Influence of the stem fixation scenario on load transfer in a hip resurfacing arthroplasty with a biomimetic stem.

Finite element (FE) analysis is a widely used tool for extensive preclinical testing of orthopaedic implants such as hip resurfacing femoral components, including evaluation of different stem fixation scenarios (cementation vs osseointegration, etc.). Most FE models use surface-to-surface contact elements to model the load-bearing interfaces that connect bone, cement and implant and neglect the mechanical effects of phenomena such as residual stresses from bone cement curing. The objective of the current study is to evaluate and quantify the effect of different stem fixation scenarios and related phenomena such as residual stresses from bone cement curing. Four models of a previously clinically available implant (Durom) were used to model different stem fixation scenarios of a new biomimetic stem: a cemented stem, a frictional stem, a partially and completely bonded stem, with and without residual stresses from bone cement curing. For the frictional stem, stem-bone micromotions were increased from 0% to 61% of the available surface subjected to micromotions between 10 and 40µm with the inclusion of residual stresses from bone cement curing. Bonding the stem, even partially, increased stress in the implant at the stem-head junction. Complete bonding of the stem decreased bone strain at step tip, at the cost of increased strain shielding when compared with the frictional stem and partially bonded stem. The increase of micromotions and changes in bone strain highlighted the influence of interfacial conditions on load transfer, and the need for a better modeling method, one capable of assessing the effect of phenomena such as interdigitation and residual stresses from bone cement curing.

Effect of Si and Fe doping on calcium phosphate glass fibre reinforced polycaprolactone bone analogous composites.

Reinforcing biodegradable polymers with phosphate-based glass fibres (PGF) is of interest for bone repair and regeneration. In addition to increasing the mechanical properties, PGF can also release bioinorganics, as they are water soluble, a property that may be controllably translated into a fully degradable composite. Herein, the effect of Si and Fe on the solubility of calcium-containing phosphate-based glasses (PG) in the system (50P(2)O(5)-40CaO-(10-x)SiO(2)-xFe(2)O(3), where x=0, 5 and 10 mol.%) were investigated. On replacing SiO(2) with Fe(2)O(3), there was an increase in the glass transition temperature and density of the PG, suggesting greater crosslinking of the phosphate chains. This significantly reduced the dissolution rates of degradation and ion release. Two PG formulations, 50P(2)O(5)-40CaO-10Fe(2)O(3) (Fe10) and 50P(2)O(5)-40CaO-5Fe(2)O(3)-5SiO(2) (Fe5Si5), were melt drawn into fibres and randomly incorporated into polycaprolactone (PCL). Initially, the flexural strength and modulus significantly increased with PGF incorporation. In deionized water, PCL-Fe(5)Si(5) displayed a significantly greater weight loss and ion release compared with PCL-Fe10. In simulated body fluid, brushite was formed only on the surface of PCL-Fe(5)Si(5). Dynamic mechanical analysis in phosphate buffered saline (PBS) at 37°C revealed that the PCL-Fe10 storage modulus (E') was unchanged up to day 7, whereas the onset of PCL-Fe(5)Si(5)E' decrease occurred at day 4. At longer-term ageing in PBS, PCL-Fe(5)Si(5) flexural strength and modulus decreased significantly. MC3T3-E1 preosteoblasts seeded onto PCL-PGF grew up to day 7 in culture. PGF can be used to control the properties of biodegradable composites for potential application as bone fracture fixation devices.

Anisotropic bone remodeling of a biomimetic metal-on-metal hip resurfacing implant.

Hip resurfacing (HR) is a highly attractive option for young and active patients. Some surgeons have advocated cementing the metaphyseal stem of the femoral component to improve fixation and survivorship of HR. However, extending component fixation to the metaphysis may promote femoral head strain shielding, which in turn may reduce survival of the femoral component. Replacing the metallic metaphyseal stem by a composite material with bone-matching properties could help to alleviate this phenomenon. This study uses finite element analysis to examine the strain state in the femoral head for three types of implant fixation: an unfixed metallic stem, an osseointegrated biomimetic stem and a cemented metallic stem. Bone remodeling is also simulated to evaluate long-term bone resorption due to strain shielding. Results show that the unfixed stem causes strain shielding in the femoral head, and that cementing the stem increases strain shielding. The biomimetic stem does not eliminate the strain shielding effect, but reduces it significantly versus the metallic cemented version. The current finite element study suggests that an osseointegrated metaphyseal stem made of biomimetic material in hip resurfacing implants could become an interesting alternative when fixation extension is desired.

Reduced stress shielding with limited micromotions using a carbon fibre composite biomimetic hip stem: a finite element model.

