Biomechanics of the Human Osteochondral Unit: A Systematic Review.

The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.

Tensile Yield Strain of Human Cortical Bone from the Femoral Diaphysis Is Constant among Healthy Adults and across the Anatomical Quadrants.

The literature suggests that the yield strain of cortical bone is invariant to its stiffness (elastic modulus) and strength (yield stress). However, data about intra-individual variations, e.g., the influence of different collagen/mineral organisations observed in bone aspects withstanding different habitual loads, are lacking. The hypothesis that the yield strain of human cortical bone tissue, retrieved from femoral diaphyseal quadrants subjected to different habitual loads, is invariant was tested. Four flat dumbbell-shaped specimens were machined from each quadrant of the proximal femoral diaphysis of five adult donors for a total of 80 specimens. Two extensometers attached to the narrow specimen region were used to measure deformation during monotonic tensile testing. The elastic modulus (linear part of the stress-strain curve) and yield strain/stress at a 0.2% offset were obtained. Elastic modulus and yield stress values were, respectively, in the range of 12.2-20.5 GPa and 75.9-136.6 MPa and exhibited a positive linear correlation. All yield strain values were in the narrow range of 0.77-0.87%, regardless of the stiffness and strength of the tissue and the anatomical quadrant. In summary, the results corroborate the hypothesis that tensile yield strain in cortical bone is invariant, irrespective also of the anatomical quadrant. The mean yield strain value found in this study is similar to what was reported by inter-species and evolution studies but slightly higher than previous reports in humans, possibly because of the younger age of our subjects. Further investigations are needed to elucidate a possible dependence of yield strain on age.

Surface Analysis of Ti-Alloy Micro-Grooved 12/14 Tapers Assembled to Non-Sleeved and Sleeved Ceramic Heads: A Comparative Study of Retrieved Hip Prostheses.

Ti6Al4V titanium alloy (Ti-alloy) sleeved ceramic heads have become widely used in revision surgery when the hip stem is left in situ. This solution guarantees a new junction between the bore of the ceramic head and the Ti-alloy sleeve, regardless of any possible, slight surface damage to the Ti-alloy taper of the stem. However, this solution introduces an additional Ti-alloy/Ti-alloy interface pairing, which is potentially susceptible to mechanically assisted crevice corrosion. This study evaluated both qualitatively and quantitatively the damage that occurred in vivo on Ti-alloy micro-grooved 12/14 tapers of (i) primary implants with non-sleeved ceramic heads (Group 1), (ii) secondary implants with non-sleeved ceramic heads (Group 2), and (iii) secondary implants with sleeved ceramic heads (Group 3). A total of 45 explants-15 for each group, including short-, medium- and long-neck heads-underwent optical evaluation for surface damage (Goldberg scoring), surface roughness analysis, and SEM/EDX analysis. The Goldberg scores did not reveal different patterns in the tapers' surface damage; surface damage was classified as absent or mild (surface damage score ≤2) in 94%, another 94%, and 92% of the analysed regions for Group 1, Group 2, and Group 3, respectively. Small but significant differences in morphological changes occurred in the tapers of the three groups: reductions no greater than a few percentage points in median values of roughness parameters were found in Group 1 and Group 2, while negligible changes were found in Group 3. SEM/EDX analysis revealed little (i.e., a slight increase in the oxygen content) to undetectable changes in the chemical composition on the Ti-alloy surface independently of the group. These results suggest that the Ti-alloy/Ti-alloy sleeve/taper junction is only mildly susceptible to mechanically assisted crevice corrosion. Assembling a sleeved ceramic head, with variable neck lengths up to a "long-neck", to a Ti-alloy micro-grooved 12/14 taper of a stem left in situ does not seem to increase the risk of revision due to trunnionosis, as long as junction stability (i.e., the proper seating of the sleeved ceramic head on the 12/14 taper) is achieved intraoperatively.

Applying a homogeneous pressure distribution to the upper vertebral endplate: Validation of a new loading system, pilot application to human vertebral bodies, and finite element predictions of DIC measured displacements and strains.

