Cancellous Bone Research Articles

Diaphyseal Impaction Grafting Combined with Metaphyseal Cones: Outcomes in 88 Revision Total Knee Arthroplasties.

Metaphyseal cones with cemented stems can be successfully utilized in most revision total knee arthroplasties (TKAs). However, if the diaphysis has been previously violated, fixation of the cemented stem, which is important for cone ingrowth and construct survival, can be compromised. The initial results of our novel technique combining diaphyseal impaction bone-grafting with a metaphyseal cone were promising but required additional study. The purpose of the present study was to assess results of this technique in a larger cohort. A metaphyseal cone combined with diaphyseal impaction grafting and a cemented stem was utilized in 88 revision TKAs at our institution, including 35 from our prior study. The mean age at the time of revision was 67 years, and 67% of patients were male. Patients had had a mean of 4 prior knee arthroplasty procedures. The 2 most common reasons for revision were aseptic loosening (78%) and 2-stage reimplantation for periprosthetic joint infection (PJI) (19%). The mean follow-up was 4 years. At the time of the latest follow-up, no cone-impaction grafting constructs required re-revision for aseptic loosening. Five-year survivorship free from any revision of the cone-impaction grafting construct and free from any reoperation was 95% and 65%, respectively. A total of 25 knees (28%) underwent reoperation, with the 2 most common indications being PJI and periprosthetic fracture. All cones were osseointegrated, and all bone graft appeared stable or incorporated. One patient had radiographic evidence of tibial component loosening despite a well-fixed cone; however, this patient was asymptomatic and had not undergone revision at 9 years. When presented with a sclerotic, polished diaphyseal canal with deficient cancellous bone and concomitant metaphyseal bone loss, our technique of combining diaphyseal impaction grafting with a metaphyseal cone proved extremely durable in this larger series of patients. No cone-impaction grafting constructs required re-revision for aseptic loosening. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Biomechanical analysis of 3D printed porous extremely-low modulus Ti-24Nb-4Zr-8Sn lumbar interbody fusion cage-A finite element study

ABSTRACT This study aimed to design and assess the biomechanical properties of a 3D-printed porous titanium alloy lumbar fusion cage, comparing it to traditional PEEK cages in lumbar PLIF surgery using finite element modelling. Employing Ti-24Nb-4Zr-8Sn (Ti2448) and Ti-6Al-4 V (Ti64) materials via EBM-3D printing, the fabricated cage exhibited enhanced mechanical stability when paired with the same internal fixation system. Biomechanical analysis revealed superior performance of both Ti2448 and Ti64 porous models over PEEK, notably Ti2448. These porous titanium cages effectively mitigate maximum stress at the cage-endplate interface, ensuring uniform stress distribution and minimizing subsidence risk. Additionally, their porous structure fosters osteogenesis, while the low modulus titanium alloy, resembling human cancellous bone, enhances interbody fusion and diminishes the probability of cage subsidence.

Machine-learning models for diagnosis of rotator cuff tears in osteoporosis patients based on anteroposterior X-rays of the shoulder joint

