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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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2
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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. [PMID: 38465895 DOI: 10.1002/jbm.a.37691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
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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
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Peng L, Li H, Deng H, Gao T, Li R, Xu Z, Tian Q, Zhao T, Li J, Yang Y, Wang C, Liu S, Guo Q. Combination of a human articular cartilage-derived extracellular matrix scaffold and microfracture techniques for cartilage regeneration: A proof of concept in a sheep model. J Orthop Translat 2024; 44:72-87. [PMID: 38259590 PMCID: PMC10801125 DOI: 10.1016/j.jot.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background The utilization of decellularized extracellular matrix has gained considerable attention across numerous areas in regenerative research. Of particular interest is the human articular cartilage-derived extracellular matrix (hACECM), which presents as a promising facilitator for cartilage regeneration. Concurrently, the microfracture (MF) technique, a well-established marrow stimulation method, has proven efficacious in the repair of cartilage defects. However, as of the current literature review, no investigations have explored the potential of a combined application of hACECM and the microfracture technique in the repair of cartilage defects within a sheep model. Hypothesis The combination of hACECM scaffold and microfracture will result in improved repair of full-thickness femoral condyle articular cartilage defects compared to the use of either technique alone. Study design Controlled laboratory study. Methods Full-thickness femoral condyle articular cartilage defect (diameter, 7.0 mm; debrided down to the subchondral bone plate) were created in the weight-bearing area of the femoral medial and lateral condyles (n = 24). All of defected sheep were randomly divided into four groups: control, microfracture, hACECM scaffold, and hACECM scaffold + microfracture. After 3, 6 and 12 months, the chondral repair was assessed for standardized (semi-) quantitative macroscopic, imaging, histological, immunohistochemical, mechanics, and biochemical analyses in each group. Result At 3, 6 and 12 months after implantation, the gross view and pathological staining of regenerative tissues were better in the hACECM scaffold and hACECM scaffold + microfracture groups than in the microfracture and control groups; Micro-CT result showed that the parameters about the calcified layer of cartilage and subchondral bone were better in the hACECM scaffold and hACECM scaffold + microfracture groups than the others, and excessive subchondral bone proliferation in the microfracture group. The results demonstrate that human cartilage extracellular matrix scaffold alone is an efficient, safe and simple way to repair cartilage defects. Conclusion hACECM scaffolds combined with/without microfracture facilitate chondral defect repair. The translational potential of this article Preclinical large animal models represent an important adjunct and surrogate for studies on articular cartilage repair, while the sheep stifle joint reflects many key features of the human knee and are therefore optimal experimental model for future clinical application in human. In this study, we developed a human articular cartilage-derived extracellular matrix scaffold and to verify the viability of its use in sheep animal models. Clinical studies are warranted to further quantify the effects of hACECM scaffolds in similar settings.
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Affiliation(s)
- Liqing Peng
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Orthopedics, First People's Hospital of Shuangliu District, No. 120, Chengbeishang Street, Shuangliu District, Chengdu, 610200, China
| | - Hao Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Haoyuan Deng
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Tianze Gao
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Runmeng Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Ziheng Xu
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Qinyu Tian
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tianyuan Zhao
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Jianwei Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Yongkang Yang
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Chao Wang
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuyun Liu
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Quanyi Guo
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
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Lee JA, Koh YG, Kim PS, Park JH, Kang KT. Effect of surface matching mismatch of focal knee articular prosthetic on tibiofemoral contact stress using finite element analysis. Bone Joint Res 2023; 12:497-503. [PMID: 37582511 PMCID: PMC10427223 DOI: 10.1302/2046-3758.128.bjr-2023-0010.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Aims Focal knee arthroplasty is an attractive alternative to knee arthroplasty for young patients because it allows preservation of a large amount of bone for potential revisions. However, the mechanical behaviour of cartilage has not yet been investigated because it is challenging to evaluate in vivo contact areas, pressure, and deformations from metal implants. Therefore, this study aimed to determine the contact pressure in the tibiofemoral joint with a focal knee arthroplasty using a finite element model. Methods The mechanical behaviour of the cartilage surrounding a metal implant was evaluated using finite element analysis. We modelled focal knee arthroplasty with placement flush, 0.5 mm deep, or protruding 0.5 mm with regard to the level of the surrounding cartilage. We compared contact stress and pressure for bone, implant, and cartilage under static loading conditions. Results Contact stress on medial and lateral femoral and tibial cartilages increased and decreased, respectively, the most and the least in the protruding model compared to the intact model. The deep model exhibited the closest tibiofemoral contact stress to the intact model. In addition, the deep model demonstrated load sharing between the bone and the implant, while the protruding and flush model showed stress shielding. The data revealed that resurfacing with a focal knee arthroplasty does not cause increased contact pressure with deep implantation. However, protruding implantation leads to increased contact pressure, decreased bone stress, and biomechanical disadvantage in an in vivo application. Conclusion These results show that it is preferable to leave an edge slightly deep rather than flush and protruding.
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Affiliation(s)
- Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - Paul S. Kim
- Department of Orthopaedic Surgery, The Bone Hospital, Seoul, South Korea
| | - Joon-Hee Park
- Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
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Veizi E, Güven Ş, Naldöven ÖF, Çepni Ş, Çay N, Işık Ç, Bozkurt M. Low local curvature index and history of previous surgery are risk factors for revision in focal metallic inlay implants. Knee 2023; 43:42-50. [PMID: 37269796 DOI: 10.1016/j.knee.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/27/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Focal chondral defects are debilitating lesions with poor healing potential. Focal metallic inlay implants were developed as a salvage procedure, whose reoperation causes and risk factors for revision are still debatable. The aim of this study is to analyze the local subchondral curvature matching of focal metallic inlay implants and its effects on survival and clinical results. METHODS Patients operated with a knee focal metallic inlay resurfacing implant between 2014 and 2017 were eligible. Surgery was indicated for painful, focal, full-thickness cartilage lesions that had failed alternative treatments. Inclusion criteria were patients treated for a lesion ≤ 5 cm2 in the femoral condyle, aged 40-65 years, with complete surgical records and a knee CT scan. The curvature index (Kindex) was calculated as the ratio of the mean curvature of the implant (K1) to the mean curvature of the subchondral bone (K2). RESULTS Sixty-nine patients were included, of which 60.9% were female. Mean age was 54.8 ± 6.0. Seven patients (10.1%) underwent revision surgery. When adjusted for age and sex, lesion size was not significantly correlated to revision in a multivariate regression model, while previous surgery and smaller K index were. A positive history for previous surgery was significantly correlated with worse clinical outcomes in surviving patients. CONCLUSION A positive history of previous knee surgery and a low local curvature index are risk factors for revision after focal metallic inlay implant resurfacing. Patients with a history of knee surgery should be counseled on the advantages and disadvantages before undergoing a focal resurfacing procedure.
