Toward long-live ceramic on ceramic hip joints: In vitro investigation of squeaking of coated hip joint with layer-by-layer reinforced PVA coatings

Mohammed A. Almomani; Mohammad M. Fares; Elham M. Almesidieen

doi:10.1515/epoly-2022-0048

Article Open Access

Toward long-live ceramic on ceramic hip joints: In vitro investigation of squeaking of coated hip joint with layer-by-layer reinforced PVA coatings

Mohammed A. Almomani , Mohammad M. Fares and Elham M. Almesidieen

Published/Copyright: May 30, 2022

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From the journal e-Polymers Volume 22 Issue 1

Abstract

This study attempts to find a promising solution for the squeaking of ceramic on ceramic (COC) bearing surfaces by introducing reinforced poly(vinylalcohol) (PVA) layer-by-layer coatings on the bearing surface of Stryker Trident femoral head. A customized hip simulator was established to provide a realistic simulation of the normal gait (flexion–extension) of the hip joint, and to examine squeaking for coated and uncoated femoral heads. Different characterization techniques were employed to study the coatings’ structure. The PVA macromolecules were successfully cross-linked via epichlorohydrin agent, and chemically bonded onto the surface, forming a superior reinforced PVA coating on the femoral head’s surface. These coatings play a dominant role in increasing the pre-squeaking age of the hip joint due to reduction in hard-on-hard contact and femoral head liner clearance with their good viscoelastic properties. Which cause, damping friction-induced vibrations. This improvement resembles novel-type, long-life, and stable hip joint biomaterials with distinguished and promising pre-squeaking age.

Keywords: squeaking; ceramic on ceramic; hip joints; reinforced PVA; layer-by-layer coating

1 Introduction

The hip joint in the pelvis region consists of two major parts the femoral head (ball) connected with the thighbone and the acetabular (socket) connected with the pelvic bone (1), and they are surrounded by an aqueous synovial fluid (SF) that acts as a shock absorber (2). The geometry of ball-in-socket and the presence of the SF make the hip joint transmit a high dynamic load and provide a wide range of motions (3). If the joint malfunctions, the diseased hip joint is replaced with an artificial one through a surgical procedure (4,5).

The bearing surfaces of the acetabular and femoral head of the artificial joint are made of either metallic, polymeric, and/or ceramic materials (6,7). They are coupled as hard-on-hard bearings or hard on polyethylene bearings such as metal on metal (MOM), metal on polyethylene (MOP), ceramic on polyethylene (COP), and ceramic on ceramic (COC) bearings.

Wear is the major drawback of MOM and MOP implants which limits their use (8,9). On the other hand, ceramics have superior wear resistance, greater hardness, lower surface roughness, more scratch-resistant, smoother, and a high degree of wettability than other implant materials. Also, ceramic wear debris has significantly less toxicity than MOM debris and is less biologically active than polyethylene particles (10–12). For all these reasons, COC bearings are excellent implant materials for hip joints. Although COC bearings have good characteristics, the audible noise (“squeak”) is a major concern among clinicians and patients for their use as it might be intolerable for some patients (12). Previous research studies indicate that the squeaking problem is caused by multifactorial reasons including implant factors, patient factors, and surgical factors. The implant factors are associated with bearing surface contact during the walking gait cycle, patient factors are associated with mechanical demands applied to the hip, and surgical factors are related to the placement of acetabular component on the pelvic bone during surgery (13–25).

A synthetic bearing material that reduces or delays joint squeaking would be beneficial in prolonging the life of the hip joint, creating a positive psychological impact on patients, improving the nature of their life, and increasing their satisfaction with the implant. The polymeric materials are potential candidates for this application. For example, polyvinyl alcohol (PVA) has been previously used as a replacement for particular cartilage because of the similarity of its mechanical properties with that of cartilage and its biocompatibility (26,27). In addition, PVA has excellent non-toxicity, non-carcinogenic, and bioadhesive characteristics, and therefore it is widely used in biomedical applications such as drug delivery, contact lenses, articular cartilage, artificial skin, artificial pancreas, soft tissue replacement, catheter, hemodialysis membranes, and the lining for the artificial heart (28). Thus, PVA is proposed here as an artificial bearing material that reduces squeaking of COC hip joints.

