41 results found
Reynolds A, Boughton O, Doyle R, et al., 2024, Dynamics of manual impaction instruments during THA, Bone & Joint Research, ISSN: 2046-3758
Karia M, Boughton O, Mohan S, et al., 2023, Enhancing acetabular reaming accuracy: optimal techniques and a novel reamer design, Journal of Orthopaedic Surgery and Research, Vol: 18, Pages: 1-7, ISSN: 1749-799X
IntroductionSuccessful press-fit implantation relies on an accurately reamed bone cavity. Inaccurate reaming can lead to a suboptimal press-fit risking fracture and cup deformation or excessive micromotion and loosening. Several factors may impact reaming accuracy including the reamer design, the surgeon’s technique and the bone quality. The aim of this study is to investigate the accuracy of reaming techniques and the accuracy of a novel reamer design.MethodsEighty composite bone models, half high-density and half low-density, were reamed with either a conventional or an additively-manufactured reamer with a novel design employing either a straight or ‘whirlwind’ reaming technique. Reamed cavities were scanned using a 3D laser scanner and the median difference between achieved and expected diameters compared. ResultsThe novel reamer design was more accurate than the unused conventional reamer, using both whirlwind (0.1mm (IQR 0-0.2) vs 0.3mm (IQR 0.3-0.4); p<0.001) and straight techniques (0.3mm (IQR 0.1-1.0) vs 1.2mm (IQR 1-1.6); p=0.001). Whirlwind reaming was more accurate than straight reaming using both conventional (0.3mm (IQR 0.3-0.4) vs 1.2mm (IQR 1-1.6); p<0.0001) and single use reamers (0.1mm (IQR 0-0.2) vs 0.3mm (IQR 0.1-1.0); p=0.007). Reaming errors were higher in low-density bone compared to high-density bone, for both reamer types and reaming techniques tested (0.6mm (IQR 0.3-1.5) vs 0.3mm (IQR 0.1-0.8); p=0.005). ConclusionWe present a novel reamer design that demonstrates superior accuracy to conventional reamers in achieving the desired reaming diameter. Improved reaming accuracy was also demonstrated using both devices and in both bone models, using a ‘whirlwind’ technique. We recommend the use of this novel reamer design employing a ‘whirlwind’ technique to optimise reaming accuracy. Particular attention should be paid towards patients with lower bone quality which may be more susceptible to highe
Stavri R, Tay T, Wiles CC, et al., 2023, A cross-sectional study of bone nanomechanics in hip fracture and aging, Life, Vol: 13, ISSN: 2075-1729
Bone mechanics is well understood at every length scale except the nano-level. We aimed to investigate the relationship between bone nanoscale and tissue-level mechanics experimentally. We tested two hypotheses: (1) nanoscale strains were lower in hip fracture patients versus controls, and (2) nanoscale mineral and fibril strains were inversely correlated with aging and fracture. A cross-sectional sample of trabecular bone sections was prepared from the proximal femora of two human donor groups (aged 44–94 years): an aging non-fracture control group (n = 17) and a hip-fracture group (n = 20). Tissue, fibril, and mineral strain were measured simultaneously using synchrotron X-ray diffraction during tensile load to failure, then compared between groups using unpaired t-tests and correlated with age using Pearson’s correlation. Controls exhibited significantly greater peak tissue, mineral, and fibril strains than the hip fracture (all p < 0.05). Age was associated with a decrease in peak tissue (p = 0.099) and mineral (p = 0.004) strain, but not fibril strain (p = 0.260). Overall, hip fracture and aging were associated with changes in the nanoscale strain that are reflected at the tissue level. Data must be interpreted within the limitations of the observational cross-sectional study design, so we propose two new hypotheses on the importance of nanomechanics. (1) Hip fracture risk is increased by low tissue strain, which can be caused by low collagen or mineral strain. (2) Age-related loss of tissue strain is dependent on the loss of mineral but not fibril strain. Novel insights into bone nano- and tissue-level mechanics could provide a platform for the development of bone health diagnostics and interventions based on failure mechanisms from the nanoscale up.
