G.H. van Lenthe

Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling

Periprosthetic adaptive bone remodelling after total hip arthroplasty can be simulated in computer models, combining bone remodelling theory with finite element analysis. Patient specific three-dimensional finite element models of retrieved bone specimens from an earlier bone densitometry (DEXA) study were constructed and bone remodelling simulations performed. Results of the simulations were analysed both qualitatively and quantitatively. Patterns of predicted bone loss corresponded very well with the DEXA measurements on the retrievals. The amount of predicted bone loss, measured quantitatively by simulating DEXA on finite element models, was found to be inversely correlated with the initial bone mineral content. It was concluded that the same clinically observed correlation can therefore be explained by mechanically induced remodelling. This finding extends the applicability of numerical pre-clinical testing to the analysis of interaction between implant design and initial state of the bone.

Increase in bone volume fraction precedes architectural adaptation in growing bone.

In mature trabecular bone, both density and trabecular orientation are adapted to external mechanical loads. Few quantitative data are available on the development of architecture and mechanical adaptation in juvenile trabecular bone. We studied the hypothesis that a time lag occurs between the adaptation of trabecular density and the adaptation of trabecular architecture during development. To investigate this hypothesis we used ten female pigs at 6, 23, 56, 104, and 230 weeks of age. Three-dimensional morphological and mechanical parameters of trabecular bone samples from the vertebra and proximal tibia were studied using microcomputed tomography and micro-finite element analysis. Both bone volume fraction and stiffness increased rapidly in the initial growth phase (from 6 weeks on), whereas the morphological anisotropy started increasing only after 23 weeks of age. In addition, the anisotropy reached its highest value much later in the development than did bone volume fraction. Hence, the alignment of trabeculae was still progressing at the time of peak bone mass. Therefore, our hypothesis was supported by the time lag between the increase in trabecular density and the adaptation of the trabecular architecture. The rapid increase of bone volume fraction in the initial growth phase can be explained by the enormous weight increase of the pigs. The trabeculae aligned at later stages when the increase in weight, and thus the loading, was slowed considerably compared with the early growth stage. Hence, the trabecular architecture was more efficient in later years. We conclude that density is adapted to external load from the early phase of growth, whereas the trabecular architecture is adapted later in the development.

Frictional heating of total hip implants. Part 1: measurements in patients.

Hip implants heat up due to friction during long lasting, high loading activities like walking. Thermal damage in the surrounding soft and hard tissues and deteriorated lubrication of synovial fluid could contribute to implant loosening. The goal of this study was to determine the implant temperatures in vivo under varying conditions. Temperatures and contact forces in the joints were measured in seven joints of five patients using instrumented prostheses with alumina ceramic heads and telemetry data transmission. The peak temperature in implants with polyethylene cups rose up to 43.1 degrees C after an hour of walking but varied considerably individually. Even higher temperatures at the joints are probable for patients with higher body weight or while jogging. The peak temperature was lower with a ceramic cup, showing the influence of friction in the joint. During cycling the peak temperatures were lower than during walking, proving the effect of force magnitudes on the produced heat. However, no positive correlation was found between force magnitude and maximum temperature during walking. Other individual parameters than just the joint force influence the implant temperatures. Based on the obtained data and the available literature about thermal damage of biological tissues a detrimental effect of friction induced heat on the stability of hip implants cannot be excluded. Because the potential risk for an individual patient cannot be foreseen, the use and improvement of low friction implant materials is important.

Assessing forearm fracture risk in postmenopausal women

SummaryA diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.IntroductionThis study seeks to test the clinical utility of approaches for assessing forearm fracture risk.MethodsAmong 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in microfinite element (μFE) models.ResultsFracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4–2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1–2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4–0.7), and strength (µFE failure load; OR, 1.8; 95% CI, 1.3–2.5); the factor-of-risk (applied load in a forward fall ÷ μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4–2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71).ConclusionsDetailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.

