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The Journal of Bone & Joint Surgery British Volume
Vol. 60-B, Issue 4 | Pages 579 - 582
1 Nov 1978
Hughes S Khan R Davies R Lavender P

The residue and extraction of technetium-labelled methylene diphosphonate (99mTc-MDP), a substance used in bone scanning, was examined in the canine tibia and found to be low. Examination of washout curves suggested that there were four compartments in cortical bone, a vascular, a perivascular, a bone fluid and a bone compartment. After an osteotomy in the canine tibia the residue of 99mTc-MDP increased. This was believed to be due to an increase in the blood supply to the bone and to an associated increase in new bone available for exchange. Bone scanning in a fracture is therefore a reflection of the vascular status of the bone being examined and of the uptake by bone. This is dependent on there being an adequate blood supply to the bone and an increased number of mineral-binding sites


The Bone & Joint Journal
Vol. 102-B, Issue 11 | Pages 1435 - 1437
1 Nov 2020
Katakura M Mitchell AWM Lee JC Calder JD


The Journal of Bone & Joint Surgery British Volume
Vol. 70-B, Issue 3 | Pages 397 - 403
1 May 1988
Amis A

This study aimed to compare the holding strength of various commercially-available anchorage devices for artificial ligaments, so that surgeons might make a reasoned choice. Tensile tests to failure were performed on screws, bollards, toggles and staples which had been implanted into cadaveric bones. The holding strength of all devices correlated significantly with the local thickness of cortical bone, so it is recommended that anchorages should be placed away from the joint line, into diaphyseal bone if possible. A new trans-cortical grommet was developed which, when used around an AO screw, had significantly greater holding strength than the other devices


Bone & Joint Research
Vol. 10, Issue 3 | Pages 188 - 191
1 Mar 2021
Nicholson T Scott A Newton Ede M Jones SW


The Journal of Bone & Joint Surgery British Volume
Vol. 47-B, Issue 2 | Pages 354 - 363
1 May 1965
Charnley J

It has been shown by mechanical analysis that by using cement to bond the stem of a femoral head prosthesis to bone two advantages are obtained when the conditions are compared with conventional methods. 1. "Fretting" between the implant and the living bone is eliminated. This source of persistent relative movement is probably the most important starting point for the progressive loosening of weight-bearing implants. 2. When cement is used the bond with the bone is exposed to stresses which are of an order three hundred times less than the shear strength of bone. The conventional prostheses expose the bond to compressive stresses which are near to the failure limits of the compressive strength of bone, especially in elderly patients with atrophic cortical bone in the femoral neck


The Journal of Bone & Joint Surgery British Volume
Vol. 36-B, Issue 1 | Pages 123 - 131
1 Feb 1954
Enticknap JB

1. A case is described of the marble bone disease of Albers-Schönberg in a woman of forty-one who died from subarachnoid haemorrhage. Several congenital abnormalities were present. 2. No significant abnormality of the chemical composition of the bones was discovered. 3. The long bones were more resilient, stronger, softer and of higher specific gravity than normal and the abnormal compact bone of the skull was less resilient, weaker, harder and of about the same density as normal bones. 4. The simple investigation of determining the breaking strength of cortical bone yielded results similar to the more complex investigations and if applied to a larger series of cases could provide sound data on which to base speculations about this condition


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 1 | Pages 130 - 133
1 Jan 2001
Hobbs CM Watkins PE

We used laser Doppler flowmetry (LDF) to measure flux in cortical bone fragments as a method of determining their vascular status and viability. In an experimental tibial osteotomy measurements of flux were made from specific cortical sites both before and after osteotomy. Flux levels fell rapidly in non-vascularised fragments and remained significantly reduced throughout the experiment. By contrast, those in vascularised fragments were significantly reduced one and two hours after the osteotomy but then increased. From three hours after the osteotomy there was no significant difference in flux levels between the vascularised fragments and proximal bone stock. We conclude that measurement of bone flux by LDF may have a role in the objective evaluation of the viability of bone fragments, but that further studies are required to validate the technique before its adoption in the management of the injured patient


The Journal of Bone & Joint Surgery British Volume
Vol. 74-B, Issue 1 | Pages 57 - 62
1 Jan 1992
Athanasou N Quinn J Bulstrode C

