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Biomedical subjects

J D Bobyn

Publications and source records attributed to J D Bobyn.

At least 55 records · Page 3Linked to original sources
PubMed1992

Evaluation of metallic personalized hemiarthroplasty: a canine patellofemoral model.

The purpose of this study was to characterize the response of articular cartilage to weight bearing against a metallic personalized hemiarthroplasty prosthesis. Ten dogs each underwent surgery in which an elastomeric replica of the left femoral patellar groove was made. Using this replica, a 0.5-mm-thick prosthesis was cast in Co-Cr alloy and subsequently the surface was polished to a mirror finish which had a center line average roughness value in the range of human hemiarthroplasty implants. A second surgery was performed to resurface the left trochlea with this prosthesis. Five animals were sacrificed at 3 months and 5 at 6 months. Cartilage damage occurred primarily in the distal region of the patella, and was especially evident at 6 months. Mechanical indentation tests conducted on patellar cartilage in a saline bath at 37 degrees C indicated both increased deformation and residual deformation in the affected areas, indicative of degenerative change. Areas of fibrillation with a depletion of proteoglycans were identified histologically. These areas were only superficial at 3 months but became more extensive at 6 months. Rheological analysis of the synovial fluid of tests joints indicated that a decrease in viscosity occurred from 3 to 6 months, an additional indicator of progressive degeneration. This novel implant model showed that even if a metallic hemiarthroplasty implant had an identical geometry as the joint surface being replaced and had a reasonably smooth surface, cartilage degeneration inevitably resulted.

Animals↗
PubMed1992

Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses.

Fourteen femora containing porous-coated anatomic medullary locking (AML) femoral prostheses were retrieved from 12 patients at autopsy. Clinical roentgenograms in 13 femora showed bone remodeling changes, indicating that the implants were fixed by osseointegration. Under simulated physiologic loading, micromotion between the implant and the bone was measured using electrical displacement transducers connected to the implant and to the adjacent cortex. The micromotion between the implants at the areas of porous coating and the adjacent cortex in the one case of failed bone ingrowth measured 150 microns. Maximum relative motion between the cortex and the implant in the areas of porous coating for the 13 cases showing signs of bone ingrowth was 40 microns, and this was completely elastic relative displacement. With all implants, the micromotion between the cortex and the stem was always greatest over the uncoated portion of the stem. Four of the implants were proximally porous coated. With these, the micromotion was greater over the uncoated areas than with more extensively coated stems and was always greatest at the uncoated tip of the prosthesis. The amount of micromotion was directly related to the extent of porous coating on the implant. Maximum tip motion for the proximally coated implants was 210 micra, whereas for the fully porous-coated implants, it was 40 microns. In nine of the autopsies, the contralateral normal femur was obtained in addition to the femur containing the AML (the in vivo remodeled femur). These were used for comparative studies of strain shielding and femoral remodeling. Cortical strains were measured in the in vivo remodeled femora and were compared with measurements made in the contralateral normal femora before and following implantation of a stem identical to that present on the clinically treated side. The data showed major strain reductions in all the postmortem implanted normal femora. Comparison of the strain data from the postmortem implanted normal femora with those from the in vivo remodeled femora clearly indicated that extensive bone remodeling did not result in restoration of cortical strain levels anywhere near normal. Strain shielding continued to exist in all of the remodeled specimens, even up to 7.5 years after surgery. This strain shielding was associated with bone remodeling changes that resulted in regional reductions in bone mineral content that ranged from 7% to 78%. These observations are unique, important, and valuable in defining the in vivo function and clinical behavior of this type of porous-coated femoral component.

Aged↗
PubMed1992

A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty.

Dual-energy x-ray absorptiometry analysis was used to determine the periprosthetic bone-mineral content of ten femora that had been obtained at the autopsies of five elderly patients who had had an AML (anatomic medullary locking) prosthesis in situ for seventeen to eighty-four months. Clinical radiographs showed resorptive remodeling changes characteristic of femora containing this implant. Before the absorptiometry was performed, an identical prosthesis had been inserted into the contralateral, normal femur of each cadaver. The mean difference in the periprosthetic bone-mineral content between the remodeled femora and the femora in which the prosthesis had been implanted post mortem ranged from 7 to 52 per cent, with the bone-mineral content always less in the remodeled femora. The greatest mean decrease in bone-mineral content (45 per cent) occurred adjacent to the proximal one-third of the remodeled femora. The percentage decrease in periprosthetic bone-mineral content in the remodeled femora had an inverse linear relationship with the corresponding bone-mineral content of the contralateral control femora. Preoperative analysis of bone density may therefore be useful for prediction of the extent of resorptive bone-remodeling after total hip replacement.

