1
|
Liu Y, Zheng L, Li S, Zhang Z, Lin Z, Ma W. Finite element study on the micromechanics of cement-augmented proximal femoral nail anti-rotation (PFNA) for intertrochanteric fracture treatment. Sci Rep 2024; 14:10322. [PMID: 38710745 DOI: 10.1038/s41598-024-61122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
Blade cut-out is a common complication when using proximal femoral nail anti-rotation (PFNA) for the treatment of intertrochanteric fractures. Although cement augmentation has been introduced to overcome the cut-out effect, the micromechanics of this approach remain to be clarified. While previous studies have developed finite element (FE) models based on lab-prepared or cadaveric samples to study the cement-trabeculae interface, their demanding nature and inherent disadvantages limit their application. The aim of this study was to develop a novel 'one-step forming' method for creating a cement-trabeculae interface FE model to investigate its micromechanics in relation to PFNA with cement augmentation. A human femoral head was scanned using micro-computed tomography, and four volume of interest (VOI) trabeculae were segmented. The VOI trabeculae were enclosed within a box to represent the encapsulated region of bone cement using ANSYS software. Tetrahedral meshing was performed with Hypermesh software based on Boolean operation. Finally, four cement-trabeculae interface FE models comprising four interdigitated depths and five FE models comprising different volume fraction were established after element removal. The effects of friction contact, frictionless contact, and bond contact properties between the bone and cement were identified. The maximum micromotion and stress in the interdigitated and loading bones were quantified and compared between the pre- and post-augmentation situations. The differences in micromotion and stress with the three contact methods were minimal. Micromotion and stress decreased as the interdigitation depth increased. Stress in the proximal interdigitated bone showed a correlation with the bone volume fraction (R2 = 0.70); both micromotion (R2 = 0.61) and stress (R2 = 0.93) at the most proximal loading region exhibited a similar correlation tendency. When comparing the post- and pre-augmentation situations, micromotion reduction in the interdigitated bone was more effective than stress reduction, particularly near the cement border. The cementation resulted in a significant reduction in micromotion within the loading bone, while the decrease in stress was minimal. Noticeable gradients of displacement and stress reduction can be observed in models with lower bone volume fraction (BV/TV). In summary, cement augmentation is more effective at reducing micromotion rather than stress. Furthermore, the reinforcing impact of bone cement is particularly prominent in cases with a low BV/TV. The utilization of bone cement may contribute to the stabilization of trabecular bone and PFNA primarily by constraining micromotion and partially shielding stress.
Collapse
Affiliation(s)
- Yurui Liu
- Department of Anesthesiology, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Liqin Zheng
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaobin Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhengze Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziling Lin
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| |
Collapse
|
2
|
Wautier D, Thienpont E. Appearance and evolution of radiolucent lines below the tibial implant in primary total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:1333-1344. [PMID: 37878076 DOI: 10.1007/s00402-023-05100-9] [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: 06/04/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate total knee arthroplasty (TKA) radiographically to detect the occurrence of radiolucent lines (RLL) under the tibial base plate and to determine what type of RLL may have a correlation with aseptic loosening (AL). The study had two hypotheses: (1) RLLs may have different radiological aspects and evolutions in time depending of different factors (2) Signs of micro- and/or macro-mobility of the implant are necessary before diagnosing aseptic loosening of the tibial component. METHODS Retrospective cohort study of 774 patients operated with a Vanguard TKA (Zimmer Biomet, Warsaw, IN, US) from 2007 to 2015. RLLs were recorded in a database and described according to their radiological aspect, localization, time of apparition, progression and eventual evolution to AL. Other collected parameters were pre- and post-operative HKA angles, amount of post-operative HKA correction, surgical, clinical and demographic data. RESULTS 178/774 TKAs (23%) showed RLLs under the tibial base plate including 9 (1.2%) tibial implants needing revision for AL. Three different types and two aspects of RLLs were observed. Important deformity corrections or undercorrected implants were recognized as a mechanical risk factor for loosening. Elderly women with osteoporosis and young men with important pre-operative deformities were identified as clinical risk factors for RLLs. CONCLUSIONS RLLs are frequently present at the epiphyseal bone/implant interface after total knee arthroplasty, but do not mean the implant is loose. They can be considered a sign of reduced epiphyseal surface fixation due to micro mobility of the tibial implant. Aseptic loosening can be observed radiologically when signs of macro-mobility of the implant are present at the metaphyseal level. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- D Wautier
- Department of Orthopedic Surgery, CHU UCL Namur, Godinne, Avenue Docteur Gaston Therasse 1, 5530, Yvoir, Belgium.
