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Siverino C, Tirkkonen-Rajasalo L, Freitag L, Günther C, Thompson K, Styger U, Zeiter S, Eglin D, Stadelmann VA. Restoring implant fixation strength in osteoporotic bone with a hydrogel locally delivering zoledronic acid and bone morphogenetic protein 2. A longitudinal in vivo microCT study in rats. Bone 2024; 180:117011. [PMID: 38176642 DOI: 10.1016/j.bone.2023.117011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024]
Abstract
Osteoporosis poses a major public health challenge, and it is characterized by low bone mass, deterioration of the microarchitecture of bone tissue, causing a consequent increase in bone fragility and susceptibility to fractures and complicating bone fixation, particularly screw implantation. In the present study, our aim was to improve implant stability in osteoporotic bone using a thermoresponsive hyaluronan hydrogel (HA-pNIPAM) to locally deliver the bisphosphonate zoledronic acid (ZOL) to prevent bone resorption and bone morphogenetic protein 2 (BMP2) to induce bone formation. Adult female Wistar rats (n = 36) were divided into 2 treatment groups: one group of SHAM-operated animals and another group that received an ovariectomy (OVX) to induce an osteoporotic state. All animals received a polyetheretherketone (PEEK) screw in the proximal tibia. In addition, subgroups of SHAM or OVX animals received either the HA-pNIPAM hydrogel without or with ZOL/BMP2, placed into the defect site prior to screw implantation. Periprosthetic bone and implant fixation were monitored using longitudinal in vivo microCT scanning post-operatively and at 3, 6, 9, 14, 20 and 28 days. Histological assessment was performed post-mortem. Our data showed that pure hydrogel has no impact of implant fixation The ZOL/BMP2-hydrogel significantly increased bone-implant contact and peri-implant bone fraction, primarily through reduced resorption. STATEMENT OF CLINICAL SIGNIFICANCE: Local delivery of ZOL and BMP2 using a biocompatible hydrogel improved implant stability in osteoporotic bone. This approach could constitute a potent alternative to systemic drug administration and may be useful in avoiding implant loosening in clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | - David Eglin
- AO Research Institute Davos, Davos, Switzerland; Mines Saint-Étienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Saint-Étienne, France.
| | - Vincent A Stadelmann
- AO Research Institute Davos, Davos, Switzerland; Schulthess Klinik, Department of Research and Development, Zürich, Switzerland.
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Bjelić D, Finšgar M. Bioactive coatings with anti-osteoclast therapeutic agents for bone implants: Enhanced compliance and prolonged implant life. Pharmacol Res 2022; 176:106060. [PMID: 34998972 DOI: 10.1016/j.phrs.2022.106060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 12/18/2022]
Abstract
The use of therapeutic agents that inhibit bone resorption is crucial to prolong implant life, delay revision surgery, and reduce the burden on the healthcare system. These therapeutic agents include bisphosphonates, various nucleic acids, statins, proteins, and protein complexes. Their use in systemic treatment has several drawbacks, such as side effects and insufficient efficacy in terms of concentration, which can be eliminated by local treatment. This review focuses on the incorporation of osteoclast inhibitors (antiresorptive agents) into bioactive coatings for bone implants. The ability of bioactive coatings as systems for local delivery of antiresorptive agents to achieve optimal loading of the bioactive coating and its release is described in detail. Various parameters such as the suitable concentrations, release times, and the effects of the antiresorptive agents on nearby cells or bone tissue are discussed. However, further research is needed to support the optimization of the implant, as this will enable subsequent personalized design of the coating in terms of the design and selection of the coating material, the choice of an antiresorptive agent and its amount in the coating. In addition, therapeutic agents that have not yet been incorporated into bioactive coatings but appear promising are also mentioned. From this work, it can be concluded that therapeutic agents contribute to the biocompatibility of the bioactive coating by enhancing its beneficial properties.
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Affiliation(s)
- Dragana Bjelić
- Faculty of Chemistry and Chemical Engineering, University of Maribor, Smetanova ulica 17, 2000 Maribor, Slovenia.
| | - Matjaž Finšgar
- Faculty of Chemistry and Chemical Engineering, University of Maribor, Smetanova ulica 17, 2000 Maribor, Slovenia.
