Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis, but the patients and surgeons are still troubled by the complications, for example severe wear and fracture of the post, as well as prosthetic loosening. Understanding the in vivo biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction. Therefore, six different designs of posterior-stabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively, and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities: walking, right turn and squatting. The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking, turning right, and squatting, which may increase the risk of the fracture and wear as well as the early loosening. The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear. The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation. This study provides a theoretical support for guiding surgeon selection, improving posterior-stabilized prosthetic design and reducing the prosthetic failure.
Arthroplasty, Replacement, Knee/methods* ; Biomechanical Phenomena ; Humans ; Knee Joint/surgery* ; Knee Prosthesis ; Prosthesis Design ; Range of Motion, Articular/physiology* ; Tibia/surgery*

BACKGROUND: Degenerative osteoarthritis of the knee usually shows arthritic change in the medial tibiofemoral joint with severe varus deformity. In total knee arthroplasty (TKA), the medial release technique is often used for achieving mediolateral balancing. But, in a more severe varus knee, there are more difficult technical problems. Bony resection of the medial proximal tibia (MPT) as an alternative technique for achieving soft tissue balancing was assessed in terms of its effectiveness and possibility of quantification. METHODS: TKAs were performed in 78 knees (60 patients) with vertical bone resection of the MPT for soft tissue balancing from September 2011 to March 2013. During operation, the medial and lateral gaps were measured before and after the bony resection technique. First, the correlation between the measured thickness of the resected bone and the change in medial and lateral gaps was analyzed. Second, the possibility of quantification of each parameter was evaluated by linear regression and the coefficient ratio was obtained. RESULTS: A significant correlation was identified between alteration in the medial gap change in extension and the measured thickness of the vertically resected MPT (r = 0.695, p = 0.000). In the medial gap change in flexion, there was no statistical significance (r = 0.214, p = 0.059). When the MPT was resected at an average thickness of 8.25 +/- 1.92 mm, the medial gap in extension was increased by 2.94 +/- 0.87 mm. In simple linear regression, it was predictable that MPT resection at a thickness of 2.80 mm was required to increase the medial gap by 1.00 mm in knee extension. CONCLUSIONS: The method of bone resection of the MPT can be considered effective with a predictable result for achieving soft tissue balancing in terms of quantification during TKA.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods/*statistics & numerical data ; Female ; Humans ; Knee/*physiology/*surgery ; Male ; Middle Aged ; Osteoarthritis, Knee/*surgery ; Tibia/*physiology/*surgery

BACKGROUNDFor a child with osteosarcoma, prediction of the limb length discrepancy at maturity is important when planning for limb salvage surgery. The purpose of this study was to provide a reliable prediction method.

METHODSA retrospective review of Chinese children receiving chemotherapy for osteosarcoma before skeletal maturity was conducted. Standing full-length radiographs of the lower extremity were used for length measurements. Length-for-age curves were constructed using the LMS method. The lower limb multiplier for a specific age and gender was calculated using the formula M = Lm/L, where M was the gender- and age-specific multiplier, Lmwas the bone length at maturity, and L was the age-specific bone length. Prematurity and postmaturity radiographs were used to assess the accuracy of the prediction methods.

RESULTSA total of 513 radiographs of 131 boys and 314 radiographs of 86 girls were used to calculate the coefficients of the multiplier. The multipliers of 8-, 9-, 10-, 11-, 12-, 13-, 14-, 15-, 16-, 17-, and 18-year-old boys after chemotherapy for osteosarcoma were 1.394, 1.306, 1.231, 1.170, 1.119, 1.071, 1.032, 1.010, 1.004, 1.001, and 1.000, respectively; while for girls at the same ages, the multipliers were 1.311, 1.221, 1.146, 1.092, 1.049, 1.021, 1.006, 1.001, 1.000, 1.000, and 1.000, respectively. Prematurity and postmaturity femoral and tibial lengths of 21 patients were used to assess the prediction accuracy. The mean prediction error was 0 cm, 0.8 cm, and 1.6 cm for the multiplier method using our coefficients, Paley's coefficients, and Anderson's method, respectively.

CONCLUSIONSOur coefficients for the multiplier method are reliable in predicting lower limb length growth of Chinese children with osteosarcoma.

