Biomedical subjects

D Dowson

Publications and source records attributed to D Dowson.

At least 37 records · Page 2Linked to original sources

PubMed1996

Prospective clinical and joint simulator studies of a new total hip arthroplasty using alumina ceramic heads and cross-linked polyethylene cups.

We report the findings from independent prospective clinical and laboratory-based joint-simulator studies of the performance of ceramic femoral heads of 22.225 mm diameter in cross-linked polyethylene (XLP) acetabular cups. We found remarkable qualitative and quantitative agreement between the clinical and simulator results for the wear characteristics with time, and confirmed that ceramic femoral heads penetrate the XLP cups at only about half the rate of otherwise comparable metal heads. In the clinical study, 19 hips in 17 patients were followed for an average of 77 months. In the hip-joint simulator a similar prosthesis was tested for 7.3 million cycles. Both clinical and simulator results showed relatively high rates of penetration over the first 18 months or 1.5 million cycles, followed by a very much lower wear thereafter. Once an initial bedding-in of 0.2 mm to 0.4 mm had taken place the subsequent rates of penetration were very small. The initial clinical wear during bedding-in averaged 0.29 mm/year; subsequent progression was an order of magnitude lower at about 0.022 mm/year, lower than the 0.07 mm/year in metal-to-UHMWP Charnley LFAs. Our results show the excellent tribological features of alumina-ceramic-to-XLP implants, and also confirm the value of well-designed joint simulators for the evaluation of total joint replacements.

Adult↗

PubMed1995

Contact pressure prediction in total knee joint replacements. Part 1: General elasticity solution for elliptical layered contacts.

A general elasticity contact theory has been developed to predict the contact area and the contact pressure in total knee joint replacements with elliptical contacts where the thickness of ultra high molecular weight polyethylene (UHMWPE) is similar or less than the contact half width. The interfacial boundary condition between the UHMWPE component and the underlying metal substrate has been considered to be either perfectly bonded or perfectly unbonded in the model. Poisson's ratio for UHMWPE has been assumed to be 0.3 or 0.4. The effect of the thickness of the UHMWPE layer on the contact area and the contact pressure has been examined. The predictions of the maximum contact pressure and the contact area have been presented in non-dimensional forms and can readily be applied for typical design configurations of current total knee joint replacements. Furthermore, the present results can readily be applied to design considerations for total knee joint replacements to reduce contact stresses within the UHMWPE component.

Elasticity↗

PubMed1995

Contact pressure prediction in total knee joint replacements. Part 2: Application to the design of total knee joint replacements.

The general elasticity contact theory for elliptical geometry developed in Part 1 (1) has been applied to the design of current total knee joint replacements. A two-step curve-fitting technique using cubic spline interpolation routines has been adopted to represent the full elasticity solutions. The curve fit results of the maximum contact pressure have been compared with the full elasticity solution for a specified elliptical geometry and different polyethylene thicknesses and good agreement has been demonstrated. The computing time required by the curve-fitting technique is very small compared with the full elasticity solution and therefore can readily be applied to the design of knee joint replacements. Furthermore, reasonable agreement has also been found for the contact area for a typical knee joint design between the present theoretical prediction and the experimental measurement using pressure-sensitive film. Predictions of the maximum contact pressure have been made for an existing knee joint replacement in order to illustrate the present analysis in the design cycle. It has been shown that the effect of the thickness of ultra high molecular weight polyethylene is relatively small on contact stress predictions provided a sufficiently large value is chosen. On the other hand, the effect of conformity has a much greater influence on the contact stress distribution, particularly in the direction of the smaller principal radius.

Elasticity↗

PubMed1995

Cushion form bearings for total knee joint replacement. Part 1: Design,friction and lubrication.

Cushion knee prostheses have been designed and constructed that produce approximately equal initial contact areas and theoretical film thicknesses compared with a conventional UHMWPE (ultra-high molecular weight polyethylene) joint. These compliant bearings had a flat tibial component which imposed fewer biomechanical constraints and allowed a greater range of movement. Friction experiments have been carried out on a pendulum simulator apparatus. The results showed that the cushion knee joints operated just within the mixed lubrication regime, but that they benefited from a substantial measure of fluid film lubrication. Microelastohydrodynamic lubrication was effective in preserving low friction and thin but effective lubricating films.