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Affiliation(s)
- Enejd Veizi
- Ankara City Hospital, Department of Orthopedics and Traumatology, 06000 Ankara, Turkey.
| | - Şahan Güven
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Ömer Faruk Naldöven
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Şahin Çepni
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Nurdan Çay
- Yıldırım Beyazıt University, Faculty of Medicine, Ankara City Hospital, Department of Radiology, Ankara, Turkey
| | - Çetin Işık
- Memorial Ataşehir Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Murat Bozkurt
- Ankara Acıbadem Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
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6
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Demott C, Jones MR, Chesney CD, Grunlan MA. Adhesive Hydrogel Building Blocks to Reconstruct Complex Cartilage Tissues. ACS Biomater Sci Eng 2023; 9:1952-1960. [PMID: 36881710 PMCID: PMC10848198 DOI: 10.1021/acsbiomaterials.2c01438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
Cartilage has an intrinsically low healing capacity, thereby requiring surgical intervention. However, limitations of biological grafting and existing synthetic replacements have prompted the need to produce cartilage-mimetic substitutes. Cartilage tissues perform critical functions that include load bearing and weight distribution, as well as articulation. These are characterized by a range of high moduli (≥1 MPa) as well as high hydration (60-80%). Additionally, cartilage tissues display spatial heterogeneity, resulting in regional differences in stiffness that are paramount to biomechanical performance. Thus, cartilage substitutes would ideally recapitulate both local and regional properties. Toward this goal, triple network (TN) hydrogels were prepared with cartilage-like hydration and moduli as well as adhesivity to one another. TNs were formed with either an anionic or cationic 3rd network, resulting in adhesion upon contact due to electrostatic attractive forces. With the increased concentration of the 3rd network, robust adhesivity was achieved as characterized by shear strengths of ∼80 kPa. The utility of TN hydrogels to form cartilage-like constructs was exemplified in the case of an intervertebral disc (IVD) having two discrete but connected zones. Overall, these adhesive TN hydrogels represent a potential strategy to prepare cartilage substitutes with native-like regional properties.
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Affiliation(s)
- Connor
J. Demott
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - McKenzie R. Jones
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Caleb D. Chesney
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Melissa A. Grunlan
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
- Department
of Materials Science & Engineering, Texas A&M University, College
Station, Texas 77843-3003, United States
- Department
of Chemistry, Texas A&M University, College Station, Texas 77843-3003, United States
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Demott CJ, Grunlan MA. Emerging polymeric material strategies for cartilage repair. J Mater Chem B 2022; 10:9578-9589. [PMID: 36373438 DOI: 10.1039/d2tb02005j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cartilage is found throughout the body, serving an array of essential functions. Owing to the limited healing capacity of cartilage, damage or degeneration is often permanent and so requires clinical intervention. Established surgical techniques generally rely on biological grafting. However, recent advances in polymeric materials provide an encouraging alternative to overcome limits of auto- and allografts. For regenerative engineering of cartilage, a polymeric scaffold ideally supports and instructs tissue regeneration while also providing mechanical integrity. Scaffolds direct regeneration via chemical and mechanical cues, as well as delivery and support of exogenous cells and bioactive factors. Advanced polymeric scaffolds aim to direct regeneration locally, replicating the heterogeneities of native tissues. Alternatively, new cartilage-mimetic hydrogels have potential to serve as synthetic cartilage replacements. Prepared as multi-network or composite hydrogels, the most promising candidates have simultaneously realized the hydration, mechanical, and tribological properties of native cartilage. Collectively, the recent rise in polymers for cartilage regeneration and replacement proposes a changing paradigm, with a new generation of materials paving the way for improved clinical outcomes.
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Materials Science & Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Chemistry, Texas A&M University, College Station, TX 77843-3003, USA.
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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9
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Demott CJ, Jones MR, Chesney CD, Yeisley DJ, Culibrk RA, Hahn MS, Grunlan MA. Ultra-High Modulus Hydrogels Mimicking Cartilage of the Human Body. Macromol Biosci 2022; 22:e2200283. [PMID: 36040017 DOI: 10.1002/mabi.202200283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/12/2022] [Indexed: 12/25/2022]
Abstract
The human body is comprised of numerous types of cartilage with a range of high moduli, despite their high hydration. Owing to the limitations of cartilage tissue healing and biological grafting procedures, synthetic replacements have emerged but are limited by poorly matched moduli. While conventional hydrogels can achieve similar hydration to cartilage tissues, their moduli are substantially inferior. Herein, triple network (TN) hydrogels are prepared to synergistically leverage intra-network electrostatic repulsive and hydrophobic interactions, as well as inter-network electrostatic attractive interactions. They are comprised of an anionic 1st network, a neutral 2nd network (capable of hydrophobic associations), and a cationic 3rd network. Collectively, these interactions act synergistically as effective, yet dynamic crosslinks. By tuning the concentration of the cationic 3rd network, these TN hydrogels achieve high moduli of ≈1.5 to ≈3.5 MPa without diminishing cartilage-like water contents (≈80%), strengths, or toughness values. This unprecedented combination of properties poises these TN hydrogels as cartilage substitutes in applications spanning articulating joints, intervertebral discs (IVDs), trachea, and temporomandibular joint disc (TMJ).
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - McKenzie R Jones
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - Caleb D Chesney
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - Daniel J Yeisley
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Robert A Culibrk
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Mariah S Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Department of Materials Science & Engineering, and Department of Chemistry, Texas A&M University, College Station, TX, 77843-3003, USA
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10
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Spalding T, Damasena I. Next Generation Cartilage Repair and the Pre-arthroplasty Patient. Pre-arthroplasty artificial Implants Part B: Metallic. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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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: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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12
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Al-Bayati M, Martinez-Carranza N, Roberts D, Högström M, Stålman A. Good subjective outcome and low risk of revision surgery with a novel customized metal implant for focal femoral chondral lesions at a follow-up after a minimum of 5 years. Arch Orthop Trauma Surg 2022; 142:2887-92. [PMID: 34523047 DOI: 10.1007/s00402-021-04160-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Patients with focal cartilage lesions experience functional impairment. Results for biological treatments in the middle-aged patient is poor. Previous studies with focal prosthetic inlay resurfacing have shown a higher risk of conversion to total knee replacement at mid-term follow-up. A novel customized implant (Episealer, Episurf, Stockholm, Sweden) has been proposed to improve implant positioning and survival. The primary objective was to assess subjective-, objective function and implant survival at a minimum of five years after surgery. MATERIALS AND METHODS The inclusion criteria were patients aged 30-65 years with symptomatic focal chondral defects in the medial femoral condyle, International Cartilage Research Society grade 3 or 4 and failed conservative or surgical treatment. Minimum follow-up of 5 years. Clinical and radiologic assessments were made. Patient-reported outcome measurements at the latest follow-up were compared with the baseline data for the Knee injury and Osteoarthritis Outcome Score (KOOS), the EuroQoL (EQ-5D), the Tegner Activity Scale and a Visual Analog Scale of pain (VAS 0-10). RESULTS Ten patients with the mean follow-up period of 75 months (60-86 months, SD 10) were included. Signs of osteoarthritis were seen in one patient (Ahlbäck 1). No cases with revision to knee replacement. VAS for pain and KOOS showed improvements that reached significance for VAS (p ≤ 0.001) and the KOOS subscores Pain (p = 0.01), ADL (p = 0.003), Sport and Recreation (p = 0.024) and Quality of Life (p = 0.003). CONCLUSION A good subjective outcome, a low risk of progression to degenerative changes and the need for subsequent surgery were seen at the mid-term follow-up with this customized focal knee-resurfacing implant. LEVEL OF EVIDENCE Prospective case series, level 4.
