|
1
|
Dunbar NJ, Zhu Y, Babazadeh-Naseri A, Akin JE, Spazzoli B, Belvedere C, Donati DM, Leardini A, Fregly BJ. Blinded prediction of custom-made pelvic implant failure using patient-specific finite element modeling. Med Eng Phys 2025; 138:104321. [PMID: 40180533 DOI: 10.1016/j.medengphy.2025.104321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 12/17/2024] [Accepted: 03/06/2025] [Indexed: 04/05/2025]
Abstract
Additively manufactured, custom-made implants used for reconstruction are a promising treatment following tumor resection. However, failure rates due to mechanical factors remain high when used in the pelvis for even state-of-the-art prosthesis designs. In a collaborative effort between a clinical and an engineering research team, this study evaluated whether patient-specific biomechanical modeling could predict, in a blinded fashion, the mode and location of a clinically-observed mechanical failure. Multiple failure criteria were considered including the risk of bone fracture due to overloading or stress shielding and prosthesis fracture due to overloading or fatigue. The blinded predictions indicated that the risk of fatigue failure in the pubic screws were eight times higher than the most critical ilium screw and two times higher than the most critical cancellous screw. Simulation of stress-shielding during walking matched evidence of osteolysis in the ilium and pubis. Incorporating patient-specific modeling into the custom implant design process may lead to improved durability.
Collapse
Affiliation(s)
- Nicholas J Dunbar
- Department of Mechanical Engineering, Rice University, Houston, TX, USA.
| | - Yuhui Zhu
- Department of Mechanical Engineering, Rice University, Houston, TX, USA.
| | | | - John E Akin
- Department of Mechanical Engineering, Rice University, Houston, TX, USA.
| | - Benedetta Spazzoli
- Third Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Davide M Donati
- Third Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, TX, USA.
| |
Collapse
|
|
2
|
Su H, Zhen P, Hou J, Qin W, Liu J, Pan K, Jack G, Nie X, Hua Q, Zhao J. Finite element analysis safety of tibial cortex transverse transport. Bone Joint Res 2025; 14:281-291. [PMID: 40164177 PMCID: PMC11957848 DOI: 10.1302/2046-3758.144.bjr-2024-0157.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Aims Tibial cortex transverse transport (TTT) represents an innovative surgical technique used in managing lower limb ischaemic conditions, focusing specifically on diabetic foot ulcers. This study aimed to assess the safety of TTT by evaluating the stress magnitude and distribution on the tibia and tibial osteotomy blocks. Methods A 3D finite element model was developed to simulate the TTT system, including the tibia, osteotomy blocks, skin, and TTT device. The models were reconstructed using Mimics, Geomagic, and SolidWorks, and analyzed with Ansys finite element processing software. To estimate the fracture risk under specific conditions, we calculated the stress limits and distribution the tibia could withstand without fracturing under various loading scenarios, such as torsion and axial compression. Results The results indicate that stress on the tibial cortex increased progressively with the advancement of bone transport fixation adjustment, and was primarily concentrated around the pinholes used to lift the osteotomy block. No significant differences were observed between the control and TTT groups. Conclusion Through finite element analysis, it was determined that TTT does not compromise the overall stability of the tibia, and the TTT device provides protection against bone fracture caused by window-cutting in diabetic patients. Therefore, to preserve the TTT system's stability, its components must be protected from high-impact forces.
Collapse
Affiliation(s)
- Hongjie Su
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China
| | - Puxiang Zhen
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- National Demonstration Center for Experimental (General practice) Education, Hubei University of Science and Technology, Xianning, China
| | - Jun Hou
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- College of Stomatology, Guangxi Medical University, Nanning, China
| | - Wencong Qin
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Liu
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China
| | - Kaixiang Pan
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guan Jack
- Bay Area Foot and Ankle Medical Clinic, San Jose, California, USA
| | - Xinyu Nie
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China
| | - Qikai Hua
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China
| | - Jinmin Zhao
- Department of Orthopaedic Surgery, Guangxi Diabetic Foot Salvage Engineering Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedic Surgery, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China
| |
Collapse
|
|
3
|
Venkata Krishna D, Ravi Sankar M, Nagendra Reddy T. Location-dependent behaviour and Johnson-Cook constitutive model parameters for bovine femoral bone. Comput Methods Biomech Biomed Engin 2025:1-10. [PMID: 40022297 DOI: 10.1080/10255842.2025.2470799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/23/2024] [Accepted: 02/16/2025] [Indexed: 03/03/2025]
Abstract
The bone's inhomogeneous structure instigates the varied mechanical properties from point to point, resulting in the constitutive model developed for a particular region failing when adopted for an arbitrary area. In the present study, bovine femoral bone diaphysis is partitioned into lower, mid, and upper diaphysis. The constitutive model was developed using the experimental data of uniaxial tensile test performed at various strain rates considering the locational variation of bone mineral density, which can be adapted for any arbitrary region of the femoral bone. The results showed that the predictive accuracy of the proposed model is within the acceptable range.
