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L E Claes
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ABSTRACT: The conditions for experimental orthopedic and trauma research in Germany have improved during recent years. At present, however, only a few research centers provide significant and continuous research. Recently advertised new professorships considerably enhance the chances of further improvement and it is hoped that this process will continue. The recruitment of orthopedic and trauma surgeons for professional research remains an unsolved problem due to financial and working conditions. To do both qualified research and clinical work on a high level over a long period of time is hardly possible within the existing structures. This problem can only be solved by establishing professional research laboratories with permanent scientific and technical staff and limited leave of absence for doctors from clinical work. Even in the future professional research departments and centers will have a notable advantage in the competition for research grants. Looking ahead there is hope that the conditions for orthopedic and trauma research will continue to improve and gain a relevance reflecting the importance of this field.
Der Unfallchirurg 10/2009; 112(12):1079-81, 1083-4. · 0.61 Impact Factor
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ABSTRACT: Cell culture studies have shown that NSAID may influence osteogenic activities of osteoblast cultures. However, these studies did not consider long-term effects on differentiating cells. The influence of Voltaren with the non-steroidal agent diclofenac on proliferation and gene expression of the osteoblast-like cell line SaOS-2 was investigated 2, 9, and 16 days after incubation. Two days after 24 h of incubation, 50 microg/ml diclofenac reduced the proliferation and collagen type I expression while 9 and 16 days later no effect was found on either of the parameters. In contrast, 50 microg/ml NSAID has no effect on alkaline phosphatase expression 2 days after incubation while 9 and 16 days later expression had been reduced. Lower concentrations (1.56 and 0.19 microg/ml) had no effects on the studied parameters. BrdU and MTT test showed that 50 microg/ml diclofenac reduced proliferative and metabolic activity. Lower concentrations (< or =25 microg/ml) had a lower or no influence. The findings indicate that the NSAID impairment depends on cellular differentiation stage and is not confined to the time during or immediately after NSAID incubation. According to these results in vitro testing of drugs should be performed over a longer time period to detect possible long-term impacts.
Der Unfallchirurg 02/2005; 108(1):18, 20-4. · 0.61 Impact Factor
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ABSTRACT: Zellkulturstudien wiesen nach, dass nichtsteroidale Antirheumatika osteogene Aktivitten von Osteoblastenkulturen beeinflussen. Lngerfristige Effekte auf die sich differenzierenden Osteoblasten wurden dabei allerdings nicht bercksichtigt. Deshalb wurde der Einfluss von Voltaren mit dem nichtsteroidalen Wirkstoff Diclofenac auf die Proliferation und Genexpression von SaOS-2-Zellen 2, 9 und 16Tage nach Inkubation untersucht.50g/ml Diclofenac hatten 2Tage nach 24-stndiger Inkubation einen hemmenden Effekt auf die Proliferation und Kollagenexpression. Nach 9 und 16Tagen Kulturdauer waren keine Effekte mehr nachweisbar. Im Gegensatz dazu wurde die Expression der alkalischen Phosphatase erst 9 und 16Tage nach Inkubation vermindert. Geringere Konzentrationen (1,56 und 0,19g/ml) hatten keine Effekte auf die beiden untersuchten Parameter. Im BrdU- und MTT-Test fhrten 50g/ml Diclophenac zu einer Erniedrigung der Stoffwechsel- und Proliferationsrate. Geringere Konzentrationen (25g/ml) hatten einen geringeren oder keinen Einfluss.Eine medikamentse Beeintrchtigung verschiedener Knochenzellaktivitten ist abhngig von der Zelldifferenzierung und nicht auf den Zeitpunkt whrend oder unmittelbar nach Medikamentengabe beschrnkt. In-vitro-Tests von Medikamenten in der Osteoblastenkultur sollten deshalb ber einen lngeren Zeitraum erfolgen.Cell culture studies have shown that NSAID may influence osteogenic activities of osteoblast cultures. However, these studies did not consider long-term effects on differentiating cells.The influence of Voltaren with the nonsteroidal agent diclofenac on proliferation and gene expression of the osteoblast-like cell line SaOS-2 was investigated 2, 9, and 16days after incubation.Two days after 24h of incubation, 50g/ml diclofenac reduced the proliferation and collagen type I expression while 9 and 16days later no effect was found on either of the parameters. In contrast, 50g/ml NSAID had no effect on alkaline phosphatase expression 2days after incubation while 9 and 16days later expression had been reduced. Lower concentrations (1.56 and 0.19g/ml) had no effects on the studied parameters. BrdU and MTT test showed that 50g/ml diclofenac reduced proliferative and metabolic activity. Lower concentrations (25g/ml) had a lower or no influence.The findings indicate that the NSAID impairment depends on cellular differentiation stage and is not confined to the time during or immediately after NSAID incubation. According to these results in vitro testing of drugs should be performed over a longer time period to detect possible long-term impacts.
