Advance Biomedical Material

Engineering
(BME-511)

Presented to: Dr. Nida Iqbal

Presented by: Ukasha Jawad
Roll no: 2024MSBME5
Topic: Hip Joint Replacement Implant
Table of content
• Introduction
• Biomaterial importance in hip joint replacement
• Anatomy of the hip joint
• Hip joint problems
• The reason behind bone damage
• Types
• Hip replacement component (biomaterial)
• Material consideration (metal, ceramics, polymer)
• Failure Mechanism
• Advances in hip replacement
• References
Introduction to hip replacement
• Hip replacement (HR) is a widely performed surgical procedure aimed
at alleviating pain and restoring function in individuals suffering from
advanced arthritis of the hip joint. The most common indication for this
surgery is osteoarthritis, which significantly impacts the quality of life
due to joint pain and stiffness.
• The procedure involves replacing the damaged hip joint with an
artificial implant.
• The choice of biomaterial can affect the range of motion, friction, and
overall performance of the hip joint.
Biomaterial Importance in Hip
Replacement
• Biomaterials play a crucial role in the success of hip replacement
surgeries, as they directly influence the performance, longevity, and
safety of the implants.
• Compatibility and Biocompatibility: Biomaterials must be
biocompatible, meaning they should not provoke an adverse immune
response when implanted in the body
• Mechanical Properties: The materials used in hip implants must
possess appropriate mechanical properties, such as strength,
stiffness, and wear resistance, to withstand the forces exerted during
normal activities
• Infection Resistance: Some biomaterials are designed to reduce the
risk of infection, a significant concern in joint replacement surgeries.

• Wear Resistance: The bearing surfaces of hip implants are subject to

wear over time. Advanced biomaterials, such as ceramics and highly
cross-linked polyethylene, have been developed to minimize wear
debris, which can lead to complications like osteolysis and implant
loosening.
 Anatomy of the Hip Joint
The hip joint is a ball-and-socket joint that plays
a crucial role in supporting the weight of the
body and allowing for a wide range of motion.
Bones:
Femur: The thigh bone has a rounded head
that fits into the acetabulum of the pelvis,
forming the ball of the ball-and-socket joint
Pelvis: Composed of three bones—the ilium,
ischium, and pubis. The acetabulum is the
cup-shaped socket located on the lateral
aspect of the pelvis that houses the femoral
head. Fig 1.1: Anatomy of Hip Joint
Ligaments:
• Iliofemoral Ligament: One of the strongest ligaments in the body, it
connects the ilium to the femur and helps prevent excessive
extension of the hip.
• Pubofemoral Ligament: Connects the pubis to the femur and limits
excessive abduction and extension.
• Ischiofemoral Ligament: Connects the ischium to the femur and helps
stabilize the joint, particularly during internal rotation

Fig 1.2: Anatomy of ligament

Articular Cartilage:
A smooth, white tissue that covers the ends of the femur and the
acetabulum.
Joint Capsule:
A fibrous tissue that surrounds the hip joint, providing stability and
containing synovial fluid, which lubricates the joint and nourishes
the cartilage.

Fig 1.3: Anatomy of Hip Joint

 Hip joint problem
• Osteoarthritis: A degenerative joint disease characterized by the breakdown
of cartilage, leading to pain, stiffness, and reduced mobility
• Hip Fractures: Breaks in the femur (thigh bone) near the hip joint, often due
to falls or trauma, particularly in older adults.

Fig 1.4: Hip joint osteoarthritis Fig 1.5: Hip fracture

• Rheumatoid Arthritis: An autoimmune condition that causes
inflammation in the joints, including the hip, resulting in pain and
swelling
• Tendinitis: Inflammation of the tendons around the hip joint, often
due to overuse or repetitive motion
• Avascular Necrosis: A condition where blood supply to the femoral
head is disrupted, leading to bone death and joint collapse.

Fig 1.6: Avascular necrosis of hip joint

Reason for bone damage
• The aging process affects the resilience and repair capacity of
cartilage
• Abnormal joint mechanics, often due to previous injuries or structural
abnormalities, can lead to increased wear on the cartilage.
• Specific risk factors include age, gender, trauma, and joint
morphology. For instance, the median age for primary total hip
replacement in the UK is noted to be 69 years, indicating that older
age is a significant risk factor.
Reason for bone damage
• The association between obesity and osteoarthritis is mentioned,
although it is noted that the relationship is less strong for hip
osteoarthritis compared to knee osteoarthritis.

