In vivo measured joint friction in hip implants during walking after a short rest.

Abstract

INTRODUCTION:It has been suspected that friction in hip implants is higher when walking is initiated after a resting period than during continuous movement. It cannot be excluded that such increased initial moments endanger the cup fixation in the acetabulum, overstress the taper connections in the implant or increase wear. To assess these risks, the contact forces, friction moments and friction coefficients in the joint were measured in vivo in ten subjects. Instrumented hip joint implants with telemetric data transmission were used to access the contact loads between the cup and head during the first steps of walking after a short rest. RESULTS:The analysis demonstrated that the contact force is not increased during the first step. The friction moment in the joint, however, is much higher during the first step than during continuous walking. The moment increases throughout the gait cycle were 32% to 143% on average and up to 621% individually. The high initial moments will probably not increase wear by much in the joint. However, comparisons with literature data on the fixation resistance of the cup against moments made clear that the stability can be endangered. This risk is highest during the first postoperative months for cementless cups with insufficient under-reaming. The high moments after a break can also put taper connections between the head and neck and neck and shaft at a higher risk. DISCUSSION:During continuous walking, the friction moments individually were extremely varied by factors of 4 to 10. Much of this difference is presumably caused by the varying lubrication properties of the synovia. These large moment variations can possibly lead to friction-induced temperature increases during walking, which are higher than the 43.1°C which have previously been observed in a group of only five subjects.