Biomedical subjects

M Morlock

Publications and source records attributed to M Morlock.

At least 19 recordsLinked to original sources

PubMed2006

Orientation of the acetabular component. A comparison of five navigation systems with conventional surgical technique.

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.

Acetabulum↗

PubMed2002

[Placement of pedicle screws using different navigation systems. A laboratory trial with 12 spinal preparations].

A well-known problem occurring with thoracolumbar spondylodesis is the perforation of pedicle screws through the pedicle wall. It occurs in up to 40% of the implanted screws. To reduce this problem, computed tomography (CT)-based navigation systems have been introduced, which allow the surgeon multidimensional control of the screw position in virtual reality and real time during insertion. In the recent past, fluoroscopy-based navigation systems have also been built. We inserted 77 pedicle screws in human lumbar cadaveric spine specimens either without navigation, with CT-based navigation, or with fluoroscopy-based navigation. In the critical sizes of pedicles between 6.5 and 9 mm, we found the best results with CT-based navigation, but there was no significant difference between the three methods. The minimal pedicle and the screw diameters should be reported in every study on pedicle screw misplacement and spine navigation since they represent the most important factor in pedicle wall perforations.

Bone Screws↗

PubMed2002

[Definition of pedicle malposition. Primary stability and loosening characteristics of pedicle screws in relation to position: spongious anchoring, cortical anchoring, perforation and malposition].

Totally misplaced pedicle screws will lead to major stability problems. There are no publications about the stability behavior of screws, which have no pure trabecular position and perforate the pedicle slightly. Since neurological problems are only described with screws perforating the pedicle medially by at least 4 mm, this question has great relevance concerning the definition of pedicular malposition. Sixty-eight pedicle screws were tested in human cadaveric lumbar spines. Their vertical path was measured at the beginning and end of 1000 sinusoidal cycles with a force amplitude of 160 N. They were divided into four groups according to their screw position as mentioned in the title. We found no significant differences in primary stability or loosening between the groups. The cortical contact and perforation groups had slightly better results, which were not significant in comparison to the other two groups.

Biomechanical Phenomena↗

PubMed2002

[Comparison of different vertebral body prosthesis with reference to migration and primary stability in dorsoventral spondylodesis after corporectomy with and without laminectomy].

In order to allow speedy mobilization after vertebral body replacement, high primary stability as well as prevention of implant dislocation are required. It is unclear whether differences between common vertebral body replacement systems exist and whether spreadable implants improve primary stability. Migration characteristics of 3 different vertebral body replacement systems were determined using human lumbar spine specimens. Primary stability was assessed by loading specimens successively in 5 conditions: native, after dorsal spondylodesis, after laminectomy and after vertebral body replacement. Migration was shown to depend on cage design and spike shape. Dorsal spondylodesis in combination with vertebral body replacement reduced flexion/extension movement effectively independent of cage design. Stabilization potential in lateral bending was limited. None of the cages limited movement under torsional loading effectively. The possibility to spread the cage had a positive effect on stabilization.

Biomechanical Phenomena↗

PubMed2002

What can we learn from explanted endovascular devices?

OBJECTIVE: To examine the durability of the Stentor and Vanguard endovascular devices in human implants. METHODS: The textile covering, the polypropylene ligatures and the stent metal of 34 devices (25 Stentor, 9 Vanguard) with a mean duration of implantation of 28.8 +/- 16 months was examined by means of stereomicroscopy and scanning electron microscopy. RESULTS: The polyester textile covering showed gaps along the sutured seam and isolated holes in the fabric. All of the examined polypropylene ligatures were worn, some ruptured. Four different types of stent corrosion were classified--pits (100%), bizarre craters (68%), large deficiencies (14%) and fractures (32%). CONCLUSION: Holes in the polyester fabric and frame dislocations are specific for the design of Stentor and Vanguard grafts. The early corrosion of the stent metal Nitinol in these devices is surprising. Until more experience is gained with other devices, we have to be reminded, that the "gold standard" for the long-term durability of artificial vascular grafts is still "today's" conventional graft.

Blood Vessel Prosthesis↗

PubMed2002

[Injury of polyester grafts by vascular clamps].

