Subsidence of Spinal Fusion Cages: A Systematic Review.

Background: Although many research studies investigating subsidence of intervertebral fusion cages have been published, to our knowledge, no study has comprehensively compared cage subsidence among all lumbar intervertebral fusion (LIF) techniques. This study aimed to review the literature reporting evidence of cage subsidence linked to LIF. The amount of subsidence was compared and associated with the procedures and corresponding implants used, and the effect of cage subsidence on clinical outcomes was investigated.

Intracranial Displacement Measurements Within Targeted Anatomical Regions of a Postmortem Human Surrogate Brain Subjected to Impact.

The dynamic response of the human brain subjected to impulsive loading conditions is of fundamental importance to the understanding of traumatic brain injuries. Due to the complexity of such measurements, the existing experimental datasets available to researchers are sparse. However, these measurements are used extensively in the validation of complex finite element models used in the design of protective equipment and the development of injury mitigation strategies.

A Parametric Analysis of Embedded Tissue Marker Properties and Their Effect on the Accuracy of Displacement Measurements.

Datasets obtained from cadaveric experimentation are broadly used in validating finite element models of head injury. Due to the complexity of such measurements in soft tissues, experimentalists have relied on tissue-embedded radiographic or sonomicrometry tracking markers to resolve tissue motion caused by impulsive loads. Dynamic coupling of markers with the surrounding tissue has been a previous concern, yet a thorough sensitivity investigation of marker influences on tissue deformation has not been broadly discussed.

Impact-Induced Cortical Strain Concentrations at the Sulcal Base and Its Implications for Mild Traumatic Brain Injury.

This study investigated impact-induced strain fields within brain tissue surrogates having different cortical gyrification. Two elastomeric surrogates, one representative of a lissencephalic brain and the other of a gyrencephalic brain, were drop impacted in unison at four different heights and in two different orientations. Each surrogate contained a radiopaque speckle pattern that was used to calculate strain fields.

Previous Damage Accumulation Can Influence Femoral Fracture Strength: A Finite Element Study.

To manage osteoporotic hip fracture risk, it is necessary to understand failure mechanisms of bone at both the material and organ level. The structural response of bone is dependent on load history. Repeated loading causes progressive microstructural cracking, resulting in reduced apparent-level stiffness and, if damage is significant, reductions to peak load bearing capability.

Higher patient activity level and subchondral stiffening in asymptomatic cam femoroacetabular impingement subjects.

A cam deformity is proposed as a cause of idiopathic osteoarthritis. Increased subchondral bone mineral density (BMD) is associated with this degenerative process of osteoarthritis, and the patient's activity level may contribute to it. Therefore, the correlation between activity level and subchondral BMD in subjects with cam deformity FAI was studied.

Unravelling the hip pistol grip/cam deformity: Origins to joint degeneration.

This article reviews a body of work performed by the investigators over 9 years that has addressed the significance of cam morphology in the development of hip osteoarthritis (OA). Early hip joint degeneration is a common clinical presentation and preexisting abnormal joint morphology is a risk factor for its development. Interrogating Hill's criteria, we tested whether cam-type femoroacetabular impingement leads to hip OA.

Femoral fracture load and fracture pattern is accurately predicted using a gradient-enhanced quasi-brittle finite element model.

Nonlinear finite element (FE) modeling can be a powerful tool for studying femoral fracture. However, there remains little consensus in the literature regarding the choice of material model and failure criterion. Quasi-brittle models recently have been used with some success, but spurious mesh sensitivity remains a concern.

Validation of an alignment method using motion tracking system for in-vitro orientation of cadaveric hip joints with reduced set of anatomical landmarks.

Accurate in-vitro orientation of cadaveric hip joints is challenging due to limited available anatomical landmarks. Published hip joint in-vitro investigations commonly lack details on methods used to achieve reported orientations and the accuracy with which the desired orientation has been achieved. The aim of this study was to develop an accurate method for orienting hip joints with limited anatomical landmarks for in-vitro investigations, and to compare this method against orientation using guiding axes and by visual approximation.

Surgical Correction of Cam Deformity in Association with Femoroacetabular Impingement and Its Impact on the Degenerative Process within the Hip Joint.

Background: Cam morphology in association with femoroacetabular impingement (FAI) is a recognized cause of hip pain and cartilage damage and proposed as a leading cause of arthritis. The purpose of this study was to analyze the functional and biomechanical effects of the surgical correction of the cam deformity on the degenerative process associated with FAI.

Methods: Ten male patients with a mean age of 34.

Properties of the cartilage layer from the cam-type hip impingement deformity.

Femoro-acetabular impingement (FAI) is associated with significant acetabular cartilage damage and degenerative arthritis. To understand the contact stress and thus biomechanical mechanisms that may contribute to degeneration, the material behaviour of the cartilage layer is required. The objective of this study is to determine the fibril-reinforced poroelastic properties and composition of cartilage from cam deformities and to compare to those of normal cartilage.

Stress distribution and consolidation in cartilage constituents is influenced by cyclic loading and osteoarthritic degeneration.

The understanding of load support mechanisms in cartilage has evolved with computational models that better mimic the tissue ultrastructure. Fibril-reinforced poroelastic models can reproduce cartilage behaviour in a variety of test conditions and can be used to model tissue anisotropy as well as assess stress and pressure partitioning to the tissue constituents. The goal of this study was to examine the stress distribution in the fibrillar and non-fibrillar solid phase and pressure in the fluid phase of cartilage in axisymmetric models of a healthy and osteoarthritic hip joint.

Influence of ingrowth regions on bone remodelling around a cementless hip resurfacing femoral implant.

