Timothy M Wright

Hospital for Special Surgery, New York City, NY, USA

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Publications (68)170.54 Total impact

  • Article: Trabecular bone adaptation to loading in a rabbit model is not magnitude-dependent.
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    ABSTRACT: Although mechanical loading is known to influence trabecular bone adaptation, the role of specific loading parameters requires further investigation. Previous studies demonstrated that the number of loading cycles and loading duration modulate the adaptive response of trabecular bone in a rabbit model of applied loading. In the current study, we investigated the influence of load magnitude on the adaptive response of trabecular bone using the rabbit model. Cyclic compressive loads, producing peak pressures of either 0.5 or 1.0 MPa, were applied daily (5 days/week) at 1 Hz and 50 cycles/day for 4 weeks post-operatively to the trabecular bone on the lateral side of the distal right femur, while the left side served as an nonloaded control. The adaptive response was characterized by microcomputed tomography and histomorphometry. Bone volume fraction, bone mineral content, tissue mineral density, and mineral apposition rate (MAR) increased in loaded limbs compared to the contralateral control limbs. No load magnitude dependent difference was observed, which may reflect the critical role of loading compared to the operated, nonloaded contralateral limb. The increased MAR suggests that loading stimulated new bone formation rather than just maintaining bone volume. The absence of a dose-dependent response of trabecular bone observed in this study suggests that a range of load magnitudes should be examined for biophysical therapies aimed at augmenting current treatments to enhance long-term fixation of orthopedic devices. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
    Journal of Orthopaedic Research 02/2013; · 2.81 Impact Factor
  • Article: Retrieval analysis of nonmodular constrained tibial inserts after primary total knee replacement.
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    ABSTRACT: Large angular deformities can be a challenge when performing primary total knee replacement. Some investigators have advocated the use of increased component constraint in these settings. The goal of this study was to determine the location and extent of damage to a consecutive series of retrieved constrained tibial inserts used in primary arthroplasty. There was significant post and articular damage in retrieved implants. Reliance on the polyethylene post for implant stability was associated with post and articular surface damage and may be a potential source of failure. Attempts to achieve implant stability using soft tissue techniques seem justified.
    Orthopedic Clinics of North America 11/2012; 43(5):e39-43. · 1.25 Impact Factor
  • Article: Rotating-platform Has No Surface Damage Advantage Over Fixed-bearing TKA.
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    ABSTRACT: BACKGROUND: Rotating-platform TKA, although purported to have superior kinematics, has shown no clinical advantages over those of fixed-bearing TKA. Our design-matched retrieval study aimed to investigate if differences in bearing wear damage exist between fixed- and mobile-bearing TKAs with similar condylar geometry. QUESTIONS/PURPOSES: We asked whether (1) the rotating platform's more conforming tibiofemoral articulation would be associated with less severe damage; (2) the location of damage and wear would be similar on the tibiofemoral or backside surfaces of two contemporary designs with similar condylar geometry; and (3) the combined damage and deformation measured as thickness would differ between the two designs. METHODS: We performed damage grading and damage mapping on 25 rotating-platform and 17 fixed-bearing inserts. The patient demographic data from each of these cohorts were comparable. Inserts were also laser-scanned from which we obtained thicknesses, and inferior surface three-dimensional scans, from which we determined dimensional changes. RESULTS: Rotating-platform and fixed-bearing inserts had similar tibiofemoral damage scores. However, the scores on the inferior surface of rotating platforms were greater, often as a result of third-body debris scratching observed on both damage mapping and three-dimensional scans. The extent of damage as a function of surface area was greater for rotating platforms, consistent with the greater tibiofemoral conformity. Dimensional changes on the inferior surfaces of the fixed bearing followed loading areas of the knee. However, no differences were seen in the thicknesses between fixed- and rotating-platform bearings. CONCLUSIONS: The increased total damage score on the rotating platform, coupled with increased surface area damaged and the propensity for third-body debris, indicates no damage advantage to this mobile-bearing design.
    Clinical Orthopaedics and Related Research 09/2012; · 2.53 Impact Factor
  • Article: Suture number determines strength of rotator cuff repair.
