also affect wear'/'6 although the reason is not fully understood#7 &his type of polymer is a %is! coelastic material with molecular weight that ranges from /#6 million to 7 million# -t is composed of folded chains in a crystalline arrangement and loose amorphous chains with particle domains fused together "y melting 32ig# 15# Cross!lin)ing of chains occurs only in the amorphous regions where polymer chains are free to "ond with one another# A folded chain has a spe! cific orientation# Collecti%ely' the chains tend to align and orient themsel%es in a common direction when the surface is su"jected to a directional force such as unidirectional ru""ing# Orientation of the surface crystalline domain chains occurs easily when the surface is cut' polished' or ru""ed# Soft +!ray a"sorption spectroscopy0'8 can measure the molecular orienta! tion at polyethylene surfaces su"jected to different motions of wear from a wear test and a joint simulator test# Similar results ha%e also "een o"ser%ed on retrie%ed implants# 2igure 2 shows the partial electron yield of a sample su"jected to soft +!ray "eams under two different sample orientations 3elec! tric field parallel to and perpendicular to the wear direction5# &he spectrum difference measures the degree of polymer chain alignment at the ru""ed surface# 2igure . portrays the difference spectra 3su"tracting the spectrum perpendicular to the electric field from the parallel spectrum5' in which a larger difference indicates a higher degree of chain alignment#9 &a"le 1 summari4es the molecular orientation results of %arious cross! lin)ed samples from a )nee simulator test# Some degree of molecular orien! 1/8 aterial and :esign Considerations 2igure 2 Soft +!ray a"sorption spectra showing the molecular orientation of surface layer after 2000 unidirectional sliding cycles# ; < electric field 2igure . Soft +!ray a"sorption spectra showing the effect of annealing on two different polyethylene samples# ; < electric field 1/9 -mplant Wear in &otal 1oint (eplacement &a"le 1 olecular orientation of polyethylene "efore and after wear for differ! ent degrees of cross!lin)ing tation is o"ser%ed for all these cases "ut the rate of orientation %aries for dif! ferent degrees of cross!lin)ing# &his can "e e+plained "y the different degrees of freedom of mo%ement of the folded polymer chains as a function of the degrees of constraint imposed "y cross!lin)ing the chains# 2or the most highly cross!lin)ed materials' more test time is necessary to "rea) the cross lin)s and orient the folded chains# &he chain "rea)ing mechanism is pro"a"ly a mechanical fatigue process at the molecular le%el# &he ease with which the surface molecules can "e oriented or aligned has se%eral signifi! cant implications for the o"ser%ed wear phenomena# One hypothesis is that "y su"jecting the material to unidirectional sliding' the surface molecules align parallel to the wear direction forming a ,uasi!glassy material# Wear therefore occurs "y tensile crac)ing and "rittle fracture of the hardened sur! face layer' producing a relati%ely low amount of wear# When the surface is su"jected to reciprocating motions' the alignment is not as good "ut still occurs along the a+is of the motion# ore loosely "ound chains are worn away' generating more wear# When the surface motion is multia+ial' the sur! face molecules are in a constant state of flu+ and all fracture modes 3tensile' shear' and twist5 come into play# &he result is a much higher amount of wear than in the other cases#10 According to this hypothesis' the "asic wear mechanism for polyethylene can "e assumed to "e molecular or nanometer in scale' with loose polymer chains stic)ing out of the surface that are pluc)ed away as the metallic sur! face slides "y# Additional wear mechanisms from a"rasion 3third!"ody effect5' contact pressure!induced deformation' and elastic!plastic flow from 160 aterial and :esign Considerations glo"al contact stresses are seen as well# 2or %iscoelastic and plastic materi! als' the formation of surface wa%elets in the direction of motion has "een well documented'11 a possi"le e+planation for the isolated islands o"ser%ed on the surfaces of retrie%ed implants#12 &he fi"ril wear particles reco%ered from periprosthetic tissues and from lu"ricating fluids in joint simulators might also "e e+plained "y the elastic!plastic deformation and the rolling of thin molecular sheets detached from the su"strate "y fatigue crac)ing# 1oint simulator tests ha%e "een de%eloped to simulate the "iomechanics of human joints in a controlled condition# (esults from simulator testing can