Advertisement

Biomaterials in Total Joint Arthroplasty

  • Lindsey N. Bravin
  • Matthew J. Dietz
Chapter

Abstract

Total joint arthroplasties have increased significantly in number over the past several decades and appear to continue to increase exponentially in correlation with the demands of an aging population. The multifaceted approach to providing patients with a lasting implant is divided among the patient characteristics, surgical skills, and the biomaterials of the implant. The following chapter reviews the most commonly used biomaterials for total joint arthroplasty, their properties, their interaction with other implants, and the current progress in improving each material for greater stability, sterility, and survivability. This chapter also highlights the clinical relevance of these materials by presenting several case reports of failures of varying materials.

Keywords

Total joint arthroplasty Total joint replacement Biomaterials Polyethylene Ultra-high molecular weight polyethylene Polyethylene wear Ceramic Zirconium Cobalt chrome Metallosis Bearing surfaces Implant manufacturing 

Notes

Acknowledgements

The authors would like to acknowledge Dr. Adam Klein and Dr. Ryan Murphy for sharing their expertise and experiences. The authors would also like to thank Suzanne Danley for her critical review and editing. The work reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 2U54GM104942-02. The Content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Supplementary material

Video 1

Caption (MP4 9734 kb)

Video 2

Caption (MP4 20915 kb)

