The difference between stretching and splitting muscle trauma during THA seems not to play a dominant role in influencing periprosthetic BMD changes.

BACKGROUND: Periprosthetic bone adaptation in the proximal femur after total hip arthroplasty can result in reduced bone mineral density that may contribute to increased risk of aseptic loosening or fracture. Functional loading of the proximal femur postoperatively may depend upon the type of surgical muscle trauma - splitting or stretching - and is likely to influence the preservation of periprosthetic bone mineral. Since the maintenance of bone is known to be highly age and gender dependent, the aim of this study was to investigate the interplay between muscle trauma and age and gender influences on periprosthetic bone adaptation. METHODS: Ninet y-three patients were consecutively recruited into either a transgluteal (splitting) or anterolateral (stretching) surgical approach and examined 7 days and 12 months after an elective primary hip arthroplasty (Zweymüller Alloclassic stem), using dual-energy X-ray absorptiometry measurements to quantify proximal femoral bone mineral density. FINDINGS: The results indicate that neither gender, age nor surgical trauma type, but only the combination of age and gender, were significant predictors of postoperative remodelling rate, with younger men (<65) and older women exhibiting the largest bone atrophy. INTERPRETATION: This study has demonstrated that the difference between stretching and splitting surgical trauma to the muscles during total hip replacement does not play a dominant role in influencing periprosthetic bone mineral changes. However, this data does suggest that certain patient populations may particularly benefit from muscle and bone preserving procedures.

Generic rules of mechano-regulation combined with subject specific loading conditions can explain bone adaptation after THA.

Bone adaptation after total hip arthroplasty is associated with the change in internal load environment, and can result in compromised bone stock, which presents a considerable challenge should a revision procedure be required. Under the assumption of a generic mechano-regulatory algorithm for governing bone adaptation, the aim of this study was to understand the contribution of subject specific loading conditions towards explaining the local periprosthetic remodelling variations in patients. CT scans of 3 consecutive THA patients were obtained and used for the construction of subject specific finite element models using verified musculoskeletal loading and physiological boundary conditions. Using either strain energy density or equivalent strain as mechano-transduction signals, predictions of bone adaptation were compared to DEXA derived BMD changes from 7 days to 12 months post-implantation. Individual changes in BMD of up to 33.6% were observed within the 12 month follow-up period, together with considerable inter-patient variability of up to 26%. Estimates of bone adaptation using equivalent strain and balanced loading conditions led to the best agreement with in vivo measured BMD, with RMS errors of only 3.9%, 7.3% and 7.3% for the individual subjects, compared to errors of over 10% when the loading conditions were simplified.This study provides evidence that subject specific loading conditions and physiological boundary constraints are essential for explaining inter-patient variations in bone adaptation patterns. This improved knowledge of the rules governing the adaptation of bone following THA helps towards understanding the interplay between mechanics and biology for better identifying patients at risk of excessive or problematic periprosthetic bone atrophy.

Toward characterization of craniofacial biomechanics.

Surgical reconstruction of craniofacial deformities has advanced significantly in recent years. However, unlike orthopedic surgery of the appendicular skeleton, the biomechanical characterization of the human craniofacial skeleton (CFS) has yet to be elucidated. Attempts to simplify facial skeletal structure into straightforward mechanical device analogies have been insufficient in delineating craniofacial biomechanics. Advanced computational engineering analysis methods offer the potential to accurately and completely define the internal mechanical environment of the CFS. This study developed a finite element (FE) model in the I-deas 10 FEM software package of a preserved cadaveric human CFS and compared the predictions of this model against in vitro strain measurement of simulated occlusal loading forces from a single masseter muscle. The FE model applied shell element modeling to capture the behavior of the thin cortical bone that may play an important role in stabilizing the facial structures against functional loads. In vitro testing included strain measurements at 12 locations for a total of 16 independent channels with less than 150 N of tensile force applied through the masseter muscle into the zygomatic arch origin at 4 different orientations, with 3 trials of 500 recorded data points for each loading orientation. Linear regression analysis yielded a moderate prediction (r = 0.57) between the model and experimentally measured strains. Exclusion of strain comparisons in regions that required greater modeling assumptions greatly improved the correlation (r = 0.70). Future validation studies will benefit from improved placement of strain gauges as guided by FE model predicted strain patterns.