• Environmental factors such as lifestyle and occupational stressors can

also contribute to the development of osteoarthritis
Types of hip replacement

Total Hip Replacement (THR) Partial Hip Replacement (PHR)

• Total hip replacement involves • Partial hip replacement, also
the complete removal of the known known as hemiarthroplasty,
damaged hip joint and its involves replacing only one part of
replacement with an artificial the hip joint, typically the femoral
joint (prosthesis). This procedure head, while leaving the acetabulum
is typically performed when the intact. This procedure is often
entire joint is severely damaged, performed in cases of hip fractures,
often due to conditions like particularly in older adults.
osteoarthritis, rheumatoid
arthritis, or avascular necrosis
THR PHR
• THR is indicated for extensive joint • PHR is typically used for specific
damage and involves replacing cases like hip fractures and involves
both the femoral head and the replacing only the femoral head,
acetabulum, leading to significant which may be sufficient for certain
pain relief and functional patients but may not provide the
improvement. same functional outcomes as total
hip replacement

Fig 1.7: THR of hip joint Fig 1.8: PHR of hip joint
Hip Replacement Component
• Acetabular Component: This is the socket part
of the hip replacement that is implanted into the
pelvis It usually consists of a metal shell that
may have a plastic, ceramic, or metal liner to
provide a smooth surface for the femoral head
to move against.
• Femoral Component: This component replaces
the femoral head (the ball part of the hip joint).
It typically consists of a metal stem that is
inserted into the femur (thigh bone) and a ball
that fits into the acetabular component. The
femoral head can be made of metal, ceramic, or Fig 1.9: Hip joint components
a combination of materials.
• Cemented Components: These components are fixed in place using a special
bone cement, which allows for immediate stability and is often used in older
patients or those with weaker bones.
• Cementless Components: These rely on the bone growing into the surface of
the implant for stability. They are typically made of porous materials that
encourage bone ingrowth and are often used in younger, more active
patients

Fig 1.10:Cemented and cementless component

• Liner: The liner is placed inside the acetabular component and can be
made of various materials, including polyethylene (plastic), ceramic, or
metal. The choice of liner affects wear rates and longevity of the implant

• Bearing Surface: The bearing surface refers to the interface between the
femoral head and the acetabular liner. Common bearing surfaces include
metal-on-polyethylene, ceramic-on-ceramic, and metal-on-metal, each
with its advantages and disadvantages regarding wear and longevity

• Additional Components (screws) : These may be used to secure the

acetabular component to the pelvis, ensuring stability and proper
alignment
 Material Considerations
• Metals: Commonly used metals
include titanium and cobalt-
chromium alloys, which are strong
and biocompatible.
• Ceramics: Ceramic components are
used for their durability and low wear
rates, particularly in the femoral
head.
• Polyethylene: This plastic material is
often used for the acetabular liner
due to its good wear characteristics
and ability to absorb shock
Fig 1.11: Parts of implants and their material
Metal in hip joint replacement
Titanium, stainless steel, and cobalt-chromium alloys are used in hip
replacements due to their strength and durability.
• Titanium: Known for its strength and biocompatibility, titanium is
commonly used for femoral stems and acetabular components.
• Cobalt-Chromium Alloys: These alloys are also used for femoral heads
due to their durability and resistance to wear

However, issues like metal ion release and wear debris have led to the
decline of some metal-on-metal designs.
Ceramics in hip joint replacement
Ceramic materials are highlighted for their low wear rates and high
durability. They are often used for femoral heads in total hip
replacements, providing a smooth surface that reduces friction against
the acetabular liner

Ceramic-on-ceramic bearings are highlighted, particularly for younger

patients. Ceramics like alumina and zirconia offer high wear resistance
and excellent biocompatibility.
but ceramics can be brittle.
Polymer in hip joint replacement
• Ultra-high-molecular-weight polyethylene (UHMWPE) is often used in
the socket (acetabular) component. Improvements like cross-linked
polyethylene help reduce wear, making it more durable for long-term
use.

• This plastic material is frequently used for the acetabular liner.

Modern generations of highly cross-linked polyethylene have been
developed to reduce wear and improve longevity, making it a popular
choice in hip replacement surgeries.
Other components
• Alumina: This is a type of ceramic that has been used in some hip
replacements, particularly for its biocompatibility and wear
resistance.

• Metal-on-Metal (MoM): This bearing surface involves both the

femoral head and acetabular liner being made of metal. While it
offers some advantages in terms of wear, it has been associated with
complications such as metal ion release and adverse local tissue
reactions.
 Failure Mechanisms in Hip
Replacements
• Polyethylene Wear: Early metal-on-polyethylene (MoP) bearings had high
failure rates due to wear debris generated from softer polyethylene.
Modern highly cross-linked polyethylene has improved wear resistance,
but wear debris can still be a concern, leading to osteolysis (bone loss) and
implant loosening

• Metal Ion Debris: Metal-on-metal (MoM) prostheses can generate metal

ion debris at the bearing surface, which may trigger adverse reactions in
surrounding tissues, leading to localized bone destruction and soft tissue
necrosis. This is particularly problematic in uncemented metal-on-metal
total hip replacements, which have shown higher revision rates due to
these issues
• Implant Fracture: Earlier ceramic implants were more brittle and had a
higher risk of fracture. However, modern ceramic-on-ceramic bearings
have reduced this risk, although they can still be more expensive and
may produce noise (squeaking) during movement

