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Paul K, Elphingstone JW, Williams M, Manfredi JN, Jardaly A, Schick S, Floyd S, Brabston EW, Momaya AM, Ponce BA. Suspensory fixation for bone transfer procedures in shoulder instability is superior to screws in an angled construct: a biomechanical analysis. JSES Int 2024; 8:250-256. [PMID: 38464447 PMCID: PMC10920126 DOI: 10.1016/j.jseint.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to the anterior glenoid surface; however, malpositioning of the graft leads to oblique screw insertion that contributes to complications. Suture buttons (SBs) are a more recent fixation technique that have not been studied alongside standard screw fixation in the context of biomechanical models of angulated fixation. This study aims to compare the biomechanical strength of single and double, screw and SB fixation at various levels of angulation. Methods Testing was performed using polyurethane models from Sawbones. The graft piece was secured with screw fixation (Arthrex, Naples, FL, USA) or suspensory button (ABS Tightrope, Arthrex, Naples, FL, USA). Single or double constructs of screws and SBs were affixed at 0°, 15°, and 30° angles to the face of the glenoid component. An aluminum testing jig held the samples securely while a materials testing system applied loads. Five constructs were used for each condition and assessed load to failure testing. Results For single fixation constructs, suspensory buttons were 60% stronger than screws at 0° (P < .001), and 52% stronger at 15° (P = .004); however, at 30°, both were comparable (P = .180). Interestingly, single suspensory button at 15° was equivalent to a single screw at 0° (P = .310). For double fixation, suspensory buttons (DT) were 32% stronger than screws at 0° (P < .001) and 35% stronger than screws at 15° (P < .001). Both double fixation methods were comparable at 30° (P = .061). Suspensory buttons at 15° and 30° were equivalent to double screws at 0 (P = .280) and 15° (P = .772), respectively. Conclusion These measurements indicate that the suspensory button has a significantly higher load to failure capacity over the screw fixation technique, perpendicularly and with up to 15° of angulation. These analyses also indicate that the suspensory button fixation offers superior strength even when positioned more obliquely than the screw fixation. Therefore, suspensory button fixation may confer more strength while offering greater margin for error when positioning the graft.
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Affiliation(s)
- Kyle Paul
- Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Joseph W. Elphingstone
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marshall Williams
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
| | - John N. Manfredi
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Achraf Jardaly
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
| | - Samuel Schick
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Floyd
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W. Brabston
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amit M. Momaya
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A. Ponce
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
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Kriener K, Whiting H, Storr N, Homes R, Lala R, Gabrielyan R, Kuang J, Rubin B, Frails E, Sandstrom H, Futter C, Midwinter M. Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review. JBI Evid Synth 2023; 21:2309-2405. [PMID: 37732940 DOI: 10.11124/jbies-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research. INTRODUCTION Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests. INCLUSION CRITERIA Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review. METHODS This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats. RESULTS Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values. CONCLUSIONS This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards. REVIEW REGISTRATION Open Science Framework https://osf.io/fgb34.
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Affiliation(s)
- Kyleigh Kriener
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Harrison Whiting
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, Royal Brisbane Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas Storr
- Gold Coast University Hospital, Southport, QLD Australia
| | - Ryan Homes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Raushan Lala
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Robert Gabrielyan
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Jasmine Kuang
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Bryn Rubin
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Edward Frails
- Department of Chemical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hannah Sandstrom
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Christopher Futter
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Anaesthesia and Intensive Care Program, Herston Biofabrication institute, Brisbane, QLD, Australia
| | - Mark Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
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Liu W, Zhang Y, Lyu Y, Bosiakov S, Liu Y. Inverse design of anisotropic bone scaffold based on machine learning and regenerative genetic algorithm. Front Bioeng Biotechnol 2023; 11:1241151. [PMID: 37744255 PMCID: PMC10512832 DOI: 10.3389/fbioe.2023.1241151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: Triply periodic minimal surface (TPMS) is widely used in the design of bone scaffolds due to its structural advantages. However, the current approach to designing bone scaffolds using TPMS structures is limited to a forward process from microstructure to mechanical properties. Developing an inverse bone scaffold design method based on the mechanical properties of bone structures is crucial. Methods: Using the machine learning and genetic algorithm, a new inverse design model was proposed in this research. The anisotropy of bone was matched by changing the number of cells in different directions. The finite element (FE) method was used to calculate the TPMS configuration and generate a back propagation neural network (BPNN) data set. Neural networks were used to establish the relationship between microstructural parameters and the elastic matrix of bone. This relationship was then used with regenerative genetic algorithm (RGA) in inverse design. Results: The accuracy of the BPNN-RGA model was confirmed by comparing the elasticity matrix of the inverse-designed structure with that of the actual bone. The results indicated that the average error was below 3.00% for three mechanical performance parameters as design targets, and approximately 5.00% for six design targets. Discussion: The present study demonstrated the potential of combining machine learning with traditional optimization method to inversely design anisotropic TPMS bone scaffolds with target mechanical properties. The BPNN-RGA model achieves higher design efficiency, compared to traditional optimization methods. The entire design process is easily controlled.
