Compressive Strength of Tibial Cancellous Bone: Instron® and Osteopenetrometer Measurements in an Autopsy Material

The topographic variation of proximal tibial cancellous bone strength was investigated in 12 knees from routine autopsies. Samples from eight knees were tested to compressive failure in an Instron^® material testing machine, and four knees were tested with the osteopenetrometer, an instrument developed for intraoperative measurement of bone strength. Ultimate stress, elastic modulus and energy absorption of the bone were calculated from the Instron-curves. Mechanical properties varied considerably from knee to knee, but the topographic patterns were remarkably constant. The medial condyle showed the highest strength, the intercondylar area the lowest. On the medial side the bone was strongest at the front, while on the lateral side the reverse was true. The two horizontal levels tested did not differ significantly. The osteopenetrometer measurements closely modelled the pattern of ultimate stress.     

Compressive Strength of Tibial Cancellous Bone: Instron® and Osteopenetrometer Measurements in an Autopsy Material

The topographic variation of proximal tibial cancellous bone strength was investigated in 12 knees from routine autopsies. Samples from eight knees were tested to compressive failure in an Instron^® material testing machine, and four knees were tested with the osteopenetrometer, an instrument developed for intraoperative measurement of bone strength. Ultimate stress, elastic modulus and energy absorption of the bone were calculated from the Instron-curves. Mechanical properties varied considerably from knee to knee, but the topographic patterns were remarkably constant. The medial condyle showed the highest strength, the intercondylar area the lowest. On the medial side the bone was strongest at the front, while on the lateral side the reverse was true. The two horizontal levels tested did not differ significantly. The osteopenetrometer measurements closely modelled the pattern of ultimate stress.     

Biomechanical Study of Patellar Component Fixation with Varying Degrees of Bone Loss

BackgroundThe decision as to whether or not to resurface the patella in revision total knee arthroplasty (TKA) is affected by the amount of patellar bone stock remaining; however, the impact of the cancellous bone status on patellar component fixation has not been studied. Therefore, we conducted a biomechanical study of patellar component fixation with varying degrees of cancellous bone loss.MethodsSixty pairs of cadaveric patellae were randomly assigned between 3 groups and prepared in similar manner to a TKA with the standard 3-hole configuration. A control patella and an experimental patella were designated in each pair. To simulate bone loss in the experimental patellae, 1, 2, and 3 of the standard drill holes were uniformly enlarged to 12 mm in group 1, group 2, and group 3, respectively. Afterward, an all-polyethylene patellar component was cemented to each patella, as done intraoperatively. Patellar components were then sheared off using a materials testing system. The resulting mean offset yield force was analyzed within each group using paired t-tests.ResultsThe mean offset yield force for the control patellae was greater than the experimental patellae in group 1. In groups 2 and 3, the experimental patellae produced a greater mean offset yield force than the control patellae. Comparison within each group did not demonstrate a statistically significant difference.ConclusionBone loss with enlargement of the patellar fixation holes, as is frequently seen in revision TKA, with holes up to 12 mm, does not significantly decrease patellar component fixation shear strength in this biomechanical cadaveric study.     

Efficacy of bone staples for fixation

The pull-out strength of two types of bone staples (A, Techmedica; B, Richards) was evaluated in a canine model and compared with a control of 6.5 mm cancellous bone screw (Synthes). Fifteen adult mongrel dogs were divided into three groups of five animals each. The implants were placed in the lateral femoral condyle and proximal humerus on the right side at time zero, and on the left side 3 weeks later. The dogs were killed at 6 weeks. In addition a third site, the tibial tubercle, was used to examine the effectiveness of each device for patellar tendon reattachment. The strength of the reattached patellar tendon was measured and compared with a control intact patellar tendon insertion. The pull-out loads from bone of the two staple types are not statistically different. The displacement to failure, however, was found to be 71% greater (p less than 0.007), and the work to failure 128% greater (p less than 0.010) for staple A as compared with staple B. This may be of clinical relevance in avoiding staple back-out. Both staples were inferior to the screw for pull-out load displacement and work to failure (p less than 0.0001). All reattached tendons were significantly weaker (mean 202 N) than the intact tendon (mean 1,448 N) regardless of implant type. The dissected specimens uniformly showed necrosis of the tendon under the implant. Healing was by massive scar formation surrounding the implant.     

