1
|
Kim S, Koh J, Bedi A, Amirouche F. Lesion Size Location Dependency on Maximum Pressure in Osteochondral Defects: Experiments and Finite-Element Analysis. Orthop J Sports Med 2024; 12:23259671241281735. [PMID: 39421044 PMCID: PMC11483734 DOI: 10.1177/23259671241281735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/03/2024] [Indexed: 10/19/2024] Open
Abstract
Background Osteochondral defects (OCDs) in the knee joint have significant clinical implications, particularly regarding contact pressures and pressure distribution. Understanding how these factors are influenced by defect size and location is crucial for developing effective therapeutic strategies. Purpose/Hypothesis The purpose of this study was to investigate the impact of defect size and location on contact pressures and pressure distribution in the knee joint. It was hypothesized that an increase in defect size would result in elevated contact pressures and alterations in pressure distribution, with specific variations related to defect location. Study Design Descriptive laboratory study. Methods The study utilized 6 cadaveric knees, including the patella and fibula, subjected to controlled compressive loading for measuring contact pressures. Simultaneously, computed tomography-based models were created for finite-element analysis (FEA) to investigate the impact of varying defect sizes and locations on contact pressures and pressure distribution in the knee joint, excluding the patellofemoral joint. The study employed analysis of variance to assess contact pressure and defect size association. Comparison between medial and lateral femoral condyles at full extension and 30° flexion angle was performed, followed by post hoc testing. Fisher exact test analyzed peak pressure point location and defect size, categorizing them into medial and lateral. Results An increase in defect size corresponded with heightened contact pressures on both medial and lateral femoral condyles at full extension (P = .013 for medial and P = .024 for lateral). However, this correlation did not yield significant differences at 30° of flexion (P = .674 for medial and P = .333 for lateral). During mechanical testing, the highest pressures occurred near 5 mm defect dimensions. FEAs showed a significant increase in pressure and circumferential-edge stress with 7-mm defects. Peak contact pressure points shifted laterally with more significant defects. Conclusion Our study demonstrated the impact of defect size, location, and alignment on knee joint contact pressures. Intervening promptly with defects exceeding 3 mm is crucial, as significant stress levels manifest beyond this threshold. Significant increases in contact pressures were noted with larger defect sizes, particularly between 3 and 10 mm at full extension. Peak pressure points shifted with defect size increments, and alignment variations showed minimal stress variation at 30° compared with 0°. FEA validated increasing contact pressures up to 7 mm defect size, beyond which pressures stabilized or slightly decreased. A concentrated pressure distribution on the medial side was observed. These findings inform our understanding of the biomechanical implications of OCDs. Clinical Relevance In the field of sports medicine, this research offers valuable insights to clinicians and researchers, elucidating key factors influencing knee joint health and the potential consequences of OCDs.
Collapse
Affiliation(s)
- Sunjung Kim
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jason Koh
- Department of Orthopaedic Surgery, Northshore University Health System, an Affiliate of the University of Chicago Pritzker School of Medicine, Skokie, Illinois, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, Northshore University Health System, an Affiliate of the University of Chicago Pritzker School of Medicine, Skokie, Illinois, USA
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Northshore University Health System, an Affiliate of the University of Chicago Pritzker School of Medicine, Skokie, Illinois, USA
| |
Collapse
|
2
|
van Hugten PPW, Jeuken RM, Asik EE, Oevering H, Welting TJM, van Donkelaar CC, Thies JC, Emans PJ, Roth AK. In vitro and in vivo evaluation of the osseointegration capacity of a polycarbonate-urethane zirconium-oxide composite material for application in a focal knee resurfacing implant. J Biomed Mater Res A 2024; 112:1424-1435. [PMID: 38465895 DOI: 10.1002/jbm.a.37691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
