Gender differences in ethmoid sinus morphology_ 3D reconstruction of computed tomographic images.

BACKGROUND: The ethmoid sinus (ES) is a three-dimensional (3D) complex structure, a clear understanding of the ES anatomy is helpful to plan intranasal surgery. However, most prior studies use 2D measurements, which may not accurately depict the 3D structure. The current study measured the gender differences in ES morphology based on 3D reconstruction of computed tomography (CT) images. METHODS: The 3D models were reconstructed using CT images. Twenty-one males and 15 females were enrolled in the study. The ES dimensions, including width, height and aspect ratio (AR) of each cutting-plane section, were measured at 10% increments along with the anteroposterior axis of the ES. The gender differences in the above parameters were further evaluated by an independent t-test. RESULTS: The width of the ES for males is 12.0 ± 2.1 mm, which was significantly greater than that in females (10.0 ± 2.1 mm). The average height for males is 18.4 ± 3.5 mm, and 18.2 ± 3.4 mm for females. The AR of female (male) is around 0.56 (0.63) for the anterior ES and 0.66 (0.75) for the posterior. There are significant differences between genders in the parameters of width and AR (p < 0.05). CONCLUSION: This study found that the aspect ratio greatly varies along the length of ES, indicating that the cross-section of the ES in the anterior is closer to an elliptical shape and turns closer to a circular shape near its posterior. There is a significant difference between genders in width and aspect ratio. The results would be helpful to know the complex anatomic details of the ethmoid sinus.

Outcomes after arthroscopic treatment for scaphoid nonunion using ipsilateral radius bone graft and a headless compression screw: a comparison between the patients with and without avascular necrosis.

PURPOSE: To determine whether avascular necrosis can affect clinical outcomes or the union incidence after arthroscopic bone grafting for the treatment of scaphoid nonunion. METHODS: This retrospective comparative study included thirty-four patients with scaphoid nonunion that underwent arthroscopic bone graft from the ipsilateral radius and internal fixation. The patients were divided into two cohorts (group A, with avascular necrosis, n = 15; group B, without avascular necrosis, n = 19) based on pre-operative magnetic resonance imaging findings. Additionally, the patients were grouped in accordance with the location of nonunion (waist, n = 27; proximal pole, n = 7). The mean follow-up was 20.7 months (range 12.0-40.0 months). Clinical outcomes, including the visual analog scale (VAS) pain score, grip strength, range of motion (ROM), Mayo Wrist Score (MWS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score, were evaluated. Radiographic measurements for carpal bone alignment were assessed as well. RESULTS: Union rates did not differ between groups (group A, 93.3%; group B, 94.7%: p = 0.863), and the post-operative VAS pain score, ROM, and MWS were similar at follow-up for a minimum of one year. DASH and grip strength were significantly better in group B, but the intergroup differences were minimal (mean DASH 11.9 versus 9.6; mean grip strength 77.5% versus 95.4% of contralateral side). There was no significant intergroup difference in mean time to achieving union (group A, 14.9 weeks; group B, 14.6 weeks; p = 0.900). In post-operative radiographic assessments, no significant intergroup differences were noted in any of the parameters. Subgroup analysis regarding the location of nonunion showed there were no significant intergroup differences in union rates, mean time to achieving union, and clinical outcome measures at the last post-operative follow-up. CONCLUSIONS: Arthroscopic bone grafting and internal fixation in the treatment of scaphoid nonunion provided good union rates and satisfactory outcomes regardless of vascularity status.

Catastrophic failure of a titanium locking plate in a proximal humeral fracture: case report and literature review.

BACKGROUND: Angular stable locking plates have shown good clinical results in treating proximal humeral fractures, but complications are not uncommon. This study reported a rare case of catastrophic failure of a titanium locking plate. A retrieval analysis of the implants was performed using an optic microscope and a scanning electron microscope. CASE PRESENTATION: A 69-year-old male reported a right proximal humeral fracture at the surgical neck and was treated by open reduction and internal fixation with a locking plate system. Ninety-six days after surgery, the patient came to clinic for acute local pain over the shoulder without any trauma. The radiographs showed a complete breakage of the implant accompanying displaced fracture. Revision surgery was performed to restabilize the fracture with a longer locking plate. The follow-up radiographs at 9 months showed complete union of the bone fracture. CONCLUSIONS: From the retrieval analysis, repetitive torsion loads on the vulnerable area of the implant are assumed to cause this catastrophic event. It is recommended that adequate activity restriction, such as reaching, be undertaken to avoid this rare complication. Current study also provides contributive information for the modification of plate design and pre-operative planning for device configuration to improve the success rate of locking plate fixation.