Der Unfallchirurg 12/2004; 108(1):18-24. · 0.61 Impact Factor
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G D Krischak,
F Gebhard,
W Mohr,
V Krivan,
A Ignatius,
A Beck,
N J Wachter,
P Reuter,
M Arand,
L Kinzl, L E Claes
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ABSTRACT: Stainless steel and commercially pure titanium are widely used materials in orthopedic implants. However, it is still being controversially discussed whether there are significant differences in tissue reaction and metallic release, which should result in a recommendation for preferred use in clinical practice.
A comparative study was performed using 14 stainless steel and 8 commercially pure titanium plates retrieved after a 12-month implantation period. To avoid contamination of the tissue with the elements under investigation, surgical instruments made of zirconium dioxide were used. The tissue samples were analyzed histologically and by inductively coupled plasma atomic emission spectrometry (ICP-AES) for accumulation of the metals Fe, Cr, Mo, Ni, and Ti in the local tissues. Implant corrosion was determined by the use of scanning electron microscopy (SEM).
With grades 2 or higher in 9 implants, steel plates revealed a higher extent of corrosion in the SEM compared with titanium, where only one implant showed corrosion grade 2. Metal uptake of all measured ions (Fe, Cr, Mo, Ni) was significantly increased after stainless steel implantation, whereas titanium revealed only high concentrations for Ti. For the two implant materials, a different distribution of the accumulated metals was found by histological examination. Whereas specimens after steel implantation revealed a diffuse siderosis of connective tissue cells, those after titanium exhibited occasionally a focal siderosis due to implantation-associated bleeding. Neither titanium- nor stainless steel-loaded tissues revealed any signs of foreign-body reaction.
We conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the 'golden standard' for osteosynthesis material in general.
Archives of Orthopaedic and Trauma Surgery 04/2004; 124(2):104-13. · 1.37 Impact Factor
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G.D. Krischak,
F. Gebhard,
W. Mohr,
V. Krivan,
A. Ignatius,
A. Beck,
N.J. Wachter,
P. Reuter,
M. Arand,
L. Kinzl, L.E. Claes
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ABSTRACT: IntroductionStainless steel and commercially pure titanium are widely used materials in orthopedic implants. However, it is still being controversially discussed whether there are significant differences in tissue reaction and metallic release, which should result in a recommendation for preferred use in clinical practice.Materials and methodsA comparative study was performed using 14 stainless steel and 8 commercially pure titanium plates retrieved after a 12-month implantation period. To avoid contamination of the tissue with the elements under investigation, surgical instruments made of zirconium dioxide were used. The tissue samples were analyzed histologically and by inductively coupled plasma atomic emission spectrometry (ICP-AES) for accumulation of the metals Fe, Cr, Mo, Ni, and Ti in the local tissues. Implant corrosion was determined by the use of scanning electron microscopy (SEM).ResultsWith grades 2 or higher in 9 implants, steel plates revealed a higher extent of corrosion in the SEM compared with titanium, where only one implant showed corrosion grade 2. Metal uptake of all measured ions (Fe, Cr, Mo, Ni) was significantly increased after stainless steel implantation, whereas titanium revealed only high concentrations for Ti. For the two implant materials, a different distribution of the accumulated metals was found by histological examination. Whereas specimens after steel implantation revealed a diffuse siderosis of connective tissue cells, those after titanium exhibited occasionally a focal siderosis due to implantation-associated bleeding. Neither titanium- nor stainless steel-loaded tissues revealed any signs of foreign-body reaction.ConclusionWe conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the golden standard for osteosynthesis material in general.
