Ronald C. Anderson

An evaluation of skeletal attachment to LTI pyrolytic carbon, porous titanium, and carbon-coated porous titanium implants

Porous titanium, carbon-coated porous titanium, and low-temperature isotropic (LTI) pyrolytic carbon transcortical implants were placed in the femora of mongrel dogs. Mechanical and histologic analyses were performed in specimens that remained in situ for six months. Qualitative histologic results indicated that the bone formed a direct appositional interface with as-deposited LTI carbon. The bone tissue response to the two systems with porous coatings was similar. Both systems showed little fibrous tissue interposition and a high degree of mineralized bone ingrowth. The ingrown bone was well organized. However, there was some evidence that the ingrown bone mineral differed significantly from the bulk bone mineral. The only difference between carbon-coated and uncoated porous systems was a significant increase in the percentage of bone ingrowth, with carbon-coated specimens having a 4% increase in bone volume. The strength of appositional attachment to LTI carbon was shown to be at least one order of magnitude weaker than bone ingrowth attachment to the porous systems. The interface shear stiffness of the two porous systems was equivalent; however, the attachment shear strength of bone growth into carbon-coated porous titanium was significantly increased compared with that of bone growth into the uncoated porous titanium. Correlation of the percentage of bone ingrowth and pushout strength was also found to be statistically significant, suggesting that the presence of the carbon coating enhanced bone ingrowth, which resulted in significantly increased shear strengths.

Histologic and microradiographic analysis of a revised porous-coated anatomic (PCA) patellar component: a case report

A retrieved uncemented, porous-coated human patellar component was evaluated histologically and microradiographically. The metal portion of the component and porous coating were made of cobalt--chromium-based alloy. Because of adhesive capsulitis and inadequate knee flexion, the patient had revision surgery 11 months after the original total knee arthroplasty. Clinically, the device was not grossly loose. Contact microradiography of the porous material showed no calcified tissue ingrowth. Undecalcified histologic sections demonstrated only fibrous tissue ingrowth, with obvious bone-resorptive activity as well as numerous multinucleated giant cells adjacent to the porous metal.

Stress analysis of halo pin insertion by non-linear finite element modeling

Halo fixation is associated with a high complication rate. The most common complications are loose pins and pin site infections believed to be exacerbated by loose pins. Although pin designs and the technique of pin insertion have changed little in over 30 years, the pin/skull mechanics are poorly understood. Halo pin insertion was modeled using nonlinear finite element analyses to determine the stress distribution in the human skull underlying and surrounding the point of pin fixation. Model validity was established by comparing pin insertion depth and the profile of the hole generated in the bone to the results of experimental mechanical tests. The region surrounding the pin tip within 1 mm was found to undergo plastic deformation and compressive loading in excess of the compressive yield strength of cortical bone. The implication is that damaged bone in this region is responsible for the high incidence of halo pin loosening. Resorption or migration of bone particles with periodic relief of compression in this region due to daily cyclic forces might result in an enlarged pin site and eventually, a loose pin.

Contact Analysis of a Posterior Cervical Spine Plate Using a Three-Dimensional Canine Finite Element Model

The development of a three-dimensional finite element model of a posteriorly plated canine cervical spine (C3-C6) including contact nonlinearities is described. The model was created from axial CT scans and the material properties were derived from the literature. The model demonstrated sufficient accuracy from the results of a mesh convergence test. Significant steps were taken toward establishing model validation by comparison of plate surface strains with a posteriorly plated canine cervical spine under three-point bending. This model was developed to better characterize the contact pressures at the various interfaces under average physiologic canine loading. The analysis showed that the screw-plate interfaces had the highest values of all the mechanical parameters evaluated.

Optimum Pore Size for Bone Cement Fixation

The interface shear properties of porous coated Ti-6Al-4V alloy embedded in bone cement were examined as a function of pore size. Cylindric Ti-6Al-4V alloy push-out specimens were coated with two layers of spheric powders having particle size ranges of 297-420 microns, 420-500 microns, 595-707 microns, and 850-1400 microns. Sintering resulted in mean pore sizes of 165, 285, 345, and 550 microns, respectively, and porosities in the range of 40%-44%. There was a statistically significant difference between the mean pore sizes obtained from the four particle size ranges. There were no differences between the mean porosities. The porous-coated specimens were embedded in bone cement and mechanical push-out testing was performed. Non-coated specimens having a satin surface finish were also embedded in bone cement and tested. The noncoated metal specimens displayed an interface shear strength of 4.2 +/- 0.4 MPa, whereas the shear strengths for the porous-coated specimens were significantly higher and increased as pore size increased. The mean interface shear strengths determined were 17.0 +/- 2.1 MPa (165 microns pore size), 18.1 +/- 2.3 MPa (285 micron pore size), 23.6 +/- 1.7 MPa (345 microns pore size), and 25.4 +/- 3.4 MPa (550 microns pore size). Significant differences in shear strength for the porous-coated specimens were found between the two smaller particle sizes and the two larger particle sizes. As pore size increased from 285 microns to 345 microns, a statistically significant increase in shear strength from 18.1 MPa to 23.6 MPa was observed.