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13
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Martinez-Carranza N, Rockborn P, Roberts D, Högström M, Stålman A. Successful Treatment of Femoral Chondral Lesions with a Novel Customized Metal Implant at Midterm Follow-Up. Cartilage 2021; 13:1726S-1733S. [PMID: 33106003 PMCID: PMC8808814 DOI: 10.1177/1947603520967064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Full-depth cartilage lesions do not heal spontaneously and may progress to osteoarthritis (OA). Treatment for these lesions is warranted when symptomatic. At younger age, biological treatment remains the gold standard, but treatment in the middle-aged patient remains a clinical challenge and focal metal implants have been proposed. We aim to present the subjective outcome at 2 years and the risk of reoperation for any reason at midterm after surgery with a novel customized implant for focal femoral chondral lesions in the knee. METHODS In a prospective cohort study, 30 patients were included between January 2013 and December 2017 at 9 different clinics in Sweden. The primary outcome was subjective outcome measurements (Visual Analogue Scale [VAS], EuroQoL [EQ5D], Knee injury and Osteoarthritis Outcome Score [KOOS]) at a minimum of 2 years. The secondary outcome was reoperations for any reason during the follow-up period until December 2019 (mean of 55 months) studied retrospectively by analyzing medical records. RESULTS The VAS, EQ5D, and all the KOOS subscales showed significant improvements from preoperatively to the 2-year follow-up. The VAS showed the greatest improvement at the early (3 months) postoperative stage (P < 0.001). Five (7%) patients underwent reoperations and one of these was revised to hemiarthroplasty due to OA progression. No implant loosening was detected in any of the cases. CONCLUSIONS This customized resurfacing metal implant showed good safety and patient satisfaction. The risk of OA progression and implant loosening is low. Subjective function and pain improved significantly.
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Affiliation(s)
- Nicolas Martinez-Carranza
- Department of Orthopaedics, Institution
of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet,
Stockholm, Sweden,Division of Orthopaedics, Karolinska
University Hospital, Stockholm, Sweden,Nicolas Martinez-Carranza, Division of
Orthopaedics, Karolinska University Hospital, Hälsovägen, SE-141 86 Stockholm,
Sweden.
| | - Peter Rockborn
- Orthopedic Clinic, Vrinnevi Hospital,
Norrköping, Sweden
| | - David Roberts
- Ortho Center Skåne and Department of
Orthopaedics, Skane University Hospital, Malmo, Sweden
| | - Magnus Högström
- Sports Medicine Umeå and Orthopedics,
Umeå, Sweden,Department of Surgical and Perioperative
Sciences, Umeå University, Umeå, Sweden
| | - Anders Stålman
- Stockholm Sports Trauma Research Center,
MMK, Karolinska Institutet, Stockholm, Sweden
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14
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Moewis P, Kaiser R, Trepczynski A, von Tycowicz C, Krahl L, Ilg A, Holz J, Duda GN. Patient-specific resurfacing implant knee surgery in subjects with early osteoarthritis results in medial pivot and lateral femoral rollback during flexion: a retrospective pilot study. Knee Surg Sports Traumatol Arthrosc 2021; 31:1247-1266. [PMID: 34601628 PMCID: PMC10050034 DOI: 10.1007/s00167-021-06749-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Metallic resurfacing implants have been developed for the treatment of early, small, condylar and trochlear osteoarthritis (OA) lesions. They represent an option for patients who do not fulfill the criteria for unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) or are too old for biological treatment. Although clinical evidence has been collected for different resurfacing types, the in vivo post-operative knee kinematics remain unknown. The present study aims to analyze the knee kinematics in subjects with patient-specific episealer implants. This study hypothesized that patient-specific resurfacing implants would lead to knee kinematics close to healthy knees, resulting in medial pivot and a high degree of femoral rollback during flexion. METHODS Retrospective study design. Fluoroscopic analysis during unloaded flexion-extension and loaded lunge was conducted at > 12 months post-surgery in ten episealer knees, and compared to ten healthy knees. Pre- and post-operative clinical data of the episealer knees were collected using a visual analog scale (VAS), the EQ 5d Health, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. RESULTS A consistent medial pivot was observed in both episealer and healthy knees. Non-significant differences were found in the unloaded (p = 0.15) and loaded (p = 0.51) activities. Although lateral rollback was observed in both groups, it was significantly higher for the episealer knees in both the unloaded (p = 0.02) and loaded (p = 0.01) activities. Coupled axial rotation was significantly higher in the unloaded (p = 0.001) but not in the loaded (p = 0.06) activity in the episealer knees. Improved scores were observed at 1-year post-surgery in the episealer subjects for the VAS (p = 0.001), KOOS (p = 0.001) and EQ Health (p = 0.004). CONCLUSION At 12 month follow-up, a clear physiological knee kinematics pattern of medial pivot, lateral femoral rollback and coupled axial external femoral rotation during flexion was observed in patients treated with an episealer resurfacing procedure. However, higher femoral rollback and axial external rotation in comparison to healthy knees was observed, suggesting possible post-operative muscle weakness and consequent insufficient stabilization at high flexion.
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Affiliation(s)
- Philippe Moewis
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - René Kaiser
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Adam Trepczynski
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Leonie Krahl
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ansgar Ilg
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Johannes Holz
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
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15
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Stenger V, Zeiter S, Buchholz T, Arens D, Spadavecchia C, Schüpbach-Regula G, Rohrbach H. Is a Block of the Femoral and Sciatic Nerves an Alternative to Epidural Analgesia in Sheep Undergoing Orthopaedic Hind Limb Surgery? A Prospective, Randomized, Double Blinded Experimental Trial. Animals (Basel) 2021; 11:2567. [PMID: 34573533 PMCID: PMC8467810 DOI: 10.3390/ani11092567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
Peripheral nerve blocks are commonly used in human and veterinary medicine. The aim of the study was to compare the analgesic efficacy of a combined block of the femoral and sciatic nerves with an epidural injection of ropivacaine in experimental sheep undergoing orthopaedic hind limb surgery. Twenty-five sheep were assigned to two groups (peripheral nerve block; sciatic and femoral nerves (P); epidural analgesia (E)). In group P 10 mL ropivacaine 0.5% was injected around the sciatic and the femoral nerves under sonographic guidance and 10 mL NaCl 0.9% into the epidural space while in group E 10 mL ropivacaine 0.5% was injected into the epidural space and 10 mL NaCl 0.9% to the sciatic and the femoral nerves. During surgery, heart rate, respiratory rate and mean blood pressure were used as indicators of nociception. In the postoperative phase, nociception was evaluated every hour by use of a purposefully adapted pain score until the animal showed painful sensation at the surgical site. The mean duration of analgesia at the surgical wound was 6 h in group P and 8 h in group E. Mean time to standing was 4 h in group P and 7 h in group E. In conclusion time to standing was significantly shorter in group P while the duration of nociception was comparable in both groups. The peripheral nerve block can be used as an alternative to epidural analgesia in experimental sheep.