Collapse
Affiliation(s)
- Devara Venkata Krishna
- Department of Mechanical Engineering, Indian Institute of Technology Tirupati, Tirupati, Andhra Pradesh, India
| | - Mamilla Ravi Sankar
- Department of Mechanical Engineering, Indian Institute of Technology Tirupati, Tirupati, Andhra Pradesh, India
| | - Thopireddy Nagendra Reddy
- Department of Microbiology, Sri Venkateswara Veterinary University Tirupati, Tirupati, Andhra Pradesh, India
| |
Collapse
|
|
4
|
Petrucci M, La Mattina AA, Curreli C, Tassinari E, Viceconti M. A finite element model to simulate intraoperative fractures in cementless hip stem designs. Med Eng Phys 2025; 135:104274. [PMID: 39922645 DOI: 10.1016/j.medengphy.2024.104274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 11/11/2024] [Accepted: 12/01/2024] [Indexed: 02/10/2025]
Abstract
Intraoperative femur fractures are a complication of hip arthroplasty, strongly related to the cementless stem design; this kind of fracture is not always recognised during surgery, and revision surgery may be necessary. The present study aimed to simulate intraoperative crack propagation during stem implantation using subject-specific quasi-static finite element models. Eleven subject-specific finite element femur models were built starting from CT data, and the implant pose and size of a non-commercial cementless stem were identified. The model boundary conditions were set with a compressive load from 1000 N to 10 000 N, to simulate the surgeon's hammering, and element deactivation was used to model the crack propagation. Two damage quantifiers were analysed to identify a threshold value that would allow us to assess if a fracture occurred. A methodology to assess the primary stability of the stem during insertion was also proposed, based on a push-out test. Crack propagation up to the surface was obtained in six patients; in two cases there was no crack generation, while in three patients the crack did not reach the external surface. This study demonstrates the possibility to simulate the propagation of the fracture intraoperatively during hip replacement surgery and generate quantitative information about the bone damage using a virtual cohort of simulated patients with anatomical and physiological variability.
Collapse
Affiliation(s)
- Maila Petrucci
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy
| | | | - Cristina Curreli
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Tassinari
- Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Viceconti
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy.
| |
Collapse
|
|
5
|
Soodmand I, Becker AK, Sass JO, Jabs C, Kebbach M, Wanke G, Dau M, Bader R. Heterogeneous material models for finite element analysis of the human mandible bone - A systematic review. Heliyon 2024; 10:e40668. [PMID: 39759346 PMCID: PMC11698920 DOI: 10.1016/j.heliyon.2024.e40668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 11/06/2024] [Accepted: 11/22/2024] [Indexed: 01/07/2025] Open
Abstract
Subject-specific finite element (FE) modeling of the mandible bone has recently gained attention for its higher accuracy. A critical modeling factor is including personalized material properties from medical images especially when bone quality has to be respected. However, there is no consensus on the material model for the mandible that realistically estimates the Young's modulus of the bone. Therefore, the present study aims to review FE studies employing heterogeneous material modeling of the human mandible bone, synthesizing these models, investigating their origins, and assessing their risk of bias. A systematic review using PRISMA guidelines was conducted on publications before 1st July 2024, involving PubMed, Scopus, and Web of Science. The search string considered (a) anatomical site (b) modeling strategy, and (c) metrics of interest. Two inclusion and five exclusion criteria were defined. A review of 77 FE studies identified 12 distinct heterogeneous material models, built based on different in vitro or computational methodologies leading to varied performance and highly deviated range of estimated Young's modulus. They are proposed for bones from five different anatomical sites than mandible and for both trabecular and cortical bone domains. The original studies were characterized with a low to medium risk of bias. This review assessed the current state of material modeling for subject-specific FE models in the craniomaxillofacial field. Recommendations are provided to support researchers in selecting density-modulus relationships. Future research should focus on standardizing experimental protocols, validating models through combined simulation and experimental approaches, and investigating the anisotropic behaviour of the mandible bone.
