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Background: White blood cell (WBC) scintigraphy plays a major role in the diagnostic approach to periprosthetic infections. Although the procedure has been standardized by the publication of several guidelines, the interpretation of this technique may be susceptible to intra and inter-variability. We aimed to assess the reproducibility of interpretation between nuclear medicine physicians and by the same physician and to demonstrate that Cohen's coefficient is more unstable than Gwet's coefficient, as the latter is influenced by the prevalence rates. Methods: We enrolled 59 patients who performed a Technetium-99m WBC (99mTc-WBC) scintigraphy for suspected hip or knee prosthesis infection. Three physicians, blinded to all patient clinical data, performed two image readings. Each WBC study was assessed both visually and semi-quantitatively according to the guidelines of the European Association of Nuclear Medicine (EANM). For semi-quantitative analysis, readers drew an irregular Region of Interest (ROI) over the suspected infectious lesion and copied it to the normal contralateral bone. The mean counts per ROI were used to calculate lesion-to-reference tissue ( L R ) ratios for both late and delayed images. An increase in L R over time ( L R late > L R delayed ) of more than 20% was considered indicative of infection. Agreement between readers and between readings was assessed by the first-order agreement coefficient (Gwet's AC1). Reading time for each scan was compared between the three readers in both the first and the second reading, using the Generalized Linear Mixed Model. Results: An excellent agreement was found among all three readers: 0.90 for the first reading and 0.94 for the second reading. Both inter- and intra-variability showed values ≥0.86. Gwet's method demonstrated greater robustness than the Cohen coefficient when assessing the intra and inter-rater variability, since it is not influenced by the prevalence rate. Conclusions: These studies can contribute to improving the reliability of nuclear medicine imaging techniques and to evaluating the effectiveness of trainee preparation. [ABSTRACT FROM AUTHOR]

Background: The growth of arthroplasty procedures requires innovative strategies to reduce inpatients' hospital length of stay (LOS). This study aims to develop a machine learning prediction model that may aid in predicting LOS after hip or knee arthroplasties. Methods: A collection of all the clinical notes of patients who underwent elective primary or revision arthroplasty from 1 January 2019 to 31 December 2019 was performed. The hospitalization was classified as "short LOS" if it was less than or equal to 6 days and "long LOS" if it was greater than 7 days. Clinical data from pre-operative laboratory analysis, vital parameters, and demographic characteristics of patients were screened. Final data were used to train a logistic regression model with the aim of predicting short or long LOS. Results: The final dataset was composed of 1517 patients (795 "long LOS", 722 "short LOS", p = 0.3196) with a total of 1541 hospital admissions (729 "long LOS", 812 "short LOS", p < 0.001). The complete model had a prediction efficacy of 78.99% (AUC 0.7899). Conclusions: Machine learning may facilitate day-by-day clinical practice determination of which patients are suitable for a shorter LOS and which for a longer LOS, in which a cautious approach could be recommended. [ABSTRACT FROM AUTHOR]

This research aims to identify the prevalence of failure for Birmingham Hip Prosthesis (BHR) in total hip arthroplasty and to analyze its reasons from biomaterials and biofunctional perspectives. We present our current analysis and tests on a series of different BHR-retrieved prostheses after premature failure. Relevant clinical data, such as X-ray investigations and intraoperative images for clinical case studies, were analyzed to better understand all factors involved in BHR prosthesis failure. A detailed analysis of the failures highlighted uneven cement distribution, overloading in certain areas, and void formation in the material. A closer investigation using microscopical techniques revealed the presence of a crack originating from the gap between the cement mantle and human bone. Additionally, scanning electron microscopy analyses were conducted as part of the investigation to examine bone cement morphology in detail and better understand the interactions at the interfaces between implant, cement, and bone. In conclusion, this research emphasizes the importance of surgical technique planning and the cementation procedure in the success rate of BHR prostheses. It also underscores the need to carefully evaluate patient characteristics and bone quality to minimize the risk of BHR prosthesis failure. The cementation procedure seems to be essential for the long-term functionality of the BHR prosthesis. [ABSTRACT FROM AUTHOR]

Background: Our study addresses the lack of consensus on measuring leg length discrepancy (LLD) after total hip arthroplasty (THA). We will assess the inter-observer variability and correlation between the five most commonly used LLD methods and investigate the use of trigonometric principles in overcoming the limitations of current techniques. Methods: LLD was measured on postoperative AP pelvic radiographs using five conventional methods. CT images created a 3D computer model of the pelvis and femur. The resulting models were projected onto a 2D, used to measure LLD by the five methods. The measurements were evaluated via Taguchi analysis, a statistical method identifying the process's most influential factors. The approach was used to assess the new trigonometric method. Results: Conventional methods demonstrated poor correlation. Methods referenced to the centers of the femoral heads were insensitive to LLD originating outside the acetabular cup. Methods referencing either the inter-ischial line or the inter-obturator foramina to the lesser trochanter were sensitive to acetabular and femoral components. Trigonometry-based measurements showed a higher correlation. Conclusions: Our results underscore clinicians' need to specify the methods used to assess LLD. Applying trigonometric principles was shown to be accurate and reliable, but it was contingent on proper radiographic alignment. [ABSTRACT FROM AUTHOR]

A total hip arthroplasty (THA) can improve quality of life, but loosening of the hip prosthesis is a complex problem in which vitamin D may also play a role. The Vitamin D Receptor (VDR) is involved in the response of cells to the action of vitamin D, and its genetic variability raises the question of whether individual differences could influence the risk of prosthesis loosening. The aim of this study was to investigate the relationship between VDR single nucleotide polymorphisms (SNPs) (ApaI, BsmI, FokI and TaqI) and the serum VDR and 25(OH)D levels in three groups of patients: (1) arthroscopy patients after THA without loosening of the prosthesis (CA—Control Arthroplasty), (2) patients after THA with loosened hip prostheses (L—Loosening) and (3) the control group (C—Control). Our results suggest that the genotypes tt of TaqI, BB of BsmI, and FF of FokI may influence the VDR effect in patients with loosened protheses. Our results showed that the ACAC haplotype (AtBF) was over two times more frequent in the L group than in CA + C: OR =2.35 [95% CI 1.44–3.83; p = 0.001]. There was no significant correlation between the VDR and serum 25(OH)D levels, but there were differences between studied groups. [ABSTRACT FROM AUTHOR]

We investigated micro-threaded stem taper surface and its impact on premature failures, aseptic loosening, and infection in cementless hip endoprostheses. Our study focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of the microstructure and surface properties of two new and three retrieved Zweymüller stem tapers. The retrieved samples were selected and examined based on the head–stem taper interface being the sole source of modularity with a metallic component, specifically between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning -electron microscopy (SEM) was employed for morphological and microstructural analyses. Energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The roughness of the micro-threated stem tapers from different manufacturers was investigated using an optical profilometer, with standard roughness parameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness profile) being measured. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers with ceramic heads. Consequently, three retrieved tapers and two new ones for comparison underwent potentiodynamic measurements in Hank's solution to determine the corrosion rate of new and retrieved stem taper surfaces. The results showed a low corrosion rate for both new and prematurely failed retrieved samples due to aseptic loosening. However, the corrosion rate was higher in infected and low-grade infected tapers. In conclusion, our study suggests that using ceramic heads reduces taper corrosion and subsequently decreases the incidence of premature failures in total hip arthroplasty. [ABSTRACT FROM AUTHOR]