Currently available focal knee resurfacing implants (FKRIs) are fully or partially composed of metals, which show a large disparity in elastic modulus relative to bone and cartilage tissue. Although titanium is known for its excellent osseointegration, the application in FKRIs can lead to potential stress-shielding and metal implants can cause degeneration of the opposing articulating cartilage due to the high resulting contact stresses. Furthermore, metal implants do not allow for follow-up using magnetic resonance imaging (MRI).To overcome the drawbacks of using metal based FKRIs, a biomimetic and MRI compatible bi-layered non-resorbable thermoplastic polycarbonate-urethane (PCU)-based FKRI was developed. The objective of this preclinical study was to evaluate the mechanical properties, biocompatibility and osteoconduction of a novel Bionate® 75D - zirconium oxide (B75D-ZrO2) composite material in vitro and the osseointegration of a B75D-ZrO2 composite stem PCU implant in a caprine animal model. The tensile strength and elastic modulus of the B75D-ZrO2 composite were characterized through in vitro mechanical tests under ambient and physiological conditions. In vitro biocompatibility and osteoconductivity were evaluated by exposing human mesenchymal stem cells to the B75D-ZrO2 composite and culturing the cells under osteogenic conditions. Cell activity and mineralization were assessed and compared to Bionate® 75D (B75D) and titanium disks. The in vivo osseointegration of implants containing a B75D-ZrO2 stem was compared to implants with a B75D stem and titanium stem in a caprine large animal model. After a follow-up of 6 months, bone histomorphometry was performed to assess the bone-to-implant contact area (BIC). Mechanical testing showed that the B75D-ZrO2 composite material possesses an elastic modulus in the range of the elastic modulus reported for trabecular bone. The B75D-ZrO2 composite material facilitated cell mediated mineralization to a comparable extent as titanium. A significantly higher bone-to-implant contact (BIC) score was observed in the B75D-ZrO2 implants compared to the B75D implants. The BIC of B75D-ZrO2 implants was not significantly different compared to titanium implants. A biocompatible B75D-ZrO2 composite approximating the elastic modulus of trabecular bone was developed by compounding B75D with zirconium oxide. In vivo evaluation showed an significant increase of osseointegration for B75D-ZrO2 composite stem implants compared to B75D polymer stem PCU implants. The osseointegration of B75D-ZrO2 composite stem PCU implants was not significantly different in comparison to analogous titanium stem metal implants.
Collapse
Affiliation(s)
- Pieter P W van Hugten
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ralph M Jeuken
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erkan E Asik
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| | | | - Tim J M Welting
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Corrinus C van Donkelaar
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Peter J Emans
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| |
Collapse
|
3
|
Day GA, Jones AC, Mengoni M, Wilcox RK. A Finite Element Model to Investigate the Stability of Osteochondral Grafts Within a Human Tibiofemoral Joint. Ann Biomed Eng 2024; 52:1393-1402. [PMID: 38446329 PMCID: PMC10995060 DOI: 10.1007/s10439-024-03464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024]
Abstract
Osteochondral grafting has demonstrated positive outcomes for treating articular cartilage defects by replacing the damaged region with a cylindrical graft consisting of bone with a layer of cartilage. However, factors that cause graft subsidence are not well understood. The aim of this study was to develop finite element (FE) models of osteochondral grafts within a tibiofemoral joint, suitable for an investigation of parameters affecting graft stability. Cadaveric femurs were used to experimentally calibrate the bone properties and graft-bone frictional forces for use in corresponding image-based FE models, generated from µCT scan data. Effects of cartilage defects and osteochondral graft repair were measured by examining contact pressure changes using further in vitro tests. Here, six defects were created in the femoral condyles, which were subsequently treated with osteochondral autografts or metal pins. Matching image-based FE models were created, and the contact patches were compared. The bone material properties and graft-bone frictional forces were successfully calibrated from the initial tests with good resulting levels of agreement (CCC = 0.87). The tibiofemoral joint experiment provided a range of cases that were accurately described in the resultant pressure maps and were well represented in the FE models. Cartilage defects and repair quality were experimentally measurable with good agreement in the FE model pressure maps. Model confidence was built through extensive validation and sensitivity testing. It was found that specimen-specific properties were required to accurately represent graft behaviour. The final models produced are suitable for a range of parametric testing to investigate immediate graft stability.
