Aims. To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. Methods. The OCD lesion was created on the trochlear groove of left articular cartilage of femur per rat (40 rats in total). The experimental groups were Sham, OCD, and ESWT (0.25 mJ/mm. 2. , 800 impulses, 4 Hz). The animals were euthanized at 2, 4, 8, and 12 weeks post-treatment, and histopathological analysis, micro-CT scanning, and immunohistochemical staining were performed for the specimens. Results. In the histopathological analysis, the macro-morphological grading scale showed a significant increase, while the histological score and cartilage repair scale of ESWT exhibited a significant decrease compared to OCD at the 8- and 12-week timepoints. At the 12-week follow-up, ESWT exhibited a significant improvement in the volume of damaged bone compared to OCD. Furthermore, immunohistochemistry analysis revealed a significant decrease in type I collagen and a significant increase in type II collagen within the newly formed hyaline cartilage following ESWT, compared to OCD. Finally, SRY-box transcription factor 9 (SOX9), aggrecan, and TGF-β, BMP-2, -3, -4, -5, and -7 were significantly higher in ESWT than in OCD at 12 weeks. Conclusion. ESWT promoted the effect of TGF-β/BMPs, thereby modulating the production of extracellular matrix proteins and transcription factor involved in the regeneration of articular cartilage and subchondral bone in an OCD rat model. Cite this article: Bone Joint Res 2024;13(7):342–352

Aims

Micromotion of the polyethylene (PE) inlay may contribute to backside PE wear in addition to articulate wear of total knee arthroplasty (TKA). Using radiostereometric analysis (RSA) with tantalum beads in the PE inlay, we evaluated PE micromotion and its relationship to PE wear.

Introduction. The role of porosity in the longevity of polymethylmethacrylate (PMMA) bone cement mantles remains unclear, although porosity reduction is probably desirable. It is not known whether pore patterns, pore distribution or pore morphology contribute to failure, since it is difficult to assess these features with traditional techniques. We used a novel microtomographic technique to quantitatively and qualitatively assess porosity in PMMA cements of differing viscosities to establish whether pore distribution can be effectively assessed and to document any differences in porosity (in both quantity, distribution and morphology). Each cement was also examined with and without the addition of vacuum, since this is thought to reduce porosity. Methods and materials. Four PMMA bone cements of different viscosities (three of the same brand and the fourth chosen due to its popularity) were prepared and moulded according to established protocols (ASTM F451-99a), with and without the addition of vacuum. 25 samples per group (200 total) were prepared and densities for each sample calculated using Archimedes' principle. Four samples per group (total 32) were randomly selected for further analysis. These samples underwent micro-computer tomography (micro-CT) at a magnification of 20× and slice thickness of 13.67μm and reconstructed images were analysed with in-house developed software to measure pore size and volume. Results were analysed and compared with the two-sample T-test assuming significance at P<0.05. Qualitative assessment of pore character and distribution was made using three dimensional (3D) reconstruction. Results. Densities and mean total pore volume showed an overall reduction in porosity with vacuum. Mean pore volume (MPV) was not significantly different between samples due to the huge range of pore sizes. Qualitative assessment revealed a striking, distinctive pore distribution between cements with an asymmetric distribution in the high viscosity group. Pore size was also qualitatively distinct between cement types and groups with and without vacuum. Conclusion. Micro-CT allows detailed in vitro quantitative and qualitative assessment of porosity in PMMA cement. Pore volume, architecture and volumetric distribution differ in cements of differing viscosity and with or without the application of vacuum. This effect is marked enough to allow distinction between cements based on their micro-CT appearances. Further study using this technique in combination with other methods (such as quantitative analysis of 3D pore distribution) may shed light on the failure mechanisms in PMMA cement mantles, particularly with regard to the role of pore orientation, distribution and size

Objectives

Up to 40% of unicompartmental knee arthroplasty (UKA) revisions are performed for unexplained pain which may be caused by elevated proximal tibial bone strain. This study investigates the effect of tibial component metal backing and polyethylene thickness on bone strain in a cemented fixed-bearing medial UKA using a finite element model (FEM) validated experimentally by digital image correlation (DIC) and acoustic emission (AE).

As many as 25% to 40% of unicompartmental knee replacement (UKR) revisions are performed for pain, a possible cause of which is proximal tibial strain. The aim of this study was to examine the effect of UKR implant design and material on cortical and cancellous proximal tibial strain in a synthetic bone model. Composite Sawbone tibiae were implanted with cemented UKR components of different designs, either all-polyethylene or metal-backed. The tibiae were subsequently loaded in 500 N increments to 2500 N, unloading between increments. Cortical surface strain was measured using a digital image correlation technique. Cancellous damage was measured using acoustic emission, an engineering technique that detects sonic waves (‘hits’) produced when damage occurs in material.

Anteromedial cortical surface strain showed significant differences between implants at 1500 N and 2500 N in the proximal 10 mm only (p < 0.001), with relative strain shielding in metal-backed implants. Acoustic emission showed significant differences in cancellous bone damage between implants at all loads (p = 0.001). All-polyethylene implants displayed 16.6 times the total number of cumulative acoustic emission hits as controls. All-polyethylene implants also displayed more hits than controls at all loads (p < 0.001), more than metal-backed implants at loads ≥ 1500 N (p < 0.001), and greater acoustic emission activity on unloading than controls (p = 0.01), reflecting a lack of implant stiffness. All-polyethylene implants were associated with a significant increase in damage at the microscopic level compared with metal-backed implants, even at low loads. All-polyethylene implants should be used with caution in patients who are likely to impose large loads across their knee joint.

Cite this article: Bone Joint J 2013;95-B:1339–47.

Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure.

The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.