Biomechanical comparison of a new expandable intramedullary nail and conventional intramedullary nails for femoral osteosynthesis in dogs.

Intramedullary nailing of diaphyseal femoral fractures is a commonly used treatment method in dogs because of its biological and biomechanical advantages compared to bone plating. To achieve adequate resistance of the intramedullary nail against torsional and axial compressive forces, additional application of transcortical screws is needed. As these interlocking screws represent a frequent cause of post-operative complications, a new expandable intramedullary nail (EXPN) was developed, which was designed to provide adequate fracture stabilisation without the need for transcortical fixation. The evaluation of the biomechanical properties of the new EXPN with regard to torsional, compressive and bending stability as well as direct comparison to the biomechanical properties of conventional Steinmann (STMN)- and interlocking (ILN) nails was carried out with different biomechanical test arrangements. No significant statistical differences regarding the torsional and bending resistance between the EXPN and ILN group were seen, which indicates that rotatory as well as bending stability of the innovative EXPN is similar to the conventional ILN. Nevertheless, the percentage deviation between the attempted and successfully reached physiological compressive forces was significantly higher (p = 0.045) in the EXPN group compared to the ILN group, which indicates that the compressive stability of the innovative EXPN might be weaker compared to the ILN. In summary, the new EXPN represents an interesting alternative to conventional intramedullary nails. However, in direct comparison to conventional interlocking nails, the EXPN has shown weaknesses in the neutralization of axial compressive forces, which indicates that at least biomechanically the interlocking nail seems advantageous. Further in-vitro and in-vivo investigations are required before clinical use can be recommended.

Influence of Hip Prosthesis Size and Its Coating Area on Bone Remodeling.

We developed a numerical model to describe the bone remodeling process in periprosthetic bone tissues and validated it by means of dual energy X-ray absorptiometry methods with different types of hip implants. In this paper, we applied the numerical model to investigate the influence of implant size and of the size of the porous coated area on bone remodeling in a periprosthetic human femur in an effort to define properties of implants, which would reduce bone remodeling after total hip arthroplasty. Two different sizes of a newly designed implant and three different coating area sizes were investigated in this paper. The results show that the smaller the implant, the less bone remodeling occurs. Reducing prosthesis size by 2mm from all sides has decreased bone remodeling by 14.4%. Extending the coating area on both, lateral and medial parts of the implant, has decreased bone remodeling in the lateral part of the femur and increased it in the medial part. In conclusion, depending on these results, the oversized hip replacement would cause more bone resorption in the femur. Concerning the coating area, the manufacturer must find a compromise between the small coating area with less bone remodeling in the medial part of the femur as well as less primary stability and the bigger coating area with less bone remodeling in the lateral part of the femur, but with higher bone remodeling in its medial part and more primary stability.

Comparative measurements of bone mineral density and bone contrast values in canine femora using dual-energy X-ray absorptiometry and conventional digital radiography.

BACKGROUND: Aseptic loosening due to bone remodelling processes after total hip replacement is one common cause for revision surgery. In human medicine, dual-energy X-ray absorptiometry (DEXA) is the gold standard for quantitative evaluation of bone mineral density, whereas in veterinary medicine conventional radiography is used for follow-up studies. Recently, a method has been described using digital X-ray images for quantitative assessment of grey scale values of bone contrast. Therefore, the aim of the present study was to evaluate the correlation of bone mineral density (BMD) measured by DEXA with grey scale values (GV) measured in digital X-ray images (RX50, RX66) ex vivo. RESULTS: The measured GV in the chosen X-ray settings showed on average a good correlation (r = 0.61) to the measured BMD with DEXA. Correlation between the two X-ray settings was very good (r = 0.81). For comparisons among regions of interests (ROIs) a difference of 8.2% was found to be statistically significant, whereas in the case of RX50 and RX66 differences of 5.3% and 4.1% were found to be statistically significant. CONCLUSIONS: Results indicate that measuring absolute changes in bone mineral density might be possible using digital radiography. Not all significant differences between ROIs detectable with DEXA can be displayed in the X-ray images because of the lower sensitivity of the radiographs. However, direct comparison of grey scale values of the periprosthetic femur in one individual patient during the follow-up period, in order to predict bone remodelling processes, should be possible, but with a lesser sensitivity than with DEXA. It is important that the same X-ray settings are chosen for each patient for follow-up studies.

Numerical investigations of stress shielding in total hip prostheses.

