The Effect of Gamma Radiation Sterilization on the Fatigue Crack Propagation Resistance of Human Cortical Bone

• Published in: Journal of bone and joint surgery. American volume 2004-12, Vol.86 (12), p.2648-2657
• Main Authors: Mitchell, Erika J, Stawarz, Allison M, Kayacan, Ramazan, Rimnac, Clare M
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Aged; Biological and medical sciences; Biomechanical Phenomena; Bone and Bones - physiopathology; Bone and Bones - radiation effects; Bone Density; Bone Transplantation; Female; Fractures, Bone - physiopathology; Gamma Rays; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Orthopedic surgery; Sterilization; Stress, Mechanical; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200412000-00010

BackgroundClinical evidence has suggested that the rate of fracture in allografts sterilized with gamma radiation may be higher than that in controls. Gamma radiation sterilization has been shown to affect the post-yield properties of bone but not the elastic modulus. Since most allograft fractures occur with subcritical loads during activities of daily living, it may be that the fatigue properties of irradiated allografts are diminished. In this study, the fatigue crack propagation behavior of cortical bone sterilized with gamma radiation was compared with that of gender and age-matched controls. We hypothesized that gamma radiation significantly reduces the resistance of cortical bone to fatigue crack growth.MethodsSpecimens for fatigue crack propagation testing were machined from four pairs of fresh-frozen human femora obtained from four individuals (a younger male, younger female, older male, and older female donor). Half of the specimens were sterilized with 31.7 kGy of gamma radiation. The specimens were cyclically loaded to failure in a servohydraulic testing system, and crack growth was monitored. The cyclic stress intensity factor and the fatigue crack growth rate were calculated to examine the kinetics of fatigue crack growth. Following testing, the damage zone around the fracture plane was analyzed histologically.ResultsThe morphology and kinetics of crack growth in irradiated specimens differed from the control data. Overall, the irradiated bone was significantly less resistant to fatigue crack growth than was control tissue (p < 0.05). There was less microdamage associated with fracture in the irradiated specimens than in the control specimens, with the exception of the bone from the older female donor.ConclusionsGamma radiation sterilization significantly reduces the fatigue crack propagation resistance of cortical bone. Irradiated specimens also demonstrate a smaller amount of microdamage along the fracture plane. These findings may be due to ultrastructural alterations in the collagen matrix caused by radiation.Clinical RelevanceThis study suggests that, despite having pre-yield mechanical properties that are similar to those of nonirradiated bone, gamma-radiation-sterilized allograft may be more predisposed to fracture even under the subcritical loads that occur during the activities of daily living.