Bonicelli A, Tay T, Cobb JP, et al., 2023, Association between nanoscale strains and tissue level nanoindentation properties in age-related hip-fractures, JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS, Vol: 138, ISSN: 1751-6161
Behforootan S, Thorniley M, Minonzio J-G, et al., 2022, Can guided wave ultrasound predict bone mechanical properties at the femoral neck in patients undergoing hip arthroplasty?, JOURNAL OF THE MECHANICAL BEHAVIOR OF BIOMEDICAL MATERIALS, Vol: 136, ISSN: 1751-6161
Arnold M, Zhao S, Doyle R, et al., 2021, Power tool use in orthopaedic surgery: iatrogenic injury, its detection and technological advances, JBJS Open Access, Vol: 6, Pages: 1-16, ISSN: 2472-7245
Background: Power tools are an integral part to orthopaedic surgery but have the capacity to cause iatrogenic injury. This systematic review aimed to investigate the prevalence of iatrogenic injury due to power tools in orthopaedic surgery and discuss the current methods 9that can be used to reduce this. Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed and Scopus databases. Exclusion criteria included injuries related to cast saw, temperature induced damage and complications not clearly related to power tool use. Results: 3694 abstracts were retrieved, and 88studies were included in the final analysis. Only a few studies and individual case reports directly looked at prevalence of injury due to power tools. This included 2 studies looking at frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%),2 studies investigating frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%)and 3 studies investigating vascular injury during total joint arthroplasty (124 vascular injuries involving 138 blood vessels,0.13% and 0.1% incidence)in addition to 1 questionnaire sent electronically to surgeons. There are multiple methods to prevent damage during the use of power tools. These include robotics, Revised Manuscript (Maximum 3000 Words)simulation, specific drill settings and real-time feedback techniques such as spectroscopy and electromyography. Conclusion: Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations the use of advanced technologies to reduce the chance of iatrogenic injury should be considered. Clinical Relevance: Power tools used during orthopaedic surgery have the potentia
Abel R, Behforootan S, Boughton O, et al., 2021, Ultrasound and Bone Disease: A Systematic Review, World Journal of Surgery and Surgical Research
Grigoras M, Boughton O, Cleary M, et al., 2021, Short-term outcomes of total knee arthroplasty performed with and without a tourniquet, SICOT-J, Vol: 7, ISSN: 2426-8887
Boughton O, Cobb J, owyang D, et al., 2021, Patient and Public Involvement Within Orthopaedic Research: A Systematic Review, Journal of Bone and Joint Surgery: American Volume, ISSN: 0021-9355
Nanoscale mineralized collagen fibrils may be important determinants of whole-bone mechanical properties and contribute to the risk of age-related fractures. In a cross-sectional study nano-and tissue-level mechanics were compared across trabecular sections from the proximal femora of three groups(n=10 each): ageing non-fractured donors (Controls);untreated fracture patients (Fx-Untreated); bisphosphonate-treated fracture patients (Fx-BisTreated).Collagen fibril, mineral and tissue mechanics were measured using synchrotron X-Ray diffraction,of bone sections under load. Mechanical data were compared across groups, and tissue-level data were regressed against nano. Compared to controls fracture patients exhibited significantly lower critical strain, max strain and normalized strength, with lower peak collagen and mineral strain. Bisphosphonate-treated exhibited the lowest properties. In all three groups, peak mineral strain coincided with maximum tissue strength (i.e. ultimate stress), whilst peak fibril strain occurred afterwards(i.e. higher strain). Tissue strain and strength were positively and strongly correlated with peak fibril and mineral strains. Age-related fractures were associated with lower peak fibril and mineral strain irrespective of treatment. Indicating earlier mineral disengagement and the subsequent onset of fibril sliding is one of the key mechanisms leading to fracture. Treatments for fragility should target collagen-mineral interactions to restore nano-scale strain to that of healthy bone.
