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Sample records for experimental orthopedic implants

  1. Superelastic Orthopedic Implant Coatings

    Science.gov (United States)

    Fournier, Eric; Devaney, Robert; Palmer, Matthew; Kramer, Joshua; El Khaja, Ragheb; Fonte, Matthew

    2014-07-01

    The demand for hip and knee replacement surgery is substantial and growing. Unfortunately, most joint replacement surgeries will fail within 10-25 years, thereby requiring an arduous, painful, and expensive revision surgery. To address this issue, a novel orthopedic implant coating material ("eXalt") has been developed. eXalt is comprised of super elastic nitinol wire that is knit into a three-dimensional spacer fabric structure. eXalt expands in vivo to conform to the implantation site and is porous to allow for bone ingrowth. The safety and efficacy of eXalt were evaluated through structural analysis, mechanical testing, and a rabbit implantation model. The results demonstrate that eXalt meets or exceeds the performance of current coating technologies with reduced micromotion, improved osseointegration, and stronger implant fixation in vivo.

  2. Porous metal for orthopedics implants

    OpenAIRE

    Matassi, Fabrizio; Botti, Alessandra; Sirleo, Luigi; Carulli, Christian; Innocenti, Massimo

    2013-01-01

    Porous metal has been introduced to obtain biological fixation and improve longevity of orthopedic implants. The new generation of porous metal has intriguing characteristics that allows bone healing and high osteointegration of the metallic implants. This article gives an overview about biomaterials properties of the contemporary class of highly porous metals and about the clinical use in orthopaedic surgery.

  3. New biomaterials for orthopedic implants

    OpenAIRE

    Ong KL; Yun BM; White JB

    2015-01-01

    Kevin L Ong, Brian Min Yun, Joshua B WhiteExponent, Inc., Philadelphia, PA, USAAbstract: With the increasing use of orthopedic implants worldwide, there continues to be great interest in the development of novel technologies to further improve the effective clinical performance of contemporary treatment modalities and devices. Continuing research interest also exists in developing novel bulk biomaterials (eg, polycarbonate urethanes, silicon) or novel formulations of existing but less widely ...

  4. Physical modification of polyetheretherketone for orthopedic implants

    Science.gov (United States)

    Du, Ya-Wei; Zhang, Li-Nan; Hou, Zeng-Tao; Ye, Xin; Gu, Hong-Sheng; Yan, Guo-Ping; Shang, Peng

    2014-12-01

    Polyetheretherketone (PEEK) is regarded as one of the most potential candidates for replacing current implant applications. To obtain good bone-implant interfaces, many modification methods have been developed to enable PEEK and PEEK-based composites from bio-inert to bioactive. Among them, physical methods have aroused significant attention and been widely used to modify PEEK for orthopedic implants. This review summarizes current physical modification techniques of PEEK for orthopedic applications, which include composite strategies, surface coating methods and irradiation treatments. The positive consequences of those modification methods will encourage continuing investigations and stimulate the wide range of applications of PEEK-based implants in orthopedics.

  5. RAPID MANUFACTURING SYSTEM OF ORTHOPEDIC IMPLANTS.

    Science.gov (United States)

    Relvas, Carlos; Reis, Joana; Potes, José Alberto Caeiro; Fonseca, Fernando Manuel Ferreira; Simões, José Antonio Oliveira

    2009-01-01

    This study, aimed the development of a methodology for rapid manufacture of orthopedic implants simultaneously with the surgical intervention, considering two potential applications in the fields of orthopedics: the manufacture of anatomically adapted implants and implants for bone loss replacement. This work innovation consists on the capitation of the in situ geometry of the implant by direct capture of the shape using an elastomeric material (polyvinylsiloxane) which allows fine detail and great accuracy of the geometry. After scanning the elastomeric specimen, the implant is obtained by machining using a CNC milling machine programmed with a dedicated CAD/CAM system. After sterilization, the implant is able to be placed on the patient. The concept was developed using low cost technology and commercially available. The system has been tested in an in vivo hip arthroplasty performed on a sheep. The time increase of surgery was 80 minutes being 40 minutes the time of implant manufacturing. The system developed has been tested and the goals defined of the study achieved enabling the rapid manufacture of an implant in a time period compatible with the surgery time.

  6. Enhancing orthopedic implant bioactivity: refining the nanotopography.

    Science.gov (United States)

    Wang, Guocheng; Moya, Sergio; Lu, ZuFu; Gregurec, Danijela; Zreiqat, Hala

    2015-01-01

    Advances in nanotechnology open up new possibilities to produce biomimetic surfaces that resemble the cell in vivo growth environment at a nanoscale level. Nanotopographical changes of biomaterials surfaces can positively impact the bioactivity and ossointegration properties of orthopedic and dental implants. This review introduces nanofabrication techniques currently used or those with high potential for use as surface modification of biomedical implants. The interactions of nanotopography with water, proteins and cells are also discussed, as they largely determine the final success of the implants. Due to the well-documented effects of surface chemistry and microtopography on the bioactivity of the implant, we here elaborate on the ability of the nanofabrication techniques to combine the dual (multi) modification of surface chemistry and/or microtopography.

  7. EVALUATION OF THE KNOWLEDGE ON COST OF ORTHOPEDIC IMPLANTS AMONG ORTHOPEDIC SURGEONS

    Science.gov (United States)

    Arliani, Gustavo Gonçalves; Sabongi, Rodrigo Guerra; Batista, Alysson Ferreira; Astur, Diego Costa; Falotico, Guilherme Guadagnini; Cohen, Moises

    2016-01-01

    ABSTRACT Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants. Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology. Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials. Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario.Level of Evidence III, Cross-Sectional Study. PMID:28243178

  8. Bioactive glass coatings for orthopedic metallic implants

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    Lopez-Esteban, Sonia; Saiz, Eduardo; Fujino, Sigheru; Oku, Takeo; Suganuma, Katsuaki; Tomsia, Antoni P.

    2003-06-30

    The objective of this work is to develop bioactive glass coatings for metallic orthopedic implants. A new family of glasses in the SiO2-Na2O-K2O-CaO-MgO-P2O5 system has been synthesized and characterized. The glass properties (thermal expansion, softening and transformation temperatures, density and hardness) are in line with the predictions of established empirical models. The optimized firing conditions to fabricate coatings on Ti-based and Co-Cr alloys have been determined and related to the glass properties and the interfacial reactions. Excellent adhesion to alloys has been achieved through the formation of 100-200 nm thick interfacial layers (Ti5Si3 on Ti-based alloys and CrOx on Co-Cr). Finally, glass coatings, approximately 100 mu m thick, have been fabricated onto commercial Ti alloy-based dental implants.

  9. Prediction of bone density around orthopedic implants delivering bisphosphonate.

    Science.gov (United States)

    Stadelmann, Vincent A; Terrier, Alexandre; Gauthier, O; Bouler, J-M; Pioletti, Dominique P

    2009-06-19

    The fixation of an orthopedic implant depends strongly upon its initial stability. Peri-implant bone may resorb shortly after the surgery. This resorption is directly followed by new bone formation and implants fixation strengthening, the so-called secondary fixation. If the initial stability is not reached, the resorption continues and the implant fixation weakens, which leads to implant loosening. Studies with rats and dogs have shown that a solution to prevent peri-implant resorption is to deliver bisphosphonate from the implant surface. The aims of the study were, first, to develop a model of bone remodeling around an implant delivering bisphosphonate, second, to predict the bisphosphonate dose that would induce the maximal peri-implant bone density, and third to verify in vivo that peri-implant bone density is maximal with the calculated dose. The model consists of a bone remodeling equation and a drug diffusion equation. The change in bone density is driven by a mechanical stimulus and a drug stimulus. The drug stimulus function and the other numerical parameters were identified from experimental data. The model predicted that a dose of 0.3 microg of zoledronate on the implant would induce a maximal bone density. Implants with 0.3 microg of zoledronate were then implanted in rat femurs for 3, 6 and 9 weeks. We measured that peri-implant bone density was 4% greater with the calculated dose compared to the dose empirically described as best. The approach presented in this paper could be used in the design and analysis processes of experiments in local delivery of drug such as bisphosphonate.

  10. New approach to orthopedic implant design

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    Hollerbach, K; Perfect, S; Martz, H; Ashby, E

    1999-07-03

    This report describes the accomplishments of a three year LDRD project, aimed at developing computational models and methodologies for improving prosthetic joint design. The investigators developed human models as well as prosthetic joint models. Input data came both from high resolution scans performed at Lawrence Livermore National Laboratory (LLNL) and from data provided by collaborators. Results of the approach, in addition to being presented at scientific meetings, are being used to obtain US Food and Drug Administration (FDA) approval in the process of putting new implant designs on the market.

  11. Can Direct Current Electrotherapy Be Used for Patients With Orthopedic Implants?

    Science.gov (United States)

    Thaler, Evangeline; Toledo, Felippe; Korte, Holger

    2017-03-01

    Although electrotherapy appears to have particularly interesting applications in the field of postoperative orthopedic rehabilitation, relatively little scientifically based research has been conducted in the area of electrotherapy with regard to safety involving patients with orthopedic implants. Three electrotherapy forms were tested, such as high-volt stimulation (HVS), transcutaneous electric nerve stimulation (TENS), and galvanic current (GAL), using a model system containing a metal implant plate to evaluate whether heating in excess of 3°C would occur. All changes in temperature for HVS, GAL, and TENS therapeutic electrical currents observed in our model system fall below the predefined 3°C. To the best of our knowledge, this is the first experimental based observation that prolonged exposure to a direct electrical current at therapeutic strength does not result in heating of metal titanium plates.

  12. Surface Functionalization of Orthopedic Titanium Implants with Bone Sialoprotein.

    Directory of Open Access Journals (Sweden)

    Andreas Baranowski

    Full Text Available Orthopedic implant failure due to aseptic loosening and mechanical instability remains a major problem in total joint replacement. Improving osseointegration at the bone-implant interface may reduce micromotion and loosening. Bone sialoprotein (BSP has been shown to enhance bone formation when coated onto titanium femoral implants and in rat calvarial defect models. However, the most appropriate method of BSP coating, the necessary level of BSP coating, and the effect of BSP coating on cell behavior remain largely unknown. In this study, BSP was covalently coupled to titanium surfaces via an aminosilane linker (APTES, and its properties were compared to BSP applied to titanium via physisorption and untreated titanium. Cell functions were examined using primary human osteoblasts (hOBs and L929 mouse fibroblasts. Gene expression of specific bone turnover markers at the RNA level was detected at different intervals. Cell adhesion to titanium surfaces treated with BSP via physisorption was not significantly different from that of untreated titanium at any time point, whereas BSP application via covalent coupling caused reduced cell adhesion during the first few hours in culture. Cell migration was increased on titanium disks that were treated with higher concentrations of BSP solution, independent of the coating method. During the early phases of hOB proliferation, a suppressive effect of BSP was observed independent of its concentration, particularly when BSP was applied to the titanium surface via physisorption. Although alkaline phosphatase activity was reduced in the BSP-coated titanium groups after 4 days in culture, increased calcium deposition was observed after 21 days. In particular, the gene expression level of RUNX2 was upregulated by BSP. The increase in calcium deposition and the stimulation of cell differentiation induced by BSP highlight its potential as a surface modifier that could enhance the osseointegration of orthopedic implants

  13. A touch probe method of operating an implantable RFID tag for orthopedic implant identification.

    Science.gov (United States)

    Liu, Xiaoyu; Berger, J Lee; Ogirala, Ajay; Mickle, Marlin H

    2013-06-01

    The major problem in operating an implantable radio-frequency identification (RFID) tag embedded on an orthopedic implant is low efficiency because of metallic interference. To improve the efficiency, this paper proposes a method of operating an implantable passive RFID tag using a touch probe at 13.56 MHz. This technology relies on the electric field interaction between two pairs of electrodes, one being a part of the touch probe placed on the surface of tissue and the other being a part of the tag installed under the tissue. Compared with using a conventional RFID antenna such as a loop antenna, this method has a better performance in the near field operation range to reduce interference with the orthopedic implant. Properly matching the touch probe and the tag to the tissue and the implant reduces signal attenuation and increases the overall system efficiency. The experiments have shown that this method has a great performance in the near field transcutaneous operation and can be used for orthopedic implant identification.

  14. Allergy to orthopedic metal implants - a prospective study.

    Science.gov (United States)

    Kręcisz, Beata; Kieć-Świerczyńska, Marta; Chomiczewska-Skóra, Dorota

    2012-09-01

    Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure. The study was conducted in two stages. Stage I (pre-implantation) - 60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) - 48 subjects participated in the same procedures as those conducted in Stage I. Stage I - symptoms of "metal dermatitis" were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II - 10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre- and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants. Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.

  15. PEEK Biomaterials in Trauma, Orthopedic, and Spinal Implants

    Science.gov (United States)

    Kurtz, S. M.; Devine, J. N.

    2007-01-01

    Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature. PMID:17686513

  16. PEEK biomaterials in trauma, orthopedic, and spinal implants.

    Science.gov (United States)

    Kurtz, Steven M; Devine, John N

    2007-11-01

    Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature.

  17. Selective laser sintering of calcium phosphate materials for orthopedic implants

    Science.gov (United States)

    Lee, Goonhee

    control of micro and macro pore structure, to maximize bone healing and provide sufficient mechanical strength. It also permits the complete removal of the polymeric binders that are resided in the SLS process. In collaboration with the University of Texas Health Science Center at San Antonio and BioMedical Enterprises, Inc., porous implants based on anatomical geometry have been successfully implanted in rabbits and dogs. These histologic animal studies reveal excellent biocompatibility and show its great potential for commercial custom-fit implant manufacture. The second research effort involves fabrication of fully dense bone for application in dental restoration and load-bearing orthopedic functions. Calcium phosphate glass melts, proven to be biocompatible in the first effort, were cast into carbon molds. Processes were developed for preparing the molds. These carbon molds of anatomic shape can be prepared from either Computer Numerical Control (CNC) milling of slab stock or SLS processing of thermoset-coated graphite powder. The CNC milling method provides accurate dimension of the molds in a short period of time, however, the capable geometries are limited; generally two pieces of molds are required for complex shapes. The SLS method provides very complex shape green molds. However, they need to go through pyrolysis of thermoset binder to provide the high temperature capability reached at calcium phosphate melt temperatures (1100°C) and noticeable shrinkage was observed during pyrolysis. The cast glass was annealed to develop polycrystalline calcium phosphate. This process also exhibits great potential.

  18. Production of new titanium alloy for orthopedic implants

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    Taddei, E.B. [Instituto Tecnologico de Aeronautica (ITA), Centro Tecnico Aeroespacial, Sao Jose dos Campos-SP, 12228-904 (Brazil)]. E-mail: elisa@ita.br; Henriques, V.A.R. [AMR-DiviSao de Materiais-Instituto de Aeronautica e Espaco (IAE), Centro Tecnico Aeroespacial, Sao Jose dos Campos-SP, 12228-904 (Brazil); Silva, C.R.M. [AMR-DiviSao de Materiais-Instituto de Aeronautica e Espaco (IAE), Centro Tecnico Aeroespacial, Sao Jose dos Campos-SP, 12228-904 (Brazil); Cairo, C.A.A. [AMR-DiviSao de Materiais-Instituto de Aeronautica e Espaco (IAE), Centro Tecnico Aeroespacial, Sao Jose dos Campos-SP, 12228-904 (Brazil)

    2004-11-01

    The beta titanium alloys is one of the most promising groups of the titanium alloys. This fact is due to the good formability, mechanical properties and potential applications; moreover, these alloys present the highest level of mechanical, fatigue and corrosion resistance. The beta titanium alloys present the lowest elastic modulus, an interesting property for orthopedic implants. A {beta} alloy recently developed for this application is Ti-35Nb-7Zr-5Ta. In this work, the alloy was produced by powder metallurgy, unique available alternative for obtaining parts with porous structure (until 50% of porosity), that is one important characteristic for the osteointegration. The Ti-35Nb-7Zr-5Ta samples were manufactured by blended elemental method from a sequence of uniaxial and cold isostatic pressing with subsequent densification by sintering among 900 at 1700 deg. C, in vacuum. The objective of this work is the analysis of alloy microstructural evolution from the elemental powders dissolution under the increase of the sintering temperature. The alloy was characterized by scanning electron microscopy, X-ray diffraction and Vickers microhardness measurements. Density was measured by Archimedes method. The results show that a {beta}-homogeneous microstructure is obtained in the whole sample with the increase of sintering temperature. With the beginning of the {beta}-stabilizers (Nb and Ta) dissolution, at low sintering temperatures, there is the formation of an intermediary Widmanstaetten ({alpha}+{beta}) phase.

  19. Biological strategies for improved osseointegration and osteoinduction of porous metal orthopedic implants.

    Science.gov (United States)

    Lewallen, Eric Alexander; Riester, Scott M; Bonin, Carolina A; Kremers, Hilal Maradit; Dudakovic, Amel; Kakar, Sanjeev; Cohen, Robert C; Westendorf, Jennifer J; Lewallen, David G; van Wijnen, Andre J

    2015-04-01

    The biological interface between an orthopedic implant and the surrounding host tissue may have a dramatic effect upon clinical outcome. Desired effects include bony ingrowth (osseointegration), stimulation of osteogenesis (osteoinduction), increased vascularization, and improved mechanical stability. Implant loosening, fibrous encapsulation, corrosion, infection, and inflammation, as well as physical mismatch may have deleterious clinical effects. This is particularly true of implants used in the reconstruction of load-bearing synovial joints such as the knee, hip, and the shoulder. The surfaces of orthopedic implants have evolved from solid-smooth to roughened-coarse and most recently, to porous in an effort to create a three-dimensional architecture for bone apposition and osseointegration. Total joint surgeries are increasingly performed in younger individuals with a longer life expectancy, and therefore, the postimplantation lifespan of devices must increase commensurately. This review discusses advancements in biomaterials science and cell-based therapies that may further improve orthopedic success rates. We focus on material and biological properties of orthopedic implants fabricated from porous metal and highlight some relevant developments in stem-cell research. We posit that the ideal primary and revision orthopedic load-bearing metal implants are highly porous and may be chemically modified to induce stem cell growth and osteogenic differentiation, while minimizing inflammation and infection. We conclude that integration of new biological, chemical, and mechanical methods is likely to yield more effective strategies to control and modify the implant-bone interface and thereby improve long-term clinical outcomes.

  20. In-vivo orthopedic implant diagnostic device for sensing load, wear, and infection

    Science.gov (United States)

    Evans, III, Boyd McCutchen; Thundat, Thomas G.; Komistek, Richard D.; Dennis, Douglas A.; Mahfouz, Mohamed

    2006-08-29

    A device for providing in vivo diagnostics of loads, wear, and infection in orthopedic implants having at least one load sensor associated with the implant, at least one temperature sensor associated with the implant, at least one vibration sensor associated with the implant, and at least one signal processing device operatively coupled with the sensors. The signal processing device is operable to receive the output signal from the sensors and transmit a signal corresponding with the output signal.

  1. Corrosion behavior of a welded stainless-steel orthopedic implant.

    Science.gov (United States)

    Reclaru, L; Lerf, R; Eschler, P Y; Meyer, J M

    2001-02-01

    The corrosion behavior of combinations of materials used in an orthopedic implant: the spherical part (forged or forged and annealed) constituting the head, the weld (tungsten inert gas (TIG) or electron beam (EB) techniques), and the cylindrical part (annealed) constituting the shaft of a femoral prosthesis - has been investigated. Open-circuit potentials, potentiodynamic curves, Tafel slope, mixed potential theory and susceptibility to intergranular attack are electrochemical and chemical procedures selected for this work. Electrochemical measurements using a microelectrode have been made in the following zones: spherical part, cylindrical part, weld, and weld/sphere, and weld/shaft interfaces. To detect intergranular attack, the Strauss test has been used. At the interfaces, corrosion currents, measured (Icorr) and predicted (Icouple) are low, in the order of the pico- to nanoampere. The electrochemical behavior of the electron beam (EB) weld is better than that of the tungsten inert gas (TIG). Welds at interfaces can behave either anodically or cathodically. It is better if welds, which are sensitive parts of the femoral prosthesis, behave cathodically. In this way, the risk of starting localized corrosion (pitting, crevice or intergranular corrosion) from a galvanic couple, remains low. From this point of view, the sample with the EB weld offers the best behavior. All the other samples containing a TIG type of weld exhibit a less favorable behavior. The mechanical treatments (forged, and forged and annealed) of the steel sphere did not show any difference in the corrosion behavior. No intergranular corrosion has been observed at the weld/steel interface for unsensitized samples. With sensitized samples, however, a TIG sample has exhibited some localized intergranular corrosion at a distance of 500 microm along the weld/stainless steel (sphere) interface.

  2. PREPARATION AND CHARACTERIZATION OF Ti-Al-Nb ALLOYS FOR ORTHOPEDIC IMPLANTS

    Directory of Open Access Journals (Sweden)

    Oliveira V.

    1998-01-01

    Full Text Available Pure titanium shows very interesting characteristics such as high strength-to-weight ratio, very good corrosion resistance and excellent biocompatibility, which make this material appropriate for use in orthopedic and dental implants. Due to the mechanical properties of pure titanium, its use in implants is restricted to applications which involve moderate mechanical stress, such as dental implants. In applications where high mechanical strength is necessary, like orthopedic implants, it is appropriate to employ titanium-based alloys, which have better properties than pure titanium. The present work is related to the microstructure and corrosion resistance characterization of the Ti-6Al-7Nb alloy, designed to be used in orthopedic prostheses.

  3. An overview of recent advances in designing orthopedic and craniofacial implants

    OpenAIRE

    Mantripragada, Venkata P.; Lecka-Czernik, Beata; Ebraheim, Nabil A.; Jayasuriya, Ambalangodage C.

    2013-01-01

    Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, coba...

  4. Value and clinical application of orthopedic metal artifact reduction algorithm in CT scans after orthopedic metal implantation

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    Hu, Yi; Pan, Shinong; Zhao, Xudong; Guo, Wenli; He, Ming; Guo, Qiyong [Shengjing Hospital of China Medical University, Shenyang (China)

    2017-06-15

    To evaluate orthopedic metal artifact reduction algorithm (O-MAR) in CT orthopedic metal artifact reduction at different tube voltages, identify an appropriate low tube voltage for clinical practice, and investigate its clinical application. The institutional ethical committee approved all the animal procedures. A stainless-steel plate and four screws were implanted into the femurs of three Japanese white rabbits. Preoperative CT was performed at 120 kVp without O-MAR reconstruction, and postoperative CT was performed at 80–140 kVp with O-MAR. Muscular CT attenuation, artifact index (AI) and signal-to-noise ratio (SNR) were compared between preoperative and postoperative images (unpaired t test), between paired O-MAR and non-O-MAR images (paired Student t test) and among different kVp settings (repeated measures ANOVA). Artifacts' severity, muscular homogeneity, visibility of inter-muscular space and definition of bony structures were subjectively evaluated and compared (Wilcoxon rank-sum test). In the clinical study, 20 patients undertook CT scan at low kVp with O-MAR with informed consent. The diagnostic satisfaction of clinical images was subjectively assessed. Animal experiments showed that the use of O-MAR resulted in accurate CT attenuation, lower AI, better SNR, and higher subjective scores (p < 0.010) at all tube voltages. O-MAR images at 100 kVp had almost the same AI and SNR as non-O-MAR images at 140 kVp. All O-MAR images were scored ≥ 3. In addition, 95% of clinical CT images performed at 100 kVp were considered satisfactory. O-MAR can effectively reduce orthopedic metal artifacts at different tube voltages, and facilitates low-tube-voltage CT for patients with orthopedic metal implants.

  5. Short-Term and Long-Term Effects of Orthopedic Biodegradable Implants

    Science.gov (United States)

    Amini, Ami R.; Wallace, James S.; Nukavarapu, Syam P.

    2012-01-01

    Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable materials, as with permanent materials, mounts an acute host inflammatory response. Over time, the implant degradation profile and possible degradation product toxicity mediate long-term biodegradable implant-induced inflammation. However, unlike permanent implants, this inflammation is likely to cease once the material disappears. Implant-mediated inflammation is a critical determinant for implant success. Thus, for the development of a proactive biodegradable implant that has the ability to promote optimal bone regeneration and minimal detrimental inflammation, a thorough understanding of short- and long-term inflammatory events is required. Here, we discuss an array of biodegradable orthopedic implants, their associated short- and long- term inflammatory effects, and methods to mediate these inflammatory events. PMID:22043969

  6. Brandon Research, Inc. Orthopedic Implant Cooperative Research and Development Agreement (CRADA) Final Report

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    Freeman, W.R.

    1999-04-22

    The project was a joint research effort between the U. S. Department of Energy's (DOE) Kansas City Plant (KCP) and Brandon Research, Inc. to develop ways to improve implants used for orthopedic surgery for joint replacement. The primary product produced by this study is design information, which may be used to develop implants that will improve long-term fixation and durability in the host bone environment.

  7. Early Diagnosis of Orthopedic Implant Failure Using Macromolecular Imaging Agents

    Science.gov (United States)

    Ren, Ke; Dusad, Anand; Zhang, Yijia; Purdue, P. Edward; Fehringer, Edward V.; Garvin, Kevin L.; Goldring, Steven R.; Wang, Dong

    2014-01-01

    Purpose To develop and evaluate diagnostic tools for early detection of wear particle-induced orthopaedic implant loosening. Methods N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer was tagged with an near infrared dye and used to detect the inflammation induced by polymethylmethacrylate (PMMA) particles in a murine peri-implant osteolysis model. It was established by inserting implant into distal femur and with routine PMMA particles challenging. The osteolysis was evaluated by micro-CT and histological analysis at different time points. Results Significant peri-implant osteolysis was found three-month post PMMA particle challenge by micro-CT and histological analysis. At one-month time point, when there was no significant peri-implant bone loss, HPMA copolymer-near infrared dye conjugate was found to specifically target to the femur with PMMA particles deposition, but not the contralateral control femur with PBS infusion. Conclusion The results from this study demonstrated the feasibility of utilizing the macromolecular diagnostic agent to report particle-induced peri-implant inflammation prior to the development of detectable osteolysis. Recognition of this early pathological event would provide the window of opportunity for prevention of peri-implant osteolysis and subsequent orthopaedic implant failure. PMID:24590878

  8. Surface evaluation of orthopedic hip implants marketed in Brazil

    Science.gov (United States)

    Souza, M. M.; Trommer, R. M.; Maru, M. M.; Roesler, C. R. M.; Barros, W. S.; Dutra, M. S.

    2016-07-01

    One of the factors that contribute to the quality of total hip prostheses is the degree of accuracy in the manufacturing of the joint surfaces. The dimensional control of joint components is important because of its direct influence on the durability and, consequently, in the patients’ life quality. This work presents studies on the form and roughness of orthopedic hip prostheses marketed in Brazil. The results provide data for quality control of the surfaces of the femoral heads and acetabular components of hip prostheses and indicate the need of improvement in the procedures used to this control.

  9. Disaster Victim Identification using Orthopedic Implants in the 2011 East-Japan Earthquake and Tsunami.

    Science.gov (United States)

    Numata, Norio; Makinae, Haruka; Yoshida, Wataru; Daimon, Masao; Murakami, Hideki

    2017-03-01

    On March 11, 2011, an earthquake (magnitude 9.0) devastated Japan's east coast, and the associated tsunami resulted in social and mechanical destruction. Search for the missing people is still ongoing. Surgical implants are common in the general population. Medical implants usually have lot numbers, and their forensic use is common for victim identification. This investigation was conducted mainly in the cities of Kamaishi and Otsuchi, both of which were affected by the tsunami disaster in 2011. We visited 6 mortuaries with the police between March 20 (9 days after the tsunami) and April 20 (40 days after the tsunami) to examine the presence of surgical scars and related information. Unidentified human remains were investigated by visual and tactile examination. We also visited temples where the ashes were preserved. If implants were found, their lot numbers and estimated surgical procedures were recorded to determine positive identification. Ten of 233 sets of unidentified human remains before cremation displayed characteristics of a potential past surgical history. However, only 2 of these 233 sets had orthopedic implants. Instead, non-combustible orthopedic implants were found and recognized in 8 of the 331 sets of unidentified human ashes in the temples after cremation; the lot numbers were fully legible in 2 of the 8 sets. We estimated the surgical procedures, which led to positive identification. In conclusion, lot numbers and the surgical knowledge of orthopedic surgeons could assist with the positive identification of disaster victims. However, the relevant information can be erased after cremation.

  10. Enhancing osseointegration of orthopedic implants with titania nanotube surfaces

    Science.gov (United States)

    Baker, Erin A.

    Introduction: As joint arthroplasty surgical procedures increase annually, the development of new strategies, including novel materials and surface modifications, to attain solid bone-implant fixation are needed to increase implant terms of service. In this study, we evaluate two morphologies of titania nanotubes in both in vitro and in vivo experiments to quantify osseointegrative potential and material-level biocompatibility. Materials and Methods: Samples were prepared via an electrochemical etching process. Two different titania nanotube (TiNT) morphologies were produced, Aligned and Trabecular. For the in vitro experiment, Sprague Dawley (SD) rat marrow-derived bone marrow cells (BMC) were seeded on samples. Alkaline phosphatase (ALP) activity, osteocalcin (OC) expression, expression of relevant genes as well as cell attachment and morphology were assessed. In the first in vivo experiment, Kirschner wires were implanted unilaterally into SD rat femora with a TiNT-etched or unmodified (Control) implant. General health assessments and weekly body weights were recorded. At a 12-week endpoint, hematologic, systemic metal ion, and histologic analyses were performed. For the second in vivo experiment, Kirschner wires were implanted bilaterally into SD rat femora, with a TiNT-etched implant in one femora and unmodified (Control) implant as an internal control. At 4- and 12-week endpoints, femora were assessed via biomechanics, undecalcified histology, micro-computed tomography (muCT), and backscattered electron imaging (BEI) to characterize de novo bone formation. Results: In vitro experiments demonstrated BMC attachment and differentiation into osteoblasts as well as greater ALP activity, OC expression, total cell counts, and gene expression (of Col1a1, IGF-1, and osteonectin) on TiNT surfaces versus Controls. Cells on TiNT-etched substrates were smaller in diameter and more eccentric than Controls. In the first in vivo experiment, there were significant differences

  11. Sistema de fabrico rápido de implantes ortopédicos Rapid manufacturing system of orthopedics implants

    Directory of Open Access Journals (Sweden)

    Carlos Relvas

    2009-06-01

    Full Text Available Este estudo teve como objectivo o desenvolvimento uma metodologia de fabrico rápido de implantes ortopédicos, em simultaneidade com a intervenção cirúrgica, considerando duas potenciais aplicações na área ortopédica: o fabrico de implantes anatomicamente adaptados e o fabrico de implantes para substituição de perdas ósseas. A inovação do trabalho desenvolvido consiste na obtenção in situ da geometria do implante, através da impressão directa de um material elastomérico (polivinilsiloxano que permite obter com grande exactidão a geometria pretendida. Após digitalização do modelo obtido em material elastomérico, o implante final é fabricado por maquinagem recorrendo a um sistema de CAD/CAM dedicado. O implante após esterilização, pode ser colocado no paciente. O conceito foi desenvolvido com recurso a tecnologias disponíveis comercialmente e de baixo custo. O mesmo foi testado sob a forma de uma artroplastia da anca realizada in vivo numa ovelha. O acréscimo de tempo de cirurgia foi de 80 minutos sendo 40 directamente resultantes do processo de fabrico do implante. O sistema desenvolvido revelou-se eficiente no alcance dos objectivos propostos, possibilitando o fabrico de um implante durante um período de tempo perfeitamente compatível com o tempo de cirurgia.This study, aimed the development of a methodology for rapid manufacture of orthopedic implants simultaneously with the surgical intervention, considering two potential applications in the fields of orthopedics: the manufacture of anatomically adapted implants and implants for bone loss replacement. This work innovation consists on the capitation of the in situ geometry of the implant by direct capture of the shape using an elastomeric material (polyvinylsiloxane which allows fine detail and great accuracy of the geometry. After scanning the elastomeric specimen, the implant is obtained by machining using a CNC milling machine programmed with a dedicated CAD

  12. Biodegradable/biocompatible coated metal implants for orthopedic applications.

    Science.gov (United States)

    Saleh, Mohamed M; Touny, A H; Al-Omair, Mohammed A; Saleh, M M

    2016-05-12

    Biocompatible metals have been suggested as revolutionary biomaterials for bone-grafting therapies. Although metals and their alloys are widely and successfully used in producing biomedical implants due to their good mechanical properties and corrosion resistance, they have a lack in bioactivity. Therefore coating of the metal surface with calcium phosphates (CaP) is a benign way to achieve well bioactivity and get controlled corrosion properties. The biocompatibility and bioactivity calcium phosphates (CaP) in bone growth were guided them to biomedical treatment of bone defects and fractures. Many techniques have been used for fabrication of CaP coatings on metal substrates such as magnesium and titanium. The present review will focus on the synthesis of CaP and their relative forms using different techniques especially electrochemical techniques. The latter has always been known of its unique way of optimizing the process parameters that led to a control in the structure and characteristics of the produced materials.

  13. An overview of recent advances in designing orthopedic and craniofacial implants.

    Science.gov (United States)

    Mantripragada, Venkata P; Lecka-Czernik, Beata; Ebraheim, Nabil A; Jayasuriya, Ambalangodage C

    2013-11-01

    Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer's property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials. Copyright © 2013 Wiley Periodicals, Inc.

  14. An overview of recent advances in designing orthopedic and craniofacial implants

    Science.gov (United States)

    Mantripragada, Venkata P.; Lecka-Czernik, Beata; Ebraheim, Nabil A.; Jayasuriya, Ambalangodage C.

    2016-01-01

    Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer’s property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials. PMID:23766134

  15. Limiting models for calcification in fibrous tissues adjacent to orthopedic implants: variational indicator functions and influences of implant stiffness.

    Science.gov (United States)

    Harrigan, T P

    1998-07-01

    Calcification and eventual integration of orthopedic implants into bone is important to many load-bearing devices, and the influence of load and implant stiffness on this process are assessed in this mathematical modelling study. Three research questions are posed in this study. First, can limiting material models provide useful information on the overall behavior of the tissue adjacent to a loaded orthopedic implant? Second, can the limiting models lead to optimization criteria? Third, can an optimization approach be used to differentiate between the four prospective remodeling rate equations which are proposed? The answers are yes, yes, and no, respectively. A two degree of freedom lumped parameter model for axial loading of an intramedullary implant is considered. Two limiting composite material models are used, and the strain energy density in the calcified and non-calcified phases are assessed as stimuli for calcification. The rate equations posed here assume that the calcified material volume fraction decreases at high strain-energy densities, and increases at small strain-energy densities. In all four cases (both models, both phases) the steady states for these rate equations find equilibrium points of indicator functions which are a weighted sum of total strain energy and the mass of calcified tissue in the layer considered. The weights on strain-energy density and mass differ in each case. This shows that for appropriate choices of parameters, all four models can yield the same results, and it also shows that an optimization approach does not uniquely determine the appropriate rate equation in these cases. The rate equations showed complicated dynamic behavior and a phase-plane analysis was used which led to upper bounds on load, which depended on implant stiffness and distal support. The predictions of the four cases studied are compared.

  16. Survey Finds Few Orthopedic Surgeons Know The Costs Of The Devices They Implant

    Science.gov (United States)

    Okike, Kanu; O’Toole, Robert V.; Pollak, Andrew N.; Bishop, Julius A.; McAndrew, Christopher M.; Mehta, Samir; Cross, William W.; Garrigues, Grant E.; Harris, Mitchel B.; Lebrun, Christopher T.

    2014-01-01

    Orthopedic procedures represent a large expense to the Medicare program, and costs of implantable medical devices account for a large proportion of those procedures’ costs. Physicians have been encouraged to consider costs in the selection of devices, but several factors make acquiring information about costs difficult. To assess physicians’ levels of knowledge about costs, we asked orthopedic attending physicians and residents at seven academic medical centers to estimate the costs of thirteen commonly used orthopedic devices between December 2012 and March 2013. The actual cost of each device was determined at each institution; estimates within 20 percent of the actual cost were considered correct. Among the 503 physicians who completed our survey, attending physicians correctly estimated the cost of the device 21 percent of the time, and residents did so 17 percent of the time. Thirty-six percent of physicians and 75 percent of residents rated their knowledge of device costs “below average” or “poor.” However, more than 80 percent of all respondents indicated that cost should be “moderately,” “very,” or “extremely” important in the device selection process. Surgeons need increased access to information on the relative prices of devices and should be incentivized to participate in cost-containment efforts. PMID:24395941

  17. Allergic reaction to vanadium causes a diffuse eczematous eruption and titanium alloy orthopedic implant failure.

    Science.gov (United States)

    Engelhart, Sally; Segal, Robert J

    2017-04-01

    Allergy as a cause of adverse outcomes in patients with implanted orthopedic hardware is controversial. Allergy to titanium-based implants has not been well researched, as titanium is traditionally thought to be inert. We highlight the case of a patient who developed systemic dermatitis and implant failure after surgical placement of a titanium alloy (Ti6Al4V) plate in the left foot. The hardware was removed and the eruption cleared in the following weeks. The plate and screws were submitted for metal analysis. The elemental composition of both the plate and screws included 3 major elements-titanium, aluminum, and vanadium-as well as trace elements. Metal analysis revealed that the plate and screws had different microstructures, and electrochemical studies demonstrated that galvanic corrosion could have occurred between the plate and screws due to their different microstructures, contributing to the release of vanadium in vivo. The patient was patch tested with several metals including components of the implant and had a positive patch test reaction only to vanadium trichloride. These findings support a diagnosis of vanadium allergy and suggests that clinicians should consider including vanadium when patch testing patients with a suspected allergic reaction to vanadium-containing implants.

  18. Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

    Science.gov (United States)

    Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

    2012-09-01

    Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

  19. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection.

    Directory of Open Access Journals (Sweden)

    Kerryl E Piper

    Full Text Available BACKGROUND: C-reactive protein (CRP and erythrocyte sedimentation rate (ESR have been shown to be useful for diagnosis of prosthetic hip and knee infection. Little information is available on CRP and ESR in patients undergoing revision or resection of shoulder arthroplasties or spine implants. METHODS/RESULTS: We analyzed preoperative CRP and ESR in 636 subjects who underwent knee (n=297, hip (n=221 or shoulder (n=64 arthroplasty, or spine implant (n=54 removal. A standardized definition of orthopedic implant-associated infection was applied. Receiver operating curve analysis was used to determine ideal cutoff values for differentiating infected from non-infected cases. ESR was significantly different in subjects with aseptic failure infection of knee (median 11 and 53.5 mm/h, respectively, p=<0.0001 and hip (median 11 and 30 mm/h, respectively, p=<0.0001 arthroplasties and spine implants (median 10 and 48.5 mm/h, respectively, p=0.0033, but not shoulder arthroplasties (median 10 and 9 mm/h, respectively, p=0.9883. Optimized ESR cutoffs for knee, hip and shoulder arthroplasties and spine implants were 19, 13, 26, and 45 mm/h, respectively. Using these cutoffs, sensitivity and specificity to detect infection were 89 and 74% for knee, 82 and 60% for hip, and 32 and 93% for shoulder arthroplasties, and 57 and 90% for spine implants. CRP was significantly different in subjects with aseptic failure and infection of knee (median 4 and 51 mg/l, respectively, p<0.0001, hip (median 3 and 18 mg/l, respectively, p<0.0001, and shoulder (median 3 and 10 mg/l, respectively, p=0.01 arthroplasties, and spine implants (median 3 and 20 mg/l, respectively, p=0.0011. Optimized CRP cutoffs for knee, hip, and shoulder arthroplasties, and spine implants were 14.5, 10.3, 7, and 4.6 mg/l, respectively. Using these cutoffs, sensitivity and specificity to detect infection were 79 and 88% for knee, 74 and 79% for hip, and 63 and 73% for shoulder arthroplasties, and 79 and

  20. Review of the regulations for the use of stainless steels for orthopedic implants in Argentina

    Science.gov (United States)

    Daga, Bernardo; Rivera, Graciela; Boeri, Roberto

    2007-11-01

    Motivated by the relatively high rate of failure of orthopedic implants in Argentina, the authors review the current normative regulating the use of stainless steels in the fabrication of these metallic parts in the country, and compare it with the regulations currently in use in other countries. The analysis shows that several standards in effect in the country do not comply with broadly recognized international standards. This situation is aggravated by a recent revision of the normative that failed to improve the quality standards to reach levels similar to those applied in developed countries or even in MERCOSUR associates. The national organization in charge of implant certification in Argentina, complying with the law, accepts the applicability of IRAM standards to certify stainless steels implants. In the opinion of the authors, the current practice used to certify implants does not guarantee the structural stability and biocompatibility of the devices, increasing the risk of failure in service, and escalating the cost of the public health care system.

  1. Review of the regulations for the use of stainless steels for orthopedic implants in Argentina

    Energy Technology Data Exchange (ETDEWEB)

    Daga, Bernardo; Rivera, Graciela; Boeri, Roberto [INTEMA, Faculty of Engineering, National University of Mar del Plata - CONICET Juan B.Justo 4302, B7608FDQ, Mar del Plata (Argentina)

    2007-11-15

    Motivated by the relatively high rate of failure of orthopedic implants in Argentina, the authors review the current normative regulating the use of stainless steels in the fabrication of these metallic parts in the country, and compare it with the regulations currently in use in other countries. The analysis shows that several standards in effect in the country do not comply with broadly recognized international standards. This situation is aggravated by a recent revision of the normative that failed to improve the quality standards to reach levels similar to those applied in developed countries or even in MERCOSUR associates. The national organization in charge of implant certification in Argentina, complying with the law, accepts the applicability of IRAM standards to certify stainless steels implants. In the opinion of the authors, the current practice used to certify implants does not guarantee the structural stability and biocompatibility of the devices, increasing the risk of failure in service, and escalating the cost of the public health care system.

  2. Insight of magnesium alloys and composites for orthopedic implant applications – a review

    Directory of Open Access Journals (Sweden)

    R Radha

    2017-09-01

    Full Text Available Magnesium (Mg and its alloys have been widely researched for orthopedic applications recently. Mg alloys have stupendous advantages over the commercially available stainless steel, Co-Cr-Ni alloy and titanium implants. Till date, extensive mechanical, in-vitro and in-vivo studies have been done to improve the biomedical performance of Mg alloys through alloying, processing conditions, surface modification etc. This review comprehensively describes the strategies for improving the mechanical and degradation performance of Mg alloys through properly tailoring the composition of alloying elements, reinforcements and processing techniques. It also highlights the status and progress of research in to (i the selection of nutrient elements for alloying, reinforcement and its effects (ii type of Mg alloy system (binary, ternary and quaternary and composites (iii grain refinement for strengthening through severe plastic deformation techniques. Furthermore it also emphasizes on the importance of Mg composites with regard to hard tissue applications.

  3. New Ti-Ta-Zr-Nb alloys with ultrahigh strength for potential orthopedic implant applications.

    Science.gov (United States)

    Ozan, Sertan; Lin, Jixing; Li, Yuncang; Wen, Cuie

    2017-11-01

    In this study, a new series of Ti-Ta-Zr-Nb alloys (Ti-38.3Ta-22Zr-8.1Nb, Ti-38.9Ta-25Zr-5Nb, Ti-39.5Ta-28Zr-2.5Nb, designated TTZN-1, TTZN-2, TTZN-3, respectively) with high elastic strain and high mechanical strength have been developed as alternatives to conventional orthopedic implant materials. The TTZN alloys have been designed using the electronic parameters of the alloying elements, combined with the approaches of the electron-to-atom ratio (e/a) and molybdenum equivalence (Moeq). X-ray diffraction analysis has revealed that all the TTZN alloys are comprised of a single β phase, however, transmission electron microscopy observations revealed that ω and β phases co-existed in the microstructure. The compression strains of the TTZN alloys range from 22% to 36% and the compression strength from 1787 to 1807MPa. The tensile Young's modulus, elastic strain and yield strength are 73.12 ± 4.43, 74.98 ± 2.19 and 76.62 ± 2.38 (GPa); 1.57 ± 0.27, 1.25 ± 0.27 and 1.29 ± 0.16 (%); and 1107.42 ± 144.68, 932.11 ± 195.22 and 953.58 ± 120.76MPa for TTZN-1, TTZN-2 and TTZN-3, respectively. Further, all the TTZN alloys exhibit excellent cytocompatibility as their cell adhesion density is higher than that of CP-Ti. This study demonstrates that these TTZN alloys can be anticipated to be promising candidate for orthopedic implant materials due to their high mechanical strength and high elastic strain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Constipation prophylaxis in children undergoing orthopedic surgery: A quasi-experimental study.

    Science.gov (United States)

    Mantegazzi, Laila Sara; Seliner, Brigitte; Imhof, Lorenz

    2016-07-01

    This study evaluated the effectiveness of constipation prophylaxis administered with the support of an advanced practice nurse. A quasi-experimental study with a historical control group of 112 pediatric (age 1-18) orthopedic patients and an intervention group of 59 patients was conducted in a surgical ward in Switzerland. The implementation of a standardized constipation prophylaxis led to an absolute risk reduction (27%) of constipation. Fisher's exact test showed a significant difference in the prevalence of constipation in the two samples, p = .001. Constipation prophylaxis is a necessity in pediatric orthopedics. © 2016, Wiley Periodicals, Inc.

  5. Early osteoblast responses to orthopedic implants: Synergy of surface roughness and chemistry of bioactive ceramic coating.

    Science.gov (United States)

    Aniket; Reid, Robert; Hall, Benika; Marriott, Ian; El-Ghannam, Ahmed

    2015-06-01

    Pro-osteogenic stimulation of bone cells by bioactive ceramic-coated orthopedic implants is influenced by both surface roughness and material chemistry; however, their concomitant impact on osteoblast behavior is not well understood. The aim of this study is to investigate the effects of nano-scale roughness and chemistry of bioactive silica-calcium phosphate nanocomposite (SCPC50) coated Ti-6Al-4V on modulating early bone cell responses. Cell attachment was higher on SCPC50-coated substrates compared to the uncoated controls; however, cells on the uncoated substrate exhibited greater spreading and superior quality of F-actin filaments than cells on the SCPC50-coated substrates. The poor F-actin filament organization on SCPC50-coated substrates is thought to be due to the enhanced calcium uptake by the ceramic surface. Dissolution analyses showed that an increase in surface roughness was accompanied by increased calcium uptake, and increased phosphorous and silicon release, all of which appear to interfere with F-actin assembly and osteoblast morphology. Moreover, cell attachment onto the SCPC50-coated substrates correlated with the known adsorption of fibronectin, and was independent of surface roughness. High-throughput genome sequencing showed enhanced expression of extracellular matrix and cell differentiation related genes. These results demonstrate a synergistic relationship between bioactive ceramic coating roughness and material chemistry resulting in a phenotype that leads to early osteoblast differentiation. © 2014 Wiley Periodicals, Inc.

  6. Development of nanofluorapatite polymer-based composite for bioactive orthopedic implants and prostheses

    Science.gov (United States)

    Hu, Gangfeng; Wang, Hui; Yao, Xiaocong; Bi, Dawei; Zhu, Gang; Tang, Songchao; Wei, Jie; Yang, Lili; Tong, Peijian; Xiao, Luwei

    2014-01-01

    Fluorapatite with low solubility is a promising biomaterial due to its structure, which is similar to hydroxyapatite. In this study a bioactive composite of nanofluorapatite (n-FA) and polyamide 12 (PA12) was fabricated. The results revealed that the mechanical properties (such as compressive strength and elastic modulus), hydrophilicity, and antibacterial properties of n-FA/PA12 composite were obviously improved by adding n-FA into PA12 as compared with PA12. In addition, cell proliferation of MC3T3-E1 cells cultured on n-FA/PA12 composite was significantly higher than with PA12, and alkaline phosphatase activity of MC3T3-E1 cells on the n-FA/PA12 composite was expressed at obviously higher levels as compared with PA12. The results suggest that n-FA/PA12 composite could support cell proliferation and differentiation, showing good cytocompatibility. Histological evaluation indicates that n-FA/PA12 composite enhances the efficiency of new bone formation with the introduction of n-FA into PA12, and the quantity of the newly formed bone for n-FA/PA12 composite is significantly higher than with PA12. In conclusion, n-FA/PA12 composite exhibits good biocompatibility and osteogenesis, which might be used for various orthopedic prostheses and dental implants. PMID:25143735

  7. Bioactive ceramic coating on orthopedic implants for enhanced bone tissue integration

    Science.gov (United States)

    Aniket

    Tissue integration between bone and orthopedic implant is essential for implant fixation and longevity. An immunological response leads to fibrous encapsulation of metallic implants leading to implant instability and failure. Bioactive ceramics have the ability to directly bond to bone; however, they have limited mechanical strength for load bearing applications. Coating bioactive ceramics on metallic implant offers the exciting opportunity to enhance bone formation without compromising the mechanical strength of the implant. In the present study, we have developed a novel bioactive silica-calcium phosphate nanocomposite (SCPC) coating on medical grade Ti-6Al-4V orthopedic implant using electrophoretic deposition (EPD) and evaluated bone tissue response to the coated implant at the cellular level. The effect of SCPC composition and suspending medium pH on the zeta potential of three different SCPC formulations; SCPC25, SCPC50 and SCPC75 were analyzed. The average zeta potential of SCPC50 in pure ethanol was more negative than that of SCPC25 or SCPC75; however the difference was not statistically significant. Ti-6Al-4V discs were passivated, coated with SCPC50 (200 nm - 10 mum) and thermally treated at 600 - 800 ºC to produce a coating thickness in the range of 43.1 +/- 5.7 to 30.1 +/- 4.6 μm. After treatment at 600, 700 and 800 ºC, the adhesion strength at the SCPC50/Ti-6Al-4V interface was 42.6 +/- 3.6, 44.7 +/- 8.7 and 47.2 +/- 4.3 MPa, respectively. XRD analyses of SCPC50 before and after EPD coating indicated no change in the crystallinity of the material. Fracture surface analyses showed that failure occurred within the ceramic layer or at the ceramic/polymer interface; however, the ceramic/metal interface was intact in all samples. The adhesion strength of SCPC50-coated substrates after immersion in PBS for 2 days (11.7 +/- 3.9 MPa) was higher than that measured on commercially available hydroxyapatite (HA) coated substrates (5.5 +/- 2.7 MPa), although the

  8. Evaluation of MR issues for the latest standard brands of orthopedic metal implants: Plates and screws

    Energy Technology Data Exchange (ETDEWEB)

    Zou, Yue-fen, E-mail: zou_yf@163.com [Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing (China); Chu, Bin, E-mail: 18262636700@163.com [Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing (China); Wang, Chuan-bing, E-mail: wangchuanb_csr@163.com [Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing (China); Hu, Zhi-yi, E-mail: huzhiyi@medmail.com.cn [Department of Spine Surgery, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing (China)

    2015-03-15

    Highlights: •Although previous studies have indicated that most of the orthopedic implants are compatible in MR imaging system especially for titanium alloy, there are still concerns about the safety of patients with stainless steel implants, who were refused to a MR scan in most cases in our country. •In this study, it was verified that both titanium alloy and stainless steel materials (plates and screws) cause a weak force and low MRI-related heating at a 1.5-T or less, which do not pose an additional hazard or risk to patients. In addition, we also had explored the influence of different sequences and parameters on size of metallic artifacts to obtain optimized pulse sequences with appropriate parameters for reducing artifacts, which would be convenient and useful in clinical work. -- Abstract: Purpose: The study was performed to evaluate magnetic resonance (MR) issues for the latest standard brands of plates and screws used in orthopedic surgery at a 1.5-T MR system, including the safety and metallic artifacts. Methods: The plates and screws (made of titanium alloy and stainless steel materials, according to the latest standard brands) were assessed for displacement in degrees, MRI-related heating and artifacts at a 1.5-T MR system. The displacement in degrees of the plates and screws was evaluated on an angel-measurement instrument at the entrance of the MR scanner. The MRI-related heating was assessed on a swine leg fixed with a plate by using a “worst-case” pulse sequence. A rectangular water phantom was designed to evaluate metallic artifacts of a screw on different sequences (T1/T2-weighted FSE, STIR, T2-FSE fat saturation, GRE, DWI) and then artifacts were evaluated on T2-weighted FSE sequence by modifying the scanning parameters including field of view (FOV), echo train length (ETL) and bandwidth to identify the influence of parameters on metallic artifacts. 15 volunteers with internal vertebral fixation (titanium alloy materials) were scanned

  9. In vitro study of nanostructured diopside coating on Mg alloy orthopedic implants

    Energy Technology Data Exchange (ETDEWEB)

    Razavi, Mehdi, E-mail: mehdi.razavi@okstate.edu [Biomaterials Research Group, Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111 (Iran, Islamic Republic of); Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461 (Iran, Islamic Republic of); School of Materials Science and Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); School of Electrical and Computer Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); Fathi, Mohammadhossein [Biomaterials Research Group, Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111 (Iran, Islamic Republic of); Dental Materials Research Center, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Savabi, Omid [Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461 (Iran, Islamic Republic of); Vashaee, Daryoosh [School of Electrical and Computer Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); Tayebi, Lobat, E-mail: lobat.tayebi@okstate.edu [School of Materials Science and Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); School of Chemical Engineering, Oklahoma State University, Stillwater, OK 74078 (United States)

    2014-08-01

    The high corrosion rate of Mg alloys has hindered their application in various areas, particularly for orthopedic applications. In order to decrease the corrosion rate and to improve the bioactivity, mechanical stability and cytocompatibility of the Mg alloy, nanostructured diopside (CaMgSi{sub 2}O{sub 6}) has been coated on AZ91 Mg alloy using a combined micro arc oxidation (MAO) and electrophoretic deposition (EPD) method. The crystalline structure, the morphology and the composition of the samples were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). Electrochemical corrosion test, immersion test, and compression test were used to evaluate the corrosion resistance, the in vitro bioactivity and the mechanical stability of the samples, respectively. The cytocompatibility of the samples was tested by the cell viability and the cell attachment of L-929 cells. The results confirmed that the diopside coating not only slows down the corrosion rate, but also enhances the in vitro bioactivity, mechanical stability and cytocompatibility of AZ91 Mg alloy. Therefore, Mg alloy coated with nanostructured diopside offers a promising approach for biodegradable bone implants. - Highlights: • The diopside coating was applied on Mg alloy using the combined MAO and EPD methods. • The corrosion resistance of the diopside coated Mg alloy was noticeably improved. • The in vitro bioactivity of the diopside coated Mg alloy was considerably increased. • The mechanical stability of biodegradable Mg alloy was enhanced by diopside coating. • The cytocompatibility of the Mg alloy was improved employing diopside coating.

  10. Incorporation of raloxifene-impregnated allograft around orthopedic titanium implants impairs early fixation but improves new bone formation.

    Science.gov (United States)

    Hermansen, Lars L; Sørensen, Mette; Barckman, Jeppe; Bechtold, Joan E; Søballe, Kjeld; Baas, Jørgen

    2015-02-01

    The anti-osteoporotic drug raloxifene reduces the risk of vertebral fractures by increasing bone mass density. We investigated whether raloxifene offers any benefits in augmenting early fixation of orthopedic implants in the setting of impaction bone grafting. 24 non-weight-bearing grafted gap implants were inserted bilaterally into the tibia of 12 dogs. The 2.5-mm peri-implant gap was filled with either raloxifene-impregnated or untreated bone allograft. Implants were harvested after 28 days. Implant fixation was assessed by mechanical testing and histomorphometric evaluation. Raloxifene-treated allograft reduced early implant fixation compared to untreated allograft, as measured by inferior maximum shear strength (p raloxifene group had more newly formed bone in the gap around the implant (p = 0.02), but also less allograft (p = 0.03). The accelerated allograft resorption in the raloxifene group explained the impaired early fixation, despite its stimulation of new bone formation. Our results with local and possible high-dose treatment are not consistent with current theory regarding the mechanism of how systemic raloxifene administration counteracts the decrease in BMD in postmenopausal women. Instead of being solely anti-resorptive as generally held, our results indicate a possible anabolic side of raloxifene.

  11. Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation.

    Science.gov (United States)

    Bebko, Serge P; Green, David M; Awad, Samir S

    2015-05-01

    Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients. To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation. A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared. Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery. Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI. A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of

  12. Value of monoenergetic dual-energy CT (DECT) for artefact reduction from metallic orthopedic implants in post-mortem studies.

    Science.gov (United States)

    Filograna, Laura; Magarelli, Nicola; Leone, Antonio; Guggenberger, Roman; Winklhofer, Sebastian; Thali, Michael John; Bonomo, Lorenzo

    2015-09-01

    The aim of this ex vivo study was to assess the performance of monoenergetic dual-energy CT (DECT) reconstructions to reduce metal artefacts in bodies with orthopedic devices in comparison with standard single-energy CT (SECT) examinations in forensic imaging. Forensic and clinical impacts of this study are also discussed. Thirty metallic implants in 20 consecutive cadavers with metallic implants underwent both SECT and DECT with a clinically suitable scanning protocol. Extrapolated monoenergetic DECT images at 64, 69, 88, 105, 120, and 130 keV and individually adjusted monoenergy for optimized image quality (OPTkeV) were generated. Image quality of the seven monoenergetic images and of the corresponding SECT image was assessed qualitatively and quantitatively by visual rating and measurements of attenuation changes induced by streak artefact. Qualitative and quantitative analyses showed statistically significant differences between monoenergetic DECT extrapolated images and SECT, with improvements in diagnostic assessment in monoenergetic DECT at higher monoenergies. The mean value of OPTkeV was 137.6 ± 4.9 with a range of 130 to 148 keV. This study demonstrates that monoenergetic DECT images extrapolated at high energy levels significantly reduce metallic artefacts from orthopedic implants and improve image quality compared to SECT examination in forensic imaging.

  13. Value of monoenergetic dual-energy CT (DECT) for artefact reduction from metallic orthopedic implants in post-mortem studies

    Energy Technology Data Exchange (ETDEWEB)

    Filograna, Laura [University of Zurich, Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, Zurich (Switzerland); Catholic University of Rome, School of Medicine, University Hospital ' ' A. Gemelli' ' , Department of Radiological Sciences, Rome (Italy); Magarelli, Nicola; Leone, Antonio; Bonomo, Lorenzo [Catholic University of Rome, School of Medicine, University Hospital ' ' A. Gemelli' ' , Department of Radiological Sciences, Rome (Italy); Guggenberger, Roman; Winklhofer, Sebastian [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Thali, Michael John [University of Zurich, Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, Zurich (Switzerland)

    2015-09-15

    The aim of this ex vivo study was to assess the performance of monoenergetic dual-energy CT (DECT) reconstructions to reduce metal artefacts in bodies with orthopedic devices in comparison with standard single-energy CT (SECT) examinations in forensic imaging. Forensic and clinical impacts of this study are also discussed. Thirty metallic implants in 20 consecutive cadavers with metallic implants underwent both SECT and DECT with a clinically suitable scanning protocol. Extrapolated monoenergetic DECT images at 64, 69, 88, 105, 120, and 130 keV and individually adjusted monoenergy for optimized image quality (OPTkeV) were generated. Image quality of the seven monoenergetic images and of the corresponding SECT image was assessed qualitatively and quantitatively by visual rating and measurements of attenuation changes induced by streak artefact. Qualitative and quantitative analyses showed statistically significant differences between monoenergetic DECT extrapolated images and SECT, with improvements in diagnostic assessment in monoenergetic DECT at higher monoenergies. The mean value of OPTkeV was 137.6 ± 4.9 with a range of 130 to 148 keV. This study demonstrates that monoenergetic DECT images extrapolated at high energy levels significantly reduce metallic artefacts from orthopedic implants and improve image quality compared to SECT examination in forensic imaging. (orig.)

  14. Investigating the structure and biocompatibility of niobium and titanium oxides as coatings for orthopedic metallic implants

    Energy Technology Data Exchange (ETDEWEB)

    Pradhan, D.; Wren, A.W.; Misture, S.T.; Mellott, N.P., E-mail: mellott@alfred.edu

    2016-01-01

    Applying sol gel based coatings to orthopedic metallic implant materials can significantly improve their properties and lifespan in vivo. For this work, niobium (Nb{sub 2}O{sub 5}) and titanium (TiO{sub 2}) oxides were prepared via solution processing in order to determine the effect of atomic arrangement (amorphous/crystalline) on bioactivity. Thermal evaluation on the synthesized materials identified an endotherm for Nb{sub 2}O{sub 5} at 75 °C with 40% weight loss below 400 °C, and minimal weight loss between 400 and 850 °C. Regarding TiO{sub 2} an endotherm was present at 92 °C with 25% weight loss below 400 °C, and 4% between 400 and 850 °C. Phase evolution was determined using High Temperature X-ray Diffraction (HT-XRD) where amorphous-Nb{sub 2}O{sub 5} (450 °C), hexagonal-Nb{sub 2}O{sub 5} (525 °C), orthorhombic-Nb{sub 2}O{sub 5} (650 °C), amorphous-TiO{sub 2} (275 °C) and tetragonal TiO{sub 2} (500 °C) structures were produced. Simulated body fluid (SBF) testing was conducted over 1, 7 and 30 days and resulted in positive chemical and morphological changes for crystalline Nb{sub 2}O{sub 5} (525 °C) and TiO{sub 2} (500 °C) after 30 days of incubation. Rod-like CaP deposits were observed on the surfaces using Scanning Electron Microscopy (FE-SEM) and Grazing Incidence-X-ray Diffraction (GI-XRD) shows that the deposits were X-ray amorphous. Cell viability was higher with the TiO{sub 2} (122%) samples when compared to the growing cell population while Nb{sub 2}O{sub 5} samples exhibited a range of viability (64–105%), partially dependent on materials atomic structure. - Highlights: • Niobium and titanium oxides were prepared to determine the effect of structure on bioactivity. • Simulated body fluid testing resulted in positive surface chemical and morphological changes. • Amorphous, rod-like CaP deposits were observed on the surfaces. • Niobium oxide exhibited a range of viability partially dependent on materials atomic structure.

  15. Evaluation of MR issues for the latest standard brands of orthopedic metal implants: plates and screws.

    Science.gov (United States)

    Zou, Yue-Fen; Chu, Bin; Wang, Chuan-Bing; Hu, Zhi-Yi

    2015-03-01

    The study was performed to evaluate magnetic resonance (MR) issues for the latest standard brands of plates and screws used in orthopedic surgery at a 1.5-T MR system, including the safety and metallic artifacts. The plates and screws (made of titanium alloy and stainless steel materials, according to the latest standard brands) were assessed for displacement in degrees, MRI-related heating and artifacts at a 1.5-T MR system. The displacement in degrees of the plates and screws was evaluated on an angel-measurement instrument at the entrance of the MR scanner. The MRI-related heating was assessed on a swine leg fixed with a plate by using a "worst-case" pulse sequence. A rectangular water phantom was designed to evaluate metallic artifacts of a screw on different sequences (T1/T2-weighted FSE, STIR, T2-FSE fat saturation, GRE, DWI) and then artifacts were evaluated on T2-weighted FSE sequence by modifying the scanning parameters including field of view (FOV), echo train length (ETL) and bandwidth to identify the influence of parameters on metallic artifacts. 15 volunteers with internal vertebral fixation (titanium alloy materials) were scanned with MR using axial and sagittal T2-FSE, sagittal T2-FSE fat suppression and STIR with conventional and optimized parameters, respectively. Then all images were graded by two experienced radiologists having the experience of more than 7 years under double-blind studies that is neither of them knew which was conventional parameter group and optimized parameter group. The average deflection angle of titanium alloy and stainless steel implants were 4.3° and 7.7°, respectively, (less than 45°) which indicated that the magnetically induced force was less than the weight of the object. The deflection angle of the titanium alloy implants was less than the stainless steel one (t=9.69, Pinfluence of the scanning parameters on metallic artifacts was verified that metallic artifacts increased with longer echo train length and bigger

  16. Direct in vivo inflammatory cell-induced corrosion of CoCrMo alloy orthopedic implant surfaces.

    Science.gov (United States)

    Gilbert, Jeremy L; Sivan, Shiril; Liu, Yangping; Kocagöz, Sevi B; Arnholt, Christina M; Kurtz, Steven M

    2015-01-01

    Cobalt-chromium-molybdenum (CoCrMo) alloy, used for over five decades in orthopedic implants, may corrode and release wear debris into the body during use. These degradation products may stimulate immune and inflammatory responses in vivo. We report here on evidence of direct inflammatory cell-induced corrosion of human implanted and retrieved CoCrMo implant surfaces. Corrosion morphology on CoCrMo implant surfaces, in unique and characteristic patterns, and the presence of cellular remnants and biological materials intimately entwined with the corrosion indicates direct cellular attack under the cell membrane region of adhered and/or migrating inflammatory cells. Evidence supports a Fenton-like reaction mechanism driving corrosion in which reactive oxygen species are the major driver of corrosion. Using in vitro tests, large increases in corrosion susceptibility of CoCrMo were seen (40-100 fold) when immersed in phosphate buffered saline solutions modified with hydrogen peroxide and hydrochloric acid to represent the chemistry under inflammatory cells. This discovery raises significant new questions about the clinical consequences of such corrosion interactions, the role of patient inflammatory reactions, and the detailed mechanisms at play. © 2014 Wiley Periodicals, Inc.

  17. Cobalt-alloy implant debris induce HIF-1α hypoxia associated responses: a mechanism for metal-specific orthopedic implant failure.

    Directory of Open Access Journals (Sweden)

    Lauryn Samelko

    Full Text Available The historical success of orthopedic implants has been recently tempered by unexpected pathologies and early failures of some types of Cobalt-Chromium-Molybdenum alloy containing artificial hip implants. Hypoxia-associated responses to Cobalt-alloy metal debris were suspected as mediating this untoward reactivity at least in part. Hypoxia Inducible Factor-1α is a major transcription factor involved in hypoxia, and is a potent coping mechanism for cells to rapidly respond to changing metabolic demands. We measured signature hypoxia associated responses (i.e. HIF-1α, VEGF and TNF-α to Cobalt-alloy implant debris both in vitro (using a human THP-1 macrophage cell line and primary human monocytes/macrophages and in vivo. HIF-1α in peri-implant tissues of failed metal-on-metal implants were compared to similar tissues from people with metal-on-polymer hip arthroplasties, immunohistochemically. Increasing concentrations of cobalt ions significantly up-regulated HIF-1α with a maximal response at 0.3 mM. Cobalt-alloy particles (1 um-diameter, 10 particles/cell induced significantly elevated HIF-1α, VEGF, TNF-α and ROS expression in human primary macrophages whereas Titanium-alloy particles did not. Elevated expression of HIF-1α was found in peri-implant tissues and synovial fluid of people with failing Metal-on-Metal hips (n = 5 compared to failed Metal-on-Polymer articulating hip arthroplasties (n = 10. This evidence suggests that Cobalt-alloy, more than other metal implant debris (e.g. Titanium alloy, can elicit hypoxia-like responses that if unchecked can lead to unusual peri-implant pathologies, such as lymphocyte infiltration, necrosis and excessive fibrous tissue growths.