Biomechanical Phenomena↗

PubMed1995

Cushion form bearings for total knee joint replacement. Part 2: Wear and durability.

Cushion knee prostheses have been designed and constructed to produce larger initial contact areas and thicker theoretical film thicknesses than a conventional UHMWPE (ultra-high molecular weight polyethylene) joint. The compliant bearing had a flat tibial component which imposed fewer biomechanical constraints and allowed greater range of movement. Wear tests were performed in a knee joint simulator and creep tests were carried out in a servo-hydraulic apparatus. Various failure modes of cushion joints that require further study were identified. However, the results showed that adequate durability was achieved from a 20 MPa polyurethane material in joint simulating tests carried out over 0.5, 1.0 and 5.0 million cycles. Most importantly, during these tests, no detectable wear debris was generated. It is believed that this is the first time that the full potential of cushion bearings has been demonstrated in a joint simulator over periods corresponding to about five years of service in vivo.

Friction↗

PubMed1994

A parametric analysis of the contact stress in ultra-high molecular weight polyethylene acetabular cups.

It is well known that the wear factor for ultra-high molecular weight polyethylene (UHMWPE) sliding on metallic or ceramic counterfaces is largely independent of contact stress for modest loading conditions and sliding distances. However, it is now recognized that under more severe stress levels and with sliding distances comparable to those encountered in current replacement synovial joints, subsurface fatigue contributes to the volume of wear debris. Since the fatigue process is influenced by surface stress levels it is becoming increasingly important to limit the contact stress through design in order to minimize the volume of UHMWPE wear debris in implants. The contact pressure in UHMWPE acetabular cups has been predicted using both the simple elasticity analysis and the finite element method. It has been shown that the radial clearance between the femoral head and the socket is the dominant parameter in determining the contact stress. Thus, the radial clearance should be controlled so the contact half width is close to the femoral head radius (a total included angle of contact of 120 degrees) to minimize the contact pressure. There is little benefit to be gained by increasing the contact half width greater than the femoral head radius. This is consistent with the geometrical constraint of the anatomical position and the direction of loading. It has been shown that the radius of the femoral head has the most significant effect on the maximum contact pressure for these closely conforming contacts where the contact half width is close to the femoral head radius. The effect of the elastic modulus and the thickness of UHMWPE is relatively small under these contact conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗

PubMed1994

A tribological study of a series of retrieved accord knee explants.

A tribological study of a series of 27 retrieved Accord meniscal bearing knee joints has been carried out. The roughness of the articulating surfaces of the meniscal and the femoral components was investigated, and the penetration into the polyethylene meniscal component was determined. There was generally little damage to the highly polished metallic femoral components. A general polishing and smoothing of the ultra high molecular weight polyethylene meniscal components was observed, although there was some subsequent deterioration of the polyethylene surfaces in certain cases. The penetration rate of the femoral components into the menisci was low, and was found to be similar to that reported for other meniscal knee joints.

Adult↗

PubMed1994

Comparative study of the wear of UHMWPE with zirconia ceramic and stainless steel femoral heads in artificial hip joints.

The wear of ultra high molecular weight polyethylene (UHMWPE) when sliding against zirconia ceramic and stainless steel counterfaces has been compared in a pin-on-plate reciprocator and in a hip joint simulator. A lower wear factor was found for the UHMWPE when sliding on the zirconia ceramic counterfaces in the pin-on-plate tests. In the hip joint simulator test, the acetabular cups articulating on zirconia heads showed consistently lower volume changes than the cups articulating on stainless steel heads. The higher volume changes found with the stainless steel heads were associated with an increased roughness of the femoral heads during the tests. This roughening was caused by the adherence of a rough polymer transfer film.

Biocompatible Materials↗

PubMed1993

Friction and lubrication in cushion form bearings for artificial hip joints.

Two hip joint prostheses were designed and constructed to be elastohydrodynamically equivalent producing approximately equal initial contact areas and theoretical film thicknesses. One was made from conventional UHMWPE (ultra-high molecular weight polyethylene) and the other was a cushion component which had a low modulus layer introduced into the joint space. Friction measurements were carried out on a pendulum simulator apparatus and the two joints were compared. In addition the experimental results were compared with theoretical values of friction predicted from elastohydrodynamic lubrication theory. Values for the friction factor at peak load and peak velocity in the cushion cup (0.003-0.009) were much lower than in the UHMWPE cup (0.017-0.042). The low friction values in the cushion cup are consistent with fluid film lubrication in the contact with the thin lubricating film being preserved by microelastohydrodynamic action.