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| |
Collapse
|
3
|
Dagneaux L, Canovas F, Jourdan F. Finite element analysis in the optimization of posterior-stabilized total knee arthroplasty. Orthop Traumatol Surg Res 2024; 110:103765. [PMID: 37979672 DOI: 10.1016/j.otsr.2023.103765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/06/2023] [Indexed: 11/20/2023]
Abstract
Posterior-stabilized total knee arthroplasty (PS-TKA) is associated with high rates of satisfaction and functional recovery. This is notably attributed to implant optimization in terms of design, choice of materials, positioning and understanding of biomechanics. Finite elements analysis (FEA) is an assessment technique that contributed to this optimization by ensuring mechanical results based on numerical simulation. By close teamwork between surgeons, researchers and engineers, FEA enabled testing of certain clinical impressions. However, the methodological features of the technique led to wide variations in the presentation and interpretation of results, requiring a certain understanding of numerical and biomechanical fields by the orthopedic community. The present study provides an up-to-date review, aiming to address the following questions: what are the principles of FEA? What is the role of FEA in studying PS design in TKA? What are the key elements in the literature for understanding the role of FEA in PS-TKA? What is the contribution of FEA for understanding of tibiofemoral and patellofemoral biomechanical behavior? What are the limitations and perspectives of digital simulation and FEA in routine practice, with a particular emphasis on the "digital twin" concept? LEVEL OF EVIDENCE: V, expert opinion.
Collapse
Affiliation(s)
- Louis Dagneaux
- Service de chirurgie orthopédique et traumatologie du membre inférieur, hôpital Lapeyronie, CHU de Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France; Laboratoire de mécanique et génie civil (LMGC), Montpellier University of Excellence (MUSE), université de Montpellier, 860, rue de St-Priest, 34090 Montpellier, France.
| | - François Canovas
- Service de chirurgie orthopédique et traumatologie du membre inférieur, hôpital Lapeyronie, CHU de Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Franck Jourdan
- Laboratoire de mécanique et génie civil (LMGC), Montpellier University of Excellence (MUSE), université de Montpellier, 860, rue de St-Priest, 34090 Montpellier, France
| |
Collapse
|
4
|
Wu D, Wang Q, Tsai HK, Zhou S, Zheng D, Jiang Q, Xu Z. Bond strength of metal-free polyether-ether-ketone knee prostheses compared to metal knee prostheses with bone cement: A preliminary in vitro study. J Orthop Surg (Hong Kong) 2023; 31:10225536231217537. [PMID: 37997347 DOI: 10.1177/10225536231217537] [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] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is the most effective treatment for advanced-stage knee arthritis, and the majority of knee prostheses are made of metal. Nevertheless, metal prostheses still have several problems. The objective of this study is to introduce new metal-free knee prostheses made of polyether-ether-ketone (PEEK) and to compare their cement bond strength with metal prostheses. METHODS Twelve sets of knee prostheses were divided into four groups (unloaded PEEK, unloaded Metal, 10 million cycles (MC) PEEK, 10 MC Metal, N = 3 each), and then attached to composite bones using bone cement. Both the 10 MC PEEK and 10 MC Metal groups were subjected to dynamic gait simulations of 10 MC, whereas the other two sets were not. Afterwards, a pull-off strength test was performed on the femoral prostheses and a shear strength test was performed on the tibial prostheses. RESULTS No apparent cracks were observed in the bone cement after subjecting the PEEK and Metal groups to 10 million cycles of dynamic simulation. No statistically significant differences were observed (p > .05) in the strength tests for unloaded PEEK vs. unloaded Metal, 10 MC PEEK vs.10 MC Metal in the femoral pull-off test, and for unloaded PEEK vs. unloaded Metal in the tibial shear test. The shear strength of 10 MC PEEK was significantly lower (p < .05) compared to that of 10 MC Metal. CONCLUSIONS By comparing the force analysis of previous investigations on knee prostheses with the failure pattern observed in the PEEK knee prosthesis of this study, which replicates that of the metal prosthesis. We believe that the combination of the peek knee prosthesis with bone cement is reliable. We anticipate that metal-free PEEK knee prostheses will find application in Total Knee Arthroplasty (TKA) in the future, thereby benefiting patients.
