Coefficient of Friction and Height Loss: Two Criteria Used to Determine the Mechanical Property and Stability of Regenerated Versus Natural Articular Cartilage.

BACKGROUND: The coefficient of friction (CoF) serves as an indicator for the mechanical properties of natural and regenerated articular cartilage (AC). After tribological exposure, a height loss (HL) of the cartilage pair specimens can be measured. Our aim was to determine the CoF and HL of regenerated AC tissue and compare them with those of natural AC from non-operated joints and AC from joints where the regenerated tissues had been created after different treatments. METHODS: In partial-thickness defects of the trochleae of the stifle joints of 60 Göttingen Minipigs, regenerated AC was created. In total, 40 animals received a Col I matrix, 20 laden with autologous chondrocytes, and 20 without. The defects of 20 animals were left empty. The healing periods were 24 and 48 weeks. A total of 10 not-operated animals, delivered the "external" control specimens. Osteochondral pins were harvested from defect and non-defect areas, the latter serving as "internal" controls. Using a pin-on-plate tribometer, we measured the CoF and the HL. RESULTS: The CoF of the regenerated AC ranged from 0.0393 to 0.0688, and the HL, from 0.22 mm to 0.3 mm. The differences between the regenerated AC of the six groups and the "external" controls were significant. The comparison with the "internal" controls revealed four significant differences for the CoF and one for the HL in the operated groups. No differences were seen within the operated groups. CONCLUSIONS: The mechanical quality of the regenerated AC tissue showed inferior behavior with regard to the CoF and HL in comparison with natural AC. The comparison of regenerated AC tissue with AC from untreated joints was more promising than with AC from the treated joints.

[Oedipus, a traumatological - orthopaedic case? - Essay on an unfortunate figure from antiquity]. / Ödipus, ein traumatologisch - orthopädischer Fall?

This essay studies the physical shape, character and fate of Oedipus, applying relevant and current medical scientific criteria. The abuses he suffered during childhood play an important role in this context. The name Oedipus is usually translated as "swollen foot", but according to various etymological sources, the name can be interpreted in different ways. One of these interpretations alludes to fact that it was easy for the hero to solve the riddle of the sphinx because its key message addressed an orthopedic issue as it was dealing with the function of the feet. During Oedipus' life, he suffered many injuries and disorders, which can be classified using the current ICD code. There is, for example, his blindness after he had blinded himself. In addition, we can assume that Oedipus suffered from a post-traumatic stress disorder and a borderline personality disorder following the child abuse caused by his parents who intended to kill him. Thus, the discussion about his own responsibility for his actions is again being put into question. Oedipus`s life story is once again proof that Greek mythology can reflect the reality of life.

Resilience to height loss of articular cartilage of osteoarthritic stifle joints of old pigs, compared with healthy cartilage from young pigs in a tribological pin-on-plate exposure, revealing similar friction forces.

INTRODUCTION: We saw a lack of data on the biomechanical behavior of degenerated articular cartilage (OA) compared with that of healthy cartilage, even though the susceptibility to wear and tear of articular cartilage plays a key role in the progression of osteoarthritis (OA). Therefore, we performed a comparison between naturally occurring OA and healthy cartilage from pigs, before and after tribological stress. AIM: The aim of the study was to compare OA-cartilage with healthy cartilage and to analyze the resilience to tribological shear stress, which will be measured as height loss (HL), and to friction forces of the cartilage layers. The findings will be substantiated in macro- and microscopical evaluations before and after tribological exposure. METHODS: We assessed stifle joints of fifteen old and sixteen young pigs from the local abattoir radiologically, macroscopically and histologically to determine possible OA alterations. We put pins from the femoral part of the joints and plates from the corresponding tibial plateaus in a pin-on-plate tribometer under stress for about two hours with about 1108 reciprocating cycles under a pressure of approximately 1 MPa. As a surrogate criterion of wear and tear, the HL was recorded in the tribometer. The heights of the cartilage layers measured before and after the tribological exposure were compared histologically. The condition of the cartilage before and after the tribological exposure was analyzed both macroscopically with an adapted ICRS score and microscopically according to Little et al. (2010). We assessed the friction forces acting between the surfaces of the cartilage pair-specimens. RESULTS: Articular cartilage taken from old pigs showed significant degenerative changes compared to that taken from the young animals. The macroscopic and microscopic scores showed strong alterations of the cartilage after the tribological exposure. There was a noticeable HL of the cartilage specimens after the first 100 to 300 cycles. The HL after tribological exposure was lower in the group of the old animals with 0.52 mm ± 0.23 mm than in the group of the young animals with 0.86 mm ± 0.26 mm (p < 0.0001). The data for the HL was validated by the histological height measurements with 0.50 mm ± 0.82 mm for the old and 0.79 mm ±0.53 mm for the young animals (p = 0.133). The friction forces measured at the cartilage of the old animals were 2.25 N ± 1.15 N and 1.89 N ± 1.45 N of the young animals (p = 0.3225). CONCLUSION: Unlike articular cartilage from young pigs, articular cartilage from old pigs showed OA alterations. Tribological shear stress exposure revealed that OA cartilage showed less HL than healthy articular cartilage. Tribological stress exposure in a pin-on-plate tribometer seemed to be an appropriate way to analyze the mechanical stability of articular cartilage, and the applied protocol could reveal weaknesses of the assessed cartilage tissue. Friction and HL seemed to be independent parameters when degenerated and healthy articular cartilage were assessed under tribological exposure in a pin-on- plate tribometer.