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Affiliation(s)
- Valentina Stenger
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Tim Buchholz
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Daniel Arens
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Claudia Spadavecchia
- Department of Clinical Veterinary Medicine, Anaesthesia Section, Vetsuisse Faculty Bern, 3012 Bern, Switzerland;
| | | | - Helene Rohrbach
- Department of Clinical Veterinary Medicine, Anaesthesia Section, Vetsuisse Faculty Bern, 3012 Bern, Switzerland;
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16
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Elbardesy H, Nagle M, Simmons L, Harty J. The partial femoral condyle focal resurfacing (HemiCAP-UniCAP) for treatment of full-thickness cartilage defects, systematic review and meta-analysis. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Knee osteochondral defects are a common problem among people, especially young and active patients. So effective joint preserving surgeries is essential to prevent or even delay the onset of osteoarthritis for these group of patients. This study aims to critically appraise and evaluate the evidence for the results and effectiveness of femoral condyle resurfacing (HemiCAP/ UniCAP) in treatment of patients with focal femoral condyle cartilage defect.
Using the search terms : HemiCAP, UniCAP, Episurf, focal, femoral, condyle, inlay and resur-facing, we reviewed the PubMed and EMBASE and the Cochrane Database of Systematic Reviews (CDSR) to find any articles published up to March 2020.
The short term follow-up of the HemiCAP shows (6.74 %) revision rate. However, 29.13 % loss of follow up let us consider these results with caution especially if the revision rate progressively increased with time to 19.3 % in 5-7 years with no enough evidence for the long term results except the data from the Australian Joint Registry 2018, where the cumulative revision rate was 40.6 % (33.5, 48.4) at ten years. The UniCAP that used for defect more than 4 cm 2 has a high revision rate (53.66 %) which is considered unacceptable revision rate in com-parison to another similar prosthesis such as Uni-Knee Arthroplasty (UKA).
The evidence from published studies and our meta- analysis suggests that partial resurfacing of the femoral condyle (HemiCAP) doesn’t support its usage as a tool to treat the focal cartilage defect in middle- aged patients.
The UniCAP as femoral condyle resurfacing has very high revision rate at 5-7 years (53.66 %) which make us recommend against its usage.
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17
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Springer B, Boettner F. Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing. Life (Basel) 2021; 11:life11050394. [PMID: 33925287 PMCID: PMC8146542 DOI: 10.3390/life11050394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects.
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Affiliation(s)
- Bernhard Springer
- Department of Orthopedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
- Correspondence:
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18
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Zhao J, Kirillova A, Kelly CN, Xu H, Koshut WJ, Yang F, Gall K, Wiley BJ. High-Strength Hydrogel Attachment through Nanofibrous Reinforcement. Adv Healthc Mater 2021; 10:e2001119. [PMID: 32940005 DOI: 10.1002/adhm.202001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Indexed: 01/08/2023]
Abstract
The repair of a cartilage lesion with a hydrogel requires a method for long-term fixation of the hydrogel in the defect site. Attachment of a hydrogel to a base that allows for integration with bone can enable long-term fixation of the hydrogel, but current methods of forming bonds to hydrogels have less than a tenth of the shear strength of the osteochondral junction. This communication describes a new method, nanofiber-enhanced sticking (NEST), for bonding a hydrogel to a base with an adhesive shear strength three times larger than the state-of-the-art. An example of NEST is described in which a nanofibrous bacterial cellulose sheet is bonded to a porous base with a hydroxyapatite-forming cement followed by infiltration of the nanofibrous sheet with hydrogel-forming polymeric materials. This approach creates a mineralized nanofiber bond that mimics the structure of the osteochondral junction, in which collagen nanofibers extend from cartilage into a mineralized region that anchors cartilage to bone.
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Affiliation(s)
- Jiacheng Zhao
- Department of Chemistry Duke University 124 Science Drive, Box 90354 Durham NC 27708 USA
| | - Alina Kirillova
- Department of Mechanical Engineering and Materials Science Duke University 144 Hudson Hall, Box 90300 Durham NC 27708 USA
| | - Cambre N. Kelly
- Department of Mechanical Engineering and Materials Science Duke University 144 Hudson Hall, Box 90300 Durham NC 27708 USA
| | - Heng Xu
- Department of Chemistry Duke University 124 Science Drive, Box 90354 Durham NC 27708 USA
| | - William J. Koshut
- Department of Mechanical Engineering and Materials Science Duke University 144 Hudson Hall, Box 90300 Durham NC 27708 USA
| | - Feichen Yang
- Department of Chemistry Duke University 124 Science Drive, Box 90354 Durham NC 27708 USA
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science Duke University 144 Hudson Hall, Box 90300 Durham NC 27708 USA
| | - Benjamin J. Wiley
- Department of Chemistry Duke University 124 Science Drive, Box 90354 Durham NC 27708 USA
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Holz J, Spalding T, Boutefnouchet T, Emans P, Eriksson K, Brittberg M, Konradsen L, Kösters C, Verdonk P, Högström M, Lind M. Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years. Knee Surg Sports Traumatol Arthrosc 2021; 29:2899-2910. [PMID: 33025052 PMCID: PMC8384793 DOI: 10.1007/s00167-020-06289-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage repair surgery. This study reports on the early clinical and functional outcomes in patients undergoing treatment with an individualised mini-metal implant for an isolated focal chondral defect in the knee. METHODS Open-label, multicentre, non-randomised, non-comparative retrospective observational analysis of prospectively collected clinical data in a consecutive series of 80 patients undergoing knee reconstruction with the Episealer® implant. Knee injury and Osteoarthritis Outcome Score (KOOS) and VAS scores, were recorded preoperatively and at 3 months, 1 year, and 2 years postoperatively. RESULTS Seventy-five patients were evaluated at a minimum 24 months following implantation. Two patients had undergone revision (2.5%), 1 declined participation, and 2 had not completed the full data requirements, leaving 75 of the 80 with complete data for analysis. All 5 KOOS domain mean scores were significantly improved at 1 and 2 years (p < 0.001-0.002). Mean preoperative aggregated KOOS4 of 35 (95% CI 33.5-37.5) improved to 57 (95% CI 54.5-60.2) and 59 (95% CI 55.7-61.6) at 12 and 24 months respectively (p < 0.05). Mean VAS score improved from 63 (95% CI 56.0-68.1) preoperatively to 32 (95% CI 24.4-38.3) at 24 months. The improvement exceeded the minimal clinically important difference (MCID) and this improvement was maintained over time. Location of defect and history of previous cartilage repair did not significantly affect the outcome (p > 0.05). CONCLUSION The study suggests that at 2 years, Episealer® implants are safe with a low failure rate of 2.5% and result in clinically significant improvement. Individualised mini-metal implants with appropriate accurate guides for implantation appear to have a place in the management of focal femoral chondral and osteochondral defects in the knee. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Johannes Holz
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany.