Adolescent ; Body Height ; physiology ; Bone Neoplasms ; surgery ; Child ; Female ; Femur ; anatomy & histology ; Humans ; Limb Salvage ; Lower Extremity ; anatomy & histology ; Male ; Models, Theoretical ; Osteosarcoma ; surgery ; Radiography ; Retrospective Studies ; Tibia ; anatomy & histology

BACKGROUND: Anatomic footprint restoration of anterior cruciate ligament (ACL) is recommended during reconstruction surgery. The purpose of this study was to compare and analyze the femoral and tibial tunnel positions of transtibial single bundle (SB) and transportal double bundle (DB) ACL reconstruction using three-dimensional computed tomography (3D-CT). METHODS: In this study, 26 patients who underwent transtibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft. 3D-CTs were taken within 1 week after the operation. The obtained digital images were then imported into the commercial package Geomagic Studio v10.0. The femoral tunnel positions were evaluated using the quadrant method. The mean, standard deviation, standard error, minimum, maximum, and 95% confidence interval values were determined for each measurement. RESULTS: The femoral tunnel for the SB technique was located 35.07% +/- 5.33% in depth and 16.62% +/- 4.99% in height. The anteromedial (AM) and posterolateral (PL) tunnel of DB technique was located 30.48% +/- 5.02% in depth, 17.12% +/- 5.84% in height and 34.76% +/- 5.87% in depth, 45.55% +/- 6.88% in height, respectively. The tibial tunnel with the SB technique was located 45.43% +/- 4.81% from the anterior margin and 47.62% +/- 2.51% from the medial tibial articular margin. The AM and PL tunnel of the DB technique was located 33.76% +/- 7.83% from the anterior margin, 45.56% +/- 2.71% from the medial tibial articular margin and 53.19% +/- 3.74% from the anterior margin, 46.00% +/- 2.48% from the medial tibial articular margin, respectively. The tibial tunnel position with the transtibial SB technique was located between the AM and PL tunnel positions formed with the transportal DB technique. CONCLUSIONS: Using the 3D-CT measuring method, the location of the tibia tunnel was between the AM and PL footprints, but the center of the femoral tunnel was at more shallow position from the AM bundle footprint when ACL reconstruction was performed by the transtibial SB technique.
Adult ; Anterior Cruciate Ligament Reconstruction/*methods ; *Femur/radiography/surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Knee Joint/physiology ; Male ; Prospective Studies ; Surgery, Computer-Assisted/*methods ; *Tibia/radiography/surgery ; Tomography, X-Ray Computed

BACKGROUND: The purpose of this study was to compare the initial stability of anatomical and non-anatomical single bundle anterior cruciate ligament (ACL) reconstruction and to determine which would better restore intact knee kinematics. Our hypothesis was that the initial stability of anatomical single bundle ACL reconstruction would be superior to that of non-anatomical single bundle ACL reconstruction. METHODS: Anterior tibial translation (ATT) and internal rotation of the tibia were measured with a computer navigation system in seven pairs of fresh-frozen cadaveric knees under two testing conditions (manual maximum anterior force, and a manual maximum anterior force combined with an internal rotational force). Tests were performed at 0, 30, 60, and 90 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either anatomical or non-anatomical single bundle ACL reconstruction. RESULTS: Under manual maximal anterior force, both reconstruction techniques showed no significant difference of ATT when compared to ACL intact knee state at 30degrees of knee flexion (p > 0.05). Under the combined anterior and internal rotatory force, non-anatomical single-bundle ACL reconstruction showed significant difference of ATT compared to those in ACL intact group (p < 0.05). In contrast, central anatomical single bundle ACL reconstruction showed no significant difference of ATT compared to those in ACL intact group (p > 0.05). Internal rotation of the tibia showed no significant difference in the ACL intact, the ACL transected, non-anatomical reconstructed and anatomical reconstructed knees. CONCLUSIONS: Anatomical single bundle ACL reconstruction restored the initial stability closer to the native ACL under combined anterior and internal rotational forces when compared to non-anatomical ACL single bundle reconstruction.
Aged ; Aged, 80 and over ; Anterior Cruciate Ligament/*anatomy & histology/physiology/*surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; Biomechanics/physiology ; Cadaver ; Humans ; Knee Joint/*anatomy & histology/physiology/*surgery ; Middle Aged ; Random Allocation ; Range of Motion, Articular/physiology ; Tibia/anatomy & histology/physiology/surgery