A low-energy hit, such as a slight fall from a bed, results in a bone fracture, especially in the hip, which is a life-threatening risk for the older adult and a heavy burden for the social economy. Patients with low-energy traumatic bone fractures usually suffer a higher level of bony catabolism accompanied by osteoporosis. Bone marrow-derived stem cells (BMSCs) are critical in osteogenesis, leading to metabolic homeostasis in the healthy bony microenvironment. However, whether the BMSCs derived from the patients who suffered osteoporosis and low-energy traumatic hip fractures preserve a sustained mesodermal differentiation capability, especially in osteogenesis, is yet to be explored in a clinical setting. Therefore, we aimed to collect BMSCs from clinical hip fracture patients with osteoporosis, followed by osteogenic differentiation comparison with BMSCs from healthy young donors. The CD markers identification, cytokines examination, and adipogenic differentiation were also evaluated. The data reveal that BMSCs collected from elderly osteoporotic patients secreted approximately 122.8 pg/mL interleukin 6 (IL-6) and 180.6 pg/mL vascular endothelial growth factor (VEGF), but no PDGF-BB, IL-1b, TGF-b1, IGF-1, or TNF-α secretion. The CD markers and osteogenic and adipogenic differentiation capability in BMSCs from these elderly osteoporotic patients and healthy young donors are equivalent and compliant with the standards defined by the International Society of Cell Therapy (ISCT). Collectively, our data suggest that the elderly osteoporotic patients-derived BMSCs hold equivalent differentiation and proliferation capability and intact surface markers identical to BMSCs collected from healthy youth and are available for clinical cell therapy. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) stands out as one of the most prevalent sexual disorders in men, with its incidence progressively escalating with age. As delineated by the International Consultation Committee for Sexual Medicine on Definitions/Epidemiology/Risk Factors for Sexual Dysfunction, the prevalence of ED among men under 40 years is estimated to be within the range of 1–10%. The aim of this study was to determine the relationship between the concentration of bioelements (Zn, Cu, Fe, Cr, Mg, and Mn) in the serum and bone tissue and the concentration of selected hormones in men with and without erectile dysfunction. Materials and methods: The retrospective cohort study included 152 men who underwent total hip arthroplasty for hip osteoarthritis at the Department of Orthopaedic Traumatology and Musculoskeletal Oncology at the Pomeranian Medical University in Szczecin. Certain exclusion criteria were applied to ensure the integrity of the study. These included individuals with diabetes, a history of cancer, alcohol abuse, liver or kidney failure, New York Heart Association (NYHA) class III or IV heart failure, and those taking medications that affect bone metabolism, such as mineral supplements, neuroleptics, chemotherapeutic agents, immunosuppressants, corticosteroids, or antidepressants. Patients with hypogonadism or infertility were excluded from the study. Results: The study showed an association between bioT concentrations and Cu concentrations in both patients with and without erectile dysfunction. A correlation between bioactive testosterone and Cr concentrations was also observed in both groups. Patients with erectile dysfunction showed a relationship between bioT concentration and Zn concentration, TT concentration and Mn concentration, FT concentration and Zn concentration, and E2 concentration and Cr concentration. An analysis of elemental concentrations in bone tissue showed an association between FT and Mg and Mn concentrations, but only in patients with erectile dysfunction. In patients without erectile dysfunction, a correlation was observed between FT and Cu concentrations. A correlation was also observed between bioT concentrations and Mg, Mn, and Zn concentrations, but only in patients with erectile dysfunction. In patients without erectile dysfunction, a correlation was observed between bioT and Cu concentrations. Conclusions: Studying the relationship between the concentration of bioelements (Zn, Cu, Fe, Cr, Mg, and Mn) in the serum and bone tissue and the concentration of selected hormones in men may be important in explaining the etiology of the problem. The study of the concentration of Zn and Cu in bone tissue and serum showed that these two elements, regardless of the place of accumulation, may be related to the concentration of androgens in men. [ABSTRACT FROM AUTHOR]

This document is a special issue of the journal Biomimetics, focusing on advances in biomimetic scaffolds for hard tissue surgery. The special issue includes contributions on topics such as biomimetic design strategies, techniques for fabricating scaffolds, novel biomaterials, biodegradability design, surface functionalization, and clinical applications. The published papers cover a range of areas, including bone and joint surgery, maxillofacial surgery, and general surgery. The articles discuss various contributions to the field of biomimetic scaffolds for hard tissue surgery, including the use of spider silk, biomimetic fixation for arthroplasty endoprostheses, and bioactive 3D implants for long bone defects. The document demonstrates advancements in the field and the potential for biomimetic scaffolds to assist in tissue regeneration. [Extracted from the article]

We investigated the impact of mesenchymal stem cell (MSC) therapy on treating bilateral human hip osteonecrosis, analyzing 908 cases. This study assesses factors such as tissue source and cell count, comparing core decompression with various cell therapies. This research emphasizes bone repair according to pre-treatment conditions and the specificities of cell therapy in osteonecrosis repair, indicating a potential for improved bone repair strategies in hips without femoral head collapse. This study utilized a single-center retrospective analysis to investigate the efficacy of cellular approaches in the bone repair of osteonecrosis. It examined the impact on bone repair of tissue source (autologous bone marrow concentrate, allogeneic expanded, autologous expanded), cell quantity (from none in core decompression alone to millions in cell therapy), and osteonecrosis stage and volume. Excluding hips with femoral head collapse, it focused on patients who had bilateral hip osteonecrosis, both pre-operative and post-operative MRIs, and a follow-up of over five years. The analysis divided these patients into seven groups based on match control treatment variations in bilateral hip osteonecrosis, primarily investigating the outcomes between core decompression, washing effect, and different tissue sources of MSCs. Younger patients (<30 years) demonstrated significantly better repair volumes, particularly in stage II lesions, than older counterparts. Additionally, bone repair volume increased with the number of implanted MSCs up to 1,000,000, beyond which no additional benefits were observed. No significant difference was observed in repair outcomes between different sources of MSCs (BMAC, allogenic, or expanded cells). The study also highlighted that a 'washing effect' was beneficial, particularly for larger-volume osteonecrosis when combined with core decompression. Partial bone repair was the more frequent event observed, while total bone repair of osteonecrosis was rare. The volume and stage of osteonecrosis, alongside the number of injected cells, significantly affected treatment outcomes. In summary, this study provides comprehensive insights into the effectiveness and variables influencing the use of mesenchymal stem cells in treating human hip osteonecrosis. It emphasizes the potential of cell therapy while acknowledging the complexity and variability of results based on factors such as age, cell count, and disease stage. [ABSTRACT FROM AUTHOR]

