BACKGROUND: For over 10 years, the RM Pressfit cup™ has been used in our department. This is a one-piece, elastic, cementless implant designed with standard polyethylene (PE), covered with a thin coating of titanium particles. To date, there is no French study evaluating this cup after more than 10 years. Therefore, we conducted a retrospective study in order to: 1) evaluate the survival of the implant with a minimum follow-up of 10 years, 2) evaluate the functional scores at the last follow-up, 3) measure the wear of the PE, 4) identify radiological loosening, 5) search for risk factors for cup removal, 6) identify complications that required management in the operating theatre.
OBJECTIVE: The working hypothesis was that the survival of this implant was greater than 95% at 10 years\' follow-up, in accordance with the criteria of the National Institute for Health and Care Excellence (NICE).
METHODS: This was a retrospective monocentric study, including adult patients who underwent total hip arthroplasty (THA) with an RM Pressfit cup™ (28 mm friction size) for coxarthrosis (primary or secondary) or femoral head osteonecrosis. Exclusion criteria were a follow-up period of less than 10 years, the placement of an RM Pressfit cup™ as a secondary intention for a THA (n = 5) or following a trochanteric fracture (n = 1). In total, 163 patients (182 hips) with a median age (Q1-Q3) of 63 (56-68) years, and a sex ratio (M/F) of 1.7 were included. Functional scores were evaluated using the Harris and Oxford scores. Radiographs were analyzed in the immediate postoperative period and at the last follow-up.
RESULTS: The median follow-up was 10.5 (10-11.5) years. Of the 182 included hips, 7 cups were removed, corresponding to a 10-year survival rate of 96.1% (95% CI [93.3; 96.9]). The median Harris and Oxford scores at 10.5 years were 95 (90-98) and 19 (17-23) points, respectively. The median PE wear rate was 0.058 (0.039-0.087) mm/year. Univariate analysis showed that male gender was associated with PE wear (OR = 3.6; 95% CI [1.3; 12.9] (p = 0.012)). Ten cups (6%) showed radiological instability with migration greater than 3 mm and/or variation in inclination greater than 8 °, and only 9 hips (6%) showed bone resorption. No preoperative or perioperative factors analyzed were associated with cup removal. Dislocation accounted for 71% (n = 5) of the causes of cup removal. Additionally, 6 hips experienced at least one dislocation episode requiring reduction by external maneuvers in the operating room, bringing the overall dislocation rate in the series to 6% (n = 11). Increased cup inclination was the only risk factor for prosthetic dislocation (OR = 1.2; 95% CI [1.09; 1.4] (p = 0.0003)). Overall complications requiring surgical intervention included 15 (8.3%) implanted cups (7 removed cups, 6 dislocation episodes requiring reduction by external maneuvers in the operating room, and 2 hips reoperated for washing and changing of mobile components due to early infection).
CONCLUSIONS: The RM Pressfit cup™ gives good long-term clinical and radiological results with an overall survival of 96.1% and a low complication rate over 10 years. Over the last 2 years the RM Vitamys™ cup has been introduced allowing the use of 32 mm femoral head diameter for size 48 cups, to reduce the risk of dislocation.
METHODS: IV; retrospective cohort.

Wear is a ubiquitous phenomenon that limits the life of many engineered components with sliding interfaces through the gradual removal of material. The wear of polymers is crucial in many applications, ranging from bearings to orthopedic implants to nanolithography processes. The wear rate of polymers is strongly affected by the stress and temperature at the interface. The effects of temperature and stress are often described empirically since the wear process involves complex interactions between multiple asperities on rough surfaces over a range of length scales. Nanoscale tribology experiments at the single-asperity level have provided new insights into the underlying mechanisms of wear. Experiments on hard covalently bonded materials, including silicon and diamond, have demonstrated that wear is an atomic attrition wear process that can be modeled using stress-assisted transition state theory. Here, we examine the wear of a common polymer, polymethylmethacrylate (PMMA), at the nanoscale as a function of stress and temperature and show that the polymer wear is controlled by a combination of atomic attrition and viscoelastic relaxation. While the wear experiments are conducted at the nanoscale via atomic force microscopy, the results show that accounting for the local stress distribution at the contact interface is critical to understanding the wear behavior, an effect that was not considered in earlier studies on hard materials. Using a model that accounts for the stress distribution, we demonstrate the ability to predict the wear volume within 8%.