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Affiliation(s)
- Wenhang Liu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Youwei Zhang
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Yongtao Lyu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
- DUT-BSU Joint Institute, Dalian University of Technology, Dalian, China
| | - Sergei Bosiakov
- Faculty of Mechanics and Mathematics, Belarusian State University, Minsk, Belarus
| | - Yadong Liu
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian University of Technology, Dalian, China
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Hsu KL, Yeh ML, Kuan FC, Hong CK, Chuang HC, Wang WM, Su WR. Biomechanical comparison between various screw fixation angles for Latarjet procedure: a cadaveric biomechanical study. J Shoulder Elbow Surg 2022; 31:1947-1956. [PMID: 35398164 DOI: 10.1016/j.jse.2022.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is a reliable treatment for the management of anterior glenohumeral instability with glenoid bone loss. However, the biomechanical properties of different fixation angles between screw and glenoid surface (α angle) have rarely been studied. The aim of the study was to investigate and compare the fixation stability, failure load, and failure mechanism between different α angles for Latarjet procedures, which were performed on cadaver specimens. METHODS Twenty-four shoulder specimens (8 in each of 3 groups) were dissected free of all soft tissue, and a 25% glenoid defect was created. The coracoid process was osteomized and fixed with 2 screws at 3 different α angles: 0° (group A), 15° (group B), and 30° (group C). Specimens were mounted to a testing apparatus, and cyclic loading (100 cycles at 1 Hz) was applied with a staircase protocol (50, 100, 150, and 200 N). Gross graft displacement and interface displacement were measured. The ultimate failure loads and failure mechanisms were recorded. RESULTS There was no significant difference in gross displacement under any cyclic load between 3 groups. However, a significant larger interface displacement was noted in group C than in group A in 150-N cyclic loading (P = .017). Under failure strength testing, all 24 specimens failed because of screw cutout from the glenoid, and the ultimate failure load was similar among the three groups. CONCLUSION Compared with the 0° α angle, the displacement after cyclic loading did not significantly increase when the α angle was increased to 15° but significantly increased at 30° for Latarjet procedures, which were performed on cadaver specimens. The results suggest that surgeons should apply the screws as parallel as possible to the glenoid surface when performing the Latarjet procedure. Although mild deviation may not reduce fixation stability, α angles greater than 30° should be avoided.
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Affiliation(s)
- Kai-Lan Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Wang
- Department of Statistics and Institute of Data Science, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Martin EJ, Duquin TR, Ehrensberger MT. Reverse total shoulder arthroplasty baseplate stability with locking vs. non-locking peripheral screws. Clin Biomech (Bristol, Avon) 2022; 96:105665. [PMID: 35636305 DOI: 10.1016/j.clinbiomech.2022.105665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are many options for glenosphere baseplate fixation commercially available, yet there is little biomechanical evidence supporting one type of fixation over another. In this study, we compared the biomechanical fixation of a reverse total shoulder glenoid baseplate secured with locking or non-locking peripheral screws. METHODS Both a non-augmented mini baseplate with full backing support and an augmented baseplate were testing after implantation in solid rigid polyurethane foam. Each baseplate was implanted with a 30 mm central compression screw and four peripheral screws, either locking or non-locking (15 mm anterior/posterior and 30 mm superior/inferior). A 1 Hz cyclic force of 0-750 N was applied at a 60o angle for 5000 cycles. Throughout the test, the displacement of the baseplate was measured using a 3D Digital Image Correlation System. FINDINGS The amount of migration measured in the both the non-augmented and augment cases shows no significant differences between locking and non-locking cases at the final cycle count (non-augment: 5.66 +/- 2.29 μm vs. 3.71 +/- 1.23 μm; p = 0.095, augment: 15.43 +/- 8.49 μm vs. 12.46 +/- 3.24 μm; p = 0.314). Additionally, the amount of micromotion measured for both sample types shows the same lack of significant difference (non-augment: 10.79 +/- 5.22 μm vs. 10.16 +/- 7.61 μm; p = 0.388, augment: 55.03 +/- 10.13 μm vs. 54.84 +/- 10.65 μm; p = 0.968). INTERPRETATION The presence of locking versus non-locking peripheral screws does not make a significant difference on the overall stability of a glenoid baseplate, in both a no defect case with a non-augmented baseplate and a bone defect case with an augmented baseplate.
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Affiliation(s)
- Elise J Martin
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, USA; Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Thomas R Duquin
- Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mark T Ehrensberger
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, USA; Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA.
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Bola M, Simões J, Ramos A. Finite element analysis to predict short and medium-term performance of the anatomical Comprehensive® Total Shoulder System. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106751. [PMID: 35306286 DOI: 10.1016/j.cmpb.2022.106751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The number of Total Shoulder Arthroplasties (TSA) has increased in these last years with significant increase of clinical success. However, glenoid component loosening remains the most common cause of failure. OBJECTIVE In this study we evaluated the critical conditions to predict short and medium-term performance of the uncemented anatomical Comprehensive® Total Shoulder System using a finite element model that was validated experimentally. METHODS The finite element models of an implanted shoulder analysed included total shoulder components with pegs. The models were simulated in 3 phases of adduction: 45°, 60° and 90° to determine the most critical situation. Two different bone-implant fixation conditions were considered: post-surgery and medium term (2 years). RESULTS These show that the critical condition is for the shoulder in 90° adduction were the highest contact stress (70 MPa) was observed in the glenoid component. Relatively to the interface implant-bone strains, the maximum (-16000 µε) was observed for the short-term in the lateral region of the humerus. The highest micromotions were observed in the central fixation post of the glenoid component, ranging from 20 to 25 µm, and 325 µm in the lateral plane of the humeral component. CONCLUSION The predicted results are in accordance with clinical studies published and micromotions of the humeral component can be used to predict loosening and to differentiate shoulder implant designs.
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Affiliation(s)
- Margarida Bola
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal
| | - José Simões
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal; ESAD- College of Art and Design, Avenida Calouste Gulbenkian, Senhora da Hora, Matosinhos 4460-268, Portugal
| | - António Ramos
- TEMA, Biomechanics Research Group, Department of Mechanical Engineering, University of Aveiro, Campo Universitário de Santiago, Aveiro 3810-193, Portugal.