ObjectiveThis study aims to diagnose Rotator Cuff Tears (RCT) and classify the severity of RCT in patients with Osteoporosis (OP) through the analysis of shoulder joint anteroposterior (AP) X-ray-based localized proximal humeral bone mineral density (BMD) measurements and clinical information based on machine learning (ML) models. MethodsA retrospective cohort of 89 patients was analyzed, including 63 with both OP and RCT (OPRCT) and 26 with OP only. The study analyzed a series of shoulder radiographs from April 2021 to April 2023. Grayscale values were measured after plotting ROIs based on AP X-rays of shoulder joint. Five kinds of ML models were developed and compared based on their performance in predicting the occurrence and severity of RCT from ROIs' greyscale values and clinical information (age, gender, advantage side, lumbar BMD, and acromion morphology (AM)). Further analysis using SHAP values illustrated the significant impact of selected features on model predictions. ResultsR1-6 had a positive correlation with BMD respectively. The nine variables, including greyscale R1-6, age, BMD, and AM, were used in the prediction models. The RF model was determined to be superior in effectively diagnosing RCT in OP patients, with high AUC scores of 0.998, 0.889, and 0.95 in the training, validation, and testing sets, respectively. SHAP values revealed that the most influential factors on the diagnostic outcomes were the grayscale values of all cancellous bones in ROIs. A column-line graph prediction model based on nine variables was constructed, and DCA curves indicated that RCT prediction in OP patients was favored based on this model. Furthermore, the RF model was also the most superior in predicting the types of RCT within the OPRCT group, with an accuracy of 86.364% and 73.684% in the training and test sets, respectively. SHAP values indicated that the most significant factor affecting the predictive outcomes was the AM, followed by the grayscale values of the greater tubercle, among others. ConclusionsML models, particularly the RF algorithm, show significant promise in diagnosing RCT occurrence and severity in OP patients using conventional shoulder X-rays based on the nine variables. This method presents a cost-effective, accessible, and non-invasive diagnostic strategy that has the potential to substantially enhance the early detection and management of RCT in OP patient population.

Improving material properties of a poloxamer P407 hydrogel-based hydroxyapatite bone substitute material by adding silica-A comparative in vivo study.

The structure and handling properties of a P407 hydrogel-based bone substitute material (BSM) might be affected by different poloxamer P407 and silicon dioxide (SiO2) concentrations. The study aimed to compare the mechanical properties and biological parameters (bone remodeling, BSM degradation) of a hydroxyapatite: silica (HA)-based BSM with various P407 hydrogels in vitro and in an in vivo rat model. Rheological analyses for mechanical properties were performed on one BSM with an SiO2-enriched hydrogel (SPH25) as well on two BSMs with unaltered hydrogels in different gel concentrations (PH25 and PH30). Furthermore, the solubility of all BSMs were tested. In addition, 30 male Wistar rats underwent surgical creation of a well-defined bone defect in the tibia. Defects were filled randomly with PH30 (n = 15) or SPH25 (n = 15). Animals were sacrificed after 12 (n = 5 each), 21 (n = 5 each), and 63 days (n = 5 each). Histological evaluation and histomorphometrical quantification of new bone formation (NB;%), residual BSM (rBSM;%), and soft tissue (ST;%) was conducted. Rheological tests showed an increased viscosity and lower solubility of SPH when compared with the other hydrogels. Histomorphometric analyses in cancellous bone showed a decrease of ST in PH30 (p = .003) and an increase of NB (PH30: p = .001; SPH: p = .014) over time. A comparison of both BSMs revealed no significant differences. The addition of SiO2 to a P407 hydrogel-based hydroxyapatite BSM improves its mechanical stability (viscosity, solubility) while showing similar in vivo healing properties compared to PH30. Additionally, the SiO2-enrichment allows a reduction of poloxamer ratio in the hydrogel without impairing the material properties.

Fabrication and characterization of β-TCP/Zn-1Mg composite scaffolds for orthopedic applications

Bone tissue defects have emerged as a significant health concern, impacting individuals' overall well-being and daily functionality. The implantation of scaffold materials for bone repair is crucial to structurally replace the damaged bone area, providing essential mechanical support and fulfilling other functional requirements. In this study, in order to develop bone repair scaffold materials with enhanced mechanical properties, moderate corrosion behavior, favorable cytocompatibility, and notable antibacterial activity, xβ-TCP/Zn-1Mg composite scaffolds with varying β-TCP concentrations (x = 0, 0.5, 1, 3) were fabricated using an atmospheric pressure infiltration molding method. The resulting scaffolds featured interconnected and uniformly distributed pores, with an average pore size of approximately 250 μm and a porosity of around 60 %. The xβ-TCP/Zn-1Mg composite scaffolds exhibited a plateau stress ranging from 13.22 to 16.89 MPa and an elastic modulus between 0.62 and 0.82 GPa, closely resembling the mechanical properties of human cancellous bone. The incorporation of β-TCP accelerated the degradation process and promoted calcium phosphate deposition on the specimen's surface. Additionally, the β-TCP/Zn-1Mg composite scaffolds demonstrated significant antibacterial activity against both Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Furthermore, 2-fold diluted extracts derived from xβ-TCP/Zn-1Mg composite scaffolds were found to enhance the proliferation of MC3T3-E1 pre-osteoblast cells, indicating good cytocompatibility. Therefore, the xβ-TCP/Zn-1Mg scaffold materials hold promise as a compelling candidate for orthopedic applications.

