Osteoporotic Femoral Heads Research Articles

Difference in femoral head and neck material properties between osteoarthritis and osteoporosis

Background Osteoarthritis and osteoporosis are the two most common musculoskeletal diseases found in the aged population. It is of interest to measure and study the material properties of the femoral head and neck of these two groups, and hopefully to offer explanation of the observed phenomenon that most patients suffer from one of the two disorders, not both. Methods Seven osteoarthritic and seven osteoporotic femoral heads were used for this study. The principal compressive region of the femoral heads were cut to determine the Young’s modulus and yielding stress by a material testing machine. Comparisons between these two groups were conducted by using material properties and the properties normalized by individual patient physical parameters, including body weight, body height and femoral head diameter, respectively. The finite element model of femoral neck cuboid in OA and OP were obtained based on the micro-CT-scan cross-section. The intrinsic material properties were calculated from the solid FE models. Findings The results showed significant differences in density, modulus and strength between the osteoarthritic and osteoporotic femoral heads as measured, with the former having 2–3 times the values of the latter. Femoral head diameter has stronger influence in mechanical properties than patient’s body weight and body height. Regarding to bone volume (BV), bone surface (BS), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and true trabecular elastic modulus, the intrinsic material properties of femoral neck with OA were higher than OP. Interpretation It is still unknown why patients do not suffer from both osteoporosis and osteoarthritis at the same time. Many studies aimed to investigate the mechanical property of two groups. However, individual difference of the femoral head and neck is too difficult to obtain a reasonable comparison between these two groups. This study investigated the two groups more quantitatively and further estimated the factors which influence mechanical properties from a biomechanical point of view.

Comparison of fixation methods for use in osteoporotic femoral heads: twin hooks and lag screw

Comparison of fixation methods for use in osteoporotic femoral heads: twin hooks and lag screw

Trabecular Bone Tissue Strains in the Healthy and Osteoporotic Human Femur

Quantitative information about bone tissue-level loading is essential for understanding bone mechanical behavior. We made microfinite element models of a healthy and osteoporotic human femur and found that tissue-level strains in the osteoporotic femoral head were 70% higher on average and less uniformly distributed than those in the healthy one. Bone tissue stresses and strains in healthy load-adapted trabecular architectures should be distributed rather evenly, because no bone tissue is expected to be overloaded or unused. In this study, we evaluate this paradigm with the use of microfinite element (microFE) analyses to calculate tissue-level stresses and strains for the human femur. Our objectives were to quantify the strain distribution in the healthy femur, to investigate to what extent this distribution is affected by osteoporosis, to determine if osteoporotic bone is simply bone adapted to lower load levels, and to determine the "safety factor" for trabecular bone. microFE models of a healthy and osteoporotic proximal femur were made from microcomputed tomography images. The models consisted of over 96 and 71 million elements for the healthy and osteoporotic femur, respectively, and represented their internal and external morphology in detail. Stresses and strains were calculated for each element and their distributions were calculated for a volume of interest (VOI) of trabecular bone in the femoral head. The average tissue-level principal strain magnitude in the healthy VOI was 304 +/- 185 microstrains and that in the osteoporotic VOI was 520 +/- 355 microstrains. Calculated safety factors were 8.6 for the healthy and 4.9 for the osteoporotic femurs. After reducing the force applied to the osteoporotic model to 59%, the average strain compared with that of the healthy femur, but the SD was larger (208 microstrains). Strain magnitudes in the osteoporotic bone were much higher and less uniformly distributed than those in the healthy one. After simulated joint-load reduction, strain magnitudes in the osteoporotic femur were very similar to those in the healthy one, but their distribution is still wider and thus less favorable.

Increased metabolism of bone collagen in post-menopausal female osteoporotic femoral heads

Our previous studies demonstrated that the residual collagen in osteoporotic bone was not normal but possessed higher levels of lysine hydroxylation and modified cross-linking. However, the mechanism for these changes was not clear. In the current investigation, an assessment of bone collagen metabolism in osteoporosis (OP) revealed an increase in the overall metabolism of collagen relative to age-matched controls. The increased metabolism accounts for the observed post-translational modifications of collagen which lead to a more fragile bone matrix. The rate of bone metabolism is therefore an important aspect of the pathogenesis of osteoporosis, the greater the turnover the greater the propensity of a more fragile tissue. Clearly, the quality of bone tissue does not depend solely on adequate bone density but also on the state of the collagenous matrix.

Increasing bone screw anchoring in the femur head by cement administration via the implant--a biomechanical study

Osteoporosis reveals a higher risk of fractures. Due to the lack of possibilities to anchor fixation elements, fracture treatment often turns out to be complicated. An experimental study served to investigate the extent to which the application of bone cement through a modified gliding screw (Dynamic Hip Screw DHS) would improve the screw anchoring in osteoporotic femoral heads. Quasi-static compressive and torsional load tests were used to assess the desired improvement of the screw anchoring. Cadaver femur pairs served to compare the cement augmentation to the uncemented contralateral control. The improvement of the holding strength of the screw under static compressive and torsional load depended on the cement flow into the adjacent bone tissue. The filling with additional cement was only successful after having created a small hollow space at the screw tip with a special instrument. Consequently, under compression as well as torsion, the cement application yielded improvements from 17% up to several times as much. In the application of gliding screws in osteoporotic femoral heads, the locally limited cement application through the implant has been shown to be a biomechanical possibility to improve screw fixation.