  18. Effects of gold coating on experimental implant fixation

    Science.gov (United States)

    Zainali, Kasra; Danscher, Gorm; Jakobsen, Thomas; Jakobsen, Stig S.; Baas, Jørgen; Møller, Per; Bechtold, Joan E.; Soballe, Kjeld

    2013-01-01

    Insertions of orthopedic implants are traumatic procedures that trigger an inflammatory response. Macrophages have been shown to liberate gold ions from metallic gold. Gold ions are known to act in an antiinflammatory manner by inhibiting cellular NF-κB–DNA binding and suppressing I-κ B-kinase activation. The present study investigated whether gilding implant surfaces augmented early implant osseointegration and implant fixation by its modulatory effect on the local inflammatory response. Ion release was traced by autometallographic silver enhancement. Gold-coated cylindrical porous coated Ti6Al4V implants were inserted press-fit in the proximal part of tibiae in nine canines and control implants without gold inserted contralateral. Observation time was 4 weeks. Biomechanical push-out tests showed that implants with gold coating had ~50% decrease in mechanical strength and stiffness. Histomorphometrical analyses showed gold-coated implants had a decrease in overall total bone-to-implant contact of 35%. Autometallographic analysis revealed few cells loaded with gold close to the gilded implant surface. The findings demonstrate that gilding of implants negatively affects mechanical strength and osseointegration because of a significant effect of the released gold ions on the local inflammatory process around the implant. The possibility that a partial metallic gold coating could prolong the period of satisfactory mechanical strength, however, cannot be excluded. PMID:18335533

  19. Bioresorbable Fe-Mn and Fe-Mn-HA Materials for Orthopedic Implantation: Enhancing Degradation through Porosity Control.

    Science.gov (United States)

    Heiden, Michael; Nauman, Eric; Stanciu, Lia

    2017-07-01

    Resorbable, porous iron-manganese-hydroxyapatite biocomposites with suitable degradation rates for orthopedic applications are prepared using salt-leaching for the first time. These transient biomaterials have the potential to replace inert, permanent implants that can suffer from long-term complications, or have to be surgically removed, leaving an unfavorable void. Fe30Mn-10HA materials are newly developed to address inadequate resorption rates of degradable materials proposed for orthopedic environments in the past. In this study, controllable porosities with 300 µm diameter pores are introduced into Fe30Mn alloys and Fe30Mn-10HA composites, which enhance tissue ingrowth. For the composites, a Ca2 Mn7 O14 phase generated within the Fe30Mn matrix during the sintering process greatly increases degradability. The combination of this second phase and added porosity is found to contribute to increased bone-like apatite layer formation, mouse bone marrow mesenchymal stem cell attachment, and reduction of detrimental oxide layer flaking. Remarkably, after thirty days in vitro, there is a significant increase in degradation up to 0.82 ± 0.04 mm per year for 30 wt% porous Fe30Mn-10HA biocomposites, compared to 0.02 ± 0.00 mm per year for traditional nonporous Fe30Mn, thereby increasing the viability of these materials for future clinical studies. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  20. Orthobiologics in Pediatric Orthopedics.

    Science.gov (United States)

    Murphy, Robert F; Mooney, James F

    2017-07-01

    Orthobiologics are biologic devices or products used in orthopedic surgery to augment or enhance bone formation. The use of orthobiologics in pediatric orthopedics is less frequent than in other orthopedic subspecialties, mainly due to the naturally abundant healing potential and bone formation in children compared with adults. However, orthobiologics are used in certain situations in pediatric orthopedics, particularly in spine and foot surgery. Other uses have been reported in conjunction with specific procedures involving the tibia and pelvis. The use of bioabsorable implants to stabilize children's fractures is an emerging concept but has limited supporting data. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Wear resistance of laser-deposited boride reinforced Ti-Nb-Zr-Ta alloy composites for orthopedic implants

    Energy Technology Data Exchange (ETDEWEB)

    Samuel, Sonia [Department of Materials Science and Engineering University of North Texas, Denton, TX (United States); Nag, Soumya [Department of Materials Science and Engineering Ohio State University, Columbus, OH (United States); Scharf, Thomas W.; Banerjee, Rajarshi [Department of Materials Science and Engineering University of North Texas, Denton, TX (United States)

    2008-04-01

    The inherently poor wear resistance of titanium alloys limits their application as femoral heads in femoral (hip) implants. Reinforcing the soft matrix of titanium alloys (including new generation {beta}-Ti alloys) with hard ceramic precipitates such as borides offers the possibility of substantially enhancing the wear resistance of these composites. The present study discusses the microstructure and wear resistance of laser-deposited boride reinforced composites based on Ti-Nb-Zr-Ta alloys. These composites have been deposited using the LENS{sup TM} process from a blend of elemental Ti, Nb, Zr, Ta, and boron powders and consist of complex borides dispersed in a matrix of {beta}-Ti. The wear resistance of these composites has been compared with that of Ti-6Al-4V ELI, the current material of choice for orthopedic femoral implants, against two types of counterfaces, hard Si{sub 3}N{sub 4} and softer SS440C stainless steel. Results suggest a substantial improvement in the wear resistance of the boride reinforced Ti-Nb-Zr-Ta alloys as compared with Ti-6Al-4V ELI against the softer counterface of SS440. The presence of an oxide layer on the surface of these alloys and composites also appears to have a substantial effect in terms of enhanced wear resistance.

  2. The Pathology of Orthopedic Implant Failure Is Mediated by Innate Immune System Cytokines

    Directory of Open Access Journals (Sweden)

    Stefan Landgraeber

    2014-01-01

    Full Text Available All of the over 1 million total joint replacements implanted in the US each year are expected to eventually fail after 15–25 years of use, due to slow progressive subtle inflammation at the bone implant interface. This inflammatory disease state is caused by implant debris acting, primarily, on innate immune cells, that is, macrophages. This slow progressive pathological bone loss or “aseptic loosening” is a potentially life-threatening condition due to the serious complications in older people (>75 yrs of total joint replacement revision surgery. In some people implant debris (particles and ions from metals can influence the adaptive immune system as well, giving rise to the concept of metal sensitivity. However, a consensus of studies agrees that the dominant form of this response is due to innate reactivity by macrophages to implant debris where both danger (DAMP and pathogen (PAMP signalling elicit cytokine-based inflammatory responses. This paper discusses implant debris induced release of the cytokines and chemokines due to activation of the innate (and the adaptive immune system and the subsequent formation of osteolysis. Different mechanisms of implant-debris reactivity related to the innate immune system are detailed, for example, danger signalling (e.g., IL-1β, IL-18, IL-33, etc., toll-like receptor activation (e.g., IL-6, TNF-α, etc., apoptosis (e.g., caspases 3–9, bone catabolism (e.g., TRAP5b, and hypoxia responses (Hif1-α. Cytokine-based clinical and basic science studies are in progress to provide diagnosis and therapeutic intervention strategies.

  3. Development of an optically-based tension-indicating implanted orthopedic screw with a luminescent spectral ruler

    Science.gov (United States)

    Ravikumar, Nakul; Rogalski, Melissa M.; Benza, Donny; Lake, Joshua; Urban, Matthew; Pelham, Hunter; Anker, Jeffrey N.; DesJardins, John D.

    2017-03-01

    An orthopaedic screw was designed with an optical tension-indicator to non-invasively quantify screw tension and monitor the load sharing between the bone and the implant. The screw both applies load to the bone, and measures this load by reporting the strain on the screw. The screw contains a colorimetric optical encoder that converts axial strain into colorimetric changes visible through the head of the screw, or luminescent spectral changes that are detected through tissue. Screws were tested under cyclic mechanical loading to mimic in-vivo conditions to verify the sensitivity, repeatability, and reproducibility of the sensor. In the absence to tissue, color was measured using a digital camera as a function of axial load on a stainless steel cannulated (hollow) orthopedic screw, modified by adding a passive colorimetric strain gauge through the central hole. The sensor was able to quantify clinically-relevant bone healing strains. The sensor exhibited good repeatability and reproducibility but also displayed hysteresis due to the internal mechanics of the screw. The strain indicator was also modified for measurement through tissue by replacing the reflective colorimetric sensor with a low-background X-ray excited optical luminescence signal. Luminescent spectra were acquired through 6 mm of chicken breast tissue. Overall, this research shows feasibility for a unique device which quantifies the strain on an orthopedic screw. Future research will involve reducing hysteresis by changing the mechanism of strain transduction in the screw, miniaturizing the luminescent strain gauge, monitoring bending as well as tension, using alternative luminescent spectral rulers based upon near infrared fluorescence or upconversion luminescence, and application to monitoring changes in pretension and load sharing during bone healing.

  4. In vitro analysis with human bone marrow stem cells on Ti-15Mo alloy for dental and orthopedic implants application

    Directory of Open Access Journals (Sweden)

    N.T.C. Oliveira

    2011-03-01

    Full Text Available Aim: Nowadays, research on orthopedic and dental implants is focused on titanium alloys for their mechanical properties and corrosion resistance in the human body environment. Another important aspect to be investigated is their surface topography, which is very important to osseointegration. With laser beam irradiation for roughening the implants surface an easier control of the microtopography is achieved, and surface contamination is avoided. The aim of this study was to assess human bone marrow stem cells response to a newly developed titanium alloy, Ti-15Mo, with surface topography modified by laser beam irradiation. Materials and methods: A total of 10 Ti machined disks (control, 10 Ti-15Mo machined disks and 10 Ti-15Mo disks treated by laser beam-irradiation were prepared. To study how Ti-15Mo surface topografy can induce osteoblast differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells marker were analyzed, using real time Reverse Transcription-Polymerase Chain Reaction. Results: In Test 1 (comparison between Ti-15Mo machined disks and Ti-machined disks quantitative real-time RT–PCR showed a significant induction of ALPL, FOSL1 and SPP1, which increase 20% or more. In Test 2 (comparison between Ti-15Mo laser treated disks and Ti-machined disks all investigated genes were up-regulated. By comparing Test 1 and Test 2 it was detected that COL1A1, COL3A1, FOSL1 and ENG sensibly increased their expression whereas RUNX2, ALPL and SPP1 expression remained substantially unchanged. Conclusion: The present study demonstrated that laser treated Ti-15Mo alloys are promising materials for implants application.

  5. Electrophoretic deposition of bioactive silica-calcium phosphate nanocomposite on Ti-6Al-4V orthopedic implant.

    Science.gov (United States)

    Aniket; El-Ghannam, Ahmed

    2011-11-01

    Bioactive silica-calcium phosphate nanocomposite (SCPC) has been coated on Ti-6Al-4V implant employing an electrophoretic deposition (EPD) technique. The effects of composition and pH of the suspending medium on the zeta potential of three different SCPC formulations; SCPC25, SCPC50 and SCPC75 were analyzed. The average zeta potential of SCPC50 in pure ethanol was more negative than that of SCPC25 or SCPC75; however, the difference was not statistically significant. Discs of Ti-6Al-4V were passivated, coated with SCPC50 (200 nm-10 μm) and thermally treated at 600-800°C to produce a coating thickness in the range of 43.1 ± 5.7 to 30.1 ± 4.6 μm. After treatment at 600, 700, and 800°C, the adhesion strength at the SCPC50/Ti-6Al-4V interface was 42.6 ± 3.6, 44.7 ± 8.7, and 47.2 ± 4.3 MPa, respectively. SEM-EDX analyses of SCPC50-coated Ti-6Al-4V preimmersed in PBS for 7 days showed the formation of a Ca-deficient hydroxyapatite surface layer. ICP-OES analyses of the immersing solution (n = 6) showed an increase in the ionic concentration of Si from 3.3 ± 0.9 to 5.0 ± 1.2 ppm between days 1 and 4; after which no significant change in the Si concentration was measured. Bone marrow mesenchymal stem cells attached to the SCPC50-coated implants expressed significantly higher (p SCPC50 can efficiently be coated on Ti-6Al-4V using EPD. The SCPC50 coating has the potential to enhance bone integration with the orthopedic implant. 2011 Wiley Periodicals, Inc.

  6. Characterization of cell cultures in contact with different orthopedic implants biomaterials

    Science.gov (United States)

    Ouenzerfi, G.; Hannoun, A.; Hassler, M.; Brizuela, L.; Youjil, S.; Bougault, C.; Trunfio-Sfarghiu, A.-M.

    2016-08-01

    The aim of this study is to identify the role of biological and mechanical constraints (at the cellular level) surrounding living tissues (cartilage and bone) in the presence of different joint implant biomaterials. In this fact, cells cultures in the presence of different types of biomaterials (pyrolytic carbon, cobalt-Chromium, titanium) has been performed. These cell cultures were subjected to biological characterization tests and mechanical characterization. The obtained results correlate with the in vivo observations (a promotion of the creation of a neocartilagical tissue in contact with the Pyrolytic Carbon implants).

  7. Ica-expression and gentamicin susceptibility of Staphylococcus epidermidis biofilm on orthopedic implant biomaterials

    NARCIS (Netherlands)

    Nuryastuti, Titik; Krom, Bastiaan P.; Aman, Abu T.; Busscher, Henk J.; van der Mei, Henny C.

    Ica-expression by Staphylococcus epidermidis and slime production depends on environmental conditions such as implant material and presence of antibiotics. Here, we evaluate biofilm formation and ica-expression of S. epidermidis strains on biomaterials involved in total hip-and knee arthroplasty

  8. Orthopedic services

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007455.htm Orthopedic services To use the sharing features on this page, please enable JavaScript. Orthopedics, or orthopedic services, aim at the treatment of ...

  9. Size tuning of Ag-decorated TiO₂ nanotube arrays for improved bactericidal capacity of orthopedic implants.

    Science.gov (United States)

    Esfandiari, N; Simchi, A; Bagheri, R

    2014-08-01

    Surface modification of orthopedic implants using titanium dioxide nanotubes and silver nanoparticles (SNs) is a promising approach to prevent bacteria adhesion, biofilm formation, and implant infection. Herein, we utilized a straightforward and all-solution process to prepare silver-decorated TiO2 nanotube arrays with surface density of 10(3) to 10(4) per µm(2). With controlling the synthesis conditions, hexagonal closed-packed nanotubes with opening diameter of 30-100 nm that are decorated with SNs with varying sizes (12-40 nm) were prepared. Various analytical techniques were utilized to characterize the size, morphology, distribution, valance state, surface roughness, and composition of the prepared antibacterial films. The bactericidal capacity of the films were studied on Escherichia coli (E. coli) by drop-test method and correlated with the size and percentage of Ag as well as the surface density of TiO2 nanotube arrays. Synergetic effect of TiO2 nanotubes and SNs on the antibacterial activity of the composite films is shown. The bactericidal capacity is found to depend on the size characteristics of the Ag-TiO2 coating. The highest antibacterial activity is obtained for TiO2 nanotubes with opening diameter of about 100 nm and SNs with an average size of 20 nm. MTT assay using osteoblast MG63 cells was performed to examine the cell viability. We suggest that release rate of the silver ions is an important factor controlling the antibacterial activity. Additionally, the size dependency of the bactericidal capacity implies that electrical coupling between silver and TiO2 nanotubes and improved hydrophobicity of the coating might influence the bacterial behavior of the hybrid nanostructures. © 2013 Wiley Periodicals, Inc.

  10. Performances of low-dose dual-energy CT in reducing artifacts from implanted metallic orthopedic devices

    Energy Technology Data Exchange (ETDEWEB)

    Filograna, Laura [Catholic University of Rome, School of Medicine, University Hospital ' ' A. Gemelli' ' , Department of Radiological Sciences, Institute of Radiology, Rome (Italy); University of Zurich, Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, Zurich (Switzerland); Magarelli, Nicola; Leone, Antonio; Bonomo, Lorenzo [Catholic University of Rome, School of Medicine, University Hospital ' ' A. Gemelli' ' , Department of Radiological Sciences, Institute of Radiology, Rome (Italy); De Waure, Chiara; Calabro, Giovanna Elisa [Catholic University of Rome, School of Medicine, University Hospital ' ' A. Gemelli' ' , Research Centre for Health Technology Assessment, Department of Public Health, Section of Hygiene, Rome (Italy); Finkenstaedt, Tim [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Thali, Michael John [University of Zurich, Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, Zurich (Switzerland)

    2016-07-15

    The objective was to evaluate the performances of dose-reduced dual-energy computed tomography (DECT) in decreasing metallic artifacts from orthopedic devices compared with dose-neutral DECT, dose-neutral single-energy computed tomography (SECT), and dose-reduced SECT. Thirty implants in 20 consecutive cadavers underwent both SECT and DECT at three fixed CT dose indexes (CTDI): 20.0, 10.0, and 5.0 mGy. Extrapolated monoenergetic DECT images at 64, 69, 88, 105, 120, and 130 keV, and individually adjusted monoenergy for optimized image quality (OPTkeV) were generated. In each group, the image quality of the seven monoenergetic images and of the SECT image was assessed qualitatively and quantitatively by visually rating and by measuring the maximum streak artifact respectively. The comparison between SECT and OPTkeV evaluated overall within all groups showed a significant difference (p <0.001), with OPTkeV images providing better images. Comparing OPTkeV with the other DECT images, a significant difference was shown (p <0.001), with OPTkeV and 130-keV images providing the qualitatively best results. The OPTkeV images of 5.0-mGy acquisitions provided percentages of images with scores 1 and 2 of 36 % and 30 % respectively, compared with 0 % and 33.3 % of the corresponding SECT images of 10- and 20-mGy acquisitions. Moreover, DECT reconstructions at the OPTkeV of the low-dose group showed higher CT numbers than the SECT images of dose groups 1 and 2. This study demonstrates that low-dose DECT permits a reduction of artifacts due to metallic implants to be obtained in a similar manner to neutral-dose DECT and better than reduced or neutral-dose SECT. (orig.)

  11. The promising application of graphene oxide as coating materials in orthopedic implants: preparation, characterization and cell behavior.

    Science.gov (United States)

    Zhao, Changhong; Lu, Xiuzhen; Zanden, Carl; Liu, Johan

    2015-02-10

    To investigate the potential application of graphene oxide (GO) in bone repair, this study is focused on the preparation, characterization and cell behavior of graphene oxide coatings on quartz substrata. GO coatings were prepared on the substrata using a modified dip-coating procedure. Atomic force microscopy (AFM), scanning electron microscopy (SEM) and Raman spectroscopy results demonstrated that the as-prepared coatings in this study were homogeneous and had an average thickness of ~67 nm. The rapid formation of a hydroxyapatite (HA) layer in the simulated body fluid (SBF) on GO coated substrata at day 14, as proved by SEM and x-ray diffraction (XRD), strongly indicated the bioactivity of coated substrata. In addition, MC3T3-E1 cells were cultured on the coated substrata to evaluate cellular activities. Compared with the non-coated substrata and tissue culture plates, no significant difference was observed on the coated substrata in terms of cytotoxicity, viability, proliferation and apoptosis. However, interestingly, higher levels of alkaline phosphatase (ALP) activity and osteocalcin (OC) secretion were observed on the coated substrata, indicating that GO coatings enhanced cell differentiation compared with non-coated substrata and tissue culture plates. This study suggests that GO coatings had excellent biocompatibility and more importantly promoted MC3T3-E1 cell differentiation and might be a good candidate as a coating material for orthopedic implants.

  12. Activation of human leukocytes on tantalum trabecular metal in comparison to commonly used orthopedic metal implant materials.

    Science.gov (United States)

    Schildhauer, T A; Peter, E; Muhr, G; Köller, M

    2009-02-01

    We analyzed leukocyte functions and cytokine response of human leukocytes toward porous tantalum foam biomaterial (Trabecular Metaltrade mark, TM) in comparison to equally sized solid orthopedic metal implant materials (pure titanium, titanium alloy, stainless steel, pure tantalum, and tantalum coated stainless steel). Isolated peripheral blood mononuclear cells (PBMC) and polymorphonuclear neutrophil leukocytes (PMN) were cocultured with equally sized metallic test discs for 24 h. Supernatants were analyzed for cytokine content by enzyme-linked immunosorbent assay. Compared to the other used test materials there was a significant increase in the release of IL (interleukin)-1ra and IL-8 from PMN, and of IL-1ra, IL-6, and TNF-alpha from PBMC in response to the TM material. The cytokine release correlated with surface roughness of the materials. In contrast, the release of IL-2 was not induced showing that mainly myeloid leukocytes were activated. In addition, supernatants of these leukocyte/material interaction (conditioned media, CM) were subjected to whole blood cell function assays (phagocytosis, chemotaxis, bacterial killing). There was a significant increase in the phagocytotic capacity of leukocytes in the presence of TM-conditioned media. The chemotactic response of leukocytes toward TM-conditioned media was significantly higher compared to CM obtained from other test materials. Furthermore, the bactericidal capacity of whole blood was enhanced in the presence of TM-conditioned media. These results indicate that leukocyte activation at the surface of TM material induces a microenvironment, which may enhance local host defense mechanisms.

  13. Negative Pressure Wound Therapy With Instillation and Dwell Time Used to Treat Infected Orthopedic Implants: A 4-patient Case Series.

    Science.gov (United States)

    Dettmers, Robert; Brekelmans, Wouter; Leijnen, Michiel; van der Burg, Boudewijn; Ritchie, Ewan

    2016-09-01

    Infection following orthopedic implants for bone fixation or joint replacement is always serious and may require removal of the osteosynthetic material. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an emerging therapy for the treatment of complex wounds, including infected wounds with osteosynthetic material. The purpose of this case study was to evaluate the outcomes of 4 patients (1 man, 3 women; age range 49 to 71 years) with a postoperative wound infection (POWI) following fracture repair and internal fixation. All patients were at high risk for surgical complications, including infections. Standard infection treatments (antibiotics) had been unsuccessful. Based on the available literature, a NPWTi-d protocol was developed. Following surgical debridement, wounds were instilled with polyhexanide biguanide with a set dwell time of 15 minutes, followed by continuous NPWTi-d of -125 mm Hg for 4 hours. The system was changed every 3 to 4 days until sufficient granulation tissue was evident and negative pressure without instillation could be used. Systemic antibiotics were continued in all patients. Granulation tissue was found to be sufficient in 12 to 35 days in the 4 cases, no recurrence of infection was noted, and the osteosynthesis material remained in place. No adverse events were observed. Research is needed to compare the safety and effectiveness of this adjunct treatment in the management of challenging wounds to other patient and wound management approaches.

  14. Molecular characterization of a prevalent ribocluster of methicillin-sensitiveStaphylococcus aureus from orthopedic implant infections. Correspondencewith MLST CC30

    Directory of Open Access Journals (Sweden)

    Lucio eMontanaro

    2016-02-01

    Full Text Available ABSTRACTStaphylococcus aureus is the leading etiologic agent of orthopedic implant infections. Here a ribocluster of 27 S. aureus strains underwent further molecular characterization and subtyping by multilocus sequence typing (MLST and spa-typing. This cluster had been detected by automated ribotyping (with EcoRI as restriction enzyme of 200 S. aureus isolates from periprosthetic infections come for revision at the Rizzoli Orthopaedic Institute. The ribocluster, consisting of agr type III isolates, with a 74% co-presence of bone sialoprotein-binding (bbp and collagen-binding (cna genes, turned out devoid of mecA and IS256 and exhibited a high prevalence of toxic shock syndrome toxin gene (tst, 85%. Sequences achieved by spa typing and MLST were analyzed by BURP and goeBURST. Two predominant spa types, t012 (32% and t021 (36%, and one predominant sequence type, ST30 (18/27, 67%, a Staphylococcus aureus lineage spread worldwide and regarded as the ancestor of MLST CC30, were identified. Two new sequence types (ST2954, ST2960 and one new spa type (t13129 were detected for the first time. BURP clustered the isolates into two spa clonal complexes, CC021/012 (22/27, 81% and CC166 (4/27, 15%, plus one singleton, while goeBURST recognized solely MLST CC30. Interestingly, the 27-strains cluster detected by ribotyping corresponded exactly to CC30.

  15. In vitro electrochemical corrosion and cell viability studies on nickel-free stainless steel orthopedic implants.

    Science.gov (United States)

    Salahinejad, Erfan; Hadianfard, Mohammad Jafar; Macdonald, Digby Donald; Sharifi-Asl, Samin; Mozafari, Masoud; Walker, Kenneth J; Rad, Armin Tahmasbi; Madihally, Sundararajan V; Tayebi, Lobat

    2013-01-01

    The corrosion and cell viability behaviors of nanostructured, nickel-free stainless steel implants were studied and compared with AISI 316L. The electrochemical studies were conducted by potentiodynamic polarization and electrochemical impedance spectroscopic measurements in a simulated body fluid. Cytocompatibility was also evaluated by the adhesion behavior of adult human stem cells on the surface of the samples. According to the results, the electrochemical behavior is affected by a compromise among the specimen's structural characteristics, comprising composition, density, and grain size. The cell viability is interpreted by considering the results of the electrochemical impedance spectroscopic experiments.

  16. Pitting, crevice and galvanic corrosion of REX stainless-steel/CoCr orthopedic implant material.

    Science.gov (United States)

    Reclaru, L; Lerf, R; Eschler, P Y; Blatter, A; Meyer, J M

    2002-08-01

    The corrosion behavior of surgical implant CoCr alloy and REX 734 steel has been investigated. The pitting or crevice corrosion potentials have been determined to reach values as high as 500 mV vs. SCE for CoCr and 450 mV vs. SCE for REX 734. The galvanic corrosion behavior of CoCr/REX 734 couples has been evaluated with various electrochemical techniques. The measurement of the corrosion current of the galvanic couple as well as its prediction by applying mixed potential theories on measured potentiodynamic polarization curves revealed low galvanic currents in the range of nanoamperes.

  17. In Vitro Electrochemical Corrosion and Cell Viability Studies on Nickel-Free Stainless Steel Orthopedic Implants

    Science.gov (United States)

    Salahinejad, Erfan; Hadianfard, Mohammad Jafar; Macdonald, Digby Donald; Sharifi-Asl, Samin; Mozafari, Masoud; Walker, Kenneth J.; Rad, Armin Tahmasbi; Madihally, Sundararajan V.; Tayebi, Lobat

    2013-01-01

    The corrosion and cell viability behaviors of nanostructured, nickel-free stainless steel implants were studied and compared with AISI 316L. The electrochemical studies were conducted by potentiodynamic polarization and electrochemical impedance spectroscopic measurements in a simulated body fluid. Cytocompatibility was also evaluated by the adhesion behavior of adult human stem cells on the surface of the samples. According to the results, the electrochemical behavior is affected by a compromise among the specimen's structural characteristics, comprising composition, density, and grain size. The cell viability is interpreted by considering the results of the electrochemical impedance spectroscopic experiments. PMID:23630603

  18. Carbon-carbon composites for orthopedic prosthesis and implants. CRADA final report

    Energy Technology Data Exchange (ETDEWEB)

    Burchell, T D; Klett, J W; Strizak, J P [Oak Ridge National Lab., TN (United States); Baker, C [FMI, Biddeford, ME (United States)

    1998-01-21

    The prosthetic implant market is extensive. For example, because of arthritic degeneration of hip and knee cartilage and osteoporotic fractures of the hip, over 200,000 total joint replacements (TJRs) are performed in the United States each year. Current TJR devices are typically metallic (stainless steel, cobalt, or titanium alloy) and are fixed in the bone with polymethylacrylate (PMMA) cement. Carbon-carbon composite materials offer several distinct advantages over metals for TJR prosthesis. Their mechanical properties can be tailored to match more closely the mechanical properties of human bone, and the composite may have up to 25% porosity, the size and distribution of which may be controlled through processing. The porous nature of carbon-carbon composites will allow for the ingrowth of bone, achieving biological fixation, and eliminating the need for PMMA cement fixation.

  19. Orthopedic-Implant Associated Infection due to Gram-Negative Bacilli: The Worrisome Impact of Acinetobacter baumannii Multidrug Resistance in a Brazilian Center

    Science.gov (United States)

    Silva, Raquel; Salles, Mauro Costa; Matosa, Roberta; Ayres, Bernardo; Dias, Viviane; Caetano, Luciana M

    2017-01-01

    Abstract Background Orthopedic implant-associated surgical site infection (SSI) is a severe complication presenting a treatment challenge. Recently, Gram-negative bacteria orthopedic infections have become a global concern. Objectives: To describe the bacterial profile of orthopedic implant-associated Gram-negative infections and specific outcome of Acinetobacter baumannii infections. Methods A single-center, retrospective cohort study analyzing the infection control database on the year 2016. Cases selected were those osteosynthesis or prosthetic joint, which evolved with SSI and Gram-negative bacterial growth in bone tissue or periprosthetic cultures. Results In 2016, 4001 clean surgeries with orthopedic implant placement were performed; of which 84 fulfillled the criteria for SSI, according to CDC/NHSH definitions (54 cases of open fracture reduction, 24 of hip arthroplasty, five of knee arthroplasty). Main agent of infections was Staphylococcus aureus (29.9%); Gram-negative bacteria however were responsible for 57.3% of infections (Enterobacter ssp. 22.4%; Acinetobacter baumannii 14.9%; Klebsiella pneumoniae 10%; Pseudomonas aeruginosa 10%). Among them, 100% Enterobacter ssp. were sensitive to carbapenems and 75% to ciprofloxacin. Klebsiella pneumoniae showed sensitivity to carbapenems in 85.7%, Pseudomonas aeruginosa showed sensitivity in 85.7% to carbapenems and 100% to ciprofloxacin. However, Acinetobacter baumannii showed the least favorable profile amongst Gram-negatives since only 12.5% of strains were sensitive to carbapenems, 28.6% to Ampicilin-sulbactam, 22.2% to ciprofloxacin, while showing 100% sensitivity to polymyxins. From 13 patients in whom Acinetobacter baumannii was isolated, none presented sepsis related to this infection, yet four of them died as result of hospitalization-related complications (30.7% mortality rate). Among these deaths, two were related to total hip arthroplasty, one to knee arthroplasty and one to open fracture fixation

  20. Influence of cooling rate on microstructure of Ti-Nb alloy for orthopedic implants

    Energy Technology Data Exchange (ETDEWEB)

    Afonso, C.R.M. [State University of Campinas (Unicamp), Department of Materials Engineering (Dema/FEM), CP 6122, CEP 13083-970, Campinas-SP (Brazil); Aleixo, G.T. [State University of Campinas (Unicamp), Department of Materials Engineering (Dema/FEM), CP 6122, CEP 13083-970, Campinas-SP (Brazil); Ramirez, A.J. [LME - Electron Microscopy Lab, LNLS - Brazilian Laboratory of Synchrotron Light, CP 6192, CEP 13084-971, Campinas-SP (Brazil); Caram, R. [State University of Campinas (Unicamp), Department of Materials Engineering (Dema/FEM), CP 6122, CEP 13083-970, Campinas-SP (Brazil)]. E-mail: rcaram@fem.unicamp.br

    2007-05-16

    Beta titanium alloys form one of the most versatile group of materials with respect to processing, microstructure and mechanical properties, mainly in applications as biomaterials. Development of new Ti-based alloys for implant application involves more biocompatible metallic alloying elements, such as Nb, Ta, Zr and Mo. Heat treatment of Ti alloys plays an important role in determining microstructure. The aim of this work is the analysis of microstructure and phases formed during water quenching of {beta} Ti-20Nb alloy through different cooling rates. Ti-20Nb alloy was swaged at 780-860 deg. C and then machined as a cylinder. Cylindrical sample was treated within the {beta} field and then water quenched from the bottom imposing different cooling rates through the sample. Samples from different regions (cooling rates) were characterized by using X-ray diffractometry (XRD), scanning (SEM) and transmission electron microscopy (TEM), and Vickers microhardness. XRD results showed the increase of {beta}/{alpha} phases peak intensity ratio increase with decreasing of cooling rate. As the distance from the bottom (water source) of Ti-20Nb sample decreases, the imposed cooling rate increases, the volume of {alpha} martensite acicular phase increases and the size decreases with diminishing of {alpha} phase quantity. The lowest elastic modulus E = 74 GPa was found for water quenched sample under a cooling rate of 160 K/s.

  1. Magnesium Powder Injection Molding (MIM) of Orthopedic Implants for Biomedical Applications

    Science.gov (United States)

    Wolff, M.; Schaper, J. G.; Suckert, M. R.; Dahms, M.; Ebel, T.; Willumeit-Römer, R.; Klassen, T.

    2016-04-01

    Metal injection molding (MIM) has a high potential for the economic near-net-shape mass production of small-sized and complex-shaped parts. The motivation for launching Mg into the MIM processing chain for manufacturing biodegradable medical implants is related to its compatibility with human bone and its degradation in a non-toxic matter. It has been recognized that the load-bearing capacity of MIM Mg parts is superior to that of biodegradable polymeric components. However, the choice of appropriate polymeric binder components and alloying elements enabling defect-free injection molding and sintering is a major challenge for the use of MIM Mg parts. This study considered the full processing chain for MIM of Mg-Ca alloys to achieve ultimate tensile strength of up to 141 MPa with tensile yield strength of 73 MPa, elongation at fracture Af of 7% and a Young's modulus of 38 GPa. To achieve these mechanical properties, a thermal debinding study was performed to determine optimal furnace and atmosphere conditions, sintering temperature, heating rates, sintering time and pressure.

  2. Gentamicin-loaded poly(lactic-co-glycolic acid) microparticles for the prevention of maxillofacial and orthopedic implant infections

    Energy Technology Data Exchange (ETDEWEB)

    Flores, Claudia [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Degoutin, Stephanie [Univ. Lille, 59000 Lille (France); UMET, Ingénierie des Systèmes Polymères, Université de Lille 1, 59655 Villeneuve d' Ascq (France); Chai, Feng [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Raoul, Gwenael [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Service Chirurgie Maxillo-Faciale, CHRU de Lille, 59000 Lille (France); Hornez, Jean-Chritophe [Laboratoire des Matériaux Céramiques et Procédés Associés (LMCPA), Université de Valenciennes, 59300 Valenciennes (France); Martel, Bernard [Univ. Lille, 59000 Lille (France); UMET, Ingénierie des Systèmes Polymères, Université de Lille 1, 59655 Villeneuve d' Ascq (France); Siepmann, Juergen [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Ferri, Joel [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France); Service Chirurgie Maxillo-Faciale, CHRU de Lille, 59000 Lille (France); Blanchemain, Nicolas, E-mail: nicolas.blanchemain@univ-lille2.fr [Univ. Lille, 59000 Lille (France); INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, 59000 Lille (France)

    2016-07-01

    Trauma and orthopedic surgery can cause infections as any open surgical procedures. Such complications occur in only1 to 5% of the cases, but the treatment is rather complicated due to bacterial biofilm formation and limited drug access to the site of infection upon systemic administration. An interesting strategy to overcome this type of complications is to prevent bacterial proliferation and biofilm formation via the local and controlled release of antibiotic drugs from the implant itself. Obviously, the incorporation of the drug into the implant should not affect the latter's biological and mechanical properties. In this context, we optimized the preparation process for gentamicin-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles, which can be incorporated in the macropores of calcium phosphate-based bone substitutes. Microparticles were prepared using a double emulsion solvent extraction/evaporation technique. The processing parameters were optimized in order to provide an average microparticle size of about 60 μm, allowing for incorporation inside the macropores (100 μm) of the hydroxyapatite scaffold. Gentamicin-loaded PLGA microparticles showed a sustained release for 25–30 days and a rapid antibacterial activity due to a burst effect, the extent of which was controlled by the initial loading of the microparticles. SEM pictures revealed a highly porous microparticle structure, which can help to reduce the micro environmental pH drop and autocatalytic effects. The biological evaluation showed the cytocompatibility and non-hemolytic property of the microparticles, and the antibacterial activity against Staphylococcus aureus under the given conditions. - Highlights: • The optimization of microparticle preparation parameters allows to obtain a size compatible with the bone substitute porosity • PDL% has a direct impact on the burst effect, a control release of gentamicin was obtained • The incorporation of microparticles into the

  3. New Ti-Alloys and Surface Modifications to Improve the Mechanical Properties and the Biological Response to Orthopedic and Dental Implants: A Review.

    Science.gov (United States)

    Kirmanidou, Yvoni; Sidira, Margarita; Drosou, Maria-Eleni; Bennani, Vincent; Bakopoulou, Athina; Tsouknidas, Alexander; Michailidis, Nikolaos; Michalakis, Konstantinos

    2016-01-01

    Titanium implants are widely used in the orthopedic and dentistry fields for many decades, for joint arthroplasties, spinal and maxillofacial reconstructions, and dental prostheses. However, despite the quite satisfactory survival rates failures still exist. New Ti-alloys and surface treatments have been developed, in an attempt to overcome those failures. This review provides information about new Ti-alloys that provide better mechanical properties to the implants, such as superelasticity, mechanical strength, and corrosion resistance. Furthermore, in vitro and in vivo studies, which investigate the biocompatibility and cytotoxicity of these new biomaterials, are introduced. In addition, data regarding the bioactivity of new surface treatments and surface topographies on Ti-implants is provided. The aim of this paper is to discuss the current trends, advantages, and disadvantages of new titanium-based biomaterials, fabricated to enhance the quality of life of many patients around the world.

  4. Flapless implant surgery: an experimental study.

    Science.gov (United States)

    Jeong, Seung-Mi; Choi, Byung-Ho; Li, Jingxu; Kim, Han-Sung; Ko, Chang-Yong; Jung, Jae-Hyung; Lee, Hyeon-Jung; Lee, Seoung-Ho; Engelke, Wilfried

    2007-07-01

    The purpose of this study was to examine the effect of flapless implant surgery on crestal bone loss and osseointegration in a canine mandible model. In 6 mongrel dogs, bilateral, edentulated, flat alveolar ridges were created in the mandible. After 3 months of healing, 2 implants in each side were placed by either flap or flapless procedures. After a healing period of 8 weeks, microcomputerized tomography at the implantation site was performed. Osseointegration was calculated as percentage of implant surface in contact with bone. Additionally, bone height was measured in the peri-implant bone. The mean osseointegration was greater at flapless sites (70.4%) than at sites with flaps (59.5%) (P flapless sites (10.1 mm) than at sites with flaps (9.0 mm) (P Flapless surgery can achieve results superior to surgery with reflected flaps. The specific improvements of this technique include enhanced osseointegration of dental implants and increased bone height.

  5. Experimental model of capsular contracture in silicone implants

    Directory of Open Access Journals (Sweden)

    Bastos Érika Malheiros

    2003-01-01

    Full Text Available The breast implant procedure is one of the most performed into Plastic Surgery and the contracture that occurs the capsule formed around the breast implants one of most frequent complication. We describe here one experimental model of capsule contracture in rats.

  6. Angulated Dental Implants in Posterior Maxilla FEA and Experimental Verification

    Directory of Open Access Journals (Sweden)

    Hamed A. Hamed

    2018-02-01

    Full Text Available AIM: This study aimed to evaluate the effect of different implant angulations in posterior maxilla on stress distribution by finite element analysis and verify its results experimentally. METHODS: Two simplified models were prepared for an implant placed vertically and tilted 25° piercing the maxillary sinus. Geometric models' components were prepared by Autodesk Inventor then assembled in ANSYS for finite element analysis. The results of finite element analysis were verified against experimental trials results which were statistically analysed using student t-test (level of significance p < 0.05. RESULTS: Implant - abutment complex absorbed the load energy in case of vertical implant better than the case of angulated one. That was reflected on cortical bone stress, while both cases showed stress levels within the physiological limits. Comparing results between FEA and experiment trials showed full agreement. CONCLUSION: It was found that the tilted implant by 25° can be utilised in the posterior region maxilla for replacing maxillary first molar avoiding sinus penetration. The implant-bone interface and peri-implant bones received the highest Von Mises stress. Implant - bone interface with angulated implant received about 66% more stresses than the straight one.

  7. Bone reactions at implants subjected to experimental peri-implantitis and static load. A study in the dog

    DEFF Research Database (Denmark)

    Gotfredsen, K; Berglundh, T; Lindhe, J

    2002-01-01

    AIM: The aim of the present experiment was to study peri-implant tissue reactions to lateral static load at implants subjected to experimental mucositis or peri-implantitis. MATERIAL AND METHODS: 5 beagle dogs were used. The mandibular premolars were extracted. After 12 weeks, 3 implants were...

  8. Orthopedic evaluation

    Science.gov (United States)

    Walden, T.

    1978-01-01

    The clinical performance of the Lixiscope in orthopedics was compared with routine radiography. Portability and size were the major advantages of the Lixiscope. The main disadvantage at this point in time was the Lixiscope's inability to study large areas.

  9. Reposição cirúrgico-ortopédica de implante mal posicionado: relato de caso Surgical-orthopedic repositioning of malpositioned implant: a case report

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Ferreira da Silva

    2005-06-01

    Full Text Available A reabilitação bucal por meio da colocação de implantes dentários tem se tornado um procedimento freqüente da clínica odontológica. Falhas no planejamento ou na execução da técnica podem levar a casos onde, apesar de osseointegrado, o implante não apresenta condições de restauração satisfatória devido ao seu mal posicionamento. Diversos autores têm relatado a possibilidade de se utilizar osteotomias segmentares de maxila ou mandíbula para reposicionar um segmento alveolar com implante, mostrando que esta pode ser uma técnica efetiva e previsível para restaurar implantes em posição anatômica comprometida. O presente trabalho apresenta o caso clínico de uma paciente de 20 anos de idade onde foi realizada osteotomia segmentar de maxila associada à distração osteogênica para correção de um implante mal posicionado.Oral rehabilitation through dental implants has become a common procedure at dental practice. However, if the implant is placed in an inappropriate position either because of inadequate presurgical planning or poor surgical technique, it may be unrestorable in spite of osseointegrated. Many authors have reported the possibility of using segmental maxillary or mandibular osteotomies to reposition an alveolar segment with its implants. This can be an effective, predictable technique for restoring implants in a compromised anatomic position. This paper presents a case report describing the use of this procedure associated to distraction osteogeneis to reposition one malpositioned implant in a 20 years old girl.

  10. Characterization of electric discharge machining, subsequent etching and shot-peening as a surface treatment for orthopedic implants

    Science.gov (United States)

    Stráský, Josef; Havlíková, Jana; Bačáková, Lucie; Harcuba, Petr; Mhaede, Mansour; Janeček, Miloš

    2013-09-01

    Presented work aims at multi-method characterization of combined surface treatment of Ti-6Al-4V alloy for biomedical use. Surface treatment consists of consequent use of electric discharge machining (EDM), acid etching and shot peening. Surface layers are analyzed employing scanning electron microscopy and energy dispersive X-ray spectroscopy. Acid etching by strong Kroll's reagent is capable of removing surface layer of transformed material created by EDM. Acid etching also creates partly nanostructured surface and significantly contributes to the enhanced proliferation of the bone cells. The cell growth could be positively affected by the superimposed bone-inspired structure of the surface with the morphological features in macro-, micro- and nano-range. Shot peening significantly improves poor fatigue performance after EDM. Final fatigue performance is comparable to benchmark electropolished material without any adverse surface effect. The proposed three-step surface treatment is a low-cost process capable of producing material that is applicable in orthopedics.

  11. Experimental characterization of monocrystalline Si targets implanted with Sb + ions

    Science.gov (United States)

    Labbani, R.; Serrar, H.; Baouni, L.

    2010-02-01

    Monocrystalline silicon targets were submitted to a beam of antimony ions. The Si(1 1 1) substrates were implanted at an energy of 120 keV, at room temperature, to a dose varying from 1×10 15 to 5×10 15 Sb + cm -2. To recover the radiation defects generated by Sb + ions, a thermal annealing was performed, at 900 °C for 30 min under very high vacuum. The study of antimony ion implantation in the monocrystalline silicon targets was performed by means of different experimental techniques: X-ray diffraction, optical and electrical measurements. The perturbations enhanced by Sb + ion implantation and the recovery of the damage were investigated with great interest. Although the selected techniques are not frequently applied to investigate such phenomena, they have provided important results. In as-implanted specimens, it was found that the radiation damage increased with the increase of antimony dose. After the annealing treatment, a good recovery of defects was obtained especially in the samples implanted with the low dose (i.e. 1×10 15 Sb + cm -2).

  12. Experimental studies of irradiated and hydrogen implantation damaged reactor steels

    Energy Technology Data Exchange (ETDEWEB)

    Slugeň, Vladimír, E-mail: vladimir.slugen@stuba.sk; Pecko, Stanislav; Sojak, Stanislav

    2016-01-15

    Radiation degradation of nuclear materials can be experimentally simulated via ion implantation. In our case, German reactor pressure vessel (RPV) steels were studied by positron annihilation lifetime spectroscopy (PALS). This unique non-destructive method can be effectively applied for the evaluation of microstructural changes and for the analysis of degradation of reactor steels due to neutron irradiation and proton implantation. Studied specimens of German reactor pressure vessel steels are originally from CARINA/CARISMA program. Eight specimens were measured in as-received state and two specimens were irradiated by neutrons in German experimental reactor VAK (Versuchsatomkraftwerk Kahl) in the 1980s. One of the specimens which was in as-received and neutron irradiated condition was also used for simulation of neutron damage by hydrogen nuclei implantation. Defects with the size of about 1–2 vacancies with relatively small contribution (with intensity on the level of 20–40 %) were observed in “as-received” steels. A significant increase in the size of the induced defects due to neutron damage was observed in the irradiated specimens resulting in 2–3 vacancies. The size and intensity of defects reached a similar level as in the specimens irradiated in the nuclear reactor due to the implantation of hydrogen ions with energies of 100 keV (up to the depth <500 nm).

  13. Experimental studies of irradiated and hydrogen implantation damaged reactor steels

    Science.gov (United States)

    Slugeň, Vladimír; Pecko, Stanislav; Sojak, Stanislav

    2016-01-01

    Radiation degradation of nuclear materials can be experimentally simulated via ion implantation. In our case, German reactor pressure vessel (RPV) steels were studied by positron annihilation lifetime spectroscopy (PALS). This unique non-destructive method can be effectively applied for the evaluation of microstructural changes and for the analysis of degradation of reactor steels due to neutron irradiation and proton implantation. Studied specimens of German reactor pressure vessel steels are originally from CARINA/CARISMA program. Eight specimens were measured in as-received state and two specimens were irradiated by neutrons in German experimental reactor VAK (Versuchsatomkraftwerk Kahl) in the 1980s. One of the specimens which was in as-received and neutron irradiated condition was also used for simulation of neutron damage by hydrogen nuclei implantation. Defects with the size of about 1-2 vacancies with relatively small contribution (with intensity on the level of 20-40 %) were observed in "as-received" steels. A significant increase in the size of the induced defects due to neutron damage was observed in the irradiated specimens resulting in 2-3 vacancies. The size and intensity of defects reached a similar level as in the specimens irradiated in the nuclear reactor due to the implantation of hydrogen ions with energies of 100 keV (up to the depth <500 nm).

  14. Orthopedic bioactive implants: Hydrogel enrichment of macroporous titanium for the delivery of mesenchymal stem cells and strontium.

    Science.gov (United States)

    Lopa, Silvia; Mercuri, David; Colombini, Alessandra; De Conti, Gennyfer; Segatti, Francesco; Zagra, Luigi; Moretti, Matteo

    2013-12-01

    Insufficient implant stability is an important determinant in the failure of cementless prostheses. To improve osseointegration, we aim at generating a bioactive implant combining a macroporous titanium (TT) with a biocompatible hydrogel to encapsulate osteo-inductive factors and osteoprogenitor cells. Amidation and cross-linking degree of an amidated carboxymethylcellulose hydrogel (CMCA) were characterized by FT-IR spectrometry and mechanical testing. Bone marrow mesenchymal stem cells (BMSCs) from osteoarthritic patients were cultured on CMCA hydrogels, TT, and TT loaded with CMCA (TT + CMCA) with an optimized concentration of SrCl2 to evaluate cell viability and osteo-differentiation. Amidation and cross-linking degree were homogeneous among independent CMCA batches. SrCl2 at 5 μg/mL significantly improved BMSCs osteo-differentiation increasing calcified matrix (P < 0.01), type I collagen expression (P < 0.05) and alkaline phosphatase activity. TT + CMCA samples better retained cells into the TT mesh, significantly improving cell seeding efficiency with respect to TT (P < 0.05). BMSCs on TT + CMCA underwent a more efficient osteo-differentiation with higher alkaline phosphatase (P < 0.05) and calcium levels compared to cells on TT. Based on these in vitro results, we envision the association of TT with strontium-enriched CMCA and BMSCs as a promising strategy to generate bioactive implants promoting bone neoformation at the implant site. Copyright © 2013 Wiley Periodicals, Inc., a Wiley Company.

  15. Endothelial Cell Implantation and Survival within Experimental Gliomas

    Science.gov (United States)

    Lal, Bachchu; Indurti, Ravi R.; Couraud, Pierre-Olivier; Goldstein, Gary W.; Laterra, John

    1994-10-01

    The delivery of therapeutic genes to primary brain neoplasms opens new opportunities for treating these frequently fatal tumors. Efficient gene delivery to tissues remains an important obstacle to therapy, and this problem has unique characteristics in brain tumors due to the blood-brain and blood-tumor barriers. The presence of endothelial mitogens and vessel proliferation within solid tumors suggests that genetically modified endothelial cells might efficiently transplant to brain tumors. Rat brain endothelial cells immortalized with the adenovirus E1A gene and further modified to express the β-galactosidase reporter were examined for their ability to survive implantation to experimental rat gliomas. Rats received 9L, F98, or C6 glioma cells in combination with endothelial cells intracranially to caudate/putamen or subcutaneously to flank. Implanted endothelial cells were identified by β-galactosidase histochemistry or by polymerase chain reaction in all tumors up to 35 days postimplantation, the latest time examined. Implanted endothelial cells appeared to cooperate in tumor vessel formation and expressed the brain-specific endothelial glucose transporter type 1 as identified by immunohistochemistry. The proliferation of implanted endothelial cells was supported by their increased number within tumors between postimplantation days 14 and 21 (P = 0.015) and by their expression of the proliferation antigen Ki67. These findings establish that genetically modified endothelial cells can be stably engrafted to growing gliomas and suggest that endothelial cell implantation may provide a means of delivering therapeutic genes to brain neoplasms and other solid tumors. In addition, endothelial implantation to brain may be useful for defining mechanisms of brain-specific endothelial differentiation.

  16. Characterization of electric discharge machining, subsequent etching and shot-peening as a surface treatment for orthopedic implants

    Energy Technology Data Exchange (ETDEWEB)

    Stráský, Josef, E-mail: josef.strasky@gmail.com [Charles University, Department of Physics of Materials (Czech Republic); Havlíková, Jana; Bačáková, Lucie [Institute of Physiology, Academy of Sciences of the Czech Republic (Czech Republic); Harcuba, Petr [Charles University, Department of Physics of Materials (Czech Republic); Mhaede, Mansour [Clausthal University of Technology, Institute of Materials Science and Engineering (Germany); Faculty of Engineering, Zagazig University (Egypt); Janeček, Miloš [Charles University, Department of Physics of Materials (Czech Republic)

    2013-09-15

    Presented work aims at multi-method characterization of combined surface treatment of Ti–6Al–4V alloy for biomedical use. Surface treatment consists of consequent use of electric discharge machining (EDM), acid etching and shot peening. Surface layers are analyzed employing scanning electron microscopy and energy dispersive X-ray spectroscopy. Acid etching by strong Kroll's reagent is capable of removing surface layer of transformed material created by EDM. Acid etching also creates partly nanostructured surface and significantly contributes to the enhanced proliferation of the bone cells. The cell growth could be positively affected by the superimposed bone-inspired structure of the surface with the morphological features in macro-, micro- and nano-range. Shot peening significantly improves poor fatigue performance after EDM. Final fatigue performance is comparable to benchmark electropolished material without any adverse surface effect. The proposed three-step surface treatment is a low-cost process capable of producing material that is applicable in orthopedics.

  17. A multi-scaled hybrid orthopedic implant: bone ECM-shaped Sr-HA nanofibers on the microporous walls of a macroporous titanium scaffold

    Science.gov (United States)

    Han, Yong; Zhou, Jianhong; Zhang, Lan; Xu, Kewei

    2011-07-01

    We report here, for the first time, a novel multi-scaled hybrid orthopedic implant material consisting of a macroporous Ti scaffold, whose macropores' walls have a microporous titania layer which is fully covered with nanofibers of Sr-doped hydroxyapatite (Sr-HA). The microporous titania layer is formed on and within the Ti scaffold by micro-arc oxidation, which firmly binds to the Ti substrate and contains Ca2 + , Sr2 + and PO43 - ions. It is then hydrothermally treated to form Sr-HA nanofibers. During the hydrothermal treatment, Sr-HA nanoprisms nucleate from Ca0.5Sr0.5TiO3 pre-formed on the TiO2 and grow in length to nanofibers at the expense of Ca2 + , Sr2 + and PO43 - ions that migrate from the TiO2. These Sr-HA nanofibers construct a network structure similar to the hierarchical organization of bone extracellular matrix (ECM), and the resulting nanofibrous surface displays a firm adhesion to substrate, superhydrophilicity and apatite-inducing ability. The induced apatite prefers to nucleate on the basal-faceted surfaces of Sr-HA nanofibers. The nanofiber-walled scaffold has a great potential for load-bearing orthotopic use.

  18. A multi-scaled hybrid orthopedic implant: bone ECM-shaped Sr-HA nanofibers on the microporous walls of a macroporous titanium scaffold.

    Science.gov (United States)

    Han, Yong; Zhou, Jianhong; Zhang, Lan; Xu, Kewei

    2011-07-08

    We report here, for the first time, a novel multi-scaled hybrid orthopedic implant material consisting of a macroporous Ti scaffold, whose macropores' walls have a microporous titania layer which is fully covered with nanofibers of Sr-doped hydroxyapatite (Sr-HA). The microporous titania layer is formed on and within the Ti scaffold by micro-arc oxidation, which firmly binds to the Ti substrate and contains Ca2+, Sr2+ and PO4(3-) ions. It is then hydrothermally treated to form Sr-HA nanofibers. During the hydrothermal treatment, Sr-HA nanoprisms nucleate from Ca0.5Sr0.5TiO3 pre-formed on the TiO2 and grow in length to nanofibers at the expense of Ca2+, Sr2+ and PO4(3-) ions that migrate from the TiO2. These Sr-HA nanofibers construct a network structure similar to the hierarchical organization of bone extracellular matrix (ECM), and the resulting nanofibrous surface displays a firm adhesion to substrate, superhydrophilicity and apatite-inducing ability. The induced apatite prefers to nucleate on the basal-faceted surfaces of Sr-HA nanofibers. The nanofiber-walled scaffold has a great potential for load-bearing orthotopic use.

  19. The biological response to orthopedic implants for joint replacement. II: Polyethylene, ceramics, PMMA, and the foreign body reaction.

    Science.gov (United States)

    Gibon, Emmanuel; Córdova, Luis A; Lu, Laura; Lin, Tzu-Hua; Yao, Zhenyu; Hamadouche, Moussa; Goodman, Stuart B

    2017-08-01

    Novel evidence-based prosthetic designs and biomaterials facilitate the performance of highly successful joint replacement (JR) procedures. To achieve this goal, constructs must be durable, biomechanically sound, and avoid adverse local tissue reactions. Different biomaterials such as metals and their alloys, polymers, ceramics, and composites are currently used for JR implants. This review focuses on (1) the biological response to the different biomaterials used for TJR and (2) the chronic inflammatory and foreign-body response induced by byproducts of these biomaterials. A homeostatic state of bone and surrounding soft tissue with current biomaterials for JR can be achieved with mechanically stable, infection free and intact (as opposed to the release of particulate or ionic byproducts) implants. Adverse local tissue reactions (an acute/chronic inflammatory reaction, periprosthetic osteolysis, loosening and subsequent mechanical failure) may evolve when the latter conditions are not met. This article (Part 2 of 2) summarizes the biological response to the non-metallic materials commonly used for joint replacement including polyethylene, ceramics, and polymethylmethacrylate (PMMA), as well as the foreign body reaction to byproducts of these materials. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1685-1691, 2017. © 2016 Wiley Periodicals, Inc.

  20. Experimental and failure analysis of the prosthetic finger joint implants

    Science.gov (United States)

    Naidu, Sanjiv H.

    Small joint replacement arthroplasty of the hand is a well accepted surgical procedure to restore function and cosmesis in an individual with a crippled hand. Silicone elastomers have been used as prosthetic material in various small hand joints for well over three decades. Although the clinical science aspects of silicone elastomer failure are well known, the physical science aspects of prosthetic failure are scant and vague. In the following thesis, using both an animal model, and actual retrieved specimens which have failed in human service, experimental and failure analysis of silicone finger joints are presented. Fractured surfaces of retrieved silicone trapezial implants, and silicone finger joint implants were studied with both FESEM and SEM; the mode of failure for silicone trapezium is by wear polishing, whereas the finger joint implants failed either by fatigue fracture or tearing of the elastomer, or a combination of both. Thermal analysis revealed that the retrieved elastomer implants maintained its viscoelastic properties throughout the service period. In order to provide for a more functional and physiologic arthroplasty a novel finger joint (Rolamite prosthesis) is proposed using more recently developed thermoplastic polymers. The following thesis also addresses the outcome of the experimental studies of the Rolamite prosthesis in a rabbit animal model, in addition to the failure analysis of the thermoplastic polymers while in service in an in vivo synovial environment. Results of retrieved Rolamite specimens suggest that the use for thermoplastic elastomers such as block copolymer based elastomers in a synovial environment such as a mammalian joint may very well be limited.

  1. Implant stability and marginal bone level of microgrooved zirconia dental implants: A 3-month experimental study on dogs

    Directory of Open Access Journals (Sweden)

    Delgado-Ruíz Rafael Arcesio

    2014-01-01

    Full Text Available Background/Aim. The modification of implant surfaces could affect mechanical implant stability as well as dynamics and quality of peri-implant bone healing. The aim of this 3-month experimental study in dogs was to investigate implant stability, marginal bone levels and bone tissue response to zirconia dental implants with two laser-micro-grooved intraosseous surfaces in comparison with nongrooved sandblasted zirconia and sandblasted, high-temperature etched titanium implants. Methods. Implant surface characterization was performed using optical interferometric profilometry and energy dispersive X-ray spectroscopy. A total of 96 implants (4 mm in diameter and 10 mm in length were inserted randomly in both sides of the lower jaw of 12 Fox Hound dogs divided into groups of 24 each: the control (titanium, the group A (sandblasted zirconia, the group B (sandblasted zirconia plus microgrooved neck and the group C (sandblasted zirconia plus all microgrooved. All the implants were immediately loaded. Insertion torque, periotest values, radiographic crestal bone level and removal torque were recorded during the 3-month follow-up. Qualitative scanning electon micro-scope (SEM analysis of the bone-implant interfaces of each group was performed. Results. Insertion torque values were higher in the group C and control implants (p the control > the group B > the group A (p the control > the group B > the group A (p < 0.05. SEM showed that implant surfaces of the groups B and C had an extra bone growth inside the microgrooves that corresponded to the shape and direction of the microgrooves. Conclusion. The addition of micro-grooves to the entire intraosseous surface of zirconia dental implants enhances primary and secondary implant stability, promotes bone tissue ingrowth and preserves crestal bone levels.

  2. Re-osseointegration after treatment of peri-implantitis at different implant surfaces. An experimental study in the dog.

    Science.gov (United States)

    Persson, L G; Berglundh, T; Lindhe, J; Sennerby, L

    2001-12-01

    Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI(R) solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial "re-osseointegration" occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth

  3. Effects of gold coating on experimental implant fixation

    DEFF Research Database (Denmark)

    Zainali, Kasra; Danscher, Gorm; Jakobsen, Thomas

    2009-01-01

    -kinase activation. The present study investigated whether gilding implant Surfaces augmented early implant osseointegration and implant fixation by its modulatory effect on the local inflammatory response. Ion release was traced by autometallographic silver enhancement. Gold-coated cylindrical porous coated Ti6Al4V...... implants Were inserted press-fit in the proximal part of tibiae in nine canines and control implants without gold inserted contralateral. Observation time was 4 weeks. Biomechanical push-out tests showed that implant,,, with gold coating had decrease in mechanical strength and stiffness....... Histomorphometrical analyses showed gold-coated implants had a decrease in overall total bone-to-implant contact of 35%. Autometallographic analysis revealed few cells loaded with gold close to the gilded implant surface. The findings demonstrate that gilding of implants negatively, affects mechanical strength...

  4. Medical Issues: Orthopedics

    Science.gov (United States)

    ... support & care > living with sma > medical issues > orthopedics Orthopedics In SMA, muscle weakness can cause several complications. ... difficulty sitting, standing, or performing normal daily activities. Orthopedic Considerations Doctors and therapists classify individuals with SMA ...

  5. Osseointegration at implants placed into delayed reimplanted roots: an experimental study in dogs.

    Science.gov (United States)

    de Carvalho Cardoso, Leandro; Poi, Wilson Roberto; Botticelli, Daniele; Junior, Idelmo Rangel Garcia; Pantani, Fabio; Pereira, Cassiano Costa Silva

    2014-05-01

    To evaluate peri-implant bone repair of implants placed into the roots of delayed reimplanted teeth, in a process of ankylosis and external replacement resorption. The third and fourth mandibular premolars of four (4) beagle dogs were used as experimental sites. The study was divided into three stages: stage 1 - endodontic and extraction/reimplantation session, stage 2 - decrowning session and stage 3 - implant placement. Two groups were identified: (I) immediate implants, including implants installed in fresh extraction sockets of the distal roots, and (II) experimental implants, including implants installed into the retained ankylotic mesial roots. In each group, 16 implants were planned to be inserted, but only 9 immediate implants and 12 experimental implants were used for analyses. Implants were intended to heal in a submerged mode. After 4 months of healing, the animals were sacrificed and ground sections were obtained for histomorphometric evaluation. Eleven of the twelve implants in the experimental group were found successful regarding clinical and radiographic aspects. For immediate implants, a lower BIC% was found at the coronal portion (BIC% 1 = 42.2%) compared with the three most coronal threads portion (BIC% 2 = 55.1). Also, experimental implants presented a lower BIC% at the coronal portion (BIC% 1 = 36.9%) compared with the three most coronal threads portion (BIC% 2 = 45.3). Comparison between groups showed a higher degree of BIC% and mineralization in immediate group compared with experimental group. The differences, however, did not yield statistical significance. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  6. Experimental investigation of commercial small diameter dental implants in porcine mandibular segments.

    Science.gov (United States)

    Hasan, Istabrak; Heinemann, Friedhelm; Schwegmann, Monika; Keilig, Ludger; Stark, Helmut; Bourauel, Christoph

    2017-02-01

    Small diameter (mini) dental implants have become more popular in recent years as alternatives to classical implant treatment in clinical cases with critical bony situations. However, an in-depth scientific analysis of the mechanical and biomechanical effects of small diameter implants has not yet been published. The aim of the present study was to investigate experimentally different commercial mini implants by measuring their displacements under immediate loading. Twelve commercially available mini implants were measured. Implants were inserted into porcine mandibular segments and loaded by means of a predefined displacement of 0.5 mm of the loading system. The implants were loaded at an angle of 30° to the implant long axis using the self-developed biomechanical hexapod measurement system. Implant displacements were registered. The experimental results were compared to the numerical ones from a previous study. Measured implant displacements were within the range of 39-194 μm. A large variation in the displacements was obtained among the different implant systems due to the different designs and thread profiles. Comparing experimental and numerical results, the displacements that were obtained numerically were within the range of 79-347 μm. The different commercial mini implants showed acceptable primary stability and could be loaded immediately after their insertion.

  7. [Experimental study of delayed implantation on bone grafts].

    Science.gov (United States)

    Zhang, Guo-Zhi; Zhang, Guo-Quan

    2007-05-01

    To explore the feasibility of transplantation of frozen autogenous mandible with delayed implantation. Operations were performed to create two defects in the bilateral mandible of 16 dogs. The left defect was grafted by composite transplantation of frozen autogenous mandible (immersed in -196 degrees C liquid nitrogen) with fresh cancellous ilium (composite transplantation group, CTG). The right defect was grafted by fresh ilium (iliac transplantation group, ITG). Three months after transplantation one IMZ TPS dental implant was placed into the graft of each side. At 3, 6, 9, 12 weeks postoperatively, 4 animals were sacrificed respectively and the grafts with dental implant were harvested for gross observation, X-Ray examination and histological evaluation to compare peri-implant bone healing between composite transplantation group and iliac transplantation group. There was no absorbing bone density reducing image of peri-implant at each stage. The quantified X-Ray gray extent displayed obvious variation of interfacial bone density between two kinds of grafts at 3 weeks, 6 weeks and 9 weeks after implantation. The composite transplantation group obviously surpassed the iliac transplantation group. At 12 weeks after the implantation, there was no significant difference between the peri-implant bones of both sides. There was satisfactory osseointegration between the implants and the two kinds of grafts. The healing style of peri-implant bone was similar. Good osseointegration was performed between the implant and the composite transplantation of frozen autogenous mandible following delayed implantation.

  8. Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

    OpenAIRE

    Nayfeh Jamal F; Hosni Yasser A; Harrysson Ola LA

    2007-01-01

    Abstract Background Conventional knee and hip implant systems have been in use for many years with good success. However, the custom design of implant components based on patient-specific anatomy has been attempted to overcome existing shortcomings of current designs. The longevity of cementless implant components is highly dependent on the initial fit between the bone surface and the implant. The bone-implant interface design has historically been limited by the surgical tools and cutting gu...

  9. Three-dimensional Technologies in Orthopedics.

    Science.gov (United States)

    Papagelopoulos, Panayiotis J; Savvidou, Olga D; Koutsouradis, Panagiotis; Chloros, George D; Bolia, Ioanna K; Sakellariou, Vasileios I; Kontogeorgakos, Vasileios A; Mavrodontis, Ioannis I; Mavrogenis, Andreas F; Diamantopoulos, Panos

    2018-01-01

    New 3-dimensional digital technologies are revolutionizing orthopedic clinical practice, allowing structures of any complexity to be manufactured in just hours. Such technologies can make surgery for complex cases more precise, more cost-effective, and possibly easier to perform. Applications include pre-operative planning, surgical simulation, patient-specific instrumentation and implants, bioprinting, prosthetics, and orthotics. The basic principles of 3- dimensional technologies, including imaging, design, numerical simulation, and printing, and their current applications in orthopedics are reviewed. [Orthopedics. 2018; 41(1):12-20.]. Copyright 2018, SLACK Incorporated.

  10. Evaluation of bone loss in antibacterial coated dental implants: An experimental study in dogs.

    Science.gov (United States)

    Godoy-Gallardo, Maria; Manzanares-Céspedes, Maria Cristina; Sevilla, Pablo; Nart, José; Manzanares, Norberto; Manero, José M; Gil, Francisco Javier; Boyd, Steven K; Rodríguez, Daniel

    2016-12-01

    The aim of this study was to evaluate the in vivo effect of antibacterial modified dental implants in the first stages of peri-implantitis. Thirty dental implants were inserted in the mandibular premolar sites of 5 beagle dogs. Sites were randomly assigned to Ti (untreated implants, 10units), Ti_Ag (silver electrodeposition treatment, 10units), and Ti_TSP (silanization treatment, 10units). Coated implants were characterized by scanning electron microscopy, interferometry and X-ray photoelectron spectroscopy. Two months after implant insertion, experimental peri-implantitis was initiated by ligature placement. Ligatures were removed 2months later, and plaque formation was allowed for 2 additional months. Clinical and radiographic analyses were performed during the study. Implant-tissue samples were prepared for micro computed tomography, backscattered scanning electron microscopy, histomorphometric and histological analyses and ion release measurements. X-ray, SEM and histology images showed that vertical bone resorption in treated implants was lower than in the control group (Pimplant surface. Histological analysis suggested an increase of peri-implant bone formation on silanized implants. However, the short post-ligature period was not enough to detect differences in clinical parameters among implant groups. Within the limits of this study, antibacterial surface treatments have a positive effect against bone resorption induced by peri-implantitis. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Evaluation of physicochemical properties of surface modified Ti6Al4V and Ti6Al7Nb alloys used for orthopedic implants.

