Lance J. Wilson

Periprosthetic fracture torque for short versus standard cemented hip stems: an experimental in vitro study.

In an attempt to preserve proximal femoral bone stock and achieve a better fit in smaller femora, especially in the Asian population, several new shorter stem designs have become available. We investigated the torque to periprosthetic femoral fracture of the Exeter short stem compared with the conventional length Exeter stem in a Sawbone model. Forty-two stems; 21 shorter and 21 conventional stems both with three different offsets were cemented in a composite Sawbone model and torqued to fracture. Results showed that Sawbone femurs break at a statistically significantly lower torque to failure with a shorter compared to conventional-length Exeter stem of the same offset. Both standard and short-stem designs are safe to use as the torque to failure is 7-10 times that seen in activities of daily living.

Cement-in-Cement Revision for Selected Vancouver Type B1 Femoral Periprosthetic Fractures: A Biomechanical Analysis

The aim of this study was to perform a biomechanical analysis of the cement-in-cement (c-in-c) technique for fixation of selected Vancouver Type B1 femoral periprosthetic fractures and to assess the degree of cement interposition at the fracture site. Six embalmed cadaveric femora were implanted with a cemented femoral stem. Vancouver Type B1 fractures were created by applying a combined axial and rotational load to failure. The femora were repaired using the c-in-c technique and reloaded to failure. The mean primary fracture torque was 117 Nm (SD 16.6, range 89-133). The mean revision fracture torque was 50 Nm (SD 16.6, range 29-74), which is above the torque previously observed for activities of daily living. Cement interposition at the fracture site was found to be minimal.

In vitro cyclic testing of the Exeter stem after cement within cement revision.

Cement-within-cement (C-C) revision arthroplasty minimizes the complications associated with removal of secure polymethylmethacrylate. Failure at the interfacial region between new and old cement mantles remains a theoretical concern. This article assesses the cyclic fatigue properties of bilaminar cement mantles after C-C revision in vitro with the Exeter stem. Seven Exeter stems were cemented into Sawbone femurs and removed, and new undersized stems were cemented into the preserved mantle. The new constructs were loaded for 1,000,000 cycles at body temperature. Cement mantles were inspected postcycling. In no case was there delamination or failure of the cement mantle. The findings support the hypothesis that use of a thin revision cement mantle in conjunction with a polished double-tapered stem is not detrimental to the overall success of the implant. In the presence of a secure cement-bone interface in suitable patients, we recommend C-C revision techniques using double-tapered polished femoral stems.

Shortening Cemented Femoral Implants An In Vitro Investigation to Quantify Exeter Femoral Implant Rotational Stability vs Simulated Implant Length

The Exeter stems vary in length from 90 to 150 mm. The shorter stems generally have lower offsets. The purpose of this study was to determine if length of stem, with fixed offset, affected rotational stability. Mechanical testing was carried out on 10 implant-cement constructs with 2 loading profiles, rising from chair and stair climbing, at different simulated implant lengths using purpose-built apparatus. This paper presents a mechanism for clinically observed rotational stability and explains the mechanical characteristics required for rotational stability in Exeter femoral stems.

Comparison of mechanical and ultrasound elastic modulus of ovine tibial cortical bone

Finite element models of bones can be created by deriving geometry from an X-ray CT scan. Material properties such as the elastic modulus can then be applied using either a single or set of homogeneous values, or individual elements can have local values mapped onto them. Values for the elastic modulus can be derived from the CT density values using an elasticity versus density relationship. Many elasticity-density relationships have been reported in the literature for human bone. However, while ovine in vivo models are common in orthopaedic research, no work has been done to date on creating FE models of ovine bones. To create these models and apply relevant material properties, an ovine elasticity-density relationship needs to be determined. Using fresh frozen ovine tibias the apparent density of regions of interest was determined from a clinical CT scan. The bones were the sectioned into cuboid samples of cortical bone from the regions of interest. Ultrasound was used to determine the elastic modulus in each of three directions - longitudinally, radially and tangentially. Samples then underwent traditional compression testing in each direction. The relationships between apparent density and both ultrasound, and compression modulus in each direction were determined. Ultrasound testing was found to be a highly repeatable non-destructive method of calculating the elastic modulus, particularly suited to samples of this size. The elasticity-density relationships determined in the longitudinal direction were very similar between the compression and ultrasound data over the density range examined. A clear difference was seen in the elastic modulus between the longitudinal and transverse directions of the bone samples, and a transverse elasticity-density relationship is also reported.

