Prof. Pitkin, M.R. Dr. Tech. Sci. Tufts University, Boston, MA 02111, USA. Phone 617-636-7000, e-mail: firstname.lastname@example.org
In the heading: Original researches
Year: 2022 Volume: 4 Journal number: 2
Article type: scientific and practical
Introduction. The use of a medullary canal to place implants in total joint replacement has been a paradigm in orthopedics for more than a century, and in the technology of direct attachment of limb prostheses to the skeleton for about three decades. This situation remains as such, despite the fact that the inner walls of the canal can be resorbed, increasing its diameter and, as a result, reducing its ability to hold the implant. Resorption, or negative remodeling, is an inevitable physiological component of bone development and growth and is one of the factors in the loosening of the implanted rod.
Aim. As a possible avenue for reducing the effects of negative medullary remodeling, this paper draws attention to the anisotropy of bone remodeling and proposes an implantation methodology that activates positive remodeling.
Materials and methods. The methodology we discuss here utilizes circumferential osteogenesis, which occurs in response to distraction of pre-cut grooves in the bone tube. We call this technique distraction implantation by analogy with the classic version of distraction osteogenesis by Dr. Ilizarov. Namely, with distraction osteogenesis, carried out not for lengthening, but for broadening the limb, when the bone is cut in the longitudinal direction.
Results. The method of distraction implantation is presented by the appropriate design of the implant stem and illustrated by a pilot animal study.
Discussion. Similarities and distinctions between classical distraction osteogenesis and the new distraction implantation have been discussed.
Conclusion. The similarity of the new method of distraction implantation was shown with the classical method of distraction osteogenesis in its modification for widening of the bone.
A temporary decrease in the strength of the bone tube due to longitudinal cuts is compensated by a significant increase in the strength of both bone and implant attachment after completion of cortical remodeling.
The new method of distraction implantation may represent an alternative to currently accepted technologies, provided that sufficient bone strength is ensured in a period between the implantation and completion of circular regeneration within the cuts.
After additional studies, it seems promising to use a new method of distraction implantation for direct skeletal attachment of limb prostheses, as well as for total joint arthroplasty.
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