Early loosening and implant migration are two problems that lead to failures in cementless (press-fit) femoral knee components of total knee replacements. To begin to address these early failures, this study determined the anterior-posterior mechanical properties from four locations in the human distal femur. Thirty-three cylindrical specimens were removed perpendicular to the press-fit surface after the surgical cuts on 10 human cadaveric femurs (age 71.5+/-14.2 years) had been made. Compression testing was performed that utilized methods to reduce the effects of end-artifacts. The bone mineral apparent density (BMAD), apparent modulus of elasticity, yield and ultimate stress, and yield and ultimate strain were measured for 28 cylindrical specimens. The apparent modulus, yield and ultimate stress, and yield and ultimate strain each significantly differed (p<0.05) in the superior and inferior locations. Linear and power law relationships between superior and inferior mechanical properties and BMAD were determined. The inferior apparent modulus and stresses were higher than those in the superior locations. These results show that the press-fit fixation characteristics of the femoral knee component differ on the anterior shield and posterior condyles. This information will be useful in the assignment of mechanical properties in finite element models for further investigations of femoral knee components. The property-density relations also have applications for implant design and preoperative assessment of bone strength using clinically available tools.

The failure of an osseous fracture to heal, or the development of a nonunion, is common; however, current diagnostic measures lack the capability of early and reliable detection of such events. Analyses of radiographic imaging and clinical examination, in combination, remain the gold standard for diagnosis; however, these methods are not reliable for early detection. Delayed diagnosis of a nonunion is costly from both the patient and treatment standpoints. In response, repeated efforts have been made to identify bone metabolic markers as diagnostic or prognostic tools for monitoring bone healing. Thus far, the evidence regarding a correlation between the kinetics of most bone metabolic markers and nonunion is very limited. With the aim of classifying the role of biological pathways of bone metabolism and of understanding bone conditions in the development of osteoporosis, advances have been made in our knowledge of the molecular basis of bone remodeling, fracture healing, and its failure. Procollagen type I amino-terminal propeptide has been shown to be a reliable bone formation marker in osteoporosis therapy and its kinetics during fracture healing has been recently described. In this article, we suggest that procollagen type I amino-terminal propeptide presents a good opportunity for early detection of nonunion. We also review the role and potential of serum PINP, as well as other markers, as indications of fracture healing.

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Implant survival rate is a primary concern for individuals receiving a primary total knee arthroplasty. Loosening is the primary reason for revision surgery and was therefore the focus of the current study. To better understand the mechanics of implant fixation, the time-dependent fixation of a femoral knee component was measured in vitro on three cadaveric femurs. The fixation of each femoral knee component was measured with strain gauged implants for at least 10min on each femoral component. Additionally, impaction forces were measured during the implantation of each component. These forces were 2-6 times less than previously reported. The implantation impact forces were higher for the bones with higher bone density. Power law regressions were fit to the absolute value of the principal strains measured on the components over time to quantify the relaxation of the bone. The average power coefficient value for the three bones was lower for the bones with higher bone density. The average power coefficient value for the maximum principal strains was significantly higher than that of the minimum principal strains in each bone. The results were extrapolated to approximate the fixation strength at 9 months after implantation. In this time period the strain was predicted to decrease to between 78 and 91% of the strain 1s after implantation where those with lower bone density will have decreased fixation strength.