Friction, wear, and the consequent energy dissipation pose significant challenges in systems with moving components, spanning various domains, including nanoelectromechanical systems (NEMS/MEMS) and bio-MEMS (microrobots), hip prostheses (biomaterials), offshore wind and hydro turbines, space vehicles, solar mirrors for photovoltaics, triboelectric generators, etc. Nature-inspired bionic surfaces offer valuable examples of effective texturing strategies, encompassing various geometric and topological approaches tailored to mitigate frictional effects and related functionalities in various scenarios. By employing biomimetic surface modifications, for example, roughness tailoring, multifunctionality of the system can be generated to efficiently reduce friction and wear, enhance load-bearing capacity, improve self-adaptiveness in different environments, improve chemical interactions, facilitate biological interactions, etc. However, the full potential of bioinspired texturing remains untapped due to the limited mechanistic understanding of functional aspects in tribological/biotribological settings. The current review extends to surface engineering and provides a comprehensive and critical assessment of bioinspired texturing that exhibits sustainable synergy between tribology and biology. The successful evolving examples from nature for surface/tribological solutions that can efficiently solve complex tribological problems in both dry and lubricated contact situations are comprehensively discussed. The review encompasses four major wear conditions: sliding, solid-particle erosion, machining or cutting, and impact (energy absorbing). Furthermore, it explores how topographies and their design parameters can provide tailored responses (multifunctionality) under specified tribological conditions. Additionally, an interdisciplinary perspective on the future potential of bioinspired materials and structures with enhanced wear resistance is presented. [ABSTRACT FROM AUTHOR]

Modular artificial hip joints are a clinical standard today. However, the release of wear products from the head–taper interface, which includes wear particles in the nm size range, as well as metal ions, have raised concerns. Depending on the loading of such taper joints, a wide variety of different mechanisms have been found by retrieval analyses. From these, this paper concentrates on analyzing the contribution of gross slip fretting corrosion at ultra-mild wear rates using a bovine calf serum solution (BCS) as the lubricant. The parameters were chosen based on biomechanical considerations, producing wear rates of some ng/m wear path. In parallel, the evolution of tribomaterial (third bodies) was analyzed as to its constituents and generation rates. It has already been shown earlier that, by an advantageous combination of wear mechanisms and submechanisms, certain constituents of the tribomaterial remain inside the contact area and act like extreme-pressure lubricant additives. For the known wear and corrosion resistance of austenitic high-nitrogen steels (AHNSs), which outperform CoCrMo alloys even under inflammatory conditions, we hypothesized that such steels will generate ultra-mild wear rates under gross slip fretting. While testing AHNSs against commercially available biomedical-grade materials of CoCrMo and TiAlV alloys, as well as zirconia-toughened alumina (ZTA) and against itself, it was found that AHNSs in combination with a Ti6Al4V alloy generated the smallest wear rate under gross slip fretting corrosion. This paper then discusses the wear behavior on the basis of ex situ analyses of the worn surfaces as to the acting wear mechanisms and submechanisms, as well as to the tribological reaction products. [ABSTRACT FROM AUTHOR]

(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with "pseudotumors" associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision. [ABSTRACT FROM AUTHOR]

This paper presents advances in designs of resurfacing arthroplasty endoprostheses that occurred through their historical generations. The critical characteristics of contemporary generation hip resurfacing arthroplasty endoprostheses are given and the failures resulting from the specific generation cemented and short stem fixation of the femoral component are reviewed. On the background of these failures, the critical need arises for an alternative approach to the fixation of components of resurfacing arthroplasty leading towards the first generation of biomimetic fixation for resurfacing arthroplasty endoprostheses. The state of the art of the completed bioengineering research on the first biomimetic fixation for resurfacing arthroplasty endoprostheses is presented. This new design type of completely cementless and stemless resurfacing arthroplasty endoprostheses of the hip joint (and other joints), where endoprosthesis components are embedded in the surrounding bone via the prototype biomimetic multi-spiked connecting scaffold (MSC-Scaffold), initiates the first at all generations of biomimetic endoprostheses of diarthrodial joints. [ABSTRACT FROM AUTHOR]

Hip implants have a modular structure which enables patient-specific adaptation but also revision of worn or damaged friction partners without compromising the implant-bone connection. To reduce complications during the extraction of ceramic inlays, this work presents a new approach of a shape-memory-alloy-actuator which enables the loosening of ceramic inlays from acetabular hip cups without ceramic chipping or damaging the metal cup. This technical in vitro study exam-ines two principles of heating currents and hot water for thermal activation of the shape-memory-alloy-actuator to generate a force between the metal cup and the ceramic inlay. Mechanical tests concerning push-in and push-out forces, deformation of the acetabular cup according to international test standards, and force generated by the actuator were generated to prove the feasibility of this new approach to ceramic inlay revision. The required disassembly force for a modular acetabular device achieved an average value of 602 N after static and 713 N after cyclic loading. The actuator can provide a push-out force up to 1951 N. In addition, it is shown that the necessary modifications to the implant modules for the implementation of the shape-memory-actuator-system do not result in any change in the mechanical properties compared to conventional systems. [ABSTRACT FROM AUTHOR]

Cannulated hip screws (CHS) can be used for the minimally invasive fixation of non-dislocated femoral neck fractures. Usually, three screws are inserted. This study aims to determine whether fixation by two CHS leads to similar results as fixation by three CHS. Since January 2019, all patients with an indication for internal fixation by CHS were treated with two CHS and followed prospectively. Results were compared to an equal-sized control group of patients who underwent fixation by three CHS (before 2019). The primary outcome was reoperation, while the secondary outcome was screw dislocation. Since January 2019, 50 patients were treated by two CHS. Of these, 14 patients (28%) underwent reoperation versus 13 patients (26%) in the control group (p = 1.000). Reoperations included screw replacement, hemiarthroplasty, and total hip prosthesis. Three major reasons for reoperation were pain due to osteosynthesis material (n = 15), coxarthrosis (n = 4), and screw cut out (n = 3). Six weeks postoperative X-rays showed a screw dislocation of 2 mm for the two CHS group and 1 mm for the three CHS group (p = 0.330). Clinical outcomes were very similar between the groups. The overall results were good; however, the reoperation rate varied from 26 to 28%. The majority of reoperations were screw replacements. Screw dislocation seems to be more prominent in patients treated with two screws (2 mm versus 1 mm). Fixation by two cannulated hip screws is an acceptable treatment method for non-dislocated femoral neck fractures, and the insertion of a third screw does not lead to superior clinical results. [ABSTRACT FROM AUTHOR]