Particularities of the bone tissue regenerative properties of the proximal part of the tibia in patients with rheumatoid arthritis with multi-plane knee deformities

Background. Rheumatoid arthritis (RA) has no equal among the musculoskeletal system diseases in terms of the severity of joint damage. Knee joint damage was noted in 65–70 % of RA patients and it is the most common cause of disability. The purpose was to study the indices of osteogenic activity of stromal (mesenchymal) stem cells (MSCs) of the articular bone ends of the knee joint in patients with secondary knee osteoarthritis (KOA) due to RA in the presence of multi-plane deformations. Materials and methods. The studied material was samples of cancellous bone of the anterior and posterior parts of the plateau of the proximal part of the tibia and spongiosa from a depth of 1 cm and 3 cm from the articular surface, namely from the proximal epimetaphysis of the tibia, removed during knee arthroplasty of patients with secon­dary KOA due to RA and in patients with primary KOA in the presence of multi-plane deformations. Using the method of cloning colony-forming units of fibroblasts (CSF) of bone tissues, 38 patients were examined, including 9 patients with RA and 29 patients with primary KOA with damage to the knee joint in the presence of multi-plane deformations. Results. The total number of nucleated cells in 1 cm3 of spongiosa of the front part of the tibial plateau was 2.3 times lower compared to the parameter of this index in the posterior part (p < 0.05). The characteristics of spongy tissue in terms of the number of nucleated cells and the content of CSF in 1 cm3 from a depth of 3 cm from the articular surface of the proximal epimetaphysis of the tibia of patients with RA were almost 3 times higher compared to the indices of patients with primary KOA (p < 0.05). Conclusions. Changes in the renovation processes of bone tissue in patients with secondary KOA due to RA and in patients with primary KOA in the presence of multi-plane deformations are unidirectional, but their expressiveness is greater in patients with RA. At a depth of 3 cm from the articular surface of the proximal epimetaphysis of the tibia, the conditions for secondary fixation of the leg of the knee joint replacement are much better, all other conditions being equal, so the "survival" of the endoprosthesis with an elongated leg will be greater.

Three-dimensional comprehensive evaluation of unilateral alveolar cleft bone grafting with iliac bone and chin bone blocks

In this study, we aimed to provide guidance for selecting bone grafting materials in cases of alveolar clefts. Twenty-nine patients with unilateral complete alveolar clefts were categorized into three groups based on the bone grafting material used: Group A (iliac bone block grafts), Group B (iliac cancellous bone grafts), and Group C (chin bone block grafts). Cone-beam computed tomography (CBCT) data were analyzed using Mimics 19.0 software. Results showed that Group A had the highest bone formation rate, with significant differences observed between Groups A and B, as well as between Groups B and C. Group A and Group C had the highest proportion of Type I in volume assessment, while Group B had the highest proportion of Type III, Significant differences were observed in the distribution of volume assessment scores among the three groups. Bone height measurement results indicated that buccal-side measurement points had a higher proportion of Type I bone height than palatal-side measurement points. Bone width measurement results showed that Type I bone width was highest in Group C, while Type IV bone width was highest in Group B. Significant differences were observed in the distribution of implanted bone width among the three groups. Total grafting scores indicated that Types A and D were predominant in Groups A and C, while Group B had the highest proportion of Type D. Significant differences were observed in the distribution of total grafting scores among the three groups. The comprehensive evaluation method provides accurate assessment of alveolar cleft bone grafting outcomes and is applicable in clinical settings. Based on the results, we consider both iliac bone blocks and chin bone blocks as suitable materials for alveolar cleft bone grafting. Grafting material selection should consider preoperative gap volume measured using CBCT, required bone quantity, donor site complications, and overall clinical needs.