pro%ide confirmation of the material=s performance for a gi%en geometric design under a %ariety of operating conditions# $oth controlled wear tests and joint simulator tests ha%e "een used to esta"lish the conditions necessary to generate the types of wear damage occurring in hip and )nee joints#1.!18 2or e+ample' multidirectional joint motions are necessary to generate wear rates and wear particle morphologies that are similar to in %i%o e+perience' e%en though the multidirectional motions com"ined with the applied loads imparted "y hip joint simulators do not themsel%es duplicate typical joint motions that patients might impart across their joints# &o simulate a )nee joint e+perimentally re,uires more comple+ motions than simulating a hip joint simply "ecause of the increased degrees of free! dom# >nee joint simulators ha%e only "een commercially a%aila"le since 1990# &here are two "asic designs of )nee joint simulators' differing pri! marily in their input signals# -n one type' the operator predefines the applied loading and the motions 3fle+ion!e+tension' anteroposterior translation' and internal!e+ternal rotation of the femoral component on the ti"ial compo! nent5# Surface geometry and friction do not determine the positions of the femoral component during motion as the simulator dri%es the components through the predetermined motions# ?alid results rely on a priori )nowledge of the )inematics# &he correlation of results from this type of simulator with those o"ser%ed on retrie%ed implants has not "een esta"lished#19!21 -n the second type of )nee simulator design' the inputs are forces and moments' "ut the simulator does not directly control the position of the femoral component relati%e to the ti"ial component#17 -nstead' the femoral and ti"ial components are free to mo%e relati%e to one another within con! straints pro%ided "y the input forces and moments' the surface geometry of each component' alignment of the components' friction "etween the articu! lating surfaces' and soft!tissue restraints 3simulated "y springs5# &he limita! tions of this second type of )nee joint simulator are that the position of the femoral component as a function of fle+ion angle is not directly controlled and that a larger num"er of inputs must "e selected for each test# Studies on this second simulator type ha%e shown that implant design has a significant independent effect on )inematics and wear22 and that wear de"ris generated during wear tests of a )nee design match "oth the morphology and the si4e of the particles retrie%ed from the )nee joints of patients with the same implant design#2. @either type of )nee simulator' howe%er' has "een %alidat! ed as demonstrati%e that the locations and type of wear damage o"ser%ed in retrie%ed components can "e systematically recreated for a "road range of 161 -mplant Wear in &otal 1oint (eplacement )nee designs' which may "e the only current means of %alidation# *ntil methods are de%eloped to accurately measure clinical wear rates in total )nee replacements' %alidation of )nee joint simulators on the "asis of match! ing the clinical wear rate is impossi"le# &here are many %ariations of test protocols emphasi4ing different motions and the fre,uency of such motions as e+hi"ited "y human acti%ities# &he correlations de%eloped "etween a particular test protocol and retrie%al studies encompass "oth materials and design# Such correlations ta)e a long time to de%elop unless early failures are o"ser%ed# As new materials and new joint simulator test protocols continue to e%ol%e' such correlations necessarily lag "ehind# &herefore' the philosophy of joint simulator testing is to o%er! stress the materials and the design# &he use of the historical data"ase also reinforces the effecti%eness of the materials and design e%aluations# As such' joint simulator testing remains a main staple in today=s highly sophisticated material e%aluation process# A mechanistic understanding of wear pro%ides a framewor) for e%aluat! ing different materials and designs# ;ach "earing material has indi%idual characteristics and properties that reflect "oth its initial fa"rication and su"! se,uent changes that might ha%e occurred in ser%ice# 2or e+ample' polyethy! lene properties and wear characteristics will depend on the starting resin and the method of fa"rication 3molding or e+trusion5' "ut may also "e affected "y su"se,uent sterili4ation procedures' o+idati%e degradation' or crystalline reorientation under dynamic and large joint contact loads#2/ When material com"inations are used to form an artificial joint' the properties of the