UNLABELLED: Protected vascular clamps are not new. Clamp associated damage of human arteries has already been published over 20 years ago. The necessity of protective clamps seems to have been forgotten. In our explant archive (230 explants) we have observed an accumulation of graft ruptures in the groin (13 of 25 ruptures). We presume a multifactorial process. Clamp damage could be part of it. The aim of this study is to prove the clamp induced damage of polyester vascular grafts and to examine whether protected clamps can reduce this. METHOD: Five unprotected (Aesculap(R) FB512R, FB502, FB517, Ulrich CC1235, CV3535) and 5 protected vascular clamp types (Aesculap(R) FB667, FB668, Edwards(R) - formally Baxter(R) - Fogarty(R) CV5050, CV5201, Edwards(R) Cosgrove(R) CV1033) were tested. A longitudinal burst test was performed after maximal clamp closure on 6 different, multifilament polyester yarns of 2 different vascular grafts manufacturers (B. Braun(R), Edwards(R)). RESULTS: The yarn tests with protected clamps showed no difference to those of the unclamped yarns. After clamping with unprotected vascular clamps the stress-strain-diagrams differed significantly. The mean, maximum burst strength was up to 75 % lower. Video documentation revealed filament ruptures. Damage of the yarn surface was seen on a simple woven graft in scanning electron microscopy (SEM). DISCUSSION: The application of unprotected vascular clamps on polyester vascular grafts is common in Germany (56 %). The observed damage of multifilament polyester yarns makes it necessary to re-consider the use of unprotected vascular clamps. The benefit for biological vessels has already been shown.

Blood Vessel Prosthesis↗

PubMed2001

Duration and frequency of every day activities in total hip patients.

Little knowledge about frequency and duration of daily activities in patients after total hip arthroplasty is available. Such information is required for the definition of realistic load collectives for pre-clinical testing of prostheses. It could also be helpful for the quantitative evaluation of surgery outcome with different prosthesis types. The purpose of this study was to develop and apply a system for the determination of frequency and duration of patient activities in their habitual environment and to compare the results to a clinical outcome score (Harris hip score).A portable activity monitoring system (weight 1.6 kg including batteries) was designed using a Palm top computer, 2 inclination sensors for the thigh and calf and one goniometer positioned at the knee joint. An algorithm was developed to identify frequency and duration of the activities lying, sitting, standing, walking and stair climbing from the signals of the 3 sensors. 42 patients participated in the study and were equipped with the system in the morning at their home. Datasets of 31 patients (age 62.5+/-11.5 y) covered more than 6h (9.8 +/- 1.6 h) and were included in the analysis. Prosthesis specific data as well as the Harris hip score were collected. The most frequent patient activity was sitting (44.3% of the time), followed by standing (24.5%), walking (10.2%), lying (5.8%) and stair climbing (0.4%). The median number of steps/stairs was 6048/164. The number of step cycles representing one year in vivo use should, consequently, be increased to 1.1 million. The Harris hip score (91.4 +/- 9.8) correlated significantly with the number of stairs (r(2) = 0.26, p = 0.003) and showed a positive tendency with the number of steps per day. No differences in activity levels between prosthesis specific factors were found.

Activities of Daily Living↗

PubMed2001

Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty.

A patient complained about a squeaking noise in his total hip arthroplasty. Clinical evaluation revealed good function, and there were no signs of loosening on the radiograph. Physiotherapy did not alter this phenomenon, and ultimately a revision was performed 42 months after the first surgery. The analysis of the retrievals revealed that a zirconium oxide ceramic head had been paired with a monolithic alumina ceramic cup. The cup showed large deviations from an ideal sphere but minor wear signs. The head exhibited heavy local damage in the articulation zone. This damage might have been caused by the observed unsatisfactory fit between cup and ball, resulting in high stress concentrations and increased wear of the zirconium head. The characteristics of the zirconium and aluminum ceramics pairing might have worsened the process. The combination of implants used in this retrieved wear couple was never approved. To prevent such problems, components of different manufacturers should never be mixed and matched unless explicitly stated.

Aluminum Oxide↗

PubMed2001

Corroded nitinol wires in explanted aortic endografts: an important mechanism of failure?