Compression Bioreactor-Based Mechanical Loading Induces Mobilization of Human Bone Marrow-Derived Mesenchymal Stromal Cells into Collagen Scaffolds In Vitro.

Articular cartilage (AC) is an avascular tissue composed of scattered chondrocytes embedded in a dense extracellular matrix, in which nourishment takes place via the synovial fluid at the surface. AC has a limited intrinsic healing capacity, and thus mainly surgical techniques have been used to relieve pain and improve function. Approaches to promote regeneration remain challenging. The microfracture (MF) approach targets the bone marrow (BM) as a source of factors and progenitor cells to heal chondral defects in situ by opening small holes in the subchondral bone. However, the original function of AC is not obtained yet. We hypothesize that mechanical stimulation can mobilize mesenchymal stromal cells (MSCs) from BM reservoirs upon MF of the subchondral bone. Thus, the aim of this study was to compare the counts of mobilized human BM-MSCs (hBM-MSCs) in alginate-laminin (alginate-Ln) or collagen-I (col-I) scaffolds upon intermittent mechanical loading. The mechanical set up within an established bioreactor consisted of 10% strain, 0.3 Hz, breaks of 10 s every 180 cycles for 24 h. Contrary to previous findings using porcine MSCs, no significant cell count was found for hBM-MSCs into alginate-Ln scaffolds upon mechanical stimulation (8 ± 5 viable cells/mm3 for loaded and 4 ± 2 viable cells/mm3 for unloaded alginate-Ln scaffolds). However, intermittent mechanical stimulation induced the mobilization of hBM-MSCs into col-I scaffolds 10-fold compared to the unloaded col-I controls (245 ± 42 viable cells/mm3 vs. 22 ± 6 viable cells/mm3, respectively; p-value < 0.0001). Cells that mobilized into the scaffolds by mechanical loading did not show morphological changes. This study confirmed that hBM-MSCs can be mobilized in vitro from a reservoir toward col-I but not alginate-Ln scaffolds upon intermittent mechanical loading, against gravity.

Tribometer for measuring coefficients of friction of uneven surfaces like articular cartilage.

To examine coefficients of friction (COFs) of articular cartilage, it is necessary to use cartilage as a friction partner. Irregularities of surfaces require special tribometers and calculation methods. The aim of this study was to establish a tribometer system for measuring a low COF of cartilage and to develop and validate an algorithm that takes the irregularities into consideration. We used a pin-on-plate tribometer that allows a vertical displacement of the pin to follow the surface of the plate and developed an algorithm that takes these irregularities into account. We were, thus, able to take into consideration a forward and backward movement, an upward and downward movement, and different force ratios. The algorithm was validated using a spherical POM (polyoxymethylene) pin against a stainless steel plate at slope angles up to 24°. First examinations with articular cartilage against articular cartilage samples of a stifle joint of a pig were then performed. The newly developed tribometer worked well when POM against a stainless steel hump was examined. The COF increased for slope angles steeper than ±15°. There was an interaction between the COF and the slope angle, but not for the range within ±15°. Cartilage examinations revealed COFs as published in the literature. The tribometer and the algorithm were suitable for the detection of low COF of irregular surfaces of the plate within a range of ±15°. The COF resulting from the forward and backward movements should be averaged.

