| Implant stability is affected by local bone microstructural quality. | |
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MedLine Citation:
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PMID: 21609793 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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It is known that low bone quality, caused for instance by osteoporosis, not only increases the risk of fractures, but also decreases the performance of fracture implants; yet the specific mechanisms behind this phenomenon are still largely unknown. We hypothesized that especially peri-implant bone microstructure affects implant stability in trabecular bone, to a greater degree than more distant bone. To test this hypothesis we performed a computational study on implant stability in trabecular bone. Twelve humeral heads were measured using micro-computed tomography. Screws were inserted digitally into these heads at 25 positions. In addition, at each screw location, a virtual biopsy was taken. Bone structural quality was quantified by morphometric parameters. The stiffness of the 300 bone-screw constructs was quantified as a measure of implant stability. Global bone density correlated moderately with screw-bone stiffness (r(2)=0.52), whereas local bone density was a very good predictor (r(2)=0.91). The best correlation with screw-bone stiffness was found for local bone apparent Young's modulus (r(2)=0.97), revealing that not only bone mass but also its arrangement in the trabecular microarchitecture are important for implant stability. In conclusion, we confirmed our hypothesis that implant stability is affected by the microstructural bone quality of the trabecular bone in the direct vicinity of the implant. Local bone density was the best single morphometric predictor of implant stability. The best predictability was provided by the mechanical competence of the peri-implant bone. A clinical implication of this work is that apparently good bone stock, such as assessed by DXA, does not guarantee good local bone quality, and hence does not guarantee good implant stability. New tools that could quantify the structural or mechanical quality of the peri-implant bone may help improve the surgical intervention in reaching better clinical outcomes for screw fixation. |
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Authors:
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Andreas J Wirth; Jörg Goldhahn; Cyril Flaig; Peter Arbenz; Ralph Müller; G Harry van Lenthe |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-13 |
Journal Detail:
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Title: Bone Volume: - ISSN: 1873-2763 ISO Abbreviation: - Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-5-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8504048 Medline TA: Bone Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011. Published by Elsevier Inc. |
Affiliation:
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Institute for Biomechanics, ETH Zurich, Zurich, Switzerland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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