2 COC squeaking

The highly pitched and audible sound that occurs during walking, known as “squeaking” causes pain and uncomfortable feeling for patients, which necessitate revising the implant (29), has no specific time to appear. In some cases, it was reported that it appears after 14 months post-surgery (23), and it takes longer time in other cases, but the mean time prior to noise appearance is 66 months post-surgery. Also, after squeaking appearance, its frequency and intensity remained stable over time (20,30).

Several factors may cause squeaking in COC hip joints, some of these factors are related to patients (i.e., activity, weight, and height) (20), surgical (i.e., acetabular component orientation, edge loading wear, and neck-rim impingent during high or low antiversion) (13,22,25), implant design (stem design, stem cross-section, stem taper angle, acetabular cup design, oscillatory motion of femoral stem, etc.) (16,31,32), and materials (mechanical and tribological properties, processing technique, structure, etc.) (30).

Two mechanisms are used to explain the squeaking phenomenon: friction-induced vibrations and rolling–slipping mechanisms. The first mechanism is based on the assumption that the audible noise or squeaking on COC hip joints is a result of the oscillatory vibration motion caused by the friction force at the contact bearing surfaces between femoral head and acetabular cup (33,34). The later one relates the squeaking to the induced vibrations from the rolling/sliding of the femoral head inside the cup during flexion motion of COC hip joints bearing as a result of the head-cup clearance (17).

Since the squeaking of COC total hip arthroplasty is a multifactorial phenomenon, it is not easy to eliminate the root cause of the squeaking noise. Some studies suggested that the squeaking can be reduced either clinically by minimizing friction raising factors (such as edge loading and situations promoting metal transfer or stripe wear) or by developing an endoprosthesis design to avoid the unstable vibrations (35), also by adjusting the vibration by additional more stiffness and damping effect of the peripheral structure (34). Accordingly, the squeaking COC bearing is not eliminated, and the only solution is by revision surgery. Therefore, this study attempts to find a promising solution for the squeaking of COC bearing surfaces by introducing a multilayer coating of PVA on the bearing surface of the Stryker Trident femoral head.

3 Materials of study

COC Stryker Alumina COC bearings were used in this study, because it is the most widely used ceramic material in biomedical applications, it has high stability in human body, chemically inert, and high resistance to corrosion (36). A 32 mm alumina ceramic V40^TM femoral head and a 32 mm alumina ceramic acetabular liner with a 56 mm acetabular shell were chosen because they are the most commonly used sizes clinically. All ceramic parts used in this study were produced by Stryker Orthopedic Company.

PVA polymer was chosen to be the artificial material used in this study for coating the femoral alumina ceramic head due to its biodegradable properties, and inertness in the human body. PVA was purchased from Sigma Aldrich.

A bovine serum fluid was used in this study as a lubricant solution at the bearing surfaces of the artificial hip joint to simulate the SF in a natural joint. It was diluted with a 25% bovine serum (ISO standard) because SF after hip arthroplasty has lower viscosity than normal joint. Bovine serum was bought from Life Technologies Company.

4 Experimental procedure

4.1 Customized hip joint simulator

A custom homemade hip simulator was built in order to provide a realistic simulation for the normal gait motion (flexion–extension) of the hip joint in humans. Figure 1 shows an image of the hip simulator subsystems (motion generating, and loading). In this simulator, the motion is initiated by a silent AC electric motor (1 hp, 1,400 rpm), the motor shaft is attached to one end of a gear box (ratio 10:1), and the motor speed is reduced to 130 rpm at gear box gear head. The motion is transmitted via pulley system to a flywheel that is connected to a bar linkage to rotate the hosting frame of acetabular cup. Figure 2a shows an image of the swing hosting frame of the acetabular cup. The test chamber is noise insulated from the surrounding, so that only sound generated at the hip joint bearing contact surfaces is recorded. The hosting frame of acetabular cup of prosthesis is allowed to swing not more than 80^o. This angle was selected to simulate the normal gait of the human body. The simulator is also equipped with an instrument to measure the generated sound, and thus enable identification of the squeaking onset. The femoral head of the joint is fixed to a column of hydraulic jack to apply a predetermined amount of static axial compression (∼140 kg), as shown in Figure 2b.

