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Taghvaei M, Taheri M, Sadighi A, Zegarski R, Schaer TP, Palmese GR, Najafi AR, Siegler S. Fixation strength of swelling copolymeric anchors in artificial bone. J Orthop Res 2024; 42:1223-1230. [PMID: 38111190 DOI: 10.1002/jor.25770] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
Fixation with suture anchors and metallic hardware for osteosynthesis is common in orthopedic surgeries. Most metallic commercial bone anchors achieve their fixation to bone through shear of the bone located between the threads. They have several deficiencies, including stress-shielding due to mechanical properties mismatch, generation of acidic by-products, poor osteointegration, low mechanical strength and catastrophic failure often associated with large bone defects that may be difficult to repair. To overcome these deficiencies, a swelling porous copolymeric material, to be used as bone anchors with osteointegration potential, was introduced. The purpose of this study was to investigate the fixation strength of these porous, swelling copolymeric bone anchors in artificial bone of various densities. The pull-out and subsidence studies indicate an effective fixation mechanism based on friction including re-fixation capabilities, and minimization of damage following complete failure. The study suggests that this swelling porous structure may provide an effective alternative to conventional bone anchors, particularly in low-density bone.
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Affiliation(s)
- Moein Taghvaei
- School of Biomedical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mehrangiz Taheri
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Amirreza Sadighi
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ryan Zegarski
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Thomas P Schaer
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Ahmad R Najafi
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
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Borsinger TM, Quevedo Gonzalez FJ, Pagan CA, Karasavvidis T, Sculco PK, Wright TM, Kahlenberg CA, Lipman JD, Debbi EM, Vigdorchik JM, Mayman DJ. Is Tibial Bone Mineral Density Related to Sex, Age, Preoperative Alignment, or Fixation Method in Primary Total Knee Arthroplasty? J Arthroplasty 2024:S0883-5403(24)00272-9. [PMID: 38548236 DOI: 10.1016/j.arth.2024.03.056] [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: 11/15/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has regained interest for its potential for long-term biologic fixation. The density of the bone is related to its ability to resist static and cyclic loading and can affect long-term implant fixation; however, little is known about the density distribution of periarticular bone in TKA patients. Thus, we sought to characterize the bone mineral density (BMD) of the proximal tibia in TKA patients. METHODS We included 42 women and 50 men (mean age 63 years, range: 50 to 87; mean body mass index 31.6, range: 20.5 to 49.1) who underwent robotic-assisted TKA and had preoperative computed tomography scans with a BMD calibration phantom. Using the robotic surgical plan, we computed the BMD distribution at 1 mm-spaced cross-sections parallel to the tibial cut from 2 mm above the cut to 10 mm below. The BMD was analyzed with respect to patient sex, age, preoperative alignment, and type of fixation. RESULTS The BMD decreased from proximal to distal. The greatest changes occurred within ± 2 mm of the tibial cut. Age did not affect BMD for men; however, women between 60 and 70 years had higher BMD than women ≥ 70 years for the total cut (P = .03) and the medial half of the cut (P = .03). Cemented implants were used in 1 86-year-old man and 18 women (seven < 60 years, seven 60 to 70 years, and four ≥ 70 year old). We found only BMD differences between cemented or cementless fixation for women < 60 years. CONCLUSIONS To our knowledge, this is the first study to characterize the preoperative BMD distribution in TKA patients relative to the intraoperative tibial cut. Our results indicate that while sex and age may be useful surrogates of BMD, the clinically relevant thresholds for cementless knees remain unclear, offering an area for future studies.
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Affiliation(s)
- Tracy M Borsinger
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Moriarty TF, Hickok NJ, Saeed K, Schaer TP, Chen AF, Schwarz EM. The 2023 Orthopaedic Research Society International Consensus Meeting on musculoskeletal infection. J Orthop Res 2024; 42:497-499. [PMID: 37823833 DOI: 10.1002/jor.25714] [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: 07/19/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
The Orthopaedic Research Society's Research Interest Group completed its international consensus meeting (ICM) on musculoskeletal infections (MSKI) following the 2023 Annual Meeting. The work products from this ICM include the 65 questions with recommendation and rationale, and the voting results from the 72 delegates. There are also five Consensus Articles in this issue of the Journal of Orthopaedic Research from the ICM Sections: Host Immunity, Established Infection-Treatment, Clinical Questions not addressed by the prior MSKI ICMs, In Vitro, and Animal Models. This Introduction summarizes the 3-year Delphi process used by the ICM with timelines and critical milestones. It also highlights several challenges that had to be addressed, and a large body of work that remains.
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Affiliation(s)
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kordo Saeed
- University Hospital Southampton, NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Thomas P Schaer
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Antonia F Chen
- Department of Orthpaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward M Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
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Khatoon MA, Karim SMK, Wasim M, Ali R, Zaighum M, Iqbal N. Frequency of Urinary Tract Infection Among Patients Undergoing Implant Fixation for Acute Trauma. Cureus 2023; 15:e49817. [PMID: 38045632 PMCID: PMC10692962 DOI: 10.7759/cureus.49817] [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] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE This study aims to determine the frequency of urinary tract infection (UTI), identify the isolated bacteria, and assess antibiotic sensitivity in patients undergoing orthopedic implant fixation for hip fractures. METHODOLOGY After ethical approval from the institutional review board, this retrospective cross-sectional study was conducted at the Orthopedic Surgery Department of Dow University Hospital Karachi from June 2022 to June 2023. Through non-probability consecutive sampling, 186 patients above 16 years of age, of either gender, presenting with hip fractures such as intracapsular or extracapsular fractures, who underwent surgical fixation, were included in the study. A urine sample for urinalysis of these patients was sent on admission. Patients who presented with open fractures or those treated with conservative management were excluded from the study. The fracture diagnosis was confirmed on radiographs. All other relevant baseline investigations were also performed before surgery, per protocol, and urine-detailed and cultured reports were followed. In addition, each patient was asked about common symptoms of UTI before surgery and then diagnosed with UTI on positive urine culture and sensitivity (CS). RESULTS Out of 186 hip fracture patients, 98 (52.7%) were males and 88 (47.3%) were females, with a mean age of 61.03 ± 16.43 (16-96) years. Pre-operative UTI symptoms were reported by 79 patients, including dysuria (16; 20.3%), polyuria (19; 24.0%), and burning (44; 55.7%). UTI was diagnosed on culture and sensitivity report in 65 (34.9%) patients with Escherichia coli as commonly diagnosed bacteria 35 (53.8%), followed by Enterococcus 8 (12.4%), Klebsiella 7 (10.9%), Pseudomonas aeruginosa 3 (4.7%), and Acinetobacter 2 (3.1%) patients. E. coli was sensitive to amikacin, amoxicillin/clavulanic acid, ampicillin, cefixime, ceftriaxone, cefuroxime, ciprofloxacin, colistin, cotrimoxazole, fosfomycin, gentamycin, levofloxacin, meropenem, nitrofurantoin, polymyxin B, and piperacillin-tazobactam. CONCLUSION Urinary tract infection is common in patients undergoing orthopedic implant fixation for hip fractures, which can lead to potentially serious outcomes. Overall, hygiene, prompt treatment, and standard protocol should be utilized to treat those infected and minimize the spread.
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Affiliation(s)
- Malik Amna Khatoon
- Orthopaedic Surgery, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Syed Muhammad Khalid Karim
- Orthopaedics and Trauma, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Muhammad Wasim
- Orthopaedic Surgery, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Rufina Ali
- Trauma and Orthopaedics, Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT), Karachi, PAK
| | - Mariam Zaighum
- Orthopaedics and Trauma, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Naveed Iqbal
- Trauma and Orthopaedics, Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT), Karachi, PAK
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Wahbeh JM, Park SH, Iyer S, Ebramzadeh E, Sangiorgio SN. Observations of bony ongrowth and clinical fixation in two retrieved disc replacements. J Biomed Mater Res B Appl Biomater 2023. [PMID: 37191359 DOI: 10.1002/jbm.b.35263] [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: 01/27/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
Total disc replacements utilize textured coatings to maximize bony ongrowth. However, the contribution of direct bony attachment to overall fixation for total disc replacements has not been reported. The goal of the present study was to document the extent of bony attachment to the surfaces of two clinically functional total disc replacements that were securely fixed at the time of revision. Two metal-and-polymeric disc replacements, one cervical and one lumbar, were evaluated following surgical retrieval. The cervical device was retrieved at 8 months and the lumbar device at 28 months post-operative. Both devices were reported well-fixed at the time of removal, with large bone masses attached to one endplate of each device. Visual inspections, non-destructive gravimetric measurements, and surface metrology were performed to assess fixation. These inspections suggested that both devices had been fixed at the time of removal with little in vivo mechanical damage, as surgical extraction damage was noted on both devices and provided imaging showed a lack of device migration. Devices were then embedded and sectioned to evaluate the bone-implant interface. High resolution photographs and contact microradiographs were taken to assess bony attachment. In contrast to initial analysis, these images revealed radiolucent gaps between the endplates and bone masses. Little direct contact between the bone and endplate surface was identified and the original surgical cuts were still visible. Both devices were clinically fixed at the time of removal and neither had complications associated with loosening. However, osseointegration was minimal in one of the devices and altogether absent from the other. The findings of the present study suggest that other factors may influence overall clinical fixation such as the surgical preparation of the vertebral bone or the surface roughness of the treated endplates. Despite the limitations of the present study, this information is unique to the current total disc replacement literature and the ongrowth and fixation of devices should be considered as a topic for future investigation.
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Affiliation(s)
- Jenna M Wahbeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sumant Iyer
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sophia N Sangiorgio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Sivakumar A, Rickman M, Thewlis D. Gait biomechanics after proximal femoral nailing of intertrochanteric fractures. J Orthop Res 2023; 41:862-874. [PMID: 35953287 PMCID: PMC10946975 DOI: 10.1002/jor.25427] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/06/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Proximal femur fractures in the elderly are associated with significant loss of independence, mobility, and quality of life. This prospective study aimed to: (1) investigate gait biomechanics in intertrochanteric fracture (ITF) patients (A1 and A2 AO/OTA) managed via femoral nailing at 6 weeks and 6 months postoperative and how these compared with similarly aged elderly controls; and (2) investigate whether femoral offset shortening (FOS) and lateral lag screw protrusion (LSP) were associated with changes in gait biomechanics at postoperative time points. Hip radiographs and gait data were collected for 34 patients at 6 weeks and 6 months postoperatively. Gait data were also collected from similarly aged controls. FOS and LSP were measured from radiographs. Joint angles, external moments, and powers were calculated for the hip, knee, and ankle and compared between time points in ITF patients and healthy controls using statistical parametric mapping. The relationship between radiographic measures with gait speed, step length, peak hip abduction, and maximum hip abduction moment was assessed using a Pearson correlation. External hip adduction moments and hip power generation improved in the first 6 months postoperative, but differed significantly from healthy controls during single limb stance. LSP showed a moderate correlation with maximum hip abduction moment at 6 weeks postoperative (r = -0.469, p = 0.048). These results provide new detail on functional outcomes after ITF and potential mechanisms that functional deficiencies may stem from. Lag screw prominence may be an important factor in maintaining functional independence and minimizing the risk of secondary falls after ITF in the elderly.
