The knowledge of the lumbar spine biomechanics is essential for clinical applications. Due to the difficulties to experiment on living people and the irregular results published, simulation based on finite elements (FE) has been developed, making it possible to adequately reproduce the biomechanics of the lumbar spine. A 3D FE model of the complete lumbar spine (vertebrae, discs, and ligaments) has been developed. To verify the model, radiological images (X-rays) were taken over a group of 25 healthy, male individuals with average age of 27.4 and average weight of 78.6 kg with the corresponding informed consent. A maximum angle of 34.40° is achieved in flexion and of 35.58° in extension with a flexion-extension angle of 69.98°. The radiological measurements were 33.94 ± 4.91°, 38.73 ± 4.29°, and 72.67°, respectively. In lateral bending, the maximum angles were 19.33° and 23.40 ± 2.39, respectively. In rotation a maximum angle of 9.96° was obtained. The model incorporates a precise geometrical characterization of several elements (vertebrae, discs, and ligaments), respecting anatomical features and being capable of reproducing a wide range of physiological movements. Application to disc degeneration (L5-S1) allows predicting the affection in the mobility of the different lumbar segments, by means of parametric studies for different ranges of degeneration.

More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

Arthrodesis is a recommended treatment in advanced stages of degenerative disc disease. Despite dynamic fixations were designed to prevent abnormal motions with better physiological load transmission, improving lumbar pain and reducing stress on adjacent segments, contradictory results have been obtained. This study was designed to compare differences in the biomechanical behaviour between the healthy lumbar spine and the spine with DYNESYS and DIAM fixation, respectively, at L4-L5 level. Behaviour under flexion, extension, lateral bending and axial rotation are compared using healthy lumbar spine as reference. Three 3D finite element models of lumbar spine (healthy, DYNESYS and DIAM implemented, respectively) were developed, together a clinical follow-up of 58 patients operated on for degenerative disc disease. DYNESYS produced higher variations of motion with a maximum value for lateral bending, decreasing intradiscal pressure and facet joint forces at instrumented level, whereas screw insertion zones concentrated stress. DIAM increased movement during flexion, decreased it in another three movements, and produced stress concentration at the apophyses at instrumented level. Dynamic systems, used as single systems without vertebral fusion, could be a good alternative to degenerative disc disease for grade II and grade III of Pfirrmann.

Low back pain, which most common cause is degenerative disc disease, currently represents a serious problem due to its socio-economic repercussions. Different factors are involved in the degenerative process, being the most common: the loads on the spine, repeated flexion movements and individual genetic characteristics. Nowadays, there is no agreement on whether instability is the main cause of low back pain, or only one reason among many, and on whether increased spinal mobility, associated with instability, occurs either locally or at the lumbar spine as a whole. In this work, the simulation of disc degeneration is based on a finite element model of lumbar spine. A parametric study based on mechanical properties was established, for each lumbar spine movement, by evaluating the disc degeneration in 10% steps, from healthy disc to maximum degeneration. The results show as general trend a progressive mobility increase as the disc degeneration level raises. As main conclusion, disc degeneration causes increased mobility at all vertebral levels, with moderate values for incipient degeneration and much higher values for advanced degeneration, affecting more severely to the levels closest to degenerated disk. The great mobility increase detected at L5 could explain the instability detected as a clinical symptom.

Osteoporotic vertebral fractures represent a major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture from bone mineral density (BMD) measurements. A previously developed model, based on the Damage and Fracture Mechanics, was applied for the evaluation of the mechanical magnitudes involved in the fracture process from clinical BMD measurements. BMD evolution in untreated patients and in patients with seven different treatments was analyzed from clinical studies in order to compare the variation in the risk of fracture. The predictive model was applied in a finite element simulation of the whole lumbar spine, obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body. For every vertebra, strontium ranelate exhibits the highest decrease, whereas minimum decrease is achieved with oral ibandronate. All the treatments manifest similar trends for every vertebra. Conversely, for the natural BMD evolution, as bone stiffness decreases, the mechanical damage and fracture probability show a significant increase (as it occurs in the natural history of BMD). Vertebral walls and external areas of vertebral end plates are the zones at greatest risk, in coincidence with the typical locations of osteoporotic fractures, characterized by a vertebral crushing due to the collapse of vertebral walls. This methodology could be applied for an individual patient, in order to obtain the trends corresponding to different treatments, in identifying at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.