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3
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Einafshar M, Hashemi A, van Lenthe GH. Homogenized finite element models can accurately predict screw pull-out in continuum materials, but not in porous materials. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 202:105966. [PMID: 33662802 DOI: 10.1016/j.cmpb.2021.105966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Bone screw fixation can be estimated with several test methods such as insertion torque, pull-out, push-in and bending tests. A basic understanding of the relationship between screw fixation and bone microstructure is still lacking. Computational models can help clarify this relationship. The objective of the paper is to evaluate homogenized finite element (hFE) models of bone screw pull-out. METHODS Experimental pull-out tests were performed on three materials: two polyurethane (PU) foams having a porous microstructure, and a high density polyethylene (HDPE) which is a continuum material. Forty-five titanium pedicle screws were inserted to 10, 20, and 30 mm in equally sized blocks of all three materials (N = 5/group). Pull-out characteristics i.e. stiffness (S), yield force (Fy), peak pull-out force (Fult) and displacement at Fult (dult) were measured. hFE models were created replicating the experiments. The screw was modeled as a rigid body and 5 mm axial displacement was applied to the head of the screw. Simulations were performed evaluating two different conditions at the bone-screw interface; once in which the screw fitted the pilot hole exactly ("free-stressed") and once in which interface stresses resulting from the insertion process were taken into account ("pre-stressed"). RESULTS The simulations representing the pre-stressed condition in HDPE matched the experimental data well; S, Fy, and Fult differed less than 11%, 2% and 0.5% from the experimental data, respectively, whereas dult differed less than 16%. The free-stressed simulations were less accurate, especially stiffness (158% higher than the pre-stressed condition) and dult (30% lower than pre-stressed condition) were affected. The simulations representing PU did not match the experiments well. For the 20 mm insertion depth, S, Fy and Fult differed by more than 104%, 89% and 66%, respectively from the experimental values. Agreement did not improve for 10 and 30 mm insertion depths. CONCLUSIONS We found that hFE models can accurately quantify screw pull-out in continuum materials such as HDPE, but not in materials with a porous structure, such as PU. Pre-stresses in the bone induced by the insertion process cannot be neglected and need to be included in the hFE simulations.
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Affiliation(s)
- Mohammadjavad Einafshar
- Biomechanical engineering group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ata Hashemi
- Biomechanical engineering group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
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Longitudinal time-lapse in vivo micro-CT reveals differential patterns of peri-implant bone changes after subclinical bacterial infection in a rat model. Sci Rep 2020; 10:20901. [PMID: 33262377 PMCID: PMC7708479 DOI: 10.1038/s41598-020-77770-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023] Open
Abstract
Subclinical infection associated with orthopedic devices can be challenging to diagnose. The goal of this study was to evaluate longitudinal, microcomputed tomography (microCT) imaging in a rat model of subclinical orthopedic device-related infection caused by Staphylococcus epidermidis and four different Cutibacterium (previously Propionibacterium) acnes strains, and compare outcomes with non-inoculated and historical S. aureus-inoculated controls. Sterile screws or screws colonized with bacteria were placed in the tibia of 38 adult Wistar rats [n = 6 sterile screws; n = 6 S. epidermidis-colonized screws; n = 26 C. acnes-colonized screws (covering all three main subspecies)]. Regular microCT scans were taken over 28 days and processed for quantitative time-lapse imaging with dynamic histomorphometry. At euthanasia, tissues were processed for semiquantitative histopathology or quantitative bacteriology. All rats receiving sterile screws were culture-negative at euthanasia and displayed progressive bony encapsulation of the screw. All rats inoculated with S. epidermidis-colonized screws were culture-positive and displayed minor changes in peri-implant bone, characteristic of subclinical infection. Five of the 17 rats in the C. acnes inoculated group were culture positive at euthanasia and displayed bone changes at the interface of the screw and bone, but not deeper in the peri-implant bone. Dynamic histomorphometry revealed significant differences in osseointegration, bone remodeling and periosteal reactions between groups that were not measurable by visual observation of still microCT images. Our study illustrates the added value of merging 3D microCT data from subsequent timepoints and producing inherently richer 4D data for the detection and characterization of subclinical orthopedic infections, whilst also reducing animal use.