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    ABSTRACT: Failure of surgical repair of a rotator cuff tear continues to be a clinical problem. For other tendon repairs, increasing the number of sutures improves both biomechanical performance and clinical outcomes. Several investigators have shown biomechanical advantages of double-row techniques but have used many more sutures than were used with the single-row techniques with which the double-row techniques were compared. The purposes of our study were to establish whether using a greater number of sutures would improve the biomechanical properties of a rotator cuff repair model, and whether using equal numbers of sutures would lead to equivalent results between single and double-row configurations. Fresh-frozen sheep infraspinatus tendons underwent single-row repair with two, four, or six mattress sutures and double-row repair with use of four mattress sutures. Specimens were pretensioned at 10 N for one minute, then cycled from 10 to 180 N for 200 cycles at 0.2 Hz; this was followed by load to failure. Cyclic gap formation, failure load, and failure type were recorded. The four-suture single-row and four-suture double-row repairs had similar gap formation during cyclic testing, with no significant differences between them. Cyclic gap formation in the two-suture single-row group was 6.7 and 7.1 mm (97% and 109%) greater than that in the four and six-suture single-row groups after 200 cycles (p < 0.001). The average loads to failure of the two, four, and six-suture single-row groups were 274, 362, and 572 N (p < 0.0001). The average load to failure of the four-suture double-row group was 386 N, which was similar to the value in the four-suture single-row group (p = 0.58). In an ovine rotator cuff tendon repair model, increasing the number of sutures decreased cyclic gap formation and increased load to failure. Single and double-row repairs are biomechanically equivalent when the number of sutures is kept constant. The results of this study support the use of greater numbers of sutures in rotator cuff repair and disagree with the assertion that double-row repairs are biomechanically superior to single-row repairs.
    The Journal of Bone and Joint Surgery 07/2012; 94(14):e100. · 3.27 Impact Factor
  • Article: Matched-pair total knee arthroplasty retrieval analysis: oxidized zirconium vs. CoCrMo.
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    ABSTRACT: Oxidized zirconium (OxZr) was introduced to serve as a ceramic surface for femoral components in TKA. The aim of this study was to compare retrieved OxZr components and corresponding PE inserts in matched comparison with conventional cobalt/chrome/molybdenum alloy (CoCrMo). Eleven retrieved posterior stabilized TKA with an OxZr femoral component were included. This included 6 implants from an earlier preliminary study. From a cohort of 56 retrieved TKA with conventional CoCrMo femoral components, pairs were matched according to duration of implantation, patient age, reason for revision, and BMI. Polyethylene inlays and femoral components were optically scored for in vivo damage. The average damage score of the tibial PE inserts was significantly lower with OxZr components (p=0.01). Mainly burnishing and scratches were found. The average wear score in the visual analysis of the femoral components was significantly lower for the OxZr as well (p=0.005). Femoral components made of OxZr were less sensitive to in vivo damage and corresponding PE inlays also showed less damage than CoCrMo components.
    The Knee 12/2011; 18(6):448-52. · 1.74 Impact Factor
  • Article: A pre-clinical test platform for the functional evaluation of scaffolds for musculoskeletal defects: the meniscus.
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    ABSTRACT: In an attempt to delay the progression of osteoarthritis from an index injury, early intervention via repair of injured musculoskeletal soft tissue has been advocated. Despite the development of a number of scaffolds intended to treat soft tissue defects, information about their functional performance is lacking. The goal of this study was to consolidate a suite of in vitro and in vivo models into a pre-clinical test platform to assess the functional performance of meniscal repair scaffolds. Our objective was to assess the ability of a scaffold (Actifit™; Orteq, UK) to carry load without detrimentally abrading against articular cartilage. Three test modules were used to assess the functional performance of meniscal repair scaffolds. The first module tested the ability of the scaffold to carry load in an in vitro model designed to measure the change in normal contact stress magnitude on the tibial plateau of cadaveric knees after scaffold implantation. The second module assessed the in vitro frictional coefficient of the scaffold against cartilage to assess the likelihood that the scaffold would destructively abrade against articular cartilage in vivo. The third module consisted of an assessment of functional performance in vivo by measuring the structure and composition of articular cartilage across the tibial plateau 12 months after scaffold implantation in an ovine model. In vitro, the scaffold improved contact mechanics relative to a partly meniscectomized knee suggesting that, in vivo, less damage would be seen in the scaffold implanted knees vs. partly meniscectomized knees. However, there was no significant difference in the condition of articular cartilage between the two groups. Moreover, in spite of the high coefficient of friction between the scaffold and articular cartilage, there was no significant damage in the articular cartilage underneath the scaffold. The discrepancy between the in vitro and in vivo models was likely influenced by the abundant tissue generated within the scaffold and the unexpected tissue that regenerated within the site of the partial meniscectomy. We are currently augmenting our suite of tests so that we can pre-clinically evaluate the functional performance at time zero and as a function of time after implantation.
