The Scientific Bulletin of VALAHIA University MATERIALS and MECHANICS Nr.

7 (year 10) 2012

ASPECTS OF ORTHOPEDIC IMPLANTS AND PROSTHESES.

MATERIALS. PROCESSING TECHNOLOGIES

Simona MIHAI1,a, Viviana FILIP1,b;

1
Valahia University of Targoviste, Romania;
E-mail: [email protected] , [email protected]

Abstract. The goal of this paper is to summarize and present the types of orthopaedic implants and hip prostheses, the biocompatible
materials used and the conventional and unconventional processing technologies used to make them.

Keywords: implants / prostheses, biomaterials, conventional / unconventional processing technologies

1. INTRODUCTION Charnley and the 38+ mm value and above proposed by

himself and by other authors, all coupled with a
Biological motion (life and locomotion of the living
polyethylene cup, became an ideal implant standard
organisms) is a superior form of movement, which has
great popularity in the '70s " [3], [4], [5], [6].
special qualities and mechanisms that can not be
explained solely by the application of mechanical
movements or by the physical or chemical laws, which
are considered lower forms [1].
In the understanding and interpretation of the biological
motion, the application of mechanical, physics or
chemistry laws fails to reproduce the whole complexity
of the phenomena.
The application of these laws may render, schematic and
mechanistic, only singular aspects of the complex
biological process which is the animal or human
locomotion. Mobility is a basic function of the human
body and when this cannot be performed, a series of Figure 1 X-ray photograph of the normal joint
problems arises from the fact that the human being morphology
becomes socially dependent.
The research in the process of achieving an implant / 2. IMPLANTS AND ORTHOPEDIC PROSTHESES
orthopaedic hip prosthesis is based on the knowledge of
the locomotor system, of the hip joint anatomy, the bone Vestiges and some documents prove some preoccupation
structure and its shape and on the study of the forces for the construction of prostheses several hundred years
acting on the joint and bone, the knowledge and choice ago. Real progress is evident in the sixteenth century.
of the biocompatible material for implants / prosthesis Only in the twentieth century there were stated precise
and the best manufacturing technology. rules for the surgical treatment of fractures by means of
The natural hip joint (Figure 1) is a "ball in cup"-shape metal devices. In 1907 A. Lambotte (Belgium) defines
joint. The "ball" is nothing but the head of the femur. fixation: "My aim is mostly the bone suture study, or
The "Cup" is the acetabulum, a hip bone cavity. speaking more precisely, fixation" [7].

Although continuous improvements are made on the Immobilization or surgical fixation is done with screws,
implants design, materials and fastening techniques, the plates with screws, clasps, wire, bindings, stems or any
ideal solution has not been found yet, and the basic other mechanical means of fixation, using compatible
concepts defined by Sir John Charnley (1911-1982), materials (austenitic steels, titanium and titanium alloys
regarded as the father of modern prosthetic arthroplasty that do not corrode).
[2], are still valid. "The design of the single block A. Lambotte performs internal fixation with plates and
banana-type tail stem with a 32 mm femoral head, external clasps and in 1913 he publishes his work -
which is between the 22.2 mm value proposed by "Operative Treatment of Fractures" which highlights the

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functional principles for the internal fixation of the Fracture fixation plates are devices commonly used in
fractures occurred inside joints. (Figure 2) [7]. the healing of broken bones.
For fixing fractures along the bone there are used
intramedullary devices that are inserted in the
intramedullary cavity.
In comparison with plate fixation, intramedullary
devices can position the bone so as to respond better to
the bending and they are better also for the central-axial
fixation. However twisting resistance is lower than in the
plate fixations case, which is why these devices are used
on a small scale [8]. Figure 5 shows a screw-plate
fixation device, and Figure 6 shows various examples of
nail-plate fixation systems.

Figure 2 Fracture Fixation Methods, A. Lambotte

For fracture fixation there are used various devices in the
form of wire rods, stems, screws, etc. These were the
first metal implants, from the simplest to the most
complex forms. There are several types and sizes of
plates; pictures of osteosynthesis plates are shown in
Figure 3.

Figure 5 Screw-plate fixation device

Figure 3 Types of osteosynthesis plates

Figure 4 shows various models of femur osteosynthesis
plates and their positioning.