    Science.gov (United States)

    Basiaga, Marcin; Kajzer, Wojciech; Walke, Witold; Kajzer, Anita; Kaczmarek, Marcin

    2016-11-01

    The paper presents the results of selected functional properties of TiO2 layers deposited by ALD method on the surface of Ti6Al4V and Ti6Al7Nb alloys intended for implants in bone surgery. TiO2 layer was applied at the constant temperature of the ALD process at T=200°C at a variable number of cycles, which resulted in a different layer thickness. Different process cycles of 500, 1250, and 2500 were analyzed. The application of experimental methods (AFM, SEM, wettability, potentiodynamic test, EIS, scratch test, nanohardness and layer thickness) enabled to select the optimal number of cycles, and thus the thickness of the TiO2 layer of the most favorable functional properties. The obtained results clearly showed that regardless of the type of titanium substrate, the TiO2 layer applied in a 2500cycle ALD process has the best physicochemical and electrochemical properties. These properties have major impact on biocompatibility, and therefore the quality of the final product. The information obtained can be useful for manufacturers of medical devices involved in the production of implants used in reconstructive surgery of skeletal system. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Immunological aspects of clinical and experimental cardiac valve allograft implantation

    NARCIS (Netherlands)

    F.B.S. Oei (Frank)

    2001-01-01

    textabstractThe documented history of allogeneic cardiac valve implantation began in 1952. In that year, the first successful implantation of an canine aortic valve in the descendlng aorta of another dog, was carried out by Conrad Lam etal. Driven by the succes seen in this animal model Murray et

  13. Impact of dental implant insertion method on the peri-implant bone tissue: Experimental study

    Directory of Open Access Journals (Sweden)

    Stamatović Novak

    2013-01-01

    Full Text Available Background/Aim. The function of dental implants depends on their stability in bone tissue over extended period of time, i.e. on osseointegration. The process through which osseointegration is achieved depends on several factors, surgical insertion method being one of them. The aim of this study was to histopathologically compare the impact of the surgical method of implant insertion on the peri-implant bone tissue. Methods. The experiment was performed on 9 dogs. Eight weeks following the extraction of lower premolars implants were inserted using the one-stage method on the right mandibular side and two-stage method on the left side. Three months after implantation the animals were sacrificed. Three distinct regions of bone tissue were histopathologically analyzed, the results were scored and compared. Results. In the specimens of one-stage implants increased amount of collagen fibers was found in 5 specimens where tissue necrosis was also observed. Only moderate osteoblastic activity was found in 3 sections. The analysis of bone-to-implant contact region revealed statistically significantly better results regarding the amount of collagen tissue fibers for the implants inserted in the two-stage method (Wa = 59 105, α = 0.05. No necrosis and osteoblastic activity were observed. Conclusion. Better results were achieved by the two-stage method in bone-to-implant contact region regarding the amount of collagen tissue, while the results were identical regarding the osteoblastic activity and bone tissue necrosis. There was no difference between the methods in the bone-implant interface region. In the bone tissue adjacent to the implant the results were identical regarding the amount of collagen tissue, osteoblastic reaction and bone tissue necrosis, while better results were achieved by the two-stage method regarding the number of osteocytes.

  14. No effect of hydroxyapatite particles in phagocytosable sizes on implant fixation: an experimental study in dogs

    DEFF Research Database (Denmark)

    Rahbek, O; Kold, S; Bendix, K

    2005-01-01

    on the mechanical fixation and gap healing around experimental HA implants. Nonloaded implants (n = 30) were inserted bilaterally into the proximal tibia of 15 dogs with a 2-mm gap to the bone. The peri-implant gap was either (1) empty (n = 6) or filled with (2) hyaluronic acid (n = 8), (3) hyaluronic acid and HA...... particles (n = 8), or (4) hyaluronic acid and PE particles (n = 8). After 4 weeks, the animals were killed. The implant interface was evaluated by pushout testing until failure and by histomorphometry. Both HA and PE particles were found to be phagocytosed by macrophage-like cells in the interfacial tissue...

  15. Common Childhood Orthopedic Conditions

    Science.gov (United States)

    ... Videos for Educators Search English Español Common Childhood Orthopedic Conditions KidsHealth / For Parents / Common Childhood Orthopedic Conditions What's in this article? Flatfeet Toe Walking ...

  16. [Post-treatment rehabilitation after autologous chondrocyte implantation: State of the art and recommendations of the Clinical Tissue Regeneration Study Group of the German Society for Accident Surgery and the German Society for Orthopedics and Orthopedic Surgery].

    Science.gov (United States)

    Pietschmann, M F; Horng, A; Glaser, C; Albrecht, D; Bruns, J; Scheffler, S; Marlovits, S; Angele, P; Aurich, M; Bosch, U; Fritz, J; Frosch, K H; Kolombe, T; Richter, W; Petersen, J P; Nöth, U; Niemeyer, P; Jagodzinsky, M; Kasten, P; Ruhnau, K; Müller, P E

    2014-03-01

    Over the course of the past two decades autologous chondrocyte implantation (ACI) has become an important surgical technique for treating large cartilage defects. The original method using a periostal flap has been improved by using cell-seeded scaffolds for implantation, the matrix-based autologous chondrocyte implantation (mb-ACI) procedure. Uniform nationwide guidelines for post-ACI rehabilitation do not exist. A survey was conducted among the members of the clinical tissue regeneration study group concerning the current rehabilitation protocols and the members of the study group published recommendations for postoperative rehabilitation and treatment after ACI based on the results of this survey. There was agreement on fundamentals concerning a location-specific rehabilitation protocol (femoral condyle vs. patellofemoral joint). With regard to weight bearing and range of motion a variety of different protocols exist. Similar to this total agreement on the role of magnetic resonance imaging (MRI) for postsurgical care was found but again a great variety of different protocols exist. This manuscript summarizes the recommendations of the members of the German clinical tissue regeneration study group on postsurgical rehabilitation and MRI assessment after ACI (level IVb/EBM).

  17. Improvement of biodegradability, bioactivity, mechanical integrity and cytocompatibility behavior of biodegradable mg based orthopedic implants using nanostructured Bredigite (Ca7MgSi 4O 16) bioceramic coated via ASD/EPD technique.

    Science.gov (United States)

    Razavi, Mehdi; Fathi, Mohammadhossein; Savabi, Omid; Vashaee, Daryoosh; Tayebi, Lobat

    2014-12-01

    This research explored the influence of surface modification of AZ91 Mg alloy on the biodegradation, bioactivity, mechanical integrity and cytocompatibility of the alloy. For this purpose, a nanostructured bredigite (Ca7MgSi4O16) ceramic coating was prepared on biodegradable AZ91 Mg alloy through anodic spark deposition and electrophoretic deposition method. The phase composition and surface morphology of the coated alloy were characterized by X-ray diffraction, scanning electron microscope and transmission electron microscope. The properties of samples were investigated by electrochemical measurements, immersion test, compression examination and cell culturing. The results showed that the degradation resistance, bioactivity, mechanical integrity and cytocompatibility of biodegradable Mg alloy were improved by the anodic spark deposition and electrophorretic deposition of the nanostructured bredigite coating. Therefore, the nanostructured bredigite ceramic coating is identified as a good coating for AZ91 Mg alloy for the purpose of making biodegradable metallic orthopedic implants.

  18. Time-dependent cytokine expression in bone of experimental animals after hydroxyapatite (Hap) implantation

    Energy Technology Data Exchange (ETDEWEB)

    Pilmane, M [Riga Stradins University, Institute of Anatomy and Anthropology, Dzirciema 16, LV-1007, Riga (Latvia); Salms, G; Salma, I; Skagers, A [Riga Stradins University, Department of Oral and Maxillofacial Surgery, Dzirciema 20. LV-1007, Riga (Latvia); Locs, J; Loca, D; Berzina-Cimdina, L, E-mail: pilmane@latnet.lv [Riga Technical University, Riga Biomaterials innovation and development centre, Pulka 3/3, LV-1007, Riga (Latvia)

    2011-06-23

    Proinflammatory cytokines mediate bone loss around the implants in patients with peri-implant disease. However, there is no complete data about the expression of cytokines into the bone around the implants. The aim of this work was to investigate the distribution and appearance of inflammatory cytokines and anti-inflammatory proteins in the bone of jaw of experimental rabbits in different time periods after HAp implantation. Material was obtained from 8 rabbits in lower jaw 6 and 8 months after HAp implants were placed. Tissues were processed for immunohistochemical detection of tumor necrosis factor alfa (TNF{alpha}), Interleukin 1, 6, 8, 10 (IL-1, IL-6, IL-8, IL-10) and defensin 2. Results demonstrated practically unchanged expression of IL-6 and IL-10 between both - experimental and control side 6 months after implantation, while IL-1 and IL-8 notably increased in control side. IL-1 and IL-10 expression did not change in either the experimental side nor the controle side after 8 months HAP implantation, but IL-6 and IL-8 demonstrated a decrease in the control sites. Only IL-8 was elevated with time in experimental sites, while IL-10 showed individual variations in 2 cases.

  19. Time-dependent cytokine expression in bone of experimental animals after hydroxyapatite (Hap) implantation

    Science.gov (United States)

    Pilmane, M.; Salms, G.; Salma, I.; Skagers, A.; Locs, J.; Loca, D.; Berzina-Cimdina, L.

    2011-06-01

    Proinflammatory cytokines mediate bone loss around the implants in patients with peri-implant disease. However, there is no complete data about the expression of cytokines into the bone around the implants. The aim of this work was to investigate the distribution and appearance of inflammatory cytokines and anti-inflammatory proteins in the bone of jaw of experimental rabbits in different time periods after HAp implantation. Material was obtained from 8 rabbits in lower jaw 6 and 8 months after HAp implants were placed. Tissues were processed for immunohistochemical detection of tumor necrosis factor alfa (TNFα), Interleukin 1, 6, 8, 10 (IL-1, IL-6, IL-8, IL-10) and defensin 2. Results demonstrated practically unchanged expression of IL-6 and IL-10 between both - experimental and control side 6 months after implantation, while IL-1 and IL-8 notably increased in control side. IL-1 and IL-10 expression did not change in either the experimental side nor the controle side after 8 months HAP implantation, but IL-6 and IL-8 demonstrated a decrease in the control sites. Only IL-8 was elevated with time in experimental sites, while IL-10 showed individual variations in 2 cases.

  20. Experimental verification of using nanostructured ceramic implants and osteograft

    Science.gov (United States)

    Rerikh, V. V.; Lastevskiy, A. D.; Sadovoy, M. A.; Zaidman, A. M.; Bataev, A. V.; Predein, Yu. A.; Avetisyan, A. R.; Romanenko, V. V.; Mamonova, E. V.; Nikulina, A. A.; Semantsova, E. S.; Smirnov, A. I.

    2017-09-01

    Ventral interbody fusion was carried out in 8 mini pigs in order to determine the effectiveness of anterior stabilization of the vertebral unit with implants made of nanostructured alumina ceramics using cellular technologies to form a bone block. A ceramic cage with a through cylindrical orifice in the center was implanted into the interbody gap; either cellular osteograft (group 1) or cellular autograft (group 2) was placed in it. The adjacent vertebrae were fixed anteriorly with a ceramic plate containing 4 screws. Bone block formation was studied radiographically, morphologically, and by MSCT. The signs of osteointegration of ceramic implants were observed in both groups after 90 days. MSCT and morphological analysis revealed the formation of the osteoceramic block and completed osteogenesis in the bone-graft contact region in group 1 compared to the control group (p < 0.05).

  1. [Orthopedic biomaterials].

    Science.gov (United States)

    Sedel, L; Nizard, R; Meunier, A

    1995-03-01

    It is very challenging to insure long term security and effectiveness for joint arthroplasties, artificial ligaments, extensive bone replacement and some other orthopaedic biomaterials. How can we predict the long term security and efficacy of such an implant? Only an interdisciplinary approach can provide a satisfactory answer. The surgeon must define the needs, he must find the appropriate surgical techniques and conduct the clinical trial. The material scientist must elaborate safe and secure materials with regards to their biotolerance and mechanical resistance. This has to be performed in close connection with the biomechanics lab. Biomechanic Science must predict the expected stresses. It has to design special simulator to quantify in vitro material toughness, wear characteristics, lubrication, behaviour and surface deformation. Biological and mechanical standardized tests have to be carried on. Then it is possible to conduct a clinical trial, prospectively in comparison to another already developed material. Clinical studies could serve to measure efficacy and radiological modification. After failure, it is possible to analyse retrieved specimen, to measure the material degradation in real environment, to perform biological studies on retrieved tissues i.e. : macrophagic activities, tissue response, bone ingrowth, inflammatory or immunological reaction. For more than twenty years we worked on alumina against alumina total hips. The idea was to develop a low debris system to enhance long term longevity of the prosthesis. The Charnley design has proven its effectiveness for more than fifteen years, but polyethylene wear is responsible for late failures. This is specially crucial for young patients, male sex and high activity level patients. At the beginning, biological studies and mechanical tests were performed, it appeared that the biological tolerance of alumina ceramic was excellent, the fracture toughness was adequate, but there were some problems related

  2. Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

    Directory of Open Access Journals (Sweden)

    Nayfeh Jamal F

    2007-09-01

    Full Text Available Abstract Background Conventional knee and hip implant systems have been in use for many years with good success. However, the custom design of implant components based on patient-specific anatomy has been attempted to overcome existing shortcomings of current designs. The longevity of cementless implant components is highly dependent on the initial fit between the bone surface and the implant. The bone-implant interface design has historically been limited by the surgical tools and cutting guides available; and the cost of fabricating custom-designed implant components has been prohibitive. Methods This paper describes an approach where the custom design is based on a Computed Tomography scan of the patient's joint. The proposed design will customize both the articulating surface and the bone-implant interface to address the most common problems found with conventional knee-implant components. Finite Element Analysis is used to evaluate and compare the proposed design of a custom femoral component with a conventional design. Results The proposed design shows a more even stress distribution on the bone-implant interface surface, which will reduce the uneven bone remodeling that can lead to premature loosening. Conclusion The proposed custom femoral component design has the following advantages compared with a conventional femoral component. (i Since the articulating surface closely mimics the shape of the distal femur, there is no need for resurfacing of the patella or gait change. (ii Owing to the resulting stress distribution, bone remodeling is even and the risk of premature loosening might be reduced. (iii Because the bone-implant interface can accommodate anatomical abnormalities at the distal femur, the need for surgical interventions and fitting of filler components is reduced. (iv Given that the bone-implant interface is customized, about 40% less bone must be removed. The primary disadvantages are the time and cost required for the

  3. In vivo study of nanostructured diopside (CaMgSi{sub 2}O{sub 6}) coating on magnesium alloy as biodegradable orthopedic implants

    Energy Technology Data Exchange (ETDEWEB)

    Razavi, Mehdi, E-mail: mrzavi2659@gmail.com [Biomaterials Research Group, Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111 (Iran, Islamic Republic of); Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461 (Iran, Islamic Republic of); School of Materials Science and Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); School of Electrical and Computer Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); Fathi, Mohammadhossein [Biomaterials Research Group, Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111 (Iran, Islamic Republic of); Dental Materials Research Center, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Savabi, Omid [Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461 (Iran, Islamic Republic of); Razavi, Seyed Mohammad [School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461 (Iran, Islamic Republic of); Heidari, Fariba; Manshaei, Maziar [Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461 (Iran, Islamic Republic of); Vashaee, Daryoosh [School of Electrical and Computer Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); Tayebi, Lobat, E-mail: lobat.tayebi@okstate.edu [School of Materials Science and Engineering, Helmerich Advanced Technology Research Center, Oklahoma State University, Tulsa, OK 74106 (United States); School of Chemical Engineering, Oklahoma State University, Stillwater, OK 74078 (United States)

    2014-09-15

    Highlights: • In vitro biocompatibility of biodegradable Mg alloy was improved by diopside coating. • In vivo biocompatibility of biodegradable Mg alloy was improved by diopside coating. • Degradation behavior of biodegradable Mg alloy was improved by diopside coating. - Abstract: In order to improve the corrosion resistance and bioactivity of a biodegradable magnesium alloy, we have recently prepared a nanostructured diopside (CaMgSi{sub 2}O{sub 6}) coating on AZ91 magnesium alloy through a combined micro-arc oxidation (MAO) and electrophoretic deposition (EPD) method (reported elsewhere). In this work, we performed a detailed biocompatibility analysis of the implants made by this material and compared their performance with those of the uncoated and micro arc oxidized magnesium implants. The biocompatibility evaluation of samples was performed by culturing L-929 cells and in vivo animal study, including implantation of samples in greater trochanter of rabbits, radiography and histological examinations. The results from both the in vitro and in vivo studies indicated that the diopside/MAO coated magnesium implant significantly enhanced cell viability, biodegradation resistance and new bone formation compared with both the uncoated and the micro-arc oxidized magnesium implants. Our data provides an example of how the proper surface treatment of magnesium implants can overcome their drawbacks in terms of high degradation rate and gas bubble formation under physiological conditions.

  4. Experimental acrylonitrile butadiene styrene and polyamide evisceration implant: a rabbit clinical and histopathology study

    Directory of Open Access Journals (Sweden)

    D.C. Gomes Júnior

    Full Text Available ABSTRACT The purpose of this study was to evaluate acrylonitrile butadiene styrene (ABS and polyamide implants in rabbits submitted to evisceration at the macroscopic and microstructure level and to assess clinical response and histopathological changes as well. For the experimental study implants of 12mm diameter were prepared by rapid prototyping, weighed and the outer and inner surfaces evaluated macroscopically and by electron microscopy. In addition, a compression test was performed and ultrastructural damage was then determined. After evisceration of the left eyeball, nine New Zealand rabbits received ABS implants and nine others received polyamide implants. The animals were assessed daily for 15 days after surgery and every seven days until the end of the study (90 days. Histopathological evaluation was performed at 15, 45 and 90 days after surgery. The ABS implants weighed approximately 0.44g, while the polyamide ones weighed 0.61g. Scanning electron microscopy demonstrated that the ABS implants had regular-sized, equidistant micropores, while the polyamide ones showed micropores of various sizes. The force required to fracture the ABS implant was 14.39 ±0.60 Mpa, while for the polyamide one, it was 16.80 ±1.05 Mpa. Fifteen days after surgery, we observed centripetal tissue infiltration and scarce inflammatory infiltrate. Implants may be used in the filling of anophthalmic cavities, because they are inert, biocompatible and allow tissue integration.

  5. Electrosurgery Induced Damage to Ti-6Al-4V and CoCrMo Alloy Surfaces in Orthopedic Implants In Vivo and In Vitro.

    Science.gov (United States)

    Kubacki, Gregory W; Sivan, Shiril; Gilbert, Jeremy L

    2017-11-01

    Recent observations of specific metal damage patterns on retrieved total joint implants implied a cellular origin and was termed inflammatory cell-induced (ICI) corrosion. Although ICI corrosion continues to present a potential damage source for metallic biomaterials surfaces, an alternate source of some damage patterns may arise from electrosurgery instruments in total joint arthroplasty. To characterize electrosurgically-induced damage patterns on metal implants, a model system of highly polished CoCrMo and Ti-6Al-4V disks and commercial electrosurgical generator was evaluated in various modes and power settings using monopolar and bipolar configurations. Surfaces were tested dry, wet with phosphate-buffered saline, or covered with known thicknesses of hydrated 5% agarose hydrogel. In all cases, surface damage was generated on both alloy surfaces, directly resulting from plasma discharge interacting with the metal. Direct surface contact caused pitting and oxide buildup at the contact area. Damage was produced through 3 mm thickness of hydrogel on the surface and across metal-metal junctions representing modular tapers. Damage patterns on wetted surfaces were highly consistent with damage patterns observed on retrieved total joint implants; circular, ruffled areas with centralized pits, occasionally presenting trail- and weld-like features. Surgeons using electrosurgical systems in proximity to metallic implants should exercise caution. Discharge of electrical energy through implants can induce localized surface damage and may result in other adverse outcomes. Although these results show some damage reported to be ICI corrosion is indeed the result of electrosurgery, there remains damage observed in retrievals not explained by this process. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Shock-implanted noble gases. II - Additional experimental studies and recognition in naturally shocked terrestrial materials

    Science.gov (United States)

    Bogard, Donald; Horz, Friedrich; Johnson, Pratt

    1989-01-01

    The process by which ambient gases can be implanted into silicates by shocks was investigated by analyzing the noble-gas content of several experimentally and naturally shocked silicate samples. The retentivity of shock-implanted gas during stepwise heating in the laboratory was defined in terms of two parameters, namely, the activation energy for diffusion and the extraction temperature at which 50 percent of the gas is released, both of which correlate with the shock pressure. The experiments indicate that, with increasing shock pressure, gas implantation occurs through an increasing production of microcracks/defects in the silicate lattice. The degree of annealing of these defects control the degree of diffusive loss of implanted gas.

  7. Histopathological comparative analysis of peri-implant soft tissue response after dental implant placement with flap and flapless surgical technique. Experimental study in pigs.

    Science.gov (United States)

    Vlahovic, Zoran; Markovic, Aleksa; Golubovic, Mileta; Scepanovic, Miodrag; Kalanovic, Milena; Djinic, Ana

    2015-11-01

    The aim of this study was comparing the effect of flapless vs. flap technique of implant placement on inflammation degree of peri-implant soft tissue, through histopathological analysis. The experiment was conducted on five domestic pigs. Nine weeks after tooth extraction, implants were installed. Each animal received six implants in mandible. According to split-mouth design, randomly one side was used for flapless technique using mini-incision, while on the other side, flap was raised. After 7, 14, 21, 28, and 90 days, the experimental animals were sacrificed. Samples for histopathological analyzes were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The degree of inflammatory response in the peri-implant soft tissue was estimated through ordinal scores from 0 to 3. In the flap group Score 3 indicating high degree of inflammation was present from day 7 to day 21, in contrast to flapless group where Score 3 was not recorded during the entire follow-up. Three months after implantation, there were no signs of inflammation neither around flap nor around flapless implants. Flapless surgical implantation technique using mini-incision decreases peri-implant soft tissue inflammatory reaction compared with flap surgery. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. EXPERIMENTAL STUDY OF OSTEOINTERGRATION OF SYNTHETIC MATERIAL POLYTETRAFLUOROETHYLENE IMPLANTED IN BONE

    Directory of Open Access Journals (Sweden)

    V. N. Trezubov

    2010-01-01

    Full Text Available The authors presented the results of experimental study devoted the examination of features of synthetic polymer polytetrafluoroethylene (ePTFE implanted in the bone. It was determined that ePTFE with 70% porosity has the more marked osteointegration and can be recommended for clinical use.

  9. Regression of experimental endometriotic implants in a rat model with the angiotensin II receptor blocker losartan.

    Science.gov (United States)

    Cakmak, Bulent; Cavusoglu, Turker; Ates, Utku; Meral, Ayfer; Nacar, Mehmet Can; Erbaş, Oytun

    2015-04-01

    Endometriosis is a common disease in women of reproductive age, and many different treatments have been developed, although none has provided a cure. In this study, the efficacy of losartan, an angiotensin II type 1 receptor blocker and an antiangiogenic and anti-inflammatory agent, on regression of experimental endometriotic implants in a rat model was investigated. Peritoneal endometriosis was surgically induced in 16 mature female Sprague-Dawley rats. The peritoneal endometriotic implant was confirmed after 28 days, and the animals were divided randomly into two groups. The control group (n = 8) was given 4 mL/day tap water by oral gavage, and the losartan group (n = 8) was given 20 mg/kg per day losartan p.o. We compared endometriotic implant size, extent and severity of adhesion, as well as plasma and peritoneal lavage fluid cytokine levels including vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α, plasma inflammatory factor pentraxin-3 (PTX-3) and C-reactive protein (CRP) between the treatment groups. Mean surface endometriotic area, histological score of implants, adhesion formation, plasma VEGF, TNF, PTX-3 and CRP levels were significantly lower in the losartan group compared with control (P losartan group than in the control group (P 0.05). Losartan suppressed the implant surface area of experimental endometriosis in rats and reduced the levels of plasma VEGF, TNF-α, PTX-3 and CRP. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  10. Comparative radiographic and resonance frequency analyses of the peri-implant tissue after dental implants placement using flap and flapless techniques: an experimental study on domestic pigs.

    Science.gov (United States)

    Vlahović, Zoran; Mihailović, Branko; Lazić, Zoran; Golubović, Mileta

    2013-06-01

    Flapless implant surgery has become very important issue during recent years, mostly thanks to computerization of dentistry and software planning of dental implants placements. The aim of this study was to compare flap and flapless surgical techniques for implant placement through radiographic and radiofrequency analyses. The experiment was made in five domestic pigs. Nine weeks following domestic pigs teeth extraction, implants were placed, on the right side using surgical technique flap, and flapless on the left side. Digital dental Xrays were applied to determine primary dental implant stability quality (ISQ). At certain intervals, not later than three months, the experimental animals were sacrificed, and just before it, control X-rays were applied to measure dental implants stability. Radiographic analysis showed that peri-implant bone resorption in the first 4 weeks following placement implants with flap and flapless surgical techniques was negligible. After the 3 months, mean value of peri-implant bone resorption of the implants placed using flap tehnique was 1.86 mm, and of those placed using flapless tehnique was 1.13 mm. In relation to the primary dental implant stability in the first and second week there was an expected decrease in ISQ values, but it was less expressed in the dental implants placed using the flapless technique. In the third week the ISQ values were increased in the dental implants placed by using both techniques, but the increase in flapless implant placement was higher (7.4 ISQ) than in flap implant placement (1.5 ISQ). The upward trend continued in a 4-week period, and after 3 months the dental implant stability values in the implants placed using flap technique were higher than the primary stability for 7.1 ISQ, and in the implants placed using flapless technique were higher comparing to the primary stability for 10.1 ISQ units. Based on the results of radiographic and resonance frequency analyses it can be concluded that the flapless

  11. Comparative radiographic and resonance frequency analyses of the peri-implant tissue after dental implants placement using flap and flapless techniques: An experimental study on domestic pigs

    Directory of Open Access Journals (Sweden)

    Vlahović Zoran

    2013-01-01

    Full Text Available Background/Aim. Flapless implant surgery has become very important issue during recent years, mostly thanks to computerization of dentistry and software planning of dental implants placements. The aim of this study was to compare flap and flapless surgical techniques for implant placement through radiographic and radiofrequency analyses. Methods. The experiment was made in five domestic pigs. Nine weeks following domestic pigs teeth extraction, implants were placed, on the right side using surgical technique flap, and flapless on the left side. Digital dental Xrays were applied to determine primary dental implant stability quality (ISQ. At certain intervals, not later than three months, the experimental animals were sacrificed, and just before it, control X-rays were applied to measure dental implants stability. Results. Radiographic analysis showed that peri-implant bone resorption in the first 4 weeks following placement implants with flap and flapless surgical techniques was negligible. After the 3 months, mean value of peri-implant bone resorption of the implants placed using flap technique was 1.86 mm, and of those placed using flapless technique was 1.13 mm. In relation to the primary dental implant stability in the first and second week there was an expected decrease in ISQ values, but it was less expressed in the dental implants placed using the flapless technique. In the third week the ISQ values were increased in the dental implants placed by using both techniques, but the increase in flapless implant placement was higher (7.4 ISQ than in flap implant placement (1.5 ISQ. The upward trend continued in a 4- week period, and after 3 months the dental implant stability values in the implants placed using flap technique were higher than the primary stability for 7.1 ISQ, and in the implants placed using flapless technique were higher comparing to the primary stability for 10.1 ISQ units. Conclusion. Based on the results of radiographic and

  12. Human fetal osteoblast behavior on zirconia dental implants and zirconia disks with microstructured surfaces. An experimental in vitro study.

    Science.gov (United States)

    Delgado-Ruíz, Rafael Arcesio; Gomez Moreno, Gerardo; Aguilar-Salvatierra, Antonio; Markovic, Aleksa; Mate-Sánchez, Jose Eduardo; Calvo-Guirado, José Luis

    2016-11-01

    To measure the lateral surface area of microgrooved zirconia implants, to evaluate the cell geometry and cell density of human fetal osteoblasts seeded on zirconia microgrooved implants, to describe the surface roughness and chemistry, and to evaluate the activity of human fetal osteoblasts seeded on zirconia microgrooved disks. This experimental in vitro study used 62 zirconia implants and 130 zirconia disks. Two experimental groups were created for the implants: 31 non-microgrooved implants (Control) and 31 microgrooved implants (Test); two experimental groups were created for the disks: 65 non-microgrooved disks (Control) and 65 microgrooved disks (Test). The following evaluations of the implants were made: lateral surface area (LSA), cell morphology, and density of human fetal osteoblasts seeded on implant surfaces. On the disks, surface parameters (roughness and chemistry) and cell activity (alkaline phosphatase - ALP and alizarin red - ALZ) were evaluated at 7 and 15 days. LSA was lower for control implants (62.8 mm) compared with test implants (128.74 mm) (P implants presented cells rich in lamellipodia prolongations, attached to the inner walls or to the borders of the microgrooves and in the flat areas between the microgrooves. Cell density was higher in the test group compared with controls (P implants with microgrooves. (ii) The LSA of microgrooved zirconia implants is greater and provides more available surface compared with implants of the same dimensions without microgrooves. (iii) Microgrooves on zirconia implants modify the morphology and guide the size and alignment of human fetal osteoblasts. (iv) Zirconia surfaces with microgrooves of 30 μm width and 70 μm separation between grooves enhance ALP and ALZ expression by human fetal osteoblasts. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Experimentally induced peri-implant mucositis. A clinical study in humans.

    Science.gov (United States)

    Pontoriero, R; Tonelli, M P; Carnevale, G; Mombelli, A; Nyman, S R; Lang, N P

    1994-12-01

    The purpose of this study was to compare the clinical and microbiological (microscopic) parameters during the development of experimental gingivitis and experimental peri-implant mucositis. Twenty partially edentulous patients were treated for moderate to advanced periodontal disease. Following active periodontal therapy consisting of motivation, instruction in oral hygiene practices, scaling and root planing and periodontal surgery where indicated, IMZ oral implants were incorporated in posterior edentulous areas. After 3 months of healing, the prosthetic abutments were connected, and the patients were closely supervised for another 2 months of healing. At this time, baseline data were obtained. Re-examinations were scheduled at 3 and 6 months. Following this, the patients were asked to refrain from oral hygiene practices for 3 weeks. At all examinations including the end of the period of no oral hygiene, the following clinical parameters were obtained: Plaque Index, Gingival Index and Sulcus Bleeding Index, all modified by Mombelli et al. (1987), probing pocket depths and recession in mm. Furthermore, submucosal/subgingival plaque samples were obtained and analyzed using phase contrast microscopy. At the end of the 3-week period of plaque accumulation, optimal oral hygiene was reinstituted. There were no statistically significant differences between the mean values of all parameters at implant compared to tooth sites at any observation periods. The period of no oral hygiene demonstrated a similar cause-effect relationship between the accumulation of bacterial plaque and the development of peri-implant mucositis as established for the gingival units by the experimental gingivitis model.

  14. The effect of the local use of chlorhexidine in surgical treatment of experimental peri-implantitis in dogs.

    Science.gov (United States)

    Carcuac, Olivier; Abrahamsson, Ingemar; Charalampakis, Georgios; Berglundh, Tord

    2015-02-01

    To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using different anti-infective procedures. Four implants with different surface characteristics (A: TiOblast, B: OsseoSpeed, C: AT-I, D: TiUnite) were installed in a randomized order in each side of the mandible in 6 labrador dogs 3 months after tooth extraction. Experimental peri-implantitis was induced 3 months later. Surgical treatment of peri-implantitis was performed. The implants were cleaned with gauze soaked in either saline (control) or chlorhexidine (test). Clinical and radiographical examinations were performed and microbiological samples were taken during a 6-month period after surgery. Biopsies were obtained and prepared for histological analysis. Clinical signs of soft tissue inflammation were reduced after surgical therapy in most test and control sites. While the analysis of bone level alterations in radiographs together with histological and microbiological assessments of resolution of peri-implantitis lesions failed to demonstrate statistically significant differences between test and control procedures, the evaluations disclosed significant differences between implant D and implants A, B and C on treatment outcome. It is suggested that (i) the local use of chlorhexidine has minor influence on treatment outcome, (ii) resolution of peri-implantitis following surgical treatment without the adjunctive use of local and systemic antimicrobial agents is possible and (iii) the results are influenced by implant surface characteristics. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Three-Dimensional Printing in Orthopedic Surgery.

    Science.gov (United States)

    Eltorai, Adam E M; Nguyen, Eric; Daniels, Alan H

    2015-11-01

    Three-dimensional (3D) printing is emerging as a clinically promising technology for rapid prototyping of surgically implantable products. With this commercially available technology, computed tomography or magnetic resonance images can be used to create graspable objects from 3D reconstructed images. Models can enhance patients' understanding of their pathology and surgeon preoperative planning. Customized implants and casts can be made to match an individual's anatomy. This review outlines 3D printing, its current applications in orthopedics, and promising future directions. Copyright 2015, SLACK Incorporated.

  16. Development and experimental study of large size composite plasma immersion ion implantation device

    Science.gov (United States)

    Falun, SONG; Fei, LI; Mingdong, ZHU; Langping, WANG; Beizhen, ZHANG; Haitao, GONG; Yanqing, GAN; Xiao, JIN

    2018-01-01

    Plasma immersion ion implantation (PIII) overcomes the direct exposure limit of traditional beam-line ion implantation, and is suitable for the treatment of complex work-piece with large size. PIII technology is often used for surface modification of metal, plastics and ceramics. Based on the requirement of surface modification of large size insulating material, a composite full-directional PIII device based on RF plasma source and metal plasma source is developed in this paper. This device can not only realize gas ion implantation, but also can realize metal ion implantation, and can also realize gas ion mixing with metal ions injection. This device has two metal plasma sources and each metal source contains three cathodes. Under the condition of keeping the vacuum unchanged, the cathode can be switched freely. The volume of the vacuum chamber is about 0.94 m3, and maximum vacuum degree is about 5 × 10‑4 Pa. The density of RF plasma in homogeneous region is about 109 cm‑3, and plasma density in the ion implantation region is about 1010 cm‑3. This device can be used for large-size sample material PIII treatment, the maximum size of the sample diameter up to 400 mm. The experimental results show that the plasma discharge in the device is stable and can run for a long time. It is suitable for surface treatment of insulating materials.

  17. Effect of alpha-lipoic acid on endometrial implants in an experimental rat model.

    Science.gov (United States)

    Pınar, Neslihan; Soylu Karapınar, Oya; Özcan, Oğuzhan; Özgür, Tümay; Bayraktar, Suphi

    2017-10-01

    To investigate the antioxidant and anti-inflammatory effects of alpha-lipoic acid (ALA) in the treatment of endometriosis in an experimental rat model by evaluating biochemical and histopathologic parameters. Experimental endometriosis was induced by the peritoneal implantation of autologous endometrial tissue. The rats were randomly divided into two groups with eight rats each. Group I was intraperitoneally administered ALA 100 mg/kg/day for 14 days. Group II was intraperitoneally administered saline solution at the same dosage and over the same period. Endometrial implant volume was measured in both groups both pre- and post-treatment. Tumor necrosis factor alpha (TNF-α) was measured in peritoneal fluid. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were assessed in serum. The implants were histopathologically evaluated. In the ALA group, the serum TOS and OSI levels, the endometrial implant volumes, the TNF-α levels in serum and peritoneal fluid, and the histopathologic scores were significantly lower compared to the control group (P Alpha-lipoic acid may have a therapeutic potential in the treatment of endometriosis due to its antioxidant and anti-inflammatory effects. © 2017 Société Française de Pharmacologie et de Thérapeutique.

  18. Biofilms in orthopedic infections: a review of laboratory methods.

    Science.gov (United States)

    Dibartola, Alex C; Swearingen, Matthew C; Granger, Jeffrey F; Stoodley, Paul; Dusane, Devendra H

    2017-04-01

    Bacterial infection after hardware implantation in orthopedic surgery is a devastating issue as it often necessitates increased hospital costs and stays, multiple revision surgeries, and prolonged use of antibiotics. Because of the nature of hardware implantation into the body, these infections are commonly in the form of attached biofilms. The current literature on a range of methodologies to study clinically explanted infected orthopedic hardware, with potential biofilm, in the laboratory setting is limited. General methods include traditional and advanced culturing techniques, microscopy imaging techniques, and techniques that manipulate genetic material. The future of diagnostic techniques for infected implants, innovative hardware design, and treatment solutions for patients all depend on the successful evaluation and characterization of clinical samples in the laboratory setting. This review provides an overview of current methods to study biofilms associated with orthopedic infections and insight into future directions in the field. © 2017 APMIS. Published by John Wiley & Sons Ltd.

  19. An improved cochlear implant electrode array for use in experimental studies

    Science.gov (United States)

    Shepherd, Robert; Verhoeven, Kristien; Xu, Jin; Risi, Frank; Fallon, James; Wise, Andrew

    2012-01-01

    Experimental studies play an important role in establishing the safety and efficacy of cochlear implants and they continue to provide insight into a new generation of electrode arrays and stimulation strategies. One drawback has been the limited depth of insertion of an electrode array in experimental animals. We compared the insertion depth and trauma associated with the insertion of Cochlear Ltd’s Hybrid-L (HL) array with a standard 8 ring array in cat cochleae. Both arrays were inserted into cadaver cochleae and an X-ray recorded their anatomical location. The implanted cochlea was serially sectioned and photographed at 300µm intervals for evidence of electrode insertion trauma. Subsequently two cats were chronically implanted with HL arrays and electrically-evoked potentials recorded over a three month period. Mean insertion depth for the HL arrays was 334.8° (SD = 21°; n=4) versus 175.5°(SD = 6°; n=2) for the standard array. This relates to ~10.5 mm and 6 mm respectively. A similar insertion depth was measured in a chronically implanted animal with a HL array. Histology from each cadaver cochleae showed that the electrode array was always located in the scala tympani; there was no evidence of electrode insertion trauma to the basilar membrane, the osseous spiral lamina or the spiral ligament. Finally, evoked potential data from the chronically implanted animals exhibited significantly lower thresholds compared with animals implanted with a standard 8 ring array, with electrical thresholds remaining stable over a three month observation period. Cochlear Ltd’s HL electrode array can be safely inserted ~50% of the length of the cat scala tympani, placing the tip of the array close to the 4 kHz place. This insertion depth is considerably greater than is routinely achieved using a standard 8-ring electrode array (~12 kHz place). The HL array evokes low thresholds that remain stable over three months of implantation. This electrode array has potential

  20. Spontaneous progression of ligature induced peri-implantitis at implants with different surface roughness: an experimental study in dogs

    DEFF Research Database (Denmark)

    Berglundh, T; Gotfredsen, K; Zitzmann, N U

    2007-01-01

    : The aim of the current experiment was to study the progression of peri-implantitis around implants with different surface roughness. MATERIAL AND METHODS: In five beagle dogs, three implants with either a sandblasted acid-etched surface (SLA) or a polished surface (P) were installed bilaterally...

  1. Histopathology of experimental myiasis in mice as a result of infestation and experimental implantation of Dermatobia hominis larvae.

    Science.gov (United States)

    Leite, A C R; Nascimento, M F A; Leite, L H R; Leite, V H R

    2011-05-01

    A laboratory model of myiasis as a result of Dermatobia hominis (L.) larvae was developed using mice as hosts. Mice in three groups were each infested with one newly hatched larva and skin biopsies processed for histopathology at 4, 12, and 20 d postinfestation (dpi). Mice in three other groups were each subjected to implantation of one larva collected from an infested (donor) mouse at 4, 12, and 20 dpi. Skin lesions of these receptor mice were then assessed at 10, 14, and 6 d postimplantation (dpimp), respectively. The inflammatory process in infested mice at 4 dpi was discrete, consisting of a thin necrotic layer around the larva, edema, many neutrophils, few eosinophils, mast cells, and proliferation of fibroblasts. At 12 dpi, there was a thicker necrotic layer, edema, many neutrophils and eosinophils, few mast cells, neoformation of capillaries, proliferation of the endothelium and fibroblasts, and early stages of fibrosis. These histopathological characteristics together with fibrosis were observed over a large area of the lesion at 20 dpi. Mice submitted to larval implantations demonstrated similar skin histopathology to that seen in the infested rodents, 10 dpimp corresponding to 12 dpi and 6 or 14 dpimp to 20 dpi. In all mice, the progressive acute inflammatory process followed a sequence linked to factors such as size of larvae and presence of secretory-excretory products. Both infested mice and those implanted experimentally with D. hominis larvae were shown to be suitable models for the study of the parasite-host relationship in this important zoonotic myiasis.

  2. Intravitreal implantation of the biodegradable cyclosporin A drug delivery system for experimental chronic uveitis.

    Science.gov (United States)

    Dong, Xiaoguang; Shi, Weiyun; Yuan, Gongqiang; Xie, Lixin; Wang, Shenguo; Lin, Ping

    2006-04-01

    The purpose was to evaluate the efficacy of the intravitreal implantation of the biodegradable cyclosporin A (CsA) drug delivery system (DDS) for experimental chronic uveitis. The DDS was prepared by formulating CsA into glycolide-co-lactide-co-caprolactone copolymer (PGLC). Right eyes of 30 New Zealand white rabbits were used to establish a model of uveitis and randomized into control, intravitreal non-medicated DDS, oral CsA (15 mg/kg daily), and intravitreal CsA-PGLC DDS (each containing 2 mg CsA) groups. The progress of ocular inflammation, results of electroretinography, and histopathological examination of ocular, renal, and hepatic functions were recorded. Intravitreal CsA levels were measured in another 13 rabbits receiving an implant of the CsA-PGLC DDS. Chronic uveitis was successfully induced in all 30 eyes. The inflammation in the eyes with no treatment, non-medicated implant, and oral CsA was more severe than those with the CsA-PGLC DDS at each timepoint. The electroretinography b-wave was depressed much less in the CsA-PGLC DDS group than in the other three groups (ptoxicity was detected. Intravitreal implantation of the biodegradable CsA-PGLC DDS may effectively reduce the intraocular inflammation in rabbits with no toxicity, which provides a potentially safe and convenient approach for the treatment of chronic uveitis.

  3. Avaliação da resistência à torção em parafusos utilizados em implantes - um panorama brasileiro The torsion strength of orthopedic implant screws - a suvey of brazilian samples

    OpenAIRE

    Andrea Madeira Kliauga; Paulo Sergio Carvalho Pereira da Silva; Girodano,Enrico J.; Ivan Della Vale Epiphanio; Celio Canimaga; Claudemiro Bolfarini

    2010-01-01

    Desde 2004, o CCDM realiza ensaios mecânicos em implantes ortopédicos. Os componentes mais utilizados - e conseqüentemente ensaiados - são parafusos, comumente fabricados com aço inoxidável ASTM F138, ou liga de titânio ASTM F136. O objetivo desse trabalho é avaliar os resultados referentes aos ensaios de torção em parafusos metálicos, dando um panorama das propriedades médias dos produtos ensaiados. Tais resultados provieram de material fornecido por 15 fabricantes diferentes, num total de 4...

  4. 3D-printed patient-specific applications in orthopedics

    Directory of Open Access Journals (Sweden)

    Wong KC

    2016-10-01

    Full Text Available Kwok Chuen Wong Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Abstract: With advances in both medical imaging and computer programming, two-dimensional axial images can be processed into other reformatted views (sagittal and coronal and three-dimensional (3D virtual models that represent a patients’ own anatomy. This processed digital information can be analyzed in detail by orthopedic surgeons to perform patient-specific orthopedic procedures. The use of 3D printing is rising and has become more prevalent in medical applications over the last decade as surgeons and researchers are increasingly utilizing the technology’s flexibility in manufacturing objects. 3D printing is a type of manufacturing process in which materials such as plastic or metal are deposited in layers to create a 3D object from a digital model. This additive manufacturing method has the advantage of fabricating objects with complex freeform geometry, which is impossible using traditional subtractive manufacturing methods. Specifically in surgical applications, the 3D printing techniques can not only generate models that give a better understanding of the complex anatomy and pathology of the patients and aid in education and surgical training, but can also produce patient-specific surgical guides or even custom implants that are tailor-made to the surgical requirements. As the clinical workflow of the 3D printing technology continues to evolve, orthopedic surgeons should embrace the latest knowledge of the technology and incorporate it into their clinical practice for patient-specific orthopedic applications. This paper is written to help orthopedic surgeons stay up-to-date on the emerging 3D technology, starting from the acquisition of clinical imaging to 3D printing for patient-specific applications in orthopedics. It 1 presents the necessary steps to prepare the medical images that are

  5. Experimental study of bone response to hydroxyapatite coating implants: bone-implant contact and removal torque test.

    Science.gov (United States)

    Eom, Tae-Gwan; Jeon, Gyeo-Rok; Jeong, Chang-Mo; Kim, Young-Kyun; Kim, Su-Gwan; Cho, In-Hee; Cho, Yong-Seok; Oh, Ji-Su

    2012-10-01

    The objective of this study was to evaluate the early osseointegration of hydroxyapatite (HA)-coated implant. Twelve adult male miniature pigs were used in this study. The removal torque of implants placed in the tibia of miniature pigs was measured. For implants placed in the mandible, histomorphometric evaluation was performed for the evaluation of the bone-implant contact (BIC) ratio. After 4, 8, and 12 weeks, removal torque values were increased. Among the 3 groups, the HA-coated group showed the highest values (P < .05). At 4 and 8 weeks, the BIC ratio of HA was significantly higher than that of resorbable blast medium or sand blasted with alumina and acid etched (P < .05). It was concluded that HA-coated implants are relatively favorable in early loading stages. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. HA-Coated Implant

    DEFF Research Database (Denmark)

    Daugaard, Henrik; Søballe, Kjeld; Bechtold, Joan E

    2014-01-01

    The goal of osseointegration of orthopedic and dental implants is the rapid achievement of a mechanically stable and long lasting fixation between living bone and the implant surface. In total joint replacements of cementless designs, coatings of calcium phosphates were introduced as a means...

  7. Healing of experimental femoral defects in rats after implantation of collagen-calcium phosphate biocomposites

    Directory of Open Access Journals (Sweden)

    O. V. Korenkov

    2017-06-01

    Full Text Available The aim of this study was to investigate the healing process of experimental defects of the femoral shaft diaphysis of rats after implantation of osteoplastic material Collapan into its cavity. In experi-mental animals, a perforated defect with diameter of 2.5 mm was created in the medullary canal of the femoral shaft and filled with osteoplastic material Collapan. In control rats, the defect was left un-filled. The bone fragments were examined on the 15th and 30th day by light microscopy morphometry and scanning electron microscopy. It was found that application of osteoplastic material Collapan in the femoral diaphysis defect optimised reparative osteogenesis, showed high biocompatibility, osteo-conductive properties, resorption ability and good integration with tissue-specific structures of the regenerate

  8. The influence of Young's modulus of loaded implants on bone remodeling: an experimental and numerical study in the goat knee.

    NARCIS (Netherlands)

    Stoppie, N.; Oosterwyck, H. Van; Jansen, J.A.; Wolke, J.G.C.; Wevers, M.; Naert, I.

    2009-01-01

    The aim of this study was to examine the influence of the Young's modulus of the implant material on the bone remodeling in a loaded condition. A combined animal experimental and computational study was set up. The animal experimental group comprised of 16 Saanen goats, each receiving one titanium

  9. Evaluation of bone loss in antibacterial coated dental implants: An experimental study in dogs

    DEFF Research Database (Denmark)

    Gallardo, Maria Godoy; Manzanares-Céspedes, Maria Cristina; Sevilla, Pablo

    2016-01-01

    The aim of this study was to evaluate the in vivo effect of antibacterial modified dental implants in the first stages of peri-implantitis. Thirty dental implants were inserted in the mandibular premolar sites of 5 beagle dogs. Sites were randomly assigned to Ti (untreated implants, 10 units), Ti...

  10. Blood clearance of Howell-Jolly bodies in an experimental autogenic splenic implant model.

    Science.gov (United States)

    Marques, R G; Lucena, S B S G; Caetano, C E R; de Sousa, V Oliveira; Portela, M C; Petroianu, A

    2014-06-01

    Autogenic splenic implant (ASI) is one of the few alternatives for preservation of splenic tissue when total splenectomy is inevitable. The aim of this study was to determine the morphological and functional regeneration of ASIs, as indicated by the clearance of Howell-Jolly (HJ) bodies, in an experimental model. Ninety-nine male Wistar rats were divided into three groups: sham-operated (group 1), total splenectomy alone (group 2), and total splenectomy combined with ASI (group 3). Animals in group 3 were further allocated to nine subgroups of nine rats each, and analysed at different time points (1, 4, 8, 12, 16, 20, 24, 28 and 32 weeks after surgery). Blood smears were prepared at predetermined times for detection of HJ bodies. Morphological regeneration of tissue in the ASI was analysed by histology. At 1 week, the regenerated mass corresponded to about 7 per cent of the tissue implanted, reaching approximately 54 per cent at 24 weeks. The HJ body levels were increased in groups 2 and 3 until 8 weeks after surgery, following which levels in the ASI group became similar to those in the sham-operated group. HJ bodies were difficult to detect when a level of 22.5 per cent of regenerated ASI mass was reached. Functional regeneration of ASIs occurred from 8 weeks after surgery. When 22.5 per cent of regenerated ASI mass was reached almost no HJ bodies could be observed in the bloodstream, resembling a spleen in situ. Splenectomy has been practised routinely, both in the emergency setting and as a therapeutic elective procedure. There is a correlation between asplenia/hyposplenia and the occurrence of fulminant sepsis, underlining the importance of developing surgical methods for preserving splenic function. Both clinical and experimental studies have shown at least partial morphological and functional regeneration of autogenic splenic implants (ASIs). Experimental studies investigating the immunoprotective effect of ASIs, based mostly on exposure of animals to

  11. Comparison of the analgesic properties of transdermally administered fentanyl and intramuscularly administered buprenorphine during and following experimental orthopedic surgery in sheep.

    Science.gov (United States)

    Ahern, Benjamin J; Soma, Lawrance R; Boston, Raymond C; Schaer, Thomas P

    2009-03-01

    To evaluate the analgesic properties of transdermally administered fentanyl and IM administered buprenorphine in sheep undergoing unilateral tibial osteotomy. 20 mature sheep. Fentanyl patches (n = 15 sheep) or placebo patches (5 sheep) were applied 12 hours before sheep underwent general anesthesia and a unilateral tibial osteotomy. Buprenorphine was administered to the placebo group every 6 hours commencing at time of induction. Signs of pain were assessed every 12 hours after surgery by 2 independent observers unaware of treatment groups. There were no differences in preoperative and intraoperative physiologic data between the 2 groups. Sheep treated with fentanyl required less preoperative administration of diazepam for sedation and had significantly lower postoperative pain scores, compared with those treated with buprenorphine. No complications associated with the antebrachium at the site of patch application were detected. Under the conditions of this study, transdermally administered fentanyl was a superior option to IM administered buprenorphine for alleviation of postoperative orthopedic pain in sheep. This information can be used to assist clinicians in the development of a rational analgesic regimen for research and clinical patients.

  12. Peri-implant tissue reactions to immediate nonocclusal loaded implants with different collar design: an experimental study in dogs.

    Science.gov (United States)

    Negri, Bruno; Calvo Guirado, José L; Maté Sánchez de Val, José E; Delgado Ruíz, Rafael A; Ramírez Fernández, María P; Barona Dorado, Cristina

    2014-02-01

    The aim of this study was to evaluate bone remodelling and soft tissue reactions around immediate nonocclusal loaded implants with different collar configuration in beagle dogs. The mandibular bilateral second, third and fourth premolars of six beagle dogs were extracted. After 3 months of healing, four implants were placed in the mandibles of each dog. Randomly, two implants with a 1.5 mm polished surface collar (TSA, control group) and two implants with a 0.7 mm polished surface collar and 2.5 mm microthreaded area (TSAA, test group) were inserted. Both groups were treated with a minimal mucoperiosteal flap elevation approach. Impressions were taken and two single screw-retained restorations were inserted in each hemi-mandible 2 days after the implant placement. The animals were sacrificed at 1, 2 and 3 months (two specimens each), and biopsies were obtained. Samples were processed for ground sectioning. Histomorphometric analysis was carried out to compare buccal and lingual bone height loss and soft tissue behaviour between the two groups. Crestal bone resorption was significantly higher in the control group (P > 0.05). The establishment of the biological width showed similar outcomes for both groups. Only the distance from the top of the peri-implant mucosa to the apical portion of the barrier epithelium at lingual aspect was significantly more pronounced in the control group (P > 0.05). The alterations that occurred in the peri-implant tissues were related to the adaptation that occurred after the loading conditions in both groups. The microthread design might have an effect in maintaining the marginal bone loss against loading. © 2012 John Wiley & Sons A/S.

  13. Results of bone regenerate study after osteosynthesis with bioinert and calcium phosphate-coated bioactive implants in experimental femoral neck fractures (experimental study

    Directory of Open Access Journals (Sweden)

    K. S. Kazanin

    2015-01-01

    Full Text Available Objective - to analyze the results of X-ray, cytomorphometric and immunohistochemistry experimental studies of bone regenerates after osteosynthesis with bioinert and calcium phosphate-coated bioactive implants. Material and methods. The study was conducted on experimental femoral neck fractures in rabbit males. Reparative osteogenesis processes were studied in groups of bioinert titanium implant osteosynthesis and calcium phosphate-coated bioactive titanium implant osteosynthesis. The animals were clinically followed-up during the postoperative period. X-ray, cytomorphometric and immunohistochemistry studies of samples extracted from femoral bones were conducted over time on days 1, 7, 14, 30 and 60. The animal experiments were kept and treated according to recommendations of international standards, Helsinki Declaration on animal welfare and approved by the local ethics committee. All surgeries were performed under anesthesia, and all efforts were made to minimize the suffering of the animals. Results. In the animal group without femoral neck fracture osteosynthesis, femoral neck pseudoarthrosis was observed at the end of the experiment. The results of cytomorphometric and immunohistochemistry studies conducted on day 60 of the experiment confirmed that the cellular composition of the bone regenerate in the group of calcium phosphate-coated bioactive titanium implants corresponded to a more mature bone tissue than in the group of bioinert titanium implants. Conclusion. The results of the statistical analysis of cytomorphometric and immunohistochemistry data show that the use of calcium phosphate-coated bioactive titanium implants allows to achieve significantly earlier bone tissue regeneration.

  14. Nanomedicine applications in orthopedic medicine: state of the art.

    Science.gov (United States)

    Mazaheri, Mozhdeh; Eslahi, Niloofar; Ordikhani, Farideh; Tamjid, Elnaz; Simchi, Abdolreza

    2015-01-01

    The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges.

  15. Nanomedicine applications in orthopedic medicine: state of the art

    Science.gov (United States)

    Mazaheri, Mozhdeh; Eslahi, Niloofar; Ordikhani, Farideh; Tamjid, Elnaz; Simchi, Abdolreza

    2015-01-01

    The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges. PMID:26451110

  16. Effect of glenoid implant design on glenohumeral stability: an experimental study.

    Science.gov (United States)

    Sins, Lauranne; Tétreault, Patrice; Petit, Yvan; Nuño, Natalia; Billuart, Fabien; Hagemeister, Nicola

    2012-10-01

    Though several glenoid implants were developed over the past years, a high rate of glenoid loosening remains. This complication is linked to the glenohumeral stability, defined as humeral head translation. In an intact shoulder, this concept is ensured by all active and passive elements, particularly the labrum. Two features of a glenoid implant can be adjusted to improve the stability, or, in other words, to decrease the translations: the first is the mismatch, defined as the difference of curvature between the prosthetic head and glenoid; the second is the shape of the glenoid component. Therefore, the objective of this study was to compare the performance of 2 glenoid components (Ceraver, Roissy, France): (1) a standard design and (2) a design named "labrum design" with a superior part simulating the anatomic labrum. An experimental device was developed to evaluate forces and kinematics. The device simulated active, dynamic and continuous abduction of an entire arm. It reproduced the Scapulo-Humeral Rhythm. The labrum design was installed first. To evaluate the effect of mismatch on the glenohumeral stability, 3 humeral heads were tested, corresponding to the ones recommended by the company. The experiment was repeated for the standard design. The results obtained show a general decrease of the prosthetic head translation with the labrum design compared to the standard design. No noticeable effect of mismatch was found. A proof of concept of the interest of the artificial labrum was provided since it improved the glenohumeral stability. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Dental implants immediate loading versus the standard 2-staged protocol: an experimental study in dogs.

    Science.gov (United States)

    Rismanchian, Mansour; Attar, Bijan Movahedian; Razavi, Sayed Mohammad; Shamsabad, Ali Nasir; Rezaei, Majid

    2012-02-01

    The endeavors to shorten implant treatment time have led to the concept of immediate loading. This research was designed to compare the immediate loading and the 2-staged methods on implant placement from a clinical, histological, and histomorphometric standpoint. Three months postextraction of 12 premolars of 3 dogs, 12 implants were inserted. Bone-implant contact (BIC), implant stability quotient (ISQ), the bone type in a 2-mm periphery around the implant, and the marginal bone loss (MBL) were recorded for unloaded implants (n  =  6) and immediately loaded ones (n  =  6). BIC, ISQ, MBL in the mesial, and the bone types around the implants were not significantly different in the 2 groups. The distal MBL was higher in the immediately loaded group. Immediate loading does not appear to be perilous for osseointegration, BIC, or new bone type around implants.

  18. Shock-implanted noble gases - An experimental study with implications for the origin of Martian gases in shergottite meteorites

    Science.gov (United States)

    Bogard, Donald D.; Horz, Friedrich; Johnson, Pratt H.

    1986-01-01

    The shock-implantation of gases is studied by artificially shocking whole rock and power samples of terrestrial basalt to pressures of 2-40 GPa. Ar, Kr, Xe, and Ne were implanted into the silicate. It is observed that the amount of implanted gas is linearly proportional to its partial pressure over a pressure range of 0.0001 to 0.1 atmosphere. The fractionation effect in the implanted gas and the gas diffusion properties are examined. The amounts of gas that would have been implanted with 100 percent efficiency are calculated from the measured porosities of the power samples and are compared to observed abundances. It is determined that the implantation efficiencies are approximately 0.5 percent at 2 GPa, 7 percent at 5 GPa, and greater than 50 percent at both 20 and 35 GPa. The experimental data correlate with the shock implantation of Martian gases without mass fractionation into the shock-melted phase of meteorite EETA 79001.

  19. Bone Morphometric Evaluation around Immediately Placed Implants Covered with Porcine-Derived Pericardium Membrane: An Experimental Study in Dogs

    Directory of Open Access Journals (Sweden)

    Ryo Jimbo

    2012-01-01

    Full Text Available Objective. To investigate whether porcine-derived bioresorbable pericardium membrane coverage enhances the osseointegration around implants placed in fresh extraction sockets. Study Design. Twenty-four commercially available endosseous implants were placed in the fresh extraction sockets of the mandibular first molar of mature beagles (. On one side, implants and osteotomy sites were covered with porcine-derived bioresorbable pericardium membranes, whereas on the other side, no membranes were used. After 6 weeks, samples were retrieved and were histologically processed for histomorphometric analysis. Results. The histological observation showed that bone loss and soft tissue migration in the coronal region of the implant were evident for the control group, whereas bone fill was evident up to the neck of the implant for the membrane-covered group. Bone-to-implant contact was significantly higher for the membrane-covered group compared to the control group, 75% and 45% (, respectively. Conclusion. The experimental membranes proved to regenerate bone around implants placed in fresh extraction sockets without soft tissue intrusion.

  20. Effect of titanium dental implants on proton therapy delivered for head tumors: experimental validation using an anthropomorphic head phantom

    Science.gov (United States)

    Oancea, C.; Shipulin, K.; Mytsin, G.; Molokanov, A.; Niculae, D.; Ambrožová, I.; Davídková, M.

    2017-03-01

    A dosimetric experiment was performed at the Medico-Technical Complex in the Joint Institute for Nuclear Research, Dubna, to investigate the effects of metallic dental implants in the treatment of head and neck tumours with proton therapy. The goal of the study was to evaluate the 2D dose distributions of different clinical treatment plans measured in an anthropomorphic phantom, and compare them to predictions from a treatment planning system. The anthropomorphic phantom was sliced into horizontal segments. Two grade 4 Titanium implants were inserted between 2 slices, corresponding to a maxillary area. GafChromic EBT2 films were placed between the segments containing the implants to measure the 2D delivered dose. Two different targets were designed: the first target includes the dental implants in the isocentre, and in the second target, the proton beam is delivered through the implants, which are located at the entrance region of the Bragg curve. The experimental results were compared to the treatment plans made using our custom 3D Treatment Planning System, named RayTreat. To quantitatively determine differences in the isodose distributions (measured and calculated), the gamma index (3 mm, 3%) was calculated for each target for the matrix value in the region of high isodose (> 90%): for the experimental setup, which includes the implants in the SOBP region, the result obtained was 84.3%. When the implants were localised in the entrance region of the Bragg curve, the result obtained was 86.4%. In conclusion, the uncertainties introduced by the clinically planned dose distribution are beyond reasonable limits. The linear energy transfer spectra in close proximity to the implants were investigated using solid state nuclear track detectors (TED). Scattered particles outside the target were detected.

  1. Is Salvage of Recently Infected Breast Implant After Breast Augmentation or Reconstruction Possible? An Experimental Study.

    Science.gov (United States)

    Castus, P; Heymans, O; Melin, P; Renwart, L; Henrist, C; Hayton, E; Mordon, S; Leclère, F M

    2018-01-23

    The reinsertion of an infected implant when peri-prosthetic infection occurs early after breast augmentation or breast reconstruction remains controversial. In this experimental study, the authors tried to remove bacteria, and their biofilm, from the colonized surface of breast prostheses, without damaging their integrity. A total of 112 shell samples of silicone breast prostheses, smooth (SPSS) and textured (TPSS), were colonized by S. epidermidis (SE) or S. aureus (SA) strains, all able to produce biofilms. After 15 days, all the samples were removed from the contaminated culture broth and constituted 4 groups of 20 contaminated samples: SPSS/SE (group I), SPSS/SA (group II), TPSS/SE (group III), TPSS/SE (group IV). In another group-group SEM-, 16 colonized samples were used for documentation with scanning electron microscopy (SEM). The remaining 16 samples were used to test the limits of detection of the sterility test. All samples of groups I-IV and 8 samples of group SEM were « washed » with a smooth brush in a povidone-iodine bath and rinsed with saline solution. A subset of the washed samples was sent for SEM and the others were immersed in sterile broth and were incubated at 35 °C for 3 weeks (groups I-IV). Fifteen days after contamination, all the samples in groups I-IV were colonized. In the SEM group, SEM images attested to the presence of bacteria in biofilm attached to the shells. After cleaning, SEM did not reveal any bacteria and there was no visible alteration in the outer structure of the shell. Sterility tests performed after decontamination in groups I-IV remained negative for all the samples. Breast prostheses recently contaminated with Staphylococci, frequently involved in peri-prosthetic breast implant infection and capable of producing biofilms, can be efficiently decontaminated by the procedure used in this study. Our decontamination procedure did not alter the surface structure of the prostheses. This decontamination procedure

  2. Healing of implants installed in over- or under-prepared sites--an experimental study in dogs.

    Science.gov (United States)

    Rea, Massimiliano; Lang, Niklaus P; Ricci, Sara; Mintrone, Francesco; González González, Gladys; Botticelli, Daniele

    2015-04-01

    To study bone healing at implants installed with different insertion torques. In six Labrador dogs, all mandibular premolars and first molars were extracted. After 4 months of healing, flaps were elevated, and two implant sites were prepared at each side of the mandible. In the right side of the mandible, the distal sites were prepared conventionally, while the mesial sites were over-prepared by 0.2 mm. As a consequence, a final insertion torque of ~30 Ncm at the distal and a minimal insertion torque close to 0 Ncm at the mesial sites were obtained. In the left sides of the mandible, however, the recipient sites were underprepared by 0.3 mm resulting in an insertion torque of ≥ 70 Ncm at both implants. Cover screws were applied, and flaps sutured to fully submerge the experimental sites. After 4 months, the animals were sacrificed and ground sections obtained for histological evaluation. The mineralized bone-to-implant contact was in the range of 55.2-62.1%, displaying the highest value at implants with ~30 Ncm insertion torque and the lowest value at the implant sites with close to 0 Ncm insertion torque. No statistically significant differences were revealed. Bone density was in the range of 43.4-54.9%, yielding the highest value at implants with ≥ 70 Ncm insertion torque and the lowest at the implant sites with close to 0 Ncm insertion torque. The difference between the sites of ~30 Ncm and the corresponding ≥ 70 Ncm insertion torque reached statistical significance. Similar amounts of osseointegration were obtained irrespective of the insertion torque applied. Moreover, implants installed in sites with close to 0 Ncm insertion torque may properly osseointegrate as well. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery?

    Science.gov (United States)

    Schmitz, Marweh; Bertram, Martin; Kneser, Ulrich; Keller, Andrea K; Horch, Raymund E

    2013-10-01

    Capsular contracture remains a hitherto unsolved complication after implantation of silicone gel-filled breast prostheses. Based on clinical and experimental data, the use of an acellular dermal matrix as a sheath around implants may lead to lesser capsular contracture acting as a proposed biological environment mimicking wound bed tissue. The aim of our study was to analyse the tissue reaction after implantation of silicone prosthesis with and without an envelope of acellular dermal matrix. Implantation of 60 silicone prostheses in the back of Lewis rats were carried out, randomly paired taking one rat from group A and one from group B. Group A included implants completely enveloped with xenogenic acellular dermis and group B undraped silicone implants. At 3, 6 and 12 weeks postoperatively, the samples were explanted and subjected to histological and immunohistochemical evaluation. A new myofibroblast tissue layer was identified in proximity to the implant in both groups. The thickness of the layer in group A was continuously thinner than in group B regarding the different explantation time points. Implants completely wrapped with acellular dermal matrix showed significantly lesser inflammatory signs at 3 and 12 weeks after implantation compared to controls. Cell proliferation after 12 weeks was significantly decreased in group A. The slight myofibroblast layer and reduced rate of inflammation and proliferation in the treatment group show a positive effect of total acellular dermal matrix envelope and hypothesise the decrease of capsular contracture in long-term periods. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Client counseling in orthopedic emergencies.

    Science.gov (United States)

    Brackenridge, S S; Kirby, B M; Johnson, S W

    1995-09-01

    Important client communication issues associated with most orthopedic emergencies are addressed. Information on client communication and support, providing a prognosis, discussing economic concerns, discharge planning, euthanasia, and client grief is presented. The issue of animal abuse as a cause of orthopedic emergencies also is examined.

  5. Experimental versus computational analysis of micromotions at the implant-bone interface

    NARCIS (Netherlands)

    Tarala, M.; Janssen, D.; Telka, A.; Waanders, D.; Verdonschot, N.J.J.

    2011-01-01

    In total hip arthroplasty, micromotions at the implant-bone interface influence the long-term survival of the prosthesis. These micromotions are often measured using sensors that are fixed to the implant and bone at points that are remote from the interface. Given that the implant-bone system is not

  6. Experimental study on penetration of dental implants into the maxillary sinus in different depths

    Directory of Open Access Journals (Sweden)

    Weijian ZHONG

    2013-12-01

    Full Text Available The exposing of dental implant into the maxillary sinus combined with membrane perforation might increase risks of implant failure and sinus complications. Objective: The purpose of this study was to investigate the effects of the dental implant penetration into the maxillary sinus cavity in different depths on osseointegration and sinus health in a dog model. Material and Methods: Sixteen titanium implants were placed in the bilateral maxillary molar areas of eight adult mongrel dogs, which were randomly divided into four groups according to the different penetrating extents of implants into the sinus cavities (group A: 0 mm; group B: 1 mm; group C: 2 mm; group D: 3 mm. The block biopsies were harvested five months after surgery and evaluated by radiographic observation and histological analysis. Results: No signs of inflammatory reactions were observed in any maxillary sinus of the eight dogs. The tips of the implants with penetrating depth of 1 mm and 2 mm were found to be fully covered with newly formed membrane and partially with new bone. The tips of the implants with penetrating depth over 3 mm were exposed in the sinus cavity and showed no membrane or bone coverage. No significant differences were found among groups regarding implant stability, bone-to-implant contact (BIC and bone area in the implant threads (BA. Conclusions: Despite the protrusion extents, penetration of dental implant into the maxillary sinus with membrane perforation does not compromise the sinus health and the implant osseointegration in canine.

