Investigation of explanted hip and acetabulum hip prostheses]

Retrieved ceramic femoral heads and acetabular cups were investigated. On the basis of the case studies, the reasons for revision are discussed. Wear patterns and wear rates were found to differ from those observed in hip simulating testing. Monolithic ceramic cups showed a high wear rate. Owing to their limited range of motion, ceramic "mushroom heads" are associated with impingement that leads to a high risk of cup loosening, high wear rates and in vivo fractures. The combination of ceramic "mushroom heads" and cups is not recommended. An evaluation of complications shows that some can be explained by patient behaviour--e.g. Japanese sitting position, horse riding. Designers need to develop new concepts offering a larger range of motion, for example, with head diameters of 32 and 36 mm that reduce the risk of impingement, subluxation and dislocation, while increasing the range of motion. The potential of ceramic/ceramic coupling has been known since the 70s, and ceramic concepts for total hip replacement are currently experiencing a renaissance, although further developments are still possible.     

Development of acetabulum after closed reduction in developmental hip dysplasia

The radiographic study of acetabulum development after closed reduction of 87 congenitally dislocated hips in 64 patients who were treated between 1980 and 1990 was conducted retrospectively. An average patient's age at the moment of closed hip reduction was 16 months (range between 6 to 24 months). On the average, patients were 16 months old (range between 6 to 24 months) at the moment of closed hip reduction. Development of bony acetabulum was followed for 8 years by measuring the AC angle. According to the age at the moment of closed reduction patients were sorted into three groups, the first group from 6 months to 12 months old (39 hips), the second group from 12 to 24 months old (28 hips) and the third group from 24 to 36 months old (20 hips). At the beginning of the treatment mean values of the AC angle in the first group were 37.2 degrees +/- 3.31 degrees; in the second group 39.7 degrees +/- 3.2 degrees; and in the third group 43.8 degrees +/- 2.7 degrees. The final values of the AC angle in the first group were 14.7 degrees +/- 3.21 degrees, in the second group 21 degrees +/- 3.02 degrees; and in the third group 24 degrees +/- 3.76 degrees. Normally and mildly dysplastic hips were achieved in 80.5% treated hips, while in 19.5% treated hips medium and serious dysplasia retarded. The acetabulum development in dysplastic hip after retained stable concentric reduction was the same as in the normal hip. The operative reconstruction of acetabulum should not be done before the third year of life.     

Ceramic acetabulum for hip endoprostheses. 8: Revisions]

For total hip replacement, ceramic femoral heads and acetabular liners are being used with success. However, reports of revision surgery necessitated by fractures or marked wear of ceramic components are still being published. The revision rate due to fracture is less than 0.01%, and much lower than for other complications. Nevertheless, improvement of safety remains a topic of discussion. This article reviews the results of investigations of explanted ceramic heads and liners, and discusses the problems caused by ceramic wear and chipping. Recommendations for revision surgery in such cases are given.     

Hemiarthroplasty of hip joint: An experimental validation using porcine acetabulum

Biphasic properties of articular cartilage allow it to be an excellent bearing material and have been studied through several simplified experiments as well as finite element modelling. However, three-dimensional biphasic finite element (FE) models of the whole joint are rare. The current study was carried out to experimentally validate FE methodology for modelling hemiarthroplasty. Material properties such as equilibrium elastic modulus and permeability of porcine acetabular cartilage were initially derived by curve-fitting an experimental deformation curve with that obtained using FE. These properties were then used in the hemiarthroplasty hip joint modelling. Each porcine acetabular cup was loaded with 400N using a 34mm diameter CoCr femoral head. A specimen-specific FE model of each acetabular cup was created using μCT and a series of software processes. Each model was analysed under conditions similar to those tested experimentally. Contact stresses and contact areas predicted by the model, immediately after loading, were then compared with the corresponding experimentally measured values. Very high peak contact stresses (maximum experimental: 14.09MPa) were recorded. A maximum difference of 12.42% was found in peak contact stresses. The corresponding error for contact area was 20.69%. Due to a fairly good agreement in predicted and measured values of contact stresses and contact areas, the integrated methodology developed in this study can be used as a basis for future work. In addition, FE predicted total fluid load support was around 80% immediately after loading. This was lower than that observed in conforming contact problems involving biphasic cartilage and was due to a smaller local contact area and variable clearance making fluid exudation easier.     