Archives of Orthopaedic and Trauma Surgery 02/2004; 124(2):104-113. · 1.37 Impact Factor
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ABSTRACT: Regarding orthopaedic implant loosening it has been hypothesized that particle-activated macrophages release interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha). This in turn stimulates osteoblasts to release interleukin-6 (IL-6) and prostaglandin E(2) (PGE(2)). These mediators recruit and activate osteoclasts and may therefore lead to bone resorption and loss of implant fixation. In this study we compared the ability of different materials to induce the release of IL-6 and PGE(2) from primary isolated, human osteoblasts without preceding activation by macrophages. We tested stainless steel, cobalt-chromium alloy (CoCrMo), commercially pure titanium (cpTi), Ti-6Al-7Nb and Ti-6Al-4V processed in the same manner as corresponding clinical implants. After 12 and 24h the cells had actively secreted IL-6 and PGE(2). There were no clear differences among the implant materials or with the plastic control. The amount of factors the cells released in our study compare well with the findings of other authors who investigated osteoblasts on plastic. In comparison with the literature these amounts are lower than secretion levels of osteoblasts stimulated with implant particles, IL-1 or TNF-alpha. Moreover, other authors found that osteoclasts require higher concentrations of PGE(2) to become activated than the concentrations measured in our experiments. Therefore, the amount of PGE(2) released from the osteoblasts in our study is probably not sufficient to induce osteolytic activity. Because of contradictory statements in the literature it is unclear if the measured IL-6 concentrations promote osteolytic activity. Differences in material composition does not significantly influence the release of these factors if the materials have similar surface roughnesses.
Biomaterials 11/2003; 24(23):4191-6. · 7.40 Impact Factor
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ABSTRACT: The surfaces of retrieved failed cementless total hip implants made of cobalt-chromium-molybdenum casting alloy and of wrought titanium 6-aluminum 4-vanadium alloy were studied with the use of scanning-electron microscopy (SEM), energy-dispersive X-ray analysis (EDX) and X-ray photoelectron spectroscopy (XPS). New implants of the same make served as controls. The XPS scans revealed a dense carbon layer on the entire analyzed specimen. The relative composition of the titanium alloy implants showed an overall agreement with the international standards for implants for surgery, and the overall surface composition did not change over the period of the implantation. However, an inhomogeneous distribution of the constituents could be demonstrated in the retrieved as well as in the new MEC-screw rings made of TiAl6V4 alloy, an implant that has been linked to a high early failure rate. In the CoCr-alloy components (Lord-screw rings) a high percentage of aluminum, mainly organized in aluminum inclusions, was found in the retrieved as well as in the new implants.
Journal of Biomedical Materials Research Part B Applied Biomaterials 03/2003; 64(2):99-106. · 2.15 Impact Factor
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ABSTRACT: Porous composite materials made of poly(L, DL-lactide) and a ceramic component, alpha-tricalcium phosphate (alpha-TCP) or one of the rapidly resorbable glass ceramics, GB9N or GB14N, respectively, were developed to be used as bone substitutes. The present article describes the mechanical properties and the in vitro degradation characteristic of the different composite materials. The yield strength, the elastic modulus, and the molecular weight were measured after in vitro degradation up to 78 weeks. The initial strengths of the alpha-TCP composite (12.5 +/- 0.7 MPa) was higher than that of the GB9N and GB14N composites (8.3 +/- 0.2 MPa and 10.9 +/- 0.2 MPa, respectively). The initial elastic moduli of the composites were between 450 and 650 MPa. The mechanical properties remained constant until a degradation period of 26 weeks. Then they decreased continuously until they were completely lost at week 52. The molecular weight (M(w)) decreased steadily from 91,000 D in the case of the alpha-TCP composite and 78,000 D and 85,000 D in the case of the GB9N or GB14N composites, respectively, to about 10,000 D at week 78. It was concluded that the composites show adequate mechanical properties in the range of cancellous bone and a suitable degradation characteristic to be used as bone substitute materials.
Journal of Biomedical Materials Research 11/2001; 57(1):126-31.
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ABSTRACT: Current procedures for treatment of degenerative disc disease may not restore flexibility or disc height to the intervertebral disc. Recently, a prosthetic device, intended to replace the degenerated nucleus pulposus, was developed. In this biomechanical in vitro test the authors study the effect of implanting a prosthetic nucleus in cadaveric lumbar intervertebral discs postnucleotomy and determine if the flexibility and disc height of the L4-5 motion segment is restored.
