Bone properties surrounding hydroxyapatite-coated custom osseous integrated dental implants.

Calcium phosphate (hydroxyapatite or HA) coatings have been applied to Custom Osseous Integrated Implants (COIIs) to improve the quality of the bone-implant integration, yet little is known concerning the biomechanical properties of bone surrounding the HA-coated implants in humans over the long term. The purpose of this study was to characterize the mechanical and histomorphometric properties of the bone along the implant interface. Specimens were prepared from three similar mandibular implants that were functional in three female patients for about 11 years. Histomorphometric analyses showed bone-implant contact averaging 75% for all specimens. Area coverage of residual HA-coating ranged from 52 to 70%. When compared with previous studies, these results show a relatively high percentage of residual HA after a decade in vivo. Nanoindentation showed similar average values of hardness and modulus (p = 0.53 and p = 0.56, respectively) comparing bone adjacent to residual HA-coating and regions where the coating was absent. The elastic modulus was significantly lower for bone near the bone-implant interface (<200 µm) as compared with bone distant (>1000 µm) from the interface (p = 0.05), thereby reflecting different properties of the bone near these interfaces. Backscattered electron imaging showed darker gray levels which indicated decreased mineral content in bone adjacent to the implant, consistent with the nanoindentation results.

Synthesis and Mechanical Wear Studies of Ultra Smooth Nanostructured Diamond (USND) Coatings Deposited by Microwave Plasma Chemical Vapor Deposition with He/H(2)/CH(4)/N(2) Mixtures.

Ultra smooth nanostructured diamond (USND) coatings were deposited by microwave plasma chemical vapor deposition (MPCVD) technique using He/H(2)/CH(4)/N(2) gas mixture. The RMS surface roughness as low as 4 nm (2 micron square area) and grain size of 5-6 nm diamond coatings were achieved on medical grade titanium alloy. Previously it was demonstrated that the C(2) species in the plasma is responsible for the production of nanocrystalline diamond coatings in the Ar/H(2)/CH(4) gas mixture. In this work we have found that CN species is responsible for the production of USND coatings in He/H(2)/CH(4)/N(2) plasma. It was found that diamond coatings deposited with higher CN species concentration (normalized by Balmer H(α) line) in the plasma produced smoother and highly nanostructured diamond coatings. The correlation between CN/H(α) ratios with the coating roughness and grain size were also confirmed with different set of gas flows/plasma parameters. It is suggested that the presence of CN species could be responsible for producing nanocrystallinity in the growth of USND coatings using He/H(2)/CH(4)/N(2) gas mixture. The RMS roughness of 4 nm and grain size of 5-6 nm were calculated from the deposited diamond coatings using the gas mixture which produced the highest CN/H(α) species in the plasma. Wear tests were performed on the OrthoPOD(®), a six station pin-on-disk apparatus with ultra-high molecular weight polyethylene (UHMWPE) pins articulating on USND disks and CoCrMo alloy disk. Wear of the UHMWPE was found to be lower for the polyethylene on USND than that of polyethylene on CoCrMo alloy.

Elastic and viscoelastic properties of the human pubic symphysis joint: effects of lateral impact joint loading.

The human pelvis is susceptible to severe injury in vehicle side impacts owing to its close proximity to the intruding door and unnatural loading through the greater trochanter. Whereas fractures of the pelvic bones are diagnosed with routine radiographs (x-rays) and computerized tomography (CT scans), non-displaced damage to the soft tissues of pubic symphysis joints may go undetected. If present, trauma-induced joint laxity may cause pelvic instability, which has been associated with pelvic pain in non-traumatic cases. In this study, mechanical properties of cadaveric pubic symphysis joints from twelve normal and eight laterally impacted pelves were compared. Axial stiffness and creep responses of these isolated symphyses were measured in tension and compression (perpendicular to the joint). Bending stiffness was determined in four primary directions followed by a tension-to-failure test. Loading rate and direction correlated significantly (p<0.05) with stiffness and tensile strength of the unimpacted joints, more so than donor age or gender. The impacted joints had significantly lower stiffness in tension (p <0.04), compression (p<0.003), and posterior bending (p<0.03), and more creep under a compressive step load (p<0.008) than the unimpacted specimens. Tensile strength was reduced following impact, however, not significantly. We concluded that the symphysis joints from the impacted pelves had greater laxity, which may correlate with post-traumatic pelvic pain in some motor vehicle crash occupants.

