The diploma thesis is focused on the run-in phase of total hip replacement. Mutual adjustment of contact surfaces takes place in this phase and polyethylene acetabular cup shows notable creep behaviour. The magnitude of creep deformations is assessed experimentally in relation to acetabular cups orientation in human body after its implantation. The condition of articulating surfaces is also assessed as well as resulting coefficient of friction in run-in phase. Physiological load and kinematics of the artificial joint as well as physiological conditioning is achieved by new module of existing joint simulator, which is created as part of this thesis. Deformations and condition of articulating surfaces are assessed via optical methods and SEM. Findings about the run-in phase are compared with existing FEM analyses to evaluate simplifications used in these analyses. Measurement of creep deformations has also potential to improve the accuracy of acetabular wear diagnosis in clinical practice.

Introduction Developmental dysplasia of the hip has since 1953 in Sweden most commonly been treated with the von Rosen splint. Over time, different types of splints have been developed, one of which is the Orebro splint. In some countries it is advised to have long-term follow-ups with radiological exams of patients treated with a splint. In Orebro, there is currently no mandatory follow-up after treatment with the Orebro splint. Aim The aims were to investigate how many children, despite treatment with the Orebro splint, developed dysplasia in the adolescence period, to study the hip function in children treated with the Orebro splint and investigate if there were any differences in treatment outcomes between males and females. Methods All children born between 2000 and 2012, treated with the Orebro splint, were eligible for inclusion. The outcome measures for quality of life and hip function were EQ-5D-Y-VAS and CHOHES score. The outcome measures for the pelvic radiological exams were Acetabular Index and Center Edge angle. Results Data from 46 patients were collected, 7 males and 39 females. 5,3% of the patients showed residual dysplasia. Both males and females showed overall good results in the radiological images, the surveys, and the clinical exams. The results did not show significant differences between the genders. Conclusion Even though our participants reported an overall good quality of life, our results showed some cases of residual dysplasia. However, the small sample size makes it difficult to assess whether the Orebro splint is equal to other splints regarding treatment outcomes.

Total hip joint prostheses made of CoCrMo heads versus ultra high molecular weight polyethylene (UHMWPE) cups have a limited lifetime, mainly due to the wear of the UHMWPE cups as a result of high friction between the articulating surfaces leading to osteolysis and implant loosening with revision surgery becoming inevitable in more active patients. Tribology plays an important role in developing the design, minimizing wear and reducing friction of hip joint prostheses in order to improve their long-term performance, with good lubricating properties. Metal-on-metal hip resurfacing prostheses have shown significantly lower wear rates compared with conventional metal-on-polyethylene implants and thus osteolysis is potentially reduced leading to increased lifetime of the prosthesis. Nevertheless, excessive wear of metal-on-metal joints leads to metal ion release, causing pseudo-tumours and osteolysis. An alternative approach to such bearings is the use of newly developed carbon fiber-reinforced poly-ether-ether-ketone (CFR PEEK) acetabular cups articulating against ceramic femoral heads due to their better wear resistance compared to UHMWPE. In this study, therefore, friction and lubrication properties of large diameter, as cast, Co-Cr-Mo metal-on-metal hip resurfacing implants with various diameters and clearances have been investigated and compared to those of the newly developed zirconia toughened alumina (ZTA) ceramic femoral heads articulating against carbon fiber reinforced poly-ether-ether-ketone (CFR PEEK) acetabular cups with different diameters and clearances. Friction hip simulator was used to measure frictional torque and then friction factors were calculated along with Sommerfeld numbers leading to Stribeck analysis and hence the lubricating mode was also investigated. This involved using lubricants based on pure bovine serum (BS) and diluted bovine serum (25 vol. %BS+75 vol. %distilled water) with and without carboxymethyl cellulose (CMC) (as gelling agent). Standard Rheometer was used to measure lubricant viscosity ranged from 0.0014 to 0.236 Pas at a shear rate of 3000 . Pure bovine serum, diluted bovine serum without CMC and with CMC (25BS+75DW+0.5gCMC and +1gCMC) showed pseudoplastic flow behaviour up to shear rate of ~139 s⁻¹ above which a Newtonian flow with significant increase in shear stress was observed. The viscosity flow curves for the 25BS+75DW+2gCMC, +3.5gCMC and +5gCMC showed only shear