Figure 1

(a) Motion generating part of the hip simulator and (b) loading unit of the hip simulator.

Figure 2

(a) Image of the swing hosting frame of acetabular cup and (b) image of the femoral head COC attached to the loading column.

4.2 Femoral head coating

The procedure followed in refs (37,38) to synthesize layer-by-layer polymeric protective coatings for the aluminum substrate was used as a guideline to synthesize PVA coatings in the current research work. Three main steps were used to coat the alumina ceramic femoral head with PVA; they are acetabular head surface activation, PVA alkaline solution preparation, and application of the coating. First, the femoral head was dipped in an aqueous solution of pH = 10 and maintained for 1 h to activate its surface with negative charges. Then, PVA alkaline solution was prepared by dissolving 1.0 g PVA granules (molecular weight = 72,000 g·mol⁻¹) in 1 L of a solution adjusted to pH = 12 at 70°C, the solution was continuously mixed with a magnetic stirrer. Later, the activated femoral head was macerated in PVA solution for about 30 min and 2.5 mL of the cross-linking agent Epichlorohydrin (EPH) was added into the solution to act as a mediator layer with the femoral head’s surface. After completion of time, the femoral head covered with a monolayer of PVA cross-linked was removed and allowed to dry at ambient temperature. The same procedure was repeated to form a layer-by-layer coating on the surface of COC bearings. A schematic diagram and flow chart that describes the steps used to create the coating are shown in Figures 3 and 4, respectively.

Figure 3

A schematic diagram shows the steps used to coat the acetabular head with a monolayer of PVA.

Figure 4

Flow chart shows the steps used to coat the acetabular head with a layer-by-layer of PVA.

4.3 In vitro squeaking test

The hip joint simulator was used to examine the squeaking for both uncoated and coated femoral heads. A sound meter (EXTECH Instruments) that acquires two points per second was used. All tests were videotaped. The obtained data were analyzed using Microsoft Excel software by plotting the noise level chart that shows the sound level in decibels (dB) versus the number of cycles. This plot was used to determine the squeaking onset (cycle at which squeaking starts to occur). In the beginning, background noise was determined by running the motion-generating mechanism of the simulator, without applying any load and without using the artificial hip joint. The goal of this test was to determine all sounds and mechanical noises from devices in the system than the sounds being monitored. Later, this noise has to be eliminated from the results of other tests in order to get a nice and clear signal for the sound being emitted from the bearing contact surfaces. The following tests were performed: uncoated dry condition test, uncoated lubricated condition test, and multilayer lubricated condition test. Tests were conducted using a load of 140 kg. For each test, a new 32 mm alumina femoral head was used, and the test continued until the onset of squeaking. For the purpose of evaluating the effect of lubrication on squeaking, one uncoated head was tested without using lubricant at the hip joint bearing contact surfaces, and one uncoated head was tested with the presence of 25% bovine serum as a solution. To assess the efficiency of coating on delaying the squeaking onset, all coated heads with the different layered structures (bilayer, trilayer, and pentalayer) were tested with the presence of 25% bovine serum.

5 In vitro hip joint squeaking test results

5.1 Background noise

In this test, the noises acquired from running the motion generating part of the simulator and without applying load were analyzed. Excel software was used to plot the noise level chart that shows the sound level (dB) versus time as shown in Figure 5. The acquired noise signal was fluctuated within the range between 71 and 87 dB.

Figure 5

The background noise chart attained by running the motion generating part of the simulator and without load.

