A new technique to measure the dynamic contact pressures on the Tibial Plateau.

Studies of the load transfer role of the meniscus have been limited to static experimental and analytical approaches. The objective of this study was to develop an experimental technique to allow the contact pressures on the tibial plateau of cadaveric knees to be measured under dynamic physiological loads. Accordingly, we adapted a load-controlled knee joint simulator to accept a cadaveric sheep knee, programmed the simulator with sheep gait kinematics data, and utilized a pressure sensor array to measure the contact pressure distribution on the lateral tibial plateau during gait. The technique was applied to six sheep knees that were tested intact and after meniscectomy. Meniscectomy resulted in a 267% increase in average contact pressure, a 117% increase in peak contact pressure, and an 80% decrease in contact area, all measured at the point of maximum peak contact stress in the gait cycle. It is envisaged that the experimental model herein developed will allow for the screening of candidate materials prior to more expensive and time-consuming animal models.

A novel surface treatment for porous metallic implants that improves the rate of bony ongrowth.

Rapid implant fixation could prove beneficial in a host of clinical applications from total joint arthroplasty to trauma. We hypothesized that a novel self-assembled monolayer of phosphonate molecules (SAMP) covalently bonded to the oxide surface of titanium alloy would enhance bony integration. Beaded metallic rods were treated with one of three coatings: SAMP, SAMP + RGD peptide, or hydroxyapatite. Rods were inserted retrogradely into both distal femurs of 60 rabbits. Fifteen rabbits were sacrificed at 2, 4, 8, and 16 weeks. At each time, seven specimens for mechanical pull-out testing and three for histomorphometric analysis were available for each coating. At four weeks, both SAMP groups had significantly higher failure loads when compared to hydroxyapatite (p < 0.01). No significant differences were found among groups at other times, though the SAMP-alone group remained stronger at 16 weeks. Histology showed abundant new bone formation around all the three groups, though more enhanced formation was apparent in the two SAMP groups. With this novel treatment, with or without RGD, the failure load of implants doubled in half the time as compared with hydroxyapatite. Where early implant fixation is important, the SAMP treatment provides a simple, cost-effective enhancement to bony integration of orthopaedic implants.

Bearing surface design changes affect contact patterns in total knee arthroplasty.

The impact of design changes intended to improve wear of knee replacements can be assessed from analysis of retrieved implants. We hypothesized changes in bearing surface conformity from the Insall-Burstein II knee to a successor, the Optetrak, intended to improve contact stresses would be apparent in wear patterns observed on retrieved tibial inserts. From 151 Insall-Burstein II and 54 Optetrak retrieved components, 35 pairs (Insall-Burstein II and Optetrak) were matched on length of implantation, body mass index, and age. Digital images of the bearing surfaces were used to identify and measure wear modes, which were then converted to a percentage of the total possible contact area. Burnishing was the most prevalent mode for both designs followed by scratching and then pitting. The percentage of involved area was greater for the Optetrak for 23 pairs. Interestingly, for the nine matched pairs with length of implantation longer than 2 years, six of the Insall-Burstein II inserts had considerably greater scratching and pitting and five exhibited abrasion and creep absent from Optetrak implants. Bearing surface design is a major factor that can affect kinematics and contact patterns. Our observations confirm the considerable impact of small changes in conformity and suggest models predicting contact stresses adequately reflect in vivo performance.

Remelting of highly cross-linked polyethylene worn under laboratory conditions.

It has been suggested that apparent wear damage in highly cross-linked polyethylene acetabular liners can be removed with subsequent remelting of retrieved liners. To test this hypothesis, we remelted liners that had been previously tested under controlled laboratory conditions and that had experienced nonzero wear rates and visible wear damage. Five liner groups were examined: three with a range of irradiation doses without heat treatment, and two irradiated to 100 kGys, one with remelting, and the other annealing. All groups had been worn in a hip simulator under impingement conditions that produced nonzero wear rates and loss of machining marks. Each liner was cut into quadrants that were graded for wear damage before and after posttest remelting. Cross-linked liners not previously heat-treated lost all prior damage and all machining marks. Remelted liners and three of six annealed liners experienced only a slight return of machining marks at the interface of the burnished area and the remaining intact machining marks. Our experiments represent a severe wear case but demonstrate removal of material from the surface through measurable wear prevents the return of identifiable machining marks despite remelting.

Effect of crosslinking, remelting, and aging on UHMWPE damage in a linear experimental wear model.