Hip resurfacing arthroplasty is an alternative to traditional hip replacement that can conserve proximal bone stock and has gained popularity but bone resorption may limit implant survival and remains a clinical concern. The goal of this study was to analyze bone remodelling patterns around an uncemented resurfacing implant and the influence of ingrowth regions on resorption. A computed tomography-derived finite element model of a proximal femur with a virtually implanted resurfacing component was simulated under peak walking loads.

Effect of boundary conditions, impact loading and hydraulic stiffening on femoral fracture strength.

Patient specific quantitative CT (QCT) imaging data together with the finite element (FE) method may provide an accurate prediction of a patient's femoral strength and fracture risk. Although numerous FE models investigating femoral fracture strength have been published, there is little consent on the effect of boundary conditions, dynamic loading and hydraulic strengthening due to intra-medullary pressure on the predicted fracture strength. We developed a QCT-derived FE model of a proximal femur that included node-specific modulus assigned based on the local bone density.

Mechanisms of stem subsidence in femoral impaction allografting.

Failure of the femoral component of total hip arthroplasty is often accompanied by bone loss that can pose a significant challenge to the orthopaedic surgeon. Femoral impaction allografting has attractive potential for restoring bone stock in deficient femurs. However, there have been reports of problematic postoperative stem subsidence with this procedure.

In vivo evaluation of calcium polyphosphate for bone regeneration.

Current problems associated with bone allografts include risk of disease transmission, limited availability, and cost. Synthetic scaffolds have been proposed as substitute graft materials to address these issues. Calcium polyphosphate is a novel synthetic scaffold material that has shown good mechanical properties and biocompatibility.

The effect of abductor muscle and anterior-posterior hip contact load simulation on the in-vitro primary stability of a cementless hip stem.

Background: In-vitro mechanical tests are commonly performed to assess pre-clinically the effect of implant design on the stability of hip endoprostheses. There is no standard protocol for these tests, and the forces applied vary between studies. This study examines the effect of the abductor force with and without application of the anterior-posterior hip contact force in the in-vitro assessment of cementless hip implant stability.

Effect of bone graft substitute on marrow stromal cell proliferation and differentiation.

Marrow stromal cells (MSCs) are ideally suited for tissue engineered bone grafts since they have the potential to regenerate bone, but may also maintain the homeostasis of the repaired tissue through their ability for self-renewal. An ideal bone graft substitute should support MSC self-renewal as well as differentiation to ensure complete bone defect regeneration and maintenance. The purpose of this investigation was to determine the effect of different substrate materials on MSC expansion and differentiation.

The differential in vitro and in vivo responses of bone marrow stromal cells on novel porous gelatin-alginate scaffolds.

Tissue engineering and stem cell therapy hold great potential of being able to fully restore, repair and replace damaged, diseased or lost tissues in the body. Biocompatible porous scaffolds are used for the delivery of cells to the regeneration sites. Marrow stromal cells (MSCs), also referred to as mesenchymal stem cells, are an attractive cell source for tissue engineering, due to the relative ease of isolation and the ability of in vitro expanded MSCs to generate multiple cell types, including osteoblasts, chondrocytes and adipocytes.

Effects of continuous and pulsatile PTH treatments on rat bone marrow stromal cells.

Bone marrow stromal cells (MSCs) differentiation and proliferation are controlled by numerous growth factors and hormones. Continuous parathyroid hormone (PTH) treatment has been shown to decrease osteoblast differentiation, whereas pulsatile PTH increases osteoblast differentiation. However, the effects of PTH treatments on MSCs have not been investigated.

Cement flow during impaction allografting: a finite element analysis.

Cement intrusion into cancellous or impacted bone is not well understood. We adopted an engineering mechanics approach to predict the effect of surgical variables on the cement intrusion into impacted cancellous bone, used for the revision of failed total hip replacement with the impaction allografting technique. Specifically, a three-dimensional finite element model was used to determine the effects of cement viscosity, the magnitude and duration of pressurization, and the distribution of the porosity along the femur on cement intrusion.

Biological and mechanical changes of the bone graft-cement interface after impaction allografting.

In impaction allografting, the host bone interface may consist of morsellized allograft alone or as a composite with bone cement. The objective of this study was to investigate the temporal changes in the interface for these two materials in a rat bone chamber model. To simulate the impaired endosteal circulation after impaction allografting, bone chambers were tightened bilaterally to the endosteal surfaces of proximal tibiae of mature rats and filled with pure allograft or cement/allograft composite.

Mechanical characteristics of the bone-graft-cement interface after impaction allografting.

Impaction allografting is an attractive procedure for the treatment of failed total hip replacements. The graft-cement-host bone interface after impaction allografting has not been characterized, although it is a potential site of subsidence for this type of revision total hip reconstruction. In six human cadaveric femurs, the cancellous bone was removed proximally and local diaphyseal lytic defects were simulated.

A biomechanical study comparing cortical onlay allograft struts and plates in the treatment of periprosthetic femoral fractures.

Background: Periprosthetic femoral fractures with well-fixed femoral components can be difficult to manage and internal fixation is usually necessary. This study was designed to determine the effect of cable plate, strut allograft and combined plate and strut allograft fixations of periprosthetic femoral fractures.

Methods: A transverse fracture at the level of the tip of the femoral stem was simulated in six cadaveric femurs.

Kinematic response of lumbar functional spinal units to axial torsion with and without superimposed compression and flexion/extension.

Experimental data suggest that lumbar torsion contributes to lumbar disc degenerative changes, such as instability, spondylolisthesis and spinal canal stenosis. However, some basic mechanical characteristics of the lumbar spine under torsional loading have not yet been reported in detail. For example, the function of the facet joints under combined mechanical loads such as torsion with superimposed flexion or extension postures is an area of interest about which little biomechanical data have been reported.