| | - Tim Spalding
- grid.412570.50000 0004 0400 5079Department Trauma and Orthopaedics, University Hospital Coventry, Clifford Bridge Road, Coventry, UK
| | - Tarek Boutefnouchet
- grid.412570.50000 0004 0400 5079Department Trauma and Orthopaedics, University Hospital Coventry, Clifford Bridge Road, Coventry, UK
| | - Pieter Emans
- grid.412966.e0000 0004 0480 1382Department of Orthopaedics, Maastricht UMC+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Karl Eriksson
- grid.4714.60000 0004 1937 0626Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Mats Brittberg
- grid.415546.7Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, 434 80 Kungsbacka, Sweden
| | - Lars Konradsen
- grid.411702.10000 0000 9350 8874Department of Orthopaedic Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Bispebjerg, Denmark
| | - Clemens Kösters
- Clinic for Orthopaedics, Trauma and Hand Surgery, Maria-Josef-Hospital Greven, Lindenstr. 29, 48268 Greven, Germany
| | - Peter Verdonk
- Orthoca, AZ Monica Hospitals, Harmoniestraat 68, 2018 Antwerp, Belgium
| | - Magnus Högström
- grid.12650.300000 0001 1034 3451Sports Medicine Umeå AB and Orthopedics, Department of Surgical and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden
| | - Martin Lind
- grid.154185.c0000 0004 0512 597XDeptartment of Orthopedics, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Århus, Denmark
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20
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Roth KE, Betz S, Schmidtmann I, Maier GS, Ludwig HR, Vogl T, Theisen A, Brochhausen C, Götz H, Drees P, Rompe JD, Kurth AA. Biological responses to individualized small titanium implants for the treatment of focal full-thickness knee cartilage defects in a sheep model. Knee 2020; 27:1078-1092. [PMID: 32307219 DOI: 10.1016/j.knee.2020.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/21/2019] [Accepted: 03/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The present study aimed to evaluate the functional, radiological and histological outcome of a customized focal implant for the treatment of focal full-thickness cartilage defects in sheep. METHODS The study used magnetic resonance imaging data as the basis for construction of the titanium implant using a three-dimensional printing technique. This was then placed on the medial condyle of the knee joint in eight sheep and left in place in vivo over a period of six months. Following euthanasia, the local biological response was analyzed using micro-computed tomography, light microscopy and histological evaluation (International Cartilage Repair Society (ICRS) score). The variables were analyzed using a generalized linear mixed model. Odds ratios were given with 95% confidence intervals. RESULTS The osseointegration rate was 62.1% (SD 3.9%). All implants were prone to the neighboring cartilage bed (4.4-1096.1 μm). Using the IRCS score, the elements 'surface', 'matrix', 'cell distribution' and 'cell population' all showed pathological changes on the operated side, although these did not correlate with implant elevation. On average, a difference of 0.7 mm (±2 mm) was found between the digitally planned implant and the real implant. CONCLUSIONS As a result of imprecise segmentation and difficult preparation conditions at the prosthesis bed, as well as changes at the surface of the implant over the operational lifetime of the prosthesis, it must be stated that the approach implemented here of using a customized implant for the treatment of focal full-thickness cartilage defects at the knee did not meet our expectations.
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Affiliation(s)
- Klaus Edgar Roth
- Centre of Orthopedic and Trauma Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
| | - Simon Betz
- University of Applied Sciences, Computer Science and Engineering, Frankfurt, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Gerrit Steffen Maier
- Centre of Orthopedic and Trauma Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Hans-Reiner Ludwig
- University of Applied Sciences, Computer Science and Engineering, Frankfurt, Germany
| | - Thomas Vogl
- Institute for diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Alf Theisen
- Ernst Struengmann Institute (ESI) for Neuroscience, Frankfurt, Germany
| | - Christoph Brochhausen
- Institute for Pathology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Hermann Götz
- Platform for Biomaterial Research, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Drees
- Centre of Orthopedic and Trauma Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | | | - Andreas Alois Kurth
- Centre of Orthopedic and Trauma Surgery, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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21
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Ryd L, Flodström K, Manley MT. Patient-Specific Implants for Focal Cartilage Lesions in The Knee: Implant Survivorship Analysis up to Seven Years Post-Implantation. Surg Technol Int 2020; 38:379-386. [PMID: 33352614 DOI: 10.52198/21.sti.38.os1384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the quest for increased surgical precision and improved joint kinematics, Computer-Assisted Orthopedic Surgery (CAOS) shows promising results for both total and partial joint replacement. In the knee, computer-assisted joint design can now be applied to the treatment of younger patients suffering pain and restriction of activity due to focal defects in their femoral articular cartilage. By taking MRI scans of the affected knee and digitally segmenting these scans, we can identify and map focal defects in cartilage and bone. Metallic implants matched to the defect can be fabricated, and guide instrumentation to ensure proper implant alignment and depth of recession in the surrounding cartilage can be designed from segmented MRI scans. Beginning in 2012, a series of 682 patient-specific implants were designed based on MRI analysis of femoral cartilage focal defects, and implanted in 612 knees. A Kaplan-Meier analysis found a cumulative survivorship of 96% at 7-year follow-up from the first implantation. Fourteen (2.3%) of these implants required revision due to disease progression, incorrect implant positioning, and inadequate lesion coverage at the time of surgery. These survivorship data compare favorably with all other modes of treatment for femoral focal cartilage lesions and support the use of patient-specific implants designed from segmented MRI scans in these cases.
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Affiliation(s)
- Leif Ryd
- Episurf Medicalm, Stockholm, Sweden
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22
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Diermeier T, Venjakob A, Byrne K, Burgkart R, Foehr P, Milz S, Imhoff AB, Vogt S. Effects of focal metallic implants on opposing cartilage - an in-vitro study with an abrasion test machine. BMC Musculoskelet Disord 2020; 21:261. [PMID: 32316943 PMCID: PMC7175572 DOI: 10.1186/s12891-020-03292-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background For focal cartilage defects, biological repair might be ineffective in patients over 45 years. A focal metallic implant (FMI) (Hemi-CAP Arthrosurface Inc., Franklin, MA, USA) was designed to reduce symptoms. The aim of this study was to evaluate the effects of a FMI on the opposing tibial cartilage in a biomechanical set-up. It is hypothesized that a FMI would not damage the opposing cartilage under physiological loading conditions. Methods An abrasion machine was used to test the effects of cyclic loading on osteochondral plugs. The machine applied a compressive load of 33 N and sheared the samples 10 mm in the anteroposterior direction by 1 Hz. Tibial osteochondral plugs from porcine knees were placed in opposition to a FMI and cycled for 1 or 6 h. After testing each plug was fixed, stained and evaluated for cartilage damage. Results After 1 h of loading (n = 6), none of the osteochondral plugs showed histologic signs of degradation. After 6 h of loading (n = 6) three samples had histologic signs of injury in the tangential zone (grade 1) and one had signs of injury in the transitional and deep zones (grade 2). Exploration for 6 h resulted in significant more cartilage damage compared to the shorter exploration time (p = 0.06). However, no significant difference between saline and hyaluronic acid was evident (p = 0.55). Conclusion Under physiologic loading conditions, contact with a FMI leads to cartilage damage in the opposing articular cartilage in six hours. In clinical practice, a thorough analysis of pre-existing defects on the opposing cartilage is recommended when FMI is considered.