  7. Experimental validation of 3D printed patient-specific implants using digital image correlation and finite element analysis.

    Science.gov (United States)

    Sutradhar, Alok; Park, Jaejong; Carrau, Diana; Miller, Michael J

    2014-09-01

    With the dawn of 3D printing technology, patient-specific implant designs are set to have a paradigm shift. A topology optimization method in designing patient-specific craniofacial implants has been developed to ensure adequate load transfer mechanism and restore the form and function of the mid-face. Patient-specific finite element models are used to design these implants and to validate whether they are viable for physiological loading such as mastication. Validation of these topology optimized finite element models using mechanical testing is a critical step. Instead of inserting the implants into a cadaver or patient, we embed the implants into the computer-aided skull model of a patient and, fuse them together to 3D print the complete skull model with the implant. Masticatory forces are applied in the molar region to simulate chewing and measure the stress-strain trajectory. Until recently, strain gages have been used to measure strains for validation. Digital Image Correlation (DIC) method is a relatively new technique for full-field strain measurement which provides a continuous deformation field data. The main objective of this study is to validate the finite element model of patient-specific craniofacial implants against the strain data from the DIC obtained during the mastication simulation and show that the optimized shapes provide adequate load-transfer mechanism. Patient-specific models are obtained from CT scans. The principal maximum and minimum strains are compared. The computational and experimental approach to designing patient-specific implants proved to be a viable technique for mid-face craniofacial reconstruction. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Osseous adaptation to continuous loading of rigid endosseous implants

    Science.gov (United States)

    Roberts, W. E.; Smith, R. K.; Mozsary, P. G.; Zilberman, Y.; Smith, R. S.

    1984-01-01

    The effect of loading on etched Ti implants in the femurs of young (3 mo) and adult (6 mo) rabbits is investigated experimentally. The results are presented in photographs, fluorescence and polarization micrographs, radiographs, and drawings and discussed. Implantation is followed by formation of coarse woven bone within 3 d and mature lamellar bone by 6 wks, with nonspecific subperiosteal bony hypertrophy in the young rabbits only. Spring loading at 100 g produces spontaneous spiral-type fractures when applied immediately, but the implants remain rigid when loads are applied after 6-12 wks of healing. The mechanisms of bone formation involved are examined, and the potential of endosseous implants as anchors in orthodontics or dentofacial-orthopedics is confirmed.

  9. Advances in regenerative orthopedics.

    Science.gov (United States)

    Evans, Christopher H

    2013-11-01

    Orthopedic injuries are common and a source of much misery and economic stress. Several relevant tissues, such as cartilage, meniscus, and intra-articular ligaments, do not heal. And even bone, which normally regenerates spontaneously, can fail to mend. The regeneration of orthopedic tissues requires 4 key components: cells, morphogenetic signals, scaffolds, and an appropriate mechanical environment. Although differentiated cells from the tissue in question can be used, most cellular research focuses on the use of mesenchymal stem cells. These can be retrieved from many different tissues, and one unresolved question is the degree to which the origin of the cells matters. Embryonic and induced pluripotent stem cells are also under investigation. Morphogenetic signals are most frequently supplied by individual recombinant growth factors or native mixtures provided by, for example, platelet-rich plasma; mesenchymal stem cells are also a rich source of trophic factors. Obstacles to the sustained delivery of individual growth factors can be addressed by gene transfer or smart scaffolds, but we still lack detailed, necessary information on which delivery profiles are needed. Scaffolds may be based on natural products, synthetic materials, or devitalized extracellular matrix. Strategies to combine these components to regenerate tissue can follow traditional tissue engineering practices, but these are costly, cumbersome, and not well suited to treating large numbers of individuals. More expeditious approaches make full use of intrinsic biological processes in vivo to avoid the need for ex vivo expansion of autologous cells and multiple procedures. Clinical translation remains a bottleneck. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  10. Pregnancy outcomes after orthopedic trauma.

    Science.gov (United States)

    Cannada, Lisa K; Pan, Ping; Casey, Brian M; McIntire, Donald D; Shafi, Shahid; Leveno, Kenneth J

    2010-09-01

    This study was performed to determine the effects of orthopedic trauma on pregnancy outcomes in pregnant trauma patients. This was an observational study completed after electronically linking databases for the obstetric service and the trauma service at our Level I trauma center. All pregnant women who presented during the years 1995 to 2007 were eligible for inclusion. Selected pregnancy outcomes in women who delivered at our trauma center during or after their trauma admission were evaluated according to the presence of orthopedic injuries. Statistical analyses were performed using χ, Student's t test, and Wilcoxon rank-sum test; and p injuries (6%) and 990 without orthopedic injuries. Women with orthopedic trauma had an average gestational age of 28 weeks versus 31 weeks for women without orthopedic trauma. Compared with the patients without orthopedic injuries, patients with orthopedic injuries had a significant increased risk of preterm birth before 37 weeks of gestation (31% vs. 3%; p injuries are high-risk obstetrical patients and may benefit from referral to a medical center capable of handling both the primary injury and the potential preterm birth associated with the injury.

  11. [Experimental study of dental implants with nanostructured non-resorbable coating integration into bone tissue].

    Science.gov (United States)

    Grigor'ian, A S; Khamraev, T K; Toporkova, A K; Amirov, A R

    2010-01-01

    In 2 dogs on both sides of mandible premolars were removed. In 3 months after dental alveolus healing intraosseous screwdriver dental implants (Konmet, Russia) were installed in the place of the removed teeth. Analogous operation was done on the contralateral side: the same type of implants were installed but with new nanostructured multifunctional biocompatible non-resorbable coating (MBNC) of the Ti-Ca-P-C-O-N composition. The animals were taken out of the experiment in 4 months after implants installation and implant-bone blocks were studied by SEM-method. According to the SEM-data in the region of the contact of implant-bone without new MBNC only fibrous connective tissue was formed. In case when MBNC was used the close welding of bone tissue with implant surface was observed that was considered as sign of osteointegration.

  12. Application of Silver Nanoparticle-based Materials in Orthopedic Surgery

    OpenAIRE

    Hsu, Ginny

    2014-01-01

    Implant-associated bacterial infections are one of the most serious complications in orthopedic surgery. Treatment of these infections often requires multiple operations, device removal, long-term systemic antibiotics, and extended rehabilitation, and is frequently ineffective, leading to worse clinical outcomes and increased financial costs. In the current study, we found that silver nanoparticle/poly (DL-lactic-co-glycolic acid) (PLGA)-coated metal materials have bactericidal activity in a ...

  13. Occupational hazards facing orthopedic surgeons.

    Science.gov (United States)

    Lester, J D; Hsu, S; Ahmad, C S

    2012-03-01

    Physicians are exposed to occupational hazards of which they are often unaware. Orthopedic surgery has a particularly hazardous work environment in which surgeons are at increased risk for exposure to infection, radiation, smoke, chemicals, excessive noise, musculoskeletal injuries, as well as emotional and psychological disturbances. Understanding these risks and the precautions that can be taken to avoid them will help protect orthopedic surgeons from potential harm.

  14. Theoretical Evaluation and Experimental Validation of Localized Therapeutic Hypothermia Application to Preserve Residual Hearing After Cochlear Implantation.

    Science.gov (United States)

    Tamames, Ilmar; King, Curtis; Huang, Chin-Yuh; Telischi, Fred F; Hoffer, Michael E; Rajguru, Suhrud M

    2017-12-13

    Cochlear implantation surgery has been shown to result in trauma to inner ear sensory structures, resulting in loss of residual hearing. Localized therapeutic hypothermia has been shown in clinical care to be a neuroprotective intervention. Previously, we have shown in an experimental model that localized hypothermia protects cochlear hair cells and residual hearing function against surgical and cochlear implantation trauma. Using experimental temperature measurements carried out in human cadaver temporal bones and a finite element model of the inner ear, the present study examined the temperature distribution of a custom-designed hypothermia delivery system in the human inner ear organs. The efficacy of the hypothermia probe and resulting heat distribution across human cochlea and surrounding tissues were modeled in three-dimensional in COMSOL. The geometry and dimensions of inner ear and temporal bones were derived from computed tomographic and magnetic resonance imaging images. Model predictions were compared with experimental observations from five human temporal bones. In both the modeling and experimental studies, the cochlear temperature was lowered by 4 to 6 °C on the round window from a baseline of 37 °C within 16 to 18 minutes. The model simulations showed uniformly distributed cooling across the cochlea. This study provides insight for design, operation, and protocols for efficacious delivery of mild therapeutic hypothermia to the human cochlea that may significantly benefit patients undergoing surgical cochlear implantation by preserving residual hearing. There was a close correlation between the results of the numerical simulations and experimental observations in this study. Our custom-designed system is capable of effectively providing mild therapeutic hypothermia locally to the human cochlea. When combined with results from in vivo animal experiments, the present study suggests that the application of localized therapeutic hypothermia may hold

  15. Pectin nanocoating of titanium implant surfaces - an experimental study in rabbits

    DEFF Research Database (Denmark)

    Gurzawska, Katarzyna Aleksandra; Dirscherl, Kai; Jørgensen, Bodil

    2017-01-01

    that may increase adhesion of bone proteins, and bone cells at the implant surface. Nanocoating with pectins, plant cell wall-derived polysaccharides, is frequently done using rhamnogalacturonan-I (RG-I). AIM: The aim of the study was to evaluate the effect of nanocoating titanium implants with plant cell......) into the left and right tibia of rabbits. Machined titanium implants without RG-I nanocoating were used as controls (n = 32). Total number of 128 implants was placed in tibias of 16 rabbits. Fluorochrome bone labels, calcein green and alizarin red S were given intravenously after 9 and 12 days, respectively....... The bone response to the nanocoated implants was analyzed qualitatively and quantitatively after 2, 4, 6, and 8 weeks of healing using light microscopy and histomorphometric methods. RESULTS: The RG-I coating influenced the surface chemical composition; wettability and roughness, making the surface more...

  16. Biodegradable Orthopedic Magnesium-Calcium (MgCa Alloys, Processing, and Corrosion Performance

    Directory of Open Access Journals (Sweden)

    Yuebin Guo

    2012-01-01

    Full Text Available Magnesium-Calcium (Mg-Ca alloy has received considerable attention as an emerging biodegradable implant material in orthopedic fixation applications. The biodegradable Mg-Ca alloys avoid stress shielding and secondary surgery inherent with permanent metallic implant materials. They also provide sufficient mechanical strength in load carrying applications as opposed to biopolymers. However, the key issue facing a biodegradable Mg-Ca implant is the fast corrosion in the human body environment. The ability to adjust degradation rate of Mg-Ca alloys is critical for the successful development of biodegradable orthopedic implants. This paper focuses on the functions and requirements of bone implants and critical issues of current implant biomaterials. Microstructures and mechanical properties of Mg-Ca alloys, and the unique properties of novel magnesium-calcium implant materials have been reviewed. Various manufacturing techniques to process Mg-Ca based alloys have been analyzed regarding their impacts on implant performance. Corrosion performance of Mg-Ca alloys processed by different manufacturing techniques was compared. In addition, the societal and economical impacts of developing biodegradable orthopedic implants have been emphasized.

  17. Plasma Biomedicine in Orthopedics

    Science.gov (United States)

    Hamaguchi, Satsohi

    2012-10-01

    Various effects of plasmas irradiation on cells, tissues, and biomaterials relevant for orthopedic applications have been examined. For direct application of plasmas to living cells or tissues, dielectric barrier discharges (DBDs) with helium flows into ambient air were used. For biomaterial processing, on the other hand, either helium DBDs mentioned above or low-pressure discharges generated in a chamber were used. In this presentation, plasma effects on cell proliferation and plasma treatment for artificial bones will be discussed. First, the conditions for enhanced cell proliferation in vitro by plasma applications have been examined. The discharge conditions for cell proliferation depend sensitively on cell types. Since cell proliferation can be enhanced even when the cells are cultured in a plasma pre-treated medium, long-life reactive species generated in the medium by plasma application or large molecules (such as proteins) in the medium modified by the plasma are likely to be the cause of cell proliferation. It has been found that there is strong correlation between (organic) hydroperoxide generation and cell proliferation. Second, effects of plasma-treated artificial bones made of porous hydroxyapatite (HA) have been examined in vitro and vivo. It has been found that plasma treatment increases hydrophilicity of the surfaces of microscopic inner pores, which directly or indirectly promotes differentiation of mesenchymal stem cells introduced into the pores and therefore causes faster bone growth. The work has been performed in collaboration with Prof. H. Yoshikawa and his group members at the School of Medicine, Osaka University.

  18. Roentgen Stereophotogrammetry In Orthopedics

    Science.gov (United States)

    Selvik, Goran

    1983-07-01

    A system for roentgen stereophotogrammetry has been used in Lund, Sweden, since August 1972 and by August 1982 ten thousand stereo films have been evaluated using this method. Patient investigations started March 1973 and of the more than 500 patients investigated 300 have been referred by orthopedic surgeons. The skeletal parts investigated had been permanently marked with tantalum balls 0.5 or 0.8 mm in diameter. The causes for the investigation have been bone growth disorders in the Lower extremity (134 patients), spinal fusions (35 patients), high tibial osteotomies for gonarthrosis (21 patients) and endoprosthetic replacement of the knee (68 patients) or hip (42 patients) joint. By the roentgen stereophotogrammetric analysis (RSA), information on for instance the development of angular deformities and staple loosening in the leg, the healing process of the intended fusion in the spine or at the knee, and on the migration and stability of prosthetic components have been obtained. RSA is of value both for prognostic and followup purposes, and is versatile enough in proper setting to be used as a routine clinical investigation.

  19. Integration of fluoridated implants in onlay autogenous bone grafts - an experimental study in the rabbit tibia.

    Science.gov (United States)

    Dasmah, Amir; Kashani, Hossein; Thor, Andreas; Rasmusson, Lars

    2014-09-01

    Bone augmentation before treatment with endosseous implants is a common procedure for rehabilitation of the edentulous jaw. Both machined and surface modified implants have been used in one-stage and two-stage surgery protocols with varying results and survival rates. The influence of surface modification on the integration of implants has been documented in both non-grafted and grafted bone. The aim of this study was to compare the integration and stability of surface modified fluoridated vs. machined implants when placed simultaneously with an onlay bone graft. Eight rabbits were used in this study. A disc shaped bone graft was harvested from each side of the sagittal suture of the calvarial bone and fixed bi-cortically to the proximal tibial metaphysis by means of a dental implant, 9 mm long and 3.5 mm in diameter with a smooth machined surface as control and a blasted, fluoridated surface as test. Test and control sides were randomised. After a healing time of 8 weeks, the rabbits were sacrificed and the implants were removed en block for light microscopic analysis. Bone to implant contact (BIC) was registered as well as the amount of bone filling a rectangle indicating a region of interest (ROI) in the grafted area. Resonance frequency analysis (RFA) was conducted both at the time of surgery and at the end of the study. Our results showed statistically significant differences in BIC within the grafted area and the total bone to implant contact between the test and control sides in favour of the surface modified implants. The bone area filling the threads within a region of interest showed no statistically significant difference between the test and control sides. RFA showed higher implant stability with significant differences at the time of sacrifice in favour of the fluoridated implants. Surface modified fluoridated implants showed a higher degree of osseointegration and stability in onlay bone grafts compared with control implants with machined surface

  20. The Effect of Simplifying Dental Implant Drilling Sequence on Osseointegration: An Experimental Study in Dogs

    Directory of Open Access Journals (Sweden)

    Gabriela Giro

    2013-01-01

    Full Text Available Objectives. To test the hypothesis that there would be no differences in osseointegration by reducing the number of drills for site preparation relative to conventional drilling sequence. Methods. Seventy-two implants were bilaterally placed in the tibia of 18 beagle dogs and remained for 1, 3, and 5 weeks. Thirty-six implants were 3.75 mm in diameter and the other 36 were 4.2 mm. Half of the implants of each diameter were placed under a simplified technique (pilot drill + final diameter drill and the other half were placed under conventional drilling where multiple drills of increasing diameter were utilized. After euthanisation, the bone-implant samples were processed and referred to histological analysis. Bone-to-implant contact (BIC and bone-area-fraction occupancy (BAFO were assessed. Statistical analyses were performed by GLM ANOVA at 95% level of significance considering implant diameter, time in vivo, and drilling procedure as independent variables and BIC and BAFO as the dependent variables. Results. Both techniques led to implant integration. No differences in BIC and BAFO were observed between drilling procedures as time elapsed in vivo. Conclusions. The simplified drilling protocol presented comparable osseointegration outcomes to the conventional protocol, which proved the initial hypothesis.

  1. Artificial implantation materials; Sztuczne materialy implantacyjne

    Energy Technology Data Exchange (ETDEWEB)

    Lewandowska-Szumiel, M. [Akademia Medyczna, Warsaw (Poland)

    1997-10-01

    The radiation techniques for sterilization of orthopedic materials and high performance biomaterials have been reviewed. The radiation formulation of synthetic biomaterials for implantation and other medical use have been also performed. 18 refs, 3 tabs.

  2. Morphological Changes in Blood Cells After Implantation of Titanium and Plastic Clips in the Neurocranium - Experimental Study on Dogs

    OpenAIRE

    Katica, Muhamed; Celebicic, Mirza; Gradascevic, Nedzad; Obhodzas, Muamer; Sulji?, Enra; Ocuz, Muhamed; Delibegovic, Samir

    2017-01-01

    Introduction: Various studies confirm the biocompatibility and efficacy of clips for certain target tissues, but without any comparative analysis of hematological parameters. Therefore, we conducted a study to assess the possible association of the implantation of titanium and plastic clips in the neurocranium with possible morphological changes in the blood cells of experimental animals. Materials and Methods: As a control, the peripheral blood smears were taken before surgery from 12 adult ...

  3. Bone conditioning to enhance implant osseointegration: an experimental study in pigs.

    Science.gov (United States)

    Schlegel, Karl Andreas; Kloss, Frank Rudolf; Kessler, Peter; Schultze-Mosgau, Stefan; Nkenke, Emeka; Wiltfang, Joerg

    2003-01-01

    Osseointegration of implants depends on time and the local bone conditions regarding quality and quantity. This led to the bone classification by Lekholm and Zarb. The aim of the present study was to enhance osseointegration of implants through conditioning of the bone bed and to compare in this context the efficacy of bone condensation, an osteoinductive collagen (Colloss), and platelet-rich plasma (PRP). Porcine frontal skull bone was used for the preparation of Identical-size implant beds. Before placement of the implants (Ankylos, 3.5 x 4 mm), the implant beds were untreated (control) or conditioned with condensation, Colloss, or PRP. The animals were sacrificed after 2, 4, and 8 weeks. The specimens were then compared and analyzed by microradiography, and statistical analysis was performed using the Wilcoxon signed rank test. At the early observation times, significant effects on the sites of topical bone conditioning in comparison to the control group could be seen regarding the implant-bone interface (2 weeks: control 31%, Colloss 60%, condensation 73%, PRP 47%; 4 weeks: control 39%, Colloss 51%, condensation 40%, PRP 42%) and peri-implant bone density (2 weeks: control 31%, Colloss 48%, condensation 59%, PRP 39%; 4 weeks: control 47%, Colloss 53%, condensation 41%, PRP 50%). A leveling of the results between groups was found at 8 weeks (implant-bone interface: control 51%, Colloss 58%, condensation 55%, PRP 62%; peri-implant bone density: control 50%, Colloss 55%, condensation 51%, PRP 51%). Overall, bone condensation and Colloss apparently influenced bone formation process from the onset, but over the entire 8-week healing period, differences in bone formation were not significant It can be stated that, in the initial healing phase, an effect of topical bone conditioning may be achieved by the different described methods.

  4. Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility.

    Directory of Open Access Journals (Sweden)

    Jan Bauer

    Full Text Available In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS, more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population lived in an area with significant low orthopedic accessibility (average z-score = -4.0, whereas 31,748,161 people (39.0% of total population lived in an area with significant high orthopedic accessibility (average z-score = 8.0. Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001 and the official degree of care provision (r = 0.33; p<0.001 and negatively correlated with regional social deprivation (r = -0.47; p<0.001. Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.

  5. Biomaterial systems for orthopedic tissue engineering

    Science.gov (United States)

    Spoerke, Erik David

    2003-06-01

    The World Health Organization has estimated that one out of seven Americans suffers from a musculoskeletal impairment, annually incurring 28.6 million musculoskeletal injuries---more than half of all injuries. Bone tissue engineering has evolved rapidly to address this continued health concern. In the last decade, the focus of orthopedic biomaterials design has shifted from the use of common engineering metals and plastics to smart materials designed to mimic nature and elicit favorable bioresponse. Working within this new paradigm, this thesis explores unique chemical and materials systems for orthopedic tissue engineering. Improving on current titanium implant technologies, porous titanium scaffolds were utilized to better approximate the mechanical and structural properties of natural bone. These foam scaffolds were enhanced with bioactive coatings, designed to enhance osteoblastic implant colonization. The biopolymer poly(L-lysine) was incorporated into both hydroxypatite and octacalcium phosphate mineral phases to create modified organoapatite and pLys-CP coatings respectively. These coatings were synthesized and characterized on titanium surfaces, including porous structures such as titanium mesh and titanium foam. In addition, in vitro osteoblastic cell culture experiments probed the biological influences of these coatings. Organoapatite (OA) accelerated preosteoblastic colonization of titanium mesh and improved cellular ingrowth into titanium foam. Alternatively, the thin, uniform pLys-CP coating demonstrated significant potential as a substrate for chemically binding biological molecules and supramolecular assemblies. Biologically, pLys-CP demonstrated enhanced cellular attachment over titanium and inorganic calcium phosphate controls. Supramolecular self-assembled nanofiber assemblies were also explored both as stand-alone tissue engineering gels and as titanium coatings. Self-supporting nanofiber gels induced accelerated, biomimetic mineralization

  6. Influence of Drilling Speed on Stability of Tapered Dental Implants: An Ex Vivo Experimental Study.

    Science.gov (United States)

    Almeida, Karen P; Delgado-Ruiz, Rafael; Carneiro, Leandro G; Leiva, Alberto Bordonaba; Calvo-Guirado, Jose Luis; Gómez-Moreno, Gerardo; Malmström, Hans; Romanos, Georgios E

    2016-01-01

    The aim of this study was to evaluate whether the drilling speed used during implant site preparation influences primary stability. Eighty tapered designed implants (3.8 × 10 mm) were inserted following osteotomies created in solid rigid polyurethane foam (simulating bone type II) and cellular rigid polyurethane foam (simulating bone type IV). Half were prepared using drilling speeds of 800 rpm (low speed), and the other half were prepared using speeds of 1,500 rpm (high speed). Following insertion, implant primary stability was measured using Periotest and Osstell (resonance frequency analysis [RFA]) devices. Two-way analysis of variance (ANOVA) used for this study found that the drilling speed used to create the osteotomies appeared to have no significant impact on primary stability. The bone quality and not the osteotomy drilling speed seems to influence the implant primary stability.

  7. Enhanced osseointegration of titanium implants with nanostructured surfaces: an experimental study in rabbits.

    Science.gov (United States)

    Salou, Laëtitia; Hoornaert, Alain; Louarn, Guy; Layrolle, Pierre

    2015-01-01

    Titanium and its alloys are commonly used for dental implants because of their good mechanical properties and biocompatibility. The surface properties of titanium implants are key factors for rapid and stable bone tissue integration. Micro-rough surfaces are commonly prepared by grit-blasting and acid-etching. However, proteins and cells interact with implant surfaces in the nanometer range. The aim of this study was to compare the osseointegration of machined (MA), standard alumina grit-blasted and acid-etched (MICRO) and nanostructured (NANO) implants in rabbit femurs. The MICRO surface exhibited typical random cavities with an average roughness of 1.5 μm, while the NANO surface consisted of a regular array of titanium oxide nanotubes 37±11 nm in diameter and 160 nm thick. The MA and NANO surfaces had a similar average roughness of 0.5 μm. The three groups of implants were inserted into the femoral condyles of New Zealand White rabbits. After 4 weeks, the pull-out test gave higher values for the NANO than for the other groups. Histology corroborated a direct apposition of bone tissue on to the NANO surface. Both the bone-to-implant contact and bone growth values were higher for the NANO than for the other implant surfaces. Overall, this study shows that the nanostructured surface improved the osseointegration of titanium implants and may be an alternative to conventional grit-blasted and acid-etched surface treatments. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  8. A review on the wettability of dental implant surfaces I: theoretical and experimental aspects.

    Science.gov (United States)

    Rupp, Frank; Gittens, Rolando A; Scheideler, Lutz; Marmur, Abraham; Boyan, Barbara D; Schwartz, Zvi; Geis-Gerstorfer, Jürgen

    2014-07-01

    The surface wettability of biomaterials determines the biological cascade of events at the biomaterial/host interface. Wettability is modulated by surface characteristics, such as surface chemistry and surface topography. However, the design of current implant surfaces focuses mainly on specific micro- and nanotopographical features, and is still far from predicting the concomitant wetting behavior. There is an increasing interest in understanding the wetting mechanisms of implant surfaces and the role of wettability in the biological response at the implant/bone or implant/soft tissue interface. Fundamental knowledge related to the influence of surface roughness (i.e. a quantification of surface topography) on titanium and titanium alloy surface wettability, and the different associated wetting regimes, can improve our understanding of the role of wettability of rough implant surfaces on the biological outcome. Such an approach has been applied to biomaterial surfaces only in a limited way. Focusing on titanium dental and orthopaedic implants, the present study reviews the current knowledge on the wettability of biomaterial surfaces, encompassing basic and applied aspects that include measurement techniques, thermodynamic aspects of wetting and models predicting topographical and roughness effects on the wetting behavior. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  9. A new floating piezoelectric microphone for the implantable middle ear microphone in experimental studies.

    Science.gov (United States)

    Jia, Xian-Hao; Gao, Na; Xu, Xin-da; Wu, Yong-Zhen; Kang, Hou-Yong; Chi, Fang-Lu

    2016-12-01

    The new floating piezoelectric microphone is feasible for use as an implantable middle ear microphone in a totally implantable cochlear implant. A piezoelectric sensor that is driven by the acoustic vibration of the ossicles is one possible design for a microphone for a totally implantable cochlear implant. Such a new floating piezoelectric microphone has been manufactured in the lab. The purpose of this article was to study the frequency response of the new floating piezoelectric microphone in the intact ossicular chain and to identify whether it is usable and implantable. The frequency response of the new floating piezoelectric microphone was analyzed using in vitro testing of fresh cadaveric heads. The microphone, which was designed with an integrated unibody structure to ensure good biocompatibility and capsulation, was attached to the long process of the incus by a titanium clip, or placed in the tympanic cavity and stimulated with pure tones of different frequencies. The new floating piezoelectric microphone can pick up the vibration of the long process of the incus and convert it into electrical signals sensitively and flatly.

  10. Osteoporotic rat models for evaluation of osseointegration of bone implants

    NARCIS (Netherlands)

    Alghamdi, H.S.A.; Beucken, J.J.J.P van den; Jansen, J.A.

    2014-01-01

    Osseointegration of dental and orthopedic bone implants is the important process that leads to mechanical fixation of implants and warrants implant functionality. In view of increasing numbers of osteoporotic patients, bone implant surface optimization strategies with instructive and drug-loading

  11. Medical photography: principles for orthopedics.

    Science.gov (United States)

    Uzun, Metin; Bülbül, Murat; Toker, Serdar; Beksaç, Burak; Kara, Adnan

    2014-04-05

    Medical photography is used clinically for patient evaluation, treatment decisions, and scientific documentation. Although standards for medical photography exist in many branches of medicine, we have not encountered such criteria in publications in the area of orthopedics. This study aims to (1) assess the quality of medical images used in an orthopedic publication and (2) to propose standards for medical photography in this area. Clinical photographs were reviewed from all issues of a journal published between the years 2008 and 2012. A quality of clinical images was developed based on the criteria published for the specialties of dermatology and cosmetic surgery. All images were reviewed on the appropriateness of background, patient preparation, and technique. In this study, only 44.9% of clinical images in an orthopedic publication adhered to the proposed conventions. Standards have not been established for medical photography in orthopedics as in other specialty areas. Our results suggest that photographic clinical information in orthopedic publications may be limited by inadequate presentation. We propose that formal conventions for clinical images should be established.

  12. Moral Dilemmas in Pediatric Orthopedics.

    Science.gov (United States)

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result. Copyright 2015, SLACK Incorporated.

  13. Experimental and computational analysis of micromotions of an uncemented femoral knee implant using elastic and plastic bone material models.

    Science.gov (United States)

    Berahmani, Sanaz; Janssen, Dennis; Verdonschot, Nico

    2017-08-16

    It is essential to calculate micromotions at the bone-implant interface of an uncemented femoral total knee replacement (TKR) using a reliable computational model. In the current study, experimental measurements of micromotions were compared with predicted micromotions by Finite Element Analysis (FEA) using two bone material models: linear elastic and post-yield material behavior, while an actual range of interference fit was simulated. The primary aim was to investigate whether a plasticity model is essential in order to calculate realistic micromotions. Additionally, experimental bone damage at the interface was compared with the FEA simulated range. TKR surgical cuts were applied to five cadaveric femora and micro- and clinical CT- scans of these un-implanted specimens were made to extract geometrical and material properties, respectively. Micromotions at the interface were measured using digital image correlation. Cadaver-specific FEA models were created based on the experimental set-up. The average experimental micromotion of all specimens was 53.1±42.3µm (mean±standard deviation (SD)), which was significantly higher than the micromotions predicted by both models, using either the plastic or elastic material model (26.5±23.9µm and 10.1±10.1µm, respectively; p-valuematerial models). The difference between the two material models was also significant (p-value<0.001). The predicted damage had a magnitude and distribution which was comparable to the experimental bone damage. We conclude that, although the plastic model could not fully predict the micro motions, it is more suitable for pre-clinical assessment of a press-fit TKR implant than using an elastic bone model. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs

    DEFF Research Database (Denmark)

    Gotfredsen, K; Nimb, L; Hjörting-Hansen, E

    1992-01-01

    bilaterally and 24 commercial pure titanium implants were placed immediately in extraction sockets and covered with mucoperiosteum. Each dog had inserted 4 implants: 1 screw implant and 1 cylindrical implant blasted with titanium-dioxide-particles; 1 screw implant and 1 cylindrical implant with machine......-produced (m.p.) surface (controls). After a healing period of 12 weeks, 16 implants from 4 animals were used for removal torque test, which demonstrated that significantly higher removal torque force was needed to unscrew the implants blasted with titanium-dioxide-particles, than the normal m.p. implants......-blasted implants and the control implants. The implants blasted with titanium-dioxide-particles in this study showed a better anchorage than implants with a machine-produced surface. The screw implants showed a better anchorage than the cylindrical implants....

  15. Bone healing at implants with different surface configurations: an experimental study in dogs.

    Science.gov (United States)

    Beolchini, Marco; Lang, Niklaus P; Gómez Moreno, Gerardo; Iezzi, Giovanna; Botticelli, Daniele; Calvo Guirado, José Luis

    2016-02-01

    To study osseointegration of implants with surface modifications by the use of fluoroboric acid and/or H2 O2 installed in conventional sites or sites with circumferential marginal defects. Four implants with different surfaces were used. One basic surface (ZirTi(®)) was sandblasted with zirconium microspheres and acid etched additionally with hydrofluoric acid. A second surface was treated with fluoroboric acid instead of hydrofluoric acid. The remainder of the other two surfaces was additionally treated with H2O2. The edentulous mandibles of 6 foxhound dogs were used to randomly install 8.5-mm-long implants with the different surfaces and to study the histological healing after 1 and 3 months. To study osteoconductivity, additional four recipient sites were prepared with the coronal region being widened so that a 4 mm deep and 0.85 mm wide marginal defect resulted after the placement of the four implants with different surfaces. No filler material or membranes were used, and a fully submerged healing was allowed for 3 months. At the conventional sites, new bone formation ranged between 68.5% and 74.9% after 1 month. After 3 months, bone-to-implant contact ranged from 72.6% at the ZirTi(®) surface to 84.1% at the fluoroboric acid-treated implants, the difference being statistically significant. At the sites with marginal defects, bone formation ranged from 0.77 mm at the surface treated with fluoroboric acid and H2O2 , to 1.93 mm at the surface treated with fluoroboric acid alone. Fluoroboric acid treatment alone of titanium implant surfaces resulted in improved osseointegration and osteoconductivity after 3 months. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. A Comparative Study of Densitometric Parameters of the Bone Tissue Under Transosseous Osteosynthesis by Using Experimental Implants Coated with Superhard Compounds

    Directory of Open Access Journals (Sweden)

    Galimzyan KABIROV

    2015-07-01

    Full Text Available By X-ray computed tomography (CT, density characteristics of the tibiae bones in 25 experimental adult male rats were studied after their tibiae bones have experimentally fractured and then repaired by osteosynthesis using different implants. According to the data that was obtained by computed tomography, it has been defined that bone densities depend on the type of the implant and the chemical composition of the coating which is applied on the surface of the implant. Thus, average values of the density of the tibiae bones in the experimental rats with implants coated with a combination of titanium and hafnium nitrides were not different from the density values of the intact bones. At the same time, the densities of the tibiae in rats with implants made of copper and implants coated with a combination of titanium and zirconium nitrides were 1.5-2 times lower than those of the intact bones. This leads us to conclude that implants coated with titanium and hafnium nitrides are biologically and chemically inert because less pathologic changes in the bone tissue were observed, in contrast to the copper-based implants and those where the coating contains zirconium.

  17. Implante Autólogo Ovariano no Omento Maior: Estudo Experimental Ovarian Autotransplantation to the Greater Omentum: Experimental Model

    Directory of Open Access Journals (Sweden)

    Luiz Ronaldo Alberti

    2002-01-01

    Full Text Available Objetivos: avaliar os aspectos morfofuncionais de ovários implantados no omento maior, bem como a melhor técnica para implantação do ovário: se íntegro ou fatiado. Métodos: foram divididas aleatoriamente 40 ratas Wistar com ciclos estrais normais em quatro grupos: Grupo I (n = 5, controle - laparotomia; Grupo II (n = 5, ooforectomia total bilateral; Grupo III (n = 15, implante autólogo íntegro no omento maior e Grupo IV (n = 15, implante autólogo fatiado no omento maior. Realizaram-se esfregaços vaginais nos 3º e 6º mes pós-operatório e estudos histológicos dos implantes ovarianos, avaliando-se: degeneração, fibrose, reação inflamatória, angiogênese, cistos foliculares, desenvolvimento folicular e corpos lúteos. Resultados: os animais do Grupo I ciclaram normalmente. As ratas do Grupo II não apresentaram ciclo, permanecendo em diestro. No Grupo III, 11 ratas permaneceram em diestro, três apresentaram ciclos incompletos e apenas uma ciclou normalmente. No Grupo IV, três animais não ciclaram, oito tiveram esfregaços vaginais incompletos e quatro ciclaram normalmente. Os achados histológicos dos animais pertencentes ao Grupo III evidenciaram histoarquitetura normal em dez ratas, porém nas outras cinco, houve degeneração ovariana. No Grupo IV, 14 ratas tiveram ovários com histoarquitetura preservada e em apenas uma houve sinais de degeneração. Conclusões: o implante autólogo ovariano no omento maior foi viável, obtendo-se melhor preservação morfofuncional com a implantação de fatias.Purpose: in order to maintain the gonadal function after oophorectomy, morphofunctional aspects of ovarian autotransplantation to the greater omentum and the best kind of implantation, intact or sliced, were investigated. Methods: forty cycling female Wistar rats were randomly divided into four groups: Group I (n = 5, control - laparotomy; Group II (n = 5, bilateral oophorectomy; Group III (n = 10, intact ovarian

  18. [The beginnings of orthopedic surgery in Israel].

    Science.gov (United States)

    Tauber, Chanan

    2013-08-01

    In early mandatory Israel, orthopedics was mainly conservative, The first modern orthopedic surgeon was Ernst Spira from Czechoslovakia who established an orthopedic service at the Beilinson Hospital in Petah Tikva and left in 1948 to establish the Orthopedic Department and the Rehabilitation Center in Tel Hashomer, which treated the War of Independence casualties including amputees and victims of spinal cord injuries. A second orthopedic department was opened in Tel Hashomer by Shmuel Weissman who left in 1961 to open the Orthopedic Department at the Ichilov hospital in Tel Aviv. Shmuel Weissman became the first Chairman of Orthopedic Surgery at the Tel Aviv University medical school. In 1955, Myer Makin opened a modern orthopedic department in the Hadassah Hospital in Jerusalem and the Alyn Hospital for crippled children. In 1951, Assaf Harofeh Hospital opened the Department of Orthopedic Surgery headed by Anatol Axer who specialized in the treatment and rehabilitation of polio patients. The majority of the second generation of orthopedic department directors was trained by these four surgeons. Major developments in the 1960s and 1970s were the introduction of the AO system revolutionizing fracture treatment from conservative to operative treatment, the advent of total hip and knee replacements, Harrington instrumentation in spinal surgery and arthroscopy were major advances in orthopedic patient care brought to Israel by the aforementioned second generation of orthopedic surgeons. Hand surgery became an independent subspecialty of orthopedics and was lead by the internationally renowned hand surgeon, Isidore Kessler.

  19. Estudo experimental da biocompatibilidade de novo material para implante orbitário

    Directory of Open Access Journals (Sweden)

    Rodrigo Beraldi Kormann

    2013-06-01

    Full Text Available OBJETIVO:Avaliar a biocompatibilidade de material FullCure 720®, que é uma resina, na confecção de implante orbitário. Avaliou-se a resposta clínica dos animais, toxicidade sistêmica e a resposta inflamatória crônica. Os animais foram pesados, exames bioquímicos e resposta inflamatória foram avaliados. Foi efetuada evisceração e colocado implante esférico orbitário. Os animais foram acompanhados durante o período de 60 dias, onde se avaliou o comportamento clínico e sinais locais. Após este período, procedeu-se a eutanásia seguida da enucleação. Foi realizada análise macroscópica e histomorfométrica. Os resultados revelaram comportamento normal dos animais, com ausência de exposição ou extrusão dos implantes, morte de algum animal e ausência de toxicidade sistêmica. Houve formação de uma cápsula fibrosa entre a capa escleral e o implante orbitário, resposta inflamatória considerada normal quando em contato com o tecido do coelho. A resina FullCure 720® utilizada como implante orbitário, mostrou-se biocompatível neste estudo.

  20. An experimental examination of mutimodal imagine system for implant site assessment

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang Seo; Kim, Kee Deog [Dept. of Dental Radiology, College of Dentistry, Yonsei University, Seoul (Korea, Republic of)

    1998-02-15

    The scanora X-ray unit uses the principles of narrow beam radiography and spiral tomography. Starting with a panoramic overview as a scout image, multiple tomographic projection could be selected. This study evaluated the accuracy of spiral tomography in comparison to routine panoramic radiography for dental implant treatment planing. An experimental study was performed on a cadaver mandible to assess the accuracy of panoramic radiography and spiral tomography film images for measurement of metallic spheres. After radiographic images of the metallic spheres on the surgical stent were measured and corrected for a fixed magnification of radiographic images, following results were obtained. 1. In the optimal position of the mandible, the minimal horizontal and vertical distortion was evident in the panoramic radiography images. The mean horizontal and vertical magnification error in anterior sites was 5.25% and 0.75%, respectively. The mean horizontal and vertical magnification error in posterior sites was 0.50% and 1.50%, respectively. 2. In the displaced forward or in and eccentric position of the mandible, the magnification error of the panoramic radiography images increased significantly over the optimal position. Overall, the mean horizontal magnification error of the anterior site in the different position changed dramatically within a range of -17.25% to 39.00%, compared to the posterior range of -5.25% to 8.50%. However, the mean vertical magnification error stayed with the range of 0.5% to 3.75% for all the mandibular positions. 3. The magnification effects in the tomographic scans were nearly identical for the anterior and posterior with a range of 2.00% to 5.75% in the horizontal and 4.50% to 5.50% in the vertical dimension, respectively. 4. A statistically significant difference between the anterior and posterior measurements was found in the horizontal measurements of the panoramic radiography images of the displaced dorward and backward position of the

  1. Reliable experimental setup to test the pressure modulation of Baerveldt Implant tubes for reducing post-operative hypotony

    Science.gov (United States)

    Ramani, Ajay

    Glaucoma encompasses a group of conditions that result in damage to the optic nerve and can cause loss of vision and blindness. The nerve is damaged due to an increase in the eye's internal (intraocular) pressure (IOP) above the nominal range of 15 -- 20 mm Hg. There are many treatments available for this group of diseases depending on the complexity and stage of nerve degradation. In extreme cases where drugs or laser surgery do not create better conditions for the patient, ophthalmologists use glaucoma drainage devices to help alleviate the IOP. Many drainage implants have been developed over the years and are in use; but two popular implants are the Baerveldt Glaucoma Implant and the Ahmed Glaucoma Valve Implant. Baerveldt Implants are non-valved and provide low initial resistance to outflow of fluid, resulting in post-operative complications such as hypotony, where the IOP drops below 5 mm of Hg. Ahmed Glaucoma Valve Implants are valved implants which initially restrict the amount of fluid flowing out of the eye. The long term success rates of Baerveldt Implants surpass those of Ahmed Valve Implants because of post-surgical issues; but Baerveldt Implants' initial effectiveness is poor without proper flow restriction. This drives the need to develop new ways to improve the initial effectiveness of Baerveldt Implants. A possible solution proposed by our research team is to place an insert in the Baerveldt Implant tube of inner diameter 305 microns. The insert must be designed to provide flow resistance for the early time frame [e.g., first 30 -- 60 post-operative days] until sufficient scar tissue has formed on the implant. After that initial stage with the insert, the scar tissue will provide the necessary flow resistance to maintain the IOP above 5 mm Hg. The main objective of this project was to develop and validate an experimental apparatus to measure pressure drop across a Baerveldt Implant tube, with and without inserts. This setup will be used in the

  2. CORRELATIONS BETWEEN OPHTHALMOLOGY AND ORTHOPEDICS.

    Science.gov (United States)

    Cazac, Cristian

    2015-01-01

    Although orthopedics and ophthalmology seem to be two different medical specialties, numerous studies that have been conducted in the past 35 years have shown a tight connection between several ocular pathologies and an increased risk of hip fractures due to falling. This article aims to review the ocular pathologies that have been proven to be associated with an increased risk of falling, to integrate the results of several studies showing a direct relationship between ocular pathologies and an increased risk of falling and finally to suggest ways in which the incidence of traumatic orthopedic injuries can be reduced by applying ophthalmologic principles.

  3. Diagnostic imaging in bovine orthopedics.

    Science.gov (United States)

    Kofler, Johann; Geissbühler, Urs; Steiner, Adrian

    2014-03-01

    Although a radiographic unit is not standard equipment for bovine practitioners in hospital or field situations, ultrasound machines with 7.5-MHz linear transducers have been used in bovine reproduction for many years, and are eminently suitable for evaluation of orthopedic disorders. The goal of this article is to encourage veterinarians to use radiology and ultrasonography for the evaluation of bovine orthopedic disorders. These diagnostic imaging techniques improve the likelihood of a definitive diagnosis in every bovine patient but especially in highly valuable cattle, whose owners demand increasingly more diagnostic and surgical interventions that require high-level specialized techniques. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Anchorage of titanium implants with different surface characteristics: an experimental study in rabbits

    DEFF Research Database (Denmark)

    Gotfredsen, K; Berglundh, T; Lindhe, J

    2000-01-01

    ) TiO2-blasted with particles of grain size 10 to 53 microns; (3) TiO2-blasted, grain size 63 to 90 microns; (4) TiO2-blasted, grain size 90 to 125 microns; (5) titanium plasma-sprayed (TPS). The surface topography was determined by the use of an optical instrument. Twelve rabbits, divided into two...... groups, had a total of 120 implants inserted in the tibiae. One implant from each of the five surface categories was placed within the left tibia of each rabbit. By a second operation, implants were installed in the right tibia, after 2 weeks in group A and after 3 weeks in group B. Fluorochrome labeling...

  5. EXPERIMENTAL SUBSTANTIATION OF APPLICATION GEL IMPLANT «SFERO®GEL» AND FILM IMPLANT «ELASTOPOB»® AT A TRAUMA OF PERIPHERAL NERVOUS SYSTEM IN EXPERIMENT

    Directory of Open Access Journals (Sweden)

    A. G. Fedyakov

    2009-01-01

    Full Text Available The purpose of the present work was the experimental substantiation of application of new biodegraded materials: gel implant «Sfero®Gel» and a film membrane of «ElastoPOB»® a domestic production, in surgery of defeats of peripheral nerves. Experimental researches carried out on females of nonlinear rats, is powerful 200–250 gramme. In experience 10 animals are used, 20 operative interventions on sciatic nerves are executed. Morphological studying of the received material in 101 days after operation was carried out. At application of a membrane «ElastoPOB»® it was defined delimitin of peripheral nerves from surrounding tissue. A film membrane of «ElastoPOB»® is perspective to apply at traumas of a nervous fabric for the purpose of formation of a friable hem in a damage zone. On the basis of the received experimental data it is possible to make the conclusion about possibility and expediency of application of biodegraded materials in surgical treatment of defeats of peripheral nervous system. 

  6. Noun plural production in preschoolers with early cochlear implantation: an experimental study of Dutch and German.

    Science.gov (United States)

    Laaha, Sabine; Blineder, Michaela; Gillis, Steven

    2015-04-01

    Studies investigating language skills of children after cochlear implantation usually present general measures of expressive/receptive vocabulary and grammar and rarely tackle the acquisition of specific language phenomena (word classes, grammatical constructions, word forms, etc.). Furthermore, research is largely restricted to children acquiring English. Cross-linguistic comparisons among children acquiring different languages are almost inexistent. The present study targets the acquisition of noun plurals (e.g., dogs, balls) by Dutch- and German-speaking children implanted before their second birthday. Given its structural complexity and irregularity, noun plural formation is a good indicator of grammatical proficiency in children at risk for a developmental delay. The study sample consisted of 14 cochlear-implanted (CI) children (M=55 months of age), 80 age-matched normally hearing (NH) controls, and 40 normally hearing controls matched by Hearing Age (HA). The children were administered an elicitation task in which they had to provide plural forms to a set of singular nouns. The analysis focussed on the following variables: Hearing status (CI, NH), Language (Dutch, German), and Suffix Predictability/Stem Transparency of the plural words. There was no significant difference between children with CI and their NH peers in correct plural production. In both child groups, plural responses followed the predicted pattern of Suffix Predictability/Stem Transparency. However, children with CI significantly more frequently replied to the test item with a recast of the singular noun instead of the plural, and the probability of these responses increased with later age of CI implantation. Furthermore, Dutch-speaking children showed an overall better performance than German-speaking children. The findings suggest that after 3 years of implant use, preschoolers with early cochlear implantation show age-appropriate patterns of noun plural formation, but still have to catch up

  7. Implante Autólogo Ovariano no Omento Maior: Estudo Experimental

    OpenAIRE

    Alberti,Luiz Ronaldo; Vasconcellos,Leonardo de Souza; Barbosa,Juliano Ferreira; Petroianu,Andy

    2002-01-01

    Objetivos: avaliar os aspectos morfofuncionais de ovários implantados no omento maior, bem como a melhor técnica para implantação do ovário: se íntegro ou fatiado. Métodos: foram divididas aleatoriamente 40 ratas Wistar com ciclos estrais normais em quatro grupos: Grupo I (n = 5), controle - laparotomia; Grupo II (n = 5), ooforectomia total bilateral; Grupo III (n = 15), implante autólogo íntegro no omento maior e Grupo IV (n = 15), implante autólogo fatiado no omento maior. Realizaram-se esf...

  8. ATTITUDES OF ORTHOPEDIC SPECIALISTS TOWARD EFFECTS OF MEDICAL DEVICE PURCHASING.

    Science.gov (United States)

    Lingg, Myriam; Merida-Herrera, Everth; Wyss, Kaspar; Durán-Arenas, Luis

    2017-01-01

    The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes. We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico. We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments. To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.

  9. Comparative radiographic and resonance frequency analyses of the peri-implant tissue after dental implants placement using flap and flapless techniques: An experimental study on domestic pigs

    OpenAIRE

    Vlahović Zoran; Mihailović Branko; Lazić Zoran; Golubović Mileta

    2013-01-01

    Background/Aim. Flapless implant surgery has become very important issue during recent years, mostly thanks to computerization of dentistry and software planning of dental implants placements. The aim of this study was to compare flap and flapless surgical techniques for implant placement through radiographic and radiofrequency analyses. Methods. The experiment was made in five domestic pigs. Nine weeks following domestic pigs teeth extraction, implants were placed, on the right side us...

  10. Experimental assessment of a new direct fixation implant for artificial limbs.

    NARCIS (Netherlands)

    Tomaszewski, P.K.; Lasnier, B.; Hannink, G.J.; Verkerke, G.J.; Verdonschot, N.J.J.

    2013-01-01

    An alternative to prosthetic socket rehabilitation of patients with transfemoral amputation is realized by means of direct skeletal fixation devices. offering significant improvements in mobility and comfort. However, strain shielding due to high stiffness of these metal-based implants causes

  11. Experimental assessment of a new direct fixation implant for artificial limbs

    NARCIS (Netherlands)

    Tomaszewski, P. K.; Lasnier, B.; Hannink, G.; Verkerke, G. J.; Verdonschot, N.

    An alternative to prosthetic socket rehabilitation of patients with transfemoral amputation is realized by means of direct skeletal fixation devices, offering significant improvements in mobility and comfort. However, strain shielding due to high stiffness of these metal-based implants causes

  12. Bone tissue engineering for spine fusion : An experimental study on ectopic and orthotopic implants in rats

    NARCIS (Netherlands)

    van Gaalen, SM; Dhert, WJA; van den Muysenberg, A; Oner, FC; van Blitterswijk, C; Verbout, AJ; de Bruijn, J.D.

    2004-01-01

    Alternatives to the use of autologous bone as a bone graft in spine surgery are needed. The purpose of this study was to examine tissue-engineered bone constructs in comparison with control scaffolds without cells in a posterior spinal implantation model in rats. Syngeneic bone marrow cells were

  13. Design and experimental study of joint torque balance mechanism of seed implantation articulated robot

    Directory of Open Access Journals (Sweden)

    Zhang Yongde

    2015-06-01

    Full Text Available This article discusses several new mechanisms that may be used in prostate cancer seed implant robotics. We have developed relatively simple but effective mathematical models of multi-needle puncture prostate using nonlinear spring–damper model; based on Automatic Dynamic Analysis of Mechanical Systems or dynamics module, displacement simulation for prostate is performed, and simulation results indicate that the multi-needle puncture mechanism could reduce prostate displacement in the y- or z-direction. Then aiming at the limitation of human body structure space and seed implant needle insertion path, a revolute-revolute-translational-type prostate seed implantation robot with three-dimensional transrectal ultrasound navigation is designed. It is noteworthy that drive torque fluctuation is caused by the center of gravity change of revolute-revolute tandem cantilever structure; an elastic balance mechanism is designed to realize the complete balance of cantilever weight. Based on Automatic Dynamic Analysis of Mechanical Systems or dynamics module, static drive torque simulation of 2-revolute tandem cantilever structure is performed. Finally, we manufacture the robot prototype and make verification experiment to the cantilever balancing device, and the experiment results provide evidence that elastic balance mechanism can realize the complete balance of cantilever weight, improve the fluctuation in the amplitude value of driving torque, and increase its operation stationary of seed implantation robot system.

  14. Orthopedic Management of Spina Bifida

    Science.gov (United States)

    Thomson, Jeffrey D.; Segal, Lee S.

    2010-01-01

    The management of orthopedic problems in spina bifida has seen a dramatic change over the past 10 years. The negative effects of spasticity, poor balance, and the tethered cord syndrome on ambulatory function are better appreciated. There is less emphasis on the hip radiograph and more emphasis on the function of the knee and the prevention of…

  15. Expression of bone matrix proteins during the osseus healing of topical conditioned implants: an experimental study.

    Science.gov (United States)

    Schlegel, Karl Andreas; Thorwarth, Michael; Plesinac, Alexandra; Wiltfang, Joerg; Rupprecht, Stephan

    2006-12-01

    Osseointegration of implants depends on time and local bone conditions regarding quality and quantity. This led to the bone classification by Lekholm et al. The aim of the present study was to follow the expression of bone matrix proteins during the phase of osseointegration after conditioning of the bone bed by means of immunohistochemistry. In the porcine frontal skull, implant beds of identical size were created. Before placement of the implants (Ankylos 4 x 3.5 mm), the implant beds were conditioned using bone condensation (cond), an osteoinductive collagen (Co) and platelet-rich plasma (PRP). These conditioning methods were compared with standard procedure. The animals were sacrificed after 2, 4 and 8 weeks. The specimens were then analyzed by light microcopy and immunohistochemistry for expression of bone morphogenic proteins (BMP)2, procollagen I and osteocalcin (OC). Light microscopy revealed an initial effect of condensation and the bovine collagen at 2 weeks in comparison with the standard group. The PRP did not achieve a significant effect. At 8 weeks, the results of the standard, bone condensation and the bovine collagen group had aligned. The PRP group showed a significantly lower bone-implant contact (BIC) (P=0.003) compared with the standard group. BMP2 expression was significantly higher in all evaluated test groups at 4 and 8 weeks, as well as at 2 weeks in the condensation group. The procollagen I expression at 2 weeks was significantly increased for PRP and lower in the collagen and condensation group compared with standard procedure. Values for 4 and 8 weeks were slightly higher than in the standard group. No significant differences were obvious in the OC group at any time. During the initial healing phase, an effect of the evaluated methods of topical bone conditioning can be demonstrated by differences in the expression of BMP2 and procollagen I. These findings had leveled at 8 weeks and were, in contrast, not detectable in the expression of

  16. EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

    Directory of Open Access Journals (Sweden)

    V. M. Mashkov

    2012-01-01

    Full Text Available Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group, one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group. During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.

  17. Experimental substantiation of the design of a prosthetic heart valve for «valve-in-valve» implantation

    Directory of Open Access Journals (Sweden)

    K. Yu. Klyshnikov

    2017-01-01

    Full Text Available The aim of the study was to perform a series of in vitro tests of a prototype of the developing heart valve prosthesis to evaluate its functional characteristics. Materials and methods. In this work we have used the frames and full prototypes of the prosthesis, consisting of a stent-like stainless steel support frame with mounted biological leaflets and cover. The authors evaluated the calculated and experimental forces necessary for the displacement of the sutureless implanted prosthesis using the test machine under uniaxial tension. The risk of defects and damages to the supporting framework as a result of implantation was evaluated by scanning electron microscopy. The hydrodynamic characteristics of the prosthesis were investigated under physiological conditions and «valvein-valve» implantation. Evaluation of the ergonomics and applicability of the proposed construction on the cadaver heart model of cattle was carried out. Results. As a result of the forces assessment, it was found that the force required to shear the prosthesis was 3.12 ± 0.37 N, while the calculated value was 1.7 N, which is significantly lower than the obtained value. The comparison of the images obtained with small and large magnifications demonstrated the absence of critical surface defects. Additional analysis under the super-large magnifications also did not reveal problem areas. During the hydrodynamic study, it was shown that the average transplant gradient increased slightly from 2.8–3.4 to 3.2–4.5 mm Hg for the initial prosthesis and the «valve-in-valve» complex, respectively. The decrease of the effective orifice area was 6–9% relative to the initial one. Evaluation of the implantation technique demonstrated the consistency of the approach: the use of the developed holder in combination with the balloon implantation system made it possible to position the prosthesis throughout the procedure. Conclusion. The series of tests demonstrates the consistency

  18. Experimental evaluation of tooth movement in the beagle dog with the mini-screw implant for orthodontic anchorage.

    Science.gov (United States)

    Owens, Shannon E; Buschang, Peter H; Cope, Jason B; Franco, Pedro F; Rossouw, P Emile

    2007-11-01

    The purposes of this study were to evaluate the stability of mini-screw implants (MSIs) and tooth movements in relation to the timing, amount, and location of force application. Additionally, clinical measurements of peri-implant health were recorded to determine predictors for MSI failure. A randomized split-mouth design was used in 7 skeletally mature male beagle dogs. All third premolars were extracted to facilitate retraction of the second premolars via sectional orthodontic appliances. In the maxilla, the effect of delayed vs immediate loading was tested under constant force (25 g). In the mandible, the effect of force level (25 vs 50 g) was tested on immediately loaded MSIs. All experimental MSIs had a corresponding unloaded control. Clinical records and measurements of tooth movement were taken at specified intervals. The overall success rate of the implants was 93% with no significant effects of timing, amount, or location of force applied. Peri-implant tissue health was not predictive of MSI failure. The maxillary and the mandibular second premolars were moved 3.3 +/- 1.0 and 3.8 +/- 1.3 mm, respectively. No significant differences in tooth movement were observed between immediate and delayed loading, at either 25 or 50 g or force, or between the maxilla and the mandible. These results support the notion that immediate MSI loading with light forces (25 and 50 g) can be accomplished with high rates of success, producing clinically relevant amounts of tooth movement that are not influenced by the amount of force or the location at which they are applied.

  19. Histological and Histomorphometric Evaluation of Zirconia Dental Implants Modified by Femtosecond Laser versus Titanium Implants: An Experimental Study in Fox Hound Dogs.

    Science.gov (United States)

    Calvo-Guirado, Jose Luis; Aguilar-Salvatierra, Antonio; Delgado-Ruiz, Rafael Arcesio; Negri, Bruno; Fernández, María Piedad Ramírez; Maté Sánchez de Val, José Eduardo; Gómez-Moreno, Gerardo; Romanos, Georgios E

    2015-06-01

    This study applied femtosecond laser technology to zirconia dental implants (Bredent GmbH & Co.KG, Senden, Germany) to generate a surface texture of microgrooves over the entire intraosseous surface, analyzing its behavior in an in vivo model in comparison with titanium implants with sandblasted and acid-etched surfaces. The study used six American Fox Hound dogs. Each received four implants per hemi-mandible, making a total of eight implants per animal. The 48 immediate loaded implants were divided into two groups of 24 titanium implants (control group) and 24 zirconia implants (study/test group), distributed randomly. Bone-to-implant contact (BIC) values and crestal resorption were determined at 1 and 3 months, also measuring calcium, phosphorous, and carbon concentrations by means of energy dispersive x-ray. BIC percentages after 30 days were 51.36% for titanium implants and 44.68% for zirconia implants. After 90 days, values increased to 61.73% in titanium and 47.94% in zirconia implants. After 30 days, there was more crestal bone lost in the titanium group (0.77 mm) compared with the zirconia group (0.01 mm). After 90 days, zirconia implants showed greater marginal bone resorption (1.25 mm) compared with the titanium group (0.37 mm). The present study shows that zirconia implants with modified surfaces can produce good osseointegration values when compared with titanium implants in terms of BIC and crestal bone resorption at 1 and 3 months. © 2013 Wiley Periodicals, Inc.

  20. Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs

    DEFF Research Database (Denmark)

    Gotfredsen, K; Nimb, L; Hjörting-Hansen, E

    1992-01-01

    The aim of the present study was to compare the anchorage of TiO2-blasted screw and cylindrical implants with conventionally used machine-produced screw and cylindrical implants inserted immediately in extraction sockets on dogs. 6 adult mongrel dogs had 3rd and 4th mandibular premolars extracted...... bilaterally and 24 commercial pure titanium implants were placed immediately in extraction sockets and covered with mucoperiosteum. Each dog had inserted 4 implants: 1 screw implant and 1 cylindrical implant blasted with titanium-dioxide-particles; 1 screw implant and 1 cylindrical implant with machine...

  1. Is montelukast effective in regression of endometrial implants in an experimentally induced endometriosis model in rats?

    Science.gov (United States)

    Kiykac Altinbas, Sadiman; Tapisiz, Omer Lutfi; Cavkaytar, Sabri; Simsek, Gulcin; Oguztuzun, Serpil; Goktolga, Umit

    2015-01-01

    Montelukast, a selective antagonist of Type 1 cysteinyl leukotriene receptors (CysLT1Rs), antagonizes the proinflammatory and proasthmatic activities of CysLT1Rs. We investigated the effect of montelukast on a surgically induced endometriosis rat model. Thirty-two sexually mature, cycling, female Wistar-Albino rats, in which endometriotic implants were surgically induced, were randomly divided into three groups. Group I [Montelukast (M), 10 rats)] was given 1.6 mg/kg/day of oral montelukast sodium. Group II [Leuprolide acetate (L), 11 rats] was given 1 mg/kg single dose of s.c.leuprolide acetate. Group III [Control (C), 11 rats] received saline solution through an orogastric tube and served as controls. After a 3-weeks medication, the rats were sacrificed to investigate the endometriotic implants for size and morphological and histological characteristics, including immunoreactivity of MMP-2 and VEGF. The mean area of implants decreased from 48.2 ± 24.7 to 29.3 ± 15.8mm(2) in Group I (M) (P = 0.008) and from 62 ± 32.1 to 39.9 ± 18.1mm(2) in Group II (L) (P=0.003). In Group III (C), the mean area increased from 41.1 ± 31.1 to 60.4 ± 37.1mm(2) (P = 0.025). Histopathological analysis showed statistically significant lower scores in rats treated with montelukast compared to leuprolide and controls. MMP H scores were not different between the groups in both epithelial and stromal MMP-2 immunostaining. VEGF H scores were statistically lower in Group 1 (M) in epithelial VEGF immunostaining when compared to Group II (L) and Group III (C) (P=0.006). Montelukast may effectively cause a significant decrease in the area of endometriotic implants. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. A Psychophysics experimental software to evaluate electrical pitch discrimination in Nucleus cochlear implanted patients

    Science.gov (United States)

    Pérez Zaballos, M. T.; Ramos de Miguel, A.; Killian, M.; Ramos Macías, A.

    2016-02-01

    Multichannel electrode array design in cochlear implants has evolved into two major categories: straight and perimodiolar electrodes. When implanted, the former lies along the outer wall of the scala tympani, while the later are located closer to the modiolus, where the neural ends are. Therefore, a perimodiolar position of the electrode array could be expected to result in reduced stimulus thresholds and stimulating currents, increased dynamic range, and more localized stimulation of the neural elements. However, their advantage for pitch discrimination has not been conclusively stated. Therefore, in order to study electrode independence, a psychophysical software has been developed, making use of Nucleus Implant Communicator tools provided by Cochlear company under a research agreement. The application comprises a graphical interface to facilitate its use, since previous software has always required some type of computer language skills. It allows for customization of electrical pulse parameters, measurement of threshold and comfort levels, loudness balancing and alternative forced choice experiments to determine electrode discrimination in Nucleus© users.

  3. Experimental formation of periodontal structure around titanium implants utilizing bone marrow mesenchymal stem cells: a pilot study.

    Science.gov (United States)

    Marei, Mona K; Saad, Manal M; El-Ashwah, Adham M; El-Backly, Rania M; Al-Khodary, Mohammed A

    2009-01-01

    Tissue engineering in the head and neck area, presents numerous advantages. One of the most remarkable advantages is that regeneration of only a small amount of tissue can be highly beneficial to the patient, particularly in the field of periodontal tissue regeneration. For decades, successful osseointegration has provided thousands of restorations that maintain normal function. With the increasing need to utilize dental implants for growing patients and enhance their function to simulate normal tooth physiology and proprioception, there appears to be an urgent need for t concept of periodontal tissue regeneration around dental implants. In the present work, 5 goats wer used for immediate implant placement post canine teeth extraction. Each goat received 2 implan fixtures; the control side received a porous hollow root-form poly (DL-Lactide-co-Glycolide) scaf around the titanium fixture, and the experimental side received the same scaffold but seeded with autogenous bone marrow-derived mesenchymal stem cells. One animal was killed 10 days postoperatively, and the others were killed after 1 month. The results showed that on th experimental side, periodontal-like tissue with newly formed bone was demonstrated both at 1 days and after 1 month, while the control specimens showed early signs of connective tissue regeneration around the titanium fixture at 10 days, but was not shown in the 1 month specimens. I can be concluded that undifferentiated mesenchymal stem cells were capable of differentiating t provide the 3 critical tissues required for periodontal tissue regeneration: cementum, bone, a periodontal ligament. This work may provide a new approach for periodontal tissue regeneration.

  4. Histopathological comparative analysis of periimplant bone inflammatory response after dental implant insertion using flap and flapless surgical technique. An experimental study in pigs.

    Science.gov (United States)

    Vlahović, Zoran; Marković, Aleksa; Lazić, Zoran; Šćepanović, Miodrag; Đinić, Ana; Kalanović, Milena

    2017-09-01

    To evaluate by histopathological analysis the peri-implant bone inflammation degree, in certain time intervals (7, 14, 21 and 28 days), following mini-incision flapless and flap implant placement. The experiment was conducted on four domestic pigs. Nine weeks prior to implant insertion, second and third mandibular premolars were extracted. Each animal received six implants in lower jaw. On one randomly chosen side of jaw flapless technique using mini-incision was performed, while on the other side implants were inserted after flap raising. After 7, 14, 21, and 28 days, the experimental animals were sacrificed. Following mandibular resection and decalcification, the samples for histopathological analysis of the peri-implant bone were obtained in the empty implant bed area, from the buccal side of the mandible, adjacent to implant neck region and parallel to crestal edge of implant bed. The degree of inflammatory response of the peri-implant bone was estimated through ordinal scores from 0 to 2. Seven days after the surgery all samples in the flap group had score 2 indicating high inflammation degree, in contrast to lower inflammatory reaction in flapless group. On the 14th and 21st postoperative day decreasing of inflammation degree was noted in all samples of the flapless group (score 1), while in flap group samples presented scores 1 and 2. Twenty-eight days after the implant placement, further reduction of inflammation in the flapless group (33% of samples had score 0) was observed. Flapless technique in comparison to conventional flap procedure minimizes postoperative bone inflammatory reactions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Linear and Angular Deviations of Implants Placed in Experimental Casts with Stereolithographic Drill Guides Fixed by O'ring Ortho Implant Devices

    OpenAIRE

    Novellino,Marcelo Michele; Sesma,Newton; Lagana,Dalva Cruz; Ferrari, Glais

    2013-01-01

    The aim of this study was to evaluate whether the introduction of a device, resulting from the combination of an o'ring attachment with an orthodontic implant (o'ring ortho implant, O'ROI), to affix the surgical template of CAD/CAM-guided implant surgery contribute to minimizing the deviations in the position and inclination of implants at the time of their placement. Ten models simulating bone tissue were fabricated and randomly divided into 2 groups: 5 with the scanning and surgical templat...

  6. Orthopedic surgery in ancient Egypt

    OpenAIRE

    Blomstedt, Patric

    2014-01-01

    Background ? Ancient Egypt might be considered the cradle of medicine. The modern literature is, however, sometimes rather too enthusiastic regarding the procedures that are attributed an Egyptian origin. I briefly present and analyze the claims regarding orthopedic surgery in Egypt, what was actually done by the Egyptians, and what may have been incorrectly ascribed to them. Methods ? I reviewed the original sources and also the modern literature regarding surgery in ancient Egypt, concentra...

  7. Anchorage of TiO2-blasted, HA-coated, and machined implants: an experimental study with rabbits

    DEFF Research Database (Denmark)

    Gotfredsen, K; Wennerberg, A; Johansson, C

    1995-01-01

    The purpose of this study was to evaluate the histometrical and biomechanical anchorage of TiO2-blasted implants and TiO2-blasted implants coated with hydroxyapatite. The control implants were machined. Twenty-six rabbits had a total of 156 implants placed in the proximal part of the tibia. Each ...

