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Biomedical subjects

W R Walsh

Publications and source records attributed to W R Walsh.

At least 55 records · Page 3Linked to original sources
PubMed1999

An improved method for measuring tibiofemoral contact areas in total knee arthroplasty: a comparison of K-scan sensor and Fuji film.

A computerised, real time, thin-film pressure transducer method is used to measure tibiofemoral contact area in total knee arthroplasty (TKA) devices that is easier and more reliable and reproducible as compared to the Fuji pressure-sensitive film technique. Many authors have suggested that contact areas and pressures within TKA devices can be a predictor of wear and failure of the ultra-high molecular weight polyethylene (UHMWPE) tibial insert. In this study, two contact area measurement techniques (Fuji pressure-sensitive Film and K-scan sensor system) were compared using a custom TKA testing jig designed for freedom of movement so that in any loading configuration the component found and seated in its own "home" position. The K-scan system was used to measure contact areas of one TKA design at several angles from 0 to 110 degrees flexion with loads equating to 4, 4.5, and 5 times body weight. For comparison, four ranges of Fuji film were used to measure areas at the same flexion angles but at 5 times body weight only. Contact areas measured with the Fuji films were 11-36% (p < 0.05) lower than those measured by the K-scan sensor.

Analysis of Variance↗
PubMed1999

High pressures are generated at the tip of laparoscopic graspers.

BACKGROUND: Despite its importance the interface between tissue and instrument is poorly understood. METHODS: A thin film pressure transducer was deployed between the jaws of eight different laparoscopic instruments and a simulated tissue to study the forces generated at the tip of laparoscopic graspers and the effect of a change in angle of tissue tension at the interface between tissue and laparoscopic grasper. RESULTS: Pressure was concentrated at the tip of the instrument. Localized pressures increased on average from 210 kPa to 650 kPa as the angle of grasp was increased from 0 to 135 degrees. There was a wide variation between instruments with some exhibiting increases in tip pressure of a factor of eight as the angle was increased. CONCLUSION: High pressures are generated at the tip of laparoscopic graspers. Pressures increase as the angle of incidence of the grasper in relation to the tissue increases. The changes in pressure with change in angle are independent of load and handle pressure.

Humans↗
PubMed1999

Expression of growth factors in the mandibular distraction zone: a sheep study.

Interest in craniofacial osteodistraction has increased in recent years parallel with the growing attention given to the role of growth factors in tissue healing and regeneration. This study was embarked upon to investigate the expression of bFGF, TGF-beta and IGF-1 in the distraction zone of the mandible. Fourteen growing sheep were allocated to three experimental groups. Six animals were allocated to Groups A and B (n = 12) and underwent bilateral mandibular corticotomies with fixation of an external lengthening device. The distraction protocol consisted of a rate of 1.0 mm/day (twice daily) for 20 days followed by a consolidation phase of 20 days after which the sheep were sacrificed. Group C comprised of age matched sham operated animals (n = 2). Bone histochemistry for growth factors were performed in the harvested mandibles. A strong staining of bFGF was seen in the osteoblasts, osteocytes and osteoid matrix following 20 days of distraction and 20 days of consolidation compared to the control group. TGF-beta and IGF-1 demonstrated mild but clear staining in osteocyte and osteoblast cells and TGF-beta stained positively in the osteoid seam in the experimental groups. These finding suggest that bFGF, IGF-1 and TGF-beta may play different roles in the remodelling phase of distraction osteogenesis.

Animals↗
PubMed1999

The role of transforming growth factor-beta, insulin-like growth factor I, and basic fibroblast growth factor in distraction osteogenesis of the mandible.

Distraction osteogenesis is a viable method for regenerating large amounts of bone. In contrast to fracture healing, the mode of bone formation in distraction osteogenesis is primarily intramembranous ossification. The basic biology of the process is still not well understood. The growth factor cascade is likely to play an important role in distraction. This study examines the growth factor cascade in a lengthened ovine mandible model. Twenty-four animals were divided into four groups with varying rates of distraction (1, 2, 3, and 4 mm/day). A unilateral distractor at the angle of the mandible was used. The mandibles were lengthened to 24 mm and fixed for a period of 5 weeks, after which the animals were killed. The sections were probed for transforming growth factor-beta, basic fibroblast growth factor, and insulin-like growth factor I. The growth factors studied were present in all four groups. Transforming growth factor-beta, basic fibroblast growth factor, and insulin-like growth factor I were present in both the bony matrix of the sections and the cytoplasm of the cells, osteoblasts, and a small number of mesenchymal cells. The sections obtained from groups distracted at faster rates showed stronger presence of the growth factors examined by more intense staining. In fracture healing, the localization of transforming growth factor-beta in stage I of healing corresponded with the precise region of intramembranous ossification in stage II. Diffuse presence of transforming growth factor-beta throughout the lengthened region corresponded with the process of intramembranous ossification observed in distraction. In fracture healing, insulin-like growth factor I and basic fibroblast growth factor have been shown to promote proliferation and differentiation of osteoblasts from precursor cells. The intense presence of insulin-like growth factor I and basic fibroblast growth factor in the distracted region may account for osteoblast proliferation and formation from precursor mesenchymal cells. Mechanical strain has been shown to increase the expression of transforming growth factor-beta and insulin-like growth factor I. Distraction may serve as a source of mechanical strain, which may explain, in part, the expression of these growth factors, particularly in the faster groups.

