Influence of the change in stem length on the load transfer and bone remodelling for a cemented resurfaced femur

The effect of a short-stem femoral resurfacing component on load transfer and potential failure mechanisms has rarely been studied. The stem length has been reduced by approximately 50% as compared to the current long-stem design. Using 3-D FE models of natural and resurfaced femurs, the study is aimed at investigating the influence of a short-stem resurfacing component on load transfer and bone remodelling. Applied loading conditions include normal walking and stair climbing. The mechanical role of the stem along with implant–cement and stem–bone contact conditions was observed to be crucial. Shortening the stem length to half of the current length (long-stem) led to several favourable effects, even though the stress distributions in the implant and the cement were similar in both the cases. The short-stem implant led not only to a more physiological stress distribution but also to bone apposition (increase of 20–70% bone density) in the superior resurfaced head, when the stem–bone contact prevailed. This also led to a reduction in strain concentration in the cancellous bone around the femoral neck–component junction. The normalised peak strain in this region was lower for the short-stem design as compared to that of the long-stem one, thereby reducing the initial risk of neck fracture. The effect of strain shielding (50–75% reduction) was restricted to a small bone volume underlying the cement, which was approximately half of that of the long-stem design. Consequently, bone resorption was considerably less for the short-stem design. The short-stem design offers better prospects than the long-stem resurfacing component.     

Non-contacting electrode system for the measurement of strain generated potentials in bone

Current methods employing contact electrodes for the measurement of the electromechanical properties of bone produce errors in the measurement due to the effects of polarization at the bone-electrode interface, and the flow of electric charges in the bone measuring circuit. In addition, signal artefacts may result from the movement of an electrode in contact with a specimen undergoing mechanical deformation. The principles for a non-contacting method, based on charge induction on a conductive plate placed in the field of a charged body (bone), and the resulting non-contacting electrode system are presented in this paper. The new electrode enabled measurement of strain generated potentials (SGP) in bone with minimal effect from the measuring circuit and provided new results previously masked by contacting measurement methods. Furthermore, the new electrode is a potential tool for further investigation of the in vitro electromechanical behaviour of bone, particularly in partially hydrated specimens and in vivo, thereby avoiding invasive methods or use of ionizing radiation.     

Numerical analysis of an osseointegrated prosthesis fixation with reduced bone failure risk and periprosthetic bone loss

Currently available implants for direct attachment of prosthesis to the skeletal system after transfemoral amputation (OPRA system, Integrum AB, Sweden and ISP Endo/Exo prosthesis, ESKA Implants AG, Germany) show many advantages over the conventional socket fixation. However, restraining biomechanical issues such as considerable bone loss around the stem and peri-prosthetic bone fractures are present. To overcome these limiting issues a new concept of the direct intramedullary fixation was developed. We hypothesize that the new design will reduce the peri-prosthetic bone failure risk and adverse bone remodeling by restoring the natural load transfer in the femur. Generic CT-based finite element models of an intact femur and amputated bones implanted with 3 analyzed implants were created and loaded with a normal walking and a forward fall load. The strain adaptive bone remodeling theory was used to predict long-term bone changes around the implants and the periprosthetic bone failure risk was evaluated by the von Mises stress criterion. The results show that the new design provides close to physiological distribution of stresses in the bone and lower bone failure risk for the normal walking as compared to the OPRA and the ISP implants. The bone remodeling simulations did not reveal any overall bone loss around the new design, as opposed to the OPRA and the ISP implants, which induce considerable bone loss in the distal end of the femur. This positive outcome shows that the presented concept has a potential to considerably improve safety of the rehabilitation with the direct fixation implants.     

A method for direct recording of electromechanical data from skeletal bone in living animals

This paper has described techniques permitting the first simultaneous recordings of ‘stress-generated’ electrical potentials from bone, together with mechanical strain, during ambulation in a living animal. Results of further studies should advance understanding of the mechanisms underlying Wolffs Law, and assist in design of devices intended to stimulate bone formation by application of electrical energy.     

Ineffective erythropoiesis in acute human P. falciparum malaria

An analysis of erythroblast cell kinetics utilizing quantitative 14C-autoradiography has been performed in five cases of acute Plasmodium falciparum malaria prior to and, in four patients, 3 or 6 days after the onset of antimalarial therapy. Associated with no or only moderate anemia were changes of erythroblast morphology, a considerable shift in the frequency of red and white blood cell precursors in the bone marrow, and a reduced rate of erythroblast proliferation. There was a marked loss of polychromatic erythroblasts, which was smaller but still detectable during the therapeutic phase. The results provide some quantitative data on the extent of "parenchymal damage" of bone marrow and stress the impact of ineffective erythropoiesis and reduced rate of erythropoietic proliferation on the emergence of anemia in Plasmodium falciparum malaria.     