thinning up to a shear rate of 3000 . The shear rate application modified the flow behaviour of bovine serum from a pseudoplastic to a Newtonian flow depending on its purity and CMC content. This will cause a different frictional behaviour depending on joint diameter and clearance, as seen in this work. The experimental data were compared with theoretical iv predictions of the lubricating regimes by calculating theoretical film thickness and lambda ratio. The metal-on-metal Biomet ReCaps showed similar trends of Stribeck curves, i.e. friction factors decreased from ~0.12 to ~0.05 as Sommerfeld numbers increased in the range of viscosities ~0.001-0.04Pas indicating mixed lubrication regimes above which the friction factor increased to ~0.13 at a viscosity of 0.236Pas. The Stribeck analyses suggested mixed lubrication as the dominant mode with the lowest friction factor in the range ~0.09 - ~0.05 at the physiological viscosities of ~0.01 to ~0.04 Pas and that such joints can be used for more active patients as compared to the conventional total hip replacement joints with 28mm diameter. The Stribeck curves for all ZTA ceramic-on-CFR PEEK components illustrated a similar trend with BS fluids showing higher friction factors (in the range 0.22-0.13) than the diluted BS+CMC fluids (in the range 0.24-0.05). The friction tests revealed boundary-mixed lubrication regimes for the ZTA ceramic-on-CFR-PEEK joints. The results, so far, are promising and suggest clearly that the newly developed ZTA ceramic femoral heads articulating against CFR PEEK cups have similar friction and lubrication behaviour at optimum clearances to those of currently used metal-onmetal hip resurfacing implants at the range of viscosities 0.00612 to 0.155Pas. These results clearly suggest that the ZTA ceramic-on-CFR-PEEK joints showed low friction at the physiological viscosities of ~0.01Pas in the range ~0.1-0.05, suggesting that these novel joints may be used as an alternative material choice for the reduction of osteolysis. The result of this investigation has suggested that the optimum clearance for the 52mm diameter MOM Biomet ReCaps could be ~170μm. However, 48 and 54mm joints showed lower friction due to clearances to be >200μm. For the 52mm ZTA ceramic-on-CFR-PEEK joints the optimum clearance seems to be ≥ 630μm radial clearance. These results suggested that increased clearance bearings have the potential to generate low friction and hence no risk of micro- or even macro-motion for the ceramic-on-CFR-PEEK joints. This study found no correlation between theoretical predictions and experimental data for all metal-onmetal and ZTA ceramic-on-CFR PEEK bearings at the physiological viscosity (0.0127Pas). However, at lubricant viscosity of 0.00157Pas, the theoretical prediction of lubrication regime correlated well with the experimental data, both illustrating boundary lubrication. As expected, a decrease in viscosity resulted decrease in the film thickness.

A esquistossomose é uma doença causada por trematódeos do gênero Schistosoma. Dentre os genes identificados no transcriptoma do parasita, membros da família gênica SmVAL (Schistosoma mansoni Venom Allergen-Like) foram apontados como candidatos vacinais. SmVALs foram identificadas em secreções de cercárias e esquistossômulos cultivados in vitro, os transcritos SmVAL4 e 24 foram localizados nas glândulas acetabulares de germ ball e a proteína nativa SmVAL4 foi identificada em extrato de cercárias, indicando funções durante a penetração da pele. Já os transcritos SmVAL13 e 14 foram localizados na glândula esofágica anterior de vermes adultos, sugerindo papéis no processo de alimentação sanguínea. A imunização com as proteínas rSmVAL4, 6, 7, 13, 14 e 18 coadministradas não protegeu camundongos contra o desafio experimental, porém, observou-se uma diminuição do número de fêmeas e do número de ovos no grupo imunizado. A investigação de funções para as proteínas secretadas mostrou que a rSmVAL18 interage com plasminogênio in vitro favorecendo a invasão do hospedeiro. / Schistosomiasis is a disease caused by trematodes of the genus Schistosoma. Among the genes identified in the parasite transcriptome, members of SmVAL (Schistosoma mansoni Venom Allergen-Like) gene family were proposed as vaccine candidates. SmVALs were identified in cercariae and schistosomule secretions in vitro, the SmVAL4 and 24 transcripts were located to the germ ball acetabular glands and SmVAL4 native protein was identified in cercariae extract, indicating functions in skin penetration. On the other hand, SmVAL13 and 14 transcripts were located to the anterior esophageal gland of adult worms, suggesting roles in the blood feeding processes. Immunization with rSmVAL4, 6, 7, 13, 14 and 18 proteins co-administered did not protected mice against experimental challenge, however, there was a decrease in the number of females and the number of eggs in the immunized group. The investigation of functions for secreted proteins showed that rSmVAL18 interacts with plasminogen in vitro thus favoring the host invasion.