Stress Shielding After Total Knee Replacement May Cause Bone Resorption In The Distal Femur

Inadequate bone stock is often found in revision surgery of femoral components of total knee replacements. Our aim was to test the hypothesis that these remodelling patterns can be explained by stress shielding, and that prosthetic bonding characteristics affect maintenance of bone mass. We made a three-dimensional finite-element model of an average male femur with a cemented femoral knee component. This model was integrated with iterative remodelling procedures. Two extreme prosthetic bonding conditions were analysed and gradual changes in bone density were calculated. The long-term bone loss under the femoral knee component resembled clinical findings which confirms the hypothesis that stress shielding can cause distal femoral bone loss. Our study predicts, contrary to clinical findings, that an equilibrium situation is not reached after two years, but that bone resorption may continue. This hidden bone loss may be so drastic that large reconstructions are needed at the time of revision.

Frictional heating of total hip implants. Part 2 : finite element study

Due to higher friction artificial hip joints warm up more than natural joints during walking and other continuous activities. This could lead to thermal damage in the surrounding tissues and be a reason for long-term implant loosening, an effect which has not yet been investigated. In vivo measurements with instrumented implants showed temperatures inside the prosthetic head up to 43.1 degrees C (Part 1 of this work). Based on the experimental data a finite element model was developed to calculate the temperatures in the tissues surrounding the hip implant to determine whether these tissues can heat up to critical levels. Various parameters were investigated which could account for the variations in the measured temperatures in the patients, including the perfusion rate in tissues, the volume of synovial fluid, and different implant materials. We found that the synovial fluid is most endangered by thermal damage and consequent deterioration of lubricating properties. Implants with a cobalt-chromium head and a polyethylene cup are unfavourable as they can elevate the temperature in the synovia to more than 46 degrees C. With regard to thermal properties stems made from cobalt-chromium alloys are superior to titanium stems, by better conducting heat to the femur and minimizing the synovial fluid temperature. Factors determining the temperatures during walking are insufficiently known or cannot be determined in the individual patient. Therefore, the risk of a thermally induced implant loosening cannot currently be estimated. Under unfavourable conditions such a risk exists, however. General improvements of implant materials and clinical studies on the possibility of implant loosening due to high temperatures are therefore required.

Time-lapsed assessment of microcrack initiation and propagation in murine cortical bone at submicrometer resolution

The strength of bone tissue is not only determined by its mass, but also by other properties usually referred to as bone quality, such as microarchitecture, distribution of bone cells, or microcracks and damage. It has been hypothesized that the bone ultrastructure affects microcrack initiation and propagation. Due to its high resolution, bone assessment by means of synchrotron radiation (SR)-based computed tomography (CT) allows unprecedented three-dimensional (3D) and non-invasive insights into ultrastructural bone phenotypes, such as the canal network and the osteocyte lacunar system. The aims of this study were to describe the initiation and propagation of microcracks and their relation with these ultrastructural phenotypes. To this end, femora from the two genetically distinct inbred mouse strains C3H/He (C3H) and C57BL/6 (B6) were loaded axially under compression, from 0% strain to failure, with 1% strain steps. Between each step, a high-resolution 3D image (700 nm nominal resolution) was acquired at the mid-diaphysis using SR CT for characterization and quantitative analysis of the intracortical porosity, namely the bone canal network, the osteocyte lacunar system and the emerging microcracks. For C3H mice, the canal, lacunar, and microcrack volume densities accounted typically for 1.91%, 2.11%, and 0.27% of the cortical total volume at 2% apparent strain, respectively. Due to its 3D nature, SR CT allowed to visualize and quantify also the volumetric extent of microcracks. At 2% apparent strain, the average microcrack thickness for both mouse strains was 2.0 microm for example. Microcracks initiated at canal and at bone surfaces, whereas osteocyte lacunae provided guidance to the microcracks. Moreover, we observed that microcracks could appear as linear cracks in one plane, but as diffuse cracks in a perpendicular plane. Finally, SR CT images permitted visualization of uncracked ligament bridging, which is thought to be of importance in bone toughening mechanisms. In conclusion, this study showed the power of SR CT for 3D visualization and quantification of the different ultrastructural phases of the intracortical bone porosity. We particularly postulate the necessity of 3D imaging techniques to unravel microcrack initiation and propagation and their effects on bone mechanics. We believe that this new investigation tool will be very useful to further enhance our understanding of bone failure mechanisms.