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Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Arne Venjakob
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, Düsseldorf, Germany
| | - Kevin Byrne
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rainer Burgkart
- Department for Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter Foehr
- Department for Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Milz
- Department of Anatomy Munich, Ludwig-Maximilians University Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephan Vogt
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Sports Orthopedics, Hessing Klinik, Augsburg, Germany
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23
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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: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Martinez-Carranza N, Hultenby K, Lagerstedt AS, Schupbach P, Berg HE. Cartilage Health in Knees Treated with Metal Resurfacing Implants or Untreated Focal Cartilage Lesions: A Preclinical Study in Sheep. Cartilage 2019; 10:120-128. [PMID: 28703030 PMCID: PMC6376557 DOI: 10.1177/1947603517720260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Full-depth cartilage lesions do not heal and the long-term clinical outcome is uncertain. In the symptomatic middle-aged (35-60 years) patient, treatment with metal implants has been proposed. However, the cartilage health surrounding these implants has not been thoroughly studied. Our objective was to evaluate the health of cartilage opposing and adjacent to metal resurfacing implants. METHODS The medial femoral condyle was operated in 9 sheep bilaterally. A metallic resurfacing metallic implant was immediately inserted into an artificially created 7.5 mm defect while on the contralateral knee the defect was left untreated. Euthanasia was performed at 6 months. Six animals, of similar age and study duration, from a previous study were used for comparison in the evaluation of cartilage health adjacent to the implant. Cartilage damage to joint surfaces within the knee, cartilage repair of the defect, and cartilage adjacent to the implant was evaluated macroscopically and microscopically. RESULTS Six animals available for evaluation of cartilage health within the knee showed a varying degree of cartilage damage with no statistical difference between defects treated with implants or left untreated ( P = 0.51; 95% CI -3.7 to 6.5). The cartilage adjacent to the implant (score 0-14; where 14 indicates no damage) remained healthy in these 6 animals showing promising results (averaged 10.5; range 9-11.5, SD 0.95). Cartilage defects did not heal in any case. CONCLUSION Treatment of a critical size focal lesion with a metal implant is a viable alternative treatment.
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Affiliation(s)
- Nicolas Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden,Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden,Nicolas Martinez-Carranza, Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Kjell Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anne Sofie Lagerstedt
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - Peter Schupbach
- Schupbach Ltd, Service and Research Laboratory for Histology, Electron Microscopy and Micro CT, Horgen, Switzerland
| | - Hans E. Berg
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden,Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Heuijerjans A, Wilson W, Ito K, van Donkelaar CC. Osteochondral resurfacing implantation angle is more important than implant material stiffness. J Orthop Res 2018; 36:2911-2922. [PMID: 29943463 PMCID: PMC6586006 DOI: 10.1002/jor.24101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/18/2018] [Indexed: 02/04/2023]
Abstract
Osteochondral resurfacing implants are a promising treatment for focal cartilage defects. Several implant-factors may affect the clinical outcome of this treatment, such as the implant material stiffness and the accuracy of implant placement, known to be challenging. In general, softer implants are expected to be more accommodating for implant misalignment than stiffer implants, and motion is expected to increase effects from implant misalignment and stiffness. 3D finite element models of cartilage/cartilage contact were employed in which implantation angle (0°, 5°, 10°) and implant material stiffness (E = 5 MPa, 100 MPa, 2 GPa) were varied. A creep loading (0.6 MPa) was simulated, followed by a sliding motion. Creep loading resulted in low maximum collagen strains of 2.5% in the intact case compared to 11.7% with an empty defect. Implants mostly positively affected collagen strains, deviatoric strains, and hydrostatic pressures in the adjacent cartilage, but these effects were superior for correct alignment (0°). The main effect of implant misalignment was bulging of opposing cartilage tissue into the gap caused by the misalignment. This increased collagen strains and hydrostatic pressures. Deviatoric strains were increased adjacent to the gap. Subsequent sliding initially increased strains for a stiff, misaligned implant, but generally sliding decreased strains. In conclusion, implants can decrease the detrimental effect of defects, but correct implant alignment is crucial, more than implant material stiffness. Implant misalignment causes a gap, causing potentially damaging cartilage deformation during prolonged loading, for example, standing, even for soft implants. Mild motion may positively affect the cartilage. © 2018 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:2911-2922, 2018.
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Affiliation(s)
- Ashley Heuijerjans
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
| | - Wouter Wilson
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
| | - Keita Ito
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
| | - Corrinus C. van Donkelaar
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
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26
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Stålman A, Sköldenberg O, Martinez-Carranza N, Roberts D, Högström M, Ryd L. No implant migration and good subjective outcome of a novel customized femoral resurfacing metal implant for focal chondral lesions. Knee Surg Sports Traumatol Arthrosc 2018; 26:2196-204. [PMID: 29167954 DOI: 10.1007/s00167-017-4805-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Managing focal cartilage injuries in the middle-aged patient poses a challenge. Focal prosthetic inlay resurfacing has been proposed to be a bridge between biologics and conventional joint arthroplasty. Patient selection and accurate implant positioning is crucial to avoid increased contact pressure to the opposite cartilage surface. A customized femoral condyle implant for focal cartilage injuries was designed to precisely fit each patient's individual size and location of damage. The primary objective was to assess implant safety profile, surgical usability of the implant and instruments, and implant migration with radiostereometric analysis (RSA). METHODS Ten patients 36-56 years with focal chondral defects, ICRS 3-4 of the femoral cartilage and failed earlier conservative or surgical interventions with VAS pain > 40. The patients were followed for 2 years with subjective outcome measures (VAS, EQ5D, KOOS) and RSA. The customized implant and guide instruments were manufactured by computer-aided design/computer-aided manufacturing (CAD/CAM) techniques using MRI data. RESULTS VAS, EQ5D and KOOS showed improvements that reached significance for VAS (p ≤ 0.001), Tegner (p = 0.034) and the KOOS subscores ADL (p = 0.0048), sport and recreation (p = 0.034) and quality of life (p = 0.037). VAS and KOOS scores improved gradually at 3, 6 and 12 months. The improvements in EQ5D, KOOS pain and KOOS symptoms did not reach statistical significance. No infections, deep venous thrombosis or other complications occured in the postoperative period. No radiographic signs of damage to the opposing tibial cartilage was noted. The surgical usability of implants and instruments were good. RSA did not show any implant migration. CONCLUSION This is the first clinical report of a new customized, focal knee resurfacing system. The short-term implant safety and patient-related outcome measures showed good-to-excellent results. LEVEL OF EVIDENCE Prospective case series, Level 4.
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27
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Abstract
Namely, in the last two decades, large animal models - small ruminants (sheep and goats), pigs, dogs and horses - have been used to study the physiopathology and to develop new therapeutic procedures to treat human clinical osteoarthritis. For that purpose, cartilage and/or osteochondral defects are generally performed in the stifle joint of selected large animal models at the condylar and trochlear femoral areas where spontaneous regeneration should be excluded. Experimental animal care and protection legislation and guideline documents of the US Food and Drug Administration, the American Society for Testing and Materials and the International Cartilage Repair Society should be followed, and also the specificities of the animal species used for these studies must be taken into account, such as the cartilage thickness of the selected defect localization, the defined cartilage critical size defect and the joint anatomy in view of the post-operative techniques to be performed to evaluate the chondral/osteochondral repair. In particular, in the articular cartilage regeneration and repair studies with animal models, the subchondral bone plate should always be taken into consideration. Pilot studies for chondral and osteochondral bone tissue engineering could apply short observational periods for evaluation of the cartilage regeneration up to 12 weeks post-operatively, but generally a 6- to 12-month follow-up period is used for these types of studies.