Holding power of metallic screws in cancellous bone and metallic plates in cortical bone. An experimental study on rabbits using polymethylmethacrylate and bone graft as supporting material.

The holding power of metallic screws in cancellous bone and metallic plates in cortical bone was tested in sixty rabbits (n = 60). These metallic devices were fixed either without support or with the support of plastic material or autogenous bone graft. The fixation firmness was studied radiographically and by a test of the bonding strength. After six weeks, the mean value of the holding power of screws in cancellous bone without support was 440 N, and that of screws supported by polymethylmethacrylate 674 N and by bone graft 540 N. Corresponding values after twelve weeks were 436 N, 664 N, and 616 N. Fixation with polymethylmethacrylate was better than either fixation without support (P < 0.001, t-test) or fixation with bone graft (P < 0.01), whereas fixation with bone graft was better than fixation without support (P < 0.07). The best fixation was achieved by polymethylmethacrylate according to group mean values. Our investigation of the holding power of plates in cortical bone did not reveal any statistically significant differences between the methods used.     

Bone stiffness predicts strength similarly for human vertebral cancellous bone in compression and for cortical bone in tension

The yield strength and ultimate strength of cortical and cancellous bone tissue are very highly correlated to bone stiffness. For samples of human vertebral cancellous bone in compression and for bovine cortical bone in tension, the coefficient of determination (r2) for regression between ultimate strength and stiffness was 0.89 and 0.92, and between yield strength and stiffness it was 0.94 and 0.93, respectively. The slope of the regression for human vertebral cancellous bone ultimate strength predicted by stiffness was not statistically different from similar regressions for cortical bone in tension in either a bovine sample or in published data from multiple species. We believe that the observed correlation results from the evolutionary need to build sufficiently strong bones using cells that are sensitive to deformation and that directly control bone stiffness, but not strength. The practical significance of this work is that an in vivo estimate of bone stiffness (e.g., from ultrasound measurement) may be a surrogate for bone strength.     

A histomorphological study of tendon reconstruction to a hydroxyapatite-coated implant: regeneration of a neo-enthesis in vivo.

The attachment of tendons and ligaments to massive endoprostheses remains a clinical challenge due to the difficulty in achieving a soft tissue implant interface with a mechanical strength sufficient to transmit the forces necessary for locomotion. We have used an in vivo animal model to study patellar tendon attachment to an implant surface. The interface generated when the patellar tendon was attached to a hydroxyapatite (HA) coated implant was examined using light microscopy and a quantitative histomorphological analysis was performed. In the Autograft Group, the interface was augmented with autogenous cancellous bone and marrow graft, and at six weeks an indirect-like insertion was observed. At twelve weeks, the interface was observed to be a layered neo-enthesis, whose morphology was similar to a normal direct tendon insertion. In the HA Group, the tendon-implant interface was not augmented, and the implant was enveloped by a dense collagenous fibrous tissue. This study shows that a tendon-implant neo-enthesis can develop in situ by employing a suitable implant surface in association with biological augmentation.     

