Hydrozoan sperm-specific SPKK motif-containing histone H2B variants stabilise chromatin with limited compaction.

Many animals achieve sperm chromatin compaction and stabilisation by replacing canonical histones with sperm nuclear basic proteins (SNBPs) such as protamines during spermatogenesis. Hydrozoan cnidarians and echinoid sea urchins lack protamines and have evolved a distinctive family of sperm-specific histone H2Bs (spH2Bs) with extended N termini rich in SPK(K/R) motifs. Echinoid sperm packaging is regulated by spH2Bs. Their sperm is negatively buoyant and fertilises on the sea floor. Hydroid cnidarians undertake broadcast spawning but their sperm properties are poorly characterised. We show that Hydractinia echinata and H. symbiolongicarpus sperm chromatin possesses higher stability than somatic chromatin, with reduced accessibility to transposase Tn5 integration and to endonucleases in vitro. In contrast, nuclear dimensions are only moderately reduced in mature Hydractinia sperm. Ectopic expression of spH2B in the background of H2B.1 knockdown results in downregulation of global transcription and cell cycle arrest in embryos, without altering their nuclear density. Taken together, SPKK-containing spH2B variants act to stabilise chromatin and silence transcription in Hydractinia sperm with only limited chromatin compaction. We suggest that spH2Bs could contribute to sperm buoyancy as a reproductive adaptation.

Quantifying Joint Congruence With an Elastic Foundation.

The level of congruence between the articulating surfaces of a diarthrodial joint can vary substantially between individuals. Quantifying joint congruence using the most widespread metric, the "congruence index," is not straightforward: the areas of the segmented bone that constitute the articular surfaces require accurate identification, their shape must be carefully described with appropriate functions, and the relative orientation of the surfaces measured precisely. In this work, we propose a new method of measuring joint congruence, which does not require these steps. First, a finite element (FE) simulation of an elastic layer compressed between each set of segmented bones is performed. These are then interpreted using the elastic foundation model, enabling an equivalent, but simpler, contact geometry to be identified. From this, the equivalent radius (quantification of joint congruence) is found. This defines the radius of a sphere contacting plane (or "ball on flat") that produces an equivalent contact to that in each joint. The minimal joint space width (in this joint position) can also be estimated from the FE simulations. The new method has been applied to ten healthy instances of the thumb metacarpophalangeal (MCP) joint. The ten thumb MCPs had similar levels and variability of congruence as the other diarthrodial joints that have been characterized previously. This new methodology enables efficient quantification of joint congruence and minimal joint space width directly from CT- or MRI-derived bone geometry in any relative orientation. It lends itself to large data sets and coupling with kinematic models.

Does a PEEK Femoral TKA Implant Preserve Intact Femoral Surface Strains Compared With CoCr? A Preliminary Laboratory Study.

BACKGROUND: Both the material and geometry of a total knee arthroplasty (TKA) component influence the induced periprosthetic bone strain field. Strain, a measure of the local relative deformation in a structure, corresponds to the mechanical stimulus that governs bone remodeling and is therefore a useful in vitro biomechanical measure for assessing the response of bone to new implant designs and materials. A polyetheretherketone (PEEK) femoral implant has the potential to promote bone strains closer to that of natural bone as a result of its low elastic modulus compared with cobalt-chromium (CoCr). QUESTIONS/PURPOSES: In the present study, we used a Digital Image Correlation (DIC) technique to answer the following question: Does a PEEK TKA femoral component induce a more physiologically normal bone strain distribution than a CoCr component? To achieve this, a DIC test protocol was developed for periprosthetic bone strain assessment using an analog model; the protocol aimed to minimize errors in strain assessment through the selection of appropriate analysis parameters. METHODS: Three synthetic bone femurs were used in this experiment. One was implanted with a CoCr femoral component and one with a PEEK femoral component. The third (unimplanted) femur was intact and used as the physiological reference (control) model. All models were subjected to standing loads on the corresponding polyethylene (ultrahigh-molecular-weight polyethylene) tibial component, and speckle image data were acquired for surface strain analysis using DIC in six repeat tests. The strain in 16 regions of interest on the lateral surface of each of the implanted bone models was plotted for comparison with the corresponding strains in the intact case. A Wilcoxon signed-rank test was used to test for difference at the 5% significance level. RESULTS: Surface analog bone strain after CoCr implantation indicated strain shielding (R2 = 0.6178 with slope, ß = 0.4314) and was lower than the intact case (p = 0.014). The strain after implantation with the PEEK implant deviated less from the intact case (R2 = 0.7972 with slope ß = 0.939) with no difference (p = 0.231). CONCLUSIONS: The strain shielding observed with the contemporary CoCr implant, consistent with clinical bone mineral density change data reported by others, may be reduced by using a PEEK implant. CLINICAL RELEVANCE: This bone analog in vitro study suggests that a PEEK femoral component could transfer more physiologically normal bone strains with a potentially reduced stress shielding effect, which may improve long-term bone preservation. Additional studies including paired cadaver tests are necessary to test the hypothesis further.

