Remodelling of bone stumps under the influence of various mechanical load regimes

Authors

DOI:

https://doi.org/10.26641/1997-9665.2025.4.19-29

Keywords:

amputation, bone tissue, remodelling, terms.

Abstract

Relevance. Despite the long history of limb amputation surgery, the timing and magnitude of mechanical loading of stumps have not yet been clarified. The aim of the study was to investigate the optimal timing and magnitude of mechanical loading of bone stumps after amputation. Methods. Two series of experiments were conducted on 18 rabbits with amputation of the thigh in the middle third and myoplasty. In the control series, after 4, 8, and 16 weeks, cyclic mechanical loading was applied to the end of the bone stump with an energy of 0.5 mJ/mm2 at a frequency of 2 Hz, with 400 pulses per session. In the experimental series, at the same time intervals, the load was applied twice a day at 200 pulses per session. The observation periods were 6, 10, and 18 weeks. The research method was histological with vessel filling with a 10% gelatin mixture. Results. In the control series, most experiments showed pathological remodelling of bone tissue with the development of atrophy, bone shape distortion, bone curvature, and stress fractures. In the experimental series, organotypic stumps were formed with normalisation of structure and microcirculation. The best results of bone tissue remodelling were obtained in the series with the onset of mechanical loads in both series at 10 weeks, 8 weeks after amputation. Conclusion. Mechanical daily loading of the bone stump with energy of 0.5 mJ/mm2, frequency of 2 Hz, with 400 pulses per session at 4, 8, and 16 weeks causes significant disturbances in bone remodelling with the formation of cone-shaped and spindle-shaped stumps, deviation of the end from the axis, and stress fractures. The same load (0.5 mJ/mm2, frequency 2 Hz, 400 pulses) divided into two sessions per day of 200 pulses with an interval of 4 hours contributes to the formation of an organotypic cylindrical shape of the stump with a balance of resorptive and reparative processes. The start of mechanical loads 8 weeks after amputation does not cause significant disturbances in the remodelling of the bone tissue of the stump and is the most optimal.

