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What design factors influence wear behavior at the bearing surfaces in total joint replacements?

Dr. Brown is Richard and Janice Johnston Chair of Orthopaedic Biomechanics, and Professor, Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA. Dr. Bartel is Willis H. Carrier Professor in Engineering Emeritus, Cornell University, Ithaca, NY, and Senior Scientist, Hospital for Special Surgery, New York, NY.

*The Implant Wear Symposium 2007 Engineering Work Group included Donald L. Bartel, PhD, Thomas D. Brown, PhD, Ian C. Clarke, PhD, Roy D. Crowninshield, PhD, Darryl D'Lima, MD, PhD, A. Seth Greenwald, DPhil(Oxon), Steven M. Kurtz, PhD, Jack Lemons, PhD, Michael T. Manley, PhD, Harry A. McKellop, PhD, Orhun K. Muratoglu, PhD, Ebru Oral, PhD, Lisa Pruitt, PhD, Clare Rimnac, PhD, Peter S. Walker, PhD, and Timothy Wright, PhD.

Dr. Brown or a member of his immediate family has received research or institutional support from DePuy, Arthrosurface, and the National Institutes of Health and is a consultant to or an employee of Smith & Nephew. Dr. Bartel or a member of his immediate family has received research or institutional support and royalties from the Hospital for Special Surgery, holds stock in Exactech, and is a consultant to or employee of Stryker Orthopaedics.

Bearing surface wear in total joint replacements arises from local stresses that exceed the mechanical strength of the articulating materials. Because both the tensile/compressive principal stresses and maximum shear stress near the bearing surface increase when contact stresses increase, minimizing contact stresses has been a central design goal, especially in total knees. Wear rates increase with factors such as increased sliding distance in metal-on-polyethylene bearings, or suboptimal fluid film lubrication in the case of hard-on-hard total hip implants. These factors in turn depend directly on implant design. Advanced preclinical assessment technologies such as laboratory physical simulators and finite element analyses have provided means by which the dependence of wear rate on mechanical design factors can be quantified. However, untoward complexities occurring in vivo, such as impingement or third-body challenge, can appreciably compromise wear performance even for implants that are well-designed in terms of bearing surface stress minimization.