  8. Bundled payments in orthopedic surgery.

    Science.gov (United States)

    Bushnell, Brandon D

    2015-02-01

    As a result of reading this article, physicians should be able to: 1. Describe the concept of bundled payments and the potential applications of bundled payments in orthopedic surgery. 2. For specific situations, outline a clinical episode of care, determine the participants in a bundling situation, and define care protocols and pathways. 3. Recognize the importance of resource utilization management, quality outcome measurement, and combined economic-clinical value in determining the value of bundled payment arrangements. 4. Identify the implications of bundled payments for practicing orthopedists, as well as the legal issues and potential future directions of this increasingly popular alternative payment method. Bundled payments, the idea of paying a single price for a bundle of goods and services, is a financial concept familiar to most American consumers because examples appear in many industries. The idea of bundled payments has recently gained significant momentum as a financial model with the potential to decrease the significant current costs of health care. Orthopedic surgery as a field of medicine is uniquely positioned for success in an environment of bundled payments. This article reviews the history, logistics, and implications of the bundled payment model relative to orthopedic surgery. Copyright 2015, SLACK Incorporated.

  9. Influence of surgical technique in the peritoneal carcinomatosis surgical wound implant: experimental model in mice.

    Science.gov (United States)

    Rosa, Roberto Maranhão; Caiado, Rafael Coelho; Reis, Paulo Roberto de Melo; Lacerda, Elisângela de Paula Silveira; Sugita, Denis Masashi; Mrué, Fátima

    2015-01-01

    The number of malignancies increased alarmingly. Surgery constitutes one of the most efficient therapeutic modalities for the treatment of solid tumors. The neoplastic implant in surgical wound is a complication whose percentage of occurrence reported in the literature is variable, but sets with high morbidity and therapeutic difficulties. Protecting the wound is one of the recommended principles of oncologic surgery. To evaluate the influence of wound protection in the development of tumor implantation. Sarcoma 180 tumor cells were used, with intraperitoneal inoculation in Swiss mice. After the establishment of neoplastic ascites, animals were randomized into two groups of 10, each group consisting of five males and five females. In both groups, laparotomy and manipulation of intra-abdominal organs was performed. In a group laparotomy was performed using the protection of the abdominal wound and the other group without it. On the 9th postoperative day macroscopic evaluation of the operative scar was performed, which was later removed for microscopic evaluation. There was microscopic infiltration of tumor cells in the wound of all animals. However, the group that held the protection, infiltration was less intense when compared to the group without it. The infiltration was also more severe in females than in males of the same group. Tumor infiltration into the wound was more intense in the group in which the protection of the surgical site was not performed, and in females when compared to males of the same group.

  10. Required minimum primary stability and torque values for immediate loading of mini dental implants: an experimental study in nonviable bovine femoral bone.

    Science.gov (United States)

    Dilek, Ozkan; Tezulas, Emre; Dincel, Mert

    2008-02-01

    Immediate loading of implants decreases the period a patient has to remain edentulous. However, for successful immediate loading in clinical practice, a strong initial fixation with bone is a prerequisite. In the present study, it is aimed to measure the primary stability, minimum placement, and removal torque values of mini dental implants which were originally designed for immediate loading. Therefore, mini dental implants (10, 13, 15, and 18 mm length and 1.8 and 2.4 mm diameter) were inserted into nonviable femoral bovine bone with a physiodispenser which can show the torque values digitally. After the implants were inserted, the primary stability values were measured with Periotest. Then the implants were removed from the bone using the same physiodispenser and the removal torque values of the implants were measured. Finally, 3 related tables were created, which show the match of the 3 different values (primary stability, placement, and removal torque) for each implant. The best Periotest values are -8 to +9, which reveal the best primary fixation range. In the tables, placement and removal torque values that correspond to this range are observed. In conclusion, it is believed that the results will aid the dentists in their decision for the selection of the Periotest value ranges and their related placement and removal torque values to decide for immediate loading of the mini dental implants. Mini dental implants, which are especially designed for immediate loading, can only be loaded immediately if their Periotest values (and their related placement and removal torque values) are measured to be between the range of -8 to +9. It is believed that the placement and removal torque values below the -8 to +9 Periotest range are not suitable for immediate loading procedure. Because this study concentrates only on experimental results, further clinical research is needed to be made in order to draw more definite conclusions about immediate loading of the mini dental

  11. Implantable synthetic cytokine converter cells with AND-gate logic treat experimental psoriasis.

    Science.gov (United States)

    Schukur, Lina; Geering, Barbara; Charpin-El Hamri, Ghislaine; Fussenegger, Martin

    2015-12-16

    Psoriasis is a chronic inflammatory skin disease characterized by a relapsing-remitting disease course and correlated with increased expression of proinflammatory cytokines, such as tumor necrosis factor (TNF) and interleukin 22 (IL22). Psoriasis is hard to treat because of the unpredictable and asymptomatic flare-up, which limits handling of skin lesions to symptomatic treatment. Synthetic biology-based gene circuits are uniquely suited for the treatment of diseases with complex dynamics, such as psoriasis, because they can autonomously couple the detection of disease biomarkers with the production of therapeutic proteins. We designed a mammalian cell synthetic cytokine converter that quantifies psoriasis-associated TNF and IL22 levels using serially linked receptor-based synthetic signaling cascades, processes the levels of these proinflammatory cytokines with AND-gate logic, and triggers the corresponding expression of therapeutic levels of the anti-inflammatory/psoriatic cytokines IL4 and IL10, which have been shown to be immunomodulatory in patients. Implants of microencapsulated cytokine converter transgenic designer cells were insensitive to simulated bacterial and viral infections as well as psoriatic-unrelated inflammation. The designer cells specifically prevented the onset of psoriatic flares, stopped acute psoriasis, improved psoriatic skin lesions and restored normal skin-tissue morphology in mice. The antipsoriatic designer cells were equally responsive to blood samples from psoriasis patients, suggesting that the synthetic cytokine converter captures the clinically relevant cytokine range. Implanted designer cells that dynamically interface with the patient's metabolism by detecting specific disease metabolites or biomarkers, processing their blood levels with synthetic circuits in real time, and coordinating immediate production and systemic delivery of protein therapeutics may advance personalized gene- and cell-based therapies. Copyright © 2015

  12. Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

    Science.gov (United States)

    Ebnezar, John; Bali, Yogita; John, Rakesh

    2017-01-01

    Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management. PMID:28149067

  13. Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

    Science.gov (United States)

    Ebnezar, John; Bali, Yogita; John, Rakesh

    2017-01-01

    Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

  14. Locking mechanism for orthopedic braces

    Science.gov (United States)

    Chao, J. I.; Epps, C. H., Jr.

    1981-01-01

    An orthopedic brace locking mechanism is described which under standing or walking conditions cannot be unlocked, however under sitting conditions the mechanism can be simply unlocked so as to permit bending of the patient's knee. Other features of the device include: (1) the mechanism is rendered operable, and inoperable, dependent upon the relative inclination of the brace with respect to the ground; (2) the mechanism is automatically locked under standing or walking conditions and is manually unlocked under sitting conditions; and (3) the mechanism is light in weight and is relatively small in size.

  15. Estudo experimental da aplicação do ventrículo artificial eletromecânico pulsátil implantável Experimental study of pulsatile implantable electromechanical artificial ventricle

    Directory of Open Access Journals (Sweden)

    Jarbas Jakson Dinkhuysen

    2011-03-01

    Full Text Available OBJETIVO: Apresentar os resultados da aplicação deste dispositivo em animais de experimentação, promovendo auxílio hemodinâmico apenas ao ventrículo esquerdo (VE. MÉTODOS: Entre junho 2002 e outubro 2009, foram implantados em 27 bezerros com idade 2½ a 4 meses e peso 80/100 kg e, por meio de anestesia geral e ventilação controlada e de toracotomia lateral esquerda, era introduzida cânula no ápice do VE e anastomose término/lateral de tubo vascular de politetrafluoretileno (PTFE com a porção descendente da aorta torácica, ambos interligados ao dispositivo implantado no subcutâneo abaixo do diafragma (24 e intratorácico (três. Em cinco bezerros, o dispositivo foi aplicado com auxílio de circulação extracorpórea (CEC e, em 22, sem CEC. RESULTADOS: Ocorreram dois óbitos durante o implante e três por causas diversas nas primeiras horas de pós-operatório (PO, sendo um relacionado ao dispositivo. A sobrevivência entre o 1º e 6º dia de PO ocorreu em 17 animais e entre o 8º e 31º dia de PO em cinco, com causas determinantes diversas, não só por problemas clínico/cirúrgicos, mas também relacionados ao dispositivo. O impacto hemodinâmico avaliado pela análise da pressão sistêmica mostrou incremento que variou de 20 a 40 mmHg e os dados laboratoriais analisados demonstraram baixos impactos traumáticos à crase sanguínea e boa biocompatibilidade. CONCLUSÃO: Trata-se de pesquisa árdua e complexa onde a cada experimento são identificados problemas não só de implantabilidade, mas também relacionados ao dispositivo, que vão sendo sistematicamente corrigidos, tornando-o cada vez mais seguro e eficaz.OBJECTIVE: The objective is to present the results of the application this device in experimental animals unloading only the left ventricle. METHODS: Between June 2002 and October 2009, were implanted in 27 calfs with age between 2½ to 4 months and 80 to 100 kg of weight, with general anaesthesia and controled

  16. Histologic and histomorphometric evaluation of peri-implant bone subjected to immediate loading: an experimental study with Macaca fascicularis.

    Science.gov (United States)

    Romanos, George E; Toh, Chooi Gait; Siar, Chong Huat; Swaminathan, Dasan

    2002-01-01

    Immediately loaded splinted implants can become osseointegrated when they are placed in the anterior part of the mandible. The concept of immediate loading has not been well examined in the posterior mandible. The aim of this study was to evaluate the hard tissue reactions around immediately loaded implants placed in the posterior mandible in the monkey model. Six adult M. fascicularis monkeys were used in this study. Thirty-six Ankylos implants (Degussa Dental, Hanau-Wolfgang, Germany) were placed after extraction of the second premolar, first, and second molar teeth and complete healing of the sockets. Control (C) group implants were placed and, after osseointegration, were loaded for 1 month using temporary acrylic resin prostheses and later for 2 months using splinted metal crowns. In the contralateral region of the mandible, test (T) group implants were placed and loaded immediately with the same sequence as carried out for the C implants. After sacrifice of the animals, specimens were examined histologically and evaluated histomorphometrically. All implants were osseointegrated. Compact, cortical bone in contact with the implant surface without any gaps or connective tissue formation was demonstrated. Histomorphometric findings of the bone-implant-contacts showed no significant differences between the T and C group implants. Peri-implant mineralized bone areas presented statistically significant differences and showed a higher density of bone between the threads of immediately loaded implants (P < .05). Immediately loaded splinted implants in the posterior mandible can become osseointegrated with a hard tissue peri-implant response similar to that of delayed loaded implants. Moreover, immediate loading seems to increase the ossification of the alveolar bone around endosseous implants.

  17. The effects of hydroxyapatite coating and bone allograft on fixation of loaded experimental primary and revision implants

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Mouzin, Olivier R G; Kidder, Louis A

    2003-01-01

    in each of the 8 treatment groups (total 64 implants in 32 dogs). The observation period was 4 weeks after revision. Outcome measures are based on histomorphometry and mechanical pushout properties. The revision setting was always inferior to its primary counterpart. Bone graft improved the revision......, to obtain the same level of fixation associated with primary implants. Our findings suggest that the combination of HA implant and bone graft may be of benefit in the clinical revision implant setting....

  18. Cochlear Implants

    Science.gov (United States)

    ... implant procedure Welcome to the Food and Drug Administration (FDA) website on cochlear implants. Cochlear implants are electronic hearing devices. Doctors implant cochlear implants into people ...

  19. Orthopedic surgery in ancient Egypt.

    Science.gov (United States)

    Blomstedt, Patric

    2014-12-01

    Ancient Egypt might be considered the cradle of medicine. The modern literature is, however, sometimes rather too enthusiastic regarding the procedures that are attributed an Egyptian origin. I briefly present and analyze the claims regarding orthopedic surgery in Egypt, what was actually done by the Egyptians, and what may have been incorrectly ascribed to them. I reviewed the original sources and also the modern literature regarding surgery in ancient Egypt, concentrating especially on orthopedic surgery. As is well known, both literary sources and the archaeological/osteological material bear witness to treatment of various fractures. The Egyptian painting, often claimed to depict the reduction of a dislocated shoulder according to Kocher's method, is, however, open to interpretation. Therapeutic amputations are never depicted or mentioned in the literary sources, while the specimens suggested to demonstrate such amputations are not convincing. The ancient Egyptians certainly treated fractures of various kinds, and with varying degrees of success. Concerning the reductions of dislocated joints and therapeutic amputations, there is no clear evidence for the existence of such procedures. It would, however, be surprising if dislocations were not treated, even though they have not left traces in the surviving sources. Concerning amputations, the general level of Egyptian surgery makes it unlikely that limb amputations were done, even if they may possibly have been performed under extraordinary circumstances.

  20. A new material to prevent urethral damage after implantation of artificial devices: an experimental study

    Directory of Open Access Journals (Sweden)

    Salvador Vilar Correia Lima

    Full Text Available ABSTRACT Objective To validate the application of the bacterial cellulose (BC membrane as a protecting barrier to the urethra. Materials and Methods Forty female Wistar rats (four groups of 10: Group 1 (sham, the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis. Results Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2, statistically different in the group 2 compared with groups 1 (p=0.0044 and 3 (p=0.0154. At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1μm when com-pared to groups 1 (p=0.0001 and 3 (p<0.0001. Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159. Conclusion BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage.

  1. Osseointegration of cobalt-chrome alloy implants.

    Science.gov (United States)

    Mavrogenis, Andreas F; Papagelopoulos, Panayiotis J; Babis, George C

    2011-01-01

    Osseointegration or osteointegration refers to a direct bone-to-metal interface without interposition of non-bone tissue. The long-term clinical success of bone implants is critically related to wide bone-to-implant direct contact. However, only poor bone formation or even host bone resorption have been shown where bone is in tight contact with the implant surface. It has been suggested that an appropriate space between implant and host bone may be useful for early peri-implant bone formation. Additionally, osseointegration depends on the topographical and chemical characteristics of the implant surface. Cobalt-chrome (Co-Cr) is a metal alloy of cobalt and chromium. Because of its high strength, temperature endurance and wear resistance, it is commonly used in dental and orthopedic implants. In orthopedic implants it is usually composed of cobalt with chromium, molybdenum, and traces of other elements. Co-Cr alloys are especially useful where high stiffness or a highly polished and extremely wear-resistant material is required. This article reviews the Co-Cr alloy orthopedic implants in terms of their properties, porous coating, osseointegration, outcome, and failure.

  2. Validation of an experimental polyurethane model for biomechanical studies on implant supported prosthesis - tension tests

    Directory of Open Access Journals (Sweden)

    Mariane Miyashiro

    2011-06-01

    Full Text Available OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, frequently hinder the development of clinical trials. The purpose of this in vitro study was to determine the modulus of elasticity of a polyurethane isotropic experimental model via tension tests, comparing the results to those reported in the literature for mandibular bone, in order to validate the use of such a model in lieu of mandibular bone in biomechanical studies. MATERIAL AND METHODS: Forty-five polyurethane test specimens were divided into 3 groups of 15 specimens each, according to the ratio (A/B of polyurethane reagents (PU-1: 1/0.5, PU-2: 1/1, PU-3: 1/1.5. RESULTS: Tension tests were performed in each experimental group and the modulus of elasticity values found were 192.98 MPa (SD=57.20 for PU-1, 347.90 MPa (SD=109.54 for PU-2 and 304.64 MPa (SD=25.48 for PU-3. CONCLUSION: The concentration of choice for building the experimental model was 1/1.

  3. Mechanical, histological and histomorphometric evaluation of modified by femtosecond laser zirconia implants versus titanium implants. An experimental study in dogs at three months

    Directory of Open Access Journals (Sweden)

    J.L. Calvo-Guirado

    2013-06-01

    Full Text Available Aim The present study was aimed at quantifying implant´s stability and elemental composition by Periotest® and evaluating bone to implant contact (BIC and crestal bone loss of modified by femtosecond laser zirconia and titanium implants.Materials and methods Forty-eight implants were divided into 2 groups: titanium (control and modified by femtosecond laser zirconia (test and then inserted in 6 American Foxhound dogs. Primary stability and secondary stability were measured by Periotest, BIC was evaluated by histomorphometry at 1 and 3 months, elemental composition of the surrounding bone in both groups after 1 and 3 months was assessed.Results Differences between groups regarding primary stability and secondary stability were not significant (p>0.05. The Carbon ratio at zirconia (12.529% was significantly lower (p0.05 regarding BIC for titanium vs modified zirconia were observed. Crestal bone loss at 3 months was significantly (p<0.05 lower (0.07 ±0.34 mm in titanium group than in zirconia (1.25 ± 1.73 mm.Conclusion Surface treatment by using femtosecond laser equalizes osseointegration of zirconia implants.

  4. Morphological Changes in Blood Cells After Implantation of Titanium and Plastic Clips in the Neurocranium - Experimental Study on Dogs.

    Science.gov (United States)

    Katica, Muhamed; Celebicic, Mirza; Gradascevic, Nedzad; Obhodzas, Muamer; Suljić, Enra; Ocuz, Muhamed; Delibegovic, Samir

    2017-04-01

    Various studies confirm the biocompatibility and efficacy of clips for certain target tissues, but without any comparative analysis of hematological parameters. Therefore, we conducted a study to assess the possible association of the implantation of titanium and plastic clips in the neurocranium with possible morphological changes in the blood cells of experimental animals. As a control, the peripheral blood smears were taken before surgery from 12 adult dogs that were divided into two experimental groups. After placing titanium and plastic clips in the neurocranium, the peripheral blood of the first group was analyzed on the seventh postoperative day, while the peripheral blood of the second group was analyzed on the sixtieth day. By microscopy of the blood smears, the following parameters were analyzed: the presence of poikilocytosis of the red blood cells, degenerative changes in the leukocytes and leukogram. There were no statistically significant differences between the mean values of the groups. Monocytosis was detected (first group 22.83 % and second 16.30 %), as well as neutropenia (46.80 %, in the second group). Degenerative changes to neutrophils and the occurrence of atypical lymphocytes were observed in the second experimental group (60th postoperative day). A mild adverse effect from the biomaterials present in the neurocranium of dogs was detected, affecting the majority of leukocytic cells. A chronic recurrent inflammatory process was caused by the presence of the plastic and titanium clips in the brain tissue. No adverse effect of biomaterials on erythrocytes in the neurocranium was detected in the dogs studied. Further studies are necessary to explain the occurrence of degenerative changes in the neutrophils and lymphocytes.

  5. Experimental and computational investigation of Morse taper conometric system reliability for the definition of fixed connections between dental implants and prostheses.

    Science.gov (United States)

    Bressan, Eriberto; Lops, Diego; Tomasi, Cristiano; Ricci, Sara; Stocchero, Michele; Carniel, Emanuele Luigi

    2014-07-01

    Nowadays, dental implantology is a reliable technique for treatment of partially and completely edentulous patients. The achievement of stable dentition is ensured by implant-supported fixed dental prostheses. Morse taper conometric system may provide fixed retention between implants and dental prostheses. The aim of this study was to investigate retentive performance and mechanical strength of a Morse taper conometric system used as implant-supported fixed dental prostheses retention. Experimental and finite element investigations were performed. Experimental tests were achieved on a specific abutment-coping system, accounting for both cemented and non-cemented situations. The results from the experimental activities were processed to identify the mechanical behavior of the coping-abutment interface. Finally, the achieved information was applied to develop reliable finite element models of different abutment-coping systems. The analyses were developed accounting for different geometrical conformations of the abutment-coping system, such as different taper angle. The results showed that activation process, occurred through a suitable insertion force, could provide retentive performances equal to a cemented system without compromising the mechanical functionality of the system. These findings suggest that Morse taper conometrical system can provide a fixed connection between implants and dental prostheses if proper insertion force is applied. Activation process does not compromise the mechanical functionality of the system. © IMechE 2014.

  6. The Role of MDR-Acinetobacter baumannii in Orthopedic Surgical Site Infections.

    Science.gov (United States)

    Helal, Sohier; El Anany, Mervat; Ghaith, Doaa; Rabeea, Samar

    2015-10-01

    Gram-positive microorganisms were the main causative organisms of orthopedic surgical site infections (SSI); however the rising incidence of multiple drug resistant Acinetobacter baumannii (MDR-AB) infections in orthopedic operations causes a great concern because of their limited array of therapeutic options. Our objective was to remark the changing microbiology in orthopedic SSI and to evaluate the MDR CHROMagar Acinetobacter media for screening of MDR-AB. Aspirated pus samples were collected from infected wounds of 100 patients in the orthopedics unit of El-Helal Hospital, samples were cultured on conventional media and MDR CHROMagar Acinetobacter media, the reveled MDR-AB colonies were subjected to polymerase chain reaction (PCR) to detect blaOXA-51 like gene. Out of 100 infected wounds SSI cases represented 90/100 (90%) according to CDC 2013 definitions. Staphylococcus aureus was the dominant organism 40/90 (44.4%) (P value 0.038), all S. aureus isolates were methicillin-resistant Staphylococcus aureus (MRSA), followed by Klebsiella pneumoniae 22/90 (24.44%) and Acinetobacter 15/90 (16.67%). Implant was highly associated with SSI cases 80/90 (89%). Also, prolonged hospital stay>7 d was significantly associated with SSI 69/90 (77%) (p=0.001). Staphylococcus aureus was the main causative organism of orthopedic SSI (44.4%), whereas A. baumannii represented only (16.67%) of the causative organisms. MDR Acinetobacter CHROMagar reduced the turnaround time for screening of MDR-AB.

  7. Visual loss after orthopedic procedures.

    Science.gov (United States)

    Kaeser, Pierre-François; Borruat, François-Xavier

    2011-02-01

    Perioperative visual loss (PVL) is a very rare and unpredictable complication of surgery performed at distance from the visual pathways, mostly after spine or cardiac procedures. We report 6 consecutive patients with PVL after routine orthopedic procedures (osteosynthesis for complex fracture of the femur [2], total hip arthroplasty [2], hip prosthesis arthroplasty [1], bilateral simultaneous total knee arthroplasty [1]) and reviewed the literature on the subject. An ischemic optic neuropathy was diagnosed in all cases, and visual loss was bilateral in 5 of 6 patients. Partial visual improvement occurred in only 3 of 11 eyes. No specific therapy is available for PVL. Postoperative visual disturbances should prompt without delay an ophthalmic evaluation because emergent correction of anemia, systemic hypotension, or hypovolemia might improve visual prognosis of PVL. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. The Role of Biomimetic Incubation of Sandblasted Titanium Implants in the Process of Osseointegration: An Experimental Study in Dogs

    Directory of Open Access Journals (Sweden)

    Nigmon L. Khabilov

    2015-03-01

    Full Text Available The aim of the present study was to examine the surface characteristics and values of removal torque of an implant surface subjected to sandblasting with 125µm Al2O3 particles with a following immersion in biomimetic fluid and to compare that surface with a machined implant surface. Study protocol: Forty-eight conical implants were initially made of second-grade titanium alloy. The diameter of implants was 4mm at the head and 2.6 at the apex, all implants were of 8 mm length and of large variable thread design. Half of them were subjected to sand blasting and immersion in biomimetic fluid at 37 ⁰C for four weeks with daily replenishment of solution until the moment of placement; another 24 implants were left with untreated machined surface. Three-dimensional roughness values were obtained with the help of confocal laser scanning microscope. Forty-eight implants were implanted in 12 dogs. Twenty-four implants were retrieved after a 6-week healing period following installation, and the remaining 24 were removed upon the completion of 16 weeks, using a torque calibrator ((BTG150CN-S TOHNICHI with a 20 cN•m - 150 cN•m scale of force registration was applied for the measurements of the removal torque. Results: The mean 3-dimensional roughness value of biomimetically treated implant surfaces was 1.34±0.24µm and the mean roughness value measured for the machined surfaces was 0.33±0.04µm (P<0.05. As to the average parameters of maximum peak-trough distance, these were equal to 2.85 for machined and 24.25 for incubated sandblasted implants. Machined implants demonstrated 49.5±10.3 removal torque values after the 6-week healing period. But for the immersed sandblasted implants the same parameter was equal to 72.7±15.98 Ncm. During a 16-week recovery period, these values increased up to 77.5±15.16 Ncm and 89.7±11.83 Ncm for machined and biomimetically treated sandblasted implants, respectively, P<0.05. Conclusion: The present study

  9. Guided tissue regeneration ensures osseointegration of dental implants placed into extraction sockets. An experimental study in monkeys

    DEFF Research Database (Denmark)

    Warrer, L; Gotfredsen, K; Hjørting-Hansen, E

    1991-01-01

    The aim of the present study was to explore the possibility of achieving osseointegration of dental titanium implants, inserted into alveoli immediately after tooth extraction, by covering the recipient site with a teflon membrane. In each of 7 monkeys, mucoperiosteal flaps were raised...... present between the implant and the socket walls. In one side of the jaw, a membrane (Gore-Tex Augmentation Material) was adjusted to cover the implant. The implant in the other side of the jaw served as control and was only covered by the tissue flaps. Microscopic analysis after 3 months of healing...... on the buccal and palatal aspects of the maxillary molars in both sides of the jaw. The second molars were then extracted and self tapping titanium implants of the screw type (Astra Dental Implants) were inserted into the sockets of the largest roots. In the coronal portion of the sockets, a void was always...

  10. Influence of microgap location and configuration on radiographic bone loss in nonsubmerged implants: an experimental study in dogs.

    Science.gov (United States)

    Weng, Dietmar; Nagata, Maria Jose Hitomi; Leite, Christiane Mota; de Melo, Luiz Gustavo Nascimento; Bosco, Alvaro Francisco

    2011-01-01

    The implant-abutment connection (microgap) influences the peri-implant bone morphology. However, it is unclear if different microgap configurations additionally modify bone reactions. This preliminary study aimed to radiographically monitor peri-implant bone levels in two different microgap configurations during 3 months of nonsubmerged healing. Six dogs received two implants with internal Morse taper connection (INT group) on one side of the mandible and two implants with external-hex connection (EXT group) on the other side. One implant on each side was positioned at bone level (equicrestal); the second implant was inserted 1.5 mm below the bone crest (subcrestal). Healing abutments were attached directly after implant insertion, and the implants were maintained for 3 months without prosthetic loading. At implant placement and 1, 2, and 3 months, standardized radiographs were taken to monitor peri-implant bone levels. All implants osseointegrated. A total bone loss of 0.48 ± 0.66 mm was measured in the equicrestal INT group, 0.69 ± 0.43 mm in the equicrestal EXT group, 0.79 ± 0.93 mm in the subcrestal INT group, and 1.56 ± 0.53 mm in the subcrestal EXT group (P > .05, paired t tests). Within the four groups, bone loss over time became significantly greater in the EXT groups than in the INT groups. The greatest bone loss was noted in the subcrestal EXT group. Within the limits of this animal study, it seems that even without prosthetic loading, different microgap configurations exhibit different patterns of bone loss during nonsubmerged healing. Subcrestal positioning of an external butt joint microgap may lead to faster radiographic bone loss.

  11. Comparison of Lyophilized Glutaraldehyde-Preserved Bovine Pericardium with Different Vascular Prostheses for Use as Vocal Cords Implants: Experimental Study

    Science.gov (United States)

    Olmos-Zuñiga, J. Raúl; Jasso-Victoria, Rogelio; Gaxiola-Gaxiola, Miguel; Sotres-Vega, Avelina; Hernández-Jiménez, Claudia; Baltazares-Lipp, Matilde; Arredondo del Bosque, Fernando; Santillan-Doherty, Patricio

    2015-01-01

    This study compared the use of lyophilized glutaraldehyde-preserved bovine pericardium (LGPBP), polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), and Teflon felt (TF) as implants for vocal cords (VC) medialization and aimed to assess the endoscopic, macroscopic, and microscopic VC changes after medialization in a canine model. In 18 mongrel dogs, the right VC were medialized with LGPBP and the left were implanted as follows: Group I (n = 6): LGPBP and PTFE; Group II (n = 6): LGPBP and PET; Group III (n = 6): LGPBP and TF. Surgical handling of the implants was compared. Three months after surgery, macroscopic and microscopic changes of VC and implants were evaluated. LGPBP offered the best surgical handling (p = 0.005, Kruskal-Wallis). TF implants showed extrusion (p = 0.005, Kruskal-Wallis) and severe inflammation. All VC formed fibrous capsules around the implants; the ones developed by LGPBP implants were thinner (p = 0.001, ANOVA, Tukey). VC implanted with synthetic materials showed eosinophilic infiltration (p = 0.01, Kruskal-Wallis). We concluded that the LGPBP could be used as an implant for VC medialization because it is biocompatible, easy to handle and remove during surgical procedures, and nonabsorbable or extrudable and produces an inflammatory reaction similar to PTFE and PET. PMID:26075232

  12. Submerged flapless technique vs. conventional flap approach for implant placement: experimental domestic pig study with 12-month follow-up.

    Science.gov (United States)

    Pérez-Albacete Martínez, Carlos; Vlahović, Zoran; Šćepanović, Miodrag; Videnović, Goran; Barone, Antonio; Calvo-Guirado, José Luis

    2016-08-01

    The aim of our study was to compare osseointegration and peri-implant crestal bone resorption in submerged flapless and conventional flap surgery over a 12-month follow-up. The study used five domestic pigs. Implants were inserted 9 weeks after tooth extraction. Each animal received six implants in the mandible, following a split-mouth design: one side was treated using a flapless technique using mini-incisions, while a flap was raised on the other. The animals were sacrificed at 2 weeks, 1, 3, 6 and 12 months after implant placement. Radiographic images were taken to analyze crestal bone loss, and samples were extracted for histopathological and bone-to-implant contact (BIC) analyses. Significantly, greater crestal bone loss (P = 0.005) was obtained in the flap group compared with the flapless group. The flapless group presented significantly higher percentages of BIC (P surgery (flap or flapless) affects peri-implant bone preservation and osseointegration of regular platform implants. Flapless surgery is associated with peri-implant crestal bone preservation. Flapless surgery in combination with submerged implants allows higher osseointegration values. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Ancillary services available to the orthopedic surgeon.

    Science.gov (United States)

    Bert, Jack M

    2008-01-01

    The delivery of high quality medical services is approaching a crisis situation in the United States. As physician reimbursements decline and overhead increases, orthopedic surgeons must seek additional sources of revenue to remain financially viable and control the quality of medical care that they deliver. The orthopedic surgeon group is well positioned to control its own service lines and deliver excellent patient care as a result. This article reviews the possibilities of multiple types of ancillary service lines available for the orthopedic group practice.

  14. Experimental model of biofilm implant-related osteomyelitis to test combination biomaterials using biofilms as initial inocula.

    Science.gov (United States)

    Williams, Dustin L; Haymond, Bryan S; Woodbury, Kassie L; Beck, J Peter; Moore, David E; Epperson, R Tyler; Bloebaum, Roy D

    2012-07-01

    Currently, the majority of animal models that are used to study biofilm-related infections use planktonic bacterial cells as initial inocula to produce positive signals of infection in biomaterials studies. However, the use of planktonic cells has potentially led to inconsistent results in infection outcomes. In this study, well-established biofilms of methicillin-resistant Staphylococcus aureus were grown and used as initial inocula in an animal model of a Type IIIB open fracture. The goal of the work was to establish, for the first time, a repeatable model of biofilm implant-related osteomyelitis, wherein biofilms were used as initial inocula to test combination biomaterials. Results showed that 100% of animals that were treated with biofilms developed osteomyelitis, whereas 0% of animals not treated with biofilm developed infection. The development of this experimental model may lead to an important shift in biofilm and biomaterials research by showing that when biofilms are used as initial inocula, they may provide additional insights into how biofilm-related infections in the clinic develop and how they can be treated with combination biomaterials to eradicate and/or prevent biofilm formation. Copyright © 2012 Wiley Periodicals, Inc.

  15. The influence of external ultrasound on the histologic architecture of the organic capsule around smooth silicone implants: experimental study in rats.

    Science.gov (United States)

    Mendes, F H; Viterbo, F; DeLucca, L

    2008-05-01

    Capsular contracture is the main complication related to breast silicone implants, and its prevention remains a medical challenge. The authors present experimental research examining the effect of external ultrasound on the formation and contracture of peri-implant capsules. In this study, 42 male Wistar rats had a 2-mm smooth surface implant placed in a dorsal submuscular pocket. They then were separated into "ultrasound" and "control" groups that received repeated external applications either with or without the ultrasound power on. Ultrasound applications were given three times a week for a period of 90 days. After that, both groups were housed under the same conditions with no application scheduled. Five animals of each group, killed at 30, 60, 90, and 180 days, had their implants removed along with the capsule, which received a special histologic preparation via annular sectioning that provided wide circumferential observation of the capsular tissue. Sections were stained with hematoxylin/eosin stain, Masson's trichrome stain, and Pricrosirius Red stain for regular microscopic evaluation under normal and polarized light. Histologic data showed that capsules from the ultrasound and control groups had statistically significant differences. Ultrasound application developed a capsular architecture similar to that shown within textured silicone implants, and its effect had an early definition with subsequent stabilization. The authors conclude that early and repeated external ultrasound application enhances the thickness, cellular count, and vascularity of smooth silicone capsular tissue, whereas it diminishes the pattern of parallel orientation of collagen fibers.

  16. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Orthopedic manual surgical instrument. 888.4540... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4540 Orthopedic manual surgical instrument. (a) Identification. An orthopedic manual surgical instrument is a nonpowered hand-held device...

  17. The effect of injectable calcium phosphate cement on bone anchorage of titanium implants: an experimental feasibility study in dogs.

    NARCIS (Netherlands)

    Arisan, V.; Anil, A.; Wolke, J.G.C.; Ozer, K.

    2010-01-01

    Calcium phosphate has high osteotransductive potential. The injectable form of calcium phosphate cement (ICAP) can be used as an adjunctive supportive agent for dental implants. The aim of this study was to assess the effect of an ICAP on the reverse torque resistance of titanium implants. Two

  18. Adipose-Derived Stem Cells as a Tool for Dental Implant Osseointegration: an Experimental Study in the Dog.

    Science.gov (United States)

    Bressan, Eriberto; Botticelli, Daniele; Sivolella, Stefano; Bengazi, Franco; Guazzo, Riccardo; Sbricoli, Luca; Ricci, Sara; Ferroni, Letizia; Gardin, Chiara; Velez, Joaquin Urbizo; Zavan, Barbara

    2015-01-01

    The biological interaction between the jaw bones and dental implant is fundamental for the long-term success of dental implant placement. Nevertheless, the insufficient bone volume remains a major clinical problem, especially in case of immediate dental implant. Using a canine model, the present study proves the regenerative potential of adipose- derived stem cells (ADSCs) to repair peri-implant bone defects occurring in immediate dental implant placement. In six labradors, all mandibular premolars and the first molars were extracted bilaterally and three months later dental implants were installed with a marginal gap. The marginal defects were filled with hydroxyapatite (HA)-based scaffolds previously seeded with ADSCs. After one month of healing, specimens were prepared for histological and histomorphometric evaluations. Histological analyses of ground sections show that ADSCs significantly increase bone regeneration. Several new vessels, osteoblasts and new bone matrix were detected. By contrast, no inflammatory cells have been revealed. ADSCs could be used to accelerate bone healing in peri- implant defects in case of immediate dental implant placement.

  19. Evaluation of guided bone generation around implants placed into fresh extraction sockets: an experimental study in dogs

    DEFF Research Database (Denmark)

    Gotfredsen, K; Nimb, L; Buser, D

    1993-01-01

    . The objective of this study was to evaluate the crestal bone healing response adjacent to implants placed immediately into fresh extraction sockets with and without covering membranes. Eight adult mongrel dogs had the third and fourth mandibular premolars extracted bilaterally. Thirty-two submerged titanium...... hollow-screw implants were inserted immediately into the extraction sockets. On the right side, the implants were covered with an expanded polytetrafluorethylene membrane, whereas the left side served as a control. One dog was killed after 2 weeks, one after 4 weeks, and six after 12 weeks. Soft tissue...... dehiscence developed over 10 implants (12-week dogs) covered with membranes. Dehiscence was noted histologically over three contralateral control implants. When soft tissue dehiscence occurred and the membrane was left exposed without oral hygiene during healing, the degree of bone integration...

  20. Immediate implant placement using a biodegradable barrier, polyhydroxybutyrate-hydroxyvalerate reinforced with polyglactin 910. An experimental study in dogs

    DEFF Research Database (Denmark)

    Gotfredsen, K; Nimb, L; Hjørting-Hansen, E

    1994-01-01

    The purpose of this study was to evaluate the use of a biodegradable membrane of polyhydroxybutyrate-hydroxyvalerate copolymer reinforced with polyglactin 910 fibers, as an occlusive barrier over implants placed into fresh extraction sockets. Ten dogs had the 3rd and 4th mandibular premolars...... extracted bilaterally. Each dog had 4 Astra Dental Implants placed directly into the fresh extraction sockets. The top of the fixtures was placed at the same level as the top of the buccal cortical bone. The two implants in the right side were covered with the hydrolyzable polyester material...... (polyhydroxybutyrate-hydroxyvalerate reinforced with polyglactin 910 fibers; PHB-HV/PG), and the 2 implants in the left side were controls without occlusive membranes. Soft tissue dehiscences were registered for half of the implants in the test side but were not noted in the control side. The histomorphological...

  1. Comparative experimental re-evaluation of the two implanting methods of silicone gel testicular prostheses in beagle dogs

    Directory of Open Access Journals (Sweden)

    Chen Peng

    2011-04-01

    Full Text Available Abstract Background Testicular prosthesis has been applied clinically for decades, and implantation of testis prosthesis under the tunica albuginea has been considered to be the standard method in the most of the reports. However, postoperative scrotal appearance, the mobilization and the palpitation of the prosthesis are not always satisfactory to all the patients. Modifications in surgical techniques might be necessary to bring improvements to the clinical outcomes in testicular prosthesis implantation. Findings In a group of 9 beagle dogs in this study, an orchiectomy succeeded with a testicular prosthesis implantation under the tunica vaginalis, and a complete mechanical denudation of the testicular parenchyma succeeded with an implantation under the tunica albuginea were performed, respectively. Histopathological evaluations of the scrotal tissues and the implants, which were made at the end of the follow-up, showed that all the tested animals lived uneventful lives during the follow-up period, and no rejections or infections were found. Prostheses implanted under the tunica vaginalis showed a more satisfying mobilization and palpation than those implanted under the tunica albuginea. Chronic inflammation in the para-prosthesis tissues with vascular proliferation and fibrinogenesis were more common in the "under tunica albuginea" group than that in the "under tunica vaginalis" group, although differences in fibrinogenesis between the two groups were found to be statistically insignificant. Conclusions In this comparative study, we have re-evaluated the two most popular implantation methods of testicular prosthesis, the "under the tunica albuginea" and the "under the tunica vaginalis" pathways, in animal models. We found that the testicular prosthesis were all well tolerated, but the prosthesis implanted under the tunica vaginalis showed a more satisfying result concerning appearance, palpability, and histopathological findings than that of

  2. Comparative experimental re-evaluation of the two implanting methods of silicone gel testicular prostheses in beagle dogs.

    Science.gov (United States)

    Hao, Tong-Li; Chen, Peng

    2011-04-02

    Testicular prosthesis has been applied clinically for decades, and implantation of testis prosthesis under the tunica albuginea has been considered to be the standard method in the most of the reports. However, postoperative scrotal appearance, the mobilization and the palpitation of the prosthesis are not always satisfactory to all the patients. Modifications in surgical techniques might be necessary to bring improvements to the clinical outcomes in testicular prosthesis implantation. In a group of 9 beagle dogs in this study, an orchiectomy succeeded with a testicular prosthesis implantation under the tunica vaginalis, and a complete mechanical denudation of the testicular parenchyma succeeded with an implantation under the tunica albuginea were performed, respectively. Histopathological evaluations of the scrotal tissues and the implants, which were made at the end of the follow-up, showed that all the tested animals lived uneventful lives during the follow-up period, and no rejections or infections were found. Prostheses implanted under the tunica vaginalis showed a more satisfying mobilization and palpation than those implanted under the tunica albuginea. Chronic inflammation in the para-prosthesis tissues with vascular proliferation and fibrinogenesis were more common in the "under tunica albuginea" group than that in the "under tunica vaginalis" group, although differences in fibrinogenesis between the two groups were found to be statistically insignificant. In this comparative study, we have re-evaluated the two most popular implantation methods of testicular prosthesis, the "under the tunica albuginea" and the "under the tunica vaginalis" pathways, in animal models. We found that the testicular prosthesis were all well tolerated, but the prosthesis implanted under the tunica vaginalis showed a more satisfying result concerning appearance, palpability, and histopathological findings than that of the "under the tunica albuginea" group. The "under the tunica

  3. Deproteinized bovine bone mineral particles and osseointegration of implants without primary bone contact: an experimental study in dogs.

    Science.gov (United States)

    Sivolella, Stefano; Bressan, Eriberto; Salata, Luiz A; Quiñones, Maria E; Lang, Niklaus P; Botticelli, Daniele

    2014-03-01

    To evaluate the influence on osseointegration of Deproteinized bovine bone mineral (DBBM) particles used to fill defects of at least 1 mm around implants having no primary contact with bone. Premolars and first molars were extracted bilaterally from the mandible of six Labrador dogs. After 3 months of healing, mucoperiosteal full-thickness flaps were elevated, and one recipient site was prepared in the molar region of each hemi-mandible to place implants. These were installed with a deliberate circumferential and periapical space to the bone walls of 1.2 mm. All implants were stabilized with passive fixation plates to maintain the implants in situ and without any contact with the implant bed. The control sites were left to be filled with coagulum, while at the test sites, the residual gap was filled with DBBM. After 3 months of submerged healing, the animals were sacrificed. Ground sections were prepared and analyzed histomorphometrically. Mineralized bone-to-implant contact was 4.0% and 3.9% for control and test sites, respectively. The width of the residual defects was 0.48 mm and 0.88 mm at the control and test sites, respectively. The percentage of implant surface covered by a layer of dense connective tissue of 0.12 mm of width on average was 84.9% and 88.5% at the control and test sites, respectively. A minor and not predictable degree of contact or distance osteogenesis was obtained on the implant surface when primary contact of the implant surface with the implant bed had deliberately been avoided. DBBM grafting of the artificial gap did not favor osseointegration. Neither did it enhance the ability to bridge the gap with newly formed bone in an artificial defect wider than 1 mm. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  4. Comparative experimental re-evaluation of the two implanting methods of silicone gel testicular prostheses in beagle dogs

    Science.gov (United States)

    2011-01-01

    Background Testicular prosthesis has been applied clinically for decades, and implantation of testis prosthesis under the tunica albuginea has been considered to be the standard method in the most of the reports. However, postoperative scrotal appearance, the mobilization and the palpitation of the prosthesis are not always satisfactory to all the patients. Modifications in surgical techniques might be necessary to bring improvements to the clinical outcomes in testicular prosthesis implantation. Findings In a group of 9 beagle dogs in this study, an orchiectomy succeeded with a testicular prosthesis implantation under the tunica vaginalis, and a complete mechanical denudation of the testicular parenchyma succeeded with an implantation under the tunica albuginea were performed, respectively. Histopathological evaluations of the scrotal tissues and the implants, which were made at the end of the follow-up, showed that all the tested animals lived uneventful lives during the follow-up period, and no rejections or infections were found. Prostheses implanted under the tunica vaginalis showed a more satisfying mobilization and palpation than those implanted under the tunica albuginea. Chronic inflammation in the para-prosthesis tissues with vascular proliferation and fibrinogenesis were more common in the "under tunica albuginea" group than that in the "under tunica vaginalis" group, although differences in fibrinogenesis between the two groups were found to be statistically insignificant. Conclusions In this comparative study, we have re-evaluated the two most popular implantation methods of testicular prosthesis, the "under the tunica albuginea" and the "under the tunica vaginalis" pathways, in animal models. We found that the testicular prosthesis were all well tolerated, but the prosthesis implanted under the tunica vaginalis showed a more satisfying result concerning appearance, palpability, and histopathological findings than that of the "under the tunica

  5. Cochlear implant

    Science.gov (United States)

    Hearing loss - cochlear implant; Sensorineural - cochlear; Deaf - cochlear; Deafness - cochlear ... of the cochlear implant. WHO USES A COCHLEAR IMPLANT? Cochlear implants allow deaf people to receive and process ...

  6. Battlefield Acquired Immunogenicity to Metals Affects Orthopedic Implant Outcome

    Science.gov (United States)

    2013-10-01

    include minor bruising/hematoma (12.3%), diaphoresis with hypotension (2.6%), syncope (ə%), and cellulitis or phlebitis (ə%). Standard aseptic...Diaphoresis with hypotension (2.6%) • Syncope (ə%) • Cellulitis or Phlebitis (ə%) The following information will be collected for all AEs: • Date/time

  7. Nanotechnology:. A New Approach to Improve Orthopedic Implants

    Science.gov (United States)

    Zhou, Hongjian; Sun, Fangfang; Lee, Jaebeom

    2013-09-01

    Tissue engineering utilizes the expertise in the fields of materials science, biology, chemistry, transplantation medicine, and engineering to design materials that can temporarily serve in a structural and/or functional capacity during regeneration of a defect. Hydroxyapatite (HAp) scaffolds are among the most extensively studied materials for this application. However, HAps have been reported to be too weak to treat such defects and, therefore, have been limited to non-load-bearing applications. Recent advancements in nanoscience and nanotechnology have reignited investigation of HAp formation in the nanorange to clearly define small-scale properties of HAp. It has been suggested that nano- HAp may be an ideal biomaterial due to its good biocompatibility and bone integration ability. In this chapter, a new view on nano-HAp particles highlights the importance of size, crystal morphology controls, and composites with other inorganic particles in the application of biomedical material development. We have also reviewed nanosized HAp-based highly porous composite materials used for bone tissue engineering, introduced various fabrication methods used to prepare nHAp/polymer composite scaffolds, and characterized these scaffolds on the basis of their biodegradability and biocompatibility through in vitro or in vivo tests. Finally, we provide a summary and our own perspectives on this active area of research.

  8. Vascular complications in orthopedic surgery.

    Science.gov (United States)

    Chervu, A; Quinones-Baldrich, W J

    1988-10-01

    Vascular complications may be seen secondary to trauma or in the perioperative period following elective surgery. Prompt recognition and correction of these problems are of utmost importance to assure functional viability of the affected extremity. Evaluation may be complicated by the presence of preexisting atherosclerotic occlusive disease in the elderly patient. Relevant points in the history and physical examination include mechanism of injury, preexisting disease, evaluation of motor and sensory function, and presence and character of pulses. Noninvasive vascular studies should be obtained in all patients. Absolute indications for angiography include absent pulses, signs and symptoms of ischemia, a bruit, and a posterior knee dislocation; decreased pulses, a significant hematoma, and proximity of the fracture fragment are relative indications. Controversial issues in the management of combined orthopedic and vascular injuries include the use of internal versus external fixation, the use of prosthetic versus autogenous material, and the need for venous reconstruction. Popliteal artery trauma is still associated with a high limb loss rate, and careful evaluation of knee injuries is necessary. Vascular compromise may also complicate joint replacement surgery. These complications are preventable, and management is greatly simplified by a detailed preoperative evaluation.

  9. VATS-guided epicardial pacemaker implantation. Hand-sutured fixation of atrioventricular leads in an experimental setting.

    Science.gov (United States)

    Furrer, M; Fuhrer, J; Altermatt, H J; Ris, H; Mettler, D; Althaus, U; Carrel, T

    1997-12-01

    In neonates and infants epicardial stimulation may be preferred to endocardial stimulation because of growth-associated lead problems and the risk of vascular complications associated with transvenous electrodes. This study analyzes the feasibility of atrioventricular implantation of a new epicardial lead using the video-assisted thoracic surgical (VATS) technique in an animal model. Bipolar steroid-eluting epicardial leads were implanted in seven young white pigs. In five animals bipolar atrial and ventricular pacing leads (n = 10) were inserted and fixed by the VATS technique, while two animals served as controls and underwent implantation through anterolateral thoracotomy. Surgical feasibility, pacing, and sensing thresholds of the leads as well as hemodynamic parameters during pacing were studied. Histological changes beneath the electrodes were evaluated 1 week after the implantation. All animals survived the pacemaker lead implantation. One animal which underwent thoracotomy died because of irreversible ventricular fibrillation induced by rapid ventricular pacing. One animal in the VATS group exhibited intraoperative herniation of the heart through the pericardial window. All animals with left-sided VATS implantations demonstrated good individual pacing and sensing threshold values. The mean cardiac output was 1.6 times higher during AAI-mode pacing as compared to VVI-mode pacing at a heart rate of 140/min. One animal died postoperatively due to respiratory failure. No displacements of the pacemaker leads were observed in the survivors. While VATS-guided implantation of epicardial, atrial, and ventricular leads is feasible, technical improvements of the system are mandatory for safe clinical application.

  10. A chlorhexidine-releasing epoxy-based coating on titanium implants prevents Staphylococcus aureus experimental biomaterial-associated infection.

    Science.gov (United States)

    Riool, M; Dirks, A J; Jaspers, V; de Boer, L; Loontjens, T J; van der Loos, C M; Florquin, S; Apachitei, I; Rijk, L N; Keul, H A; Zaat, S A

    2017-02-14

    Prevention of biomaterial-associated infections (BAI) remains a challenging problem, in particular due to the increased risk of resistance development with the current antibiotic-based strategies. Metallic orthopaedic devices, such as non-cemented implants, are often inserted under high mechanical stress. These non-cemented implants cannot be protected by e.g. antibioticreleasing bone cement or other antimicrobial approaches, such as the use of bioactive glass. Therefore, in order to avoid abrasion during implantation procedures, we developed an antimicrobial coating with great mechanical stability for orthopaedic implants, to prevent Staphylococcus aureus BAI. We incorporated 5 and 10 wt % chlorhexidine in a novel mechanically stable epoxy-based coating, designated CHX5 and CHX10, respectively. The coatings displayed potent bactericidal activity in vitro against S. aureus, with over 80 % of the release (19 µg/cm2 for CHX5 and 41 µg/cm2 for CHX10) occurring within the first 24 h. In mice, the CHX10 coating significantly reduced the number of CFU (colony forming units), both on the implants and in the peri-implant tissues, 1 d after S. aureus challenge. The CHX10-coated implants were well-tolerated by the animals, with no signs of toxicity observed by histological analysis. Moreover, the coating significantly reduced the frequency of culture-positive tissues 1 d, and of culture-positive implants 1 and 4 d after challenge. In summary, the chlorhexidine-releasing mechanically stable epoxy-based CHX10 coating prevented implant colonisation and S. aureus BAI in mice and has good prospects for clinical development.

  11. Immediate implant placement using a biodegradable barrier, polyhydroxybutyrate-hydroxyvalerate reinforced with polyglactin 910. An experimental study in dogs

    DEFF Research Database (Denmark)

    Gotfredsen, K; Nimb, L; Hjørting-Hansen, E

    1994-01-01

    The purpose of this study was to evaluate the use of a biodegradable membrane of polyhydroxybutyrate-hydroxyvalerate copolymer reinforced with polyglactin 910 fibers, as an occlusive barrier over implants placed into fresh extraction sockets. Ten dogs had the 3rd and 4th mandibular premolars...... extracted bilaterally. Each dog had 4 Astra Dental Implants placed directly into the fresh extraction sockets. The top of the fixtures was placed at the same level as the top of the buccal cortical bone. The two implants in the right side were covered with the hydrolyzable polyester material...

  12. A paradigm for the development and evaluation of novel implant topologies for bone fixation: in vivo evaluation.

    Science.gov (United States)

    Long, Jason P; Hollister, Scott J; Goldstein, Steven A

    2012-10-11

    While contemporary prosthetic devices restore some function to individuals who have lost a limb, there are efforts to develop bio-integrated prostheses to improve functionality. A critical step in advancing this technology will be to securely attach the device to remnant bone. To investigate mechanisms for establishing robust implant fixation in bone while undergoing loading, we previously used a topology optimization scheme to develop optimized orthopedic implants and then fabricated selected designs from titanium (Ti)-alloy with selective laser sintering (SLS) technology. In the present study, we examined how implant architecture and mechanical stimulation influence osseointegration within an in vivo environment. To do this, we evaluated three implant designs (two optimized and one non-optimized) using a unique in vivo model that applied cyclic, tension/compression loads to the implants. Eighteen (six per implant design) adult male canines had implants surgically placed in their proximal, tibial metaphyses. Experimental duration was 12 weeks; daily loading (peak load of ±22 N for 1000 cycles) was applied to one of each animal's bilateral implants for the latter six weeks. Following harvest, osseointegration was assessed by non-destructive mechanical testing, micro-computed tomography (microCT) and back-scatter scanning electron microscopy (SEM). Data revealed that implant loading enhanced osseointegration by significantly increasing construct stiffness, peri-implant trabecular morphology, and percentages of interface connectivity and bone ingrowth. While this experiment did not demonstrate a clear advantage associated with the optimized implant designs, osseointegration was found to be significantly influenced by aspects of implant architecture. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Applications of finite element simulation in orthopedic and trauma surgery

    Science.gov (United States)

    Herrera, Antonio; Ibarz, Elena; Cegoñino, José; Lobo-Escolar, Antonio; Puértolas, Sergio; López, Enrique; Mateo, Jesús; Gracia, Luis

    2012-01-01

    Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints

  14. 915 MHz microwave ablation with implanted internal cooled-shaft antenna: Initial experimental study in in vivo porcine livers

    Energy Technology Data Exchange (ETDEWEB)

    Cheng Zhigang, E-mail: qlczg@yahoo.cn [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28, Fuxing Road, Haidian District, Beijing 100853 (China); Xiao Qiujin, E-mail: xiaoqj@hotmail.com [Department of Ultrasound, Chinese PLA Ninety-fourth Hospital, Nanchang, Jiangxi Province 330000 (China); Wang Yang, E-mail: wangyang301@sohu.com [Department of Ultrasound, Chinese PLA General Hospital, 28, Fuxing Road, Haidian District, Beijing 100853 (China); Sun Yuanyuan, E-mail: qlczg@sina.com [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28, Fuxing Road, Haidian District, Beijing 100853 (China); Lu Tong, E-mail: lutong_java@yahoo.com.cn [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28, Fuxing Road, Haidian District, Beijing 100853 (China); Liang Ping, E-mail: liangping301@yahoo.com.cn [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28, Fuxing Road, Haidian District, Beijing 100853 (China)

    2011-07-15

    Purpose: To explore a preferred power output for further clinical application based on the ablated lesions induced by the four power outputs of 915 MHz microwave in experimental study of in vivo porcine livers. Materials and methods: A KY2000-915 microwave ablation system with an implanted 915 MHz internal cooled-shaft antenna was used in this study. A total of 24 ablations were performed in eight in vivo porcine livers. The energy was applied for 10 min at microwave output powers of 50 W, 60 W, 70 W, and 80 W. Long-axis and short-axis diameters of the coagulation zone were measured on all gross specimens. Results: The shapes of the 915 MHz microwave ablation lesions were elliptical commonly. As the power increased, the long-axis and short-axis diameters of the coagulation zone had a tendency to rise. But the long-axis diameter of the ablated lesion at 50 W was not significantly smaller than that of the ablated lesion at 60 W (P > 0.05) and there were no statistical differences in short-axis diameters of the ablated lesion among the three power outputs of 60 W, 70 W and 80 W (P > 0.05). After 10 min irradiation of 60 W, the long-axis and short-axis diameters of the coagulation zone were 5.02 {+-} 0.60 cm and 3.65 {+-} 0.46 cm, respectively. Conclusions: For decreasing the undesired damages of liver tissues along the shaft and the number of antenna in further clinically percutaneous microwave ablation treatment, the power of 60 W may be a preferred setting among the four power outputs used in present study.

  15. Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs()

    DEFF Research Database (Denmark)

    Barckman, Jeppe; Baas, Jorgen; Sørensen, Mette

    2013-01-01

    Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants....

  16. Effect of intraarticular stainless steel implants on the health of the rabbit knee joint: an experimental study.

    Science.gov (United States)

    Stubbs, M; Zhang, H; Vrahas, M S; Baratta, R V; Zieske, A

    2000-11-01

    This study was designed to investigate the histologic changes to the knee joints of rabbits after insertion of a metal implant in retrograde fashion. Eighteen rabbits had a modified stainless steel screw implanted in one knee, with the other knee serving as a sham-operated control. The animals were killed after two, six, or twelve months. The histologic status of the cartilage and synovium were graded by the Modified Mankin and Mirra criteria, respectively. At the time of killing, every insertion site was covered by fibrous tissue. Statistical analysis showed no significant differences in histologic scores between implanted and control knees. Insertion of a stable, well-fixed implant results in no deleterious effect to the knee joint.

  17. A novel implantation model for evaluation of bone healing response to dental implants: the goat iliac crest.

    NARCIS (Netherlands)

    Schouten, C.; Meijer, G.J.; Beucken, J.J.J.P. van den; Spauwen, P.H.M.; Jansen, J.A.

    2010-01-01

    OBJECTIVES: Despite the availability of numerous animal models for testing the biological performance of dental and orthopedic implants, the selection of a suitable model is complex. This paper presents a new model for objective and standardized evaluation of bone responses to implants using the

  18. Integration of implant planning workflows into the PACS infrastructure

    Science.gov (United States)

    Gessat, Michael; Strauß, Gero; Burgert, Oliver

    2008-03-01

    The integration of imaging devices, diagnostic workstations, and image servers into Picture Archiving and Communication Systems (PACS) has had an enormous effect on the efficiency of radiology workflows. The standardization of the information exchange between the devices with the DICOM standard has been an essential precondition for that development. For surgical procedures, no such infrastructure exists. With the increasingly important role computerized planning and assistance systems play in the surgical domain, an infrastructure that unifies the communication between devices becomes necessary. In recent publications, the need for a modularized system design has been established. A reference architecture for a Therapy Imaging and Model Management System (TIMMS) has been proposed. It was accepted by the DICOM Working Group 6 as the reference architecture for DICOM developments for surgery. In this paper we propose the inclusion of implant planning systems into the PACS infrastructure. We propose a generic information model for the patient specific selection and positioning of implants from a repository according to patient image data. The information models are based on clinical workflows from ENT, cardiac, and orthopedic surgery as well as technical requirements derived from different use cases and systems. We show an exemplary implementation of the model for application in ENT surgery: the selection and positioning of an ossicular implant in the middle ear. An implant repository is stored in the PACS. It makes use of an experimental implementation of the Surface Mesh Module that is currently being developed as extension to the DICOM standard.

  19. An Experimental Study to Determine the Role of Inferior Vena Cava Filter in Preventing Bone Cement Implantation Syndrome

    OpenAIRE

    Guo, Wangang; Zheng, Qiangsun; Li, Bingling; Shi, Xiaoqin; Xiang, Dingcheng; Wang, Chen

    2015-01-01

    Background: Inferior vena cava filters (IVCF) are frequently used for preventing pulmonary embolism (PE) following deep venous thromboembolism. Objectives: The present study was designed to investigate whether IVCF could prevent or impede the occurrence of bone cement implantation syndrome (BCIS), since PE is considered as the central mechanism of BCIS. Materials and Methods: Fifteen sheep were divided into three groups: bone cement free (BCF) group, cement implantation (CI) group and IVCF gr...

  20. Deflections of an implant-supported cantilever beam subjected to vertically directed loads: in vitro measurements in three dimensions using an optoelectronic method. I. Experimental set-up.

    Science.gov (United States)

    Cassel, Björn; Lundgren, Dan; Karlsson, Dan

    2011-03-01

    The aim of this in vitro study was to develop and test an experimental set-up consisting of a video camera and computer-based optoelectronic motion analysis system, synchronized with a loading device, for studying load-dependent deflections in three dimensions of single implant-supported cantilever beams. One Brånemark System implant was tightly screwed into a steel plate so that the entire implant became submerged. An abutment was attached to the implant and a cast 22-mm-long cantilever gold alloy beam incorporating a prefabricated gold cylinder was attached to the abutment with a prosthetic gold screw. A force transducer was glued on the upper surface of the beam end with its centre 19.4 mm from the centre of the implant abutment gold cylinder unit to register the applied load. A specially designed loading device was used to apply increasing vertical loads of the beam end via the transducer. The motion analysis system was synchronized with the transducer to enable measurements of three-dimensional positional changes of the beam end related to known loads. Vertical loads from 15.7 to 40.4 N were applied resulting in vertical positional changes of the beam end ranging from 40.8 to 225.2 μm (z-axis). The corresponding horizontal changes perpendicular to the long axis of the beam (y-axis) due to counterclockwise horizontal rotation of the beam around the abutment- and prosthetic cylinder threads varied from 7.4 to 77.4 μm. This rotation changed the position of the beam end from 11.9 to 49.3 μm along the x-axis of the coordinate system toward the supporting implant. It was possible to arrange an experimental set-up for optoelectronic 3-D measurements within such a limited measurement volume that would permit satisfactory registrations of small load-dependent deflections of the prosthetic beam and implant components. © 2010 John Wiley & Sons A/S.

  1. Experimental and numerical optical characterization of plasmonic copper nanoparticles embedded in ZnO fabricated by ion implantation and annealing

    Energy Technology Data Exchange (ETDEWEB)

    Le, Khai Q. [Faculty of Science and Technology, Hoa Sen University, Ho Chi Minh City (Viet Nam); Department of Physics, Faculty of Science, Jazan University, P.O. Box 114, 45142 Jazan (Saudi Arabia); Nguyen, Hieu P.T. [Department of Electrical and Computer Engineering, New Jersey Institute of Technology, NJ 07102 (United States); Ngo, Quang Minh [Institute of Material Sciences, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Road, Cau Giay, Hanoi (Viet Nam); Canimoglu, Adil [Nigde University, Faculty of Arts and Sciences, Physics Department, Nigde (Turkey); Can, Nurdogan, E-mail: cannurdogan@yahoo.com [Celal Bayar University, Faculty of Arts and Sciences, Department of Physics, Muradiye, Manisa (Turkey); Department of Physics, Faculty of Science, Jazan University, P.O. Box 114, 45142 Jazan (Saudi Arabia)

    2016-06-05

    Here we describe the successfully fabrication of metal nanoparticle crystals by implanting copper (Cu) ions into single zinc oxide (ZnO) crystals with ion energy of 400 keV at ion doses of 1 × 10{sup 16} to 1 × 10{sup 17} ions/cm{sup 2}. After implantation and post-annealing treatment, the Cu implanted ZnO produces a broad range of luminescence emissions, ranging from green to yellow. A green luminescence peak at 550 nm could be ascribed to the isolated Cu ions. The changes in luminescence emission bands between the initial implant and annealed suggest that the implants give rise to clustering Cu nanoparticles in the host matrix but that the annealing process dissociates these. Numerical modelling of the Cu nanoparticles was employed to simulate their optical properties including the extinction cross section, electron energy loss spectroscopy and cathodoluminescence. We demonstrate that the clustering of nanoparticles generates Fano resonances corresponding to the generation of multiple resonances, while the isolation of nanoparticles results in intensity amplification. - Highlights: • We present the fabrication of metal nanoparticle crystals by implanting Cu into ZnO. • The luminescence properties were studied at different annealing temperature. • Numerical modelling of the Cu nanoparticles was employed. • We demonstrate that the clustering of nanoparticles generates Fano resonances.

  2. kgp, rgpA, and rgpB DNA vaccines induce antibody responses in experimental peri-implantitis.

    Science.gov (United States)

    Guo, Meihua; Wang, Zhifeng; Fan, Xin; Bian, Yuanyuan; Wang, Tiantian; Zhu, Lina; Lan, Jing

    2014-11-01

    Peri-implantitis is the key factor for implant failure. This study aims to evaluate kgp, rgpA, and rgpB DNA vaccines to induce an immune response and prevent peri-implantitis. The kgp, rgpA, and rgpB genes were amplified by polymerase chain reaction (PCR) from Porphyromonas gingivalis (Pg) ATCC 33277 and cloned into the pVAX1 vector. Titanium implants were placed into the mandibular bone of dogs. Three months later, the animals were divided into four groups, immunized with pVAX1-kgp, pVAX1-rgpA, pVAX1-rgpB, or pVAX1. Cotton ligatures infiltrated with Pg were tied around the neck of the implants. Immunoglobulin (Ig)G and IgA antibodies were detected by enzyme-linked immunosorbent assay before and after immunization. The kgp, rgpA, and rgpB genes were successfully cloned into the pVAX1 plasmid. Animals immunized with pVAX1-kgp and pVAX1-rgpA showed higher titers of IgG and IgA antibodies compared to those before immunization (P implantitis animal models, whereas pVAX1-rgpB was ineffective.

  3. Transcatheter implantation of self-expandable valved prosthesis in outlet right ventricle an experimental study in pigs.

    Science.gov (United States)

    Guilhen, José Cícero Stocco; Palma, José Honório; Gaia, Diego Felipe; Araujo, Andre Telis Vilela de; Teles, Carlos Alberto; Branco, João Nelson; Buffolo, Enio

    2011-01-01

    Patients with congenital heart disease who underwent pulmonary valvotomy or surgery to open the pulmonary valve ring are prone to develop residual pulmonary insufficiency or stenosis that may lead to right heart failure with clinical deterioration. These children require multiple interventions throughout their lives, which impose a high rate of morbidity and mortality. To develop a less invasive technique for implantation of a valved prosthesis through the right ventricle. The valved prosthesis consists of an auto expanding metal stent built with nitinol, surrounded with polyester, where the three leaflets of bovine pericardium were mounted. Twelve pigs were used to perform the implants. Echocardiographic control was performed immediately after implantation and one, four, eight and 12 weeks. One animal showed reflux of moderate to severe and three mild reflux. Transvalvular gradients measured before implantation ranged from 3 to 6 mmHg and that soon after the implant was increased, ranging from 7 to 45 mmHg. There was a decrease in these gradients during follow up and in only four of the twelve animals the gradients were above 20 mmHg. Thrombus formation occurred in the prosthesis of six animals, and this was the most frequent complication. These findings highlight the need for studies with the use of anticoagulants and antiplatelet, an attempt to reduce this event. The study aims to contribute for the start of the use of prosthetic heart valves that could be implanted through minimally invasive techniques without the use of cardiopulmonary bypass.

  4. Role of toll-like receptor 2 in inflammation and alveolar bone loss in experimental peri-implantitis versus periodontitis.