Image-based personalized Finite Element Models (pFEM) could detect alterations in physiological deformation of human vertebral bodies, but their accuracy has been seldom reported. Meaningful validation experiments should allow vertebral endplate deformability and ensure well-controlled boundary conditions. This study aimed to (i) validate a new loading system to apply a homogeneous pressure on the vertebral endplate during vertebral body compression regardless of endplate deformation; (ii) perform a pilot study on human vertebral bodies measuring surface displacements and strains with Digital Image Correlation (DIC); (iii) determine the accuracy of pFEM of the vertebral bodies. Homogeneous pressure application was achieved by pressurizing a fluid silicone encased in a rubber silicone film acting on the cranial endplate. The loading system was validated by comparing DIC-measured longitudinal strains and lower-end contact pressures, measured on three homogeneous pseudovertebrae of constant transversal section at 2.0 kN, against theoretically calculated values. Longitudinal strains and contact pressures were rather homogeneous, and their mean values close to theoretical calculations (5% underestimation). DIC measurements of surface longitudinal and circumferential displacements and strains were obtained on three human vertebral bodies at 2.0 kN. Complete displacement and strain maps were achieved for anterolateral aspects with random errors ≤0.2 µm and ≤30 µstrain, respectively. Venous plexus and double curvatures limited the completeness and accuracy of DIC data in posterior aspects. pFEM of vertebral bodies, including cortical bone mapping, were built from computed tomography images. In anterolateral aspects, pFEM accuracy of the three vertebrae was: (i) comparable to literature in terms of longitudinal displacements (R2>0.8); (ii) extended to circumferential displacements (pooled data: R2>0.9) and longitudinal strains (zero median error, 95% error: <27%). Circumferential strains were overestimated (median error: 39%). The new methods presented may permit to study how physiological and pathologic conditions influence the ability of vertebral endplates/bodies to sustain loads.

Long-term survivorship of an exchangeable-neck hip prosthesis with a Ti-alloy/Ti-alloy neck-stem junction.

INTRODUCTION: Breakage of exchangeable-neck (EN) and adverse local tissue reactions (ALTRs) to neck-stem junction (NSJ) damage products are responsible for increasing the revision rate of EN hip prostheses. We investigated the survivorship of an EN hip prosthesis including a NSJ with both components made of titanium alloy (Ti-alloy/Ti-alloy) to assess whether, and to what extent, EN breakage and NSJ damage affected implant survivorship. MATERIALS AND METHODS: Using data from a hip replacement registry, we determined survivorship of 2857 EN prostheses. Long-offset configurations of head and EN were implanted in heavy (> 90 kg) patients only in 23 hips. We investigated under which conditions EN breakages or ALTRs occurred. We also measured titanium (Ti) and vanadium (V) blood concentrations in 24 patients with a unilateral well-working prosthesis. RESULTS: The 17-year survival rates for any reason and aseptic loosening of any component were 88.9% (95%CI 87.5-90.1; 857 hips at risk) and 96.9% (95%CI 96.0-97.6), respectively. There were two cases of EN breakage and one case of ALTR (metallosis), due to rim-neck impingement, out of 276 revisions. After an average period of 9.8 years (range 7.8-12.8 years), the maximum Ti and V blood concentrations in patients with a well-working prosthesis were 5.0 µg/l and 0.16 µg/l, respectively. CONCLUSION: The present incidence of EN breakage or ALTR is lower than those reported in other studies evaluating EN hip prosthesis survivorship. This study suggests that (i) the risk of EN breakage is reduced by limiting the use of long-offset configurations in heavy patients and (ii) Ti-alloy/Ti-alloy NSJ damage products do not promote ALTR nor significantly alter the rate of implant loosening. Since design decisions and implant configuration determine the NSJ strength, the NSJ strength in working conditions must be thoroughly investigated to proper define the clinical indications for any EN design.

Optimization of In Situ Indentation Protocol to Map the Mechanical Properties of Articular Cartilage.