Gender differences in femoral trochlea morphology.

PURPOSE: This study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three-dimensional reconstruction method. The morphological data were compared between genders. METHODS: Computed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure the lateral and medial anterior condylar heights (LACH and MACH, respectively), lateral and medial trochlear groove widths (LTW and MTW, respectively), and for trochlear groove tracking. The absolute values and normalized data were compared between male and female subjects. The sulcus angle and deepest point of the trochlear groove at each cross-section were also analyzed to determine the differences in the depth of the trochlear groove. RESULTS: The absolute dimensions of LACH, MACH, LTW, and MTW were significantly smaller in the female subjects, by 10.5%, 36.9%, 10.3%, and 11.0%, respectively, than in the males (p < 0.05). After normalization, no significant difference was found in the condylar height between the genders. However, the female subjects had a significantly larger value of approximately 7.9% for the normalized trochlear width. CONCLUSION: Male subjects had greater condylar heights and widths than the female subjects. Although the trajectory of the trochlear groove varied greatly among the subjects, the trochlear groove appeared to be wider and shallower in the female subjects than in the male subjects. These results provide important information for the design of femoral trochlea to fit Asian female patients. LEVEL OF EVIDENCE: III.

Abutment screw withdrawal after conical abutment settlement: A pilot study.

OBJECTIVE: This study investigated the effects of abutment screw withdrawal after conical abutment settlement on the stability of the implant-abutment connection. MATERIALS AND METHODS: Twenty implants of a conical connection system were used. Two two-piece abutment designs were used: cone only (n = 10; NI) and cone plus octagonal index design (n = 10; I); for each design, five samples were used with (S) and without (NS) abutment screw withdrawal before a cyclic test. Finally, four groups, namely Gr S(NI), Gr S(I), Gr NS(NI), and Gr NS(I), were included. The cyclic test included cyclic loading of 20-200 N, 30°, and 4-mm off-axis to implant axis at 10 Hz for 106 cycles, simulating a clinical time interval of 40 months. The fatigue cycles were recorded. The axial displacement of the conical abutments during abutment settlement, screw withdrawal, and cyclic loading were measured. Abutment morphology was examined through scanning electron microscopy (SEM). RESULTS: Only Gr NS(NI) failed the test, indicating that without the index design and abutment screw withdrawal, and connection stability seriously deteriorated. Gr NS(I) exhibited significantly higher axial displacement into the implant after abutment settlement than did Gr NS(NI). It also exhibited continuous axial displacement into the implant after cyclic loading. SEM after cyclic testing in Gr NS(I) revealed marked burnishing on lateral edges of the index, indicating that the index design provides an antitorsional ability. CONCLUSION: Although this study has few limitations, abutment screw withdrawal is feasible in this conical implant-abutment connection system with index design.

Stress distribution of the patellofemoral joint in the anatomic V-shape and curved dome-shape femoral component: a comparison of resurfaced and unresurfaced patellae.

PURPOSE: Whether to resurface the patella in knee replacement remains a controversial issue. The geometrical design of the trochlear groove in the femoral component could play an important role in determining the stress distribution on the patellofemoral joint, but this has not been sufficiently reported on. This study attempted to determine the effect of implant design on contact mechanics by means of a finite element method. METHODS: Two designs, an anatomical V-shape design (VSD) and a dome-shape design (DSD), for the anterior trochlear surface in a contemporary femoral component were chosen for examining the contact characteristics. The use and absence of patella resurfacing was simulated. The stress and strain distribution on the patellar bone and the polyethylene component were calculated for comparison. RESULTS: Without patellar resurfacing, the maximal compressive strain in the patellar bone in the VSD model was about 20 % lower than the DSD model. On the other hand, with resurfacing, the maximal strain for the VSD model was 13.3 % greater than for DSD. Uneven stress distribution at the bone-implant interface was also noted for the two designs. CONCLUSION: The femoral component with a V-shape trochlear groove reduced the compressive strain on the unresurfaced patella. If resurfacing the patella, the femoral component with a curved domed-shape design might reduce the strain in the remaining patellar bone. Uneven stress could occur at the bone-implant interface, so design modifications for improving fixation strength and medialization of the patellar button would be helpful in reducing the risk of peg fracture or loosening. LEVEL OF EVIDENCE: III.

