Aetiology of Hip dislocation

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

Impression creep of zinc and the rate-controlling dislocation mechanism of plastic flow at high temperatures

The impression creep behaviour of zinc is studied in the range 300 to 500 K and the results are compared with the data from conventional creep tests. The steady-state impression velocity is found to exhibit the same stress and temperature dependence as in conventional tensile creep with the same power law stress exponent. Also studied is the effect of indenter size on the impression velocity. The thermal activation parameters for plastic flow at high temperatures derived from a number of testing techniques agree reasonably well. Grain boundary sliding is shown to be unimportant in controlling the rate of plastic flow at high temperatures. It is observed that the Cottrell-Stokes law is obeyed during high-temperature deformation of zinc. It is concluded that a mechanism such as forest intersection involving attractive trees controls the high-temperature flow rather than a diffusion mechanism.

Dislocation after total hip replacement: there is no such thing as a safe zone for socket placement with the posterior approach

Introduction Malorientation of the socket contributes to instability after hip arthroplasty but the optimal orientation of the cup in relation to the pelvis has not been unequivocally described. Large radiological studies are few and problems occur with film standardisation, measurement methodology used and alternative definitions of describing acetabular orientation. Methods A cohort of 1,578 patients from a single institution is studied where all patient data was collected prospectively. Risk factors for patients undergoing surgery are analysed. Radiological data was compared between a series of non-dislocating hips and dislocating cases matched 2:1 by operation type, age and diagnosis. Results The overall dislocation rate for all 1,578 cases was 3.23% but the rate varied according to the type of surgery performed. The rate in uncomplicated primary cases was 2.4% which increased to 9.3% for second stage implantation for a two stage procedure for infection. There was no significant difference in the variability of the dislocating and non-dislocating groups for either inclination (p = 0.393) or anteversion (p = 0.661). Conclusions A “safe zone” for socket orientation to avoid dislocation could not be defined. The cause of dislocation is multifactorial, re-establishing the anatomic centre of rotation, balancing soft tissues and avoidance of impingement around the hip are important considerations.

Amorphization by dislocation accumulation in shear bands

Microcrystalline γ-Y2Si2O7 was indented at room temperature and the deformation microstructure was investigated by transmission electron microscopy in the vicinity of the indent. The volume directly beneath the indent comprises nanometer-sized grains delimited by an amorphous phase while dislocations dominate in the periphery either as dense slip bands in the border of the indent or, further away, as individual dislocations. The amorphous layers and the slip bands are a few nanometers thick. They lie along well-defined crystallographic planes. The microstructural organization is consistent with a stress-induced amorphization process whereby, under severe mechanical conditions, the crystal to amorphous transformation is mediated by slip bands containing a high density of dislocations. It is suggested that the damage tolerance of γ-Y2Si2O7, which is exceptional for a ceramic material, benefits from this transformation.

Grain boundary sliding during diffusion and dislocation creep in a Mg-0.7 pct Al alloy

Early studies on grain boundary sliding (GBS) in Mg alloys have suggested frequently that the contribution of GBS to creep is high even under conditions corresponding to dislocation creep. The role of creep strain and grain size in influencing the experimental measurements has not been clearly identified. Grain boundary sliding measurements were conducted in detail over experimental conditions corresponding to diffusion creep as well as dislocation creep in a single-phase Mg-0.7 wt pet Al alloy. The results indicated clearly that the GBS contribution to creep was Very high during,, diffusion creep at low stresses (similar to 75 pct) and substantially reduced during dislocation creep at high stresses (similar to 15 pct). These measurements were consistent with the observation of significant intragranular slip band activity observed in most grains at high stresses and very little slip band activity at low stresses. The experimental measurements and analysis indicated also that the GBS contribution to creep was high during the initial stages of creep and decreased to a steady-state value at large strains.

