Biomechanics of Implant Fixation in Osteoporotic Bone

Anderson, Ken; Ko, Frank C.; Virdi, Amarjit S.; Sumner, Dale R.; Ross, Ryan D.

doi:10.1007/s11914-020-00614-2

Cited by 15 publications

(10 citation statements)

References 108 publications

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“…Both osteoporosis and T2DM are often clinically managed with drugs known to effect bone microarchitecture and bone matrix composition. For example, bisphosphonates are known to have positive effects on early implant fixation clinically, 3 as well as osseointegration 42 . Bisphosphonates have also been shown to alter bone matrix composition including crystallinity 6–8 .…”

Section: Discussionmentioning

confidence: 99%

“…While our strategy was to utilize the OXV and ZDF rat models to introduce variance in bone composition, it is worth noting that these models do not fully recapitulate the human diseases. Thus, while there is clear evidence that osteoporosis is deleterious to orthopedic implant fixation, 3,24 the effects of T2DM on orthopedic implant fixation are less clear and require further study. Nevertheless, the model systems are useful for understanding how bone microarchitecture and composition influence implant fixation strength.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, implant fixation strength is assessed using planar X‐ray imaging or dual‐energy X‐ray absorptiometry (DXA)‐based measures of bone mineral density (BMD) 3 . Both strategies primarily assess the quantity of bone in proximity to the implant as surrogate markers for bone‐implant contact.…”

Section: Introductionmentioning

confidence: 99%

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The relative contribution of bone microarchitecture and matrix composition to implant fixation strength in rats

Anderson

Fullam

et al. 2021

Journal Orthopaedic Research

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Bone microarchitectural parameters significantly contribute to implant fixation strength but the role of bone matrix composition is not well understood. To determine the relative contribution of microarchitecture and bone matrix composition to implant fixation strength, we placed titanium implants in 12‐week‐old intact Sprague–Dawley rats, ovariectomized‐Sprague–Dawley rats, and Zucker diabetic fatty rats. We assessed bone microarchitecture by microcomputed tomography, bone matrix composition by Raman spectroscopy, and implant fixation strength at 2, 6, and 10 weeks postimplantation. A stepwise linear regression model accounted for 83.3% of the variance in implant fixation strength with osteointegration volume/total volume (50.4%), peri‐implant trabecular bone volume fraction (14.2%), cortical thickness (9.3%), peri‐implant trabecular crystallinity (6.7%), and cortical area (2.8%) as the independent variables. Group comparisons indicated that osseointegration volume/total volume was significantly reduced in the ovariectomy group at Week 2 (~28%) and Week 10 (~21%) as well as in the diabetic group at Week 10 (~34%) as compared with the age matched Sprague–Dawley group. The crystallinity of the trabecular bone was significantly elevated in the ovariectomy group at Week 2 (~4%) but decreased in the diabetic group at Week 10 (~3%) with respect to the Sprague–Dawley group. Our study is the first to show that bone microarchitecture explains most of the variance in implant fixation strength, but that matrix composition is also a contributing factor. Therefore, treatment strategies aimed at improving bone‐implant contact and peri‐implant bone volume without compromising matrix quality should be prioritized.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The relative contribution of bone microarchitecture and matrix composition to implant fixation strength in rats

Anderson

Fullam

et al. 2021

Journal Orthopaedic Research

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“…There is a wide range of treatment options available including standard first line antiresorptive treatment, monoclonal antibody (Denosumab) slows down the natural rate bone break down, biological anabolic medicines that promote bone formation (Teriparatide) [4]. In addition, there are surgical options including implant fixation or percutaneous vertebroplasty [24,25]. Multidisciplinary team input including management of falls risk, muscle and balance strengthening and polypharmacy review remains an essential component to provide holistic person centred approach.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

et al. 2020

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Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

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“…Implant qualities including structure, strength, stiffness, porosity, coefficient of friction, and surface roughness have significant impact on the quality and quantity of bone osseointegration as well as the long-term survival of press-fit implants[ 4 , 5 ]. In patients with osteopenia and osteoporosis, both qualitative and quantitative properties of bone tissue deteriorate, leading to a weakening of bone metabolism that then leads to accelerated osteoclastogenesis and bone resorption[ 6 , 7 ]. The above situation is an unfavorable condition for the implantation of uncemented press-fit acetabular components[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Osseointegration of porous titanium and tantalum implants in ovariectomized rabbits: A biomechanical study

Bondarenko

Filipenko

Karpinsky

et al. 2021

WJO

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BACKGROUND Today, biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty. Long-term stable fixation of these implants depends on the osseointegration of the acetabular cup bone tissue into the acetabular cup implant, and their ability to withstand functional loads. AIM To compare the strength of bone-implant osseointegration of four types of porous metal implants in normal and osteoporotic bone in rabbits. METHODS The study was performed in 50 female California rabbits divided into non-ovariectomized (non-OVX) and ovariectomized groups (OVX) at 6 mo of age. Rabbits were sacrificed 8 wk after the implantation of four biomaterials [TTM, CONCELOC, Zimmer Biomet's Trabecular Metal (TANTALUM), and ATLANT] in a 5-mm diameter defect created in the left femur. A biomechanical evaluation of the femur was carried out by testing implant breakout force. The force was gradually increased until complete detachment of the implant from the bone occurred. RESULTS The breakout force needed for implant detachment was significantly higher in the non-OVX group, compared with the OVX group for all implants (TANTALUM, 194.7 ± 6.1 N vs 181.3 ± 2.8 N; P = 0.005; CONCELOC, 190.8 ± 3.6 N vs 180.9 ± 6.6 N; P = 0.019; TTM, 186.3 ± 1.8 N vs 172.0 N ± 11.0 N; P = 0.043; and ATLANT, 104.9 ± 7.0 N vs 78.9 N ± 4.5 N; P = 0.001). In the OVX group, The breakout forces in TANTALUM, TTM, and CONCELOC did not differ significantly ( P = 0.066). The breakout force for ATLANT in the OVX group was lower by a factor of 2.3 compared with TANTALUM and CONCELOC, and by 2.2 compared with TTM ( P = 0.001). In the non-OVX group, the breakout force for ATLANT was significantly different from all other implants, with a reduction in fixation strength by a factor of 1.9 ( P = 0.001). CONCLUSION TANTALUM, TTM, and CONCELOC had equal bone-implant osseointegration in healthy and in osteoporotic bone. ATLANT had significantly decreased osseointegration ( P = 0.001) in healthy and in osteoporotic bone.

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Biomechanics of Implant Fixation in Osteoporotic Bone

Cited by 15 publications

References 108 publications

The relative contribution of bone microarchitecture and matrix composition to implant fixation strength in rats

The relative contribution of bone microarchitecture and matrix composition to implant fixation strength in rats

Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Osseointegration of porous titanium and tantalum implants in ovariectomized rabbits: A biomechanical study

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