Bioreactor for mobilization of mesenchymal stem/stromal cells into scaffolds under mechanical stimulation: Preliminary results.

INTRODUCTION: Articular cartilage (AC) is a viscoelastic tissue with a limited regenerative capability because of the lack of vasculature. Mechanical stimulation contributes to the homeostasis of functional AC since it promotes the delivery of nutrients, cytokines and growth factors between the distant chondrocytes. We hypothesized that biomechanical stimulation might enhance mobilization of endogenous mesenchymal stem/stromal cells (MSCs) from neighboring niches as the bone marrow. AIM: This study aimed to introduce a bioreactor for inducing mobilization of MSCs from one compartment to another above by mechanical stimulation in vitro. METHODS: A novel mechanical system for evaluating mobilization of cells in a 3D context in vitro is presented. The system consists of a compression bioreactor able to induce loading on hydrogel-based scaffolds, custom-made software for settings management and data recording, and image based biological evaluation. Intermittent load was applied under a periodic regime with frequency of 0.3 Hz and unload phases of 10 seconds each 180 cycles over 24 hours. The mechanical stimulation acted on an alginate scaffold and a cell reservoir containing MSCs below it. The dynamic compression exerted amplitude of 200 µm as 10% strain regarding the original height of the scaffold. RESULTS: The bioreactor was able to stimulate the scaffolds and the cells for 24.4 (±1.7) hours, exerting compression with vertical displacements of 185.8 (±17.8) µm and a force-amplitude of 1.87 (±1.37; min 0.31, max 4.42) N. Our results suggest that continuous mechanical stimulation hampered the viability of the cells located at the cell reservoir when comparing to intermittent mechanical stimulation (34.4 ± 2.0% vs. 66.8 ± 5.9%, respectively). Functionalizing alginate scaffolds with laminin-521 (LN521) seemed to enhance the mobilization of cells from 48 (±21) to 194 (±39) cells/mm3 after applying intermittent mechanical loading. CONCLUSION: The bioreactor presented here was able to provide mechanical stimulation that seemed to induce the mobilization of MSCs into LN521-alginate scaffolds under an intermittent loading regime.

Report on a large animal study with Göttingen Minipigs where regenerates and controls for articular cartilage were created in a large number. Focus on the conditions of the operated stifle joints and suggestions for standardized procedures.

The characterization of regenerated articular cartilage (AC) can be based on various methods, as there is an unambiguous accepted criterion neither for the natural cartilage tissue nor for regenerates. Biomechanical aspects should be considered as well, leading to the need for more equivalent samples. The aim of the study was to describe a large animal model where 8 specimens of regenerated AC can be created in one animal plus the impact of two surgeries on the welfare of the animals. The usefulness of the inclusion of a group of untreated animals (NAT) was to analyzed. Based on the histological results the conditions of the regenerates were to be described and the impact on knee joints were to be explored in terms of degenerative changes of the cartilage. The usefulness of the statistical term "effect size" (ES) will be explained with histological results. We analyzed an animal model where 8 AC regenerates were obtained from one Göttingen Minipig, on both sides of the trochleae. 60 animals were divided into 6 groups of 10 each, where the partial thickness defects in the trochlea were filled with matrices made of Collagen I with or without autologous chondrocytes or left empty over the healing periods of 24 and 48 weeks. One additional control group consisting of 10 untreated animals was used to provide untouched "external" cartilage. We harvested 560 samples of regenerated tissue and "external" controls, besides that, twice the number of further samples from other parts of the joints referred to as "internal" controls were also harvested. The animals recovered faster after the 1st operation when the defects were set compared to the 2nd operation when the defects were treated. 9% of all animals were lost. Other complications were for example superficial infections, seroma, diarrhea, febrile state and an injury of a claw. The histological results of the treatments proved the robustness of the study design where we included an "external" control group (NAT) in which the animals were not operated. Comparable significant differences between treated groups and the NAT group were detected both after ½ year and after 1 year. Spontaneous regenerated AC as control revealed differences after an observation time of nearly 1 year. The impact of the treatment on cartilage adjacent to the defect as well as the remaining knee joint was low. The ES was helpful for planning the study as it is shown that the power of a statistical comparison seems to be more influenced by the ES than by the sample size. The ranking of the ES was done exemplarily, listing the results according to their magnitude, thus making the results comparable. We were able to follow the 3 R requirements also in terms of a numerical reduction of animals due to the introduction of a group of untreated animals. This makes the model cost effective. The presented study may contribute as an improvement of the standardization of large animal models for research and regulatory requirements for regenerative therapies of AC.