5.2 Dry condition test

The noise attained by simulating the hip joint motion under normal gait conditions, as loaded with 140 kg and with the absence of any lubricant at the bearing contact surfaces is shown in Figure 6. It can be seen that there is a transition of the noise level after 54 cycles of the test start, where the noise level became different from the observed background noise level and exceeded 90 dB, and then it continued to increase. The noise reached a high level and became unbearable after 150 cycles, where the noise detected became more than 115 dB. The noise level at which the transition occurs defines the “squeaking onset.”

Figure 6

Noise level chart of the dry condition test (blue is a background noise, and red is noise signal after squeaking occurrence).

5.3 Uncoated lubricant condition test

In this test, a 25% bovine serum solution was added at the bearing surfaces of the examined hip joint. The squeaking onset occurred at 13,200 cycles, which corresponds to 110 min.

5.4 Bilayer coating test

A new femoral head from a stryker coated with bilayers of PVA was used in this test. The simulator runs under the same conditions as in the uncoated lubricant condition test. In this test, the squeaking onset occurred at a larger number of cycles in comparison with the uncoated lubricant condition test. The squeaking occurred at approximately 21,000 cycles, instead of 13,200 cycles, and thus the pre-squeaking age of the hip joint was extended by 7,800 cycles. Referring to the literature, statistical medical studies of squeaking onset for patients who had implanted hip joints started to appear on average after approximately 5 years from the surgery (18). In in vitro tests, with conditions similar to those performed in this study, the squeaking onset was after 2 h of the test start.

5.5 Trilayer coating test

In this test, a new alumina femoral head from a stryker coated with trilayers of PVA was examined. The squeaking onset occurred after 50,405 cycles. This delay in squeaking achieved by increasing the number of coating layers is attributed to the increase of the covered area of the head with increase of number of layers. This will help to reduce friction in the contact area and prevent hard-to-hard contact, which in turn postpones the occurrence of squeaking.

5.6 Pentalayer coating test

In this test, a new femoral head coated with five layers of PVA was used; a 25% bovine serum was added at the bearings surfaces and 140 kg uniaxial compression was applied; the squeaking occurred after 86,400 cycles. This delay in squeaking is attributed to the reduction in hard-on-hard contact with the increase of number of coating layers, and the role of viscoelastic PVA in damping friction-induced vibrations on COC bearings.

6 Characterization of reinforced PVA coating

6.1 ¹HNMR spectroscopy

¹HNMR spectroscopy is a strong tool for structural identification of chemical compounds. It is considered as finger-print for the chemical structure of the reinforcement process of PVA through the EPH crosslinker. Figure 7 illustrates chemical identification of reinforced PVA coating.

Figure 7

¹HNMR spectrum of the reinforced PVA coating.

Apparently, the PVA and the EPH cross-linker moieties were available in the spectrum. For PVA moiety, CH₂ peak of the backbone is located at δ = 1.60 ppm (peak 4), CH peaks of the backbone are located at δ = 2.03 and 2.22 ppm (peaks 5 and 6), and OH peak at δ = 3.76 ppm (peak 9). Moreover, peak 3 located at δ = 1.44 ppm corresponds to two adjacent CH₂ groups of head-to-head configuration, whereas peaks 1 and 2 located at δ = 0.88 and 1.25 ppm correspond to terminal and head CH₃ groups of the chain, respectively. On the other hand, EPH moiety shows different peaks of heteroatom backbone and pendant groups as appeared in the spectrum; three CH peaks of the heteroatom backbone located at δ = 3.64, 3.95, and 4.84 ppm, respectively (peaks 7, 10, and 12), CH₂ peak of the heteroatom backbone located at δ = 3.71 ppm (peak 8), and CH₂OH peak of the pendant groups located at δ = 4.04 ppm (peak 11). Eventually, peak “m” located at δ = 5.34 ppm corresponds to left unreacted monomers of the purchased PVA.