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Mohtashami Z, Esmaili Z, Vakilinezhad MA, Seyedjafari E, Akbari Javar H. Pharmaceutical implants: classification, limitations and therapeutic applications. Pharm Dev Technol 2019; 25:116-132. [DOI: 10.1080/10837450.2019.1682607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Zahra Mohtashami
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaili
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamid Akbari Javar
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Patellar bone strain after total knee arthroplasty is correlated with bone mineral density and body mass index. Med Eng Phys 2019; 68:17-24. [PMID: 30979584 DOI: 10.1016/j.medengphy.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/20/2022]
Abstract
Patella-related complications after total knee arthroplasty (TKA) remain a major clinical concern. Previous studies have suggested that increased postoperative patellar bone strain could be related to such complications, but there is limited knowledge on patellar strain after TKA. The objective of this study was to predict patellar bone strain after TKA and evaluate correlations with various preoperative data. Fourteen TKA patients with a minimum follow-up of one year were included in this study. Using preoperative CT datasets, preoperative planning, and postoperative X-rays, a method is presented to generate patient-specific finite element models after virtual TKA. Patellar kinematics and forces were predicted during a squat movement, and patellar bone strain was evaluated at 60° of knee flexion. Strain varied greatly among patients, but was strongly negatively correlated (r = -0.85, p < 0.001) with bone mineral density (BMD) and moderately positively (r = 0.54, p = 0.05) with body mass index (BMI). The BMI/BMD ratio explained 87% of strain, and should be further investigated as a potential risk factor for clinical complications. This study represents a preliminary step towards the identification of patients at risk of patellar complications after TKA.
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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] [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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Basudan AM, Shaheen MY, de Vries RB, van den Beucken JJJP, Jansen JA, Alghamdi HS. Antiosteoporotic Drugs to Promote Bone Regeneration Related to Titanium Implants: A Systematic Review and Meta-Analysis. TISSUE ENGINEERING PART B-REVIEWS 2018; 25:89-99. [PMID: 30191772 DOI: 10.1089/ten.teb.2018.0120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
IMPACT STATEMENT This meta-analysis was to investigate literature on the administration of antiosteoporotic drugs as an effective adjunct therapy for implant osseointegration using in vivo animal models.
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Affiliation(s)
- Amani M Basudan
- 1 Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Marwa Y Shaheen
- 1 Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Rob B de Vries
- 2 Systematic Review Center for Laboratory Animal Experimentation, Department for Health Evidence (section HTA), Radboudumc, Nijmegen, The Netherlands
| | | | - John A Jansen
- 3 Department of Biomaterials, Radboudumc, Nijmegen, The Netherlands
| | - Hamdan S Alghamdi
- 1 Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,3 Department of Biomaterials, Radboudumc, Nijmegen, The Netherlands
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Terrier A, Fernandes CS, Guillemin M, Crevoisier X. Fixed and mobile-bearing total ankle prostheses: Effect on tibial bone strain. Clin Biomech (Bristol, Avon) 2017; 48:57-62. [PMID: 28755611 DOI: 10.1016/j.clinbiomech.2017.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total ankle replacement is associated to a high revision rate. To improve implant survival, the potential advantage of prostheses with fixed bearing compared to mobile bearing is unclear. The objective of this study was to test the hypothesis that fixed and mobile bearing prostheses are associated with different biomechanical quantities typically associated to implant failure. METHODS With a validated finite element model, we compared three cases: a prosthesis with a fixed bearing, a prosthesis with a mobile bearing in a centered position, and a prosthesis with mobile bearing in an eccentric position. Both prostheses were obtained from the same manufacturer. They were tested on seven tibias with maximum axial compression force during walking. We tested the hypothesis that there was a difference of bone strain, bone-implant interfacial stress, and bone support between the three cases. We also evaluated, for the three cases, the correlations between bone support, bone strain and bone-implant interfacial stress. FINDINGS There were no statistically significant differences between the three cases. Overall, bone support was mainly trabecular, and less effective in the posterior side. Bone strain and bone-implant interfacial stress were strongly correlated to bone support. INTERPRETATIONS Even if slight differences are observed between fixed and mobile bearing, it is not enough to put forward the superiority of one of these implants regarding their reaction to axial compression. When associated to the published clinical results, our study provides no argument to warn surgeons against the use of two-components fixed bearing implants.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland.