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Affiliation(s)
- Arjun Sivakumar
- Centre for Orthopaedic & Trauma ResearchUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Mark Rickman
- Centre for Orthopaedic & Trauma ResearchUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Orthopaedics & TraumaRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma ResearchUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Orthopaedics & TraumaRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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7
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Xu H, Chen AF, Shoji MM, Fitz W, Lange JK. Are There More Radiolucent Lines in Patients Who Underwent Total Knee Arthroplasty With or Without a Tourniquet During Cementation at 5 to 8 Years After Surgery? J Arthroplasty 2023; 38:1052-1056. [PMID: 36858126 DOI: 10.1016/j.arth.2023.02.057] [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: 09/25/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study investigated the presence and progression of radiolucent lines (RLLs) after cemented total knee arthroplasty (TKA) with or without tourniquet use. METHODS There were 369 consecutive primary cemented TKAs with 5 to 8 years of follow-up. A tourniquet was used during component cementation in patients who underwent surgery from January 3, 2006, to March 31, 2010. No tourniquet was used from August 14, 2009, to October 14, 2014. There were 192 patients in the tourniquet group (TQ) and 177 patients in the no tourniquet group (NQ). Patient demographics, reoperations, and complications were recorded. RLLs were identified on anteroposterior, lateral, and skyline x-rays at 1, 2, and 5 to 8 years postoperatively using the modern knee society radiographic evaluation system. Demographics, reoperations, complications, and RLLs were compared. Age, sex, and body mass index were similar between groups. Mean tourniquet time in TQ was 11 minutes (range, 8 to 25). RESULTS The presence of RLLs differed between groups, with 65% of TQ knees having RLLs under any part of the prostheses versus 46% of NQ knees (P < .001). The progression of RLL >2 mm occurred in 26.0% of knees in TQ and 16.7% of knees in NQ (P = .028). There were 13 TKAs that underwent subsequent revision surgery. There was no statistically or clinically significant difference in revision rate between groups (7 revisions in TQ, 6 in NQ, P = .66). CONCLUSION Less RLLs were identified in NQ versus TQ. There were no statistically or clinically significant differences in revision rates between the NQ and TQ groups at 5 to 8 years.
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Affiliation(s)
- Haijun Xu
- Department of Orthopaedic Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica M Shoji
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wolfgang Fitz
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Gafar Ahmed M, AlHammad ZA, Al-Jandan B, Almohammadi T, Khursheed Alam M, Bagde H. Silicone Facial Implants, to Fixate or Not to Fixate: A Narrative Review. Cureus 2023; 15:e34524. [PMID: 36874350 PMCID: PMC9984266 DOI: 10.7759/cureus.34524] [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] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Silicone implants are one of the most widely used implants for facial augmentation, especially in the chin, mandibular angle, and malar area, utilizing different surgical approaches. Despite their various advantages, many complications have also been reported, including hematoma, infection, bone resorption, numbness, displacement, and asymmetry. This study aims to evaluate the need for facial-implant fixation and compare and contrast fixated and nonfixated facial silicone implants in different facial sites. A narrative review of the topic of facial-implant stabilization using the PubMed database inclusion criteria included articles that discussed the topic of facial implants, were published in English, and included critical information such as the location of the implant, type of stabilization, follow-up periods, and complications. A total of 11 studies were included. Of these, two were prospective clinical studies, three were case series, and the remaining six were retrospective clinical studies. The studies were published between 1995 and 2018. The sample size varied from 2 to 601 cases. Stabilization includes suturing, monocortical screws, or no stabilization. Complications were reported in most of these studies, including asymmetry, bone resorption or erosion, displacement, dissatisfaction, edema, hematoma, infection, mucosal irritation, pain, and paresthesia. The follow-up period ranged from one month to 17 years. Despite the varied settings of these studies, silicone facial implant complications were reported in both fixated and nonfixated implants, with a lack of significant differences between fixated and nonfixated facial silicone implants regarding the method of fixation.
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Affiliation(s)
- Mohamed Gafar Ahmed
- Department of Oral and Maxillofacial Surgery, King Fahd Hospital of the University, Dammam, SAU
| | - Ziyad A AlHammad
- Saudi Board of Oral & Maxillofacial Surgery, Ministry of Health, Riyadh, SAU
| | - Badr Al-Jandan
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Turki Almohammadi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Jouf University, Sakaka, SAU
| | | | - Hiroj Bagde
- Department of Periodontology, Rama Dental College Hospital and Research Centre, Kanpur, IND
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Kim G, Inage K, Shiga Y, Mukaihata T, Tajiri I, Eguchi Y, Suzuki-Narita M, Takaoka H, Hozumi T, Mizuki N, Tsuchiya R, Otagiri T, Hishiya T, Arai T, Toshi N, Furuya T, Maki S, Nakamura J, Hagiwara S, Aoki Y, Koda M, Takahashi H, Akazawa T, Ohtori S, Orita S. Bone union-promoting effect of romosozumab in a rat posterolateral lumbar fusion model. J Orthop Res 2022; 40:2576-2585. [PMID: 35088447 DOI: 10.1002/jor.25287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/29/2021] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
This study investigated the effect of romosozumab on bone union in a rat posterolateral lumbar fixation model. Posterolateral lumbar fixation was performed on 8-week-old male Sprague Dawley rats (n = 20). For bone grafting, autogenous bone (40 mg) was harvested from the spinous processes of the 10th thoracic vertebra until the 2nd lumbar vertebra and implanted between the intervertebral joints and transverse processes of the 4th and 5th lumbar vertebrae on both sides. Rats were matched by body weight and equally divided into two groups: R group (Evenity®, 25 mg/kg) and control (C) group (saline). Subcutaneous injections were administered twice a week until 8 weeks after surgery. Computed tomography was performed at surgery and week 8 after surgery. The area and percentage of bone trabeculae in the total area of bone fusion were calculated. Statistical analysis was performed using an unpaired t test (p < 0.05). We found that the R group rats had significantly higher mean bone union rate and volume than did the C group rats at all time courses starting week 4 after surgery. The R group had significantly higher increase rates than did the C group at weeks 4 and 6 after surgery. The percentage of bone trabeculae area in the R group was approximately 1.7 times larger than that in the C group. Thus, we demonstrated that romosozumab administration has stimulatory effects on bony outgrowth at bone graft sites. We attribute this to the modeling effect of romosozumab.
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Affiliation(s)
- Geundong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohito Mukaihata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ikuko Tajiri
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyako Suzuki-Narita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryuto Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuma Otagiri
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahisa Hishiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahito Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Noriyasu Toshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Chiba University Center for Frontier Medical Engineering, Chiba, Japan
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Willemsen K, Tryfonidou M, Sakkers R, Castelein RM, Zadpoor AA, Seevinck P, Weinans H, Meij B, van der Wal BCH. Patient-specific 3D-printed shelf implant for the treatment of hip dysplasia: Anatomical and biomechanical outcomes in a canine model. J Orthop Res 2022; 40:1154-1162. [PMID: 34191341 PMCID: PMC9291530 DOI: 10.1002/jor.25133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/22/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
A solution for challenging hip dysplasia surgery could be a patient-specific 3D-printed shelf implant that is positioned extra-articular and restores the dysplastic acetabular rim to normal anatomical dimensions. The anatomical correction and biomechanical stability of this concept were tested in a canine model that, like humans, also suffers from hip dysplasia. Using 3D reconstructed computed tomography images the 3D shelf implant was designed to restore the radiological dysplastic hip parameters to healthy parameters. It was tested ex vivo on three dog cadavers (six hips) with hip dysplasia. Each hip was subjected to a biomechanical subluxation test, first without and then with the 3D shelf implant in place. Subsequently, an implant failure test was performed to test the primary implant fixation. At baseline, the dysplastic hips had an average Norberg angle of 88 ± 3° and acetabular coverage of 47 ± 2% and subluxated at an average of 83 ± 2° of femoral adduction. After adding the patient-specific shelf implants the dysplastic hips had an average Norberg angle of 122 ± 2° and acetabular coverage of 67 ± 3% and subluxated at an average of 117 ± 2° of femoral adduction. Implant failure after primary implant fixation occurred at an average of 1330 ± 320 Newton. This showed that the patient-specific shelf implants significantly improved the coverage and stability of dysplastic hips in a canine model with naturally occurring hip dysplasia. The 3D shelf is a promising concept for treating residual hip dysplasia with a straightforward technology-driven approach; however, the clinical safety needs to be further investigated in an experimental proof-of-concept animal study.
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Affiliation(s)
- Koen Willemsen
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marianna Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Ralph Sakkers
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - René M. Castelein
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Peter Seevinck
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Harrie Weinans
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of Biomechanical EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Björn Meij
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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11
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Cox ZC, Green CC, Otero JE, Mason JB, Martin JR. Varus Collapse in Total Knee Arthroplasty: Does Fixation or Bone Fail First? J Arthroplasty 2022; 37:162-167. [PMID: 34592354 DOI: 10.1016/j.arth.2021.09.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Aseptic tibial loosening is now considered the most common reason that total knee arthroplasties (TKA) fail long term. There are unique subsets of patients that fail into varus alignment of the tibial tray with collapse of the medial proximal tibia. It is currently unknown if the implant fixation fails first or if the proximal medial tibia collapses first. MATERIALS We performed a retrospective analysis of 88 patients that were revised at our institution secondary to aseptic varus collapse of the proximal tibia. Two fellowship-trained arthroplasty surgeons performed a retrospective analysis on sequential precollapse radiographs in each patient to determine which failed first: the implant fixation (implant-cement or cement-bone interface) or the medial proximal tibia. DISCUSSION 36/88 (40.9%) patients had a series of precollapse radiographs that could be reviewed. Failure at the implant-cement interface before varus collapse in 23 vs 22 patients, failure at the implant-cement and cement-bone interface before varus collapse in two patients, and contemporaneous failure at the implant-cement interface and varus collapse in 11 vs 12 patients were identified by reviewers one and two, respectively. CONCLUSION The most frequent mechanism of failure identified was failure of the implant-cement interface followed by subsequent medial tibial varus collapse. Improving implant fixation may decrease the incidence of this unique failure mechanism. We advocate the use of supplemental stem fixation in high-risk patients and optimal cement techniques for all patients as methods of potentially avoiding tibial varus collapse, one of the most frequent modes of long-term failure.
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Affiliation(s)
- Zach C Cox
- OrthoCarolina Hip and Knee Center, Charlotte, NC
| | - Cody C Green
- OrthoCarolina Hip and Knee Center, Charlotte, NC
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12
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Dubé-Cyr R, Villemure I, Arnoux PJ, Rawlinson J, Aubin CÉ. Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance. J Orthop Res 2021; 39:2693-2702. [PMID: 33620100 DOI: 10.1002/jor.25012] [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: 09/24/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
The sacroiliac joint (SIJ) is a known pain generator that, in severe cases, may require surgical fixation to reduce intra-articular displacements and allow for arthrodesis. The objective of this computational study was to analyze how the number of implants affected SIJ stabilization with patient-specific characteristics such as the pelvic geometry and bone quality. Detailed finite element models were developed to account for three pelvises of differing anatomy. Each model was tested with a normal and low bone density (LD) under two types of loading: compression only and compression with flexion and extension moments. These models were instrumented with one to three cylindrical, threaded and fenestrated implants through a posterior oblique trajectory, requiring less muscle dissection than the more common lateral trajectory used with triangular implants. Compared with the noninstrumented pelvis, the change in range of motion (ROM) and stress distribution were used to characterize joint stabilization. Noninstrumented mobility ranged from 0.86 to 2.55 mm and from 1.37° to 6.11°. Across patient-specific characteristics, the ROM reduction with one implant varied from 3% to 21% for vertical and 15% to 47% for angular displacements. With two implants, the ROM reduction ranged from 12% to 41% for vertical and from 28% to 61% for angular displacements. Three implants, however, did not further improve the joint stability (14% to 42% for vertical and 32% to 63% for angular displacements). With respect to patient characteristics, an LD led to a decreased stabilization and a higher volume of stressed bone (>75% of yield stress). A better understanding of how patient characteristics affect the implant performance could help improve surgical planning of sacroiliac arthrodesis.
