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PURPOSE:
The purpose of this study was to find a suitable method of labelling cartilage samples for the measurement of distraction distances in biomechanical testing.
METHODS:
Samples of bovine cartilage were labelled using five different methods: hydroquinone and silver nitrate (AgNO3), potassium permanganate (KMnO4) with sodium thiosulphate (Na2S2O3), India ink, heat, and laser energy. After the labelling, we analysed the cartilage samples with regard to cytotoxity by histochemical staining with ethidiumbromide homodimer (EthD-1) and calcein AM. Furthermore, we tested cartilages labelled with India ink and heat in a T-peel test configuration to analyse possible changes in the mechanical behaviour between marked and unlabelled samples.
RESULTS:
Only the labelling methods with Indian ink or a heated needle showed acceptable results in the cytotoxity test with regard to labelling persistence, accuracy, and the influence on consistency and viability of the chondrocytes. In the biomechanical T-peel configuration, heat-labelled samples collapsed significantly earlier than unlabelled samples.
CONCLUSION:
Labelling bovine cartilage samples with Indian ink in biomechanical testing is a reliable, accurate, inexpensive, and easy-to-perform method. This labelling method influenced neither the biomechanical behaviour nor the viability of the tissue compared to untreated bovine cartilage.
A new bone substitute, consisting of hydroxylapatite and calcium sulphate, was prepared in two formulations and analysed for its mechanical strength and antibiotic elution.The bone substitute PerOssal has osteoconductive and degradable properties. The material has a built-in capillary structure, which results in an immediate fluid uptake. Antibiotics absorbed to the bone substitute resulted in a prolonged release rate. Mechanical strength was investigated by an unconfined compression test up to failure under both wet and dry conditions for both formulations of the bone substitute. Antibiotic release was analysed microbiologically for two antibiotics, vancomycin and gentamicin, over an elution period of 10 days using the agar diffusion method.The drug release analysis resulted in a prolonged release rate of both antibiotics over 10 days. In vitro the amount of gentamicin and vancomycin eluted at day 10. From one pellet still exceeded the minimal inhibitory concentration of most aetiologically important pathogens. Formulation two of the present bone substitute is significantly harder in both wet and dry conditions when compared to formulation one. Both formulations lose strength in the wet condition relative to their performance in the dry condition. However, formulation two is as hard under wet conditions as formulation one is when dry.PerOssal is a suitable new degradable osteoconductive bone substitute that can be loaded with antibiotic solutions, which are released in effective doses over 10 days. The mechanical strength of PerOssal is sufficient to support cancellous bone defects in non-weight-bearing areas or in combination with osteosynthesis.
To avoid dislocation of the shoulder joint after reverse total shoulder arthroplasty, it is important to achieve sufficient shoulder stability when placing the implant components during surgery. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this research was to develop a temporary reverse shoulder implant prototype that would allow intraoperative measurement of shoulder stiffness while varying the position of the implant components. Joint angle and torque measurement techniques were developed to determine shoulder stiffness. Hall sensors were used to measure the joint angles by converting the magnetic flux densities into angles. The accuracy of the joint angle measurements was tested using a test bench. Torques were determined by using thin-film pressure sensors. Various mechanical mechanisms for variable positioning of the implant components were integrated into the prototype. The results of the joint angle measurements showed measurement errors of less than 5° in a deflection range of ±15° adduction/abduction combined with ±45° flexion/extension. The proposed design provides a first approach for intra-operative assessment of shoulder stiffness. The findings can be used as a technological basis for further developments.
Introduction
Dislocation of the shoulder joint is one of the more common complications after reverse total shoulder arthroplasty [1], which is often associated with malposition of the prosthetic components [2]. Therefore, achieving sufficient shoulder stability should not be neglected when positioning the implant components. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this work is to develop a reverse shoulder implant prototype that allows intraoperative measurement of shoulder stiffness while varying the position of the implant components. The measured stiffness could provide a quantitative statement regarding the optimal positioning of the implant components, which can be adjusted accordingly in the final reverse shoulder prosthesis.
Methods
To measure the stiffness of the shoulder joint, it is necessary to record the joint angles and the torques generated during movement. The changes in the rotation angles were measured using 3D hall sensors and magnets. The magnets were placed under the humerosocket, and the hall sensors were integrated into the glenosphere. The strength of the magnetic field was used to determine the position of the humerosocket in relation to the glenosphere. The accuracies of the angle measurements were tested using a test bench.
Three thin film pressure sensors were used to record forces at different points under the humerosocket. To obtain a force value from the sensor signal, the sensors were calibrated using a load cell. The variation of the implant components positions was integrated into the prototype implant through different constructive mechanisms to adjust the stiffness of the shoulder joint.