Collapse
Affiliation(s)
- Gavin A Day
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, Leeds, UK.
| | - Alison C Jones
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, Leeds, UK
| | - Marlène Mengoni
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, Leeds, UK
| |
Collapse
|
4
|
Schuiringa GH, Pastrama M, Ito K, van Donkelaar CC. Towards a load bearing hydrogel: A proof of principle in the use of osmotic pressure for biomimetic cartilage constructs. J Mech Behav Biomed Mater 2023; 137:105552. [PMID: 36371992 DOI: 10.1016/j.jmbbm.2022.105552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Cartilage defects occur frequently and can lead to osteoarthritis. Hydrogels are a promising regenerative strategy for treating such defects, using their ability of mimicking the native extracellular matrix. However, commonly used hydrogels for tissue regeneration are too soft to resist load-bearing in the joint. To overcome this, an implant is being developed in which the mechanical loadbearing function originates from the osmotic pressure generated by the swelling potential of a charged hydrogel, which is restricted from swelling by a textile spacer fabric. This study aims to quantify the relationship between the swelling potential of the hydrogel and the compressive stiffness of the implant.
Collapse
Affiliation(s)
- Gerke H Schuiringa
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Maria Pastrama
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Corrinus C van Donkelaar
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands.
| |
Collapse
|
5
|
Damen AHA, Schuiringa GH, Ito K, van Donkelaar CC. The effect of HydroSpacer implant placement on the wear of opposing and adjacent cartilage. J Orthop Res 2022. [PMID: 36403126 DOI: 10.1002/jor.25487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
A HydroSpacer implant, that is, a swelling hydrogel confined by a spacer fabric, was developed to repair focal cartilage defects and to prevent progression into osteoarthritis. The present study evaluated the effect of implant placement height in an osteochondral (OC) plug on wear of the opposing and adjacent cartilage. Three-dimensional warp-knitted spacer fabrics, polycaprolactone with poly(4-hydroxybutyrate) pile yarns, were filled with a hyaluronic acid methacrylate and chondroitin sulfate methacrylate hydrogel. After polymerization of the hydrogel, these HydroSpacers were implanted in OC defects (ø 6 mm) created in bovine OC plugs (ø 10 mm) and allowed to swell to equilibrium. A custom-made pin-on-plate wear apparatus was used to apply simultaneous compression and sliding against bovine cartilage. Cartilage damage, visualized with Indian ink, was only seen for the group in which the HydroSpacer was placed flush with the surrounding cartilage. A significant increase on average surface roughness of the sliding path compared to the adjacent cartilage confirmed surface damage for this group. When the implants were recessed (with and without extra hydrogel layer on top of the implant), this damage was not observed, but the cartilage surrounding the implants was compressed (without damage) indicating substantial load sharing with the implant. Furthermore, it was shown that all defects treated with a HydroSpacer implant resulted in shear forces comparable to intact cartilage. Clinical significance: The present study suggests that placing a HydroSpacer implant recessed into the surrounding cartilage would decrease wear of the opposing cartilage. Altogether, this study supports the development of textile-constraining hydrogels for cartilage replacement.