The prosthetic disc nucleus device consists of two hydrogel pellets, each enclosed in a woven polyethylene jacket. Six human cadaveric lumbar motion segments (obtained in individuals who, at the time of death, were a mean age of 56.7 years) were loaded with moments of +/- 7.5 Nm in flexion-extension, lateral bending, and axial rotation. The following states were investigated: intact, postnucleotomy, and after device implantation. Range of motion (ROM) and neutral zone (NZ) measurements were determined. Change in disc height from the intact state was measured after nucleotomy and device implantation, with and without a 200-N preload.
Compared with the intact state (100%), the nucleotomy increased the ROM in flexion-extension to 118%, lateral bending to 112%, and axial rotation to 121%; once the device was implanted the ROM was reduced to 102%, 88%, and 90%, respectively. The NZ increased the ROM to 210%, lateral bending to 173%, and axial rotation to 107% after nucleotomy, and 146%, 149%, 44%, respectively, after device implantation. A 200-N preload reduced the intact and postnucleotomy disc heights by approximately 1 mm and 2 mm, respectively. The original intact disc height was restored after implantation of the device. The results of the cadaveric L4-5 flexibility testing indicate that the device can potentially restore ROM, NZ, and disc height to the denucleated segment.
Journal of Neurosurgery 11/2001; 95(2 Suppl):208-14. · 2.96 Impact Factor
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ABSTRACT: Tricalcium phosphate ceramics (TCPs) are increasingly used as bone substitutes. They demonstrate good biocompatibility and degrade relatively slowly. New glass ceramics based on calcium alkali orthophosphates (Ca(2)KNa(PO(4))(2)) were developed that degrade faster than TCP but could have reduced biocompatibility due to their high solubility. Therefore, they were modified by a neutralizing surface treatment. The aim of this study was to evaluate the biocompatibility of some of these ceramics, GB1a, GB9, and GB14, which differ in the amount of added Na, K, Mg, or Si ions, with standard and modified surfaces. The in vitro cytotoxicity of the ceramics GB1a, GB9, and GB14 was determined by the agar diffusion and filter test and the microculture tetrazolium (MTT) assay. In order to investigate the influence of surface modification, these three ceramics were compared to their surface-treated counterparts, GB1aN, GB9N, and GB14N. GB1a, the ceramic with the highest in vitro solubility, showed the strongest toxic influence in all cell culture tests. GB9 and GB14 produced better results. In contrast, the counterparts with modified surfaces exhibited no (GB9N, GB14N) or weak (GB1aN) signs of cytotoxicity. It is concluded that the toxicity of the ceramics GB1a, GB9, and GB14 depends on their solubility. A positive influence of the surface treatment on in vitro biocompatibility was demonstrated. Therefore, the surface-treated glass ceramics could be promising materials for bone replacement.
Journal of Biomedical Materials Research 07/2001; 55(3):285-94.
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ABSTRACT: Loading of the spine is still not well understood. The most reliable results seemed to come from the intradiscal pressure measurements from studies by Nachemson, 1966. A new similar study by Wilke et al. (1999) complemented the present study and confirmed some of the earlier data, although it contradicted others. The new data did not confirm that the load on the spine is higher in sitting compared with standing and did not find distinct differences between positions in which subjects were lying down. The objective of this paper was to compare results from two independent in vivo studies (applying different methods) to provide information about spinal loading. In one of these studies (Wilke 1999), intradiscal pressure was measured in one volunteer in different postures and exercises, and in the other study (Rohlmann et al. 1994) the loads on an internal spinal fixation device (an implant for stabilising unstable spines) were determined in 10 patients. The absolute values of the results from both studies were normalized and compared for many body positions and dynamic exercises. The relative differences in intradiscal pressure and flexion bending moments in the fixators corresponded in most cases. Both studies showed slightly lower loads for sitting than for standing and comparatively low loads in all lying positions. High loads were measured for jogging, jumping on a trampoline and skipping. Differences between trends for intradiscal pressure and for flexion bending moments in the fixators were found when the load was predominantly carried by the anterior spinal column, as during flexion of the upper part of the body or when lifting and carrying weights. The combination of the results from these two methods may improve the understanding of the biomechanical behaviour of the lumbar spine and may be used to validate models and theories of spinal loading.