Statin Given Perorally to Adult Rats Increases Cancellous Bone Mass and Compressive Strength

Recently, it has been shown that statins increased cancellous bone formation and volume in 3-month-old rats and induced a minor decrease in osteoclast number. In the present study, one-year-old female rats were given simvastatin (10 mg/kg) or placebo daily for 3 months by a gastric tube. Specimens, 2.0 mm high, were cut transversely from the 5th lumbar vertebral body. The cancellous bone core diameters within the cortical shell of each specimen were delineated by a micro-CT scanner and then the cancellous bone was compressed in a materials testing machine between an upper and a lower platen with a diameter corresponding to the diameter of the cancellous bone core of each specimen. The cancellous bone volume was determined histomorphometrically on transverse sections. The cancellous bone volume in the simvastatin group (52.7 +/- 1.6%, mean value +/- SEM) was increased by 23% compared with the placebo group (42.8 +/- 1.7%). The compressive stress of the cancellous bone from the simvastatin group (31.8 +/- 2.7 MPa) was increased by 24% compared with the placebo group (24.1 +/- 1.9 MPa). No changes were found in cortical bone mass and strength after the statin treatment. In conclusion, statin given perorally to adult rats increased cancellous bone mass and increased cancellous bone compressive strength. The cancellous bone was found to possess normal biomechanical competence after the statin treatment.     

Biomechanical testing of quadriceps tendon–patellar bone grafts: an alternative graft source for press-fit anterior cruciate ligament reconstruction?

Introduction: Press-fit fixation of bone-patellar tendon–bone (BPTB) grafts in anterior cruciate ligament (ACL) reconstruction has been analyzed biomechanically in previous studies; however, the use of quadriceps tendon–patellar bone (QTPB) grafts has not been studied so far. It is hypothesized that QTPB grafts provide primary fixation strength comparable to BPTB grafts in press-fit ACL reconstruction with respect to bone plug length and loading angle. Materials and methods: Fifty-two QTPB grafts were harvested from fresh human cadaver knees (mean age 73.3 years) with the length of the patellar bone plug being either 15 mm (Group I) or 25 mm (Group II). The grafts were anchored within fresh porcine femora (mean age 12 months) using a press-fit fixation technique. Forty-eight specimens were loaded to failure at 10 mm/s with varying loading angles of 0°, 30°, and 60° until failure. A microradiographic pre–post-implantation analysis was conducted on four grafts. Results: The biomechanical testing showed a significant difference in the ultimate failure loads comparing Group I (mean 224±79.3 N) to Group II (mean 339±61.4 N), both showing mean ultimate failure loads to increase with rising loading angle. The predominant mode of failure was graft pullout at axial loading and tendon rupture at 60° loading angle. The microradiographic analysis revealed an iatrogenic damage of the bone–tendon junction on the cancellous aspect of the bone plug in all trials, corresponding with the site of impactor placement during implantation. Conclusion: QTPB grafts provide a loading capability comparable to BPTB grafts in press-fit ACL reconstruction. The broad and profound area of quadriceps tendon attachment to the patellar bone plug makes graft implantation demanding.     

Bone-grafting for severe patellar bone loss during revision knee arthroplasty

BACKGROUND: Severe patellar bone loss may preclude adequate fixation of another patellar prosthesis as a part of revision knee replacement. The purpose of this study was to describe the surgical technique and early clinical results of an alternative to the conventional treatment options of either patellectomy or retention of the remaining patellar osseous shell. The goals of this procedure are to restore patellar bone stock and potentially to improve the functional outcome. METHODS: Severe patellar bone loss had left a "patellar shell" that precluded insertion of another patellar implant in nine of 100 consecutive knees undergoing revision total knee arthroplasty. Rather than performing a patellectomy or simply retaining the patellar osseous shell in these nine knees (eight patients), I performed a surgical procedure in which a tissue flap was secured to the patellar rim to contain cancellous bone graft inserted into the patellar bone defect. Final follow-up was at a mean of 36.7 months (range, twenty-four to fifty-five months) after the patellar bone-grafting procedure. RESULTS: The mean preoperative Knee Society scores for function and pain were 39 points (range, 18 to 82 points) and 40 points (range, 20 to 80 points), respectively. At the time of final follow-up, the Knee Society function and pain scores had improved significantly, to a mean function score of 91 points (range, 80 to 98 points) and a mean pain score of 84 points (range, 65 to 100 points) (p<0.05). The point of greatest patellar thickness measured intraoperatively ranged from 7 to 9 mm. Patellar thickness on immediate postoperative Merchant radiographs averaged 22 mm (range, 20 to 25 mm) whereas, at the time of final follow-up, patellar thickness averaged 19.7 mm (range, 17 to 22.5 mm). CONCLUSIONS: In contrast with other treatment alternatives, this surgical procedure imparts the potential for restoring patellar bone stock and may improve functional outcome by facilitating patellar tracking and improving quadriceps leverage. On the basis of satisfactory short-term to mid-term clinical results, this technique of patellar bone-grafting appears to be an important addition to the armamentarium of surgeons performing revision knee arthroplasties.     