6.2 Thermogravimetric analysis (TGA) and its first derivative (DTGA)

TGA and DTGA are characterization tools for determining thermal stability and decomposition temperatures of polymer constituents. Any chemical change that occurs in the structure of the polymer may be reflected in its thermal stability. The use of the first derivative is meant to determine the exact decomposition temperature. Figure 8 shows the TGA thermograms of PVA and reinforced PVA coating that were used for coating of alumina femoral head. Moreover, Figures 9 and 10 show the DTGA thermograms of received PVA and reinforced PVA coatings, respectively. Apparently, free uncross-linked PVA fraction shows decomposition temperature at 270°C, whereas the cross-linked reinforced PVA shows decomposition temperature at 432°C.

Figure 8

TGA of as-received PVA and reinforced PVA coating thermograms.

Figure 9

DTGA thermogram of the as-received PVA.

Figure 10

DTGA thermogram of reinforced PVA coating.

Clearly, the reinforcement process of PVA achieved by adding EPH has imparted larger thermal stability and larger coating characteristics. Figure 11 shows the structural changes that occur as the cross-linking process occurs.

Figure 11

Scheme of chemical structure of free uncross-linked PVA chains and cross-linked reinforced PVA coating.

6.3 X-ray diffraction (XRD)

XRD pattern indicates the formation of crystalline regions within the micro- and nano-scale polymeric structures. Figure 12 illustrates the XRD of the as-received PVA and cross-linked reinforced PVA coating. The % crystallinity indicates the changes in crystalline structure as a result of the cross-linking process. The % crystallinity can be calculated through the following relation:

(1) % Crystallinity = Area of crystalline peaks Background area × 100

Figure 12

XRD of as-received PVA and reinforced PVA coating.

Apparently, large crystalline regions are observed in the as-received PVA. Such crystalline regions correspond to the melting characteristics of PVA polymer. The % crystallinities of the as-received and reinforced PVA samples were 38.9% and 35.5%, respectively. The crystalline regions were partly destructed through the EPH crosslinker. The interaction of EPH with hydroxyl groups of the polymer backbone tends to dislocate and disjoint some crystallites and convert them into amorphous regions, leading to the formation of less crystalline, more amorphous, and more cross-linked polymeric structures. Such adequate morphology and chemical structures were found to play a dominant role in the formation of efficient alumina surface coating against continuous friction exposure, and hence prevent squeaking for prolonged time.

6.4 Transmission electron microscopy (TEM)

TEM is used to monitor physical and/or chemical changes that occur on the surface, shape, and size of PVA macromolecules. Figure 13 shows nano-scale TEM images of the reinforced PVA coating sample.

Figure 13

TEM images of reinforced PVA coating. (a) Formation of clusters from the assembly of 35–70 nm diameter spherical reinforced PVA macromolecules above each other; (b) nano-size spherical macromolecules bounded to each other, in a linear form, through a very fine angstrom-size thread; and (c and d) free and unbounded spheres and spheroids of reinforced PVA macromolecules flowing around in solution.

Figure 13a shows the formation of clusters from the assembly of 35–70 nm diameter spherical reinforced PVA macromolecules above each other. Such an assembly of macromolecules above each other is an indication of the presence of crystalline regions detected in the XRD spectrum. On the other hand, Figure 13b shows that the nano-size spherical macromolecules are bounded to each other, in a linear form, through a very fine angstrom-size thread. Such binding represents the cross-linking process of spherical PVA macromolecules via EPH cross-linking agent, which came in accordance with TGA results. In addition, Figure 13c and d presents free and unbounded spheres and spheroids of reinforced PVA macromolecules flowing around in solution. Consequently, reinforced PVA in solution had three configurational structures: cluster forms, cross-linked forms, and free unbounded forms. Such configurational structures play a significant role in binding the alumina surface, and forming the protective elastic coating capable of resisting and delaying the appearance of squeaking for a prolonged period of time.

6.5 Environmental scanning electron microscope (ESEM)

ESEM technique is used to examine the surface morphological changes of alumina ceramic femoral head, i.e., the appearance of newly formed cracks, scratches, and/or occurrence of fracture after being exposed to the friction force before and after coating. The as-received femoral head was free of cracks and scratches. However, the surface has some scratches and signs of abrasion wear appeared after being tested with the presence of lubricant (Figures 14 and 15). More scratches are seen on the surface of the sample tested in the dry condition and in the absence of lubrication.