Ergonomics 07/2001; 44(8):781-94. · 1.41 Impact Factor
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ABSTRACT: The aim of the study was to assess the mechanical efficacy of a new resorbable polymer developed on the basis of alkylene bis(dilactoyl)-methacrylate to improve the anchorage of osteosynthesis material in cancellous bone. Cancellous bone screws were inserted in bovine as well as in human vertebrae and human femoral condyles and were augmented with the new polymer or polymethylmethacrylate (PMMA), respectively. Nonaugmented screws were used as controls. A removal torque test, a dynamic fatigue test, and a pullout test were performed. Augmentation with the new polymer increased the removal torque by 84% in human femoral bone. In the dynamic fatigue test of bovine vertebrae, the removal torque after cyclic loading was 115% higher for the new polymer compared to the nonaugmented controls. In the human vertebrae, the reinforcement with the new polymer increased the removal torque after dynamic loading by 114%. The augmentation with the new polymer increased the pullout force by 88% in bovine vertebrae and by 118% in human vertebrae in comparison to nonaugmented screws. It was concluded that augmentation by the new resorbable polymer significantly enhanced the anchorage of bone screws in cancellous bone. The mechanical efficiency of the new polymer was comparable to that of PMMA cement.
Journal of Biomedical Materials Research 06/2001; 58(3):254-60.
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ABSTRACT: Fusion is the main goal in the surgical management of the injured and unstable spine. A wide variety of implants is available to enhance this. Our study was performed to evaluate the stabilising characteristics of several anterior, posterior and combined systems of fixation. Six thoracolumbar (T11 to L2) spines from 13-week-old calves were first tested intact. Then the vertebral body of T13 was removed and the defect replaced and supported by a wooden block to simulate bone grafting. Dorsal implants consisting of a Universal Spine System (USS) fracture system and an AO Fixateur interne (AOFI), and ventral implants comprising of a Kaneda Classic, a Kaneda SR, a prototype of the VentroFix single clamp/single rod construct (SC/SR) and the VentroFix single clamp/double rod construct (SC/DR) were first implanted individually to stabilise the removal of the vertebral body. Simulating the combined anteroposterior stabilisations, all ventral implants were combined with the AOFI. The range of motion (ROM) was measured under loads of up to 7.5 Nm. The load was applied in a custom-made spine tester in the three primary directions while measuring the intervertebral movements using a goniometric linkage system. The dorsal systems limited ROM in flexion below 0.9 degrees and in extension between 3.3 degrees and 3.6 degrees (median values). The improved Kaneda System SR yielded a mean ROM of 1.8 degrees in flexion and in extension. The median rotation found with the VentroFix (SC/DR) was 3.2 degrees for flexion and 2.8 degrees for extension. Reinforcement of the ventral constructs with a dorsal system reduced the ROM in flexion and extension in all cases to 0.4 degrees and lower. In rotation, the median ROM of the anterior systems ranged from 2.7 degrees to 5.1 degrees and for the posterior systems from 3.9 degrees to 5.7 degrees, while the combinations provided a ROM of 1.2 degrees to 1.9 degrees. In lateral bending, the posterior implants restricted movement to 1.1 degrees, whereas the anterior implants allowed up to 5.2 degrees. The combined systems provided the highest stability at less than 0.6 degrees. Our study revealed distinct differences between posterior and anterior approaches in all primary directions. Also, different stabilisation characteristics were found within the anterior and posterior groups. Combinations of these two approaches provided the highest stability in all directions.
Journal of Bone and Joint Surgery - British Volume 06/2001; 83(4):609-17. · 2.83 Impact Factor
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ABSTRACT: Recent studies have shown osteogenic effects of high-frequency mechanical stimuli. The purpose of this study was whether externally applied, high-frequency, low-magnitude interfragmentary movements affect the process of bone healing. In 12 sheep, a transverse osteotomy with a 3 mm gap was created in the right metatarsus and externally stabilized by a rigid circular fixator. External stimulation was performed in six sheep with the use of ground-based vibration. The sheep were standing with their hind limbs on a platform that produced vertical movements resulting in interfragmentary movements of approximately 0.02 mm magnitude at 20 Hz frequency. The other six sheep remained rigidly stabilized by external fixation during the 8-week study and served as a control group. Healing was assessed postmortem by densitometric and mechanical examinations. No significant differences were found between the two groups, although callus formation was slightly enhanced (11%) in the stimulated group compared with the control group. Mechanical stimuli attributable to weightbearing in the control group were sufficient enough to initiate callus formation even under rigid, external fixation. Thus, external mechanical stimulation with the stimulation design described in the current study might not be indicated for improvement of bone healing.