Collapse
Affiliation(s)
- Iman Soodmand
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Ann-Kristin Becker
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Jan-Oliver Sass
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christopher Jabs
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Gesa Wanke
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Michael Dau
- Department of Oral, Maxillofacial Plastic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
|
6
|
Olivares-Hernandez AE, Olivares-Robles MA, Méndez-Méndez JV, Gutiérrez-Camacho C. Microfilm Coatings: A Biomaterial-Based Strategy for Modulating Femoral Deflection. J Funct Biomater 2024; 15:283. [PMID: 39452582 PMCID: PMC11508653 DOI: 10.3390/jfb15100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/16/2024] [Accepted: 09/23/2024] [Indexed: 10/26/2024] Open
Abstract
Wear on the surface of the femoral head increases the risk of hip and femur fractures. Biomechanical experiments conducted on the femur are based on its bending and torsional rigidities. Studies regarding the deflection of the femur bone when the femoral head is coated with microfilms composed of durable and compatible biomaterials are poor. This study aimed to investigate the effects of different biomaterial microfilm coatings over the femoral head on the deflection of the human femur. We utilized 2023 R1 finite element analysis (FEA) software to model the directional deformation on the femoral head and examine the femur's deflection with varying microfilm thicknesses. The deflection of the femur bone was reported when the femoral head was uncoated and coated with titanium, stainless steel, and pure gold microfilms of different thicknesses (namely, 50, 75, and 100 μm). Our results show that the femur's minimum and maximum deflection occurred for stainless steel and gold, respectively. The deformation of the femur was lower when the femoral head was coated with a 50-micrometer microfilm of stainless steel, compared to the deformation obtained with gold and titanium. When the thickness of the microfilm for each of the materials was increased, the deformation continued to decrease. The minimum deformation of the femur occurred for a thickness of 100 μm with stainless steel, followed by titanium and gold. The difference in the directional deformation of the femur between the materials was more significant when the coating was 100 μm, compared to the thicknesses of 50 and 75 μm. The findings of this study are expected to significantly contribute to the development of advanced medical techniques to enhance the quality of life for patients with femur bone-related issues. This information can be used to develop more resilient coatings that can withstand wear and tear.
Collapse
Affiliation(s)
- Ana Elisabeth Olivares-Hernandez
- Instituto Politecnico Nacional, Seccion de Estudios de Posgrado e Investigacion, Escuela Nacional de Ciencias Biologicas, Ciudad de Mexico 11340, Mexico
| | - Miguel Angel Olivares-Robles
- Instituto Politecnico Nacional, Seccion de Estudios de Posgrado e Investigacion, Escuela Superior de Ingenieria Mecanica y Electrica Unidad Culhuacan, Coyoacan, Ciudad de Mexico 04430, Mexico
| | - Juan Vicente Méndez-Méndez
- Instituto Politecnico Nacional, Centro de Nanociencias y Micro y Nanotecnologías, “Unidad Profesional Adolfo Lopez Mateos”, Luis Enrico Erro s/n, Ciudad de Mexico 07738, Mexico;
| | - Claudia Gutiérrez-Camacho
- Hospital Infantil de Mexico Federico Gomez, Direccion de Enseñanza y Desarrollo Académico, Ciudad de Mexico 06720, Mexico;
| |
Collapse
|
|
7
|
Frazer L, Kote V, Hostetler Z, Davis M, Nicolella DP. A comparative analysis of dimensionality reduction surrogate modeling techniques for full human body finite element impact simulations. Comput Methods Biomech Biomed Engin 2024; 27:1250-1263. [PMID: 37458327 DOI: 10.1080/10255842.2023.2236747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/08/2023] [Indexed: 07/12/2024]
Abstract
Fast-running surrogate computational models (simpler computational models) have been successfully used to replace time-intensive finite element models. However, it is unclear how well they perform in accurately and efficiently replicating complex, full human body finite element models. Here we survey several surrogate modeling techniques and assess their accuracy in predicting full strain fields of tissues of interest during a highly dynamic behind armor blunt trauma impact to the liver. We found that coupling dimensionality reduction on the high-dimensional output space (principal component analysis or autoencoders) with machine learning techniques (Gaussian Process Regression or multi-output neural networks) provides a framework capable of accurately and efficiently replacing complex full human body models. It was found that these surrogate models can successfully predict the strain fields (<10% average strain error) of select tissues during a nonlinear impact event but careful consideration should be given to element parsing and modeling technique.
