With the increased clinical interest in metal-on-metal and ceramic-on-ceramic total-hip replacements (THRs), the objective of this hip simulator study was to identify the relative wear ranking of three bearing systems, namely CoCr-polyethylene (M-PE), CoCr-CoCr (M-M) and ceramic-on-ceramic (C-C). Volumetric wear rates were used as the method of comparison. The seven THR groupings included one M-PE study, two M-M studies and four C-C studies. Special emphasis was given to defining the 'run-in' phase of accelerated wear that rigid-on-rigid bearings generally exhibit. The hypothesis was that characterization of the run-in and steady state wear phases would clarify not only the tribological performance in vitro but also help correlate these in vitro wear rates with the 'average' wear rates measured on retrieved implants. The implant systems were studied on multichannel hip simulators using the Paul gait cycle and bovine serum as the lubricant. With 28 mm CoCr heads, the PE (2.5 Mrad/N2) wear rates averaged 13 mm3/10(6) cycles duration. This was considered a low value compared with the clinical model of 74 mm3/year (for 28 mm heads). Our later studies established that this low laboratory value was a consequence of the serum parameters then in use. The mating CoCr heads (with PE cups) wore at the steady state rate of 0.028 mm3/10(6) cycles. The concurrently run Metasul M-M THRs wore at the steady state rate of 0.119 mm3/10(6) cycles with high-protein serum. In the second Metasul M-M study with low-protein serum, the THR run-in rate was 2.681 mm3/10(6) cycles and steady state was 0.977 mm3/10(6) cycles. At 10 years, these data would predict a 70-fold reduction in M-M wear debris compared with the clinical PE wear model. All M-M implants exhibited biphasic wear trends, with the transition point at 0.5 x 10(6) cycles between run-in and steady state phases, the latter averaging a 3-fold decrease in wear rate. White surface coatings on implants (coming from the serum solution) were a confounding factor but did not obscure the two orders of magnitude wear performance improvement for CoCr over PE cups. The liners in the alumina head-alumina cup combination wore at the steady state rate of 0.004 mm3/10(6) cycles over 14 x 10(6) cycles duration (high-protein serum). The zirconia head-alumina cup THR combination wore at 0.174 and 0.014 mm3/10(6) cycles for run-in and steady state rates respectively (low-protein serum). The zirconia head and cup THR combination wore slightly higher initially with 0.342 and 0.013 mm3/10(6) cycles for run-in and steady state rates respectively. Other wear studies have generally predicted catastrophic wear for such zirconia-ceramic combinations. It was noted that the zirconia wear trends were frequently masked by the effects of tenacious white surface coatings. It was possible that these coatings protected the zirconia surfaces somewhat in this simulator study. The experimental ceramic Crystaloy THR had the highest ceramic run-in wear at 0.681 mm3/10(6) cycles and typical 0.016 mm3/10(6) cycles for ...

The objective of this study is to assess whether a new biodegradable elastomer, poly(1,8-octanediol citrate) (POC), would be a suitable material to engineer elastomeric scaffolds for cartilage tissue engineering. Porous POC scaffolds were prepared via the salt-leaching method and initially assessed for their ability to rapidly recover from compressive deformation (% recovery ratio). Controls consisted of scaffolds made from other materials commonly used in cartilage tissue engineering, including 2% agarose, 4% alginate, non woven poly(glycolic acid) (PGA) meshes, and non woven poly(L-lactide-co-glycolide) (PLGA) meshes. Articular chondrocytes from bovine knee were isolated and seeded onto porous disk-shaped POC scaffolds, which were subsequently cultured in vitro for up to 28 days. POC scaffolds completely recover from compressive deformation, and the stress-strain curve is typical of an elastomer (recovery ratio>98%). Agarose gel (2%) scaffolds broke during the compression test. The recovery ratio of 4% alginate gel scaffolds, PLLA, and PGA were 72, 85, and 88%, respectively. The Young's modulus of POC-chondrocyte constructs and cell-free POC scaffolds cultured for 28 days were 12.02+/-2.26 kPa and 3.27+/-0.72 kPa, respectively. After 28 days of culture, the recovery ratio of POC-chondrocyte constructs and cell-free POC scaffolds were 93% and 99%, respectively. The glycosaminoglycan (GAG) and collagen content at day 28 was 36% and 26% of that found in bovine knee cartilage explants. Histology/immunohistochemistry evaluations confirm that chondrocytes were able to attach to the pore walls within the scaffold, maintain cell phenotype, and form a cartilaginous tissue during the 28 days of culture.