Toward a disruptive, minimally invasive small finger joint implant concept: Cellular and molecular interactions with materials in vivo.

Osteoarthritis (OA) poses significant therapeutic challenges, particularly OA that affects the hand. Currently available treatment strategies are often limited in terms of their efficacy in managing pain, regulating invasiveness, and restoring joint function. The APRICOTⓇ implant system developed by Aurora Medical Ltd (Chichester, UK) introduces a minimally invasive, bone-conserving approach for treating hand OA (https://apricot-project.eu/). By utilizing polycarbonate urethane (PCU), this implant incorporates a caterpillar track-inspired design to promote the restoration of natural movement to the joint. Surface modifications of PCU have been proposed for the biological fixation of the implant. This study investigated the biocompatibility of PCU alone or in combination with two surface modifications, namely dopamine-carboxymethylcellulose (dCMC) and calcium-phosphate (CaP) coatings. In a rat soft tissue model, native and CaP-coated PCU foils did not increase cellular migration or cytotoxicity at the implant-soft tissue interface after 3 d, showing gene expression of proinflammatory cytokines similar to that in non-implanted sham sites. However, dCMC induced an amplified initial inflammatory response that was characterized by increased chemotaxis and cytotoxicity, as well as pronounced gene activation of proinflammatory macrophages and neoangiogenesis. By 21 d, inflammation subsided in all the groups, allowing for implant encapsulation. In a rat bone model, 6 d and 28 d after release of the periosteum, all implant types were adapted to the bone surface with a surrounding fibrous capsule and no protracted inflammatory response was observed. These findings demonstrated the biocompatibility of native and CaP-coated PCU foils as components of APRICOTⓇ implants. STATEMENT OF SIGNIFICANCE: Hand osteoarthritis treatments require materials that minimize irritation of the delicate finger joints. Differing from existing treatments, the APRICOTⓇ implant leverages polycarbonate urethane (PCU) for minimally invasive joint replacement. This interdisciplinary, preclinical study investigated the biocompatibility of thin polycarbonate urethane (PCU) foils and their surface modifications with calcium-phosphate (CaP) or dopamine-carboxymethylcellulose (dCMC). Cellular and morphological analyses revealed that both native and Ca-P coated PCU elicit transient inflammation, similar to sham sites, and a thin fibrous encapsulation in soft tissues and on bone surfaces. However, dCMC surface modification amplified initial chemotaxis and cytotoxicity, with pronounced activation of proinflammatory and neoangiogenesis genes. Therefore, native and CaP-coated PCU possess sought-for biocompatible properties, crucial for patient safety and performance of APRICOTⓇ implant.

Experimental validation of numerically predicted strain and micromotion in intact and implanted composite hemi-pelvises.

The failure mechanisms of acetabular prostheses may be investigated by understanding the changes in load transfer due to implantation and using the analysis of the implant-bone micromotion. Computational finite element (FE) models allow detailed mechanical analysis of the implant-bone structure, but their validity must be assessed as a first step, before they can be employed in preclinical investigations. In this study, FE models of composite hemi-pelvises, intact and implanted with an acetabular cup, were experimentally validated. Strains and implant-bone micromotions in the hemi-pelvises were compared with those predicted by the equivalent FE models. Regression analysis indicated close agreement between the measured and FE strains, with a high correlation coefficient (0.95-0.98), a low standard error (SE) (36-53 mu epsilon) and a low error in regression slope (7%-11%). Measured micromotions along three orthogonal directions were small, less than 30 microm, whereas the FE-predicted values were found to be less than 85 .m. Although the trends were similar, the deviations are due to artefacts in experimental measurement and additional imperfections in recreating experimental loading and boundary conditions in the FE model. This supports the FE model as a valid predictor of the measured strain in the composite pelvis models, confirming its suitability for further computational investigations on acetabular prostheses.