Collapse
Affiliation(s)
- Dengxian Wu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Qianjin Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Hung-Kang Tsai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Sheng Zhou
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Donggui Zheng
- Suzhou SinoMed Biomaterials Co., Ltd, Suzhou, Jiangsu, PR China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| |
Collapse
|
5
|
Zheng XQ, Huang J, Lin JL, Song CL. Pathophysiological mechanism of acute bone loss after fracture. J Adv Res 2023; 49:63-80. [PMID: 36115662 PMCID: PMC10334135 DOI: 10.1016/j.jare.2022.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 07/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Acute bone loss after fracture is associated with various effects on the complete recovery process and a risk of secondary fractures among patients. Studies have reported similarities in pathophysiological mechanisms involved in acute bone loss after fractures and osteoporosis. However, given the silence nature of bone loss and bone metabolism complexities, the actual underlying pathophysiological mechanisms have yet to be fully elucidated. AIM OF REVIEW To elaborate the latest findings in basic research with a focus on acute bone loss after fracture. To briefly highlight potential therapeutic targets and current representative drugs. To arouse researchers' attention and discussion on acute bone loss after fracture. KEY SCIENTIFIC CONCEPTS OF REVIEW Bone loss after fracture is associated with immobilization, mechanical unloading, blood supply damage, sympathetic nerve regulation, and crosstalk between musculoskeletals among other factors. Current treatment strategies rely on regulation of osteoblasts and osteoclasts, therefore, there is a need to elucidate on the underlying mechanisms of acute bone loss after fractures to inform the development of efficacious and safe drugs. In addition, attention should be paid towards ensuring long-term skeletal health.
Collapse
Affiliation(s)
- Xuan-Qi Zheng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Jie Huang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Jia-Liang Lin
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chun-Li Song
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
| |
Collapse
|
6
|
Mirulla AI, Muccioli GMM, Fratini S, Zaffagnini S, Ingrassia T, Bragonzoni L, Innocenti B. Analysis of different geometrical features to achieve close-to-bone stiffness material properties in medical device: A feasibility numerical study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106875. [PMID: 35588661 DOI: 10.1016/j.cmpb.2022.106875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE In orthopedic medical devices, elasto-plastic behavior differences between bone and metallic materials could lead to mechanical issues at the bone-implant interface, as stress shielding. Those issue are mainly related to knee and hip arthroplasty, and they could be responsible for implant failure. To reduce mismatching-related adverse events between bone and prosthesis mechanical properties, modifying the implant's internal geometry varying the bulk stiffness and density could be the right approach. Therefore, this feasibility study aims to assess which in-body gap geometry improves, by reducing, the bulk stiffness. METHODS Using five finite element models, a uniaxial compression test in five cubes with a 20 mm thickness was simulated and analyzed. The displacements, strain and Young Modulus were calculated in four cubes, each containing internal prismatic gaps with different transversal sections (squared, hexagonal, octagonal, and circular). Those were compared with a fifth full-volume cube used as control. RESULTS The most significant difference have been achieved in displacement values, in cubes containing internal gaps with hexagonal and circular transversal sections (82 µm and 82.5 µm, respectively), when compared to the full-volume cube (69.3 µm). CONCLUSIONS This study suggests that hexagonal and circular shape of the gaps allows obtaining the lower rigidity in a size range of 4 mm, offering a starting approach to achieve a "close-to-bone" material, with a potential use in prosthetic devices with limited thickness.
