Failure Analysis on Interface Stress in Unicompartmental Knee Arthroplasty / 医用生物力学

Objective To analyze interface stress of cemented tibial prosthesis platform and determine the interface stress damage area, so as to provide references for stress failure of tibial platform in clinical single condylar replacement. Methods The full cycle gait was simulated by human dynamics software to obtain the load-bearing condition of knee joint. A complete model of the knee joint was established by medical imaging and three-dimensional (3D) reconstruction software, and unicompartmental replacement was performed. The distribution of interfacial stress of tibial prosthesis platform after single condylar replacement was analyzed by finite element method. ResultsIn gait, force and angle of the knee joint changed periodically with time, a cycle lasted 1.3 s, and the peak of knee joint resultant force was 760 N. The maximum shear stress of the interface was 11.82 MPa and the maximum tensile stress was 6.849 MPa, both occurred at inner front end of the corner of prosthesis cement interface. The maximum interface stress of titanium alloy prosthesis was lower than that of stainless steel prosthesis. Conclusions The decrease in elastic modulus of prosthesis can reduce the maximum principal stress at the interface. Considering the interface stress, titanium alloy prosthesis is better than stainless steel prosthesis. The area of tibial prosthetic platform interface damage is mainly at the medial anterior and posterior corners and lateral middle ends,so improving the ability of prosthesis cement bonding in this area can prevent the loosening of tibial prosthesis of unicompartmental knee joint.The findings have practical implications for the prevention of tibial prosthetic platform loosening after unicompartmental knee arthroplasty in clinic.

Monitoring osseointegrated prosthesis loosening and fracture using electrical capacitance tomography

A noncontact, noninvasive, electrical permittivity imaging technique is proposed for monitoring loosening of osseointegrated prostheses and bone fracture. The proposed method utilizes electrical capacitance tomography (ECT), which employs a set of noncontact electrodes, arranged in a circular fashion around the imaging area, for electrical excitations and measurements. An inverse reconstruction algorithm was developed and implemented to reconstruct the electrical permittivity distribution of the interrogated region from boundary capacitance measurements. In this study, osseointegrated prosthesis phantoms were prepared using plastic rods and Sawbone femur specimens, which were subjected to prosthesis loosening and fracture monitoring tests. The results demonstrated that the spatial location and extent of prosthesis loosening and bone fracture could be estimated from the ECT reconstructed permittivity maps. The resolution of the reconstructed images was further enhanced by a limited region tomography algorithm, and its accuracy in terms of identifying the severity, location, and shape of bone fracture was also investigated and compared with conventional full region tomography.

Clinics in diagnostic imaging (167). Total shoulder arthroplasty glenoid component loosening with secondary rotator cuff failure

A 59-year-old woman who had previously undergone an anatomic left total shoulder arthroplasty presented with increasing left shoulder pain and significant reduction in motion of the left shoulder joint. No evidence of prosthetic loosening or periprosthetic fracture was detected on the radiographs or fluoroscopic arthrogram images. Dual-energy computed tomography (DECT) images revealed evidence of loosening of the glenoid component and secondary rotator cuff failure. This case illustrates how a combination of detailed clinical history, careful physical examination and DECT arthrogram evaluation may be used to identify complications of an anatomic total shoulder arthroplasty.

Loosening torque of Universal Abutment screws after cyclic loading: influence of tightening technique and screw coating

PURPOSE: The purpose of this study was to evaluate the influence of tightening technique and the screw coating on the loosening torque of screws used for Universal Abutment fixation after cyclic loading. MATERIALS AND METHODS: Forty implants (Titamax Ti Cortical, HE, Neodent) (n=10) were submerged in acrylic resin and four tightening techniques for Universal Abutment fixation were evaluated: A - torque with 32 Ncm (control); B - torque with 32 Ncm holding the torque meter for 20 seconds; C - torque with 32 Ncm and retorque after 10 minutes; D - torque (32 Ncm) holding the torque meter for 20 seconds and retorque after 10 minutes as initially. Samples were divided into subgroups according to the screw used: conventional titanium screw or diamond like carbon-coated (DLC) screw. Metallic crowns were fabricated for each abutment. Samples were submitted to cyclic loading at 106 cycles and 130 N of force. Data were analyzed by two-way ANOVA and Tukey's test (5%). RESULTS: The tightening technique did not show significant influence on the loosening torque of screws (P=.509). Conventional titanium screws showed significant higher loosening torque values than DLC (P=.000). CONCLUSION: The use of conventional titanium screw is more important than the tightening techniques employed in this study to provide long-term stability to Universal Abutment screws.

Pullout Strength after Expandable Polymethylmethacrylate Transpedicular Screw Augmentation for Pedicle Screw Loosening

OBJECTIVE: Pedicle screw fixation for spine arthrodesis is a useful procedure for the treatment of spinal disorders. However, instrument failure often occurs, and pedicle screw loosening is the initial step of a range of complications. The authors recently used a modified transpedicular polymethylmethacrylate (PMMA) screw augmentation technique to overcome pedicle screw loosening. Here, they report on the laboratory testing of pedicle screws inserted using this modified technique. METHODS: To evaluate pullout strengths three cadaveric spinal columns were used. Three pedicle screw insertion methods were utilized to compare pullout strength; the three methods used were; control (C), traditional transpedicular PMMA augmentation technique (T), and the modified transpedicular augmentation technique (M). After control screws had been pulled out, loosening with instrument was made. Screw augmentations were executed and screw pullout strength was rechecked. RESULTS: Pedicle screws augmented using the modified technique for pedicle screw loosening had higher pullout strengths than the control (1106.2+/-458.0 N vs. 741.2+/-269.5 N; p=0.001). Traditional transpedicular augmentation achieved a mean pullout strength similar to that of the control group (657.5+/-172.3 N vs. 724.5+/-234.4 N; p=0.537). The modified technique had higher strength than the traditional PMMA augmentation technique (1070.8+/-358.6 N vs. 652.2+/-185.5 N; p=0.023). CONCLUSION: The modified PMMA transpedicular screw augmentation technique is a straightforward, effective surgical procedure for treating pedicle screw loosening, and exhibits greater pullout strength than traditional PMMA transpedicular augmentation. However, long-term clinical evaluation is required.