    Science.gov (United States)

    Yu, X; Hu, Y; Freire, M; Yu, P; Kawai, T; Han, X

    2017-09-05

    Peri-implantitis and periodontitis are different entities in immune characteristics even though they share similar features in clinical and radiologic signs. Toll-like receptor 2 (TLR-2), one of the key pathogen-recognition receptors in the innate immune system, plays an important role in the progression of periodontitis. However, the role of TLR-2 in peri-implantitis remains unclear. The objective of this study was to investigate the role of TLR-2 in inflammation and alveolar bone loss in a murine model of ligature-induced peri-implantitis and to compare it with ligature-induced periodontitis. Smooth-surface titanium implants were placed in the alveolar bone of the left maxillary molars of wild-type (WT) and Tlr2 knockout (Tlr2-KO) mice 6 weeks after tooth extraction. Silk ligatures were applied to the left implant fixtures and the right maxillary second molars to induce peri-implantitis and periodontitis 4 weeks after implant placement. Two weeks after ligation, bone loss around the implants and maxillary second molars was analysed by micro-computed tomography (micro-CT), and inflammation around the implants and maxillary second molars was assessed at the same time point using histology and TRAP staining, respectively. Expression of mRNA for proinflammatory cytokines (interleukin-1β [Il1β], tumor necrosis factor-α [Tnfα]), an anti-inflammatory cytokine (interleukin-10 [Il10]) and osteoclastogenesis-related cytokines (Rankl, osteoprotegerin [Opg]) were evaluated, in gingival tissue, using real-time quantitative PCR (RT-qPCR). The success rate of implant osseointegration was significantly higher in Tlr2-KO mice (85.71%) compared with WT mice (53.66%) (P = .0125). Micro-CT revealed significantly decreased bone loss in Tlr2-KO mice compared with WT mice (P = .0094) in peri-implantitis. The levels of mRNA for Il1β (P = .0055), Tnfα (P = .01) and Il10 (P = .0019) in gingiva were significantly elevated in the peri-implantitis tissues of WT mice, but

  5. A novel phased-concept course for the delivery of anatomy and orthopedics training in medical education.

    Science.gov (United States)

    Klima, Stefan; Hepp, Pierre; Löffler, Sabine; Cornwall, Jon; Hammer, Niels

    2017-07-01

    Integration of anatomy and clinical teaching is a theoretical ideal, yet there is a worldwide paucity of such amalgamation. These teaching models provide support for medical trainees, an important element in Germany where orthopedic intern numbers have declined and anecdotal evidence suggests disinterest in orthopedics. The aim of the study was to develop an integrated anatomy-surgical course for undergraduate medical training, assess the model developed, and explore how medical students perceive orthopedics as a career. The course was to deliver medical anatomy and clinical orthopedic training, focusing on interdisciplinary teaching and learning, vertical integration of clinical knowledge and skills, and professional interaction. Survey evaluation of the course and students' perceptions of orthopedic careers was performed, including Likert-type responses rating variables of interest. A phased-concept program of five courses, each optional and under one-week in duration, was developed parallel to the undergraduate medical program. Delivered by anatomists and surgeons, courses included biomechanics, advanced dissection, surgical approaches, casts and implants, and sports medicine. Course data indicate positive support for course format, stimulation of interest, and high clinical relevance. Students are generally interested in surgery, and identify hierarchy, lawsuits, bureaucracy and physical stress as barriers to orthopedic careers. This novel phased-concept successfully delivers combined anatomy and surgery training in a vertically-integrated format while addressing students' clinical and professional skills. The format facilitates an appreciation of potential career options in orthopedics, while fostering professional skills during medical training. Barriers to careers in orthopedics can now be addressed in future courses. Anat Sci Educ 10: 372-382. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

  6. A review on the wettability of dental implant surfaces II: Biological and clinical aspects.

    Science.gov (United States)

    Gittens, Rolando A; Scheideler, Lutz; Rupp, Frank; Hyzy, Sharon L; Geis-Gerstorfer, Jürgen; Schwartz, Zvi; Boyan, Barbara D

    2014-07-01

    Dental and orthopedic implants have been under continuous advancement to improve their interactions with bone and ensure a successful outcome for patients. Surface characteristics such as surface topography and surface chemistry can serve as design tools to enhance the biological response around the implant, with in vitro, in vivo and clinical studies confirming their effects. However, the comprehensive design of implants to promote early and long-term osseointegration requires a better understanding of the role of surface wettability and the mechanisms by which it affects the surrounding biological environment. This review provides a general overview of the available information about the contact angle values of experimental and of marketed implant surfaces, some of the techniques used to modify surface wettability of implants, and results from in vitro and clinical studies. We aim to expand the current understanding on the role of wettability of metallic implants at their interface with blood and the biological milieu, as well as with bacteria, and hard and soft tissues. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  7. Sub-crestal positioning of implants results in higher bony crest resorption: an experimental study in dogs.

    Science.gov (United States)

    Cesaretti, Gianfranco; Lang, Niklaus P; Salata, Luiz A; Schweikert, Michael T; Gutierrez Hernandez, Maria Elena; Botticelli, Daniele

    2015-12-01

    To compare peri-implant soft- and hard-tissue integration at implants installed juxta- or sub-crestally. Furthermore, differences in the hard and soft peri-implant tissue dimensions at sites prepared with drills or sonic instruments were to be evaluated. Three months after tooth extraction in six dogs, recipient sites were prepared in both sides of the mandible using conventional drills or a sonic device (Sonosurgery(®)). Two implants with a 1.7-mm high-polished neck were installed, one with the rough/smooth surface interface placed at the level of the buccal bony crest (control) and the second placed 1.3 mm deeper (test). After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. The buccal distances between the abutment/fixture junction (AF) and the most coronal level of osseointegration (B) were 1.6 ± 0.6 and 2.4 ± 0.4 mm; between AF and the top of the bony crest (C), they were 1.4 ± 0.4 and 2.2 ± 0.2 mm at the test and control sites, respectively. The top of the peri-implant mucosa (PM) was located more coronally at the test (1.2 ± 0.6 mm) compared to the control sites (0.6 ± 0.5 mm). However, when the original position of the bony crest was taken into account, a higher bone loss and a more apical position of the peri-implant mucosa resulted at the test sites. The placement of implants into a sub-crestal location resulted in a higher vertical buccal bone resorption and a more apical position of the peri-implant mucosa in relation to the level of the bony crest at implant installation. Moreover, peri-implant hard-tissue dimensions were similar at sites prepared with either drills or Sonosurgery(®). © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Soft tissue dimensions in flapless immediate implants with and without immediate loading: an experimental study in the beagle dog.

    Science.gov (United States)

    Blanco, Juan; Carral, Cristina; Liñares, Antonio; Pérez, Javier; Muñoz, Fernando

    2012-01-01

    The aim of the present study was to evaluate the peri-implant soft tissue dimensions in flapless immediate implants with and without immediate loading. This study was carried out on six beagle dogs. Four implants were placed (two per side) immediately after tooth extraction (third and fourth premolars). Flapless immediate implant placement was performed in one hemimandible (control). The same procedure was performed in the contralateral side and immediate prosthesis was connected (test). After 3 months of healing, the dogs were sacrificed. None of the implants and prosthesis were lost. Barrier epithelium in the loaded group was 2.51 mm at the buccal and 2.34 mm at the lingual aspect. In the no loaded group, the results were similar, 2.54 and 2.2 mm at the buccal and lingual side, respectively. Connective tissue in the loaded group was 1.38 mm at the buccal and 0.65 mm at the lingual aspect, and in the no loaded group 1.48 mm at the buccal and 0.53 mm at the lingual side. Biological width dimensions were 3.9 mm at the buccal and 2.95 mm at the lingual aspect for the loaded group, and 4.01 and 2.64 mm at the buccal and lingual aspect for the no loaded group. The results of the present study suggested that soft tissues dimensions around immediate implants with immediate loading were similar to immediate implants without loading. © 2011 John Wiley & Sons A/S.

  9. Morphological and chemical evaluation of bone with apatite-coated Al2O3 implants as scaffolds for bone repair

    Directory of Open Access Journals (Sweden)

    A. L. M. Maia F.

    2013-12-01

    Full Text Available The clinical challenge in the reconstruction of bone defects has stimulated several studies in search of alternatives to repair these defects. The ceramics are considered as synthetic scaffolds and are used in dentistry and orthopedics. This study aimed to evaluate by micro energy-dispersive X-ray fluorescence spectrometry (µ-EDXRF and scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS, the influence of uncoated and apatite-coated Al2O3 implants on bone regeneration. Twelve samples of Al2O3 implants were prepared and half of this samples (n = 6 were apatite-coated by the modified biomimetic method and then the ceramic material were implanted in the tibia of rabbits. Three experimental groups were tested: Group C - control, surgery procedure without ceramic implant, Group Ce - uncoated Al2O3 implants (n = 6 and Group CeHA - apatite-coated Al2O3 implants (n = 6. The deposition of bone tissue was determined by measuring the weight content of Ca and P through surface mapping of bone-implant interface by µ-EDXRF and through point analysis by EDS. It was observed after thirty days of treatment a greater deposition of Ca and P in the group treated with CeHA (p <0.001 compared to group C. The results suggest that ceramic coated with hydroxyapatite (CeHA can be an auxiliary to bone deposition in tibia defect model in rabbits.

  10. Bibliometric analysis of the orthopedic literature.

    Science.gov (United States)

    Hui, Zhaoyang; Yi, Zhongmei; Peng, Jun

    2013-10-01

    Bibliometric indicators are used to assess research performance. The goal of this study was to explore publication output to construct a picture of orthopedics that may be beneficial to researchers and orthopedic specialists. All orthopedics articles published in 61 journals from 2000 to 2011 were retrieved from the Science Citation Index Expanded database. The numbers of articles, citations, authors, institutions, and journals were analyzed and subjected to quantitative and qualitative comparisons. The number of published orthopedics articles increased between 2000 and 2011. Articles published by authors from the United States always ranked first in number, although the United States' share is decreasing in the world literature. Authors from the United States published the most-cited articles and the most articles in journals with top-10 impact factors; moreover, the United States also had the greatest share of experts and highly ranked institutions. The United Kingdom, Germany, and Japan were always within the world's top 4 in terms of numbers of articles and citations. The shares of Germany, South Korea, and China among total orthopedics articles increased, especially that of China. In 2011, China ranked the fifth in the world, with its world share increasing from 0.64% in 2000 to 5.05% in 2011. However, China lags behind in average citations per article, top research institutions, and most prolific authors. According to the total citations per article, the University of Pittsburgh, Harvard University, and the Hospital for Special Surgery were the most prolific institutions. Copyright 2013, SLACK Incorporated.

  11. Core Concepts: Orthopedic Intern Curriculum Boot Camp.

    Science.gov (United States)

    Seeley, Mark A; Kazarian, Erick; King, Brandon; Biermann, Janet S; Carpenter, James E; Caird, Michelle S; Irwin, Todd A

    2016-01-01

    Orthopedic surgical interns must gain a broad array of clinical skills in a short time. However, recent changes in health care have limited resident-patient exposures. With the reported success of simulation training in the surgical literature, the American Board of Orthopaedic Surgery (ABOS) and Residency Review Committee for Orthopaedic Surgery have required that surgical simulation training be a component of the intern curricula in orthopedic surgical residencies. This study examined the short-term effectiveness of an orthopedic "intern boot camp" covering 7 of 17 simulation training concept modules published by the ABOS. Eight orthopedic post-graduate year 1 (PGY-1) residents (study group) completed a structured 3-month curriculum and were compared with 7 post-graduate year 2 (PGY-2) residents (comparison group) who had just completed their orthopedic surgical internship. Seven core skills were assessed using both task-specific and global rating scales. The PGY-1 residents demonstrated a statistically significant improvement in all 7 modules with respect to their task-specific pre-test scores: sterile technique (P=.001), wound closure (Porthopedic internship elevated a variety of clinical skills to levels exhibited by PGY-2 residents. Copyright 2016, SLACK Incorporated.

  12. Artificial intelligence for analyzing orthopedic trauma radiographs.

    Science.gov (United States)

    Olczak, Jakub; Fahlberg, Niklas; Maki, Atsuto; Razavian, Ali Sharif; Jilert, Anthony; Stark, André; Sköldenberg, Olof; Gordon, Max

    2017-12-01

    Background and purpose - Recent advances in artificial intelligence (deep learning) have shown remarkable performance in classifying non-medical images, and the technology is believed to be the next technological revolution. So far it has never been applied in an orthopedic setting, and in this study we sought to determine the feasibility of using deep learning for skeletal radiographs. Methods - We extracted 256,000 wrist, hand, and ankle radiographs from Danderyd's Hospital and identified 4 classes: fracture, laterality, body part, and exam view. We then selected 5 openly available deep learning networks that were adapted for these images. The most accurate network was benchmarked against a gold standard for fractures. We furthermore compared the network's performance with 2 senior orthopedic surgeons who reviewed images at the same resolution as the network. Results - All networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network. The network performed similarly to senior orthopedic surgeons when presented with images at the same resolution as the network. The 2 reviewer Cohen's kappa under these conditions was 0.76. Interpretation - This study supports the use for orthopedic radiographs of artificial intelligence, which can perform at a human level. While current implementation lacks important features that surgeons require, e.g. risk of dislocation, classifications, measurements, and combining multiple exam views, these problems have technical solutions that are waiting to be implemented for orthopedics.

  13. [Research and analysis to Shui nationality medicine treatment orthopedics & traumatology].

    Science.gov (United States)

    Hu, Jian-Shan; Li, Pu; Yang, Yong; Chen, Xin-Chun; Lin, Li

    2013-05-01

    To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research.

  14. Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs.

    Science.gov (United States)

    Bengazi, Franco; Lang, Niklaus P; Caroprese, Marino; Urbizo Velez, Joaquin; Favero, Vittorio; Botticelli, Daniele

    2015-02-01

    To study the buccal dimensional tissue changes at oral implants following free gingival grafting, with or without including the keratin layer, performed at the time of implant installation into alveolar mucosa. The mandibular premolars and first molars were extracted bilaterally in six Beagle dogs. In the right side of the mandible (Test), flaps were first elevated, and the buccal as well as part of the lingual masticatory mucosa was removed. An incision of the periosteum at the buccal aspect was performed to allow the flap to be coronally repositioned. Primary wound closure was obtained. In the left side, the masticatory (keratinized) mucosa was left in situ, and no sutures were applied (Control). After 3 months of healing, absence of keratinized mucosa was confirmed at the test sites. Two recipient sites were prepared at each side of the mandible in the region of the third and fourth premolars. All implants were installed with the shoulder placed flush with the buccal alveolar bony crest, and abutments were connected to allow a non-submerged healing. Two free gingival mucosal grafts were harvested from the buccal region of the maxillary canines. One graft was left intact (gingival mucosal graft), while for the second, the epithelial layer was removed (gingival connective tissue graft). Subsequently, the grafts were fixed around the test implants in position of the third and fourth premolars, respectively. After 3 months, the animals were euthanized and ground sections obtained. Similar bony crest resorption and coronal extension of osseointegration were found at test and control sites. Moreover, similar dimensions of the peri-implant soft tissues were obtained at test and control sites. The increase in the alveolar mucosal thickness by means of a gingival graft affected the peri-implant marginal bone resorption and soft tissue recession around implants. This resulted in outcomes that were similar to those at implants surrounded by masticatory mucosa, indicating

  15. Healing at implant sites prepared conventionally or by means of Sonosurgery ®. An experimental study in dogs.

    Science.gov (United States)

    Viganò, Paolo; Botticelli, Daniele; Salata, Luiz A; Schweikert, Michael T; Urbizo Velez, Joaquin; Lang, Niklaus P

    2015-04-01

    To compare peri-implant tissue healing at implants installed in sites prepared with conventional drills or a sonic device. In six Beagle dogs, the mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness muco-periosteal flaps were elevated and recipient sites were prepared in both sides of the mandible. In the right side (control), the osteotomies were prepared using conventional drills, while, at the left side (test), a sonic device (Sonosurgery(®)) was used. Two implants were installed in each side of the mandible. After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. The time consumed for the osteotomies at the test was more than double compared to the conventional control sites. No statistically significant differences were found for any of the histological variables evaluated for hard and soft tissue dimensions. Although not statistically significant, slightly higher mineralized bone-to-implant contact was found at the test (65.4%) compared to the control (58.1) sites. Similar healing characteristics in osseointegration and marginal hard tissue remodeling resulted at implants installed into osteotomies prepared with conventional drills or with the sonic instrument (Sonosurgery(®)). © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Surface modification of implants in long bone

    Science.gov (United States)

    Förster, Yvonne; Rentsch, Claudia; Schneiders, Wolfgang; Bernhardt, Ricardo; Simon, Jan C.; Worch, Hartmut; Rammelt, Stefan

    2012-01-01

    Coatings of orthopedic implants are investigated to improve the osteoinductive and osteoconductive properties of the implant surfaces and thus to enhance periimplant bone formation. By applying coatings that mimic the extracellular matrix a favorable environment for osteoblasts, osteoclasts and their progenitor cells is provided to promote early and strong fixation of implants. It is known that the early bone ongrowth increases primary implant fixation and reduces the risk of implant failure. This review presents an overview of coating titanium and hydroxyapatite implants with components of the extracellular matrix like collagen type I, chondroitin sulfate and RGD peptide in different small and large animal models. The influence of these components on cells, the inflammation process, new bone formation and bone/implant contact is summarized. PMID:23507866

  17. Effect of membranes and porous hydroxyapatite on healing in bone defects around titanium dental implants. An experimental study in monkeys

    DEFF Research Database (Denmark)

    Gotfredsen, K; Warrer, K; Hjørting-Hansen

    1991-01-01

    The purpose of the present study was to examine the effect of treating bony craters around titanium dental implant with polytetrafluoroethylene membranes (PTFE), with and without grafting of hydroxyapatite (HA), and with HA alone. 4 standardized bone defects were prepared in the alveolar ridge...... of edentulous areas in each of 7 monkeys. A titanium implant was then placed centrally in each defect, and in each monkey, the defects were treated with 1 of the following 4 treatment modalities: (1) coverage with PTFE membrane; (2) grafting of HA and covering with a PTFE membrane; (3) HA grafting; (4......) no treatment. Following a healing period of 12 weeks, all animals were sacrificed and mesio-distal ground sections of the treated areas were prepared. The histological analysis showed that all bone defects around the implants treated with PTFE membranes and 5 of the defects treated with HA and PTFE membranes...

  18. An Overview of the History of Orthopedic Surgery.

    Science.gov (United States)

    Swarup, Ishaan; O'Donnell, Joseph F

    Orthopedic surgery has a long and rich history. While the modern term orthopedics was coined in the 1700s, orthopedic principles were beginning to be developed and used during primitive times. The Egyptians continued these practices, and described ways to recognize and manage common orthopedic conditions. The Greeks and Romans subsequently began to study medicine in a systematic manner, and greatly improved our understanding of orthopedic anatomy and surgical technique. After a period of little progress during the Middle Ages, rapid advancement was noted during the Renaissance, including the description of various injuries, improvements in surgical technique, and development of orthopedic hospitals. Collectively, these advances provided the foundation for modern orthopedics. Currently, orthopedic surgery is a rapidly developing field that has benefited from the works of numerous scholars and surgeons. It is important to recognize the successes and failures of the past, in order to advance research and practice as well as improve patient care and clinical outcomes.

  19. A CHLORHEXIDINE-RELEASING EPOXY-BASED COATING ON TITANIUM IMPLANTS PREVENTS STAPHYLOCOCCUS AUREUS EXPERIMENTAL BIOMATERIAL-ASSOCIATED INFECTION

    NARCIS (Netherlands)

    Riool, M.; Dirks, A. J.; Jaspers, V.; de Boer, L.; Loontjens, T. J.; van der Loos, C. M.; Florquin, S.; Apachitei, I.; Rijk, L. N.; Keul, H. A.; Zaat, S. A.

    2017-01-01

    Prevention of biomaterial-associated infections (BAI) remains a challenging problem, in particular due to the increased risk of resistance development with the current antibiotic-based strategies. Metallic orthopaedic devices, such as non-cemented implants, are often inserted under high mechanical

  20. An experimental intraarticular implantation of woven carbon fiber pad into osteochondral defect of the femoral condyle in rabbit.

    Science.gov (United States)

    Kang, H J; Han, C D; Kang, E S; Kim, N H; Yang, W I

    1991-06-01

    The defects of the articular cartilage structure are not replaced unless the subchondral plate has been breached. However, following the creation of a defect in the subchondral plate, the area is filled in with a fibrous tissue which gradually transforms to hyaline cartilage. The porous nontoxic materials of both biologic and synthetic origin have reportedly been used as matrices for repairing bone and cartilage. Following implantation, carbon fibre, chemically inert and well-tolerated by the body, induces a proliferation of ordered fibrous tissue. We implanted carbon fiber pads in osteochondral defects in rabbits. Those repairs were compared to control holes with no implants. The pads appeared to induce the gross appearance of a restored joint surface, mechanically strong to loading for periods from 2 to 6 weeks. Also, carbon fiber pads promoted the healing of the osteochondral defects in the rabbit femoral condyle, supplying well-organized cartilagenous tissue over repaired subchondral bone. The use of carbon fiber pads as implant material is suggested for the restoration of articular surface in osteoarthritis and osteochondritis dissecans.

  1. An Experimental Study to Determine the Role of Inferior Vena Cava Filter in Preventing Bone Cement Implantation Syndrome

    OpenAIRE

    Guo; Zheng,; Li; Shi; Xiang; Wang,

    2015-01-01

    Background Inferior vena cava filters (IVCF) are frequently used for preventing pulmonary embolism (PE) following deep venous thromboembolism. Objectives The present study was designed to investigate whether IVCF could prevent or impede the occurrence of bone cement implantation syndrome (BCIS), since PE is considered as the central mechanism of BCIS. Materials and Methods Fifteen ...

  2. Percutaneous implantation of an intraventricular device for the treatment of heart failure: experimental results and proof of concept.

    Science.gov (United States)

    Nikolic, Serjan D; Khairkhahan, Alex; Ryu, Miho; Champsaur, Gerard; Breznock, Eugene; Dae, Michael

    2009-11-01

    A percutaneous system to implant a ventricular partitioning device (VPD) has been developed to partition the left ventricular (LV) cavity for treating regional wall motion abnormalities associated with post-left anterior descending (LAD) infarction, dilated left ventricle, and systolic dysfunction. The hemodynamic effects of this novel approach were evaluated in an ovine model with an anteroapical infarction created by a coil placed in the LAD. LV anteroapical infarction (MI) was induced in 10 animals. The VPD device was implanted at 6 weeks after MI in 5 animals. The hemodynamic status of each animal was evaluated at 30 weeks post-MI in treated ("VPD+MI" group, n=5) and nontreated ("MI" group, n=5). The comparison of end-point hemodynamic variables shows a significantly smaller end-systolic LV volume in the animals receiving the implant (70.1+/-9.0 mL in "VPD+MI" group vs. 102.9+/-10.3 mL in "MI" group, P < .02), improved ejection fraction (46.9+/-5.2% in "VPD+MI" group vs. 34.7+/-6.8% in "MI" group, P < .04) and preserved cardiac output (5.2+/-0.7 L/min in "VPD+MI" group vs. 5.0+/-1.8 L/min in "MI" group, P=NS), suggesting more efficient mechanical performance of the LV with the implanted VPD. A significant reduction in LV volumes and corresponding improvement in LV function occurred after device implantation indicating a potential beneficial effect of this new device in treatment of post MI LV dilation.

  3. Finite Element Analysis of Stress and Strain Distribution in the Bone around the Implants used for Orthodontic Anchorage

    Directory of Open Access Journals (Sweden)

    P S Vijayalakshmi

    2012-01-01

    Full Text Available Biomechanical influences on bone structure play an important role in the longevity of bone around an implant. The quantity and direction of applied force influence the implant and cause deformation of the bone. FEA was used to analyze the changes in the bone on loading the implant with orthodontic force in oblique and vertical directions and orthopedic force. The Mini-implants used in the present study efficiently resisted the oblique loading. But their use, for the purpose of orthopedic loading is questionable. FE models showed the area with the highest stress and strain to be around the neck of the implant and the surrounding bone at the cervical margin.

  4. [Regeneration processes in bone defects after implantation of composite material of different density of polylactide origin filled with HAP (experimental-morphological study)].

    Science.gov (United States)

    Kulakov, A A; Grigor'ian, A S; Krotova, L I; Popov, V K; Volozhin, A I; Losev, V F

    2009-01-01

    In experimental-morphological study on 6 dogs the dynamics of regenerate formation in ulna and mandible defects after implantation in them composite material of different density (0.46-0.50 and 0.38-0.42 g/cm(3)) of polylactide (PL) origin filled with HAP was followed at the terms of 6 and 9 months. Histologic study and structural determinant distribution analysis in the content of regenerate showed that optimal results according to the bone defect substitution by bone regenerate criterion at 9th month of the experiment were received after composite material from PL and HAP with the density of 0.38-0.42 g/cm(3) implantation. Newly formed trabecular bone tissue was seen in the regenerate and as well as strong tendency for bone matrix maturation. It was confirmed by the appearance of lamellar structures in newly formed bone trabecules situated in peripheral zones of bone defect. In bone mandible defects the substitution process of the implants from PL with HAP by the bone tissue was much slower than in ulna defects.

  5. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Eligibility criteria: Orthopedic impairment. 1308... DISABILITIES Health Services Performance Standards § 1308.12 Eligibility criteria: Orthopedic impairment. (a) A child is classified as having an orthopedic impairment if the condition is severe enough to adversely...

  6. [Experimental study of transforming growth factor-β3 combined with dental pulp stem cells in promoting the implant's osseointegration].

    Science.gov (United States)

    Wang, T; Muhetaer, Huojia; Li, J

    2017-06-09

    Objective: To investigate the effect of transforming growth factor-β3 (TGF-β3) and dental pulp stem cells (DPSC) in promoting the implant's osteointegration. Methods: Thirty-three New Zealand white rabbits were randomly divided into phosphate buffer saline (PBS) group, DPSC group and TGF-β3 + DPSC group (12 rabbits/group). Two teeth from the rabbits's mandibular incisors or molars were pulled out randomly, then implant were placed in the tooth extraction site immediately. In PBS group, the implant area was filled with Bio-Oss powder 0.30 g mixed by PBS 20 μl only; while the implant area was filled with Bio-oss powder 0.30 g and 1×10(8)/L DPSC 20 μl in DPSC group; in the the TGF-β3+DPSC group the implant area was filled with Bio-Oss powder 0.30 g mixed with 1×10(8)/L DPSC 20 μl and 80 μg/L TGF-β3 20 μl. Eighteen New Zealand rabbits were executed in the 4 weeks and 8 weeks respectively. The treated alveolar bone tissue and implant were collected for plastic section. Alizarin red staining (ARS), immunohistochemical detection (IHC) of bone sialoprotein (BSP), osteocalcin (OC) and type Ⅰ collagen (COL-Ⅰ) were performed after 4 weeks and 8 weeks. Combined bone lamelta width (CBLW) and implant bone contact rate (IBCR), trabecular width (TW) and trabecular area percentage (TA) were observed by histomorphometric measurement. Results: ARS staining: 4 weeks after the operation, the TGF-β3+ DPSC group showed more red calcified nodules than the other two groups; 8 weeks after operation, the red calcified nodule was further increased. 4 weeks after the operation, the expression of BSP, OC and COL-Ⅰ was (0.35± 0.04), (0.36 ± 0.03) and (0.39 ± 0.01) respectively in TGF-β3+ DPSC group, (0.27 ± 0.02), (0.24 ± 0.01) and (0.28±0.03) respectively in DPSC group, and (0.13±0.03), (0.15±0.02) and (0.16±0.02) respectively in PBS group. Eight weeks after operation, the expression of BSP, OC and COL-Ⅰ was (0.51±0.02), (0.49±0.03) and (0.53±0.02) respectively

  7. Preparation Methods for Improving PEEK’s Bioactivity for Orthopedic and Dental Application: A Review

    Directory of Open Access Journals (Sweden)

    Davood Almasi

    2016-01-01

    Full Text Available There is an increased interest in the use of polyether ether ketone (PEEK for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods.

  8. Neonatal maxillary orthopedics: past to present

    NARCIS (Netherlands)

    Kuijpers-Jagtman, A.M.; Prahl, C.; Berkowitz, S.

    2013-01-01

    Neonatal maxillary orthopedics was introduced in the treatment protocol for cleft lip and palate in the 1950s of the last century. A wide range of appliances has been designed with pin-retained active appliances at one end of the spectrum and passive appliances at the other. Although neonatal

  9. Prosthesis infections after orthopedic joint replacement

    DEFF Research Database (Denmark)

    Song, Zhijun; Borgwardt, Lotte; Høiby, Niels

    2013-01-01

    Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore...

  10. Imaging of orthopedic trauma and surgery

    Energy Technology Data Exchange (ETDEWEB)

    Berquist, T.H.

    1986-01-01

    This book discusses imaging of orthopedia trauma and surgery. A review of the pertinent anatomy, mechanism of injury, and radiology and orthopedic classification is provided for each topic discussed. The book employs recent advances in technique and focuses on adult skeletal trauma, and joint replacement.

  11. Emotional intelligence in orthopedic surgery residents.

    Science.gov (United States)

    Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

    2014-04-01

    Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

  12. Electrochemical coating of dental implants with anodic porous titania for enhanced osteointegration

    Directory of Open Access Journals (Sweden)

    Amirreza Shayganpour

    2015-11-01

    Full Text Available Clinical long-term osteointegration of titanium-based biomedical devices is the main goal for both dental and orthopedical implants. Both the surface morphology and the possible functionalization of the implant surface are important points. In the last decade, following the success of nanostructured anodic porous alumina, anodic porous titania has also attracted the interest of academic researchers. This material, investigated mainly for its photocatalytic properties and for applications in solar cells, is usually obtained from the anodization of ultrapure titanium. We anodized dental implants made of commercial grade titanium under different experimental conditions and characterized the resulting surface morphology with scanning electron microscopy equipped with an energy dispersive spectrometer. The appearance of nanopores on these implants confirm that anodic porous titania can be obtained not only on ultrapure and flat titanium but also as a conformal coating on curved surfaces of real objects made of industrial titanium alloys. Raman spectroscopy showed that the titania phase obtained is anatase. Furthermore, it was demonstrated that by carrying out the anodization in the presence of electrolyte additives such as magnesium, these can be incorporated into the porous coating. The proposed method for the surface nanostructuring of biomedical implants should allow for integration of conventional microscale treatments such as sandblasting with additive nanoscale patterning. Additional advantages are provided by this material when considering the possible loading of bioactive drugs in the porous cavities.

  13. Light microscopic identification and semiquantification of polyethylene particles in methylmethacrylate and paraffin-embedded experimental bone implant specimens

    DEFF Research Database (Denmark)

    Rahbek, O; Kold, S; Overgaard, S

    2005-01-01

    The aim of this study was to evaluate the identification of polyethylene (PE) particles in relatively thick methylmethacrylate (MMA) sections widely used in bone implant research. The sensitivity and specificity were compared between decalcified paraffin-embedded oil red O (ORO) stained and MMA......-embedded sections using polarized light. Furthermore, we introduced a grading system to semiquantify the level of PE particles in peri-implant tissue. Paraffin-embedded and MMA-embedded sections were compared concerning intra-observer agreement of the grading system. Moreover, the semiquantitative assessment...... of particle level was compared between the two section types. We found a sensitivity and specificity of polarized light of 100% for both paraffin ORO-stained and MMA sections. The intra-observer agreement on both types was comparable and acceptable. The ratings of differently processed blocks (MMA...

  14. Characteristics of highly successful orthopedic surgeons: a survey of orthopedic chairs and editors

    Science.gov (United States)

    Klein, Guy; Hussain, Nasir; Sprague, Sheila; Mehlman, Charles T.; Dogbey, Godwin; Bhandari, Mohit

    2013-01-01

    Background Highly successful orthopedic surgeons are a small group of individuals who exert a large influence on the orthopedic field. However, the characteristics of these leaders have not been well-described or studied. Methods Orthopedic surgeons who are departmental chairs, journal editors, editorial board members of the Journal of Bone and Joint Surgery (British edition), or current or past presidents of major orthopedic associations were invited to complete a survey designed to provide insight into their motivations, academic backgrounds and accomplishments, emotional and physical health, and job satisfaction. Results In all, 152 surgeons completed the questionnaire. We identified several characteristics of highly successful surgeons. Many have contributed prolific numbers of publications and book chapters and obtained considerable funding for research. They were often motivated by a “desire for personal development (interesting challenge, new opportunities),” whereas “relocating to a new institution, financial gain, or lack of alternative candidates” played little to no role in their decisions to take positions of leadership. Most respondents were happy with their specialty choice despite long hours and high levels of stress. Despite challenges to their time, successful orthopedic surgeons made a strong effort to maintain their health; compared with other physicians, they exercise more, are more likely to have a primary care physician and feel better physically. Conclusion Departmental chairs, journal editors and presidents of orthopedic associations cope with considerable demands of clinical, administrative, educational and research duties while maintaining a high level of health, happiness and job satisfaction. PMID:23706848

  15. On guided bone reformation in the maxillary sinus to enable placement and integration of endosseous implants. Clinical and experimental studies.

    OpenAIRE

    Cricchio, Giovanni

    2011-01-01

    Dental caries and periodontal disease are the major causes for tooth loss. While dental caries commonly involve the posterior teeth in both jaws, the teeth most commonly lost due to periodontal problems are the first and second molars in the maxilla. As a consequence, the upper posterior jaw is frequently edentulous. Implant therapy today is a predictable treatment modality for prosthetic reconstruction of edentulous patient. Insufficient amounts of bone, due to atrophy following loss of teet...

  16. Comparative experimental re-evaluation of the two implanting methods of silicone gel testicular prostheses in beagle dogs

    OpenAIRE

    Chen Peng; Hao Tong-li

    2011-01-01

    Abstract Background Testicular prosthesis has been applied clinically for decades, and implantation of testis prosthesis under the tunica albuginea has been considered to be the standard method in the most of the reports. However, postoperative scrotal appearance, the mobilization and the palpitation of the prosthesis are not always satisfactory to all the patients. Modifications in surgical techniques might be necessary to bring improvements to the clinical outcomes in testicular prosthesis ...

  17. Influence of immediate loading on healing of implants installed with different insertion torques--an experimental study in dogs.

    Science.gov (United States)

    Rea, Massimiliano; Botticelli, Daniele; Ricci, Sara; Soldini, Claudio; González, Gladys González; Lang, Niklaus P

    2015-01-01

    To evaluate the influence of different insertion torques on healing of implants loaded immediately or left unloaded. In six Labrador dogs, all mandibular premolars and molars were extracted. After 4 months of healing, flaps were elevated, and two implant sites were prepared at each side of the mandible. The distal sites were prepared conventionally while the mesial sites were underprepared by 0.3 mm. As a consequence, different final insertion torques of about 30 Ncm at the distal and >70 Ncm at the mesial sites were recorded. Healing abutments were applied to the left and transmucosal abutments to the right side. Flaps were sutured, crown preparation of the upper right second and third premolars was performed, and impressions were taken. Within 24 h, crowns were cemented both to implants and teeth in the right side of the mouth. After 4 months, the animals were sacrificed and ground sections obtained for histological evaluation. A higher buccal bony crestal resorption and a more apical position of the coronal level of osseointegration were found at the loaded compared with the unloaded sites. MBIC% and percentages of peri-implant mineralized tissue (MB%) were higher at the loaded compared with the unloaded sites. Moreover, a higher MBIC% was found at the lower compared with the higher final insertion torque. Immediate loading does not seem to have a negative effect on osseointegration. High torque values for the immediate loading procedures were not necessary. Probably, low torque values, were sufficient to obtain primary stability and hence may provide better osseointegration than high torque value. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Bone Ceramic® at Implants Installed Immediately into Extraction Sockets in the Molar Region: An Experimental Study in Dogs.

    Science.gov (United States)

    Pereira, Flávia Priscila; Hochuli-Vieira, Eduardo; Maté Sánchez de Val, José E; De Santis, Enzo; Salata, Luiz Antonio; Botticelli, Daniele

    2016-04-01

    The aim of this paper was to study the healing of 1-1.4 mm wide buccal defects at implants placed immediately into extraction sockets (IPIES) filled with a mixture of synthetic hydroxyapatite (HA) 60% and beta-tricalciumphosphate (TCP) 40% or left with the clot alone and both covered with collagen membranes. Eight Labrador dogs were used and implants were placed immediately into the extraction sockets of the first molar bilaterally. A mixture of synthetic HA 60% and beta-TCP 40% at the test or the clot alone at the control sites were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membrane and a non-submerged healing was allowed. After 4 months, the animals were euthanized, biopsies harvested and processed for histomorphometric analysis. At the time of installation, residual buccal defects occurred that were 1.1 mm and 1.4 mm wide and 3 mm and 4 mm deep at the control and test sites, respectively. After 4 months of healing, the top of the bony crest and the coronal level of osseointegration were located respectively at 0.1 ± 1.8 mm and 1.5 ± 1.8 mm at the test, and 0.6 ± 1.6 mm and 1.2 ± 0.7 mm at the control sites apically to the implant shoulder. Bone-to-implant contact at the buccal aspect was 34.9 ± 25.9% and 36.4 ± 17.3% at the test and control sites, respectively. No statistically significant differences were found between test and control sites for any of the variables analyzed at the buccal aspects. The use of a mixture of synthetic HA 60% and beta-TCP 40% to fill residual buccal defects 1-1.4 mm wide at IPIES did not improve significantly the results of healing. © 2015 Wiley Periodicals, Inc.

  19. Modulation of Abnormal Metabolic Brain Networks by Experimental Therapies in a Nonhuman Primate Model of Parkinson Disease: An Application to Human Retinal Pigment Epithelial Cell Implantation.

    Science.gov (United States)

    Peng, Shichun; Ma, Yilong; Flores, Joseph; Cornfeldt, Michael; Mitrovic, Branka; Eidelberg, David; Doudet, Doris J

    2016-10-01

    Abnormal covariance pattern of regional metabolism associated with Parkinson disease (PD) is modulated by dopaminergic pharmacotherapy. Using high-resolution (18)F-FDG PET and network analysis, we previously derived and validated a parkinsonism-related metabolic pattern (PRP) in nonhuman primate models of PD. It is currently not known whether this network is modulated by experimental therapeutics. In this study, we examined changes in network activity by striatal implantation of human levodopa-producing retinal pigment epithelial (hRPE) cells in parkinsonian macaques and evaluated the reproducibility of network activity in a small test-retest study. (18)F-FDG PET scans were acquired in 8 healthy macaques and 8 macaques with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced bilateral nigrostriatal dopaminergic lesions after unilateral putaminal implantation of hRPE cells or sham surgery. PRP activity was measured prospectively in all animals and in a subset of test-retest animals using a network quantification approach. Network activity and regional metabolic values were compared on a hemispheric basis between animal groups and treatment conditions. All individual macaques showed clinical improvement after hRPE cell implantation compared with the sham surgery. PRP activity was elevated in the untreated MPTP hemispheres relative to those of the normal controls (P therapy and other symptomatic interventions. With further validation in large samples, (18)F-FDG PET imaging with network analysis may provide a viable biomarker for assessing treatment response in animal models of PD after experimental therapies. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  20. An in vitro assessment of surface modification strategies for orthopedic applications

    Energy Technology Data Exchange (ETDEWEB)

    Poh, Chye Khoon; Cai, Yanli [Department of Orthopaedic Surgery, National University of Singapore, Kent Ridge, Singapore 119074 (Singapore); Tan, Xiao Wei [Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751 (Singapore); Tan, Hark Chuan [Department of Orthopaedic Surgery, National University of Singapore, Kent Ridge, Singapore 119074 (Singapore); Wang, Wilson, E-mail: doswangw@nus.edu.sg [Department of Orthopaedic Surgery, National University of Singapore, Kent Ridge, Singapore 119074 (Singapore)

    2013-10-01

    Despite current advances in orthopedic implant technology, there are still problems associated with their usage including loosening and tissue rejection. The utilization of biosignal proteins such as growth factors for development of bioactive implant materials holds great potential. Therefore in this study various techniques of surface modification (physical adsorption, cross-linking and covalent binding) of vascular endothelial growth factor on titanium alloy were investigated. The binding efficiency of the surface conjugation was determined using an enzyme-linked immunosorbent assay kit. X-ray photoelectron spectroscopy was used to determine the chemical composition of the surfaces. Cellular functions were investigated with human dermal microvascular endothelial cells and human mesenchymal stem cells. The results indicated covalent binding to be the most viable methodology, conferring enhancement of cell–implant interactions without demonstrable cell toxicity, which is beneficial for orthopedic applications. - Highlights: • Surface functionalization strategies were assessed on titanium alloy. • Mitogenic effect was evaluated over an extended period. • Covalent immobilization appears to have the best results.

  1. The Impact of Force Transmission on Narrow-Body Dental Implants Made of Commercially Pure Titanium and Titanium Zirconia Alloy with a Conical Implant-Abutment Connection: An Experimental Pilot Study.

    Science.gov (United States)

    Nelson, Katja; Schmelzeisen, Rainer; Taylor, Thomas D; Zabler, Simon; Wiest, Wolfram; Fretwurst, Tobias

    2016-01-01

    The purpose of this study was to visualize the mode and impact of force transmission in narrowdiameter implants with different implant-abutment designs and material properties and to quantify the displacement of the abutment. Narrow-diameter implants from two manufacturers were examined: Astra 3.0-mm-diameter implants (Astra OsseoSpeed TX; n = 2) and Straumann Bone Level implants with a 3.3-mm diameter made of commercially pure titanium (cpTi) Gr. 4 (n = 2) and 3.3-mm TiZr-alloy (n = 2; Bone Level, Straumann) under incremental force application using synchrotron radiography (absorption and inline x-ray phase-contrast) and tomography. During loading (250 N), Astra 3.0 and Bone Level 3.3- mm implants showed a deformation of the outer implant shoulder of 61.75 to 95 μm independent of the implant body material; the inner implant diameter showed a deformation of 71.25 to 109.25 μm. A deformation of the implant shoulder persisted after the removal of the load (range, 42.75 to 104.5 μm). An angulated intrusion of the abutment (maximum, 140 μm) into the implant body during load application was demonstrated; this spatial displacement persisted after removal of the load. This study demonstrated a deformation of the implant shoulder and displacement of the abutment during load application in narrow-diameter implants.

  2. Comparison and evaluation of experimental mediastinitis models: precolonized foreign body implants and bacterial suspension inoculation seems promising

    Directory of Open Access Journals (Sweden)

    Kose Necmi

    2006-04-01

    Full Text Available Abstract Background Post-sternotomy mediastinitis (PSM is a devastating surgical complication affecting 1–3% of patients that undergo cardiac surgery. Staphylococcus aureus is one of the most commonly encountered bacterial pathogen cultured from mediastinal samples obtained from patients with PSM. A component of the membrane of the gram positive bacteria, lipoteichoic acid, stimulates the blood monocytes and macrophages to secrete cytokines, radicals and nitrogen species leading to oxido-inflammatory damage. This seems to be responsible for the high mortality rate in PSM. For the evaluation of the pathogenesis of infection or for the investigation of alternative treatment models in infection, no standard model of mediastinitis seems to be available. In this study, we evaluated four mediastinitis models in rats. Methods The rats were divided into four groups to form different infection models. Group A: A suspension of 1 × 107 colony-forming units Staphylococcus aureus in 0,5 mL was inoculated from the right second intercostal space into the mediastinum. Group B: A hole was created in the right second intercostal space and a piece of stainless-steel implant with a length of 0.5 cm was inserted into the mediastinum and a suspension of 1 × 107 cfu bacteria in 0,5 mL was administered via the tail vein. Group C: Precolonized stainless-steel implant was inserted into the mediastinum. Group D: Precolonized stainless-steel implant was inserted into the mediastinum and the bacteria suspension was also injected into the mediastinum. On the 10th day, rats were sacrificed and the extension of infection in the mediastenae was evaluated by quantitative cultures. Myeloperoxidase activity (MPO and malondialdehyde (MDA levels were determined in the sera to evaluate the neutrophil activation and assess the inflammatory oxidation. Results The degree of infection in group C and D were 83.3% and 100% respectively (P P Conclusion Infected implants and high

  3. Sequential Healing at Calcium- versus Calcium Phosphate-Modified Titanium Implant Surfaces: An Experimental Study in Dogs.

    Science.gov (United States)

    Favero, Riccardo; Botticelli, Daniele; Antunes, Antonio A; Martinez Sanchez, Roxanna; Caroprese, Marino; Salata, Luiz A

    2016-04-01

    The aim of this paper was to study the sequential healing of bone tissues at implants with different configuration and different modified surfaces. Twelve Beagle dogs were used. Extractions of all teeth from the second premolar to the first molar were performed in both sides of the mandible. After 3 months, full-thickness flaps were elevated and two implants of different systems and with different surfaces were randomly installed in the premolar region in one side of the mandible. One surface was acid etched and further modified with calcium ions (BTI unicCa®), the other was sandblasted and acid etched plus a nanometer calcium phosphate deposition (3i T3®). The flaps were sutured to allow a fully submerged healing. The surgery on the other side of the mandible and the sacrifices were planned in such a way to obtain biopsies representing the healing after 1, 2, 4, and 8 weeks (n = 6 per period). After 1 and 2 weeks of healing, the mean values of new bone apposition on the implant surfaces were 5.9 ± 3.3% and 29.8 ± 16.0% at BTI unicCa and 4.6 ± 3.3% and 12.4 ± 5.6% at 3i T3, respectively. After 4 and 8 weeks, the percentage increased, being 49.4 ± 8.1% and 63.6 ± 7.3% at BTI unicCa and 40.3 ± 10.0% and 47.3 ± 20.2 at 3i T3, respectively. Differences statistically significant between the two surfaces were found only at the 2- and 4-week observation periods. Concomitantly, the old bone was resorbed at both surfaces from about 15-17% after 1 week to about 4-6% after 8 weeks of healing. Moderately rough surfaces modified with calcium ions or discrete calcium phosphate nanocrystalline deposition showed similar patterns of sequential healing. Higher new bone percentages were found at BTI unicCa compared with the 3i T3 implants, the difference being statistically significant at 2 and 4 weeks observation. © 2015 Wiley Periodicals, Inc.

  4. Orthopedic assessment of young children: developmental variations.

    Science.gov (United States)

    Killam, P E

    1989-07-01

    Parents often seek orthopedic evaluation of their young children because of apparent abnormalities. However, many of these are simply developmental variations that are part of normal growth and development. Pes planus, or flat foot, is one of the earliest and most common concerns. Torsional variations are also often seen; the presenting complaint may be intoeing (metatarsus adductus, tibial torsion and increased femoral anteversion) or out-toeing (pes calcaneovalgus and external rotation contractures of the hips). Angular variations (genu varum and genu valgum) are also seen frequently in young children. In assessing each finding, consideration must be given to the age at which the finding may be considered within normal limits, methods of examination and documentation, the expected course, findings that may signify abnormality, and appropriate follow-up and referral. An understanding of these common developmental variations in the orthopedic assessment of young children will enable the health care provider to respond to parents' concerns with accurate information and counseling.

  5. Occupational injuries among pediatric orthopedic surgeons

    Science.gov (United States)

    Alsiddiky, Abdulmonem M.; Alatassi, Raheef; Altamimi, Saad M.; Alqarni, Mahdi M.; Alfayez, Saud M.

    2017-01-01

    Abstract In this cross-sectional study, we surveyed all pediatric orthopedic surgeons in Saudi Arabia using an anonymous electronic questionnaire composed of 23 items to identify the rate of occupational injuries and obtain other relevant information. Thirty-nine participants completed the questionnaire (response rate: 83%). Participants who sustained occupational injuries throughout their careers represented 82.5%. The most injured areas were the hands, eyes, and back by 54.5%, 24.2%, and 15.2%, respectively. Approximately 11.1% were injured while operating on infected patients. Approximately 30.3% reported their injuries to their institution. We concluded that the rate of occupational injuries among pediatric orthopedic surgeons is very high and underreported. PMID:28640103

  6. Hydroxyapatite-lignin composite as a metallic implant-bone tissue osseointegration improver: experimental study in dogs

    Directory of Open Access Journals (Sweden)

    Fabrício Luciani Valente

    2015-01-01

    Full Text Available The study aimed to evaluate biocompatibility, osteoconduction and osseointegration of a pasty composite of hydroxyapatite (20% and lignin (80% as a promoter of metal implant and bone tissue integration. An intramedullary Schanz pin was implanted in both tibias of fifteen bitches. In the left tibia, the pin was coated with the biomaterial at the time of surgery. Marrow cavity was also filled with the biomaterial. Right limb did not receive the biomaterial, then constituting the control group. Tibias were harvested from five animals at 8, 60 and 150 days after surgery; three of them were analyzed by histological and biomechanical assessment and the two remaining tibias by X-ray diffraction. Results showed that the biomaterial is biocompatible, with osteoconductivity and osseointegration properties. Histological analysis and diffractograms showed the presence of hydroxyapatite in samples in all periods, although the presence of organic material of low crystallinity was variable. There was no statistical difference in the forces required for removal of the biocompatibility, osteoconductivity and osseointegration, it was not able to promote a better intramedullary pin anchorage.

  7. Tantalum—A bioactive metal for implants

    Science.gov (United States)

    Balla, Vamsi Krishna; Bose, Susmita; Davies, Neal M.; Bandyopadhyay, Amit

    2010-07-01

    Metallic biomaterials currently in use for load-bearing orthopedic applications are mostly bioinert and therefore lack sufficient osseointegration. Although bioactive ceramics such as hydroxyapatite (HA) can spontaneously bond to living bone tissue, low fracture toughness of HA limits their use as a bone substitute for load-bearing applications. Surface modification techniques such as HA coating on metals are current options to improve osseointegration in load-bearing metal implants. Over the last few decades researchers have attempted to find a bioactive metal with high mechanical strength and excellent fatigue resistance that can bond chemically with surrounding bone for orthopedic applications. Recent in vitro, in vivo, and clinical studies demonstrated that tantalum is a promising metal that is bioactive. However, tantalum applications in biomedical devices have been limited by processing challenges rather than biological performances. In this article, we provide an overview of processing aspects and biological properties of tantalum for load-bearing orthopedic applications.

  8. Role of tissue engineered collagen based tridimensional implant on the healing response of the experimentally induced large Achilles tendon defect model in rabbits: a long term study with high clinical relevance

    Science.gov (United States)

    2013-01-01

    Background Tendon injury is one of the orthopedic conditions poses with a significant clinical challenge to both the surgeons and patients. The major limitations to manage these injuries are poor healing response and development of peritendinous adhesions in the injured area. This study investigated the effectiveness of a novel collagen implant on tendon healing in rabbits. Results Seventy five mature White New-Zealand rabbits were divided into treated (n = 55) and control (n = 20) groups. The left Achilles tendon was completely transected and 2 cm excised. The defects of the treated animals were filled with collagen implants and repaired with sutures, but in control rabbits the defects were sutured similarly but the gap was left untreated. Changes in the injured and normal contralateral tendons were assessed weekly by measuring the diameter, temperature and bioelectrical characteristics of the injured area. Clinical examination was done and scored. Among the treated animals, small pilot groups were euthanized at 5, 10, 15, 20, 30, 40 and 60 (n = 5 at each time interval) and the remainder (n = 20) and the control animals at 120 days post injury (DPI). The lesions of all animals were examined at macroscopic and microscopic levels and the dry matter content, water delivery and water uptake characteristics of the lesions and normal contralateral tendons of both groups were analyzed at 120 DPI. No sign of rejection was seen in the treated lesions. The collagen implant was invaded by the inflammatory cells at the inflammatory phase, followed by fibroplasia phase in which remnant of the collagen implant were still present while no inflammatory reaction could be seen in the lesions. However, the collagen implant was completely absorbed in the remodeling phase and the newly regenerated tendinous tissue filled the gap. Compared to the controls, the treated lesions showed improved tissue alignment and less peritendinous adhesion, muscle atrophy and fibrosis

  9. An advanced simulator for orthopedic surgical training.

    Science.gov (United States)

    Cecil, J; Gupta, Avinash; Pirela-Cruz, Miguel

    2017-12-08

    The purpose of creating the virtual reality (VR) simulator is to facilitate and supplement the training opportunities provided to orthopedic residents. The use of VR simulators has increased rapidly in the field of medical surgery for training purposes. This paper discusses the creation of the virtual surgical environment (VSE) for training residents in an orthopedic surgical process called less invasive stabilization system (LISS) surgery which is used to address fractures of the femur. The overall methodology included first obtaining an understanding of the LISS plating process through interactions with expert orthopedic surgeons and developing the information centric models. The information centric models provided a structured basis to design and build the simulator. Subsequently, the haptic-based simulator was built. Finally, the learning assessments were conducted in a medical school. The results from the learning assessments confirm the effectiveness of the VSE for teaching medical residents and students. The scope of the assessment was to ensure (1) the correctness and (2) the usefulness of the VSE. Out of 37 residents/students who participated in the test, 32 showed improvements in their understanding of the LISS plating surgical process. A majority of participants were satisfied with the use of teaching Avatars and haptic technology. A paired t test was conducted to test the statistical significance of the assessment data which showed that the data were statistically significant. This paper demonstrates the usefulness of adopting information centric modeling approach in the design and development of the simulator. The assessment results underscore the potential of using VR-based simulators in medical education especially in orthopedic surgery.

  10. Methods of orthopedic treatment of dentition defects

    Directory of Open Access Journals (Sweden)

    Konnov V.V.

    2016-09-01

    Full Text Available The article is devoted to the methods of orthopedic treatment of dentition defects. To restore the functionality and individual aesthetic standards of dental system, with different types of partial loss of teeth, depending on the anatomical and topographical conditions, various kinds of dental prosthesis designs are used in the oral cavity: non-removable (bridges, cantilever, adhesive dentures and removable (laminar and clasp dental prostheses, as well as their combinations.

  11. Redefining the Economics of Geriatric Orthopedics

    Science.gov (United States)

    Nacca, Christopher; Paller, David; Daniels, Alan H

    2014-01-01

    Introduction: The heath care system in the United States is in the midst of a transition, in large part to help accommodate an older and more medically complex population. Central to the current evolution is the reassessment of value based on the cost utility of a particular procedure compared to alternatives. The existing contribution of geriatric orthopedics to the societal burden of disease is substantial, and literature focusing on the economic value of treating elderly populations with musculoskeletal injuries is growing. Materials and Methods: A literature review of peer-reviewed publications and abstracts related to the cost-effectiveness of treating geriatric patients with orthopedic injuries was carried out. Results: In our review, we demonstrate that while cost-utility studies generally demonstrate net society savings for most orthopedic procedures, geriatric populations often contribute to negative net society savings due to decreased working years and lower salaries while in the workforce. However, the incremental cost-effective ratio for operative intervention has been shown to be below the financial willingness to treat threshold for common procedures including joint replacement surgery of the knee (ICER US$8551), hip (ICER US$17 115), and shoulder (CE US$957) as well as for spinal procedures and repair of torn rotator cuffs (ICER US$12 024). We also discuss the current trends directed toward improving institutional value and highlight important complementary next steps to help overcome the growing demands of an older, more active society. Conclusion: The geriatric population places a significant burden on the health care system. However, studies have shown that treating this demographic for orthopedic-related injuries is cost effective and profitable for providers under certain scenarios. PMID:26246943

  12. Undergraduate orthopedic education: Is it adequate?

    Directory of Open Access Journals (Sweden)

    Menon Jagdish

    2009-01-01

    Full Text Available Background : Basic musculoskeletal knowledge is essential to the practice of medicine. The purpose of this study was to assess the adequacy of musculoskeletal knowledge of medical students. Materials and Methods : The validated basic competency examination in musculoskeletal medicine devised by Freidman and Bernstein was administered to final year medical students just prior to their final professional examination. Participants were also required to assess their confidence at making a musculoskeletal physical examination and diagnosis as well as comment on the adequacy of time in the curriculum devoted to Orthopedics. Results : The response rate was 83% (40/48. The average cognitive examination score was 48.3%. Two participants (5% obtained a score of ≥ 73.1%, the recommended mean passing score. Seventeen students (42.5% felt orthopedic clinical cases were the most difficult to perform a physical examination and diagnose. Thirteen students (32.5% felt that the time devoted to orthopedics in the medical curriculum was inadequate. Conclusions : Ninety-five percent of the students failed to show basic musculoskeletal competency. A change in medical curriculum and teaching methods is required to address this problem.

  13. [Orthopedics and patients under national socialism dictatorship].

    Science.gov (United States)

    Thomann, K D; Rauschmann, M

    2001-10-01

    The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

  14. Proximal spinal muscular atrophy: current orthopedic perspective

    Directory of Open Access Journals (Sweden)

    Haaker G

    2013-11-01

    Full Text Available Gerrit Haaker, Albert Fujak Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Abstract: Spinal muscular atrophy (SMA is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. Keywords: spinal muscular atrophy, scoliosis, contractures, fractures, lung function, treatment, rehabilitation, surgery, ventilation, nutrition, perioperative management

  15. Orthopedic gene therapy--lost in translation?

    Science.gov (United States)

    Evans, C H; Ghivizzani, S C; Robbins, P D

    2012-02-01

    Orthopedic gene therapy has been the topic of considerable research for two decades. The preclinical data are impressive and many orthopedic conditions are well suited to genetic therapies. But there have been few clinical trials and no FDA-approved product exists. This paper examines why this is so. The reasons are multifactorial. Clinical translation is expensive and difficult to fund by traditional academic routes. Because gene therapy is viewed as unsafe and risky, it does not attract major funding from the pharmaceutical industry. Start-up companies are burdened by the complex intellectual property environment and difficulties in dealing with the technology transfer offices of major universities. Successful translation requires close interactions between scientists, clinicians and experts in regulatory and compliance issues. It is difficult to create such a favorable translational environment. Other promising fields of biological therapy have contemplated similar frustrations approximately 20 years after their founding, so there seem to be more general constraints on translation that are difficult to define. Gene therapy has noted some major clinical successes in recent years, and a sense of optimism is returning to the field. We hope that orthopedic applications will benefit collaterally from this upswing and move expeditiously into advanced clinical trials. Copyright © 2011 Wiley Periodicals, Inc.

  16. Sol-Gel Derived Hydroxyapatite Coating on Mg-3Zn Alloy for Orthopedic Application

    Science.gov (United States)

    Singh, Sanjay; Manoj Kumar, R.; Kuntal, Kishor Kumar; Gupta, Pallavi; Das, Snehashish; Jayaganthan, R.; Roy, Partha; Lahiri, Debrupa

    2015-04-01

    In recent years, magnesium and its alloys have gained a lot of interest as orthopedic implant constituents because their biodegradability and mechanical properties are closer to that of human bone. However, one major concern with Mg in orthopedics is its high corrosion rate that results in the reduction of mechanical integrity before healing the bone tissue. The current study evaluates the sol-gel-derived hydroxyapatite (HA) coating on a selected Mg alloy (Mg-3Zn) for decreasing the corrosion rate and increasing the bioactivity of the Mg surface. The mechanical integrity of the coating is established as a function of the surface roughness of the substrate and the sintering temperature of the coating. Coating on a substrate roughness of 15-20 nm and sintering at 400°C shows the mechanical properties in similar range of bone, thus making it suitable to avoid the stress-shielding effect. The hydroxyapatite coating on the Mg alloy surface also increases corrosion resistance very significantly by 40 times. Bone cells are also found proliferating better in the HA-coated surface. All these benefits together establish the candidature of sol-gel HA-coated Mg-3Zn alloy in orthopedic application.

  17. 3D Crack Behavior in the Orthopedic Cement Mantle of a Total Hip Replacement

    Directory of Open Access Journals (Sweden)

    Abderahmen Sahli

    2014-01-01

    Full Text Available The total hip replacement is an operation that replaces a diseased hip with a mechanical articulation. Both components of the mechanical articulation (stem and the cup are bonded to bone using orthopedic cement, whose reliability determines the longevity of the implant. The cement around the metallic stem forms a mantle whose strength and toughness determine its resistance to fatigue and failure by fracture. Typical cements are acrylic polymers that often suffer from internal cracks and other defects created during polymerization. This study is a systematic analysis of preexisting 3D crack behavior in the orthopedic cement mantle when subjected to external body forces. Different crack orientations and angular positions around the mantle are studied to identify which locations will propagate the crack. This is accomplished by a global stress analysis of the mantle followed by a failure analysis. Amongst others, the existence of a crack in the proximal region of the orthopedic cement is identified as a critical area, especially in the lateral sides of the stem in the radial direction.

  18. Wear Tests of a Potential Biolubricant for Orthopedic Biopolymers

    Directory of Open Access Journals (Sweden)

    Martin Thompson

    2015-03-01

    Full Text Available Most wear testing of orthopedic implant materials is undertaken with dilute bovine serum used as the lubricant. However, dilute bovine serum is different to the synovial fluid in which natural and artificial joints must operate. As part of a search for a lubricant which more closely resembles synovial fluid, a lubricant based on a mixture of sodium alginate and gellan gum, and which aimed to match the rheology of synovial fluid, was produced. It was employed in a wear test of ultra high molecular weight polyethylene pins rubbing against a metallic counterface. The test rig applied multidirectional motion to the test pins and had previously been shown to reproduce clinically relevant wear factors for ultra high molecular weight polyethylene. After 2.4 million cycles (125 km of sliding in the presence of the new lubricant, a mean wear factor of 0.099 × 10−6 mm3/Nm was measured for the ultra high molecular weight polyethylene pins. This was over an order of magnitude less than when bovine serum was used as a lubricant. In addition, there was evidence of a transfer film on the test plates. Such transfer films are not seen clinically. The search for a lubricant more closely matching synovial fluid continues.

  19. An Experimental Study to Determine the Role of Inferior Vena Cava Filter in Preventing Bone Cement Implantation Syndrome.

    Science.gov (United States)

    Guo, Wangang; Zheng, Qiangsun; Li, Bingling; Shi, Xiaoqin; Xiang, Dingcheng; Wang, Chen

    2015-07-01

    Inferior vena cava filters (IVCF) are frequently used for preventing pulmonary embolism (PE) following deep venous thromboembolism. The present study was designed to investigate whether IVCF could prevent or impede the occurrence of bone cement implantation syndrome (BCIS), since PE is considered as the central mechanism of BCIS. Fifteen sheep were divided into three groups: bone cement free (BCF) group, cement implantation (CI) group and IVCF group. In all the groups, an osteotomy proximal to the greater trochanter of left femur was carried out. In BCF group, the femoral canal was not reamed out or packed with any bone cement. In CI and IVCF groups, the left femoral canals were packed with bone cement, to simulate the cementing procedures carried out in hip replacement. An OptEase(®) filter was placed and released in inferior vena cava, prior to packing cement in the femoral canal in IVCF group, while the IVCF was not released in the CI group. The BCF group was considered as control. Systolic blood pressure (SBP), saturation of oxygen (SaO2) and partial pressure of carbon dioxide (PaCO2) declined significantly 10 min after the bone cement packing, in CI group, compared to those in BCF group. This was accompanied by a rise in the arterial pH. However, IVCF prevented those changes in the CI group. On ultrasonography, there were dotted echoes in right atrium in the CI group, after bone cement packing, while such echoes were hardly seen in the IVCF group. This study demonstrates that IVCF could prevent BCIS effectively, and, as a corollary, suggests that PE represents the leading cause of the constellation of BCIS symptoms.

  20. Influence of orthopedic reinforced gloves versus double standard gloves on contamination events during small animal orthopedic surgery.

    Science.gov (United States)

    Hayes, Galina; Singh, Ameet; Gibson, Tom; Moens, Noel; Oblak, Michelle; Ogilvie, Adam; Reynolds, Debbie

    2017-10-01

    To determine the influence of orthopedic reinforced gloves on contamination events during small animal orthopedic surgery. Prospective randomized controlled trial SAMPLE POPULATION: Two hundred and thirty-seven pairs of orthopedic gloves (474 gloves) and 203 pairs of double standard gloves (812 gloves) worn during 193 orthopedic procedures. Primary and assistant surgeons were randomized to wear either orthopedic reinforced gloves or double gloves. Gloves were leak tested to identify perforations at the end of procedures. Perforations detected intraoperatively or postoperatively were recorded. A contamination event was defined as at least one perforation on either hand for orthopedic reinforced gloves, or a perforation of both the inner and outer glove on the same hand for double gloves. Baseline characteristics between the 2 intervention groups were similar. There was no difference in contamination events between the double-gloved and orthopedic gloved groups (OR = 0.95, 95% CI = 0.49-1.87, P = .89). The same percentage of contamination events (8% glove pairs used) occurred in the double gloved group (17 contamination events) and in the orthopedic gloved group (19 contamination events). The odds of a contamination event increased by 1.02 (95% CI 1.01-1.03, P contamination events in small animal orthopedic procedures. Surgeons reluctant to double glove due to perceptions of decreased dexterity and discomfort may safely opt for wearing orthopedic gloves, which may improve their compliance. © 2017 The American College of Veterinary Surgeons.

  1. Effect of polychromatic visible light on proliferation of tumor cells under conditions in vitro and in vivo—after implantation to experimental animals

    Science.gov (United States)

    Knyazev, N. A.; Samoilova, K. A.; Filatova, N. A.; Galaktionova, A. A.

    2009-06-01

    The question of the character of effect of visible and near infrared (IR) radiation of Sun and artificial sources on growth of malignant tumors remains open due to controversy and a relatively small amount of available data, which restricts use of this most important environmental and the efficient physiotherapeutic factors at various human pathological states and first of all at the rehabilitation of oncological patients after radical methods of cancer treatment (surgical removal of tumor, intensive medication and radiation therapy), when immunomodulatory antiinflamatory, wound-healing and analgesic properties of visible and near IR light can be drawn. In the present work, using polychromatic visible light, close to this dominant component of the terrestrial solar radiation (380-750 nm, 40 mW/cm2) we irradiated tumor cells of the murine hepatoma (MH-22a line) under conditions in vitro (the monolayer of cells in Petri dishes) and in vivo (after subcutaneous implantation of these cells to mice of the C3HA line). A high resistance of the MH-22a cells to polychromatic visible radiation has been established under conditions in vitro: irradiation at dose 24 J/cm2 did not inhibit their proliferation whereas a dose of 9.6 J/cm2, stimulated statistically significantly proliferation of the cells (by 24-40%). However, stimulation of the tumor cell proliferation, did not develop under conditions in vivo, when mice were irradiated (9.6 J/cm2)—daily for 5 days before the implantation of tumor cells and for 5 days after implantation (in the latter case there was a probability of transcutaneous irradiation of tumor cells). By implanting to the animals of tumor cells at various concentrations (from 2ṡ105 to 25ṡ103 cells per mouse), we did not revealed at any of 10 terms of observations for 41-45 days both an increase of incidence of the tumor development and acceleration of tumor growth as well as a decrease of the animals survival as compared with group of non

  2. Nanotechnology-enhanced orthopedic materials fabrications, applications and future trends

    CERN Document Server

    Yang, Lei

    2015-01-01

    Nanotechnology-Enhanced Orthopedic Materials provides the latest information on the emergence and rapid development of nanotechnology and the ways it has impacted almost every aspect of biomedical engineering. This book provides readers with a comprehensive overview of the field, focusing on the fabrication and applications of these materials, presenting updated, practical, and systematic knowledge on the synthesis, processing, and modification of nanomaterials, along with the rationale and methodology of applying such materials for orthopedic purposes. Topics covered include a wide range of orthopedic material formulations, such as ceramics, metals, polymers, biomolecules, and self-assemblies. Final sections explore applications and future trends in nanotechnology-enhanced orthopedic materials. Details practical information on the fabrication and modification of new and traditional orthopedic materials Analyzes a wide range of materials, designs, and applications of nanotechnology for orthopedics Investigate...

