The Influence of Kinematic Conditions and Variations in Component Positioning on the Severity of Edge Loading and Wear of Ceramic-on-Ceramic Hip Bearings

Dynamic separation and direct edge loading of hip replacement bearings can be caused by many factors, including implant positioning, implant design, changes in device over time, surgical variations and patient variations. Such dynamic separation and direct edge loading can lead to increased wear. Different input kinematic conditions have been used for experimental hip simulator studies to produce clinically relevant elliptical contact wear paths between the bearings during gait. The aim of this study was to investigate the influence of input kinematics (two axes of rotation simulation conditions (without abduction/adduction) and three axes of rotation simulation conditions (with abduction/adduction and different loading profiles) and variations in component positioning (different levels of medial-lateral translational mismatch at standard and steep cup inclination angles) on the occurrence, severity of edge loading, dynamic separation and wear of size 36 mm ceramic-on-ceramic hip bearings on an electromechanical hip joint simulator. The results showed that, overall, either of the two axes or three axes input profiles were equally valid in providing a suitable preclinical testing method for assessing the occurrence and severity of edge loading and wear under edge loading conditions. In terms of component positioning, as cup inclination and medial-lateral translational mismatch increased, so did dynamic separation, axial load at the rim, severity of edge loading and wear.