Observations on the Effect of Movement on Bone Ingrowth into Porous-Surfaced Implants

Pilliar, Robert M.; Lee, J M; Maniatopoulos, C.

doi:10.1097/00003086-198607000-00023

Cited by 915 publications

(661 citation statements)

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“…The authors believed this finding was due to postoperative cage micromotion. Pilliar et al [36] studied the effect of micromotion on bone ingrowth into porous surfaced implants, and found that while small micromotion of up to 28 µm does not affect bone ingrowth, large micromotion of over 150 µm can produce fibrous tissue development at the implant-endplate interface. Micromotion might in fact be beneficial to biologic fusion, provided it is not excessive.…”

Section: Cage Design Characteristicsmentioning

confidence: 99%

Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

Tsantrizos¹,

Andreou²,

Aebi³

et al. 2000

European Spine Journal

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IntroductionInterbody fusion is preferred over postero-lateral fusion because it warrants a stronger biomechanical construct [12] and higher fusion rate [11]. It favors load transmission via the anterior column, full restoration of disc height and lordosis, annular fiber tensioning and least demands of bone graft volume [12]. A successful interbody construct provides adequate axial support to resist graft subsidence or collapse and reduces the post-operative segmental mobility to permit graft incorporation [30]. As such, the axial compressive strength and relative three-dimensional stability of an interbody construct are biomechanical measures describing the likelihood of a successful bone fusion [5].Anterior lumbar interbody fusion (ALIF) and posterior lumbar interbody fusion (PLIF) are two accepted approaches of grafted interbody fusion, the latter often combined with pedicle instrumentation [11]. The ALIF proceAbstract Anterior lumbar interbody fusion (ALIF) cages are expected to reduce segmental mobility. Current ALIF cages have different designs, suggesting differences in initial stability. The objective of this study was to compare the effect of different stand-alone ALIF cage constructs and cage-related features on initial segmental stability. Human multisegmental specimens were tested intact and with an instrumented L3/4 disc level. Five different ALIF cages (I/F, BAK, TIS, SynCage, and ScrewCage) were tested non-destructively in axial rotation, flexion/extension and lateral bending. A cage 'pull-out' concluded testing. Changes in neutral zone (NZ) and range of motion (ROM) were analyzed. Cage-related measurements normalized to vertebral dimensions were used to predict NZ and ROM. No cage construct managed to reduce NZ. The BAK and TIS cages had the largest NZ increase in flexion/extension and lateral bending, respectively. Cages did reduce ROM in all loading directions. The TIS cage was the least effective in reducing the ROM in lateral bending. Cages with sharp teeth had higher 'pull-out' forces. Antero-posterior and mediolateral cage dimensions, cage height and wedge angle were found to influence initial stability. The performance of stand-alone ALIF cage constructs generally increased the NZ in any loading direction, suggesting potential directions of initial segmental instability that may lead to permanent deformity. Differences between cages in flexion/extension and lateral bending NZ are attributed to the severity of geometrical cage-endplate surface mismatch. Stand-alone cage constructs reduced ROM effectively, but the residual ROM present indicates the presence of micromotion at the cage-endplate interface.

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Section: Cage Design Characteristicsmentioning

confidence: 99%

Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

Tsantrizos¹,

Andreou²,

Aebi³

et al. 2000

European Spine Journal

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show abstract

“…A main requirement in achieving the fusion is the need to obtain adequate stability and maintain it during a period sufficient for bone consolidation [11,12,17]. Cage insertion provides an immediate segmental stabilization of the spine, by reducing the intervertebral mobility, although the stabilizing effect varies depending on the surgical approach [12,19,20].…”

Section: Introductionmentioning

confidence: 99%

Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

et al. 2001

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Many studies have concluded that stand alone cages provide limited stabilization to the spine, and this primary stabilization decreases postoperatively due to various factors. A supplemental fixation may, therefore, be needed to improve the stability. Extensive biomechanical analysis was performed in the present study to further evaluate the stabilization achieved by a laterally inserted cage and the role of an anterior lateral supplemental fixation. Eight human cadaver functional spinal units were subjected sequentially to four different test conditions: (1) intact, (2) instrumented laterally with a long cylindrical threaded cage, (3) the same cage supplemented with a lateral fixation plate, the plate being firmly connected to the cage, and (4) removal of the connection between the plate and the cage. Pure moments were