    HSS Journal 07/2011; 7(2):157-63.
  • Article: Tibial compression is anabolic in the adult mouse skeleton despite reduced responsiveness with aging.
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    ABSTRACT: The ability of the skeleton to adapt to mechanical stimuli diminishes with age in diaphyseal cortical bone, making bone formation difficult for adults. However, the effect of aging on adaptation in cancellous bone, tissue which is preferentially lost with age, is not well characterized. To develop a model for early post-menopausal women and determine the effect of aging on cancellous bone adaptation in the adult mouse skeleton, in vivo tibial compression was applied to adult (26 week old) osteopenic female mice using loading parameters, peak applied load and peak diaphyseal strain magnitude, that were previously found to be osteogenic in young, growing (10 week old) mice. A Load-Matched group received the same peak applied loads (corresponding to +2100 με at the medial diaphysis of the tibia) and a Strain-Matched group received the same peak diaphyseal strains (+1200 με, requiring half the load) as the young mice. The effects of mechanical loading on bone mass and architecture in adult mice were assessed using micro-computed tomography and in vivo structural stiffness measures. Adaptation occurred only in the Load-Matched group in both the metaphyseal and diaphyseal compartments. Cancellous bone mass increased 54% through trabecular thickening, and cortical area increased 41% through medullary contraction and periosteal expansion. Adult mice were able to respond to an anabolic stimulus and recover bone mass to levels seen in growing mice; however, the adaptive response was reduced relative to that in 10 week old female mice for the same applied load. Using this osteogenic loading protocol, other factors affecting pathological bone loss can be addressed using an adult osteopenic mouse model.
    Bone 05/2011; 49(3):439-46. · 4.02 Impact Factor
  • Article: Trunnion fracture of the anatomic medullary locking a plus femoral component.
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    ABSTRACT: Fracture of the neck of the femoral component after total hip arthroplasty is an infrequent complication. We present a report of 2 cases of trunnion fractures of fully porous-coated femoral stems (AML A Plus, DePuy International, Leeds, England), which had been implanted for 6 and 7 years after the index procedures. In both cases, failure emanated from a region where the trunnion had been intentionally grooved; and in both cases, the diameter of the trunnion was small, and evidence of corrosion contributing to the initiation of the failure was noted. Although this is the first report of trunnion fractures in this particular implant design, a close monitoring of prostheses with this specific trunnion should be considered. In addition, further analysis of clinical results and complications with this implant is warranted.
    The Journal of arthroplasty 04/2011; 26(3):504.e13-6. · 1.79 Impact Factor
  • Article: Retrieved highly crosslinked UHMWPE acetabular liners have similar wear damage as conventional UHMWPE.
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    ABSTRACT: Highly crosslinked UHMWPE is associated with increased wear resistance in hip simulator and clinical studies. Laboratory and case studies, however, have described rim fracture in crosslinked acetabular liners. Controversy exists, therefore, on the relative merits of crosslinked liners over conventional liners in terms of wear performance versus resistance to fatigue cracking. We asked whether crosslinked liners would show less surface damage than conventional liners but would be more susceptible to fatigue damage. We examined 36 conventional UHMWPE and 39 crosslinked UHMWPE retrieved implants with similar patient demographics and identical design for evidence of wear damage, including articular surface damage, impingement, screw-hole creep, and rim cracks. We observed no difference in wear damage scores for the two liners. Conventional liners more frequently impinged but were more often elevated with smaller head sizes. We observed creep in approximately 70% of both types of liners. Incipient rim cracks were found in five crosslinked liners, and one liner had a rim fracture. Only one conventional liner had an incipient rim crack. Contrary to our expectation, damage was similar between crosslinked and conventional UHMWPE liners. Moreover, the 15% occurrence (six of 39) of incipient or complete fractures in crosslinked liners as compared with a 3% occurrence (one of 36) in conventional liners may have implications for the long-term performance of crosslinked liners. Longer-term studies will be necessary to establish the fate of rim cracks and thus the overall clinical fatigue performance of crosslinked liners.
