Search

Scratches on the metal bearing surface of metal-on-polyethylene total joint replacements have been found to appreciably accelerate abrasive/adhesive wear of polyethylene, and constitute a source of the considerable variability of wear rate seen within clinical cohorts. Scratch orientation with respect to the local direction of relative surface sliding is presumably a factor affecting instantaneous debris liberation during articulation. A three-dimensional local finite element model was developed, of orientation-specific polyethylene articulation with a scratched metal counterface, to explore continuum-level stress/strain parameters potentially correlating with the orientation dependence of scratch wear in a corresponding physical experiment. Computed maximum stress values exceeded the yield strength of ultra-high molecular weight polyethylene (UHMWPE) for all scratch orientations but did not vary appreciably among scratch orientations. Two continuum-level parameters judged most consistent overall with the direction dependence of experimental wear were (1) cumulative compressive total normal strain in the direction of loading, and (2) maximum instantaneous compressive total normal strain transverse to the sliding direction. Such stress/strain metrics could be useful in global computational models of wear acceleration, as surrogates to incorporate anisotropy of local metal surface roughening. [DOI: 10.1115/1.2939273] Keywords: wear, wear surrogate, scratch wear, scratch orientation, finite element analysis, arthroplasty, THA, TKA, polyethylene, UHMWPE

Third-body effects appear to be responsible for an appreciable portion of the wear rate variability within cohorts of patients with metal-on-polyethylene joint replacements. The parameters dominating the rate of polyethylene debris liberation by counterface scratches are not fully understood, but one seemingly contributory factor is the scratch's orientation relative to the direction of instantaneous local surface sliding. To study this influence, arrays of 550 straight parallel scratches each representative of the severe end of the clinical range were diamond stylus-ruled onto the surface of polished stainless steel plates. These ruled plates were then worn reciprocally against polyethylene pins (both conventional and highly cross-linked) at traverse angles varied parametrically relative to the scratch direction. Wear was measured gravimetrically, and particulate debris was harvested and morphologically characterized. Both of the polyethylene variants tested showed pronounced wear rate peaks at acute scratch traverse angles (15 deg for conventional and 5 deg for cross-linked), and had nominally comparable absolute wear rate magnitudes. The particulate debris from this very aggressive test regime primarily consisted of extremely large and elongated strands, often tens or even hundreds of microns in length. These data suggest that counterface damage regions with preferential scratch directionality can liberate large amounts of polyethylene debris, apparently by a slicing/shearing mechanism, at critical (acute) attack angles. However, the predominant manifestation of this wear volume was in the form of particles far beyond the most osteolytically potent size range.

Damage to the femoral head in total hip arthroplasty often takes the form of discrete scratches, which can lead to dramatic wear acceleration of the polyethylene (PE) liner. Here, a novel formulation is reported for finite element (FE) analysis of wear acceleration due to scratch damage. A diffused-light photography technique was used to globally locate areas of damage, providing guidance for usage of high-magnification optical profilometry to determine individual scratch morphology. This multiscale image combination allowed comprehensive input of scratch-based damage patterns to an FE Archard wear model, to determine the wear acceleration associated with specific retrieval femoral heads. The wear algorithm imposed correspondingly elevated wear factors on areas of PE incrementally overpassed by individual scratches. Physical validation was provided by agreement with experimental data for custom-ruled scratch patterns. Illustrative wear acceleration results are presented for four retrieval femoral heads. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome is commonly viewed as resulting from chronic mechanical insult of the median nerve by adjacent anatomical structures. Both the median nerve and its surrounding soft tissue structures are well visualized on magnetic resonance (MR) images of the wrist and hand. Addressing nerve damage from impingement of flexor digitorum tendons co-occupying the tunnel is attractive, but to date has been restricted by a lack of means for making individual identifications of the respective tendons. In this image analysis work, we have developed a region-growing method to positively identify each individual digital flexor tendon within the carpal tunnel by tracking it from a more distal MR section where the respective tendon identities are unambiguous. Illustratively, the new method was applied to MRI scans from four different subjects in a variety of hand poses. Conventional shape measures yielded less discriminatory information than did evaluations of individual tendon location and arrangement. This new method of rapid identification of individual tendons will facilitate analysis of tendon/nerve interactions within the tunnel, thereby providing better information about mechanical insult of the median nerve. [ABSTRACT FROM AUTHOR]

