The effect of anterior-posterior shear load on the wear of ProDisc-L TDR.

The current wear-testing standard (ISO18192-1) for total disc replacement (TDR) requires only four degrees of freedom (DOF) inputs: axial load, flexion-extension, lateral bending and axial rotation. The study aim was to assess the effect of an additional DOF, anterior-posterior (AP) shear on the wear of the ProDisc-L TDR. A 5DOF simulator was used to test ProDisc-L implants under 4DOF and 5DOF conditions. The 4DOF conditions were defined by ISO18192-1 whilst the 5DOF used ISO18192-1 conditions with the addition of an AP load of +175 and -140 N (anterior and posterior, respectively), extrapolated from in vivo data. The implants were mounted such that the polyethylene insert could be removed for gravimetric measurements. Tests were run using bovine serum (15 g/l protein concentration) as a lubricant for five million cycles (MC), with measurements repeated every 1 MC. The mean wear rate in the 4DOF test was 12.7 +/- 2.1 mg/MC compared to 11.6 +/- 1.2 mg/MC in the 5DOF test. There were marked differences in the wear scars between 4DOF and 5DOF simulations. With 4DOF, wear scars were centralised on the dome of the insert, whilst 5DOF scars were larger, breaching the anterior rim of the dome causing deformation at the edge. The 4DOF wear test showed similar gravimetric wear rates to previously published ISO-tested TDRs. The addition of AP load was found to have no significant effect on the overall wear rate. However, there were pronounced differences in the respective wear scars, which highlights the need for more research in order to understand the factors that influence wear of TDR.

The accuracy and precision of a micro computer tomography volumetric measurement technique for the analysis of in-vitro tested total disc replacements.

Total disc replacements (TDRs) in the spine have been clinically successful in the short term, but there are concerns over long-term failure due to wear, as seen in other joint replacements. Simulators have been used to investigate the wear of TDRs, but only gravimetric measurements have been used to assess material loss. Micro computer tomography (microCT) has been used for volumetric measurement of explanted components but has yet to be used for in-vitro studies with the wear typically less than < 20 mm3 per 10(6) cycles. The aim of this study was to compare microCT volume measurements with gravimetric measurements and to assess whether microCT can quantify wear volumes of in-vitro tested TDRs. microCT measurements of TDR polyethylene cores were undertaken and the results compared with gravimetric assessments. The effects of repositioning, integration time, and scan resolution were investigated. The best volume measurement resolution was found to be +/- 3 mm3, at least three orders of magnitude greater than those determined for gravimetric measurements. In conclusion, the microCT measurement technique is suitable for quantifying in-vitro TDR polyethylene wear volumes and can provide qualitative data (e.g. wear location), and also further quantitative data (e.g. height loss), assisting comparisons with in-vivo and ex-vivo data. It is best used alongside gravimetric measurements to maintain the high level of precision that these measurements provide.