Absorptiometry, Photon↗
PubMed1992

Producing and avoiding stress shielding. Laboratory and clinical observations of noncemented total hip arthroplasty.

Experimental canine model studies of stiff versus flexible, fully porous-coated, metallic femoral stems (differing by three- to fivefold in stiffness characteristics) revealed markedly different resorptive bone remodeling patterns. The flexible stem resulted in about 30% more cortical bone retention adjacent to the implant at one-year postimplantation and larger differences in dogs killed two and three years after surgery. Strain-gauge studies confirmed that there are differences in cortical bone strains with the two stem designs, the flexible stem producing a more uniform and more nearly normal strain distribution medially. Differences in cortical bone remodeling were quantified using dual energy X-ray absorptiometry (DEXA). The bone mineral content in femora with the flexible stem decreased less than 20%, compared to normal. At three years postimplantation, the bone mineral content of the femora with the stiff stem was about 50% that of the femora with the flexible stem. Clinically, DEXA revealed that 5%-15% changes in bone mineral density at various periimplant sites were common within the first two years after surgery; these changes were not usually evident roentgenographically. Serial roentgenographically distinct bone resorption was usually associated with bone mineral density changes of 20%-50%. Five- to 13-year roentgenographic follow-up observations of 213 cases with the Anatomic Medullary Locking prosthesis showed that pronounced bone resorption occurred in 33% of patients. Larger stems (greater than 13 mm in diameter) and stems with extensive porous coating had a significantly higher incidence of pronounced bone resorption than smaller stems and those with proximal coating. The stiffness characteristics of the human femur were established as a function of canal size and compared with those of noncemented hip prostheses. Increased mechanical compatibility was found for stems made of titanium alloy and with design features that reduce cross-sectional area and moment of inertia. Clinical data suggest that to reduce the likelihood of pronounced bone resorption, it would be beneficial for the implant to possess a bending stiffness of about one half to one third that of the human femur.

Absorptiometry, Photon↗
PubMed1992

Results of implant retrieval from postmortem specimens in patients with well-functioning, long-term total hip replacement.

The evaluation of postmortem specimens provides a unique opportunity to gain understanding of the interface between host and well-functioning prostheses unavailable from revision specimens that, by nature, are accompanied by the artifacts generated during their removal. The preliminary findings from the relatively limited number of specimens described in this collaborative study demonstrate the value of the effort and are presented to encourage surgeons to participate in this program and to make their patients aware of the value of the information they may provide.

Adult↗
PubMed1990

Study of soft tissue ingrowth into canine porous coated femoral implants designed for osteosarcomas management.

The objective of this project was to characterize soft tissue bonding to porous coated implants such as those that would be used for resection-reconstruction of osteosarcoma cases. We were interested in determining conditions which would provide both mechanical attachment of the implant to the surrounding tissue and produce a vascularized interface. In a bilateral canine implant model, both femoral mid-shafts were replaced with a porous coated cobalt-chrome segmental implant fabricated with average pore sizes of 300 microns or 900 microns. Twelve implants, six of each pore size, were used in six dogs. Two dogs were sacrificed at 2, 4, and 6 months after implantation. The soft tissue-implant interface was characterized mechanically with peel tests and histologically using light microscopy and immunohistochemistry. At all periods, a nonvascularized fibrous membrane surrounded the smaller pore size implants, without ingrowth or mechanical bonding. In contrast, a vascularized membrane developed within and around the larger pore size implants; the attachment strength increasing with implantation time. The vascularity increased in size and quantity with time. This study demonstrates the feasibility of obtaining vascularized soft tissue attachment to tumor replacement implants with appropriate porous coated implant design.

Animals↗
PubMed1990

Adherence of HDPE powder coating on Co-Cr surfaces: effect of substrate preparation and gas sterilization.

As part of the development of a hemiarthroplasty implant with a compliant surface layer, the effect of surface preparation of a cast Co-Cr alloy substrate on the adhesion of a polymeric coating was studied. High-density polyethylene (HDPE) coatings were deposited on Co-Cr alloys without adhesive by spraying powder onto the surface of specimens maintained at a controlled temperature. Prior to deposition, two different types of surface preparation were carried out: chemical etching and grit-blasting. Adherence tests were performed in order to study the effect of the surface preparation of a Co-Cr alloy on the adherence of the HDPE film. The etching process enhanced the adherence by a factor of 10 compared to the grit-blasting process. For coatings deposited on grit-blasted Co-Cr surfaces, rupture occurred at the interface (adhesive mode) as well as in the coating (cohesive mode). A full cohesive mode was observed for films deposited on etched surfaces. Gas sterilization with an ethylene oxide and Freon 12 solution did not change significantly the adherence of the film deposited on etched surfaces. Examination of the surfaces indicated that the etching process created a specific type of porosity consisting of dendritic cavities whereas grit-blasting produced surface irregularities. Cavities produced by etching were larger that the polymer powder particles and could be easily filled. The coating of an etched Co-Cr alloy substrate with a layer of HDPE provided an interface that could probably sustain the physiological loading in a normal synovial joint.

