Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.

The outcomes of hip resurfacing arthroplasty are largely dependent on prosthesis positioning. The biomechanics of notching, accurate measurement of femoral implant version and the use of computer navigation of the Birmingham Hip Resurfacing procedure were studied in this work. First, biomechanical tests were conducted with varying notch sizes and femoral positions, and it was determined that anterior notching weakens the construct (p=0.027) when the femur is in flexion and less so when in single-leg stance (p=0.155). Second, three novel techniques were used by three observers to measure the implant version in a lateral radiograph to determine which displayed a more accurate intra-class correlation. The third study examined the role of computer navigation as a learning device for improving the accuracy of femoral implant positioning using a manual alignment jig to curtail sequelae associated with malalignment.

The outcomes of hip resurfacing arthroplasty are largely dependent on prosthesis positioning. The biomechanics of notching, accurate measurement of femoral implant version and the use of computer navigation of the Birmingham Hip Resurfacing procedure were studied in this work. First, biomechanical tests were conducted with varying notch sizes and femoral positions, and it was determined that anterior notching weakens the construct (p=0.027) when the femur is in flexion and less so when in single-leg stance (p=0.155). Second, three novel techniques were used by three observers to measure the implant version in a lateral radiograph to determine which displayed a more accurate intra-class correlation. The third study examined the role of computer navigation as a learning device for improving the accuracy of femoral implant positioning using a manual alignment jig to curtail sequelae associated with malalignment.

Hip resurfacing arthroplasty is touted as an attractive alternative to total hip arthroplasty for treatment of severe joint pain and limited mobility in young patients because it is bone conserving and allows for a greater range of motion. There is concern in the orthopaedic community, however, regarding surgically-induced deformation of hip resurfacing cups. Cup deformation could potentially compromise the tight clearance between the femoral head and cup, resulting in increased wear, acoustic emissions, and joint binding. This phenomenon has been investigated both experimentally and with finite element analysis (FEA). Finite element studies have contributed significantly to our understanding of cup deformation, such as the effect of different cup dimensions on deformation results, but unfortunately such studies were deficient in a number of ways. The first objective of this thesis was to create a three-dimensional finite element model of resurfacing cup deformation that addressed the limitations of previous models pertaining to pelvic geometry, meshing, material properties, and cup insertion, in order to more fully elucidate cup deformation. The second objective was to demonstrate that two-dimensional characterization of cup deformation at the cup rim is insufficient, by more fully characterizing cup deformation in three-dimensions. The geometry was obtained via laser scanning and digital processing of a hemi-pelvis replica, meshing was performed without the use of shell elements, linear elasticity with strain-hardening after the onset of yielding was assigned to the cup and bone, and the most appropriate method for simulation of cup insertion was determined via two-dimensional axisymmetric analyses. Also, cup deformation was characterized in three-dimensions. The key findings of this thesis are that bone yield behaviour has important implications on press-fitting simulation, and the cup deforms irregularly and possibly plastically during press-fitting. A three-dimensional finite element model of resurfacing cup deformation that addressed the limitations of previous models was successfully created. Measurement of deformation at the rim of the resurfacing cup for characterization of cup deformation is insufficient; full characterization of cup deformation in three-dimensions is necessary. Future work should incorporate clinical testing to obtain model inputs such as impact and muscle forces, as well as model validation.

