Current implant designs and materials provide a high grade of quality and safety, but aseptic implant loosening is still the main reason for total hip revision. Highly cross-linked polyethylene (HX-PE) is used successfully in total hip replacements (THR) since several years. The good wear properties lead to a reduction of wear debris and may contribute to a longer survival time of the THRs. Furthermore, thin HX-PE liner allows the use of larger femoral heads associated with a decreased risk of dislocation and an improved range of motion. However, the cross-linking process is associated with a loss of mechanical properties of the polyethylene material which compromise the use of thin HX-PE liner in terms of high stress situations.

The aim of the present study was the experimental wear analysis of HX-PE liner under steep acetabular cup position. Furthermore, a finite element analysis (FEA) was performed in order to calculate the stress within the HX-PE material in case of steep cup position under physiological loading.

Experimental wear testing was performed for 5 Mio load cycles, using highly cross-linked polyethylene (HX-PE) acetabular liner combined with 44 mm ceramic femoral heads at a standard position of the acetabular cup (30° inclination) according to ISO 14242 as well as at 60° cup inclination. The wall thickness of the HX-PE liner was 3.8 mm. A hip wear simulator, according to ISO 14242 (EndoLab GmbH, Rosenheim, Germany), was used and wear was determined gravimetrically. Moreover, finite element models of the THR system at standard and steep cup position was created by Abaqus/CAE (Dessault Systemes Providence, USA). Using the finite element software Abaqus (Dessault Systemes Providence, USA) the total hip implants were physiologically loaded with maximum force of the gait cycle (3.0 kN). Thereby, the stresses within the HX-PE material were analysed.

The average gravimetrical wear rates of the HX-PE liners at standard implant position (30°) and 60° cup inclination showed small wear amounts of 3.15 ± 0.32 mg and 1.92 ± 1.00 mg per million cycles, respectively. The FEA revealed a clear increase of stresses at the HX-PE liner with respect to steep cup position (von Mises stress of 8.78 MPa) compared to ISO standard implant position (von Mises stress of 5.70 MPa).

The wear simulator tests could not demonstrate significant differences of gravimetrical wear amount of HX-PE liners under steep hip cup position compared to standard implant position. The small contact surface between the femoral head and the SX-PE liner during the wear testing may lead to the low wear rate of the misaligned acetabluar cup. Moreover, the FEA showed that the effect of a misaligned acetabular cup on the stresses within the polyethylene liner can be critical. Although an increase of wear could not be detected a steeper acetabular cup position using thin HX-PE liners should be avoided due to higher stresses preventing implant failure in clinical application.

Introduction:

The higher resisting torque against dislocation and the large range of motion due to the enlarged effective head diameter substantiate the use of eccentric dual-mobility cups in case of total hip joint instability [1,2]. As a result of force-dependent self-centering mechanism, an increased movement of the intermediate-component can be expected whose effect on wear propagation is unknown so far. Currently available hip joint simulators are only able to vary the load by the absolute value and not by the direction of resulting force. Therefore, the uniaxial force transmission may lead to a unique and stable alignment of the intermediate-component during testing. The purpose of this numerical study was to evaluate relative movements of the intermediate-component during daily life activities with respect to wear propagation.

At present, wear investigations of total hip replacement (THR) are performed in accordance with the ISO standard 14242, which is based on empirically determined relative motion data and exclusively describes the gait cycle. However, besides continuous walking, a number of additional activities characterize the movement sequences in everyday life and influence the wear rates as well as the size and shape of wear debris. Disagreements of in vitro and in vivo wear mechanisms seemed to be a result of differences between in vitro and in vivo kinematics and dynamics. This requires an optimization of the current test procedures and parameters. Hence, the aim of the present study was to evaluate most frequent activities of daily living, based on available in vivo data, in order to generate parameter sets according to loading and rotational movements close to the physiological situation.

For the generation of angular patterns, time-dependent three-dimensional trajectories of reference points were used from the HIP98 database of Bergmann. The data set was evaluated and interpolated using analytical techniques to simulate consecutive smooth motion cycles in hip wear simulators or further test devices. The calculated relative joint movement was expressed by an ordered set of three elementary rotations and was complemented with three force components of the joint contact force to generate kinematically and dynamically consistent parameter sets. The obtained sets included the activities walking, knee bending, stair climbing and a combined load case of sitting down and standing up for an averaged patient.

Generated slide tracks, created by the use of the angular patterns, demonstrated differences according to the kinematics between selected daily life activities and those established for the ISO standard 14242. In particular, for the relative flexion-extension rotational movement, routine activities showed significant higher ranges of motion. Additionally, the depicted force pattern underlined that the prevailing force component varied considerably between different activities.

These deviations in range of motion and joint forces could be attributed to disagreements between in vitro and in vivo results of THR wear testing. The Integration of frequent activities of daily living in the in vivo test protocol could be realized by means of the sequential arrangement of the four investigated activities.