Advances in the discovery of cathepsin K inhibitors on bone resorption

Cathepsin K (Cat K), highly expressed in osteoclasts, is a cysteine protease member of the cathepsin lysosomal protease family and has been of increasing interest as a target of medicinal chemistry efforts for its role in bone matrix degradation. Inhibition of the Cat K enzyme reduces bone resorption and thus, has rendered the enzyme as an attractive target for anti-resorptive osteoporosis therapy. Over the past decades, considerable efforts have been made to design and develop highly potent, excellently selective and orally applicable Cat K inhibitors. These inhibitors are derived from synthetic compounds or natural products, some of which have passed preclinical studies and are presently in clinical trials at different stages of advancement. In this review, we briefly summarised the historic development of Cat K inhibitors and discussed the relationship between structures of inhibitors and active sites in Cat K for the purpose of guiding future development of inhibitors.     

Modelling external bone adaptation using evolutionary structural optimisation

External remodelling is significant in the bone healing process, and it is essential to predict the bone external shape in the design of artificial bone grafts. This paper demonstrates the effectiveness of the evolutionary structural optimisation (ESO) method for the simulation of bone morphology. A two-dimensional ESO strategy is developed which is capable of finding the modified bone topology beginning with any geometry under any loading conditions. The morphology of bone structure is described by the quantitative bone adaptation theory, which is integrated with the finite element method. The evolutionary topology optimisation process is introduced to find the bone shape. A rectangle, which occupies a larger space than the external shape of the bone structure, is specified as a design domain; the evolutionary process iteratively eliminates and redistributes material throughout the domain to obtain an optimum arrangement of bone materials. The technique has been tested on a wide range of examples. In this paper, the formation of trabecular bone architecture around an implant is studied; as another example, the growth of the coronal section of a vertebral body is predicted. The examples support the assertion that the external shape of bone structure can be successfully predicted by the proposed ESO procedure.     

A reference curve for axial bioelectric potentials in rabbit tibia

A high coefficient of variation is characteristic of the bioelectric potentials recorded from living long bones. As a consequence, the data collected from animal and human experiments are difficult to use in practical ways. A distribution curve for bone bioelectric potentials has been calculated using polynomial regression analysis to process the voltage values recorded on the whole length of rabbit tibiae, with reference electrodes positioned in three different points of the bone. The distribution curve so obtained is presented to fulfill the need for a reference curve for the bioelectric potentials recorded from rabbit tibial surfaces.     

Four-body contact potentials derived from two protein datasets to discriminate native structures from decoys

Two-body inter-residue contact potentials for proteins have often been extracted and extensively used for threading. Here, we have developed a new scheme to derive four-body contact potentials as a way to consider protein interactions in a more cooperative model. We use several datasets of protein native structures to demonstrate that around 500 chains are sufficient to provide a good estimate of these four-body contact potentials by obtaining convergent threading results. We also have deliberately chosen two sets of protein native structures differing in resolution, one with all chains' resolution better than 1.5 A and the other with 94.2% of the structures having a resolution worse than 1.5 A to investigate whether potentials from well-refined protein datasets perform better in threading. However, potentials from well-refined proteins did not generate statistically significant better threading results. Our four-body contact potentials can discriminate well between native structures and partially unfolded or deliberately misfolded structures. Compared with another set of four-body contact potentials derived by using a Delaunay tessellation algorithm, our four-body contact potentials appear to offer a better characterization of the interactions between backbones and side chains and provide better threading results, somewhat complementary to those found using other potentials.     