Prosthetic reconstruction can serve as a feasible alternative, delivering both functional and aesthetic benefits to individuals with hand and finger injuries, frequent causes of emergency room visits. Implant-related infections pose significant challenges in arthroplasty and osteosynthesis procedures, contributing to surgical failures. As a potential solution to this challenge, this study developed a new class of silver (Ag)-doped chitosan (CS) coatings via electrophoretic deposition (EPD) on osseointegrated prostheses for infection therapy. These coatings were successfully applied to additively manufactured Ti6Al4V ELI samples. In the initial phase, the feasibility of the composite coating was assessed using the Thermogravimetric Analysis (TGA) and Attenuated Total Reflection (ATR) techniques. The optimized structures exhibited impressive water uptake in the range of 300–360%. Codeposition with an antibacterial agent proved effective, and scanning electron microscopy (SEM) was used to examine the coating morphology. Biologically, CS coatings demonstrated cytocompatibility when in direct contact with a fibroblast cell line (L929) after 72 h. When exposed to the Staphylococcus epidermidis strain (ATCC 12228), these coatings inhibited bacterial growth and biofilm formation within 24 h. These findings underscore the significant potential of this approach for various applications, including endoprostheses like hip implants, internal medical devices, and transcutaneous prostheses such as osseointegrated limb prosthetics for upper and lower extremities. [ABSTRACT FROM AUTHOR]

Biological augmentation of bony defects in weight-bearing areas of both the acetabulum and the femur remains challenging. The calcium-silicate-based ceramic Baghdadite is a very interesting material to be used in the field of revision total hip arthroplasty for the treatment of bony defects in weight-bearing and non-weight-bearing areas alike. The aim of this study was to investigate the biocompatibility of Baghdadite utilizing an osteoblast-like, human osteosarcoma cell line (MG-63) and the human monocytic leukemia-derived cell line (THP-1). THP-1-derived macrophages and MG-63 were indirectly exposed to Baghdadite for 7 days using a transwell system. Viability was assessed with MTT assay and pH analysis. To investigate proliferation rate, both cell lines were labelled using CFSE and flow cytometrically analyzed. ELISA was used to measure the secretion of IL-1ß, IL-6 and TNFα. The investigation of viability, while showing a slight difference in optical density for the MTT assays in MG-63 cells, did not present a meaningful difference between groups for both cell lines. The comparison of pH and the proportion of living cells between groups did not present with a significant difference for both THP-1 and MG-63. Baghdadite did not have a relevant impact on the proliferation rate of the investigated cell lines. Mean fluorescence intensity was calculated between groups with no significant difference. Baghdadite exerted a proinflammatory effect, which could be seen in an upregulated production of TNFα in macrophages. Production of IL-1ß and IL-6 was not statistically significant, but the IL-6 ELISA showed a trend to an upregulated production as well. A similar effect on MG-63 was not observed. No relevant cytotoxicity of Baghdadite ceramics was encountered. Baghdadite ceramics exhibit a proinflammatory potential by significantly increasing the secretion of TNFα in THP-1-derived macrophages. Whether this proinflammatory potential results in a clinically relevant effect on osteointegration is unclear and requires further investigation. Baghdadite ceramics provide an interesting alternative to conventional bone substitutes and should be further investigated in a biomechanical and in vivo setting. [ABSTRACT FROM AUTHOR]

This paper presents the development, modeling, and control of L03, an underactuated 3D bipedal robot with symmetrical hips and straight legs. This innovative design requires only five actuators, two for the legs and three for the hips. This paper is divided into three parts: (1) mechanism design and kinematic analysis; (2) trajectory planning for the center of mass and foot landing points based on the Divergent Component of Motion (DCM), enabling lateral and forward walking capabilities for the robot; and (3) gait stability analysis through prototype experiments. The primary focus of this study is to explore the application of underactuated symmetrical designs and determine the number of motors required to achieve omnidirectional movement of a bipedal robot. Our simulation and experimental results demonstrate that L03 achieves simple walking with a stable and consistent gait. Due to its lightweight construction, low leg inertia, and straight-legged design, L03 can achieve ground perception and gentle ground contact without the need for force sensors. Compared to existing bipedal robots, L03 closely adheres to the characteristics of the linear inverted pendulum model, making it an invaluable platform for future algorithm research. [ABSTRACT FROM AUTHOR]

With the simultaneous increase in the number of endoprostheses being performed, advances in the field of biomaterials are becoming apparent—whereby the materials and technologies used to construct implants clearly improve the implants' quality and, ultimately, the life of the patient after surgery. The aim of this study was to modify the titanium alloy Ti6Al4V ELI used in the construction of hip joint endoprostheses. This is why the continuous development of biomaterials is so important. This paper presents the results of research for a new application of polymer poly(ethylene-alt-maleic anhydride) as a drug release layer, placed on the surface of a titanium alloy. The obtained layers were analyzed using Raman spectroscopy (spectra and maps), Fourier transform infrared spectroscopy (spectra and maps), contact angle measurements as well as scanning electron microscopy and energy dispersive spectroscopy imaging and topography analysis. The results confirmed that the polymer layer obtained on the plate surface after the alkali heat treatment process is much better—it binds much more polymer and thus the applied drug. In addition, a longer and more gradual release of the drug was observed for the alkali heat treatment modification than for H2O2 solution. [ABSTRACT FROM AUTHOR]

One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years. [ABSTRACT FROM AUTHOR]

The wear of artificial joints can lead to joint noise and tissue pathology within the human body, which is a primary factor affecting their service life. In response to the issue of wear in ceramic–titanium alloy artificial hip joints, this study employed hip joint wear simulations and experimental wear testing on hip joint specimens to investigate the impact of different contact surface parameters on the wear of ceramic–titanium alloy articulating surfaces. The objective was to provide guidance for joint surface treatment to minimize wear. The simulation results demonstrated that the contacting surfaces of the articulating components exhibited a crescent-shaped surface composition before and after wear. The initial variation in the surface friction coefficient had minimal influence on the wear rate after stabilization, whereas excessively high friction coefficients led to erratic changes in wear depth. Based on the simulation results, experimental research was conducted to compare the wear results of different surface roughness values ranging from 60 to 550 nm. The findings revealed that a surface roughness of 150 nm exhibited the least amount of wear and the best anti-wear performance. Furthermore, an exploration of the mechanism behind the influence of different surface friction coefficients on the wear of the articulating surfaces provided valuable insights for surface processing and wear analysis of artificial joints. [ABSTRACT FROM AUTHOR]

Background: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck–body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection. Methods: A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed. Results: Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage. Conclusions: Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A "tumor-like" debridement can reduce this complication. [ABSTRACT FROM AUTHOR]

This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients' general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts. [ABSTRACT FROM AUTHOR]

Subsurface mesoscale cracks exist widely in the outer ring of full ceramic ball bearings (FCBBs), which is a potential threat for the stable operation of related devices such as aero engines, food processing machinery, and artificial replacement hip joints. This paper establishes a dynamic model of subsurface mesoscale cracks in the outer ring of FCBBs based on strain energy theory, and the influence of different crack lengths on the running state is analyzed. The existence of mesoscale cracks is regarded as weakening on the stiffness coefficient, and the deterioration degree of outer ring stiffness of subsurface cracks is thereby quantified. It is found that a small wave peak appears in the vibration time-domain signal when there is a mesoscale crack on the outer ring subsurface, and the crack evolution is evaluated by the amplitude of the corresponding feature frequency. Finally, the accuracy of the model is verified by experiments. The model realizes the identification and degree evaluation of subsurface mesoscale cracks in FCBBs, and provides theoretical references for the diagnosis and status monitoring for FCBB rotor systems. [ABSTRACT FROM AUTHOR]