    Clinical Orthopaedics and Related Research 02/2011; 469(2):387-94. · 2.53 Impact Factor
  • Article: Corrosion at the stem-sleeve interface of a modular titanium alloy femoral component as a reason for impaired disengagement.
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    ABSTRACT: Modularity in sleeved femoral components allows the exchange of the stem without disruption of the fixation between the sleeve and the surrounding bone at revision surgery. Failure to disengage the stem from the sleeve would represent an unnecessary compromise from the intended usefulness of the modular design. We report the results of an examination of 22 modular titanium alloy femoral components retrieved after 0.0 to 8.8 years in vivo. In 7 implants, the stem-sleeve interface could not be disengaged without cutting through the components or using mechanical force. Moderate to severe corrosion was detected in all 7 of these cases. Corrosive surface changes were observed in an additional 6 interfaces. There was no correlation with the length of time that the devices had been implanted. When only the stem is to be revised, orthopedic surgeons should be aware of difficulties in disengagement and anticipate alternative surgical procedures.
    The Journal of arthroplasty 01/2011; 26(1):113-9, 119.e1. · 1.79 Impact Factor
  • Article: Implant design influences tibial post wear damage in posterior-stabilized knees.
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    ABSTRACT: The tibial post in posterior-stabilized total knees is a potential source of polyethylene wear debris, but the relationship between the shape and location of the tibial post in relation to the tibiofemoral bearing surfaces and the subsequent wear damage patterns remains unknown. We used observations made on retrieved implant components from three contemporary posterior-stabilized knee designs to examine how differences in tibial post design affected wear damage on the post. We examined 113 retrieved Zimmer NexGen(®), 103 Exactech Optetrak(®), and 58 Smith and Nephew Genesis(®) II posterior-stabilized inserts using a subjective scale to grade post damage. All 274 inserts demonstrated wear damage. Total wear scores and scores for wear damage on the anterior post differed among designs: Optetrak(®) 20 ± 4 and 5 ± 1, NexGen(®) 13 ± 4 and 3 ± 1, and Genesis(®) II 8 ± 3 and 1 ± 1, respectively. The Optetrak(®) had predominantly anterior wear damage, the NexGen(®) had more global wear damage, and the Genesis(®) II had predominantly posterior wear damage. Tibial post wear damage and anterior post wear damage were primarily determined by implant design and to a lesser extent by length of implantation and revision diagnosis. Although tibial post wear damage is multifactorial, the primary determinant of wear damage, and specifically anterior wear damage, is implant design. The constraint provided by the posterior-stabilized post-cam contact in modern knee arthroplasties is reflected in the wear damage patterns that occur during in vivo use. Unintended constraint such as anterior impingement should be addressed through design modifications for future posterior-stabilized knee arthroplasties.
    Clinical Orthopaedics and Related Research 01/2011; 469(1):160-7. · 2.53 Impact Factor
  • Article: The effect of sacral decortication on lumbosacral fixation in a calf spine model.