Clinical Orthopaedics and Related Research 05/2001; · 2.53 Impact Factor
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ABSTRACT: Loads acting in an internal fixator measured in vitro under the application of pure moments such as those commonly used for implant testing and basic research were compared with loads measured in 10 patients in vivo.
To investigate whether these recommended loading conditions are valid by comparing in vivo measurements and those obtained in an in vitro experiment.
Pure bending moments are often preferred as loading conditions for spinal in vitro testing, either for implant testing or basic research. The advantage of this loading pattern is that the bending moment is uniform along the multisegmental specimen. However, functional loading of the spine by muscles or external loads subjects the spine to a combination of forces and moments.
In an in vivo experiment, loads acting on an internal spinal fixator in 10 patients were determined before and after anterior interbody fusion during flexion, extension, left and right lateral bending, and left and right axial twisting of the upper body with the patient standing. For comparison, an equivalent in vitro data set was created with 7 human lumbar specimens in which the same type of fixator was used. All specimens were tested under the application of pure bending moments in the three main motion planes in the intact state with fixator, after corpectomy, and with bone graft.
Consistent qualitative agreement between in vivo and in vitro measurements for the loads acting in the internal spinal fixator were found for axial rotation and lateral bending. For flexion and extension, reasonable agreement was found only for the intact spines with fixators. After corpectomy and after inserting a bone graft, the median values for axial force and bending moment in the sagittal plane in vitro did not agree with in vivo measurements. An axial preload in the in vitro experiment slightly increased the axial compression force and flexion bending moment in the fixators.
The application of pure moments to intact lumbar spinal specimens in vitro produces forces and moments in implants comparable with loads observed in vivo. During basic research on intact specimens or implant testing involving a removed disc or corpectomy, muscle forces are necessary to simulate realistic conditions.
Spine 04/2001; 26(6):636-42. · 2.08 Impact Factor
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ABSTRACT: Commercially pure titanium (cpTi), titanium alloys, and steel are often used for dental and orthopedic implants. In these applications titanium is considered the "gold standard." However, tissue reactions around titanium implants and the changing trend to leave orthopedic devices in the body have led to a new examination of the preferred material. This in vitro study tested the behavior of osteoblasts on cpTi, Ti-6Al-7Nb, and stainless steel with surface designs similar to clinical implants. After surface characterization by scanning electron microscopy and profilometry, cell proliferation and the differentiation parameters of alkaline phosphatase (ALP) activity and osteocalcin were measured. For all materials tested, the growth curves showed a similar kinetic. On Ti-6Al-7Nb, ALP activity was significantly lower when compared with steel, and cpTi and did not change over the time. ALP activity increased moderately on steel and cpTi. Osteocalcin levels were higher on both titanium materials than on steel. Based on undisturbed cell growth and the relatively high alkaline phosphatase and osteocalcin levels, we suggest that cpTi provides the best biocompatibility with regard to proliferation, in addition to more reliable early and late differentiation markers of human osteoblasts in vitro.
Journal of Biomedical Materials Research 03/2001; 54(2):209-15.
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ABSTRACT: The aim of the study was the development of a resorbable membrane for guided bone regeneration (GBR) with improved biocompatibility, which should be stiff enough to avoid membrane collapse during bone healing. Combining a bioactive ceramic with a resorbable polymer may improve the biocompatibility and osteoconductivity of resorbable devices. The present article describes the preparation, the mechanical properties, and the in vitro degradation characteristic of a composite membrane made of poly(L, DL-lactide) and alpha-tricalcium phosphate in comparison to a membrane made of pure poly(L, DL-lactide). The tensile strength and the elastic modulus as well as the molecular weight of the membranes were measured after in vitro degradation in buffer at 37 degrees C up to 28 weeks. The initial tensile strength of the composite and the polymer membrane was 37.3 +/- 2.4 MPa and 27.7 +/- 2.3 MPa and the elastic modulus 3106 +/- 108 MPa and 3101 +/- 104 MPa, respectively. The mechanical properties remained constant up to 8 weeks and then decreased slowly until week 28. The molecular weight of both membranes decreased steadily from 170,000 D to 30,000 D. It was concluded that the mechanical requirements for a membrane for GBR were fulfilled by the composite membrane.