BACKGROUND: Despite the importance of soft tissue balancing during total knee arthroplasty (TKA), all estimating techniques are dependent on a surgeon's manual distraction force or subjective feeling based on experience. We developed a new device for dynamic gap balancing, which can offer constant load to the gap between the femur and tibia, using pneumatic pressure during range of motion. METHODS: To determine the amount of distraction force for the new device, 3 experienced surgeons' manual distraction force was measured using a conventional spreader. A new device called the consistent load pneumatic tensor was developed on the basis of the biomechanical tests. Reliability testing for the new device was performed using 5 cadaveric knees by the same surgeons. Intraclass correlation coefficients (ICCs) were calculated. RESULTS: The distraction force applied to the new pneumatic tensioning device was determined to be 150 N. The interobserver reliability was very good for the newly tested spreader device with ICCs between 0.828 and 0.881. CONCLUSIONS: The new pneumatic tensioning device can enable us to properly evaluate the soft tissue balance throughout the range of motion during TKA with acceptable reproducibility.
Arthroplasty, Replacement, Knee/*instrumentation/methods ; Biomechanics ; Equipment Design ; Femur/surgery ; Humans ; Knee Joint/physiology/*surgery ; Mechanical Processes ; Range of Motion, Articular ; Reproducibility of Results ; Tibia/surgery

OBJECTIVETo study biomechanical changes of newly formed bones 24 weeks after repairing large defects of long bones of goats using heterogeneous deproteinated bone (DPB) prepared by modified methods as an engineering scaffold.

METHODSAccording to a fully randomized design, 18 goats were evenly divided into three groups: normal bone control group (Group A), autologous bone group (Group B) and experimental group (Group C). Each goat in Groups B and C were subjected to the periosteum and bone defect at middle-lower part of the right tibia (20% of the whole tibia in length), followed by autologous bone or DPB plus autologous MSCs + rhBMP2 implantation, respectively and semi-ring slot fixation; while goats in Group A did not perform osteotomy. At 24 weeks after surgery, biomechanical tests were carried out on the tibias.

RESULTSAt 24 weeks after surgery, the results of anti-compression test on tibias in three groups were recorded by a functional recorder presented as linear pressure-deformation curve. The shapes of the curves and their change tendency were similar among three groups. The ultimate pressure values were 10.74 MPa+/-1.23 MPa, 10.11 MPa+/-1.35 MPa and 10.22 MPa+/-1.32 MPa and fracture compression rates were 26.82%+/-0.87%, 27.17%+/-0.75% and 28.22%+/-1.12% in Groups A, B and C, respectively. Comparisons of anti-compression ultimate pressures and fracture compression rates among three groups demonstrated no significant difference (P(AB) equal to 0.415, P(BC) equal to 0.494). Three-point anti-bend test on tibias was recorded as load-deformation curves, and the shapes of the curves and their change tendency were similar among three groups. The ultimate pressure values of the anti-bend test were 481.52 N+/-12.45 N, 478.34 N+/-14.68 N and 475.62 N+/-13.41 N and the fracture bend rates were 2.62 mm+/-0.12 mm, 2.61 mm+/-0.15 mm and 2.81 mm+/-0.13 mm in Groups A, B and C, respectively. There was no significant difference between groups (P(AB) equal to 0.7, P(BC) equal to 0.448). The ultimate anti-torsion torque values were 6.55 Nm+/-0.25 Nm, 6.34 Nm+/-0.18 Nm and 6.42 Nm+/-0.21 Nm and fracture torsion rates were 29.51 degree+/-1.64degree, 28.88 degree+/-1.46 degree and 28.81 degree+/-1.33 degree in Groups A, B and C, respectively. There was no significant difference between groups (P(AB) equal to 0.123, P(BC) equal to 0.346).

CONCLUSIONSThe biomechanical characteristics of newly formed bones from heterogeneous DPB for repairing large segmental long bone defect are comparable to those of normal bones and autologous bones. DPB has the potential for clinical usage as bone graft material.

Animals ; Biomechanical Phenomena ; Female ; Goats ; Male ; Proteins ; Tibia ; physiology ; surgery ; Tissue Engineering ; Torsion, Mechanical

OBJECTIVETo assess the effect of muscle contraction on bone capillary permeability.