Hip–knee–ankle–foot prostheses (HKAF) are full lower-limb devices for people with hip amputations that enable individuals to regain their mobility and move freely within their chosen environment. HKAFs typically have high rejection rates among users, as well as gait asymmetry, increased trunk anterior–posterior lean, and increased pelvic tilt. A novel integrated hip–knee (IHK) unit was designed and evaluated to address the limitations of existing solutions. This IHK combines powered hip and microprocessor-controlled knee joints into one structure, with shared electronics, sensors, and batteries. The unit is also adjustable to user leg length and alignment. ISO-10328:2016 standard mechanical proof load testing demonstrated acceptable structural safety and rigidity. Successful functional testing involved three able-bodied participants walking with the IHK in a hip prosthesis simulator. Hip, knee, and pelvic tilt angles were recorded and stride parameters were analyzed from video recordings. Participants were able to walk independently using the IHK and data showed that participants used different walking strategies. Future development of the thigh unit should include completion of a synergistic gait control system, improved battery-holding mechanism, and amputee user testing. [ABSTRACT FROM AUTHOR]

When replacing a damaged artificial hip joint, treatment involves using antibiotic-laced bone cement as a spacer. One of the most popular materials used for spacers is PMMA; however, it has limitations in terms of mechanical and tribological properties. To overcome such limitations, the current paper proposes utilizing a natural filler, coffee husk, as a reinforcement for PMMA. The coffee husk filler was first prepared using the ball-milling technique. PMMA composites with varying weight fractions of coffee husk (0, 2, 4, 6, and 8 wt.%) were prepared. The hardness was measured to estimate the mechanical properties of the produced composites, and the compression test was utilized to estimate the Young modulus and compressive yield strength. Furthermore, the tribological properties of the composites were evaluated by measuring the friction coefficient and wear by rubbing the composite samples against stainless steel and cow bone counterparts under different normal loads. The wear mechanisms were identified via scanning electron microscopy. Finally, a finite element model for the hip joint was built to investigate the load-carrying capacity of the composites under human loading conditions. The results show that incorporating coffee husk particles can enhance both the mechanical and tribological properties of the PMMA composites. The finite element results are consistent with the experimental findings, indicating the potential of the coffee husk as a promising filler material for enhancing the performance of PMMA-based biomaterials. [ABSTRACT FROM AUTHOR]

Background: Modularity in revision THA (RTHA) has become accepted during the last three decades. Nevertheless, specific risks of modularity of current revision devices such as breakage of taper junctions occur during follow-up. Data reporting failure rates are predominantly given by the manufacturers but independent data acquisition is missing so far. Questions/Purposes: 1. What time-related risk of breakage of taper junction between neck and body of an established modular revision device can be expected in a consecutive single institutional series and a mid-term follow-up? 2. Are there specific factors influencing breakage in this cohort? Materials and Methods: A retrospective analysis was performed of a consecutive series of 89 cases after femoral revision using a tapered modular revision stem. Mean follow-up period was 7.1 (range: 3.0–13.7) years. Breakage of stem as failure criteria of the implant was investigated with a Kaplan–Meier analysis. Results: Breakage of taper junctions occurred in four patients during follow-up showing a time-depending implant survival of 94.2 (95% CI: 88.6–100%) after 13.7 years. Implant survival of stems with lateralized necks of 87.4 (95% CI: 75.6–100%) after 13.7 years was significantly lower compared to the standard offset variant with 100% after 13.5 years (log rank test p = 0.0283). Chi square test also revealed a significantly higher risk of breakage of lateralized necks compared to standard offset pieces (p = 0.0141). Three of four patients were obese with a mean BMI of 37.9 kg/m2. Grade of obesity (grade 1 or higher) had significant influence on risk of breakage. Survival of the implant was significantly lower in obese patients with at least grade 1 obesity compared to patients with a BMI < 30 kg/m2 (82.9 (95% CI: 64.9–100%) after 11.6 years vs. 98.4 (95% CI: 95.3–100%) after 13.7 years; log-rank p = 0.0327). Conclusions: Cumulative risk for failure of taper junctions was high in this consecutive single institutional cohort and may further increase during follow-up. As independent data acquisition in registries is missing, failure rate may be higher than reported data of the manufacturers. The use of lateralized offset necks in obese patients of at least grade 1 obesity showed a significantly higher risk of breakage. The use of monobloc revision devices may be an option, but randomized control trials are currently missing to establish standardized treatment protocols considering individual risks for both monobloc and/or modular implants. [ABSTRACT FROM AUTHOR]

Due to polymeric wear debris causing osteolysis from polymer, metal ions causing metallosis from metal, and brittle characteristic causing fracture failure from ceramic in the application on bearing of total hip prosthesis requires the availability of new material options as a solution to these problems. Polycrystalline diamond (PCD) has the potential to become the selected material for hard-on-hard bearing in view of its advantages in terms of mechanical properties and biocompatibility. The present study contributes to confirming the potential of PCD to replace metals and ceramics for hard-on-hard bearing through von Mises stress investigations. A computational simulation using a 2D axisymmetric finite element model of hard-on-hard bearing under gait loading has been performed. The percentage of maximum von Mises stress to respective yield strength from PCD-on-PCD is the lowest at 2.47%, with CoCrMo (cobalt chromium molybdenum)-on-CoCrMo at 10.79%, and Al2O3 (aluminium oxide)-on-Al2O3 at 13.49%. This confirms that the use of PCD as a hard-on-hard bearing material is the safest option compared to the investigated metal and ceramic hard-on-hard bearings from the mechanical perspective. [ABSTRACT FROM AUTHOR]

Novel designs of porous and semi-porous hip stems attempt to alleviate complications such as aseptic loosening, stress shielding, and eventual implant failure. Various designs of hip stems are modeled to simulate biomechanical performance using finite element analysis; however, these models are computationally expensive. Therefore, the machine learning approach is incorporated with simulated data to predict the new biomechanical performance of new designs of hip stems. Six types of algorithms based on machine learning were employed to validate the simulated results of finite element analysis. Afterwards, new designs of semi-porous stems with outer dense layers of 2.5 and 3 mm and porosities of 10–80% were used to predict the stiffness of the stems, stresses in outer dense layers, stresses in porous sections, and factor of safety under physiological loads using machine learning algorithms. It was determined that decision tree regression is the top-performing machine learning algorithm as per the used simulation data in terms of the validation mean absolute percentage error which equals 19.62%. It was also found that ridge regression produces the most consistent test set trend as compared with the original simulated finite element analysis results despite relying on a relatively small data set. These predicted results employing trained algorithms provided the understanding that changing the design parameters of semi-porous stems affects the biomechanical performance without carrying out finite element analysis. [ABSTRACT FROM AUTHOR]