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Wang F, Zheng L, Theopold J, Schleifenbaum S, Heyde CE, Osterhoff G. Methods for bone quality assessment in human bone tissue: a systematic review. J Orthop Surg Res 2022; 17:174. [PMID: 35313901 PMCID: PMC8935787 DOI: 10.1186/s13018-022-03041-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques. Methods A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: “(bone quality”. Ti,ab.) AND “(human bone specimens)”. Results The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included. Conclusions Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03041-4.
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Affiliation(s)
- Fangxing Wang
- ZESBO - Center for Research On Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany. .,Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany.
| | - Leyu Zheng
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Stefan Schleifenbaum
- ZESBO - Center for Research On Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
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Lacheta L, Miles J, Douglass B, Millett P. The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis. Arthrosc Sports Med Rehabil 2021; 3:e549-e554. [PMID: 34027468 PMCID: PMC8129443 DOI: 10.1016/j.asmr.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the biomechanical influence of differential loading of suture strands (torque) on the fixation strength of knotted and knotless all-suture anchors. Methods The biomechanical strength of 48 all-suture anchors was evaluated for 4 conditions in polyurethane foam blocks: (1) 12 knotted all-suture anchors loaded proportionately, (2) 12 knotted all-suture anchors with 1 suture strand bearing 50% of total force (partial torque), (3) 12 knotted all-suture anchors with 1 strand fixated and the other loaded (full torque), and (4) 12 knotless all-suture anchors with the loop kept open via a fixed rod. Force for 1 mm and 2 mm of displacement and ultimate failure load were assessed. Results For 1 mm of displacement, groups 2, 3, and 4 showed significantly lower forces than group 1 (all P < .001), with no statistically significant difference between groups 2 and 3 (P = .516); for 2 mm of displacement, all groups showed significantly lower forces than group 1 (P < .001), which positively correlated with applied torque. No differences in the mean ultimate loads observed between testing groups 1, 2, and 4 were noted, with 93.3 ± 3.8 N, 91.4 ± 4.7 N, and 92.6 ± 5.6 N, respectively; however, group 3 exhibited a significantly lower mean ultimate load (62.3 ± 1.7 N) than all other groups (P < .001). Conclusions The ultimate failure load of knotted and knotless all-suture anchor fixation was partially affected by loading differentials between strands in this validated foam block model. Differential loading of knotted all-suture anchor fixation presented greater initial displacement when compared with symmetrically loaded knotted all-suture anchors. Despite an initial increase in displacement, knotless all-suture anchors showed similar ultimate failure loads to knotted all-suture anchors with strands loaded equally. Clinical Relevance The role of suture strand loading imbalance on anchor fixation is variable and should be considered during placement and fixation of the repair constructs in a clinical setting.
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Affiliation(s)
- Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Center for Musculoskeletal Surgery, Charitè Universitaetsmedizin Berlin, Berlin, Germany
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Jon Miles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Peter Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to Peter Millett, M.D., M.Sc., Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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Verhaegen F, Campopiano E, Debeer P, Scheys L, Innocenti B. How much bone support does an anatomic glenoid component need? J Shoulder Elbow Surg 2020; 29:743-754. [PMID: 32197764 DOI: 10.1016/j.jse.2019.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND An important reason for failure of anatomic total shoulder arthroplasty is glenoid component loosening. We investigated the effect of backside bone support on the risk of failure of a glenoid component. METHODS A finite element model was developed. Virtual surgery was performed for 2 types of glenoid components (cemented all polyethylene [PE] vs. metal backed [MB]), both with gradually decreasing backside bone support. Both bone failure and fixation failure were analyzed. The percentages of bone failure and fixation failure in terms of the critical cement volume (CCV) and micromotion-threshold percentage ratio (MTPR) for the PE and MB components, respectively, were defined and compared. RESULTS For the reference PE model, the percentages of bone failure and fixation failure (CCV) were 17% and 34%, respectively. With eccentric loading for the MB component, the percentages of bone failure and fixation failure (MTPR) were 6% and 3%, respectively. A global increase in failure was observed with decreasing bone support. The increase in fixation failure, starting from the reference values (MTPR vs. CCV), was relatively more pronounced for the MB component (136% vs. 128%). DISCUSSION Decreasing backside bone support for an anatomic glenoid component leads to an increased risk of fixation and bone failure. For PE components, decreasing backside support to 95% bone support had only a limited effect. In the case of an MB component, we noticed an increase in micromotion and bone failure already starting from 97% bone support. We conclude that an anatomic glenoid component should always be implanted while maximizing backside bone support.
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Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
| | - Emma Campopiano
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Philippe Debeer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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Mahaffy MD, Knowles NK, Berkmortel C, Abdic S, Walch G, Johnson JA, Athwal GS. Density distribution of the type E2 glenoid in cuff tear arthropathy. J Shoulder Elbow Surg 2020; 29:167-174. [PMID: 31473132 DOI: 10.1016/j.jse.2019.05.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/10/2019] [Accepted: 05/26/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the cortical-like and cancellous bone density variations in superiorly eroded glenoids due to cuff tear arthropathy. The purpose of this study was to analyze regional bone density in type E2 glenoids. METHODS Clinical shoulder computed tomography scans were obtained from 32 patients with a type E2 superior erosion (10 men and 22 women; mean age, 73 years). Measurement regions were organized into quadrants (superior, inferior, anterior, and posterior) and depth regions. The depth regions were incremented by 2 mm from 0 to 10 mm. A repeated-measures multiple analysis of variance was performed to assess differences and interactions between mean densities (cortical-like and cancellous bone) in each depth, in each quadrant, and between sexes. RESULTS The lowest cancellous bone density was found in the inferior glenoid quadrant compared with all other quadrants (307 ± 50 Hounsfield units [HU], P < .001). At the glenoid surface, the superior quadrant contained the highest mean density for cortical-like bone (895 ± 97 HU); this differed significantly from the posterior, anterior, and inferior quadrants (P ≤ .033). As for depth of measurement, cortical-like bone was most dense at the glenoid surface (0-2 mm, 892 ± 91 HU), and density decreased significantly at depths greater than 2 mm (P ≤ .019). CONCLUSION In patients with type E2 glenoids due to cuff tear arthropathy, the densest bone was found in the superior quadrant in the area of erosion. The inferior quadrant, which tends to be unloaded as the humeral head migrates superiorly, had the lowest density bone. In addition, the best-quality bone was located at the glenoid surface as compared with deeper in the vault.