References

  1. 1.
    Koenig L, et al. Estimating the societal benefits of THA after accounting for work status and productivity: a Markov model approach. Clin Orthop Relat Res. 2016;474(12):2645–54.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ruiz D Jr, et al. The direct and indirect costs to society of treatment for end-stage knee osteoarthritis. J Bone Joint Surg Am. 2013;95(16):1473–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Elmallah RK, et al. Determining cost-effectiveness of total hip and knee arthroplasty using the short form-6D utility measure. J Arthroplast. 2017;32(2):351–4.CrossRefGoogle Scholar
  4. 4.
    Kurtz S, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.PubMedGoogle Scholar
  5. 5.
    Kurtz S, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87(7):1487–97.PubMedGoogle Scholar
  6. 6.
    Kurtz SM, et al. International survey of primary and revision total knee replacement. Int Orthop. 2011;35(12):1783–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Neuprez A, et al. Patients’ expectations impact their satisfaction following total hip or knee arthroplasty. PLoS One. 2016;11(12):e0167911.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Lim JB, et al. Comparison of patient quality of life scores and satisfaction after common orthopedic surgical interventions. Eur J Orthop Surg Traumatol. 2015;25(6):1007–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Naal FD, et al. Clinical improvement and satisfaction after total joint replacement: a prospective 12-month evaluation on the patients’ perspective. Qual Life Res. 2015;24(12):2917–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Flego A, et al. Addressing obesity in the management of knee and hip osteoarthritis—weighing in from an economic perspective. BMC Musculoskelet Disord. 2016;17:233.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gold HT, et al. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplast. 2016;31(11):2385–8.CrossRefGoogle Scholar
  12. 12.
    Bauer TW, Schils J. The pathology of total joint arthroplasty. II. Mechanisms of implant failure. Skeletal Radiol. 1999;28(9):483–97.CrossRefPubMedGoogle Scholar
  13. 13.
    Blumenfeld TJ, Bargar WL. Early aseptic loosening of a modern acetabular component secondary to a change in manufacturing. J Arthroplast. 2006;21(5):689–95.CrossRefGoogle Scholar
  14. 14.
    Bonsignore LA, Goldberg VM, Greenfield EM. Machine oil inhibits the osseointegration of orthopaedic implants by impairing osteoblast attachment and spreading. J Orthop Res. 2015;33(7):979–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Suhardi VJ, et al. A fully functional drug-eluting joint implant. Nat Biomed Eng. 2017;1.Google Scholar
  16. 16.
    McKee GK, Watson-Farrar J. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br. 1966;48(2):245–59.CrossRefPubMedGoogle Scholar
  17. 17.
    Charnley KEA. The classic: arthroplasty of hip: a new operation. Reprinted from Lancet pp. 1129–32, 1961. Clin Orthop Relat Res. 1973;95:4–8.Google Scholar
  18. 18.
    Bankston AB, et al. Comparison of polyethylene wear in machined versus molded polyethylene. Clin Orthop Relat Res. 1995;(317):37–43.Google Scholar
  19. 19.
    Faris PM, et al. Polyethylene sterilization and production affects wear in total hip arthroplasties. Clin Orthop Relat Res. 2006;453:305–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Rose RM, et al. On the origins of high in vivo wear rates in polyethylene components of total joint prostheses. Clin Orthop Relat Res. 1979;(145):277–86.Google Scholar
  21. 21.
    Landy MM, Walker PS. Wear of ultra-high-molecular-weight polyethylene components of 90 retrieved knee prostheses. J Arthroplast. 1988;3(Suppl):S73–85.CrossRefGoogle Scholar
  22. 22.
    Oonishi H, et al. Wear of highly cross-linked polyethylene acetabular cup in Japan. J Arthroplast. 2006;21(7):944–9.CrossRefGoogle Scholar
  23. 23.
    Muratoglu OK, et al. A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul award. J Arthroplast. 2001;16(2):149–60.CrossRefGoogle Scholar
  24. 24.
    Muratoglu OK, et al. Effect of radiation, heat, and aging on in vitro wear resistance of polyethylene. Clin Orthop Relat Res. 2003;(417):253–62.Google Scholar
  25. 25.
    Tower SS, et al. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am. 2007;89(10):2212–7.PubMedGoogle Scholar
  26. 26.
    Birman MV, et al. Cracking and impingement in ultra-high-molecular-weight polyethylene acetabular liners. J Arthroplast. 2005;20(7 Suppl 3):87–92.CrossRefGoogle Scholar
  27. 27.
    Oparaugo PC, et al. Correlation of wear debris-induced osteolysis and revision with volumetric wear-rates of polyethylene: a survey of 8 reports in the literature. Acta Orthop Scand. 2001;72(1):22–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Sochart DH. Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty. Clin Orthop Relat Res. 1999;363:135–50.CrossRefGoogle Scholar
  29. 29.
    Kurtz SM. UHMWPE biomaterials handbook : ultra-high molecular weight polyethylene in total joint replacement and medical devices. 3rd ed. Amsterdam; Boston: Elsevier/WA, William Andrew is an Imprint of Elsevier; 2016. xxiv, 815 pages.Google Scholar
  30. 30.
