The purpose of this study was to compare the structural properties of a new vs. established design of composite replicate femurs and tibias. The new design has a cortical bone analog consisting of short-glass-fiber-reinforced (SGFR) epoxy, rather than the fiberglass-fabric-reinforced (FFR) epoxy in the currently available design. The hypothesis was that this new cortical bone analog would improve the uniformity of structural properties between specimens, while having mean stiffness values in the range of natural human bones. The composite replicate bones were tested under bending, axial, and torsional loads. In general, the new SGFR bones were significantly less stiff than the FFR bones, although both bone designs reasonably approximated the structural stiffnesses of natural human bones. With the exceptions of the FFR bone axial tests, the highest variability between specimens was 6.1%. The new SGFR bones had similar variability in structural properties when compared to the FFR bones under bending and torsional loading, but had significantly less variability under axial loading. Differences in epiphyseal geometry between the FFR and SGFR bones, and subsequent seating in the testing fixtures, may account for some of the differences in structural properties; axial stiffness was especially dependent on bone alignment. Stiffness variabilities for the composite replicate bones were much smaller than those seen with natural human bones. Axial strain distribution along the proximal-medial SGFR femur had a similar shape to what was observed on natural human femurs by other investigators, but was considerably less stiff in the more proximal locations.

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Trabecular bone (TB) is a complex quasi-random network of interconnected plates and rods. TB constantly remodels to adapt to the stresses to which it is subjected (Wolff s Law). In osteoporosis, this dynamic equilibrium between bone formation and resorption is perturbed, leading to bone loss and structural deterioration, both increasing fracture risk. Bone s mechanical behavior can only be partially explained by variations in bone mineral density, which led to the notion of bone structural quality. Previously, we developed digital topological analysis (DTA) which classifies plates, rods, profiles, edges, and junctions in a TB skeletal representation. Although the method has become quite popular, a major limitation of DTA is that it provides only hard classifications of different topological entities, failing to distinguish between narrow and wide plates. Here, we present a new method called volumetric topological analysis (VTA) for regional quantification of TB topology. At each TB location, the method uniquely classifies its topology on the continuum between perfect plates and perfect rods, facilitating early detections of TB alterations from plates to rods according to the known etiology of osteoporotic bone loss. Several new ideas, including manifold distance transform, manifold scale, and feature propagation have been introduced here and combined with existing DTA and distance transform methods, leading to the new VTA technology. This method has been applied to multi-detector CT and μCT images of four cadaveric distal tibia and five distal radius specimens. Both intra- and inter-modality reproducibility of the method has been examined using repeat CT and μCT scans of distal tibia specimens. Also, the method s ability to predict experimental biomechanical properties of TB via CT imaging under in vivo conditions has been quantitatively examined and the results found are very encouraging.

A laboratory test was undertaken to evaluate the interfacial frictional characteristics of cortical and cancellous bone, as well as a novel porous tantalum biomaterial (Hedrocel ® , Implex Corp.). Three sets of tests were conducted to measure the friction coefficients of (1) bovine cancellous bone against bovine cortical bone; (2) net-shape formed porous tantalum against bovine cortical and cancellous bone; and (3) electron-discharge-machine formed (EDM'd) porous tantalum against bovine cortical and cancellous bone. The bovine cortical bone was tested in three conditions: periosteum-intact, periosteum-denuded and surface-flattened. An inclined plane apparatus was used to determine the coefficients of friction. By gradually increasing the substrate tilt, the angle of slippage was determined, and the friction coefficient was calculated.The average friction coefficients of cancellous bone against periosteum-intact, periosteum-denuded and surface-flattened cortical bone were 0.91 ± 0.14, 0.61 ± 0.07 and 0.58 ± 0.06, respectively. Porous tantalum specimens prepared from a preshaped vitreous carbon skeleton, when tested against periosteum-intact, periosteum-denuded and surface-flattened cortical bone, and against cancellous bone, had average friction coefficients of 1.10 ± 0.18, 0.82 ± 0.15, 0.86 ± 0.11, and 0.98 ± 0.17, respectively. Porous tantalum specimens prepared by electron-discharge machining, when tested against periosteum-intact cortical bone, periosteum-denuded cortical bone and cancellous bone, had average friction coefficients of 1.75 ± 0.33, 0.74 ± 0.07, and 0.88 ± 0.09, respectively. The friction coefficient of the porous tantalum material was very high in comparison to natural bone autografts or allografts, and to conventional orthopedic implant coating materials (sintered beads and wire mesh). Other factors being equal, this high-friction characteristic would be expected to translate into higher initial stability of a porous tantalum implant, as compared to natural bone grafts.

Background: Joint instability has long been empirically recognized as a leading risk factor for osteoarthritis. However,

BACKGROUND CONTEXT: Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed. PURPOSE: To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression. STUDY DESIGN/SETTING: Systematic review and meta-analysis. PATIENT SAMPLE: The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7−166). OUTCOME MEASURES: Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events. METHODS: This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes' raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence FDA device/drug status: Not applicable.

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