Feasibility of using diamond-like carbon films in total joint replacements: a review.

Diamond-like Carbon (DLC) has been used as a coating material of choice for a variety of technological applications owing to its favorable bio-tribo-thermo-mechanical characteristics. Here, the possibility of bringing DLC into orthopedic joint implants is examined. With ever increasing number of patients suffering from osteoarthritis as well as with the ingress of the osteoarthritic joints' malaise into younger and more active demographics, there is a pressing need to augment the performance and integrity of conventional total joint replacements (TJRs).

Factors Associated With Early Discharge in Pediatric Trauma Patients Transported by Rotor: A Retrospective Analysis.

Objective: Helicopter emergency medical services (HEMS) play a crucial role in providing timely transport for pediatric trauma patients. This service carries the highest risk of any mode of medical transport and a high financial burden, and patient outcomes are seldom investigated. This study evaluated the characteristics of pediatric trauma patients discharged within 24 hours after transport by HEMS.

An overview of the tribological and mechanical properties of PEEK and CFR-PEEK for use in total joint replacements.

Poly-ether-ether-ketone (PEEK) and PEEK composites are outstanding candidates for biomedical applications, such as orthopedic devices, where biocompatibility and modulus match with surrounding tissue are requisite for long-term success. The mechanical properties can be optimized by incorporating fillers such as continuous and chopped carbon fibers. While much is known about the mechanical and tribological behavior of PEEK composites, there are few articles that summarize the viability of using PEEK reinforced with carbon fibers in orthopedic implants.

A methodological framework for nanomechanical characterization of soft biomaterials and polymers.

Nanoindentation utilizes a hard indenter probe to deform the sample surface in order to measure local properties, such as indentation modulus and hardness. Initially intended for characterization of elastic and elastic-plastic materials, nanoindentation has more recently been utilized for viscoelastic solids as well as hydrated and soft biological materials. An advantage to nanoindentation is the ability to determine the nano- and microscale properties of materials with complex microstructures as well as those of limited sample dimension.

Abiraterone acetate plus prednisone in non-metastatic biochemically recurrent castration-naïve prostate cancer.

Background: Intermittent androgen deprivation therapy (ADT) in biochemically recurrent castration-naïve prostate cancer is non-inferior to continuous therapy. We hypothesised that finite-duration abiraterone acetate plus prednisone (Abi +P) added to ADT will further reduce the duration of treatment exposure by prolonging time to prostate-specific antigen (PSA) recurrence without impacting eugonad state recovery.

Methods: This phase II, randomised, open-label trial enrolled patients with rising PSA ≥ 0.

Comparison of macro-, micro- and nanomechanical properties of clinically-relevant UHMWPE formulations.

We characterized a set of eleven clinically relevant formulations of UHMWPE for total joint replacements. Although their molecular and supermolecular structure were quite similar as evidenced by IR, DSC and SAXS measurements, there were slight differences in their crystallinity (DSC crystallinity ranging from 52 to 61%), which were connected with processing conditions, such as the total radiation dose, thermal treatment and/or addition of biocompatible stabilizers. Mechanical properties were assessed at all length scales, using macroscale compression testing, non-instrumented and instrumented microindentation hardness testing (at loading forces ~500 mN), and nanoindentation hardness testing measured at both higher and lower loading (~4 mN and ~0.

A 3D-transient elastohydrodynamic lubrication hip implant model to compare ultra high molecular weight polyethylene with more compliant polycarbonate polyurethane acetabular cups.

Wear remains a significant challenge in the design of orthopedic implants such as total hip replacements. Early elastohydrodynamic lubrication modeling has predicted thicker lubrication films in hip replacement designs with compliant polycarbonate polyurethane (PCU) bearing materials compared to stiffer materials like ultra-high molecular weight polyethylene (UHMWPE). The predicted thicker lubrication films suggest improved friction and wear performance.

Oxidized Zirconium Components Maintain a Smooth Articular Surface Except Following Hip Dislocation.