Regional trabecular bone matrix degeneration and osteocyte death in femora of glucocorticoid- treated rabbits.

Glucocorticoids at pharmacological concentrations cause osteoporosis and aseptic necrosis, particularly in the proximal femur. Several mechanisms have been proposed, but the primary events are not clear. We studied changes in the bone structure and cellular activity in femora of glucocorticoid-treated rabbits before the occurrence of fracture or collapse. In rabbits treated 28 days with 4 micromol/kg.day of methylprednisolone acetate, changes in the cortical bone were minor. However, metabolic labeling showed that bone formation was virtually absent in the subarticular trabecular bone, and scanning electron microscopy showed resorption of 50-80% of the trabecular surface. Thus, reduction in bone synthesis and increased resorption were involved in bone loss. Vascular changes, which have been hypothesized to mediate glucocorticoid damage, were not seen, but histological changes suggested that trabecular bone was damaged. Matrix integrity was examined using laser scanning confocal microscopy to detect passive tetracycline adsorption. In treated animals, but not controls, tetracycline was adsorbed, in a novel lamellar pattern, in 50--200 microm regions extending deep into trabeculae. This showed that the matrix, which is normally impervious, was exposed at these sites. TUNEL assays showed that matrix damage correlated with cell death in the subarticular trabecular bone of treated animals. The pattern of cell death involving cohorts of osteoblasts and osteocytes comprised up to half of the bone volume in affected regions and is consistent with an apoptotic mechanism. Small numbers of TUNEL-labeled osteoblasts, but no osteocytes, were detected in control bone. We conclude that exposure of bone matrix permeability and that regional cell death consistent with apoptosis is an early event in glucocorticoid-induced bone damage.

Acetabular fracture patterns: associations with motor vehicle crash information.

BACKGROUND: Motor vehicle crashes are the most common cause of acetabular fractures, which have been associated with significant morbidity and mortality. METHODS: To date, medical and collision information has been collected on 83 acetabular fracture patients treated at the University of Alabama at Birmingham's Level I trauma center. The fractures were grouped according to the Judet-Letournel classification scheme and investigated for correlation with age, sex, vehicle type, impact direction, and seat-belt use. RESULTS: The database included 41 women and 42 men with a combined average age of 32.8 years. Femoral shaft axis loading fractures correlated significantly with male sex, trucks, and frontal impacts. Greater trochanter loading fractures occurred statistically more frequently in side impacts. Women received a significant higher percentage of off-axis loading fractures, which were associated more in angled frontal impacts. CONCLUSION: Acetabular fracture type strongly correlated with impact direction, supporting the fracture mechanisms proposed by Judet and Letournel.

Stress intensity factors for a vertical surface crack in polyethylene subject to rolling and sliding contact.

Pitting wear is a dominant form of polyethylene surface damage in total knee replacements, and may originate from surface cracks that propagate under repeated tribological contact. In the present study, stress intensity factors, KI and KII, were calculated for a surface crack in a polyethylene-CoCr-bone system in the presence of rolling or sliding contact pressures. Variations in crack length and load location were studied to determine probable crack propagation mechanisms and modes. The crack tip experienced a wide range of mixed-mode conditions that varied as a function of crack length, load location, and sliding friction. Positive KI values were observed for shorter cracks in rolling contact and for all crack lengths when the sliding load moved away from the crack. KII was greatest when the load was directly adjacent to the crack (g/a = +/- 1), where coincidental Mode I stresses were predominantly compressive. Sliding friction substantially increased both KImax and KIImax. The effective Mode I stress intensity factors, Keff, were greatest at g/a = +/- 1, illustrating the significance of high shear stresses generated by loads adjacent to surface cracks. Keff trends suggest mechanisms for surface pitting by which surface cracks propagate along their original plane under repeated reciprocating rolling or sliding, and turn in the direction of sliding under unidirectional sliding contact.

