Accelerated wear protocols for understanding clinical wear in modern hip prostheses
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Success of total hip replacements is well reported however, failures as a result of wear processes and the biological response to these products continue to challenge the orthopaedic community. Lately, corrosion of metal surfaces as well as wear particles have seen particular interest with elevated blood cobalt levels widely reported in patients receiving metal-on-metal (MoM) hip replacements. Some instances have also reported this in patients with metal-on-polyethylene (MoP) components and these corrosion products are believed to contribute to hypersensitivity reactions reported. This thesis considers wear and cobalt release in MoP and MoM hip bearings tested under standard and challenging hip simulator conditions and includes an exploration of novel bearing coatings to reduce cobalt release. The incorporation of silver into these coatings may be sufficient to produce an antibacterial response, reducing the risk of mid-term infections, another reported cause of failure. Polyethylene wear was low under standard and clinically relevant adverse conditions in 28mm and 52 mm diameter MoP bearings (less than 35 mm3/mc). Cobalt release was measurable in 28 mm diameter MoP bearings (51 ppb/mc) with higher levels produced in large 52 mm diameters (123 ppb/mc), the first time this has been reported, although cobalt release was substantially less than that observed in MoM bearings (6909 ppb/mc). Alumina abrasives introduced in the lubricant substantially damaged MoP bearings, increasing the cobalt release to 70,690 ppb after 1 mc, greater than found after edge loaded MoM bearings (19,240 ppb). The removal of these particles still produced elevated cobalt levels compared to standard conditions and increased polyethylene wear to 435 mm3/mc. A chromium nitride (CrN) coating in MoP bearings was resistant to this abrasive damage showing no delamination in the coating, with negligible cobalt released after 7.04 mc (153 ppb) and maintained a polyethylene wear rate below 20 mm3/mc. Silver CrN coatings on both bearing surfaces of MoM components prevented cobalt release under standard conditions, with silver release after 0.17 mc up to 3,720 ppb in high silver surface coatings, although the wear was relatively high (5.24 mm3/mc). A silver CrN coating with a low concentration of silver at the surface reduced wear and was resistant to 5 mc of edge loading. It generated 241 ppb of cobalt and maintained comparable steady state wear rates (0.65 mm3/mc) to the uncoated metal while releasing 18,786 ppb silver which may be sufficient to be an effective anti-microbial agent. These coatings may provide potential clinical benefits in MoP and MoM bearings by reducing both wear and cobalt release in ideal and adverse conditions. There may also be beneficial wear products in the form of silver, although further testing of optimised coatings is required.
AuthorsDe Villiers, Danielle
- Theses