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Bone Density Micro-CT Assessment during Embedding of the Innovative Multi-Spiked Connecting Scaffold in Periarticular Bone to Elaborate a Validated Numerical Model for Designing Biomimetic Fixation of Resurfacing Endoprostheses. MATERIALS 2021; 14:ma14061384. [PMID: 33809176 PMCID: PMC8000753 DOI: 10.3390/ma14061384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/26/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
Our team has been working for some time on designing a new kind of biomimetic fixation of resurfacing endoprostheses, in which the innovative multi-spiked connecting scaffold (MSC-Scaffold) that mimics the natural interface between articular cartilage and periarticular trabecular bone in human joints is the crucial element. This work aimed to develop a numerical model enabling the design of the considered joint replacement implant that would reflect the mechanics of interacting biomaterials. Thus, quantitative micro-CT analysis of density distribution in bone material during the embedding of MSC-Scaffold in periarticular bone was applied. The performed numerical studies and corresponding mechanical tests revealed, under the embedded MSC-Scaffold, the bone material densification affecting its mechanical properties. On the basis of these findings, the built numerical model was modified by applying a simulated insert of densified bone material. This modification led to a strong correlation between the re-simulation and experimental results (FVU = 0.02). The biomimetism of the MSC-Scaffold prototype that provided physiological load transfer from implant to bone was confirmed based on the Huber–von Mises–Hencky (HMH) stress maps obtained with the validated finite element (FE) model of the problem. The micro-CT bone density assessment performed during the embedding of the MSC-Scaffold prototype in periarticular bone provides insight into the mechanical behaviour of the investigated implant-bone system and validates the numerical model that can be used for the design of material and geometric features of a new kind of resurfacing endoprostheses fixation.
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Tsitlakidis S, Westhauser F, Horsch A, Beckmann N, Bitsch R, Klotz M. Femoral neck prostheses: A systematic analysis of the literature. Orthop Rev (Pavia) 2019; 11:8204. [PMID: 31579193 PMCID: PMC6769360 DOI: 10.4081/or.2019.8204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
Primary total hip arthroplasty (THA) is one of the most successful surgical procedures. Considering the demographic change the use of new ultra-short femoral implants has gained importance especially when treating young patients. Main features are bone conservation, metaphyseal anchoring and thus reducing stress shielding by proximal load transferring. The objective of this study is to give an overview over the subject of femoral neck prostheses. A systematic review was conducted. A total number of 27 publications were taken into this systematic review. Over all, just a few follow-up, biomechanical and radiostereometric studies have been conducted in the past. Still no long-term results (>10 years of follow-up) are available. The available mid-term results indicate unsatisfactory survival rates. Aseptic loosening was the most common reason for revision. Valgus angle and good bone mineral density were considered to be crucial for primary stability of femoral neck prostheses. Register data report a very low percentage of femoral neck prostheses in THA with even more diminishing implantation rates. To conclude, further studies are necessary in order to provide evidence-based recommendations. Currently, due to the inhomogeneous and poor data a reasonable and legitimate recommendation cannot be given.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Westhauser
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Axel Horsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicholas Beckmann
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi Bitsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Clinic for Orthopedic and Trauma Surgery, Kepler University Hospital, Linz, Austria
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Rogala P, Uklejewski R, Winiecki M, Dąbrowski M, Gołańczyk J, Patalas A. First Biomimetic Fixation for Resurfacing Arthroplasty: Investigation in Swine of a Prototype Partial Knee Endoprosthesis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6952649. [PMID: 31355275 PMCID: PMC6634287 DOI: 10.1155/2019/6952649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/10/2019] [Accepted: 05/21/2019] [Indexed: 02/05/2023]
Abstract
Resurfacing hip and knee endoprostheses are generally embedded in shallow, prepared areas in the bone and secured with cement. Massive cement penetration into periarticular bone, although it provides sufficient primary fixation, leads to the progressive weakening of peri-implant bone and results in failures. The aim of this paper was to investigate in an animal model the first biomimetic fixation of components of resurfacing arthroplasty endoprostheses by means of the innovative multispiked connecting scaffold (MSC-Scaffold). The partial resurfacing knee arthroplasty (RKA) endoprosthesis working prototype with the MSC-Scaffold was designed for biomimetic fixation investigations using reverse engineering methods and manufactured by selective laser melting. After Ca-P surface modification of bone contacting surfaces of the MSC-Scaffold, the working prototypes were implanted in 10 swines. Radiological, histopathological, and micro-CT examinations were performed on retrieved bone-implant specimens. Clinical examination confirmed very good stability (4 in 5-point Likert scale) of the operated knee joints. Radiological examinations showed good implant fixation (radiolucency less than 2 mm) without any signs of migration. Spaces between the MSC-Scaffold spikes were penetrated by bone tissue. The histological sections showed newly formed trabecular bone tissue between the spikes, and the trabeculae of periscaffold bone were seen in contact with the spikes. The micro-CT results showed the highest percentage of bone tissue ingrowths into the MSC-Scaffold at a distance of 2.5÷3.0 mm from the spikes bases. The first biomimetic fixation for resurfacing arthroplasty was successfully verified in 10 swines investigations using RKA endoprosthesis working prototypes. The performed research shows that the MSC-Scaffold allows for cementless and biomimetic fixation of resurfacing endoprosthesis components in periarticular cancellous bone.