Journal of Biomedical Materials Research 02/2001; 58(5):564-9.
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ABSTRACT: Porous composites made of poly(L, DL-lactide) (PLA) and alpha-tricalcium phosphate (alpha-TCP) or the glass ceramic, GB14N, respectively, were investigated in a loaded implant model in sheep. Six, 12 and 24 months after implantation histological and biomechanical evaluation were performed and compared to autogenous bone transplants. No significant differences were observed between the composites. After 6 months, the interconnecting pores of the alpha-TCP-composite and the GB14N-composite were filled with newly formed bone (14 +/- 5% or 29 +/-15% of the implant, respectively) and soft tissue (30 +/-9% or 21 +/-12% of the implant, respectively). Only a mild inflammatory response was observed. The reaction was similar after 12 months. However, after 24 months a strong inflammatory reaction was seen. The newly formed bone was partly osteolytic. The adverse reaction occurred simultaneously to a significant reduction of the PLA component. The histological results were reflected by the biomechanical outcomes. Both composites showed compression strengths in the range of the autologous bone graft until 12 months of implantation. After 2 years, however, the strengths were significantly decreased. It is concluded that the new composites cannot yet be used for clinical application. An improvement in biocompatibility might be reached by a better coordination of the degradation times of the polymer and the ceramic component.
Journal of Biomedical Materials Research 02/2001; 58(6):701-9.
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ABSTRACT: Peripheral quantitative computed tomography (pQCT) is an established diagnostic method for assessment of bone mineral density in the diagnosis of osteoporosis. However, the capacity of structural parameters of cancellous bone measured by high-resolution computed tomography remains to be explored. In 33 patients, bone mineral density (BMD) of the proximal femur was measured in vitro by pQCT using cylindrical biopsies from the intertrochanteric region harvested before the implantation of an artificial hip joint. By digital image analysis of CT scans, parameters derived from histomorphometry describing the microarchitecture of cancellous bone were measured. The biopsies were also loaded to failure by an uniaxial compression test to determine the biomechanical parameters, Young's modulus, strength, and maximum energy absorption (E(max)). Strong correlations were found for BMD vs. mechanical parameters (r = 0.73 for Young's modulus, r = 0.82 for strength, and r = 0.79 for E(max); p < 0.001, n = 29). The morphological parameters, bone volume per trabecular volume (BV/TV), apparent trabecular thickness (app.Tb.Th), apparent trabecular separation (app.Tb.Sp), and trabecular number (Tb.N), correlated significantly with all mechanical parameters. The combination of morphological parameters with BMD in a multivariate regression model led to an overall, but only moderate, increase in R(2) in all cases. Our data confirm the high predictive value of BMD for the mechanical competence of cancellous bone of the intertrochanteric region. However, quantification of cancellous bone structure by image analysis of CT scans may provide additional qualitative information for the analysis of bone strength.
Bone 02/2001; 28(1):133-9. · 4.02 Impact Factor
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ABSTRACT: Resorbable augmentation devices for cruciate ligament surgery have been developed to temporarily protect healing tendon grafts or sutured ligaments against high tensile loads during the postoperative healing period. Materials available at present [e.g., polydioxanone (PDS)] show a half-life tensile strength of only 4-6 weeks, whereas the process of revitalization and recovering of the transplanted tendon graft can take up to 12 months. Therefore, a device that provides gradually decreasing mechanical properties with a half-time strength of at least 6 months would be desirable. In order to obtain a suitable material, we investigated the degradation kinetics of a variety of different resorbable fibers made of poly(L-lactide) and poly(L-lactide-co-glycolide). The fiber materials differed in processing and treatment parameters like thermal posttreatment, irradiation, and fiber diameter. The fibers were degraded in vitro and were tested for mechanical properties and molecular weight at various time points up to 72 weeks. The half-time strength of the materials ranged between 5 and 64 weeks, depending on their treatment parameters. In contrast, the stiffness did not decrease adequately. However, an augmentation stiffness that does not change much versus time could not provide a gradual increase in graft load, which is important to stimulate the orientation of the collagenous tissue. Therefore, design of an augmentation construct braided out of more than one quickly degrading fiber materials is suggested. After the breakdown of the faster-degrading fiber components the stiffness would automatically decrease by the diminution of the load-carrying fiber volume.
Journal of Biomedical Materials Research 02/2001; 58(6):666-72.
