Implant Strength Contributes to the Osseointegration Strength of Porous Metallic Materials.

Creating the optimal environment for effective and long term osseointegration is a heavily researched and sought-after design criteria for orthopedic implants. A validated multimaterial finite element (FE) model was developed to replicate and understand the results of an experimental in vivo push-out osseointegration model. The FE model results closely predicted global force (at 0.5 mm) and stiffness for the 50-90% porous implants with an r2 of 0.97 and 0.98, respectively. In addition, the FE global force at 0.5 mm showed a correlation to the maximum experimental forces with an r2 of 0.90. The highest porosity implants (80-90%) showed lower stiffnesses and more equitable load sharing but also failed at lower a global force level than the low porosity implants (50-70%). The lower strength of the high porosity implants caused premature plastic deformation of the implant itself during loading as well as significant deformations in the ingrown and surrounding bone, resulting in lower overall osseointegration strength, consistent with experimental measurements. The lower porosity implants showed a balance of sufficient bony ingrowth to support osseointegration strength coupled with implant mechanical properties to circumvent significant implant plasticity and collapse under the loading conditions. Together, the experimental and finite element modeling results support an optimal porosity in the range of 60-70% for maximizing osseointegration with current structure and loading.

Effect of intramedullary nail stiffness on load-sharing in tibiotalocalcaneal arthrodesis: A patient-specific finite element study.

Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails can be manufactured with multiple materials and some feature the ability to dynamize the arthrodesis construct. However, the impact of IM nail material and nail dynamization on load-sharing and in the setting of bone resorption have not been quantified. This work utilized a patient-specific finite element analysis model of TTC arthrodesis to investigate IM nails with differing material moduli and the impact of nail dynamization on load-sharing and intersegmental compression in the setting of bone resorption. Each nail was virtually inserted into a patient-specific model of a hindfoot, which was segmented into the three bones of the TTC complex and assigned material properties based on the densitometry of the bone. Compression, amount of load-sharing, and stress distributions after simulated bone resorption were quantified and compared between the varying IM nails. Simulations revealed that bone segments were only subjected to 17% and 22% of dynamic gait forces in the titanium and carbon fiber nail constructs, whereas the pseudoelastic NiTi nail constructs allowed for 67% of the same. The titanium and carbon fiber nails lost all initial compression in less than 0.13mm of bone resorption, whereas the NiTi nail maintained compression through all simulated values of bone resorption. These data highlight the poor load-sharing of static nail TTC arthrodesis constructs and the ability of a pseudoelastic IM nail construct to maintain intersegmental compression when challenged with bone resorption.

Three-dimensional image registration of MR proximal femur images for the analysis of trabecular bone parameters.

This study investigated the feasibility of automatic image registration of MR high-spatial resolution proximal femur trabecular bone images as well as the effects of gray-level interpolation and volume of interest (VOI) misalignment on MR-derived trabecular bone structure parameters. For six subjects in a short-term study, a baseline scan and a follow-up scan of the proximal femur were acquired on the same day. For ten subjects in a long-term study, a follow-up scan of the proximal femur was acquired 1 year after the baseline. An automatic image registration technique, based on mutual information, utilized a baseline and a follow-up scan to compute transform parameters that aligned the two images. In the short-term study, these parameters were subsequently used to transform the follow-up image with three different gray-level interpolators. Nearest-neighbor interpolation and B-spline approximation did not significantly alter bone parameters, while linear interpolation significantly modified bone parameters (p<0.01). Improvement in image alignment due to the automatic registration for the long-term and short-term study was determined by inspecting difference images and 3D renderings. This work demonstrates the first application of automatic registration, without prior segmentation, of high-spatial resolution trabecular bone MR images of the proximal femur. Additionally, inherent heterogeneity in trabecular bone structure and imprecise positioning of the VOI along the slice (anterior-posterior) direction resulted in significant changes in bone parameters (p<0.01). Results suggest that automatic mutual information registration using B-spline approximation or nearest neighbor gray-level interpolation to transform the final image ensures VOI alignment between baseline and follow-up images and does not compromise the integrity of MR-derived trabecular bone parameters used in this study.

