An evaluation of electrical stimulation for improving periprosthetic attachment

Abstract

Transcutaneous osseointegrated implants (TOI) have been shown to improve functionality for patients with limb loss by allowing direct skeletal attachment between an exoprosthesis and host bone. However, a lengthy rehabilitation period has limited the expansion of TOI and may be accelerated with electrical stimulation. The purpose of this study was to determine the ability of direct current (DC) cathode stimulation to enhance osseointegration of intramedullary implants in skeletally matured rabbits. Bilateral implants were inserted in the hind limbs of 25 adult female rabbits. The left hind limb of each animal was continually stimulated with a potential difference of 0.55 volts based on finite element analysis predictions. After sacrifice, the limbs were divided into two groups: Group I for histology and Group II for biomechanical testing. The bone-implant construct was evaluated in the Group I animals using appositional bone index (ABI), mineral apposition rates (MAR), histological staining, and scanning electron microscopy (SEM). Group II implants were sectioned and subjected to mechanical push-out tests. Data indicated no statistical differences for ABI, MAR, and porosity between the electrically stimulated implants (ESI) and the unstimulated control implants (UCI) at three weeks and six weeks. Higher mechanical push-out forces were observed in the UCI group at six weeks (p = 0.034). Data indicated that DC cathode stimulation may improve suboptimal implant "fit and fill" as an increase in trabecular bone was noted around the cathode in the ESI group. However, longer time duration animal studies and variations in electrical modalities may be required before electrically induced osseointegration becomes clinically feasible.

Biocompatibility of (Ba,Ca)(Zr,Ti)O3 piezoelectric ceramics for bone replacement materials

“…One of these mechanisms is the formation of electric potentials in load‐bearing bone upon application of mechanical stress (Rajabi, Jaffe, & Arinzeh, ; Riddle & Donahue, ). In vivo studies indicate that direct current electrical stimulation applied to an implant site enhances initial‐stage implant osseointegration, improves interfacial strength, and increases bone formation (Dergin et al, ; Isaacson et al, ; Salman & Park, ). In current clinical practice, electrical stimulation is used to treat non‐union fractures via direct current, inductive, and capacitive coupling procedures (Aleem et al, ; Griffin & Bayat, ; Kuzyk & Schemitsch, ).…”

Lattice Cleaving: A Multimaterial Tetrahedral Meshing Algorithm with Guarantees

“…The first simulation is from an osseointegrated bone implant experiment, studying the effects of using direct current cathode stimulation to enhance the ability of implants to fuse into the skeletons of rabbits [26]. The second simulation is used for modeling the effects of EEG source on a human skull [17].…”

Establishing Multiscale Models for Simulating Whole Limb Estimates of Electric Fields for Osseointegrated Implants

“…Electrically induced osseointegration has been demonstrated in humans [6, 7] and experimentally validated in an in vivo animal study [11] using the multiscale modeling process described herein as an initial measure. Preliminary work has demonstrated that electrical stimulation may alleviate problems with poor implant fit and fill [11] and with additional experimental refinement, may directly demonstrate the link between mutiscale modeling assumptions and periprosthetic skeletal attachment.…”

“…Preliminary work has demonstrated that electrical stimulation may alleviate problems with poor implant fit and fill [11] and with additional experimental refinement, may directly demonstrate the link between mutiscale modeling assumptions and periprosthetic skeletal attachment. However, before electrical stimulation can be used as a therapeutic aid, model refinements which account for tissue orientation and fiber direction will be necessary to increase model accuracy.…”

“…However, to our knowledge only three studies to date, all from our laboratory, have evaluated the potential for electrically induced TOI [6, 7, 11]. The mechanism of electrical stimulation based ossification has been associated with electrochemical reactions that alter pH and oxygen content around a bony defect [10].…”