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Affiliation(s)
- Roxanne Dubé-Cyr
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Boulevard Pierre Dramard, Aix-Marseille Université, Marseille, France
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France
| | - Pierre-Jean Arnoux
- iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Boulevard Pierre Dramard, Aix-Marseille Université, Marseille, France
| | - Jeremy Rawlinson
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Medtronic, Spinal Applied Research, Memphis, Tennessee, USA
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France
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13
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Nielsen MS, Mikkelsen MD, Ptak SH, Hejbøl EK, Ohmes J, Thi TN, Nguyen Ha VT, Fretté X, Fuchs S, Meyer A, Schrøder HD, Ding M. Efficacy of marine bioactive compound fucoidan for bone regeneration and implant fixation in sheep. J Biomed Mater Res A 2021; 110:861-872. [PMID: 34792851 DOI: 10.1002/jbm.a.37334] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022]
Abstract
The need for a substitute for allograft and autograft is rising as bone graft surgeries exceed available supplies. We investigated the efficacy of the low-molecular weight marine bioactive compound fucoidan (FUC) on bone regeneration and implant fixation in seven female sheep, as FUC has shown great promise as a bone substitute. Titanium implants were inserted bilaterally in the distal femurs to test three hydroxyapatite/fucoidan (HA/FUC) groups and compared to allograft. The HA was coated with either 500 or 1500 μg of FUC, obtained by microwave-assisted chemical extraction, or 500 μg of FUC obtained by an enzyme-assisted extraction method. The concentric 2-mm gap around the implant was filled with either one of the HA/FUCs or allograft from the donor sheep. After 12 weeks, implant-bone blocks were harvested and divided into three parts for mechanical push-out testing, immunohistochemistry, and micro-CT and histomorphometry. Pronounced bone formations were observed by micro-CT and histomorphometry in all groups, but higher bone volume fractions were seen in the allograft group compared to the three HA/FUC groups. The trabecular thickness, trabecular separation, and architectural anisotropy were all significantly higher in the allograft group compared to the three HA/FUC groups. In conclusion, adequate bone formation was observed in all groups, although the bone formation was significantly greater in the allograft group. Also, no significant differences existed in the shear mechanical properties between groups, suggesting that the combination of HA and FUC can achieve a similar fixation strength to allograft in this model.
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Affiliation(s)
- Mads Suhr Nielsen
- Orthopedic Research laboratory, Department of Orthopedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Dalgaard Mikkelsen
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Signe Helle Ptak
- SDU Chemical Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense, Denmark
| | - Eva Kildall Hejbøl
- Department of Pathology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julia Ohmes
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thuan Nguyen Thi
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Vy Tran Nguyen Ha
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Xavier Fretté
- SDU Chemical Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense, Denmark
| | - Sabine Fuchs
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Anne Meyer
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Henrik Daa Schrøder
- Department of Pathology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ming Ding
- Orthopedic Research laboratory, Department of Orthopedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Godlewski B, Dominiak M. Advantages and Disadvantages of the Use of Various Types of Interbody Implants in Cervical Spine Surgery. Critical Review of the Literature. Ortop Traumatol Rehabil 2021; 22:213-220. [PMID: 32986004 DOI: 10.5604/01.3001.0014.3457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Most cervical spine procedures in patients with degenerative disc disease involve discectomy and remo-val of osteophytes in posterior vertebral body surfaces followed by interbody stabilisation with an interbody implant. Interbody implants are made of a variety of materials, differing in structural design, shape and surface topography. Considering that fusion between the implant and host bone is crucial for long-term positive outcomes, the choice of an appropriate implant is significantly important clinically and continues to be an important area of study. MATERIAL AND METHODS Relevant published studies indexed by Medline were identified via PubMed and reviewed. The findings were combined with the authors' experiences. The database query was based on keywords related to implants in cervical spine surgery. This article presents the currently most popular types of implants by describing their properties and indicating their strengths and weaknesses as well as differences between different implant types. RESULTS Currently, the most popular interbody cages in cervical spine surgery are polyetheretherketone (PEEK) im-plants, titanium-coated PEEK implants and titanium implants. Besides the type of material used, the shape and surface structure of an implant appear to be of significant importance for a successful bony fusion. CONCLUSIONS 1. 3D printing and the ability to produce 3-dimensional porous-surfaced implants opens up considerable pro-spects for this technique in the production of modern interbody implants. 2. Implants that facilitate the engagement (interlocking) of greater volumes of bone (e.g. porous implants) offer better implant fixation, with the type of material used being less important.
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Affiliation(s)
- Bartosz Godlewski
- Szpital św. Rafała w Krakowie, Polska / St. Raphael Hospital in Cracow, Poland Oddział Kliniczny Ortopedii i Traumatologii Narządu Ruchu z Pododdziałem Chirurgii Kręgosłupa. Scanmed / Department of Orthopaedics and Musculoskeletal Traumatology, with Spinal Surgery Ward. Scanmed
| | - Maciej Dominiak
- Szpital św. Rafała w Krakowie, Polska / St. Raphael Hospital in Cracow, Poland Oddział Kliniczny Ortopedii i Traumatologii Narządu Ruchu z Pododdziałem Chirurgii Kręgosłupa. Scanmed / Department of Orthopaedics and Musculoskeletal Traumatology, with Spinal Surgery Ward. Scanmed
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15
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Abstract
AIMS We wanted to evaluate the effects of a bone anabolic agent (bone morphogenetic protein 2 (BMP-2)) on an anti-catabolic background (systemic or local zoledronate) on fixation of allografted revision implants. METHODS An established allografted revision protocol was implemented bilaterally into the stifle joints of 24 canines. At revision surgery, each animal received one BMP-2 (5 µg) functionalized implant, and one raw implant. One group (12 animals) received bone graft impregnated with zoledronate (0.005 mg/ml) before impaction. The other group (12 animals) received untreated bone graft and systemic zoledronate (0.1 mg/kg) ten and 20 days after revision surgery. Animals were observed for an additional four weeks before euthanasia. RESULTS No difference was detected on mechanical implant fixation (load to failure, stiffness, energy) between local or systemic zoledronate. Addition of BMP-2 had no effect on implant fixation. In the histomorphometric evaluation, implants with local zoledronate had more area of new bone on the implant surface (53%, p = 0.025) and higher volume of allograft (65%, p = 0.007), whereas implants in animals with systemic zoledronate had the highest volume of new bone (34%, p = 0.003). Systemic zoledronate with BMP-2 decreased volume of allograft by 47% (p = 0.017). CONCLUSION Local and systemic zoledronate treatment protects bone at different stages of maturity; local zoledronate protects the allograft from resorption and systemic zoledronate protects newly formed bone from resorption. BMP-2 in the dose evaluated with experimental revision implants was not beneficial, since it significantly increased allograft resorption without a significant compensating anabolic effect. Cite this article: Bone Joint Res 2021;10(8):488-497.
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Affiliation(s)
- Rasmus Cleemann
- Orthopedics, Zealand University Hospital Koge, Køge, Denmark.,Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Elective Surgery Center - Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Mette Sorensen
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas West
- Orthopedics, Regionshospitalet Horsens, Horsens, Denmark
| | - Kjeld Soballe
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Joan E Bechtold
- Department of Orthopedic Surgery, Hennepin Healthcare Research Institute, Minneapolis Medical Research Foundation, Orthopedic Biomechanics Laboratory, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jorgen Baas
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
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16
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Zhang M, Wang JY, Su J, Wang JJ, Yan ST, Luan YC, Cheng CK. Wear Assessment of Tibial Inserts Made of Highly Cross-Linked Polyethylene Supplemented with Dodecyl Gallate in the Total Knee Arthroplasty. Polymers (Basel) 2021; 13:1847. [PMID: 34199509 DOI: 10.3390/polym13111847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: the wear of tibial insert is still one of primary factors leading to failure of total knee arthroplasty (TKA). Dodecyl gallate (DG) has shown improvements in the oxidation stability of highly cross-linked polyethylene (HXLPE). This study aimed to assess the application of HXLPE supplemented with DG (HXLPE-DG) on the tibial insert in TKA concerning the wear resistance and the potential impact on implant fixation; Methods: tibial inserts made of HXLPE-DG were subjected to a 3 million loading-cycle wear test following ISO 14243-1:2009. The loss of mass and wear rate of the tibial inserts were calculated. The quantity, size,- and shape of wear particles were recorded; Results: the test specimens lost an average mass of 16.00 mg ± 0.94 mg, and were on an average wear rate of 3.92 mg/million cycles ± 0.19 mg/million cycles. The content of wear particles in the calf serum medium was 3.94 × 108 particles/mL ± 3.93 × 107 particles/mL, 96.66% ± 0.77% of the particles had an equivalent circular diameter less than 0.5 μm. The aspect ratio of wear particles was 1.40 (min: 1.01; max: 6.42). Conclusions: HXLPE-DG displayed advantages over the commonly used materials for tibial inserts and presented the potential of application in TKA.
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17
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Veldman HD, de Bot RTAL, Heyligers IC, Boymans TAEJ, Hiligsmann M. Cost-effectiveness analyses comparing cemented, cementless, hybrid and reverse hybrid fixation in total hip arthroplasty: a systematic overview and critical appraisal of the current evidence. Expert Rev Pharmacoecon Outcomes Res 2021; 21:579-593. [PMID: 33472442 DOI: 10.1080/14737167.2021.1878880] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: This study aims to present an overview and critical appraisal of all previous studies comparing costs and outcomes of the different modes of fixation in total hip arthroplasty (THA). A secondary aim is to provide conclusions regarding the most cost-effective mode of implant fixation per gender and age-specific population in THA, based on high quality studies.Methods: A systematic search was conducted to identify cost-effectiveness analyses (CEAs) comparing different modes of implant fixation in THA. Analysis of results was done with solely CEAs that had a high methodological quality.Results: A total of 12 relevant studies were identified and presented, of which 5 were considered to have the methodological rigor for inclusion in the analysis of results. These studies found that either cemented or hybrid fixation was the most cost-effective implant fixation mode for most age- and gender-specific subgroups.Conclusion: Currently available well performed CEAs generally support the use of cemented and hybrid fixation for all age-groups relevant for THA and both genders. However, these findings were mainly based on a single database and depended on assumptions made in the studies' methodology. Issues discussed in this paper have to be considered and future work is needed.
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Affiliation(s)
- H D Veldman
- Zuyderland Medical Center, Dept. Of Orthopaedic Surgery and Traumatology, Heerlen, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands
| | - R T A L de Bot
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands.,Maastricht University Medical Center, dept. of Orthopaedics, Maastricht, The Netherlands
| | - I C Heyligers
- Zuyderland Medical Center, Dept. Of Orthopaedic Surgery and Traumatology, Heerlen, The Netherlands.,School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - T A E J Boymans
- Maastricht University Medical Center, dept. of Orthopaedics, Maastricht, The Netherlands
| | - M Hiligsmann
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands
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18
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Moran MM, Wilson BM, Li J, Engen PA, Naqib A, Green SJ, Virdi AS, Plaas A, Forsyth CB, Keshavarzian A, Sumner DR. The gut microbiota may be a novel pathogenic mechanism in loosening of orthopedic implants in rats. FASEB J 2020; 34:14302-14317. [PMID: 32931052 DOI: 10.1096/fj.202001364r] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
Particles released from implants cause inflammatory bone loss, which is a key factor in aseptic loosening, the most common reason for joint replacement failure. With the anticipated increased incidence of total joint replacement in the next decade, implant failure will continue to burden patients. The gut microbiome is increasingly recognized as an important factor in bone physiology, however, its role in implant loosening is currently unknown. We tested the hypothesis that implant loosening is associated with changes in the gut microbiota in a preclinical model. When the particle challenge caused local joint inflammation, decreased peri-implant bone volume, and decreased implant fixation, the gut microbiota was affected. When the particle challenge did not cause this triad of local effects, the gut microbiota was not affected. Our results suggest that cross-talk between these compartments is a previously unrecognized mechanism of failure following total joint replacement.