Ghouse S, Reznikov N, Boughton O, et al., 2019, The design and in vivo testing of a locally stiffness-matched porous scaffold, Applied Materials Today, Vol: 15, Pages: 377-388, ISSN: 2352-9407
An increasing volume of work supports utilising the mechanobiology of bone for bone ingrowth into a porous scaffold. However, typically during in vivo testing of implants, the mechanical properties of the bone being replaced are not quantified. Consequently there remains inconsistencies in the literature regarding ‘optimum’ pore size and porosity for bone ingrowth. It is also difficult to compare ingrowth results between studies and to translate in vivo animal testing to human subjects without understanding the mechanical environment. This study presents a clinically applicable approach to determining local bone mechanical properties and design of a scaffold with similar properties. The performance of the scaffold was investigated in vivo in an ovine model.The density, modulus and strength of trabecular bone from the medial femoral condyle from ovine bones was characterised and power-law relationships were established. A porous titanium scaffold, intended to maintain bone mechanical homeostasis, was additively manufactured and implanted into the medial femoral condyle of 6 ewes. The stiffness of the scaffold varied throughout the heterogeneous structure and matched the stiffness variation of bone at the surgical site. Bone ingrowth into the scaffold was 10.73 ± 2.97% after 6 weeks. Fine woven bone, in the interior of the scaffold, and intense formations of more developed woven bone overlaid with lamellar bone at the implant periphery were observed. The workflow presented will allow future in vivo testing to test specific bone strains on bone ingrowth in response to a scaffold and allow for better translation from in vivo testing to commercial implants.
Boughton O, Ma S, Cai X, et al., 2019, Computed tomography porosity and spherical indentation for determining cortical bone millimetre-scale mechanical properties, Scientific Reports, Vol: 9, ISSN: 2045-2322
The cortex of the femoral neck is a key structural element of the human body, yet there is not a reliable metric for predicting the mechanical properties of the bone in this critical region. This study explored the use of a range of non-destructive metrics to measure femoral neck cortical bone stiffness at the millimetre length scale. A range of testing methods and imaging techniques were assessed for their ability to measure or predict the mechanical properties of cortical bone samples obtained from the femoral neck of hip replacement patients. Techniques that can potentially be applied in vivo to measure bone stiffness, including computed tomography (CT), bulk wave ultrasound (BWUS) and indentation, were compared against in vitro techniques, including compression testing, density measurements and resonant ultrasound spectroscopy. Porosity, as measured by micro-CT, correlated with femoral neck cortical bone’s elastic modulus and ultimate compressive strength at the millimetre length scale. Large-tip spherical indentation also correlated with bone mechanical properties at this length scale but to a lesser extent. As the elastic mechanical properties of cortical bone correlated with porosity, we would recommend further development of technologies that can safely measure cortical porosity in vivo.Introduction
Uemura K, Boughton O, Logishetty K, et al., 2019, A single-use, size-specific, nylon arthroplasty guide: a preliminary study, Hip International, ISSN: 1120-7000
Boughton O, Uemura K, Tamura K, et al., 2019, Gender and Disease Severity Determine Proximal Femoral Morphology in Developmental Dysplasia of the Hip, Journal of Orthopaedic Research, ISSN: 0736-0266
Reznikov N, Boughton O, Ghouse S, et al., 2019, Individual response variations in scaffold-guided bone regeneration are determined by independent strain- and injury-induced mechanisms, Biomaterials, Vol: 194, Pages: 183-194, ISSN: 0142-9612
This study explored the regenerative osteogenic response in the distal femur of sheep using scaffolds having stiffness values within, and above and below, the range of trabecular bone apparent modulus. Scaffolds 3D-printed from stiff titanium and compliant polyamide were implanted into a cylindrical metaphyseal defect 15 × 15 mm. After six weeks, bone ingrowth varied between 7 and 21% of the scaffold pore volume and this was generally inversely proportional to scaffold stiffness. The individual reparative response considerably varied among the animals, which could be divided into weak and strong responders. Notably, bone regeneration specifically within the interior of the scaffold was inversely proportional to scaffold stiffness and was strain-driven in strongly-responding animals. Conversely, bone regeneration at the periphery of the defect was injury-driven and equal in all scaffolds and in all strongly- and weakly-responding animals. The observation of the strain-driven response in some, but not all, animals highlights that scaffold compliance is desirable for triggering host bone regeneration, but scaffold permanence is important for the load-bearing, structural role of the bone-replacing device. Indeed, scaffolds may benefit from being nonresorbable and mechanically reliable for those unforeseeable cases of weakly responding recipients.
