Aseptic loosening continues to be a problem with total hip replacements. In cemented total hip replacement, mechanically induced loosening most often initiates at the stem-cement or cement-bone interface. Improving the outcomes of cemented total hip replacement is limited by our lack of understanding of the actual mechanical conditions that cause loosening, and the multifactorial nature of the failure process that depends on stem design, stem surface conditions, and cementing technique. In this work, a research program is described to investigate: (1) the specific mechanical fatigue conditions under which the stem-cement and cement-bone interfaces fail; (2) the manner in which stem design, stem surface, and cementing process contribute to the fatigue failure process at the interfaces and in the bulk cement; and (3) the interactions between these three design factors in affecting the fatigue failure process. The end goal of this research is to define design guidelines that will reduce the revision rates of cemented hip replacements due to implant loosening. It is the hypothesis of this work that stem design, stem surface, and cementing conditions can each effect the overall failure (loosening) of the implant system. In the proposed research, fracture mechanics-based approaches will be used to characterized the fatigue behavior and failure of the stem-cement and cement-bone interfaces. Models for interface response will be developed from a combination of experimental and theoretical methods, and these models will be verified by comparison of predicted to observed results for experiments that are different than those used for model development. Cyclic fatigue experiments of cemented stem construct will be performed with an aggressive stair climbing loading regime for each of the design conditions. These experiments will directly test the hypothesis stated above through use of a 23 factorial experimental design. Finally, fully 3-D fatigue models of each of the eight design cases will be performed to elucidate the failure mechanisms found in the experiments. When combined, the experimental and computational approaches will provide design guidelines that could significantly reduce revision rates of cemented hip replacements due to implant loosening.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR042017-08
Application #
6632544
Study Section
Orthopedics and Musculoskeletal Study Section (ORTH)
Program Officer
Panagis, James S
Project Start
1996-07-15
Project End
2005-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
8
Fiscal Year
2003
Total Cost
$216,600
Indirect Cost
Name
Upstate Medical University
Department
Orthopedics
Type
Schools of Medicine
DUNS #
058889106
City
Syracuse
State
NY
Country
United States
Zip Code
13210
Goodheart, Jacklyn R; Miller, Mark A; Oest, Megan E et al. (2017) Trabecular resorption patterns of cement-bone interlock regions in total knee replacements. J Orthop Res 35:2773-2780
Srinivasan, Priyanka; Miller, Mark A; Verdonschot, Nico et al. (2017) A modelling approach demonstrating micromechanical changes in the tibial cemented interface due to in vivo service. J Biomech 56:19-25
Cyndari, Karen I; Goodheart, Jacklyn R; Miller, Mark A et al. (2017) Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties? J Arthroplasty 32:2289-2300
Srinivasan, Priyanka; Miller, Mark A; Verdonschot, Nico et al. (2017) Strain shielding in trabecular bone at the tibial cement-bone interface. J Mech Behav Biomed Mater 66:181-186
Srinivasan, Priyanka; Miller, Mark A; Verdonschot, Nico et al. (2016) Experimental and computational micromechanics at the tibial cement-trabeculae interface. J Biomech 49:1641-1648
Zimmerman, William F; Miller, Mark A; Cleary, Richard J et al. (2016) Damage in total knee replacements from mechanical overload. J Biomech 49:2068-2075
Miller, Mark A; Goodheart, Jacklyn R; Khechen, Benjamin et al. (2016) Changes in microgaps, micromotion, and trabecular strain from interlocked cement-trabecular bone interfaces in total knee replacements with in vivo service. J Orthop Res 34:1019-25
Howard, Karen I; Miller, Mark A; Damron, Timothy A et al. (2014) The distribution of implant fixation for femoral components of TKA: a postmortem retrieval study. J Arthroplasty 29:1863-70
Goodheart, Jacklyn R; Miller, Mark A; Mann, Kenneth A (2014) In vivo loss of cement-bone interlock reduces fixation strength in total knee arthroplasties. J Orthop Res 32:1052-60
Oest, Megan E; Miller, Mark A; Howard, Karen I et al. (2014) A novel in vitro loading system to produce supraphysiologic oscillatory fluid shear stress. J Biomech 47:518-25

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