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Affiliation(s)
- Meghan M Moran
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Brittany M Wilson
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jun Li
- Department of Internal Medicine, Division of Rheumatology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Phillip A Engen
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA
| | - Ankur Naqib
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, USA.,Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA
| | - Stefan J Green
- Genome Research Core, Research Resources Center, University of Illinois-Chicago, Chicago, IL, USA
| | - Amarjit S Virdi
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Anna Plaas
- Department of Internal Medicine, Division of Rheumatology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Christopher B Forsyth
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA
| | - Ali Keshavarzian
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA
| | - Dale R Sumner
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
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19
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Koff MF, Burge AJ, Potter HG. Clinical magnetic resonance imaging of arthroplasty at 1.5 T. J Orthop Res 2020; 38:1455-1464. [PMID: 31975444 PMCID: PMC7293946 DOI: 10.1002/jor.24606] [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: 10/25/2019] [Revised: 01/10/2019] [Accepted: 01/22/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) has historically been avoided for the routine clinical evaluation of metal implants at many clinical centers due to the presence of artifact that creates in-plane and through-plane distortions and signal intensity voids in generated images. However, when the image acquisition parameters are appropriately modified and advanced multi-spectral pulse sequences are used, high-quality diagnostic images can be generated and may be used for diagnosing patients with suspected periprosthetic pathology. MRI provides superior soft-tissue contrast and excellent sensitivity for mobile water and is, therefore, a valuable tool in the evaluation of these patients, given the increasing prevalence of arthroplasty within the general population. Knowledge of expected normal postoperative appearance in patients with total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty facilitates the detection of abnormal findings in this population, as does familiarity with common pathologic conditions encountered in the periprosthetic region. This review article will provide background information regarding the presence of image artifacts, methods to reduce the artifacts, and application of MRI at 1.5 T for evaluating common complications in subjects with total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty.
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Affiliation(s)
- Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Alissa J. Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
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20
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Abrahams JM, Callary SA, Jang SW, Hewitt J, Howie DW, Solomon LB. Accuracy of EBRA-cup measurements after reconstruction of severe acetabular defects at revision THR. J Orthop Res 2020; 38:1497-1505. [PMID: 32039492 DOI: 10.1002/jor.24623] [Citation(s) in RCA: 9] [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: 09/02/2019] [Accepted: 01/30/2020] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is the most accurate method of measuring component migration using radiographs but is restricted to use in prospective studies. Ein-Bild-Roentgen-analyze (EBRA)-Cup can be used retrospectively, but its accuracy to measure component migration following revision is unknown. This study aimed to determine the accuracy of EBRA-Cup measurements of uncemented acetabular component migration after revision total hip replacement (THR). The secondary aim was to compare the number of cases identified using EBRA-Cup and RSA as having proximally migrated above and below 1 mm at 2 years postoperatively. EBRA-Cup measurements were performed on plain antero-posterior pelvic radiographs taken at the same time as RSA radiographs in a prospective cohort of 53 hips undergoing acetabular revision. At 2 years, the mean difference between the RSA and EBRA-Cup measurements for 17 components used to treat pelvic discontinuity was 0.90 mm, significantly greater than the mean difference of 0.28 mm for 36 components without discontinuity (P = .0001). The mean difference between the RSA and EBRA-Cup measurements at 2 years for hips that were reconstructed with an acetabular component alone, 0.28 mm, was significantly lower than hips that were reconstructed with an acetabular component in combination with an augment and/or cage, 0.74 mm (P = .0005). In conclusion, EBRA-Cup can accurately measure migration of uncemented acetabular components used at revision THR. The presence of pelvic discontinuity, and addition of augments and cages, significantly influenced the accuracy of EBRA-Cup measurements. EBRA-Cup and RSA had good agreement on classification of components that migrated proximally above or below 1 mm at 2 years, with 100% sensitivity, and 87% specificity.
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Affiliation(s)
- John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Sung W Jang
- Department of Orthopaedic Surgery, Pohang Se Myeong Christianity Hospital, Pohang-si, Gyeongsangbuk-do, Korea
| | - Joseph Hewitt
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Donald W Howie
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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21
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Yousefi AM. A review of calcium phosphate cements and acrylic bone cements as injectable materials for bone repair and implant fixation. J Appl Biomater Funct Mater 2020; 17:2280800019872594. [PMID: 31718388 DOI: 10.1177/2280800019872594] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Treatment of bone defects caused by trauma or disease is a major burden on human healthcare systems. Although autologous bone grafts are considered as the gold standard, they are limited in availability and are associated with post-operative complications. Minimally invasive alternatives using injectable bone cements are currently used in certain clinical procedures, such as vertebroplasty and balloon kyphoplasty. Nevertheless, given the high incidence of fractures and pathologies that result in bone voids, there is an unmet need for injectable materials with desired properties for minimally invasive procedures. This paper provides an overview of the most common injectable bone cement materials for clinical use. The emphasis has been placed on calcium phosphate cements and acrylic bone cements, while enabling the readers to compare the opportunities and challenges for these two classes of bone cements. This paper also briefly reviews antibiotic-loaded bone cements used in bone repair and implant fixation, including their efficacy and cost for healthcare systems. A summary of the current challenges and recommendations for future directions has been brought in the concluding section of this paper.
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Affiliation(s)
- Azizeh-Mitra Yousefi
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, USA
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22
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Abstract
Bioresorbable iron-manganese alloys (Fe-30%Mn) are considered as one of the next-generation resorbable materials for orthopedic applications. Previous in vitro study showed that Fe30Mn scaffolds with 10% porosity displayed strong mechanical properties and adequate degradation rate without severe cytotoxicity effect. However, the cellular compatibility of these alloys in terms of cell-to-cell and alloy-to-cell interactions is not ideal. Collagen is the most abundant protein in human bone, providing structural support beneficial to bone healing. We hypothesized that coating collagen on Fe30Mn can improve osteointegration or activities promoting cell adhesion, migration, and proliferation, as the alloy degrades. After preparing collagen coating on Fe-30Mn via spin coating, we conducted a corrosion test and a direct cytotoxicity test on four Fe30Mn groups: non-porous and 10% porosity, with and without collagen coating. Furthermore, we evaluated and compared the morphologies of cells over a period of 7 days. Results showed that there was no significant difference between the collagen-coated and non-coated groups in corrosion rates, yet a significant decrease from the porous non-coated group to the porous collagen-coated group in cytotoxicity level was found. Cell morphology on the porous non-coated group displayed round shape, whereas that on the porous collagen-coated group displayed flattened spreading. The study showed that the collagen coating significantly increased the initial cell viability and adhesion for both the porous and non-porous groups without impeding their degradation rates. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:523-535, 2020.
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Affiliation(s)
- Sabrina Huang
- School of Materials Science and Engineering, Purdue University, Neil Armstrong Hall of Engineering, 701 West Stadium Avenue, West Lafayette, Indiana, 47907-2045
| | - Ana Ulloa
- School of Materials Science and Engineering, Purdue University, Neil Armstrong Hall of Engineering, 701 West Stadium Avenue, West Lafayette, Indiana, 47907-2045
| | - Eric Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,School of Mechanical Engineering, Purdue University, West Lafayette, Indiana.,Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana
| | - Lia Stanciu
- School of Materials Science and Engineering, Purdue University, Neil Armstrong Hall of Engineering, 701 West Stadium Avenue, West Lafayette, Indiana, 47907-2045
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23
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Freitag L, Günther C, Eberli U, Fürst A, Zeiter S, Stadelmann VA. Relative effects of age on implant integration in a rat model: A longitudinal in vivo microct study. J Orthop Res 2019; 37:541-552. [PMID: 30575124 DOI: 10.1002/jor.24210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 02/04/2023]
Abstract
The effect of age on implant fixation in bone is not always considered during the design of preclinical models. The decision on animal's age is often related to practical or historical reasons, which ultimately may affect the reproducibility of results. This study aimed to quantify the effect of age by monitoring the fixation of contrast-enhanced PEEK screws in rats, hypothesizing that the kinetics of fixation is impaired in older animals but that age effects are less severe than osteoporotic effects. The time course of implant fixation was investigated in healthy rats at 24, 40, and 60 weeks of age; and in ovariectomized rats. Implant fixation was monitored using in-vivo microCT and dynamic histomorphometry during 1 month. The rats were euthanized 28 days post screw insertion. The data was analyzed both in absolute value and after normalization to baseline bone mass. In absolute terms, greater age had a detrimental effect on bone implant contact, bone fraction, implant stiffness, and bone remodeling but less than ovariectomy. Interestingly, once data was normalized to baseline bone mass this effect disappeared, suggesting that the physiologic response to implant placement was not affected by age. In conclusion, implant fixation kinetics is less affected by age than by baseline bone mass in this rat model. Animals of different ages can therefore be compared but data must be construed relatively to baseline bone mass and not in absolute terms. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-12, 2018.
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Affiliation(s)
| | - Christian Günther
- AO Research Institute Davos, Davos, Switzerland.,Klinik für Pferdechirurgie, Vetsuisse-Fakultät der Universität Zürich, Zürich, Switzerland
| | | | - Anton Fürst
- Klinik für Pferdechirurgie, Vetsuisse-Fakultät der Universität Zürich, Zürich, Switzerland
| | | | - Vincent A Stadelmann
- AO Research Institute Davos, Davos, Switzerland.,Schulthess Clinic, Department of Research and Development, Zürich, Switzerland
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24
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Chamseddine M, Breden S, Pietschmann MF, Müller PE, Chevalier Y. Periprosthetic bone quality affects the fixation of anatomic glenoids in total shoulder arthroplasty: in vitro study. J Shoulder Elbow Surg 2019; 28:e18-e28. [PMID: 30274689 DOI: 10.1016/j.jse.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/22/2018] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid loosening, a common complication of shoulder arthroplasty, could relate to implant design and bone quality. However, the role of bone density has not been tested experimentally yet. In this study, tests on cadaveric specimens of varying bone density were performed to evaluate the effects of bone quality on loosening of typical anatomic glenoid implants. METHODS Cadaveric scapulae scanned with a quantitative computed tomography scanner to determine bone mineral density (BMD) were implanted with either pegged or keeled cemented glenoid components and tested under constant glenohumeral load while a humeral head component was moved cyclically in the inferior and superior directions. Implant superior and inferior edge lifting, defined as displacement from the underlying bone, was measured with linear variable differential transducers until we reached 23,000 test cycles, and statistical testing was performed for differences in edge lifting due to implant design and related to periprosthetic BMD. RESULTS Edge lifting was statistically significant at all time points, but on average, implant design had no effect. Lifting was highest in specimens in which BMD below the lifting edge was lower, with trends of increased displacement with decreased BMD. CONCLUSIONS Implant lifting was greater in glenoids of lower bone density for both implant designs. This finding suggests that fixation failure will most likely occur in bone of lower density and that the fixation design itself may play a secondary role.