Doyle R, Boughton O, Plant D, et al., 2019, An in vitro model of impaction during hip arthroplasty, Journal of Biomechanics, Vol: 82, Pages: 220-227, ISSN: 0021-9290
Impaction is required to properly seat press-fit implants and ensure initial implant stability and long term bone ingrowth, however excessive impaction or press-fit presents a high fracture risk in the acetabulum and femur. Current in-vitro impaction testing methods do not replicate the compliance of the soft tissues surrounding the hip, a factor that may be important in fracture and force prediction. This study presents the measurement of compliance of the soft tissues supporting the hip during impaction in operative conditions, and replicates these in vitro. Hip replacements were carried out on 4 full body cadavers while impact force traces and acetabular/femoral displacement were measured. Compliance was then simulated computationally using a Voigt model. These data were subsequently used to inform the design of a representative in-vitro drop rig. Effective masses of 19.7 kg and 12.7 kg, spring stiffnesses of 8.0 kN/m and 4.1 kN/m and dashpot coefficients of 595 N s/m and 322 N s/m were calculated for the acetabular and femoral soft tissues respectively. A good agreement between cadaveric and in-vitro peak displacement and rise time during impact is found. Such an in-vitro setup is of use during laboratory testing, simulation or even surgical training.
Ma S, Goh EL, Karunaratne A, et al., 2018, The Effects of Bisphosphonate at the Nanoscale: Effects on Bone Collagen, Mineral Strain and Collagen-Mineral Interaction, Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, Publisher: WILEY, Pages: 410-411, ISSN: 0884-0431
Zhao S, Arnold M, Ma S, et al., 2018, Standardizing compression testing for measuring the stiffness of human bone, BONE & JOINT RESEARCH, Vol: 7, Pages: 524-538, ISSN: 2046-3758
Zhao S, Arnold M, Ma S, et al., 2018, Standardising compression testing for measuring the stiffness of human bone: a systematic review, Bone and Joint Research, Vol: 7, Pages: 524-538, ISSN: 2046-3758
Objectives: The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing; an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods: A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed and Scopus databases. Studies using bulk tissue, animal tissue, whole bone or testing techniques other than compression testing were excluded. Results: 4712 abstracts were retrieved with a total of 177 papers included in the analysis. 20 studies directly analysed the compression testing technique to improve the accuracy of the testing technique. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration and loading protocol. Conclusions: Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, though further studies are needed to help establish standardised bone testing techniques to increase the comparability and reliability of bone stiffness studies.
Wiik AV, Brevadt M, Johal H, et al., 2018, The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines., Journal of Orthopaedics and Traumatology, Vol: 19, ISSN: 1590-9921
BACKGROUND: The purpose of this study was to examine the gait pattern of total hip arthroplasty (THA) patients with a new short femoral stem at different speeds and inclinations. MATERIALS AND METHODS: A total of 40 unilateral THA patients were tested on an instrumented treadmill. They comprised two groups (shorter stemmed THA n = 20, longer stemmed THA n = 20), both which had the same surgical posterior approach. The shorter femoral stemmed patients were taken from an ongoing hip trial with minimum 12 months postop. The comparative longer THR group with similar disease and severity were taken from a gait database along with a demographically similar group of healthy controls (n = 35). All subjects were tested through their entire range of gait speeds and inclines with ground reaction forces collected. Body weight scaling was applied and a symmetry index to compare the implanted hip to the contralateral normal hip. An analysis of variance with significance set at α = 0.05 was used. RESULTS: The experimental groups were matched demographically and implant groups for patient reported outcome measures and radiological disease. Both THA groups walked slower than controls, but symmetry at all intervals for all groups were not significantly different. Push-off loading was less favourable for both the shorter and longer stemmed THR groups (p < 0.05) depending on speed. CONCLUSIONS: Irrespective of femoral stem length, symmetry for ground reaction forces for both THA groups were returned to a normal range when compared to controls. However individual implant performance showed inferior (p < 0.05) push-off forces and normalised step length in both THR groups when compared to controls. LEVEL OF EVIDENCE: III.
