Fracture of Contemporary Femoral Stems: Common Trends in This Rare Occurrence.

Background: Fracture of contemporary femoral stems is a rare occurrence in total hip arthroplasty. A knowledge gap remains regarding manufacturing, patient, and surgeon factors that may contribute to the increased risk of this complication.

Methods: We analyzed 13 contemporary fractured porous-coated femoral stems of various designs to determine cause and contributing factors of mechanical failure.

Biological and functional evaluation of a novel pyrolytic carbon implant for the treatment of focal osteochondral defects in the medial femoral condyle: assessment in a canine model.

Background: Osteochondral defects continue to be a clinical treatment challenge, and when left untreated, may cause pain and functional impairment. Pyrolytic carbon is a unique isotropic biomaterial used in heart valve and small joint replacements due to its excellent wear properties and biocompatibility with bone and articular cartilage. Therefore, a proposed solution is to utilize a focal pyrolytic carbon hemiarthroplasty implant as an alternative resurfacing treatment strategy for isolated cartilage lesions.

Correlation of computed tomography with histology in the assessment of periprosthetic defect healing.

Computed tomography (CT) may more accurately assess the healing of grafted osteolytic lesions around acetabular components compared with plain radiographs, although clinical validation is lacking. To determine whether clinical or micro-CT imaging could assess accurately the grafted lesion compared with histology, we therefore quantified bone healing and ingrowth to determine an effective rhBMP-2 dose and ratio to allograft bone when grafted adjacent to a cementless porous-coated component. We grafted surgically created acetabular defects in canines (n = 20) before uncemented total hip arthroplasty.

The effects of blood and fat on Morse taper disassembly forces.

Biological debris between modular components using Morse tapers in hip arthroplasty can lead to weakening of the implant construct. We conducted a study to determine the effect of blood and fat within the taper interface. Tapers were divided into groups 1 (clean), 2 (surface covered with blood and fat), and 3 (blood and fat wiped off).

The effect of low-intensity pulsed ultrasound on autologous osteochondral plugs in a canine model.

Background: Low-intensity pulsed ultrasound promotes the enchondral portion of fracture healing, which has a direct stimulatory effect on cartilage formation and maturation.

Hypothesis: Daily ultrasound treatment positively affects the repair and incorporation of modified autologous osteochondral plugs in a canine model.

Study Design: Controlled laboratory study.

Bone defect healing with an osteogenic protein-1 device combined with carboxymethylcellulose.

One consideration for the practical use and application of osteogenic proteins is an effective method of delivery. This study evaluated a putty-type collagen carrier with recombinant human osteogenic protein-1 (rhOP-1) ability to heal canine critical sized (2.5 cm) ulna segmental defects compared to rhOP-1 with a particulate collagen carrier (OP device).

Osteogenic protein-1 in knee arthritis and arthroplasty.

The use of graft materials to restore bone stock and promote healing and implant stabilization is a crucial part of total knee arthroplasty, especially in revision surgery. Recent research has centered on the use of osteoinductive materials to promote bone formation. Osteogenic proteins are members of a superfamily of proteins called transforming growth factor-beta that, either alone or in combination with other regulatory molecules, induce new bone formation.

Biomechanical study of pedicle screw fixation in severely osteoporotic bone.

Background Context: Obtaining adequate purchase with standard pedicle screw techniques remains a challenge in poor quality bone. The development of alternate insertion techniques and screw designs was prompted by recognition of potential fixation complications. An expandable pedicle screw design has been shown to significantly improve fixation compared to a conventional screw in poor quality bone.

Comparison of methods for determining the presence and extent of anterior lumbar interbody fusion.

Study Design: Titanium alloy interbody fusion devices with autogenous bone were placed in the L5-L6 disc space of 31 adult pig-tailed monkeys through an anterolateral (retroperitoneal) approach. Anteroposterior and lateral radiographs, CT imaging, and histologic analysis of the specimens were performed.

Objectives: This study compared the accuracy of plain film radiographs and CT imaging for determining bony fusion of a titanium interbody device implanted in a non-human primate model.

Direct current stimulation of titanium interbody fusion devices in primates.

Background Context: The fusion rate for anterior lumbar interbody fusion (ALIF) varies widely with the use of different interbody devices and bone graft options. Adjunctive techniques such as electrical stimulation may improve the rate of bony fusion.

Purpose: To determine if direct current (DC) electrical stimulation of a metallic interbody fusion device enhanced the incidence or extent of anterior bony fusion.

Osteoinductive agents in reconstructive hip surgery: a look forward.

The use of autograft and allograft material to restore bone stock and promote healing and implant stabilization is a crucial part of total hip arthroplasty, especially in the revision situation. Recent research has centered on the use of osteoinductive materials such as osteogenic proteins or bone morphogenetic proteins to promote bone formation. These proteins are members of the transforming growth factor-beta superfamily of proteins that either alone or in combination with other regulatory molecules induce new bone formation.

Induction of bone ingrowth from acetabular defects to a porous surface with OP-1.

Reliable ingrowth of bone into porous-coated cementless total hip components can be expected in primary surgery. In the revision scenario, however, bone deficiency frequently is encountered and the remaining bone may have less ingrowth potential. Allograft bone and bone graft substitutes may be successful in healing bone defects, but have virtually no capacity to induce bone growth from the defect into the porous surface.

Patellar tracking during simulated quadriceps contraction.

The current study compared patella tracking during simulated concentric and eccentric quadriceps contractions in 12 knees from cadavers using a three-dimensional electromagnetic tracking system. The patella shifted (translated) and tilted medially during approximately the initial 22 degrees tibiofemoral flexion. The patella then shifted and tilted laterally for the remaining arc of tibiofemoral flexion (90 degrees).

Repair of articular cartilage defects with osteogenic protein-1 (BMP-7) in dogs.

Background: Articular cartilage injury has a poor prognosis for repair. Mesenchymal cells, when exposed to osteogenic proteins and other cytokines, can differentiate into cells that behave phenotypically as chondrocytes. In this study, we examined the ability of recombinant human osteogenic protein-1 (rhOP-1 or rhBMP-7) to elicit the repair of osteochondral defects in dogs.

The effect of demineralized bone matrix gel on bone ingrowth and fixation of porous implants.

The presence of demineralized bone matrix (DBM) gel did not enhance or accelerate attachment strength or bone ingrowth and resulted in a significant decrease in implant interface attachment strength at 3 weeks. Hydroxyapatite (HA) coating resulted in significant increases in interface shear strength and bone ingrowth compared with non-HA-coated porous implants at all time periods. The HA-coated implants achieved greater attachment strength and bone ingrowth at earlier time periods and maintained greater attachment strength at long-term periods.

Healing course of primate ulna segmental defects treated with osteogenic protein-1.

Twelve African green monkeys were implanted with recombinant human osteogenic protein-1 (rhOP-1) placed on a bovine bone-derived Type I collagen carrier to characterize healing in an ulna segmental bone defect model at 1, 3, 12, and 20 weeks postoperative. Defect healing was evaluated by plain film radiography, computed tomography (CT), magnetic resonance imaging (MRI), bone mineral density (BMD), and histologic analysis. Radiographically, new bone formation was observed as early as 3 weeks postoperative.