Tissue engineering aims at developing complex composite scaffolds for articular cartilage repair. These scaffolds must exhibit a mechanical behavior similar to the whole osteochondral unit. In situ spherical indentation allows us to map the mechanical behavior of articular cartilage, avoiding removal of the underlying bone tissue. Little is known about the impact of grid spacing, indenter diameter, and induced deformation on the cartilage response to indentation. We investigated the impact of grid spacing (range: a to 3a, where a is the radius of the contact area between cartilage and indenter), indenter diameter (range: 1 to 8 mm), and deformation induced by indentation (constant indentation depth versus constant nominal deformation) on cartilage response. The bias induced by indentations performed in adjacent grid points was minimized with a 3a grid spacing. The cartilage response was indenter-dependent for diameters ranging between 1 and 6 mm with a nominal deformation of 15%. No significant differences were found using 6 mm and 8 mm indenters. Six mm and 8 mm indenters were used to map human articular cartilage with a grid spacing equal to 3a. Instantaneous elastic modulus E0 was calculated for constant indentation depth and constant nominal deformation. E0 value distribution did not change significantly by switching the two indenters, while dispersion decreased by 5-6% when a constant nominal deformation was applied. Such an approach was able to discriminate changes in tissue response due to doubling the indentation rate. The proposed procedure seems to reduce data dispersion and properly determine cartilage mechanical properties to be compared with those of complex composite scaffolds.

Intercalary reconstruction of long bones by massive allograft: Comparison of construct stability ensured by three different host-graft junctions and two types of fixations in a synthetic femur model.

An intercalary segmental allograft is an option for limb salvage in bone tumours. Stable and congruent intercalary reconstructions are a prerequisite for achieving host-graft union. However, a too rigid fixation could increase the risk of late complications correlated with negative bone remodelling. This study compared the reconstruction stiffness achieved by three different host-graft junctions, namely, end-to-end, modified step-cut, and taper. A low-stiffness bone plate was used as the fixation method, except for the taper junction where a low-stiffness intramedullary nail was also used to investigate the effects of different types of fixation on construct stiffness. Composite femora were tested under four loading conditions to determine coronal and sagittal bending stiffness, as well as torsional stiffness in opposite directions. Stiffness values were expressed as a percentage of intact host bone stiffness (%IBS). While a reduction of coronal bending stiffness was found with taper junctions (76%IBS) compared with the high values ensured by end-to-end (96%IBS) and modified step-cut junctions (92%IBS), taper junctions significantly increased stiffness under sagittal bending and torsion in intra- and extra-direction: end-to-end 29%IBS, 7%IBS, 7%IBS, modified step-cut 38%IBS, 20%IBS, 21%IBS, and taper junction 52%IBS, 55%IBS, 56%IBS, respectively. Construct stiffness with taper junctions was decreased by 11-41%IBS by replacing the bone plate with an intramedullary nail. Taper junctions can be an alternative to achieve intercalary reconstructions with more homogeneous and, in three out of four loading conditions, significantly higher construct stability without increasing bone plate stiffness. The risk of instability under high torsional loads increases when taper junctions are associated with a low-stiffness intramedullary nail.

A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture.

BACKGROUND: Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. METHODS: The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1-15.6). Retrieval analysis was performed in one case for which the ceramic components were available. RESULTS: Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head-neck taper interface. CONCLUSIONS: Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head-neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.

An experimental procedure to perform mechanical characterization of small-sized bone specimens from thin femoral cortical wall.