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Affiliation(s)
- Matthew D Mahaffy
- Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, ON, Canada
| | - Nikolas K Knowles
- Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, ON, Canada
| | - Carolyn Berkmortel
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, ON, Canada; Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada
| | - Sejla Abdic
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, ON, Canada; Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | | | - James A Johnson
- Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, ON, Canada; Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, ON, Canada.
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11
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Roche C, DiGeorgio C, Yegres J, VanDeven J, Stroud N, Flurin PH, Wright T, Cheung E, Zuckerman JD. Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates. JSES OPEN ACCESS 2019; 3:296-303. [PMID: 31891029 PMCID: PMC6928260 DOI: 10.1016/j.jses.2019.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Little guidance exists regarding the minimum screw length and screw quantity necessary to achieve fixation in reverse total shoulder arthroplasty (rTSA); to that end, this study quantified the displacement of 2 different sizes of glenoid baseplates using multiple different screw lengths and quantities of screws in a low-density polyurethane bone-substitute model. Methods Testing of rTSA glenoid loosening was conducted according to ASTM F 2028-17. To independently evaluate the impact of screw quantity and screw length on rTSA glenoid fixation for 2 different sizes of glenoid baseplates, baseplates were constructed using 2 screws, 4 screws, or 6 screws (with the latter being used for the larger baseplate only) with 3 different poly-axial locking compression screw lengths. Results Both sizes of glenoid baseplates remained well fixed after cyclic loading regardless of screw length or screw quantity. Baseplates with 2 screws had significantly greater displacement than baseplates with 4 or 6 screws. No differences were observed between baseplates with 4 screws and those with 6 screws (used for the larger baseplate). Both sizes of baseplates with 18-mm screws had significantly greater displacement than baseplates with 30- or 46-mm screws. For larger baseplates, those with 30-mm screws had significantly greater displacement than those with 46-mm screws in the superior-inferior direction. Discussion For the 2 different sizes of baseplates tested in this study, rTSA glenoid fixation was impacted by both screw quantity and screw length. Irrespective of screw quantity, longer screws showed significantly better fixation. Irrespective of screw length, the use of more screws showed significantly better fixation, up to a point, as the use of more than 4 screws showed no incremental benefit. Finally, longer screws can be used as a substitute for additional fixation if it is not feasible to use more screws.
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Affiliation(s)
| | | | | | | | | | | | - Thomas Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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12
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Burton WS, Sintini I, Chavarria JM, Brownhill JR, Laz PJ. Assessment of scapular morphology and bone quality with statistical models. Comput Methods Biomech Biomed Engin 2019; 22:341-351. [DOI: 10.1080/10255842.2018.1556260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- William S. Burton
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Irene Sintini
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | | | | | - Peter J. Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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13
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Zhao S, Arnold M, Ma S, Abel RL, Cobb JP, Hansen U, Boughton O. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018; 7:524-538. [PMID: 30258572 PMCID: PMC6138811 DOI: 10.1302/2046-3758.78.bjr-2018-0025.r1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing, an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed, and Scopus databases. Studies using bulk tissue, animal tissue, whole bone, or testing techniques other than compression testing were excluded. Results A total of 4712 abstracts were retrieved, with 177 papers included in the analysis; 20 studies directly analyzed the compression testing technique to improve the accuracy of testing. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration, and loading protocol. Conclusion Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, although further studies are needed to establish standardized bone testing techniques in order to increase the comparability and reliability of bone stiffness studies. Cite this article: S. Zhao, M. Arnold, S. Ma, R. L. Abel, J. P. Cobb, U. Hansen, O. Boughton. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018;7:524–538. DOI: 10.1302/2046-3758.78.BJR-2018-0025.R1.