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    ABSTRACT: Animal cadaveric biomechanical study. We hypothesized that increasing bony destabilization of a bovine cadaveric sacrum by anterior pedicle screw penetration and bilateral alar decortication would decrease the amount of load necessary for failure of the construct and result in failure through the decortication sites. Fusion to the sacrum has become commonly used for treatment of neuromuscular scoliosis and fusions in osteoporotic patients. Fixation failure after attempted fusion to the sacrum may be attributed to iatrogenic causes such as S1 screw penetration and sacral ala decortication. Sixteen fresh-frozen 6- to 8-week-old calf spines were tested after instrumentation with pedicle screws and bilateral rods from L2 to S1 using four constructs: (1) S1 screws with posterior-only purchase; (2) S1 screws with bicortical purchase; (3) S1 screws with bicortical purchase and sacral alar decortication; and (4) S1 screws with bicortical purchase, decortication, and iliac fixation. A destructive flexural bending load was applied at L2 to each construct. Ultimate failure moment (Nm) was compared among the four groups, using a one-way analysis of variance combined with Holm-Sidak post hoc test. No significant difference in failure moment was found among groups 1, 2, and 3. The addition of iliac fixation (group 4) significantly increased bending load to failure (P < 0.01), and iliac screw dislodgement was the dominant mechanism of failure. All specimens in group 3 failed with fractures extending through the decortication site. Groups 1 and 2 specimens failed by fracturing through the S1 body. Sacral alar decortication and anterior pedicle screw purchase did not decrease the failure moment in long instrumentation to the sacrum. Pattern of failure was affected, with alar decortication being the site of fracture in each construct in which it was performed. Iliac fixation increased the failure moment under catastrophic loading conditions even when combined with sacral alar decortication and bicortical pedicle screw purchase.
    Spine 01/2011; 36(6):E388-92. · 2.08 Impact Factor
  • Article: Erratum: Analysis of frictional behavior and changes in morphology resulting from cartilage articulation with porous polyurethane foams.
    Journal of Orthopaedic Research 12/2010; 28(12):1677. · 2.81 Impact Factor
  • Article: Wear damage in mobile-bearing TKA is as severe as that in fixed-bearing TKA.
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    ABSTRACT: Mobile-bearing TKAs reportedly have no clinical superiority over fixed-bearing TKAs, but a potential benefit is improved polyethylene wear behavior. We asked whether extent of damage and wear patterns would be less severe on retrieved mobile-bearing TKAs than on fixed-bearing TKAs and if correlations with patient demographics could explain differences in extent or locations of damage. We performed damage grading and mapping of 48 mobile-bearing TKAs retrieved due to osteolysis/loosening, infection, stiffness, instability or malpositioning. Visual grading used stereomicroscopy to identify damage, and a grade was assigned based on extent and severity. Each damage mode was then mapped onto a photograph of the implant surface, and the area affected was calculated. Marked wear damage occurred on both surfaces, with burnishing, scratching, and pitting the dominant modes. Damage occurred over a large portion of both surfaces, exceeding the available articular borders in nearly 30% of implants. Wear of mobile-bearing surfaces included marked third-body debris. Damage on tibiofemoral and mobile-bearing surfaces was not correlated with patient BMI or component alignment. Damage on mobile-bearing surfaces was positively correlated with length of implantation and was greater in implants removed for osteolysis or instability than in those removed for stiffness or infection. Each bearing surface in mobile-bearing implants was damaged to an extent similar to that in fixed-bearing implants, making the combined damage score higher than that for fixed-bearing implants. Mobile-bearing TKAs did not improve wear damage, providing another argument against the superiority of these implants over fixed-bearing implants.
    Clinical Orthopaedics and Related Research 11/2010; 469(1):123-30. · 2.53 Impact Factor
  • Article: Evaluation of a porous polyurethane scaffold in a partial meniscal defect ovine model.
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    ABSTRACT: The objective of this study was to assess the performance of a degradable porous polyurethane scaffold in a partial meniscectomy ovine model. We subjected 42 skeletally mature ewes to unilateral partial excision of the lateral meniscus. In 19 animals the defect was left unfilled; in 23 animals a scaffold was inserted. Knees were examined by magnetic resonance imaging, gross inspection, and histologic inspection of the cartilage of the tibial plateau. In contrast to what has been previously reported in a complete meniscal replacement model, cartilage damage did not occur under the site of scaffold implantation; this was likely influenced by the rapid infiltration of cells and the dense tissue that formed within the scaffold. Cartilage damage in both groups was located close to the midline of the joint. No significant difference in the condition of the articular cartilage of the tibial plateau was seen between groups up to 12 months postoperatively. This result was influenced by the fact that the partly meniscectomized knees also showed unexpected tissue regeneration within the defect site, which raises concern about the suitability of using a partial meniscectomy as a control in the ovine model. Our study has shown that implantation of a polyurethane scaffold in a partial meniscectomy ovine model promotes tissue ingrowth without damaging the cartilage with which it articulates. Meniscal deficiency is a common occurrence, the effective clinical management of which is limited by the absence of an off-the-shelf implantable construct.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2010; 26(11):1510-9. · 3.02 Impact Factor
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    Article: Observations on retrieved humeral polyethylene components from reverse total shoulder arthroplasty.