Osteoarthritis in the Knee Joints of Göttingen Minipigs after Resection of the Anterior Cruciate Ligament? Missing Correlation of MRI, Gene and Protein Expression with Histological Scoring.

INTRODUCTION: The Göttingen Minipig (GM) is used as large animal model in articular cartilage research. The aim of the study was to introduce osteoarthritis (OA) in the GM by resecting the anterior cruciate ligament (ACLR) according to Pond and Nuki, verified by histological and magnetic resonance imaging (MRI) scoring as well as analysis of gene and protein expression. MATERIALS AND METHODS: The eight included skeletally mature female GM were assessed after ACLR in the left and a sham operation in the right knee, which served as control. 26 weeks after surgery the knee joints were scanned using a 3-Tesla high-field MR tomography unit with a 3 T CP Large Flex Coil. Standard proton-density weighted fat saturated sequences in coronal and sagittal direction with a slice thickness of 3 mm were used. The MRI scans were assessed by two radiologists according to a modified WORMS-score, the X-rays of the knee joints by two evaluators. Osteochondral plugs with a diameter of 4mm were taken for histological examination from either the main loading zone or the macroscopic most degenerated parts of the tibia plateau or condyle respectively. The histological sections were blinded and scored by three experts according to Little et al. Gene expression analysis was performed from surrounding cartilage. Expression of adamts4, adamts5, acan, col1A1, col2, il-1ß, mmp1, mmp3, mmp13, vegf was determined by qRT-PCR. Immunohistochemical staining (IH) of Col I and II was performed. IH was scored using a 4 point grading (0-no staining; 3-intense staining). RESULTS AND DISCUSSION: Similar signs of OA were evident both in ACLR and sham operated knee joints with the histological scoring result of the ACLR joints with 6.48 ± 5.67 points and the sham joints with 6.86 ± 5.84 points (p = 0.7953) The MRI scoring yielded 0.34 ± 0.89 points for the ACLR and 0.03 ± 0.17 for the sham knee joints. There was no correlation between the histological and MRI scores (r = 0.10021). The gene expression profiles as well as the immunohistochemical findings showed no significant differences between ACLR and sham knee joints. In conclusion, both knee joints showed histological signs of OA after 26 weeks irrespective of whether the ACL was resected or not. As MRI results did not match the histological findings, MRI was obviously unsuitable to diagnose the OA in GM. The analysis of the expression patterns of the 10 genes could not shed light on the question, whether sham operation also induced cartilage erosion or if the degeneration was spontaneous. The modified Pond-Nuki model may be used with reservation in the adult minipig to induce an isolated osteoarthritis.

Analysis of the osseointegrative force of a hyperhydrophilic and nanostructured surface refinement for TPS surfaces in a gap healing model with the Göttingen minipig.