PURPOSE: To analyze surface alterations and fractures observed in the nitinol stent wires of explanted endovascular grafts used for treatment of abdominal aortic aneurysm. METHODS: Twenty-one explanted Stentor devices and 1 Cragg stent were received from investigators in Germany and France. After macroscopy and photography, the explants were cleaned and the polyester coating removed. The frame was examined completely by stereomicroscopy, and irregularities were assayed by scanning electron microscopy and energy dispersive x-ray analysis (EDAX). The observed alterations were classified according to stereomicroscopic and electron microscopic morphology. RESULTS: The mean implantation interval for the endografts was 29.1 +/- 13.2 months (range 5-46). All examined explants, even those retrieved after only a few months in situ, showed pitlike surface damage 10-25 microm in diameter. Larger, irregularly shaped surface alterations were observed in approximately 70% of the explants. Older explants (age >32 months) presented vast regions of decay, with bending of the wire and stress cracks in some areas. EDAX examination revealed decreased nickel concentration in the corroded regions. CONCLUSIONS: Corrosion of the nitinol wire in endovascular grafts is confirmed. Presumably, the observed pitting and irregularly shaped corrosion defects are the precursors of material failure. They weaken the thin wire, which leads to stress cracks and eventually fracture of the stent wire under circulatory pulsation. Cell-induced electrochemical corrosion and active cellular destruction of surfaces are well-known mechanisms that must be investigated for their possible roles in the corrosion of stent metals.

Alloys↗

PubMed2001

[Late complications after alloplastic vascular replacement].

The follow-up of 273 AAA patients operated 1981-1985 showed a mean dilation of polyester grafts of 17.4% in 12 days and 34.8% in 3 years. This early dilation is due to mesh expansion of the warp knitted grafts. It has no clinical relevance. In contrary the late dilation after approximately 10 years is due to degradation. The evaluation of 436 explanted grafts attained from 75 hospitals showed graft rupture to be the cause of the explanation for 42/255 (16%) polyester grafts and 2/42 (5%) PTFE grafts. The most ruptures were observed in the surrounding of the inguinal ligament after 10 to 20 years of duration. In comparison to modern endovascular grafts the conventional polyester and PTFE grafts still are the gold standard of durability.

Aortic Aneurysm, Abdominal↗

PubMed2000

The use of water-jetting technology in prostheses revision surgery-first results of parameter studies on bone and bone cement.

Water-jet cutting techniques have been used in industrial applications for many different materials. Recently these techniques have been developed into a revolutionary cutting tool for soft tissues in visceral surgery. The present study investigates the usage of this cutting technology for the revision surgery of endoprostheses. In the first part of the study, samples of bovine bone and acrylic bone cement (PMMA) were cut using an industrial jet cutting device with pure water. Below 400 bar, only PMMA was cut; above 400 bar, bone was also cut, but only pressures above 800 bar resulted in clinically useful rates of material removal (cut depth 2. 4 mm at 10 mm/min traverse speed). In the second part of the study, the effect of adding biocompatible abrasives to the water in order to reduce the required pressure was investigated, resulting in a significantly higher removal of material. At 600 bar, PMMA was cut 5. 2 mm deep with plain water and 15.2 mm deep with added abrasives. The quality of the cuts was increased by the abrasive. Though there was no clear selectivity between bone and PMMA any more, the rate of material removal at similar pressures was significantly higher for PMMA than for bone (600 bar: 1.6 mm cut depth for bone samples, 15.2 mm for PMMA). The measured cut depths with either method were not influenced by a change of the cutting direction with respect to the main direction of the osteons in the bone. However, a reduction of the jet surface angle (90 degrees to 23 degrees ) resulted for bone in a significantly lower cut depth at 600 bar (plain water: 0.62 mm vs. 0.06 mm; abrasive: 1.61 mm vs. 0.60 mm). The laboratory experiments indicate that abrasive water jets may be suitable for cutting biomaterials like bone and bone cement.

Analysis of Variance↗

PubMed2000

[Water jet cutting for bones and bone cement--parameter study of possibilities and limits of a new method].