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Affiliation(s)
- S Zhao
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - M Arnold
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - S Ma
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - R L Abel
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - J P Cobb
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - U Hansen
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - O Boughton
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, London, UK
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14
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Kramer JD, Robinson S, Purviance C, Montgomery W. Analysis of glenoid inter-anchor distance with an all-suture anchor system. J Orthop 2018; 15:102-106. [PMID: 29657449 DOI: 10.1016/j.jor.2018.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 01/14/2018] [Indexed: 01/02/2023] Open
Abstract
Background All-suture anchors used in arthroscopic shoulder stabilization employ small diameter anchors, which allow greater placement density on narrow surfaces such as the glenoid. There is no consensus in the literature about how close to one another two anchors may be implanted. Purpose The purpose of the present study is to compare the strength characteristics of two all-suture anchors placed in cadaveric human glenoid at variable distances to one another, in order to determine the minimum distance required for optimal strength. Methods Twelve fresh-frozen human cadaveric glenoids were implanted with 1.4 mm all-suture anchors at varying inter-anchor distances. Each glenoid was used for four tests, for a total of 48 tests. Anchors were implanted adjacent to one another or with 2, 3, or 5 mm bone bridges between pilot holes. The glenoids then underwent pullout testing using a test frame with a 5N preload followed by displacement of 12.5 mm/s. The primary outcomes were stiffness, failure strength, and ultimate strength. Results Stiffness was 13.52 ± 3.8, 17.97 ± 5.02, 17.59 ± 4.65 and 18.95 ± 4.67 N/mm for the adjacent, 2, 3, and 5 mm treatment groups, respectively. The adjacent group had a significantly lower stiffness compared to the other treatment groups. Failure strength was 48.68 ± 20.64, 76.16 ± 23.78, 73.19 ± 35.83 and 87.04 ± 34.67 N for the adjacent, 2, 3, and 5 mm treatment groups, respectively. The adjacent group had a significantly lower failure strength compared to the other treatment groups. Ultimate strength was also measured to be 190.59 ± 140.93, 268.7 ± 115.1, 283.23 ± 118.43, and 291.28 ± 118.24 for the adjacent, 2, 3, and 5 mm treatment groups, respectively. Conclusions This biomechanical study provides evidence that 1.4 mm all-suture anchors demonstrate similar strength characteristics when placed at least 2 mm or greater from one another. When 1.4 mm all-suture anchors were placed adjacent to one another, there was an observed decrease in failure strength and stiffness. Clinical relevance This study suggests that 1.4 mm all-suture anchors may be placed as close as 2 mm to one another while preserving strength characteristics.
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Affiliation(s)
- Jonathan D Kramer
- St. Mary's Medical Center, San Francisco Orthopedic Residency Program, 450 Stanyan St, San Francisco, CA 94115, United States
| | - Sean Robinson
- St. Mary's Medical Center, San Francisco Orthopedic Residency Program, 450 Stanyan St, San Francisco, CA 94115, United States
| | - Connor Purviance
- The Taylor Collaboration, 450 Stanyan St, San Francisco, CA 94115, United States
| | - William Montgomery
- St. Mary's Medical Center, San Francisco Orthopedic Residency Program, 450 Stanyan St, San Francisco, CA 94115, United States
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15
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Jun BJ, Vasanji A, Ricchetti ET, Rodriguez E, Subhas N, Li ZM, Iannotti JP. Quantification of regional variations in glenoid trabecular bone architecture and mineralization using clinical computed tomography images. J Orthop Res 2018; 36:85-96. [PMID: 28561262 DOI: 10.1002/jor.23620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to demonstrate feasibility of a clinical CT imaging and analysis technique to quantify regional variations in trabecular bone architecture and mineralization of glenoid bones. Specifically, our objective was to determine to what extent clinical CT imaging of intact upper extremities can describe variations of trabecular bone architectures at anatomic and peri-implant regions by comparing trabecular bone architectures as measured by high-resolution, micro CT imaging of same excised glenoid bones. Bone volume fraction (BVF), trabecular bone thickness (TbTh), number of trabecular bone (TbN), spacing (TbS), pattern factor (TbPf), bone surface area (BSA), and skeletal connectivity (Conn.), in addition to bone mineral content (BMC) and bone mineral density (BMD), were quantified from both clinical and micro CT images using whole bone, anatomic, and peri-implant bone masks. Strong correlations of BVF, TbTh, TbSp, BMC, and BMD were found between clinical CT and micro CT imaging methods. The variations in BVF, TbTh, TbSp, TbN, BMC, and BMD at anatomical and peri-implant regions were larger than those at whole bone regions. In this study, we have demonstrated that this clinical CT imaging methodology can be used to quantify variations of a patient's glenoid bone at anatomic and peri-implant levels. Statement of Clinical Significance. An in vivo quantitative assessment of glenoid trabecular bone architecture in the anatomic and peri-implant regions may improve our understanding on the role of bone quality on glenoid component loosening following total shoulder arthroplasty. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:85-96, 2018.
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Affiliation(s)
- Bong-Jae Jun
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland 44195, Ohio
| | | | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio
| | - Eric Rodriguez
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio
| | - Naveen Subhas
- Department of Radiology, Cleveland Clinic, Cleveland 44195, Ohio
| | - Zong-Ming Li
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland 44195, Ohio
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio
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16
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Geraldes DM, Hansen U, Jeffers J, Amis AA. Stability of small pegs for cementless implant fixation. J Orthop Res 2017; 35:2765-2772. [PMID: 28387966 PMCID: PMC5763372 DOI: 10.1002/jor.23572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 04/03/2017] [Indexed: 02/04/2023]
Abstract
Most glenoid implants rely on large centrally located fixation features to avoid perforation of the glenoid vault in its peripheral regions. Upon revision of such components there may not be enough bone left for the reinsertion of an anatomical prosthesis. Multiple press-fit small pegs would allow for less bone resection and strong anchoring in the stiffer and denser peripheral subchondral bone. This study assessed the fixation characteristics, measured as the push-in (Pin ) and pull-out (Pout ) forces, and spring-back, measured as the elastic displacement immediately after insertion, for five different small press-fitted peg configurations manufactured out of UHMWPE cylinders (5 mm diameter and length). A total of 16 specimens for each configuration were tested in two types of solid bone substitute: Hard (40 PCF, 0.64 g/cm3 , worst-case scenario of Pin ) and soft (15 PCF, 0.24 g/cm3 , worst-case scenario of spring-back and Pout ). Two different diametric interference-fits were studied. Geometries with lower stiffness fins (large length to width aspect ratio) were the best performing designs in terms of primary fixation stability. They required the lowest force to fully seat, meaning they are less damaging to the bone during implantation, while providing the highest Pout /Pin ratio, indicating that when implanted they provide the strongest anchoring for the glenoid component. It is highlighted that drilling of chamfered holes could minimize spring-back displacements. These findings are relevant for the design of implants press-fitted pegs because primary fixation has been shown to be an important factor in achieving osseointegration and longevity of secondary fixation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2765-2772, 2017.
