Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat

We hypothesized that reduced stem stiffness of orthopaedic implants contributes to a high risk of loosening, since interface stresses and relative motions may exceed a tolerable range. To study this hypothesis, three types of load-bearing implant with different stiffnesses were inserted into the tibia of the goat. Histological analysis was performed of bone repair after insertion of the implant, bone ingrowth, interface disruption and loosening. A finite element model of the configuration provided the quantitative range of interface stresses and relative motions for the present experiment. The implants were made out of stainless steel, hollow titanium and a thin titanium core covered with a polyacetal coating. The stiffness ratios of these implants were approximately 10:4:1, respectively. All implants were coated with a layer of hydroxyapatite (HA) in order to minimize the possible biological effects of the different implant materials. Irrespective of the type of implant, there was a repair phase that lasted 6-12 weeks. The stiff implants functioned well. Large areas of bone bonding to the HA layer were found after the repair phase at 12 weeks postoperatively. After 24 weeks, some signs of loosening were observed. More loosening occurred with the hollow titanium and polyacetal implants, mainly during the repair phase. Three hollow titanium and three polyacetal coated implants survived this period, and were killed after 24 weeks. The integrity of the HA layer at the bone-implant interface of the titanium implants was good. In the polyacetal implants, the repair reaction of the cortical bone was incomplete. Bone ingrowth into HA was largely lacking. In conclusion, we found significant differences in the repair and interface reactions around implants of different stiffness. Stiff implants showed favourable initial interface conditions for bone ingrowth. Intermediate and flexible implants provoked unfavourable interface conditions for initial bone ingrowth. The finite element study showed that the flexible stems produce larger micromotions and higher interface stresses at the bone-prosthesis interface than the stiff stems, indicating an explanation for the histological findings.     

Diagnostic and therapeutic thoracic surgery in leukemia and severe aplastic anemia

We examined the hypothesis that peak magnitude strain gradients are spatially correlated with sites of bone formation. Ten adult male turkeys underwent functional isolation of the right radius and a subsequent 4-week exogenous loading regimen. Full field solutions of the engendered strains were obtained for each animal using animal-specific, orthotropic finite element models. Circumferential, radial, and longitudinal gradients of normal strain were calculated from these solutions. Site-specific bone formation within 24 equal angle pie sectors was determined by automated image analysis of microradiographs taken from the mid-diaphysis of the experimental radii. The loading regimen increased mean cortical area (+/-SE) by 32.3 +/- 10.5% (p = 0.01). Across animals, some periosteal bone formation was observed in every sector. The amount of periosteal new bone area contained within each sector was not uniform. Circumferential strain gradients (r2 = 0.36) were most strongly correlated with the observed periosteal bone formation. SED (a scalar measure of stress/strain magnitude with minimal relation to fluid flow) was poorly correlated with periosteal bone formation (r2 = 0.01). The combination of circumferential, radial, and longitudinal strain gradients accounted for over 60% of the periosteal new bone area (r2 = 0.63). These data indicate that strain gradients, which are readily determined given a knowledge of the bone's strain environment and geometry, may be used to predict specific locations of new bone formation stimulated by mechanical loading.     

Surface-dimpled commercially pure titanium implant and bone ingrowth

The purpose of this investigation was to examine the effect of the surface macrostructure of a dimpled commercially pure titanium (cp Ti) implant on bone ingrowth in vivo by means of histological examination and a push-out test. Cylindrical implants were inserted in one femur of each experimental rabbit and the animals were killed at 1.5, 3 and 13 months after implantation. The femur with the implant of each animal was then examined in a push-out test. The fracture surfaces of the bone-implant interface after the push-out test were examined under light and electron microscopy. It seems that the dimpled cp Ti surface results in the increased retention of the cp Ti implant in bone due to interlocking between vital bone and the dimples.     

A histomorphometric and histologic analysis of the implant interface in five successful, autopsy-retrieved, noncemented porous-coated knee arthroplasties