Change in collateral ligament length and tibiofemoral movement following joint line variation in TKA.

PURPOSE: The primary intent of total knee arthroplasty is the restoration of normal knee kinematics, with ligamentous constraint being a key influential factor. Displacement of the joint line may lead to alterations in ligament attachment sites relative to knee flexion axis and variance of ligamentous constraints on tibiofemoral movement. This study aimed to investigate collaterals strains and tibiofemoral kinematics with different joint line levels. METHODS: A previously validated knee model was employed to analyse the change in length of the collateral ligaments and tibiofemoral motion during knee flexion. The models shifted the joint line by 3 and 5 mm both proximally and distally from the anatomical level. The data were captured from full extension to flexion 135°. RESULTS: The elevated joint line revealed a relative increase in distance between ligament attachments for both collateral ligaments in comparison with the anatomical model. Also, tibiofemoral movement decreased with an elevation in the joint line. Conversely, lowering the joint line led to a significant decrease in distance between ligament attachments, but greater tibiofemoral motion. CONCLUSION: Elevation of the joint line would strengthen the capacity of collateral ligaments for knee motion constraint, whereas a distally shifted joint line might have the advantage of improving tibiofemoral movement by slackening the collaterals. It implies that surgeons can appropriately change the joint line position in accordance with patient's requirement or collateral tensions. A lowered joint line level may improve knee kinematics, whereas joint line elevation could be useful to maintain knee stability. LEVEL OF EVIDENCE: V.

Biomechanical evaluation of a new pedicle screw-based posterior dynamic stabilization device (Awesome Rod System)--a finite element analysis.

BACKGROUND: Pedicle-screw-based posterior dynamic stabilization devices are designed to alleviate the rate of accelerated degeneration of the vertebral level adjacent to the level of spinal fusion. A new pedicle-screw-based posterior dynamic stabilization device- the Awesome Dynamic Rod System was designed with curve cuts on the rods to provide flexibility. The current study was conducted to evaluate the biomechanical properties of this new device. METHODS: Finite element models were developed for the intact spine (INT), the Awesome Dynamic Rod Implanted at L4-L5 (AWE), a traditional rigid rod system implanted at L4-L5 along with an interbody cage (FUS), and the Awesome Dynamic Rod System implanted at L4-L5 along with an interbody cage as an adjunct to fusion procedures and extension of dynamic fixation to L3-L4 (AWEFUS). The models were subjected to axial loads and pure moments and evaluated by a hybrid method on range of motion (ROM)s, disc stresses, pedicle screws stresses, and facet joint contact forces. RESULTS: FUS sustained the lowest L4-L5 ROM decrement in flexion and torsion. AWE demonstrated the lowest adjacent level ROM increment in all moments except for extension at L3-L4, and AWEFUS showed the greatest ROM increment at L2-L3. AWE demonstrated lowest adjacent segment disc stress in flexion, lateral bending and torsion at L3-L4. AWEFUS showed the highest disc stress increment in flexion, extension, and lateral bending, and the lowest disc stress decrement in torsion at L2-L3. AWE sustained greater adjacent facet joint contact forces than did FUS in extension and lateral bending at L3-L4, and AWEFUS demonstrated the greatest contact forces concentrating at L2-L3. CONCLUSION: The results demonstrate that the Awesome Dynamic Rod System preserved more bridged segment motion than did the traditional rigid rod fixation system except in extension. However, the Awesome Dynamic Rod System bore a greater facet joint contact force in extension. The Awesome Dynamic Rod System did protect the adjacent level of fusion segments, but led to much greater ROM, disc stresses, and facet joint contact forces increasing at the adjacent level of instrumented segments.

Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction.