    Kurtz SM, et al. Advances in the processing, sterilization, and crosslinking of ultra-high molecular weight polyethylene for total joint arthroplasty. Biomaterials. 1999;20(18):1659–88.CrossRefPubMedGoogle Scholar
  31. 31.
    Peacock AJ. Handbook of polyethylene. New York, NY: Marcel Dekker; 2000.CrossRefGoogle Scholar
  32. 32.
    Callaghan JJ. The adult hip: hip arthroplasty surgery. 3rd ed. Philadelphia: Wolters Kluwer; 2016. 2 volumes (xxxi, 1490, 30 pages).Google Scholar
  33. 33.
    Oral E, et al. Diffusion of vitamin E in ultra-high molecular weight polyethylene. Biomaterials. 2007;28(35):5225–37.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Oral E, et al. Wear resistance and mechanical properties of highly cross-linked, ultrahigh-molecular weight polyethylene doped with vitamin E. J Arthroplast. 2006;21(4):580–91.CrossRefGoogle Scholar
  35. 35.
    Oral E, et al. The effects of high dose irradiation on the cross-linking of vitamin E-blended ultrahigh molecular weight polyethylene. Biomaterials. 2008;29(26):3557–60.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Shareghi B, Johanson PE, Karrholm J. Wear of vitamin E-infused highly cross-linked polyethylene at five years. J Bone Joint Surg Am. 2017;99(17):1447–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Currently Available HXLPE Implants Available in the US, in Zimmer Longevity Highly Cross-linked Polyethylene: Clinical Value Dossier. 2012.Google Scholar
  38. 38.
    WILES P. The surgery of the osteoarthritic hip. Br J Surg. 1958;45(193):488–97.CrossRefPubMedGoogle Scholar
  39. 39.
    Reed-Hill R. Physical metallury principles. 2nd ed. New York: Van Nostrand; 1973.Google Scholar
  40. 40.
    Kuhn AT. Corrosion of co-Cr alloys in aqueous environments. Biomaterials. 1981;2(2):68–77.CrossRefPubMedGoogle Scholar
  41. 41.
    Fenske G. Ion implantation, in ASM handbook: friction, lubrication and wear technology, vol. 1992. Metals Park, OH: ASM International. p. 850.Google Scholar
  42. 42.
    Bunshah R. PVD and CVD coatings, in ASM handbook: friction, lubrication and wear technology, vol. 1992. Metals Park, OH: ASM International. p. 840.Google Scholar
  43. 43.
    Streicher RM, et al. New surface modification for Ti-6Al-7Nb alloy: oxygen diffusion hardening (ODH). Biomaterials. 1991;12(2):125–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Jones DM, et al. Focal osteolysis at the junctions of a modular stainless-steel femoral intramedullary nail. J Bone Joint Surg Am. 2001;83A(4):537–48.CrossRefGoogle Scholar
  45. 45.
    Urban RM, et al. Migration of corrosion products from modular hip prostheses. Particle microanalysis and histopathological findings. J Bone Joint Surg Am. 1994;76(9):1345–59.CrossRefPubMedGoogle Scholar
  46. 46.
    Jacobs JJ, et al. Local and distant products from modularity. Clin Orthop Relat Res. 1995;(319):94–105.Google Scholar
  47. 47.
    Gilbert J. Mechanically assisted corrosion of biomedical alloys. In: American Society for Materials Handbook, Corrosion 2006. Materials Park, OH: ASM International. p. 826–36.Google Scholar
  48. 48.
    Gilbert JL, et al. In vivo oxide-induced stress corrosion cracking of Ti-6Al-4V in a neck-stem modular taper: emergent behavior in a new mechanism of in vivo corrosion. J Biomed Mater Res B Appl Biomater. 2012;100((2):584–94.CrossRefGoogle Scholar
  49. 49.
    ASTM Annual Book of Standards. vol. 13. Philadelphia, PA: American Society for Testing and Materials; 1995.Google Scholar
  50. 50.
    Kwon YM, et al. Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours. J Bone Joint Surg Br. 2010;92(3):356–61.CrossRefPubMedGoogle Scholar
  51. 51.
    Masonis JL, et al. Zirconia femoral head fractures: a clinical and retrieval analysis. J Arthroplasty. 2004;19(7):898–905.CrossRefPubMedGoogle Scholar
  52. 52.
    Huot JC, et al. The effect of radiation dose on the tensile and impact toughness of highly cross-linked and remelted ultrahigh-molecular weight polyethylenes. J Biomed Mater Res B Appl Biomater. 2011;97((2):327–33.CrossRefGoogle Scholar
  53. 53.
    Atwood SA, et al. Tradeoffs amongst fatigue, wear, and oxidation resistance of cross-linked ultra-high molecular weight polyethylene. J Mech Behav Biomed Mater. 2011;4(7):1033–45.CrossRefPubMedGoogle Scholar
  54. 54.
    Hannouche D, et al. Ceramics in total hip replacement. Clin Orthop Relat Res. 2005;(430):62–71.Google Scholar
  55. 55.
    Jeffers JR, Walter WL. Ceramic-on-ceramic bearings in hip arthroplasty: state of the art and the future. J Bone Joint Surg Br. 2012;94(6):735–45.CrossRefPubMedGoogle Scholar
  56. 56.
    Hamadouche M, et al. Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study. J Bone Joint Surg Am. 2002;84-A(1):69–77.CrossRefPubMedGoogle Scholar
  57. 57.
    Wroblewski BM, et al. Prospective clinical and joint simulator studies of a new total hip arthroplasty using alumina ceramic heads and cross-linked polyethylene cups. J Bone Joint Surg Br. 1996;78(2):280–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Wroblewski BM, Siney PD, Fleming PA. Low-friction arthroplasty of the hip using alumina ceramic and cross-linked polyethylene. A ten-year follow-up report. J Bone Joint Surg Br. 1999;81(1):54–5.CrossRefPubMedGoogle Scholar