Construction of multileveled and oriented micro/nano channels in Mg doped hydroxyapitite bioceramics and their effect on mimicking mechanical property of cortical bone and biological performance of cancellous bone

Drawing on the structure and components of natural bone, this study developed Mg-doped hydroxyapatite (Mg-HA) bioceramics, characterized by multileveled and oriented micro/nano channels. These channels play a critical role in ensuring both mechanical and biological properties, making bioceramics suitable for various bone defects, particularly those bearing loads. Bioceramics feature uniformly distributed nanogrooves along the microchannels. The compressive strength or fracture toughness of the Mg-HA bioceramics with micro/nano channels formed by single carbon nanotube/carbon fiber (CNT/CF) (Mg-HA(05-CNT/CF)) are comparable to those of cortical bone, attributed to a combination of strengthened compact walls and microchannels, along with a toughening mechanism involving crack pinning and deflection at nanogroove intersections. The introduction of uniform nanogrooves also enhanced the porosity by 35.4 %, while maintaining high permeability owing to the capillary action in the oriented channels. This leads to superior degradation properties, protein adsorption, and in vivo osteogenesis compared with bioceramics with only microchannels. Mg-HA(05-CNT/CF) exhibited not only high strength and toughness comparable to cortical bone, but also permeability similar to cancellous bone, enhanced cell activity, and excellent osteogenic properties. This study presents a novel approach to address the global challenge of applying HA-based bioceramics to load-bearing bone defects, potentially revolutionizing their application in tissue engineering.

A cross-sectional study of the anatomy of the jaws of a central-European caucasian population using cone beam computer tomography as a prerequisite for designing pre-formed calcium phosphate cement scaffolds

PurposeThis study aims to measure the cortical and cancellous bone thickness in the upper and lower jaws, serving as a data template for developing pre-defined calcium phosphate cement primary implant forms. These measurements are crucial for creating a biphasic scaffold. MethodsForty complete jaws were assessed for cortical bone shape and thickness using statistical analysis and specific software tools. Sex and age were considered, and four groups were created. ResultsThe cumulative thickness of the cortical layer varied from region to region. In both the upper and lower jaws, the cortical layer in the molar region was significantly thicker than in the frontal region. Within the alveolar process, cortical thickness increases with distance from the alveolar crest on both sides. The oral side of the lower jaw is significantly thicker than the vestibular side. For the upper jaw, no significant differences between the oral and vestibular sides were found in this study. Additionally, it is noteworthy that men have a significantly thicker cortical layer than women. Regarding age, no significant overall differences were found. ConclusionMathematical analysis of anatomical forms using polynomial functions improves understanding of jaw anatomy. This approach facilitates the design of patient-specific scaffold structures, minimizing the need for costly and time-consuming planning and enabling more efficient implementation of optimal therapy.

Effect of angled abutments in the posterior maxillary region on tilted implants: a 3D finite element analysis.

The aim of this study was to evaluate the bone tissue effects under dynamic loading using finite element analysis (FEA) for four angled abutments with different deviated palatal lateral tilt angles. A three-dimensional model of the posterior maxillary region and an implant crown model were reconstructed and assembled with a three-dimensional model of the implant, angled abutment, and central screw to create a total of 10 three-dimensional finite element models tilted at , , , and in three groups, and the dynamic loads simulating oral mastication were loaded on the implant crown to analyze the equivalent stresses and strains in the peri-implant bone tissues. Under the dynamic loading, the cortical bone on the buccal side of the implant neck showed different degrees of stress concentration, and the cortical bone stress was much higher than the cancellous bone, and the strain concentration area of each model was located in the bone tissue around the implant neck and base. For the use of angular abutment, under the premise that the cortical bone stresses and strains of the 10 models meet the requirements for use, the peak stresses of 2.907 MPa, 3.018 MPa, and 2.164 MPa were achieved by using the angular abutment to achieve the tilt angles of , , and implantation, which is more advantageous compared with other models.