BACKGROUND:Methylnaltrexone has been shown to be effective for treating opioid-induced constipation (OIC) in chronic settings, but its effects on acute OIC have not been studied.

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Wear rates of polytetrafluoroethylene (PTFE) and polyethylene cups were compared in 9-channel and 12-channel simulators, using serum lubrication and gravimetric techniques for wear assessment. Cobalt-chromium (CoCr) and alumina ceramic femoral heads in 22-42 mm diameter range were used to validate simulator wear rates against clinical data. This was also the first study of three femoral head sizes evaluated concurrently in a simulator (with three replicate specimens) and also the first report in which any wear experiments were repeated. Fluid absorption artefacts were within +/-1 per cent of wear magnitude for PTFE and +/-8 per cent for polyethylene and were corrected for. Wear rates were linear as a function of test duration. Precision within each set of three cups was within +/-6 per cent. The wear rates from experiments repeated over 15 months were reproducible to within +/-24 per cent. However, the magnitudes of the simulator wear rates were not clinically accurate, the PTFE wear rates (2843 mm3/10(6) cycles; 22 mm diameter) were over three times higher than in vivo, the polyethylene 30 to 50 per cent on the low side (23 mm3/10(6) cycles; 22 mm diameter). Volumetric wear rate increased with respect to size of femoral head and a linearly increasing relationship of 7 8 per cent/mm was evident with respect to femoral head diameter for both PTFE and polyethylene. These data compared well with the clinical data.

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Controversy surrounds wear data from laboratory hip simulator studies, whether derived from water-based or serum-based studies or whether a major design parameter such as the size of the femoral head has an effect on the volume of wear particulate released. To investigate these relationships, we studied cup wear in water- and serum-based lubricants using as our standard the polytetrafluoroethylene (PTFE) data derived by Charnley. To model Charnley's clinical experience, PTFE acetabular cups were used in sets of three each of four sizes of CoCr femoral heads: 22.25-, 28-, 32-, and 42-mm diameters. Six criteria were used to evaluate the performance of the lubricants against clinical accuracy and scientific methods. The PTFE wear data from the serum-based tests was consistently linear with the duration of the test, exhibited a precision within +/-3% about the average for each set of three cups, and copious amounts of wear debris were clearly seen circulating and settling to the bottom of the wear chambers. The wear data clearly demonstrated Charnley's thesis that volume of wear increases with regard to the size of the femoral head in a linear manner. This increase was considered satisfactory at 9%/ mm. However, in terms of clinical accuracy, the simulator wear rates averaged 3 to 4 times greater than the comparable clinical data for wear magnitude. Thus, the serum-based tests satisfied three of the six criteria used. The PTFE wear data from the water-based tests was generally nonlinear, continually increasing with test duration. These wear trends were examined in three discrete phases to estimate the changing wear rates. By the end of the tests, the wear rates had increased from 1.3 to 3.9 times, with the 42-mm heads showing the greatest change. The resulting precision was never better than +/-26% and deteriorated to +/-70%. In terms of clinical accuracy, the water-based wear rates varied from 2 to 7 times less than the Charnley PTFE wear magnitudes, averaging 4 times less. The water-based data did not satisfactorily model the relationship between increased wear with increased head size. Minimal PTFE wear debris was observed, and what did emerge after thousands of wear cycles appeared as streamers up to 30 mm long and up to 5 mm wide. When these detached, they floated up to the surface where they could be separated into smaller particulates. A similar phenomenon was noted for polyethylene wear tests conducted with water lubrication. Thus the water-based tests satisfied none of the six validation criteria evaluated. These data raise serious doubts as to the validity of testing implant and material combinations in water as a predictor of clinical performance. Bovine serum was not totally satisfactory, but the wear data did model some of the important clinical characteristics of hip joint behavior.