Aseptic loosening of the prosthesis is still a problem in artificial joint implants. The loosening can be caused by, among other factors, resorption of the bone surrounding the prosthesis owing to stress shielding. In order to find out the influence of the prosthesis type on post-operative stress shielding, a static finite element analysis of a femur provided with the conventional uncemented stem BICONTACT and of one with the femoral neck prosthesis SPIRON was carried out. Strain energy densities and maximal principal strain distributions were calculated and compared with the physiological situation. Here, stress shielding was demonstrated in both periprosthetic femora. To determine the areas of the stress shielding, the bone in each FE model was subdivided into three regions of interest (ROI): proximal, diaphyseal, and distal. The numerical computations show stress shielding in the proximal ROI of both periprosthetic femora. Diaphyseally, the femoral neck prosthesis SPIRON, in contrast to the conventional uncemented long-stem prosthesis BICONTACT, causes no decrease in the strain distribution and thus no stress shielding. Distally, no change in the load distribution of either periprosthetic femur could be found, compared with the physiological situation.

Strain adaptive bone remodelling: influence of the implantation technique.

Total hip arthroplasties (THA) can be performed with cemented and uncemented femoral components. Aseptic loosening of the joint replacement still illustrates a problem for both implantation techniques. This loosening can be caused, among other factors, by resorption of the bone surrounding the implant due to stress shielding. In order to analyse the absolute influence of the implantation technique on the bone degeneration in the periprosthetic femur, the strain adaptive bone remodelling after THA was investigated in a three-dimensional finite element (FE) simulation of a femur provided with a cemented and uncemented BICONTACT (Aesculap, Tuttlingen, Germany) femoral component. For this, a bone density evolution theory was implemented in the FE code MSC.MARC. In these static FE simulations, the muscle and hip resultant forces represent the maximum loading situation in the normal walking cycle. To describe the mechanical properties of the bone, an isotropic material law dependent upon density was used. The situation directly after implantation without any bone ingrowth was simulated. The cemented femoral component was bonded to the bone by a homogenous cement mantle. The numerical results show that proximally, the bone resorption areas surrounding the BICONTACT stem are heavily dependent upon anchoring technique. Furthermore, no significant bone remodelling is calculated in the distal periprosthetic femur in both models.

Problems with ultrasonic measurements of shear modules of structured media.

The elastic constants of linearly elastic, isotropic or anisotropic bone material are required for many numerical simulations. These constants are often measured ultrasonically, but this can lead to mistakes, especially if shear modules of spongiosa are considered. The reason is that spongiosa is a structure composed of trabeculae, each of which acts as a kind of beam which allows longitudinal, shear and also bending waves to propagate; the bending waves are as fast as the longitudinal waves and are indistinguishable from the shear waves. Furthermore, mistakes in measuring Young's modulus cannot be avoided in every case. Several numerical simulations of wave propagations in homogeneous media, and especially in periodically and irregularly structured media, were carried out via the application of explicit finite element codes. Results showing the above-mentioned effects are presented and discussed. These can help to explain in detail why mistakes may occur during ultrasonic measurements.

[Determination of the elastic properties of the compact bone in the femur of dogs]. / Ermittlung der elastischen Eigenschaften der Kompakta im Femur des Hundes.

Total hip endoprotheses are a good possibility for treatment degenerative wear and pathologic damage of the hip joint in man as well as in dogs. However, aseptic loosening of the protheses, especially in the area of the shaft, is still a problem in conventional total hip endoprotheses. The purpose of the present study was to use the finite-element-analysis (FEA), to enhance endoprothetic design and to prevent loosening of protheses. In order to simulate the femur of the dog for numerical analysis, a material law for the compacta in the femur of the dog was developed. The elastic properties of the compacta were experimentally determined by using compression tests of bone samples of euthanised dogs. The results show constant denseness and a constant axial elastic modul in the compacta.

Physiological elevations of glucocorticoids potentiate glutamate accumulation in the hippocampus.