(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015–1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020–31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Ti6Al4V titanium alloy (Ti-alloy) sleeved ceramic heads have become widely used in revision surgery when the hip stem is left in situ. This solution guarantees a new junction between the bore of the ceramic head and the Ti-alloy sleeve, regardless of any possible, slight surface damage to the Ti-alloy taper of the stem. However, this solution introduces an additional Ti-alloy/Ti-alloy interface pairing, which is potentially susceptible to mechanically assisted crevice corrosion. This study evaluated both qualitatively and quantitatively the damage that occurred in vivo on Ti-alloy micro-grooved 12/14 tapers of (i) primary implants with non-sleeved ceramic heads (Group 1), (ii) secondary implants with non-sleeved ceramic heads (Group 2), and (iii) secondary implants with sleeved ceramic heads (Group 3). A total of 45 explants—15 for each group, including short-, medium- and long-neck heads—underwent optical evaluation for surface damage (Goldberg scoring), surface roughness analysis, and SEM/EDX analysis. The Goldberg scores did not reveal different patterns in the tapers' surface damage; surface damage was classified as absent or mild (surface damage score ≤2) in 94%, another 94%, and 92% of the analysed regions for Group 1, Group 2, and Group 3, respectively. Small but significant differences in morphological changes occurred in the tapers of the three groups: reductions no greater than a few percentage points in median values of roughness parameters were found in Group 1 and Group 2, while negligible changes were found in Group 3. SEM/EDX analysis revealed little (i.e., a slight increase in the oxygen content) to undetectable changes in the chemical composition on the Ti-alloy surface independently of the group. These results suggest that the Ti-alloy/Ti-alloy sleeve/taper junction is only mildly susceptible to mechanically assisted crevice corrosion. Assembling a sleeved ceramic head, with variable neck lengths up to a "long-neck", to a Ti-alloy micro-grooved 12/14 taper of a stem left in situ does not seem to increase the risk of revision due to trunnionosis, as long as junction stability (i.e., the proper seating of the sleeved ceramic head on the 12/14 taper) is achieved intraoperatively. [ABSTRACT FROM AUTHOR]

Dual mobility (DM) implants are being increasingly used for total hip arthroplasties due to the additional range of motion and joint stability they afford over more traditional implant types. Currently, there are no reported methods for monitoring their motions under realistic operating conditions while in vitro and, therefore, it is challenging to predict how they will function under clinically relevant conditions and what failure modes may exist. This study reports the development, calibration, and validation of a novel inertial tracking system that directly mounts to the mobile liner of DM implants. The tracker was custom built and based on a miniaturized, off-the-shelf inertial measurement unit (IMU) and employed a gradient-decent sensor fusion algorithm for amalgamating nine degree-of-freedom IMU readings into three-axis orientation estimates. Additionally, a novel approach to magnetic interference mitigation using a fixed solenoid and magnetic field simulation was evaluated. The system produced orientation measurements to within 1.0° of the true value under ideal conditions and 3.9° with a negligible drift while in vitro, submerged in lubricant, and without a line of sight. [ABSTRACT FROM AUTHOR]

Nowadays, there is an ever-increasing diversity of materials available, each with its own set of features, capabilities, benefits, and drawbacks. There is no single definitive criteria for selecting the perfect biomedical material; designers and engineers must consider a vast array of distinct biomedical material selection qualities. The goal of this study is to establish fairly operational rules and aggregation operators (AOs) in a linear Diophantine fuzzy context. To achieve this goal, we devised innovative operational principles that make use of the notion of proportional distribution to provide an equitable or fair aggregate for linear Diophantine fuzzy numbers (LDFNs). Furthermore, a multi-criteria decision-making (MCDM) approach is built by combining recommended fairly AOs with evaluations from multiple decision-makers (DMs) and partial weight information under the linear Diophantine fuzzy paradigm. The weights of the criterion are determined using incomplete data with the help of a linear programming model. The enhanced technique might be used in the selection of compounds in a variety of applications, including biomedical programmes where the chemicals used in prostheses must have qualities similar to those of human tissues. The approach presented for the femoral component of the hip joint prosthesis may be used by orthopaedists and practitioners who will choose bio-materials. This is due to the fact that biomedical materials are employed in many sections of the human body for various functions. [ABSTRACT FROM AUTHOR]

Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent years for hip replacement in younger and more active patients. Obesity is increasingly spreading even in the younger population. The aim of this case-series study is to evaluate short stems compared to traditional hip prostheses in the obese population. A total of 77 consecutive patients with a BMI greater than or equal to 30 Kg/m2 were enrolled in this prospective study and were divided into two groups: 49 patients have been implanted with short stems while 28 patients were implanted with traditional stems. All the patients were treated for primary osteoarthritis or avascular necrosis and all the stems were implanted by the same surgeon using a posterior approach. Clinical (Harris Hip Score—HHS, Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC, visual analogue scale—VAS, 12-item Short Form Health Survey—SF-12) and radiographic outcomes were recorded. Radiological evaluations were carried out by three different blinded surgeons. A statistical analysis was performed (chi-square, t-test, Wilcoxon Rank Sum Test, 2-factor ANOVA). At a mean follow-up of 42.6 months both groups showed a marked improvement in pain and in the clinical scores between pre- and post-surgical procedures (p < 0.05) with no significant differences between the two groups at last follow-up (p > 0.05). The radiological evaluations, with high concordance correlation between the three blinded surgeons (ICC consistently >0.80), showed good positioning and osseointegration in all cases, with no significant differences in the restoration of the joint geometry and complications. No revisions were recorded during the follow-up period. In conclusion, short stems appear to be a good option for bone preservation even in obese patients, showing comparable results to traditional implants. [ABSTRACT FROM AUTHOR]

Artificial implants are very essential for the disabled as they are utilized for bone and joint function in orthopedics. However, materials used in such implants suffer from restricted mechanical and tribological properties besides the difficulty of using such materials with complex structures. The current study works on developing a new polymer green composite that can be used for artificial implants and allow design flexibility through its usage with 3D printing technology. Therefore, a natural filler extracted from corn cob (CC) was prepared, mixed homogeneously with the Polylactic-acid (PLA), and passed through a complete process to produce a green composite filament suit 3D printer. The corn cob particles were incorporated with PLA with different weight fractions zero, 5%, 10%, 15%, and 20%. The physical, mechanical, and tribological properties of the PLA-CC composites were evaluated. 3D finite element models were constructed to evaluate the PLA-CC composites performance on a real condition implant, hip joints, and through the frictional process. Incorporating corn cob inside PLA revealed an enhancement in the hardness (10%), stiffness (6%), compression ultimate strength (12%), and wear resistance (150%) of the proposed PLA-CC composite. The finite element results of both models proved an enhancement in the load-carrying capacity of the composite. The finite element results came in line with the experimental results. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) has started to unfold diverse fields of applications by providing unique solutions to manufacturing. Laser cladding is one of the prominent AM technologies that can be used to fulfill the needs of custom implants. In this study, the wear resistance of the laser cladded titanium alloy, Ti-17Nb-6Ta, has been evaluated under varied loads in Ringer's solution. Microstructural evaluation of the alloy was performed by SEM and EDX, followed by phase analysis through XRD. The wear testing and analysis have been carried out with a tribometer under varied loads of 10, 15, and 20 N while keeping other parameters constant. Abrasion was observed to be the predominant mechanism majorly responsible for the wearing of the alloy at the interface. The average wear rate and coefficient of friction values were 0.016 mm3/Nm and 0.22, respectively. The observed values indicated that the developed alloy exhibited excellent wear resistance, which is deemed an essential property for developing biomedical materials for human body implants such as artificial hip and knee joints. [ABSTRACT FROM AUTHOR]

