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Synthesis Lectures on Biomedical Engineering Armando Reyes Rojas · Alfredo Aguilar Elguezabal · Alessandro Alan Porporati · Miguel Bocanegra Bernal · Hilda Esperanza Esparza Ponce Performance of Metals and Ceramics in Total Hip Arthroplasty Synthesis Lectures on Biomedical Engineering Series Editor John Enderle, Storr, USA This series consists of concise books on advanced and state-of-the-art topics that span the field of biomedical engineering. Each Lecture covers the fundamental principles in a unified manner, develops underlying concepts needed for sequential material, and pro- gresses to more advanced topics and design. The authors selected to write the Lectures are leading experts on the subject who have extensive background in theory, application, and design. The series is designed to meet the demands of the 21st century technology and the rapid advancements in the all-encompassing field of biomedical engineering. Armando Reyes Rojas · Alfredo Aguilar Elguezabal · Alessandro Alan Porporati · Miguel Bocanegra Bernal · Hilda Esperanza Esparza Ponce Performance of Metals and Ceramics in Total Hip Arthroplasty Armando Reyes Rojas Alfredo Aguilar Elguezabal Laboratorio Nacional de Nanotecnologia Laboratorio Nacional de Nanotecnologia Centro de Investigación en Materiales Centro de Investigación en Materiales Avanzados S.C. Avanzados S.C. Chihuahua, Mexico Chihuahua, Mexico Alessandro Alan Porporati Miguel Bocanegra Bernal Medical Products Division Laboratorio Nacional de Nanotecnologia CeramTec GmbH Centro de Investigación en Materiales Plochingen, Germany Avanzados S.C. Chihuahua, Mexico Department of Engineering and Architecture University of Trieste Trieste, Italy Hilda Esperanza Esparza Ponce Laboratorio Nacional de Nanotecnologia Centro de Investigación en Materiales Avanzados S.C. Chihuahua, Mexico ISSN 1930-0328 ISSN 1930-0336 (electronic) Synthesis Lectures on Biomedical Engineering ISBN 978-3-031-25419-2 ISBN 978-3-031-25420-8 (eBook) https://doi.org/10.1007/978-3-031-25420-8 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Joint replacement using different materials has been in use over the past 50 years with outstanding success. Millions of people throughout the world have benefited from total hip arthroplasty THA surgery, extending their mobility and quality of life by years. How- ever, a clear conclusion can be the one reported by Kuncická et al. [1] pointing out that there are opportunities to improve joint replacements by improving the materials from which they are made. Materials such as metals, ceramics, and polymers serve critical functions in implant systems, and therefore their respective roles and properties are fre- quently shifting with the advancements in each category and the introduction of hybrid material systems. After reviewing different metallic, ceramic, polymeric, and composite materials used nowadays in THA, there remain issues that must be solved to ensure good pain relief, increasing more and more the activity levels in young patients undergoing hip replacement, as well as longevity of the prosthesis, reaching a higher range of motion as well as stability in those ranges. It was observed that the mechanical, material, and processing issues are imperative in the design, selection, and improvement in the fabrication of hip replacements. For a specific application such as THA, a correct choice of the defined material to fulfill the requirements of different standards for a particular total hip arthroplasty system component is necessary. The proper selection of metallic, ceramic, polymeric, or composite material plays a crucial role in getting the combination of properties such as high strength, wear, and corrosion resistance, as well as biocompatibility. With the passage of time and balancing the pros and cons of the various materials used for applications in THA, it could be determined that the use of ceramic materials (alumina matrix composite mainly) is best suited as bearing material for example. In conclusion, the innovations in the design and fabrication processes for the different materials for THA are raising the great reality of being able to obtain, in the medium term, implants with improved performance to match both the biocompatibility and mechanical complexity of the hip implants. However, to achieve this, surgeons in close alliance with biologists and engineers cannot be ignored. They must be persuaded of the long-term durability and reliability of the available biomaterials. Everything mentioned leads to v vi Preface the future to see novel biomaterials being developed that will increase the lifespan of orthopedic implants. Today it is not possible to fully ensure which material is the one that will dominate orthopedics. Chihuahua, Mexico Armando Reyes Rojas Chihuahua, Mexico Alfredo Aguilar Elguezabal Plochingen, Germany/Trieste, Italy Alessandro Alan Porporati Chihuahua, Mexico Miguel Bocanegra Bernal Chihuahua, Mexico Hilda Esperanza Esparza Ponce Reference 1. Kuncická L, Kocich R, Lowe TC. Advances in metals and alloys for joint replacement. Prog Mater Sci 2017;88:232–80. https://doi.org/10.1016/j.pmatsci.2017.04.002. Contents 1 Introduction ........................................................ 