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Synovial Fluid Lubrication of Artificial Joints

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Artificial implants offer an engineering solution to the loss of joint function due to trauma or disease. The number of procedures has rapidly increased over the last 50 years; for example there are over 90,000 total hip replacements yearly in the UK alone. However there are significant clinical concerns over the use of 2nd generation Metal-on-Metal (MoM) hip joints as these have been associated with the development of periprosthetic tissue lesions. The UK National Joint Register reports higher than expected revision rates for LHMoM joints (>5%) compared to 2% for conventional MoM hips. Implant failure is often linked to high levels of metal ions in the blood and severe implant wear often due to edge loading. The reasons for increased wear and failure are complex and include design, metallurgy, implantation (particularly cup position) and patient factors. The patient factors include gait, lifestyle and synovial fluid (SF) composition. Most studies of hip joint tribology have focussed on material and design aspects usually tested under optimised gait conditions, whilst research into fundamental mechanisms of synovial fluid lubrication and the effect of patient SF composition on implant wear has been ignored. Artificial hips are lubricated by periprosthetic SF which reforms in the synovial cavity after the operation. Healthy and periprosthetic SF contains a complex mixture of large and surface active molecules including proteins, phospholids and hyaluronan. The lubrication behaviour of SF is therefore complex and not described by simple fluid models and this has significant implications for the development of suitable screening methods and predictive models for implant lubrication. The talk will present some of the background to the MoM problem and recent research into the mechanisms of SF lubricant film formation and the implications of these findings for our understanding of implant tribology.

This talk is part of the Institute for Energy and Environmental Flows (IEEF) series.

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