Replacement surgery of hip joint consists of the substitution of the joint with an implant able to recreate the articulation functionality. This article aims to review the current state of the art of the biomaterials used for hip implants. Hip implants can be realized with different combination of materials, such as metals, ceramics and polymers. In this review, we analyze, from international literature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e., being biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a low wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We analyzed the scientific literature, collecting information on the material behavior and the human-body response to it. Particular attention has been given to the tribological behavior of the biomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After more than 50 years of evolution, in term of designs and materials, the actual wear rate of the most common implants is low, allowing us to sensibly reduce the risk related to the widespread debris distribution in the human body.
The hip joint replacement is one of the most successful orthopedic surgical procedures although it involves challenges to overcome. The patient group undergoing total hip arthroplasty now includes younger and more active patients who require a broad range of motion and a longer service lifetime for the replacement joint. It is well known that wear tests have a long duration and they are very expensive, thus studying the effects of geometry, loading, or alignment perturbations may be performed by Finite Element Analysis. The aim of the study was to evaluate total deformation and stress intensity on ultra-high molecular weight polyethylene liner coupled with hard material head during one step. Moving toward in-silico wear assessment of implants, in the presented simulations we used a musculoskeletal multibody model of a human body giving the loading and relative kinematic of the investigated tribo-system during the gait. The analysis compared two frictional conditions -dry and wet and two geometrical cases- with and without radial clearance. The loads and rotations followed the variability of the gait cycle as well as stress/strain acting in the UHWMPE cup. The obtained results allowed collection of the complete stress/strain description of the polyethylene cup during the gait and calculation of the maximum contact pressure on the lateral edge of the insert. The tensional state resulted in being more influenced by the geometrical conditions in terms of radial clearance than by the variation of the friction coefficients due to lubrication phenomena.
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