The importance of femur/acetabulum cartilage in the biomechanics of the intact hip: experimental and numerical assessment

Experimental studies have been made to study and validate the biomechanics of the pair femur/acetabulum considering both structures without the presence of cartilage. The main goal of this study was to validate a numerical model of the intact hip. Numerical and experimental models of the hip joint were developed with respect to the anatomical restrictions. Both iliac and femur bones were replicated based on composite replicas. Additionally, a thin layer of silicon rubber was used for the cartilage. A three-dimensional finite element model was developed and the boundary conditions of the models were applied according to the natural physiological constrains of the joint. The loads used in both models were used just for comparison purposes. The biomechanical behaviour of the models was assessed considering the maximum and minimum principal bone strains and von Mises stress. We analysed specific biomechanical parameters in the interior of the acetabular cavity and on femur's surface head to determine the role of the cartilage of the hip joint within the load transfer mechanism. The results of the study show that the stress observed in acetabular cavity was 8.3 to 9.2 MPa. When the cartilage is considered in the joint model, the absolute values of the maximum and minimum peak strains on the femur's head surface decrease simultaneously, and the strains are more uniformly distributed on both femur and iliac surfaces. With cartilage, the cortex strains increase in the medial side of the femur. We prove that finite element models of the intact hip joint can faithfully reproduce experimental models with a small difference of 7%.     

Detection of the hip center in computer-assisted surgery: An in vitro assessment study

The HKA i.e. the angle between the hip, knee and ankle centers is a clinical parameter widely used in orthopedic surgery. It can be intraoperatively assessed with computer-assisted surgery navigation systems by computing the 3D location of these joint centers. The hip center is computed using functional methods but is defined by the experts as the anatomical center of the femoral head. The aim of this in vitro study is therefore to assess, first, the accuracy of these functional methods for the determination of the HKA and, second, their reproducibility. We have analyzed on six cadaveric lower limbs the accuracy and the reproducibility of functional methods and their impact on the HKA values. The anatomical hip center has been used as the reference value. The reproducibility is 5.2 mm for the determination of the functional hip centers. The average impact on the HKA is 1.2° (4° max). Despite a lack of reproducibility of the functional methods, the impact on the HKA is limited. The accuracy of the functional methods on the HKA can therefore be enough for some clinical applications.     

Simulator for migration processes and wear in the artificial hip acetabulum for radiologic measurement]

For assessing migration of cups, standard X-rays or stereo radiological images (SRI) are available. In addition, software is also available for measurements. The accuracies of the various systems are established statistically, in part combined with phantoms, and compared. To date, no known phantom is available for the simulation of acetabular cup migration with account being taken of the position of the pelvis in the X-ray beam. Such an appliance covering 8 different parameters has now been developed, the cup can be moved horizontally, vertically and in the loading direction. Angular accuracy is +/- 0.5 degree, and wear of a magnitude of 0.25 mm can be simulated. Two degree elevation of the pelvis, left or right, can be simulated. The position of the pelvis around the horizontal axis permits continuous variation. This appliance can simulate migratory movements of the acetabular cup within a pelvis, and wear within the cup. In addition, the spatial position of the pelvis can be varied. The X-ray images can be used to investigate the accuracy of evaluation strategies.     

Histological study of the fetal development of the human acetabulum and labrum: significance in congenital hip disease.