Collapse
Affiliation(s)
- Lance Frazer
- Musculoskeletal Biomechanics Section, Materials Engineering Department, Southwest Research Institute, San Antonio, TX, USA
| | - Vivek Kote
- Musculoskeletal Biomechanics Section, Materials Engineering Department, Southwest Research Institute, San Antonio, TX, USA
| | | | | | - Daniel P Nicolella
- Musculoskeletal Biomechanics Section, Materials Engineering Department, Southwest Research Institute, San Antonio, TX, USA
| |
Collapse
|
|
8
|
Namvar A, Lozanovski B, Downing D, Williamson T, Kastrati E, Shidid D, Hill D, Buehner U, Ryan S, Choong PF, Sanaei R, Leary M, Brandt M. Finite element analysis of patient-specific additive-manufactured implants. Front Bioeng Biotechnol 2024; 12:1386816. [PMID: 38784769 PMCID: PMC11111884 DOI: 10.3389/fbioe.2024.1386816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction: Bone tumors, characterized by diverse locations and shapes, often necessitate surgical excision followed by custom implant placement to facilitate targeted bone reconstruction. Leveraging additive manufacturing, patient-specific implants can be precisely tailored with complex geometries and desired stiffness, enhancing their suitability for bone ingrowth. Methods: In this work, a finite element model is employed to assess patient-specific lattice implants in femur bones. Our model is validated using experimental data obtained from an animal study (n = 9). Results: The results demonstrate the accuracy of the proposed finite element model in predicting the implant mechanical behavior. The model was used to investigate the influence of reducing the elastic modulus of a solid Ti6Al4V implant by tenfold, revealing that such a reduction had no significant impact on bone behavior under maximum compression and torsion loading. This finding suggests a potential avenue for reducing the endoprosthesis modulus without compromising bone integrity. Discussion: Our research suggests that employing fully lattice implants not only facilitates bone ingrowth but also has the potential to reduce overall implant stiffness. This reduction is crucial in preventing significant bone remodeling associated with stress shielding, a challenge often associated with the high stiffness of fully solid implants. The study highlights the mechanical benefits of utilizing lattice structures in implant design for enhanced patient outcomes.
Collapse
Affiliation(s)
- Arman Namvar
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
- Department of Surgery, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Bill Lozanovski
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - David Downing
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Tom Williamson
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
- Stryker, Sydney, NSW, Australia
| | - Endri Kastrati
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
- Stryker, Sydney, NSW, Australia
| | - Darpan Shidid
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - David Hill
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
| | | | - Stewart Ryan
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter F. Choong
- Department of Surgery, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Reza Sanaei
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Melbourne, VIC, Australia
| | - Martin Leary
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Milan Brandt
- RMIT Centre for Additive Manufacture, School of Engineering, RMIT University, Melbourne, VIC, Australia
| |
Collapse
|
|
9
|
Truskey GA. The Potential of Deep Learning to Advance Clinical Applications of Computational Biomechanics. Bioengineering (Basel) 2023; 10:1066. [PMID: 37760168 PMCID: PMC10525821 DOI: 10.3390/bioengineering10091066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
When combined with patient information provided by advanced imaging techniques, computational biomechanics can provide detailed patient-specific information about stresses and strains acting on tissues that can be useful in diagnosing and assessing treatments for diseases and injuries. This approach is most advanced in cardiovascular applications but can be applied to other tissues. The challenges for advancing computational biomechanics for real-time patient diagnostics and treatment include errors and missing information in the patient data, the large computational requirements for the numerical solutions to multiscale biomechanical equations, and the uncertainty over boundary conditions and constitutive relations. This review summarizes current efforts to use deep learning to address these challenges and integrate large data sets and computational methods to enable real-time clinical information. Examples are drawn from cardiovascular fluid mechanics, soft-tissue mechanics, and bone biomechanics. The application of deep-learning convolutional neural networks can reduce the time taken to complete image segmentation, and meshing and solution of finite element models, as well as improving the accuracy of inlet and outlet conditions. Such advances are likely to facilitate the adoption of these models to aid in the assessment of the severity of cardiovascular disease and the development of new surgical treatments.
Collapse
Affiliation(s)
- George A Truskey
- Department of Biomedical Engineering, Duke University, Durham, NC 27701, USA
| |
Collapse
|
|
10
|
Inglis B, Grumbles D, Dailey HL. Dual-zone material assignment method for correcting partial volume effects in image-based bone models. Comput Methods Biomech Biomed Engin 2023; 26:1431-1442. [PMID: 36062947 DOI: 10.1080/10255842.2022.2119383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
In image-based finite element analysis of bone, partial volume effects (PVEs) arise from image blur at tissue boundaries and as a byproduct of geometric reconstruction and meshing during model creation. In this study, we developed and validated a material assignment approach to mitigate partial volume effects. Our validation data consisted of physical torsion testing of intact tibiae from N = 20 Swiss alpine sheep. We created finite element models from micro-CT scans of these tibiae using three popular element types (10-node tetrahedral, 8-node hexahedral, and 20-node hexahedral). Without partial volume management, the models over-predicted the torsional rigidity compared to physical biomechanical tests. To address this problem, we implemented a dual-zone material model to treat elements that overlap low-density surface voxels as soft tissue rather than bone. After in situ inverse optimization, the dual-zone material model produced strong correlations and high absolute agreement between the virtual and physical tests. This suggests that with appropriate partial volume management, virtual mechanical testing can be a reliable surrogate for physical biomechanical testing. For maximum flexibility in partial volume management regardless of element type, we recommend the use of the following dual-zone material model for ovine tibiae: soft-tissue cutoff density of 665 mgHA/cm3 with a soft tissue modulus of 50 MPa (below cutoff) and a density-modulus conversion slope of 10,225 MPa-cm3/mgHA for bone (above cutoff).
