Comparison of two pore sizes of LAE442 scaffolds and their effect on degradation and osseointegration behavior in the rabbit model

The magnesium alloy LAE442 emerged as a possible bioresorbable bone substitute over a decade ago. In the present study, using the investment casting process, scaffolds of the Magnesium (Mg) alloy LAE442 with two different and defined pore sizes, which had on average a diameter of 400 μm (p400) and 500 μm (p500), were investigated to evaluate degradation and osseointegration in comparison to a ß‐TCP control group. Open‐pored scaffolds were implanted in both greater trochanter of rabbits. Ten scaffolds per time group (6, 12, 24, and 36 weeks) and type were analyzed by clinical, radiographic and μ‐CT examinations (2D and 3D). None of the scaffolds caused adverse reactions. LAE442 p400 and p500 developed moderate gas accumulation due to the Mg associated in vivo corrosion, which decreased from week 20 for both pore sizes. After 36 weeks, p400 and p500 showed volume decreases of 15.9 and 11.1%, respectively, with homogeneous degradation, whereas ß‐TCP lost 74.6% of its initial volume. Compared to p400, osseointegration for p500 was significantly better at week 2 postsurgery due to more frequent bone‐scaffold contacts, higher number of trabeculae and higher bone volume in the surrounding area. No further significant differences between the two pore sizes became apparent. However, p500 was close to the values of ß‐TCP in terms of bone volume and trabecular number in the scaffold environment, suggesting better osseointegration for the larger pore size

Differential thermography for experimental, full-field stress analysis of hip arthroplasty

A hip prosthesis implant produces a significant deviation in the stress pattern compared with the physiologic condition. In this work, the stress patterns are evaluated experimentally on synthetic femora, by means of thermoelastic stress analysis. Two factors have been considered: stem implantation and head offset. Stress maps were obtained using differential thermography and correlated to these factors. Thermoelastic stress maps have demonstrated to be sensitive to the implant and the head offset. In detail, the standard deviation of stresses can reduce from -5% to -50% (with reference to the physiologic one), depending on stem design; peak stresses change their position or disappear for different implant position or press-fitting, the sensitivity of average stresses to the offset is at least equal to 0.07MPa/mm. On the whole, a methodology was developed, allowing the experimental evaluation and comparison of the stress distributions produced by different implant

Clinical and radiological evaluation of Trabecular Metal and the Smith–Robinson technique in anterior cervical fusion for degenerative disease: a prospective, randomized, controlled study with 2-year follow-up

A prospective, randomized, controlled study was carried out to compare the radiological and clinical outcomes after anterior cervical decompression and fusion (ACDF) with Trabecular Metal™ (TM) to the traditional Smith–Robinson (SR) procedure with autograft. The clinical results of cervical fusion with autograft from the iliac crest are typically satisfactory, but implications from the donor site are frequently reported. Alternative materials for cervical body interfusion have shown lower fusion rates. Trabecular Metal is a porous tantalum biomaterial with structure and mechanical properties similar to that of trabecular bone and with proven osteoconductivity. As much as 80 consecutive patients planned for ACDF were randomized for fusion with either TM or tricortical autograft from the iliac crest (SR) after discectomy and decompression. Digitized plain radiographic images of 78 (98%) patients were obtained preoperatively and at 2-year follow-up and were subsequently evaluated by two senior radiologists. Fusion/non-fusion was classified by visual evaluation of the A–P and lateral views in forced flexion/extension of the cervical spine and by measuring the mobility between the fused vertebrae. MRI of 20 TM cases at 2 years was successfully used to assess the decompression of the neural structures, but was not helpful in determining fusion/non-fusion. Pain intensity in the neck, arms and pelvis/hip were rated by patients on a visual analog scale (VAS) and neck function was rated using the Neck Disability Index (NDI) the day before surgery and 4, 12 and 24 months postoperatively. Follow-ups at 12 and 24 months were performed by an unbiased observer, when patients also assessed their global outcome. Fusion rate in the SR group was 92%, and in the TM group 69% (P < 0.05). The accuracy of the measurements was calculated to be 2.4°. Operating time was shorter for fusion with TM compared with autograft; mean times were 100 min (SD 18) and 123 min (SD 23), respectively (P = 0.001). The patients’ global assessments of their neck and arm symptoms 2 years postoperatively for the TM group were rated as 79% much better or better after fusion with TM and 75% using autograft. Pain scores and NDI scores were significantly improved in both groups when compared with baseline at all follow-ups, except for neck pain at 1 year for the TM group. There was no statistically significant difference in clinical outcomes between fusion techniques or between patients who appeared radiologically fused or non-fused. There was no difference in pelvic/hip pain between patients operated on with or without autograft. In our study, Trabecular Metal showed a lower fusion rate than the Smith–Robinson technique with autograft after single-level anterior cervical fusion without plating. There was no difference in clinical outcomes between the groups. The operative time was shorter with Trabecular Metal implants

Effective anisotropic elastic constants of bimaterial interphases: comparison between experimental and analytical techniques

The effective elastic constants of a bimaterial composite were experimentally measured with the goal of validating the numerical predications of these constants made by homogenization theory. Secondly, solutions predicted by homogenization theory were compared to predictions made with more standard composite theories. Composite specimens consisting of titanium and epoxy were developed to mimic a porous titanium/tissue interphase. Tensile and shear tests (ASTM D3983) measured the stiffness along the porous coating/epoxy interphase ( E L ), across the interphase ( E T ) and in shear ( G LT ). No significant differences in moduli were found between the experimental measurements and predictions made with homogenization theory, nor between the experimental measurements and Hashin-Shtrikman estimates. Homogenization theory predicted results usually within 20% of Hashin-Shtrikman estimates, but typically more than 50% different from what is predicted by the rule of mixtures. However, homogenization theory allows calculation of anisotropic stiffness estimates and local strains, neither of which is possible using Hashin-Shtrikman estimates. With this experimental validation, the accuracy of homogenization theory for use in implant/tissue interface mechanics applications is confirmed. Since the composite interphase is anisotropic and more compliant in the transverse direction, with stiffness an order of magnitude lower across the interphase, local mechanics, tissue ingrowth and remodeling may be strongly directional dependent.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46748/1/10856_2004_Article_BF00058722.pd

Basic Science Considerations in Primary Total Hip Replacement Arthroplasty

Total Hip Replacement is one of the most common operations performed in the developed world today. An increasingly ageing population means that the numbers of people undergoing this operation is set to rise. There are a numerous number of prosthesis on the market and it is often difficult to choose between them. It is therefore necessary to have a good understanding of the basic scientific principles in Total Hip Replacement and the evidence base underpinning them. This paper reviews the relevant anatomical and biomechanical principles in THA. It goes on to elaborate on the structural properties of materials used in modern implants and looks at the evidence base for different types of fixation including cemented and uncemented components. Modern bearing surfaces are discussed in addition to the scientific basis of various surface engineering modifications in THA prostheses. The basic science considerations in component alignment and abductor tension are also discussed. A brief discussion on modular and custom designs of THR is also included. This article reviews basic science concepts and the rationale underpinning the use of the femoral and acetabular component in total hip replacement