| | - Caroline Sieger Fernandes
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - Maïka Guillemin
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - Xavier Crevoisier
- Service of Orthopaedics and Traumatology, University Hospital Center and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Terrier A, Obrist R, Becce F, Farron A. Cement stress predictions after anatomic total shoulder arthroplasty are correlated with preoperative glenoid bone quality. J Shoulder Elbow Surg 2017; 26:1644-1652. [PMID: 28412104 DOI: 10.1016/j.jse.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that biomechanical parameters typically associated with glenoid implant failure after anatomic total shoulder arthroplasty (aTSA) would be correlated with preoperative glenoid bone quality. METHODS We developed an objective automated method to quantify preoperative glenoid bone quality in different volumes of interest (VOIs): cortical bone, subchondral cortical plate, subchondral bone after reaming, subchondral trabecular bone, and successive layers of trabecular bone. Average computed tomography (CT) numbers (in Hounsfield units [HU]) were measured in each VOI from preoperative CT scans. In parallel, we built patient-specific finite element models of simulated aTSAs to predict cement stress, bone-cement interfacial stress, and bone strain around the glenoid implant. CT measurements and finite element predictions were obtained for 20 patients undergoing aTSA for primary glenohumeral osteoarthritis. We tested all linear correlations between preoperative patient characteristics (age, sex, height, weight, glenoid bone quality) and biomechanical predictions (cement stress, bone-cement interfacial stress, bone strain). RESULTS Average CT numbers gradually decreased from cortical (717 HU) to subchondral and trabecular (362 HU) bone. Peak cement stress (4-10 MPa) was located within the keel hole, above the keel, or behind the glenoid implant backside. Cement stress, bone-cement interfacial stress, and bone strain were strongly negatively correlated with preoperative glenoid bone quality, particularly in VOIs behind the implant backside (subchondral trabecular bone) but also in deeper trabecular VOIs. CONCLUSION Our numerical study suggests that preoperative glenoid bone quality is an important parameter to consider in aTSA, which may be associated with aseptic loosening of the glenoid implant. These initial results should now be confronted with clinical and radiologic outcomes.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Raphaël Obrist
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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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] [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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Latypova A, Pioletti D, Terrier A. Importance of trabecular anisotropy in finite element predictions of patellar strain after Total Knee Arthroplasty. Med Eng Phys 2017; 39:102-105. [DOI: 10.1016/j.medengphy.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
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13
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Pura JA, Bobyn JD, Tanzer M. Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines. Clin Orthop Relat Res 2016; 474:1224-33. [PMID: 26831478 PMCID: PMC4814409 DOI: 10.1007/s11999-016-4714-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving porous implant fixation could improve the reliability and durability of these reconstructive procedures. QUESTIONS/PURPOSES In this study, we asked whether there is a positive and dose-dependent effect of the local release of the bisphosphonate alendronate from (1) alendronate/hydroxyapatite (HA) porous-coated titanium implants compared with bare metal porous controls; and (2) alendronate/HA on porous-coated titanium implants compared with HA-coated porous controls with respect to extent of bone ingrowth, bone apposition, and periimplant bone formation in a canine model? METHODS Three-dimensional printed porous-coated cylindrical implants coated with three different doses (0.02, 0.06, and 0.18 mg/cm(2)) of alendronate were inserted bilaterally in the intramedullary canal of the proximal femora of 15 adult mongrel dogs (age range, 3-9 years; mean, 5 years) weighing between 36 kg and 60 kg (mean, 43 kg). In each dog, an implant coated with HA and one of three different doses of alendronate was inserted on one side while the contralateral femur had a bare metal porous control implant and an identical control implant with a coating of HA. The dose effect of locally released alendronate on the extent of bone ingrowth, bone apposition, and periimplant bone was assessed by backscattered electron microscopy of three pairs of cross-sections taken from each implant at 12 weeks after surgery. A linear mixed model was used to perform the statistical analyses to account for the correlation in the data resulting from the multiple measures performed on each dog. RESULTS Compared with paired bare metal controls, periimplant bone increased by 92% (p = 0.007), and 114% (p < 0.001) in the femora with the alendronate implants with a dose of 0.06 mg/cm(2), or 0.18 mg/cm(2), respectively. At a dose of 0.02 mg/cm(2), there was no difference (46% change; p = 0.184, with the numbers available). The comparison of the alendronate-dosed implants with their HA-coated controls showed that the intermediate dose of 0.06 mg/cm(2) alendronate had the greatest effect on net bone formation. Bone apposition was enhanced with the 0.06-mg/cm(2) alendronate femoral implants (82%; p = 0.008), although there was no change in bone ingrowth (37% change; p = 0.902, with the numbers available). When compared with the HA-coated control implants, the greatest effect of the alendronate-dosed implants was the increased amount of periimplant bone at the intermediate dose of 0.06-mg/cm(2) (108%, p = 0.009). There was no effect of the low (0.02-mg/cm(2)) and high (0.18-mg/cm(2)) alendronate-dosed implants (4%, and 6%, respectively; p = 0.321, p = 0.502). Overall, all three alendronate-dosed implants revealed little to no effect on bone ingrowth compared with the HA-coated control implants. CONCLUSIONS The local release of alendronate from a three-dimensional printed porous-coated implant from the three doses studied showed an overall improvement in bone apposition and periimplant bone at the intermediate dose compared with bare metal or with HA-coated controls, although the effect was more pronounced compared with bare metal. Long-term studies to show the effects of localized alendronate delivery and mechanical fixation would be the next step for future studies. CLINICAL RELEVANCE Local release of alendronate from a three-dimensional printed porous-coated implant may improve the reliability of cementless fixation of currently available porous-coated bare metal implants.