Depth profiling via nanoindentation for characterisation of the elastic modulus and hydraulic properties of thin hydrogel layers.

The accurate determination of the mechanical properties of hydrogels is of fundamental importance for a range of applications, including in assessing the effect of stiffness on cell behaviour. This is a particular issue when using thin hydrogel layers adherent to stiff substrate supports, as the apparent stiffness can be significantly influenced by the constraint of the underlying impermeable substrate, leading to inaccurate measurements of the elastic modulus and permeability of thin hydrogel layers. This study used depth profiling nanoindentation and a poroelastic model for spherical indentation to identify the elastic moduli and hydraulic conductivity of thin polyacrylamide (PAAm) hydrogel layers (∼27 µm-782 µm thick) on impermeable substrates. The apparent stiffness of thin PAAm layers increased with indentation depth and was significantly greater than those of thicker hydrogels, which showed no influence of indentation depth. The hydraulic conductivity decreased as the geometrical confinement of hydrogels increased, indicating that the fluid became more constrained within the confinement areas. The impact of geometrical confinement on the apparent modulus and hydraulic conductivity of thin PAAm hydrogel layers was then established, and their elastic moduli and intrinsic permeability were determined in relation to this effect. This study offers valuable insights into the mechanical characterisation of thin PAAm hydrogel layers used for the fundamental study of cell mechanobiology.

Experimental validation of finite element models of intact and implanted composite hemipelvises using digital image correlation.

A detailed understanding of the changes in load transfer due to implantation is necessary to identify potential failure mechanisms of orthopedic implants. Computational finite element (FE) models provide full field data on intact and implanted bone structures, but their validity must be assessed for clinical relevance. The aim of this study was to test the validity of FE predicted strain distributions for the intact and implanted pelvis using the digital image correlation (DIC) strain measurement technique. FE models of an in vitro hemipelvis test setup were produced, both intact and implanted with an acetabular cup. Strain predictions were compared to DIC and strain rosette measurements. Regression analysis indicated a strong linear relationship between the measured and predicted strains, with a high correlation coefficient (R = 0.956 intact, 0.938 implanted) and a low standard error of the estimate (SE = 69.53 µÎµ, 75.09 µÎµ). Moreover, close agreement between the strain rosette and DIC measurements improved confidence in the validity of the DIC technique. The FE model therefore was supported as a valid predictor of the measured strain distribution in the intact and implanted composite pelvis models, confirming its suitability for further computational investigations.

Measuring the elastic modulus of soft biomaterials using nanoindentation.

The measurement of the elastic modulus of soft biomaterials via nanoindentation relies on the accurate determination of the zero-point of the tip-sample interaction on which the depth of penetration into the sample is based. Non-cantilever based nanoindentation systems were originally designed for hard materials, and therefore monitoring the zero-point contact presents a significant challenge for the characterisation of very soft biomaterials. This study investigates the ability of non-cantilever based nanoindentation to differentiate between hydrogels with elastic moduli on the order of single kiloPascals (kPa) using a bespoke soft contact protocol and low flexural stiffness of instrument. Polyethylene glycol (PEG) hydrogels were fabricated as a model system with a range of elastic moduli by varying the polymer concentration and degree of crosslinking. Elastic modulus values were calculated using the Oliver-Pharr method, Hertzian contact model, as well as a viscoelastic model to account for the time-dependent behaviour of the gels. The stiffness measurements were validated by measuring cantilever beams with the equivalent flexural stiffness to that of the PEG hydrogels being tested. The results demonstrated a high repeatability of the measurements, enabling differentiation between hydrogels with elastic moduli in the single kPa to hundreds of kPa range.

Key considerations for finite element modelling of the residuum-prosthetic socket interface.