Dans le cadre de ce travail de thèse nous nous sommes intéressés à deux pathologies fémoro-acétabulaires dont la pathogénie semble liée aux « conditions biomécaniques » locales. La première partie de cette thèse était consacrée à l’analyse de l’influence de l’anatomie osseuse sur l’apparition de l’ostéonécrose aseptique de la tête fémorale. Nous avons réalisé des analyses analytique de l’anatomie des patients souffrant d’ONA (notre hypothèse était que nous retrouverions un profil anatomique particulier chez les patients souffrant d’ONA par rapport à la population générale.Nos résultats démontrent que les patients souffrant d’ONA présentent fréquemment une anatomie particulière. Notre modèle en éléments finis de la hanche de dix patients souffrant d’ONAi, a permis de valider notre hypothèse puisqu’il existe un recouvrement quasi-parfait, entre la zone de nécrose osseuse et celle supportant les contraintes fémoro-acétabulaires. L’hypothèse selon laquelle une pathogénie mécanique puisse être responsable du développement l’ostéonécrose aseptique de la tête fémorale est vérifiée par nos travaux.Dans la seconde partie de cette thèse nous avons décrit le rôle mécanique du LA par une évaluation multimodale combinant analyse cinématique,de contraintes fémoro-labrales et enfin analyse en éléments finis. Les résultats de ces études ont permis de constater que le LA se déforme lors du mouvement reflétant une transmission de contraintes fémoro-labrales lors du mouvement d’abduction. Ces contraintes ont pu être enregistrées à l’aide de capteurs piezo-resistifs, elles augmentent lors du mouvement d’abduction. Ces éléments ont été confirmés par notre modèle en éléments finis. / As parts of this thesis we focused on two femoro-acetabular diseases whose pathogenesis appears to be related to "biomechanical local conditions". The first part of this thesis was devoted to analyze the influence of bony anatomy on the development of aseptic osteonecrosis of the femoral head. We thus aimed to analyze ONA patients’ anatomy in a matched-controlled fashioned study. Our results demonstrate that patients with ONA often present a particular anatomy. A finite element model of ten iONA hips validated our hypothesis since we found an overlap between bone necrosis area and femoro-acetabular strains bearing area. The assumption that a mechanical pathogenesis may be responsible for ONA development has been confirmed by our results.If the relationship between bony anatomy and bone disease is quite intuitive, acetabular labrum involvement (AL) in the regulation of femoro-acetabular mechanical conditions is unclear. The mechanical role of the AL is widely controversial, though some authors attributed, AL, a key role in hip joint’s mechanics, others advocated its complete resection in case of painful traumatic tears. We tried to demonstrate AL’s mechanical role in a multimodal analysis combining kinematic, strains and finite element analysis. The AL deforms during abduction movement reflecting femoro-labral strains’ transmission. Those strains have been recorded using piezo-resistive sensors, they increase during adduction to abduction movement. These elements were confirmed by our finite element model: labral resection changed the Femoro-acetabular strains to the detriment of cartilage surfaces.