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Affiliation(s)
- Isabel R Dias
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal. .,3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark - Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco - Guimarães, 4805-017, Portugal. .,Department of Veterinary Medicine, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Carlos A Viegas
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.,3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark - Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco - Guimarães, 4805-017, Portugal.,Department of Veterinary Medicine, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro P Carvalho
- Department of Veterinary Medicine, University School Vasco da Gama, Av. José R. Sousa Fernandes 197, Lordemão, Coimbra, 3020-210, Portugal.,CIVG - Vasco da Gama Research Center, University School Vasco da Gama, Coimbra, Portugal
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28
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Heuijerjans A, Wilson W, Ito K, van Donkelaar CC. The critical size of focal articular cartilage defects is associated with strains in the collagen fibers. Clin Biomech (Bristol, Avon) 2017; 50:40-46. [PMID: 28987870 DOI: 10.1016/j.clinbiomech.2017.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/15/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Abstract
The size of full-thickness focal cartilage defect is accepted to be predictive of its fate, but at which size threshold treatment is required is unclear. Clarification of the mechanism behind this threshold effect will help determining when treatment is required. The objective was to investigate the effect of defect size on strains in the collagen fibers and the non-fibrillar matrix of surrounding cartilage. These strains may indicate matrix disruption. Tissue deformation into the defect was expected, stretching adjacent superficial collagen fibers, while an osteochondral implant was expected to prevent these deformations. Finite element simulations of cartilage/cartilage contact for intact, 0.5 to 8mm wide defects and 8mm implant cases were performed. Impact, a load increase to 2MPa in 1ms, and creep loading, a constant load of 0.5MPa for 900s, scenarios were simulated. A composition-based material model for articular cartilage was employed. Impact loading caused low strain levels for all models. Creep loading increased deviatoric strains and collagen strains in the surrounding cartilage. Deviatoric strains increased gradually with defect size, but the surface area at which collagen fiber strains exceeded failure thresholds, abruptly increased for small increases of defect size. This was caused by a narrow distribution of collagen fiber strains resulting from the non-linear stiffness of the fibers. We postulate this might be the mechanism behind the existence of a critical defect size. Filling of the defect with an implant reduced deviatoric and collagen fiber strains towards values for intact cartilage.
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Affiliation(s)
- A Heuijerjans
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - W Wilson
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - C C van Donkelaar
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands.
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29
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Becher C, Cantiller EB. Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature. Arch Orthop Trauma Surg 2017; 137:1307-17. [PMID: 28526923 DOI: 10.1007/s00402-017-2717-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The rationale of focal articular prosthetic resurfacing used as a primary arthroplasty procedure in the treatment of articular cartilage defects is still under debate. Conflicting reports raise concern about high rates of re-operations and continued development of osteoarthritis, while others have reported good outcomes. The goal of this paper is to present the long-term results of two patients with a 12-year follow-up and to report the results of a literature review. MATERIALS AND METHODS Two patients (male, 70 years; female 63 years) with a follow-up of 12 years were reviewed. Patients were evaluated with standard radiographs to assess the progression of osteoarthritis (OA), a clinical examination including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale. The literature review was performed using the search terms HemiCAP, focal, femoral, condyle, inlay, and resurfacing to identify articles published in the English language up until September 25, 2016. RESULTS The clinical and radiographic follow-ups of the patients were 11.9 and 11.8 years, respectively. Both patients were satisfied with their outcome and would have the operation again. Comparing the first postoperative to 12-year follow-up X-rays, the radiographic results demonstrated no signs of periprosthetic loosening, preservation of joint space, and no change in the osteoarthritic stage. KOOS Scores were 86 and 83 for pain, 89 and 93 for symptoms, 88 and 100 for activities of daily living (ADL), 75 and 65 for sports and recreation, and 75 and 81 for quality of life (QOL). The Tegner activity level was 5 and 4. The literature review comprised 6 studies with 169 focal articular prosthetic resurfacing procedures in 169 patients (84 male, 85 female) with a mean age at implantation ranging from 44.7 to 53.7 years and a follow-up range of 20 months to 7 years. Five studies were classified as level 4 and one as level 3. Clinical and radiographic results showed mainly good to excellent outcomes but were different among the studies depending on the indication. Re-operation rates ranged from 0 to 23% depending on the length of follow-up. CONCLUSIONS The results suggest that focal articular prosthetic resurfacing is an effective and safe treatment option in selected cases.
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Affiliation(s)
- Lars Goebel
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg/Saar, Germany.,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Dieter Kohn
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg/Saar, Germany .,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Martinez-Carranza N, Ryd L, Hultenby K, Hedlund H, Nurmi-Sandh H, Lagerstedt AS, Schupbach P, Berg HE. Treatment of full thickness focal cartilage lesions with a metallic resurfacing implant in a sheep animal model, 1 year evaluation. Osteoarthritis Cartilage 2016; 24:484-93. [PMID: 26403063 DOI: 10.1016/j.joca.2015.09.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Full depth focal cartilage lesions do not heal spontaneously and while some of these lesions are asymptomatic they might progress to osteoarthritis. Treatment for these lesions is warranted and the gold standard treatment at younger age remains biological healing by cell stimulation. In the middle-age patient the success rate of biologic treatment varies, hence the surge of non-biological alternatives. Our objective was to evaluate the efficacy and safety of a metallic implant for treatment of these lesions with respect to the long-term panarticular cartilage homeostasis. METHODS The medial femoral condyle of 16 sheep was operated unilaterally. A metallic implant was inserted in the weight-bearing surface at an aimed height of 0.5 mm recessed. Euthanasia was performed at 6 or 12 months. Implant height and tilt was analyzed using a laser-scanning device. Damage to cartilage surfaces was evaluated macroscopically and microscopically according to the Osteoarthritis Research Society International (OARSI) recommendations. RESULTS Thirteen sheep were available for evaluation and showed a varying degree of cartilage damage linearly increasing with age. Cartilage damage of the medial tibial plateau opposing the implant was increased compared to the non-operated knee by 1.77 units (p = 0.041; 95% CI: 0.08, 3.45) on a 0-27 unit scale. Remaining joint compartments were unaffected. Implant position averaged 0.54 recessed (95% CI: 0.41, 0.67). CONCLUSIONS Our results showed a consistent and accurate placement of these implants at a defined zone. At this position cartilage wear of opposing and surrounding joint cartilage is limited. Thus expanded animal and human studies are motivated.