Biocompatible Materials↗
PubMed1990

The effect of stem stiffness on femoral bone resorption after canine porous-coated total hip arthroplasty.

Bilateral noncemented total hip arthroplasty (THA) was produced in dogs to determine the effect of stem stiffness on stress-related bone resorption. Two porous-coated femoral implants of substantially different stiffnesses were designed for direct comparison. One was manufactured from cobalt-chromium (CoCr) alloy, the other from titanium alloy. The titanium stem was hollowed out to a wall thickness of 1 mm to further reduce its stiffness. The cumulative stiffness differences were about 5.4-fold axially and 3.6-fold in bending and torsion. Staged bilateral THA was performed on eight dogs. Each dog received a stiff CoCr stem on one side and a flexible titanium stem on the other. After death, the femora were removed and processed for undecalcified thin-section histology. Bone ingrowth and remodeling were quantified by computer-aided image analysis and compared between stem designs. All femoral specimens showed bone ingrowth fixation of both stiff and flexible stems along the implant length. Tetracycline labeling indicated active bone turnover in the femoral cortex and in regions of ingrowth. However, gross differences in femoral bone remodeling were observed both roentgenographically and histologically. Femora with the flexible stems consistently showed much less bone resorption than those with the stiff stems. Quantitative analysis of paired cross-sections indicated an average of 25%-35% more cortical bone area in the femora with flexible stems. Severe resorption of the cortex in the midstem region occurred in three of the femora with the stiff stems but in none with the flexible stems. Stem stiffness strongly influences bone remodeling. The flexible stem results in more uniform load transfer and less stress shielding.

Animals↗
PubMed1988

Radiography and histology of a threaded acetabular implant. One case studied at two years.

Threaded acetabular components are widely used in cementless total hip replacement, despite a poor understanding of the nature of the bone-implant interface. We have examined one case in which the threaded titanium ring appeared to be well incorporated with no discernible radiolucency. Microradiography and histology surprisingly showed that the threads were entirely encapsulated in fibrous tissue. This raises doubt about the relevance of plain radiography to the analysis of the acetabular interface.

Acetabulum↗
PubMed1988

Radiographic and histologic study of porous coated tibial component fixation in cementless total knee arthroplasty.

Radiographic changes occurring beneath three types of non-cemented, porous coated, cobalt-chrome tibial components were retrospectively reviewed a minimum of 1 year after arthroplasty. Radiolucent zones, radiodense lines, and loose sintered particles were commonly observed. These changes are consistent with non-rigid, fibrous tissue fixation. Histologic evaluation of two specimens retrieved at revision surgery revealed predominantly fibrous tissue within the porous surface under the tibial plateau. The long-term implication of fibrous tissue fixation of porous coated tibial implants in unknown.

Adult↗
PubMed1988

The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty.

The influence of stem size and extent of porous coating on femoral bone resorption was examined in 411 cases of primary cementless hip arthroplasty. Moore design, cobalt alloy femoral implants with powder-made sintered porous coating on either one-third, two-thirds, or the full implant length were compared radiographically two years after surgery. A semiquantitative method was adopted for assessing resorption that involved dividing the anteroposterior (AP) and lateral roentgenograms into a total of 16 discrete sites. The 16 sites were qualitatively examined for evidence of resorption by either thinning or darkening of bone relative to the time immediately following surgery. Based on the number of sites that demonstrated resorption, the bone loss was classified as either minor and not likely to cause problems (0 to 4 sites) or pronounced and of potentially harmful clinical consequence (5 or more sites). Pronounced resorption occurred in 18% of the 411 cases. The use of larger stems resulted in increased occurrence of marked bone resorption: stems greater than or equal to 13.5 mm in diameter showed five times the incidence of pronounced resorption compared with stems less than or equal to 12.0 mm in diameter. Stems with two-thirds and full porous coating resulted in a twofold to fourfold increase in the incidence of pronounced bone resorption. The theoretic degree of stress shielding of the femoral shaft in bending was calculated for cases with complete canal filling and a radiographic appearance of bone ingrowth. There was a strong correlation between this theoretic factor and the observed bone resorption.

