OXINIUM An arthroplasty option for young and active patients

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OXINIUM An arthroplasty option for young and
active patients
The Answer is Black and White!

• EFORT 2009
• 3-6 June 2009
• Azad Hussain, PhD
• Implant Development Centre (IDC)
• Smith Nephew Orthopaedics Ltd

Trademark of Smith Nephew. Reg. US Pat. TM
Off.
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Demands are Changing
Patients Expectations
Life Expectancy

• Minimum Age

• Activity

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R3 Acetabular System

• Multiple bearing combinations (primary and
  revision)
• Acetabular system which utilizes various liners

Ceramic-on-Ceramic Biolox Forte
Delta Metal-on-Metal R3 Modular Resurfacing
Large Heads XLPE Options Biolox Delta, CoCr,
OXINIUM
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Science Behind Superior Performance of OXINIUM
Material
Trademark of Smith Nephew. Reg. US Pat. TM
Off.
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Biocompatibility

• Zirconium and Niobium two of the four most
  biocompatible metals

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OXINIUM?-Oxidized Zr-2.5Nb
Not a coating

• Wrought zirconium-2.5 niobium alloy is heated in
  air
• Surface transforms to stable ceramic (5 µm)
• OXINIUM is durable with toughness of metal and
  high strength

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Strength

• Supports 4.4 kN for 10 million cycles
• Thinnest condyle tested
• Bends with 19.8 kN does not break or delaminate

Tsai et al., SFB 2001
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Stability

• Not affected by autoclave exposure or damaged
  taper for headsdoes not lead to brittle fracture
  as monolithic ceramics
• Does not shatter in crush test with 89 kN (9
  tons) load
• Flattens slightly with 89 kN side load without
  stem
• Oxide maintains integrity on slightly flattened
  head

Zirconia
Oxinium
Sprague et al., ISTA 2003
Top Load
Sprague et al., ISTA 2003
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Twice as Hard as Cobalt Chrome

• Surface is twice as hard
• Substrate retains lower hardness of a metal

Long et al., SFB 1998
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4900x More Abrasion Resistant than CoCr
Hunter and Long, WBC 2000
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Half the Coefficient of Friction vs CoCr

• Lower coefficient of friction against
  polyethylene
• Lower coefficient of friction means less adhesive
  wear

Poggie et al., ASTM STP 1145
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Lubricates Better than CoCr

• A drop of fluid beads up more on a cobalt chrome
  surface
• A drop of fluid lies down more on a ceramic
  surface
• The ceramic surface of Oxidized Zirconium slides
  better than Cobalt Chrome because it lubricates
  better

Drop of fluid on a CoCr surface
Drop of fluid on a ceramic surface
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OXINIUM? Strength of a metal and
benefits of ceramic
Lubricity and abrasion resistance of a
ceramicMechanical resilience of a metal
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Laboratory Wear Studies
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Wear Performance of OXINIUM/XLPE

• 98 reduction in wear compared to standard
• Comparable to other advanced bearing couplings
• No fracture, chipping or squeaking
• Ideal for patients with soft tissue metal
  sensitivity

Trademark of Smith Nephew. Reg. US Pat. TM
Off.
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OXINIUM? A solution for metal-sensitive
patients
Nickel content is below the limit of detection
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Good et. al, JBJS 2003
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Good et. al, JBJS 2003
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Particle analysis
Reduced risk of osteolysis
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Wear under aggressive test profile Pristine
OXINIUM and CoCr against XLPE
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3
Wear Rate (mm3/mc)
2
1
0
OX-XLPE
CoCr-XLPE
Parikh et al., 2009 ORS
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Clinical Outcome
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Midterm Clinical Results
Lewis et al., 2008 Orthopaedics
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Wear - OXINIUM/XLPE vs CoCr/XLPE

• - Radiostereometric analysis (RSA) study on wear
  of 32 mm OXINIUM heads on XLPE vs 28 mm CoCr on
  XLPE
• - 30 OXINIUM hips and 44 CoCr hips (Mr Nivbrant)
• - Wear results at 2 years
• OXINIUM on XLPE Undetectable
• CoCr on XLPE 0.08 mm

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Oxidized Zirconium Summary

• Excellent biocompatibility
• Less polyethylene wear than CoCr
• Resists roughening more than CoCr
• Produces less friction than CoCr
• No fracture, chipping or squeaking
• Ideal for patients with soft tissue metal
  hypersensitivity
• Promising clinical results
• Smith Nephew was awarded the 2005 ASM
  International Engineering Materials Achievement
  Award for OXINIUM technology

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• THANK YOU FOR YOUR ATTENTION