Advanced imaging of the macrostructure and microstructure of bone

Noninvasive and/or nondestructive techniques are capable of providing more macro- or microstructural information about bone than standard bone densitometry. Although the latter provides important information about osteoporotic fracture risk, numerous studies indicate that bone strength is only partially explained by bone mineral density. Quantitative assessment of macro- and microstructural features may improve our ability to estimate bone strength. The methods available for quantitatively assessing macrostructure include (besides conventional radiographs) quantitative computed tomography (QCT) and volumetric quantitative computed tomography (vQCT). Methods for assessing microstructure of trabecular bone noninvasively and/or nondestructively include high-resolution computed tomography (hrCT), micro-computed tomography (muCT), high-resolution magnetic resonance (hrMR), and micromagnetic resonance (muMR). vQCT, hrCT and hrMR are generally applicable in vivo; muCT and muMR are principally applicable in vitro. Although considerable progress has been made in the noninvasive and/or nondestructive imaging of the macro- and microstructure of bone, considerable challenges and dilemmas remain. From a technical perspective, the balance between spatial resolution versus sampling size, or between signal-to-noise versus radiation dose or acquisition time, needs further consideration, as do the trade-offs between the complexity and expense of equipment and the availability and accessibility of the methods. The relative merits of in vitro imaging and its ultrahigh resolution but invasiveness versus those of in vivo imaging and its modest resolution but noninvasiveness also deserve careful attention. From a clinical perspective, the challenges for bone imaging include balancing the relative advantages of simple bone densitometry against the more complex architectural features of bone or, similarly, the deeper research requirements against the broader clinical needs. The considerable potential biological differences between the peripheral appendicular skeleton and the central axial skeleton have to be addressed further. Finally, the relative merits of these sophisticated imaging techniques have to be weighed with respect to their applications as diagnostic procedures requiring high accuracy or reliability on one hand and their monitoring applications requiring high precision or reproducibility on the other.     

Recent advances in ceramic implants as drug delivery systems for biomedical applications

Research in the development of new bioceramics with local drug delivery capability for bone regeneration technologies is receiving great interest by the scientific biomedical community. Among bioceramics, silica-based ordered mesoporous materials are excellent candidates as bone implants due to two main reasons: first, the bioactive behavior of such materials in contact with simulated body fluids, ie, a carbonate hydroxyapatite similar to the mineral phase of bone is formed onto the materials surfaces. Second, their capability of acting as delivery systems of a large variety of biologically active molecules, including drugs to treat bone infection, inflammation or diseases, and molecules that promote bone tissue regeneration, such as peptides, proteins, growth factors, and other osteogenic agents. The recent chemical and technological advances in the nanometer scale has allowed the design of mesoporous silicas with tailored structural and textural properties aimed at achieving a better control over molecule loading and release kinetics. Moreover organic modification of mesoporous silica walls has been revealed as a key strategy to modulate molecule adsorption and delivery rates.     

Computational Design of a Protein-Based Enzyme Inhibitor

While there has been considerable progress in designing protein–protein interactions, the design of proteins that bind polar surfaces is an unmet challenge. We describe the computational design of a protein that binds the acidic active site of hen egg lysozyme and inhibits the enzyme. The design process starts with two polar amino acids that fit deep into the enzyme active site, identifies a protein scaffold that supports these residues and is complementary in shape to the lysozyme active-site region, and finally optimizes the surrounding contact surface for high-affinity binding. Following affinity maturation, a protein designed using this method bound lysozyme with low nanomolar affinity, and a combination of NMR studies, crystallography, and knockout mutagenesis confirmed the designed binding surface and orientation. Saturation mutagenesis with selection and deep sequencing demonstrated that specific designed interactions extending well beyond the centrally grafted polar residues are critical for high-affinity binding.     

Bone mineral density and microarchitecture in participants of a 105-day experiment in isolated environment

A study on the bone system state in healthy volunteers has been performed before and after 105-day experiment in hermetically isolated environment (the Mars-105 experiment) using dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT). The values of bone mineral density (BMD), volumetric bone mineral density (VBMD), and bone structural characteristics of distal segments in radius and tibia have been evaluated. No significant DXA changes have been revealed in segments of skeleton critically important in terms of biomechanics. Microarchitectural deterioration (a decrease in the trabecula number and increase in the bone tissue heterogeneity) has been found using the pQCT technique in the radius of the majority of subjects. A VBMD decrease has been revealed for both cortical and trabecular bones in tibia, along with an unexpected trabecular bone improvement in the form of an increase in the trabecula quantity and decrease in bone tissue heterogeneity. Comprehensive studies, including estimation of projective and volumetric bone mineral densities (the bone mineral content) and bone structural characteristics (bone quality) are required to have a clear view on the changes in the bone system under the conditions of a simulation experiment.     