Long-duration leptin transgene expression in dorsal vagal complex does not alter bone parameters in female Sprague Dawley rats

The hypothalamus and dorsal vagal complex (DVC) are both important for integration of signals that regulate energy balance. Increased leptin transgene expression in either the hypothalamus or DVC of female rats was shown to decrease white adipose tissue and circulating levels of leptin and adiponectin. However, in contrast to hypothalamus, leptin transgene expression in the DVC had no effect on food intake, circulating insulin, ghrelin and glucose, nor on thermogenic energy expenditure. These findings imply different roles for hypothalamus and DVC in leptin signaling. Leptin signaling is required for normal bone accrual and turnover. Leptin transgene expression in the hypothalamus normalized the skeletal phenotype of leptin-deficient ob/ob mice but had no long-duration (≥10 weeks) effects on the skeleton of leptin-replete rats. The goal of this investigation was to determine the long-duration effects of leptin transgene expression in the DVC on the skeleton of leptin-replete rats. To accomplish this goal, we analyzed bone from three-month-old female rats that were microinjected with recombinant adeno-associated virus encoding either rat leptin (rAAV-Leptin, n = 6) or green fluorescent protein (rAAV-GFP, control, n = 5) gene. Representative bones from the appendicular (femur) and axial (3rd lumbar vertebra) skeleton were evaluated following 10 weeks of treatment. Selectively increasing leptin transgene expression in the DVC had no effect on femur cortical or cancellous bone microarchitecture. Additionally, increasing leptin transgene expression had no effect on vertebral osteoblast-lined or osteoclast-lined bone perimeter or marrow adiposity. Taken together, the findings suggest that activation of leptin receptors in the DVC has minimal specific effects on the skeleton of leptin-replete female rats.

Treatment of an Infrabony Defect of a Maxillary Canine Tooth Using Enamel Matrix Derivatives with Allogeneic Bone Augmentation in a Dog.

A 5-year-old Miniature Dachshund was presented having an infrabony pocket on the palatal aspect of the right maxillary canine tooth. The bony defect had worsened despite previous closed root planing and administration of a perioceutic agent. A second surgery using an allogeneic cancellous bone augmentation with an enamel matrix derivative was performed in the infrabony defect following open root planing. Eight months after the periodontal surgery, the osseous defect showed healing by improved periodontal probing measurements and increased radiopacity using dental radiography and computed tomography.

A comparative study of volar locking-plate fixation with corticocancellous and pure cancellous bone grafts for scaphoid nonunion with dorsal intercalated segmental instability secondary to scaphoid humpback deformity