The cortical shell of the femoral neck plays a role in determining the overall neck strength. However, there is a lack of knowledge about the mechanical properties of cortical tissue of the femoral neck due to challenges in implementing accurate testing protocols for the thin shell. Indeed, mechanical properties are commonly derived from mechanical testing performed on tissue samples extracted from the femoral diaphysis, i.e. assuming tissue homogeneity along the femur. The aim of this work was to set up a reliable methodology to determine mechanical properties of bone samples extracted from thin cortical shell of the femoral neck. A three-point bending test was used to determine elastic and post-elastic properties of cortical bone samples extracted from the inferior and superior femoral neck. An optical system was used to monitor the sample deflection. Accuracy was preliminarily evaluated by determining the elastic modulus of an aluminium alloy. A good intra- and inter-sample variability was found on determining aluminium elastic modulus: 1.6% and 3.6%, respectively. Additionally, aluminium elastic modulus value was underestimated by less than 1%. A pilot trial was performed on a human femoral neck to assess the procedure feasibility. A total of 22 samples were extracted from the inferior and superior femoral neck and successfully tested. Preliminary results suggest that mechanical properties of cortical bone tissue extracted from human femoral neck might be side dependent, the superior tissue seems to exhibit better mechanical properties than the inferior one, at least in terms of yield stress and maximum strain. This supposedly different mechanical competence must be further investigated. The proposed procedure makes it feasible to carry out such studies.

Measurement of apparent mechanical properties of trabecular bone tissue: Accuracy and limitation of digital image correlation technique.

Trabecular bone surface is distant from the ideal non-reflecting, continuous, regular, flat surface suitable for accurate digital image correlation (DIC) measurements. We tested the feasibility of DIC to accurately measure surface displacements on trabecular microstructures, using four-extensometer technique as gold standard measurement. Thirty cylindrical human trabecular bone specimens were obtained. Ten were used to evaluate if pattern creation, required for DIC, had any effect on the apparent elastic modulus (Eapp) of trabecular bone, the remaining twenty were used to assess DIC accuracy in measuring Eapp. All specimens underwent a loading scheme including i) 10 preconditioning cycles, ii) 8 monotonic compressive ramps up to 0.5% nominal deformation, and iii) a second compressive series identical to the first. Changes in Eapp, due to pattern created between the two series, were assessed using the four-extensometer techniques. Pattern quality was also evaluated. DIC and four-extensometer technique were then used in the remaining twenty specimens to measure local axial displacements and compute global axial deformation during the first and second series, respectively. DIC accuracy was assessed comparing Eapp values calculated using axial deformation determined with the two techniques. Achieved pattern had on average a speckle size of 2.8 pixels, and 42% coverage. Pattern creation did not alter significantly Eapp values (median difference=-0.6%; Wilcoxon p=0.76). DIC technique was not applicable on the most porous specimens. DIC-extensometer comparison was not possible in three low-density specimens with Eapp < 0.4 GPa because of progressive trabecular damage over test repetitions. Good agreement in Eapp values was found in the remaining sixteen specimens (median difference=-1.5%; 10th percentile=-7.5%; 90th percentile=6.9%; max difference < 10%). Four-extensometer and DIC are interchangeable techniques: the former is the most straightforward to measure the axial deformation of trabecular bone tissue under monotonic compression, the latter is a useful alternative whenever surface displacement maps are needed.

Long term breeding of the Lmna G609G progeric mouse: Characterization of homozygous and heterozygous models.

The transgenic LmnaG609G progeric mouse represents an outstanding animal model for studying the human Hutchinson-Gilford Progeria Syndrome (HGPS) caused by a mutation in the LMNA gene, coding for the nuclear envelope protein Lamin A/C, and, as an important, more general scope, for studying the complex process governing physiological aging in humans. Here we give a comprehensive description of the peculiarities related to the breeding of LmnaG609G mice over a prolonged period of time, and of many features observed in a large colony for a 2-years period. We describe the breeding and housing conditions underlining the possible interference of the genetic background on the phenotype expression. This information represents a useful tool when planning and interpreting studies on the LmnaG609G mouse model, complementing any specific data already reported in the literature about this model since its production. It is also particularly relevant for the heterozygous mouse, which mirrors the genotype of the human pathology however requires an extended time to manifest symptoms and to be carefully studied.

Nonunion fracture healing: Evaluation of effectiveness of demineralized bone matrix and mesenchymal stem cells in a novel sheep bone nonunion model.