Animals↗
PubMed1999

Resurfacing of the glenoid in total shoulder arthroplasty. A comparison, at a mean of five years, of prostheses inserted with and without cement.

BACKGROUND: Clinically evident loosening of a glenoid component inserted with cement in total shoulder arthroplasty is infrequent, but radiographic changes that indicate loosening at the implant-bone interface are common and have been associated with functional limitation. We compared the results of total shoulder arthroplasties in which the glenoid implant had been inserted with cement with those of arthroplasties in which a bone-ingrowth glenoid implant had been inserted without cement. METHODS: The results of eighty-six consecutive total shoulder arthroplasties, performed by the same surgeon, were retrospectively reviewed between four and seven years after the operation. Fifty-eight shoulders in which the primary glenoid implant was in situ were assessed with use of the Simple Shoulder Test and Short Form-36 questionnaires, clinical examination, and fluoroscopic imaging of the glenoid implant-bone interface. Thirty-two of the glenoid components had been fixed with cement and twenty-six, without cement. RESULTS: Complications occurred in 16 percent (fourteen) of the eighty-six shoulders, and 9 percent (eight) of the shoulders needed a revision operation. None of the revisions were done because of loosening of the glenoid component. Five of the eight revisions involved implants that had been inserted without cement. Three of these implants were revised because of early instability and two, because the polyethylene component had separated from the metal tray of the glenoid implant. With the numbers available, we could not detect any significant differences between the groups with respect to pain, range of motion, function of the shoulder, or general health. Radiographic analysis demonstrated a high level of interobserver agreement (kappa = 0.89). Radiolucent lines were observed after 41 percent (thirteen) of the thirty-two arthroplasties performed with cement compared with 23 percent (six) of the twenty-six arthroplasties performed without cement. The proportion of implants classified as probably loose was approximately three times greater in the group in which cement had been used. Eccentric wear of the posterior rim of the metal tray and focal osteolysis under the metal tray were observed in the group in which the component had been inserted without cement; these findings may indicate a potential for progression of radiographic loosening with increased durations of follow-up. CONCLUSIONS: We concluded that, despite the higher rate of early complications, the intermediate-term outcomes of arthroplasties in which the glenoid implant is inserted without cement are comparable with those of arthroplasties with cementing of the glenoid component.

Adult↗
PubMed1998

Initial fixation strength of polylactic acid interference screws in anterior cruciate ligament reconstruction.

The initial fixation properties of bioresorbable polylactic acid (PLA) interference screws designed for anterior cruciate ligament reconstruction were evaluated using an in vitro bovine model. The surgical technique of interference screw fixation of the bone-patellar tendon-bone autograft complex performed clinically was reproduced in an adult bovine model. The reconstructed knee was tested oriented in 30 degrees of flexion to allow examination of the femoral and tibial fixation properties simultaneously. This model examined the initial fixation strength between PLA and metal interference screws as well as a partially degraded PLA implant. Data from this in vitro model indicate that PLA interference screws can provide similar initial fixation at both time 0 and after degradation for up to 28 days compared with metal interference screws for bone-tendon-bone ACL reconstructions.

Absorption↗
PubMed1998

Intraoperative assessment of tibiofemoral contact stresses in total knee arthroplasty.

The production of polyethylene wear debris in total knee arthroplasty (TKA) is due to multiple factors. In particular, inadequate implant alignment and high bearing surface contact stresses are associated with polyethylene failure. Optimal implant placement and soft tissue balancing may contribute to reducing wear and the production of polyethylene particles. We present a case in which a quantitative technique was used to measure tibiofemoral contact stresses during implantation of a total knee prosthesis in vivo. In a knee with preoperative varus and fixed flexion deformity, medial compartment contact stresses after initial resection were reduced from 14.3 MPa to 11.3 MPa in neutral alignment by additional bone resection. Posterior cruciate release was required to reduce contact stresses further and to provide satisfactory balance between medial and lateral compartments, as determined by the operating surgeon, and was confirmed by the measurement system (3.8 MPa medially; 3.0 MPa laterally). This technique has potential to fine-tune implant positioning and ligament balancing during TKA.