1 References .......................................................... 2 2 State of the Art in Orthopaedic Implants .............................. 5 References .......................................................... 12 3 Biocompatibility .................................................... 17 References .......................................................... 20 4 Metals and Alloys Choice for Implants ................................ 23 4.1 Stainless Steels ................................................. 24 4.2 Cobalt Based Alloys ............................................. 26 4.3 Titanium and Its Alloys .......................................... 27 4.4 Tantalum and Its Alloys .......................................... 29 4.5 Niobium and Its Alloys .......................................... 33 4.6 Mg Alloys ..................................................... 34 References .......................................................... 37 5 Metal Implant Allergy ............................................... 49 References .......................................................... 55 6 Ceramics Choice for Implants ........................................ 59 6.1 Bioactive Ceramics .............................................. 60 6.2 Alumina Ceramics .............................................. 62 6.3 Zirconia Ceramics ............................................... 66 6.4 Oxide Ceramic Composites ....................................... 69 6.5 Non-oxide Ceramics ............................................. 75 References .......................................................... 78 7 Immuno-Allergological Compatibility Aspects of Ceramic Materials ..... 89 References .......................................................... 90 vii viii Contents 8 Mechanical Aspects of Implant Materials .............................. 93 8.1 Metals ......................................................... 93 8.1.1 Strength ................................................. 94 8.1.2 Wear .................................................... 96 8.1.3 Fatigue .................................................. 100 8.1.4 Corrosion ................................................ 109 8.2 Ceramics ....................................................... 122 8.2.1 Hardness ................................................ 123 8.2.2 Flexural Strength ......................................... 125 8.2.3 Fracture Toughness ....................................... 131 8.2.4 Fatigue .................................................. 136 8.2.5 Wear .................................................... 143 8.2.6 Accelerated Ageing Tests .................................. 147 References .......................................................... 153 9 Outlooks and Horizons in Materials and Technologies .................. 181 References .......................................................... 183 10 Conclusions ......................................................... 185 Reference ........................................................... 186 Abbreviations Al O Alumina 2 3 AMCs Alumina Matrix Composites ARMD Adverse Reaction to Metallic Debris ATZ Alumina-Toughened Zirconia CNB Chevron-Notched Beam CNTs Carbon Nanotubes CoC Ceramic-on-Ceramic CoM Ceramic-on-Metal CoP Ceramic-on-Polyethylene CP Ti Commercially Pure Titanium CPTi Commercially Pure hcp Titanium CVD Chemical Vapour Deposition DCM Direct Crack Measurement DLC Diamond-Like-Carbon DMLS Direct Metal Laser Sintering DNA Deoxyribonucleic acid EBSS Earle’s Balanced Salt Solution EDS X-Ray Spectroscopy EIS Electrochemical Impedance Spectroscopy ESR Electro-Slag Re-melting FDA American Food and Drug Administration FEA Finite Element Analysis Hap Hydroxyapatite HCA Active Hydroxycarbonate Apatite HCF High-Cycle Fatigue Lifetime HDP High-Density Polyethylene HIP Hot Isostatic Pressing HIPRBSN Hot Isostatic Pressing Reaction Bonding Silicon Nitride HIPSN Hot Isostatic Pressing Silicon Nitride HIPSRBSN Hot Isostatic Pressing Sintered Reaction Bonded Silicon Nitride ix