mate! rial pair dominate the component performance# -n a long!term wear process' the difference in material properties ultimately would result in different degrees of wear# $ut not all material property differences would result in o"ser%a"le or measura"le changes in wear in a short!term "ench wear test' and "oth wear "ench tests and joint simulators can "e considered short!term tests# What is the pro"a"ility that differences that are not appreciated in the short term will amplify themsel%es after years of ser%ice in the "ody? -f a series of controlled wear e+periments can "e conducted to elucidate the "asic wear mechanisms under different loads' speeds' and lu"rication en%i! ronments' a clear understanding will "e pro%ided for the material pair=s "eha%ior# :ura"ility limits could then "e defined in terms of the test %ari! a"les 3speed' load' and cycles to failure5# Often such results can "e compared to an historical data"ase' increasing the pro"a"ility that drastic mista)es can "e a%oided# (esults from e+tensi%e simulator testing can then pro%ide con! firmation of the material pair=s performance for a gi%en geometric design under a %ariety of operating conditions# With a clear understanding of wear mechanisms pro%ided "y the "ench wear tests' an intelligent com"ination of "ench wear testing and joint simulator studies pro%ides the "est practice in today=s en%ironment# 162 aterial and :esign Considerations (ele%ance Wear and simulator testing are complicated tas)s# Controlled wear testing should not "e routinely done to ,ualify a material' "ut rather to elucidate wear mechanisms# Simulator tests' on the other hand' can "e used to conduct accelerated protocols that replicateAsimulate particularly e+treme conditions' there"y esta"lishing the limits of performance for the material# &he tas) is complicated' howe%er' "y the lac) of understanding of the "asic wear mech! anisms under a %ariety of operating conditions# 2or now' confidence in the interpretation of wear testing data deri%es from successful correlation of "ench test wear surfaces with retrie%ed implant surfaces in terms of surface te+ture and wear de"ris si4e and shape#26 2uture :irections for (esearch One of the critical issues in wear and joint simulator testing is how to e+trap! olate short!term testing results to long!term projections# &his re,uires a solid understanding of the relationship "etween material structures' properties' and wear mechanisms# A carefully designed parameter study is needed to systematically e+amine the influence of speed' loading cycles' and motion directions on a material=s "eha%ior and the resulting wear phenomena# any simulation issues are related to the polyethylene wear particle gen! eration mechanisms under different wear testing conditions# 2urther 2igure / Controlled wear particle generation using surface te+turing and the resulting wear particles# 16. -mplant Wear in &otal 1oint (eplacement research to esta"lish the relationship "etween wear particle si4e' shape' and morphology and wear testing conditions is warranted# Sensiti%ity of "ioac! ti%ity to particle si4e' shape' and morphology will pro%ide additional param! eters to engineer the polymers for longer implant life# $ecause wear particle si4e and shape are important parameters in defin! ing the clinical rele%ance of wear tests and joint simulator tests' methods to characteri4e different si4es and shapes are also needed# Current characteri! 4ation techni,ues lac) precision due to the lac) of suita"le' realistic standard reference materials for instrument cali"ration and testing# &he technical challenge to produce well controlled wear particles for such a purpose' how! e%er' is highly comple+# (ecent studies underta)en to de%elop controlled si4e and shape wear par! ticles "y ru""ing ultra!high molecular weight polyethylene against a micro! te+tured steel surface show promise#27!28 -f successful' this concept 32ig# /5 may produce uniformly si4ed wear particles of %arious shapes# -t also pro! %ides insight into the "asic wear mechanisms' for e+ample how %arious si4es and shapes of wear particles are produced under different wear conditions# (eferences 1# $ar"our BS' Stone C' 2isher 1D A hip joint simulator study using new and physio! logically scratched femoral heads with ultra!high molecular weight polyethylene aceta"ular cups# Broc -nst ech ;ng 2000E21/D679!607# 2# c>ellop C' Shen 2W' :iaio W' Fancaster 1GD Wear of gamma!crosslin)ed polyethylene aceta"ular cups against roughened femoral "alls# Clin Orthop 1999E.79D0.!82# .