Collapse
Affiliation(s)
- Alicia H A Damen
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerke H Schuiringa
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Keita Ito
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Corrinus C van Donkelaar
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
6
|
Day GA, Cooper RJ, Jones AC, Mengoni M, Wilcox RK. Development of robust finite element models to investigate the stability of osteochondral grafts within porcine femoral condyles. J Mech Behav Biomed Mater 2022; 134:105411. [PMID: 36037705 DOI: 10.1016/j.jmbbm.2022.105411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022]
Abstract
Osteoarthritis (OA) is the most prevalent chronic rheumatic disease worldwide with knee OA having an estimated lifetime risk of approximately 14%. Autologous osteochondral grafting has demonstrated positive outcomes in some patients, however, understanding of the biomechanical function and how treatments can be optimised remains limited. Increased short-term stability of the grafts allows cartilage surfaces to remain congruent prior to graft integration. In this study methods for generating specimen specific finite element (FE) models of osteochondral grafts were developed, using parallel experimental data for calibration and validation. Experimental testing of the force required to displace osteochondral grafts by 2 mm was conducted on three porcine knees, each with four grafts. Specimen specific FE models of the hosts and grafts were created from registered μCT scans captured from each knee (pre- and post-test). Material properties were based on the μCT background with a conversion between μCT voxel brightness and Young's modulus. This conversion was based on the results of the separate testing of eight porcine condyles and optimization of specimen specific FE models. The comparison between the experimental and computational push-in forces gave a strong agreement with a concordance correlation coefficient (CCC) = 0.75, validating the modelling approach. The modelling process showed that homogenous material properties based on whole bone BV/TV calculations are insufficient for accurate modelling and that an intricate description of the density distribution is required. The robust methodology can provide a method of testing different treatment options and can be used to investigate graft stability in full tibiofemoral joints.
Collapse
Affiliation(s)
- Gavin A Day
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, UK.
| | - Robert J Cooper
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, UK
| | - Alison C Jones
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, UK
| | - Marlène Mengoni
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, Mechanical Engineering, University of Leeds, UK
| |
Collapse
|
7
|
van Hugten PPW, Jeuken RM, Roth AK, Seeldrayers S, Emans PJ. An optimized medial parapatellar approach to the goat medial femoral condyle. Animal Model Exp Med 2021; 4:54-58. [PMID: 33738437 PMCID: PMC7954842 DOI: 10.1002/ame2.12150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/16/2020] [Indexed: 11/12/2022] Open
Abstract
Goats or sheep are the preferred animal model for the preclinical evaluation of cartilage repair techniques due to the similarity of the goat stifle joint to the human knee. The medial femoral condyle of the stifle joint is the preferred site for the assessment of articular cartilage repair, as this is the primary location for this type of lesion in the human knee. Proper surgical exposure of the medial femoral condyle is paramount to obtain reproducible results without surgical error. When applying the standard human medial arthrotomy technique on the goat stifle joint, there are some key aspects to consider in order to prevent destabilization of the extensor apparatus and subsequent postoperative patellar dislocations with associated animal discomfort. This paper describes a modified surgical technique to approach the medial femoral condyle of the caprine stifle joint. The modified technique led to satisfactory exposure without postoperative incidence of patellar luxations and no long-term adverse effects on the joint.
Collapse
Affiliation(s)
- Pieter P. W. van Hugten
- Laboratory for Experimental OrthopedicsDepartment of Orthopedic SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Ralph M. Jeuken
- Laboratory for Experimental OrthopedicsDepartment of Orthopedic SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Alex K. Roth
- Laboratory for Experimental OrthopedicsDepartment of Orthopedic SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Saskia Seeldrayers
- Laboratory Animal FacilityMaastricht UniversityMaastrichtThe Netherlands
| | - Peter J. Emans
- Laboratory for Experimental OrthopedicsDepartment of Orthopedic SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| |
Collapse
|
8
|