Friction↗

PubMed1992

The effect of porosity of articular cartilage on the lubrication of a normal human hip joint.

The effect of porosity of articular cartilage on the lubrication of a normal human hip joint has been studied. The poroelasticity equation of articular cartilage and the modified Reynolds equation for the synovial fluid lubricant have been successfully solved under squeeze-film motion and for the conditions experienced in a normal human hip joint. It has been shown that porosity of the articular cartilage depletes the lubricant film thickness, rather than increasing it, particularly when the lubricant film thickness becomes small. Furthermore, it has been shown that articular cartilage can be treated as a single-phase incompressible elastic material in the lubrication modelling under physiological walking conditions.

Cartilage, Articular↗

PubMed1992

A full numerical solution to the problem of microelastohydrodynamic lubrication of a stationary compliant wavy layered surface firmly bonded to a rigid substrate with particular reference to human synovial joints.

A full numerical solution procedure has been developed for the microelastohydrodynamic lubrication analysis of a stationary compliant wavy layered surface firmly bonded to a rigid substrate. The results obtained have been compared with those using a simplified method adopted by Dowson and Jin(1) and good agreement has been obtained.

Elasticity↗

PubMed1992

A tribological study of retrieved hip prostheses.

One hundred Charnley cemented acetabular cups, 78 of which had the associated femoral stems, were obtained after revision surgery. Patient characteristics, which were obtained from hospital records, and roentgenographs showed that component loosening was the most common cause of failure. Examination of the acetabular cups revealed six categories of damage: socket erosion, rim wear, cement ingress, cratering, discoloration, and articulating surface scoring. Damage to the femoral stems was characterized by stem fracture and roughening of the femoral head. The latter was predominantly caused by the roentgenographic contrast medium within the acrylic cement scratching the articulating surface. The amount of wear, in terms of the penetration of the femoral head into the acetabular cup, could be measured in 87 cases. The mean penetration was 1.69 mm and the mean penetration rate was 0.21 mm per year with a range from less than 0.005 mm to 0.6 mm per year. It was shown that within this group, a high penetration rate precludes a long service life. It is therefore likely that reducing the rate of wear would improve the performance of the artificial hip joint.

Acetabulum↗

PubMed1991

Red blood cell magnesium and chronic fatigue syndrome.

The hypotheses that patients with chronic fatigue syndrome (CFS) have low red blood cell magnesium and that magnesium treatment would improve the wellbeing of such patients were tested in a case-control study and a randomised, double-blind, placebo-controlled trial, respectively. In the case-control study, 20 patients with CFS had lower red cell magnesium concentrations than did 20 healthy control subjects matched for age, sex, and social class (difference 0.1 mmol/l, 95% confidence interval [CI] 0.05 to 0.15). In the clinical trial, 32 patients with CFS were randomly allocated either to intramuscular magnesium sulphate every week for 6 weeks (15 patients) or to placebo (17). Patients treated with magnesium claimed to have improved energy levels, better emotional state, and less pain, as judged by changes in the Nottingham health profile. 12 of the 15 treated patients said that they had benefited from treatment, and in 7 patients energy score improved from the maximum to the minimum. By contrast, 3 of the 17 patients on placebo said that they felt better (difference 62%, 95% CI 35 to 90), and 1 patient had a better energy score. Red cell magnesium returned to normal in all patients on magnesium but in only 1 patient on placebo. The findings show that magnesium may have a role in CFS.

Adolescent↗

PubMed1991

The Christopher Hinton Lecture 1990. Medical engineering--the multi-disciplinary challenge.

This lecture highlights the multi-disciplinary nature of medical engineering. The author reviews various aspects in the field including artificial heart valves and total replacement synovial joints. He also considers the development of education and training and he explores the relationship between medical engineering and The Fellowship of Engineering. The author concludes that there is an immense amount of interest in the subject although more funding is needed for future development.

Biocompatible Materials↗

PubMed1991

Design considerations for cushion form bearings in artificial hip joints.