# Fiao HS' $enya B:' c>ellop CAD ;ffect of protein lu"rication on the wear proper! ties of materials for prosthetic joints# 1 $iomed ater (es 1999E/8D/76!/0.# /# 2ir)ins B1' &ipper 1F' -ngham ;' Stone C' 2arrar (' 2isher 1D -nfluence of simulator )inematics on the wear of metal!on!metal hip prostheses# Broc -nst ech ;ng 2001E216D119!121# 6# Sai))o ? Ahlroos &D &ype of motion and lu"ricant in wear simulation of polyethylene' aceta"ular cup# Broc -nst ech ;ng 1999E21.D.01!.10# 7# Shen C' Csu S' &es) 1A' Christou AD A no%el multia+ial wear tester for accelerat! ed testing of materials# &rans Orthop (es Soc 1999E2/D862# 0# 2ischer :A' Sam"asi%an S' Shen C' Csu SD Wear induced molecular orientation in *CWB; measured "y soft +!ray a"sorption# &rans Soc $iomater 1999E22D.61# 8# Sam"asi%an S' 2ischer :A' Shen C' Csu SD ;ffects of wear motion on *CWB; molecular orientation# &rans Soc $iomater 1999E22D19/# 9# Sam"asi%an S' 2ischer :A' Shen C' &es) 1A' Csu SD ;ffects of annealing on *CWB; molecular orientation' in &ransactions of the Si+th World $iomaterials Congress# 2000' p 108# 10# $ragdon C(' O=Connor :O' Fowenstein 1:' 1asty ' Syniuta W:D &he importance of multidirectional motion on the wear of polyethylene# Broc -nst ech ;ng 1997E210D160!176# 11# Chen H' -%es F>' :ally 1WD @umerical simulation of sliding contact o%er a half! plane# Wear 1996E186D8.!91# 16/ aterial and :esign Considerations 12# Wimmer A' Andriacchi &B' @atarajan (@' et alD A striated pattern of wear in ultra! high!molecular!weight polyethylene components of iller!Galante total )nee arthro! plasty# 1 Arthroplasty 1998E1.D8!17# 1.# $aldini &C' Wright &' ;stupiIJn 1A' $artel :FD An apparatus for studying wear damage in *CWB;D :escription and initial test results' in Hoganathan AB 3ed5D 1998 Ad%ances in $ioengineering# @ew Hor)' @H' AS;' 1998' ?ol .9' pp ./0!./8# 1/# $lunn GW' Wal)er BS' 1oshi A' Cardinge >D &he dominance of cyclic sliding in pro! ducing wear in total )nee replacements# Clin Orthop 1991E20.D26.!270# 16# Smith SF' *nsworth AD A fi%e!station hip joint simulator# Broc -nst ech ;ng 2001E216D71!7/# 17# Wal)er BS' $lunn GW' $roome :(' et alD A )nee simulating machine for perfor! mance e%aluation of total )nee replacements# 1 $iomechanics 1990E.0D8.!89# 10# $ar"our BS' Stone C' 2isher 1D A hip joint simulator study using simplified loading and motion cycles generating physiological wear paths and rates# Broc -nst ech ;ng 1999E21.D/66!/70# 18# :es1ardins 1:' Wal)er BS' Caider C' Berry 1D &he use of a force controlled dynamic )nee simulator to ,uantify the mechanical performance of total )nee replacement designs during functional acti%ity# 1 $iomechanics 2000E..D12.1!12/2# 19# :elu4io >1' uratoglu O>' O=Connor :O' et alD :e%elopment of an in %itro )nee delamination model in a )nee simulator with physiologic load and motion' in &ransactions of the Si+th World $iomaterials Congress# 2000' p 8/2# 20# (ies ' $an)s S' Sauer W' Anthony D A"rasi%e wear simulation in total )nee arthro! plasty# &rans Orthop (es Soc 1999E/6D86.# 21# &amura 1' Clar)e -' >awana"e >' Schroeder :' Gufstason AD &i"ial polyethylene micro!wear phenomena related to &>( )inematics# &rans Orthop (es Soc 2000E/7D/..# 22# :es1ardins 1:' Wal)er BS' Caider C' Berry 1D &he use of a force controlled dynamic )nee simulator to ,uantify the mechanical performance of total )nee replacement designs during functional acti%ity# 1 $iomechanics 2000E..D12.1!12/2# 2.# $eaule B' Camp"ell B' Wal)er BS' Schmal4reid &B' :orey 2' $lunn GWD Characteri4ation of polyethylene wear particles retrie%ed from tissues and )nee simu! lator lu"ricants# &rans Soc $iomater 2000E2.D68# 2/# c>ellop CA' Shen 2W' Camp"ell B' Ota &D ;ffect of molecular weight' calcium stearate' and sterili4ation methods on the wear of ultra high molecular weight polyethylene aceta"ular cups in a hip joint simulator# 1 Orthop (es 1999E10D.29!..9# 26# Shen C' Csu S' &es) 1A' Christou AD Wear analysis of *CWB; using a load sum method' in &ransactions of the Si+th World $iomaterials Congress# 2000' p 10/# 27# 2ang C!W' Shen C' Cho *' &es) 1A' Christou A' Csu SD Generation of different *CWB; particle shape "y wear through surface te+turing# &rans Soc $iomater 1999E22D607# 20# 2ang C!W' Sengers 1?' Csu SD Controlled si4e and shape *CWB; wear particle generation using a silicon micro!fa"ricated surface te+turing techni,ue# &rans Soc $iomater 2001E2/D.0# 28# 2ang C!W' Sengers 1? Csu SD Generation of controlled *CWB; wear particle' si4e and shape "y surface te+turingD (elationship "etween surface feature dimensions to particle si4e and shape# &rans Soc $iomater 2001E2/D686# 166
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