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Affiliation(s)
- Mohamad Chamseddine
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Sebastian Breden
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, University Hospital of Munich (Ludwig Maximilian University of Munich), Munich, Germany.
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25
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Bhadada SK, Pal R, Sood A, Dhiman V, Saini UC. Co-administration of Systemic and Intralesional Zoledronic Acid in a Case of Fibrous Dysplasia: A Potentially Novel Therapy. Front Endocrinol (Lausanne) 2019; 10:803. [PMID: 31803145 PMCID: PMC6877477 DOI: 10.3389/fendo.2019.00803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/09/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Fibrous dysplasia (FD) is a benign bone lesion characterized by replacement of normal bone with abnormal fibrous tissue, clinically manifesting as deformities, bone pains, and pathological fractures. The standard medical management for FD includes systemic bisphosphonate therapy. The efficacy of systemic bisphosphonate is however limited with minimal functional improvement and pain relief. Keeping the above lacunae in mind, we have made a solitary attempt at treating FD with locally administered zoledronic acid. A 25-year-old gentleman had presented to our institute with swelling and pain involving the left thigh and left lower leg. He was diagnosed as having polyostotic FD, confirmed on bone histopathology. He was administered 4 mg of zoledronic acid intravenously while 1 mg of the drug was injected locally into the femoral lesion under ultrasound and fluoroscopy guidance. There were no peri-procedural complications. At 6 months follow-up, there was marked improvement in pain scores at the left thigh, while that at the left leg remained unchanged. In addition, repeat bone scintigraphy showed a 20.8% and 25.3% reduction in anterior and posterior uptake values, respectively, at the left femur while that at the left tibia remained unaltered.
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Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Sanjay Kumar Bhadada
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uttam Chand Saini
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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26
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Malchau H, Garellick G, Berry D, Harris WH, Robertson O, Kärrlholm J, Lewallen D, Bragdon CR, Lidgren L, Herberts P. Arthroplasty implant registries over the past five decades: Development, current, and future impact. J Orthop Res 2018; 36:2319-2330. [PMID: 29663575 DOI: 10.1002/jor.24014] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 09/12/2017] [Accepted: 03/30/2018] [Indexed: 02/04/2023]
Abstract
Local, regional, and national registries have played an important role in the development of hip and knee arthroplasty and the treatment of patients with various maladies of these joints. Four arthroplasty registries stand out as leading forces behind the drive to popularize the use of registries and pursue the concept of evidence based medicine. The Mayo registry, started by Mark Coventry, is recognized as the oldest continuing registry for arthroplasty. The Harris Registry at Massachusetts General Hospital, along with the Mayo Registry, has greatly contributed to the advancement of arthroplasty surgery and have served an important role of identifying poorly performing implants and techniques in the United States. The Swedish Knee Arthroplasty Registry is the oldest national registry dedicated to joint arthroplasty and along with the Swedish Hip Arthroplasty Registry have established the infrastructure, analysis and reporting mechanisms, and leadership that has enabled other countries to subsequently develop national registries around the world. As more countries have adopted the concept of national registries, a new area of research is possible by pooling the resources of large registries as is now occurring with the Nordic countries. Several international organizations have been formed to promote future collaboration and develop international standards. The process of globalization of registries is a result of continued efforts over the past 50 years in improving and disseminating the knowledge gained from the early registries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2319-2330, 2018.
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Affiliation(s)
- Henrik Malchau
- Sahlgrenska University Hospital, Molndal, Sweden.,Swedish Hip Arthroplasty Register Goteborg, Sweden.,Massachusetts General Hospital, Boston, Massachusetts
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27
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Cleemann R, Bechtold JE, Sorensen M, Soballe K, Baas J. Dose-Dependent Resorption of Allograft by rhBMP-2 Uncompensated by New Bone Formation-A Canine Study With Implants and Zoledronate. J Arthroplasty 2018; 33:1215-1221.e1. [PMID: 29248483 DOI: 10.1016/j.arth.2017.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/25/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Impacted bone allograft is used to restore lost bone in total joint arthroplasties. Bone morphogenetic proteins (BMPs) can induce new bone formation to improve allograft incorporation, but they simultaneously invoke a seemingly dose-dependent allograft resorption mediated by osteoclasts. Bisphosphonates effectively inhibit osteoclast activity. Predicting allograft resorption when augmented with bone morphogenetic protein 2 (BMP-2), we intended to investigate whether a balanced bone metabolism was achievable within a range of BMP-2 doses with systemic zoledronate treatment. METHODS Implants were coated with 1 of 3 BMP-2 doses (15 μg, 60 μg, and 240 μg) or left untreated. Implants were surrounded by a 2.5-mm gap filled with impacted morselized allograft. Each of the 12 dogs included received 1 of each implant (15 μg, 60 μg, 240 μg, and untreated), 2 in each proximal humerus. During the 4-week observation period, zoledronate intravenous (0.1 mg/kg) was administered to all animals 10 days after surgery as anticatabolic treatment. Implant osseointegration was evaluated by histomorphometry and mechanical push-out tests. RESULTS Untreated implants had the best mechanical fixation and superior retention of allograft as compared to any of the BMP-2 implants. Both mechanical implant fixation and retention of allograft decreased significantly with BMP-2 dose increments. Surprisingly, there was no difference among the treatment groups in the amount of new bone. CONCLUSION The use of BMP-2 to augment impaction-grafted implants cannot be recommended even when combined with systemic zoledronate.
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Affiliation(s)
- Rasmus Cleemann
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Mette Sorensen
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Kjeld Soballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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28
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Abstract
BACKGROUND Short-stem humeral replacements achieve fixation by anchoring to the metaphyseal trabecular bone. Fixing the implant in high-density bone can provide strong fixation and reduce the risk of loosening. However, there is a lack of data mapping the bone density distribution in the proximal humerus. The aim of the study was to investigate the bone density in proximal humerus. METHODS Eight computed tomography scans of healthy cadaveric humeri were used to map bone density distribution in the humeral head. The proximal humeral head was divided into 12 slices parallel to the humeral anatomic neck. Each slice was then divided into 4 concentric circles. The slices below the anatomic neck, where short-stem implants have their fixation features, were further divided into radial sectors. The average bone density for each of these regions was calculated, and regions of interest were compared using a repeated-measures analysis of variance with significance set at P < .05. RESULTS Average apparent bone density was found to decrease from proximal to distal regions, with the majority of higher bone density proximal to the anatomic neck of the humerus (P < .05). Below the anatomic neck, bone density increases from central to peripheral regions, where cortical bone eventually occupies the space (P < .05). In distal slices below the anatomic neck, a higher bone density distribution in the medial calcar region was also observed. CONCLUSION This study indicates that it is advantageous with respect to implant fixation to preserve some bone above the anatomic neck and epiphyseal plate and to use the denser bone at the periphery.
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Affiliation(s)
- Hamidreza Alidousti
- Department of Mechanical Engineering, Imperial College London, London, UK,Reprint requests: Hamidreza Alidousti, PhD, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK. (H. Alidousti).Department of Mechanical EngineeringImperial College LondonLondonSW7 2AZUK
| | - Joshua W. Giles
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Roger J.H. Emery
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Jonathan Jeffers
- Department of Mechanical Engineering, Imperial College London, London, UK
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Jariwala SH, Wee H, Roush EP, Whitcomb TL, Murter C, Kozlansky G, Lakhtakia A, Kunselman AR, Donahue HJ, Armstrong AD, Lewis GS. Time course of peri-implant bone regeneration around loaded and unloaded implants in a rat model. J Orthop Res 2017; 35:997-1006. [PMID: 27381807 PMCID: PMC5800527 DOI: 10.1002/jor.23360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
The time-course of cancellous bone regeneration surrounding mechanically loaded implants affects implant fixation, and is relevant to determining optimal rehabilitation protocols following orthopaedic surgeries. We investigated the influence of controlled mechanical loading of titanium-coated polyether-ether ketone (PEEK) implants on osseointegration using time-lapsed, non-invasive, in vivo micro-computed tomography (micro-CT) scans. Implants were inserted into proximal tibial metaphyses of both limbs of eight female Sprague-Dawley rats. External cyclic loading (60 or 100 μm displacement, 1 Hz, 60 s) was applied every other day for 14 days to one implant in each rat, while implants in contralateral limbs served as the unloaded controls. Hind limbs were imaged with high-resolution micro-CT (12.5 μm voxel size) at 2, 5, 9, and 12 days post-surgery. Trabecular changes over time were detected by 3D image registration allowing for measurements of bone-formation rate (BFR) and bone-resorption rate (BRR). At day 9, mean %BV/TV for loaded and unloaded limbs were 35.5 ± 10.0% and 37.2 ± 10.0%, respectively, and demonstrated significant increases in bone volume compared to day 2. BRR increased significantly after day 9. No significant differences between bone volumes, BFR, and BRR were detected due to implant loading. Although not reaching significance (p = 0.16), an average 119% increase in pull-out strength was measured in the loaded implants. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:997-1006, 2017.
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Affiliation(s)
- Shailly H. Jariwala
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Hwabok Wee
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Evan P. Roush
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Tiffany L. Whitcomb
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Christopher Murter
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gery Kozlansky
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Akhlesh Lakhtakia
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802-6812
| | - Allen R. Kunselman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Henry J. Donahue
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284
| | - April D. Armstrong
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gregory S. Lewis
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
- Author to whom all correspondence should be addressed: Gregory S. Lewis, Ph.D*, Pennsylvania State University College of Medicine, 500 University Drive, Mailbox – H089, Hershey, PA-17033, Phone: (717) 531-5244, Fax no.: (717) 531-7583,
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Jakobsen T, Bechtold JE, Søballe K, Jensen T, Vestermark MT, Baas J. Local delivery of zoledronate from a poly (d,l-lactide)-coating increases fixation of hydroxy-coated implants. J Orthop Res 2017; 35:974-979. [PMID: 26925986 PMCID: PMC6338069 DOI: 10.1002/jor.23219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/03/2015] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
Abstract
Initial secure implant fixation predicts long-term survival. Bisphosphonates are anti-resorptive agents. They have been shown to increase implant fixation. We investigated whether local delivery of zoledronate from a poly-d,l-lactide (PDLLA)-coating could improve fixation and osseointegration of hydroxy-apatite coated implants. Cylindrical hydroxy-apatite coated implants were bilaterally inserted press-fit into the proximal tibiae of 10 dogs. On one side the implant was coated with PDLLA containing zoledronate. The PDLLA coating was applied upon the hydroxy-apatite coating. We used the contralateral implant as control. This implant was not coated with a poly-d,l-lactide. Observation period was 12 weeks. We evaluated implant fixation with histomorphometry and biomechanical push-out test. Zoledronate resulted in an approximately threefold increase in all biomechanical parameters when comparing data with their respective controls. We found that zoledronate increased preservation of old lamellar bone and increased formation of new woven bone. This study indicates that local delivery of zoledronate from a PDDLA coating has the potential to increase implant fixation. Studies investigating different doses of zoledronate and longer follow-up are needed. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:974-979, 2017.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Joan E Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and University of Minnesota, Minneapolis, Minnesota
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Thomas Jensen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Marianne T Vestermark
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
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31
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Ding M, Henriksen SS, Martinetti R, Overgaard S. 3D perfusion bioreactor-activated porous granules on implant fixation and early bone formation in sheep. J Biomed Mater Res B Appl Biomater 2016; 105:2465-2476. [PMID: 27655015 DOI: 10.1002/jbm.b.33783] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/08/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022]
Abstract
Early fixation of total joint arthroplasties is crucial for ensuring implant survival. An alternative bone graft material in revision surgery is needed to replace the current gold standard, allograft, seeing that the latter is associated with several disadvantages. The incubation of such a construct in a perfusion bioreactor has been shown to produce viable bone graft materials. This study aimed at producing larger amounts of viable bone graft material (hydroxyapatite 70% and β-tricalcium-phosphate 30%) in a novel perfusion bioreactor. The abilities of the bioreactor-activated graft material to induce early implant fixation were tested in a bilateral implant defect model in sheep, with allograft as the control group. Defects were bilaterally created in the distal femurs of the animals, and titanium implants were inserted. The concentric gaps around the implants were randomly filled with either allograft, granules, granules with bone marrow aspirate or bioreactor-activated graft material. Following an observation time of 6 weeks, early implant fixation and bone formation were assessed by micro-CT scanning, mechanical testing, and histomorphometry. Bone formations were seen in all groups, while no significant differences between groups were found regarding early implant fixation. The microarchitecture of the bone formed by the synthetic graft materials resembled that of allograft. Histomorphometry revealed that allograft induced significantly more bone and less fibrous tissue (p < 0.05). In conclusion, bone formation was observed in all groups, while the bioreactor-activated graft material did not reveal additional effects on early implant fixation comparable to allograft in this model. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2465-2476, 2017.
