Diamond-like carbon coatings may decrease implant wear, therefore, they are helping to reduce aseptic loosening and increase service life of total knee arthroplasties (TKAs). This two-part study addresses the development of such coatings for ultrahigh molecular weight polyethylene (UHMWPE) tibial inlays as well as cobalt-chromium-molybdenum (CoCr) and titanium (Ti64) alloy femoral components. While the deposition of a pure (a-C:H) and tungsten-doped hydrogen-containing amorphous carbon coating (a-C:H:W) as well as the detailed characterization of mechanical and adhesion properties were the subject of Part I, the tribological behavior is studied in Part II. Pin-on-disk tests are performed under artificial synovial fluid lubrication. Numerical elastohydrodynamic lubrication modeling is used to show the representability of contact conditions for TKAs and to assess the influence of coatings on lubrication conditions. The wear behavior is characterized by means of light and laser scanning microscopy, Raman spectroscopy, scanning electron microscopy and particle analyses. Although the coating leads to an increase in friction due to the considerably higher roughness, especially the UHMWPE wear is significantly reduced up to a factor of 49% (CoCr) and 77% (Ti64). Thereby, the coating shows continuous wear and no sudden failure or spallation of larger wear particles. This demonstrated the great potential of amorphous carbon coatings for knee replacements.

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The resulting inflammatory reaction to polyethylene (PE) wear debris, which may result in osteolysis, is still considered to be a main reason for aseptic loosening. In addition to the primary wear in hip joint replacements caused by head-insert articulation, relative motions between the PE liner and the metal cup may cause additional wear. In order to limit this motion, various locking mechanisms were used. We investigated three different locking mechanisms (Aesculap, DePuy, and Zimmer Biomet) to address the resulting relative motion between the acetabular cup and PE liner and the maximum disassembly force. A standardized setting with increasing load levels was used in combination with optically based three-dimensional measurements. In addition the maximum disassembly forces were evaluated according to the ASTM F1820-13 standard. Our data showed significant differences between the groups, with a maximum relative motion at the maximum load level (3.5 kN) of 86.5 ± 32.7 µm. The maximum axial disassembly force was 473.8 ± 94.6 N. The in vitro study showed that various locking mechanisms may influence cup-inlay stability.Materials 2020, 13, 1392 2 of 9 locking mechanisms are used. It is assumed that a firm connection of the components will reduce the relative motion and the particle migration inside the cup system [13,14]. Another rather rare reason for revision is the dislocation between cup and PE liner, which presumably can be attributed to the acetabular locking mechanism.The aim of this study was to evaluate specific locking mechanisms regarding the resulting relative motion between the acetabular cup and the PE liner. In addition, the maximum dissembling forces were investigated. For this purpose, three implant designs were tested, to determine if different types of locking mechanisms affect the magnitude of relative motion and dissembling force.

Background Kinematic alignment is an alternative approach to mechanical alignment. Kinematic alignment can restore the joint line to its prearthritic condition, and its advocates have suggested it may be associated with other benefits. But this alignment approach often results in tibial components that are placed in varus and femoral components that are placed in valgus alignment, which may result in an increased risk of component loosening because of wear. Like malaligned implant components, kinematically aligned knee implants could increase wear in vivo, but we lack comparative data about wear behavior between these approaches. Questions/purposes (1) Do the different alignment approaches (kinematic, mechanical, and purposefully malaligned components) result in different wear rates in a wear simulator? (2) Do the different alignment approaches lead to different worn areas on the polyethylene inserts in a wear simulator? (3) Do the different alignment approaches result in different joint kinematics in a wear simulator? Methods Mechanical alignment was simulated in a forcecontrolled manner with a virtual ligament structure according to the International Organization for Standardization (ISO 14243-1) using a knee wear simulator. To simulate kinematic alignment, flexion-extension motion, internalexternal torque, and the joint line were tilted by 4°, using a novel mechanical setup, without changing the force axis. The setup includes bearings with inclinations of 4°so that the joint axis of 4°is determined. To verify the angle of 4°, aThe study was financially supported by the nonprofit research foundation Stiftung Endoprothetik, Hamburg, Germany (S 01/20). One of the authors (TR) certifies receipt of personal payments, during the study period, in an amount of less than USD 10,000 from Zimmer Biomet Holdings, in an amount less than USD 10,000 from Aesculap AG/AQ Solutions GmbH, and in an amount less than USD 10,000 from DePuy Synthes as honoraria for lectures. One of the authors (JPK) certifies receipt of personal payments, during the study period, in an amount of less than USD 10,000 from Mathys AG and less than USD 10,000 USD from DePuy Synthes as honoraria for lectures. None of these payments influenced the design and results of the current study. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Ethical approval was not sought for the present study.