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“…This is also of paramount importance in numerical modelling studies that use such experimental data as baseline for validation (Hopkins and Hansen, 2009, Hopkins et al, 2008, Virani et al, 2008. This study found that there was considerably less relative micromotion at the baseplate/bone interface than reported previously (Harman et al, 2005, Virani et al, 2008, even less than the lowest threshold of in vivo bone ingrowth inhibition (28µm), bone (Pilliar et al, 1986). The FE simulation revealed that elastic deformation of the Sawbones alone resulted in baseplate displacement inversely proportional to the Sawbones elastic modulus and of the order of magnitude typically reported by the experimental DG measurements.…”

Section: Discussionmentioning

confidence: 69%

“…Although relative differences may be large when comparing micromotions from blocks of different densities, absolute values of micromotion remained very low, especially when compared to previously reported values and to the limits needed to create loosening. In any case, caution should be exercised when equating micromotion measured on Sawbones with the physiological limits on bone ingrowth (Cameron et al, 1973, Ducheyne et al, 1977, Jasty et al, 1997a, Jasty et al, 1997b, Pilliar et al, 1986.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the rate of problems remains high, in part because of glenoid component loosening (Gerber et al, 2009, Mole andFavard, 2007). Micromotion from 28 to 150 micrometers (µm) has been shown to inhibit bone ingrowth and lead to an unstable fibrous tissue layer between a metallic implant and the host bone (Cameron et al, 1973, Ducheyne et al, 1977, Jasty et al, 1997a, Jasty et al, 1997b, Pilliar et al, 1986. Therefore, minimizing micromotion at the time of initial fixation should lead to better ingrowth of bone and a more stable implant.…”

Section: Introductionmentioning

confidence: 99%

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In vitro assessments of reverse glenoid stability using displacement gages are misleading — Recommendations for accurate measurements of interface micromotion

Favre

Perala

Vogel

et al. 2011

Clinical Biomechanics

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BACKGROUND: Baseplate micromotion of the reverse shoulder glenoid component can lead to implant loosening. We hypothesized that a remotely positioned displacement gage measures elastic deformation of the system rather than actual micromotion at the implant/bone interface. METHODS: Reverse glenoid components were implanted into polyurethane blocks of 3 different densities. A 700 N compressive load was maintained and a vertical 700 N shear load was applied for 1000 cycles. In addition to the typical gage measurement, a digital image analysis of micromotion at the implant/block interface using high resolution cameras was performed. The measurements were validated on human specimens. A finite element model was implemented to study the isolated effect of block deformation on baseplate displacements. FINDINGS: With the gage, typically reported micromotions were measured. Two orders of magnitude lower micromotions were detected using interface image-based analysis. The finite element simulation showed that elastic deformation alone can cause micromotion magnitudes as measured with displacement gages. Polyurethane blocks of 20 and 15 lbs per cubic foot density best reproduced micromotions as measured on human specimens. INTERPRETATION: We found considerably less relative micromotion at the implant/bone interface than previously assumed. Gage measurements quantify elastic deformation and not true interface micromotion. High resolution digital imaging at the implant/bone interface is strongly recommended for an accurate assessment of reverse glenoid component micromotion. Originally published at: Favre, P; Perala, S; Vogel, P; Fucentese, S F; Goff, J R; Gerber, C; Snedeker, J G (2011). In vitro assessments of reverse glenoid stability using displacement gages are misleading -recommendations for accurate measurements of interface micromotion. Clinical Biomechanics, 26 (9)

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Observations on the Effect of Movement on Bone Ingrowth into Porous-Surfaced Implants

Cited by 915 publications

References 0 publications

Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

In vitro assessments of reverse glenoid stability using displacement gages are misleading — Recommendations for accurate measurements of interface micromotion

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