Collapse
Affiliation(s)
- Agostino Igor Mirulla
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, Palermo 90128, Italy; Department for Life Quality Studies, University of Bologna, Rimini 47921, Italy.
| | - Giulio Maria Marcheggiani Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Stefano Fratini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy
| | - Stefano Zaffagnini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Tommaso Ingrassia
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, Palermo 90128, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Rimini 47921, Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Bruxelles 1050, Belgium
| |
Collapse
|
7
|
Hu J, Gundry M, Zheng K, Zhong J, Hourigan P, Meakin JR, Winlove CP, Toms AD, Knapp KM, Chen J. The biomechanics of metaphyseal cone augmentation in revision knee replacement. J Mech Behav Biomed Mater 2022; 131:105233. [DOI: 10.1016/j.jmbbm.2022.105233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022]
|
8
|
Polakova D, Capek L, Bartos M, Kejzlar P, Rysova M, Martinova L, Sevcu A. The stiffness variability of a silk fibroin scaffold during bone cell proliferation. Proc Inst Mech Eng H 2022; 236:9544119211070345. [PMID: 35125026 DOI: 10.1177/09544119211070345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Complex assessment of gradual changes in scaffold morphology and stiffness is an essential step in bone filler development. Current approach, however, does not reflect long term cell proliferation effect as the mechanical tests are usually conducted on pristine materials without cells or cell influence on material stiffness is evaluated after one time period only. Here, biocompatible silk fibroin (SF) porous scaffolds envisioned for bone defect filling were prepared by dissolving of fibroin fibers, followed by dialysis, freeze-drying and final stabilization. Particular attention was devoted to the influence of bone cell proliferation up to 2 months on the stiffness of the material. The morphology of the material was studied in terms of its inner structure and the overall changes in the surface characteristics due to proliferation of MG 63 bone cell line. The SF scaffold stiffness significantly increased during first month followed by its decline during second month due to bone cell seeding. After 2 months, the SF scaffold was completely colonized, which resulted in a gradual decay of its structure. The length of degradation due to bone cell proliferation and mechanical behavior corresponded to the requirements set for reasonable filler material indicating that porous SF scaffolds comprise a promising biomaterial for bone regeneration.
Collapse
Affiliation(s)
- Dagmar Polakova
- Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Liberec 1, Czech Republic
- Faculty of Mechatronics, Informatics and Interdisciplinary Studies, Technical University of Liberec, Liberec 1, Czech Republic
| | - Lukas Capek
- Faculty of Textile Engineering, Technical University of Liberec, Liberec 1, Czech Republic
| | - Martin Bartos
- Institute of Dental Medicine, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague 2, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague 2, Czech Republic
| | - Pavel Kejzlar
- Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Liberec 1, Czech Republic
| | - Miroslava Rysova
- Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Liberec 1, Czech Republic
| | - Lenka Martinova
- Faculty of Textile Engineering, Technical University of Liberec, Liberec 1, Czech Republic
| | - Alena Sevcu
- Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Liberec 1, Czech Republic
| |
Collapse
|
9
|
Anijs T, Eemers S, Minoda Y, Wolfson D, Verdonschot N, Janssen D. Computational tibial bone remodeling over a population after total knee arthroplasty: A comparative study. J Biomed Mater Res B Appl Biomater 2021; 110:776-786. [PMID: 34661334 PMCID: PMC9297982 DOI: 10.1002/jbm.b.34957] [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] [Received: 07/08/2021] [Revised: 09/20/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022]
Abstract
Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to validate computational postoperative bone response using longitudinal clinical DEXA densities. Computational remodeling outcome over a population was obtained by incorporating the strain‐adaptive remodeling theory in finite element (FE) simulations of 26 different tibiae. Physiological loading conditions were applied, and bone mineral density (BMD) in three different regions of interest (ROIs) was considered over a postoperative time of 15 years. BMD outcome was compared directly to previously reported clinical BMD data of a comparable TKA cohort. Similar trends between computational and clinical bone remodeling over time were observed in the two proximal ROIs, with most rapid bone loss taking place in the initial months after TKA and BMD starting to level in the following years. The extent of absolute proximal BMD change was underestimated in the FE population compared with the clinical subject group, which might be the result of significantly higher initial clinical baseline BMD values. Large differences in remodeling response were found in the distal ROI, in which resorption was measured clinically, but a large BMD increase was predicted by the FE models. Multiple computational limitations, related to the FE mesh, loading conditions, and strain‐adaptive algorithm, likely contributed to the extensive local bone formation. Further research incorporating subject‐specific comparisons using follow‐up CT scans and more extensive physiological knee loading is recommended to optimize bone remodeling more distal to the tibial baseplate.