Figure 6 Examples of fixation using a nail-plate,

blade-plate or screw-plate system used in the femoral
neck fracture fixation
1 - McLaughlin nail-plate;
2 - STAC nail-plate, blade-plate;
3 - simple plate-nail;
4 - Additional anti-rotational screw;
5 and 6 - DKP (STAC) or DHS (AO) screw-plate where
a compression screw (5) fastened in the proximal
fragment slips in the distal part of the material (6) which
is fixed to the shaft with 1-2 screws [9].
Another type of fixation, with centromedullary plugging
stem, is shown in Figure 7.
Figure 4 Femur osteosynthesis plates and their
positioning

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Figure 10 Long stem prostheses

Figure 7 Osteosynthesis by stem plugging: To highlight the development of the implants and
orthopedic prostheses typologies I will present several
a, b, c conventional type (Kntscher stem) for femur models of hip prostheses from two manufacturing
fracture, d - the modern version, with static locking companies: Stryker Howmedica Osteonics (Figure 11)
[9]. and Zimmer (Figure 12).
Centromedullary rods are used when the plates are
difficult to apply or when bone stability cannot be
reached by other methods [8].
In the hip prosthesis procedure, the hip joint is replaced
with a set of articulated implants (Figure 8) that allow
natural movements of the hip.

Figure 11 Stryker Howmedica Osteonics

Manufacturer

Figure 8 Total hip endoprosthesis, components

The types of prostheses and implants are varied, so as to Figure 12 ZIMMER Manufacturer
cover the entire range of clinical indications.
Currently there is a great variety of types of prostheses /
The first short stem femoral prostheses made of implants categorized by:
Vitallium (1939-1940 Hohlman, 1946 Judet, 1950
Thompson), are shown in Figure 9 [10]. -the prosthetic design (single block stems, modular
prosthetic stems);
-the biomaterials that the prostheses / implants are made
of;
-fastening methods: cemented, uncemented.

3. BIOCOMPATIBLE MATERIALS
To achieve implants and orthopedic prostheses, special
materials, known as biomaterials, are used.
Figure 9 Short stem prostheses A biomaterial is an altered synthetic or biological
biomaterial material that is used to make an implant.
Long-stem femoral prosthesis (unipolar, cervico-
cephalic), made of stainless steel (Austin-Moore 1951, A classification of biomaterials can be made on
Thompson 1954), Figure 10 [10]. structural criteria, by the used material classes: metal,

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ceramic, polymeric, composite and natural origin [7], material removal technology and, more recently, the
[11], [12]. rapid prototyping technology.
Metallic biomaterials are the most used class of materials The processing technology by casting
for implants, prostheses and medical devices, because of
The casting process consists mainly in filling a cavity
its very good mechanical properties, corrosion-resistance
(mould) with metal or a liquid alloy (Figure 13). The
and acceptable biocompatibility.
moulding-casting technological process includes the
Table 1 presents some characteristics of the metallic following operations:
materials used as orthopedic implants.
-the casting technology engineering;

Table 1 Orthopedic characteristics of some metallic

-producing the model of the part and the casting runner
materials [8]. (the ledge);
Specificatio Stainless Cobalt alloys Titanium and -assembling the model and the casting gate;
n steels titanium alloys
-producing the mould;
International ASTM ASTM F-75 ASTM F-138
standards F-138 ASTM F-799 ASTM F-136 -drying and assembling the shape;
316L ASTM F-1537 ASTM F-1295 -pouring the metal or the alloy in the shape (mould) [8].
(plastic (cast and (plastic
processing forged) processing)
)
The main Cr = Cr = 19-30 Al = 6
alloying 17-20 Ni = 0-37 V=4
elements % Ni = Mo = 0-10 Hb = 7
12-14 Mo = 5-15
Mo =
2-4
-low cost - resistance to Biocompatibility
Advantages -simple wear -low elastic
processing -corrosion modulus
resistance -stamina
-stamina
Disadvantag -Short -Modest -low shear-
es term use biocompatibilit strength
y
Uses temporary -dentistry -femoral Figure 13 Images from the casting of a hip prosthesis
devices -prosthetic rods prosthesis
To obtain metallic prosthetic components, high precision
components
casting procedures are applied, in order that the cast part
-permanent
requires a small number of further processing. Casting
orthopedic
procedures that provide accurate shapes and sizes to the
devices.
parts, without the need for significant further processing,
The choice of material for manufacturing implant is are: pouring in shell moulds with fusible models or
aimed factors such as: type of interaction with the body - thermo-active mixtures, and chilled casting.
the host, duration of implantation, implant functionality. The processing technology by stamping
The stamp (mould) is a tool with an internal cavity,
4. MANUFACTURING TECHNOLOGIES made of one or more elements, which is used to give the
material the desired shape by means of plastic
In terms of processing, not all metallic biomaterials used deformation under pressure. For the stamping processing
to make implants and orthopedic prostheses are cost circular section semi-finished rolled bars are used.
effective. For example, Cobalt alloys are extremely
difficult to machine when the desired implants / The operations required by the processing by stamping
prostheses are complex in shape, and therefore these are are:
achieved by casting or metal powder processing methods -designing and producing the mould (stamp);
[13]. Titanium is relatively difficult to cast in
complicated shapes so a Titanium ingot is processed -cutting the semi-finished rolled bar;
mechanically.
-heating the semi-finished bar to reach the plastic
Among the known processing technologies there are: the deformation temperature;
casting technology, the stamping technology, the
-hot-working in the mould;