  3. Avaliação experimental de novo eletrodo para implante de marca-passo em fetos Experimental assessment of a new electrode for fetal pacing

    Directory of Open Access Journals (Sweden)

    Renato Samy Assad

    2006-09-01

    Full Text Available OBJETIVO: O bloqueio atrioventricular total (BAVT fetal apresenta mau prognóstico quando associado à hidropisia. O implante de marca-passo pode melhorar as chances de sobrevida fetal. Este estudo analisa as características eletrofisiológicas do novo eletrodo de marca-passo fetal, a hemodinâmica e metabolismo fetal sob freqüências cardíacas variadas. MÉTODO: O novo eletrodo (formato de "T" foi implantado no coração de cinco fetos de cabras. O débito cardíaco fetal foi medido com fluxômetro. O BAVT foi obtido por meio da crioablação do nó atrioventricular fetal. Os parâmetros eletrofisiológicos, hemodinâmica e metabolismo fetal foram analisados sob diversas freqüências cardíacas. RESULTADOS: O eletrodo fetal apresentou baixos limiares agudos, sem falhas no comando do estímulo. A curva do limiar de estimulação permaneceu relativamente constante para larguras de pulso acima de 0,5 mseg. A resistência foi de 1050,4 ± 76,6 ohms; e a onda R foi de 8,6 ± 5,6 mV. A freqüência cardíaca fetal abaixo de 60 bpm produziu baixo débito cardíaco fetal e hipotensão arterial (pOBJECTIVE: The prognosis of congenital complete heart block (CHB is very poor when manifested with fetal hydrops. Fetal pacing may improve the survival rate. This study aims to assess the electrophysiological characteristics of a new lead, as well as fetal hemodynamic and metabolism under different fetal heart rates. METHODS: The new lead (T-shaped was deployed into the myocardium of five fetal goats. Fetal cardiac output was measured by a flow transducer. CHB was achieved by cryosurgical ablation of fetal AV node. Electrophysiological parameters, hemodynamic and metabolic behavior of the fetus under different fetal heart rates were evaluated. RESULTS: The acute stimulation thresholds were consistently low. The voltage strength-duration curve remained relatively constant at pulse widths > 0.5 msec. The stimulation resistance was 1050.4 ± 76.6 ohms, and the

  4. Impact of a Musculoskeletal Clerkship on Orthopedic Surgery Applicant Diversity.

    Science.gov (United States)

    London, Daniel A; Calfee, Ryan P; Boyer, Martin I

    Orthopedic surgery lacks racial and sexual diversity, which we hypothesized stems from absence of exposure to orthopedics during medical school. We conducted a study to determine whether diversity of matched orthopedic surgery residency applicants increased after introduction of a required third-year rotation. We compared 2 groups: precurriculum and postcurriculum. The postcurriculum group was exposed to a required 1-month musculoskeletal rotation during the third year of medical school. Comparisons were made of percentage of total students exposed to orthopedics, percentage who applied to and matched to orthopedic surgery, and proportion of women and underrepresented minorities. A prospective survey was used to determine when students chose orthopedics and what influenced their decisions. The required rotation increased the percentage of third-year students rotating on orthopedics (25%) with no change in application rate (6%). It also led to an 81% relative increase in the proportion of female applicants and a 101% relative increase in underrepresented minority applicants. According to survey data, 79% of students chose orthopedics during their third year, and 88% thought they were influenced by their rotation. A required third-year rotation exposes more medical students to orthopedics and increases the diversity of matching students.

  5. Miniscrew implant applications in contemporary orthodontics

    Directory of Open Access Journals (Sweden)

    Hong-Po Chang

    2014-03-01

    Full Text Available The need for orthodontic treatment modalities that provide maximal anchorage control but with minimal patient compliance requirements has led to the development of implant-assisted orthodontics and dentofacial orthopedics. Skeletal anchorage with miniscrew implants has no patient compliance requirements and has been widely incorporated in orthodontic practice. Miniscrew implants are now routinely used as anchorage devices in orthodontic treatment. This review summarizes recent data regarding the interpretation of bone data (i.e., bone quantity and quality obtained by preoperative diagnostic computed tomography (CT or by cone-beam computed tomography (CBCT prior to miniscrew implant placement. Such data are essential when selecting appropriate sites for miniscrew implant placement. Bone characteristics that are indications and contraindications for treatment with miniscrew implants are discussed. Additionally, bicortical orthodontic skeletal anchorage, risks associated with miniscrew implant failure, and miniscrew implants for nonsurgical correction of occlusal cant or vertical excess are reviewed. Finally, implant stability is compared between titanium alloy and stainless steel miniscrew implants.

  6. Miniscrew implant applications in contemporary orthodontics.

    Science.gov (United States)

    Chang, Hong-Po; Tseng, Yu-Chuan

    2014-03-01

    The need for orthodontic treatment modalities that provide maximal anchorage control but with minimal patient compliance requirements has led to the development of implant-assisted orthodontics and dentofacial orthopedics. Skeletal anchorage with miniscrew implants has no patient compliance requirements and has been widely incorporated in orthodontic practice. Miniscrew implants are now routinely used as anchorage devices in orthodontic treatment. This review summarizes recent data regarding the interpretation of bone data (i.e., bone quantity and quality) obtained by preoperative diagnostic computed tomography (CT) or by cone-beam computed tomography (CBCT) prior to miniscrew implant placement. Such data are essential when selecting appropriate sites for miniscrew implant placement. Bone characteristics that are indications and contraindications for treatment with miniscrew implants are discussed. Additionally, bicortical orthodontic skeletal anchorage, risks associated with miniscrew implant failure, and miniscrew implants for nonsurgical correction of occlusal cant or vertical excess are reviewed. Finally, implant stability is compared between titanium alloy and stainless steel miniscrew implants. Copyright © 2013. Published by Elsevier B.V.

  7. Cochlear implants and medical tourism.

    Science.gov (United States)

    McKinnon, Brian J; Bhatt, Nishant

    2010-09-01

    To compare the costs of medical tourism in cochlear implant surgery performed in India as compared to the United States. In addition, the cost savings of obtaining cochlear implant surgery in India were compare d to those of other surgical interventions obtained as a medical tourist. Searches were conducted on Medline and Google using the search terms: 'medical tourism', 'medical offshoring', 'medical outsourcing', 'cochlear implants' and 'cochlear implantation'. The information regarding cost of medical treatment was obtained from personal communication with individuals familiar with India's cochlear implantation medical tourism industry. The range of cost depended on length of stay as well as the device chosen. Generally the cost, inclusive of travel, surgery and device, was in the range of $21,000-30,000, as compared to a cost range of $40,000-$60,000 in the US. With the escalating cost of healthcare in the United States, it is not surprising that some patients would seek to obtain surgical care overseas at a fraction of the cost. Participants in medical tourism often have financial resources, but lack health insurance coverage. While cardiovascular and orthopedic surgery performed outside the United States in India at centers that cater to medical tourists are often performed at one-quarter to one-third of the cost that would have been paid in the United States, the cost differential for cochlear implants is not nearly as favorable.

  8. Experimental determination of bone cortex holding power of orthopedic screw

    Directory of Open Access Journals (Sweden)

    Bolliger Neto Raul

    1999-01-01

    Full Text Available Cylindrical specimens of bone measuring 15 mm in diameter were obtained from the lateral cortical layer of 10 pairs of femurs and tibias. A central hole 3.2 mm in diameter was drilled in each specimen. The hole was tapped, and a 4.5 mm cortical bone screw was inserted from the outer surface. The montage was submitted to push-out testing up to a complete strip of the bone threads. The cortical thickness and rupture load were measured, and the shear stress was calculated. The results were grouped according to the bone segment from which the specimen was obtained. The results showed that bone cortex screw holding power is dependent on the bone site. Additionally, the diaphyseal cortical bone tissue is both quantitatively and qualitatively more resistant to screw extraction than the metaphyseal tissue.

  9. POROUS POLYMER IMPLANTS FOR REPAIR OF FULL-THICKNESS DEFECTS OF ARTICULAR-CARTILAGE - AN EXPERIMENTAL-STUDY IN RABBIT AND DOG

    NARCIS (Netherlands)

    JANSEN, HWB; VETH, RPH; NIELSEN, HKL; DEGROOT, JH; PENNINGS, AJ

    1992-01-01

    Full-thickness defects of articular cartilage were repaired by implantation of porous polymer implants in rabbits and dogs. The quality of the repair tissue was determined by collagen typing with antibodies. Implants with varying pore sizes and chemical composition were used. The effect of loading

  10. The Use of Finite Element Analysis to Enhance Research and Clinical Practice in Orthopedics.

    Science.gov (United States)

    Pfeiffer, Ferris M

    2016-02-01

    Finite element analysis (FEA) is a very powerful tool for the evaluation of biomechanics in orthopedics. Finite element (FE) simulations can effectively and efficiently evaluate thousands of variables (such as implant variation, surgical techniques, and various pathologies) to optimize design, screening, prediction, and treatment in orthopedics. Additionally, FEA can be used to retrospectively evaluate and troubleshoot complications or failures to prevent similar future occurrences. Finally, FE simulations are used to evaluate implants, procedures, and techniques in a time- and cost-effective manner. In this work, an overview of the development of FE models is provided and an example application is presented to simulate knee biomechanics for a specimen with medial meniscus insufficiency. FE models require the development of the geometry of interest, determination of the material properties of the tissues simulated, and an accurate application of a numerical solver to produce an accurate solution and representation of the field variables. The objectives of this work are to introduce the reader to the application of FEA in orthopedic analysis of the knee joint. A brief description of the model development process as well as a specific application to the investigation of knee joint stability in geometries with normal or compromised medial meniscal attachment is included. Significant increases in stretch of the anterior cruciate ligament were predicted in specimens with medial meniscus insufficiency (such behavior was confirmed in corresponding biomechanical testing). It can be concluded from this work that FE analysis of the knee can provide significant new information with which more effective clinical decisions can be made. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Medical Crowdfunding for Patients Undergoing Orthopedic Surgery.

    Science.gov (United States)

    Durand, Wesley M; Johnson, Joseph R; Eltorai, Adam E M; Daniels, Alan H

    2018-01-01

    Crowdfunding for medical expenses is growing in popularity. Through several websites, patients create public campaign profiles to which donors can contribute. Research on medical crowdfunding is limited, and there have been no studies of crowdfunding in orthopedics. Active medical crowdfunding campaigns for orthopedic trauma, total joint arthroplasty, and spine surgery were queried from a crowdfunding website. The characteristics and outcomes of crowdfunding campaigns were abstracted and analyzed. For this study, 444 campaigns were analyzed, raising a total of $1,443,528. Among the campaigns that received a donation, mean amount raised was $4414 (SE, $611). Multivariate analysis showed that campaigns with unspecified location (odds ratio, 0.26; P=.0008 vs West) and those for total joint arthroplasty (odds ratio, 0.35; P=.0003 vs trauma) had significantly lower odds of receipt of any donation. Description length was associated with higher odds of donation receipt (odds ratio, 1.13 per +100 characters; P<.0001). Among campaigns that received any donation, those with Southern location (-65.5%, P<.0001), international location (-68.5%, P=.0028), and unspecified location (-63.5%, P=.0039) raised lower amounts compared with campaigns in the West. Goal amount was associated with higher amount raised (+3.2% per +$1000, P<.0001). Resources obtained through crowdfunding may be disproportionately available to patients with specific diagnoses, those from specific regions, those who are able to craft a lengthy descriptive narrative, and those with access to robust digital social networks. Clinicians are likely to see a greater proportion of patients turning to crowdfunding as it grows in popularity. Patients may ask physicians for information about crowdfunding or request testimonials to support campaigns. Surgeons should consider their response to such requests individually. These findings shed light on the dynamics of medical crowdfunding and support robust personal and

  12. Orthopedic Resident Anatomy Review Course: A Collaboration between Anatomists and Orthopedic Surgeons

    Science.gov (United States)

    DeFriez, Curtis B.; Morton, David A.; Horwitz, Daniel S.; Eckel, Christine M.; Foreman, K. Bo; Albertine, Kurt H.

    2011-01-01

    A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months…

  13. Compliance of Dutch orthopedic departments with national guidelines on thromboprophylaxis. A survey of Dutch orthopedic thromboprohylaxis

    NARCIS (Netherlands)

    Ettema, Harmen B.; Hoppener, Marnix R.; Henny, Christiaan P.; Büller, Harry R.; Verheyen, Cees C. P. M.

    2005-01-01

    All 110 Dutch orthopedic departments were sent a survey on perioperative thromboprophylaxis protocols, and 79% responded. After hip and knee replacements, all used pharmacological thromboprophylaxis: a low-molecular weight heparin (LMWH) in 87% of departments, which was most often combined with

  14. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty.

    Science.gov (United States)

    Wasterlain, Amy S; Bello, Ricardo J; Vigdorchik, Jonathan; Schwarzkopf, Ran; Long, William J

    2017-09-01

    Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (Pinnovation advances the field but support discussing the "unproven" nature of new implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.]. Copyright 2017, SLACK Incorporated.

  15. Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome

    Science.gov (United States)

    2016-12-01

    Hypersensitivity, Trauma , orthopedic, implants, lymphocyte, metal-LTT, ions, implant debris 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...from improvised explosive devices (IEDs), improved protection from body armor, ballistic helmets, and vehicle armor are improving the wound injury...bodies in soft tissue causing plumbism 36-38. There are no strict guidelines as to when patients with gunshot or other metal fragment wounds should

  16. Presurgical Orthopedics Appliance: The Latham Technique.

    Science.gov (United States)

    Cruz, Carlos

    2016-05-01

    The Latham appliance is an active presurgical orthopedic device used for cleft defects. Its long-term effects are debated. It was introduced to help surgeons achieve a more predictable surgical outcome; hence, it should be evaluated for its presurgical benefits. The device has been successful in expanding and aligning the maxillary segments; retruding protruded premaxillae; aligning bilateral alveolar ridges; placing less tension on surgical closures; and reducing fistulation rates. However, it has not been shown to have either a positive or negative long-term effect on maxillary development or occlusion. It is a valuable preoperative tool for surgeons treating cleft defects. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Vacuum extraction enhances rhPDGF-BB immobilization on nanotubes to improve implant osseointegration in ovariectomized rats.

    Science.gov (United States)

    Zhang, Wenjie; Jin, Yuqin; Qian, Shi; Li, Jinhua; Chang, Qing; Ye, Dongxia; Pan, Hongya; Zhang, Maolin; Cao, Huiliang; Liu, Xuanyong; Jiang, Xinquan

    2014-11-01

    Nanotube morphology has been previously applied to improve osseointegration in osteoporosis, but the osteogenic capability of the technique requires further improvements. This study aimed to investigate the effects of vacuum extraction on the loading of rhPDGF-BB on nanotube arrays as well as its effects on the osseointegration of ovariectomized (OVX) rats. More rhPDGF-BB protein particles aggregated on the nanotube surface and into the nanotube after vacuum extraction for 10 min. The immobilized protein could be slowly released for at least 14 days and still kept its biological activity. In vitro, the immobilized rhPDGF-BB enhanced cell adhesion, proliferation and osteogenic differentiation. In vivo, more rhPDGF-BB immobilized on the nanotube surface also promoted the osseointegration. These results suggest that the enhanced immobilization of rhPDGF-BB on nanotube arrays can potentially be used in the future as an implant surface modification strategy in dental and orthopedic applications in osteoporotic patients. This study presents convincing evidence that enhanced immobilization of recombinant human PDGF-BB protein particles on nanotubes lead to improved osteogenic differentiation in an experimental system. When used as a surface modification strategy for dental or orthopedic implants, this method was able to promote osseointegration even in an osteoporotic animal model, raising the likelihood for potential future clinical applications. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Use and usability of custom-made orthopedic shoes

    NARCIS (Netherlands)

    van Netten, Jaap J.; Jannink, Michiel J. A.; Hijmans, Juha M.; Geertzen, Jan H. B.; Postema, Klaas

    2010-01-01

    The goal of this study was to investigate the use of custom-made orthopedic shoes (OS) and the association between the use of OS and the most relevant aspects of their usability. Over a 6-month period, patients meeting the inclusion criteria were recruited by 12 orthopedic shoe companies scattered

  19. Delay to orthopedic consultation for isolated limb injury

    Science.gov (United States)

    Rouleau, Dominique M.; Feldman, Debbie Ehrmann; Parent, Stefan

    2009-01-01

    ABSTRACT OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation. PMID:19826162

  20. Improving Response Rates among Students with Orthopedic and Multiple Disabilities

    Science.gov (United States)

    Wilkens, Christian P.; Kuntzler, Patrice M.; Cardenas, Shaun; O'Malley, Eileen; Phillips, Carolyn; Singer, Jacqueline; Stoeger, Alex; Kindler, Keith

    2014-01-01

    One challenge teachers of students with orthopedic and multiple disabilities face is providing sufficient time and opportunity to communicate. This challenge is universal across countries, schools, and settings: teachers want students to communicate because communication lies at the core of what makes us human. Yet students with orthopedic and…

  1. Monitoring the osseointegration process in porous Ti6Al4V implants produced by additive manufacturing: an experimental study in sheep.

    Science.gov (United States)

    Kayacan, Mehmet C; Baykal, Yakup B; Karaaslan, Tamer; Özsoy, Koray; Alaca, İlker; Duman, Burhan; Delikanlı, Yunus E

    2017-11-13

    This study investigated the design and osseointegration process of transitive porous implants that can be used in humans and all trabecular and compact bone structure animals. The aim was to find a way of forming a strong and durable tissue bond on the bone-implant interface. Massive and transitive porous implants were produced on a direct metal laser sintering machine, surgically implanted into the skulls of sheep and kept in place for 12 weeks. At the end of the 12-week period, the Massive and porous implants removed from the sheep were investigated by scanning electron microscopy (SEM) to monitor the osseointegration process. In the literature, each study has selected standard sizes for pore diameter in the structures they use. However, none of these involved transitional porous structures. In this study, as opposed to standard pores, there were spherical or elliptical pores at the micro level, development channels and an inner region. Bone cells developed in the inner region. Transitive pores grown gradually in accordance with the natural structure of the bone were modeled in the inner region for cells to develop. Due to this structure, a strong and durable tissue bond could be formed at the bone-implant interface. Osseointegration processes of Massive vs. porous implants were compared. It was observed that cells were concentrated on the surface of Massive implants. Therefore, osseointegration between implant and bone was less than that of porous implants. In transitive porous implants, as opposed to Massive implants, an outer region was formed in the bone-implant interface that allowed tissue development.

  2. Implante de tubo valvulado bioprótese "stentless" em posição aórtica: estudo experimental em ovinos A juvenile sheep model for the stentless bioprostheses implanted as aortic root replacements

    Directory of Open Access Journals (Sweden)

    Paulo César SANTOS

    2002-03-01

    Full Text Available INTRODUÇÃO: O tratamento das lesões valvares representa um grande desafio dentro da cirurgia cardiovascular, pois, até os dias atuais, não temos um substituto ideal para as valvas do coração. As próteses atualmente disponíveis apresentam vantagens e desvantagens; as mecânicas exigem anticoagulação definitiva e as biológicas apresentam baixa durabilidade. Para se chegar a um substituto ideal, são necessárias várias fases, desde a escolha e o preparo do material até o implante em animal de grande porte. Esta última é muito importante, pois a escolha do animal deve ser criteriosa. Ovinos juvenís são animais dóceis de fácil manipulação e suas características anatômicas e biológicas se assemelham muito ao que ocorre com o ser humano e as próteses "stentless" são substitutos mais próximos dos homoenxertos. MATERIAL E MÉTODO: Foram operados 30 ovinos juvenís com idade variando de 4,4 a 6,3 meses, peso de 25 a 37 kg, sendo 28 machos. Todos os animais foram submetidos a circulação extracorpórea para implante de bioprótese "stentless" montada em tubo de aorta porcina, com reimplante de artérias coronárias. A operação foi realizada com hipotermia moderada e cardioplegia gelada. O período de seguimento foi de 30 dias e, ao final, realizado ecocardiograma. RESULTADOS: Houve 8 (26,6% óbitos no intra-operatório e 6 (27,7% óbitos no seguimento. O tempo médio de CEC foi de 98 min. Foi realizado ecocardiograma em 16 animais e em nenhum caso foram vistos sinais de endocardite ou outras alterações; a fração média de ejeção foi de 74%. CONCLUSÃO: Este modelo experimental utilizando ovinos para o estudo de biopróteses "stentless" em posição aórtica mostrou-se bem reprodutível e a performance do enxerto bastante factível de ser avaliada, pois ovinos são animais dóceis e de fácil manipulação no seguimento tardio.INTRODUCTION: Often, studies on aortic prosthetic valves analyze their performance not at the

  3. Osseointegration of zirconia implants: an SEM observation of the bone-implant interface.

    Science.gov (United States)

    Depprich, Rita; Zipprich, Holger; Ommerborn, Michelle; Mahn, Eduardo; Lammers, Lydia; Handschel, Jörg; Naujoks, Christian; Wiesmann, Hans-Peter; Kübler, Norbert R; Meyer, Ulrich

    2008-11-06

    The successful use of zirconia ceramics in orthopedic surgery led to a demand for dental zirconium-based implant systems. Because of its excellent biomechanical characteristics, biocompatibility, and bright tooth-like color, zirconia (zirconium dioxide, ZrO2) has the potential to become a substitute for titanium as dental implant material. The present study aimed at investigating the osseointegration of zirconia implants with modified ablative surface at an ultrastructural level. A total of 24 zirconia implants with modified ablative surfaces and 24 titanium implants all of similar shape and surface structure were inserted into the tibia of 12 Göttinger minipigs. Block biopsies were harvested 1 week, 4 weeks or 12 weeks (four animals each) after surgery. Scanning electron microscopy (SEM) analysis was performed at the bone implant interface. Remarkable bone attachment was already seen after 1 week which increased further to intimate bone contact after 4 weeks, observed on both zirconia and titanium implant surfaces. After 12 weeks, osseointegration without interposition of an interfacial layer was detected. At the ultrastructural level, there was no obvious difference between the osseointegration of zirconia implants with modified ablative surfaces and titanium implants with a similar surface topography. The results of this study indicate similar osseointegration of zirconia and titanium implants at the ultrastructural level.

  4. Osseointegration of zirconia implants: an SEM observation of the bone-implant interface

    Directory of Open Access Journals (Sweden)

    Naujoks Christian

    2008-11-01

    Full Text Available Abstract Background The successful use of zirconia ceramics in orthopedic surgery led to a demand for dental zirconium-based implant systems. Because of its excellent biomechanical characteristics, biocompatibility, and bright tooth-like color, zirconia (zirconium dioxide, ZrO2 has the potential to become a substitute for titanium as dental implant material. The present study aimed at investigating the osseointegration of zirconia implants with modified ablative surface at an ultrastructural level. Methods A total of 24 zirconia implants with modified ablative surfaces and 24 titanium implants all of similar shape and surface structure were inserted into the tibia of 12 Göttinger minipigs. Block biopsies were harvested 1 week, 4 weeks or 12 weeks (four animals each after surgery. Scanning electron microscopy (SEM analysis was performed at the bone implant interface. Results Remarkable bone attachment was already seen after 1 week which increased further to intimate bone contact after 4 weeks, observed on both zirconia and titanium implant surfaces. After 12 weeks, osseointegration without interposition of an interfacial layer was detected. At the ultrastructural level, there was no obvious difference between the osseointegration of zirconia implants with modified ablative surfaces and titanium implants with a similar surface topography. Conclusion The results of this study indicate similar osseointegration of zirconia and titanium implants at the ultrastructural level.

  5. Damping Factor as a Diagnostic Parameter for Assessment of Osseointegration during the Dental Implant Healing Process: An Experimental Study in Rabbits.

    Science.gov (United States)

    Feng, Sheng-Wei; Ho, Kuo-Ning; Chan, Ya-Hui; Chang, Kai-Jung; Lai, Wei-Yi; Huang, Haw-Ming

    2016-12-01

    The purpose of this study was to evaluate the possibility of using damping factor (DF) analysis to provide additional information on osseointegration of dental implants during the healing period. A total of 30 dental implants were installed in the bilateral femoral condyles of 15 rabbits. A DF analyzer detected with an impulse-forced vibration method and a commercialized dental implant stability analyzer based on resonance frequency (RF) analysis were used to measure the implant stability immediately after implant placement and 1, 2, 4, and 8 weeks post-surgically. Results of DF and RF analyses at different time points were compared with the corresponding osseointegration performance of dental implants via micro-computed tomography (micro-CT), histological and histomorphometrical analysis. The DF values revealed a decrease with time and reached 0.062 ± 0.007 at 8 weeks after implantation, which is almost 50% lower than the initial value. Moreover, highly significant correlations between DF values and bone volume densities (R (2) = 0.9797) and percentages of bone-to-implant contact measured at trabecular bone area (R (2) = 0.9773) were also observed. These results suggested that DF analysis combined with RF analysis results in a more sensitive assessment of changes in the dental implant/bone complex during the healing period than RF analysis alone.

  6. Application of Stem Cells in Orthopedics

    Science.gov (United States)

    Schmitt, Andreas; van Griensven, Martijn; Imhoff, Andreas B.; Buchmann, Stefan

    2012-01-01

    Stem cell research plays an important role in orthopedic regenerative medicine today. Current literature provides us with promising results from animal research in the fields of bone, tendon, and cartilage repair. While early clinical results are already published for bone and cartilage repair, the data about tendon repair is limited to animal studies. The success of these techniques remains inconsistent in all three mentioned areas. This may be due to different application techniques varying from simple mesenchymal stem cell injection up to complex tissue engineering. However, the ideal carrier for the stem cells still remains controversial. This paper aims to provide a better understanding of current basic research and clinical data concerning stem cell research in bone, tendon, and cartilage repair. Furthermore, a focus is set on different stem cell application techniques in tendon reconstruction, cartilage repair, and filling of bone defects. PMID:22550505

  7. Caring for the incarcerated: an orthopedic perspective.

    Science.gov (United States)

    Munns, Justin; Samora, Julie Balch; Granger, Jeffrey F; Ng, Vincent Y

    2013-12-01

    According to the 1976 Supreme Court case of Estelle v Gamble, the government is required to provide prisoners access to the necessary care for known, serious medical needs. Failure to do so violates the Eighth Amendment prohibiting the imposition of "cruel and unusual punishment." Currently, more than 2.5 million Americans are imprisoned, the highest per capita rate in the world. In the current fiscal climate and with burgeoning health care costs for society as a whole, providing care for prisoners poses both moral and logistical challenges. From an orthopedic standpoint, caring for the incarcerated raises uniquely challenging issues due to the nature of this patient population and their types of musculoskeletal conditions.

  8. Orthopedic surgical analyzer for percutaneous vertebroplasty

    Science.gov (United States)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically

  9. Soluble Thrombomodulin and Major Orthopedic Surgery

    Directory of Open Access Journals (Sweden)

    Irina P. Antropova

    2016-09-01

    Full Text Available Background: A high level of soluble thrombomodulin (sTM is associated with a lower risk of thrombosis but can cause severe bleeding after operations. Deep vein thrombosis (DVT and blood loss are serious threats after orthopedic surgery. The aim of our pilot study was to evaluate the effect of the preoperative level of sTM on coagulation and inflammation as well as the blood loss and the development of symptomatic DVT after total large joint replacement. Methods and Results: In all patients (n=50 who underwent total hip or knee replacement, sTM, PrC, D-dimer, vWF, CRP, and platelets were determined before and after the operation. According to the preoperative sTM level, patients were divided into 2 groups: the thrombomodulin low (TML group (n=25 and thrombomodulin high (TMH group (n=25. The concentration of sTM was 4.4 [3.4, 4.7] ng/ml in the TML-group and 8.7[7.3, 10.6] ng/ml in the TMH-group. After surgery, D-dimer, vWF, platelet count and CRP were higher and total blood loss was lower in the TML group. In the TML-group, a symptomatic DVT was detected in 3(12% patients; in the TMH-group, a symptomatic DVT was identified only in 1(4% case. Conclusion: These findings support the important role of sTM in coagulation, inflammation, bleeding, and presumably in venous thrombosis after major orthopedic surgery.

  10. The orthopedic diseases of ancient Egypt.

    Science.gov (United States)

    Fritsch, Klaus O; Hamoud, Heshem; Allam, Adel H; Grossmann, Alexander; Nur El-Din, Abdel-Halim; Abdel-Maksoud, Gomaa; Soliman, Muhammad Al-Tohamy; Badr, Ibrahim; Sutherland, James D; Sutherland, M Linda; Akl, Mahmoud; Finch, Caleb E; Thomas, Gregory S; Wann, L Samuel; Thompson, Randall C

    2015-06-01

    CT scanning of ancient human remains has the potential to provide insights into health and diseases. While Egyptian mummies have undergone CT scans in prior studies, a systematic survey of the orthopedic conditions afflicting a group of these ancient individuals has never been carried out. We performed whole body CT scanning on 52 ancient Egyptian mummies using technique comparable to that of medical imaging. All of the large joints and the spine were systematically examined and osteoarthritic (OA) changes were scored 0-4 using Kellgren and Lawrence classification. The cruciate ligaments and menisci could be identified frequently. There were much more frequent OA changes in the spine (25 mummies) than in the large joints (15 cases of acromioclavicular and/or glenohumeral joint OA changes, five involvement of the ankle, one in the elbow, four in the knee, and one in the hip). There were six cases of scoliosis. Individual mummies had the following conditions: juvenile aseptic necrosis of the hip (Perthes disease), stage 4 osteochondritis dissecans of the knee, vertebral compression fracture, lateral patella-femoral joint hyper-compression syndrome, severe rotator cuff arthropathy, rotator cuff impingement, hip pincer impingement, and combined fracture of the greater trochantor and vertebral bodies indicating obvious traumatic injury. This report includes the most ancient discovery of several of these syndromes. Ancient Egyptians often suffered painful orthopedic conditions. The high frequency of scoliosis merits further study. The pattern of degenerative changes in the spine and joints may offer insights into activity levels of these people. © 2015 Wiley Periodicals, Inc.

  11. Synergistic effects of bisphosphonate and calcium phosphate nanoparticles on peri-implant bone responses in osteoporotic rats

    NARCIS (Netherlands)

    Alghamdi, H.S.A.; Bosco, R.; Both, S.K.; Iafisco, M.; Leeuwenburgh, S.C.G.; Jansen, J.A.; Beucken, J.J.J.P van den

    2014-01-01

    The prevalence of osteoporosis will increase within the next decades due to the aging world population, which can affect the bone healing response to dental and orthopedic implants. Consequently, local drug targeting of peri-implant bone has been proposed as a strategy for the enhancement of

  12. Safety and Biocompatibility of a New High-Density Polyethylene-Based Spherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits

    Directory of Open Access Journals (Sweden)

    Ivan Fernandez-Bueno

    2015-01-01

    Full Text Available Purpose. To evaluate clinically and histologically the safety and biocompatibility of a new HDPE-based spherical porous orbital implants in rabbits. Methods. MEDPOR (Porex Surgical, Inc., Fairburn, GA, USA, OCULFIT I, and OCULFIT II (AJL Ophthalmic S.A., Vitoria, Spain implants were implanted in eviscerated rabbis. Animals were randomly divided into 6 groups (n=4 each according to the 3 implant materials tested and 2 follow-up times of 90 or 180 days. Signs of regional pain and presence of eyelid swelling, conjunctival hyperemia, and amount of exudate were semiquantitatively evaluated. After animals sacrifice, the implants and surrounding ocular tissues were processed for histological staining and polarized light evaluation. Statistical study was performed by ANOVA and Kaplan-Meier analysis. Results. No statistically significant differences in regional pain, eyelid swelling, or conjunctival hyperemia were shown between implants and/or time points evaluated. However, amount of exudate differed, with OCULFIT I causing the smallest amount. No remarkable clinical complications were observed. Histological findings were similar in all three types of implants and agree with minor inflammatory response. Conclusions. OCULFIT ophthalmic tolerance and biocompatibility in rabbits were comparable to the clinically used MEDPOR. Clinical studies are needed to determine if OCULFIT is superior to the orbital implants commercially available.

  13. The Synergistic Effect of Leukocyte Platelet-Rich Fibrin and Micrometer/Nanometer Surface Texturing on Bone Healing around Immediately Placed Implants: An Experimental Study in Dogs

    Science.gov (United States)

    Neiva, Rodrigo F.; Gil, Luiz Fernando; Tovar, Nick; Janal, Malvin N.; Marao, Heloisa Fonseca; Pinto, Nelson; Coelho, Paulo G.

    2016-01-01

    Aims. This study evaluated the effects of L-PRF presence and implant surface texture on bone healing around immediately placed implants. Methods. The first mandibular molars of 8 beagle dogs were bilaterally extracted, and implants (Blossom™, Intra-Lock International, Boca Raton, FL) were placed in the mesial or distal extraction sockets in an interpolated fashion per animal. Two implant surfaces were distributed per sockets: (1) dual acid-etched (DAE, micrometer scale textured) and (2) micrometer/nanometer scale textured (Ossean™ surface). L-PRF (Intraspin system, Intra-Lock International) was placed in a split-mouth design to fill the macrogap between implant and socket walls on one side of the mandible. The contralateral side received implants without L-PRF. A mixed-model ANOVA (at α = 0.05) evaluated the effect of implant surface, presence of L-PRF, and socket position (mesial or distal), individually or in combination on bone area fraction occupancy (BAFO). Results. BAFO values were significantly higher for the Ossean relative to the DAE surface on the larger mesial socket. The presence of L-PRF resulted in higher BAFO. The Ossean surface and L-PRF presence resulted in significantly higher BAFO. Conclusion. L-PRF and the micro-/nanometer scale textured surface resulted in increased bone formation around immediately placed implants. PMID:28042577

  14. The Synergistic Effect of Leukocyte Platelet-Rich Fibrin and Micrometer/Nanometer Surface Texturing on Bone Healing around Immediately Placed Implants: An Experimental Study in Dogs

    Directory of Open Access Journals (Sweden)

    Rodrigo F. Neiva

    2016-01-01

    Full Text Available Aims. This study evaluated the effects of L-PRF presence and implant surface texture on bone healing around immediately placed implants. Methods. The first mandibular molars of 8 beagle dogs were bilaterally extracted, and implants (Blossom™, Intra-Lock International, Boca Raton, FL were placed in the mesial or distal extraction sockets in an interpolated fashion per animal. Two implant surfaces were distributed per sockets: (1 dual acid-etched (DAE, micrometer scale textured and (2 micrometer/nanometer scale textured (Ossean™ surface. L-PRF (Intraspin system, Intra-Lock International was placed in a split-mouth design to fill the macrogap between implant and socket walls on one side of the mandible. The contralateral side received implants without L-PRF. A mixed-model ANOVA (at α=0.05 evaluated the effect of implant surface, presence of L-PRF, and socket position (mesial or distal, individually or in combination on bone area fraction occupancy (BAFO. Results. BAFO values were significantly higher for the Ossean relative to the DAE surface on the larger mesial socket. The presence of L-PRF resulted in higher BAFO. The Ossean surface and L-PRF presence resulted in significantly higher BAFO. Conclusion. L-PRF and the micro-/nanometer scale textured surface resulted in increased bone formation around immediately placed implants.

  15. The Synergistic Effect of Leukocyte Platelet-Rich Fibrin and Micrometer/Nanometer Surface Texturing on Bone Healing around Immediately Placed Implants: An Experimental Study in Dogs.

    Science.gov (United States)

    Neiva, Rodrigo F; Gil, Luiz Fernando; Tovar, Nick; Janal, Malvin N; Marao, Heloisa Fonseca; Bonfante, Estevam Augusto; Pinto, Nelson; Coelho, Paulo G

    2016-01-01

    Aims. This study evaluated the effects of L-PRF presence and implant surface texture on bone healing around immediately placed implants. Methods. The first mandibular molars of 8 beagle dogs were bilaterally extracted, and implants (Blossom™, Intra-Lock International, Boca Raton, FL) were placed in the mesial or distal extraction sockets in an interpolated fashion per animal. Two implant surfaces were distributed per sockets: (1) dual acid-etched (DAE, micrometer scale textured) and (2) micrometer/nanometer scale textured (Ossean™ surface). L-PRF (Intraspin system, Intra-Lock International) was placed in a split-mouth design to fill the macrogap between implant and socket walls on one side of the mandible. The contralateral side received implants without L-PRF. A mixed-model ANOVA (at α = 0.05) evaluated the effect of implant surface, presence of L-PRF, and socket position (mesial or distal), individually or in combination on bone area fraction occupancy (BAFO). Results. BAFO values were significantly higher for the Ossean relative to the DAE surface on the larger mesial socket. The presence of L-PRF resulted in higher BAFO. The Ossean surface and L-PRF presence resulted in significantly higher BAFO. Conclusion. L-PRF and the micro-/nanometer scale textured surface resulted in increased bone formation around immediately placed implants.

  16. Safety and Biocompatibility of a New High-Density Polyethylene-Based Spherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits

    Science.gov (United States)

    Fernandez-Bueno, Ivan; Di Lauro, Salvatore; Alvarez, Ivan; Lopez, Jose Carlos; Garcia-Gutierrez, Maria Teresa; Fernandez, Itziar; Larra, Eva; Pastor, Jose Carlos

    2015-01-01

    Purpose. To evaluate clinically and histologically the safety and biocompatibility of a new HDPE-based spherical porous orbital implants in rabbits. Methods. MEDPOR (Porex Surgical, Inc., Fairburn, GA, USA), OCULFIT I, and OCULFIT II (AJL Ophthalmic S.A., Vitoria, Spain) implants were implanted in eviscerated rabbis. Animals were randomly divided into 6 groups (n = 4 each) according to the 3 implant materials tested and 2 follow-up times of 90 or 180 days. Signs of regional pain and presence of eyelid swelling, conjunctival hyperemia, and amount of exudate were semiquantitatively evaluated. After animals sacrifice, the implants and surrounding ocular tissues were processed for histological staining and polarized light evaluation. Statistical study was performed by ANOVA and Kaplan-Meier analysis. Results. No statistically significant differences in regional pain, eyelid swelling, or conjunctival hyperemia were shown between implants and/or time points evaluated. However, amount of exudate differed, with OCULFIT I causing the smallest amount. No remarkable clinical complications were observed. Histological findings were similar in all three types of implants and agree with minor inflammatory response. Conclusions. OCULFIT ophthalmic tolerance and biocompatibility in rabbits were comparable to the clinically used MEDPOR. Clinical studies are needed to determine if OCULFIT is superior to the orbital implants commercially available. PMID:26689343

  17. Prospects of implant with locking plate in fixation of subtrochanteric fracture: experimental demonstration of its potential benefits on synthetic femur model with supportive hierarchical nonlinear hyperelastic finite element analysis

    Directory of Open Access Journals (Sweden)

    Latifi Mohammed

    2012-04-01

    Full Text Available Abstract Background Effective fixation of fracture requires careful selection of a suitable implant to provide stability and durability. Implant with a feature of locking plate (LP has been used widely for treating distal fractures in femur because of its favourable clinical outcome, but its potential in fixing proximal fractures in the subtrochancteric region has yet to be explored. Therefore, this comparative study was undertaken to demonstrate the merits of the LP implant in treating the subtrochancteric fracture by comparing its performance limits against those obtained with the more traditional implants; angle blade plate (ABP and dynamic condylar screw plate (DCSP. Materials and Methods Nine standard composite femurs were acquired, divided into three groups and fixed with LP (n = 3, ABP (n = 3 and DCSP (n = 3. The fracture was modeled by a 20 mm gap created at the subtrochanteric region to experimentally study the biomechanical response of each implant under both static and dynamic axial loading paradigms. To confirm the experimental findings and to understand the critical interactions at the boundaries, the synthetic femur/implant systems were numerically analyzed by constructing hierarchical finite element models with nonlinear hyperelastic properties. The predictions from the analyses were then compared against the experimental measurements to demonstrate the validity of each numeric model, and to characterize the internal load distribution in the femur and load bearing properties of each implant. Results The average measurements indicated that the constructs with ABP, DCPS and LP respectively had overall stiffness values of 70.9, 110.2 and 131.4 N/mm, and exhibited reversible deformations of 12.4, 4.9 and 4.1 mm when the applied dynamic load was 400 N and plastic deformations of 11.3, 2.4 and 1.4 mm when the load was 1000 N. The corresponding peak cyclic loads to failure were 1100, 1167 and 1600 N. The errors

  18. Use of Hardware Battery Drill in Orthopedic Surgery.

    Science.gov (United States)

    Satish, Bhava R J; Shahdi, Masood; Ramarao, Duddupudi; Ranganadham, Atmakuri V; Kalamegam, Sundaresan

    2017-03-01

    Among the power drills (Electrical/Pneumatic/Battery) used in Orthopedic surgery, battery drill has got several advantages. Surgeons in low resource settings could not routinely use Orthopedic battery drills (OBD) due to the prohibitive cost of good drills or poor quality of other drills. "Hardware" or Engineering battery drill (HBD) is a viable alternative to OBD. HBD is easy to procure, rugged in nature, easy to maintain, durable, easily serviceable and 70 to 75 times cheaper than the standard high end OBD. We consider HBD as one of the cost effective equipment in Orthopedic operation theatres.

  19. 21 CFR 888.5850 - Nonpowered orthopedic traction apparatus and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonpowered orthopedic traction apparatus and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.5850 Nonpowered orthopedic traction apparatus and accessories. (a) Identification. A nonpowered orthopedic traction apparatus...

  20. Learning styles of first-year orthopedic surgical residents at 1 accredited institution.

    Science.gov (United States)

    Caulley, Lisa; Wadey, Veronica; Freeman, Risa

    2012-01-01

    This study represents 1 arm of a 5-year prospective study investigating the learning styles of orthopedic residents and their surgical educators. This project investigates the learning styles of the 2009-2010 year 1 orthopedic surgical residents. A cross-sectional survey using the Kolb Learning Style Inventory was completed by 13 first year orthopedic residents. Direct 1-to-1 interviews were completed with the primary investigator and each participant using the Kolb Learning Style Inventory and learning styles were determined. Converging learning style was the most common among the residents (53.8%). Residents demonstrated a high tendency toward the learning skill of abstract conceptualization combined with active experimentation, and a transition from action-oriented to more reflective learning style with age and postgraduate education. These results may be useful in creating strategies specific to each learning style that will be offered to residents to enhance future teaching and learning. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Intracranial biodegradable silica-based nimodipine drug release implant for treating vasospasm in subarachnoid hemorrhage in an experimental healthy pig and dog model.

    Science.gov (United States)

    Koskimäki, Janne; Tarkia, Miikka; Ahtola-Sätilä, Tuula; Saloranta, Lasse; Simola, Outi; Forsback, Ari-Pekka; Laakso, Aki; Frantzén, Janek

    2015-01-01

    Nimodipine is a widely used medication for treating delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. When administrated orally or intravenously, systemic hypotension is an undesirable side effect. Intracranial subarachnoid delivery of nimodipine during aneurysm clipping may be more efficient way of preventing vasospasm and DCI due to higher concentration of nimodipine in cerebrospinal fluid (CSF). The risk of systemic hypotension may also be decreased with intracranial delivery. We used animal models to evaluate the feasibility of surgically implanting a silica-based nimodipine releasing implant into the subarachnoid space through a frontotemporal craniotomy. Concentrations of released nimodipine were measured from plasma samples and CSF samples. Implant degradation was followed using CT imaging. After completing the recovery period, full histological examination was performed on the brain and meninges. The in vitro characteristics of the implant were determined. Our results show that the biodegradable silica-based implant can be used for an intracranial drug delivery system and no major histopathological foreign body reactions were observed. CT imaging is a feasible method for determining the degradation of silica implants in vivo. The sustained release profiles of nimodipine in CSF were achieved. Compared to a traditional treatment, higher nimodipine CSF/plasma ratios can be obtained with the implant.

  2. Intracranial Biodegradable Silica-Based Nimodipine Drug Release Implant for Treating Vasospasm in Subarachnoid Hemorrhage in an Experimental Healthy Pig and Dog Model

    Directory of Open Access Journals (Sweden)

    Janne Koskimäki

    2015-01-01

    Full Text Available Nimodipine is a widely used medication for treating delayed cerebral ischemia (DCI after subarachnoid hemorrhage. When administrated orally or intravenously, systemic hypotension is an undesirable side effect. Intracranial subarachnoid delivery of nimodipine during aneurysm clipping may be more efficient way of preventing vasospasm and DCI due to higher concentration of nimodipine in cerebrospinal fluid (CSF. The risk of systemic hypotension may also be decreased with intracranial delivery. We used animal models to evaluate the feasibility of surgically implanting a silica-based nimodipine releasing implant into the subarachnoid space through a frontotemporal craniotomy. Concentrations of released nimodipine were measured from plasma samples and CSF samples. Implant degradation was followed using CT imaging. After completing the recovery period, full histological examination was performed on the brain and meninges. The in vitro characteristics of the implant were determined. Our results show that the biodegradable silica-based implant can be used for an intracranial drug delivery system and no major histopathological foreign body reactions were observed. CT imaging is a feasible method for determining the degradation of silica implants in vivo. The sustained release profiles of nimodipine in CSF were achieved. Compared to a traditional treatment, higher nimodipine CSF/plasma ratios can be obtained with the implant.

  3. Impact of immediate loading on early bone healing at two-piece implants placed in fresh extraction sockets: an experimental study in the beagle dog.

    Science.gov (United States)

    Blanco, Juan; Mareque, Santiaqo; Liñares, Antonio; Pérez, Javier; Muñoz, Fernando; Ramos, Isabel

    2013-04-01

    To study early bone healing of immediately loaded implants placed in fresh extraction sockets versus immediate implants without occlusal loading in the dog. A total of 48 implants were placed in the distal sockets of Pm3 and Pm4 in the lower jaw of 12 Beagle dogs immediately after tooth extraction. In the control group, no loading was applied. In the test group, an immediate loading restoration with occlusal contacts was performed. Dogs were sacrificed at 2, 4 and 8 weeks for histological analysis. At the end of the study, there was a 100% implant and prosthesis survival. Similar results for test and control groups were observed for bone-to-implant contact (%) and peri-implant bone area. Inter-thread bone area tended to decrease in the control and increase in the test. With respect to ridge alterations, bone resorption was more pronounced on the buccal aspect and was observed in both groups. Immediate loading did not impair early stages of bone healing and crestal bone modelling at two-piece implants in fresh extraction sockets in the beagle dog; however, bone resorption occurred in all specimens in both groups. © 2013 John Wiley & Sons A/S.

  4. Dedicated orthopedic operating room unit improves operating room efficiency.

    Science.gov (United States)

    Small, Travis J; Gad, Bishoy V; Klika, Alison K; Mounir-Soliman, Loran S; Gerritsen, Ryan L; Barsoum, Wael K

    2013-08-01

    We investigated the effectiveness of dedicated orthopedic operating rooms (OR) on minimizing time spent on perioperative processes to increase OR throughput in total knee and hip arthroplasty procedures. The use of a dedicated orthopedic unit that included 6 ORs with staff allocated only for those ORs was compared to the use of a traditional staffing model. After matching to simulate randomization, each group consisted of 422 procedures. The dedicated orthopedic unit improved average anesthesia controlled time by 4 minutes (Poperative time by 7 minutes (P=.004) and turnover time by 8 minutes (P<.001). An overall improvement of 19 minutes per procedure using the dedicated unit was observed. Utilizing a dedicated orthopedic unit can save time without increasing adverse events. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Prevalence of internet and social media usage in orthopedic surgery

    National Research Council Canada - National Science Library

    Curry, Emily; Li, Xinning; Nguyen, Joseph; Matzkin, Elizabeth

    2014-01-01

    .... The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize...

  6. Orthopedic Health: Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... Orthopedic Health Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment Past Issues / Spring 2009 Table of Contents For ... may be used to help achieve an accurate diagnosis, including: ... joint for examination Treatment The only type of arthritis that can be ...

  7. Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery

    NARCIS (Netherlands)

    Struijk-Mulder, M. C.; Ettema, H. B.; Verheyen, C. C.; Büller, H. R.

    2010-01-01

    BACKGROUND: Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. OBJECTIVES: We aimed to compare (inter)national guidelines and analyse differences. Methods: MEDLINE, the Cochrane Library and the internet were searched for guidelines on the

  8. Single-staged implant placement using bone ring technique with and without membrane placement: An experimental study in the Beagle dog.

    Science.gov (United States)

    Haga-Tsujimura, Maiko; Nakahara, Ken; Kobayashi, Eizaburo; Igarashi, Kensuke; Schaller, Benoit; Saulacic, Nikola

    2017-12-12

    To evaluate the impact of a collagen membrane on bone remodeling and osseointegration of implants placed simultaneously with a bone ring technique. Standardized, vertical alveolar bone defects in the mandibles of six dogs were created. Tapered dental implants designed for two-stage subcrestal placement were inserted simultaneously with a bone ring technique. On one side of the mandible, the augmented sites were covered with a collagenous membrane. Implants with (M Group) and without membranes (NM Group) were left for an osseointegration period of 3 and 6 months, respectively. Block biopsies of the implants with surrounding bone were harvested and analyzed histologically. Implant exposure was a common finding (2/3) concomitantly with loss of healing caps. It appeared to be related to advanced bone loss around the implants. Exposure of implants was more frequent in M Group, however, without significant differences when compared to NM Group. The total bone area within the region of the bone ring was greater in the NM Group compared to the M Group. Moreover, in the region of the pristine bone of the M Group, the total bone was greater than at the corresponding NM Group sites at both observation periods. A nonparametric analysis of variance (ANOVA) revealed no significant effects of membrane placement or healing period on the total area of the bone. The total bone-to-implant contact (BIC) for the two groups was similar at each observation time point. However, BIC increased significantly at 6-month compared with 3-month observation period (p = .0088) in both groups. In vertical bone augmentation applying the bone ring technique, the disruption of soft tissue was a frequent complication. Membrane placement yielded no significant advantage on the osseointegration (BIC) of implants or bone characteristics. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Clinical Aspects of Combination of Aesthetic Fixed Orthopedic Appliances

    OpenAIRE

    Ozhohan, Z. R.; Biben, A. B.

    2016-01-01

    The article presents the results of examination of 80 patients with aesthetic fixed orthopedic appliances. The state of the occlusal surface of fixed orthopedic appliances as well as the occlusal contact surface area was studied. The occlusal surfaces were made of ceramics and zirconium dioxide. The surface area of occlusal contacts was studied using 3Shape Dental System since computer occlusiography provides the most accurate results. Physical examination indicated a higher level of ceramic ...

  10. On the use of drains in orthopedic and trauma

    African Journals Online (AJOL)

    2013-11-08

    Nov 8, 2013 ... On the use of drains in orthopedics and trauma. 367. Nigerian Journal of Clinical Practice • May-Jun 2014 • Vol 17 • Issue 3 may be incurred by the patient, not to mention the distress cause to the patient for another visit to the theatre.[4‑7] In a study of Orthopedic surgeons of the mid‑Trent region of the.

  11. Rehabilitation of orthopedic and rheumatologic disorders. 4. Musculoskeletal disorders.

    Science.gov (United States)

    Kaelin, D L; Oh, T H; Lim, P A; Brander, V A; Biundo, J J

    2000-03-01

    This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with orthopedic and musculoskeletal disorders. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses new advances in such topics as idiopathic scoliosis, nontraumatic shoulder pain, rotator cuff tendinitis, and Dupuytren's disease.

  12. Factors affecting orthopedic residency selection: a cross-sectional survey.

    Science.gov (United States)

    Strelzow, Jason; Petretta, Robert; Broekhuyse, Henry M

    2017-06-01

    Annually, orthopedic residency programs rank and recruit the best possible candidates. Little evidence exists identifying factors that potential candidates use to select their career paths. Recent literature from nonsurgical programs suggests hospital, social and program-based factors influence program selection. We sought to determine what factors influence the choice of an orthopedic career and a candidate's choice of orthopedic residency program. We surveyed medical student applicants to orthopedic programs and current Canadian orthopedic surgery residents (postgraduate year [PGY] 1-5). The confidential online survey focused on 3 broad categories of program selection: educational, program cohesion and noneducation factors. Questions were graded on a Likert Scale and tailed for mean scores. In total, 139 residents from 11 of 17 Canadian orthopedic programs (49% response rate) and 23 medical student applicants (88% response rate) completed our survey. Orthopedic electives and mandatory rotations were reported by 71% of participants as somewhat or very important to their career choice. Collegiality among residents (4.70 ± 0.6), program being the "right fit" (4.65 ± 0.53) and current resident satisfaction with their chosen program (4.63 ±0.66) were ranked with the highest mean scores on a 5-point Likert scale. There are several modifiable factors that residency programs may use to attract applicants, including early availability of clerkship rotations and a strong mentorship environment emphasizing both resident-resident and resident-staff cohesion. Desirable residency programs should develop early access to surgical and operative skills. These must be balanced with a continued emphasis on top-level orthopedic training.

  13. How Useful are Orthopedic Surgery Residency Web Pages?

    Science.gov (United States)

    Oladeji, Lasun O; Yu, Jonathan C; Oladeji, Afolayan K; Ponce, Brent A

    2015-01-01

    Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by

  14. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective

    OpenAIRE

    Zheng, Guoyan; Nolte, Lutz P.

    2015-01-01

    Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual repre...

  15. Implantable contraception.

    Science.gov (United States)

    Meckstroth, K R; Darney, P D

    2000-12-01

    Although levonorgestrel contraceptive implants have been available for over 15 years, innovations have only recently led to a wider choice. These new implants offer easier insertion and removal and other advantages depending on the type of progestin. Implants prevent pregnancy by several mechanisms, including inhibition of ovulation and luteal function and alteration of cervical mucus and the endometrium. The high efficacy and ease of maintenance make implants an ideal contraceptive for many women, including adolescents, a population that uses implants infrequently but reports high satisfaction. Implants are appropriate for women who are breastfeeding, who have contraindications to estrogen, or who have diseases such as diabetes, hypertension, sickle cell anemia, or an HIV infection because implants have few metabolic or hematologic effects. Long-term use has not been associated with a decrease in BMD and generally leads to increased blood levels and iron stores. Women who wish to space their pregnancies appreciate the nearly immediate onset of action with insertion and the rapid termination of all effects with removal. All types of implants lead to menstrual changes and other side effects in some women. Adverse effects that occur in implant users more than the general population include headaches and acne. Women must be thoroughly counseled regarding the potential for menstrual alteration, side effects, and sexually transmitted infections if they do not use condoms. Despite their initial high cost, implants are a cost-effective method over several years, even when discontinued before the life of the implant.

  16. Orthopedic injuries associated with backyard trampoline use in children.

    Science.gov (United States)

    Black, G Brian; Amadeo, Ryan

    2003-06-01

    Trampolining on an outdoor oval or circular trampoline is a popular activity for children but is associated with a number of orthopedic injuries, especially in children between the ages of 5 and 15 years. In this paper we review the orthopedic injuries in children associated with backyard trampoline use, through our experience with a series of children admitted to the Winnipeg Children's Hospital, the only tertiary care pediatric centre in Manitoba. We reviewed the charts, x-ray films and operative reports for 80 children under 16 years old (mean 9 yr, with 14 [18%] children between 2 and 4 yr) with an orthopedic injury sustained when using a trampoline in the backyard. We noted the mechanism of injury and type and severity of orthopedic injury sustained. Fifty-two (65%) children were injured on the trampoline mat, and 24 (30%) were injured when they were ejected from the trampoline. Sixty (75%) children sustained a fracture or fracture-dislocation. Forty-eight (80%) orthopedic injuries occurred in the upper extremity. No child died as a result of a trampoline injury. The use of the "backyard" trampoline by young children can cause significant orthopedic injury.

  17. [Technical orthopedics. Importance in an increasingly operatively oriented faculty].

    Science.gov (United States)

    Greitemann, B; Maronna, U

    2013-10-01

    The foundation of the German Society for Orthopedics in 1901 was due to a separation from the faculty of surgery because a surgical approach alone did not adequately deal with the symptoms. Orthopedists were initially considered as a fringe group. The conservative treatment approach was initially at the forefront and operative measures were a side line. The main aim was the rehabilitation of patients into a normal life as best as possible. In the conservative area treatment with orthopedic technical aids and appliances rapidly came to play an important role and a great multitude of technical appliances were developed with sometimes very different possible applications. Despite the clearly improved operative treatment approaches in orthopedics and trauma surgery, technical orthopedics still plays a substantial role even today. Healing and supportive aids and appliances are of decisive importance for the treatment of a multitude of diseases and handicaps. They stabilize and improve operative treatment results and often result in new approaches. This depends on cooperation between technicians, therapists and physicians in a team, even in the scientific field. Evidence-based studies on the effectiveness of technical aids are currently still uncommon but recently some clear evidence for effectiveness could be shown. Scientifically this is a very varied field of work. The demographic development presents new requirements which must be dealt with. Technical solutions are often very promising especially in this field. Technical orthopedics remains an important component of the specialty of orthopedics and trauma surgery and with an increasing tendency due to more recent research and development.

  18. Preferred use of polyhexanide in orthopedic surgery.

    Science.gov (United States)

    Röhner, Eric; Seeger, Jörn B; Hoff, Paula; Pfitzner, Tilman; Preininger, Bernd; Andreas, Kristin; Buttgereit, Frank; Perka, Carsten; Matziolis, Georg

    2011-10-05

    In orthopedic and trauma surgery, the most frequently used antiseptic is polyhexanide. Its favored application is based on prepossessing tissue compatibility in contrast to various antiseptics and a high antimicrobiological effect. Recent studies showed toxic effects of this antiseptic on human chondrocytes. The aim of this study was to further analyze the toxic and apoptotic effects of polyhexanide on primary human chondrocytes. The hypothesis of this study was that polyhexanide induces apoptosis on human chondrocytes. Primary human chondrocytes were isolated and cultured from human donors with osteoarthritis of the knee who underwent total arthroplasty and had no indication of infection. Polyhexanide at a standard concentration of 0.04% was added to the monolayer cultures. Early and late apoptotic cells were analyzed by flow cytometric detection of annexin V, active caspases, and 7AAD, and by fluorescence microscopy using annexin V and propidium iodide staining. Flow cytometric analysis demonstrated an increase of annexin V and active caspases expression of human chondrocytes after incubation with polyhexanide. Fluorescence microscopy demonstrated a high number of annexin V positive and propidium iodide negative early apoptotic cells. The data show that polyhexanide promotes apoptosis on primary human chondrocytes in vitro, which may indicate the use of polyhexanide in septic joint surgery. Copyright 2011, SLACK Incorporated.

  19. Physician-Hospital Alignment in Orthopedic Surgery.

    Science.gov (United States)

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. Copyright 2015, SLACK Incorporated.

  20. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  1. Coagulation studies in patients with orthopedic trauma

    Directory of Open Access Journals (Sweden)

    Rangarajan Kanchana

    2010-01-01

    Full Text Available Background : Head injury, severe acidosis, hypothermia, massive transfusion and hypoxia often complicate traumatic coagulopathy. First line investigations such as prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, platelet count and D-dimer levels help in the initial assessment of coagulopathy in a trauma victim. Aim : To study the coagulation profile in patients of orthopedic trauma. Settings and Design : Prospective study. Patients and Methods : Patients with head injury, severe acidosis, massive transfusion and severe hypoxia were excluded from the study. Coagulation parameters were evaluated at three intervals, at the time of admission, intra operatively and in the postoperative period. Statistical Analysis : Chi-square test was used for analysis of categorical variables. For comparison between groups, two- way ANOVA was used. Results and Conclusions : Of the 48 patients studied, 38 (80% had normal DIC scores upon admission and only 10 (20% had mild DIC scores at the time of admission. The median Injury Severity Score was 34 and they did not correlate with DIC scores. Fibrinogen levels alone were significantly different, increased progressively (mean pre op, intra op and post op levels 518 ± 31,582 ± 35 and 643 ± 27 respectively; P ≤ 0.02 since the time of admission in these patients. All the other parameters remained unchanged. Further large scale prospective studies would be required to correlate elevated fibrinogen levels with the type of trauma or surgery.

  2. Dental Implant Surgery

    Science.gov (United States)

    ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ...

  3. Hard and soft tissue changes around implants installed in regular-sized and reduced alveolar bony ridges. An experimental study in dogs.

    Science.gov (United States)

    Baffone, Gabriele; Lang, Niklaus P; Pantani, Fabio; Favero, Giovanni; Ferri, Mauro; Botticelli, Daniele

    2015-01-01

    To study bony and soft tissue changes at implants installed in alveolar bony ridges of different widths. In 6 Labrador dogs, the mandibular premolars and first molars were extracted, and a buccal defect was created in the left side at the third and fourth premolars by removing the buccal bone and the inter-radicular and interdental septa. Three months after tooth extraction, full-thickness mucoperiosteal flaps were elevated, and implants were installed, two at the reduced (test) and two at the regular-sized ridges (control). Narrow or wide abutments were affixed to the implants. After 3 months, biopsies were harvested, and ground sections prepared for histological evaluation. A higher vertical buccal bony crest resorption was found at the test (1.5 ± 0.7 mm and 1.0 ± 0.7 mm) compared to the control implants (1.0 ± 0.5 mm and 0.7 ± 0.4 mm), for both wide and narrow abutment sites. A higher horizontal alveolar resorption was identified at the control compared to the test implants. The difference was significant for narrow abutment sites. The peri-implant mucosa was more coronally positioned at the narrow abutment, in the test sites, while for the control sites, the mucosal adaptation was more coronal at the wide abutment sites. These differences, however, did not reach statistical significance. Implants installed in regular-sized alveolar ridges had a higher horizontal, but a lower vertical buccal bony crest resorption compared to implants installed in reduced alveolar ridges. Narrow abutments in reduced ridges as well as wide abutments in regular-sized ridges yielded less soft tissue recession compared to their counterparts. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Como o especialista em ortopedia e traumatologia avalia o atendimento ao trauma ortopédico no Brasil How do orthopedic surgeons rate the orthopedic trauma care in Brazil

    Directory of Open Access Journals (Sweden)

    Jorge Santos Silva

    2011-01-01

    Full Text Available OBJETIVO: Apresentar os resultados de pesquisa Datafolha, realizada no período de 23 de setembro a 18 de outubro de 2010, sobre as condições existentes para o exercício profissional na área do trauma ortopédico no Brasil. MÉTODOS: pesquisa quantitativa, com abordagem telefônica dos entrevistados, por meio de sorteio aleatório de membros da Sociedade Brasileira de Ortopedia e Traumatologia, em cadastro contendo mais de 7.000 nomes. As entrevistas foram realizadas mediante aplicação de questionário estruturado, com aproximadamente 25 minutos de duração. RESULTADOS: 97% dos entrevistados dedica parte do seu tempo ao trauma ortopédico. 87% dos entrevistados exercem outra sub-especialidade, que não o trauma ortopédico. Na média dos atendimentos no país, 43% dos pacientes pertencem à rede pública de saúde e 41% pertencem à rede de convênios. O uso de implantes importados ocorre na minoria das situações (36% e 83% dos médicos que utilizam ambos os tipos de implantes julga que os nacionais apresentam qualidade inferior. 61% dos entrevistados julga a qualidade do atendimento em serviços públicos regular, ruim ou péssima. Metade dos entrevistados declara ter problemas para a liberação de suas solicitações de procedimentos junto aos planos de saúde em pelo menos 25% das vezes em que encaminham tais pedidos. CONCLUSÃO: O trauma ortopédico é uma especialidade exercida pela grande maioria dos ortopedistas brasileiros. A estrutura dos serviços públicos é considerada insatisfatória pela maioria dos ortopedistas entrevistados. A maioria dos ortopedista deseja uma reformulação nos honorários médicos e na infra-estrutura de serviços.OBJECTIVES: The aim of this article is to present the data collected by Datafolha institute, from September 23rd. through October 18th. 2010 about orthopedic trauma care in Brazil. METHOD: A quantitative analysis based on telephonic interviews has been performed. From Brazilian Orthopedic

  5. Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

    Directory of Open Access Journals (Sweden)

    Priscila Rosalba Oliveira

    2016-05-01

    Full Text Available Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42. Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies

  6. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

    Science.gov (United States)

    Oliveira, Priscila Rosalba; Felix, Cassia da Silva; Carvalho, Vladimir Cordeiro de; Giovani, Arlete Mazzini; Reis, Rosangela Suarti Dos; Beraldo, Marisa; Albuquerque, Edmir Peralta; Ferreira, Walter Cintra; Silva, Jorge Dos Santos; Lima, Ana Lucia Lei

    2016-01-01

    Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions

  7. Impact of immediate loading on early soft tissue healing at two-piece implants placed in fresh extraction sockets: an experimental study in the beagle dog.

    Science.gov (United States)

    Mareque, S; Liñares, A; Pérez, J; Muñoz, F; Ramos, I; Blanco, J

    2014-08-01

    To study early soft tissue healing of immediately placed implants with or without immediate loading in the dog. Forty-eight implants were placed in the distal sockets of Pm3 and Pm4 in the lower jaw of 12 beagle dogs immediately after tooth extraction. In the control group, no loading was applied. In the test group, an immediate loading restoration with occlusal contacts was performed. Dogs were sacrificed at 2, 4, and 8 weeks for histological analysis. At the end of the study, there was a 100% implant and prosthesis survival. The biological width dimension was similar in both groups at all the studied healing periods. This dimension tended to decrease from week 2 to 8 in both groups, on both the buccal and lingual side. The barrier epithelium tended to stop at the implant-abutment interface in both groups and also decreased in length from week 2 to 8, on the buccal and the lingual side. Soft tissue recession remained low and occurred mainly in the test group. The characteristics, dimension, and healing pattern of the peri-implant soft tissues were similar around immediate implants with or without immediate loading. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Characteristics and trends of orthopedic publications between 2000 and 2009.

    Science.gov (United States)

    Lee, Kyoung Min; Ryu, Mi Sun; Chung, Chin Youb; Choi, In Ho; Kwon, Dae Gyu; Kim, Tae Won; Sung, Ki Hyuk; Seo, Sang Gyo; Park, Moon Seok

    2011-09-01

    This study was undertaken to investigate the trends of orthopedic publications during the last decade, and to document the country of origin, journal, funding source, and language of contribution using PubMed. Orthopedic articles published between 2000 and 2009 were retrieved from PubMed using the following search terms: "orthopaedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])" and "orthopedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])." The articles were downloaded in XML file format, which contained the following information: article title, author names, journal names, publication dates, article types, languages, authors' affiliations and funding sources. These information was extracted, sorted, and rearranged using the database's management software. We investigated the annual number of published orthopedic articles worldwide and the annual rate of increase. Furthermore, the country of publication origin, journal, funding source, and language of contribution were also investigated. A total of 46,322 orthopedic articles were published and registered in PubMed in the last 10 years. The worldwide number of published orthopedic articles increased from 2,889 in 2000 to 6,909 in 2009, showing an annual increase of 384.6 articles, or an annualized compound rate of 10.2%. The United States ranked highest in the number of published orthopedic articles, followed by Japan, the United Kingdom, Germany, and the Republic of Korea. Among the orthopedic articles published worldwide during the last 10 years, 37.9% pertained studies performed in the United States. Fifty-seven point three percent (57.3%) of articles were published in journals established in the United States. Among the published orthopaedic articles, 4,747 articles (10.2%) disclosed financial support by research funds, of which 4,688 (98.8%) articles utilized research funds from the United States. Most articles were published in English (97.2%, 45,030 articles). The number of published

  9. The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery.

    Science.gov (United States)

    Conway, Devin James; Coughlin, Richard; Caldwell, Amber; Shearer, David

    2017-01-01

    In 2006, surgeons at the University of California, San Francisco (UCSF) established the Institute for Global Orthopedics and Traumatology (IGOT), an initiative within the department of orthopedic surgery. The principal aim of IGOT is to create long-term, sustainable solutions to the growing burden of musculoskeletal injury in low- and middle-income countries (LMICs) through academic partnership. IGOT currently has relationships with teaching hospitals in Ghana, Malawi, Tanzania, Nicaragua, and Nepal. The organizational structure of IGOT is built on four pillars: Global Surgical Education (GSE), Global Knowledge Exchange (GKE), Global Research Initiative (GRI), and Global Leadership and Advocacy. GSE focuses on increasing surgical knowledge and technical proficiency through hands-on educational courses. The GKE facilitates the mutual exchange of surgeons and trainees among IGOT and its partners. This includes a global resident elective that allows UCSF residents to complete an international rotation at one of IGOT's partner sites. The GRI strives to build research capacity and sponsor high-quality clinical research projects that address questions relevant to local partners. The fourth pillar, Global Leadership and Advocacy aims to increase awareness of the global impact of musculoskeletal injury through national and international courses and events, such as the Bay Area Global Health Film Festival. At the core of each tenet is the collaboration among IGOT and its international partners. Over the last decade, IGOT has experienced tremendous growth and maturation in its partnership model based on cumulative experience and the needs of its partners.

  10. miR-451 deficiency is associated with altered endometrial fibrinogen alpha chain expression and reduced endometriotic implant establishment in an experimental mouse model.