BACKGROUND: A lot of advantages can result in a high wettability as well as a nanostructure at a titanium surface on bone implants. Thus, the aim of this study was to evaluate the osseointegrative potential of a titan plasma-sprayed (TPS) surface refinement by acid-etching with chromosulfuric acid. This results in a hyperhydrophilic surface with a nanostructure and an extreme high wetting rate. METHODS: In total, 72 dumbbell shape titan implants were inserted in the spongy bone of the femora of 18 Göttingen minipigs in a conservative gap model. Thirty-six titan implants were coated with a standard TPS surface and 36 with the hyperhydrophilic chromosulfuric acid (CSA) surface. After a healing period of 4, 8, and 12 weeks, the animals were killed. The chronological healing process was histomorphometrically analyzed. RESULTS: The de novo bone formation, represented by the bone area (BA), is increased by approximately 1.5 times after 12 weeks with little additional benefit by use of the CSA surface. The bone-to-implant contact (BIC), which represents osseoconductive forces, shows results with a highly increased osteoid production in the CSA implants beginning at 8 and 12 weeks compared to TPS. This culminates in a 17-fold increase in BIC after a healing period of 12 weeks. After 4 weeks, significantly more osteoid was seen in the gap as de novo formation in the CSA group (p = 0.0062). Osteoid was also found more frequently after 12 weeks at the CSA-treated surface (p = 0.0355). The site of implantation, intertrochanteric or intercondylar, may influence on the de novo bone formation in the gap. CONCLUSIONS: There is a benefit by the CSA surface treatment of the TPS layer for osseointegration over an observation time up to 12 weeks. Significant differences were able to be shown in two direct comparisons between the CSA and the TPS surface for osteoid formation in the gap model. Further trials may reveal the benefit of the CSA treatment of the TPS layer involving mechanical tests if possible.

Analysis of Gene Expression and Ultrastructure of Stifle Menisci from Juvenile and Adult Pigs.

The origin of the age-associated degenerative processes in meniscal tissue is poorly understood and may be related to an imbalance of anabolic and catabolic metabolism. The aim of the current study was to compare medial menisci isolated from juvenile pigs and degenerated medial menisci from adult pigs in terms of gene expression profile and ultrastructure. Medial menisci were isolated from the knee joints of juvenile and adult pigs (n = 8 for each group). Degeneration was determined histologically according to a scoring system. In addition, the gene expression profiles of 14 genes encoding extracellular matrix proteins, catabolic matrix metalloproteinases and mediators of inflammation were analyzed. Changes in the ultrastructure of the collagen network of the meniscal tissue were analyzed by using transmission electron microscopy. The histologic analysis of menisci showed significantly higher grade of degeneration in tissue isolated from adult porcine knee joints compared with menisci isolated from juvenile knee joints. In particular, destruction of the collagen network was greater in adult menisci than in juvenile menisci. Degenerated menisci showed significantly decreased gene expression of COL1A1 and increased expression of MMP2, MMP13, and IL8. The menisci from adult porcine knee joints can serve as a model for meniscal degeneration. Degenerative changes were manifested as differences in histopathology, gene expression and ultrastructure of collagen network.

Instruments for reproducible setting of defects in cartilage and harvesting of osteochondral plugs for standardisation of preclinical tests for articular cartilage regeneration.

BACKGROUND: Standardisation is required in research, so are approval procedures for advanced therapy medical products and other procedures for articular cartilage therapies. The process of creating samples needs to be reproducible. The aim of this study was to design, create and validate instruments (1) to create reproducible and accurate defects and (2) to isolate samples in the shape of osteochondral cylinders in a quick, reliable and sterile manner. METHODS: Adjustable instruments were created: a crown mill with a resolution of 0.05 mm and a front mill to create defects in articular cartilage and subchondral bone. The instruments were tested on knee joints of pigs from the slaughterhouse; 48 defects were created and evaluated. A punching machine was designed to harvest osteochondral plugs. These were validated in an in vivo animal study. RESULTS: The instruments respect the desired depth of 0.5 and 1.5 mm when creating the defects, depending on whether the person using the instrument is highly experienced (0.451 mm; confidence interval (CI): 0.390 mm; 0.512 mm and 1.403 mm; CI: 1.305 mm; 1.502 mm) or less so (0.369 mm; CI: 0.297 mm; 0.440 mm and 1.241 mm; CI: 1.141 mm; 1.341 mm). Eighty samples were taken from knee joints of Göttingen Minipigs with this punching technique. The time needed for the harvesting of the samples was 7.52 min (±2.18 min), the parallelism of the sides of the cylinders deviated by -0.63° (CI: -1.33°; 0.08°) and the surface of the cartilage deviated from the perpendicularity by 4.86° (CI: 4.154°; 5.573°). In all assessed cases, a sterile procedure was observed. CONCLUSIONS: Instruments and procedures for standardised creation and validation of defects in articular cartilage and subchondral bone were designed. Harvesting of samples in the shape of osteochondral cylinders can now be performed in a quick, reliable and sterile manner. The presented instruments and procedures can serve as helpful steps towards standardised operating procedures in the field of regenerative therapies of articular cartilage in research and for regulatory requirements.