Nonunion treatment has a high rate of success, although recalcitrant nonunion may determine the need for amputation. Therefore, new treatment options are continuously investigated in order to further reduce the risk of nonunion recurrence. This study aimed to (a) develop a new large animal model for bone atrophic nonunion and (b) compare the efficacy of demineralized bone matrix (DBM) and DBM in combination with mesenchymal stem cells (MSC) in the new nonunion model. The new model consists of a noncritical, full-thickness segmental defect created in the sheep tibia, stabilized by an intramedullary nail, and involves the creation of a locally impaired blood supply achieved through periosteum excision and electrocauterization of the stump ends. Six weeks after defect creation, lack of hard tissue callus and established nonunion was observed in all operated tibiae both by radiographic and clinical evaluation. Nonunion was treated with allogeneic DBM or autologous MSC cultivated on DBM particles (DBM + MSC) for 1 day before implantation. Twelve weeks after treatment, radiographic, microtomographic, histologic, and histomorphometric analysis showed the formation of bone callus in DBM group, whereas the fracture healing appeared at an early stage in DBM + MSC group. Torsional strength and stiffness of the DBM group appeared higher than those of DBM + MSC group, although the differences were not statistically significant. In conclusion, a new sheep bone nonunion model resembling the complexity of the clinical condition was developed. DBM is an effective option for nonunion treatment, whereas MSC do not improve the healing process when cultivated on DBM particles before implantation.

Experimentally Achievable Accuracy Using a Digital Image Correlation Technique in measuring Small-Magnitude (<0.1%) Homogeneous Strain Fields.

Measuring small-magnitude strain fields using a digital image correlation (DIC) technique is challenging, due to the noise-signal ratio in strain maps. Here, we determined the level of accuracy achievable in measuring small-magnitude (<0.1%) homogeneous strain fields. We investigated different sets of parameters for image processing and imaging pre-selection, based on single-image noise level. The trueness of DIC was assessed by comparison of Young’s modulus (E) and Poisson’s ratio (ν) with values obtained from strain gauge measurements. Repeatability was improved, on average, by 20⁻25% with experimentally-determined optimal parameters and image pre-selection. Despite this, the intra- and inter-specimen repeatability of strain gauge measurements was 5 and 2.5 times better than DIC, respectively. Moreover, although trueness was also improved, on average, by 30⁻45%, DIC consistently overestimated the two material parameters by 1.8% and 3.2% for E and ν, respectively. DIC is a suitable option to measure small-magnitude homogeneous strain fields, bearing in mind the limitations in achievable accuracy.

Achievable accuracy of hip screw holding power estimation by insertion torque measurement.

BACKGROUND: To ensure stability of proximal femoral fractures, the hip screw must firmly engage into the femoral head. Some studies suggested that screw holding power into trabecular bone could be evaluated, intraoperatively, through measurement of screw insertion torque. However, those studies used synthetic bone, instead of trabecular bone, as host material or they did not evaluate accuracy of predictions. We determined prediction accuracy, also assessing the impact of screw design and host material. METHODS: We measured, under highly-repeatable experimental conditions, disregarding clinical procedure complexities, insertion torque and pullout strength of four screw designs, both in 120 synthetic and 80 trabecular bone specimens of variable density. For both host materials, we calculated the root-mean-square error and the mean-absolute-percentage error of predictions based on the best fitting model of torque-pullout data, in both single-screw and merged dataset. FINDINGS: Predictions based on screw-specific regression models were the most accurate. Host material impacts on prediction accuracy: the replacement of synthetic with trabecular bone decreased both root-mean-square errors, from 0.54 ÷ 0.76 kN to 0.21 ÷ 0.40 kN, and mean-absolute-percentage errors, from 14 ÷ 21% to 10 ÷ 12%. However, holding power predicted on low insertion torque remained inaccurate, with errors up to 40% for torques below 1 Nm. INTERPRETATION: In poor-quality trabecular bone, tissue inhomogeneities likely affect pullout strength and insertion torque to different extents, limiting the predictive power of the latter. This bias decreases when the screw engages good-quality bone. Under this condition, predictions become more accurate although this result must be confirmed by close in-vitro simulation of the clinical procedure.

In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design.