Five clinically successful, primary uncemented porous-coated anatomic knee implants were retrieved postmortem, 13-56 months after implantation, and were sectioned and evaluated histologically and histomorphometrically for bone ingrowth. The prosthesis-bone interface was divided into the following four zones: (1) the tissue prosthetic surface interface; (2) the beaded area; (3) the immediate beadless area; and (4) the marrow space. Although fibroosseous ingrowth was present in all cases, it varied quantitatively with each case and component. Average component bone ingrowth for the prosthesis interface (Zones 1 and 2) of patellae was 29%; tibias, 6%; and femora, 8%. In Zone 3, the percentage of bone apposed to the prosthesis for the patellae was 53%; tibias 36%; and femora, 32%. Zone 4, the marrow space, was not quantitated. The fibrous tissue filling nonbone-ingrown porous space in Zone 2 appeared "ligamentoid," connecting bone to beads within Zone 2 and between Zones 2 and 3. Zone 3 exhibited a bony plate formation parallel to the prostheses. No significant inflammation was noted. Overall there was more bone ingrowth into Zone 3 than Zones 1 and 2 with greater bone ingrowth found in the patellar components. The implant interface in clinically successful noncemented porous-coated prostheses of this design is characterized histologically by a noninflammatory fibroosseous ingrowth of varying degrees, and the fibrous component of this composite structure exhibits a highly organized pattern.     

Histological evaluation of bone reactions to aluminium oxide dental implants in man: a case report

Alumina implants have been shown to possess high biocompatibility. The authors present the case of an aluminium oxide ceramic implant removed because of fracture of the abutment after a 30-month loading period. It was possible to observe microscopically that the implant was covered by highly mineralized mature compact lamellar bone; no connective tissue or inflammatory cells were present at the interface. Osteocytes were observed very close to the bone-implant interface. These features indicate the good biocompatibility of the implant.     

Remodeling dynamics of bone supporting rigidly fixed titanium implants: a histomorphometric comparison in four species including humans

The long-term maintenance of a rigid bone-implant interface (osseointegration) is the clinical goal of most dental implant systems, although the biological mechanism for retaining a foreign object in living bone is unclear. Little data are available on the physiological turnover (remodeling) of the supporting osseous tissue. The objective of this study was to histomorphometrically assess bone remodeling surrounding rigidly integrated titanium implants in multiple species. Implants, in place from 6 months to 5 years, were recovered from human, monkey, dog, and rabbit subjects. With the use of stereological point-hit and linear-intercept methods, indices of bone formation and resorption were determined. Remarkably similar patterns emerged among all investigated species. Repeated-measures ANOVA showed a 3 to 9 fold increase in remodeling within 1 mm of the bone-implant interface (P<0.001; data expressed as percent turnover / month, mean +/- SEM for n = 3-11). All morphometric indices (percent new bone, percent fluorochrome-labeled bone, percent resorption space) showed similar trends. These data suggest that the physiological mechanism for maintaining rigid osseous integration (osseointegration) is a sustained elevation of remodeling adjacent to the bone-implant interface.     

Influence of muscle forces on femoral strain distribution

Musculoskeletal loading influences the stresses and strains within the human femur and thereby affects the processes of bone modeling and remodeling. It is essential for implant design and simulations of bone modeling processes to identify locally high or low strain values which may lead to bone resorption and thereby affect the clinical outcome. Using a finite element model the stresses and strains of a femur with all thigh muscle and joint contact forces were calculated for four phases of a gait cycle. Reduced load sets with only a few major muscles were analyzed alternatively. In a completely balanced femur with all thigh muscles the stress and strain patterns are characterized by combined bending and torsion throughout the bone. Similar to in vivo recordings, the model with all thigh muscles showed peak surface strains below 2000 mu epsilon (45% gait cycle). Under simplified load regimes surface strains reached values close to 3000 mu epsilon. Within the proximal femur, the simplified load regimes produced differences in strain as high as 26% in comparison to those with all thigh muscles included. This difference is reduced to 5% if the adductors are added to a loading consisting of hip contact, abductors and ilio-tibial band. This study demonstrates the importance of an ensemble of muscle forces to reproduce a physiological strain distribution in the femur. Analytical attempts to simulate bone modeling, remodeling or bone density distributions should therefore rely on fully balanced external load regimes which account for the role of the various soft tissue forces.     

GBR with an e-PTFE membrane associated with DFDBA: histologic and histochemical analysis in a human implant retrieved after 4 years of loading

As a result of a fracture to the cemented post and core, a pure titanium implant was extracted from a 54-year-old patient after 4 years of clinical loading. At implantation, the implant was positioned into an extraction socket and the defect was treated with an e-PTFE membrane associated with a DFDBA graft. At retrieval the implant underwent histologic and histochemical examination to assess the characteristics of the regenerated bone after 4 years of prosthetic loading. The implant showed an angular bony defect at the smooth collar, but the bone-implant direct contact rate seemed to be elevated in the remaining implant surface. Normal transmitted and polarized light examinations demonstrated that most of the DFDBA particles were resorbed and substituted by vital newly formed bone. The regenerated bone appeared compact with secondary osteons and large haversian canals; however, some partially mineralized remnants residuated in the spaces, between the osteons. Within the limits of this study, the authors concluded that DFDBA can be substituted by the host bone, but the rate of substitution is very slow and not complete after 4 years. From a clinical point of view, however, the load-bearing capacity of the bone regenerated with the membrane technique associated with DFDBA appeared to be similar to that of normal bone.     