Collapse
Affiliation(s)
- Thomas Anijs
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sanne Eemers
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - David Wolfson
- DePuy Synthes Joint Reconstruction, WW Research & Development, Leeds, UK
| | - Nico Verdonschot
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Laboratory for Biomechanical Engineering, University of Twente, Faculty of Engineering Technology, Enschede, The Netherlands
| | - Dennis Janssen
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Winkler T, Sass FA, Duda GN, Schmidt-Bleek K. A review of biomaterials in bone defect healing, remaining shortcomings and future opportunities for bone tissue engineering: The unsolved challenge. Bone Joint Res 2018; 7:232-243. [PMID: 29922441 PMCID: PMC5987690 DOI: 10.1302/2046-3758.73.bjr-2017-0270.r1] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite its intrinsic ability to regenerate form and function after injury, bone tissue can be challenged by a multitude of pathological conditions. While innovative approaches have helped to unravel the cascades of bone healing, this knowledge has so far not improved the clinical outcomes of bone defect treatment. Recent findings have allowed us to gain in-depth knowledge about the physiological conditions and biological principles of bone regeneration. Now it is time to transfer the lessons learned from bone healing to the challenging scenarios in defects and employ innovative technologies to enable biomaterial-based strategies for bone defect healing. This review aims to provide an overview on endogenous cascades of bone material formation and how these are transferred to new perspectives in biomaterial-driven approaches in bone regeneration. Cite this article: T. Winkler, F. A. Sass, G. N. Duda, K. Schmidt-Bleek. A review of biomaterials in bone defect healing, remaining shortcomings and future opportunities for bone tissue engineering: The unsolved challenge. Bone Joint Res 2018;7:232–243. DOI: 10.1302/2046-3758.73.BJR-2017-0270.R1.
Collapse
Affiliation(s)
- T Winkler
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F A Sass
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - G N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - K Schmidt-Bleek
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| |
Collapse
|
11
|
Goodheart JR, Miller MA, Oest ME, Mann KA. Trabecular resorption patterns of cement-bone interlock regions in total knee replacements. J Orthop Res 2017; 35:2773-2780. [PMID: 28452065 PMCID: PMC5659954 DOI: 10.1002/jor.23586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/24/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED With in vivo service, there is loss of mechanical interlock between trabeculae and PMMA cement in total knee replacements. The mechanisms responsible for the loss of interlock are not known, but loss of interlock results in weaker cement-bone interfaces. The goal of this study was to determine the pattern of resorption of interdigitated bone using a series of 20 postmortem retrieved knee replacements with a wide range of time in service (3-22 years). MicroCT scans were obtained of a segment of the cement-bone interface below the tibial tray for each implant. Image processing methods were used to determine interface morphology and to identify supporting, interdigitated, resorbed, and isolated bone as a function of axial position. Overall, the amount of remaining interdigitated bone decreased with time in service (p = 0.0114). The distance from the cement border (at the extent of cement penetration into the bone bed) to 50% of the interdigitated volume decreased with time in service (p = 0.039). Isolated bone, when present, was located deep in the cement layer. Overall, resorption appears to start at the cement border and progresses into the cement layer. Initiation of trabecular resorption near the cement border may be a consequence of proximity to osteoclastic cells in the adjacent marrow space. CLINICAL SIGNIFICANCE Aseptic loosening of joint replacements remains an important clinical problem. This work explores the process and pattern of trabecular bone resorption responsible for loss of interface fixation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2773-2780, 2017.
Collapse
Affiliation(s)
- Jacklyn R. Goodheart
- Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Mark A. Miller
- Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Megan E. Oest
- Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Kenneth A. Mann
- Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY, 13210, USA
| |
Collapse
|