Standardized anthropological measurement of postcranial bones using three-dimensional models in CAD software

This study introduces a standardized protocol for conducting linear measurements of postcranial skeletal elements using three-dimensional (3D) models constructed from post-mortem computed tomography (PMCT) scans. Using femoral DICOM datasets, reference planes were generated and plane-to-plane measurements were conducted on 3D surface rendered models. Bicondylar length, epicondylar breadth, anterior-posterior (AP) diameter, medial-lateral (ML) diameter and cortical area at the midshaft were measured by four observers to test the measurement error variance and observer agreement of the protocol (n=6). Intra-observer error resulted in a mean relative technical error of measurement (%TEM) of 0.11 and an intraclass correlation coefficient (ICC) of 0.999 (CI=0.998-1.000); inter-observer error resulted in a mean %TEM of 0.54 and ICC of 0.996 (CI=0.979-1.000) for bicondylar length. Epicondylar breadth, AP diameter, ML diameter and cortical area also yielded minimal error. Precision testing demonstrated that the approach is highly repeatable and is recommended for implementation in anthropological investigation and research. This study exploits the benefits of virtual anthropology, introducing an innovative, standardized alternative to dry bone osteometric measurements.

Does cutting a plaster window weaken its strength

INTRODUCTION A plaster window is usually created over a pressure area, or in some cases a wound or suture line. This can relieve pressure at the site, and provide an opportunity to change dressings, check on drainage, and inspect a wound or ulcer. There is concern that this can have an effect on its function to provide fracture stability, and weakens the plaster. The biomechanical effects of windowing on plaster strength were therefore investigated, as it has not previously been reported. METHOD A laboratory study was undertaken to compare the bending, kinking and torsion loads withstood by standardised Plaster of Paris (POP), Softcast and Fibreglass casts compared to those with a 60×40mm window fabricated in the centre at clinically defined endpoints using an Instron machine. RESULTS The addition of a window significantly weakened the load to failure of POP; Fibreglass, and Softcast by 23.1% (473.1N); 25.9% (401.8N), and 29% (146.6N) respectively, during the 4-point bending tests. During the 3-point kinking tests, load to failure was reduced by 38.5% (297.8N); 35.3% (146.9N), and 51.5% (103.8N) respectively. All tests were checked for consistency and carried out in a single orthogonal plane for ease of comparison. DISCUSSION The addition of a 60×40mm window to a cast made up of POP, Fibreglass or Softcast weakens the cast load to failure by up to 51% against a 3-point loading force. Though windowing of casts is necessary in certain situations, we advise precautions such as adding further layers of plaster to the window site, keeping the window as small as possible, and advising the patient of the increased risk of weakening and failure of the plaster so that they can take more care.

Comparison of two pressurisers for cementation of the proximal femur.

Purpose. To compare pressures generated by 2 different cement pressurisers at various locations in the proximal femur. Methods. Two groups of 5 synthetic femurs were used, and 6 pressure sensors were placed in the femur at 20-mm intervals proximally to distally. Cement was filled into the femoral canal retrogradely using a cement gun with either the half-moon pressuriser or the femoral canal pressuriser. Maximum pressures and pressure time integrals (cumulative pressure over time) of the 2 pressurisers were compared. Results. At all sensors, the half-moon pressuriser produced higher maximum pressures and pressure time integrals than the femoral canal pressuriser, but the difference was significant only at sensor 1 (proximal femur). This may result in reduced cement interdigitation in the proximal femur. Conclusion. The half-moon pressuriser produced higher maximum cementation pressures and pressure time integrals than the femoral canal pressuriser in the proximal femur region, which is critical for rotational stability of the implant and prevention of implant fracture.

Biomechanical analysis of a synthetic, biodegradable impaction graft substitute.

Impaction bone grafting in revision arthroplasty is a common and successful procedure to restore primary bone stock. Reducing the amount of bone needed to fill large grafts has been a driving force for the use of synthetic materials that can act as extenders or substitutes. To this end, we evaluated the mechanical properties of a new class of biodegradable polymer beads with and without donor bone to determine its suitability for use in impaction grafting. Biodegradable methacrylated anhydride beads were synthesized using thermal polymerization techniques. The mechanical properties of the beads were then tested in an impaction grafting test chamber and compared with morsellised porcine allograft. The beads, porcine allograft and a 50/50 combination all had similar mechanical properties, both in compression and relaxation. Pure polymer beads compacted significantly less than pure allograft and retained macroporosity after impaction. Our results suggest that the biodegradable beads have sufficient mechanical properties to be considered as an impaction grafting substitute or extender. Their ability to fill space whilst retaining macroporosity may be advantageous for tissue ingrowth and remodeling.