BACKGROUND: Finite element modelling has long been proposed to support prosthetic socket design. However, there is minimal detail in the literature to inform practice in developing and interpreting these complex, highly nonlinear models. OBJECTIVES: To identify best practice recommendations for finite element modelling of lower limb prosthetics, considering key modelling approaches and inputs. STUDY DESIGN: Computational modelling. METHODS: This study developed a parametric finite element model using magnetic resonance imaging data from a person with transtibial amputation. Comparative analyses were performed considering socket loading methods, socket-residuum interface parameters and soft tissue material models from the literature, to quantify their effect on the residuum's biomechanical response to a range of parameterised socket designs. RESULTS: These variables had a marked impact on the finite element model's predictions for limb-socket interface pressure and soft tissue shear distribution. CONCLUSIONS: All modelling decisions should be justified biomechanically and clinically. In order to represent the prosthetic loading scenario in silico, researchers should (1) consider the effects of donning and interface friction to capture the generated soft tissue shear stresses, (2) use representative stiffness hyperelastic material models for soft tissues when using strain to predict injury and (3) interrogate models comparatively, against a clinically-used control.

Decreased stress shielding with a PEEK femoral total knee prosthesis measured in validated computational models.

Due to their high stiffness, metal femoral implants in total knee arthroplasty may cause stress shielding of the peri-prosthetic bone, which can lead to loss of bone stock. Using a polymer (PEEK) femoral implant reduces the stiffness mismatch between implant and bone, and therefore has the potential to decrease strain shielding. The goal of the current study was to evaluate this potential benefit of PEEK femoral components in cadaveric experiments. Cadaveric femurs were loaded in a materials testing device, while a 3-D digital image correlation set-up captured strains on the surface of the intact femurs and femurs implanted with PEEK and CoCr components. These experimental results were used to validate specimen-specific finite element models, which subsequently were used to assess the effect of metal and PEEK femoral components on the bone strain energy density. The finite element models showed strain maps that were highly comparable to the experimental measurements. The PEEK implant increased strain energy density, relative to the preoperative bone and compared to CoCr. This was most pronounced in the regions directly under the implant and near load contact sites. These data confirm the hypothesis that a PEEK femoral implant can reduce peri-prosthetic stress shielding.

Developing an Analogue Residual Limb for Comparative DVC Analysis of Transtibial Prosthetic Socket Designs.

Personalised prosthetic sockets are fabricated by expert clinicians in a skill- and experience-based process, with research providing tools to support evidence-based practice. We propose that digital volume correlation (DVC) may offer a deeper understanding of load transfer from prosthetic sockets into the residual limb, and tissue injury risk. This study's aim was to develop a transtibial amputated limb analogue for volumetric strain estimation using DVC, evaluating its ability to distinguish between socket designs. A soft tissue analogue material was developed, comprising silicone elastomer and sand particles as fiducial markers for image correlation. The material was cast to form an analogue residual limb informed by an MRI scan of a person with transtibial amputation, for whom two polymer check sockets were produced by an expert prosthetist. The model was micro-CT scanned according to (i) an unloaded noise study protocol and (ii) a case study comparison between the two socket designs, loaded to represent two-legged stance. The scans were reconstructed to give 108 µm voxels. The DVC noise study indicated a 64 vx subvolume and 50% overlap, giving better than 0.32% strain sensitivity, and ~3.5 mm spatial resolution of strain. Strain fields induced by the loaded sockets indicated tensile, compressive and shear strain magnitudes in the order of 10%, with a high signal:noise ratio enabling distinction between the two socket designs. DVC may not be applicable for socket design in the clinical setting, but does offer critical 3D strain information from which existing in vitro and in silico tools can be compared and validated to support the design and manufacture of prosthetic sockets, and enhance the biomechanical understanding of the load transfer between the limb and the prosthesis.

Measurement of Internal Implantation Strains in Analogue Bone Using DVC.

The survivorship of cementless orthopaedic implants may be related to their initial stability; insufficient press-fit can lead to excessive micromotion between the implant and bone, joint pain, and surgical revision. However, too much interference between implant and bone can produce excessive strains and damage the bone, which also compromises stability. An understanding of the nature and mechanisms of strain generation during implantation would therefore be valuable. Previous measurements of implantation strain have been limited to local discrete or surface measurements. In this work, we devise a Digital Volume Correlation (DVC) methodology to measure the implantation strain throughout the volume. A simplified implant model was implanted into analogue bone media using a customised loading rig, and a micro-CT protocol optimised to minimise artefacts due to the presence of the implant. The measured strains were interpreted by FE modelling of the displacement-controlled implantation, using a bilinear elastoplastic constitutive model for the analogue bone. The coefficient of friction between the implant and bone was determined using the experimental measurements of the reaction force. Large strains at the interface between the analogue bone and implant produced localised deterioration of the correlation coefficient, compromising the ability to measure strains in this region. Following correlation coefficient thresholding (removing strains with a coefficient less than 0.9), the observed strain patterns were similar between the DVC and FE. However, the magnitude of FE strains was approximately double those measured experimentally. This difference suggests the need for improvements in the interface failure model, for example, to account for localised buckling of the cellular analogue bone structure. A further recommendation from this work is that future DVC experiments involving similar geometries and structures should employ a subvolume size of 0.97 mm as a starting point.

