Tibial implant fixation in TKA worth a revision?-how to avoid stress-shielding even for stiff metallic implants.

In total knee arthroplasty (TKA), force is transmitted into the tibia by a combined plate-stem device along with cemented or cementless stem fixation. The present work analyzes this force transmission in finite element simulations with the main aim to avoid reported postsurgical bone density reduction as a consequence of a reduced tibial bone loading. In the numerical analysis different implant materials, stem/extension lengths and implant-to-stem interface conditions are considered, from a stiff fully cemented fixation to sliding contact conditions with a low friction coefficient. The impact of these variations on bone loading changes are measured by (i) decomposing the total force into parts mediated by the plate and by the stem and by (ii) post-surgery strain energy density (SED) deviations. Based on a bionics-inspired perspective on how nature in pre-operative conditions carries out force transfer from the knee joint into the tibia, a modified implant-bone interface is suggested that alters force transmission towards physiological conditions while preserving the geometries of the standard plate-stem endoprosthesis design. The key aspect is that the axial force is predominantly transmitted through the plate into proximal bone which requires a compliant bone-stem interface as realized by sliding friction conditions at a low friction coefficient. These interface conditions avoid stress shielding almost completely, preserve pre-surgery bone loading such that bone resorption is not likely to occur.

How can a short stem hip implant preserve the natural, pre-surgery force flow? A finite element analysis on a collar cortex compression concept (CO4).

The present work proposes a simple, novel fixation concept for short stem hip endoprostheses, which preserves the pre-surgery force flow through femoral bone to an unprecedented extent. It is demonstrated by finite element analyses that a standard implant model endowed with minor geometrical changes can overcome bone loading reduction and can achieve almost physiological conditions. The numerical results underpin that the key aspect of the novel, so-called "collar cortex compression concept CO4" is the direct, almost full load transmission from the implant collar to the resected femur cortex, which implies that the implant stem must be smooth and therefore interacts mainly by normal contact with the surrounding bone. For a stem endowed with surface porosity at already small areas, it is mainly the stem which transmits axial forces by shear, whereas the collar shows considerable unloading, which is the standard metaphyseal fixation. Only in the latter case the implant-bone stiffness contrast induces stress shielding, whereas for CO4 stress shielding is avoided almost completely, although the implant is made of a stiff Ti-alloy. CO4 is bionics-inspired in that it mimics force transmission at implant-bone interfaces following the natural conditions and it thereby preserves pre-surgery bone architecture as an optimized solution of nature.

Tenogenic differentiation of equine adipose-tissue-derived stem cells under the influence of tensile strain, growth differentiation factors and various oxygen tensions.

Mesenchymal stem cells have become extremely interesting for regenerative medicine and tissue engineering in the horse. Stem cell therapy has been proven to be a powerful and successful instrument, in particular for the healing of tendon lesions. We pre-differentiated equine adipose-tissue-derived stem cells (ASCs) in a collagen I gel scaffold by applying tensile strain, growth differentiation factors (GDFs) and various oxygen tensions in order to determine the optimal conditions for in vitro differentiation toward the tenogenic lineage. We compared the influence of 3% versus 21% oxygen tension, the use of GDF 5, GDF 6 and GDF 7 and the application of uniaxial tensile strain versus no mechanical stimulation on differentiation results as evaluated by cell morphology and by the expression of the tendon-relevant genes collagen I, collagen III, cartilage oligomeric matrix protein and scleraxis. The best results were obtained with an oxygen tension of 21%, tensile stimulation and supplementation with GDF 5 or GDF 7. This approach raises the hope that the in vivo application of pre-differentiated stem cells will improve healing and recovery time in comparison with treatment involving undifferentiated stem cells.

Compressive behaviour of bovine cancellous bone and bone analogous materials, microCT characterisation and FE analysis.

Compressive behaviour of bovine cancellous bone and three open-cell metallic foams (AlSi7Mg (30 ppi and 45 ppi); CuSn12Ni2 (30 ppi)) has been studied using mechanical testing, micro-focus computed tomography and finite element modelling. Whilst the morphological parameters of the foams and the bone appear to be similar, the mechanical properties vary significantly between the foams and the bone. Finite element models were built from the CT images of the samples and multi-linear constitutive relations were used for modelling of the bone and the foams. The global responses of the bone and foam samples were reasonably well captured by the FE models, whilst the percentage of yielded elements as a measure of damage evolution during compression seems to be indicative of the micro-mechanical behaviour of the samples. The damage evolution and distribution patterns across the bone and the foams are broadly similar for the strain range studied, suggesting possible substitution of trabecular bones with appropriate foams for biomechanical studies.

Metallic open-cell foams--a promising approach to fabricating good medical implants.

The aim of this paper is to report on the characterization of the influences of foam homogeneity and the cell strut material on the mechanical behaviour and the fracture mode of metallic foams that are promising candidates for new perfectly tailored medical implants. For two open-cell foams with identical cell geometries produced in the same precision-casting process but using different cell strut materials, the stress-strain behaviour and the evolution of damage until fracture is compared. To account for effects arising from a change in the geometry of the cell structure and the resulting homogeneity of the foam, the main characteristics of fracture for the group of closed-cell foams were included in this study. Monotonic tests carried out in compression revealed that foam homogeneity is the major factor with respect to the formation of deformation bands prior to cell collapse in metallic foams. The influence of the cell strut ductility is particularly pronounced in monotonic tension where the fracture mode changes from extremely brittle fracture to strongly plastically deformed cells, with substantial fracture elongation. In tension-tension fatigue as well as under symmetric push-pull loading conditions, damage is governed by a combination of cyclic creep and fatigue crack propagation through the specimen. From a mechanistic point of view no fundamental differences between the three foams tested were detected for these loading conditions. However, in compression-compression fatigue the same dependencies in terms of homogeneity and ductility influence the mechanisms of strain evolution that are active in monotonic compression.

Application of the EBSD technique to describe the initiation and growth behaviour of microstructurally short fatigue cracks in a duplex steel.

Up to 90% of the fatigue life of engineering alloys results from the initiation and propagation of microstructurally short cracks. Owing to their strong interactions with microstructural features, e.g. grain and phase boundaries, they exhibit substantially non-uniform propagation kinetics as compared with the growth rate of long cracks, which can be well described using a power-law function of the range of the stress-intensity factor DeltaK. In the present paper interactions between the crystallographic misorientation of grain and phase boundaries and microcracks in an austenitic/ferritic stainless steel are discussed and quantified by means of fatigue experiments in combination with the electron backscattered diffraction technique. In the second part a numerical model for the simulation of microcracks is introduced, which is capable of taking real microstructural arrangements into consideration.