Ligament-bone interaction in a three-dimensional model of the knee

In mathematical knee-joint models, the ligaments are usually represented by straight-line elements, connecting the insertions of the femur and tibia. Such a model may not be valid if a ligament is bent in its course over bony-surfaces, particularly not if the resulting redirection of the ligament force has a considerable effect on the laxity or motion characteristics of the knee-joint model. In the present study, a model for wrapping of a ligament around bone was incorporated in a three-dimensional mathematical model of the human knee. The bony edge was described by a curved line on which the contact point of the line element representing a ligament bundle was located. Frictionless contact between the ligament bundle and the bone was assumed. This model was applied to the medial collateral ligament (MCL) interacting with the bony edge of the tibia. It was found that, in comparison with the original model without bony interactions, the bony edge redirected the ligament force of the MCL in such a way that it counterbalanced valgus moments on the tibia more effectively. The effect of the bony interaction with the MCL on the internal-external rotation laxity, however, was negligible.     

Streaming potential of intact wet bone

The conversion of mechanical loads to bioelectrical signals in bone have been suggested to control repair and remodeling. These signals in wet bone are attributed to the electrokinetic behavior where mechanical forces cause electrical signals due to motion of an ion carrying extracellular fluid in the bone matrix (streaming potentials). Streaming potential experiments were performed on control and chemically treated intact wet bone plugs in aphosphate and phosphate buffers to examine the contribution of bone constituents to the electrokinetic behavior of bone tissue. Data indicate that the organic constituents of bone dominate streaming potentials. Slopes of streaming potential vs pressure are related to the electrokinetic (zeta) potential. The slopes should be analyzed in the low pressure region where data is mainly linear. Comparisons of estimated zeta potentials from streaming potentials with existing data obtained by particle electrophoresis showed similar trends.     

Application of bone morphogenetic proteins in spinal fusion

We are now entering an exciting new era in spinal surgery where the inherent osteoinductive capacity of the body has been harnessed for bone formation for therapeutic purposes. Recombinant bone morphogenetic proteins have been extensively studied in both the pre-clinical and clinical arena for spinal fusion with considerable success. The challenges facing spine surgeons now is the development of site-specific carriers and optimal doses for these growth factors. This review highlights the recent advances in this regard.     

A Graphic Comparison Between the Current-Voltage Curves of an Electrochemical Generator and Living Unstressed Rabbit Tibia

Unstressed living bone exhibits bioelectric potential differences along its surface. This electrogenic behavior has been characterized by a V=f(l) curve which is linear up to a certain limit. To better understand the origin and meaning of these potentials and to better describe this electrogenic behavior an electrochemical generator (a silver-oxide cell) was included, instead of bone, into the same measurement situation used to describe the V=f(I) curve of the rabbit tibia. The V=f(I) curve of the cell was graphically compared with the V=f(I) curve of the living unstressed rabbit tibia: the two curves were superimposable. This suggests that an electrochemical mechanism may be at the origin of the bioelectric potentials in unstressed living bone.     

Does screw–bone interface modelling matter in finite element analyses?

The effect of screw-bone interface modelling strategies was evaluated in the setting of a tibial mid-shaft fracture stabilised using locking plates. Three interface models were examined: fully bonded interface; screw with sliding contact with bone; and screw with sliding contact with bone in an undersized pilot hole. For the simulation of the last interface condition we used a novel thermal expansion approach to generate the pre-stress that the bone would be exposed to during screw insertion. The study finds that the global load-deformation response is not influenced by the interface modelling approach employed; the deformation varied by less than 1% between different interaction models. However, interface modelling is found to have a considerable impact on the local stress-strain environment within the bone in the vicinity of the screws. Frictional and tied representations did not have significantly different peak strain values (<5% difference); the frictional interface had higher peak compressive strains while the tied interface had higher tensile strains. The undersized pilot hole simulation produced the largest strains. The peak minimum principal strains for the frictional interface were 26% of those for the undersized pilot hole simulation at a load of 770 N. It is concluded that the commonly used tie constraint can be used effectively when the only interest is the global load-deformation behaviour. Different contact interface models, however, alter the mechanical response around screw holes leading to different predictions for screw loosening, bone damage and stress shielding.     

Preoperative analysis of the stability of fit of a patient-specific surgical guide

Although the use of patient-specific surgical guides has gained popularity over the past decade, little research has been done to examine in an objective and qualitative way the fit of such instruments. In this study, we have developed a model to predict the stability of a guide designed to fit on a supporting bone surface, thereby providing feedback on the translational and rotational stability of the device. The method was validated by comparing different guide designs with respect to their stability on the contact surface and comparing these results to those measured with a set of experiments. This validation experiment indicates that our stability model can be used to predict the stability of the fit of a surgical guide during the preoperative design process.