The role of inflammatory cells in aseptic loosening and failure of cemented joint replacements is unclear. Inflammatory cells from the revision joint capsule of four failed hip arthroplasties were examined to determine their nature and resorptive capacity. The capsules contained numerous macrophages and abundant foreign-body macrophage polykaryons, distinguished from osteoclasts by their antigenic phenotype and lack of response to calcitonin. When cultured on cortical bone slices in vitro, both macrophages and macrophage polykaryons produced small resorption pits and were associated with areas of superficial resorption of the bone surface. These results indicate that foreign-body induced macrophages and macrophage polykaryons are capable of a type of low-grade bone resorption which may be of pathogenic significance in the loosening of cemented joint prosthetic components


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 5 | Pages 748 - 752
1 Sep 1997
Song H Cho S Jeong S Park Y Koo K

Stable fixation after a corrective supracondylar osteotomy in adults is difficult because of the irregularity of the area of bony contact, displacement of the fragments, the predominance of cortical bone, and the need for early mobilisation. We have used the Ilizarov apparatus for fixation in 15 patients who were treated by complex osteotomies with displacement of fragments for cubitus varus or valgus. Most patients with cubitus varus required medial displacement with rotation of the distal fragment. Those with cubitus valgus required lateral shift of the distal fragment to reduce the medial prominence of the elbow that would otherwise result. All osteotomies united within the expected time without loss of correction, despite early mobilisation. Complications related to the fixation were few and had resolved at the long-term follow-up


The Journal of Bone & Joint Surgery British Volume
Vol. 72-B, Issue 5 | Pages 889 - 893
1 Sep 1990
Yamamuro T Shikata J Okumura H Kitsugi T Kakutani Y Matsui T Kokubo T

We prepared a prosthesis for the replacement of the lumbar vertebrae of sheep, using apatite- and wollastonite-containing glass-ceramic. The material is stronger than human cortical bone and has the special feature of chemical bonding to bone. Ten sheep underwent replacement of L3 and L4 vertebrae, without bone grafting. The animals were killed at intervals from three months to 27 months after operation, and the interface between the prosthesis and bone was examined radiologically, histologically and crystallographically. Bone bonding with the prosthesis had occurred in half the implants. It took at least one year for bonding to be complete, but an apatite layer on the surface of the prosthesis was observed as early as three months after the operation, suggesting the possibility of much earlier bone bonding if more rigid fixation of the prosthesis had been provided


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 5 | Pages 713 - 716
1 Sep 1994
Bischoff U Freeman M Smith D Tuke M Gregson P

We studied the wear generated by motion between polished and shot-blasted titanium-alloy (Ti-6Al-4V) or cobalt-chrome alloy (Co-Cr) surfaces and cortical bone in vitro. Semicircular sections of human proximal femoral cortex were reamed to fit metal cylinders of each alloy. The cylinders were then fitted in the bone, loaded and rotated in physiological saline. Ti-alloy resulted in more wear both of the bone and of the metal than did Co-Cr alloy. Metal wear was reduced and bone wear was increased by shot-blasting, a procedure which introduces surface residual stresses and roughens the metal surface. We conclude that when there is gross motion between a metal implant and bone, Ti-alloy is likely to generate more wear debris than Co-Cr alloy. The least wear both of bone and of metal was produced by polished Co-Cr


The Journal of Bone & Joint Surgery British Volume
Vol. 70-B, Issue 1 | Pages 17 - 22
1 Jan 1988
Geesink R de Groot K Klein C

Implants of solid sintered hydroxyapatite form very tight bonds with living bone, but are susceptible to fatigue failure. This problem can be overcome by using plasma-sprayed apatite coatings on titanium implants. A very strong bond is formed between bone and this composite material; this was studied in canine bone with plug implants, avoiding any mechanical retention. Mechanical testing showed an interface shear strength at six weeks of 49 MPa with a maximum of 64 MPa after six months. There was histological evidence of direct bonding between the apatite coating and living bone while uncoated control plugs were easily extracted. The results indicate that apatite-coated implants can form a chemical fixation with a strength comparable to that of cortical bone itself. This fixation is far stronger than that provided by current cemented or uncemented fixation techniques


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 522 - 529
1 Mar 2021
Nichol T Callaghan J Townsend R Stockley I Hatton PV Le Maitre C Smith TJ Akid R

Aims

The aim of this study was to develop a single-layer hybrid organic-inorganic sol-gel coating that is capable of a controlled antibiotic release for cementless hydroxyapatite (HA)-coated titanium orthopaedic prostheses.