    Directory of Open Access Journals (Sweden)

    Warren B Nothnick

    Full Text Available Endometriosis is defined as the growth of endometrial glandular and stromal components in ectopic locations and affects as many as 10% of all women of reproductive age. Despite its high prevalence, the pathogenesis of endometriosis remains poorly understood. MicroRNAs, small non-coding RNAs that post-transcriptionally regulate gene expression, are mis-expressed in endometriosis but a functional role in the disease pathogenesis remains uncertain. To examine the role of microRNA-451 (miR-451 in the initial development of endometriosis, we utilized a novel mouse model in which eutopic endometrial fragments used to induce endometriosis were deficient for miR-451. After induction of the disease, we evaluated the impact of this deficiency on implant development and survival. Loss of miR-451 expression resulted in a lower number of ectopic lesions established in vivo. Analysis of differential protein profiles between miR-451 deficient and wild-type endometrial fragments revealed that fibrinogen alpha polypeptide isoform 2 precursor was approximately 2-fold higher in the miR-451 null donor endometrial tissue and this elevated expression of the protein was associated with altered expression of the parent fibrinogen alpha chain mRNA and protein. As this polypeptide contains RGD amino acid "cell adhesion" motifs which could impact early establishment of lesion development, we examined and confirmed using a cyclic RGD peptide antagonist, that endometrial cell adhesion and endometriosis establishment could be respectively inhibited both in vitro and in vivo. Collectively, these results suggest that the reduced miR-451 eutopic endometrial expression does not enhance initial establishment of these fragments when displaced into the peritoneal cavity, that loss of eutopic endometrial miR-451 expression is associated with altered expression of fibrinogen alpha chain mRNA and protein, and that RGD cyclic peptide antagonists inhibit establishment of endometriosis

  11. The effect of anterior cruciate ligament resection and immediate or delayed implantation of a meniscus prosthesis on knee joint biomechanics and cartilage. An experimental study in rabbits.

    Science.gov (United States)

    Sommerlath, K G; Gillquist, J

    1993-04-01

    In a rabbit experiment with anterior cruciate ligament (ACL) resection, immediate substitution of the medial meniscus with a prosthesis was compared with delayed prosthetic implantation after a postmeniscectomy period of three weeks. The knees with a prosthetic implant were compared with their contralateral joints as well as to joints with an intact ACL and menisci. Anterior cruciate ligament resection alone led to disturbed biomechanics and cartilage degeneration. Anterior cruciate ligament resection in combination with meniscus resection increased cartilage degeneration and led to more inferior biomechanics. Ingrowth and stable fixation was less frequent when the prosthesis was inserted three weeks after meniscus resection than when inserted immediately. Furthermore, in knees with delayed prosthetic implantation, only minor improvement in terms of cartilage protection was shown when compared with knees with resection only. In contrast, knees with immediate meniscus replacement demonstrated similar joint stiffness and stress relaxation characteristics and similar cartilage protection effects as knees with a nonresected medial meniscus.

  12. Level of evidence in Spine compared to other orthopedic journals.

    Science.gov (United States)

    Wupperman, Richard; Davis, Rick; Obremskey, William T

    2007-02-01

    Two reviewers rated the 112 clinical articles, from January through June 2003, published in Spine using a level-of-evidence grading system. The ratings were compared to previously published ratings of 2 orthopedic journals with similar impact factors. To compare Spine to other orthopedic journals using a level-of-evidence rating system. A previous study evaluating the levels of evidence in 9 orthopedic journals found a correlation between higher-level studies and journal impact factor. Spine was not included in the analysis. Studies were designated therapeutic, prognostic, diagnostic, or economic, and their evidence rated as level I, II, III, or IV. Reviewers were blinded to the other's ratings. Ratings were as follows: 43.8% of the Spine articles were therapeutic, 37.5% prognostic, 17.9% diagnostic, and 0.9% economic. Of studies, 16.1% were level I, 22.3% level II, 8.0% level III, and 53.6% level IV. Kappa values for interobserver reliability showed good correlation between reviewers. There was no significant difference among Spine and 2 leading orthopedic journals in their likelihood of publishing level I or II studies. Spine publishes clinical studies with levels of evidence comparable to the 2 orthopedic journals with similar impact factors.

  13. Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

    Directory of Open Access Journals (Sweden)

    Evrim Eylem Akpinar

    2013-06-01

    Full Text Available OBJECTIVE: Pulmonary embolism (PE is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age.

  14. Orthopedic injury in electric bicycle-related collisions.

    Science.gov (United States)

    Li, Xiaoxuan; Yun, Zhe; Li, Xiaoxiang; Wang, Yucai; Yang, Tongtao; Zheng, Lianhe; Qian, Jixian

    2017-05-19

    Although electric bicycle-related injuries have become the most common reason for hospitalization due to a road crash in China, no study has comprehensively investigated electric bicycle collisions and their impact on orthopedic injuries; such a study may provide evidence to support a new road safety policy. A retrospective review of orthopedic injuries from electric bicycle collisions was performed in an urban trauma center. We collected variables including age, gender, location of fracture, presence of open or closed fractures, concomitant vascular, and neurologic injuries. A total of 2,044 cases were involved in electric bicycle collisions. The orthopedic injury victims were predominantly male and middle aged. The most common orthopedic injury was a femur fracture. Open fractures frequently involved the forearm and tibia/fibula. Male patients were more likely to suffer from multiple fractures and associated injuries than female patients. Fewer patients age 60 years old or older wore helmets at the time of the accident compared to those in other age groups. Orthopedic injuries from electric bicycle-related accidents cause patients substantial suffering that could lead to serious social consequences. Helmet use and protective clothing or similar safety gear, especially for electric bicycle users, should be required to provide greater protection.

  15. Patient Attitudes Toward Orthopedic Surgeon Ownership of Related Ancillary Businesses.

    Science.gov (United States)

    Yi, Paul H; Cross, Michael B; Johnson, Staci R; Rasinski, Kenneth A; Nunley, Ryan M; Della Valle, Craig J

    2016-08-01

    Physician ownership of businesses related to orthopedic surgery, such as surgery centers, has been criticized as potentially leading to misuse of health care resources. The purpose of this study was to determine patients' attitudes toward surgeon ownership of orthopedic-related businesses. We surveyed 280 consecutive patients at 2 centers regarding their attitudes toward surgeon ownership of orthopedic-related businesses using an anonymous questionnaire. Three surgeon ownership scenarios were presented: (1) owning a surgery center, (2) physical therapy (PT), and (3) imaging facilities (eg, Magnetic Resonance Imaging scanner). Two hundred fourteen patients (76%) completed the questionnaire. The majority agreed that it is ethical for a surgeon to own a surgery center (73%), PT practice (77%), or imaging facility (77%). Most (>67%) indicated that their surgeon owning such a business would have no effect on the trust they have in their surgeon. Although >70% agreed that a surgeon in all 3 scenarios would make the same treatment decisions, many agreed that such surgeons might perform more surgery (47%), refer more patients to PT (61%), or order more imaging (58%). Patients favored surgeon autonomy, however, believing that surgeons should be allowed to own such businesses (78%). Eighty-five percent agreed that patients should be informed if their surgeon owns an orthopedic-related business. Although patients express concern over and desire disclosure of surgeon ownership of orthopedic-related businesses, the majority believes that it is an ethical practice and feel comfortable receiving care at such a facility. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. The effects of maitland orthopedic manual therapy on improving constipation.

    Science.gov (United States)

    Koo, Ja-Pung; Choi, Jung-Hyun; Kim, Nyeon-Jun

    2016-10-01

    [Purpose] This study aimed to examine the effects of interventions on constipation and to provide basic data for physical therapy in internal medicine. [Subjects and Methods] The colon transit times of 30 subjects were measured and after the interventions. Fifteen subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were assigned to a dietary fiber group. [Results] The analysis of changes in colon transit time showed statistically significant differences in left colon transit time, rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic manual therapy group and statistically significant differences in rectosigmoid colon transit time and total colon transit time for the dietary fiber group. An analysis of group differences in the effects of Maitland orthopedic manual therapy and dietary fiber showed that the Maitland orthopedic manual therapy group achieved statistically significantly larger declines in rectosigmoid colon transit time and total colon transit time compared with the dietary fiber group. [Conclusion] This study confirmed that Maitland orthopedic manual therapy can be an effective treatment method for internal conditions such as functional constipation by almost normalizing the colon transit time, not only by improving the symptoms of constipation but also by facilitating intestinal movements.

  17. Efectos de diferentes tratamientos antiosteoporóticos sobre la osteointegración de implantes dentales en un modelo experimental en conejos

    OpenAIRE

    Almagro Fernández, María Isabel

    2011-01-01

    Los ensayos clínicos sugieren que la pérdida de masa ósea con el deterioro de la microarquitectura que caracteriza a la osteoporosis se considera un factor de riesgo para la osteointegración de los implantes dentales. Sin embargo, existen pocos estudios comparativos que proporcionen información sobre los efectos que el tratamiento antiosteoporótico provoca en la osteointegración de implantes dentales en estos pacientes. La hipótesis de esta tesis es que el tratamiento antiosteo...

  18. Optimal Irrigation and Debridement of Infected Joint Implants

    Science.gov (United States)

    Schwechter, Evan M.; Folk, David; Varshney, Avanish K.; Fries, Bettina C.; Kim, Sun Jin; Hirsh, David M.

    2014-01-01

    Acute postoperative and acute, late hematogenous prosthetic joint infections have been treated with 1-stage irrigation and debridement with polyethylene exchange. Success rates, however, are highly variable. Reported studies demonstrate that detergents are effective at decreasing bacterial colony counts on orthopedic implants. Our hypothesis is that the combination of a detergent and an antiseptic would be more effective than using a detergent alone to decrease colony counts from a methicillin-resistant Staphylococcus aureus biofilm-coated titanium alloy disk simulating an orthopedic implant. In our study of various agents tested, chlorhexidine gluconate scrub (antiseptic and detergent) was the most effective at decreasing bacterial colony counts both prereincubation and postreincubation of the disks; pulse lavage and scrubbing were not more effective than pulse lavage alone. PMID:21641757

  19. Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 applicants from 1984 to 2011.

    Science.gov (United States)

    Karnes, Jonathan M; Mayerson, Joel L; Scharschmidt, Thomas J

    2014-01-01

    This study evaluated supply and demand trends for orthopedic postgraduate year 1 (PGY1) positions from 1984 to 2011 for the purpose of estimating national intercandidate competition over time. National Resident Matching Program (NRMP) data for orthopedic surgery from 1984 to 2011 were collected. Proxy variables including (total number of orthopedic applicants/number of orthopedic PGY1 positions), (number of US senior applicants to orthopedics/number of orthopedic PGY1 positions), (number of US seniors matching into orthopedics/number of US senior orthopedic applicants), (total number of matched orthopedic applicants/total number of orthopedic applicants), and (total number of US applicants who fail to match into orthopedics/total number of US senior applicants into orthopedics) as well as average United States Medical Licensing Examination Step 1 scores were used to gauge the level of competition between candidates and were compared over time. Academic medical center in the Midwestern United States. Medical professors and medical students. The NRMP data suggested that the number of positions per applicant decreased or remained stable since 1984 and that the percentage of applicants who did not match was no higher now than in the past. This finding was primarily because of the relative decrease in the ratio of applicants to available PGY1 positions, which stems from the number of positions increasing more rapidly than the number of applicants. The NRMP data from 1984 to 2011 supported our hypothesis that intercandidate competition intensity for orthopedic PGY1 positions has not increased over time. The misconception that orthopedics is becoming more competitive likely arises from the increased number of applications submitted per candidate and the resulting relative importance placed on objective criteria such as United States Medical Licensing Examination Step 1 scores when programs select interview cohorts. Copyright © 2014 Association of Program Directors in

  20. Implant contraception.

    Science.gov (United States)

    Meckstroth, K R; Darney, P D

    2001-12-01

    The experience of 6 million Norplant users has led to several more advanced implants. Implanon is a single-rod implant system containing a low androgenic progestin and requires 1 to 2 minutes for insertion and removal. Like other implants, Implanon prevents pregnancy by changing the character of the cervical mucus and interfering with luteal function. Unlike Norplant, though, Implanon is designed to prevent ovulation for the full duration of use. Implant contraception has several advantages over other types of contraception including high efficacy, minimal required maintenance, absence of estrogen, and rapid return of fertility after discontinuation. Implants can be a good choice for adolescents; women with hypertension, diabetes, anemia, endometriosis, or other medical problems; and women who are breast-feeding. Irregular bleeding is the most common adverse effect of implants and can be treated with several medication regimens. Preinsertion counseling, however, is the most important factor in ensuring satisfaction with implants. Unfortunately, no implant system is currently available in the United States since August 2000, but Implanon is expected to reach the U.S. market within the next 2 years.

  1. Evolving trauma and orthopedics training in the UK.

    Science.gov (United States)

    Inaparthy, Praveen K; Sayana, Murali K; Maffulli, Nicola

    2013-01-01

    The ever-growing population of the UK has resulted in increasing demands on its healthcare service. Changes have been introduced in the UK medical training system to avoid loss of training time and make it more focused and productive. Modernizing medical careers (MMC) was introduced in 2005. This promised to reduce the training period for a safe trauma specialist, in trauma and orthopedics, to 10 years. At around the same time, the European Working Time Directive (EWTD) was introduced to reduce the working hours for junior doctors in training, to improve patient safety and also work-life balance of junior doctors. Introduction of the assessment tools from Orthopedic Competency assessment project (OCAP) will help tailor the training according to the needs of the trainee. The aim of this article is to review the changes in the UK orthopedic surgical training over the past two decades. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Evaluating the lifestyles of physicians and PAs in orthopedics.

    Science.gov (United States)

    Shannon, Katherine M; Merenstein, Daniel J

    2017-01-01

    Limited current research is available comparing job satisfaction and lifestyles of physicians and physician assistants (PAs). Given the professional similarities and the upward trend in employment for both professions, this research is important in educating future professionals and employers. This study examined job contentment among orthopedic physicians and PAs. A cross-sectional survey was designed to assess career and lifestyle satisfaction. The survey was e-mailed to orthopedic clinics across the United States. 27 PAs and 50 physicians completed the survey. Compared with physicians, PAs were more likely to recommend their career and to desire to switch specialties. Physicians reported a higher level of agreement that the professional schedule overshadows personal life, and that the stress and demand of the profession impair personal health. PAs in orthopedics self-reported a higher lifestyle satisfaction than physicians. One specialty was examined and larger, more diverse studies should be conducted.

  3. Therapists, Trainers, and Acupuncturists: Focused Review for the Orthopedic Surgeon.

    Science.gov (United States)

    Domes, Christopher M; Kruger, Cori L

    2015-12-01

    Effective treatment of orthopedic injuries requires a multidisciplinary team, including physical and occupational therapists, athletic trainers, massage therapists, and acupuncturists. Orthopedic surgeons commonly encounter these practitioners but may not be familiar with the training, credentialing, and most importantly, the appropriate use of members of this team. There are general similarities in practice locations as well as types of symptoms addressed by the providers discussed, which include the treatment of physical pain, evaluation and treatment of physical impairment, and some facilitation of adaptation to the limitations caused by injuries. Across the 5 types of providers discussed there are widely varying training and licensing requirements, specializations, and continuing education requirements to maintain licensure. This article provides a focused review of these members of the multidisciplinary team and highlights the current American Academy of Orthopaedic Surgeons recommendations for the use of occupational and physical therapists for orthopedic conditions, including hip fractures, total hip arthroplasty, and anterior cruciate ligament reconstruction. Copyright 2015, SLACK Incorporated.

  4. Particle migration and gap healing around trabecular metal implants

    DEFF Research Database (Denmark)

    Rahbek, O; Kold, S; Zippor, B

    2005-01-01

    Bone on-growth and peri-implant migration of polyethylene particles were studied in an experimental setting using trabecular metal and solid metal implants. Cylindrical implants of trabecular tantalum metal and solid titanium alloy implants with a glass bead blasted surface were inserted either...

  5. Improving surgeon utilization in an orthopedic department using simulation modeling

    Directory of Open Access Journals (Sweden)

    Simwita YW

    2016-10-01

    Full Text Available Yusta W Simwita, Berit I Helgheim Department of Logistics, Molde University College, Molde, Norway Purpose: Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time.Methods: The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization.Results: The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services.Conclusion: This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. Keywords: waiting time, patient, health care process

  6. About Implantable Contraception

    Science.gov (United States)

    ... Helping Your Child Deal With Death About Implantable Contraception KidsHealth > For Parents > About Implantable Contraception Print A ... How Much Does It Cost? What Is Implantable Contraception? Implantable contraception (often called the birth control implant) ...

  7. Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery

    Science.gov (United States)

    Harrysson, Ola L. A.; Marcellin-Little, Denis J.; Horn, Timothy J.

    2015-03-01

    Veterinary medicine has undergone a rapid increase in specialization over the last three decades. Veterinarians now routinely perform joint replacement, neurosurgery, limb-sparing surgery, interventional radiology, radiation therapy, and other complex medical procedures. Many procedures involve advanced imaging and surgical planning. Evidence-based medicine has also become part of the modus operandi of veterinary clinicians. Modeling and additive manufacturing can provide individualized or customized therapeutic solutions to support the management of companion animals with complex medical problems. The use of metal additive manufacturing is increasing in veterinary orthopedic surgery. This review describes and discusses current and potential applications of metal additive manufacturing in veterinary orthopedic surgery.

  8. Orthopedic Health: Healthy Joints for a Lifetime / Keep Your Moving Parts Moving

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Orthopedic Health Healthy Joints for a Lifetime Past Issues / ... being made every day in the world of orthopedic health and disease treatment —our bones, muscles, tendons, ...

  9. [Daily routine in orthopedics and traumatology - results of a nationwide survey of residents].

    Science.gov (United States)

    Merschin, D; Münzberg, M; Stange, R; Schüttrumpf, J P; Perl, M; Mutschler, M

    2014-10-01

    The subject orthopedics and traumatology suffers by a loss of attractiveness which results in a lack of young blood. The aim of this study of the Youth Forum of the German Society of Orthopedics and Traumatology (DGOU) is to register the working conditions of residents in orthopedics. In the months September and October 2013 we performed a survey on members of the following German societies: German Society of Orthopedics and Traumatology (DGOU), German Society of Traumatology (DGU) and the German Society of Orthopedics and Orthopedic Surgery (DGOOC), (age orthopedics and traumatology. In order to maintain orthopedics and traumatology as an attractive it is necessary to implement flexible working time models and to reorganize and improve training-concepts. Georg Thieme Verlag KG Stuttgart · New York.

  10. A comparative study of zirconium and titanium implants in rat: osseointegration and bone material quality.

    Science.gov (United States)

    Hoerth, Rebecca M; Katunar, María R; Gomez Sanchez, Andrea; Orellano, Juan C; Ceré, Silvia M; Wagermaier, Wolfgang; Ballarre, Josefina

    2014-02-01

    Permanent metal implants are widely used in human medical treatments and orthopedics, for example as hip joint replacements. They are commonly made of titanium alloys and beyond the optimization of this established material, it is also essential to explore alternative implant materials in view of improved osseointegration. The aim of our study was to characterize the implant performance of zirconium in comparison to titanium implants. Zirconium implants have been characterized in a previous study concerning material properties and surface characteristics in vitro, such as oxide layer thickness and surface roughness. In the present study, we compare bone material quality around zirconium and titanium implants in terms of osseointegration and therefore characterized bone material properties in a rat model using a multi-method approach. We used light and electron microscopy, micro Raman spectroscopy, micro X-ray fluorescence and X-ray scattering techniques to investigate the osseointegration in terms of compositional and structural properties of the newly formed bone. Regarding the mineralization level, the mineral composition, and the alignment and order of the mineral particles, our results show that the maturity of the newly formed bone after 8 weeks of implantation is already very high. In conclusion, the bone material quality obtained for zirconium implants is at least as good as for titanium. It seems that the zirconium implants can be a good candidate for using as permanent metal prosthesis for orthopedic treatments.

  11. Is Metal Particle Release Associated with Peri-implant Bone Destruction? An Emerging Concept.

    Science.gov (United States)

    Fretwurst, T; Nelson, K; Tarnow, D P; Wang, H-L; Giannobile, W V

    2017-11-01

    Peri-implant diseases affecting the surrounding structures of endosseous dental implants include peri-implant mucositis and peri-implantitis. The prevalence of peri-implantitis ranges between 15% and 20% after 10 y, highlighting the major challenge in clinical practice in the rehabilitation of dental implant patients. The widespread nature of peri-implant bone loss poses difficulties in the management of biological complications affecting the long-term success of osseointegrated implant reconstructions. Metal and titanium particles have been detected in peri-implant supporting tissues. However, it remains unclear what mechanisms could be responsible for the elicitation of particle and ion release and whether these released implant-associated materials have a local and/or systemic impact on the peri-implant soft and hard tissues. Metal particle release as a potential etiologic factor has been intensively studied in the field of orthopedics and is known to provoke aseptic loosening around arthroplasties and is associated with implant failures. In dental medicine, emerging information about metal/titanium particle release suggests that the potential impact of biomaterials at the abutment or bone interfaces may have an influence on the pathogenesis of peri-implant bone loss. This mini-review highlights current evidence of metal particle release around dental implants and future areas for research.

  12. Haptic computer-assisted patient-specific preoperative planning for orthopedic fractures surgery.

    Science.gov (United States)

    Kovler, I; Joskowicz, L; Weil, Y A; Khoury, A; Kronman, A; Mosheiff, R; Liebergall, M; Salavarrieta, J

    2015-10-01

    The aim of orthopedic trauma surgery is to restore the anatomy and function of displaced bone fragments to support osteosynthesis. For complex cases, including pelvic bone and multi-fragment femoral neck and distal radius fractures, preoperative planning with a CT scan is indicated. The planning consists of (1) fracture reduction-determining the locations and anatomical sites of origin of the fractured bone fragments and (2) fracture fixation-selecting and placing fixation screws and plates. The current bone fragment manipulation, hardware selection, and positioning processes based on 2D slices and a computer mouse are time-consuming and require a technician. We present a novel 3D haptic-based system for patient-specific preoperative planning of orthopedic fracture surgery based on CT scans. The system provides the surgeon with an interactive, intuitive, and comprehensive, planning tool that supports fracture reduction and fixation. Its unique features include: (1) two-hand haptic manipulation of 3D bone fragments and fixation hardware models; (2) 3D stereoscopic visualization and multiple viewing modes; (3) ligaments and pivot motion constraints to facilitate fracture reduction; (4) semiautomatic and automatic fracture reduction modes; and (5) interactive custom fixation plate creation to fit the bone morphology. We evaluate our system with two experimental studies: (1) accuracy and repeatability of manual fracture reduction and (2) accuracy of our automatic virtual bone fracture reduction method. The surgeons achieved a mean accuracy of less than 1 mm for the manual reduction and 1.8 mm (std [Formula: see text] 1.1 mm) for the automatic reduction. 3D haptic-based patient-specific preoperative planning of orthopedic fracture surgery from CT scans is useful and accurate and may have significant advantages for evaluating and planning complex fractures surgery.

  13. Quantitative solid-state NMR imaging of synthetic calcium phosphate implants.

    Science.gov (United States)

    Ramanathan, C; Ackerman, J L

    1999-06-01

    It is shown that solid-state phosphorus-31 nuclear magnetic resonance imaging can be used to measure quantitatively the mass of hydroxyapatite (HA), a synthetic calcium phosphate used as an orthopedic implant material, in the presence of bone. A three-dimensional projection reconstruction technique was used to produce solid-state images from 998 free induction decays sampled in the presence of a fixed amplitude field gradient whose direction was varied uniformly over the unit sphere. Chemical selection is achieved using T1 contrast, as the synthetic calcium phosphate has a shorter T1 (1.8 sec at 4.7 T) compared with the bone (approximately 15 sec at 4.7 T in vivo, 42 sec ex vivo). Experimental results demonstrating the linear relationship between image intensity and HA density in phantoms containing HA and silicon (IV) oxide, and HA and bone are shown. Chemically pure images of bone mineral and synthetic HA have been computed from images of New Zealand White rabbits acquired in vivo at two different recycle times. The technique can be used to follow noninvasively the resorption and remodeling of calcium phosphate implants in vivo.

  14. Low back pain as seen in orthopedic clinics of a Nigerian Teaching ...

    African Journals Online (AJOL)

    2015-08-25

    Aug 25, 2015 ... our orthopedic outpatient clinics. Materials and Methods: This was a retrospective review of database of all new patients with low back pain seen at the orthopedics clinics of Federal Teaching Hospital, Abakaliki between 2003 and 2013. Results: There were 2914 new patients seen in the orthopedic clinics ...

  15. Functional improvement following implantation of a microstructured, type-I collagen scaffold into experimental injuries of the adult rat spinal cord.

    Science.gov (United States)

    Altinova, Haktan; Möllers, Sven; Führmann, Tobias; Deumens, Ronald; Bozkurt, Ahmet; Heschel, Ingo; Damink, Leon H H Olde; Schügner, Frank; Weis, Joachim; Brook, Gary A

    2014-10-17

    The formation of cystic cavitation following severe spinal cord injury (SCI) constitutes one of the major barriers to successful axonal regeneration and tissue repair. The development of bioengineered scaffolds that assist in the bridging of such lesion-induced gaps may contribute to the formulation of combination strategies aimed at promoting functional tissue repair. Our previous in vitro investigations have demonstrated the directed axon regeneration and glial migration supporting properties of microstructured collagen scaffold that had been engineered to possess mechanical properties similar to those of spinal cord tissues. Here, the effect of implanting the longitudinally orientated scaffold into unilateral resection injuries (2mm long) of the mid-cervical lateral funiculus of adult rats has been investigated using behavioural and correlative morphological techniques. The resection injuries caused an immediate and long lasting (up to 12 weeks post injury) deficit of food pellet retrieval by the ipsilateral forepaw. Implantation of the orientated collagen scaffold promoted a significant improvement in pellet retrieval by the ipsilateral forepaw at 6 weeks which continued to improve up to 12 weeks post injury. In contrast, implantation of a non-orientated gelatine scaffold did not result in significant functional improvement. Surprisingly, the improved motor performance was not correlated with the regeneration of lesioned axons through the implanted scaffold. This observation supports the notion that biomaterials may support functional recovery by mechanisms other than simple bridging of the lesion site, such as the local sprouting of injured, or even non-injured fibres. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Reconstituição experimental da parede torácica de gatos com implante heterógeno de cartilagem auricular conservada em glicerina a 98% Experimental reconstitution of the cat's thoracic wall with dog conchal cartilage implant preserved in 98% glycerin

    Directory of Open Access Journals (Sweden)

    Josaine Cristina da Silva Rappeti

    2003-12-01

    Full Text Available Com o objetivo de testar o implante de cartilagem auricular heteróloga conservada em glicerina a 98% como alternativa para reparar defeitos na parede torácica em felinos, foram estudados doze animais adultos, sendo distribuídos em dois grupos GI e GII, e avaliados após 60 dias de pós-operatório. Todos os animais foram submetidos à ressecção costal na porção média do tórax abrangendo a 7ª, 8ª e 9ª costelas e posterior implante de cartilagem conchal heteróloga conservada em glicerina a 98%. No GI, foi preservada a musculatura adjacente, já no GII, a musculatura foi retirada. Os animais foram avaliados clinicamente no pós-operatório e, ao final do período, submetidos à eutanásia e necropsia para avaliação macroscópica e microscópica da região do implante. Observou-se proliferação de tecido fibrovascular neovascularizado sobre o implante, com aderência pulmonar e diafragmática em algumas das unidades experimentais. O implante de cartilagem heteróloga conservado em glicerina a 98% pode ser utilizado para reconstrução de parede costal cujo defeito abranja o espaço de parte de três costelas. O implante em 60 dias é substituído por tecido cicatricial, sem apresentar sinais clínicos de rejeição.Twelve adult cats were divided in groups GI and GII with the objective of testing a dog auricular cartilage implant conserved in 98% glycerin as an alternative to repair thoracic wall defects. All animals were submitted to a resection of the medial portion of the thorax by removal of the 7th, 8th and 9th ribs and posterior cartilage implantation. GI had the adjacent musculature preserved and in GII cat's had it removed. The animals were clinically evaluated in the post operative period and after sixty days submitted to euthanasia for microscopic evaluation of the implanted local. Proliferation of granulation tissue and neomorph over the implant was observed in all animals and some had lung and diaphragm adherence. The

  17. An experimental test of stroke recovery by implanting a hyaluronic acid hydrogel carrying a Nogo receptor antibody in a rat model

    Energy Technology Data Exchange (ETDEWEB)

    Ma Jun [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Tian Weiming [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Hou Shaoping [Beijing Institute of Neuroscience, Capital University of Medical Sciences, Beijing 100054 (China); Xu Qunyuan [Beijing Institute of Neuroscience, Capital University of Medical Sciences, Beijing 100054 (China); Spector, Myron [Tissue Engineering, VA Boston Healthcare System, Harvard Medical School, Boston, MA (United States); Cui Fuzhai [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China)

    2007-12-15

    The objective of the study was to determine the effects of a hyaluronic-acid-based (HA-based) hydrogel implant, carrying a polyclonal antibody to the Nogo-66 receptor (NgR), on adult rats that underwent middle cerebral artery occlusion (MCAO). Behavioral tests of a forelimb-reaching task suggested that the disabled function of the impaired forelimb in this stroke model was ameliorated by the implant to a certain extent. These behavioral findings were correlated with immunohistochemical results of investigating the distribution of NgR antibody, neurofilaments (NF) and neuron-specific class III {beta}-tubulin (TuJ1) in the brain sections. The porous hydrogel functioned as a scaffold to deliver the NgR antibody, support cell migration and development. In addition, it was found NF-positive and TuJ1-positive expressions were distributed in the implanted hydrogel. Collectively, the results demonstrate the promise of the HA hydrogel as a scaffold material and the delivery vehicle of the NgR antibody for the repair of defects and the support of neural regeneration in the brain.

  18. Penile Implants

    Science.gov (United States)

    ... men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ... the scrotum, and two inflatable cylinders inside the penis. To achieve an erection, you pump the fluid from the reservoir into ...

  19. Cochlear Implants

    Science.gov (United States)

    ... the skin. An implant does not restore normal hearing. It can help a person understand speech. Children and adults can benefit from them. National Institute on Deafness and Other Communication Disorders

  20. Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland

    DEFF Research Database (Denmark)

    Hoffmeyer, Pierre; Simmen, Hanspeter; Jakob, Marcel

    2017-01-01

    This study investigated the effectiveness and the outcomes of rivaroxaban vs the standard of care for venous thromboembolic prophylaxis in patients undergoing fracture-related surgery. A total of 413 patients undergoing fracture-related surgery from 9 Swiss orthopedic and trauma centers were...

  1. Orthopedic and Major Limb Trauma at the Tikur Anbessa University ...

    African Journals Online (AJOL)

    Background: In Ethiopia, Injuries constitute around half of all surgical emergencies, and are the primary reason for an emergency hospital visit in Addis Ababa, Ethiopia. The aim of this study was to determine the frequency and pattern of major limb traumatic injuries and orthopedic conditions treated as emergency at Tikur ...

  2. Looking at the Social Activity for Adolescents with Orthopedic Impairments

    Science.gov (United States)

    Biastro, Leslie; Frank, Heather; Larwin, Karen H.

    2015-01-01

    Adolescents with identified orthopedic impairments are often less likely to participate in social activities outside of the school setting. However, the adolescents who are able to participate in activities have higher social skills, more academic successes, and show more satisfaction in their roles as family member or friend. The aim of this…

  3. Medication Review and Patient Outcomes in an Orthopedic Department

    DEFF Research Database (Denmark)

    Lisby, Marianne; Bonnerup, Dorthe Krogsgaard; Brock, Birgitte

    2015-01-01

    OBJECTIVE: We investigated the health-related effect of systematic medication review performed by a clinical pharmacist and a clinical pharmacologist on nonelective elderly orthopedic patients. METHODS: This is a nonblinded randomized controlled study of 108 patients 65 years or older treated...

  4. [Application of platelet-rich plasma in clinical orthopedics].

    Science.gov (United States)

    Fu, Weili; Li, Qi; Li, Jian

    2014-10-01

    To summarize the application status and progress of platelet-rich plasma (PRP) in clinical orthopedics. The recent related literature concerning the application of PRP in clinical orthopedics was extensively reviewed and analyzed. Recently, a large number of clinical studies on PRP have been carried out, which are applied in bone defects or nonunion, spinal fusion, osteoarthritis and cartilage injuries, ligament reconstruction, muscle strain, tendon terminal diseases, and a variety of acute and chronic soft tissue injuries. Some results show certain effectiveness, while others demonstrate invalid. Easily drawing, achieving autologous transplantation, and the biological repair potential of the musculoskeletal tissues make PRP to be widely used in clinical orthopedics. However, there are still no uniform standards accepted and reliable clinical guidelines about the application of PRP. Furthermore, a variety of PRP products and their respective indications are also different. The clinical evidences with the greater sample size and higher quality are still needed to further support the safety and effectiveness of PRP in clinical orthopedics.

  5. 76 FR 20690 - International Consortium of Orthopedic Registries; Public Workshop

    Science.gov (United States)

    2011-04-13

    ... Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. The Food and Drug Administration (FDA) is announcing a public workshop entitled ``International Consortium of Orthopedic Registries (ICOR).'' The ] purpose of the public workshop is to facilitate discussion among FDA and worldwide...

  6. 43 Orthopedic and Major Limb Trauma at the Tikur Anbessa ...

    African Journals Online (AJOL)

    user

    2005-11-02

    Nov 2, 2005 ... Background: In Ethiopia, Injuries constitute around half of all surgical emergencies, and are the primary reason for an emergency hospital visit in Addis Ababa, Ethiopia. The aim of this study was to determine the frequency and pattern of major limb traumatic injuries and orthopedic conditions treated as ...

  7. Infant orthopedics and facial appearance: a randomized clinical trial (Dutchcleft).

    NARCIS (Netherlands)

    Prahl, C.; Prahl-Andersen, B.; Hof, M.A. van 't; Kuijpers-Jagtman, A.M.

    2006-01-01

    OBJECTIVE: To study the effect of infant orthopedics on facial appearance. DESIGN: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation

  8. Frequency of orthopedic diseases in horses: A retrospective study

    Directory of Open Access Journals (Sweden)

    Kovač Milomir

    2002-01-01

    Full Text Available This retrospective study determined the frequency of orthopedic diseases in horses. It was possible to establish 141 specific orthopedic diagnoses in 1955 horses with lameness. In 14.58 % horses, multiple pathologic orthopedic changes were determined. In 61.84 % cases, the pathologic changes were present on the thoracic limb, 28,86 % on the pelvic limb and other parts of the oganism (neck, spine, muscles in 9.29 % cases. Pathologic changes on the tendons, ligaments, tendon sheats, bursae and muscles were determined in 31.51 % cases. Diseases of the hoof were present in 25.82 % cases. According to our investigation the most frequent orthopedic diseases are: podarthritis (acute, chronic, septic (5.04 %, navicular disease (4.69 %, tendinitis m. flexor digitalis superfacialis (4.51 %, kissing spine syndrom (4.30 % periarthritis et osteoarthrosis tarsi (3.30 %, distal metacarpal/metatarzophalengeal tendovaginitis (3.30 % and high suspensory ligament desmitis (3.12 %. Most frequent fractures were diagnosed on the metacarpal/metatarsal bone II and IV (2.56 %. Osteochondrossis dissecans was most frequently determined in the tarsocrural (1.26 % and the metacarpophalengeal joint (1.56 %.

  9. Socioeconomic value of orthopedic devices: evidence and methodological challenges

    Directory of Open Access Journals (Sweden)

    Sorenson C

    2012-10-01

    Full Text Available Corinna Sorenson,1,2 Michael Drummond2,31LSE Health, London School of Economics, London, UK; 2European Health Technology Institute for Socioeconomic Research, Brussels, Belgium; 3Centre for Health Economics, University of York, York, UKAbstract: With continued technological advances in orthopedic devices and increasingly limited health care resources, greater attention will be placed on substantiating the socioeconomic value of these devices. Therefore, this study focused on a systematic review of available economic evaluations of selected orthopedic devices (n = 33 studies to assess their impact on different clinical and economic outcomes. The existing evidence suggests that they have important benefits to patients, including reduced risk of fractures, increased mobility and functioning, and enhanced quality of life, and do so cost effectively or with cost savings. However, we have identified several methodological obstacles to sufficient ascertainment of value, such as a lack of robust information on health economic outcomes and long-term evidence. We also identify areas where additional research is needed to assess more fully the value of orthopedic devices.Keywords: medical devices, orthopedics, health economic evaluation

  10. A novel implantation model for evaluation of bone healing response to dental implants: the goat iliac crest.

    Science.gov (United States)

    Schouten, C; Meijer, G J; van den Beucken, J J J P; Spauwen, P H M; Jansen, J A

    2010-04-01

    Despite the availability of numerous animal models for testing the biological performance of dental and orthopedic implants, the selection of a suitable model is complex. This paper presents a new model for objective and standardized evaluation of bone responses to implants using the iliac crest in goats. The feasibility of the iliac crest model regarding anatomy and implant positioning was determined using two cadaveric specimens and the bone structure was evaluated and compared with that of the goat femoral condyle. Additionally, the validity of the model was tested by performing an in vivo study. By means of a rather simple, safe, fast and reproducible surgical procedure, the iliac crest in goats could be approached and allowed the implantation of maximally five dental implants per iliac crest. Because of the bilateral implantation possibility, statistical comparisons between groups on either side of the goat could be performed, resulting in a high statistical power, and hence a reduction in the number of animals required to obtain significant data. In terms of surgical approach, anatomy and implant positioning, the iliac crest is the preferred model over the femoral condyle model. The iliac crest implantation model is suitable for evaluation of the osteogenic response to bone implant materials and represents a justified and deliberate alternative to the already existing animal models.

  11. Additive manufacturing technologies of porous metal implants

    Directory of Open Access Journals (Sweden)

    Yang Quanzhan

    2014-06-01

    Full Text Available Biomedical metal materials with good corrosion resistance and mechanical properties are widely used in orthopedic surgery and dental implant materials, but they can easily cause stress shielding due to the significant difference in elastic modulus between the implant and human bones. The elastic modulus of porous metals is lower than that of dense metals. Therefore, it is possible to adjust the pore parameters to make the elastic modulus of porous metals match or be comparable with that of the bone tissue. At the same time, the open porous metals with pores connected to each other could provide the structural condition for bone ingrowth, which is helpful in strengthening the biological combination of bone tissue with the implants. Therefore, the preparation technologies of porous metal implants and related research have been drawing more and more attention due to the excellent features of porous metals. Selective laser melting (SLM and electron beam melting technology (EBM are important research fields of additive manufacturing. They have the advantages of directly forming arbitrarily complex shaped metal parts which are suitable for the preparation of porous metal implants with complex shape and fine structure. As new manufacturing technologies, the applications of SLM and EBM for porous metal implants have just begun. This paper aims to understand the technology status of SLM and EBM, the research progress of porous metal implants preparation by using SLM and EBM, and the biological compatibility of the materials, individual design and manufacturing requirements. The existing problems and future research directions for porous metal implants prepared by SLM and EBM methods are discussed in the last paragraph.

  12. Cutaneous and systemic hypersensitivity reactions to metallic implants

    DEFF Research Database (Denmark)

    Basko-Plluska, Juliana L; Thyssen, Jacob P; Schalock, Peter C

    2011-01-01

    ) following the insertion of intravascular stents, dental implants, cardiac pacemakers, or implanted gynecologic devices. Despite repeated attempts by researchers and clinicians to further understand this difficult area of medicine, the association between metal sensitivity and cutaneous allergic reactions......Cutaneous reactions to metal implants, orthopedic or otherwise, are well documented in the literature. The first case of a dermatitis reaction over a stainless steel fracture plate was described in 1966. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous......, and vasculitic eruptions may occur. Also, more complex immune reactions may develop around the implants, resulting in pain, inflammation, and loosening. Nickel, cobalt, and chromium are the three most common metals that elicit both cutaneous and extracutaneous allergic reactions from chronic internal exposure...

  13. Does pediatric orthopedic subspecialization affect hospital utilization and charges?

    Science.gov (United States)

    Smith, J T; Price, C; Stevens, P M; Masters, K S; Young, M

    1999-01-01

    In the current climate of health care reform, there is a perception that overspecialization is responsible for increased medical costs. Few studies support the premise that high-quality surgical subspecialization improves the cost effectiveness of care. The purpose of this study was to compare hospital utilization and charges between a pediatric hospital staffed by pediatric orthopedic subspecialists and a community hospital system for the care of closed femur fractures and slipped capital femoral epiphysis (SCFE) in a pediatric population. We reviewed hospital charges and length-of-stay (LOS) data for all children treated for closed femoral shaft fractures and SCFE between 1992 and 1994 within the Intermountain Health Care System (IHC). Within the IHC, there are 23 community hospitals and one children's hospital (PCMC). Patients were matched for age and injury severity. Four of six orthopedic surgeons at PCMC are pediatric orthopedists, but none of the community orthopedists has subspecialty training in pediatric orthopedics. For closed femoral shaft fractures (n = 334), the average hospital charges were less (PCMC, $4,943/Other IHC, $9,031), and length of stay was shorter (PCMC, 2.81 days/Other IHC, 8.91 days) when the child was treated at the children's hospital by pediatric orthopedic subspecialists. For SCFE (n = 63), the average hospital charges were less (PCMC, $2,824/Other IHC, $3,544) and the length of stay was shorter (PCMC, 1.13 days/Other IHC, 1.64 days) at the children's hospital. These data suggest that hospital utilization and charges were significantly decreased if the care was provided by pediatric orthopedic subspecialists in a children's hospital.

  14. Sutural strain in orthopedic headgear therapy: a finite element analysis.

    Science.gov (United States)

    Holberg, Christof; Holberg, Nikola; Rudzki-Janson, Ingrid

    2008-07-01

    The goal of this study was to analyze the strains induced in the sutures of the midface and the cranial base by headgear therapy involving orthopedic forces. Does the mechanical signal induced in the sutures sufficiently account for a growth-influencing effect? A finite element model of the viscerocranium and the neurocranium was used. It consisted of 53,555 tetrahedral elements and 97,550 nodes. The strain induced in the sutures of the cranial base and the midface when applying orthopedic headgear forces of 5 and 10 N was computed and recorded with an interactive measurement tool. The magnitude and the distribution of the measured strains depended on the level and the direction of the acting force. Overall, the strain values measured at the sutures of the midface and the cranial base were moderate. The measured peak values at a load of 5 N per side were usually just below 20 microstrain irrespective of the force direction. A characteristic distribution of strain values appeared on the anatomical structures of the midface and the cranial base for each vector direction. The measurements based on the finite element method provided a good overview of the approximate magnitudes of sutural strains with orthopedic headgear therapy. The signal arriving in the sutures is apparently well below threshold, since the maximum measured strains in most sutures were about 100 fold lower than the minimal effective strain. A skeletal effect of the orthopedic headgear due to a mechanical effect on sutural growth cannot be confirmed from these results. The good clinical efficacy of headgear therapy with orthopedic forces is apparently based mainly on dentoalveolar effects, whereas the skeletal effect due to inhibition of sutural growth is somewhat questionable.

  15. A Comprehensive, High-Quality Orthopedic Intern Surgical Skills Program.

    Science.gov (United States)

    Ford, Samuel E; Patt, Joshua C; Scannell, Brian P

    2016-01-01

    To design and implement a month-long, low-cost, comprehensive surgical skills curriculum built to address the needs of orthopedic surgery interns with high satisfaction among both interns and faculty. The study design was retrospective and descriptive. The study was conducted at tertiary care referral center with a medium sized orthopedic residency surgery program (5 residents/year). Totally 5 orthopedic surgery residents and 16 orthopedic surgery faculty participated. A general mission was established-to orient the resident to the postgraduate year 1 and prepare them for success in residency. The basic tenets of the American Board of Orthopaedic Surgeons surgical skills program framework were built. Curricular additions included anatomic study, surgical approaches, joint-specific physical examination, radiographic interpretation, preoperative planning, reduction techniques, basic emergency and operating room procedures, cadaveric procedure practice, and introduction to arthroplasty. The program was held in August during protected time for intern participants. In total, 16 orthopedic surgeons instructed 85% of the educational sessions. One faculty member did most of the preparation and organization to facilitate the program. The program ran for a cumulative 89 hours, including 14.5 hours working with cadaveric specimens. The program cost a total of $8100. The average module received a 4.15 rating on a 5-point scale, with 4 representing "good" and 5 representing "excellent." The program was appropriately timed and addressed topics relevant to the intern without sacrificing clinical experience or burdening inpatient services with interns' absence. The program received high satisfaction ratings from both the interns as well as the faculty. Additionally, the program fostered early relationships between interns and faculty-an unforeseen benefit. In the future, our program plans to better integrate validated learning metrics and improve instruction pertaining to both

  16. Publication Productivity of Early-Career Orthopedic Trauma Surgeons.

    Science.gov (United States)

    Hake, Mark E; Lee, John J; Goulet, James A

    2016-01-01

    The goals of this study were to: (1) define the publication productivity of early-career orthopedic trauma surgeons over time; (2) compare the early-career publication productivity of recent orthopedic trauma fellowship graduates vs their more senior colleagues; and (3) determine the proportion of fellowship graduates who meet the Orthopaedic Trauma Association (OTA) publication criteria for active membership early in their careers. Orthopedic trauma fellowship graduates from 1982 to 2007 were analyzed. A literature search was performed for each fellow's publications for the 6-year period beginning the year of fellowship graduation. Publication productivity was compared between early and recent groups of graduates, 1987 to 1991 and 2003 to 2007, respectively. Fulfillment of OTA publication criteria was determined. Seventy-nine percent of graduates contributed to 1 or more publications. The recent group produced more total publications per graduate (4.06 vs 3.29, P=.01) and more coauthor publications (2.60 vs 2.04, P=.019) than the early group. The number of first-author publications did not differ between groups (1.46 vs 1.25, P=.26). A greater percentage of the recent group met current OTA publication criteria compared with the early group (51% vs 35%, P=.04). The findings showed that recent orthopedic trauma graduates had increased publication productivity compared with their more senior colleagues, although a proportion had not qualified for active OTA membership 6 years into their career. Overall, these data are encouraging and suggest that young orthopedic trauma surgeons remain committed to sustaining a high level of academic excellence. Copyright 2016, SLACK Incorporated.

  17. Cochlear implant by adult

    OpenAIRE

    Kratochvílová, Tereza

    2011-01-01

    Bachelor thesis "The cochlear implant in an adult deaf" deals primarily with the cochlear implant. The most extensive part of the thesis talks about this topic, which also talks about the development and design of cochlear implants, explains the difference between cochlear implantation and tribal implantation and describes operation of implant and the subsequent setting of the implant. This section is also dedicated to binaural cochlear implantation, myths of cochlear implants and problems wh...

  18. The Orthopedic Trauma Symposium: improving care of orthopedic injuries in Haiti.

    Science.gov (United States)

    Normore, Ryan; Greene, Helena; DeLong, Allison; Furey, Andrew

    2017-08-01

    Although single-trip volunteer medical teams can provide much-needed acute trauma care following natural disasters, their ability to leave a legacy of improved care in the region is often limited. One way to improve treatment of traumatic injuries is through conference-based teaching, such as the Orthopedic Trauma Symposium (OTS), which took place in Haiti in 2014. However, there is little research evaluating the effectiveness of such teaching tools. We evaluated the OTS and the potential benefits of future iterations of the course. A survey consisting of 5-point Likert scale questions as well as qualitative open feedback assessed respondents' opinions regarding the value, content and delivery of the OTS. Respondents were classified dichotomously in terms of their role in the OTS (instructor v. participant) to measure any meaningful difference in feedback. In total, 84% of all participants agreed that course content was clearly communicated, and 98% agreed that instructors were knowledgeable in the topics covered. Moreover, 87% of all participants responded that they would apply the training in their medical practices going forward. Haitian physicians, residents and medical students responded favourably to the OTS. Open-ended questions offered concise, attainable improvements for future iterations of the course. Organizations committed to improving medical care in low- and middle-income countries should take note of these findings while continuing to develop the OTS and similar initiatives globally.

  19. Development and applications of porous tantalum trabecular metal-enhanced titanium dental implants.

    Science.gov (United States)

    Bencharit, Sompop; Byrd, Warren C; Altarawneh, Sandra; Hosseini, Bashir; Leong, Austin; Reside, Glenn; Morelli, Thiago; Offenbacher, Steven

    2014-12-01

    Porous tantalum trabecular metal has recently been incorporated in titanium dental implants as a new form of implant surface enhancement. However, there is little information on the applications of this material in implant dentistry. The purpose of this article is to summarize the contemporary concept on the applications of porous tantalum trabecular metal in implant dentistry. We therefore review the current literature on the basic science and clinical uses of this material. Porous tantalum metal is used to improve the contact between osseous structure and dental implants and therefore presumably facilitate osseointegration. Success of porous tantalum metal in orthopedic implants led to the incorporation of porous tantalum metal in the design of root-form endosseous titanium implants. The porous tantalum three-dimensional enhancement of titanium dental implant surface allows for combining bone ongrowth together with bone ingrowth, or osseoincorporation. While little is known about the biological aspect of the porous tantalum in the oral cavity, there seems to be several possible advantages of this implant design. This article reviews the biological aspects of porous tantalum-enhanced titanium dental implants, in particular the effects of anatomical consideration and oral environment to implant designs. We propose here possible clinical situations and applications for this type of dental implant. Advantages and disadvantages of the implants as well as needed future clinical studies are discussed. © 2013 Wiley Periodicals, Inc.

  20. The Effect of Listening to Music on Postoperative Pain in Adult Orthopedic Patients.

    Science.gov (United States)

    Schneider, Melissa A

    2018-03-01

    Pain is a common occurrence after orthopedic surgery. Patients need additional resources to manage their pain. The purpose of this study was to determine if listening to music has a positive effect on pain scores and satisfaction in the postoperative adult orthopedic patient. There are limited studies demonstrating statistically significant decreases in postoperative pain in this group. A secondary purpose was to expose nurses on a standard medical-surgical unit to an intervention, supported by the holistic nursing model that they could use in their care. This study was a descriptive, comparative, quasi-experimental design. Patients listened to prerecorded music on individual CD players and recorded pre-post pain scores with the intervention. A satisfactory survey was completed at discharge. Results demonstrated a statistically significant reduction in patients' pain scores after listening to music. Length of listening time had no effect. Patients expressed overall satisfaction, and 100% of participants would recommend this intervention to others. Listening to music is beneficial as an adjunct to pain medication and contributes to increased patient satisfaction. It is hoped that the information gained from this study will lead to an enhancement in the standard of care for postoperative patients.

  1. Host tissue reactions of non-demineralized autogenic and xenogenic dentin blocks implanted in a non-osteogenic environment. An experimental study in rabbits.

    Science.gov (United States)

    Al-Asfour, Adel; Farzad, Payam; Andersson, Lars; Joseph, Bobby; Dahlin, Christer

    2014-06-01

    Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Deproteinized Bovine Bone Mineral or Autologous Bone at Dehiscence Type Defects at Implants Installed Immediately into Extraction Sockets: An Experimental Study in Dogs.

    Science.gov (United States)

    Pereira, Flavia Priscila; De Santis, Enzo; Hochuli-Vieira, Eduardo; de Souza Faco, Eduardo F; Pantani, Fabio; Salata, Luiz A; Botticelli, Daniele

    2016-06-01

    The aim of this study was to evaluate bone regeneration at surgically created dehiscence buccal defects at implants placed immediately into extraction sockets (IPIES) of small dimensions filled with autogenous bone or deproteinized bovine bone mineral (DBBM) associated with a collagen membrane. Eight Labrador dogs were used and implants were placed immediately into the extraction sockets of the second premolar. The buccal wall was subsequently removed to create a standardized defect, 4 mm wide coronally, 2 mm wide apically, and 6 mm high. Autogenous bone particles (AB) or DBBM granules were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membrane and a non-submerged healing was allowed. After 4 months, the animals were euthanized and bone blocks harvested and processed for histomorphometric analysis. The bony crest at the buccal aspect (C) was located 2.3 ± 0.8 mm and 1.7 ± 0.7 mm apically to the implant shoulder (IS) at the AB and DBBM sites, respectively. The coronal levels of osseointegration at the buccal aspect (B) were located 2.7 ± 0.7 mm and 2.2 ± 1.0 mm apically to IS at the AB and DBBM sites, respectively. At the AB sites, the peri-implant mucosa was located 4.3 ± 0.9 mm, 4.7 ± 0.9 mm, and 2.0 ± 1.6 mm coronally to C, B, and IS, respectively. The corresponding values at the DBBM sites were 4.3 ± 0.6 mm, 4.8 ± 0.6 mm, and 2.5 ± 0.8 mm, respectively. No statistically significant differences were found. The treatment of surgically created buccal defects at IPIES sites using Bio-Oss® (Geistlich Biomaterials, Wolhusen, LU, Switzerland) or autogenous bone, concomitantly with a collagen membrane, engenders bone regeneration to a similar extent after 4 months of healing. © 2015 Wiley Periodicals, Inc.

  3. Ligature-induced peri-implantitis in mice.

    Science.gov (United States)

    Pirih, F Q; Hiyari, S; Barroso, A D V; Jorge, A C A; Perussolo, J; Atti, E; Tetradis, S; Camargo, P M

    2015-08-01

    Peri-implantitis has a prevalence of 11-47%, involves destruction of peri-implant bone and may lead to implant loss. A detailed understanding of the pathogenesis of peri-implantitis is lacking. The objective of this study was to develop a murine model of experimental peri-implantitis. Machined, smooth-surface, screw-shaped titanium implants were placed in the healed alveolar bone of the left maxillary molars of C57BL/6J male mice, 8 wk after tooth extraction. Peri-implantitis was induced by securing silk ligatures around the head of the implant fixtures. Implant survival and peri-implant bone levels were analyzed by micro-computed tomography (micro-CT) scans and histology, 12 wk after ligature placement. Implant survival was 60% (six of 10) for implants with ligatures and 100% (eight of eight) for controls. Micro-CT revealed significantly greater bone loss around the implants that received ligatures and that survived, compared with controls. The radiographic findings were confirmed via histology and toluidine blue staining. This study describes a murine model of experimental peri-implantitis around screw-shaped titanium implants placed in the edentulous alveolar bone. This model should be a useful tool to dissect pathogenic mechanisms of peri-implantitis and evaluate potential treatment interventions. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Bioactivity of plasma implanted biomaterials

    Science.gov (United States)

    Chu, Paul K.

    2006-01-01

    Plasma immersion ion implantation and deposition (PIII&D) is an effective technique to enhance the surface bioactivity of materials. In this paper, recent progress made in our laboratory on plasma surface modification of biomedical materials is described. NiTi alloys have unique super-elastic and shape memory properties and are suitable for orthopedic implants but the leaching of toxic Ni may pose health hazards in humans. We have recently investigated the use of acetylene, oxygen and nitrogen PIII&D to prevent out-diffusion of nickel and good results have been obtained. Silicon is the most important material in the microelectronics industry but its surface biocompatibility has not been investigated in details. We have recently performed hydrogen PIII into silicon to improve the surface bioactivity and observed biomimetic growth of apatite on the surface in simulated body fluids. Diamond-like carbon (DLC) is widely used in the industry due to its excellent mechanical properties and chemical inertness and by incorporation of elements such as nitrogen and phosphorus, the surface blood compatibility can be improved. The properties as well as in vitro biological test results are discussed in this article.

  5. Recent advances in micro/nanoscale biomedical implants.

    Science.gov (United States)

    Arsiwala, Ammar; Desai, Preshita; Patravale, Vandana

    2014-09-10

    The medical device industry is growing at a very fast pace and has recorded great research activity over the past decade. The interdisciplinary nature of this field has made it possible for researchers to incorporate principles from various allied areas like pharmaceutics, bioengineering, biotechnology, chemistry, electronics, biophysics etc. to develop superior medical solutions, offering better prospects to the patient. Moreover, micro and nanotechnology have made it possible to positively affect at the sub-micron scales, the cellular processes initiated upon implantation. Literature is rife with findings on various implants and this review comprehensively summarizes the recent advances in micro/nanoscale implantable medical devices - particularly cardiovascular implants, neural implants, orthopedic and dental implants and other miscellaneous implants. Over the years, medical implants have metamorphosed from mere support providing devices to smart interventions participating positively in the healing process. We have highlighted the current research in each area emphasizing on the value addition provided by micro/nanoscale features, its course through the past and the future perspectives focusing on the unmet needs. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Superior Gain in Knowledge by Podcasts Versus Text-Based Learning in Teaching Orthopedics: A Randomized Controlled Trial.

    Science.gov (United States)

    Back, David Alexander; von Malotky, Jennifer; Sostmann, Kai; Hube, Robert; Peters, Harm; Hoff, Eike

    Digital learning (e-learning) has become a firm part of surgical undergraduate education. However, there is still a lack in analyzing e-learning tools in experimental settings without potentially biasing curricular influences. This study should compare students' learning outcome with podcasts versus book texts under laboratory conditions in the field of orthopedics. Voluntary medical students were randomly assigned for learning either with a book chapter or a podcast about common orthopedic diseases in an isolated computer room. Before and after intervention, students answered multiple-choice tests and questionnaires about their attitudes and satisfaction. The study was conducted from November 2012 to February 2013. Totally, 130 students were included (55 text users and 75 podcast users, 52 males and 78 females). There was a significant increase in the overall knowledge for both groups (p orthopedic topics to medical students. Sex plays an additional independent role in the impact of e-learning tools on students' learning outcome. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  7. Early History and Challenges of Implantable Electronics.

    Science.gov (United States)

    Ko, Wen H

    2012-06-01

    Implantable systems for biomedical research and clinical care are now a flourishing field of activities in academia as well as industrial institutions. The broad field includes experimental explorations in electronics, mechanical, chemical, and biological components and systems, and the combination of all these. Today virtually all implants involve both electronic circuits and micro-electro-mechanical-systems (MEMS). This article offers a very brief glance back at the early history of implant electronics in the period from the 1950s to the 1970s, by employing selected examples from the author's research. This short review also discusses the challenges of implantable electronics at present, and suggests some potentially important trends in the future research and development of implantable microsystems. It is aimed as an introduction of implantable/attached electronic systems to research engineers that are interested in implantable systems as a section of Biomedical Instrumentations.

  8. The effects of degree of crosslinking on the fatigue crack initiation and propagation resistance of orthopedic-grade polyethylene.

    Science.gov (United States)

    Baker, D A; Bellare, A; Pruitt, L

    2003-07-01

    Crosslinked ultrahigh molecular weight polyethylene (UHMWPE) has been recently approved by the Food and Drug Administration for use in orthopedic implants. The majority of commercially available UHMWPE orthopedic components are crosslinked using e-beam or gamma radiation. The level of crosslinking is controlled with radiation dose and free radicals are eliminated through heat treatments to prevent long-term degradation associated with chain scission or oxidation mechanisms. Laboratory studies have demonstrated a substantial improvement in the wear resistance of crosslinked UHMWPE. However, a concern about the resistance to fatigue damage remains in the clinical community, especially for tibial components that sustain high cyclic contact stresses. The objective of this study was to investigate both the initiation and propagation aspects of fatigue cracks in radiation crosslinked medical-grade UHMWPE. This work evaluated three levels of radiation, which induced three crosslink densities, on the fatigue crack propagation and total fatigue life behavior. Both as-received UHMWPE, as well as those that underwent an identical thermal history as the crosslinked UHMWPE were used as controls. Fractured crack propagation specimens were examined using scanning electron microscopy to elucidate fatigue fracture mechanisms. The results of this work indicated that a low crosslink density may optimize the fatigue resistance from both a crack initiation and propagation standpoint. Copyright 2003 Wiley Periodicals, Inc.

  9. Electrophoretic-deposited novel ternary silk fibroin/graphene oxide/hydroxyapatite nanocomposite coatings on titanium substrate for orthopedic applications

    Science.gov (United States)

    Li, Ming; Xiong, Pan; Mo, Maosong; Cheng, Yan; Zheng, Yufeng

    2016-09-01

    The combination of graphene oxide (GO) with robust mechanical property, silk fibroin (SF) with fascinating biological effects and hydroxyapatite (HA) with superior osteogenic activity is a competitive approach to make novel coatings for orthopedic applications. Herein, the feasibility of depositing ternary SF/GO/HA nanocomposite coatings on Ti substrate was firstly verified by exploiting electrophoretic nanotechnology, with SF being used as both a charging additive and a dispersion agent. The surface morphology, microstructure and composition, in vitro hemocompatibility and in vitro cytocompatibility of the resulting coatings were investigated by SEM, Raman, FTIR spectra and biocompatibility tests. Results demonstrated that GO, HA and SF could be co-deposited with a uniform, smooth thin-film morphology. The hemolysis rate analysis and the platelet adhesion test indicated good blood compatibility of the coatings. The human osteosarcoma MG63 cells displayed well adhesion and proliferation behaviors on the prepared coatings, with enhanced ALP activities. The present study suggested that SF/GO/HA nanocomposite coatings could be a promising candidate for the surface functionalization of biomaterials, especially as orthopedic implant coating.

  10. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective.

    Science.gov (United States)

    Zheng, Guoyan; Nolte, Lutz P

    2015-01-01

    Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined.

  11. Effect of enamel matrix proteins (Emdogain') on healing after re-implantation of "periodontally compromised" roots. An experimental study in the dog.

    Science.gov (United States)

    Araújo, M; Hayacibara, R; Sonohara, M; Cardaropoli, G; Lindhe, J

    2003-10-01

    The present experiment was performed to assess whether Emdogain applied on the root surface of extracted teeth or teeth previously exposed to root planning can protect the tooth from ankylosis following re-implantation. The experiment included two groups of dogs, including five animals each. The root canals of all mandibular third premolars (3 P 3) were reamed and filled with gutta-percha. A crestal incision was placed from the area of the second to the fourth premolar. Buccal and lingual full thickness flaps were elevated. With the use of a fissure bur, the crown and furcation area of 3 P 3 were severed in an apico-coronal cut. The distal and mesial tooth segments were luxated with an elevator and extracted with forceps. Group A: The mesial and distal segments of 3 P 3 were air dried on a glass surface for 60 min. The roots from the right side were conditioned and exposed to Emdogain application. The roots from the left side received the same treatment with the exception of Emdogain application. The mesial and distal tooth segments were re-implanted and the crown portions were severed with a horizontal cut and removed. The buccal and lingual flaps were mobilized and sutured to obtain complete coverage of the submerged roots. Group B: A notch was prepared in each root, 4-5 mm apical of the cemento-enamel junction. The area of the root that was located coronal to the notch was scaled and planned. The roots in the right side of the mandible were treated with Emdogain, while the roots in the left side served as controls. After 6 months of healing, the dogs were killed and blocks containing one root with surrounding tissues were harvested, and prepared for histological examination, which also included morphometric assessments. Thus, the proportions of the roots that exhibited signs of (i) replacement (ii) inflammatory and (iii) surface resorption were calculated. It was demonstrated that healing of a re-implanted root that had been extracted and deprived of vital

  12. Development and Applications of Porous Tantalum Trabecular Metal Enhanced Titanium Dental Implants

    Science.gov (United States)

    Bencharit, Sompop; Byrd, Warren C.; Altarawneh, Sandra; Hosseini, Bashir; Leong, Austin; Reside, Glenn; Morelli, Thiago; Offenbacher, Steven

    2013-01-01

    Statement of Problem Porous tantalum trabecular metal has recently been incorporated in titanium dental implants as a new form of implant surface enhancement. However, there is little information on the applications of this material in implant dentistry. Methods We, therefore review the current literature on the basic science and clinical uses of this material. Results Porous tantalum metal is used to improve the contact between osseous structure and dental implants; and therefore presumably facilitate osseointegration. Success of porous tantalum metal in orthopedic implants led to the incorporation of porous tantalum metal in the design of root-from endosseous titanium implants. The porous tantalum three-dimensional enhancement of titanium dental implant surface allows for combining bone ongrowth together with bone ingrowth, or osseoincorporation. While little is known about the biological aspect of the porous tantalum in the oral cavity, there seems to be several possible advantages of this implant design. This article reviews the biological aspects of porous tantalum enhanced titanium dental implants, in particular the effects of anatomical consideration and oral environment to implant designs. Conclusions We propose here possible clinical situations and applications for this type of dental implant. Advantages and disadvantages of the implants as well as needed future clinical studies are discussed. PMID:23527899

  13. Orthopedic cervical headgear in Class II treatment: case report

    OpenAIRE

    Enoki Carla; Matsumoto Mírian Aiko Nakane; Ferreira José Tarcísio Lima

    2003-01-01

    Early treatment for Class II malocclusion was undertaken with the objective of correcting skeletal disproportion by altering the growth pattern. A case of Class II, Division 1 malocclusion in the mixed dentition was corrected to Class I molar relationship using orthopedic cervical headgear, with nonextraction edgewise therapy. Cephalometric analysis indicated a reduction in the maxillomandibular discrepancy (ANB) correcting the Class II malocclusion to Class I malocclusion. The treatment show...

  14. Mending injured athletes: a track record of orthopedic advances.

    Science.gov (United States)

    Schnirring, Lisa

    2003-09-01

    Physicians have long been closely allied with competitive sports. In 157 AD, Galen served as a physician to Greek gladiators.(1) Severe musculoskeletal trauma certainly shortened the careers of ancient pugilists who survived their matches. However, modern gladiators-from pick-up basketball players to football professionals-often get to "play another day" because of advances in orthopedic surgery, particularly those of the last 30 years.

  15. Prevalence of Internet and social media usage in orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Emily Curry

    2014-08-01

    Full Text Available Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752 between December 2012 to January 2013 in a major academic orthopedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9% relative to other services (9.8-17.9% and was statistically higher when compared to the joints/tumor service (P<0.0001. Younger age was the biggest indicator predicting the use of social media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day’s travel (120-180 miles to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals.

  16. Prevalence of Internet and Social Media Usage in Orthopedic Surgery

    OpenAIRE

    Emily Curry; Xinning Li; Joseph Nguyen; Elizabeth Matzkin

    2014-01-01

    Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752) between December 2012 to January 2013 in a major academic o...

  17. Orthopedic communication about osteoarthritis treatment: Does patient race matter?

    Science.gov (United States)

    Hausmann, Leslie R M; Hanusa, Barbara H; Kresevic, Denise M; Zickmund, Susan; Ling, Bruce S; Gordon, Howard S; Kwoh, C Kent; Mor, Maria K; Hannon, Michael J; Cohen, Peter Z; Grant, Richard; Ibrahim, Said A

    2011-05-01

    To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee and hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs orthopedic clinics. Audio recorded visits between patients and orthopedic surgeons were coded using the Roter Interaction Analysis System and the Informed Decision-Making model. Racial differences in communication outcomes were assessed using linear regression models adjusted for study design, patient characteristics, and clustering by provider. The sample (n = 402) included 296 white and 106 African American patients. Most patients were men (95%) and ages 50-64 years (68%). Almost half (41%) reported an income <$20,000. African American patients were younger and reported lower incomes than white patients. Visits with African American patients contained less discussion of biomedical topics (β = -9.14; 95% confidence interval [95% CI] -16.73, -1.54) and more rapport-building statements (β = 7.84; 95% CI 1.85, 13.82) than visits with white patients. However, no racial differences were observed with regard to length of visit, overall amount of dialogue, discussion of psychosocial issues, patient activation/engagement statements, physician verbal dominance, display of positive affect by patients or providers, or discussion related to informed decision making. In this sample, communication between orthopedic surgeons and patients regarding the management of chronic knee and hip osteoarthritis did not, for the most part, vary by patient race. These findings diminish the potential role of communication in Veterans Affairs orthopedic settings as an explanation for well-documented racial disparities in the use of total joint replacement. Copyright © 2011 by the American College of Rheumatology.

  18. Online reviews of orthopedic surgeons: an emerging trend.

    Science.gov (United States)

    Frost, Chelsea; Mesfin, Addisu

    2015-04-01

    Various websites are dedicated to rating physicians. The goals of this study were to: (1) evalu