Glucocorticoids (GCs) are secreted during stress and can damage the hippocampus over the course of aging and impair the capacity of hippocampal neurons to survive excitotoxic insults. Using microdialysis, we have previously observed that GCs augment the extracellular accumulation of glutamate and aspartate in the hippocampus following kainic acid-induced seizures. In that study, adrenalectomized rats maintained on minimal GC concentrations were compared with those exposed to GCs elevated to near-pharmacological levels. We wished to gain insight into the physiological relevance of these observations. Thus, we have examined the effects of GCs over the normal physiological range on glutamate and aspartate profiles; this was done by implanting adrenalectomized rats with GC-secreting pellets, which produce stable and controllable circulating GC concentrations. We observe that incremental increases in GC concentrations cause incremental increases in glutamate accumulation before the kainic acid insult, as well as in the magnitude of the glutamate response to kainic acid. Elevating GC concentrations from the circadian trough to peak doubled cumulative glutamate accumulation, whereas a rise into the stress range caused a fourfold increase in accumulation. Similar, although smaller, effects also occurred with aspartate accumulation (as well as with taurine but not glutamine accumulation). These data show that the highly elevated GC concentrations that accompany neurological insults such as seizure or hypoxia-ischemia will greatly exacerbate the glutamate accumulation at that time. Furthermore, stress levels of GCs augmented glutamate accumulation even in the absence of an excitotoxic insult, perhaps explaining how sustained stress itself damages the hippocampus.(ABSTRACT TRUNCATED AT 250 WORDS)

Stress, glucocorticoids, and aging.

Attention has long been focused on the relationship between stress and aging, both under the guise of stress as an accelerator of normal aging and of aging as a time of impaired ability to cope with stress. This review examines the considerable amount of evidence in support of these views. We address these ideas with respect to glucocorticoids, the adrenal steroid hormones secreted during stress. In particular, we concentrate on three model systems: 1) programmed senescence in marsupial mice and semelparous fish as mediated by glucocorticoid excess; 2) glucocorticoid hypersecretion in rats and its role in damaging the aging brain; and 3) potential human and primate adrenocortical dysfunction during aging. We discuss physical and cognitive consequences of adrenocortical dysfunction in these systems, and how they may relate to human aging.

Glucocorticoids exacerbate kainic acid-induced extracellular accumulation of excitatory amino acids in the rat hippocampus.

Glucocorticoids (GCs) compromise the ability of hippocampal neurons to survive various insults, and do so, at least in part, by exacerbating steps in the glutamate/N-methyl-D-aspartate (NMDA)/calcium cascade of damage. As evidence, GCs impair uptake of glutamate by hippocampal astrocytes, the GC endangerment of the hippocampus is NMDA receptor dependent, and GCs exacerbate kainic acid (KA)-induced calcium mobilization. These observations predict that GCs should also exacerbate KA-induced accumulation of extracellular glutamate and aspartate. To test this, adrenalectomized rats were given replacement GCs in either the low or high physiological range. Three days later, rats were anesthetized and 1 mM KA was infused through a dialysis probe placed in the dorsal hippocampus. Extracellular amino acid concentrations in the dialysate were then assessed by HPLC. After KA infusion, high-GC rats (30 +/- 3 micrograms/dl) had significantly elevated concentrations of glutamate and aspartate compared with low-GC rats (all less than 0.95 micrograms/dl). The glutamate accumulation was due to GCs raising pre-KA concentrations, whereas the aspartate accumulation was due to GCs exacerbating the KA-induced rise. Glutamine concentrations were unaffected by KA, whereas the high-GC regimen elevated glutamine concentrations both before and after KA. Taurine concentrations rose after infusion of KA, but were unaffected by GC regime, whereas alanine concentrations were unaffected by either manipulation. Serine concentrations were unaffected by KA, but were depressed both before and after KA in high-GC rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term adrenalectomy causes loss of dentate gyrus and pyramidal neurons in the adult hippocampus.

A growing literature suggests that the hippocampus can be damaged by glucocorticoids, the adrenal steroids secreted during stress. Thus, considerable interest was generated by recent reports that prolonged elimination of glucocorticoids by adrenalectomy (ADX) damages hippocampal dentate gyrus neurons. To date, this phenomenon has only been observed in rats of peripubertal age or younger; moreover, reports differ considerably as to the magnitude of the damage induced. Therefore, we examined this issue in rats ADXd at 5 months of age. Three months later, there was a significant 26% loss of dentate neurons in a subset of rats. In agreement with these previous reports, this subset had attenuated weight gain and electrolyte imbalances, suggestive of complete removal of the adrenals and accessory adrenal tissue. As a novel observation, we also observed significant (19%) loss of CA4 pyramidal neurons. Thus, both severe under- or overexposure to glucocorticoids can be deleterious to a number of hippocampal neuron types.