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    ABSTRACT: Analyses of polyethylene components retrieved at revision of total knee, hip, and shoulder replacements have been used to study the effect of design, patient, and surgical factors on initial implant performance, but no studies have reported similar types of findings in retrieved humeral polyethylene components in reverse total shoulder arthroplasty. Our hypothesis is that while the conforming surface of the humeral polyethylene may predispose it to surface wear modalities, as seen in total hip arthroplasty, the presence of clinical instability may also increase the occurrence of focal contact stresses leading to subsurface fatigue failure. Fourteen humeral polyethylene components were retrieved from revision surgery at a single institution. Each polyethylene was analyzed for 9 modes of damage in each of 4 quadrants into which the bearing surface was divided. For each implant, the most recent radiographs before removal were scored using an adapted radiolucency score, and glenosphere positioning was measured. Despite the short mean length of implantation (0.46 ± 0.5 years), scratching and abrasion were seen in 14 and 13 components, respectively, followed by third-body debris and pitting. The modes of damage observed were most severe in the inferior quadrant of the humeral polyethylene. Scapular notching, glenoid, and humeral radiolucencies were prevalent on preoperative radiographs, but their long-term significance has not yet been elucidated. Increased glenosphere inclination was associated with decreased superior and total glenoid radiolucency, along with total polyethylene wear scores. Promising early, functional results with the use of reverse total shoulder arthroplasty has led to the increased expansion of its use, but high complication and revision rates continue to raise concerns regarding implant longevity. The presence of a clinical, adduction deficit may predispose patients to inferior quadrant polyethylene wear. Impingement of the humeral polyethylene at the lateral edge of the scapula leads to inferior quadrant wear and associated polyethylene failure, and implant instability may predispose the components to fatigue wear mechanisms. Analysis of retrieved humeral polyethylene components, along with patient, design, and surgical factors, provide important information on the causes of component failure.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 10/2010; 19(7):1003-12. · 1.93 Impact Factor
  • Article: Failure of the Patellar Tendon with the Patella Everted versus Noneverted in a Matched-Pair Cadaver Model.
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    ABSTRACT: Avoidance of patellar eversion during total knee arthroplasty may help to prevent injury to the patellar tendon. The purpose of this study was to compare the load-to-failure of the everted versus the noneverted patella in a cadaveric model. Fourteen cadaver knees (seven pairs) were loaded to failure with the patella everted in one knee and not everted in the other. Mean load-at-ultimate failure in the patella-everted group was 1,111 ± 572 N, and in the patella-noneverted group was 1,621 ± 683 N (p = 0.01). Additionally, loads-at-initial-partial failure were lower (p = 0.04) in the patella-everted compared to the patella-noneverted group, 573 ± 302 N versus 1,115 ± 358 N, respectively. A partial failure of the patellar tendon occurred in 100% of the everted specimens, whereas only 57% of the noneverted specimens had partial failure. These findings suggest patella eversion may lead to failure of the patellar insertion at lower loads than when the patella is not everted.
    HSS Journal 09/2010; 6(2):134-7.
  • Article: Unicondylar knee retrieval analysis.
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    ABSTRACT: Unicondylar knee arthroplasty (UKA) is considered an alternative to total knee arthroplasty for patients who have arthritis limited to one compartment of the knee. This study examined surface damage of 3 contemporary UKA designs that were retrieved at revision surgery. Two of the UKA designs were fixed bearing and one was mobile bearing. Demographic information was collected, as well as information about the implants used at revision surgery. Articular surface damage was greater in the fixed-bearing designs as compared to the mobile bearing, although the mobile-bearing implants had significantly shorter length of implantation. Backside damage was also graded for the mobile bearing and when combined with articular wear resulted in overall damage scores higher than both fixed-bearing designs. The fixed-bearing designs showed delamination and surface deformation, whereas the mobile bearing had no evidence of these damage modes. However, mobile-bearing components showed other types of wear, and significant wear damage was present on the bearing surfaces of the mobile-bearing implants despite a short time of implantation. At the time of conversion to a total knee arthroplasty, more than 50% of cases required the use of stems, augments, or constrained inserts for the tibial reconstruction. In conclusion, wear modes differed among UKA prosthesis designs. Revision of a UKA to a total knee arthroplasty remains complex with the tibial preparation more complicated than in the primary setting.
