Polymer-on-metal or metal-on-polymer total disc arthroplasty: does it make a difference?

STUDY DESIGN: Mechanical testing of total disc arthroplasty (TDA). OBJECTIVE: To compare the friction between a polymer socket-on-metal ball and metal socket-on-polymer ball TDA. SUMMARY OF BACKGROUND DATA: A degenerate intervertebral disc can be replaced by TDA. The most common designs have a ball and socket articulation; the contact between the surfaces leads to friction. Friction needs to be minimized to prevent loosening and wear. One of the common material combinations in disc arthroplasty devices is the articulation of a metal socket on polymer ball. However, the combination of a polymer socket on metal ball (which is used in hip arthroplasty) has not been investigated for TDA. METHODS: TDA models with either a polymer socket/metal ball or a metal socket/polymer ball were manufactured with ball radii of 10 and 14 mm, each with a radial clearance of 0.35 mm. Samples were tested using a spine simulator with a lubricant of diluted newborn calf serum. Each sample was subjected to an axial load of 1200 N; motions of flexion-extension, lateral bending, and axial rotation were then applied at frequencies of 0.25 to 2 Hz. Frictional torque was measured to compare the performance of the TDAs. RESULTS: The frictional torque was found to be significantly higher for a disc with a metal socket/polymer ball than for a disc with a polymer socket/metal ball for both 10 and 14 mm radii in axial rotation, lateral bend, and extension. The frictional torque in flexion (0°-6°) was not found to be significantly different between the 2 different material combinations. However, when the flexion motion was reduced to 0° to 2°, frictional torque in the metal socket/polymer ball was found to be significantly higher than the polymer socket/metal ball. CONCLUSION: TDA with a combination of a polymer socket/metal ball has lower friction than the conventional TDA with metal socket/polymer ball. This conclusion has implications in the design of TDA.

Effect of axial load on the flexural properties of an elastomeric total disc replacement.

STUDY DESIGN: Twelve Cadisc-L devices were subjected to flexion (0°-6°) and extension (0° to -3°) motions at compressive loads between 500 N and 2000 N at a flexural rate between 0.25°/s and 3.0°/s. OBJECTIVE: To quantify the change in flexural properties of the Cadisc-L (elastomeric device), when subjected to increasing magnitudes of axial load and at different flexural rates. SUMMARY OF BACKGROUND DATA: The design of motion preservation devices, used to replace degenerated intervertebral discs, is commonly based on a low-friction, ball-and-socket-articulating joint. Recently, elastomeric implants have been developed that attempt to provide mechanical and motion properties that resemble those of the natural disc more closely. METHODS: Twelve Cadisc-L devices (MC-10 mm-9° and MC-10 mm-12° size) were supplied by Ranier Technology Ltd (Cambridge, United Kingdom). The devices were hydrated and tested using a Bose spinal disc-testing machine (Bose Corporation, ElectroForce Systems Group, Eden Prairie, MN) in Ringer's solution at 37°C. A static load of 500 N was applied to a device and it was then subjected to motions of 0° to 6° to 0° (flexion) and 0° to -3° to 0° (extension) at a flexural rate of 0.25°/s, 0.5°/s, 1.0°/s, 1.5°/s, 2.0°/s, and 3.0°/s. Tests were repeated at 1000 N, 1500 N, and 2000 N. RESULTS: Regression analyses showed a significant (R > 0.99, P < 0.05) linear increase in bending moment and flexural stiffness with flexion and extension angles (at 1000 N and higher loads)-a significant (R > 0.994, P < 0.05) linear decrease in flexural stiffness in flexion and extension as flexural rate increased. CONCLUSION: The bending moment of the Cadisc-L increased linearly with flexion and extension angles at 1000 N and higher loads. Flexural stiffness increased with compressive load but decreased with flexural rate.