BACKGROUND: In some situations, harvested hamstring tendon grafts are not qualified for anterior cruciate ligament (ACL) reconstruction. This study aimed to present a reinforcing method with additional half peroneus longus tendon (half-PLT) graft augmentation. METHODS: Eight cases underwent ACL reconstruction with unqualified hamstring tendon grafts (diameter <7 mm) and were salvaged by additional half-PLT graft augmentation. The pivot shift test and KT-1000 tests were performed 3 years after surgery. Functional evaluation of subjective International Knee Documentation Committee (IKDC) and Lysholm scores was also done. In addition, Foot and Ankle Disability Index (FADI) scores were used to evaluate the function of the ankle donor site. RESULTS: The diameter of unqualified four-strand hamstring tendon grafts was 6.2 mm on average (range, 6.0-6.5 mm). The average diameter of hamstring grafts with half-PLT augmentation was 9.6 mm (range, 9.5-10.0 mm). The pivot shift test was negative in all patients. No significant differences between normal and abnormal knees were found by KT-1000. The average IKDC score was 86.0 (range, 83 to 89), and the average Lysholm score was 84.4 (range, 80-90). The average FADI score for the donor sites of half-PLT was 135.8 (range, 134-136). CONCLUSIONS: Additional half-PLT can successfully and safely reinforce unqualified hamstring tendon grafts for ACL reconstruction.

Clinical results of hamstring autografts in anterior cruciate ligament reconstruction: a comparison of femoral knot/press-fit fixation and interference screw fixation.

PURPOSE: To compare the clinical outcomes of femoral knot/press-fit anterior cruciate ligament (ACL) reconstruction with conventional techniques using femoral interference screws. METHODS: Among patients who underwent arthroscopic ACL reconstruction with hamstring autografts, 73 were treated with either a femoral knot/press-fit technique (40 patients, group A) or femoral interference screw fixation (33 patients, group B). The clinical results of the 2 groups were retrospectively compared. The inclusion criteria were primary ACL reconstruction in active patients. The exclusion criteria were fractures, multiligamentous injuries, patients undergoing revision, or patients with contralateral ACL-deficient knees. In the femoral knot/press-fit technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. After passage through a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (grafts' knots were stuck in the bottleneck of the femoral tunnel). A tie with Mersilene tape (Ethicon, Somerville, NJ) over a bone bridge for each tendon loop and an additional bioabsorbable interference screw were used for tibial fixation. RESULTS: The mean follow-up period was 38 months (range, 24 to 61 months). A significant improvement in knee function and symptoms was reported in most patients, as shown by improved Tegner scores, Lysholm knee scores, and International Knee Documentation Committee assessments (P < .01). The results of instrumented laxity testing, thigh muscle assessment, and radiologic assessment were clearly improved when compared with the preoperative status (P < .01). No statistically significant difference in outcomes could be observed between group A and group B (P = not significant). CONCLUSIONS: In this nonrandomized study, femoral knot/press-fit ACL reconstruction did not appear to provide increased anterior instability compared with that of conventional femoral interference screw ACL reconstruction. Favorable outcomes with regard to knee stability and patient satisfaction were achieved in most of our ACL-reconstructed patients using femoral knot/press-fit fixation with hamstring tendon autograft. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Patellofemoral kinematics during deep knee flexion after total knee replacement: a computational simulation.

PURPOSE: Actions requiring deep knee flexion, such as kneeling and squatting, are challenging to perform after total knee replacement (TKR), though many manufactures emphasize that their knee prostheses could safely achieve high flexion. Little is known about the patellofemoral kinematics during deep flexion. This study aimed to track the movement of the patella during kneeling and squatting through dynamic computational simulation. METHODS: A validated knee model was used to analyse the patellar kinematics after TKR, including shifting, tilting and rotation. The data were captured from full extension to 135° of knee flexion. For kneeling, an anterior force of 500 N was applied perpendicularly on the tibial tubercle as the knee flexed from 90° to 135°. For squatting, a ground reaction force was applied through the tibia from full extension to 135° of flexion. RESULTS: This study found that patellar shifting and rotation in kneeling were similar to those while squatting. However, during kneeling, the patella had a greater medial tilt and showed signs of abrupt patellar tilt owning to an external force being concentrated on the tibial tubercle. CONCLUSIONS: In terms of squatting and kneeling movements, the latter is a more strenuous action for the patellofemoral joint after TKR due to the high forces acting on the tibial tubercle. It is suggested that overweight patients or those requiring high flexion should try to avoid kneeling to reduce the risk of the polyethylene wear. Further modification of trochlear geometry may be required to accommodate abrupt changes in patellar tilting. LEVEL OF EVIDENCE: II.

Biomechanical considerations in the design of high-flexion total knee replacements.

