Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany.
Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany.
Acta Biomater. 2023 Mar 1;158:827-842. doi: 10.1016/j.actbio.2022.12.055. Epub 2023 Jan 1.
This retrieval study included 43 Biolox delta explants (18 CoC, 25 CoP). Implants were examined macroscopically, whereby damage was evaluated using a semi quantitative scoring system. Confocal microscopy was used to examine wear related damage patterns of the articulating surfaces. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) was used to analyze wear marks on the implant surface and wear debris in periprosthetic tissue samples. Raman spectroscopy and X-ray diffraction (XRD) were used to quantify monoclinic zirconia fractions. On all components, in vivo wear resulted predominantly in different damage patterns caused by metal transfer. In CoC bearings stripe wear was additionally detected, and some implants underwent severe damage due to component breakage. The wear scores were higher for CoC components, with no differences between the scores for CoC heads and liners. Wear features caused comparable roughening on implants from CoC and CoP bearings. SEM studies demonstrated that most wear marks were caused by metal debris released from implant components. Grain pull-out was observed in stripe wear regions. Monoclinic phase shift was observed in a similar quantity on components from CoP and CoC bearings. The increase of monoclinic zirconia content around metal deposits was minimal and was more pronounced in areas of stripe wear. The results of this study indicate, that ZTA components in general undergo minimal wear in both, CoC and CoP bearings, however, it is more pronounced in the former. Metal deposits, as the most common wear feature, have no significant effect on monoclinic phase transition. STATEMENT OF SIGNIFICANCE: In this paper, we classify all damage patterns macroscopically according to an established scoring system and assess them regarding surface roughness (confocal microscopy) and monoclinic phase content (Raman spectroscopy) in order to derive the severity for patients. We compare hard-hard and hard-soft bearings and relate damage patterns with metal transfer based on SEM/EDS examinations. Furthermore, we work out correlations between patient-specific data, cause of revision and the physical condition of each individual sample Our cohort consists of 43 Biolox delta retrievals, a comparatively large quantity. In addition, we address current topics such as metal transfer and, based on the classification of damage patterns, provide incentives and/or meaningful focal points for further research.
本检索研究共纳入 43 枚 Biolox delta 种植体（18 枚 CoC，25 枚 CoP）。对植入物进行宏观检查，采用半定量评分系统评估损伤。共聚焦显微镜用于检查关节表面的与磨损相关的损伤模式。扫描电子显微镜（SEM）结合能量色散 X 射线光谱法（EDS）用于分析植入物表面的磨损痕迹和假体周围组织样本中的磨损碎屑。拉曼光谱和 X 射线衍射（XRD）用于定量单斜氧化锆分数。在所有组件上，体内磨损主要导致由金属转移引起的不同损伤模式。在 CoC 轴承中还检测到条纹磨损，一些植入物由于组件断裂而遭受严重损伤。CoC 组件的磨损评分较高，CoC 头和衬垫的评分没有差异。CoC 和 CoP 轴承的植入物产生类似的磨损特征，导致表面粗糙度增加。SEM 研究表明，大多数磨损痕迹是由植入物组件释放的金属碎屑引起的。在条纹磨损区域观察到晶粒拔出。在 CoP 和 CoC 轴承组件上观察到相似数量的单斜相移。金属沉积物周围单斜氧化锆含量的增加最小，在条纹磨损区域更为明显。本研究结果表明，ZTA 组件在 CoC 和 CoP 轴承中总体磨损较小，但前者更为明显。作为最常见的磨损特征的金属沉积物对单斜相变没有显著影响。
在本文中，我们根据既定的评分系统对所有宏观损伤模式进行分类，并通过共聚焦显微镜评估表面粗糙度和拉曼光谱评估单斜相含量，以得出对患者的严重程度。我们比较了硬-硬和硬-软轴承，并根据 SEM/EDS 检查将损伤模式与金属转移相关联。此外，我们还研究了患者特定数据、翻修原因与每个样本物理状况之间的相关性。我们的队列包括 43 枚 Biolox delta 取出物，数量相对较多。此外，我们还涉及当前的一些话题，如金属转移，并根据损伤模式的分类，为进一步研究提供激励和/或有意义的重点。