Bone response to implant surface morphology

This study was designed to measure implant osseointegration using different surface treatments. Bilateral distal intramedullary implantation of titanium cylinders 25 mm x 5 mm was performed in 60 rabbits. The 3 surfaces tested were fiber mesh, mean pore size 400 microns; grit-blasted, mean surface roughness 6 microns; and acid-etched, mean surface roughness 18 microns. Scanning electron microscopy was used to measure the percentage of the surface of each implant in contact with bone at 2, 6, and 12 weeks postimplantation. Mechanical pull-out testing of the bone-implant interface was performed at 12 weeks. Overall, acid-etched surfaces demonstrated greater mean osseointegration than fiber mesh surfaces. All 3 surfaces demonstrated similar interface strengths. Acid etching has potential as a means of enhancing bony apposition in cementless fixation.     

Biologic attachment of an allograft bone and tendon transplant to a titanium prosthesis

An Achilles tendon allograft with its bony insertion was used to bridge a Titanium implant, containing an endoprosthetic tendon anchor, and the sheep biceps muscle. Twelve sheep were operated on unilaterally and followed up clinically and histologically for 2, 4 (n = 2), 8, and 12 months (n = 4). Full function of the front limb was regained after 8 to 12 weeks. There were no signs of mechanical loosening at all times. The morphologic changes at the bone block and implant fixation site were an initial revascularization of the allograft bone, which was observed at 2 months and enhanced at 4 months but occurred without any evidence of bone remodeling. This was changed in all specimens taken at 8 and 12 months where intensive new bone development, remodeling, and bone ingrowth in the titanium implant was found. Bone mass was shifted significantly to the tendon insertion half of the bone block because of a creeping substitution of the cancellous allograft bone and bone ingrowth to the implant. Overall bone mass slightly decreased with time but resorption of allograft bone outweighed new bone development only at lesser loaded areas. Transplantation of a bone and tendon allograft to an implant resulted in a revitalized, mechanically stable, and biologically anchored compound.     

Microscopical features in retrieved human Branemark implants: a report of 19 cases

The authors present a histologic analysis of 19 Branemark titanium implants retrieved for different causes: four implants were removed for abutment fracture, one for dental nerve dysesthesia, two for bone overheating, two for peri-implantitis, nine for mobility, one for unknown causes. In the implants removed for fracture a high bone-implant contact percentage was present (71.83 +/- 4.96%) with compact, mature bone at the interface. The picture of the failure due to bone overheating was characteristic with the presence of bone sequestra and of a gap between implant and bone filled by lymphocytes and plasma cells: many bacteria surrounded the necrotic bone and no newly regenerated bone was present. In peri-implantitis an inflammatory infiltrate was observed in the peri-implant tissues: a dense fibrous connective tissue was present around implants failed for mobility. The microscopical picture is certainly extremely important in identifying the causal determinants of an implant failure.     

Cement-mantle thickness affects cement strains in total hip replacement

Bone cement is commonly used to affix femoral implants to the bone during total hip reconstruction. Previous studies suggest that the expected life of a cemented femoral implant may depend on the thickness of the cement mantle surrounding the implant and the implant geometry. The purpose of this study was to determine whether different cement-mantle thicknesses and femoral stem sizes affected strain patterns in the bone cement around cemented femoral stems. Two different sizes of cobalt-chromium stems were cemented into composite femora with varying cement-mantle thickness. Strain gages were embedded in the cement mantle and the implanted stems were loaded axially and under conditions simulating walking and standing. An increase in stem size with the same cement-mantle thickness (approximately 2.2 mm) caused a 65% decrease in proximal medial cement strains. Increasing cement mantle thickness from 2.4 to 3.7 mm caused substantial strain reductions in the distal cement (40-49%). We conclude that increased cement-mantle thickness around femoral stems may increase the fatigue life of a bone-implant system by reducing peak strains within the cement.     