A new route to produce starch-based fiber mesh scaffolds by wet spinning and subsequent surface modification as a way to improve cell attachment and proliferation

This study proposes a new route for producing fiber mesh scaffolds from a starch-polycaprolactone (SPCL) blend. It was demonstrated that the scaffolds with 77% porosity could be obtained by a simple wet-spinning technique based on solution/precipitation of a polymeric blend. To enhance the cell attachment and proliferation, Ar plasma treatment was applied to the scaffolds. It was observed that the surface morphology and chemical composition were significantly changed because of the etching and functionalization of the fiber surfaces. XPS analyses showed an increase of the oxygen content of the fiber surfaces after plasma treatment (untreated scaffolds O/C:0.32 and plasma-treated scaffolds O/C:0.41). Both untreated and treated scaffolds were examined using a SaOs-2 human osteoblast-like cell line during 2 weeks of culture. The cell seeded on wet-spun SPCL fiber mesh scaffolds showed high viability and alkaline phosphatase enzyme activity, with those values being even higher for the cells seeded on the plasma-treated scaffolds.

Speed of sound reflects Young's modulus as assessed by microstructural finite element analysis.

We analyzed the ability of the quantitative ultrasound (QUS) parameter, speed of sound (SOS), and bone mineral density (BMD), as measured by dual-energy X-ray absorptiometry (DXA), to predict Youngs modulus, as assessed by microstructural finite element analysis (muFEA) from microcomputed tomography (muCT) reconstructions. With muFEA simulation, all bone elements in the model can be assigned the same isotropic Youngs modulus; therefore, in contrast to mechanical tests, only the trabecular structure plays a role in the determination of the elastic properties of the specimen. SOS, BMD, and microCT measurements were performed in 15 cubes of pure trabecular bovine bone in three orthogonal directions: anteroposterior (AP); mediolateral (ML); and craniocaudal (CC). The anisotropy of the architecture was determined using mean intercept length (MIL) measurements. SOS, MIL, and Youngs modulus (E) values were significantly different in all three directions (p < 0.001), with the highest values in the CC direction. There was a strong linear relationship between E and SOS in each of the three orthogonal directions, with r(2) being 0.88, 0.92, and 0.84 (all p < 0.0001) for the CC, ML, and AP directions, respectively. The relationship between E and BMD was less strong, with r(2) being between 0.66 and 0.85 (all p < 0.0001) in the different directions. There was also a significant, positive correlation between SOS and BMD in each of the three axes (r(2) being 0.81, 0.42, and 0.92 in the CC, ML, and AP directions, respectively; p < 0.0001). After correction for BMD, the correlations between SOS and E in each of the three directions remained highly significant (r(2) = 0.77, p < 0. 0001 for the AP direction; r(2) = 0.48, p < 0.001 for the CC direction; r(2) = 0.52, p < 0.005 for the ML direction). After correction for SOS, BMD remained significantly correlated with Youngs modulus in the AP and CC directions (r(2) = 0.52, p < 0.005; r(2) = 0.30, p < 0.05, respectively), but the correlation in the ML direction was no longer statistically significant. In a stepwise regression model, E was best predicted by SOS in each of the orthogonal directions. These observations illustrate the ability of the SOS technique to assess the architectural mechanical quality of trabecular bone.

The importance of murine cortical bone microstructure for microcrack initiation and propagation

In order to better understand bone postyield behavior and consequently bone failure behavior, this study aimed first to investigate cortical bone microstructure and second, to relate cortical bone microstructure to microdamage initiation and propagation in C57BL/6 (B6) and C3H/He (C3H) mice; two murine inbred strains known for their differences in bone phenotype. Murine femora of B6 and C3H were loaded axially under compression in a stepwise manner. For each loading step, 3D data sets at a nominal resolution of 700 nm were acquired by means of synchrotron radiation-based computed tomography. Cortical bone microstructure was divided into three phases: the canal network, the osteocyte lacunar system, and microdamage. Canal volume density and canal unit volume both correlated highly to crack number density (canal volume density: R(2)=0.64, p<0.005 and canal unit volume: R(2)=0.75, p<0.001). Moreover, the large canal units in C3H bone were responsible for more microdamage accumulation compared to B6 bones. This more pronounced microdamage accumulation due to large intracortical bone voids, which eventually leads to a fatal macrocrack (fracture), represents a potential contributing factor to the higher incidence of bone fractures in the elderly.