Characterising the compressive anisotropic properties of analogue bone using optical strain measurement.

The validity of conclusions drawn from pre-clinical tests on orthopaedic devices depends upon accurate characterisation of the support materials: frequently, polymer foam analogues. These materials often display anisotropic mechanical behaviour, which may considerably influence computational modelling predictions and interpretation of experiments. Therefore, this study sought to characterise the anisotropic mechanical properties of a range of commonly used analogue bone materials, using non-contact multi-point optical extensometry method to account for the effects of machine compliance and uneven loading. Testing was conducted on commercially available 'cellular', 'solid' and 'open-cell' Sawbone blocks with a range of densities. Solid foams behaved largely isotropically. However, across the available density range of cellular foams, the average Young's modulus was 23%-31% lower (p < 0.005) perpendicular to the foaming direction than parallel to it, indicating elongation of cells with foaming. The average Young's modulus of open-celled foams was 25%-59% higher (p < 0.05) perpendicular to the foaming direction than parallel to it. This is thought to result from solid planes of material that were observed perpendicular to the foaming direction, stiffening the bulk material. The presented data represent a reference to help researchers design, model and interpret tests using these materials.

Viral proteins as a potential driver of histone depletion in dinoflagellates.

Within canonical eukaryotic nuclei, DNA is packaged with highly conserved histone proteins into nucleosomes, which facilitate DNA condensation and contribute to genomic regulation. Yet the dinoflagellates, a group of unicellular algae, are a striking exception to this otherwise universal feature as they have largely abandoned histones and acquired apparently viral-derived substitutes termed DVNPs (dinoflagellate-viral-nucleoproteins). Despite the magnitude of this transition, its evolutionary drivers remain unknown. Here, using Saccharomyces cerevisiae as a model, we show that DVNP impairs growth and antagonizes chromatin by localizing to histone binding sites, displacing nucleosomes, and impairing transcription. Furthermore, DVNP toxicity can be relieved through histone depletion and cells diminish their histones in response to DVNP expression suggesting that histone reduction could have been an adaptive response to these viral proteins. These findings provide insights into eukaryotic chromatin evolution and highlight the potential for horizontal gene transfer to drive the divergence of cellular systems.

Cement mantle fatigue failure in total hip replacement: experimental and computational testing.

One possible loosening mechanism of the femoral component in total hip replacement is fatigue cracking of the cement mantle. A computational method capable of simulating this process may therefore be a useful tool in the preclinical evaluation of prospective implants. In this study, we investigated the ability of a computational method to predict fatigue cracking in experimental models of the implanted femur construct. Experimental specimens were fabricated such that cement mantle visualisation was possible throughout the test. Two different implant surface finishes were considered: grit blasted and polished. Loading was applied to represent level gait for two million cycles. Computational (finite element) models were generated to the same geometry as the experimental specimens, with residual stress and porosity simulated in the cement mantle. Cement fatigue and creep were modelled over a simulated two million cycles. For the polished stem surface finish, the predicted fracture locations in the finite element models closely matched those on the experimental specimens, and the recorded stem displacements were also comparable. For the grit blasted stem surface finish, no cement mantle fractures were predicted by the computational method, which was again in agreement with the experimental results. It was concluded that the computational method was capable of predicting cement mantle fracture and subsequent stem displacement for the structure considered.

The potential of statistical shape modelling for geometric morphometric analysis of human teeth in archaeological research.