Total hip arthroplasty (THA) enjoys excellent rates of success in older patients, but younger patients are still at risk of aseptic loosening and bone resorption from stress shielding. One solution to the stress shielding problem is to use a hip stem with mechanical properties matching those of cortical bone. The objective of the present study was to investigate numerically the biomechanical performance of such a biomimetic hip stem based on a hydroxyapatite (HA)-coated carbon fibre composite. A finite element model (FEM) of the biomimetic stem was constructed. Contact elements were studied to model the bone-implant interface in a non-osseointegrated and osseointegrated state in the best way. Three static load cases representing slow walking, stair climbing, and gait in a healthy individual were considered. Stress shielding and bone-implant interface micromotions were evaluated and compared with the results of a similar FEM based on titanium alloy (Ti-6Al-4V). The composite stems allowed for reduced stress shielding when compared with a traditional Ti-6Al-4V stem. Micromotions were slightly higher with the composite stem, but remained below 40 microm on most of the HA-coated surface. It is concluded that a biomimetic composite stem might offer a better compromise between stress shielding and micromotions than the Ti-6Al-4V stem with the same external geometry.

Development of a compliant and cytocompatible micro-fibrous polyethylene terephthalate vascular scaffold.

Bioengineering approaches have been intensively applied to create small diameter vascular grafts using artificial materials. However, a fully successful, high performing and anti-thrombogenic structure has not been achieved yet. In this study, we have designed and fabricated a novel non-woven fibrous vascular graft with biomechanical properties closely resembling those of native vessels. Vascular cell growth, preservation of cell phenotype, retention of vasoactive properties, as well as the effect of gelatin coating on the cellular interaction with the scaffolds under static and shear stress conditions were investigated. The non-woven fibrous scaffolds were made from melt blown polyethylene terephthalate fiber webs stacked by means of a consolidation technique. The scaffold variables were fiber diameter distribution and the number of consolidated web stacks. SEM analysis confirmed various fiber diameter and pore size ranges corresponding to the different conditions. The scaffolds showed burst pressure values of ∼1500 mmHg and compliance (8.4 ± 1.0 × 10(-2) % mmHg(-1) ) very similar to those of native arteries (∼8 × 10(-2) % mmHg(-1) ). The structure with the smallest fiber diameter range (1-5 µm) and pore size range (1-20 µm) was the most suitable for the growth of human brain endothelial cells and aortic smooth muscle cells. The cells maintained their specific cell phenotype, expressed collagen and elastin and produced cAMP in response to α-calcitonin gene-related peptide. However, under shear stress conditions (0.9 dyne cm(-2) ), only 30% of the cells were retained in both uncoated and gelatin-coated scaffolds indicating the need for improving the cell retention capacity of these structures, which is our future research direction. This study indicates that the biomechanical and biocompatible properties of this novel vascular scaffold are promising for the development of a vascular graft with similar characteristics to those of native vessels.

Does stem preheating have a beneficial effect on PMMA bulk porosity in cemented THA?

In cemented total hip arthroplasty (THA), porosity plays a major role in the fatigue failure of bone cement. Stem preheating procedure is known to reduce the stem/cement interfacial porosity. In the literature, no information is available about the effect of such procedure on cement bulk porosity. This study helps to find out if stem preheating can have a beneficial effect on bulk porosity, thus enhancing long-term bone cement integrity. A simplified experimental model of a stem/cement/bone construct of a cemented THA is designed to reproduce the mechanical boundary conditions of polymerizing cement. Effect of stem preheating and polymethylmethacrylate prechilling and mixing method (hand mixed and vacuum mixed) on cement porosity are investigated. Bulk porosity is analysed within three zones across the cement mantle in terms of pore number, pore area, and mean pore size. The results demonstrate that bulk cement porosity is strongly influenced by stem preheating, cement precooling as well as cement composition and mixing method. Stem preheating procedure displaces the porosity away from stem/cement interface toward bone; consequently reducing the pore area within the zone near the stem and increasing it in the middle and bone/cement zone. The most pronounced beneficial effect of stem preheating before implantation is visible for vacuum mixed procedure as the cement contains few pores of very small size (<100 µm). However, if stem is preheated, cement precooling should be avoided as it could counteract the beneficial effect of reduced porosity inside cement mantle.

Tissue response to the components of a hydroxyapatite-coated composite femoral implant.