Retrieval and Analysis of Intramedullary Rods: A Follow-up Study

From 1980 to 1983, 16 AO intramedullary femoral rods were retrieved and analyzed clinically, radiographically, and metallurgically. Cracking and/or fracture was observed in four of the 16 specimens. All cracks occurred at the point of maximum stress at the end of the slot. In two cases a structurally weaker weld zone coincided with this location. The weld zone and slot were also found to coincide in five of the uncracked rods. Two of the four cracked rods were removed because of pain, while only three of the 12 uncracked rods caused pain. Structural and material characteristics (i.e., the location of the weld at a point of maximum stress and significant variability in microstructure), rather than surgical technique or time in situ, were found to be responsible for the implant mechanical failures. Improvements should be made in fabrication techniques and material properties. For the present, careful assessment of a painful intramedullary rod and routine removal after healing are advisable.

Histologic and Microradiographic Evaluation of Textured and Nontextured Aluminum Oxide Dental Implants

This paper reports the histological and microradiographical observations of macroscopically textured and nontextured aluminum oxide dental implants. Ion beam bombardment was used to produce a wafflelike pattern of surface undulations approximately 35 microns deep. Twelve nontextured and eight textured implants were placed in the healed extraction sites of the second and forth mandibular premolars of adult mongrel dogs. Eight nontextured and five textured implants remained in situ for six months. Results consistent with previously reported clinical and radiographic findings, indicated a decreased incidence of an interposed fibrous tissue-implant interface associated with the textured implants. Texturing was not found to influence the amount of vertical bone loss. Secondarily, delayed tissue fixation due to post-retrieval mechanical testing procedures resulted in loss of valuable cellular information.

Performance of retrieved Kuntscher intramedullary rods: improved corrosion resistance with contemporary material design.

Eighteen Kuntscher-type intramedullary rods were obtained after human implantation periods ranging from 1 to 23 years. A clinical evaluation, metallurgical and chemical analyses of each implant were performed. Idiopathic, implant-related pain was the most common reason for removal, but was not related to extent of implant corrosion. When classified as early versus contemporary material compositions, a significant increase in surface corrosion, inclusion content and carbon content were demonstrated in rods made of the earlier composition of stainless steel. Intergranular corrosion was associated with structural design, rather than material microcleanliness or composition. While contemporary intramedullary fracture fixation provides excellent clinical results, the present investigation suggests that the performance of stainless steel implants may be improved through continued refinement of steel composition, careful consideration of structural design and fabrication techniques, and by routine removal of implants at the earliest opportunity.

The Effect of Post-Sintering Heat Treatments on the Tensile Properties of Ti-6A1–4V Alloy

Previous studies have shown that the application of a porous coating to a solid substrate offers several advantages over current methods of implant fixation. However, the heat treatments required to sinter porous metal coatings have also been shown to cause significant decreases in the mechanical properties of the substrate. With Ti-6A1-4V alloy, sintering above the material beta transus results in a transformation from the as-received, equiaxed microstructure, recommended for surgical implants, to a lamellar alpha-beta microstructure. This lamellar structure has been shown to have inferior mechanical properties. In the present study, microstructural analysis and mechanical testing were performed on Ti-6A1-4V alloy subjected to various post-sintering heat treatments in an attempt to improve the mechanical properties. The microstructures examined were a fine and a coarse acicular alpha in a retained beta matrix. Tensile tests were performed on specimens containing these structures and results were compared with the lamellar and equiaxed microstructures. The fine acicular alpha structure was shown to exhibit the best tensile properties for the post-sintering Ti-6A1-4V alloy microstructures examined, displaying a 9.8% elongation value, as compared to the as-received, equiaxed microstructure value of 13.5%. This represents a significant improvement over the 5.1% value obtained with the lamellar microstructure.

Tissue Reaction to a Failed Bion® Hip Prosthesis in a Dog

The tissue reaction in a dog to a failed constrained total hip replacement system with a Bion elastomer component was evaluated. The device consisted of Ti-6A1-4V alloy acetabular and femoral components connected with a Bion component. At necropsy the Bion component was found to have fractured. The tissue surrounding the Bion was granulomatous with numerous blackened regions. Histologically a severe chronic inflammatory response was present in the surrounding tissue with numerous giant cells and Bion laden macrophages.