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Affiliation(s)
- Ming Ding
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 15, 3rd floor, DK-5000 Odense C, Denmark
| | - Susan S Henriksen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 15, 3rd floor, DK-5000 Odense C, Denmark
| | | | - Søren Overgaard
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 15, 3rd floor, DK-5000 Odense C, Denmark
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Andreasen CM, Henriksen SS, Ding M, Theilgaard N, Andersen TL, Overgaard S. The efficacy of poly-d,l-lactic acid- and hyaluronic acid-coated bone substitutes on implant fixation in sheep. J Orthop Translat 2016; 8:12-19. [PMID: 30035089 PMCID: PMC5987050 DOI: 10.1016/j.jot.2016.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 05/20/2016] [Revised: 07/15/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background/Objective The present study investigated the efficacy of poly-d,l-lactic acid (PDLLA) and hyaluronic acid (HyA) on implant fixation when coated onto hydroxyapatite/beta-tri-calcium phosphate (HA/βTCP) granules. Methods The effect was assessed in a clinically relevant in vivo gap model in sheep. Thus, four titanium implants combined with either allograft (control), pure HA/βTCP, HyA infiltrated HA/βTCP, or PDLLA reinforced HA/βTCP granules were bilaterally inserted into the trabecular bone of the distal femurs in eight sheep. The insertion created a 2-mm peri-implant gap. After 12 weeks, histomorphometry and push-out test was used for quantification of newly formed bone in the gap, bone-implant contact, and implant fixation. Results The histomorphometric analysis revealed the presence of newly formed bone in all groups, though substitute groups showed fragments of nonabsorbed substitute material. A significant larger bone volume was found in the allograft group versus the HA/βTCP-PDLLA group (Zone 1), and in Zone 2 a statistically significantly larger bone volume was found in the allograft compared with the HA/βTCP group. The mechanical properties and the bone-implant contact revealed no statistically significant differences between the groups. Conclusion This study demonstrates that HA/βTCP granules coated with PDLLA and HyA have similar bone ingrowth and implant fixation as those with allograft, and with mechanical properties resembling those of allograft in advance, they may be considered as alternative substitute materials for bone formation in sheep.
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Affiliation(s)
- Christina M. Andreasen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 Ground floor, DK-5000 Odense C, Denmark
- Corresponding author. Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 Ground floor, DK-5000 Odense C, Denmark.
| | - Susan S. Henriksen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 Ground floor, DK-5000 Odense C, Denmark
| | - Ming Ding
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 Ground floor, DK-5000 Odense C, Denmark
| | - Naseem Theilgaard
- Danish Technological Institute, Gregersensvej 1, 2630 Taastrup, Denmark
| | - Thomas L. Andersen
- Department of Clinical Cell Biology (KCB), Vejle Hospital—Lillebaelt Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Søren Overgaard
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, J. B. Winsloewsvej 15 Ground floor, DK-5000 Odense C, Denmark
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Lewis GS, Brenza JB, Paul EM, Armstrong AD. Construct damage and loosening around glenoid implants: A longitudinal micro-CT study of five cadaver specimens. J Orthop Res 2016; 34:1053-60. [PMID: 26630205 PMCID: PMC5800522 DOI: 10.1002/jor.23119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/21/2015] [Accepted: 11/20/2015] [Indexed: 02/04/2023]
Abstract
The evolution of failure of bone and cement leading to loosening of glenoid components following shoulder arthroplasty is not well understood. The purpose of this study was to identify and visualize potential mechanisms of mechanical failure within cadavers, cemented with two types of components, and subject to cyclic loading. Five glenoid cadaver bones were implanted with either a three-pegged polyethylene component, or prototype posteriorly augmented component which addresses posterior bone loss. Specimens were loaded by constant glenohumeral compression combined with cyclic anterior-posterior displacement of the humeral head relative to the glenoid. At six time points across 100,000 cycles, implant loosening micromotions were optically measured, and specimens were imaged by micro-computed tomography. Scans were 3D registered and inspected for crack initiation and progression, and micro-CT based time-lapse movies were created. Cement cracking initiated at stress concentrations and progressed with additional cyclic loading. Failure planes within trabecular bone and the bone-cement interface were identified in four of the five specimens. Implant subsidence increased to greater than 1.0 mm in two specimens. Cemented glenoid structural failure can occur within the cement, along planes of trabecular bone, or at the bone cement interface. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1053-1060, 2016.
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Affiliation(s)
- Gregory S. Lewis
- Corresponding Author & Address for Reprints: Gregory S. Lewis, PhD, , Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Drive, Mail Code H089, Hershey PA 17033, (717) 531-5244 (phone)
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Goldman AH, Armstrong LC, Owen JR, Wayne JS, Jiranek WA. Does Increased Coefficient of Friction of Highly Porous Metal Increase Initial Stability at the Acetabular Interface? J Arthroplasty 2016; 31:721-6. [PMID: 26639983 DOI: 10.1016/j.arth.2015.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 08/04/2015] [Revised: 09/23/2015] [Accepted: 10/07/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Highly porous metal acetabular components illustrate a decreased rate of aseptic loosening in short-term follow-up compared with previous registry data. This study compared the effect of component surface roughness at the bone-implant interface and the quality of the bone on initial pressfit stability. The null hypothesis is that a standard porous coated acetabular cup would show no difference in initial stability as compared with a highly porous acetabular cup when subjected to a bending moment. Second, would bone mineral density (BMD) be a significant variable under these test conditions. METHODS In a cadaveric model, acetabular cup micromotion was measured during a 1-time cantilever bending moment applied to 2 generations of pressfit acetabular components. BMD data were also obtained from the femoral necks available for associated specimen. RESULTS The mean bending moment at 150 μm was not found to be significantly different for Gription (24.6 ± 14.0 N m) cups vs Porocoat (25 ± 10.2 N m; P > .84). The peak bending moment tolerated by Gription cups (33.9 ± 20.3 N m) was not found to be significantly different from Porocoat (33.5 ± 12.2 N m; P > .92). No correlation between BMD and bending moment at 150 μm of displacement could be identified. CONCLUSION The coefficient of friction provided by highly porous metal acetabular shells used in this study did not provide better resistance to migration under bending load when compared with a standard porous coated component.
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Affiliation(s)
- Ashton H Goldman
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Lucas C Armstrong
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - John R Owen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer S Wayne
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - William A Jiranek
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia
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Abstract
Conclusion The study demonstrates the medium-term stability and safety of the CONCERTO PIN cochlear implant. The use of the CONCERTO PIN proved to be suitable for the use of a surgical technique without the need for suture fixation and resulted in short surgery duration and a low medium-term complication rate. Objective The primary aim was to provide data on medium-term safety and stability of the CONCERTO PIN cochlear implant in adults and children, and to collect feedback on the surgical technique used, which involved no drilling and no suture fixation. The secondary aim was to analyze surgery duration. Methods Implantation was performed using minimally invasive surgery. During surgery, data on the surgical procedure was collected by the attending surgeons or a designee. Safety and stability of the CONCERTO PIN were assessed at first fitting (1 month after implantation) and 6 months after first fitting. Results Ninety-nine patients were implanted with a CONCERTO PIN implant and one patient with a CONCERTO implant. The CONCERTO PIN implants implanted during this study were immobilized by pins and a tight periosteal pocket. The mean (± SD) surgery duration was 27:52 (± 9:19) min.
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Affiliation(s)
- Vladislav Kuzovkov
- a St. Petersburg ENT and Speech Research Institute of Ear, Throat, Nose and Speech , St. Petersburg , Russia
| | - Serafima Sugarova
- a St. Petersburg ENT and Speech Research Institute of Ear, Throat, Nose and Speech , St. Petersburg , Russia
| | - Yuri Yanov
- a St. Petersburg ENT and Speech Research Institute of Ear, Throat, Nose and Speech , St. Petersburg , Russia
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Jakobsen T, Bechtold JE, Søballe K, Jensen T, Greiner S, Vestermark MT, Baas J. Local delivery of zoledronate from a poly (D,L-lactide)-Coating increases fixation of press-fit implants. J Orthop Res 2016; 34:65-71. [PMID: 26177742 PMCID: PMC6326075 DOI: 10.1002/jor.22979] [Citation(s) in RCA: 14] [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: 03/29/2015] [Accepted: 07/08/2015] [Indexed: 02/04/2023]
Abstract
Early secure fixation of total joint replacements is crucial for long-term survival. Antiresorptive agents such as bisphosphonates have been shown to increase implant fixation. We investigated whether local delivery of zoledronate from poly-D, L-lactide (PDLLA)-coated implants could improve implant fixation and osseointegration. Experimental titanium implants were bilaterally inserted press-fit into the proximal tibiae of 10 dogs. On one side the implant was coated with PDLLA containing zoledronate. The contralateral implant was uncoated and used as control. Observation period was 12 weeks. Implant fixation was evaluated with histomorphometry and biomechanical push-out test. We found an approximately twofold increase in all biomechanical parameters when comparing data from the zoledronate group with their respective controls. Histomorphometry showed increased amount of preserved bone and increased bone formation around the zoledronate implants. This study indicates that local delivery of zoledronate from a PDDLA coating has the potential to increase implant fixation.
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Affiliation(s)
- Thomas Jakobsen
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and University of Minnesota, Minneapolis, Minnesota
| | - Kjeld Søballe
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Jensen
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne T. Vestermark
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Baas
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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Ejaz A, Laursen AC, Jakobsen T, Rasmussen S, Nielsen PT, Laursen MB. Absence of a Tourniquet Does Not Affect Fixation of Cemented TKA: A Randomized RSA Study of 70 Patients. J Arthroplasty 2015; 30:2128-32. [PMID: 26162514 DOI: 10.1016/j.arth.2015.05.058] [Citation(s) in RCA: 33] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 02/01/2023] Open
Abstract
We aimed to determine whether not using a tourniquet in cemented TKA would affect migration of the tibial component measured by radiosterometric analysis (RSA). Seventy patients were randomized into a tourniquet group and a non-tourniquet group and using model-based RSA, the migration of the tibial component was analyzed. Primary and secondary outcome measures were maximum total point motion (MTPM) and translations and rotations. Follow-up period was 2 years. The tibial component was well fixated in both groups and no significant difference in migration between the two groups was detected (P=0.632). Mean MTPM (SD) was 0.47 mm (0.16) in the tourniquet group and 0.45 mm (0.21) in the non-tourniquet group. Absence of tourniquet indicates that stable fixation of the tibial component can be achieved in cemented TKA.