This paper introduces statistical shape modelling (SSM) for use in osteoarchaeology research. SSM is a full field, multi-material analytical technique, and is presented as a supplementary geometric morphometric (GM) tool. Lower mandibular canines from two archaeological populations and one modern population were sampled, digitised using micro-CT, aligned, registered to a baseline and statistically modelled using principal component analysis (PCA). Sample material properties were incorporated as a binary enamel/dentin parameter. Results were assessed qualitatively and quantitatively using anatomical landmarks. Finally, the technique's application was demonstrated for inter-sample comparison through analysis of the principal component (PC) weights. It was found that SSM could provide high detail qualitative and quantitative insight with respect to archaeological inter- and intra-sample variability. This technique has value for archaeological, biomechanical and forensic applications including identification, finite element analysis (FEA) and reconstruction from partial datasets.

Damage mechanisms at the cement-implant interface of polished cemented femoral stems.

The occurrence of damage on polished femoral stems has been widely reported in the literature, and bone cement has been implicated in a tribocorrosive failure process. However, the mechanisms of cement-mediated damage and the impact of cement formulation on this process are not well understood. In this study, 13 Zimmer CPT polished femoral stems, and the corresponding cement specimens were retrieved at revision surgery and analyzed using high-resolution imaging techniques. Surface damage attributed to tribocorrosion was observed on all stems. Corrosion product, in the form of black flaky surface debris, was observed on the surface of cement specimens; both energy-dispersive X-ray spectroscopy and inductively coupled plasma mass spectrometry(ICP-MS) confirmed the presence of cobalt and chromium, with the ICP-MS showing much higher levels of Cr compared to Co when compared to the original stem material. Agglomerates of ZrO2 radiopacifier were also identified on the cement surface and, in some cases, showed evidence of abrasive wear; the size of these particles correlated well with elliptical pitting evident on the surfaces of the corresponding stems. This evidence supports the hypothesis that agglomerates of hard radiopacifier particles within the cement may induce a wear-dominated tribocorrosive interaction at the stem-cement interface that damages the surface of polished CoCr femoral stems. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2027-2033, 2017.

IgM multiple myeloma with an extremely rare non-aggressive presentation: A case report.

In the present study, the case of a 41-year-old man with immunoglobulin (Ig)M multiple myeloma (MM) that presented with an unusually non-aggressive clinical course who has survived for >9 years to date, is presented. Initial diagnosis of symptomatic MM was established according to the International Myeloma Working Group consensus statement and guidelines. Due to the mild symptoms, no therapy was administered and the patient was closely followed up. Eight years after initial diagnosis, clinical, morphological and genetic progression occurred with the development of hypercalcemia, progressively deteriorating polyneuropathy, clonal expansion of plasma cells up to 50% of hematopoietic cells and demonstration of the typical t(11;14) translocation (Ig heavy chain locus rearrangement). Subsequently, 4 cycles of induction chemotherapy with velcade, cyclophosphamide and dexamethasone, were administered. At the time of writing, the patient remained alive in generally good health. To the best of our knowledge, with a survival time of >9 years, this case reports the longest survival time of an IgM MM patient to date, which contradicts previous evidence that suggests IgM MM exhibits an aggressive clinical course.

Damage accumulation, fatigue and creep behaviour of vacuum mixed bone cement.

The behaviour of bone cement under fatigue loading is of interest to assess the long-term in vivo performance. In this study, uniaxial tensile fatigue tests were performed on CMW-1 bone cement. Acoustic emission sensors and an extensometer were attached to monitor damage accumulation and creep deformation respectively. The S-N data exhibited the scatter synonymous with bone cement fatigue, with large pores generally responsible for premature failure; at 20 MPa specimens failed between 2 x 10(3) and 2 x 10(4) load cycles, while at 7 MPa specimens failed from 3 x 10(5) load cycles but others were still intact after 3 x 10(6) load cycles. Acoustic emission data revealed a non-linear accumulation of damage with respect to time, with increasing non-linearity at higher stress levels. The damage accumulation process was not continuous, but occurred in bursts separated by periods of inactivity. Damage in the specimen was located by acoustic emissions, and allowed the failure site to be predicted. Acoustic emission data were also used to predict when failure was not imminent. When this was the case at 3 million load cycles, the tests were terminated. Creep strain was plotted against the number of load cycles and a linear relationship was found when a double logarithmic scale was employed. This is the first time a brand of cement has been characterised in such detail, i.e. fatigue life, creep and damage accumulation. Results are presented in a manner that allows direct comparison with published data for other cements. The data can also be used to characterise CMW-1 in computational simulations of the damage accumulation process. Further evidence is provided for the condition-monitoring capabilities of the acoustic emission technique in orthopaedic applications.