Development of a low-cost polymethylmethacrylate stand-alone cervical cage: technical note.

BACKGROUND AND STUDY AIMS: Stand-alone cervical cages aim to provide primary stability, yield solid fusion in the long-term course, and maintain physiologic alignment. However, many implants designed for these purposes fail in achieving these goals. Following implantation, relatively high rates of cage subsidence and failure of disc height maintenance may lead to cervical kyphosis and poor alignment of the cervical spine. At the same time, costs for cage implantation are relatively high compared with their unfavorable radiologic performance. Thus the aim of the study was to develop and test mechanically a low-cost polymethylmethacrylate (PMMA) cage with similar mechanical and procedural properties compared with a commercial polyetheretherketone (PEEK) cage. MATERIAL AND METHODS: Following determination of the cage design, a casting mold was developed for the production of PMMA cages. Nine cages were produced and compared with nine PEEK cages using static compression tests for 0 and 45 degrees according to the recommendations of the American Society for Testing and Materials. Mean compressive yield strength, mean yield displacement, mean tensile strength, and mean stiffness were determined. RESULTS: At 0 degrees axial compression, the mean compressive yield strength, mean displacement, and mean tensile strength of the PMMA cage was significantly higher compared with the PEEK cage (p < 0.001). Stiffness of both implants did not differ significantly (p = 0.903). At 45 degrees axial compression, PEEK cages could not be investigated because slipping of the holding fixture occurred. Under these conditions, PMMA cages showed a mean compressive yield strength of 804.9 ± 60.5 N, a mean displacement of 0.66 mm ± 0.05 mm, a mean tensile strength of 7.92 ± 0.6 N/mm(2), and a mean stiffness of 1,228 ± 79.4 N/mm. CONCLUSIONS: The newly developed PMMA cage seems to show similar to superior mechanical properties compared with the commercial PEEK cage. Considering a preparation time of only 10 minutes and the low price for the PMMA material, the cost-benefit ratio clearly points to the use of the PMMA cage. However, clinical effectiveness has to be proven in a separate study.

Mechanical properties of mesh materials used for hernia repair and soft tissue augmentation.

BACKGROUND: Hernia repair is the most common surgical procedure in the world. Augmentation with synthetic meshes has gained importance in recent decades. Most of the published work about hernia meshes focuses on the surgical technique, outcome in terms of mortality and morbidity and the recurrence rate. Appropriate biomechanical and engineering terminology is frequently absent. Meshes are under continuous development but there is little knowledge in the public domain about their mechanical properties. In the presented experimental study we investigated the mechanical properties of several widely available meshes according to German Industrial Standards (DIN ISO). METHODOLOGY/PRINCIPAL FINDINGS: Six different meshes were assessed considering longitudinal and transverse direction in a uni-axial tensile test. Based on the force/displacement curve, the maximum force, breaking strain, and stiffness were computed. According to the maximum force the values were assigned to the groups weak and strong to determine a base for comparison. We discovered differences in the maximum force (11.1±6.4 to 100.9±9.4 N/cm), stiffness (0.3±0.1 to 4.6±0.5 N/mm), and breaking strain (150±6% to 340±20%) considering the direction of tension. CONCLUSIONS/SIGNIFICANCE: The measured stiffness and breaking strength vary widely among available mesh materials for hernia repair, and most of the materials show significant anisotropy in their mechanical behavior. Considering the forces present in the abdominal wall, our results suggest that some meshes should be implanted in an appropriate orientation, and that information regarding the directionality of their mechanical properties should be provided by the manufacturers.

An MR-compatible device for automated and safe application of laser stimuli in experiments employing nociceptive stimulation.

In this paper the establishment of an automatic laser application device that reproducibly delivers laser stimuli in a safe, controlled, and reliable manner is presented. Nociceptive stimulation is widely used in functional magnetic resonance imaging (fMRI) experiments and a number of different methods are employed. One major advantage of laser stimulation as a method to administer painful stimuli is that it selectively activates nociceptors. To avoid damage to the subject's skin, which might occur if the same skin area were stimulated too often, the laser focal spot needs to be repositioned after each stimulus. Here, we describe the design of the mechanical set-up, the functionality, the computation of laser stimulus intensity, the materials used, the monitoring system, and the interface to the control software. Additionally, MR-compatibility and functionality of the device were evaluated and assessed in a 3T MR scanner. Finally, the reliability and validity of the device were tested and demonstrated. It permits easy and investigator-independent use of laser stimulation in the MR scanner.