Lubrication mechanisms and contact mechanics have been analysed in a new generation of 'cushion form' bearings for artificial hip joints, which comprise low elastic modulus layers on the articulating surfaces. Comparisons have been made with 'hard' bearings used in existing prostheses and also with the natural hip joint. Lubricating film thicknesses are enhanced by larger contact areas and lower contact pressures. For a fixed contact area, simultaneous changes in layer thickness and radial clearance have been shown to have a small effect on elastohydrodynamic film thickness. Hard bearings designed with the same contact area as the cushion bearings produced a similar film thickness, but lubricant film thickness is not optimized in current designs. The main advantage of using a cushion bearing with low elastic modulus layers was found to be associated with microelastohydrodynamic lubrication. Careful selection of the elastic modulus is important in order to ensure that this lubrication regime was effective. Low elastic modulus layers may also produce local deformations, which enhance squeeze film action. The elastic modulus of the material should not be lower than necessary to produce effective microelastohydrodynamic lubrication, as a further reduction in modulus only increases the strain distribution in the material. A lubricant film thickness of 0.3 microns has been predicted for a cushion hip prosthesis with a femoral head diameter of 32 mm and radius of contact zone of 16 mm, using a 2 mm thick layer with an elastic modulus of 20 MPa.

Biomechanical Phenomena↗

PubMed1991

Tribology of total artificial joints.

The tribology of total artificial replacement joints is reviewed. The majority of prosthesis currently implanted comprise a hard metallic component which articulates on ultra high molecular weight polyethylene surface. These relatively hard bearing surfaces operate with a mixed or boundary lubrication regime, which results in wear and wear debris from the ultra high molecular weight polyethylene surface. This debris can contribute to loosening and ultimate failure of the prostheses. The tribological performance of these joints has been considered and a number of factors which may contribute to increased wear rates have been identified. Cushion bearing surfaces consisting of low elastic modulus materials which can articulate with full fluid film lubrication are also described. These bearing surfaces have shown the potential for greatly reducing wear debris.

Ceramics↗

PubMed1991

Stress analysis of cushion form bearings for total hip replacements.

Cushion form bearings comprise a thin layer of low elastic modulus material on the articulating surface of the bearing, which can deform to help preserve a film of lubricant between the bearing surfaces and therefore reduce friction and wear. The long-term function of this type of bearing is dependent on the strength and durability of this compliant layer. Finite difference and finite element methods have been used to analyse the stress distribution in the compliant layer of cushion form bearing for artificial hip joints under physiological loading conditions. A good agreement between finite difference and finite element methods was found. Under normal loading, the highest value of the maximum shear stress was found to be at the interface between the compliant layer and the more rigid substrate close to the edge of the contact. The values of maximum shear stress in the centre of the contact close to the articulating surface were lower than in the equivalent Hertzian contact. A friction force acting at the surface had little effect on the stress distribution for coefficients of friction less than 0.05. However, for higher values of friction coefficient (larger than 0.2), corresponding to inadequate lubrication, the maximum shear stress increased by a factor of four and was found to be located at the surface. The analysis predicts that the mode of failure will be at the interface with the substrate under fluid film or mixed lubrication conditions and at the articulating surface when the bearing runs dry with higher levels of friction. Both failure modes have been observed experimentally under the conditions specified.

Biocompatible Materials↗

PubMed1990

The influence of bone and bone cement debris on counterface roughness in sliding wear tests of ultra-high molecular weight polyethylene on stainless steel.

Studies of explanted hip prostheses have shown high wear rates of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups and roughening of the surface of the metallic femoral head. Bone and bone cement particles have also been found in the articulating surfaces of some joints. It has been proposed that bone or bone cement particles may cause scratching and deterioration in the surface finish of metallic femoral heads, thus producing increased wear rates and excessive amounts of wear debris. Sliding wear tests of UHMWPE pins on stainless steel have been performed with particles of different types of bone and bone cement added. Damage to the stainless steel counterface and the motion of particles through the interface have been studied. Particles of bone cement with zirconium and barium sulphate additives and particles of cortical bone scratched the stainless steel counterface. The cement particles with zirconium additive produced significantly greater surface damage. The number of particles entering the contact and embedding in the UHMWPE pin was dependent on particle size and geometry, surface roughness and contact stress. Particles are likely to cause surface roughening and increased wear rates in artificial joints.

Bone Cements↗