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Affiliation(s)
- Ashir Ejaz
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders C Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Jakobsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sten Rasmussen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul Torben Nielsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Mogens B Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Jakobsen T, Kold S, Baas J, Søballe K, Rahbek O. Sheep Hip Arthroplasty Model of Failed Implant Osseointegration. Open Orthop J 2015; 9:525-9. [PMID: 26664497 PMCID: PMC4671224 DOI: 10.2174/1874325001509010525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/13/2015] [Revised: 08/26/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022] Open
Abstract
Early secure stability of an implant is important for long-term survival. We examined whether micromotion of implants consistently would induce bone resorption and formation of a fibrous membrane and thereby prevent osseointegration. One micromotion implant was inserted into one of the medial femoral condyles in ten sheep. The micromotion device consists of an anchor bearing a PMMA implant and a PE plug. During each gait cycle the PE plug will make the PMMA implant axially piston 0.5 mm. After 12 weeks of observation the bone specimens were harvested and a post-mortem control implant was inserted into the contra-lateral medial femoral condyle. Histomorphometrical evaluation showed that the surface on the implant observed for 12 weeks was covered by fibrous tissue. The control implants were covered by lamellar bone. No difference was found with respect to the volume fraction of lamellar bone in a 1 mm zone around the implants. This study indicates that implant micromotion is sufficient to induce bone resorption and formation of a fibrous membrane.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Aalborg University Hospital, Department of Orthopaedics, Aalborg, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Rahbek
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Wee H, Armstrong AD, Flint WW, Kunselman AR, Lewis GS. Peri-implant stress correlates with bone and cement morphology: Micro-FE modeling of implanted cadaveric glenoids. J Orthop Res 2015; 33:1671-9. [PMID: 25929691 PMCID: PMC4591115 DOI: 10.1002/jor.22933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 11/05/2014] [Accepted: 04/24/2015] [Indexed: 02/04/2023]
Abstract
Aseptic loosening of cemented joint replacements is a complex biological and mechanical process, and remains a clinical concern especially in patients with poor bone quality. Utilizing high resolution finite element analysis of a series of implanted cadaver glenoids, the objective of this study was to quantify relationships between construct morphology and resulting mechanical stresses in cement and trabeculae. Eight glenoid cadavers were implanted with a cemented central peg implant. Specimens were imaged by micro-CT, and subject-specific finite element models were developed. Bone volume fraction, glenoid width, implant-cortex distance, cement volume, cement-cortex contact, and cement-bone interface area were measured. Axial loading was applied to the implant of each model and stress distributions were characterized. Correlation analysis was completed across all specimens for pairs of morphological and mechanical variables. The amount of trabecular bone with high stress was strongly negatively correlated with both cement volume and contact between the cement and cortex (r = -0.85 and -0.84, p < 0.05). Bone with high stress was also correlated with both glenoid width and implant-cortex distance. Contact between the cement and underlying cortex may dramatically reduce trabecular bone stresses surrounding the cement, and this contact depends on bone shape, cement amount, and implant positioning.
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Affiliation(s)
- Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - April D. Armstrong
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - Wesley W. Flint
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - Allen R. Kunselman
- Department of Public Health Sciences, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - Gregory S. Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
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Ding M, Henriksen SS, Theilgaard N, Overgaard S. Assessment of activated porous granules on implant fixation and early bone formation in sheep. J Orthop Translat 2015; 5:38-47. [PMID: 30035073 PMCID: PMC5987005 DOI: 10.1016/j.jot.2015.09.008] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/02/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background/Objective Despite recent progress in regeneration medicine, the repair of large bone defects due to trauma, inflammation and tumor surgery remains a major clinical challenge. This study was designed to produce large amounts of viable bone graft materials in a novel perfusion bioreactor to promote bone formation. Methods Cylindrical defects were created bilaterally in the distal femurs of sheep, and titanium implants were inserted. The concentric gap around the implants was randomly filled either with allograft, granules, granules with bone marrow aspirate (BMA) or bioreactor activated granule (BAG). The viable BAG consisted of autologous bone marrow stromal cells (BMSCs) seeded upon porous scaffold granules incubated in a 3D perfusion bioreactor for 2 weeks prior to surgery. 6 weeks after, the bone formation and early implant fixation were assessed by means of micro-CT, histomorphometry, and mechanical test. Results Microarchitectural analysis revealed that bone volume fraction and trabecular thickness in the allograft were not statistically different than those (combination of new bone and residue of granule) in the other 3 groups. The structure of the allograft group was typically plate-like, while the other 3 groups were combination of plate and rod. Histomorphometry showed that allograft induced significantly more bone and less fibrous tissue in the concentric gap than the other 3 granule groups, while the bone ingrowth to implant porous surface was not different. No significant differences among the groups were found regarding early implant mechanical fixation. Conclusion In conclusion, despite nice bone formation and implant fixation in all groups, bioreactor activated graft material did not convincingly induce early implant fixation similar to allograft, and neither bioreactor nor by adding BMA credited additional benefit for bone formation in this model.
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Affiliation(s)
- Ming Ding
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Corresponding author. Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Winsløwparken 15, 3.sal, DK-5000, Odense C, Denmark.
| | - Susan S. Henriksen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Naseem Theilgaard
- Danish Technological Institute, Plastics Technology, Taastrup, Denmark
| | - Søren Overgaard
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Knowles NK, Athwal GS, Keener JD, Ferreira LM. Regional bone density variations in osteoarthritic glenoids: a comparison of symmetric to asymmetric (type B2) erosion patterns. J Shoulder Elbow Surg 2015; 24:425-32. [PMID: 25306495 DOI: 10.1016/j.jse.2014.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 04/12/2014] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate characterization of regional variations in bone density in symmetric and asymmetric (B2) glenoid erosion patterns can assist with surgical planning, reaming, and component implantation. The purpose of this study was to characterize regional bone density and porosity in symmetric and asymmetric (B2) osteoarthritic glenoids. METHODS Symmetric (n = 25) and asymmetric (B2) (n = 25) erosion patterns were compared by computed tomography-based imaging software. An orthogonal coordinate system separated each glenoid into quadrants. In addition, a linear best-fit line defined the line-of-erosion between the paleoglenoid and neoglenoid in the asymmetric cohort. All glenoids were further divided into volumes at depths of 0 to 2.5 mm and 2.5 to 5 mm. Average bone density was measured in Hounsfield units. Bone voids or cysts were included to quantify regional porosity as the fraction of void volume to total glenoid volume. RESULTS For the symmetric cohort, there were no significant differences in bone density between quadrants at either depth (P ≥ .089). For the asymmetric cohort, bone density was significantly higher in the posterior quadrants compared with the anterior quadrants (P < .001), especially posteroinferiorly (P ≤ .007) at both depths. In addition, the neoglenoid had significantly higher density and lower void fraction compared with the paleoglenoid (P < .001). There were also significant differences in void fraction between quadrants for both cohorts, at both depths (P ≤ .004). CONCLUSIONS This study demonstrates that osteoarthritic glenoids with symmetric erosion have uniform subarticular bone density. However, asymmetric (B2) erosion patterns have potentially important regional variations in bone density and porosity, with the densest bone with the least porosity found posteroinferiorly or in the neoglenoid region.
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Affiliation(s)
- Nikolas K Knowles
- Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, St. Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, St. Joseph's Health Care, London, ON, Canada.
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University/Barnes-Jewish Hospital, St Louis, MO, USA
| | - Louis M Ferreira
- Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, St. Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
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Ding M, Andreasen CM, Dencker ML, Jensen AE, Theilgaard N, Overgaard S. Efficacy of a small cell-binding peptide coated hydroxyapatite substitute on bone formation and implant fixation in sheep. J Biomed Mater Res A 2014; 103:1357-65. [PMID: 25045068 DOI: 10.1002/jbm.a.35281] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 06/12/2014] [Accepted: 07/03/2014] [Indexed: 12/25/2022]
Abstract
Cylindrical critical size defects were created at the distal femoral condyles bilaterally of eight female adult sheep. Titanium implants with 2-mm concentric gaps were inserted and the gaps were filled with one of the four materials: allograft; a synthetic 15-amino acid cell-binding peptide coated hydroxyapatite (ABM/P-15); hydroxyapatite + βtricalciumphosphate+ Poly-Lactic-Acid (HA/βTCP-PDLLA); or ABM/P-15+HA/βTCP-PDLLA. After nine weeks, bone-implant blocks were harvested and sectioned for micro-CT scanning, push-out test, and histomorphometry. Significant bone formation and implant fixation could be observed in all four groups. Interestingly, the microarchitecture of the ABM/P-15 group was significantly different from the control group. Tissue volume fraction and thickness were significantly greater in the ABM/P-15 group than in the allograft group. Bone formation and bone ingrowth to porous titanium implant were not significantly different among the four groups. The ABM/P-15 group had similar shear mechanical properties on implant fixation as the allograft group. Adding HA/βTCP-PDLLA to ABM/P-15 did not significantly change these parameters. This study revealed that ABM/P-15 had significantly bone formation in concentric gap, and its enhancements on bone formation and implant fixation were at least as good as allograft. It is suggested that ABM/P-15 might be a good alternative biomaterial for bone implant fixation in this well-validated critical-size defect gap model in sheep. Nevertheless, future clinical researches should focus on prospective, randomized, controlled trials in order to fully elucidate whether ABM/P-15 could be a feasible candidate for bone substitute material in orthopedic practices.
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Affiliation(s)
- Ming Ding
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery & Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
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Ross RD, Virdi AS, Liu S, Sena K, Sumner DR. Particle-induced osteolysis is not accompanied by systemic remodeling but is reflected by systemic bone biomarkers. J Orthop Res 2014; 32:967-73. [PMID: 24604767 DOI: 10.1002/jor.22607] [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: 12/20/2013] [Accepted: 02/06/2014] [Indexed: 02/04/2023]
Abstract
Particle-induced osteolysis is caused by an imbalance in bone resorption and formation, often leading to loss of implant fixation. Bone remodeling biomarkers may be useful for identification of osteolysis and studying pathogenesis, but interpretation of biomarker data could be confounded if local osteolysis engenders systemic bone remodeling. Our goal was to determine if remote bone remodeling contributes to biomarker levels. Serum concentrations of eight biomarkers and bone remodeling rates at local (femur), contiguous (tibia), and remote (humerus and lumbar vertebra) sites were evaluated in a rat model of particle-induced osteolysis. Serum CTX-1, cathepsin K, PINP, and OPG were elevated and osteocalcin was suppressed in the osteolytic group, but RANKL, TRAP 5b, and sclerostin were not affected at the termination of the study at 12 weeks. The one marker tested longitudinally (CTX-1) was elevated by 3 weeks. We found increased bone resorption and decreased bone formation locally, subtle differences in contiguous sites, but no differences remotely at 12 weeks. Thus, the skeletal response to local particle challenge was not systemic, implying that the observed differences in serum biomarker levels reflect differences in local remodeling.