IntroductionBone grafts for scaphoid nonunion with deformity include cortcicocancellous or pure cancellous bone grafts. This study compared the outcomes between two types of bone grafts when employing a volar locking-plate in patients with scaphoid nonunion with dorsal intercalated segmental instability (DISI). Patients and MethodsThis retrospective study included 34 patients with scaphoid nonunion and DISI due to humpback deformity treated between March 2017 and January 2022. Two types of bone grafts were obtained from iliac crest. Twenty of the corticocancellous (CC) group underwent a wedge-shaped graft, while 14 patients of the pure cancellous (C-only) group received graft chips. In both groups, a 1.5-mm anatomically pre-contoured locking plate was used for fixation. Radiographic evaluations included the union rate and carpal alignment including scapholunate angle (SLA), radiolunate angle (RLA), intrascaphoid angle (ISA) and scaphoid height to length ratio (HLR). Clinical assessments encompassed wrist range-of-motion, grip strength, and patient-reported outcomes. ResultsNineteen of the 20 patients in the CC group and 12 of the 14 patients in the C-only group respectively, achieving osseous union. The mean follow-up period in CC group was 14.7 (range, 12 ∼ 24) months and that in C-only group was 12.6 (range, 12 ∼ 15) months. Postoperatively, there were no significant intergroup differences of radiographic parameters including SLA (CC; 49.9° ± 6.7° vs. C-only; 48.9° ± 3.5°, P = 0.676), RLA (1.7° ± 6.4° vs. 2.4° ± 3.3°, P = 0.74), ISA (36° ± 7.5° vs. 36.6° ± 12.2°, P = 0.881), and HLR (0.54 ± 0.09 vs. 0.53 ± 0.05, P = 0.587). Clinical outcomes, including the flexion–extension arc (137° ± 30° vs. 158° ± 33°, P = 0.122), grip strength (93.4 % ± 15.4% vs. 99.5 % ± 16.7 %, P = 0.39), Quick Disabilities of the Arm, Shoulder, and Hand scores (11.2 ± 8.3 vs. 12.5 ± 7.7, P = 0.74) and Mayo Wrist Scores (81.2 ± 13.1 vs. 89 ± 11.4, P = 0.242) also showed no significant intergroup differences. ConclusionsVolar locking-plate fixation with pure cancellous bone grafts achieved outcomes comparable to those achieved with corticocancellous bone grafts in scaphoid nonunion with deformity, possibly due to the biomechanical advantages of the volar plate to provide structural supports.

DIFFERENT APPROACHES IN BONE TISSUE ENGINEERING: ADVANTAGES AND DISADVANTAGES

Human bone tissue damage arises due to defects, injury, tumors, aging, and traffic accidents. It is one of the most challenging issues that need surgical development and advanced bone implants. Biocomposite-based bone has insufficient blood supply restricting the utilization for bone regeneration. It is often overcome by including scaffold having angiogenic factor delivery, in vitro and in vivo pre-vascularization. Bone and endothelial cell development and proliferation are stimulated by magnetic responsive scaffolds containing magnetic nanoparticles. Its porous structure allows cells to communicate and develop in all directions, which improves osteointegration. Scaffolds without seeded cells might have applications in bone tissue engineering (BTE) and it is mandatory to estimate in vitro and in vivo biocompatibility and degradation behavior. Three-dimensional (3D) printing opens the door to the creation of one-of-a-kind shapes and structures with specific properties. It helps to minimize the spread of germs during synthesis stage. The gamma rays minimize the infection communicated during transplantation but also damage the graft. When it comes to choosing biomaterials for cancellous and cortical bones, an artificial neural network has the highest recognition rate. This review paper explores the different potential approaches for bone grafting. Different techniques have been developed to create hydrogels with desirable properties for BTE, including non-toxicity, biocompatibility, controllability, and performance. A cell-free framework is used to stimulate bone regeneration, which helps in the bone the self-healing processes of bone fractures. The recent approach combines TE, material science, and genetic engineering for enhanced vascularization, restoring blood flow, and preventing cell death.

Development of porous hydroxyapatite/PVA/gelatin/alginate hybrid flexible scaffolds with improved mechanical properties for bone tissue engineering