Water jet techniques have been used in industrial cutting, drilling and cleaning applications for more than 30 years. Plain water is typically used for the cutting of non-metallic materials. The addition of abrasive substances to the stream allows almost any material to be cut. The first medical applications were reported in the early 1980s, when the water jet was used to cut organs. The present study investigates the use of water jet cutting technology for endoprosthesis revision surgery. Bone and PMMA (polymethylmethacrylate) samples were cut at different pressures using an industrial water jet cutting device. Using plain water at 400 bar, PMMA was cut selectively without damaging the bone; above 400 bar, bone was also cut, but the cutting depths in PMMA were significantly greater (p < 0.05). Adding a water-soluble abrasive disaccharide to the water results in a significantly higher removal rate for both materials (p < 0.05), but selectivity is lost, although the differences in cutting depth between the two materials was significant (p < 0.05). With an abrasive, the quality of the cut was better for both materials. The water jet technology--in particular the abrasive technique--can be used to cut biomaterials such as bone and bone cement. The diameter of the jet is a great advantage when working in the confined area at the prosthesis interface. The cutting process is essentially cold, thus eliminating a thermal effect, and the jet reaction forces are relatively low. Accurate manipulation of the hydro jet nozzle is possible both manually and by robot. The results obtained show that it is possible to remove prostheses with this cutting technique, rapidly and with little damage to the surrounding tissue. Problem areas are the development of sterile pumps and the "depth control" of the jet.

Animals↗

PubMed2000

[Stent wire fractures and mesh loosening in explanted endovascular prosthesis].

UNLABELLED: Vascular grafts are available since the middle of the 50's. Explant retrieval studies still reveal not published material degradation today, after over 40 years of product development. Endovascular grafts exist since the beginning of the 90's. New developments and modifications have lead to numerous devices. The importance of explant retrieval studies grows. MATERIALS AND METHODS: Among 33 stentgrafts, retrieved 5 to 43 months after implantation, the majority were 18 MinTec devices (17 Stentor, 1 Cragg). These 18 explants were examined by endoscopy, stereomicroscopy and scanning electron microscopy. RESULTS: The following material degradation was observed. The textile coating showed holes along the longitudinal seam, the ligatures in-between the stentframes burst, allowing the frames to dislocate. Occasional fractures of the stent wire were seen accompanied by bowl-shaped alterations of the surface. CONCLUSION: The Stentor device is, since its modification 1996, not available any longer. It was one of the most applied devices world-wide. The possible material deficiencies must be known by those performing patient follow-up. The occurrence of alterations within 43 months shows the importance of a continued follow-up besides clinical trials.

Device Removal↗

PubMed1999

Frame dislocation of body middle rings in endovascular stent tube grafts.

OBJECTIVES: To understand the cause, and propose a mechanism for frame dislocation in endovascular grafts. MATERIALS AND METHODS: Five tube grafts were explanted due to secondary distal leakage 15-21 months after operation. One bifurcated graft was removed during emergency operation after aortic rupture caused by secondary leakage. A second bifurcated graft was harvested from a patient with thrombotic occlusion of one limb, who died after transurethral prostatic resection. The inside of the grafts were examined endoscopically. The stent was inspected after removal of the fabric, broken ligatures were counted and examined by scanning electron microscopy. The fabric strength was tested by probe puncture. RESULTS: We found 17-44% of the stent ligatures of the body middle rings to be loose. The knots were intact. Degradation of the polyester textile was not observed. CONCLUSIONS: Continuous movements in the grafted aorta and blood pressure impose permanent stress to the stent frame and the polyester fabric resulting in morphological changes in the body middle ring of grafts. The clinical implications of the suture breakages are unknown although they may be related to distal secondary leakage in tube grafts.

Aortic Aneurysm, Abdominal↗

PubMed1999

[A simplified procedure for mechanical testing of lumbar spinal fixation implants].

On the basis of the current ASTM and ISO standard proposals, a simplified test procedure for spinal fixation implants has been developed. It comprises static and dynamic tests aimed at evaluating the stiffness and strength of various different internal implants. Different methods of mounting the pedicle screws to the test device are shown to significantly affect the characteristic values and failure mechanisms of the implants. The feasibility of the procedure was investigated by comparing 7 different internal fixation implants. The reproducible results revealed general differences associated with the material, dimensions and design, which latter in particular correlated with the specific failure mechanisms. For longer-term in situ duration, testing of these implants should be expanded to include an analysis of wear and corrosion properties.

Biomechanical Phenomena↗

PubMed1998

Erythropoietin loaded microspheres prepared from biodegradable LPLG-PEO-LPLG triblock copolymers: protein stabilization and in-vitro release properties.