The objective of this study was to establish the effect of postirradiation melting as a function of irradiation dose on the wear behavior and material characteristics of ultrahigh molecular weight polyethylene. Our hypothesis was that a low dose of irradiation followed by melting would have the same improved wear performance as is found with higher doses of irradiation, but without the disadvantages associated with reduced fracture toughness. The hypothesis was tested by measuring the wear performance (wear track area, incidence of pitting and delamination) in a linear doubly curved-on-flat cyclic test, material behavior (elastic modulus, fracture toughness), and aging response (density changes through the thickness) of the following materials: elevated crosslinked groups--radiated at 25, 65, and 120 kGy, melted, sterilized and aged; a melted group--melted, sterilized, and aged; and a control group--sterilized and aged. Our findings suggest that postirradiation melting, not the irradiation dose, dominates the material property changes and wear response. Melting ensured reduced modulus and therefore decreased contact stresses, superior wear performance, and good resistance to aging, even after low levels of irradiation (25 kGy). The low modulus of the 25 kGy elevated crosslinked group, coupled with increased fracture toughness compared to samples irradiated at higher doses and a resistance to aging not found in the melted group, support our hypothesis. A low dose of irradiation followed by heat treatment has the same beneficial effects in terms of improved wear performance, but without the disadvantages of reduced fracture toughness found with higher doses of irradiation.

Backside wear in modern total knee designs.

Although modularity affords various options to the orthopedic surgeon, these benefits come at a price. The unintended bearing surface between the back surface of the tibial insert and the metallic tray results in micromotion leading to polyethylene wear debris. The objective of this study was to examine the backside wear of tibial inserts from three modern total knee designs with very different locking mechanisms: Insall-Burstein II (IB II), Optetrak, and Advance. A random sample of 71 inserts were obtained from our institution's retrieval collection and examined to assess the extent of wear, depth of wear, and wear damage modes. Patient records were also obtained to determine patient age, body mass index, length of implantation, and reason for revision. Modes of wear damage (abrasion, burnishing, scratching, delamination, third body debris, surface deformation, and pitting) were then scored in each zone from 0 to 3 (0 = 0%, 1 = 0-10%, 2 = 10-50%, and 3 = >50%). The depth of wear was subjectively identified as removal of manufacturing identification markings stamped onto the inferior surface of the polyethylene. Both Advance and IB II polyethylene inserts showed significantly higher scores for backside wear than the Optetrak inserts. All IB II and Advance implants showed evidence of backside wear, whereas 17% (5 out of 30) of the retrieved Optetrak implants had no observable wear. There were no significant differences when comparing the depth of wear score between designs. The locking mechanism greatly affects the propensity for wear and should be considered when choosing a knee implant system.

Stair ascent kinematics affect UHMWPE wear and damage in total knee replacements.

Investigations were performed to characterize the wear patterns of tibial inserts in a load-controlled knee simulator by incorporating both normal gait and clinically acquired stair climbing kinematics and load conditions. Two different tibial insert designs were evaluated: the NexGen Cruciate Retaining Augmentable and NexGen Legacy Posterior Stabilized inserts. Two test conditions were run: standard gait only, and gait with bouts of stair climbing at a ratio of 70:1. Gravimetric wear measurements, damage and contact area assessments, and kinematic evaluations were performed. The addition of stair climbing kinematics significantly affected the wear behavior. Regardless of design, wear rates for standard gait tests were significantly higher than those that included bouts of stair climbing. The damage modes seen in both test conditions were primarily burnishing with secondary scratching and pitting. At 2 Mc, the damage areas were not significantly different between the two designs, but the damage area with stair climbing was significantly larger than that with gait alone. The fact that even small bouts of an additional activity of daily living could markedly impact wear simulator results calls into question the usefulness of studies that rely solely on kinematics and load inputs assumed from level gait.

Assessing the stiffness of spinal fusion in animal models.

The clinical goal of spinal fusion is to reduce motion and the associated pain. Therefore, measuring motion under loading is critical. The purpose of this study was to validate four-point bending as a means to mechanically evaluate simulated fusions in dog and rabbit spines. We hypothesized that this method would be more sensitive than manual palpation and would be able to distinguish unilateral vs bilateral fusion. Spines from four mixed breed dogs and four New Zealand white rabbits were used to simulate posterolateral fusion with polymethyl methacrylate as the fusion mass. We performed manual palpation and nondestructive mechanical testing in four-point bending in four planes of motion: flexion, extension, and right and left bending. This testing protocol was used for each specimen in three fusion modes: intact, unilateral, and bilateral fusion. Under manual palpation, all intact spines were rated as not fused, and all unilateral and bilateral simulated fusions were rated as fused. In four-point bending, dog spines were significantly stiffer after unilateral fusion compared with intact in all directions. Additionally, rabbit spines were stiffer in flexion and left bending after unilateral fusion. All specimens exhibited significant differences between intact and bilateral fusion except the rabbit in extension. For unilateral vs bilateral fusion, significant differences were present for right bending in the dog model and for flexion in the rabbit. Unilateral fusion can provide enough stability to constitute a fused grade by manual palpation but may not provide structural stiffness comparable to bilateral fusion.