Background: Oxidized zirconium (OxZr) offers theoretical advantages in total hip and knee arthroplasty (THA and TKA, respectively) relative to other biomaterials by combining the tribological benefits of ceramics with the fracture toughness of metals. Yet, some studies have found that OxZr does not improve outcomes or wear rates relative to traditional bearing materials such as cobalt-chromium (CoCr). Separately, effacement of the thin ceramic surface layer has been reported for OxZr components, though the prevalence and sequelae are unclear.

Nanomechanical analysis of medical grade PEEK and carbon fiber-reinforced PEEK composites.

Polyether ether ketone (PEEK) and PEEK composites are viable candidates for orthopedic implants owing to their ability for modulus match of surrounding bone tissue. The structural properties of these systems for load-bearing application in the body can be tailored by incorporating carbon fibers; to this end, polyacrylonitrile (PAN) and pitch fibers are commonly incorporated in the PEEK matrix. Mechanical property optimization for a given medical application requires consideration of carbon fiber type and volume fraction, as well as processing conditions for the composite systems.

Temsirolimus versus Pazopanib (TemPa) in Patients with Advanced Clear-cell Renal Cell Carcinoma and Poor-risk Features: A Randomized Phase II Trial.

Background: Temsirolimus has level 1 evidence for initial treatment of poor-risk patients with advanced renal cell carcinoma (mRCC), but its efficacy has not been directly compared with an antiangiogenic tyrosine kinase inhibitor (vascular endothelial growth factor receptor tyrosine kinase inhibitor [VEGFR TKi]) in this setting.

Objective: To evaluate temsirolimus versus pazopanib as first-line therapy in patients with mRCC, predominant clear-cell features, and clinical characteristics of a poor prognosis.

Design, Setting, And Participants: A randomized (1:1) phase II trial in 69 treatment-naïve mRCC patients and with three or more predictors of short survival for temsirolimus was conducted during 2012-2017 in a single academic cancer center.

Effect of carbon fiber type on monotonic and fatigue properties of orthopedic grade PEEK.

Carbon-fiber reinforced (CFR) PEEK implants are used in orthopedic applications ranging from fracture fixation plates to spinal fusion cages. Documented implant failures and increasing volume and variety of CFR PEEK implants warrant a clearer understanding of material behavior under monotonic and cyclic loading. To address this issue, we conducted monotonic and fatigue crack propagation (FCP) experiments on orthopedic grade unfilled PEEK and two formulations of CFR PEEK (PAN- and pitch-based carbon fibers).

Material properties of ultra-high molecular weight polyethylene: Comparison of tension, compression, nanomechanics and microstructure across clinical formulations.

This is the first study to simultaneously measure material properties in tension, compression, nanoindentation as well as microstructure (crystallinity and lamellar level properties) across a wide variety of clinically relevant ultra-high molecular weight polyethylene (UHMWPE) formulations. Methodologies for the measurement of UHMWPE mechanical properties-namely elastic modulus, yield stress, yield strain, ultimate strength, energetic toughness, Poisson's ratio, hardness and constitutive variables-are evaluated. Engineering stress-strain behavior is compared to true stress-strain behavior for UHMWPE across a range of cross-linking and antioxidant chemistry.

Phase II Study of Two Weeks on, One Week off Sunitinib Scheduling in Patients With Metastatic Renal Cell Carcinoma.

Purpose Standard frontline treatment of patients with metastatic renal cell carcinoma currently includes sunitinib. A barrier to long-term treatment with sunitinib includes the development of significant adverse effects, including diarrhea, hand-foot syndrome (HFS), and fatigue. This trial assessed the effect of an alternate 2 weeks on, 1 week off (2/1) schedule of sunitinib on toxicity and efficacy in previously untreated patients with metastatic renal cell carcinoma.

Micromechanisms of fatigue crack growth in polycarbonate polyurethane: Time dependent and hydration effects.

Polycarbonate polyurethane has cartilage-like, hygroscopic, and elastomeric properties that make it an attractive material for orthopedic joint replacement application. However, little data exists on the cyclic loading and fracture behavior of polycarbonate polyurethane. This study investigates the mechanisms of fatigue crack growth in polycarbonate polyurethane with respect to time dependent effects and conditioning.

Fatigue fracture of a cemented Omnifit CoCr femoral stem: implant and failure analysis.