Boughton OR, Ma S, Zhao S, et al., 2018, Measuring bone stiffness using spherical indentation, PLoS ONE, Vol: 13, ISSN: 1932-6203
ObjectivesBone material properties are a major determinant of bone health in older age, both in terms of fracture risk and implant fixation, in orthopaedics and dentistry. Bone is an anisotropic and hierarchical material so its measured material properties depend upon the scale of metric used. The scale used should reflect the clinical problem, whether it is fracture risk, a whole bone problem, or implant stability, at the millimetre-scale. Indentation, an engineering technique involving pressing a hard-tipped material into another material with a known force, may be able to assess bone stiffness at the millimetre-scale (the apparent elastic modulus). We aimed to investigate whether spherical-tip indentation could reliably measure the apparent elastic modulus of human cortical bone.Materials and methodsCortical bone samples were retrieved from the femoral necks of nineteen patients undergoing total hip replacement surgery (10 females, 9 males, mean age: 69 years). The samples underwent indentation using a 1.5 mm diameter, ruby, spherical indenter tip, with sixty indentations per patient sample, across six locations on the bone surfaces, with ten repeated indentations at each of the six locations. The samples then underwent mechanical compression testing. The repeatability of indentation measurements of elastic modulus was assessed using the co-efficient of repeatability and the correlation between the bone elastic modulus measured by indentation and compression testing was analysed by least-squares regression.ResultsIn total, 1140 indentations in total were performed. Indentation was found to be repeatable for indentations performed at the same locations on the bone samples with a mean co-efficient of repeatability of 0.4 GigaPascals (GPa), confidence interval (C.I): 0.33–0.42 GPa. There was variation in the indentation modulus results between different locations on the bone samples (mean co-efficient of repeatability: 3.1 GPa, C.I: 2.2–3.90 GPa). No cle
Lazic S, Boughton OR, Kellett C, et al., 2018, Day-case surgery for total hip and knee replacement: how safe and effective is it?, EFORT Open Reviews, Vol: 3, Pages: 130-135, ISSN: 2058-5241
Multimodal protocols for pain control, blood loss management and thromboprophylaxis have been shown to benefit patients by being more effective and as safe (fewer iatrogenic complications) as conventional protocols. Proper patient selection and education, multimodal protocols and a well-defined clinical pathway are all key for successful day-case arthroplasty. By potentially being more effective, cheaper than and as safe as inpatient arthroplasty, day-case arthroplasty might be beneficial for patients and healthcare systems.
Riviere C, Lazic S, Boughton OR, et al., 2018, Current concepts for aligning knee implants: patient-specific or systematic?, EFORT Open Reviews, Vol: 3, Pages: 1-6, ISSN: 2058-5241
Arnold M, Zhao S, Ma S, et al., 2017, Microindentation - a tool for measuring cortical bone stiffness?, BONE & JOINT RESEARCH, Vol: 6, Pages: 542-549, ISSN: 2046-3758
Arnold M, Zhao S, Ma S, et al., 2017, Microindentation: a tool for measuring cortical bone stiffness? A systematic review, Bone & Joint Research, Vol: 6, Pages: 542-549, ISSN: 2046-3758
Objectives: Microindentation hasthe potential to measuretheelasticity(stiffness)of individualpatients’bone. Bone elasticity plays a crucial role in the press-fit stability of orthopaedic implants.Arming surgeons with accuratebone elasticityinformation may reduce surgical complicationsincluding peri-prosthetic fractures. The question we address with this systematicreview is whether microindentation can accurately measure cortical bone stiffness.Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed, Scopus and Cochrane databases. Studies thatonly used nanoindentation, cancellous boneoranimal tissue were excluded.Results: 1094abstracts were retrieved and 32papers were included in the analysis, 20 of which used reference point indentation and 12of which used traditional depth sensing indentation.There are a number of factors thatmust be taken into account when using microindentation such as tip size, depth and method of analysis.Only two studies validated microindentation againsttraditional mechanical testing techniques. Bothstudies used reference point indentation(RPI) with one showing that RPI parameters correlate well with mechanical testing, butanother suggestedthatthey do not. Conclusion: Microindentation has been used in various studies to assess bone elasticity but only two studies with conflicting results compared microindentation to traditional mechanical testing techniques. Further research,includingmore studies comparingmicroindentationto other mechanical testing methodsare needed,before microindentation can be reliably used to calculate cortical bone stiffness.