Aged↗
PubMed1998

The role of latency in mandibular osteodistraction.

Even though osteodistraction has been well established in the extremities, the parameters used in craniofacial distraction have been essentially borrowed from orthopaedic experience. Latency is widely practised but its relevance has not been fully investigated. The purpose of this study was to establish the role of latency in mandibular distraction osteogenesis. Twenty-two growing Wethers sheep were allocated to four experimental groups. Six animals were allocated to each of Groups A, B and C and underwent bilateral mandibular corticotomies and attachment of an external lengthening device. Latent periods of 0, 4 and 7 days respectively were observed prior to beginning distraction. The distraction protocol consisted of a rate of 0.5 mm twice daily for 20 days, followed by a consolidation phase of 20 days after which the sheep were killed. Histology, bone densitometry and 3-point mechanical testing were performed on the harvested mandibles. Group D formed the control group (n = 4). Histologically, the distracted bone exhibited bone formation primarily via intramembranous ossification with scattered islands of cartilage. The regenerated bone had mechanical properties significantly weaker than the undistracted control group (P < 0.05), but between the experimental groups no statistically significant differences were demonstrable either in mechanical strength or DEXA density. These data indicate that a change in latency does not alter the properties of the regenerated bone in mandibular distraction osteogenesis and indeed no latent interval may be necessary at all in craniofacial distraction. This has implications for the duration of device fixation in distraction procedures.

Absorptiometry, Photon↗
PubMed1998

Mandibular distraction osteogenesis: a comparison of distraction rates in the rabbit model.

The rabbit model has been used to study the effects of different rates of distraction upon mandibular bone. Bilateral distraction was performed at two different rates anterior to the molar teeth. Both experimental groups were significantly inferior to sham operated controls in terms of bone density (DEXA) and mechanical testing. No difference in new bone formation between the two distraction rates was detected by these modalities. However, histological examination revealed non-union to be more common in the rapidly distracted group. This suggests that attempts to shorten the duration of external fixation in clinical mandibular distraction osteogenesis should be by methods other than more rapid distraction.

Absorptiometry, Photon↗
PubMed1998

Varying the mechanical properties of bone tissue by changing the amount of its structurally effective bone mineral content.

The effect of fluoride ions on the mechanical properties of bone tissue in tension was investigated with an in vitro model. Structurally effective Bone Mineral Content (BMC) of bovine bone tissue was changed by fluoride ion treatment. First, bovine cortical bone specimens were treated with a detergent solution in order to increase the diffusion rates of the treatment ions across the samples. After the initial treatment, different ion solutions were used to treat the tension samples (fluoride, sodium and chloride). Ionic strength and pH were varied. Experimental results showed that the sodium chloride solutions of different ionic strengths, at physiological and high pH, do not affect the mechanical properties of bone tissue in tension. However, uniform fluoride treatment across the samples reduced the mechanical strength of bone tissue by converting small amounts of bone mineral to mostly calcium fluoride. This action reduces the structurally effective BMC and also possibly effects the interface bonding between the bone mineral and the organic matrix of the bone tissue.

Animals↗
PubMed1998

Cytokines and matrix metalloproteinases mRNA expression in archival human tissues from failed total hip arthroplasty using in situ hybridization and color video image analysis.

Reports on the histological and biochemical nature of periprosthetic fibrous/granulomatous tissue has, to date, been largely limited to frozen tissue sections. This study reports the cytokine and matrix metalloproteinase profiles found in periprosthetic interface tissues in THA which have failed due to aseptic loosening and in capsular tissues obtained at primary surgery. The study employs immunohistochemistry, in situ hybridization, and color video image analysis on formalin fixed and paraffin embedded sections.

Aged↗
PubMed1997

The interosseous membrane in radio-ulnar dissociation.

In severe forearm injuries, the diagnosis of disruption of the interosseous membrane is frequently delayed and sometimes missed, giving difficulties in the salvage of forearm stability. We studied the structure and function of the interosseous membrane in 11 cadaver preparations, using mechanical and histological analysis. Seven of the specimens tested in uniaxial tension sustained a mid-substance tear of the central band of the membrane at a mean peak load of 1038 +/- 308 N. The axial stiffness was 190 +/- 44 N/mm with elongation to failure of 10.34 +/- 2.46 mm. These results provide criteria for the evaluation of reconstructive methods. A preliminary clinical investigation of the use of ultrasound suggests that this may be of value in the screening of patients with complex fractures of the forearm, and for investigating the natural history of tears of the interosseous membrane.

Adult↗
PubMed1997

Fracture healing in a rat osteopenia model.