A esquistossomose é uma doença causada por trematódeos do gênero Schistosoma. Dentre os genes identificados no transcriptoma do parasita, membros da família gênica SmVAL (Schistosoma mansoni Venom Allergen-Like) foram apontados como candidatos vacinais. SmVALs foram identificadas em secreções de cercárias e esquistossômulos cultivados in vitro, os transcritos SmVAL4 e 24 foram localizados nas glândulas acetabulares de germ ball e a proteína nativa SmVAL4 foi identificada em extrato de cercárias, indicando funções durante a penetração da pele. Já os transcritos SmVAL13 e 14 foram localizados na glândula esofágica anterior de vermes adultos, sugerindo papéis no processo de alimentação sanguínea. A imunização com as proteínas rSmVAL4, 6, 7, 13, 14 e 18 coadministradas não protegeu camundongos contra o desafio experimental, porém, observou-se uma diminuição do número de fêmeas e do número de ovos no grupo imunizado. A investigação de funções para as proteínas secretadas mostrou que a rSmVAL18 interage com plasminogênio in vitro favorecendo a invasão do hospedeiro. / Schistosomiasis is a disease caused by trematodes of the genus Schistosoma. Among the genes identified in the parasite transcriptome, members of SmVAL (Schistosoma mansoni Venom Allergen-Like) gene family were proposed as vaccine candidates. SmVALs were identified in cercariae and schistosomule secretions in vitro, the SmVAL4 and 24 transcripts were located to the germ ball acetabular glands and SmVAL4 native protein was identified in cercariae extract, indicating functions in skin penetration. On the other hand, SmVAL13 and 14 transcripts were located to the anterior esophageal gland of adult worms, suggesting roles in the blood feeding processes. Immunization with rSmVAL4, 6, 7, 13, 14 and 18 proteins co-administered did not protected mice against experimental challenge, however, there was a decrease in the number of females and the number of eggs in the immunized group. The investigation of functions for secreted proteins showed that rSmVAL18 interacts with plasminogen in vitro thus favoring the host invasion.

Total hip joint prostheses made of CoCrMo heads versus ultra high molecular weight polyethylene (UHMWPE) cups have a limited lifetime, mainly due to the wear of the UHMWPE cups as a result of high friction between the articulating surfaces leading to osteolysis and implant loosening with revision surgery becoming inevitable in more active patients. Tribology plays an important role in developing the design, minimizing wear and reducing friction of hip joint prostheses in order to improve their long-term performance, with good lubricating properties. Metal-on-metal hip resurfacing prostheses have shown significantly lower wear rates compared with conventional metal-on-polyethylene implants and thus osteolysis is potentially reduced leading to increased lifetime of the prosthesis. Nevertheless, excessive wear of metal-on-metal joints leads to metal ion release, causing pseudo-tumours and osteolysis. An alternative approach to such bearings is the use of newly developed carbon fiber-reinforced poly-ether-ether-ketone (CFR PEEK) acetabular cups articulating against ceramic femoral heads due to their better wear resistance compared to UHMWPE. In this study, therefore, friction and lubrication properties of large diameter, as cast, Co-Cr-Mo metal-on-metal hip resurfacing implants with various diameters and clearances have been investigated and compared to those of the newly developed zirconia toughened alumina (ZTA) ceramic femoral heads articulating against carbon fiber reinforced poly-ether-ether-ketone (CFR PEEK) acetabular cups with different diameters and clearances. Friction hip simulator was used to measure frictional torque and then friction factors were calculated along with Sommerfeld numbers leading to Stribeck analysis and hence the lubricating mode was also investigated. This involved using lubricants based on pure bovine serum (BS) and diluted bovine serum (25 vol. %BS+75 vol. %distilled water) with and without carboxymethyl cellulose (CMC) (as gelling agent). Standard Rheometer was used to measure lubricant viscosity ranged from 0.0014 to 0.236 Pas at a shear rate of 3000 . Pure bovine serum, diluted bovine serum without CMC and with CMC (25BS+75DW+0.5gCMC and +1gCMC) showed pseudoplastic flow behaviour up to shear rate of ¿139 above which a Newtonian flow with significant