Collapse
Affiliation(s)
- Brendan Inglis
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Daniel Grumbles
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| |
Collapse
|
|
11
|
Kramer D, Van der Merwe J, Lüthi M. A combined active shape and mean appearance model for the reconstruction of segmental bone loss. Med Eng Phys 2022; 110:103841. [PMID: 36031526 DOI: 10.1016/j.medengphy.2022.103841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
This study investigates the novel combination of an active shape and mean appearance model to estimate missing bone geometry and density distribution from sparse inputs simulating segmental bone loss of the femoral diaphysis. An active shape Gaussian Process Morphable model was trained on healthy right femurs of South African males to model shape. The density distribution was approximated based on the mean appearance of computed tomography images from the training set. Estimations of diaphyseal resections were obtained by probabilistic fitting of the active shape model to sparse inputs consisting of proximal and distal femoral data on computed tomography images. The resulting shape estimates of the diaphyseal resections were then used to map the mean appearance model to the patients' missing bone geometry, constructing density estimations. In this way, resected bone surfaces were estimated with an average error of 2.24 (0.5) mm. Density distributions were approximated within 87 (0.7) % of the intensity of the original target images before the simulated segmental bone loss. These results fall within the acceptable tolerances required for surgical planning and reconstruction of long bone defects.
Collapse
Affiliation(s)
- D Kramer
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Western-Cape, South Africa.
| | - J Van der Merwe
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Western-Cape, South Africa.
| | - M Lüthi
- The Graphics and Vision Research Group, University of Basel, Basel 4001, Switzerland.
| |
Collapse
|
|
12
|
A Density-Dependent Target Stimulus for Inverse Bone (Re)modeling with Homogenized Finite Element Models. Ann Biomed Eng 2022; 51:925-937. [PMID: 36418745 PMCID: PMC10122636 DOI: 10.1007/s10439-022-03104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
AbstractInverse bone (re)modeling (IBR) can infer physiological loading conditions from the bone microstructure. IBR scales unit loads, imposed on finite element (FE) models of a bone, such that the trabecular microstructure is homogeneously loaded and the difference to a target stimulus is minimized. Micro-FE (µFE) analyses are typically used to model the microstructure, but computationally more efficient, homogenized FE (hFE) models, where the microstructure is replaced by an equivalent continuum, could be used instead. However, also the target stimulus has to be translated from the tissue to the continuum level. In this study, a new continuum-level target stimulus relating relative bone density and strain energy density is proposed. It was applied using different types of hFE models to predict the physiological loading of 21 distal radii sections, which was subsequently compared to µFE-based IBR. The hFE models were able to correctly identify the dominant load direction and showed a high correlation of the predicted forces, but mean magnitude errors ranged from − 14.7 to 26.6% even for the best models. While µFE-based IBR can still be regarded as a gold standard, hFE-based IBR enables faster predictions, the usage of more sophisticated boundary conditions, and the usage of clinical images.
Collapse
|
|
13
|
Moolenaar JZ, Tümer N, Checa S. Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review. Front Bioeng Biotechnol 2022; 10:1037048. [PMID: 36312550 PMCID: PMC9613932 DOI: 10.3389/fbioe.2022.1037048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery. Objectives: The aims of this review are 1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, 2) to assess the clinical feasibility of the existing virtual planning approaches, and 3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods. Methods: A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation. Results: 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 min in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD: -0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous. Conclusion: Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.
Collapse
Affiliation(s)
- Jet Zoë Moolenaar
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Nazli Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Sara Checa
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| |
Collapse
|
|
14
|
A finite element study on femoral locking compression plate design using genetic optimization method. J Mech Behav Biomed Mater 2022; 131:105202. [DOI: 10.1016/j.jmbbm.2022.105202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/15/2022] [Accepted: 03/25/2022] [Indexed: 11/23/2022]
|
|
15
|
Kramer D, Van der Merwe J, Luthi M. Model Construction for the Estimation of Healthy Bone Shape and Density Distribution. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:3431-3434. [PMID: 34891977 DOI: 10.1109/embc46164.2021.9630024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Statistical models are widely used within biomedical fields for automated segmentation and reconstruction of healthy geometry. In the absence of contralateral geometry, statistical models are a viable alternative for reconstructing healthy bone anatomy. Therefore, statistical models of shape and appearance were constructed from sample data based on the right femur of South African males, and their use in an automated segmentation and density estimation application was investigated. The models reproduced the shape and density distribution of the population with an average error of 1.3 mm and a 90% density fit. These results fall within the acceptable tolerance limits of reconstructive surgery and appear promising for practical use in implant design.Clinical Relevance- Constructing and validating statistical models and registration algorithms provides the groundwork for further investigation into automating the digital reconstruction of pathological bone for use in implant design.