OBJECTIVE: Based on our recent study, which showed that cartilage fatigue failure in reciprocating sliding contact results from cyclical compressive forces, not from cyclical frictional forces, we hypothesize that a major functional role for synovial fluid (SF) is to reduce the rate of articular cartilage fatigue failure from cyclical compressive loading.
METHODS: The rate of cartilage fatigue failure due to repetitive compressive loading was measured by sliding a glass lens against an immature bovine cartilage tibial plateau strip immersed in mature bovine SF, phosphate-buffered saline (PBS), or SF/PBS dilutions (50% SF and 25% SF; n = 8 for all four bath conditions). After 24 h of reciprocating sliding (5400 cycles), samples were visually assessed, and if damage was observed, the test was terminated; otherwise, testing was continued for 72 h (16,200 cycles), with solution refreshed daily.
RESULTS: All eight samples in the PBS group exhibited physical damage after 24 h, with an average final surface roughness of Rq= 0.210 ± 0.067 mm. The SF group showed no damage after 24 h; however, two of eight samples became damaged after 72 h, producing a significantly lower average surface roughness than the PBS group (Rq=0.059 ± 0.030 mm; p < 10-4). For the remaining groups, at 72 h, one of eight samples was damaged in the 50% SF group, and five of eight samples were damaged in the 25% SF group.
CONCLUSIONS: The results strongly support our hypothesis, showing that decreased amounts of SF in the testing bath produce increased rates of fatigue failure in cartilage that was subjected to reciprocating sliding contact.

In this paper, the morphological, micromechanical and tribological characteristics of the Ti-6Al-4V ELI alloy after thermal oxidation (TO) were identified. TO was carried out at temperatures of 848 K, 898 K and 948 K over a period of 50 h. Microscopic examination revealed that an increase in temperature resulted in an improved uniformity of coverage and an increased oxide grain size. Micromechanical tests showed that TO of the Ti-6Al-4V ELI alloy led to an increase in hardness and deformation resistance. Following oxidation, a decrease (by approximately 10-22%) was observed in the total mechanical work of indentation, Wtotal, compared to the as-received material. The formation of protective oxide films on the Ti-6Al-4V ELI alloy also led to the improvement of tribological characteristics, both when tested under dry friction conditions and in Ringer\'s solution. The sliding wear resistance increased with an increase in the oxidation temperature. However, a greater degree of wear reduction (by approximately 30-50%) was found for the lubricated contact in comparison with the dry friction tests. Surface roughness also increased with the increase in temperature.

Osteoarthritis (OA) is one of the most common causes of disability around the globe, especially in aging populations. The main symptoms of OA are pain and loss of motion and function of the affected joint. Hyaline cartilage has limited ability for regeneration due to its avascularity, lack of nerve endings, and very slow metabolism. Total joint replacement (TJR) has to date been used as the treatment of end-stage disease. Various joint-sparing alternatives, including conservative and surgical treatment, have been proposed in the literature; however, no treatment to date has been fully successful in restoring hyaline cartilage. The mechanical and frictional properties of the cartilage are of paramount importance in terms of cartilage resistance to continuous loading. OA causes numerous changes in the macro- and microstructure of cartilage, affecting its mechanical properties. Increased friction and reduced load-bearing capability of the cartilage accelerate further degradation of tissue by exerting increased loads on the healthy surrounding tissues. Cartilage repair techniques aim to restore function and reduce pain in the affected joint. Numerous studies have investigated the biological aspects of OA progression and cartilage repair techniques. However, the mechanical properties of cartilage repair techniques are of vital importance and must be addressed too. This review, therefore, addresses the mechanical and frictional properties of articular cartilage and its changes during OA, and it summarizes the mechanical outcomes of cartilage repair techniques.

The present study adopts a muti-facet approach to design bio inspired concentrated alloys for potential application as articulating surfaces in joint replacements. A series of equiatomic, Nb rich and Ti rich TiMoNbZr based medium entropy alloys (MEAs) were processed via arc melting and their mechanical, in-vitro corrosion, wear, and in vitro and in vivo biocompatibility were investigated. Equiatomic MEA had primarily bcc with minor hcp phases where the single bcc was achieved with the addition of Nb. The single bcc Nb rich alloy resulted in 13% elongation, much higher than equiatomic or Ti rich alloy. All the MEAs showed comparatively higher yield strength due to the climb of edge dislocations which is the main rate limiting mechanism at 300 K, as evident molecular dynamics (MD) simulation. The locally fluctuating energy landscape promotes kinks on edge dislocation, and at local minima nanoscale segments gets pinned. Upon yielding the entangled kink leaves a trail of vacancies/interstitials and escapes via climb motion to render high yield strength. The higher corrosion and pitting resistance of Nb enriched alloys can be attributed to the stable ZrO2, Nb2O5, TiO2, and MoO3 oxides, high polarization resistance (106-105 Ωcm-2), and low defect densities (1016-1018). In vitro cell-materials interaction using MC3T3-E1 showed bioinert but cytocompatible nature of the MEAs. The wear rate of the MEAs was in the range of 7-9×10-5 mm3N-1m-1. The wear debris did not show any tissue necrosis when implanted in rabbit femur rather new bone regeneration can be seen around the particles. STATEMENT OF SIGNIFICANCE: In the present work, a noble Nb enriched MEAs with superior mechanical, in vitro wear, corrosion and cytocompatibility properties was designed for articulating surfaces in joint replacement. •Single bcc in Nb enriched MEAs resulted in 13 % elongation with high hardness and yield strength. •Climb of entangled edge segment is the rate limiting mechanism in controlling high yield strength of MEAs at 300 K. •High polarization resistance (106-105 Ωcm-2), and low defect densities (1016-1018) attributes to ZrO2, Nb2O5, TiO2, and MoO3 oxides enriched passive film. •Wet sliding wear rate ranged in order 7-9×10-5 mm3N-1m-1. In-situ generated wear debris when implanted in rabbit femur did not show any tissue necrosis rather new bone regeneration was observed around debris.