Recently, concerns have been raised about the potential effect of head-neck junction damage products at the local and systemic levels. Factors that may affect this damage process have not been fully established yet. This study investigated the possible correlations among head-neck junction damage level, implant design, material combination, and patient characteristics. Head-neck junctions of 148 retrieved implants were analysed, including both ceramic-on-ceramic (N = 61) and metal-on-metal (N = 87) bearings. In all cases, the male taper was made of titanium alloy. Damage was evaluated using a four-point scoring system based on damage morphology and extension. Patient age at implantation, implantation time, damage risk factor, and serum ion concentration were considered as independent potential predicting variables. The damage risk factor summarises head-neck design characteristics and junction loading condition. Junction damage correlated with both implantation time and damage factor risk when the head was made of ceramic. A poor correlation was found when the head was made of cobalt alloy. The fretting-corrosion phenomenon seemed mainly mechanically regulated, at least when cobalt alloy components were not involved. When a component was made of cobalt alloy, the role of chemical phenomena increased, likely becoming, over implantation time, the damage driving phenomena of highly stressed junctions.

Elastic properties and strain-to-crack-initiation of calcium phosphate bone cements: Revelations of a high-resolution measurement technique.

Calcium phosphate cements (CPCs) should ideally have mechanical properties similar to those of the bone tissue the material is used to replace or repair. Usually, the compressive strength of the CPCs is reported and, more rarely, the elastic modulus. Conversely, scarce or no data are available on Poisson's ratio and strain-to-crack-initiation. This is unfortunate, as data on the elastic response is key to, e.g., numerical model accuracy. In this study, the compressive behaviour of brushite, monetite and apatite cements was fully characterised. Measurement of the surface strains was done using a digital image correlation (DIC) technique, and compared to results obtained with the commonly used built-in displacement measurement of the materials testers. The collected data showed that the use of fixed compression platens, as opposed to spherically seated ones, may in some cases underestimate the compressive strength by up to 40%. Also, the built-in measurements may underestimate the elastic modulus by up to 62% as compared to DIC measurements. Using DIC, the brushite cement was found to be much stiffer (24.3 ± 2.3GPa) than the apatite (13.5 ± 1.6GPa) and monetite (7.1 ± 1.0GPa) cements, and elastic moduli were inversely related to the porosity of the materials. Poisson's ratio was determined to be 0.26 ± 0.02 for brushite, 0.21 ± 0.02 for apatite and 0.20 ± 0.03 for monetite. All investigated CPCs showed low strain-to-crack-initiation (0.17-0.19%). In summary, the elastic modulus of CPCs is substantially higher than previously reported and it is concluded that an accurate procedure is a prerequisite in order to properly compare the mechanical properties of different CPC formulations. It is recommended to use spherically seated platens and measuring the strain at a relevant resolution and on the specimen surface.

Suturing the myotendinous junction in total hip arthroplasty: A biomechanical comparison of different stitching techniques.

BACKGROUND: The repair of the myotendinous junction following total hip arthroplasty is challenging as this region is the weakest part of the muscle structure. This study investigated the mechanical behaviour and the mode of failure of different suturing techniques of the myotendinous junction. A new asymmetrical stitch was compared to two widely used techniques, i.e. the simple stitch (two loops in parallel) and the figure-of-eight stitch. METHODS: The ovine triceps brachii myotendinous junction was selected as the experimental model. Each technique was sewn in muscle belly on one side and in a polyester belt (no-tendon configuration) or in thin tendon (full configuration) on the other side. The former was chosen to determine the grasping power of the stitch on the muscle despite the tendon quality, the latter to simulate a very thin gluteus medius tendon. FINDINGS: The new stitch showed a higher ultimate strength (+40%) compared to the two controls in the no-tendon configuration. In the full configuration, no significant increase was observed, although failure of the new stitch always occurred at the tendon side. Furthermore, the new stitch does not alter the stiffness of repair. INTERPRETATION: The new stitch has a higher grasping power on muscle belly than the single passing-through stitches thanks to the multiple fixation points, which better distribute the load in the tissue. However, such performance can be fully exploited only in the presence of good quality tendons.

