Total shoulder arthroplasty is a well-established and widely accepted method of treatment for a variety of shoulder disorders, loosening of the glenoid prosthesis is the main complication in total shoulder arthroplasty, it is highly dependent on the quality of the glenoid cancellous bone. Very little is known about mechanical properties of this cancellous bone. The objectives of this study were to determine the mechanical properties (elastic modulus and strength) of glenoid cancellous bone in the axial, coronal and sagittal planes including regional variation using a uniaxial compression test. To our knowledge, this kind of study was not done before.

Eleven scapulas were obtained from six fresh-frozen, unembalmed human cadavers (mean age eighty-eight years). Eighty-two cubic cancellous bone specimens of 6×6×6mm3 were used for mechanical testing in the three planes. The test was a uniaxial compression along each direction, Elastic modulus and strength were determined from the stress-strain curve. Apparent density was also calculated.

The study showed significant differences in the mechanical properties with anatomic location and directions of loading. Young modulus and strength were found to be significantly higher at the posterior part of the glenoid with the weakest properties at the antero-inferior part. Cancellous bone was found to be anisotropic with higher mechanical properties in the latero-medial direction (perpendicular to the articular surface of the glenoid). The apparent density was on average equal to 0.29 g/cm3 with the higher values at the posterior and superior part of the glenoid. Good correlation between apparent density and elastic modulus was found only in the sagittal plane but not in the coronal and axial plane, the overall correlation was low (r2 = 0.22, p< 0.0001) which emphasizes the role of trabecular bone architecture in predicting mechanical properties.

The mechanical properties determined in this study provide input data for finite element method analyses and may help to assist in uncemented shoulder prosthesis design.

Mechanical tests that have been carried out to validate finite-element models predicting vertebral strength concern vertebral bodies under axial compression. But in standing position gravity loads can induce a flexion component, especially for the last thoracic and first lumbar vertebrae. The aim of the study was to evaluate the strength of complete vertebrae under anterior compression.

15 isolated vertebrae T11-L2 (four women, one man, 88 ± 14 years old) were tested to failure. The load was applied at the one third of the vertebral body depth through a ball constrained in a hole. It was homogeneously distributed on the vertebral endplate through a polymetylmetacrylate (PMMA) layer which completely fills the concavity. The solid composed by the PMMA layer and the steel plate containing the hole for the ball was called “upper plate”. Its 3D orientation was assessed using the Polaris® motion capture system (accuracy: 0.6 mm, 0.6°) thanks to tripods. Before testing, the position of the marker-frames was assessed using 3D reconstructions (obtained by bi-planar X-rays) to express all the movements relatively to the vertebral frame.

The outcome data was the position of the upper plate. The load was calculated from the measurement of the vertical load (using the testing machine sensor) and the orientation of the upper plate (using the Polaris® system).

The mean flexion of the upper-plate is equal to 1° (± 0.7°) before the vertebra collapses. As this value is weak, the optoelectronic assessment could be removed during the test if the initial 3D orientation of the upper plate relatively to the vertebral frame is assessed.

This protocol allowed collecting with accuracy all the data necessary to validate models.

Purpose of the study: The issue of patellar kinematics remains a difficult problem for patellar resurfacing during conventional or computer-assisted knee surgery, yet adequate knowledge is required for appropriate orientation of the patellar cut and insert positioning. The purpose of this study was to develop a non-invasive tool for in vivo kinematic analysis of the patellar tract and to compare results with the gold-standard invasive method.

Material and methods: A special experimental set-up designed for this study enabled experimental simulation of load-bearing flexion-extension cycles of the knee joint. Range of motion from 0 to 102° was imposed with a computer-controlled motor. The analysis was conduced on 14 complete lower limb cadaver specimens. Patellar kinematics was analyzed for each knee simultaneously with two systems: a non-invasive method using a low-dose stereoradiographic scan linked to a 3D reconstruction software; and the reference system using tripodes implanted on the patella and radio-opaque spherical markers. Six degrees of freedom were considered: three translations and three rotations. Sequential kinematic recordings were made by calculating the position of a patellar landmark in relation to a femoral landmark.

Results: The mean difference between the results obtained with the two systems was less than 1 mm for anteroposterior and vertical translations, greater for mediolateral translations. It was less than 2° for patellar flexion-extension, to the order of the motion itself for abduction-adduction, and to the order of 5° for horizontal tilt.

Discussion and conclusion: The non-invasive technique proposed here appears to be reliable for patellar translations and flexion, but need further improvement for tilt and adduction-abduction. This is particularly true for the 45° to 90° range of motion because of the difficult problem of determining the contours of the patella. Further developments for this tool are under way.

Purpose: Scoliosis is a three-dimensional deformation of the spinal column. Modern surgical techniques have attempted to address this 3D component of the problem but pre- and postoperative measurements lack precision. A solution is stereoradiographic 3D reconstruction providing 1.1 mm precision for vertebral shape and 1.4° precision for axial rotation.

Material and methods: Ten patients (seven adolescents and three adults) with idiopathic scoliosis (mean 56°, range 36°–78°) were treated with an in situ arching method. A calibrated teleradiogram (AP and lateral view) was obtained before and after surgery. The spinal columns were reconstructed by stereoradiography. Six rotation angles were measured in the three planes for each vertebra and each intervertebral space, taking into account the curvatures and their apical and junctional zones.

Results: Preoperatively, for thoracic scoliosis, measurements were: mean vertebral axial rotation (VAR) measured at the apex = 20°; mean lateral axial rotation (LAR) of the junctional zones = 30°; mean intervertebral rotation (IVR) = 10°. Depending on the curvatures, in situ arching yielded a 52–60% correction of the VAR at the apex, and 78–79% correction of the junctional zones. VLR of the junctional zoenes was improved 58–74%. Intervertebral sagittal rotation (ISR) at the summit (kyphosis) was improved 5.5° on the average.

Discussion: Unlike computed tomoraphy where scans are obtained in the supine position, three-dimensional reconstruction of the spinal column enables a precise analysis of the loaded spine. Improvement was significant in the frontal plane with 18.3° and 21.4° improvement of the VLR for the thoracic and thoracolumbar junctional zones respectively, compared with the rod rotation where the peroperative stereophotogram showed a 9.6° and 8.6° gain respectively. There was a real improvement in VAR, differing from the literature where the rotation of the rod appears to be less pronounced.

Conclusion: Three-dimensional reconstruction of the spinal column enables a segmentary analysis of scoliosis deformations. In addition, by enabling a view of the spinal column in all directions, angle measurements can be made with precision allowing repeated measurements and comparisons. This technique demonstrated the efficacy of in situ arching in improving vertebral rotation.