  59. 59.
    Wroblewski BM, Siney PD, Fleming PA. Low-friction arthroplasty of the hip using alumina ceramic and cross-linked polyethylene. A 17-year follow-up report. J Bone Joint Surg Br. 2005;87(9):1220–1.CrossRefPubMedGoogle Scholar
  60. 60.
    Allain J, et al. Poor eight-year survival of cemented zirconia-polyethylene total hip replacements. J Bone Joint Surg Br. 1999;81(5):835–42.CrossRefPubMedGoogle Scholar
  61. 61.
    De Aza AH, et al. Crack growth resistance of alumina, zirconia and zirconia toughened alumina ceramics for joint prostheses. Biomaterials. 2002;23(3):937–45.CrossRefPubMedGoogle Scholar
  62. 62.
    Chevalier J. What future for zirconia as a biomaterial? Biomaterials. 2006;27(4):535–43.CrossRefPubMedGoogle Scholar
  63. 63.
    Tribe H, et al. Advanced wear of an Oxinium™ femoral head implant following polyethylene liner dislocation. Ann R Coll Surg Engl. 2013;95(8):e133–5.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Hernigou P, Mathieu G, Poignard A. Oxinium, a new alternative femoral bearing surface option for hip replacement. Eur J Orthop Surg Traumatol. 2007;17(3):243–6.CrossRefGoogle Scholar
  65. 65.
    Kop AM, Whitewood C, Johnston DJ. Damage of oxinium femoral heads subsequent to hip arthroplasty dislocation three retrieval case studies. J Arthroplasty. 2007;22(5):775–9.CrossRefPubMedGoogle Scholar
  66. 66.
    Walter WL, et al. Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear. J Arthroplasty. 2004;19(4):402–13.CrossRefPubMedGoogle Scholar
  67. 67.
    Jarrett CA, et al. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91(6):1344–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Mai K, et al. Incidence of ‘squeaking’ after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. 2010;468(2):413–7.CrossRefPubMedGoogle Scholar
  69. 69.
    Swanson TV, et al. Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplast. 2010;25(6 Suppl):36–42.CrossRefGoogle Scholar
  70. 70.
    Kiyama T, Kinsey TL, Mahoney OM. Can squeaking with ceramic-on-ceramic hip articulations in total hip arthroplasty be avoided? J Arthroplast. 2013;28(6):1015–20.CrossRefGoogle Scholar
  71. 71.
    Restrepo C, et al. The noisy ceramic hip: is component malpositioning the cause? J Arthroplast. 2008;23(5):643–9.CrossRefGoogle Scholar
  72. 72.
    Stanat SJ, Capozzi JD. Squeaking in third- and fourth-generation ceramic-on-ceramic total hip arthroplasty: meta-analysis and systematic review. J Arthroplasty. 2012;27(3):445–53.CrossRefPubMedGoogle Scholar
  73. 73.
    Currier SF, Mautner HG. On the mechanism of action of choline acetyltransferase. Proc Natl Acad Sci U S A. 1974;71(9):3355–8.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Chevillotte C, et al. The 2009 frank Stinchfield award: “hip squeaking”: a biomechanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res. 2010;468(2):345–50.CrossRefPubMedGoogle Scholar
  75. 75.
    Chevillotte C, et al. Hip squeaking: a 10-year follow-up study. J Arthroplast. 2012;27(6):1008–13.CrossRefGoogle Scholar
  76. 76.
    Kurtz SM, et al. Do ceramic femoral heads reduce taper fretting corrosion in hip arthroplasty? A retrieval study. Clin Orthop Relat Res. 2013;471(10):3270–82.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Gill IP, et al. Corrosion at the neck-stem junction as a cause of metal ion release and pseudotumour formation. J Bone Joint Surg Br. 2012;94(7):895–900.CrossRefPubMedGoogle Scholar
  78. 78.
    Chana R, et al. Mixing and matching causing taper wear: corrosion associated with pseudotumour formation. J Bone Joint Surg Br. 2012;94(2):281–6.CrossRefPubMedGoogle Scholar
  79. 79.
    Hallab NJ, et al. Differences in the fretting corrosion of metal-metal and ceramic-metal modular junctions of total hip replacements. J Orthop Res. 2004;22(2):250–9.CrossRefPubMedGoogle Scholar
  80. 80.
    Urish KL, et al. Trunnion failure of the recalled low friction ion treatment cobalt chromium alloy femoral head. J Arthroplast. 2017;32(9):2857–63.CrossRefGoogle Scholar
  81. 81.
    Patel S, Talmo CT, Nandi S. Head-neck taper corrosion following total hip arthroplasty with Stryker meridian stem. Hip Int. 2016;26(6):e49–51.CrossRefPubMedGoogle Scholar
  82. 82.
    Gührs J, et al. The influence of stem taper re-use upon the failure load of ceramic heads. Med Eng Phys. 2015;37(6):545–52.CrossRefPubMedGoogle Scholar
  83. 83.
    MacDonald DW, et al. Fretting and corrosion damage in taper adapter sleeves for ceramic heads: a retrieval study. J Arthroplast. 2017;32(9):2887–91.CrossRefGoogle Scholar
  84. 84.
    Esposito CI, et al. What is the trouble with trunnions? Clin Orthop Relat Res. 2014;472(12):3652–8.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Jack CM, et al. The use of ceramic-on-ceramic bearings in isolated revision of the acetabular component. Bone Joint J. 2013;95-B(3):333–8.CrossRefPubMedGoogle Scholar
  86. 86.
    Thorey F, et al. Early results of revision hip arthroplasty using a ceramic revision ball head. Semin Arthroplast. 2011;22:284–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopedicsWest Virginia University School of MedicineMorgantownUSA

Personalised recommendations