Effect of surface roughness, porosity, and a resorbable calcium phosphate coating on osseointegration of titanium in a minipig model.

The aim of this study was to compare the osseointegration of four different implant surfaces in the Göttingen minipig femur model. They were prepared by glasspearlblasting (A), sandblasting (B) and titaniumplasma spraying (C and D). Surface D received additionally an electrochemically deposited layer of a resorbable calcium phosphate (CaP) layer, made mainly of brushite. Sample size was n = 20 per group. Implants were placed in the intertrochanteric and intercondylar sites of both femora. After 12 weeks, implant anchorage was measured by the pull-out test and histomorphometry measurements were carried out at the bone-implant interface. Implant anchorage was 0.7 +/- 0.3 MPa for surface A, 3.2 +/- 0.6 MPa for surface B, 6.5 +/- 1.5 MPa for surface C and 7.3 +/- 1.9 MPa for surface D. The differences between surfaces were statistically significant, with exception of C and D. The stiffness of the bone-implant interface showed no statistically significant difference between surfaces. After pull-out, surface A and B showed nearly no bone spots, while on surfaces C and D bone remains were found. Bone-implant contact was 1.9 +/- 1.1% for surface A, 10.5 +/- 3.6% for surface B, 22.4 +/- 4.5% for surface C and 48.8 +/- 4.5% for surface D. The differences were statistically significant. Implant location, intertrochanteric and intercondylar, did not affect the data. In this minipig model, rougher surfaces showed better osseointegration. After 12 weeks of healing, the resorbable CaP layer enhanced significantly the bone-implant contact but not the level of anchorage. The findings also suggest that the pull-out test should be critically evaluated to determine the shear strength between bone and porous surfaces.

Titin expression in human articular cartilage and cultured chondrocytes: a novel component in articular cartilage biomechanical sensing?

In striated muscle tissues, the giant protein titin acts as a biomechanically active filament system, coupling stress/strain to gene expression. The objective of the study is to show the existence of titin fragments in human articular cartilage, as in diarthodial joints, chondrocytes are also known to sense and respond to stretching. We have surveyed human cultured cartilage collected from adults with osteoarthritis (OA), without OA and from infants with a set of titin antibodies and primer pairs. Three different antibodies were used for immunolabelling, reacting with titin's N-terminal Z1-Z2 domains, its Novex III exon, and with its PEVK region. An antibody directed to a titin ligand was included, since in cardiac muscle, this has been shown to participate in the transmission of stretch dependent titin-based signals. Our results indicate that although at low levels, titin is expressed in cartilage. Primer pairs detected titin transcripts in cartilage, and consistent with this, antibodies directed to titin's Z-disc region and to its elastic region stained cartilage. Moreover, we also could detect transcription of the titin ligand CARP. Components of the stretch dependent signal machinery in muscle are also expressed in cartilage. Further studies are warranted to address if common stress/strain dependent signalling are conserved in muscle and cartilage tissues.

[The relation of workspace and installation space of epicyclic kinematics with six degrees of freedom]. / Das Verhältnis von Arbeitsraum zu Bauraum epizyklischer Kinematiken mit sechs Freiheitsgraden.

INTRODUCTION: The kinematics of a robotic device significantly determines its installation space when it comes to technical realisation. With regard to the deployment of robotic manipulators in surgery, manipulators with a preferably small installation space are needed. MATERIALS AND METHODS: This study describes six versions of novel epicyclic kinematics with six degrees of freedom (DOF). At first, the kinematics functionality was analysed using Gruebler's formula. Subsequently, the quantitative determination of the relation of workspace and installation space was performed using Matlab algorithms. To qualitatively describe the shape of the workspace, the Matlab visualisation features were utilised. For comparison, the well-known Hexapod was used. RESULTS: The assessed kinematics had 6-DOF-functionality. It became apparent that one version of the epicyclic kinematics having two 3-DOF disk systems mounted in a parallel way featured a particularly good relation of workspace and installation space. Compared to the Hexapod, this is approximately four times better. The shape of the workspaces of all epicyclic kinematics assessed was convex and compact. CONCLUSION: It could be shown that a novel epicyclic kinematics has a notably advantageous relation of workspace and installation space. Apparently, it seems to be well suited for the deployment in robotic machines for surgical procedures.