Typically, joint arthroplasty is performed to relieve pain and improve functionality in a diseased or damaged joint. Total knee arthroplasty (TKA) involves replacing the entire knee joint, both femoral and tibial surfaces, with anatomically shaped artificial components in the hope of regaining normal joint function and permitting a full range of knee flexion. In spite of the design of the prosthesis itself, the degree of flexion attainable following TKA depends on a variety of factors, such as the joint's preoperative condition/flexion, muscle strength, and surgical technique. High-flexion knee prostheses have been developed to accommodate movements that require greater flexion than typically achievable with conventional TKA; such high flexion is especially prevalent in Asian cultures. Recently, computational techniques have been widely used for evaluating the functionality of knee prostheses and for improving biomechanical performance. To offer a better understanding of the development and evaluation techniques currently available, this paper aims to review some of the latest trends in the simulation of high-flexion knee prostheses.

PEDF peptide plus hyaluronic acid stimulates cartilage regeneration in osteoarthritis via STAT3-mediated chondrogenesis.

Aims: Pigment epithelium-derived factor (PEDF) is known to induce several types of tissue regeneration by activating tissue-specific stem cells. Here, we investigated the therapeutic potential of PEDF 29-mer peptide in the damaged articular cartilage (AC) in rat osteoarthritis (OA). Methods: Mesenchymal stem/stromal cells (MSCs) were isolated from rat bone marrow (BM) and used to evaluate the impact of 29-mer on chondrogenic differentiation of BM-MSCs in culture. Knee OA was induced in rats by a single intra-articular injection of monosodium iodoacetate (MIA) in the right knees (set to day 0). The 29-mer dissolved in 5% hyaluronic acid (HA) was intra-articularly injected into right knees at day 8 and 12 after MIA injection. Subsequently, the therapeutic effect of the 29-mer/HA on OA was evaluated by the Osteoarthritis Research Society International (OARSI) histopathological scoring system and changes in hind paw weight distribution, respectively. The regeneration of chondrocytes in damaged AC was detected by dual-immunostaining of 5-bromo-2'-deoxyuridine (BrdU) and chondrogenic markers. Results: The 29-mer promoted expansion and chondrogenic differentiation of BM-MSCs cultured in different defined media. MIA injection caused chondrocyte death throughout the AC, with cartilage degeneration thereafter. The 29-mer/HA treatment induced extensive chondrocyte regeneration in the damaged AC and suppressed MIA-induced synovitis, accompanied by the recovery of cartilage matrix. Pharmacological inhibitors of PEDF receptor (PEDFR) and signal transducer and activator of transcription 3 (STAT3) signalling substantially blocked the chondrogenic promoting activity of 29-mer on the cultured BM-MSCs and injured AC. Conclusion: The 29-mer/HA formulation effectively induces chondrocyte regeneration and formation of cartilage matrix in the damaged AC.

Potential role of calcium sulfate/ß-tricalcium phosphate/graphene oxide nanocomposite for bone graft application_mechanical and biological analyses.

BACKGROUND: Bone grafts are extensively used for repairing bone defects and voids in orthopedics and dentistry. Moldable bone grafts offer a promising solution for treating irregular bone defects, which are often difficult to fill with traditional rigid grafts. However, practical applications have been limited by insufficient mechanical strength and rapid degradation. METHODS: This study developed a ceramic composite bone graft composed of calcium sulfate (CS), ß-tricalcium phosphate (ß-TCP) with/without graphene oxide (GO) nano-particles. The biomechanical properties, degradation rate, and in-vitro cellular responses were investigated. In addition, the graft was implanted in-vivo in a critical-sized calvarial defect model. RESULTS: The results showed that the compressive strength significantly improved by 135% and the degradation rate slowed by 25.5% in comparison to the control model. The addition of GO nanoparticles also improved cell compatibility and promoted osteogenic differentiation in the in-vitro cell culture study and was found to be effective at promoting bone repair in the in-vivo animal model. CONCLUSIONS: The mixed ceramic composites presented in this study can be considered as a promising alternative for bone graft applications.

Effects of cord pretension and stiffness of the Dynesys system spacer on the biomechanics of spinal decompression- a finite element study.