Effects of precoating surface treatments on fatigue of Ti-6A1-4V.

Grit blasting is a common procedure of roughening surfaces to promote physical attachment of porous coatings, but it has been shown to reduce fatigue strength. Shot peening is known to increase fatigue strength by inducing compressive surface stresses; however, it is not known how subsequent grit blasting affects these benefits. This study examines the endurance limits, Se, of ELI grade Ti-6A1-4V specimens under rotating cyclic bending, including polished (control); belted and beaded; belted, beaded, and grit blasted; and belted, beaded, shot peened, and grit blasted. Belting and beading resulted in a slight increase in Se, grit blasting caused a 15% reduction in Se from polished. Fifty percent of this reduction was recovered when shot peening preceded grit blasting, suggesting that residual compressive surface stresses, induced by peening, were not eliminated by the blast process. Roughness averages and RMS values did not correlate with Se trends. SEM results showed classical fatigue fractures, consistent with surface crack initiation.

Normal contact of elastic spheres with two elastic layers as a model of joint articulation.

An analytical model of two elastic spheres with two elastic layers in normal, frictionless contact is developed which simulates contact of articulating joints, and allows for the calculation of stresses and displacements in the layered region of contact. Using various layer/layer/substrate combinations, the effects of variations in layer and substrate properties are determined in relation to the occurrence of tensile and shear stresses as the source of crack initiation in joint cartilage and bone. Vertical cracking at the cartilage surface and horizontal splitting at the tidemark have been observed in joints with primary osteoarthritis. Deep vertical cracks in the calcified cartilage and underlying bone have been observed in blunt trauma experiments. The current model shows that cartilage stresses for a particular system are a function of the ratio of contact radius to total layer thickness (a/h). Surface tension, which is observed for a/h small, is alleviated as a/h is increased due to increased load, softening and/or thinning of the cartilage layer. Decreases in a/h due to cartilage stiffening lead to increased global compressive stresses and increased incidence of surface tension, consistent with impact-induced surface cracks. Cartilage stresses are not significantly affected by variations in stiffness of the underlying material. Tensile radial strains in the cartilage layer approach one-third of the normal compressive strains, and increase significantly with cartilage softening. For cases where the middle layer stiffness exceeds that of the underlying substrate, tensile stresses occur at the base of the middle layer, consistent with impact induced cracks in the zone of calcified cartilage and subchondral bone. The presence of the superficial tangential zone appears to have little effect on underlying cartilage stresses.

An analytical model of joint contact.

The stress distribution in the region of contact between a layered elastic sphere and a layered elastic cavity is determined using an analytical model to stimulate contact of articulating joints. The purpose is to use the solution to analyze the effects of cartilage thickness and stiffness, bone stiffness and joint curvature on the resulting stress field, and investigate the possibility of cracking of the material due to tensile and shear stresses. Vertical cracking of cartilage as well as horizontal splitting at the cartilage-calcified cartilage interface has been observed in osteoarthritic joints. The current results indicate that for a given system (material properties mu and nu constant), the stress distribution is a function of the ratio of contact radius to layer thickness (a/h), and while tensile stresses are seen to occur only when a/h is small, tensile strain is observed for all a/h values. Significant shear stresses are observed at the cartilage-bone interface. Softening of cartilage results in an increase in a/h, and a decrease in maximum normal stress. Cartilage thinning increases a/h and the maximum contact stress, while thickening has the opposite effect. A reduction in the indenting radius reduces a/h and increases the maximum normal stress. Bone softening is seen to have negligible effect on the resulting contact parameters and stress distribution.