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Affiliation(s)
- Diogo M. Geraldes
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom
| | - Ulrich Hansen
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom
| | - Jonathan Jeffers
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom
| | - Andrew A. Amis
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonExhibition RoadSW7 2AZ LondonUnited Kingdom,Musculoskeletal Surgery Group, Department of Surgery and CancerImperial College London School of MedicineW6 8RF LondonUnited Kingdom
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17
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Martin EJ, Duquin TR, Ehrensberger MT. Reverse total shoulder glenoid baseplate stability with superior glenoid bone loss. J Shoulder Elbow Surg 2017; 26:1748-1755. [PMID: 28689820 DOI: 10.1016/j.jse.2017.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior wear of the glenoid bone is common in patients with rotator cuff arthropathy. This can become a treatment challenge for patients who require shoulder arthroplasty. In reverse shoulder arthroplasty (RSA), glenoid bone loss may affect the stability of baseplate fixation. The primary purpose of this biomechanical laboratory study was to assess the initial fixation stability of RSA glenosphere baseplates in the presence of variable amounts of superior glenoid bone loss. MATERIALS AND METHODS High-density solid rigid polyurethane foam (30 pounds/cubic foot) was machined to model the glenoid with variable superior defects that provided different levels of support (100%, 90%, 75%, and 50%) for the glenosphere baseplate. The samples were cyclically loaded (0-750 N at 1 Hz for 5000 cycles) at a 60° glenohumeral angle. The micromotion and migration of the baseplate were calculated from displacement data captured during the loading tests with an array of 3 linear variable differential transformers mounted around the baseplate. RESULTS Micromotion was significantly greater in samples with 50% defects compared with those with smaller defects. Migration was significantly greater after testing for all defect sizes. CONCLUSIONS Initial fixation of RSA glenosphere baseplates was significantly reduced in models with 50% bone loss on the superior edge compared with models with less bone loss in this high-density bone foam model.
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Affiliation(s)
- Elise J Martin
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, USA
| | - Thomas R Duquin
- Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mark T Ehrensberger
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, USA; Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA.
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18
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Douglass NP, Behn AW, Safran MR. Cyclic and Load to Failure Properties of All-Suture Anchors in Synthetic Acetabular and Glenoid Cancellous Bone. Arthroscopy 2017; 33:977-985.e5. [PMID: 28132809 DOI: 10.1016/j.arthro.2016.11.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the cyclic displacement, maximum load to failure, and failure mode of multiple all-suture anchors (ASAs) in 2 different densities of sawbones cancellous bone substitute. METHODS Anchors tested included the Suturefix Ultra 1.7 mm, JuggerKnot 1.45 mm (No. 1 and No. 2 MaxBraid) and 2.9 mm, Y-Knot Flex 1.3 mm and 1.8 mm, Iconix 1, 2, 25, and 3, Q-Fix 1.8 mm, and Bioraptor 2.3 PK. The Bioraptor served as a non-all-suture-based control. Seven to eleven anchors were tested in both 20 and 30 pounds per cubic foot (pcf) test blocks that were chosen to simulate glenoid and acetabular cancellous bone, respectively. After a 40 N deployment force, anchors were cyclically loaded at 0.5 Hz from 10 to 50 N and then 10 to 100 N for 200 cycles each. Surviving specimens were pulled to failure at 10 mm/s. Displacement, stiffness, maximum load, and failure mode were recorded. Welch t-tests and Welch analysis of variance with Games-Howell post hoc tests were used for statistical analysis. RESULTS In higher density blocks, 11 of 12 anchors had significantly (P < .05) higher maximum loads to failure, and 8 anchors showed significantly lower post-cyclic displacement. The Q-Fix 1.8 displayed the lowest post-cyclic displacement in both densities (0.1 ± 0.2 mm, mean ± standard deviation, in both densities). All other groups exhibited at least 2.8 mm and 0.6 mm post-cyclic displacement in 20 and 30 pcf, respectively. The Bioraptor did not survive cyclic testing in 20 pcf and had 0.6 ± 0.3 mm post-cyclic displacement in 30 pcf. CONCLUSIONS ASAs show better fixation in higher density synthetic bone. The cyclic displacement and maximum load of ASAs vary widely depending on anchor design and bone density. Most anchors fail by suture anchor pullout. In general, the Bioraptor 2.3 PK outperformed ASAs in higher density test blocks with mixed results in lower density test blocks. CLINICAL RELEVANCE ASAs show mixed results compared with a traditional suture anchor. They perform better in higher density bone substitute.
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Affiliation(s)
- Nathan P Douglass
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A..
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19
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Nguyen MT, Allain JM, Gharbi H, Desceliers C, Soize C. Experimental multiscale measurements for the mechanical identification of a cortical bone by digital image correlation. J Mech Behav Biomed Mater 2016; 63:125-133. [PMID: 27348148 DOI: 10.1016/j.jmbbm.2016.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 11/16/2022]
Abstract
The implementation of the experimental methodology by optical measurements of mechanical fields, the development of a test bench, the specimen preparation, the experimental measurements, and the digital image correlation (DIC) method, have already been the object of research in the context of biological materials. Nevertheless, in the framework of the experimental identification of a mesoscopic stochastic model of the random apparent elasticity field, measurements of one specimen is required at both the macroscopic scale and the mesoscopic scale under one single loading. The nature of the cortical bone induces some difficulties, as no single speckled pattern technique is available for simultaneously obtaining the displacement at the macroscopic scale and at the mesoscopic scale. In this paper, we present a multiscale experimental methodology based on (i) an experimental protocol for one specimen of a cortical bone, (ii) its measuring bench, (iii) optical field measurements by DIC method, (iv) the experimental results, and (v) the multiscale experimental identification by solving a statistical inverse problem.