Investigation on the Failure Mechanism of DP590-22MnB5 (Quenched) and DP590-DP590 Spot-Welding Joints

The failure mechanism of DP590-22MnB5(quenched) and DP590-DP590 spot-welding joints is studied through lap-shearing experiments,metallographic observation and three-dimensional finite element simulation.Both joints cracked on the DP590 steel,but the tensile shear strength of the DP590-22MnB5(quenched) joint is greater than that of the DP590-DP590 joint.A finite element model for the lap-shearing experiment is established according to the mechanical properties of DP590 and 22MnB5(quenched) steels and the metallographic analysis of welding spots.The simulation results show that the difference in the axis rotation of the two welding spots causes different distributions of stress and strain,which shifts shear loading condition to opening loading condition.Due to larger axis rotation angle of the DP590-DP590 joint,the stress concentration occurs at the middle of the nugget circumference,and it results in lower tensile shear strength of the DP590-DP590 joint.     

Effect of coronary artery reperfusion on transmural myocardial remodeling in dogs

BACKGROUND: The effects of reperfusion after coronary occlusion on transmural remodeling of the ischemic region early and late after nontransmural infarction must importantly affect the recovery of regional function. Accordingly, analysis of local volume and three-dimensional strain was performed using a finite element method to determine regional remodeling. Systolic and remodeling strains were measured using radiographic imaging of three columns (approximately 1 cm apart) of four to six gold beads implanted across the left ventricular posterior wall in 6 dogs. METHODS AND RESULTS: After a control study, infarction was produced by 2 to 4 hours of proximal left circumflex coronary artery occlusion followed by reperfusion. Follow-up studies were performed at 2 days, 3 weeks, and 12 weeks with the dogs under anesthesia and in closed-chest conditions. Biplane cineradiography was performed to obtain the three-dimensional coordinates of the beads. At 2 days, end-systolic strains were akinetic with loss of normal transmural gradients of shortening and thickening. Remodeling strains (RS) were determined by use of a nonhomogeneous finite element method by referring the end-diastolic configuration during follow-up studies to its control state at matched end-diastolic pressures and heart rates. Tissue volume at 2 days increased substantially, more at the endocardium (30 +/- 7%) than at the epicardium (5 +/- 12%, P < .01); the increase was associated with an average RS in the wall-thickening direction of 0.18 +/- 0.15 (P < .01) with all other RS near zero. At 12 weeks systolic function partially recovered, with normal wall thickening in the epicardium (radial strain, 0.081 +/- 0.056 [control] versus 0.113 +/- 0.088 [12 weeks]) but with dysfunction in the endocardium (0.245 +/- 0.108 [control] versus 0.111 +/- 0.074 [P < .01] [12 weeks]). This inability of the inner wall to recover function may be related to increased transmural torsional shear and negative longitudinal-radial transverse shear in the inner wall. Volume loss occurred at 12 weeks in the endocardium (-36 +/- 16%) corresponding to transmural gradients in longitudinal RS and both transverse shear RS. Negative longitudinal RS was greater at the endocardium (-0.20 +/- 0.10) than at the epicardium (-0.06 +/- 0.05, P < .01). CONCLUSIONS: These results indicate the presence of marked subendocardial edema 2 days after reperfusion following 2 to 4 hours of coronary occlusion. At 3 months after reperfusion, however, there was volume loss in the inner wall due to shrinkage along the myofiber direction with reduced transmural function and loss of longitudinal shortening, while both tissue volume and function recovered completely in the outer wall.     

Prolonged expression of zinc finger immediate-early gene mRNAs and decreased protein synthesis following kainic acid induced seizures

STUDY DESIGN: A high-resolution strain measurement technique was applied to axially loaded parasagittal sections from thoracic spinal segments. OBJECTIVES: To establish a new experimental technique, develop data analysis procedures, characterize intrasample shear strain distributions, and measure intersample variability within a group of morphologically diverse samples. SUMMARY OF BACKGROUND DATA: Compression of intact vertebral bodies yields structural stiffness and strength, but not strain patterns within the trabecular bone. Finite element models yield trabecular strains but require uncertain boundary conditions and material properties. METHODS: Six spinal segments (T8-T10) were sliced in parasagittal sections 6-mm thick. Axial compression was applied in 25-N increments up to sample failure, then the load was removed. Contact radiographs of the samples were made at each loading level. Strain distributions within the central vertebral body were measured from the contact radiographs by an image correlation procedure. RESULTS: Intrasample shear strain probability distributions were log-normal at all load levels. Shear strains were concentrated directly inferior to the superior end-plate and adjacent to the anterior cortex, in regions where fractures are commonly seen clinically. Load removal restored overall sample shape, but measurable residual strains remained. CONCLUSIONS: This experimental model is a suitable means of studying low-energy vertebral fractures. The methods of data interpretation are consistent and reliable, and strain patterns correlate with clinical fracture patterns. Quantification of intersample variability provides guidelines for the design of future experiments, and the strain patterns form a basis for validation of finite element models. The results imply that strain uniformity is an important criterion in assessing risk of vertebral failure.     

