Association between mechanical stability, cortical strains and histology, of femurs retrieved with uncemented femoral prostheses

Comadoll, James L; Bianco, Peter T.; Bechtold, Joan E.; Gustilo, Ramon B.

doi:10.1016/0021-9290(92)90157-v

Cited by 2 publications

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“…Structural bone loss, increased infection and dislocation risk are also present in the revision setting (Fig. 11) [9,43], but are not present in the experimental model. Despite these limitations, the model's recalcitrant healing following the revision protocol does provide a more stringent environment that the more straightforward primary bone bed.…”

Section: Discussionmentioning

confidence: 99%

Experimental and Numerical Models of Complex Clinical Scenarios; Strategies to Improve Relevance and Reproducibility of Joint Replacement Research

Bechtold

Swider²,

Goreham-Voss

et al. 2016

Journal of Biomechanical Engineering

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This research review aims to focus attention on the effect of specific surgical and host factors on implant fixation, and the importance of accounting for them in experimental and numerical models. These factors affect (a) eventual clinical applicability and (b) reproducibility of findings across research groups. Proper function and longevity for orthopedic joint replacement implants relies on secure fixation to the surrounding bone. Technology and surgical technique has improved over the last 50 years, and robust ingrowth and decades of implant survival is now routinely achieved for healthy patients and first-time (primary) implantation. Second-time (revision) implantation presents with bone loss with interfacial bone gaps in areas vital for secure mechanical fixation. Patients with medical comorbidities such as infection, smoking, congestive heart failure, kidney disease, and diabetes have a diminished healing response, poorer implant fixation, and greater revision risk. It is these more difficult clinical scenarios that require research to evaluate more advanced treatment approaches. Such treatments can include osteogenic or antimicrobial implant coatings, allo-or autogenous cellular or tissue-based approaches, local and systemic drug delivery, surgical approaches. Regarding implantrelated approaches, most experimental and numerical models do not generally impose conditions that represent mechanical instability at the implant interface, or recalcitrant healing. Many treatments will work well in forgiving settings, but fail in complex human settings with disease, bone loss, or previous surgery. Ethical considerations mandate that we justify and limit the number of animals tested, which restricts experimental permutations of treatments. Numerical models provide flexibility to evaluate multiple parameters and combinations, but generally need to employ simplifying assumptions. The objectives of this paper are to (a) to highlight the importance of mechanical, material, and surgical features to influence implant-bone healing, using a selection of results from two decades of coordinated experimental and numerical work and (b) discuss limitations of such models and the implications for research reproducibility. Focusing model conditions toward the clinical scenario to be studied, and limiting conclusions to the conditions of a particular model can increase clinical relevance and research reproducibility.

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Section: Discussionmentioning

confidence: 99%

Experimental and Numerical Models of Complex Clinical Scenarios; Strategies to Improve Relevance and Reproducibility of Joint Replacement Research

Bechtold

Swider²,

Goreham-Voss

et al. 2016

Journal of Biomechanical Engineering

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Bone ingrowth in the presence of particulate polyethylene

Bechtold¹,

Kubic²,

Søballe³

2002

The Journal of Bone and Joint Surgery

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We have investigated whether the presence of polyethylene (PE) alone is sufficient to cause an aggressive periprosthetic tissue response, or whether certain mechanical interface conditions can allow bone to grow while in the presence of PE. An experimental implant was loaded in the presence and absence of particulate PE under stable and unstable conditions. Bone with a thin, discontinuous fibrous membrane formed in both groups of stable implants, either in the presence or absence of PE. By contrast, a continuous fibrous membrane consistently formed in both groups of unstable implants. The membrane consisted of loose fibrous connective tissue when PE was absent, and dense connective tissue with macrophages and a synovial lining when PE was present. In this model, if the interface was stable, the presence of PE was not sufficient to prevent the formation of bone or to produce a phagocytic tissue response. Only when the interface was unstable did a fibrous membrane form, and only then in the presence of PE.

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Association between mechanical stability, cortical strains and histology, of femurs retrieved with uncemented femoral prostheses

Cited by 2 publications

References 0 publications

Experimental and Numerical Models of Complex Clinical Scenarios; Strategies to Improve Relevance and Reproducibility of Joint Replacement Research

Experimental and Numerical Models of Complex Clinical Scenarios; Strategies to Improve Relevance and Reproducibility of Joint Replacement Research

Bone ingrowth in the presence of particulate polyethylene

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