Porous scaffolds based on gelatin and hydroxyapatite particles (HAp) are promising for applications in bone tissue engineering and regenerative medicine. However, they are not ideal for stress and shock protection due to low compressive strength, brittleness, and poor toughness. Herein, we developed porous hybrid scaffolds by combining multiple components into a single bone scaffold, including hydroxyapatite nanoparticles (HAp NPs), alginate, polyvinyl alcohol (PVA), and gelatin with different gelatin/PVA composition ratios. HAp NPs were synthesized in situ in PVA solution and scaffolds were fabricated using a freeze-drying method. The results showed good physicochemical properties of the scaffolds: formation of pure HAp NPs phase, high porosity, large pore sizes, large swelling capacity depending on varying gelatin/PVA ratios, as well as a long-term degradation rate up to 28 days. The porous scaffolds exhibited compressive strength close to the cancellous bone with stress-strain behavior exhibiting three-stage flexible behavior indicating improved fracture resistance with an energy absorbing capability up to 1.9 MJ/m3. The scaffolds have a yield strength of 70–403 kPa, a compressive strength at 65 % strain of 0.96–1.80 MPa, a nonporous elastic modulus of 10.44–12.40 GPa, and a densification strain of approximately 0.92 %. This work develops three-dimensional (3D) porous hybrid bone scaffolds with mechanical strength within the minimum compressive strength of cancellous bone and mechanical energy absorption capacity favor for cancellous bone repair, bone tissue engineering, and regenerative medicine applications.

EnduroBone: A 3D printed bioreactor for extended bone tissue culture

Studies of the effects of external stimuli on bone tissue, disease transmission mechanisms, and potential medication discoveries benefit from long-term tissue viability ex vivo. By simulating the in-vivo environment, bioreactors are essential for studying bone cellular activity throughout biological processes. We present the development of an automated 3D-printed bioreactor EnduroBone designed to sustain the ex-vivo viability of 10 mm diameter cancellous bone cores for an extended period. The device is supplied with two critical parameters for maintaining bone tissue viability: closed-loop continuous flow perfusion of 1 mL/min for nutrient diffusion and waste removal and direct mechanical stimulation with cyclic compression at 13.2 RPM (revolutions per minute) to promote cell viability which can lead to improved tissue stability during ex vivo culturing. The bioreactor addresses several limitations of existing systems and provides a versatile open-source platform for bone cancer research, orthopedic device testing, and other related applications. To validate the bioreactor, fresh swine samples were cultured ex-vivo, and their cell viability was determined to be maintained for up to 28 days. Periodic cell viability assessment through live/dead cell staining and confocal imaging at the start (0 days) and at several time points throughout the culture period (7, 14, 21, and 28 days) was used to demonstrate EnduroBone effectiveness in sustaining bone cell health for the extended period tested.

Comparison of the zonal distribution of calcium salt density and fat marrow in bone-healthy and osteoporotic sacra: an image data analysis using quantitative computed tomography and magnetic resonance imaging.

Pathogenesis of sacral fragility fractures is not fully understood. This study investigates zonal distribution of calcium salt and fat marrow in intact bone-healthy and osteoporotic pelvis. In addition, in unilateral sacral fractures, the fracture side was compared with the intact side. CT and MRI images of 37 pelves were analyzed. Zonal calcium salt distribution by Hounsfield units (HU) was recorded for each CT dataset. Fat marrow content was measured in MRI mDixon-Quant sequence. The cohort was divided: intact pelves with (PEO, HU < 100, n = 8) and without osteoporosis (PE, HU ≥ 100, n = 14) based on the mean HU value in LWK5. A third group consisted of patients with osteoporosis and unilateral fractures (PEOFx, n = 10). The results suggest that in PEO sacral alae experience disproportionate skeletal rarefaction. This concerns the sacral ala at the S1 level (- 25 ± 55), whereby the calcium salt content is so low that it corresponds to the S3 level of healthy bone (- 20 ± 21 HU). This explains the occurrence of transalar fractures in the load-transmitting zone S1. In PEOFx, the calcium salt density was higher and the fat content was lower on the fractured side than on the intact side, indicating bony compacting due to lateral compression and fat displacement due to hematoma in the accident mechanism. This study makes an important contribution to the understanding of the development of sacral fragility fractures. Furthermore, impaction of the cancellous bone within the fracture can be demonstrated.