Bone loss around femoral implants used for THA is a persistent clinical concern. It may be caused by stress shielding, generally attributed to a mismatch in stiffness between the implants and host bone. In this regard, a fatigue resistant, carbon fiber (CF) composite femoral implant with bone-matching stiffness has been developed. This study evaluated the tissue response to the three material components of this implant in normal and textured (blasted with 24 grit alumina) surfaces: the hydroxyapatite (HA) coating, the CF composite and the intermediate crystalline HA particulate composite layer to bond to the HA coating (blended). Sprague-Dawley rats underwent bilateral femoral implantation each receiving two rod-like implants. Bone apposition to the HA (37%) and textured Ti (41%) implants was not significantly different. Bone apposition to the untextured CF (14%) and blended (19%) implants and polished Ti (8%) implants was significantly lower. Bone apposition to the textured CF (9%) and blended (11%) implants was lower (but not statistically from the as received or untextured counterparts). Nearly all sections from femurs containing CF implants presented CF debris. There was no evidence of localized bone loss or any strong immune response associated with any of the implant materials. All materials were well tolerated with minimal inflammation despite the presence of particulate debris. The high degree of bone apposition to the HA-coated composite implants and the lack of short-term inflammation and adverse tissue response to the three material implant component support continued evaluation of this composite technology for use in THA.

Effect of the oxygen content in solution on the static and cyclic deformation of titanium foams.

It is well known that interstitials affect the mechanical properties of titanium and titanium alloys. Their effects on the fatigue properties of titanium foams have not, however, been documented in the literature. This paper presents the effect of the oxygen content on the static and dynamic compression properties of titanium foams. Increasing the oxygen content from 0.24 to 0.51 wt% O in solution significantly increases the yield strength and reduces the ductility of the foams. However, the fatigue limit is not significantly affected by the oxygen content and falls within the 92 MPa +/- 12 MPa range for all specimens investigated in this study. During cyclic loading, deformation is initially coming from cumulative creep followed by the formation of microcracks. The coalescence of these microcracks is responsible for the rupture of the specimens. Fracture surfaces of the specimens having lower oxygen content show a more ductile aspect than the specimens having higher oxygen content.

Novel carbon fiber composite for hip replacement with improved in vitro and in vivo osseointegration.

A novel composite femoral stem has been developed to match cortical stiffness and achieve fixation by osseointegration with the primary goal to reduce cortical bone loss associated with stress shielding. The femoral stem consists of three distinct material layers: the first is a long carbon fiber (CF) in a polyamide 12 (PA12) polymer matrix (PA12/CF); the second is a PA12/HA (hydroxyapatite) interface; and the third is a plasma-sprayed coating of HA. In vitro studies with MG63 cells indicated that the HA surface supported improved proliferation and differentiation of osteoblast-like cells as determined by alkaline phosphatase activity and osteocalcin production when compared with Ti-6Al-4V (Ti64). In vivo studies comparing the composite and Ti64 rods in the rabbit femur demonstrated significantly higher bone apposition to the composite than Ti64 rods. The results of this study indicate that the invasion of surrounding bone cells and thus osteointegration together with its bone-matching mechanical properties make the PA12/CF/HA stem a promising hip replacement candidate.

Bioactive hydroxyapatite coatings on polymer composites for orthopedic implants.

Hydroxyapatite [HA, Ca10(PO4)6(OH)2] coatings on polymer composite substrates were investigated for their bioactivity and their physicochemical and mechanical characteristics. HA holds key characteristics for use in orthopedic applications, such as for coating of the femoral stem in a hip replacement device. The plasma-spray technique was used to project HA onto a carbon fiber/polyamide 12 composite substrate. The resulting HA coatings exhibited mechanical adhesion as high as 23 MPa, depending on the surface treatment of the composite substrate. The purpose of this investigation was to evaluate the bioactivity of an HA-coated composite substrate. HA- coated samples have been immersed in simulated body fluid (SBF) and maintained within a shaker bath for periods of 1, 7, 14, 21, and 28 days at 37 degrees C. Scanning electron microscopy, energy dispersive X-ray spectroscopy, and X-ray diffraction techniques were performed on the samples before and after immersion into SBF. SBF was analyzed using inductively coupled plasma atomic emission spectrometry for element concentration and evaluation of the solution's purity. SBF conditioning led to the deposition of crystalline HA onto the surface of the coatings. The calcium-to-phosphorous ratios of initial HA coating and of newly deposited HA were respectively 1.72 and 1.65, close to the HA theoretical calcium/phosphorous value of 1.67. Results demonstrated that bioactive HA coatings were produced by plasma spraying, because SBF conditioning induced newly formed HA with high crystallinity. Mechanical adhesion of the HA coatings was not significantly affected upon SBF conditioning.