increase in shear stress was observed. The viscosity flow curves for the 25BS+75DW+2gCMC, +3.5gCMC and +5gCMC showed only shear thinning up to a shear rate of 3000 . The shear rate application modified the flow behaviour of bovine serum from a pseudoplastic to a Newtonian flow depending on its purity and CMC content. This will cause a different frictional behaviour depending on joint diameter and clearance, as seen in this work. The experimental data were compared with theoretical iv predictions of the lubricating regimes by calculating theoretical film thickness and lambda ratio. The metal-on-metal Biomet ReCaps showed similar trends of Stribeck curves, i.e. friction factors decreased from ~0.12 to ~0.05 as Sommerfeld numbers increased in the range of viscosities ~0.001-0.04Pas indicating mixed lubrication regimes above which the friction factor increased to ~0.13 at a viscosity of 0.236Pas. The Stribeck analyses suggested mixed lubrication as the dominant mode with the lowest friction factor in the range ~0.09 - ~0.05 at the physiological viscosities of ~0.01 to ~0.04 Pas and that such joints can be used for more active patients as compared to the conventional total hip replacement joints with 28mm diameter. The Stribeck curves for all ZTA ceramic-on-CFR PEEK components illustrated a similar trend with BS fluids showing higher friction factors (in the range 0.22-0.13) than the diluted BS+CMC fluids (in the range 0.24-0.05). The friction tests revealed boundary-mixed lubrication regimes for the ZTA ceramic-on-CFR-PEEK joints. The results, so far, are promising and suggest clearly that the newly developed ZTA ceramic femoral heads articulating against CFR PEEK cups have similar friction and lubrication behaviour at optimum clearances to those of currently used metal-onmetal hip resurfacing implants at the range of viscosities 0.00612 to 0.155Pas. These results clearly suggest that the ZTA ceramic-on-CFR-PEEK joints showed low friction at the physiological viscosities of ~0.01Pas in the range ~0.1-0.05, suggesting that these novel joints may be used as an alternative material choice for the reduction of osteolysis. The result of this investigation has suggested that the optimum clearance for the 52mm diameter MOM Biomet ReCaps could be ~170¿m. However, 48 and 54mm joints showed lower friction due to clearances to be >200¿m. For the 52mm ZTA ceramic-on-CFR-PEEK joints the optimum clearance seems to be ¿ 630¿m radial clearance. These results suggested that increased clearance bearings have the potential to generate low friction and hence no risk of micro- or even macro-motion for the ceramic-on-CFR-PEEK joints. This study found no correlation between theoretical predictions and experimental data for all metal-onmetal and ZTA ceramic-on-CFR PEEK bearings at the physiological viscosity (0.0127Pas). However, at lubricant viscosity of 0.00157Pas, the theoretical prediction of lubrication regime correlated well with the experimental data, both illustrating boundary lubrication. As expected, a decrease in viscosity resulted decrease in the film thickness.

Migration within the body of an infected host is one of the most important parts in the life cycle of flukes, including schistosomes. Migration of avian and mammalian visceral schistosomes has been a quite well studied topic (Haas a Haeberlein, 2009), which became more attractive after the discovery of T. regenti, an avian schistosome which is able to migrate through the nervous tissues of infected birds and mammals as well. Migration of T. regenti and T. szidati schistosomula within the definitive (duck) and the accidental (mouse) hosts is the main topic of the diploma thesis. This work continues with the research of K. Blažová (Faculty of Science, Charles University in Prague) who studied migration of T. regenti within the definitive hosts infected perorally with cercariae or hepatopancreases of the infected intermediate snail, Radix lagotis (unpblished). She proved that T. regenti schistosomula are able to use the central nervous system for migration to the nasal mucosa of infected birds. In our work, we focused on the early phase of migration within the perorally infected birds and mice. Invasion of esophagus by T. regenti cercariae in vitro is not conditioned by secretion of glandular products, including cathepsin B2 of T. regenti (TrCB2). Activity of TrCB2 against mucins, the main components...