Hip resurfacing arthroplasty is touted as an attractive alternative to total hip arthroplasty for treatment of severe joint pain and limited mobility in young patients because it is bone conserving and allows for a greater range of motion. There is concern in the orthopaedic community, however, regarding surgically-induced deformation of hip resurfacing cups. Cup deformation could potentially compromise the tight clearance between the femoral head and cup, resulting in increased wear, acoustic emissions, and joint binding. This phenomenon has been investigated both experimentally and with finite element analysis (FEA). Finite element studies have contributed significantly to our understanding of cup deformation, such as the effect of different cup dimensions on deformation results, but unfortunately such studies were deficient in a number of ways. The first objective of this thesis was to create a three-dimensional finite element model of resurfacing cup deformation that addressed the limitations of previous models pertaining to pelvic geometry, meshing, material properties, and cup insertion, in order to more fully elucidate cup deformation. The second objective was to demonstrate that two-dimensional characterization of cup deformation at the cup rim is insufficient, by more fully characterizing cup deformation in three-dimensions. The geometry was obtained via laser scanning and digital processing of a hemi-pelvis replica, meshing was performed without the use of shell elements, linear elasticity with strain-hardening after the onset of yielding was assigned to the cup and bone, and the most appropriate method for simulation of cup insertion was determined via two-dimensional axisymmetric analyses. Also, cup deformation was characterized in three-dimensions. The key findings of this thesis are that bone yield behaviour has important implications on press-fitting simulation, and the cup deforms irregularly and possibly plastically during press-fitting. A three-dimensional finite element model of resurfacing cup deformation that addressed the limitations of previous models was successfully created. Measurement of deformation at the rim of the resurfacing cup for characterization of cup deformation is insufficient; full characterization of cup deformation in three-dimensions is necessary. Future work should incorporate clinical testing to obtain model inputs such as impact and muscle forces, as well as model validation.

Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.

Metal-on-metal (MM) bearings have been considered as an alternative to conventional metal-on-polyethylene (MPE) bearings because of their lower volumetric wear, but concern exists due to potential metal hypersensitivity. Metal hypersensitivity reactions have been thought to be T cell-mediated delayed type hypersensitivity (DTH) reaction. However some of the MM periprosthetic tissues show the presence of B- and plasma cells, as well as massive fibrin exudation, which are not characteristic of a DTH reaction. Therefore, the exact nature of the hypersensitivity reaction(s) MM implants remains unclear. The present study aimed to compare the phenotypes of lymphocytes from the peripheral blood and synovial fluid of patients with failed MM and MPE implants, and from volunteers with no implant (peripheral blood only). Results in peripheral blood showed differences in the T-cell populations depending on the implant type. This included differences in the proportions of T-helper and T-cytotoxic cells, and T-cells expressing IFN-g. Results in synovial fluid showed a significant difference between MM and MPE groups for the B-cells. Both groups depicted a predominance of T-cell lymphocytes in synovial fluid and overall larger proportions of memory cells than in peripheral blood, but group sizes were rather small. Overall, T-cell cytokine expression (analyzed in peripheral blood only because of the limited number of synovial fluid samples) did not exhibit characteristics of a DTH reaction and the proportions of memory lymphocytes did not indicate activation of a specific subset in the MM group. Nevertheless, group sizes still remain to be increased.

Theme of this diploma thesis is the design of ice resurfacer. It deals with design of a special automatic vehicle, which is able to execute the process of ice resurfacing, without human control. With regard to the protection of the environment and health of the people inside rink arena, the propulsion system is based on the electric motor, with batteries as a power source. Final design reflects innovation of the automatization in this area. The appearance supports the uniqueness and the timelessness of the ice resurfacer and it is build up on the principles of the streamline design, with emphasis on the purity of form.