Comparison of cytology proficiency testing: glass slides vs. virtual slides.

OBJECTIVE: To compare proficiency testing in gynecologic cytology using glass slides vs. virtual slides. STUDY DESIGN: To compare performance, a sample of 111 individuals (pathologists = 52, cytotechnologists = 59) from participating in-state laboratories were administered 2 proficiency tests. The annual test of the Maryland Cytology Proficiency Testing Program (MCPTP) was administered to individuals in their laboratories following normal work practice (i.e., using microscopes and equipment with which they were familiar). The other test was CytoView II (Centers for Disease Control and Prevention, Atlanta, Georgia, U.S.A.), a computer-based test composed of virtual slides captured from the MCPTP's glass slides, which test administration personnel transported to the individual's laboratory and administered using 1 of 2 laptop computers. ANOVA was used to compare the performance on the 2 tests and the effect of various potential confounding variables. The slides were evaluated by comparing the performance average for each glass slide to that of the matching virtual slides. All data analysis was performed at the 95% confidence interval. RESULTS: The mean score of the individuals (n = 111) on the MCPTP test was 99.2% (SD = 2.2, range = 90-100%). The mean score of the individuals (n = 111) on CytoView II was 96.8% (SD = 5.8, range = 70-100%). No individual scored < 90% on the glass slide test (pass rate = 100%). Eight individuals (pathologists = 3, cytotechnologists = 5) scored < 90% on the CytoView II (pass rate = 93.8%). Comparison of an individual's performance on the 2 tests demonstrated a significant difference. When virtual slides that did not attain a 90% consensus were excluded from the scoring, a comparison of individual pass rate for the glass slide test (100%) and computer-based test (99.1%) did not demonstrate significant difference. CONCLUSION: Each slide (glass or virtual) must be field validated by cytotechnologists and pathologists. If field validation and Clinical Laboratory Improvement Amendment referencing of virtual slides are comparable to those of glass slides, computer-based testing can be equivalent.

Abnormal tibiofemoral kinematics following ACL reconstruction are associated with early cartilage matrix degeneration measured by MRI T1rho.

PURPOSE: Altered kinematics following ACL-reconstruction may be a cause of post-traumatic osteoarthritis. T(1ρ) MRI is a technique that detects early cartilage matrix degeneration. Our study aimed to evaluate kinematics following ACL-reconstruction, cartilage health (using T(1ρ) MRI), and assess whether altered kinematics following ACL-reconstruction are associated with early cartilage degeneration. METHODS: Eleven patients (average age: 33 ± 9 years) underwent 3T MRI 18 ± 5 months following ACL-reconstruction. Images were obtained at extension and 30° flexion under simulated loading (125 N). Tibial rotation (TR) and anterior tibial translation (ATT) between flexion and extension, and T(1ρ) relaxation times of the knee cartilage were analyzed. Cartilage was divided into five compartments: medial and lateral femoral condyles (MFC/LFC), medial and lateral tibias (MT/LT), and patella. A sub-analysis of the femoral weight-bearing (wb) regions was also performed. Patients were categorized as having "abnormal" or "restored" ATT and TR, and T(1ρ) percentage increase was compared between these two groups of patients. RESULTS: As a group, there were no significant differences between ACL-reconstructed and contralateral knee kinematics, however, there were individual variations. T(1ρ) relaxation times of the MFC and MFC-wb region were elevated (p ≤ 0.05) in the ACL-reconstructed knees compared to the uninjured contralateral knees. There were increases (p ≤ 0.05) in the MFC-wb, MT, patella and overall average cartilage T(1ρ) values of the "abnormal" ATT group compared to "restored" ATT group. The percentage increase in the T(1ρ) relaxation time in the MFC-wb cartilage approached significance (p=0.08) in the "abnormal" versus "restored" TR patients. CONCLUSIONS: Abnormal kinematics following ACL-reconstruction appear to lead to cartilage degeneration, particularly in the medial compartment.