Micromotions between stem and neck adapter depend on prosthesis design and material coupling. Based on the results of this study, the amount of micromotion seems to reflect the risk of fretting-induced fatigue in vivo. Bimodular hip prostheses were developed to allow surgeons an individual reconstruction of the hip joint by varying length, offset and anteversion in the operation theatre. Despite these advantages, the use of these systems led to a high rate of postoperative complications resulting in revision rates of up to 11% ten years after surgical intervention. During daily activities taper connections of modular hip implants are highly stressed regions and contain the potential of micromotions between adjacent components, fretting and corrosion. This might explain why an elevated number of fretting-induced neck fractures occurred in clinics. However, some bi-modular prostheses (e.g. Metha, Aesculap, Ti-Ti) are more often affected by those complications than others (e.g. H-Max M, Limacorporate, Ti-Ti or Metha, Ti-CoCr) implying that the design and the material coupling have an impact on this failure pattern. Therefore, the purpose of this study was to clarify whether clinical successful prostheses offer lower micromotions than those with an elevated number of in vivo fractures.Summary
Introduction
Nucleotomy almost doubles the transmitted forces on the facet joints in human lumbar spine, regardless of the amount of removed nucleus pulposus. Low back pain involves the lumbar facet joints in 15% to 45% of the cases. The surgical intervention, nucleotomy, might also lead to painful facets with a high risk; however, its mechanism is yet to be fully understood. The aim of this study is to reveal how a small amount of nucleus removal can change the force transmission on the facets.Summary
Introduction
From a mechanical point of view, the clinical use of pedicle screws in the atlas is a promising alternative to lateral mass screws due to an increased biomechanical fixation. The most established surgical technique for posterior screw fixation in the atlas (C1) is realised by screw placement through the lateral mass [1]. This surgical placement may lead to extended bleeding from the paravertebral venous plexus as well as a violation of the axis (C2) nerve roots [1]. Using pedicle screws is an emerging technique which utilises the canal passing through the posterior arch enabling the use of longer screws with a greater contact area while avoiding the venous plexus and axis nerve roots. The aim of this Summary Statement
Introduction
At the clinical CT image resolution level, there is no influence of the image voxel size on the derived finite element human cancellous bone models Computed tomography (CT)-based finite element (FE) models have been proved to provide a better prediction of vertebral strength than dual-energy x-ray absorptiometry [1]. FE models based on µCTs are able to provide the golden standard results [2], but due to the sample size restriction of the µCT and the XtremeCT machines, the clinical CT-based FE models is still the most promising tool for the in vivo prediction of vertebrae's strength. It has been found [3] that FE predicted Young's modulus of human cancellous bone increases as the image voxel size increases at the µCT resolution level [3]. However, it is still not clear whether the image voxel size in the clinical range has an impact on the predicted mechanical behavior of cancellous bone. This study is designed to answer this question.Summary
Introduction
We compared the orientation of the acetabular component obtained by a conventional manual technique with that using five different navigation systems. Three surgeons carried out five implantations of an acetabular component with each navigation system, as well as manually, using an anatomical model. The orientation of the acetabular component, including inclination and anteversion, and its position was determined using a co-ordinate measuring machine. The variation of the orientation of the acetabular component was higher in the conventional group compared with the navigated group. One experienced surgeon took significantly less time for the procedure. However, his placement of the component was no better than that of the less experienced surgeons. Significantly better inclination and anteversion (p <
0.001 for both) were obtained using navigation. These parameters were not significantly different between the surgeons when using the conventional technique (p = 0.966). The use of computer navigation helps a surgeon to orientate the acetabular component with less variation regarding inclination and anteversion.