The use of metal-on-metal bearing couples in total hip arthroplasty can lead to an increased release of metal ions, particularly cobalt and chromium over time. This can lead to local and systemic metallosis, which has cytotoxic, genotoxic, and immunotoxic effects and can cause a host of secondary disorders. We describe the case of a 37-year-old female patient that was diagnosed with warm-antibody autoimmune hemolytic anemia (WAIHA) one and a half years after bilateral large-diameter head metal-on-metal total hip arthroplasty. For 11 years, it was refractory to all therapy, including splenectomy and rituximab, requiring long-term oral prednisone for disease control. Ultimately, systemic metallosis and periprosthetic joint infection were diagnosed, requiring explantation of the prostheses. By the sixth week postoperatively, she experienced complete spontaneous remission of her WAIHA. In conclusion, WAIHA can be associated with systemic metallosis in patients with metal-on-metal prosthetic joint replacements. Both hematologists and orthopedic surgeons should be aware of this.

The present work demonstrates the development of SiC/TiS2/AlSi12Cu hybrid functionally graded composite using centrifugal casting and examines its microstructural, mechanical, and tribological properties. A gradient distribution of reinforcement particles was observed with the outer region being particle-rich. EBSD analysis confirms microstructural refinement owing to titanium\'s grain refining properties and the formation of θ-Al2Cu intermetallic phase. The outer layer of the composite attained a maximum hardness and tensile strength of 93 HB and 202 MPa respectively, which was increased by 7.5% and 8.2%, 20.4% and 13.8%, 22.5% and 44.5% in middle, inner, and as-received alloy respectively. Tribological properties were assessed via dry sliding pin-on-disk tribometer with various process parameters such as load (10-40 N), velocity (1-4 m/s) and distance (500-2000 m), optimized using response surface methodology. The higher wear resistance was attained by the optimized process parameters of 16 N load, 1.6 m/s velocity, and 804 m distance. Results indicated increased material loss with higher load, sliding distance, and velocity, but with enhanced wear resistance in the outer zone. Worn surface analysis revealed deeper grooves, delamination, particle pull-out, and wear tracks under severe conditions. The study emphasizes the composite\'s potential for high wear applications, linking its microstructural features to its superior wear behavior.

In this paper, the tribological characteristics of polyethersulfone-based composites reinforced with short carbon fibers (SCFs) at aspect ratios of 14-250 and contents of 10-30 wt.% are reported for linear metal-polymer and ceramic-polymer tribological contacts. The results showed that the wear resistance could be greatly improved through tribological layer formation. Loading PES with 30 wt.% SCFs (2 mm) provided a minimum WR value of 0.77 × 10-6 mm3/N m. The tribological layer thicknesses were estimated to be equal to 2-7 µm. Several conditions were proposed, which contributed to the formation of a tribological layer from debris, including the three-stage pattern of the changing kinetics of the time dependence of the friction coefficient. The kinetics had to sharply increase up to ~0.4-0.5 in the first (running-in) stage and gradually decrease down to ~0.1-0.2 in the second stage. Then, if these levels did not change, it could be argued that any tribological layer had formed, become fixed and fulfilled its functional role. The PES-based composites loaded with SCFs 2 mm long were characterized by possessing the minimum CoF levels, for which their three-stage changing pattern corresponded to one of the conditions for tribological layer formation. This work provides valuable insight for studying the process parameters of tribological layer formation for SCF-reinforced thermoplastic PES composites and revealing their impact on tribological properties.

Double-walled carbon nanotube-yttria-stabilized ZrO2 nanocomposites are prepared by a mixing route followed by Spark Plasma Sintering. The double-walled carbon nanotubes (DWCNTs) have been previously subjected to a covalent functionalization. The nanocomposites present a high densification and show a homogenous dispersion of DWCNTs into a matrix about 100 nm in size. The DWCNTs are well distributed at the matrix grain boundaries but form larger bundles upon the increase in carbon content. The Vickers microhardness of the nanocomposites decreases regularly upon the increase in carbon content. Incorporation of carbon at contents higher than 2 wt.% results in significantly lower friction coefficients, both against alumina and steel balls, possibly because of the elastic deformation of the DWCNTs at the surface of the sample. Their presence also favors a reduction of the steel/ceramic contacts and reduces the wear of the steel ball at high loads. DWCNTs improve wear resistance and reduce friction without incurring any severe damage, contrary to multi-walled carbon nanotubes.