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Affiliation(s)
- N Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - L Ryd
- Episurf Medical AB, Stockholm, Sweden
| | - K Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - H Hedlund
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - H Nurmi-Sandh
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - A S Lagerstedt
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - P Schupbach
- Schupbach Ltd, Service and Research Laboratory for Histology, Electron Microscopy and Micro CT, Horgen, Switzerland
| | - H E Berg
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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32
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Pilichi S, Rocca S, Pool RR, Dattena M, Masala G, Mara L, Sanna D, Casu S, Manunta ML, Manunta A, Passino ES. Treatment with embryonic stem-like cells into osteochondral defects in sheep femoral condyles. BMC Vet Res 2014; 10:301. [PMID: 25523522 PMCID: PMC4297431 DOI: 10.1186/s12917-014-0301-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023] Open
Abstract
Background Articular cartilage has poor intrinsic capacity for regeneration because of its avascularity and very slow cellular turnover. Defects deriving from trauma or joint disease tend to be repaired with fibrocartilage rather than hyaline cartilage. Consequent degenerative processes are related to the width and depth of the defect. Since mesenchymal stem cells (MSCs) deriving from patients affected by osteoarthritis have a lower proliferative and chondrogenic activity, the systemic or local delivery of heterologous cells may enhance regeneration or inhibit the progressive loss of joint tissue. Embryonic stem cells (ESCs) are very promising, since they can self-renew for prolonged periods without differentiation and can differentiate into tissues from all the 3 germ layers. To date only a few experiments have used ESCs for the study of the cartilage regeneration in animal models and most of them used laboratory animals. Sheep, due to their anatomical, physiological and immunological similarity to humans, represent a valid model for translational studies. This experiment aimed to evaluate if the local delivery of male sheep embryonic stem-like (ES-like) cells into osteochondral defects in the femoral condyles of adult sheep can enhance the regeneration of articular cartilage. Twenty-two ewes were divided into 5 groups (1, 2, 6, 12 and 24 months after surgery). Newly formed tissue was evaluated by macroscopic, histological, immunohistochemical (collagen type II) and fluorescent in situ hybridization (FISH) assays. Results Regenerated tissue was ultimately evaluated on 17 sheep. Samples engrafted with ES-like cells had significantly better histologic evidence of regeneration with respect to empty defects, used as controls, at all time periods. Conclusions Histological assessments demonstrated that the local delivery of ES-like cells into osteochondral defects in sheep femoral condyles enhances the regeneration of the articular hyaline cartilage, without signs of immune rejection or teratoma for 24 months after engraftment. Electronic supplementary material The online version of this article (doi:10.1186/s12917-014-0301-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanna Pilichi
- Department of Animal Science, Agricultural Research Agency of Sardinia, Olmedo, Sassari, 07040, Italy.
| | - Stefano Rocca
- Department of Veterinary Medicine, via Vienna, Sassari, 07100, Italy.
| | - Roy R Pool
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, 77843-4467, TX, USA.
| | - Maria Dattena
- Department of Animal Science, Agricultural Research Agency of Sardinia, Olmedo, Sassari, 07040, Italy.
| | - Gerolamo Masala
- Department of Veterinary Medicine, via Vienna, Sassari, 07100, Italy.
| | - Laura Mara
- Department of Animal Science, Agricultural Research Agency of Sardinia, Olmedo, Sassari, 07040, Italy.
| | - Daniela Sanna
- Department of Animal Science, Agricultural Research Agency of Sardinia, Olmedo, Sassari, 07040, Italy.
| | - Sara Casu
- Department of Animal Science, Agricultural Research Agency of Sardinia, Olmedo, Sassari, 07040, Italy.
| | - Maria L Manunta
- Department of Veterinary Medicine, via Vienna, Sassari, 07100, Italy.
| | - Andrea Manunta
- Department of Surgery, Microsurgery and Medicine, University of Sassari, viale San Pietro, Sassari, 07100, Italy.
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Martinez-Carranza N, Berg HE, Lagerstedt AS, Nurmi-Sandh H, Schupbach P, Ryd L. Fixation of a double-coated titanium-hydroxyapatite focal knee resurfacing implant: a 12-month study in sheep. Osteoarthritis Cartilage 2014; 22:836-44. [PMID: 24726379 DOI: 10.1016/j.joca.2014.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/28/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Focal cartilage lesions according to International Cartilage Repair Society (ICRS) grade 3-4 in the medial femoral condyle may progress to osteoarthritis. When treating such focal lesions with metallic implants a sound fixation to the underlying bone is mandatory. We developed a monobloc unipolar cobalt-chrome (Co-Cr) implant with a double coating; first a layer of commercially pure titanium (c.p.Ti) on top of which a layer of hydroxyapatite (HA) was applied. We hypothesised that such a double coating would provide long-lasting and adequate osseointegration. DESIGN (MATERIALS AND METHODS) Unilateral medial femoral condyles of 10 sheep were operated. The implants were inserted in the weight-bearing surface and immediate weight-bearing was allowed. Euthanasia was performed at 6 (three animals) or 12 months (six animals). Osseointegration was analysed with micro-computer tomography (CT), light microscopy and histomorphometric analyses using backscatter scanning electron microscopy (B-SEM) technique. RESULTS At 6 months one specimen out of three showed small osteolytic areas at the hat and at 12 months two specimens out of six showed small osteolytic areas at the hat, no osteolytical areas were seen around the peg at any time point. At both time points, a high total bone-to-implant contact was measured with a mean (95% confidence interval - CI) of 90.6 (79-102) at 6 months and 92.3 (89-95) at 12 months, respectively. CONCLUSIONS A double coating (Ti + HA) of a focal knee resurfacing Co-Cr implant was presented in a sheep animal model. A firm and consistent bond to bone under weight-bearing conditions was shown up to 1 year.
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Affiliation(s)
- N Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - H E Berg
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - A-S Lagerstedt
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - H Nurmi-Sandh
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - P Schupbach
- Schupbach Ltd, Service and Research Laboratory for Histology, Electron Microscopy and Micro CT, Horgen, Switzerland
| | - L Ryd
- Episurf Medical, Stockholm, Sweden
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Abstract
BACKGROUND AND PURPOSE Articular resurfacing metal implants have been developed to treat full-thickness localized articular cartilage defects. Evaluation of the fixation of these devices is mandatory. Standard radiostereometry (RSA) is a validated method for evaluation of prosthetic migration, but it requires that tantalum beads are inserted into the implant. For technical reasons, this is not possible for focal articular resurfacing components. In this study, we therefore modified the tip of an articular knee implant and used it as a marker for RSA, and then validated the method. MATERIAL AND METHODS We modified the tip of a resurfacing component into a hemisphere with a radius of 3 mm, marked it with a 1.0-mm tantalum marker, and implanted it into a sawbone marked with 6 tantalum beads. Point-motion RSA of the "hemisphere bead" using standard automated RSA as the gold standard was compared to manual measurement of the tip hemisphere. 20 repeated stereograms with gradual shifts of position of the specimen between each double exposure were used for the analysis. The tip motion was compared to the point motion of the hemisphere bead to determine the accuracy and precision. RESULTS The accuracy of the manual tip hemisphere method was 0.08-0.19 mm and the precision ranged from 0.12 mm to 0.33 mm. INTERPRETATION The accuracy and precision for translations is acceptable when using a small hemisphere at the tip of a focal articular knee resurfacing implant instead of tantalum marker beads. Rotations of the implant cannot be evaluated. The method is accurate and precise enough to allow detection of relevant migration, and it will be used for future clinical trials with the new implant.
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Affiliation(s)
- Olof Sköldenberg
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Thomas Eisler
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - André Stark
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Olle Muren
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Nicolas Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm and Karolinska Institutet, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Stockholm
| | - Leif Ryd
- Episurf Medical AB, Stockholm, Sweden
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Manda K, Eriksson A. Modeling of constrained articular cartilage growth in an intact knee with focal knee resurfacing metal implant. Biomech Model Mechanobiol 2013; 13:599-613. [DOI: 10.1007/s10237-013-0521-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
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