Meng X, Zhang W, Yuan Z, Chen J, Lyu Z, Wang Y. A partial hemi-resurfacing preliminary study of a novel magnetic resonance imaging compatible polyetheretherketone mini-prosthesis for focal osteochondral defects. J Orthop Translat 2021; 26:67-73. [PMID: 33437625 PMCID: PMC7773958 DOI: 10.1016/j.jot.2020.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The use of partial articular resurfacing surgery with a mini-implant has been gradually increasing; the implant is mainly made of cobalt-chromium metal material, and cartilage changes cannot be monitored after implantation. Thus, we aimed to develop a novel local articular resurfacing polyetheretherketone (PEEK) mini-implant and investigate its feasibility for postoperative magnetic resonance imaging (MRI) monitoring of implant location, bone changes, and cartilage degeneration without artefacts. METHODS Nine skeletally mature female standardised goats were used and divided into the sham, PEEK, and cobalt-chromium-molybdenum alloy (Co-Cr-Mo) groups. The animals underwent local articular resurfacing operation with Co-Cr-Mo alloy (Co-Cr-Mo group) and PEEK (PEEK group) mini-implants. X-ray, computed tomography, and MRI examinations were performed at 12 weeks postoperatively. The sham group underwent a similar surgical procedure to expose the femoral head but without implantation. Gross necropsy and surface topography measurement of the articular cartilage of the acetabulum were performed after sacrificing the animals. Imaging artefacts and opposing cartilage degeneration in the acetabulum were also examined. RESULTS Cartilage damage occurred in both the Co-Cr-Mo and PEEK groups, and the damaged cartilage area was markedly larger in the Co-Cr-Mo group than in the PEEK group, as assessed by gross necropsy and histological staining. The mean surface roughness of the opposing cartilage was approximately 65.3, 117.4, and 188.4 μm at 12 weeks in the sham, PEEK, and Co-Cr-Mo groups, respectively. The Co-Cr-Mo mini-implant was visualised on radiographs, but computed tomography and MR images were markedly affected by artefacts, whereas the opposing cartilage and surrounding tissue were clear on MR images in the PEEK group. Opposing cartilage damage and subchondral bone marrow oedema could be detected by MRI in the PEEK group. CONCLUSIONS The PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects with less cartilage damage. It is feasible to postoperatively monitor the PEEK implant location, surrounding bone changes, and opposing cartilage degeneration by MRI without artefacts. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE The use of MRI to monitor changes in the opposing cartilage after prosthesis implantation has not been widely applied because MR images are generally affected by artefacts generated by the metal prosthesis. This study revealed that the PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects, and it is feasible to monitor the PEEK implant location, surrounding bone changes, and opposing cartilage damage/degeneration by MRI without artefacts postoperatively.
Collapse
Affiliation(s)
- Xiangchao Meng
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhuocheng Lyu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - You Wang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
9
|
Damen AHA, Nickien M, Ito K, van Donkelaar CC. The performance of resurfacing implants for focal cartilage defects depends on the degenerative condition of the opposing cartilage. Clin Biomech (Bristol, Avon) 2020; 79:105052. [PMID: 32591239 DOI: 10.1016/j.clinbiomech.2020.105052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/08/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-degradable resurfacing implants are being developed for treatment of focal cartilage defects. Performance of these implants has been investigated opposing intact cartilage. This study investigates whether implants would perform equally well when the opposing cartilage is fibrillated. METHODS Human osteochondral strips (~2x1x1 cm) with a smooth (n = 9) or fibrillated (n = 17) cartilage surface were obtained from human tibial plateaus excised during total knee arthroscopy. A custom-made pin-on-plate sliding indenter was used to apply simultaneous compression (0.75-3 MPa) and movement (4 mm/s over 6 mm). Either metal implants, polycarbonate-urethane or healthy porcine osteochondral plugs with a diameter of 6 mm were used as indenter. FINDINGS Cartilage roughness of the osteochondral strips was significantly higher for the fibrillated than the smooth group prior to sliding-indentation. Roughness of the indenters was not significantly altered by sliding indentation using either smooth or fibrillated cartilage. For all but one sample, sliding of smooth cartilage against any of the indenter surfaces did not cause damage. However, samples with fibrillated cartilage showed varied responses from seemingly unaffected to severe tissue wear as quantified by analysis of Indian ink staining and histology. INTERPRETATION This study demonstrates that the opposing cartilage quality is relevant for the clinical success of implanting an artificial implant in a focal cartilage defect. Therefore it is essential to test the efficacy of newly developed implants against arthritic joint surfaces, and care should be taken when interpreting in vivo studies in which implants are inserted in healthy joints.