Methods

Coatings containing gentamicin at a concentration of 1.25% weight/volume (wt/vol), similar to that found in commercially available antibiotic-loaded bone cement, were prepared and tested in the laboratory for: kinetics of antibiotic release; activity against planktonic and biofilm bacterial cultures; biocompatibility with cultured mammalian cells; and physical bonding to the material (n = 3 in all tests). The sol-gel coatings and controls were then tested in vivo in a small animal healing model (four materials tested; n = 6 per material), and applied to the surface of commercially pure HA-coated titanium rods.


The Bone & Joint Journal
Vol. 103-B, Issue 7 Supple B | Pages 122 - 128
1 Jul 2021
Tibbo ME Limberg AK Gausden EB Huang P Perry KI Yuan BJ Berry DJ Abdel MP

Aims

The prevalence of ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is rising in concert with life expectancy, putting more patients at risk for interprosthetic femur fractures (IPFFs). Our study aimed to assess treatment methodologies, implant survivorship, and IPFF clinical outcomes.

Methods

A total of 76 patients treated for an IPFF from February 1985 to April 2018 were reviewed. Prior to fracture, at the hip/knee sites respectively, 46 femora had primary/primary, 21 had revision/primary, three had primary/revision, and six had revision/revision components. Mean age and BMI were 74 years (33 to 99) and 30 kg/m2 (21 to 46), respectively. Mean follow-up after fracture treatment was seven years (2 to 24).


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 530 - 535
1 Mar 2021
Giannicola G Castagna V Villani C Gumina S Scacchi M

Aims

It has been hypothesized that proximal radial neck resorption (PRNR) following press-fit radial head arthroplasty (RHA) is due to stress-shielding. We compared two different press-fit stems by means of radiographs to investigate whether the shape and size of the stems are correlated with the degree of PRNR.

Methods

The radiographs of 52 RHAs were analyzed both at 14 days postoperatively and after two years. A cylindrical stem and a conical stem were implanted in 22 patients (group 1) and 30 patients (group 2), respectively. The PRNR was measured in the four quadrants of the radial neck and the degree of stem filling was calculated by analyzing the ratio between the prosthetic stem diameter (PSD) and the medullary canal diameter (MCD) at the proximal portion of the stem (level A), halfway along the stem length (level B), and distally at the stem tip (level C).


The Journal of Bone & Joint Surgery British Volume
Vol. 68-B, Issue 4 | Pages 635 - 642
1 Aug 1986
Nilsson O Urist M Dawson E Schmalzried T Finerman G

In dogs, resection of a length of the ulna equal to twice the diameter of the mid-shaft leaves a defect which consistently fails to unite. In response to an implant of 100 mg of bovine bone morphogenetic protein (BMP), the defect becomes filled by callus consisting of fibrocartilage, cartilage and woven bone within four weeks. The cartilage is resorbed and replaced by new bone in four to eight weeks. Woven bone is then resorbed, colonised by bone marrow cells and remodelled into lamellar bone. Union of the defect is produced by 12 weeks. Control defects filled with autogeneic cortical bone chips unite after the same period. In regeneration induced by bone morphogenetic protein (BMP) and in repair enhanced by bone graft, union depends upon the proliferation of cells within and around the bone ends. Our working hypothesis is that BMP induces the differentiation of perivascular connective tissue cells into chondroblasts and osteoprogenitor cells and thereby augments the process of bone regeneration from the cells already present in the endosteum and periosteum


The Journal of Bone & Joint Surgery British Volume
Vol. 59-B, Issue 2 | Pages 189 - 196
1 May 1977
Nade S Burwell R

