Surgical cup placement affects the heating up of total joint hip replacements

Abstract

The long-term success of highly effective total hip arthroplasty (THA) is mainly restricted by aseptic loosening, which is widely associated with friction between the head and cup liner. However, knowledge of the in vivo joint friction and resulting temperature increase is limited. Employing a novel combination of in vivo and in silico technologies, we analyzed the hypothesis that the intraoperatively defined implant orientation defines the individual joint roofing, friction and its associated temperature increase. A total of 38,000 in vivo activity trials from a special group of 10 subjects with instrumented THA implants with an identical material combination were analyzed and showed a significant link between implant orientation, joint kinematics, joint roofing and friction-induced temperature increase but surprisingly not with acting joint contact force magnitude. This combined in vivo and in silico analysis revealed that cup placement in relation to the stem is key to the in vivo joint friction and heating-up of THA. Thus, intraoperative placement, and not only articulating materials, should be the focus of further improvements, especially for young and more active patients.

A review of advances in tribology in 2020–2021

“…In addition to these in vitro laboratory and in silico modelling studies, instrumented prostheses with various sensors were developed [672]. For example, such a technique allowed the measurement of in-vivo friction and temperature rise, showing the effect of the surgical cup placement on the heating up of total joint hip replacements [673]. Other in vivo methods were also applied, including using acoustic emission for the early detection of the failure modes in hip implants [674].…”

Is in vivo sensing in a total hip replacement a possibility? A review on past systems and future challenges

“…The justification being that the plastic encapsulation of electronics should only be used for non-permanent implants [28]. To date no study has been reported from this prosthesis however, Bergmann et al [28] and Damn et al [36] state that a clinical study on temperature rise in hip implants was planned in 100 patients.…”

Analysis of contact pressure in a 3D model of dual-mobility hip joint prosthesis under a gait cycle

“…An extended range of motion can avoid impingement in the hip joint prosthesis. Two general interactions that occur in a conventional dual-mobility hip joint prosthesis model are the acetabular cup with the liner and the liner with the femoral head, causing wear at two different locations 5,6 .Ultrahigh molecular weight polyethylene (UHMWPE) is a widely used material, especially as a bearing material for hip joint replacement surgery 7,8 . The type of UHMWPE used in the medical field has a molecular weight ranging from 3.5 to 6 million g/mol and has a degree of crystallinity ranging from 50 to 55% 9 .…”

“…Ultrahigh molecular weight polyethylene (UHMWPE) is a widely used material, especially as a bearing material for hip joint replacement surgery 7,8 . The type of UHMWPE used in the medical field has a molecular weight ranging from 3.5 to 6 million g/mol and has a degree of crystallinity ranging from 50 to 55% 9 .…”