Wiik AV, Logishetty K, Boughton O, et al., 2017, Letter to the Editor regarding 'How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation'., Journal of Biomechanics, Vol: 63, Pages: 203-203, ISSN: 0021-9290
Ridzwan M, Sukjamsri C, Pal B, et al., 2017, Femoral fracture type can be predicted from femoral structure: a finite element study validated by digital volume correlation experiments, Journal of Orthopaedic Research, Vol: 36, Pages: 993-1001, ISSN: 1554-527X
Proximal femoral fractures can be categorized into two main types: Neck and intertrochanteric fractures accounting for 53% and 43% of all proximal femoral fractures, respectively. The possibility to predict the type of fracture a specific patient is predisposed to would allow drug and exercise therapies, hip protector design, and prophylactic surgery to be better targeted for this patient rendering fracture preventing strategies more effective. This study hypothesized that the type of fracture is closely related to the patient-specific femoral structure and predictable by finite element (FE) methods. Fourteen femora were DXA scanned, CT scanned, and mechanically tested to fracture. FE-predicted fracture patterns were compared to experimentally observed fracture patterns. Measurements of strain patterns to explain neck and intertrochanteric fracture patterns were performed using a digital volume correlation (DVC) technique and compared to FE-predicted strains and experimentally observed fracture patterns. Although loaded identically, the femora exhibited different fracture types (six neck and eight intertrochanteric fractures). CT-based FE models matched the experimental observations well (86%) demonstrating that the fracture type can be predicted. DVC-measured and FE-predicted strains showed obvious consistency. Neither DXA-based BMD nor any morphologic characteristics such as neck diameter, femoral neck length, or neck shaft angle were associated with fracture type. In conclusion, patient-specific femoral structure correlates with fracture type and FE analyses were able to predict these fracture types. Also, the demonstration of FE and DVC as metrics of the strains in bones may be of substantial clinical value, informing treatment strategies and device selection and design.
Ma S, Goh EL, Jin A, et al., 2017, Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties, Scientific Reports, Vol: 7, Pages: 1-10, ISSN: 2045-2322
Osteoporosis is characterised by trabecular bone loss resulting from increased osteoclast activation and unbalanced coupling between resorption and formation, which induces a thinning of trabeculae and trabecular perforations. Bisphosphonates are the frontline therapy for osteoporosis, which act by reducing bone remodelling, and are thought to prevent perforations and maintain microstructure. However, bisphosphonates may oversuppress remodelling resulting in accumulation of microcracks. This paper aims to investigate the effect of bisphosphonate treatment on microstructure and mechanical strength. Assessment of microdamage within the trabecular bone core was performed using synchrotron X-ray micro-CT linked to image analysis software. Bone from bisphosphonate-treated fracture patients exhibited fewer perforations but more numerous and larger microcracks than both fracture and non-fracture controls. Furthermore, bisphosphonate-treated bone demonstrated reduced tensile strength and Young’s Modulus. These findings suggest that bisphosphonate therapy is effective at reducing perforations but may also cause microcrack accumulation, leading to a loss of microstructural integrity and consequently, reduced mechanical strength.
Boughton OR, Zhao S, Arnold M, et al., 2017, Measuring bone stiffness using microindentation, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 31-31, ISSN: 2049-4416
Ma S, Goh EL, Patel B, et al., 2016, Are the cracks starting to appear in bisphosphonate therapy?, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 53-53, ISSN: 2049-4416
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.