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-deburring and machining the prosthesis component Another example is the "Titanium Version EOSINT M
(turning, drilling, etc.); 270" equipment (Figure 15) [14].
-performing the thermal treatment operations of
annealing and temper hardening;
-final processing by grinding, marking, sterilization,
packaging [8].
The processing technology by material removal
The processing technologies by material removal start
from an amount of raw material and consist in removing
the excess material by turning, milling, grinding etc. A
modern method of processing by material removal is the
one used by the CNC machine tools.
A CNC (computerized numerical control) machine tool Figure 15 EOSINT M 270 Titanium Version
is made up of the actual machine tool and the numerical Equipment
control equipment (CNC). Selective LASER sintering, known as SLS, uses various
powder materials, from polyamide powders, metal
During processing both the part and the tool can move.
powders, to Quartz or Zirconium based powders etc.,
Unconventional technologies by successive layer which are melted in layers with a LASER beam of
deposition various powers. Based on the variation of the exposure
intensity and the way the material layers are deposited,
The Rapid prototyping manufacturing technology or
the hardness of the processed material may be
Rapid Prototyping (RP) emerged in the '90s and is a
controlled.
technology based on adding material as much as needed
and where necessary. The working principle of LASER sintering is shown in
Figure 16.
The new rapid prototyping technologies are able to
produce high accuracy models and prototypes in a very
short time, with the advantage of being directly
functional.
Rapid prototyping technologies have been developed in
several directions in the recent years, depending on the
material used.
An example of rapid prototyping equipment is "ARCAM
S12" (Figure 14), which uses metal powders (Cobalt-
Chromium alloys, Titanium alloys, stainless steels,
Aluminium, etc.), using an electron stream as melting
source.
The accuracy achieved is + / - 0.1 mm, depending on the
material, the thickness of the deposited layer and the
powder grain. Parts such as the Osteosynthesis implants Figure 16 SLS Working principle
are made ready for use, requiring only sterilization.
1 LASER system,
2 mirror system,
3 powder supply system,
4 mobile platform,
5 part
6 unsintered powder.

The LASER System (1) (Figure 15) generates a laser

radiation which is redirected through a mirror system
(2), towards the surface of the working platform (4).
At the beginning of the working process, the platform (4)
is in the highest position (at the top). A powder supply
system (3) lays a thin layer of powder (a controlled
amount) on the surface of platform. The LASER beam
scans the surface of the platform following a path
Figure 14 Arcam S12 Equipment corresponding to the geometry of the first section

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through the implant to be processed (a 3D implant built same implant / prosthesis with conventional technologies
in SolidWorks and saved as a .stl file. (Standard based on material deposition.
Tessellation Language) or resulting from 3D scanning
The comparative study of the results obtained in terms of
data); after the scanning process, the LASER beam
mechanical strength, surface quality, productivity, and
sinters the powder coating locally. After the scanning of
cost.
first layers surface, the working platform (4), lowers by
a distance equal to the thickness of a new layer. The Conclusions on determining the technology to be used,
process is repeated until the implant / part (5) is depending on the nature of the implant to be made.
completed. After the implant is complete, it is covered
up by un-sintered powder (6), which substitutes the
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