This paper examines the fate of decalcified allografts (homografts) of iliac cancellous bone impregnated with autologous red marrow and implanted intermuscularly into the anterior abdominal wall of rabbits. In contrast to the findings of Urist and other workers that cortical bone decalcified with hydrochloric acid (HCl) and then freeze-dried is inductive to new bone formation in various heterotopic sites, evidence is presented that iliac bone decalcified by HCl and grafted alone to a muscular site is itself very weakly inductive to bone formation. However, when combined with autologous bone marrow the HCl-decalcified bone provides a better substrate for bone formation by marrow cells than does either undecalcified iliac bone, or iliac bone decalcified with ethylene-diamine-tetra-acetic acid. The freezing or freeze-drying of decalcified bone does not affect new bone formation when implanted alone or with autologous marrow. The differences between the cortical and cancellous bone as inductive substrates for osteogenesis are discussed and the interrelationship of bone and marrow in combined bone grafts are re-evaluated


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 5 | Pages 849 - 856
1 Sep 1997
Wang W Ferguson DJP Quinn JMW Simpson AHRW Athanasou NA

Abundant implant-derived biomaterial wear particles are generated in aseptic loosening and are deposited in periprosthetic tissues in which they are phagocytosed by mononuclear and multinucleated macrophage-like cells. It has been stated that the multinucleated cells which contain wear particles are not bone-resorbing osteoclasts. To investigate the validity of this claim we isolated human osteoclasts from giant-cell tumours of bone and rat osteoclasts from long bones. These were cultured on glass coverslips and on cortical bone slices in the presence of particles of latex, PMMA and titanium. Osteoclast phagocytosis of these particle types was shown by light microscopy, energy-dispersive X-ray analysis and SEM. Giant cells containing phagocytosed particles were seen to be associated with the formation of resorption lacunae. Osteoclasts containing particles were also calcitonin-receptor-positive and showed an inhibitory response to calcitonin. Our findings demonstrate that osteoclasts are capable of phagocytosing particles of a wide range of size, including particles of polymeric and metallic bio-materials found in periprosthetic tissues, and that after particle phagocytosis, they remain fully functional, hormone-responsive, bone-resorbing cells


The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 3 | Pages 463 - 469
1 May 1985
Law H Annan I McCarthy I Hughes S Stead A Camburn M Montgomery H

We have investigated the effect of currents induced by electromagnetic fields on the healing of the tibia of sheep after osteotomy, using objective and quantifiable criteria wherever possible. A battery-powered, induction apparatus was developed and was enclosed within the cast applied to the limb, so that the treated fractures received pulsed magnetic fields for 24 hours a day while the animals were freely mobile. In all, 13 sheep were treated and 13 were used as controls. The response was assessed by radiography of the limb and of the excised bone, by histology, including measurement of the areas of callus, fibrocallus and cortical bone, and by measurement of the uptake and extraction of bone-seeking mineral. All the bones healed and no statistically significant differences between the treated animals and the controls were discovered except (at only P less than 0.05) in the uptake of bone-seeking mineral; this increased more rapidly in treated animals over the two to three weeks after osteotomy, although at six weeks the uptake in both groups was the same


The Journal of Bone & Joint Surgery British Volume
Vol. 47-B, Issue 2 | Pages 339 - 353
1 May 1965
Lagier R Rutishauser E

1. A case of essential osteolysis is presented, occurring in a young man of eighteen with no known family history and developing progressively from early childhood. The condition was radiologically evident in the elbows, hands and feet, and was accompanied by atrophy of the cancellous bone of the epiphyses of the shoulders and knees. It was also associated with certain abnormalities of the skull and vertebrae. The patient died from a nephropathy of late onset. 2. Examination of the left foot revealed on the radiologically "lysed" bony extremities a very slow process of erosion affecting essentially the epiphysial and metaphysial cortical bone, of a non-inflammatory nature and accompanied by disappearance of the hyaline cartilage. The extremities not radiologically "lysed" showed signs of erosion that were histologically similar but not macroscopically evident; they were accompanied by regressive changes in the hyaline cartilage. 3. There were no signs of renal osteodystrophy or of Sudeck's dystrophy. 4. Post-mortem tests revealed an increase in the seromucoids and failed to reveal the presence of proline in the serum or of proline and hydroxyproline in the urine. 5. The authors discuss the place of this condition among osteolyses in general