The influence of stem design on critical squeaking friction with ceramic bearings.

Ceramic-on-ceramic hip joints have been reported to squeak, a phenomenon that may occur in compromised lubrication conditions. One factor related to the incidence of in vivo squeaking is the stem design. However, it has not yet been possible to relate stem design to squeaking in deteriorating lubrication conditions. The purpose of this study was to determine critical friction factors for different stem designs. A hip simulator was used to measure the friction factor of a ceramic bearing with different stem designs and gradually deteriorating lubrication represented by evaporation of a volatile fluid lubricant. The critical squeaking friction factor was measured at the onset of squeaking for each stem. Critical friction was higher for the long cobalt chrome (0.32 ± 0.02) and short titanium stems (0.39 ± 0.02) in comparison with a long titanium stem (0.29 ± 0.02). The onset of squeaking occurred at a friction factor lower than that measured for dry conditions, in which squeaking is usually investigated experimentally. The results suggest that shorter or heavier stems might limit the possibility of squeaking as lubrication deteriorates. The method developed can be used to investigate the influence of design parameters on squeaking probability.

Vibration transfer in the ball-stem contact interface of artificial hips.

Audible squeaking has put the reputation of ceramic bearings for total hip replacements into question. Inter-articular friction induces vibrations in the ceramic head which are transferred through the head-taper interface to the femoral stem. If excited to sufficient amplitudes, squeaking can be emitted by the stem. Hence, the damping and amplification properties of this interface have a crucial influence on stem vibrations. The aim of this study was to determine the vibration transfer behavior between the head and the taper of a femoral stem and its dependence on the assembly force, in order to assess its influence on the development of audible squeaking. A ceramic head was assembled on a titanium femoral stem taper with high and low forces. Frequency response functions characterizing the head-stem interface were determined experimentally. The interface demonstrated negligible influence on vibration transfer in the squeaking frequency range (1-5 kHz). However its damping effect in lower and higher frequency ranges was significant and some areas of amplification were also found. Although squeaking vibration was not influenced by the particular interface studied, the method established can be utilized to trace taper designs with dynamic properties that decrease the susceptibility to squeaking.

High friction moments in large hard-on-hard hip replacement bearings in conditions of poor lubrication.

Disappointing clinical results for large diameter metal replacement bearings for the hip are related to compromised lubrication due to poor cup placement, which increases wear as well as friction moments. The latter can cause overload of the implant-bone interfaces and the taper junction between head and stem. We investigated the influence of lubrication conditions on friction moments in modern hip bearings. Friction moments for large diameter metal and ceramic bearings were measured in a hip simulator with cup angles varying from 0° to 60°. Two diameters were tested for each bearing material, and measurements were made in serum and in dry conditions, representing severely compromised lubrication. Moments were lower for the ceramic bearings than for the metal bearings in lubricated conditions, but approached those for metal bearings at high cup inclination. In dry conditions, friction moments increased twofold to 12 Nm for metal bearings. For ceramic bearings, the increase was more than fivefold to over 25 Nm. Although large diameter ceramic bearings demonstrate an improvement in friction characteristics in the lubricated condition, they could potentially replicate problems currently experienced due to high friction moments in metal bearings once lubrication is compromised.

Friction-induced whirl vibration: root cause of squeaking in total hip arthroplasty.

Squeaking is reported for ceramic-on-ceramic hip arthroplasty, and risk factors leading to this phenomenon have been investigated empirically in the past, this way giving hints to when this phenomenon occurs. The aim of this study is to present an experimentally validated explanation for the dynamical mechanism underlying the squeak, i.e. a description of what happens when noise is generated. First the kinematics of the ceramic bearing couple in relative motion are reconsidered. The relative motion at the contact zone can be understood as superposition of relative rotation and translation. The relative weight of both components depends substantially on the instantaneous load vector, which primarily determines the position of the contact area, and the instantaneous relative rotation vector. For the investigated gait scenarios, both load vector and rotation axis vary strongly during the gait cycle. Second, experimental vibration analysis during squeak is performed. A pronounced micrometer scale elliptical motion of the ball inside the liner is found. It is shown that the rotational component of the relative kinematics during gait indeed leads to friction induced vibrations. We show that a generic whirl type friction induced flutter instability, also known from similar (non bio-) mechanical systems, is the root cause of the emitted squeaking noise. Based on the identified mechanism, the role of THA system parameters (materials, design), patient risk factors, as well as the role of the gait cycle, will have to be reconsidered and linked in the future to develop effective measures against squeaking.

Primary implant stability after maxillary sinus augmentation with autogenous mesenchymal stem cells: a biomechanical evaluation in rabbits.