Primary Dislocation of the Patella : A Clinical Study

A total of 177 patients with primary dislocation of the patella (PDP) were admitted to two trauma centers in Helsinki, Finland during 1991 to 1992. The inclusion criteria were: 1. Acute (≤14 days old) first-time lateral dislocation of the patella. 2. No previous knee operations or major knee injuries. 3. No ligament injuries to be repaired. 4. No osteochondral fractures requiring fixation. 50 patients were excluded. 30 of these excluded patients would have met the inclusion criteria, 19 patients received treatment by consultants not involved in the study, 7 refused to participate and 4 had an erroneous randomization. 127 patients including, 82 females, were then randomized to have either tailor-made operative procedure (group O) or conservative treatment (group C). The aftercare was similar for both groups. The mean age of the patients was 20 (9-47) years. All patients were subjected to analysis of trauma history (starting position and knee movement during the dislocation), examination under anesthesia (EUA) and arthroscopy. 70 patients (52 females) were randomized by their odd year of birth to operative group O and 57 patients (30 females) by their even year of birth to conservative group C. The diagnosis of PDP was based on locked dislocation in 68 patients, on dislocatability in EUA in 47 patients, and on subluxation in EUA combined with typical intra-articular lesions in 12 patients. In group O, 63 patients had exploration of the injuries on the medial side of the knee and tailor made reconstruction added with lateral release in 54 cases. The medial injury was operated by suturing in 39 patients, by duplication in 18 patients and by additional augmentation of the medial patellofemoral ligament (MPFL) with adductor magnus tenodesis in 6 patients. 7 patients, without locking in trauma history and only subluxation in EUA had only lateral release for realignment. In adductor magnus tenodesis the proximal end of the distal tendinous part was rerouted to the upper medial border of the patella. In the conservative group C, the treatment was adjusted to the extent of patellar displacement in EUA. Patients with dislocation in EUA had 3 weeks’ immobilization with the knee in slight flexion. Mobilization was started with a soft patellar stabilizing orthosis (PSO) used for additional three weeks. The patients with subluxation in EUA wore an orthosis for six weeks. The aftercare was similar in group O. The outcome was similar in both groups. After an average of 25 (20-45) months´ follow-up, the subjective result was better in group C in respect of the mean Hughston VAS knee score (87 for group O and 90 for group C, p=0.04, visual analog scale), but similar in terms of the patient’s own overall opinion and the mean Lysholm II knee score. Recurrent instability episodes occurred in 18 patients in group O and in 20 patients in group C. After an average of 7 (6-9) years´ follow-up, the groups did not show statistical difference either in respect of the patient’s own overall opinion, or the mean Hughston VAS and Kujala knee scores. The proportions of stable patellae was 25/70 (36%) in group O and 17/57 (30%) in group O (p=0.5). In a multivariate risk analysis, there was a correlation between low Kujala score (<90) as dependent parameter and female gender (OR: 3.5; 95% CI: 1.4-9.0), and loose body on primary radiographs (OR: 4.1; 95% CI: 1.2-15). Recurrent instability correlated with young age at the time of PDP (OR: 0.9; 95% CI: 0.8-1.0/year). Girls with open tibial apophysis had the worst prognosis for instability (88%; 95% CI: 77-98). The most common mechanisms in trauma history of the patients were movement to flexion from a straight start (78%) and movement to extension from a well-bent start (8%). Spontaneous relocation of the patella had taken place in 13/39 of girls, in 11/21 of boys, in 26/42 of women and in 17/24 of men with skeletal maturity of the tibia. The dislocation in EUA was non-rotating in 96/126 patients followed by outward rotating dislocation in 14/126 patients. Operative treatment policy in PDP is not recommended. Locking tendency of the patella in PDP depended on the skeletal maturation. Recurrence rate after PDP was higher than expected.