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Affiliation(s)
- R D Ross
- Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois
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Agholme F, Macias B, Hamang M, Lucchesi J, Adrian MD, Kuhstoss S, Harvey A, Sato M, Aspenberg P. Efficacy of a sclerostin antibody compared to a low dose of PTH on metaphyseal bone healing. J Orthop Res 2014; 32:471-6. [PMID: 24243768 DOI: 10.1002/jor.22525] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 10/19/2012] [Accepted: 10/25/2013] [Indexed: 02/04/2023]
Abstract
We compared the effect of a sclerostin antibody to that of a clinically relevant dose of parathyroid hormone (PTH) in a rat model for metaphyseal bone healing. Screws of steel or poly methyl methacrylate (PMMA) were inserted bilaterally into the proximal tibia of young male rats. During 4 weeks the animals then received injections of either phosphate buffered saline (control), sclerostin antibody (25 mg/kg, twice weekly) or PTH (5 µg/kg, daily). The healing response around the screws was then assessed by mechanical testing and X-ray microtomography (µCT). To distinguish between effects on healing and general effects on the skeleton, other untraumatized bone sites and serum biomarkers were also assessed. After 4 weeks of treatment, PTH yielded a 48% increase in screw pull-out force compared to control (p = 0.03), while the antibody had no significant effect. In contrast, the antibody increased femoral cortical and vertebral strength where PTH had no significant effect. µCT showed only slight changes that were statistically significant for the antibody mainly at cortical sites. The results suggest that a relatively low dose of PTH stimulates metaphyseal repair (screw fixation) specifically, whereas the sclerostin antibody has wide-spread effects, mainly on cortical bone, with less influence on metaphyseal healing.
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Affiliation(s)
- Fredrik Agholme
- Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
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Hosein YK, King GJ, Dunning CE. The effect of stem surface treatment and material on pistoning of ulnar components in linked cemented elbow prostheses. J Shoulder Elbow Surg 2013; 22:1248-55. [PMID: 23668920 DOI: 10.1016/j.jse.2013.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 12/17/2012] [Accepted: 03/10/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ulnar component of a total elbow replacement can fail by "pistoning." Stem surface treatments have improved stability at the stem-cement interface but with varied success. This study investigated the role of surface treatment and stem substrate material on implant stability under axial loading. MATERIALS AND METHODS Sixty circular stems (diameter, 8 mm) made of cobalt chrome (n = 30) or titanium (n = 30) had different surfaces: smooth, sintered beads, and plasma spray. The surface treatment length was either 10 mm or 20 mm. Stems were potted in bone cement, allowed to cure for 24 hours, and tested in a materials testing machine under a compressive staircase loading protocol. Failure was defined as 2 mm of push-out or completion of the protocol. Two-way analyses of variance compared the effects of surface treatment and substrate material on interface strength and motion. RESULTS Significant interactions were found between surface treatment and substrate material for both interface strength and motion (P < .05). For titanium, the 20-mm beaded stems had greater interface strength than all other stems (P < .05) and had less motion than the 10-mm plasma-spray and smooth stems (P < .05). For cobalt chrome, the 20-mm beaded stems showed greater interface strength (P < .05) and similar motion (P > .05) to the 20-mm plasma-spray stems (P < .05), which outperformed all other stems (P < .05). Mechanisms of catastrophic failure varied: smooth stems debonded at the stem-cement interface, beaded stems experienced debonding of the beads from the stem, and plasma-spray stems showed loss of frictional force between the surface treatment and cement. DISCUSSION AND CONCLUSION Stem surface treatment can enhance ulnar component stability but is dependent on substrate material.
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Barckman J, Baas J, Sorensen M, Lange J, Bechtold JE, Soballe K. Does tobramycin impregnation of allograft bone affect implant fixation? - an experimental study in 12 dogs. J Biomed Mater Res B Appl Biomater 2013; 102:173-80. [PMID: 23897751 DOI: 10.1002/jbm.b.32993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 03/02/2013] [Revised: 05/08/2013] [Accepted: 05/29/2013] [Indexed: 11/11/2022]
Abstract
Clinical trials have used antibiotic impregnated impacted bone allograft in revisions of infected arthroplasties. By this method high local antibiotic concentration and good control of infection was achieved. Toxicity studies, however, suggest that high local antibiotic concentration can impair osteoblast replication. We therefore asked whether impregnating morselized allograft bone with different quantities of tobramycin before impaction would impair implant fixation. We implanted three cylindrical (10 mm × 6 mm) porous-coated titanium implants into the distal femurs of 12 dogs. The implants were surrounded by a circumferential gap of 2.5 mm into which a standardized volume of morselized allograft bone, with or without tobramycin, was impacted. In each animal, the bone graft was impregnated with either 0 mg (control), 50 mg (low dose), or 200 mg (high dose) of tobramycin per 1 mL of bone graft. At the end of the 4 weeks experimental period, the implants with surrounding bone were evaluated by histomorphometric analysis and mechanical push-out test. We found no difference between the treatment groups regarding new bone formation, bone graft resorption, or implant fixation. There was, however, a tendency toward a decrease in implant fixation with higher tobramycin dose. The present study is unable to provide evidence on whether the use of topical tobramycin with allograft is safe or whether it indeed can impair implant fixation. The tendency toward an impaired implant fixation warrants further preclinical studies. Its current clinical use should be weighed against its possible positive effects on preventing infection in complicated revisions.
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Affiliation(s)
- Jeppe Barckman
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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Barckman J, Baas J, Sørensen M, Bechtold JE, Soballe K. Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs(). Open Orthop J 2013; 7:18-24. [PMID: 23400644 PMCID: PMC3565231 DOI: 10.2174/1874325001307010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/21/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants. METHODS In each of twelve dogs, we implanted two unloaded cylindrical (10 mm x 6 mm) titanium implants into the distal femur. The implants were surrounded by a 2.5-mm gap into which morselized allograft bone with or without addition of fragmented autologous periosteum was impacted. After four weeks, the animals were euthanized and the implants were evaluated by histomorphometric analysis and mechanical push-out test. RESULTS Although less new bone was found on the implant surface and increased volume of fibrous tissue was present in the gap around the implant, no difference was found between treatment groups regarding the mechanical parameters. Increased new bone formation was observed in the immediate vicinity of the periosteum fragments within the bone graft. CONCLUSION The method for periosteal augmentation used in this study did not alter the mechanical fixation although osseointegration was impaired. The observed activity of new bone formation at the boundary of the periosteum fragments may indicate maintained bone stimulating properties of the transplanted cambium layer. Augmenting the bone graft by smaller fragments of periosteum, isolated cambium layer tissue or cultured periosteal cells could be studied in the future.
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Affiliation(s)
- Jeppe Barckman
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark
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Elmengaard B, Bechtold JE, Chen X, Søballe K. Fixation of hydroxyapatite-coated revision implants is improved by the surgical technique of cracking the sclerotic bone rim. J Orthop Res 2009; 27:996-1001. [PMID: 19148940 PMCID: PMC3674032 DOI: 10.1002/jor.20850] [Citation(s) in RCA: 4] [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] [Indexed: 02/04/2023]
Abstract
Revision joint replacement has poorer outcomes that have been associated with poorer mechanical fixation. We investigate a new bone-sparing surgical technique that locally cracks the sclerotic bone rim formed during aseptic loosening. We inserted 16 hydroxyapatite-coated implants bilaterally in the distal femur of eight dogs, using a controlled weight-bearing experimental model that replicates important features of a typical revision setting. At 8 weeks, a control revision procedure and a crack revision procedure were performed on contralateral implants. The crack procedure used a splined tool to perform a systematic local perforation of the sclerotic bone rim of the revision cavity. After 4 weeks, the hydroxyapatite-coated implants were evaluated for mechanical fixation by a push-out test and for tissue distribution by histomorphometry. The cracking revision procedure resulted in significantly improved mechanical fixation, significantly more bone ongrowth and bone volume in the gap, and reduced fibrous tissue compared to the control revision procedure. The study demonstrates that the sclerotic bone rim prevents bone ingrowth and promotes fixation by fibrous tissue. The effect of the cracking technique may be due to improved access to the vascular compartment of the bone. The cracking technique is a simple surgical method that potentially can improve the fixation of revision implants in sclerotic regions important for obtaining the fixation critical for overall implant stability.
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Affiliation(s)
- Brian Elmengaard
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University Hospital of Aarhus, Norrebrogade 44, Bygn. 1A, 1. sal, DK-8000 Aarhus C, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Midwest Orthopaedic and Minneapolis Medical Research Foundations, 914 South 8th Street/860C, Minneapolis, MN 55404
| | - Xinqian Chen
- Orthopaedic Biomechanics Laboratory, Midwest Orthopaedic and Minneapolis Medical Research Foundations, 914 South 8th Street/860C, Minneapolis, MN 55404
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University Hospital of Aarhus, Norrebrogade 44, Bygn. 1A, 1. sal, DK-8000 Aarhus C, Denmark
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Jakobsen T, Baas J, Kold S, Bechtold JE, Elmengaard B, Søballe K. Local bisphosphonate treatment increases fixation of hydroxyapatite-coated implants inserted with bone compaction. J Orthop Res 2009; 27:189-94. [PMID: 18752278 PMCID: PMC3707404 DOI: 10.1002/jor.20745] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [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: 02/04/2023]
Abstract
It has been shown that fixation of primary cementless joint replacement can independently be enhanced by either: (1) use of hydroxyapatite (HA) coated implants, (2) compaction of the peri-implant bone, or (3) local application of bisphosphonate. We investigated whether the combined effect of HA coating and bone compaction can be further enhanced with the use of local bisphosphonate treatment. HA-coated implants were bilaterally inserted into the proximal tibiae of 10 dogs. On one side local bisphosphonate was applied prior to bone compaction. Saline was used as control on the contralateral side. Implants were evaluated with histomorphometry and biomechanical push-out test. We found that bisphosphonate increased the peri-implant bone volume fraction (1.3-fold), maximum shear strength (2.1-fold), and maximum shear stiffness (2.7-fold). No significant difference was found in bone-to-implant contact or total energy absorption. This study indicates that local alendronate treatment can further improve the fixation of porous-coated implants that have also undergone HA-surface coating and peri-implant bone compaction.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Brian Elmengaard
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
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Abstract
Despite the widespread use of cement as a means of fixation of implants to bone, surprisingly little is known about the micromechanical behavior in terms of the local interfacial motion. In this work, we utilized digital image correlation techniques to quantify the micromechanics of the cement-bone interface of laboratory-prepared cemented total hip replacements subjected to nondestructive, quasistatic tensile and compressive loading. Upon loading, the majority of the displacement response localized at the contact interface region between cement and bone. The contact interface was more compliant (p = 0.0001) in tension (0.0067 +/- 0.0039 mm/MPa) than compression (0.0051 +/- 0.0031 mm/MPa), and substantial hysteresis occurred due to sliding contact between cement and bone. The tensile strength of the cement-bone interface was inversely proportional to the compliance of the interface and proportional to the cement/bone contact area. When loaded beyond the ultimate strength, the strain localization process continued at the contact interface between cement and bone with microcracking (damage) to both. More overall damage occurred to the cement than to the bone. The opening and closing at the contact interface from loading could serve as a conduit for submicron size particles. In addition, the cement mantle is not mechanically supported by surrounding bone as optimally as is commonly assumed. Both effects may influence the longevity of the reconstruction and could be considered in preclinical tests.
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Affiliation(s)
- Kenneth A. Mann
- Department of Orthopaedic Surgery, 3216 Institute for Human Performance, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, New York 13210
| | - Mark A. Miller
- Department of Orthopaedic Surgery, 3216 Institute for Human Performance, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, New York 13210
| | - Richard J. Cleary
- Department of Mathematical Sciences, Bentley College, Waltham, Massachusetts
| | - Dennis Janssen
- Department of Orthopaedic Surgery, 3216 Institute for Human Performance, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, New York 13210
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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