Biodegradable microspheres containing recombinant human Erythropoietin (EPO) were prepared from ABA triblock copolymers, consisting of hydrophobic poly(l-lactic-co-glycolic acid) A blocks and hydrophilic polyethylenoxide (PEO) B blocks. Different polymer compositions were studied for the microencapsulation of EPO using a modified double-emulsion process (W/O/W). The encapsulation efficiency for EPO, ranging from 72% to 99% was quite acceptable. The formation of high molecular weight EPO aggregates, however, was higher than in poly(d,l-lactide-co-glycolide) (PLG) microparticles. Using different excipients with known protein stabilizing properties, such as Bovine Serum Albumin (BSA), Poly-l-Histidine (PH), Poly-l-Arginine (PA) or a combination of PA with Dextran 40 (D40), the EPO aggregate content was significantly reduced to <5% of the encapsulated EPO. In contrast to PLG, ABA triblockcopolymers containing >7 mol % PEO, allowed a continuous release of EPO from microspheres for up to 2 weeks under in-vitro conditions. The release profile was comparable to FITC-Dextran 40 kDa (FD 40) loaded microspheres in the initial release phase, while EPO release was leveling off at later time points. BSA additionally prolonged the EPO release, while blends of PLG and PEO did not generate continuous EPO release profiles. LPLG-PEO-LPLG triblock-copolymers (35 mol % PEO; 30 kDa) in combination with 5% BSA yielded both an acceptable level of EPO aggregates and a continuous release profile under in-vitro conditions for up to 2 weeks. The formation of EPO aggregates at later time points is probably induced by acidic cleavage products of the biodegradable polymer and requires further optimization of the ABA polymer composition.

Biocompatible Materials↗

PubMed1998

Recombinant human erythropoietin (rhEPO) loaded poly(lactide-co-glycolide) microspheres: influence of the encapsulation technique and polymer purity on microsphere characteristics.

Recombinant human erythropoietin (EPO) and fluorescein isothiocyanate-labelled dextran (FITC-dextran) loaded biodegradable microspheres were prepared from poly(lactide-co-glycolide) (PLG) by a modified spray-drying technique. This microencapsulation method was compared with the water-in-oil-in-water (w/o/w) double-emulsion method. As expected, microsphere morphology, particle size and particle size distribution strongly depended on the production process. The spray-drying method was found to have a number of advantages compared to the w/o/w double-emulsion technique. The content of residual dichloromethane (DCM) in the final product was significantly lower in case of the microspheres prepared by spray-drying. Concerning EPO loaded microspheres, spray-drying yielded higher encapsulation efficiencies. Although the microspheres obtained by spray-drying are subjected to intensive mechanical and thermal stress during the preparation, the amount of aggregates of EPO in PLG microspheres were not increased compared to the w/o/w technique. Depending on the manufacturing method, addition of cyclic DL-lactide dimers (referred to as monomers in the following) affected the in vitro release profiles of EPO and FITC-dextran from PLG microspheres. Using differential scanning calorimetry it was shown that these low molecular weight substances only seem to be present inside the microspheres produced by spray-drying. DL-Lactide significantly reduced the initial burst release of both EPO and FITC-dextran. While the following release period of EPO was not affected by the DL-lactide content, a more linear FITC-dextran release pattern could be achieved. It can be concluded that the spray-drying technique provides a number of advantages compared to the w/o/w method. The modulation of protein release using low molecular weight additives is of particular interest for parenteral depot systems.

Calorimetry, Differential Scanning↗

PubMed1998

[Effect of various cylinder diameters of implants for lumbar inter-corporeal spinal fusion on compressive strength on the FSU model].

Anterior lumbar interbody fusion (ALIF) has evolved as a minimally invasive technique for treating lumbar instability caused by degenerative lumbar disc disease. A practical surgical method is the lateral retroperitoneal approach in which cylindrical implants are inserted in the intervertebral space. The optimal diameter of these implants remains unclear. The purpose of this biomechanical study was to investigate the influence of implant diameter on selected mechanical properties of the functional spinal units (FSU). In fresh frozen bovine FSU the bone density was first determined and cylindrical implants were then inserted. The FSU were then tested under compression loading in a material-testing machine. A tendency of the "failure loads" to decrease with increasing cylinder diameter was observed. The study reveals a strong correlation between bone density and loading capacity, with higher loads being sustained by the more strongly mineralized bone. In contrast to homogeneous material, in an FSU, larger cylinder diameter does not result in an increase in compression strength.

Animals↗