Collapse
Affiliation(s)
- A H A Damen
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - M Nickien
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - K Ito
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - C C van Donkelaar
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands.
| |
Collapse
|
10
|
Jeuken RM, Roth AK, Peters MJM, Welting TJM, van Rhijn LW, Koenen J, Peters RJRW, Thies JC, Emans PJ. In vitro and in vivo study on the osseointegration of BCP-coated versus uncoated nondegradable thermoplastic polyurethane focal knee resurfacing implants. J Biomed Mater Res B Appl Biomater 2020; 108:3370-3382. [PMID: 32614486 PMCID: PMC7586808 DOI: 10.1002/jbm.b.34672] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 04/18/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022]
Abstract
Focal knee resurfacing implants (FKRIs) are intended to treat cartilage defects in middle-aged patients. Most FKRIs are metal-based, which hampers follow-up of the joint using magnetic resonance imaging and potentially leads to damage of the opposing cartilage. The purpose of this study was to develop a nondegradable thermoplastic polyurethane (TPU) FKRI and investigate its osseointegration. Different surface roughness modifications and biphasic calcium phosphate (BCP) coating densities were first tested in vitro on TPU discs. The in vivo osseointegration of BCP-coated TPU implants was subsequently compared to uncoated TPU implants and the titanium bottom layer of metal control implants in a caprine model. Implants were implanted bilaterally in stifle joints and animals were followed for 12 weeks, after which the bone-to-implant contact area (BIC) was assessed. Additionally, 18F-sodium-fluoride (18F-NaF) positron emission tomography PET/CT-scans were obtained at 3 and 12 weeks to visualize the bone metabolism over time. The BIC was significantly higher for the BCP-coated TPU implants compared to the uncoated TPU implants (p = .03), and did not significantly differ from titanium (p = .68). Similar 18F-NaF tracer uptake patterns were observed between 3 and 12 weeks for the BCP-coated TPU and titanium implants, but not for the uncoated implants. TPU FKRIs with surface modifications could provide the answer to the drawbacks of metal FKRIs.
Collapse
Affiliation(s)
- Ralph M Jeuken
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marloes J M Peters
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim J M Welting
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jac Koenen
- DSM Biomedical BV, Geleen, The Netherlands
| | | | | | - Pieter J Emans
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
11
|
Schell H, Zimpfer E, Schmidt-Bleek K, Jung T, Duda GN, Ryd L. Treatment of osteochondral defects: chondrointegration of metal implants improves after hydroxyapatite coating. Knee Surg Sports Traumatol Arthrosc 2019; 27:3575-3582. [PMID: 30879107 DOI: 10.1007/s00167-019-05484-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The treatment of osteochondral defects in joint cartilage remains challenging due to its limited repair capacity. This study presents a metallic osteochondral plug with hydroxyapatite (HA)-coated cap edges for improved implant-tissue contact. The hypothesis was that improved attachment prevents from synovial fluid-influx and thereby avoids osteolysis and resulting implant instability. METHODS In total, 24 female, adult sheep were randomized into three groups. All animals received an Episealer®-implant in the medial condyle of the right knee. The implants were coated with two different HA versions or uncoated (control group). After 12 weeks, the implant-tissue connections were analysed radiologically and histologically. RESULTS In general, the groups with the coated cap edges showed a better quality of tissue connection to the implant. The occurrence of gaps between tissue and implant was more seldom, the binding of calcified and hyaline cartilage to the cap was significantly better than in the uncoated group. A histomorphometrically measured lower amount of void space in these groups compared to the group with the uncoated edges confirmed that. CONCLUSIONS The hypothesis of a tighter cartilage bone contact was confirmed. The HA coating of the implant's cap edges resulted in better adherence of cartilage to the implant, which was not previously reported. In conclusion, this led to a better contact between implant and cartilage as well as neighbouring bone. In clinical routine, joint fluid is aggressive, penetrates through cartilage rifts, and promotes osteolysis and loosening of implants. The observed sealing effect will act to prevent joint fluid to get access to the implant-tissue interfaces. Joint fluid is aggressive, can cause osteolysis, and can, clinically cause pain. These effects are liable to decrease with these findings and will further the longevity of these osteochondral implants.
Collapse
Affiliation(s)
- Hanna Schell
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Zimpfer
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Schmidt-Bleek
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany. .,Berlin Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leif Ryd
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|