Presently, total joint replacement (TJR) is a standard procedure in orthopedic surgery. Adequate osseointegration of the implant components still remains a clinical issue. However, active stimulation of bone tissue to enhance bone ongrowth at the implant surfaces has not been widely investigated so far. For the last several years, invasive electromagnetically induced osseotherapy has been employed in clinical practice, e.g., for the treatment of avascular necrosis, femoral neck fractures, and pseudarthrosis. In the present study, the approach of exploiting the electric stimulation effect was transferred to the field of TJR. Therefore, a commercially available total hip stem was instrumented with an electrode on its surface in order to generate an electric field supporting the regeneration of the surrounding bone tissue. The objective was to conduct numerical simulations validated by experimental investigations as a proof of concept for an instrumented electro-stimulative total hip stem. The results revealed that the calculated electric field around a total hip stem fulfills the requirements to stimulate adjacent bone tissue when using clinically applied electric voltages. The derived numerical and experimental data of electric potentials and corresponding electric fields are encouraging for the implementation of active electrical stimulation in uncemented total hip stems to enhance their osseointegration.

The dielectric properties of human bone are one of the most essential inputs required by electromagnetic stimulation for improved bone regeneration. Measuring the electric properties of bone is a difficult task because of the complexity of the bone structure. Therefore, an automatic approach is presented to calibrate the electric properties of bone. The numerical method consists of three steps: generating input from experimental data, performing the numerical simulation, and calibrating the bone dielectric properties. As an example, the dielectric properties at 20 Hz of a rabbit distal femur were calibrated. The calibration process was considered as an optimization process with the aim of finding the optimum dielectric bone properties that match most of the numerically calculated simulation and experimentally measured data sets. The optimization was carried out automatically by the optimization software tool iSIGHT in combination with the finite-element solver COMSOL Multiphysics. As a result, the optimum conductivity and relative permittivity of the rabbit distal femur at 20 Hz were found to be 0.09615 S/m and 19522 for cortical bone and 0.14913 S/m and 1561507 for cancellous bone, respectively. The proposed method is a potential tool for the identification of realistic dielectric properties of the entire bone volume. The presented approach combining iSIGHT with COMSOL is applicable to, amongst others, designing implantable electro-stimulative devices or the optimization of electrical stimulation parameters for improved bone regeneration.

The application of electromagnetic fields to support the bone-healing processes is a therapeutic approach for patients with musculoskeletal disorders. The ASNIS-III s-series screw is a bone stimulation system providing electromagnetic stimulation; however, its influence on human osteoblasts (hOBs) has not been extensively investigated. Therefore, in the present study, the impact of this system on the viability and differentiation of hOBs was examined. We used the ASNIS-III s screw system in terms of a specific experimental test set-up. The ASNIS-III s screw system was used for the application of electromagnetic fields (EMF, 3 mT, 20 Hz) and electromagnetic fields combined with an additional alternating electric field (EMF + EF) (3 mT, 20 Hz, 700 mV). The stimulation of primary hOBs was conducted 3 times per day for 45 min over a period of 72 h. Unstimulated cells served as the controls. Subsequently, the viability, the gene expression of differentiation markers and pro-collagen type 1 synthesis of the stimulated osteoblasts and corresponding controls were investigated. The application of both EMF and EMF + EF using the ASNIS-III s screw system revealed a positive influence on bone cell viability and moderately increased the synthesis of pro-collagen type 1 compared to the unstimulated controls. Stimulation with EMF resulted in a slightly enhanced gene expression of type 1 collagen and osteocalcin; however, stimulation with EMF + EF resulted in a significant increase in alkaline phosphatase (1.4-fold) and osteocalcin (1.6-fold) levels, and a notable increase in the levels of runt-related transcription factor 2 (RUNX-2; 1.54-fold). Our findings demonstrate that stimulation with electromagnetic fields and an additional alternating electric field has a positive influence on hOBs as regards cell viability and the expression of osteoblastic differentiation markers.

Electromagnetic stimulation is a common therapy used to support bone healing in the case of avascular necrosis of the femoral head. In the present study, we investigated a bipolar induction screw system with an integrated coil. The aim was to analyse the influence of the screw parameters on the electric field distribution in the human femoral head. In addition, three kinds of design parameters (the shape of the screw tip, position of the screw in the femoral head, and size of the screw insulation) were varied. The electric field distribution in the bone was calculated using the finite element software Comsol Multiphysics. Moreover, a validation experiment was set up for an identical bone specimen with an implanted screw. The electric potential of points inside and on the surface of the bone were measured and compared to numerical data. The electric field distribution within the bone was clearly changed by the different implant parameters. Repositioning the screw by a maximum of 10 mm and changing the insulation length by a maximum of 4 mm resulted in electric field volume changes of 16% and 7%, respectively. By comparing the results of numerical simulation with the data of the validation experiment, on average, the electric potential difference of 19% and 24% occurred when the measuring points were at a depth of approximately 5 mm within the femoral bone and directly on the surface of the femoral bone, respectively. The results of the numerical simulations underline that the electro‐stimulation treatment of bone in clinical applications can be influenced by the implant parameters. Bioelectromagnetics 35:547–558, 2014. © 2014 Wiley Periodicals, Inc.

Numerical investigations with regard to the AS-NIS-s screw implant's parameter variations for electrostimulation treatment of femoral head necrosis are outlined in this study. The electric field distribution caused by the screw is shown in the contour lines of the electric field norm in the femoral head. The electric field change caused by different screw designs and positioning is quantified as the percentage of the electric field volume in the femoral head. Moreover, a validation experiment was carried out and the results are compared to the numerical simulation.