No abstract

Two telemeterized femoral components were implanted in two patients as part of normal total hip replacement procedures. The two components were instrumented to measure the three force components directed along: (a) the neck axis, (b) transverse to the neck axis and in the plane of the prosthesis, and (c) transverse to the neck axis and perpendicular to the plane of the prosthesis. Data were collected at multiple sessions during the early postoperative period for a number of standard activities, including gait, stair climbing, rising from a chair, single leg stance, double leg stance, ipsilateral and contralateral straight leg lifts while supine, ipsilateral flexion and extension while standing, and ipsilateral abduction while standing and lying on the contralateral side. These data are summarized and compared with the published results from analytic studies and with the results from previous studies using instrumented femoral components. Peak loads for gait during the period of study were roughly 2.7 body weights (BW) when the patients walked at their normal pace. Contact forces at the hip during stationary single leg stance approximated the peak loads during gait with values ranging from 2.1 to 2.8 BW. The highest forces recorded reached values approaching 5.5 BW and occurred during periods of instability while the patient engaged in stationary single leg stance. Our in vivo data indicate that forces generated during the above activities increase in magnitude quite rapidly during the early postoperative period and that during this period the patients have the ability to perform the activities of daily living without generating the high amplitude joint contact forces suggested by the results of dynamic studies. Joint contact forces during gait were found to depend on speed, but the high absolute magnitudes predicted by model studies were not supported by the in vivo data.

The feasibility of using ultrasound technology as a noninvasive, nondestructive method for evaluating the mechanical properties of engineered weight-bearing tissues was evaluated. A fixture was designed to accurately and reproducibly position the ultrasound transducer normal to the test sample surface. Agarose hydrogels were used as phantoms for cartilage to explore the feasibility of establishing correlations between ultrasound measurements and commonly used mechanical tissue assessments. The hydrogels were fabricated in 1–10% concentrations with a 2–10 mm thickness. For each concentration and thickness, six samples were created, for a total of 216 gel samples. Speed of sound was determined from the time difference between peak reflections and the known height of each sample. Modulus was computed from the speed of sound using elastic and poroelastic models. All ultrasonic measurements were made using a 15 MHz ultrasound transducer. The elastic modulus was also determined for each sample from a mechanical unconfined compression test. Analytical comparison and statistical analysis of ultrasound and mechanical testing data was carried out. A correlation between estimates of compressive modulus from ultrasonic and mechanical measurements was found, but the correlation depended on the model used to estimate the modulus from ultrasonic measurements. A stronger correlation with mechanical measurements was found using the poroelastic rather than the elastic model. Results from this preliminary testing will be used to guide further studies of native and engineered cartilage.

Torques generated in one subject during the early postoperative period were measured with a telemeterized total hip component. The patient was examined during gait, stair ascent, rising from a chair, and single-limb stance. The torques were plotted against both the resultant joint contact force and the force component directed along the stem axis. During gait, the maximum torque was 35 Nm, recorded at a walking velocity of 1.7 m/sec. The peak torques during stair ascent and during rising from a seated position were found to be 23 and 15 Nm, respectively. The maximum value for torque measured in this study was 37 Nm during one attempt at single-limb stance. Comparison of plots for torque versus stem-axis component for the four activities shows that the torque increased more rapidly for chair exits than for gait up to resultant contact force values of as much as 1,000 N. For stair ascent, the same was true to values of 1,400 N. Within any given activity, the relationship between stem torque and resultant or stem-axis force showed considerable variability. These results indicate that experiments evaluating the stability of femoral components in total hip arthroplasty should incorporate a component directed along the stem axis, as well as a component normal to the plane of the prosthesis. The results also suggest that theoretical stress analysis models should consider the broad variability in the orientation of the joint force at the hip.

Polyoxymethylene (POM, acetal homopolymer, polyacetal), commercialized as Delrin by DuPont, is an engineering resin with mechanical properties that make it useful for the prototyping and manufacture of laboratory apparatus. These properties include excellent, "metal-like," machining characteristics and dimensional stability, as well as thermal stability, which allows steam sterilization. Historically, POM has been used widely, including as a surgical implant material. For these reasons, we have used this plastic as a media-wetted component in a tissue-engineering bioreactor, with good results. However, a study by LaIuppa et al.5 suggested that POM is unsuitable for use in a cell culture environment (LaIuppa et al. J Biomed Mater Res 1997;36:347-359). POM is based on the polymerization of formaldehyde, and, in addition, contains stabilizers and/or fillers. All of these could potentially be released into the medium, e.g., as formaldehyde or other thermal breakdown products, especially upon repeated autoclaving. The cited report thus appeared plausible, although contrary to our observations. In this study, we specifically assessed whether media conditioned by long-term exposure to machined white POM had a negative effect on the proliferation and chondrogenic differentiation of human mesenchymal stem cells (MSCs). We selected this cell system, as cartilage tissue engineering is the primary application of our bioreactor system. The POM samples were steam-autoclaved 1 to 20 times, to assess the possibility of any toxic thermal breakdown product release into the media. We found that MSCs did not attach directly to machined POM. Because cells that escape from the tissue construct cannot colonize the reactor and compete for nutrients, this is a desirable characteristic of a material used in a tissue-engineering bioreactor. Furthermore, the use of POM-conditioned media had no detectable impact on the proliferation rate of MSCs measured over a one-week period; nor was any effect on chondrogenic differentiation observed at up to 3 weeks in culture. In summary, the use of POM as a culture medium-wetted component appears to be innocuous, at least for human MSCs. The contrast of these findings to those of LaIuppa et al.5 may reflect a cell-type specific sensitivity, or may be due to different handling of the material.