Structural parameters and mechanical strength of cancellous bone in the femoral head in osteoarthritis do not depend on age

For normal bone, aging has been associated with a decrease of both density and failure strength, and with the development of pathologies such as osteoporosis. Conversely, it has been reported that another common disease, osteoarthritis, may alter these age-related changes in cancellous bone, suggesting that it may have a protective role against osteoporosis and the correspondent fracture risk. It was reported that in the principal compressive region of the femoral head in osteoarthritis the bone density does not depend on age. However, it is not clear if this independence on age of the cancellous bone density corresponds also to a reduced dependence on age of the strength to failure. The present work examined cancellous bone from the principal compressive region of the femoral head of 37 patients having severe osteoarthritis. The aim was (1) to investigate the dependence on age of both the structural parameters and the ultimate stress and (2) to investigate the relationships between the ultimate stress and the structural parameters. Using X-ray microcomputed tomography, three-dimensional structural parameters, such as bone volume fraction, direct trabecular thickness and structure model index were calculated. Then the specimens were compressed to failure to determine the ultimate stress. It was found that none of the investigated structural parameters did depend on age, and also the ultimate stress did not depend on age (p>0.05 for all regressions on age). In addition, the ultimate stress was significantly correlated with the structural parameters, primary with the minimum bone volume fraction and the average bone volume fraction (R(2)=0.95 and R(2)=0.84, respectively). These findings show that severe osteoarthritis or a related factor may change the age dependences of both the structural parameters and the mechanical properties usually reported for normal cancellous bone. These results suggest for this pathology to have a protective role against the age-related decrease in density, the age-related deterioration of the microarchitecture and the age-related decrease of the failure strength for the cancellous bone in the principal compressive region of the human femoral head.     

Matrix Concentration of Insulin-like Growth Factor I (IGF-I) is Negatively Associated with Biomechanical Properties of Human Tibial Cancellous Bone Within Individual Subjects

Insulin-like growth factor-I (IGF-I), abundant in bone matrix, is believed to play an important role during bone development and remodeling. To our knowledge, however, few studies have addressed the relationship between the concentration of IGF-I in bone matrix and the biomechanical properties of bone tissue. In this study, forty-five cylindrical specimens of cancellous bone were harvested from six human tibiae and scanned using microcomputed tomography (μCT). The bone volume fraction (BV/TV) was calculated from three-dimensional (3D) μCT images. Mechanical tests were then performed on a servohydraulic testing system to determine the strength and stiffness of cancellous bone. Following mechanical testing, the concentration of IGF-I in bone matrix was measured by using an enzyme-linked immunoabsorbent assay (ELISA). Within each subject, the concentration of IGF-I in bone matrix had significant (P < 0.01) negative correlations with the bone volume fraction, strength, and stiffness of cancellous bone. In particular, the anterior quadrant of the proximal tibia was significantly (P < 0.02) greater in IGF-I matrix concentration and marginally significantly lower in strength (P = 0.053) and stiffness (P = 0.059) than the posterior quadrant. The negative correlations between the cancellous bone matrix concentration of IGF-I and cancellous bone biomechanical properties within subjects found in this study may help us understand the variation of the biomechanical properties of cancellous bone in proximal human tibiae.     