Figure 14

Uncoated alumina femoral head tested in the presence of SF (lubricated condition).

Figure 15

Uncoated alumina femoral head tested in the absence of SF (dry condition).

7 Discussion

In order to show the effects of the number of layers on the pre-squeaking age of the femoral head, a summary of the test results is presented in Table 1. The table shows both the number of cycles and the time in minutes at which squeaking starts, defined as, “squeaking onset,” the change of the pre-squeaking age attained by adding a new layer to the existing layers. Also, the comparative difference of the pre-squeaking age measured as percentage of the change with respect to the uncoated lubricated condition is shown. The values of comparative pre-squeaking age difference indicate that the largest benefit and improvement achieved were for the femoral head coated with pentalayers. An exponential function can describe the relation between the number of cycles prior to squeaking onset and the number of PVA layers applied to COC femoral head.

Table 1

Summary of the squeaking onset, incremental, and comparative pre-squeaking age difference for all the tests performed

		Squeaking onset		Pre-squeaking age difference
Tests	Squeaking	Minutes	Cycle	Comparative (%)	Incremental
Background noise	No
Dry condition	Yes	0.42	50	—	—
Uncoated lubricant test	Yes	110	13,200	—	—
Bilayer of PVA coating	Yes	175	21,000	59.1	7,800
Trilayer of PVA coating	Yes	420	50,400	281.8	29,400
Pentalayer of PVA coating	No	722.42	86,690	556.7	36,290

This improvement of the pre-squeaking age is attributed to the reduction in hard-on-hard contact with increased number of PVA layers, which reduce friction at bearing surface, and thus delay squeaking onset occurrence, especially that the friction is considered as the main cause of vibration, oscillatory motion, and dynamic instability of hip joint, and thus squeaking. In addition, the increasing number of PVA layers results in a reduction in femoral-head liner clearance. This clearance reduction hinders rolling/sliding of the femoral head inside the cup during flexion motion. In addition, the viscoelastic properties of PVA act to damp friction-induced vibrations on COC bearings (39,40). Hence, these results were consistent with the two acceptable mechanisms proposed to explain squeaking occurrence (36,41,42).

The characteristics of PVA coatings were affected by using EPH cross-linking agent. Both glass transition temperature and thermal stability of reinforced cross-linked PVA were higher than those for unreinforced PVA due to the formation of large intermolecular forces between PVA chains. This improvement in thermal stability inspires the potential use of PVA to coat femoral head of the joint. Moreover, PVA coating does not peel or crack during squeaking test. Only some scratches and pits were observed in the post-SEM images of the femoral head. This type of coating provides a proof of the strong adhesion of the coating system with the surface of the underlying femoral head substrate. The ability of coating to retain its bond strength under stress during squeaking test is a result of physicochemical interaction between the coating and substrate. One crucial cause of this strong adhesion is the strong electrostatic interaction between negatively charged surfaces of femoral head with the positive PVA end.

8 Conclusion

The following points can be drawn from this current study:

Coating of COC femoral head with layer-by-layer reinforced PVA significantly delays squeaking onset, and the pre-squeaking age of the hip joints increases exponentially with the increase in number of PVA layers.
The values of comparative pre-squeaking age difference indicate that the largest benefit and improvement achieved were for the femoral head coated with pentalayers, trilayers, and bilayers, respectively.
¹HNMR and TGA results prove the effectiveness of EPH cross-linking agent in binding reinforced PVA macromolecules with each other and with the surface of the COC bearing forming nano-sized coating material.
XRD indicates the formation of crystalline regions within micro- and macroscale polymeric structures. TGA analysis of the coating material shows that reinforced PVA coating became more thermally stable, and more resistive to decomposition at elevated temperatures.
Posttest SEM images of the femoral head show the durability of the examined coatings, where no significant damage to coatings occurs, which provides evidence that PVA coating is chemically bonded to the surface of femoral head.
The morphology and the chemical structure of the layer-by-layer PVA coating on femoral head prolong pre-squeaking age of the hip joint, where comparative pre-squeaking age difference of 556.7% for pentalayer coating is observed. This provides strong evidence on the feasibility of the layer-by-layer PVA coating to resist and delay the appearance of squeaking for a prolonged period of time and to form successful thermally stable hip joint biomaterials.