La révision d’arthroplastie de la hanche en cas d’important déficit osseux acétabulaire peut être difficile. Les reconstructions avec cupule de très grand diamètre ou cupule « jumbo » (≥ 62 mm chez la femme et ≥ 66 mm chez l’homme) sont une option thérapeutique. Nous voulions évaluer la préservation et la restauration du centre de rotation de la hanche reconstruite en la comparant au coté controlatéral sain ou selon les critères de Pierchon et al. Nous voulions également évaluer la stabilité du montage à un suivi d’au moins 2 ans. Il s’agissait de 53 cas consécutifs de révision acétabulaire pour descellement non septique avec implantation d’une cupule jumbo sans ciment à l’Hôpital Maisonneuve-Rosemont. Le déficit osseux évalué selon la classification de Paprosky et al. Les cupules implantées avaient un diamètre moyen de 66 mm (62-81) chez les femmes et 68 mm (66-75) chez les hommes. L’allogreffe osseuse morcelée et massive était utilisée dans 34 et dans 14 cas respectivement. La cupule a été positionnée avec un angle d’inclinaison moyen de 41.3° (26.0-53.0). Le centre de rotation de la hanche reconstruite a été jugé satisfaisant dans 78% de cas sur l'axe médiolatéral, 71% sur l'axe craniopodal et amélioré dans 27% dans cet axe. Au recul moyen radiologique de 84.0 mois (24.0-236.4) et clinique de 91.8 mois (24.0 – 241.8): 6 cas étaient décédés, 3 perdus au suivi. On a observé le descellement radiologique dans un 1 cas, la luxation récidivante dans 5 cas et l’infection dans 4 cas. Le retrait de la cupule a été effectué dans 2 cas pour infection. L’ostéointégration des greffons osseux était complète dans tous les cas sauf 3. Les scores cliniques étaient pour le HHS de 82 +/-17, le WOMAC de 86 +/- 14 et le SF-12 physique de 46 +/- 12 et mental 53 +/-13. La cupule jumbo peut être considérée comme un moyen fiable pour gérer le déficit osseux dans les révisions acétabulaires. Elle permet de conserver ou d’améliorer la position du centre de rotation physiologique de la hanche. La fixation sans ciment favorise l’ostéointégration de la cupule et permet une stabilité à moyen terme. Le taux de complications est comparable ou inférieur à d'autres procédures de reconstruction. / Acetabular implant revision with large bone defects, can be challenging. One of the reconstruction options is a large outer diameter cup or “jumbo cup” (≥62 mm in women and ≥66 mm in men). We hypothesized that cementless jumbo cups is a reliable technique to preserve or reconstruct hip center of rotation. We also evaluated stability at least 2 two years follow up. Fifty-three consecutive non septic loosening acetabular arthroplasty revisions at Hopital Maisonneuve-Rosemont where a cementless jumbo cup was used were assessed. Bone defect was evaluated according to Paprosky classification. Mean implanted component size was 66 mm (62-81) in women and 68 mm (66-75) in men. Cancelous bone chips allograft was used in 34 cases and bulk bone allograft in 14. Immediate postoperative AP view showed a mean abduction cup angle of 41.3° (26.0-53.0). Hip centre were found at satisfy position in 78% on mediolateral axis, in 71% on craniopodal axis and it was improved in 27% in this late axis. At the mean follow up of 84.0 months (24.0-236.4) radiologically and 91.8 months (24.0-241.8) clinically: 6 patients were died and 3 were lost of follow up. Complications were: dislocation in 5 cases (4 revisions with constrained liner), infection in 4 cases (2 treated conservatively and 2 revised in 2 times procedure) and radiographic loosening in 1 case. Bone graft integration was completed in all except in 3 cases. Clinically, the mean HHS was 82% +/- 17, WOMAC 86 +/- 14, physical SF-12 46 +/- 12 and mentally SF-12 53 +/- 13. Jumbo cups appear as a reliable procedure to manage bone loss in acetabular revision. It allows conservation or improvement of physiologic hip center. Also, cementless fixation promote bone integration. with subsequent cup stabilitity. The complication rate is comparable or may be less than others reconstruction procedures .

No description available.