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Affiliation(s)
- Piotr Rogala
- Department of Orthopaedics and Traumatology, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 Street 135/147, 61-545 Poznan, Poland
- Institute of Health Sciences, Hipolit Cegielski State College of Higher Education, Card. Stefan Wyszyński Street 38, 62-200 Gniezno, Poland
- Veterinary Surgery Department, Naramowicka Street 68, 61-619 Poznań, Poland
| | - Ryszard Uklejewski
- Institute of Health Sciences, Hipolit Cegielski State College of Higher Education, Card. Stefan Wyszyński Street 38, 62-200 Gniezno, Poland
- Department of Medical Bioengineering Fundamentals, Institute of Technology, Kazimierz Wielki University, Karol Chodkiewicz Street 30, 85-064 Bydgoszcz, Poland
- Department of Technology Design/Laboratory of Bone Implants Research and Design, Institute of Mechanical Technology, Poznan University of Technology, Piotrowo Street 3, 60-965 Poznan, Poland
| | - Mariusz Winiecki
- Department of Medical Bioengineering Fundamentals, Institute of Technology, Kazimierz Wielki University, Karol Chodkiewicz Street 30, 85-064 Bydgoszcz, Poland
- Department of Technology Design/Laboratory of Bone Implants Research and Design, Institute of Mechanical Technology, Poznan University of Technology, Piotrowo Street 3, 60-965 Poznan, Poland
| | - Mikołaj Dąbrowski
- Department of Orthopaedics and Traumatology, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 Street 135/147, 61-545 Poznan, Poland
- Department of Spondyloorthopaedics and Biomechanics, W. Dega University Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 Street 135/147, 61-545 Poznan, Poland
| | - Jacek Gołańczyk
- Veterinary Surgery Department, Naramowicka Street 68, 61-619 Poznań, Poland
| | - Adam Patalas
- Department of Technology Design/Laboratory of Bone Implants Research and Design, Institute of Mechanical Technology, Poznan University of Technology, Piotrowo Street 3, 60-965 Poznan, Poland
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Pyda M, Koczy B, Widuchowski W, Widuchowska M, Stołtny T, Mielnik M, Hermanson J. Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head. Med Sci Monit 2015; 21:304-9. [PMID: 25618763 PMCID: PMC4315641 DOI: 10.12659/msm.891031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Material/Methods Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul’s method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. Results The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score – UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Conclusions Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.
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Affiliation(s)
- Michał Pyda
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Śląskie, Poland
| | - Bogdan Koczy
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Śląskie, Poland
| | - Wojciech Widuchowski
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Śląskie, Poland
| | - Małgorzata Widuchowska
- Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Stołtny
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Śląskie, Poland
| | - Michał Mielnik
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Śląskie, Poland
| | - Jacek Hermanson
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Śląskie, Poland
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Olsen M, Al Saied M, Morison Z, Sellan M, Waddell JP, Schemitsch EH. The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty. Proc Inst Mech Eng H 2014; 228:1275-80. [PMID: 25515228 DOI: 10.1177/0954411914562872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended.
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Affiliation(s)
- Michael Olsen
- Martin Orthopaedic Biomechanics Laboratory, Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mohamed Al Saied
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Zachary Morison
- Martin Orthopaedic Biomechanics Laboratory, Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Sellan
- Martin Orthopaedic Biomechanics Laboratory, Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - James P Waddell
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
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