A novel entity of massive multifocal osteolyses in the elderly

Osteolyses are common findings in elderly patients and most frequently represent malignant or locally aggressive bone tumors, infection, inflammatory and endocrine disorders, histiocytoses, and rare diseases such as Gorham-Stout syndrome. We here report on a novel entity of massive multifocal osteolyses in both shoulders, the right hip and left knee joint and the dens of an 83-year-old patient not relatable to any previously known etiopathology of bone disorders. The soft tissue mass is of myxoid stroma with an unspecific granulomatous inflammatory process, aggressively destroying extensive cortical and cancellous bone segments and encroaching on articulating bones in diarthrodial large joints. Radiological, nuclear medical, serological, histological, and immunohistochemical analyses were incapable of further classifying the disease pattern within the existing scheme of pathology. Quantitative polymerase chain reaction and next generation sequencing revealed that mutations are not suggestive of any known hereditary or acquired bone disease. Possible treatment options include radionuclide therapy for pain palliation and percutaneous radiation to arrest bone resorption while surgical treatment is inevitable for pathological fractures. This case study shall increase the awareness of the musculoskeletal community and motivate to collect further information on this rare but mutilating disorder.

Study on mechanical properties of dual-channel cryogenic 3D printing scaffold for mandibular defect repair.

Mandibular defect repair has always been a clinical challenge, facing technical bottleneck. The new materials directly affect technological breakthroughs in mandibular defect repair field. Our aim is to fabricate a scaffold of advanced biomaterials for repairing of small mandibular defect. Therefore, a novel dual-channel scaffold consisting of silk fibroin/collagen type-I/hydroxyapatite (SCH) and polycaprolactone/hydroxyapatite (PCL/HA) was fabricated by cryogenic 3D printing technology with double nozzles. The mechanical properties and behaviors of the dual-channel scaffold were investigated by performing uniaxial compression, creep, stress relaxation, and ratcheting experiments respectively. The experiments indicated that the dual-channel scaffold was typical non-linear viscoelastic consistent with cancellous tissue; the Young's modulus of this scaffold was 60.1kPa. Finite element analysis (FEA) was employed performing a numerical simulation to evaluate the implantation effect in mandible. The stress distribution of the contact area between scaffold and defect was uniform, the maximum Mises stress of cortical bone and cancellous bone in defect area were 54.520MPa and 3.196MPa, and the maximum displacement of cortical bone and cancellous bone in defect area were 0.1575mm and 0.1555mm respectively, which distributed in the incisor region. The peak maximum Mises stress experienced by the implanted scaffold was 3.128 × 10-3MPa, and the maximum displacement was 6.453 × 10-2mm distributed near incisor area. The displacement distribution of the scaffold was consistent with that of cortical and cancellous bone. The scaffold recovered well when the force applied on it disappeared. Above all, the dual-channel scaffold had excellent bio-mechanical properties in implanting mandible, which provides a new idea for the reconstruction of irregular bone defects in the mandible and has good clinical development prospects.

Influence of obesity on load-transfer mechanism, contact mechanics, and longevity of cemented acetabular cup

ObjectiveThis investigation aimed to assess the impact of obesity on the load-transfer mechanism, longevity, and contact mechanics of cemented acetabular cups. MethodsThree obesity scenarios were considered: obese case-I (100–110 kg), obese case-II (120–130 kg), and obese case-III (140–150 kg). Utilising six finite element models, the effects of different bodyweights on load transfer, contact mechanics, and cup longevity during normal walking conditions were assessed. Muscle forces and hip joint reaction forces were adjusted and linearly calibrated based on obesity cases. ResultsElevated stresses in cortical and cancellous bones, as well as the cement mantle, were observed in obese cases, suggesting a heightened risk of loosening and failure of the cemented fixation of the acetabular cup. Additionally, increased contact pressure and micromotion between articulating surfaces were noted in obese individuals, with a gradual escalation from obese case-I to obese case-III. ConclusionsThese findings highlight the significant negative impact of obesity on the performance of cemented acetabular cups, emphasizing the importance of considering bodyweight variations in the design and assessment of orthopaedic implants for optimal functionality and durability.