Results
In the range of ±45° flexion/extension combined with ±15° adduction/abduction, the joint position could be determined with sufficient accuracy (error e ≤ 5°). The areas near the combined maximum deflections of ±45° flexion/extension and ±45° adduction/abduction indicate the greatest deviation from the target angle. The force values of the thin film sensors enable the calculation of moments around two axes. As variable component position parameters, the tray offset, the neck-shaft angle and the humerus version were integrated into the implant prototype.
Discussion
Ideally, the accuracy of the angle measurements should only depend on the amount of deflection and not on the direction of deflection. The asymmetric behavior indicates a deviation from the correct positioning of the hall sensors. The application of a calibration matrix could compensate for the measurement errors and could demonstrate the potential of the new method for joint angle measurements. The accuracy of the torque measurements and the functionality of the mechanical arresting mechanisms must be investigated in further studies. Overall, the developed measurement method can help to avoid malpositioning of the implant components in reverse total shoulder arthroplasty.
References
1. Clark et al, J Shoulder and elbow surgery, 21:36-41 2012.
2. Randelli et al, J Musculoskeletal surgery, 98:15-18, 2014.
Fragestellung
Es soll in dieser Computersimulationsstudie untersucht werden, wie der Osteosyntheseverbund Platte mit Schrauben im Verbund mit einer im mittleren Drittel gebrochenen Clavicula durch das Bewegungsausmaß
in vivo belastet ist. Was sind die grundlegenden Kräfte die auf Clavicula und Implantat wirken und welchen Einfl uss hat die Bruchform.
Methodik
Die Muskel- und Gelenkkräfte sowie die Belastung des Implantatverbundes wurden mit einer muskuloskelletalen
Simulationssoftware (AnyBody Technology, V.4) berechnet. Hierfür wurden mit einem komplexen Model des menschlichen Körpers folgende Bewegungen analysiert: eine Flexion von 160° und Abduktion 160° mit
einem Gewicht von 2 kg in der Hand. Aus CT-Patientendaten wurden zwei dreidimensionale Modelle des Clavicula-Implantat Verbundes gebildet, die sich in der Frakturform unterscheiden (Querfraktur und vertikale
Fraktur). In beiden Modellen wurde eine Claviculaosteosynthese in superiorer Position mit einer 6 Loch LCP mit 2 Schrauben pro Hauptfragment verwendet. Die Materialeigenschaften wurden aus der Dichte des Materials sowie aus Literaturdaten verwendet. Die Muskel- und Gelenkkräfte aus der muskuloskelletalen Berechnung wurden auf das Finite Elemente Modell übertragen und die Spannungen und Dehnungen des Implantat-Knochenverbundes
wurden berechnet.
Ergebnisse
Es zeigte sich, dass die simulierte in vivo Belastung stark abhängig vom Flexionswinkel ist. Das Implantat ist in der superioren Lage auf Biegung belastet, welche maximale Werte im Überschulterniveau erreicht. Die Bruchform mit anatomischer Reposition und Kontakt der Hauptfragmente zueinander führt zu einer deutlichen Entlastung des Osteosyntheseverbundes im Vergleich zu einer Bruchform mit vertikaler Fraktur.
Schlussfolgerung
Aus den Analysen ist eine Positionierung der Plattenosteosynthese für die im mittleren Drittel frakturierte Clavicula in anterior-superiorer Lage wünschenswert. Die anatomische Reposition entlastet den Osteosyntheseverbund und sollte möglichst erreicht werden. Die Nachbehandlung sollte ein Bewegungsausmaß für den Arm für 4 Wochen für einfache Bruchformen auf 70° Flexion und Abduktion limitieren und für komplexe Bruchformen diese Limitierung ausgedehnt werden.
Bei der Schultersteife handelt es sich um ein häufiges Krankheitsbild in der Orthopädie bzw. Schulterchirurgie, das sowohl bei Ärztinnen und Ärzten (Allgemeinmedizinerinnen und mediziner, Fachärztinnen und -ärzte) als auch bei sonstigem medizinischem Fachpersonal, z.B. der Physiotherapie oder Pflege, nur einen geringen Bekanntheitsgrad besitzt. Zielorientierung dieser Leitlinie war es, eine fundierte Hilfestellung und Richtlinie in Bezug auf das Krankheitsbild für Ärztinnen, Ärzte und medizinisches Fachpersonal zu schaffen, den aktuellen evidenz-basierten Wissensstand zu vermitteln und eine bessere Patientinnen- und Patientenversorgung zu erzielen, inkl. der intensiven Aufklärung der Betroffenen durch die behandelnden Berufsgruppen und – wenn von den Betroffenen gewünscht – einer gemeinsamen Entscheidungsfindung bezüglich der Behandlung.
One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making.