Mechanical considerations in impaction bone grafting.

In impaction grafting of contained bone defects after revision joint arthroplasty the graft behaves as a friable aggregate and its resistance to complex forces depends on grading, normal load and compaction. Bone mills in current use produce a distribution of particle sizes more uniform than is desirable for maximising resistance to shear stresses. We have performed experiments in vitro using morsellised allograft bone from the femoral head which have shown that its mechanical properties improve with increasing normal load and with increasing shear strains (strain hardening). The mechanical strength also increases with increasing compaction energy, and with the addition of bioglass particles to make good the deficiency in small and very small fragments. Donor femoral heads may be milled while frozen without affecting the profile of the particle size. Osteoporotic femoral heads provide a similar grading of sizes, although fewer particles are obtained from each specimen. Our findings have implications for current practice and for the future development of materials and techniques.

Mechanical considerations in impaction bone grafting

In impaction grafting of contained bone defects after revision joint arthroplasty the graft behaves as a friable aggregate and its resistance to complex forces depends on grading, normal load and compaction. Bone mills in current use produce a distribution of particle sizes more uniform than is desirable for maximising resistance to shear stresses. We have performed experiments in vitro using morsellised allograft bone from the femoral head which have shown that its mechanical properties improve with increasing normal load and with increasing shear strains (strain hardening). The mechanical strength also increases with increasing compaction energy, and with the addition of bioglass particles to make good the deficiency in small and very small fragments. Donor femoral heads may be milled while frozen without affecting the profile of the particle size. Osteoporotic femoral heads provide a similar grading of sizes, although fewer particles are obtained from each specimen. Our findings have implications for current practice and for the future development of materials and techniques.

Human osteoclasts and osteoclast-like cells synthesize and release high basal and inflammatory stimulated levels of the potent chemokine interleukin-8.

Chemokines, including interleukin-8 (IL-8), function as key mediators in diverse inflammatory disorders via promoting the recruitment, proliferation, and activation of vascular and immune cells. IL-8 levels are elevated in inflammatory diseases, such as rheumatoid arthritis, osteoarthritis, osteomyelitis, and periodontal disease, that also exhibit progressive bone loss. Therefore, it is possible that IL-8 contributes to the osteopenia associated with these pathological conditions. Although macrophages, neutrophils, and endothelial cells are considered the primary sources of inflammation-induced IL-8 increases, we report here for the first time that human bone marrow-derived osteoclast-like cells (hOCL) as well as authentic bone-resorbing human osteoclasts (hOC) isolated from osteoporotic femoral heads express messenger RNA (mRNA) for IL-8 and secrete high levels of IL-8 during culture. Basal IL-8 release by cultured hOC or hOCL was orders of magnitude greater than the release of the proinflammatory cytokines IL-1beta, IL-6, and tumor necrosis factor-alpha. At a cellular level, in situ hybridization analysis revealed that IL-8 mRNA was expressed in resorbing hOC of rheumatoid arthritic pannus and was substantially greater than that expressed in hOC of noninflammatory giant cell tumor of bone tissue. Therefore, the potential inflammation-mediated induction of IL-8 was directly assessed using cultured hOCL. IL-8 release was stimulated by proinflammatory signals (IL-1alpha, tumor necrosis factor-alpha, lipopolysaccharide, or phorbol 12-myristate 13-acetate), unaffected by various other osteotropic modulators (transforming growth factor-beta1 and -beta3, IL-6, 17beta-estradiol, or calcitonin) and was decreased by interferon-gamma, vitamin D3, and the antiinflammatory glucocorticoid dexamethasone. Changes in IL-8 secretion were paralleled by corresponding changes in IL-8 mRNA steady state levels. We conclude that hOC and hOCL synthesize and secrete high constitutive and inflammation-stimulated levels of the chemokine IL-8. Consequently, hOC-derived IL-8 could act as an important regulatory signal for bone, vascular, and immune cell recruitment and activation during normal and pathological bone remodeling.

Post-translational modifications in the collagen of human osteoporotic femoral head

No detailed biochemical analysis has been made of the possible compositional changes in the collagen relating to the fragility of osteoporotic bone. We report for the first time significant changes in the compositional properties of the collagen. The major differences were observed in the post-translational modifications, namely, in the hydroxylation of lysine residues and the nature of the stabilizing cross-links of the collagen fibre. The increase in hydroxylation was greater in the head region compared to the neck region of the femoral head, whilst the decrease in the intermediate cross-links was greater in the neck region. Clearly, the collagen is altered in osteoporosis and it is important that these changes are recognised in studies of bone metabolism in osteoporosis since they may play a role in the pathogenesis of the disease.