Acknowledgments

The authors are grateful to the Scientific Research Deanship of Jordan University of Science and Technology for its support of this research (Grant No. 2014/82). Thanks also extended to all members of the engineering workshop, materials laboratory of industrial engineering, laboratories of Applied Chemistry Department, Nano Center, and Pharmaceutical Research Center at Jordan University of Science and Technology for their help and assistance.

Funding information: This study was funded by Scientific Research Deanship of Jordan University of Science and Technology (Grant No. 2014/82).
Author contributions: Mohammed A. Almomani: writing – original draft, writing – review and editing, methodology, formal analysis, project administration, conceptualization, resources; Mohammed M. Fares: PVA coating, coating characterization, writing; Elham M. Almesidieen: writing – original draft, methodology, and data curation.
Conflict of interest: Authors state no conflict of interest.

Appendix

Table A1

URL links for some of the experiments that were carried out during this research (the first column describes the test condition and the time measured from the start of experiment)

Experiment	Video URL
01 – Dry condition
	https://youtube.com/shorts/v6CjH3kLJdI?feature=share
02 – Lubricant condition without PVA coating
Initial stage	https://youtu.be/dbD18BIX76c
After 1 h	https://youtu.be/nFUa0G8tPFE
After 110 min	https://youtu.be/q8R9XlOuPr0
03 – Lubricant condition with bilayers of PVA coating
Initial stage	https://youtu.be/j0v61ItufeU
After 2 h	https://youtu.be/5fZlpz-PvA8
After 175 min	https://youtu.be/46EEKzcHf8E
04 – Lubricant condition with trilayers of PVA coating
Initial stage	https://youtu.be/7cukxfVEx0k
After 190 min	https://youtu.be/RWifpMm8688
After 7 h	https://youtu.be/kWdSjKRRv2Y
05 – Lubricant condition with pentalayers of PVA coating
Initial stage	https://youtu.be/T4IySy_WKaU
After 5 h	https://youtu.be/Ug28ahb6PrM
After 8 h	https://youtu.be/E0AGf6Hyo0o
After 12 h	https://youtu.be/M_75bphLXoc
Additional videos
Motion generating part of the hip simulator	https://youtu.be/rg437HnMEus
Loading unit of the hip simulator	https://youtube.com/shorts/lcVLTDb2sDk?feature=share

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Received: 2022-02-23

Revised: 2022-04-25

Accepted: 2022-04-27

Published Online: 2022-05-30

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

https://doi.org/10.1515/epoly-2022-0048

Keywords for this article

squeaking; ceramic on ceramic; hip joints; reinforced PVA; layer-by-layer coating

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BY 4.0

Toward long-live ceramic on ceramic hip joints: In vitro investigation of squeaking of coated hip joint with layer-by-layer reinforced PVA coatings

Article

Abstract

1 Introduction

2 COC squeaking

3 Materials of study

4 Experimental procedure

4.1 Customized hip joint simulator

4.2 Femoral head coating

4.3 In vitro squeaking test

5 In vitro hip joint squeaking test results

5.1 Background noise

5.2 Dry condition test

5.3 Uncoated lubricant condition test

5.4 Bilayer coating test

5.5 Trilayer coating test

5.6 Pentalayer coating test

6 Characterization of reinforced PVA coating

6.1 1HNMR spectroscopy

6.2 Thermogravimetric analysis (TGA) and its first derivative (DTGA)

6.3 X-ray diffraction (XRD)

6.4 Transmission electron microscopy (TEM)

6.5 Environmental scanning electron microscope (ESEM)

7 Discussion

8 Conclusion

Acknowledgments

Appendix

References

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6.1 ¹HNMR spectroscopy