• Aseptic Loosening: It is a major cause of failure in hip replacements,

particularly in cemented implants. This occurs when the bond between
the implant and bone weakens over time, leading to instability and pain.
Factors contributing to loosening include patient activity levels, implant
design, and surgical technique
• Adverse Reactions to Metal Ions: Concerns have been raised about
the potential for systemic effects from metal ion exposure in patients
with metal-on-metal implants, including the unproven association
with an increased risk of cancer. Ongoing monitoring and screening
for metal ion levels are recommended for these patients

• Surgical Technique and Implant Positioning: Improper positioning of

the implant during surgery can lead to complications such as
dislocation or increased wear rates. The choice of surgical approach
(e.g., posterior vs. anterior) can also influence outcomes and
complication rates
• Cement-related Complications: In cemented hip replacements,
complications can arise from cement-related embolic events, which
can occur during the surgical procedure. This has led to a preference
for cementless fixation in certain patient populations
Advances in hip replacement
surgery (1/6)
• Personalized Hip Joint Replacement: Surgeons are now tailoring hip
replacements to individual patients rather than using a standard
approach. This allows for better alignment and more natural joint
movement, reducing the risk of complications like dislocation

• Large Diameter Heads (LDH): Larger heads in hip implants provide a

greater range of motion and stability. This helps patients, especially
younger ones, to return to their normal activities without discomfort.
Advances in hip replacement
surgery (2/6)
• Dual-Mobility Implants: These implants reduce the risk of dislocation
after surgery, which is particularly beneficial for patients with
abnormal spinopelvic mobility

• Enhanced Recovery After Surgery (ERAS): This protocol focuses on

reducing hospital stays by improving pain control, mobilizing patients
earlier, and optimizing their overall health before surgery, resulting in
faster recoveries
Advances in hip replacement
surgery (3/6)
• Robotics and Navigation: Robotic-assisted surgeries and navigation
tools help improve the precision of hip replacement procedures,
leading to better implant positioning and reducing errors

• Advanced Pre-operative Planning: Surgeons use dynamic pre-

operative planning to improve the precision of implant placement,
leading to better long-term outcomes.
Advances in hip replacement
surgery (4/6)
• Coatings: Innovations include metallic surface coatings, such as
diamond-like carbon, which reduce wear and corrosion

• Hydrogels: New materials like polyvinyl alcohol (PVA) hydrogels are

being explored for their soft, cartilage-like properties.

• 3D Printing: Additive manufacturing allows for customized implants

that fit patients' unique anatomy, potentially reducing complications
and improving outcomes
Advances in hip replacement
surgery (5/6)
• Antimicrobial Surface Coatings: Smart surfaces that release
antibiotics or prevent bacterial attachment are being developed to
reduce the risk of infection after surgery. These include coatings
infused with silver or copper, which have natural antimicrobial
properties

• Shape Memory Alloys: Materials like nitinol, which can change shape
in response to temperature or stress, are being explored for joint
replacements. These materials could adapt better to the body
movements and reduce implant failure.
Advances in hip replacement
surgery (6/6)
• Hybrid Biomaterials: Combining different materials, such as polymers
and metals, to create implants that balance strength and flexibility.
For example, Polyether ether ketone (PEEK) reinforced with carbon
fiber offers potential as an alternative to metals, though wear
concerns remain
References
 Fontalis, A., Epinette, J.A., Thaler, M., Zagra, L., Khanduja, V. and
Haddad, F.S., 2021. Advances and innovations in total hip
arthroplasty. SICOT-J, 7.
 Ghadirinejad, K., Day, C.W., Milimonfared, R., Taylor, M., Solomon, L.B.
and Hashemi, R., 2023. Fretting Wear and Corrosion-Related Risk
Factors in Total Hip Replacement: A Literature Review on Implant
Retrieval Studies and National Joint Replacement Registry
Reports. Prosthesis, 5(3), pp.774-791.
 Mihalko, W.M., Haider, H., Kurtz, S., Marcolongo, M. and Urish, K.,
2020. New materials for hip and knee joint replacement: What's hip
and what's in kneed?. Journal of Orthopaedic Research®, 38(7),
pp.1436-1444.
 Bischoff, P., Kramer, T.S., Schröder, C., Behnke, M., Schwab, F., Geffers,
C., Gastmeier, P. and Aghdassi, S.J.S., 2023. Age as a risk factor for
surgical site infections: German surveillance data on total hip
replacement and total knee replacement procedures 2009 to
2018. Eurosurveillance, 28(9), p.2200535.
 Aqil, A. and Shah, N., 2020. Diagnosis of the failed total hip
replacement. Journal of clinical orthopaedics and trauma, 11(1), pp.2-
8.