The distribution of plastic deformation in a metal matrix composite caused by straining transverse to the fibre direction

Distributions of equivalent plastic strains in an A16061/SiC fibre composite measured using the electron back scatter pattern (EBSP) technique were compared to plastic strain and stress distributions calculated using a continuum mechanics model solved by finite element analysis (FEA). Close to the interface EBSP measurements indicated higher dislocation densities than expected for strains calculated in such a region using the FEA model, the excess dislocations presumably being necessary to preserve the continuity of the interface. EBSP measurements also indicated considerable dislocation density in matrix regions where the FEA model calculated small plastic strains due to the production of a nearly hydrostatic tensile stress state. Inhomogeneities in the microstructure of the real matrix material can generate local shear stresses and so lead to production of dislocations even though the far field stress state has no shear component. Thus the dislocation density was controlled by the magnitude of the hydrostatic tension rather than the deviatoric stress components.     

Testing and Modeling of Soil-Structure Interface

An accurate modeling of soil-structure interfaces is very important in order to obtain realistic solutions of many soil-structure interaction problems. To study the mechanical characteristics of soil-structure interface, a series of direct shear tests were performed. A charged-coupled-device camera was used to observe the sand particle movements near the interface. It is shown that two different failure modes exist during interface shearing. Elastic perfect-plastic failure mode occurs along the smooth interface, while strain localization occurs in a rough interface accompanied with strong strain-softening and bulk dilatancy. To describe the behavior of the rough interface, this paper proposes a damage constitutive model with ten parameters. The parameters are identified using data from laboratory interface shear tests. The proposed model is capable of capturing most of the important characteristics of interface behavior, such as hardening, softening, and dilative response. The interface behaviors under direct and simple shear tests have been well predicted by the model. Furthermore, the present model has been implemented in a finite element procedure correctly and calculation results are satisfactory.     

Reinforcement of PMMA bone cement with a continuous wire coil--a 3D finite element study

The changes in the mechanical response of a bone cement reinforcement, comprised of a continuous stainless steel coil imbedded within the PMMA bone cement matrix surrounding the distal tip of the total hip arthroplasty, was investigated. To achieve this, a 3D finite element model depicting two and one half rotations of the coil imbedded within the cement at the distal tip was constructed. Ideally, the wire coil should reduce the radial, and to a greater extent, the hoop stresses developing within the cement and at the cement-stem interface. As a means of comparison, a control model of only bone cement was also built. For the radial stresses, the control had about 4.5 times the compressive stress of the reinforced models (0.039 (+/-0.00065) MPa vs. 0.0087 (+/-0.0012) MPa) at the cement-stem interface. The tensile hoop stresses were also 4.5 times higher (4.272 (+/-0.0147) MPa and 0.95 (+/-0.0052) MPa) for the control than for the reinforced models. This indicates that the wire coil reinforcement is effective in reducing the cement mantle's radial and, more importantly, the hoop stresses which may lead to the failure of both the cement and the implant as a whole.     

Yield strain behavior of trabecular bone

If bone adapts to maintain constant strains and if on-axis yield strains in trabecular bone are independent of apparent density, adaptive remodeling in trabecular bone should maintain a constant safety factor (yield strain/functional strain) during habitual loading. To test the hypothesis that yield strains are indeed independent of density, compressive (n = 22) and tensile (n = 22) yield strains were measured without end-artifacts for low density (0.18 +/- 0.04 g cm(-3)) human vertebral trabecular bone specimens. Loads were applied in the superior-inferior direction along the principal trabecular orientation. These 'on-axis' yield strains were compared to those measured previously for high-density (0.51 +/- 0.06 g cm(-3)) bovine tibial trabecular bone (n = 44). Mean (+/- S.D.) yield strains for the human bone were 0.78 +/- 0.04% in tension and 0.84 +/- 0.06% in compression; corresponding values for the bovine bone were 0.78 +/- 0.04 and 1.09 +/- 0.12%, respectively. Tensile yield strains were independent of the apparent density across the entire density range (human p = 0.40, bovine p = 0.64, pooled p = 0.97). By contrast, compressive yield strains were linearly correlated with apparent density for the human bone (p < 0.001) and the pooled data (p < 0.001), and a suggestive trend existed for the bovine data (p = 0.06). These results refute the hypothesis that on-axis yield strains for trabecular bone are independent of density for compressive loading, although values may appear constant over a narrow density range. On-axis tensile yield strains appear to be independent of both apparent density and anatomic site.