'University of Pretoria - Department of Philosophy'
Abstract
Owing to the crippling nature of arthritis, surgeons have been trying for well over a century to successfully treat this debilitating disease particularly when attacking the hip joint. In the early 1970s, Sir John Charnley started with total hip replacement as a solution to this ever-increasing problem. Many different designs were developed but all the designs revolved around a femoral stem, femoral head and acetabular component. Independent of the design, longevity of the implant remains a problem. The major cause of replacements, according to various hip registers, is due to aseptic loosening resulting from osteolysis. According to these registers, the average in-vivo life of a hip replacement is approximately 12 years. The main aim of this study was to determine the root cause of mechanical failure of the acetabular cups and to determine the origin of the excessive amount of ultra-high molecular weight polyethylene (UHMWPE) wear debris floating in the joint resulting in osteolysis. During the study, various techniques were used to investigate the acetabular components to try to establish the root cause of mechanical failure. These techniques included: 1. Visual inspection 2. Investigation making use of dye penetrant spray 3. Investigation under stereo microscope 4. Investigation making use of a scanning electron microscope 5. Electrophoresis 6. Mass-spectrometric analysis 7. Analysis of the synovial fluid on high-frequency linear-oscillation machine (SRV). The wear debris retrieved from the scar tissue surrounding the joints of a number of patients was also analysed. Apart from the obvious defects such as mechanical damage due to impingement, the main defect on which this study focuses is the wear patches found on the inside of the acetabular components. The wear areas were presented as areas where the surface layer of the UHMWPE was ripped off by adhering to the rotating femoral head. This type of failure is possible if localised overheating takes place resulting in the material either adhering to the rotating femoral head or the material being squeezed out under the prevailing pressure. Both these mechanisms were confirmed by the wear debris retrieved from the scar tissue, being either droplets of UHMWPE or whisker-like wear products. To confirm the existence of elevated temperatures the brown discolouring on the inside of the acetabular cups was analysed, making use of electrophoresis, mass-spectrometric analysis and scanning electron microscope recordings. In this part of the study, it was confirmed that localised temperatures on the bearing surface had reached at least 60°C during in-vivo service. This temperature was confirmed by inserting a thermocouple just under the surface of an acetabular cup and then measuring the temperature while in-vitro testing was taking place on a hip simulator. The wear debris as retrieved was also duplicated in laboratory experiments while the temperature on the surface of an acetabular cup was monitored. It was established that wear particles similar in shape and size were formed at temperatures in excess of 90°C. At temperatures above 50°C the UHMWPE had visually shown extensive increase in creep, indicating that at these temperatures the material softens sufficiently for this type of debris to be generated The overheating as described can also only occur if there is a lack of lubrication in the bearing couple. The synovial fluid from 12 patients was retrieved during revision surgery. This synovial fluid was then tested on a high-frequency linear-oscillation machine (Optimol SRV test machine) to determine the lubricity characteristics of the synovial fluid as retrieved. It was discovered that the load-carrying capability of the synovial fluid did not comply with the minimum requirements for a fluid to function as a lubricant. The final conclusion of this study is that excessive amounts of wear debris are generated due to the localised overheating of the bearing couple as a result of insufficient lubrication. The localised heat build-up results in excessive amounts of wear debris being generated and deposited in the joint area resulting in osteolysis.Thesis (PhD (Mechanical Engineering))--University of Pretoria, 2005.Mechanical and Aeronautical Engineeringunrestricte