Stress shielding secondary to bone resorption is one of the main causes of aseptic loosening, which limits the lifespan of the hip prostheses and increases the rates of revision surgery. This study proposes a low stiffness polyether–ether–ketone (PEEK) hip prostheses, produced by fused deposition modelling to minimize the stress difference after the hip replacement. The stress shielding effect and the potential bone resorption of the PEEK implant was investigated through both experimental tests and FE simulation. A generic Ti6Al4V implant was incorporated in this study to allow fair comparison as control group. Attributed to the low stiffness, the proposed PEEK implant showed a more natural stress distribution, less stress shielding (by 104%), and loss in bone mass (by 72%) compared with the Ti6Al4V implant. The stiffness of the Ti6Al4V and the PEEK implant were measured through compression tests to be 2.76 kN/mm and 0.276 kN/mm. The factor of safety for the PEEK implant in both static and dynamic loading scenarios were obtained through simulation. Most of the regions in the PEEK implant were tested to be safe (FoS larger than 1) in terms of representing daily activities (2300 N), while the medial neck and distal restriction point of the implant attracts large von Mises stress 82 MPa and 76 MPa, respectively, and, thus, may possibly fail during intensive activities by yield and fatigue. Overall, considering the reduction in stress shielding and bone resorption in cortical bone, PEEK could be a promising material for the patient–specific femoral implants. [ABSTRACT FROM AUTHOR]

Gait disorders, muscle weakness, spinal cord injuries (SCIs) and other work-related disorders have increased the need for rehabilitation exoskeletons—specifically, for the hip because a huge percentage of mechanical power comes from the hip joint. However, realising a lightweight rehabilitation hip exoskeleton for mobility and at-home use with reliable control is challenging. The devices developed are restricted by a joint actuator and energy source design and tend to have various uncertainties. Thus, this study tested the robustness of four optimal controller cases in a simulation-based environment. We sought to determine whether the most robust optimal controller consumed less energy and demonstrated better performance in tracking the desired signal. The robustness of the optimal cases was tested with the hip torque signals of healthy subjects. The number of sit-to-stand (STS) instances and the walking distance at various speeds were calculated. The results showed that the most robust case controller was more energy efficient for STS, but not for walking activity. Furthermore, this study provides compelling evidence that various optimal controllers have different degrees of robustness and effects on energy consumption. [ABSTRACT FROM AUTHOR]

The current study deals with the design of ultra-high molecular weight polyethylene (UHMWPE) composites by integrating various micro and nanoparticles as reinforcements for enhanced performance of acetabular cups in hip prostheses. For the design, a data-driven design approach was implemented, exploiting natural computing techniques such as Artificial Neural Network (ANN) and Genetic Algorithm (GA). Experimental data related to UHMWPE reinforced with carbon nanotube, graphene, carbon fiber, and hydroxyapatite were gathered from the published works of previous researchers. To study the relationship between the volume fraction and the morphology of the particles with the tribological and mechanical properties of the composites, ANN modeling and sensitivity analyses were used. Optimization of the properties was done with the developed ANN models as objective functions in order to find the optimal combinations of reinforcements, which helps to achieve enhanced tribo-mechanical properties of the composites. This natural computing approach of designing the UHMWPE composites paved a way for experimentation. [ABSTRACT FROM AUTHOR]

This paper reviews the recent advancements in computational modelling of the lubrication of hip and knee joint replacements, especially those concerning Professor Duncan Dowson's contribution. The review starts with the development of modelling the five key parameters that appeared in the pioneered Hamrock–Dowson formula. Then, the theory and approaches for the mixed lubrication in which the artificial hip and knee joint replacements operate are reviewed. We also discuss the current challenges in modelling the lubrication behaviour of joint replacements and how these challenges could be addressed in future studies. These challenges include the mixed lubrication theory, the numerical complexities due to complicated realistic geometry, material and rheology, and individual physiological diversities. [ABSTRACT FROM AUTHOR]

Off-the-shelf hip joints are considered essential parts in rehabilitation medicine that can help the disabled. However, the failure of the materials used in such joints can cause individual discomfort. In support of the various motor conditions of the influenced individuals, the aim of the current research is to develop a new composite that can be used as an acetabular liner inside the hip joint. Polylactic acid (PLA) can provide the advantage of design flexibility owing to its well-known applicability as a 3D printed material. However, using PLA as an acetabular liner is subject to limitations concerning mechanical properties. We developed a complete production process of a natural filler, i.e., date pits. Then, the PLA and date pit particles were extruded for homogenous mixing, producing a composite filament that can be used in 3D printing. Date pit particles with loading fractions of 0, 2, 4, 6, 8, and 10 wt.% are dispersed in the PLA. The thermal, physical, and mechanical properties of the PLA–date pit composites were estimated experimentally. The incorporation of date pit particles into PLA enhanced the compressive strength and stiffness but resulted in a reduction in the elongation and toughness. A finite element model (FEM) for hip joints was constructed, and the contact stresses on the surface of the acetabular liner were evaluated. The FEM results showed an enhancement in the composite load carrying capacity, in agreement with the experimental results. [ABSTRACT FROM AUTHOR]

Choosing a suitable prosthesis to restore the functionality of the hip joint is a complex problem. The stem geometries, materials, and type of hip damage are critical factors for avoiding potential issues (aseptic loosening, fracture, and natural wear and tear). Comparing the available stems to select the best option is not straightforward because of the various loads and boundary conditions used in the tests, making the process difficult to compare the advantages and disadvantages among them. This work proposes stem assessment using a standardized base (generated from a literature review and ISO standards) to compare the stem geometries and present a new hybrid design to improve performance using the best qualities of the implants reported in the literature review. Sixteen hip prostheses were evaluated with the finite element method (FEM) using the same boundary and loading conditions through multi-objective analysis (von Mises stress and strain). Consequently, a hybrid geometry proposal was obtained by assessing specific points through the stem length (medial and lateral region) to define the cross-section (trapezoidal) and the new profile. The new hybrid implant proposal presented a stress reduction of 9.6% when compared to the reference implant P2-T (the implant with the best behavior) in the most critical activity (activity 4) using a titanium alloy. A similar stress reduction of 9.98% was obtained using ASTM F2996-13 and ISO 7206–4:2010(E) standards. [ABSTRACT FROM AUTHOR]