Aged↗
PubMed1987

The effect of proximally and fully porous-coated canine hip stem design on bone modeling.

Porous coated canine femoral hip replacement implants were evaluated for biological fixation by bone ingrowth and the effect of the extent of porous coating on bone modeling. The Co-Cr alloy implants were either fully porous coated or coated only on the proximal 40% of the stem. Two implants of each type were studied 9, 16, and 36 months after surgery. Implant fixation and bone modeling were assessed radiographically throughout the implant periods and histologically after the test animals were killed. All 12 implants appeared stably fixed within the femur and were bone-ingrown in the porous region. Radiographic features such as proximal medial and anterior cortical thinning, proximal cancellous bone hypertrophy, and new endosteal bone formation near the stem tip were noted within the first postoperative year, with no appreciable change thereafter. The extent of proximal cortical thinning varied from virtually none to as much as 40%, being more prominent with the proximally coated implants at 16 months and with the fully coated implants at 36 months. Of consistent note was cancellous hypertrophy at the junction of porous and smooth implant surfaces with proximally coated implants and new endosteal bone formation and ingrowth at the stem tip of fully coated implants. These results indicate that the proximally porous-coated implant design causes increased proximal stress transfer, but this does not necessarily preclude proximal cortical resorption.

Adaptation, Physiological↗
PubMed1987

A technique of extensile exposure for total hip arthroplasty.

A technique of trochanteric osteotomy that allows extensile exposure of the hip and wide exposure of the proximal femoral diaphysis for total joint replacement is described. Pathologic conditions of the shaft encountered during arthroplasty can therefore be addressed. The approach is based on the preservation of an intact musculoosseous-muscular sleeve comprised of the gluteus medius, greater trochanter, and vastus lateralis and allows physiologic reconstruction of the hip's soft tissue envelope. This versatile approach is particularly useful in revision surgery and in difficult primary interventions where leg length is adjusted. The surgical technique, indications, and advantages are described. Early clinical results of 90 cases are presented.

Femur↗
PubMed1987

Proximal femoral osteotomy as an adjunct in cementless revision total hip arthroplasty.

Cementless total hip replacement techniques are increasingly used in revision arthroplasty. A major challenge is to achieve implant stability in a femur distorted by a failed arthroplasty. Five patients with aseptic loosening of cemented primary or revision total hip replacements complicated by significant proximal femoral disease, four with marked angular deformity of the femur and one with a subtrochanteric nonunion, were treated successfully with cementless revision arthroplasty combined with proximal femoral osteotomy. At follow-up examination, all femoral and trochanteric osteotomies had healed and D'Aubigne and Postel scores for pain, function, and range of motion had improved. All porous prostheses demonstrated radiographic features consistent with bone ingrowth fixation. No progressive stress shielding has been observed. Concomitant femoral osteotomy to correct anatomic deformity, in association with cementless total hip arthroplasty, results in union of the osteotomy and restoration of hip function.

Adult↗
PubMed1987

Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.

Total hip replacement using porous-coated cobalt-chrome femoral implants designed for biological fixation has been evaluated in 307 patients after two years and in 89 patients after five years. Histological study of 11 retrieved specimens showed bone ingrowth in nine and fibrous tissue fixation in two. Fixation by bone ingrowth occurred in 93% of the cases in which a press fit of the stem at the isthmus was achieved, but in only 69% of those without a press fit. The clinical results at two years were excellent. The incidence of pain and limp was much lower when there was either a press fit of the stem or radiographic evidence of bone ingrowth. Factors such as age, sex, and the disease process did not influence the clinical results. Most cases showed only slight resorptive remodelling of the upper femur, but in a few cases with a larger, more rigid stem, more extensive bone loss occurred. The results after five years showed no deterioration with time. Fixation by the ingrowth of bone or of fibrous tissue both appeared to be stable, but bone ingrowth gave better clinical results.

Aged↗
PubMed1987

Histologic analysis of a retrieved microporous-coated femoral prosthesis. A seven-year case report.

A microporous-coated femoral prosthesis with an average pore size of 80 to 100 microns was retrieved after seven years in a revision operation on a failed cemented acetabular component. The proximal anterior and lateral aspects of the implant were encrusted with bone. The bone was attached to the porous coating in regions of ingrowth. The implant was stable within the femur although most of the porous coating was not bone ingrown. There was progressive bone resorption in the proximal femur, suggestive of a reactive biologic mechanism. There was also a sizable posterior pocket of granulation tissue containing chronic inflammatory round cells associated with numerous birefringent polymeric particles. Polyethylene wear debris and acrylic cement were engulfed by multinucleated giant cells enveloping the loose cup.

Acetabulum↗