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Affiliation(s)
- Jenny Ann Pura
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Avenue, Room C9-136, Montreal, QC, H3G1A4, Canada.
| | - J Dennis Bobyn
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
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14
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Latypova A, Arami A, Becce F, Jolles-Haeberli B, Aminian K, Pioletti DP, Terrier A. A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study. Clin Biomech (Bristol, Avon) 2016; 32:212-9. [PMID: 26651475 DOI: 10.1016/j.clinbiomech.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inappropriate patellar cut during total knee arthroplasty can lead to patellar complications due to increased bone strain. In this study, we evaluated patellar bone strain of a patient who had a deeper patellar cut than the recommended. METHODS A patient-specific model based on patient preoperative data was created. The model was decoupled into two levels: knee and patella. The knee model predicted kinematics and forces on the patella during squat movement. The patella model used these values to predict bone strain after total knee arthroplasty. Mechanical properties of the patellar bone were identified with micro-finite element modeling testing of cadaveric samples. The model was validated with a robotic knee simulator and postoperative X-rays. For this patient, we compared the deeper patellar cut depth to the recommended one, and evaluated patellar bone volume with octahedral shear strain above 1%. FINDINGS Model predictions were consistent with experimental measurements of the robotic knee simulator and postoperative X-rays. Compared to the recommended cut, the deeper cut increased the critical strain bone volume, but by less than 3% of total patellar volume. INTERPRETATION We thus conclude that the predicted increase in patellar strain should be within an acceptable range, since this patient had no complaints 8 months after surgery. This validated patient-specific model will later be used to address other questions on groups of patients, to eventually improve surgical planning and outcome of total knee arthroplasty.
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Affiliation(s)
- Adeliya Latypova
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Arash Arami
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Fabio Becce
- Lausanne University Hospital (CHUV), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland
| | | | - Kamiar Aminian
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Dominique P Pioletti
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Alexandre Terrier
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland.
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15
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Kettenberger U, Luginbuehl V, Procter P, Pioletti DP. In vitro and in vivo investigation of bisphosphonate-loaded hydroxyapatite particles for peri-implant bone augmentation. J Tissue Eng Regen Med 2015; 11:1974-1985. [PMID: 26549303 DOI: 10.1002/term.2094] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/04/2015] [Accepted: 09/14/2015] [Indexed: 11/05/2022]
Abstract
Locally applied bisphosphonates, such as zoledronate, have been shown in several studies to inhibit peri-implant bone resorption and recently to enhance peri-implant bone formation. Studies have also demonstrated positive effects of hydroxyapatite (HA) particles on peri-implant bone regeneration and an enhancement of the anti-resorptive effect of bisphosphonates in the presence of calcium. In the present study, both hydroxyapatite nanoparticles (nHA) and zoledronate were combined to achieve a strong reinforcing effect on peri-implant bone. The nHA-zoledronate combination was first investigated in vitro with a pre-osteoclastic cell assay (RAW 264.7) and then in vivo in a rat model of postmenopausal osteoporosis. The in vitro study confirmed that the inhibitory effect of zoledronate on murine osteoclast precursor cells was enhanced by loading the drug on nHA. For the in vivo investigation, either zoledronate-loaded or pure nHA were integrated in hyaluronic acid hydrogel. The gels were injected in screw holes that had been predrilled in rat femoral condyles before the insertion of miniature screws. Micro-CT-based dynamic histomorphometry and histology revealed an unexpected rapid mineralization of the hydrogel in vivo through formation of granules, which served as scaffold for new bone formation. The delivery of zoledronate-loaded nHA further inhibited a degradation of the mineralized hydrogel as well as a resorption of the peri-implant bone as effectively as unbound zoledronate. Hyaluronic acid with zoledronate-loaded nHA, thanks to its dual effect on inducing a rapid mineralization and preventing resorption, is a promising versatile material for bone repair and augmentation. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ulrike Kettenberger
- Laboratory of Biomechanical Orthopaedics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Vera Luginbuehl
- Pharmaceutical Technology, Institute of Biotechnology, Zürich University of Applied Sciences, Switzerland
| | - Philip Procter
- Applied Materials Science, Department of Engineering Sciences, Uppsala University, Sweden
| | - Dominique P Pioletti
- Laboratory of Biomechanical Orthopaedics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland
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