Fracture healing is influenced by mechanical and biologic factors. The capacity for fracture repair has been reported to decrease with age, although the risk of fracture increases with age. Fracture healing in an animal model of postmenopausal osteoporosis or osteopenia would provide a useful technique to evaluate and develop new treatment protocols. The authors examined the tensile and bending properties of healing femoral fractures in normal and ovariectomized rats. Mechanical data from tensile and bending tests indicate ovariectomy impairs fracture healing, which was confirmed through histologic study. Bending and tensile data provide useful information concerning the mechanical properties of the healing fracture. Tensile tests were noted to be sensitive indicators of the properties of the healing fracture.

Animals↗
PubMed1996

A novel technique for quantitative detection of mRNA expression in human bone derived cells cultured on biomaterials.

A nonisotopic and quantitative in situ hybridization technique was adapted to investigate the effect of biomaterials on the cellular expression of mRNA from human bone derived cells (HBD cells). HBD cells were cultured for 24 or 48 h on tissue culture plastic, alumina, and ion modified alumina. Osteocalcin, osteopontin, alkaline phosphatase, type I collagen alpha 1, and type I collagen alpha 2 mRNAs were quantified. Protein expression for collagen types I, III, and V, and for anti-human macrophages CD68 (DAKO-CD68, KP1) and CD68 (PG-M1), and anti-human myeloid/histiocyte antigen (DAKO-MAC 387) were determined immunohistochemically using monoclonal antibodies. At 24 and 48 h, levels of mRNA for alkaline phosphatase and osteonectin were greater than mRNA levels for osteopontin, osteocalcin, collagen type I alpha 1, and collagen type I alpha 2 for cells grown on the three substrata. However, at 48 h mRNA levels for alkaline phosphatase and osteonectin were significantly higher on the modified ceramic substrata relative to the native alumina. HBD cells appear to express CD68-KP1 when cultured for 24 h. The techniques provide a sensitive and reproducible assay to evaluate gene and protein expression of cells grown on different substrata.

Alkaline Phosphatase↗
PubMed1995

Controlled release of platelet-derived growth factor using ethylene vinyl acetate copolymer (EVAc) coated on stainless-steel wires.

Controlled delivery of bioactive molecules to modulate or control biological processes has a number of clinical applications. The present study reports a delivery system which was designed to deliver growth factors locally to a fracture site. Ethylene vinyl acetate copolymer (EVAc), bovine serum albumin (BSA) and platelet-derived growth factor (PDGF-BB) were combined and coated onto a stainless-steel Kirschner wire (K-wire). A K-wire can be used as an intramedullary nail in small animal fractures, such as the rat. PDGF-BB stimulates thymidine uptake in human bone cell cultures when released from the K-wire delivery system. BSA release was modified by providing a final coating on the K-wire of 10% pure EVAc at the end of the fabrication. Electron microscopic examination of the surface of the rods revealed different surface pores on the K-wires coated with pure EVAc. Differences in porosity and tortuosity may account, in part, for the different release kinetics observed.

Animals↗
PubMed1995

Effects of a delayed steroid injection on ligament healing using a rabbit medial collateral ligament model.

Corticosteroids are known to inhibit collagen synthesis in vitro as well as having a deleterious effect on ligament healing when applied immediately following injury. An acute injection of betamethasone into a transected rabbit medial collateral ligament significantly impaired the biomechanical and histological properties compared to non-injected transected ligaments. Differences in mechanical, histological and biochemical properties were observed up to 3 months following injury and an acute steroid injection. The present study explored the effects of a corticosteroid (betamethasone) injection 7 days following the initial injury. Biomechanical and histomorphometric analyses were carried determine if the previously observed deleterious effects of a corticosteroid injection immediately following injury can be linked to an interference in the inflammatory phase of healing due to the presence of the corticosteroid.

Analysis of Variance↗
PubMed1995

Demineralized bone matrix as a template for mineral--organic composites.

Mineralizing biological tissues are complex bioceramic-biopolymer composites engineered for a variety of functions. The organic and inorganic constituents, morphology, location, orientation, crystallinity and interactions exhibit materials or extremely fine microstructure, unique mechanical and physical properties with high strength and fracture toughness compared to the individual constituents. An understanding of mineralization, ultrastructural organization and interfacial bonding forces in mineralizing biological composite tissues, such as bone, may provide new strategies and techniques for the production of a novel class of man-made organic-ceramic composites. The present study explores the use of the organic matrix remaining after removal of the mineral phase by chelation with EDTA or solubilizing in HCl as a template for mineral deposition and the production of mineral-organic composites. Different pH conditions are employed to alter the inorganic phase which is deposited within the organic matrix. Mechanical testing and ultrastructural evaluations are carried out for characterization.

Animals↗