Dislocation dynamics in alpha titanium Dynamique des dislocations dans le titane alphaVersetzungsdynamik in alpha-Titan

The activation area and activation enthalpy are determined as a function of stress and temperature for alpha titanium. The results indicated that plastic flow below about 700°K occurs by a single thermally activated mechanism. Activation area determined by differential-stress creep tests falls in the range 80−8b2 and does not systematically depend on the impurity content. The total activation enthalpy derived from the temperature and strain-rate dependence of flow stress is 1.15 eV. The experimental data support a lattice hardening mechanism as controlling the low-temperature deformation in alpha titanium.

The nature of dislocation motion in quasicrystals

Calculations in a hydrodynamic model of quasicrystal dynamics show that dislocation motion in these systems is impeded by a drag far greater than that in crystals.

Dislocation characterization in crystals of potash alum grown by seeded solution growth under conditions of low supersaturation

An analysis has been carried out of the genesis and character of growth dislocations present in all growth sectors of single crystals of potash alum. The crystals, grown from seeded solutions by the temperature lowering method under conditions of low supersaturation, presented the well-developed forms: {111} dominant, {100} and {110}. Growth dislocations formed predominately during refacetting of the edges and corners of the seed, rounded during preparation and insertion into the supersaturated solution. From here they become refracted into the {111} sectors which proved to be the most defective. Smaller numbers of dislocations form at the {111}, {100} and {110} seed interfaces and propagate in these sectors. In crystals of inferior quality, a number of inclusions were found predominantly in the fast growing {100} sectors which become the source of additional dislocations. Dislocations present in the original seed did not propagate across the interface into the developing crystal. Dislocations of all characters were observed. The principal Burgers vectors were found to be left angle bracket100right-pointing angle bracket, left angle bracket110right-pointing angle bracket and left angle bracket111right-pointing angle bracket.

Kinetic approach to dislocation bending in low-mobility films

A kinetic model has been developed for dislocation bending at the growth surface in compressively stressed low-mobility films such as III-V nitrides. It is based on a reduction in the number of atoms at the growth surface. Stress and nonstress sources of driving force for such a reduction are discussed. A comparison between the derived equations and experimentally measured stress evolution data yields good agreement between the predicted and observed angles through which dislocations bend.

Sintering of beta titanium: Role of dislocation pipe diffusion

Sintering of titanium in its high temperature beta phase was studied by isothermal dilatometry. The sintering shrinkage y did not follow the normal time exponent type of behaviour, instead being described by the equation y = Kt(m)/[1-(A+Bt)(2)], where m = 1.93 +/- 0.07, with an activation energy of 62-90 kJ mol(-1). A detailed analysis of these results, based on the 'anomalous' diffusion behaviour reported for beta titanium, is carried out. It is shown that the generation of a high density of dislocations during the alpha --> beta phase transformation, coupled with sluggish recovery at the sintering necks, enables sintering mass transport by pipe diffusion through dislocation cores from sources of matter within the particles to become dominant.

Dislocation mechanisms for plastic flow of nickel in the temperature range 4.2 – 1200 K

The temperature ranges of thermal and athermal deformation behaviour of nickel are identified by employing the temperature-dependence of flow-stress and strain-rate cycling data. The results are used to present a unified view of dislocation mechanisms of glide encompassing the two thermally activated and the intermediate athermal regimes of plastic flow.In the low-temperature thermally activated region (<250 K) the strain rate is found to be controlled by the repulsive intersection of glide and forest dislocations, in accordance with current ideas. The athermal stress in this region can be attributed mainly to the presence of strong attractive junctions which are overcome by means of Orowan bowing, a small contribution also coming from the elastic interactions between dislocations. The values of activation area and activation energy obtained in the high-temperature region (> 750 K) negate the operation of a diffusion-controlled mechanism. Instead, the data support a thermal activation model involving unzipping of the attractive junctions. The internal (long-range) stress contribution here results solely from the elastic interactions between dislocations. This view concerning the high-temperature plastic flow is further supported by the observation that the Cottrell–Stokes law is obeyed over large strains in the range 750–1200 K.