Sequential cross-linked and annealed ultra-high-molecular-weight polyethylene (SX-PE) is known as a low-wear articulating partner, especially for total hip endoprostheses. Aging of polymeric materials, irrespective of if induced by shelf or in vivo life, can degrade their tribological and mechanical properties. However, changes in wear behavior of aged SX-PE liners have not been not quantified so far. An accelerated aging procedure, to simulate shelf and in vivo aging, was performed on thin SX-PE liners after five million load cycles using a simulator ("worn-aged") as well as on new SX-PE liners ("new-aged"). A subsequent hip simulator test was performed with both thin SX-PE liner sets in combination with large-diameter ceramic femoral head, representing a combination known as advantageous for treatment after revision because of dislocation. Oxidation indices were measured on the liners after each step of the procedure. SX-PE liners after accelerated aging show bedding-in phases during simulator test, which was a characteristic only known from clinical investigations. Hence, the wear rates of the "new-aged" ((1.71 ± 0.49) mg/million cycles) and of the "worn-aged" ((9.32 ± 0.09) mg/million cycles) SX-PE were increased in the first period compared to new unaged SX-PE liners. Subsequently, the wear rates decreased for "new-aged" and "worn-aged" inserts to (0.44 ± 0.48) mg/million cycles and (2.72 ± 0.05) mg/million cycles, respectively. In conclusion, the results show promising effects of accelerated aging on SX-PE liners in simulator testing and for potential long-term use in clinical applications. [ABSTRACT FROM AUTHOR]

(1) Introduction: The changes in the joint morphology inevitably lead to prosthesis, but the hip pathology is complex. The hip arthroplasty is a therapeutic solution and can be caused, most frequently, by primary and secondary coxarthrosis due to or followed by traumatic conditions. The main aim of this study was to find the method of revision hip prosthesis that preserves as much bone material as possible and has sufficiently good mechanical strength. (2) Materials and Methods: In this study, in a first step, the two revision prostheses were performed on bone components taken from an animal (cow), and then, they were tested on a mechanical testing machine until the prostheses physically failed, and the force causing their failure was determined. (3) Results: These prostheses were then modelled in a virtual environment and tested using the finite element method (FEM) in order to determine their behaviour under loading from normal human gait. Displacement, strain, and stress maps were obtained. (4) Discussion: Discussions on hip revision prostheses, method, and theory analysis are presented at the end of the paper. (5) Conclusions: Important conclusions are drawn based on comparative analyses. The main conclusion shows that the both orthopaedic prostheses provide a very good resistance. [ABSTRACT FROM AUTHOR]

Tribocorrosion is a current and very discussed theme in tribology and medicine for its impact on industrial applications. Currently, the phenomena are mainly oriented to the biological environment and, in particular, to medical devices such as hip prostheses, dental implants, knee joints, etc. The term tribocorrosion underlines the simultaneous action of wear and corrosion in a tribocouple. It has a non-negligible effect on the total loss of contact materials and the potential failure of the bio-couplings. This overview aims to focus firstly on the basic principles of prosthesis tribocorrosion and subsequently to describe the techniques and the analytical models developed to quantify this phenomenon, reporting the most relevant results achieved in the last 20 years, proposed in chronological order, in order to discuss and to depict the future research developments and tendencies. Despite considerable research efforts, from this investigation come many issues worthy of further investigation, such as how to prevent or minimize tribocorrosion in biological tribopairs, the development of a consolidated protocol for tribological experiments in corrosive environments joined with new biomaterials and composites, the possibility to achieve more and more accurate theoretical models, and how to be able to ensure the success of new implant designs by supporting research and development for the management of implant complications. The above issues certainly constitute a scientific challenge for the next years in the fields of tribology and medicine. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) follow-up is conventionally conducted with serial X-ray imaging in order to ensure the early identification of implant failure. The purpose of this study is to develop an automated radiographic failure detection system. Methods: 630 patients with THA were included in the study, two thirds of which needed total or partial revision for prosthetic loosening. The analysis is based on one antero-posterior and one lateral radiographic view obtained from each patient during routine post-surgery follow-up. After pre-processing for proper standardization, images were analyzed through a convolutional neural network (the DenseNet169 network), aiming to predict prosthesis failure. The entire dataset was divided in three subsets: training, validation, and test. These contained transfer learning and fine-tuning algorithms, based on the training dataset, and were implemented to adapt the DenseNet169 network to the specific data and clinical problem. Results: After the training procedures, in the test set, the classification accuracy was 0.97, the sensitivity 0.97, the specificity 0.97, and the ROC AUC was 0.99. Only five images were incorrectly classified. Seventy-four images were classified as failed, and eighty as non-failed with a probability >0.999. Conclusion: The proposed deep learning procedure can detect the loosening of the hip prosthesis with a very high degree of precision. [ABSTRACT FROM AUTHOR]

In recent years, thanks to the development of additive manufacturing techniques, pros-thetic surgery has reached increasingly cutting-edge levels, revolutionizing the clinical course of patients suffering from joint arthritis, rheumatoid arthritis, post-traumatic arthrosis, etc. This work aims to evaluate the best materials for prosthetic surgery in hip implants from a tribological and mechanical point of view by using a machine-learning algorithm coupling with multi-body modeling and Finite Element Method (FEM) simulations. The innovative aspect is represented by the use of machine learning for the creation of a humanoid model in a multibody software environment that aimed to evaluate the load and rotation condition at the hip joint. After the boundary conditions have been defined, a Finite Element (FE) model of the hip implant has been created. The material properties and the information on the tribological behavior of the material couplings under investigation have been obtained from literature studies. The wear process has been investigated through the implementation of the Archard's wear law in the FE model. The results of the FE simulation show that the best wear behavior has been obtained by CoCr alloy/UHMWPE coupling with a volume loss due to a wear of 0.004 μ m 3 at the end of the simulation of ten sitting cycles. After the best pairs in terms of wear has been established, a topology optimization of the whole hip implant structure has been performed. The results show that, after the optimization process, it was possible to reduce implant mass making the implant 28.12% more lightweight with respect to the original one. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed dynamic modeling and control method considering joint friction could be applied not only to the trajectory control of the hip joint simulator, but also to other parallel and series manipulators with high-loads. To overcome the bearing capacity deficiencies of traditional serial hip joint simulators, complex trajectory simulation, among others, as well as a parallel manipulator with two pairs of artificial hip joints and two moving platforms are proposed. The movements and driving forces of the parallel manipulator under the required motion and loading are studied to provide a basis for further research. In this study, the modeling and analysis of inverse kinematics and dynamics for a parallel manipulator with joint friction are derived. In the inverse kinematic model, kinematic relationships between the linear module slider and the moving platform are established, and expressions for the slider are deduced. Subsequently, by analyzing the frictional forces of the artificial hip joint and thrust ball bearing, a rigid body dynamics model of the parallel manipulator with joint friction is established, which is subsequently decomposed into four driving torques associated with the moving platform, joint lever, slider, and screw. Finally, the difference in the kinematic performance between the two moving platforms is analyzed using numerical simulations and experiments, and the accuracy of the established model is verified. [ABSTRACT FROM AUTHOR]