References

  1. Ma Q, Miri Z, Haugen HJ, et al. Significance of mechanical loading in bone fracture healing, bone regeneration, and vascularization. J Tissue Eng. 2023;14:20417314231172573. doi: 10.1177/ 20417314231172573.
  2. Liang W, Wu X, Dong Y, et al. Mechanical stimuli-mediated modulation of bone cell function-implications for bone remodeling and angiogenesis. Cell Tissue Res. 2021;386(3):445-54. doi: 10.1007/ s00441-021-03532-6.
  3. Nokhbatolfoghahaei H, Bohlouli M, Adavi K, et al. Computational modeling of media flow through perfusion-based bioreactors for bone tissue engineering. Proc Inst Mech Eng H. 2020;234(12): 1397-408. doi: 10.1177/0954411920944039.
  4. Taylor B, Poka A. Osteomyoplastic Transtibial Amputation: The Ertl technique. J Am Acad Orthop Surg. 2016;24(4):259-65. doi: 10.5435/ JAAOS-D-15-00026.
  5. Robling AG, Robin D, Fuchs RK, et al. Mechanical adaptation. In: Burr DB, Allen MR. (eds) Basic and applied bone biology [2nd ed.]. Cambridge, MA: Academic Press; 2019:203-33. doi: 10.1146/annurev.bioeng.8.061505.095721.
  6. Zhang ZY, Teoh SH, Chong WS, et al. A biaxial rotating bioreactor for the culture of fetal mesenchymal stem cells for bone tissue engineering. Biomaterials 2009;30(14):2694-704. doi: 10.1016/j.biomaterials.2009.01.028.
  7. Trompet D, Melis S, Chagin AS, Maes C. Skeletal stem and progenitor cells in bone development and repair. J Bone Miner Res. 2024;39(6):633-54. doi: 10.1093/jbmr/zjae069.
  8. Srivastava RK, Sapra L, Mishra PK. Osteometabolism: Metabolic Alterations in Bone Pathologies. Cells. 2022;11(23):3943. doi: 10.3390/ cells11233943.
  9. Robling AG, Castillo AB, Turner CH. Biomechanical and molecular regulation of bone remodeling. Annu Rev Biomed Eng 2006;8:455-98. doi: 10.1016/B978-0-12-813259-3.00011-7
  10. Bemben DA, Sherk VD, Ertl WJJ, Bemben MG. Acute bone changes after lower limb amputation resulting from traumatic injury. Osteoporos Int. 2017; 28(7):2177-86. doi: 10.1007/s00198-017-4018-z.
  11. Mauntel TC, Marshall SW, Hackney AC, et al. Trunk and Lower Extremity Movement Patterns, Stress Fracture Risk Factors, and Biomarkers of Bone Turnover in Military Trainees. J Athl Train. 2020;55(7):724-32. doi: 10.4085/1062-6050-134-19.
  12. Flint JH, Wade AM, Stocker DJ, et al. Bone mineral density loss after combat-related lower extremity amputation. J Orthop Trauma. 2014;28(4): 238-44. doi: 10.1097/BOT.0b013e3182a66a8a.
  13. Sherk VD, Bemben MG, Bemben DA. BMD and bone geometry in transtibial and transfemoral amputees. J Bone Miner Res. 2008;23(9):1449-57. doi: 10.1359/jbmr.080402.
  14. Hoellwarth JS, Oomatia A, Tetsworth K, et al. Bone density changes after five or more years of unilateral lower extremity osseointegration: Observational cohort study. Bone Rep. 2023;18:101682. doi: 10.1016/j.bonr.2023.101682.
  15. Islamoglu I, Çebi M, Tosun FC. The bone mineral density and isokinetic knee strength in amputee soccer players. Rev Assoc Med Bras (1992). 2023;69(8):e20230100. doi: 10.1590/1806-9282.20230100.
  16. Gailey R, Gaunaurd I, Raya M, et al. Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial. Phys Ther. 2020;100(5):773-87. doi: 10.1093/ ptj/pzaa008.
  17. Montanez J, Kairy D, Gilbert M, et al. "I would not want my leg back": Living experiences of adult amputees following intensive functional rehabilitation. Rehabil Psychol. 2025;70(4):392-404. doi: 10.1037/rep0000617.
  18. Wang L, Dong J, Xian CJ. Computational Modeling of Bone Cells and Their Biomechanical Behaviors in Responses to Mechanical Stimuli. Crit Rev Eukaryot Gene Expr. 2019;29(1):51-67. doi: 10.1615/CritRevEukaryotGeneExpr.2019025150.
  19. Shevchuk V, Bezsmertnyi Y, Branitsky O, et al. Remodeling of the Fibula Stump After Transtibial Amputation. Orthop Res Rev. 2024;16:153-62. doi: 10.2147/ORR.S459927.
  20. Aalaa M, Vahdani AM, Mohajeri Tehrani M, et al. Epidemiological Insights into Diabetic Foot Amputation and its Correlates: A Provincial Study. Clin Med Insights Endocrinol Diabetes. 2024;17: 11795514241227618. doi: 10.1177/ 11795514241227618.
  21. Shevchuk VI, Bezsmertnyi YO, Bezsmertna HV, et al. Changes in the structural organization of bone after amputation. Polish Annals of Medicine. 2020;27(2):147-53. doi: 10.29089/2020.20.00121.
  22. Shevchuk VI, Bezsmertnyi YO, Bezsmertna HV, et al. Reparative regeneration at the end of bone filing after ostoplastic amputation. Wiad Lek. 2021;74:413-7. PMID: 33813442.
  23. European Convention for the protection of vertebrate animals used for experimental and other scientific purposes. Strasburg: Council of Europe. 1986;123:52. Available from: https://rm.coe.int/ 168007a67b.
  24. Directive 2010/63/EU of the European Parliament and of the Council of 22 September 2010 on the Protection of Animals Used for Scientific Purposes. Off J Eur Union. 2010;53(L276):33–79.
  25. Zakon Ukrainy. Pro zakhyst tvaryn vid zhorstokogo povodzhennia [Law of Ukraine. On the protection of animals from cruelty]. Vidomosti Verkhovnoi Rady Ukrainy (VVR). 2006;27:230. Available from: http://zakon1.rada.gov.ua/laws/ show/3447-15.
  26. Stetsula VI, Devyatov AA. [Transosseous osteosynthesis in traumatology]. Kyiv: Zdorov’ya; 1987. 200 p. Available from: http://library.zsmu. edu.ua/cgi/irbis64r_14/fulltext/Travmatologija%20i%20ortopedija/SteculaVI87_Chresk_os.pdf
  27. Augat P, Simon U, Liedert A, et al.. Mechanics and mechano-biology of fracture healing in normal and osteoporotic bone. Osteoporos Int 2005; 16(2):S36-S43.
  28. Willie BM, Zimmermann EA, Vitienes I, et al. Bone adaptation: Safety factors and load predictability in shaping skeletal form. Bone. 2020;131:115114. doi: 10.1016/j.bone.2019.115114.
  29. Finco MG, Kim S, Ngo W, Menegaz RA. A review of musculoskeletal adaptations in individuals following major lower-limb amputation. J Musculoskelet Neuronal Interact. 2022;22(2):269-83. PMID: 35642706.
  30. Hoyt BW, Lundy AE, Colantonio DF, et al. Hounsfield Unit-Calculated Bone Mineral Density Loss Following Combat-Related Lower Extremity Amputations. J Bone Joint Surg Am. 2023;105(22): 1786-92. doi: 10.2106/JBJS.22.01258.
  31. Thomson S, Lu W, Zreiqat H, et al. Proximal bone remodeling in lower limb amputees reconstructed with an osseointegrated prosthesis. J Orthop Res. 2019;37(12):2524-30. doi: 10.1002/jor.24445.
  32. Wiedemann-Fodé E, Schiavi-Tritz J, Kerdjoudj H, Laurent C. Effects of mechanical stimuli on bone cells for regenerative medicine: A review of recent experimental and computational methods. Med Eng Phys. 2025;142:104369. doi: 10.1016/ j.medengphy.2025.104369.
  33. Pinzur MS, Gottschalk FA, Pinto MA, Smith DG. Controversies in lower extremity amputation. J Bone Joint Surg Am. 2007;89(5):1118-27. doi: 10.2106/00004623-200705000-00028.
  34. Bemben DA, Sherk VD, Ertl WJJ, Bemben MG. Acute bone changes after lower limb amputation resulting from traumatic injury. Osteoporos Int. 2017; 28(7):2177-86. doi: 10.1007/s00198-017-4018-z.

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Published

2025-10-30

How to Cite

Bondarenko , D., Bezsmertnyi , Y., Shevchuk , V., Bezsmertna, G., & Burlaka, R. (2025). Remodelling of bone stumps under the influence of various mechanical load regimes. Морфологія / Morphologia / Morfologìâ, 19(4), 19–29. https://doi.org/10.26641/1997-9665.2025.4.19-29

Issue

Vol. 19 No. 4 (2025)

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