Metal-on-metal hip resurfacing arthroplasty (MoMHRA) has undergone a recent resurgence as an alternative treatment option for young and active patients with significant hip osteoarthritis. Despite the satisfactory short-term implant survivorship, abnormal periprosthetic soft-tissue masses relating to the hip joint (pseudotumours) are being increasingly reported. These were found to be locally destructive, requiring revision surgery in a high proportion (75%) of patients, the outcome of which is poor. However, there is currently no definitive evidence of potential mechanisms involved in the occurrence of such destructive soft tissue masses. The broad aims of this thesis were: 1) to determine the extent of this emerging clinical complication (pseudotumour) with a high revision burden; and 2) to determine whether pseudotumour results from a local biological reaction to an increased wear debris burden generated by excessive MoMHRA implant wear. A clinical study investigated the prevalence of, and association between, pseudotumours and serum metal ion levels in 158 MoMHRA patients (201 hips). The overall prevalence of pseudotumour was found to be 4%, considerably higher than previously reported. The study also established that pseudotumour only occurred with elevated metal ion levels, suggesting the underlying cause is increased wear. It was postulated that pseudotumours are likely to be a biological reaction to the large amount of metal debris generated in vivo due to excessive wear. Two potential biological reactions mediating the occurrence of pseudotumours were then investigated. An in vitro clinical study demonstrated that systemic hypersensitivity type IV reaction, mediated by lymphocyte reactivity to these metals, is not the dominant biological response involved in pseudotumours. A further in vitro experiment demonstrated that metal particle-induced cytotoxicity is likely to be an important factor leading to pseudotumours. Subsequent research focused, firstly, on assessing the magnitude of bearing surface wear that occurs in pseudotumour patients, and secondly on elucidating the potential wear mechanism responsible for the increased implant wear in these patients. A retrieval study demonstrated that MoMHRA implants revised due to pseudotumour were associated with significantly greater linear wear rates. This combined with the metal ion data confirmed that pseudotumour is associated with increased wear at the MoM articulation. An edge-loading wear pattern was always found in the pseudotumour group. An in vivo study was then developed to investigate whether the edge-loading occurs during functional activities. Edge-loading in the pseudotumour group was found to occur with up to 4-fold increase in duration and up to 7-fold increase in force. This in vivo finding supported the in vitro retrieval study finding of an edge-loading wear pattern in the pseudotumour group, suggesting that edge-loading during functional activities is an important in vivo mechanism responsible for localised high wear and subsequent elevation of metal ion levels in MoMHRA patients with pseudotumours. It is concluded that pseudotumour is likely to result from a local biological reaction to increased metal debris load, generated by excessive MoMHRA implant wear due to edge-loading. In susceptible patients, the dose-dependent cytotoxicity of wear debris leads to subsequent necrosis of periprosthetic soft tissues. Clinicians need to be aware of pseudotumours and surgeons should undertake MoMHRA with great care in the knowledge that even with satisfactory component positioning, the problem can occur. In evaluating MoMHRA patients with unexplained symptoms with normal plain radiographs, further investigation with soft-tissue imaging modalities such as ultrasound or MRI is recommended.

The third generation of hip resurfacing commenced in the U.K. in the 1990’s with the Birmingham Hip Resurfacing system and is now becoming more commonplace as an attractive alternative for young and active patients due to premature failure in total hip replacement in this patient group. However the Swedish National Hip Arthroplasty Register (2010) suggests that premature failure of resurfacing arthroplasty may be more prevalent than first expected. The aim of this study is to investigate, through Finite Element Analysis, the short, medium and long term performance of Poly Methyl Methacrylate (PMMA) bone cement of the femoral component in hip resurfacing arthroplasty. The study takes a forensic engineering approach, analysing the performance of PMMA bone cement in order to provide understanding, awareness and an insight into lifestyle options. Finite Element Analysis explores and models the effect of resting periods during daily activities, patients’ bone quality and PMMA bone cement Young’s modulus on the PMMA bone cement stresses within the femoral hip resurfacing component. Mechanical tests are used to illustrate the use of the Finite Element Analysis results. Contributing to knowledge, this study verifies the significance of high metal-on-metal friction due to resting periods, developing a dynamic FEA model to quantify the premature fatigue failure of PMMA bone cement, within the femoral component of hip resurfacing arthroplasty. A decrease in bone quality added to the effect of resting periods increase the risk of PMMA fatigue failure and PMMA-metal interface failure due to an increase of PMMA tensile and shear stresses, suggesting that patients with low bone quality should avoid hip resurfacing procedures. The use of low PMMA Young’s modulus could greatly enhance the long term success of hip resurfacing arthroplasty generally and specifically reduce the risk of interface failure and PMMA bone cement failure due to resting periods and patient bone quality. Moreover, this study shows that the consequence of PMMA fatigue failure and PMMA-metal interface failure must be included in the design, patient selection, screening process, post-operative rehabilitation and long term lifestyle attributes. This study suggests that occupational therapists and patients with hip resurfacing arthroplasty should be aware of high metal-on-metal friction situations, which could lead to early failure indicated by this research. The deleterious effect of resting periods indicated by this research could be alleviated by appropriate re-initiation of synovial lubrication by movement prior to full loading. Recommendations for further work include the compilation of a PMMA bone-cement fatigue properties database and further development of the FEA modelling technique for application upon other arthroplasty procedures.