Biomechanical effects of simulated resorption cavities in cancellous bone across a wide range of bone volume fractions

Resorption cavities formed during bone remodeling may act as “stress risers” and impair cancellous bone strength, but biomechanical analyses of the effects of stress risers have been limited. To provide further insight, we assessed the theoretical biomechanical effects of virtually-added resorption cavities in cancellous bone specimens spanning a wide range of bone volume fraction (BV/TV = 0.05–0.36) and across different anatomic sites (hip and spine) and species (human and canine). Micro-CT scans of 40 cubes of cancellous bone were converted into nonlinear finite element models (voxel element size ∼ 20 µm) for strength assessment. In each model, uniform trench-like resorption cavities with nominal dimensions 500 µm (length) × 200 µm (width) × 40 µm (depth), were virtually added either at random locations throughout the specimen, or, preferentially at locations of high tissue-level strain. We found that cancellous bone strength (p < 0.0001) and its relation with BV/TV (p < 0.001) were both altered by the virtual addition of the resorption cavities. When the resorption cavities were added at random locations throughout the specimen, the reduction in strength did not depend on BV/TV or anatomic site or species. When the resorption cavities were instead added preferentially at locations of high tissue-level strain, the effect was accentuated and was greatest in low-BV/TV bone. We conclude that, in theory, uniform-sized resorption cavities can reduce cancellous bone strength over the full range of BV/TV and across species, and the effect is larger if the cavities occur at highly strained locations in low-BV/TV bone. © 2012 American Society for Bone and Mineral Research.     

Mechanical strength of bone in canine osteoporosis model: Relationship between bone mineral content and bone fragility

The purpose of this study was to clarify the relationship between bone mineral content (BMC) and mechanical strength in beagle dog models, and to find whether the mechanical strength changed with changes in BMC. We used 17 beagle dogs to create an experimental osteoporotic model, dividing them into six groups, based on age and experimental period. Presence and absence of ovariectomy (OVX); and calcium content of the diet. BMC was determined by dual-energy quantitative computed tomography in the lumbar vertebrae, and the mechanical strength of cancellous bone harvested from the lumbar vertebral body and femoral neck was measured. OVX alone did not affect either BMC or mechanical strength. However, when the dogs were ovariectomized, and then given a reduced calcium diet, the mechanical strength of the femoral neck decreased in parallel with the cortical BMC of the lumbar vertebrae. The mechanical strength of the vertebral cancellous bone was not decreased when the BMC was reduced by 20%, but was decreased when BMC was reduced by 30%.     

Bone grafting of cryosurgically treated bone defects: experiments in goats

It is hypothesized that cryosurgically treated bone defects are inappropriate host sites for cancellous bone grafting. The influence of autologous cancellous bone grafting on the healing of cryosurgically treated gap defects of long bones was investigated. A unilateral in vivo experiment was done to study bone strength and graft incorporation in the goat. The lining of a cylindrical defect of the femoral diaphysis was treated with a closed liquid nitrogen cryoprobe in 62 goats. Thirty-one animals received an impacted, morselized, cancellous bone graft harvested from the sternum. The other 31 animals served as controls. At 0, 4, 7, 10, 13, 16, and 26 weeks animals were euthanized and the femurs were evaluated for torsional strength, computed tomography, and histologic assessment. Specimens with a bone graft showed no significant increase in torsional strength with time compared to the controls. In all goats euthanized at 10 weeks or later, the graft was resorbed. The amount of bone apposition at the site of the cryosurgical lesion and the time at which the defect was bridged were similar in both groups. Autologous cancellous bone grafting does not accelerate healing of cryosurgically treated, stable, diaphyseal defects in the goat.     