BACKGROUND: The Dynesys system provides stability for destabilized spines while preserving segmental motion. However, clinical studies have demonstrated that the Dynesys system does not prevent adjacent segment disease. Moreover, biomechanical studies have revealed that the stiffness of the Dynesys system is comparable to rigid fixation. Our previous studies showed that adjusting the cord pretension of the Dynesys system alleviates stress on the adjacent level during flexion. We also demonstrated that altering the stiffness of Dynesys system spacers can alleviate stress on the adjacent level during extension of the intact spine. In the present study, we hypothesized that omitting the cord preload and changing the stiffness of the Dynesys system spacers would abate stress shielding on adjacent spinal segments. METHODS: Finite element models were developed for - intact spine (INT), facetectomy and laminectomy at L3-4 (DEC), intact spine with Dynesys system (IntDyWL), decompressed spine with Dynesys system (DecDyWL), decompressed spine with Dynesys system without cord preload (DecDyNL), and decompressed spine with Dynesys system assembled using spacers that were 0.8 times the standard diameter without cord pretension (DecDyNL0.8). These models were subjected to hybrid control for flexion, extension, axial rotation; and lateral bending. RESULTS: The greatest decreases in range of motion (ROM) at the L3-4 level occurred for axial rotation and lateral bending in the IntDyWL model and for flexion and extension in the DecDyWL model. The greatest decreases in disc stress occurred for extension and lateral bending in the IntDyWL model and for flexion in the DecDyWL model. The greatest decreases in facet contact force occurred for extension and lateral bending in the DecDyNL model and for axial rotation in the DecDyWL model. The greatest increases in ROMs at L2-3 level occurred for flexion, axial rotation and lateral bending in IntDyWL model and for extension in the DecDyNL model. The greatest increases in disc stress occurred for flexion, axial rotation and lateral bending in the IntDyWL model and for extension in the DecDyNL model. The greatest increases in facet contact force occurred for extension and lateral bending in the DecDyNL model and for axial rotation in the IntDyWL model. CONCLUSIONS: The results reveals that removing the Dynesys system cord pretension attenuates the ROMs, disc stress, and facet joint contact forces at adjacent levels during flexion and axial rotation. Removing cord pretension together with softening spacers abates stress shielding for adjacent segment during four different moments, and it provides enough security while not jeopardizes the stability of spine during axial rotation.

One-stage arthroscopic repair of rotator cuff tears with shoulder stiffness.

PURPOSE: The purpose of this study is to describe a 1-stage treatment with concomitant arthroscopic capsular release and rotator cuff repair and present clinical outcomes with a minimum follow-up of 2 years. METHODS: Arthroscopic rotator cuff repair was performed in 211 consecutive patients. Forty-three patients had severe concomitant shoulder stiffness at the time of the repair. In the stiffness group, 1-stage arthroscopic capsular release and rotator cuff repair were performed. Preoperative mean passive forward flexion was 124°, whereas external rotation at the side was 309°. All patients were evaluated at a minimum 2-year follow-up, which included a visual analog scale score for pain, tests of muscle power and range of motion, the Constant score, and the modified American Shoulder and Elbow Surgeons shoulder evaluation form and modified University of California, Los Angeles scores. RESULTS: The mean visual analog scale score during motion at the last follow-up was 1.5 in the stiffness group and 1.3 in the non-stiffness group. In the stiffness group, forward flexion was 175° whereas external rotation at the side was 60° postoperatively; shoulder motion improved (P < .001) and was comparable with that of the contralateral side. Other functional outcome instruments showed no statistical difference between the 2 groups. CONCLUSIONS: In this study, 1-stage treatment of patients with rotator cuff tears and shoulder stiffness was performed by arthroscopic capsular release and cuff repair, and overall satisfactory results were achieved in selected patients. The results of the stiffness group in this study were statistically the same as those in the non-stiffness group. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Failure of the rotating-hinge knee megaprosthesis.

Recently, rotating hinge knee prostheses were applied more frequently due to improving modern implant designs. They are predominantly used in specific conditions with major bone defect or insufficiency of the collateral ligaments around the knee, often as salvage procedures. A case of rotating hinge knee megaprosthesis failure due to isolated tibial polyethylene stopper broken, which was never reported before, was investigated and treated in our institution. We suggested that rotating hinge knee prosthesis with incompetent medial collateral ligament is apt to failure due to the high valgus moment during gait. Sacrificing lateral collateral ligament or cutting the femur in slightly less than the normal 5° to 7° valgus may eliminate the risk of complication.

Effect of cutting flute design features on primary stability of immediate implant placement and restoration: a dynamic experimental analysis.