Collapse
|
|
16
|
Lewandowski K, Kaczmarczyk Ł, Athanasiadis I, Marshall JF, Pearce CJ. A computational framework for crack propagation in spatially heterogeneous materials. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200291. [PMID: 34148414 DOI: 10.1098/rsta.2020.0291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
This paper presents a mathematical formulation and numerical modelling framework for brittle crack propagation in heterogeneous elastic solids. Such materials are present in both natural and engineered scenarios. The formulation is developed in the framework of configurational mechanics and solved numerically using the finite-element method. We show the methodology previously established for homogeneous materials without the need for any further assumptions. The proposed model is based on the assumption of maximal dissipation of energy and uses the Griffith criterion; we show that this is sufficient to predict crack propagation in brittle heterogeneous materials, with spatially varying Young's modulus and fracture energy. Furthermore, we show that the crack path trajectory orientates itself such that it is always subject to Mode-I. The configurational forces and fracture energy release rate are both expressed exclusively in terms of nodal quantities, avoiding the need for post-processing and enabling a fully implicit formulation for modelling the evolving crack front and creation of new crack surfaces. The proposed formulation is verified and validated by comparing numerical results with both analytical solutions and experimental results. Both the predicted crack path and load-displacement response show very good agreement with experiments where the crack path was independent of material heterogeneity for those cases. Finally, the model is successfully used to consider the real and challenging scenario of fracture of an equine bone, with spatially varying material properties obtained from CT scanning. This article is part of a discussion meeting issue 'A cracking approach to inventing new tough materials: fracture stranger than friction'.
Collapse
Affiliation(s)
- Karol Lewandowski
- Glasgow Computational Engineering Centre, The James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Łukasz Kaczmarczyk
- Glasgow Computational Engineering Centre, The James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Ignatios Athanasiadis
- Glasgow Computational Engineering Centre, The James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - John F Marshall
- Weipers Centre Equine Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow G61 1QH, UK
| | - Chris J Pearce
- Glasgow Computational Engineering Centre, The James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| |
Collapse
|
|
17
|
Ghouchani A, Ebrahimzadeh MH. Can Patient-specific Finite Element Models Enter Clinical Practice as a Decision Support System? THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:1-4. [PMID: 33778109 DOI: 10.22038/abjs.2020.54579.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Azadeh Ghouchani
- Department of Biomedical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | | |
Collapse
|
|
18
|
Zhang Y, Shao Q, Yang C, Ai C, Zhou D, Yu Y, Sun G. Finite element analysis of different locking plate fixation methods for the treatment of ulnar head fracture. J Orthop Surg Res 2021; 16:191. [PMID: 33722253 PMCID: PMC7958469 DOI: 10.1186/s13018-021-02334-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Ulnar head fractures are increasingly higher with the growing proportion of the elderly people. Failure to achieve a stable anatomic reduction of ulna head fracture may lead to a distal radioulnar joint (DRUJ) dysfunction and nonunion of the distal radius. Due to the lack of the postoperative reporting outcomes and the biomechanical studies, it has not been well established about the optimal management of the comminuted distal ulna head fracture. Hence, the purpose of this study is to use finite element analysis to explain the advantages and disadvantages of ulnar-side locking plate fixation compared with dorsal-side locking plate fixation and its screw arrangement in the treatment of ulnar head fractures. Methods FE models of the ulnar head fracture and the models of ulnar-side locking plate and dorsal-side plate with two or three distal screws was constructed. In order to simulate forces acting on the ulnar and the osteosynthesis material during daily-life activity in subjects who underwent reconstructive surgery, we applied three loading conditions to each model, viz. 20 N axial compression, 50 N axial compression, 1 N∙m torsion moment, 1 N∙m lateral bending moments, and 1 N∙m extension bending moments. Under these conditions, values of the von Mises stress (VMS) distribution of the implant, peak VMS, the relative displacement of the head and shaft fragments between the fracture ends and the displacement and its direction of the models were investigated. Results The stress values of ulnar-side plates were lower than those of dorsal-side plates. And the ulnar-plate fixation system also has smaller maximum displacement and relative displacement. When adding a screw in the middle hole of the ulnar head, the values of model displacement and the peak stress in fixation system are lower, but it may evidently concentrate the stress on the middle screw. Conclusions In conclusion, our study indicated that ulnar-side locking plates resulted in a lower stress distribution in the plate and better stability than dorsal-side locking plates for ulnar head fracture fixation. Adding an additional screw to the ulnar head could increase the stability of the fixation system and provide an anti-torsion function. This study requires clinical confirmation of its practicality in the treatment of ulnar head fractures. This study requires clinical confirmation as to its practicality in the treatment of ulnar head fracture.