Accuracy of Ein Bild Röntgen Analyse in determining wear in total hip arthroplasty in vitro.

The Ein Bild Röntgen Analyse system is used to radiographically measure femoral head penetration in total hip replacement components. Because determining the accuracy of any wear analysis system is more precise and comparable under in vitro conditions, we used a femoral head migration simulator to assess the accuracy of Ein Bild Röntgen Analyse and determine the effect of magnification factors on accuracy. We used onscreen magnifications of 100% and 200% to measure anteroposterior radiographs, which improved the accuracy of determining femoral head penetration. Improvements averaged 0.056 mm (95% CI +/- 0.013 mm) in the X direction and 0.024 mm (95% CI +/- 0.027 mm) in the Y direction. Femoral head penetration was simulated in 0.25-mm steps from 0-1 mm. Accuracy ranged from 0-0.029 mm (95% CI, 0.035-0.067 mm) for the X direction and from 0.001-0.013 mm (95% CI, 0.046-0.079 mm) for the Y direction. Assuming the worst accuracy combined for the X and Y directions, Ein Bild Röntgen Analyse can accurately detect femoral head penetration greater than 0.128 mm. These results are comparable with reported accuracy values for different systems and suggest that magnification tools should be considered with Ein Bild Röntgen Analyse when measuring wear radiographically.

Today's state of the art in surgical robotics*.

OBJECTIVE: This paper describes the current level of development of robots for surgery. MATERIAL AND METHODS: This paper is based on a literature search in Pubmed, IEEExplore, CiteSeer and the abstract volumes of the MICCAI 2002, 2003 and 2004, CARS 2003 and 2004, CAOS 2003 and 2004, CURAC 2003 and 2004 and MRNV 2004 meetings. RESULTS: Divided into different disciplines (imaging, abdominal and thoracic surgery, ENT, OMS, neurosurgery, orthopaedic surgery, radiosurgery, trauma surgery, urology), 159 robot systems are introduced. Their functionality, deployment, origin and mechanical set-up are described. Additional contacts and internet links are listed. CONCLUSIONS: The systems perform diverse tasks such as milling cavities in bone, harvesting skin, screwing pedicles or irradiating tumors. From a technical perspective the strong specialization of the systems stands out. Most of the systems are being developed in Germany, the United States, Japan or France.

Validation of a diffusion chamber as in vitro system for the analysis of compound diffusibility through cartilage tissue.

The validation of a diffusion chamber comprising a donor and a receptor side separated by a cartilage membrane was undertaken according to the basic principles described by Peng et al. (1998). The study had three targets: first to evaluate the chamber as in vitro system by the examination of the diffusibility of compound through bovine cartilage samples; second the analysis of the affinity of compound (RS-130830) to cartilage; third to test the influence of two pre-incubation periods (one or three nights) of the cartilage samples. The validation of the chamber as in vitro system for the analysis of compound diffusibility and affinity to cartilage was performed using membrane slices of fresh bovine cartilage and a hydroxamic acid derivative (RS-130830) known as matrix metalloproteinase inhibitor (MMPI). The influence of the pre-incubation of cartilage was also examined. Compound concentrations in donor, receptor and membrane were determined by high performance liquid chromatography-mass spectrometry (HPLC-MS). Diffusion could be demonstrated after 6 h and finally 24 h incubation: the compound concentration in the receptor increased from 0 to 35 microM (mean) while it decreased in the donor from 200 to 144 microM (mean). We also found compound in the cartilage membrane (approximately 1.2 nmol (mean)). Pre-incubation of cartilage samples in culture buffer is suitable as a storage procedure, since the results on the donor side only were influenced significantly but not for the receptor and the cartilage affinity. Thus, the system could clearly reflect relevant properties of the tested compound with regard to its diffusibility and affinity to cartilage tissue.