Recent studies have illuminated the rheological behavior of synovial fluid and the role of protein and hyaluronan (HA). However, with respect to artificial joint replacement in standardized wear simulations, bovine serum is used as fluid test medium. Little is known about the rheological characteristics of bovine serum, which are needed for precise tribological investigations. The steady shear viscosity η of bovine calf serum is determined for protein concentrations used in standardized wear simulations depending on shear rate γ˙ and temperature T. Additionally, the density of the serum is determined for both protein concentrations. The results show shear thinning behavior of bovine calf serum with a nearly Newtonian behavior in the range of high shear rates. Within the range of high shear rates, mean viscosities of η = 0.82–0.88 mPa·s were found for protein concentrations of 20 g/L and mean viscosities of η = 0.88–0.94 mPa·s for 30 g/L, decreasing with temperature. Densities of 1.004–1.005 g/cm3 and 1.007–1.008 g/cm3 were found for 20 and 30 g/L protein concentrations, respectively.

Tetrahedral amorphous carbon (ta‐C) coatings have the potential to protect biomedical implants from wear and increase their service life. This study elucidates the biocompatibility, mechanical properties, adhesion, and wear resistance of ta‐C coatings fabricated by physical vapor deposition on cobalt‐chromium‐molybdenum (CoCr) and titanium (Ti64) alloys as well as ultrahigh molecular weight polyethylene (UHMWPE). Satisfactory cytocompatibility is verified using contact angle and surface tension measurements as well as indirect and direct cell testing. Scratch testing demonstrates excellent adhesion to the substrates and as confirmed by nanoindentation, the coatings represent an up to 13‐fold and 182‐fold increase in hardness on the hard and soft materials. In metal pin‐on‐UHMWPE disk sliding experiments under simulated body fluid lubrication, the wear rates of the disk are reduced by 48% (against CoCr) and 73% (against Ti64) while the pin wear rates are reduced by factors of 20 (CoCr) and 116 (Ti64) compared to uncoated pairings. From optical and laser scanning microscopy, Raman measurements, and particle analyses, it is shown that the underlying substrates remain well protected. Nonetheless, focused ion beam scanning electron microscopy revealed coating process‐related and thermally driven subductions as well as tribologically induced near‐surface fatigue, which can potentially constitute critical wear mechanisms.

Due to different rheological behavior of human synovial fluid and the test mediums for in vitro examinations, wear tests cannot replicate the in vivo situation completely. The standards for wear testing indicate calf serum as in vitro test medium. However, these standards do not contain precise information on the main constituent components and the rheological properties. In this study, bovine calf serum and newborn calf serum with a protein concentration of 20 g/L, both approved for wear testing defined by the International Organization for Standardization (ISO), were characterized according to their rheological properties to detect differences before and during tribological simulation. The rheological behavior was determined at five defined intervals of a tribological test. The two test fluids differ in their rheological properties before and during the test and can therefore lead to deviating results in tribological testing. Furthermore, both test media changes considerably over test duration. At a test duration of 0.5 Mio cycles, both fluids have changed so that there is no longer any difference between them in terms of rheological properties. These changes could be attributed to denaturation and degradation of proteins. Thus, the choice of medium impacts tribological test results which should be considered for the interpretation of these studies.

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