Collapse
Affiliation(s)
- Yue Zhang
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Qin Shao
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Changqing Ai
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Di Zhou
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yang Yu
- Walkman biomaterial CO., LTD, Tianjin, 301609, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China.
| |
Collapse
|
|
19
|
Schlinkmann C, Roland M, Wolff C, Trampert P, Slusallek P, Diebels S, Dahmen T. A GPU-based caching strategy for multi-material linear elastic FEM on regular grids. PLoS One 2020; 15:e0240813. [PMID: 33125404 PMCID: PMC7598514 DOI: 10.1371/journal.pone.0240813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
In this study, we present a novel strategy to the method of finite elements (FEM) of linear elastic problems of very high resolution on graphic processing units (GPU). The approach exploits regularities in the system matrix that occur in regular hexahedral grids to achieve cache-friendly matrix-free FEM. The node-by-node method lies in the class of block-iterative Gauss-Seidel multigrid solvers. Our method significantly improves convergence times in cases where an ordered distribution of distinct materials is present in the dataset. The method was evaluated on three real world datasets: An aluminum-silicon (AlSi) alloy and a dual phase steel material sample, both captured by scanning electron tomography, and a clinical computed tomography (CT) scan of a tibia. The caching scheme leads to a speed-up factor of ×2-×4 compared to the same code without the caching scheme. Additionally, it facilitates the computation of high-resolution problems that cannot be computed otherwise due to memory consumption.
Collapse
Affiliation(s)
- Christian Schlinkmann
- Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Germany
- Saarland University, Saarbrücken, Germany
| | | | - Christian Wolff
- Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Germany
| | - Patrick Trampert
- Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Germany
- Saarland University, Saarbrücken, Germany
| | - Philipp Slusallek
- Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Germany
- Saarland University, Saarbrücken, Germany
| | | | - Tim Dahmen
- Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Germany
- * E-mail:
| |
Collapse
|
|
20
|
Nalabothu P, Verna C, Steineck M, Mueller AA, Dalstra M. The biomechanical evaluation of magnetic forces to drive osteogenesis in newborn's with cleft lip and palate. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:79. [PMID: 32816120 PMCID: PMC7441089 DOI: 10.1007/s10856-020-06421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
This study examined the potential for dental magnets to act as a driving force for osteogenesis in the palate of newborns with a unilateral cleft lip and palate. In the first part of the study dental magnets were arranged in a set up mimicking a distraction device and the curves of the magnetic attraction force versus gap distance curves generated, with and without the presence of palatal rugae tissue in between both sides of the distraction device. The attraction forces ranged from 1 to 12 N depending on the gap distance and the presence of soft tissue in the gap. In the second part of the study these forces were used as input for a 3D finite element model of the palate of a newborn affected by unilateral cleft lip and palate. In the analysis of load transfer, it was found that the strains generated by a magnetically induced distraction exceed 1,500 µstrain suggesting that bone locally is submitted to mild overload leading to bone apposition.
Collapse
Affiliation(s)
- Prasad Nalabothu
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, Basel, Switzerland.
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland.
| | - Carlalberta Verna
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, Basel, Switzerland
| | - Markus Steineck
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, Basel, Switzerland
| | - Andreas Albert Mueller
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Michel Dalstra
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, Basel, Switzerland
| |
Collapse
|
|
21
|
Galbusera F, Cina A, Panico M, Albano D, Messina C. Image-based biomechanical models of the musculoskeletal system. Eur Radiol Exp 2020; 4:49. [PMID: 32789547 PMCID: PMC7423821 DOI: 10.1186/s41747-020-00172-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/30/2020] [Indexed: 12/31/2022] Open
Abstract
Finite element modeling is a precious tool for the investigation of the biomechanics of the musculoskeletal system. A key element for the development of anatomically accurate, state-of-the art finite element models is medical imaging. Indeed, the workflow for the generation of a finite element model includes steps which require the availability of medical images of the subject of interest: segmentation, which is the assignment of each voxel of the images to a specific material such as bone and cartilage, allowing for a three-dimensional reconstruction of the anatomy; meshing, which is the creation of the computational mesh necessary for the approximation of the equations describing the physics of the problem; assignment of the material properties to the various parts of the model, which can be estimated for example from quantitative computed tomography for the bone tissue and with other techniques (elastography, T1rho, and T2 mapping from magnetic resonance imaging) for soft tissues. This paper presents a brief overview of the techniques used for image segmentation, meshing, and assessing the mechanical properties of biological tissues, with focus on finite element models of the musculoskeletal system. Both consolidated methods and recent advances such as those based on artificial intelligence are described.