METHODSThirty female New Zealand white rabbits were randomly divided into the experimental and control groups (n=15). The bone chambers were implanted medially into the right tibiae of the rabbit, and in the experimental group, the rabbits were stimulated by transcutaneous electrical nerve stimulator (TENS) at 4 Hz (1 h/day, 6 days/week) starting from week 2. From week 3, intravital microscopic observation was carried out weekly till week 10, and the vasculature in the tibiae was observed under fluorescent microscope with FITC and RITC staining. All the images were analyzed by Metamorph program.

RESULTSThe bone capillary permeability increased significantly in the experimental group.

CONCLUSIONSkeletal muscle contraction can increase the capillary permeability.

Animals ; Capillary Permeability ; physiology ; Female ; Implants, Experimental ; Muscle Contraction ; physiology ; Muscle, Skeletal ; physiology ; Rabbits ; Random Allocation ; Tibia ; blood supply ; surgery ; Transcutaneous Electric Nerve Stimulation

OBJECTIVETo compare the surface apposition and the bone response at early period of implantation in two differently treated implants.

METHODSThe implants were subject to double acid-etched-H2O2/HCl-heat treatment and double acid-etching treatment, and then randomly implanted into the tibia of rabbits. After 2, 4, 8 weeks of follow up, the bone specimens containing implants were prepared and examined by a field emission SEM and EDX.

RESULTA layer rich with calcium and phosphorus was clearly demonstrated on the implants surface of both groups after 2 weeks of implantation, but it was mostly disappeared after 4 weeks. There were large amounts of osteoblasts cells on double acid-etched-H2O2/HCl-heat treated implants surface indicating the initiation of osteogenesis. After 8 weeks of implantation some new bones were attached on the implants surface in both groups, more bones attached were shown on double acid-etched- H2O2/HCl-heat treated implants surface.

CONCLUSIONA calcium and phosphorus-rich layer was formed on the implants surface of both groups at early period of implantation.

Animals ; Dental Implantation ; Dental Implants ; Dental Materials ; chemistry ; Dental Prosthesis Design ; Hydrogen Peroxide ; chemistry ; Osseointegration ; physiology ; Osteogenesis ; physiology ; Rabbits ; Surface Properties ; Tibia ; surgery ; ultrastructure ; Titanium ; chemistry

OBJECTIVETo assess the value of perfusion-weighted magnetic resonance (MR) imaging (PWMRI) in monitoring vascularization in tissue-engineered bone graft.

METHODSTibial diaphyseal defect of 20 mm was induced in 25 lower limbs of 13 rhesuses and fixed with an AO reconstruction plate with 7 holes. The monkeys were randomized into 5 groups according to the materials used for defect filling: group A, with beta-tricalcium phosphate (beta-TCP), bone marrow stromal cells (BMSCs) and blood vessel bundles; group B, with beta-TCP and blood vessel bundles; group C, with beta-TCP and BMSCs; group D, with beta-TCP, and group E without filling. PWMRI, X-ray, and radionuclide imaging were carried out at weeks 4, 8, 12 postoperatively. The maximum slope rates of the single intensity-time curve (SS(max)) and the baseline values (SI(baseline)) on the same time points were calculated. Transmittances on the X-ray films and isotope counts in the region of interest (ROI) were assessed and calculated.

RESULTSCompared with other groups, group A showed the highest SS(max) at weeks 4, 8, and 12 postoperatively, and its SS(max) at week 8 was significantly higher than that at week 4 (P=0.003). The SS(max) was positively related to isotope counts in ROI at week 8 after operation (r(s)=0.899, P=0.038), and inversely related to transmittance on X-ray films at week 12 (r(s)=-0.892, P=0.042).

CONCLUSIONThe SS(max) of the single intensity-time curve can accurately reflect the vascularization of the tissue-engineered bone graft, and PWMRI allows sensitive, quantitative, noninvasive and radiation-free vascularization monitoring.

Animals ; Bone Marrow Transplantation ; methods ; Bone Substitutes ; chemistry ; therapeutic use ; Calcium Phosphates ; therapeutic use ; Female ; Macaca mulatta ; Magnetic Resonance Angiography ; Male ; Neovascularization, Physiologic ; drug effects ; physiology ; Random Allocation ; Tibia ; blood supply ; injuries ; surgery ; Tissue Engineering ; methods