松质骨显微结构参数与表观力学强度关系研究进展

通过双能X射线吸收法测量受试者的骨密度,是目前公认的诊断骨质疏松症的方法。然而,越来越多的基础和临床研究发现,骨密度的改变并不能完全解释患者骨强度的改变。大量的骨组织显微结构研究发现,松质骨的骨强度主要由骨密度、骨结构等因素决定。近年来的研究表明,在决定松质骨骨骼强度方面,骨组织的显微结构可以作为独立于骨密度之外的决定性参数。研究松质骨的力学属性和显微结构之间的关系,对于更好的理解骨质疏松的发生和对骨质疏松的诊断具有十分重要的意义。根据文献回顾,松质骨显微结构参数和表观力学强度之间关联性最为显著的为BV／TV、Tb．N、连接性、各向异性、结构模型指数等。同时笔者也对目前这些研究结果在临床上高分辨率CT上的应用情况做一总结。     

Subchondral bone strength in arthrosis. Cadaver studies of tibial condyles

We measured the axial penetration strength of subchondral cancellous bone in a close, regular pattern at the tibial resection surface of five valgus and seven varus human, cadaveric knees. The strength patterns obtained were illustrated by pseudo-three-dimensional reconstructions of strength values as a function of the location on the resection surface. The varus knees had high strength values towards the medial margin of the medial condyle. Three qualitatively different strength patterns were distinguished in the valgus knees: two knees showed a near normal strength distribution with higher peak values medially; two knees with centrolateral bony attrition had high bone strength values at the center of the lateral condyle; and one knee with moderate posterolateral bony attrition showed a high strength area at the posterolateral aspect of the lateral condyle. In both types of malalignment, there was a decrease of bone strength with the depth from the resection surface.     

Effects of High-Fat Diet on Mature Bone Mineral Content, Structure, and Mechanical Properties

Diets with a high saturated fat content can produce deleterious effects on the absorption of dietary calcium and consequently an adverse effect on bone mineralization in growing animals. Hence dietary fat may have long-term consequences for skeletal health and skeletal pathologies such as osteoporosis. Whether a diet high in saturated fat has similar negative effects on adult bone, however, remains unresolved. Thus, we investigated effects of a high-fat diet on mature bone structure and mechanics. Adult (40-week-old) roosters were maintained for 20 weeks on either a diet high in saturated fat (HF) or a low-fat (LF) diet. Cortical bone samples (tarsometatarsus) were tested mechanically in three-point bending, and cancellous bone cores from the femoral condyles and tibial plateau (four sites per knee) were tested mechanically in compression. Cortical bone cross-sectional areal data were also compared among the groups, and bone mineral content (BMC) was determined (by ashing) for both cortical bone and cancellous bone samples. There were no significant high-fat diet effects on mature cortical bone mechanical properties, geometric structure, or mineral content. Diet, however, did affect cancellous bone composition. For example, LF cancellous BMC was significantly greater than HF. Mechanical properties of the cancellous bone showed similar trends such that LF cancellous bone strength was consistently greater than HF. The potential for adverse effects of a HF diet on intestinal calcium absorption in the mature animal may be more apparent in cancellous bone, with its faster rate of turnover, than in cortical bone. Changes in cancellous bone structure and mechanical properties, related to dietary saturated fats, may have implications for understanding the role of nutrition in skeletal health and prevention of pathological bone loss (osteoporosis). Received: 27 January 1997 / Accepted: 9 October 1997     

Pairwise strength relationships of cortical and cancellous bone in human femur: an autopsy study

To analyze the mechanical properties of cortical and cancellous bone in the femur and relate them to bone mineral, we retrieved 14 pairs of femurs from elderly subjects at autopsy. Bone mineral was measured by quantitative single-energy computed tomography. Significant associations were found between two types of cortical bone mechanical tests, three-point bending and pull-out of screw, one performed on the right and the other on the left femur. Similarly, pairwise associations were found between the mechanical tests of cancellous bone, punch and cube compression, one performed on the right and the other on the left femur. Also, all mechanical tests correlated with bone mineral as determined by quantitative single-energy computed tomography. In general, bone mass measures correlated better with bone strength than did bone density measures. However, the cortical and cancellous bone mechanical properties were not interrelated, which suggests a separate regulation of the strength of these two types of bone. Bone mineral may not only have importance for the occurrence of fractures; it should be considered as an important factor in the fixation of fragile bone.