Seventy-four acetabula from a total of 140 normal human fetuses, obtained from abortions and deaths in the prenatal period, were used. The fetuses ranged from 9.1 to 40 cm in crown-rump length and are believed to be between 12 weeks and term. Acetabula were decalcified embedded in paraffin or celloidin, sectioned, and stained using conventional histologic techniques. Sections from the superior one-quarter of the acetabulum were examined for the initial appearance and later spread of osseous tissue. Throughout the fetal period bone was present only in the floor of the acetabulum and did not extend into the socket walls. Ossification was detected initially more posteriorly in the socket floor, and at all ages, ossification was more prominent on the ischial side of the socket. Despite the lack of osseous tissue a well-formed hyaline cartilage socket was present. The fetal labrum was composed of fibrous tissue with the density of fibers increasing with age. Typical-appearing chondrocytes were detected at only the inner articular margin of the labrum. Contributing from one-fifth to one-half of the socket depth, the labrum may play a greater role in containing the femoral head at birth than it does in the mature joint. In seven acetabula, from joints that were neither subluxated nor dislocated, an area of areolar tissue with capillaries was detected at the hyaline cartilage-labrum junction. Such defects may weaken the labrum and contribute to neonatal hip instability.     

SPREAD: spatial phylogenetic reconstruction of evolutionary dynamics

SUMMARY: SPREAD is a user-friendly, cross-platform application to analyze and visualize Bayesian phylogeographic reconstructions incorporating spatial-temporal diffusion. The software maps phylogenies annotated with both discrete and continuous spatial information and can export high-dimensional posterior summaries to keyhole markup language (KML) for animation of the spatial diffusion through time in virtual globe software. In addition, SPREAD implements Bayes factor calculation to evaluate the support for hypotheses of historical diffusion among pairs of discrete locations based on Bayesian stochastic search variable selection estimates. SPREAD takes advantage of multicore architectures to process large joint posterior distributions of phylogenies and their spatial diffusion and produces visualizations as compelling and interpretable statistical summaries for the different spatial projections. AVAILABILITY: SPREAD is licensed under the GNU Lesser GPL and its source code is freely available as a GitHub repository: https://github.com/phylogeography/SPREAD CONTACT: filip.bielejec@rega.kuleuven.be.     

Morphological characteristics of the acetabulum

The aim of this research was to accurately measure the surface of the semi lunar articular surface of the pelvis (facies lunata acetabuli) and the variability of the acetabular geometry, as well as to determine the correlation between measured parameters. 30 macerated anatomical specimens of pelvic bones were measured. The radius and depth were measured in the classical way, while cartilaginous surface area was measured using small fragments of measuring paper to avoid errors in measurement due to the curvature of the surface. Computerized calculations provided accurate surface values. In our research, facies lunata acetabuli measured 2294+/-329 mm2. Diameter of the opening of the acetabulum measured 25.8+/-1.9 mm. Acetabular depth was 30+/-3.2 mm. Correlations between the surface area of the facies lunata acetabuli and the radius of the acetabular opening curvature (r=0.71), surface area of the facies lunata acetabuli and the depth of the acetabulum (r=0.80) and the radius of the acetabular opening curvature and the depth of the acetabulum (r=0.80) were confirmed. For precise assessment of the facies lunata acetabuli surface area, the simplest and the cheapest method is the method of measurement using small fragments of measuring paper and software analysis. There is a significant correlation between the depth, opening of the acetabulum and surface area of the facies lunata.     

New frontiers in calvarial reconstruction: integrating computer-assisted design and tissue engineering in cranioplasty

Repair of large and complex calvarial defects remains a particular challenge for reconstruction. The paucity of techniques and materials emphasizes the need for alternative bone formation strategies. Recent integrative approaches suggest that successful reconstruction requires interdisciplinary teams, with surgeons interacting with imaging experts, materials scientists, and engineers. In this review, the authors present an overview of current materials used in calvarial reconstruction. Subsequently, progress in computer-designed prostheses, tissue engineering, and osteoinduction strategies is discussed. Finally, the authors discuss their experience with the integration of computer-aided fabrication of customized implants and tissue engineering for calvarial reconstruction.     