Suprapectoral biceps tenodesis: a biomechanical comparison of a new "soft anchor" tenodesis technique versus interference screw biceps tendon fixation.

BACKGROUND: The interference screw technique is commonly used in tenodesis of the long head of the biceps for its well-documented robust fixation strength. Some complications may occur after tenodesis with interference screw such as persistent pain, bone fracture and cyst formation. A new technique using a small "soft anchor" has been proposed to avoid the risk of occurrence of the above-mentioned complications associated with the use of the interference screw. However, the proposed technique must provide adequate fixation strength. This study investigated the mechanical performance of the new technique and compared it with interference screw fixation. METHODS: Fourteen human humeri and proximal biceps were tested after tenodesis using the two techniques. The fixation constructs were cycled 500 times between 20N and 100N at 1Hz to simulate some level of post-operative physical activity. Then, a tensile test to failure was performed to determine the strength of the two tenodesis constructs. FINDINGS: The ultimate strength was 238N (SD 96N) and 172N (SD 58N) for the "soft anchor" and the interference screw, respectively (P=0.14). In two out of seven repetitions in both groups, failure occurred at low load level due to inaccuracies in performing tenodesis. Considering these cases as outliers, the strength values increased up to 290N (SD 40N) and 202N (SD 32N) for the "soft anchor" and the interference screw, respectively (P=0.02). INTERPRETATION: The "soft anchor" technique provides a fixation strength comparable with the interference screw, but without using a screw. It could be considered as an alternative for suprapectoral biceps tenodesis.

An effective procedure to create a speckle pattern on biological soft tissue for digital image correlation measurements.

Creating a speckle pattern on biological soft tissue, which would be suitable for digital image correlation measurements, is challenging. Speckle patterns should neither cause or require sample dehydration, nor alter the mechanical response, but they should adhere to the tissue surface and withstand large deformations. A two-step procedure has been implemented to create a highly-contrasted pattern. It requires staining of the tissue with methylene blue solution to obtain a dark background and airbrushing the surface with paint to create white speckles. This study evaluated the effectiveness of the proposed procedure and whether the pattern creation had any effect on the elastic response of soft tissue. Forty porcine collateral ligaments underwent three series of cyclic tensile tests to a nominal elongation of 10% for 30 cycles. The specimen stiffness was calculated from the load-elongation curve collected during the last 10 cycles. One side of 20 ligaments was blue stained between the first and second test series, and white patterned between the second and third test series. During the last series, ligament surface images were also acquired and elaborated using the digital image correlation technique. The other 20 ligaments were untreated. The data show a small non-significant upward trend in stiffness in treated as well as in untreated ligaments (maximum increase of 1.7%). The 'successfully-correlated area' of the stereo-visible ligament surface was on average 96%, i.e. small parts of the 'stereo-visible area' were lost during computation. The described procedure is an effective method to create a pattern on biological soft tissues.

Human bone hardness seems to depend on tissue type but not on anatomical site in the long bones of an old subject.

It has been hypothesised that among different human subjects, the bone tissue quality varies as a function of the bone segment morphology. The aim of this study was to assess and compare the quality, evaluated in terms of hardness of packages of lamellae, of cortical and trabecular bones, at different anatomical sites within the human skeleton. The contralateral six long bones of an old human subject were indented at different levels along the diaphysis and at both epiphyses of each bone. Hardness value, which is correlated to the degree of mineralisation, of both cortical and trabecular bone tissues was calculated for each indentation location. It was found that the cortical bone tissue was harder (+18%) than the trabecular one. In general, the bone hardness was found to be locally highly heterogeneous. In fact, considering one single slice obtained for a bone segment, the coefficient of variation of the hardness values was up to 12% for cortical bone and up to 17% for trabecular bone. However, the tissue hardness was on average quite homogeneous within and among the long bones of the studied donor, although differences up to 9% among levels and up to 7% among bone segments were found. These findings seem not to support the mentioned hypothesis, at least not for the long bones of an old subject.