Background: Medial protrusio is a recognized complication of total hip arthroplasty, but it is not known if a medial wall breach during cup implantation increases the risk. We thus investigated the effect of up to a 2 cm defect in the medial acetabular wall in a cadaveric model. Separately, we investigated the ability of acetabular screws to rescue the construct., Methods: Nine human fresh-frozen hemipelves were reamed medially to create the defect, implanted with acetabular cups, and then loaded to failure. The nine contralateral hemipelves were reamed in a standard fashion and served as controls. Separately, nine hemipelves with a medial defect were augmented with two acetabular screws each, then loaded to failure, with the contralateral side as a control. Load-to-failure, stiffness, and energy were recorded., Findings: The presence of a medial wall defect decreased the load-to-failure by a mean of 26% (5710 v. 4221 N, p=0.024). The addition of two acetabular screws did not rescue the construct (mean 27% decrease, 4082 v. 2985 N, p=0.024). The majority of specimens failed in a supra-physiologic range of force. Bone density correlated with failure loads (R(2) range of 0.54-0.78), and osteoporotic specimens were more likely to fail at a physiologic range, consistent with forces experienced during minor stumbles or falls., Interpretation: Osteoporotic patients with a medial wall defect after hip arthroplasty may be susceptible to fracture during activities of daily living. Protected weight bearing with an assistive device may be reasonable in order to minimize fall risk until cup ingrowth is achieved.

Carpal tunnel syndrome is commonly viewed as resulting from chronic mechanical insult of the median nerve by adjacent anatomical structures. Both the median nerve and its surrounding soft tissue structures are well visualized on magnetic resonance (MR) images of the wrist and hand. Addressing nerve damage from impingement of flexor digitorum tendons co-occupying the tunnel is attractive, but to date has been restricted by lack of means for making individual identifications of the respective tendons. In this image analysis work, we have developed a region-growing method to positively identify each individual digital flexor tendon within the carpal tunnel by tracking it from a more distal MR section where the respective tendon identities are unambiguous. Illustratively, the new method was applied to MRI scans from four different subjects in a variety of hand poses. Conventional shape measures yielded less discriminatory information than did evaluations of individual tendon location and arrangement. This new method of rapid identification of individual tendons will facilitate analysis of tendon/nerve interactions within the tunnel, thereby providing better information about mechanical insult of the median nerve.

Piezoresistive array pressure sensors are widely used in orthopaedic research to determine contact stress distributions across articular joint surfaces. Experience with such sensors has shown there can be inaccuracies in how the sensor perceives applied load, depending on the material stiffnesses between which it is compressed experimentally, versus in calibration. A study was undertaken to quantify the relationship between load perception of one such sensor design (Tekscan) and the stiffness of the materials between which it is compressed. A three-dimensional finite element model of a 3x3 sensel portion of the sensing matrix was formulated, along with a layer of compression test material on each side of the sensor. The elastic modulus of the test material was varied across the range representative of cartilage (12 MPa) to hard plastic (10 GPa). Using the computed contact pressure results between contacting surfaces of the sensor layers, the percentage of load passing through the active conductor intersections was determined. The results revealed that with increase of the elastic modulus of the material between which the sensor was compressed, the percentage of load on the active conductor intersections increased monotonically. The highest sensitivity of perceived loading to test material modulus (0.1%/MPa) was seen at the low end of the modulus range. The more compliant the test material, the more the sensor layers conformed around each other's geometric incongruities, the larger the true contact areas, and the higher the fraction of the total load that passed through the intermediate (non-sensing) regions between the conductors.