Self-tapping implants with self-cutting flutes may influence primary stability, especially for the immediate implant placement and restoration protocol in which implants are affixed to the bone in the apical portion. Screw geometry differs between brands, and the effect of apical design on its clinical outcomes remains unclear. This study is aimed at investigating the influence of cutting flute shape (spiral, straight, and without flute) on primary stability by using a dynamic experimental test. Six types of dental implants were designed using computer-aided design and computer-aided manufacturing technology, consisting of three types of cutting flute shapes along with two types of screw features. A dynamic mechanical test was performed using a cyclic loading scheme. The mechanical behaviors of resistance to lateral load (RLL), maximum force, and energy dissipation were compared between groups. In the dynamic test, implants without cutting flute also exhibited higher values in RLL, maximum force, and energy dissipation. The aggressive thread implant with straight flute displayed higher RLL and had a significantly higher values in RLL (p = 0.033) at the threshold point of bone-implant interface breakdown. The implants without cutting flutes exhibited higher primary stability. Straight flute design would improve RLL for aggressive thread implant.

Biomechanical characteristics of self-expanding sinus stents during crimping and deployment_A comparison between different biomaterials.

Self-expanding sinus stents are often used in functional endoscopic sinus surgery to treat inflamed sinuses. The PROPEL self-expanding sinus stent offers mechanical support to the sinus cavity to prevent restenosis. The stent is made of a bioabsorbable material (PLGA) that disappears after wound healing. However, complications such as foreign body sensation and severe stent migration/expulsion have been reported after implantation. Little is known about the contact characteristics of self-expanding sinus stents from when the stent is crimped into the insertion device through to deployment into the sinus cavity. This current study developed a test platform to analyze the biomechanical behavior of the stent during this process. Three common bioabsorbable materials, PLGA, PCL and Mg alloy, were evaluated to understand how the choice of material affects the biomechanical characteristics of self-expanding sinus stents. The results showed that the material can have a considerable influence on the contact characteristics during crimping and deployment. When crimped, the PLGA and Mg alloy stents showed much higher plastic strain and contact stress than the PCL stent. When deployed, the PCL stent had the largest contact area (4.3 mm2) and the lowest contact pressure (0.1 MPa) on the inner surface of the sinus canal. The results indicate that PCL could be a suitable choice for self-expanding sinus stents. This current study provides a method for observing the biomechanical characteristics of sinus stents during stent crimping and deployment.

Fracture Characteristics of Commercial PEEK Dental Crowns: Combining the Effects of Aging Time and TiO2 Content.

Polyetheretherketone (PEEK) is an emerging thermoplastic polymer with good mechanical properties and an elastic modulus similar to that of alveolar bone. PEEK dental prostheses for computer-aided design/computer-aided manufacturing (CAD/CAM) systems on the market often have additives of titanium dioxide (TiO2) to strengthen their mechanical properties. However, the effects of combining aging, simulating a long-term intraoral environment, and TiO2 content on the fracture characteristics of PEEK dental prostheses have rarely been investigated. In this study, two types of commercially available PEEK blocks, containing 20% and 30% TiO2, were used to fabricate dental crowns by CAD/CAM systems and were aged for 5 and 10 h based on the ISO 13356 specifications. The compressive fracture load values of PEEK dental crowns were measured using a universal test machine. The morphology and crystallinity of the fracture surface were analyzed by scanning electron microscopy and an X-ray diffractometer, respectively. Statistical analysis was performed using the paired t-test (α = 0.05). Results showed no significant difference in the fracture load value of the test PEEK crowns with 20% and 30% TiO2 after 5 or 10 h of aging treatment; all test PEEK crowns have satisfactory fracture properties for clinical applications. Fracture surface analysis revealed that all test crowns fractured from the lingual side of the occlusal surface, with the fracture extending along the lingual sulcus to the lingual edge, showing a feather shape at the middle part of the fracture extension path and a coral shape at the end of the fracture. Crystalline analysis showed that PEEK crowns, regardless of aging time and TiO2 content, remained predominantly PEEK matrix and rutile phase TiO2. We would conclude that adding 20% or 30% TiO2 to PEEK crowns may have been sufficient to improve the fracture properties of PEEK crowns after 5 or 10 h of aging. Aging times below 10 h may still be safe for reducing the fracture properties of TiO2-containing PEEK crowns.