Primary stability of press-fit acetabulum cups using a new acetabulum reamer]

The aim of the present study was to assess the initial stability of uncemented press-fit acetabular components using a newly developed reamer designed to optimize the surgical preparation of the acetabulum. Ten synthetic human pelves were used to investigate the stability of 20 uncemented press-fit acetabular components, each of which was tested in a servohydraulic testing machine for 6 cycles under an axial load of 2.4 kN. The results of the micrometric measurements revealed satisfactory stability for a reaming depth of 2 mm, and a press-fit of 2 mm. Micromotion was less than 200 microns in all the anatomical sections of the acetabulum (ischium 63 microns, pubis 150 microns, ilium 85 microns). A press-fit of 4 mm and the smaller reaming depth of 1 mm were associated with a substantial decrease in mechanical stability.     

Regional load bearing of the canine acetabulum

OBJECTIVE: To determine the load bearing areas of the canine acetabulum. MATERIALS AND METHODS: A kinematic study of four healthy dogs was used to determine the orientation of the femur to the pelvis at mid-stance. Femora and pelves from 10 canine cadavers were loaded with the physiological canine hip reaction force and angle being replicated. Impression material placed within the acetabulum was extruded from areas of load bearing. Digital images before and after loading were used to assess if six different regions of the acetabulum were fully, partially or non-load bearing. RESULTS: All areas of the acetabulum were partially or fully load bearing. The cranial and caudal thirds of the acetabulum were 7.9 and 13.1 times more likely to be fully load bearing than the central third, respectively. There was a significant difference in load bearing between the axial, middle and abaxial thirds of the acetabulum in all tests, with the middle and abaxial thirds 72.4 and 351 times more likely to be fully load bearing than the axial third, respectively. CONCLUSION: The cranial and caudal thirds and the middle and abaxial thirds of the canine acetabulum are fully load bearing. CLINICAL RELEVANCE: The caudal third of the canine acetabulum is loaded and therefore recommendations that fractures in this area be managed conservatively need to be reconsidered.     

Regional load bearing of the feline acetabulum

OBJECTIVE: To test if the caudal acetabulum of the cat is unloaded at mid-stance as has been asserted. MATERIALS AND METHODS: A kinematic study of five healthy cats was performed to ascertain the mid-stance angle of the hip joint, and the orientation of the pelvis and femur. Femora and pelves from 10 feline cadavers were loaded at physiological load at the mid-stance angle. Impression material placed within the acetabulum was extruded from areas of load bearing. Digital images before and after loading were used to assess whether three areas of the acetabulum, cranial, central and caudal, were fully, partially or non-load bearing. RESULTS: There was a significant difference in load bearing in the three regions (p < 0.001, Kruskal-Wallis test), with a significant difference in load bearing between the cranial and central thirds (p < 0.001) and the cranial and caudal thirds (p < 0.001) but no difference between the central and caudal thirds of the acetabulum (Mann-Whitney-U test). CONCLUSIONS: The load bearing areas of the feline acetabula are the caudal and central thirds. CLINICAL RELEVANCE: The caudal acetabulum of the cat is loaded, therefore the recommendations for simple fractures being treated conservatively needs to be reconsidered.     

Development and organization of the central vacuole of Acetabularia acetabulum

* Here we analyzed the shape of the central vacuole of Acetabularia acetabulum by visualizing its development during diplophase (from juvenility through reproduction) and haplophase (from meiosis through mating). * Light microscopy and whole-organism applications of a pH-sensitive dye, neutral red, were used to visualize the anatomy of the central vacuole. We studied connectivity within the thallus by locally applying dye to morphologically distinct regions (rhizoid, stalk, apex, hairs) and observing dye movements. * In vegetative thalli most of the rhizoid, stalk and young hairs stained with dye. In reproductive structures (caps, gametangia) dye also stained the majority of the interiors. When applied to small areas, dye moved at different rates through each region of the thallus (e.g. within the stalk). Dye moved from younger hairs, but not from older hairs, into the stalk. Errors in incorporation of central vacuole into gametangia occurred at <10(-5). * These data indicate that the central vacuole of A. acetabulum is a ramified polar organelle with, potentially, a gel-like sap that actively remodels its morphology during development.