OBJECTIVES: To mechanically evaluate the effect of transplantation of precultured preosteoblasts derived from autogenic adult mesenchymal stem cells (aMSC) for experimental sinus floor augmentation on primary dental implant stability in comparison with conventional augmentation procedures in rabbits. MATERIAL AND METHODS: After experimental sinus floor augmentation with a synthetic bone substitute, autogenous bone transplantation or osteoblast precursor cells, the primary stability of implants inserted in the edentulous part of the upper jaw of New Zealand White Rabbits was examined. Mechanical evaluation was performed by determination of insertion torque values (Osseocare(™) ), percussion testing (Periotest(™) ), resonance frequency analysis (Osstell(™) and scanning laser Doppler vibrometer) and measurement of extraction forces. RESULTS: Evaluation of mechanical properties with percussion testing and resonance frequency analysis with Osstell(™) revealed slightly higher primary stability of the stem cell group whereas the scanning laser Doppler vibrometer and measurement of pull-out forces showed no significant difference to the bone substitute group. Transplantation of autogenous bone graft resulted in the highest primary implant stability. CONCLUSIONS: The three examination modalities proved suitable for the determination of primary implant stability. The experimental maxillary sinus floor augmentation with precultured osteoblast precursor cells from autogenic stems cells clearly enhanced the primary stability of implants compared with the unaugmented sinus and lead to comparable primary mechanical properties to bone substitutes in rabbits. In comparison with the autogenous bone graft stability enhancement by stem cell transplantation declined.

The influence of component design, bearing clearance and axial load on the squeaking characteristics of ceramic hip articulations.

Squeaking of hip replacements with ceramic-on-ceramic bearings has put the use of this material into question despite its superior wear behavior. Squeaking has been related to implant design. The purpose of this study was to determine the influence of particular acetabular cup and femoral stem designs on the incidence of squeaking and its characteristics. The dynamic behavior of the stem, head and stem assembled with head was investigated by determining their eigenfrequencies using experimental and numerical modal analysis. Four different stem and three different cup designs were investigated. Operational system vibrations resulting in audible squeaking were reproduced in a hip simulator and related to the respective component eigenfrequencies. The applied joint load and bearing clearance were varied in the clinically relevant range. Stems with lower eigenfrequencies were related to lower squeaking frequencies and increased acoustic pressure (loudness), and therefore to a higher susceptibility to squeaking. Higher load increased the squeaking frequency, while the acoustic pressure remained unchanged. No influence of the clearance or the cup design was found. Stem design was found to have an important influence on squeaking characteristics and its incidence, confirming and explaining similar clinical observations. Cup design itself was found to have no major influence on the dynamic behavior of the system but plays an important indirect role in influencing the magnitude of friction: Squeaking only occurs if the friction in the joint articulation is sufficient to excite vibrations to audible magnitudes. If friction is low, no squeaking occurs with any of the designs investigated.

Deformation characteristics and eigenfrequencies of press-fit acetabular cups.

BACKGROUND: elastic deformation of press-fitted acetabular cups during implantation provides primary stability. Excessive deformation can lead to chipping or improper seating of ceramic inlays and is dictated by cup stiffness, which also affects its vibrational characteristics. Purpose was to investigate the influence of cup design on deformation during press-fitting and on vibration properties. METHODS: deformation of ten acetabular cups (with and without ceramic inlay) was tested for radial loads clinically occurring during press-fitting (0-2000N). Eigenfrequencies were measured using experimental modal analysis and related to mass and stiffness. FINDINGS: the first eigenfrequency of the shells varied greatly (4-9kHz); insertion of inlays caused an increase (16-33 kHz). The range of shell stiffness was high (2.7-48.4kN/mm), increasing due to inlay insertion (124.7-376.2kN/mm). Stiffness and mass were sufficient predictors for eigenfrequencies (p<0.001,R²=0.94). INTERPRETATION: the cups investigated represent a large stiffness range. Lower cup stiffness can increase primary stability but jeopardize inlay seating, and a suitable balance must be achieved by the designer. Eigenfrequencies also decrease with decreasing stiffness but were all found to lie considerably above clinically observed squeaking frequencies, indicating that these cup designs play no predominant role in the squeaking phenomenon. The observed relation between eigenfrequencies and the quotient of stiffness and mass might be used in the development of new thin walled cup designs so that their contribution to system vibrations is prevented. Presently, surgeons should be aware of the deformation characteristics of cups in order to select a suitable press-fit magnitude.

Squeak in hip endoprosthesis systems: An experimental study and a numerical technique to analyze design variants.

Hip endoprosthesis systems are analyzed with respect to their susceptibility to self-excited vibrations and sound or noise generation. Experimental studies reveal that certain configurations can become unstable causing exponentially growing regular high-frequency oscillations that asymptotically approach a limit-cycle with considerable amplitude. Ultimately the vibrations do also lead to the emission of sound that is perceived as squeaking or squeal. To identify dominant influence factors and critical parameters, stability analyses were conducted on the basis of finite-element modeling. The resulting numerical approach, based on the determination of complex eigenvalues and eigenvectors, is shown to be an effective tool to analyze and show differences between endoprosthesis designs with respect to their susceptibility to develop squeaking phenomenons.