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Affiliation(s)
- Manh-Tu Nguyen
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi-Echelle, MSME UMR 8208 CNRS, 5 bd Descartes, 77454 Marne-La-Vallée, Cedex 2, France
| | - Jean-Marc Allain
- Ecole Polytechnique, Laboratoire de Mécanique des Solides, 91128, Palaiseau cedex, France
| | - Hakim Gharbi
- Ecole Polytechnique, Laboratoire de Mécanique des Solides, 91128, Palaiseau cedex, France
| | - Christophe Desceliers
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi-Echelle, MSME UMR 8208 CNRS, 5 bd Descartes, 77454 Marne-La-Vallée, Cedex 2, France
| | - Christian Soize
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi-Echelle, MSME UMR 8208 CNRS, 5 bd Descartes, 77454 Marne-La-Vallée, Cedex 2, France.
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20
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Dwyer T, Willett TL, Dold AP, Petrera M, Wasserstein D, Whelan DB, Theodoropoulos JS. Maximum load to failure and tensile displacement of an all-suture glenoid anchor compared with a screw-in glenoid anchor. Knee Surg Sports Traumatol Arthrosc 2016; 24:357-64. [PMID: 24201901 DOI: 10.1007/s00167-013-2760-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/28/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the biomechanical behavior of an all-suture glenoid anchor in comparison with a more conventional screw-in glenoid anchor, with regard to maximum load to failure and tensile displacement. METHODS All mechanical testing was performed using an Instron ElectroPuls E1000 mechanical machine, with a 10 N pre-load and displacement rate of 10 mm/min. Force-displacement curves were generated, with calculation of maximum load, maximum displacement, displacement at 50 N and stiffness. Pretesting of handset Y-Knots in bone analog models revealed low force displacement below 60 N of force. Subsequently, three groups of anchors were tested for pull out strength in bovine bone and cadaver glenoid bone: a bioabsorbable screw-in anchor (Bio Mini-Revo, ConMed Linvatec), a handset all-suture anchor (Y-Knot, ConMed Linvatec) and a 60 N pre-tensioned all-suture anchor (Y-Knot). A total of 8 anchors from each group was tested in proximal tibia of bovine bone and human glenoids (age range 50-90). RESULTS In bovine bone, the Bio Mini-Revo displayed greater maximum load to failure (206 ± 77 N) than both the handset (140 ± 51 N; P = 0.01) and the pre-tensioned Y-Knot (135 ± 46 N; P = 0.001); no significant difference was seen between the three anchor groups in glenoid bone. Compared to the screw-in anchors, the handset all-suture anchor displayed inferior fixation, early displacement and greater laxity in the bovine bone and cadaveric bone (P < 0.05). Pre-tensioning the all-suture anchor to 60 N eliminated this behavior in all bone models. CONCLUSIONS Handset Y-Knots display low force anchor displacement, which is likely due to slippage in the pilot hole. Pre-tensioning the Y-Knot to 60 N eliminates this behavior. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Tim Dwyer
- Women's College, Toronto Western Hospital, University of Toronto Orthopaedic Sports Medicine, 76 Grenville St, Toronto, ON, M5S 1B1, Canada.
| | - Thomas L Willett
- Musculoskeletal Research Laboratory, Division of Orthopaedic Surgery, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, 25 Orde Street, Room 416, Toronto, ON, M5T 3H7, Canada
| | | | | | - David Wasserstein
- University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada
| | - Danny B Whelan
- Women's College Hospital, Toronto, ON, Canada.,St. Michael's Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada
| | - John S Theodoropoulos
- Women's College Hospital, Toronto, ON, Canada.,Mt. Sinai Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada
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21
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Multi-patient finite element simulation of keeled versus pegged glenoid implant designs in shoulder arthroplasty. Med Biol Eng Comput 2015; 53:781-90. [DOI: 10.1007/s11517-015-1286-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Li X, Williams P, Curry EJ, Choi D, Craig EV, Warren RF, Gulotta LV, Wright T. Trabecular bone microarchitecture and characteristics in different regions of the glenoid. Orthopedics 2015; 38:e163-8. [PMID: 25760502 DOI: 10.3928/01477447-20150305-52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
Success of shoulder surgery depends on implant fixation to the glenoid trabecular bone. The purpose of this study was to evaluate the anatomic characteristics of the normal glenoid trabecular bone microarchitecture to help assist in implant design and provide data for finite element analyses. Eight cadavers without evidence of osteoarthritis were used. Glenoids were scanned with micro-computed tomography and then divided into lateral and medial, then superior, inferior, anterior, and posterior quadrants (8 total segments). Each segment was analyzed for total mineral density, bone volume fraction, structure model index, and trabecular thickness (Tb.Th), number (Tb.N), and separation. Bone volume fraction was significantly higher (P<.05) in the posterolateral (20.8%±4.5%) and posteromedial (18.6%±2.5%) regions. Both Tb.N and Tb.Th were also highest in the posterolateral (Tb.N, 1.74±0.374 mm; Tb.Th, 0.148±0.017 mm) and posteromedial (Tb.N, 1.49±0.401 mm; Tb.Th, 0.165±0.016 mm) regions. Trabecular separation was greatest in the superomedial segment (1.00±0.181 mm) and lowest in the posterolateral region (0.663±0.121 mm). For structural model index, both the posterolateral (0.314) and posteromedial (0.312) regions had lower values than the other regions. The posterior segment of the normal glenoid in both the lateral and medial regions has the highest density, which is attributed to the increased trabecular number and thickness with decreased separation. This increased density may be attributed to the posterior directed loading of the glenohumeral joint. The trabecular microarchitecture in the glenoid is plate-like, as indicated by the low structural model index.
