Julien Chaves-Jacob

Titanium implant impairment and surrounding muscle cell death following neuro-myoelectrostimulation: An in vivo study

Electrical currents have deleterious effects on biomedical metallic implants. However, following arthroplasty, neuro-myoelectrostimulation (NMES) is often used in patient rehabilitation. Such a rehabilitation technique could compromise patient recovery through deleterious effects on metallic alloys and biological tissues. The purpose of our study was to assess the effects of NMES on a Ti6Al4V implant placed in a rat tibial crest and the surrounding muscle tissues. This in vivo study allowed to bring to the fore the prosthesis behavior under mechanical and electromagnetic loads induced by NEMS stimulation. After 3 weeks, implant-to-bone adhesion significantly decreased in stimulated animals compared with nonstimulated animals. Surface mapping indicated titanium implant degradation after NMES. Furthermore, NMES alone did not induce muscle damage contrary to that found in implanted animals. The muscle damage rate was significantly higher in implanted and stimulated animals compared with implanted-only animals. It seems obvious that rehabilitation programs using the NMES technique could induce early deterioration of biomaterial employed for surgical implants. Clinicians should reconsider the use of NMES as a rehabilitation technique for patients with titanium prostheses.

Titanium Implant Impairment and Surrounding Muscle Cell Death Following High-Salt Diet: An In Vivo Study

Aim of the study High-salt consumption has been widely described as a risk factor for cardiovascular, renal and bone functions. In the present study, the extent to which high-salt diet could influence Ti6Al4V implant surface characteristic, its adhesion to rat tibial crest, and could modify muscle cell viability of two surrounding muscles, was investigated in vivo. These parameters have also been assessed following a NMES (neuro-myoelectrostimulation) program similar to that currently used in human care following arthroplasty. Results After a three-week diet, a harmful effect on titanium implant surface and muscle cell viability was noted. This is probably due to salt corrosive effect on metal and then release of toxic substance around biologic tissue. Moreover, if the use of NMES with high-salt diet induced muscles damages, the latter were higher when implant was added. Unexpectedly, higher implant-to-bone adhesion was found for implanted animals receiving salt supplementation. Conclusion Our in vivo study highlights the potential dangerous effect of high-salt diet in arthroplasty based on titanium prosthesis. This effect appears to be more important when high-salt diet is combined with NMES.

Biocompatibility of Four Common Orthopedic Biomaterials Following a High-Salt Diet: An In Vivo Study

Nowadays, salt consumption appears to be drastically above the recommended level in industrialized countries. The health consequences of this overconsumption are heavy since high-salt intake induces cardiovascular disease, kidney dysfunction, and stroke. Moreover, harmful interaction may also occur with orthopaedic devices because overconsumption of salt reinforces the corrosive aspect of biological tissues and favors bone resorption process. In the present study, we aimed to assess the in vivo effect of three weeks of a high-salt diet, associated (or not) with two weeks of the neuro-myoelectrostimulation (NMES) rehabilitation program on the biocompatibility of four biomaterials used in the manufacture of arthroplasty implants. Thus, two non-metallic (PEEK and Al2O3) and two metallic (Ti6Al4V and CrCo) compounds were implanted in the rat tibial crest, and the implant-to-bone adhesion and cell viability of two surrounded muscles, the Flexor Digitorum (FD) and Tibialis Anterior (TA), were assessed at the end of the experiment. Results indicated lower adhesion strength for the PEEK implant compared to other biomaterials. An effect of NMES and a high-salt diet was only identified for Al2O3 and Ti6Al4V implants, respectively. Moreover, compared to a normal diet, a high-salt diet induced a higher number of dead cells on both muscles for all biomaterials, which was further increased for PEEK, Al2O3, and CrCo materials with NMES application. Finally, except for Ti6Al4V, NMES induced a higher number of dead cells in the directly stimulated muscle (FD) compared to the indirectly stimulated one (TA). This in vivo experiment highlights the potential harmful effect of a high-salt diet for people who have undergone arthroplasty, and a rehabilitation program based on NMES.

Tribology of flexible and sliding spinal implants: development of experimental and numerical models

New fusionless devices are being developed to get over the limits of actual spinal surgical treatment, based on arthrodesis. However, due to their recentness, no standards exist to test and validate those devices, especially concerning the wear. A new tribological first approach to the definition of an in vitro wear protocol to study wear of flexible and sliding spinal devices is presented in this article, and was applied to a new concept. A simplified synthetic spine portion (polyethylene) was developed to reproduce a simple supra-physiological spinal flexion (10° between two vertebrae). The device studied with this protocol was tested in wet environment until 1 million cycles (Mc). We obtained an encouraging estimated wear volume of same order of magnitude compared to similar devices. An associated finite element (FE) numerical model has permitted to access contact information and study the effect of misalignment of one screw. First results could point out how to improve the design and suggest that a vertical misalignment of a screw (under or over-screwing) has more impact than a horizontal one.

Adaptation Trajectory in Five Axes Machine to Manufacture Orthopedic Prostheses

A new method of generation and adaptation of multi-axis machines ultrasonic machining paths, geometric change in gross machining is proposed in this paper. Currently, these are in most machining time are done manually by highly trained operators. The proposed method starts with a first step of association using an Iterative Closest Point ICP algorithm. In the second step, a deforming toolpath is given. To validate the theoretical developments, experimental tests were carried out for a uni-compartmental femoral knee component.