    The Journal of arthroplasty 09/2010; 25(6 Suppl):108-11. · 1.79 Impact Factor
  • Article: Effect of media mixing on ECM assembly and mechanical properties of anatomically-shaped tissue engineered meniscus.
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    ABSTRACT: This study investigated the hypothesis that controlled media mixing will enhance tissue formation and increase mechanical properties of anatomically-shaped tissue engineered menisci. Bovine meniscal fibrochondrocytes were seeded in 2% w/v alginate, cross-linked with 0.02 g/mL CaSO(4), and injected into molds of menisci. Engineered menisci were incubated for up to 6 weeks. A mixing media bioreactor was designed to ensure proper mixing of culture medium while protecting constructs from the spinning impeller. Impeller speeds were calibrated to produce Reynolds number (Re) of 0.5, 2.9, 5.8, 10.2, and 21.8. Constructs were divided a tested in confined compression and in tension to determine the equilibrium and tensile moduli, respectively. Media stimulation resulted in a 2-5 fold increase in mechanical properties and a 2-3 fold increase in matrix accumulation in constructs over 6 weeks in culture. Benefits from mixing stimulation for collagen accumulation and compressive modulus appeared to peak near Re 2.9, and decreased with increased mixing intensity. This study suggests that fluid mixing can be optimized to enhance mechanical properties of anatomically-shaped engineered constructs.
    Biomaterials 09/2010; 31(26):6756-63. · 7.40 Impact Factor
  • Article: Cancellous bone adaptation to tibial compression is not sex dependent in growing mice.
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    ABSTRACT: Mechanical loading can be used to increase bone mass and thus attenuate pathological bone loss. Because the skeleton's adaptive response to loading is most robust before adulthood, elucidating sex-specific responses during growth may help maximize peak bone mass. This study investigated the effect of sex on the response to controlled, in vivo mechanical loading in growing mice. Ten-week-old male and female C57Bl/6 mice underwent noninvasive compression of the left tibia. Peak loads of -11.5 N were applied, corresponding to +1,200 microepsilon at the tibial midshaft in both sexes. Cancellous bone mass, architecture, and dynamic formation in the proximal metaphysis were compared between loaded and control limbs via micro-computed tomography and histomorphometry. The strain environment of the proximal metaphysis during loading was characterized using finite element analysis. Both sexes responded to tibial compression through increased bone mass and altered architecture. Cancellous bone mass and tissue density were enhanced in loaded limbs relative to control limbs in both sexes through trabecular thickening and reduced separation. Changes in mass were due to increased cellular activity in loaded limbs compared with control limbs. Adaptation to loading increased the proportion of load transferred by the cancellous bone in the proximal metaphysis. For all cancellous measures, the response to tibial compression did not differ between male and female mice. When similar strains are engendered in males and females, the adaptive response in cancellous bone to mechanical loading does not depend on sex.
    Journal of Applied Physiology 09/2010; 109(3):685-91. · 3.75 Impact Factor

Institutions

  • 1984–2013
    • Hospital for Special Surgery
      • • Department of Biomechanics
      • • Department of Orthopaedic Surgery
      New York City, NY, USA
  • 2011
    • Philipps-Universität Marburg
      Marburg an der Lahn, Hesse, Germany
    • Mahidol University
      • Department of Orthopedic Surgery (Siriraj)
      Bangkok, Bangkok, Thailand
  • 2005–2011
    • Cornell University
      • • Department of Biomedical Engineering
      • • Department of Clinical Sciences
      New York City, NY, USA
  • 2008–2010
    • Weill Cornell Medical College
      • Department of Orthopaedic Surgery
      New York City, NY, USA
    • Swedish Medical Center Seattle
      Seattle, WA, USA
  • 2009
    • Charité Universitätsmedizin Berlin
      Berlin, Land Berlin, Germany
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      Saint Louis, MO, USA