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Stroud NJ, DiPaola MJ, Martin BL, Steiler CA, Flurin PH, Wright TW, Zuckerman JD, Roche CP. Initial glenoid fixation using two different reverse shoulder designs with an equivalent center of rotation in a low-density and high-density bone substitute. J Shoulder Elbow Surg 2013; 22:1573-9. [PMID: 23582705 DOI: 10.1016/j.jse.2013.01.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/18/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous glenoid implant designs have been introduced into the global marketplace in recent years; however, little comparative biomechanical data exist to substantiate one design consideration over another. MATERIALS AND METHODS This study dynamically evaluated reverse shoulder glenoid baseplate fixation and compared the initial fixation associated with 2 reverse shoulder designs having an equivalent center of rotation in low-density and high-density bone substitute substrates. RESULTS Significant differences in fixation were observed between implant designs, where the circular-porous reverse shoulder was associated with approximately twice the micromotion per equivalent test than the oblong-grit-blasted design. Additionally, 6 of the 7 circular-porous reverse shoulders failed catastrophically in the low-density bone model at an average of 2603 ± 981 cycles. None of the oblong-grit-blasted designs failed in the low-or high-density bone models and none of the circular-porous designs failed in the high-density bone models after 10,000 cycles of loading. CONCLUSION These results demonstrate that significant differences in initial fixation exist between reverse shoulder implants having an equivalent center of rotation and suggest that design parameters, other than the position of the center of rotation, significantly affect fixation in low-density and high-density polyurethane bone substitutes. Subtle changes in glenoid baseplate design can dramatically affect fixation, particularly in low-density bone substitutes that are intended to simulate the bone quality of the recipient population for reverse shoulders.
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Roche CP, Stroud NJ, Martin BL, Steiler CA, Flurin PH, Wright TW, DiPaola MJ, Zuckerman JD. The impact of scapular notching on reverse shoulder glenoid fixation. J Shoulder Elbow Surg 2013; 22:963-70. [PMID: 23333170 DOI: 10.1016/j.jse.2012.10.035] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/03/2012] [Accepted: 10/17/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapular notching is a well-documented complication of reverse shoulder arthroplasty. The effect of scapular notching on glenoid fixation is unknown. MATERIALS AND METHODS This study dynamically evaluated reverse shoulder glenoid baseplate fixation and assessed the effect of scapular notching on fixation in composite scapulae. A cyclic test was conducted to simulate 55° of humeral abduction in the scapular plane as a 750-N axial load was continuously applied to induce a variable shear and compressive load. Before and after cyclic loading, a displacement test was conducted to measure glenoid baseplate displacement in the directions of the applied static shear and compressive loads. RESULTS For the scapulae without a scapular notch, glenoid baseplate displacement did not exceed the generally accepted 150-μm threshold for osseous integration before or after cyclic loading in any component tested. For the scapulae with a scapular notch, glenoid baseplate displacement exceeded 150 μm in 2 of the 7 samples before cyclic loading and in 3 of the 7 samples after cyclic loading. The average pre-cyclic glenoid baseplate displacement in the direction of the shear load was significantly greater in scapulae with a scapular notch than those without a scapular notch both before (P = .003) and after (P = .023) cyclic loading. CONCLUSIONS Adequate glenoid baseplate fixation was achievable in most cases in scapulae with a severe scapular notch; however, the fact that this micromotion threshold was not met in all scapulae with a notch is concerning and implies that severe notching may play a role in initial glenoid baseplate stability.
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Suárez DR, Weinans H, van Keulen F. Bone remodelling around a cementless glenoid component. Biomech Model Mechanobiol 2011; 11:903-13. [PMID: 22109099 DOI: 10.1007/s10237-011-0360-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 11/05/2011] [Indexed: 12/21/2022]
Abstract
Post-operative change in the mechanical loading of bone may trigger its (mechanically induced) adaptation and hamper the mechanical stability of prostheses. This is especially important in cementless components, where the final fixation is achieved by the bone itself. The aim of this study is, first, to gain insight into the bone remodelling process around a cementless glenoid component, and second, to compare the possible bone adaptation when the implant is assumed to be fully bonded (best case scenario) or completely loose (worst case scenario). 3D finite element models of a scapula with and without a cementless glenoid component were created. 3D geometry of the scapula, material properties, and several physiological loading conditions were acquired from or estimated for a specific cadaver. Update of the bone density after implantation was done according to a node-based bone remodelling scheme. Strain energy density for different loading conditions was evaluated, weighted according to their frequencies in activities of daily life and used as a mechanical stimulus for bone adaptation. The average bone density in the glenoid increased after implantation. However, local bone resorption was significant in some regions next to the bone-implant interface, regardless of the interface condition (bonded or loose). The amount of bone resorption was determined by the condition imposed to the interface, being slightly larger when the interface was loose. An ideal screw, e.g. in which material fatigue was not considered, was enough to keep the interface micromotions small and constant during the entire bone adaptation simulation.
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Affiliation(s)
- Daniel R Suárez
- F. de Ingeniería, Pontificia Universidad Javeriana, Bogotá, Colombia.
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