A cemented, cast CoCr alloy, Omnifit Plus femoral stem was retrieved following mid-stem fracture after 24 years in vivo. The patient was an active 55-year-old male with a high body mass index (31.3) and no traumatic incidents before stem fracture.

Notch fatigue of ultrahigh molecular weight polyethylene (UHMWPE) used in total joint replacements.

Ultrahigh molecular weight polyethylene (UHMWPE) has remained the primary polymer used in hip, knee and shoulder replacements for over 50 years. Recent case studies have demonstrated that catastrophic fatigue fracture of the polymer can severely limit device lifetime and are often associated with stress concentration (notches) integrated into the design. This study evaluates the influence of notch geometry on the fatigue of three formulations of UHMWPE that are in use today.

Analysis of severely fractured glenoid components: clinical consequences of biomechanics, design, and materials selection on implant performance.

Background: The longevity of total shoulder replacement is primarily limited by the performance of the ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid component in vivo. Variations in glenoid design (conformity, thickness), biomechanics (joint kinematics), and UHMWPE material selection (sterilization, cross-linking) distinguish total shoulder replacements from hip and knee arthroplasty devices. These variables can lead to severe mechanical failures, including gross fracture.

Effect of processing, sterilization and crosslinking on UHMWPE fatigue fracture and fatigue wear mechanisms in joint arthroplasty.

Ultra high molecular weight polyethylene (UHMWPE) has been used as a bearing surface in total joint replacements (TJR) for nearly five decades. This semi-crystalline polymer has extraordinary energetic toughness owing to its high molecular weight and entanglement density. However, it is challenged by a need to offer a combined resistance to fatigue, wear and oxidation in vivo.

Fractography and oxidative analysis of gamma inert sterilized posterior-stabilized tibial insert post fractures: report of two cases.

Background: Highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) has shown success in reducing wear in hip arthroplasty but there remains skepticism about its use in Total Knee Replacement (TKR) inserts that are known to experience fatigue loading and higher local cyclic contact stresses.

Methods: Two Legacy Posterior-Stabilized (LPS) Zimmer NexGen tibial implants sterilized by gamma irradiation in an inert environment with posts that fractured in vivo were analyzed. Failure mechanisms were determined using optical and scanning electron microscopy along with oxidative analysis via Fourier Transform Infra-Red (FTIR) spectroscopy.

Effects of elastase and collagenase on the nonlinearity and anisotropy of porcine aorta.

We use enzymatic manipulation methods to investigate the individual and combined roles of elastin and collagen on arterial mechanics. Porcine aortic tissues were treated for differing amounts of time using enzymes elastase and collagenase to cause degradation in substrate proteins elastin and collagen and obtain variable tissue architecture. We use equibiaxial mechanical tests to quantify the material properties of control and enzyme treated tissues and histological methods to visualize the underlying tissue microstructure in arterial tissues.

Clinical trade-offs in cross-linked ultrahigh-molecular-weight polyethylene used in total joint arthroplasty.

Highly cross-linked formulations of ultrahigh-molecular-weight polyethylene (XLPE) offer exceptional wear resistance for total joint arthroplasty but are offset with a reduction in postyield and fatigue fracture properties in comparison to conventional ultrahigh-molecular-weight polyethylene (UHMWPE). Oxidation resistance is also an important property for the longevity of total joint replacements (TJRs) as formulations of UHMWPE or XLPE utilizing radiation methods are susceptible to free radical generation and subsequent embrittlement. The balance of oxidation, wear, and fracture properties is an enduring concern for orthopedic polymers used as the bearing surface in total joint arthroplasty.

Costs of a more spacious home after remodelling by hermit crabs.

Architectural creations occur throughout the animal kingdom, with invertebrates and vertebrates building structures such as homes to maximize their Darwinian fitness. Animal architects face many trade-offs in building optimally designed structures. But what about animals that do not build, and those that only remodel the original creations of others: do such secondary architects face similar trade-offs? Recent evidence has revealed that hermit crabs-animals well known for opportunistically moving into remnant gastropod shells-can also act as secondary architects, remodelling the shells they inherit from gastropods.