Collapse
Affiliation(s)
| | - Andrea Cina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Matteo Panico
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedicine, Neuroscience and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
|
22
|
Falcinelli C, Whyne C. Image-based finite-element modeling of the human femur. Comput Methods Biomech Biomed Engin 2020; 23:1138-1161. [PMID: 32657148 DOI: 10.1080/10255842.2020.1789863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fracture is considered a critical clinical endpoint in skeletal pathologies including osteoporosis and bone metastases. However, current clinical guidelines are limited with respect to identifying cases at high risk of fracture, as they do not account for many mechanical determinants that contribute to bone fracture. Improving fracture risk assessment is an important area of research with clear clinical relevance. Patient-specific numerical musculoskeletal models generated from diagnostic images are widely used in biomechanics research and may provide the foundation for clinical tools used to quantify fracture risk. However, prior to clinical translation, in vitro validation of predictions generated from such numerical models is necessary. Despite adopting radically different models, in vitro validation of image-based finite element (FE) models of the proximal femur (predicting strains and failure loads) have shown very similar, encouraging levels of accuracy. The accuracy of such in vitro models has motivated their application to clinical studies of osteoporotic and metastatic fractures. Such models have demonstrated promising but heterogeneous results, which may be explained by the lack of a uniform strategy with respect to FE modeling of the human femur. This review aims to critically discuss the state of the art of image-based femoral FE modeling strategies, highlighting principal features and differences among current approaches. Quantitative results are also reported with respect to the level of accuracy achieved from in vitro evaluations and clinical applications and are used to motivate the adoption of a standardized approach/workflow for image-based FE modeling of the femur.
Collapse
Affiliation(s)
- Cristina Falcinelli
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Canada
| | - Cari Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Canada
| |
Collapse
|
|
23
|
Fleps I, Bahaloo H, Zysset PK, Ferguson SJ, Pálsson H, Helgason B. Empirical relationships between bone density and ultimate strength: A literature review. J Mech Behav Biomed Mater 2020; 110:103866. [PMID: 32957183 DOI: 10.1016/j.jmbbm.2020.103866] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/06/2020] [Accepted: 05/17/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ultimate strength-density relationships for bone have been reported with widely varying results. Reliable bone strength predictions are crucial for many applications that aim to assess bone failure. Bone density and bone morphology have been proposed to explain most of the variance in measured bone strength. If this holds true, it could lead to the derivation of a single ultimate strength-density-morphology relationship for all anatomical sites. METHODS All relevant literature was reviewed. Ultimate strength-density relationships derived from mechanical testing of human bone tissue were included. The reported relationships were translated to ultimate strength-apparent density relationships and normalized with respect to strain rate. Results were grouped based on bone tissue type (cancellous or cortical), anatomical site, and loading mode (tension vs. compression). When possible, the relationships were compared to existing ultimate strength-density-morphology relationships. RESULTS Relationships that considered bone density and morphology covered the full spectrum of eight-fold inter-study difference in reported compressive ultimate strength-density relationships for trabecular bone. This was true for studies that tested specimens in different loading direction and tissue from different anatomical sites. Sparse data was found for ultimate strength-density relationships in tension and for cortical bone properties transverse to the main loading axis of the bone. CONCLUSIONS Ultimate strength-density-morphology relationships could explain measured strength across anatomical sites and loading directions. We recommend testing of bone specimens in other directions than along the main trabecular alignment and to include bone morphology in studies that investigate bone material properties. The lack of tensile strength data did not allow for drawing conclusions on ultimate strength-density-morphology relationships. Further studies are needed. Ideally, these studies would investigate both tensile and compressive strength-density relationships, including morphology, to close this gap and lead to more accurate evaluation of bone failure.
Collapse
Affiliation(s)
- Ingmar Fleps
- Institute for Biomechanics, ETH-Zürich, Zürich, Switzerland.
| | - Hassan Bahaloo
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Philippe K Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - Halldór Pálsson
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | |
Collapse
|
|
24
|
Toniolo I, Salmaso C, Bruno G, De Stefani A, Stefanini C, Gracco ALT, Carniel EL. Anisotropic computational modelling of bony structures from CT data: An almost automatic procedure. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105319. [PMID: 31951872 DOI: 10.1016/j.cmpb.2020.105319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/27/2019] [Accepted: 01/05/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The use of modelling techniques that combine CT data and bone tissue micromechanics is spreading in computational biomechanics. Finite Element models show great potential in surgical planning of intervention and in prediction of stress and strain fields through a non-invasive method. The main challenge pertains to the reliable characterization of bone mechanical behaviour. An almost automatic procedure is here defined, which provides computational models of bony structures considering the actual anisotropy of bone tissue response. The innovative aspect resides on the automatic detection of the directions of anisotropy as the eigenvectors of a three-dimensional distribution matrix of HU values. METHODS The procedure combines CT data and micromechanics modelling techniques. Regarding a specific location, the procedure reports both the orthotropic elastic constants, by the analysis of the local HU value, and the anisotropic material directions, by the analysis of the HU values distribution around the specific location. RESULTS The procedure returns the distribution of bone tissue orthotropic elasticity tensor. The procedure proves to correctly respect the differentiation between cortical and trabecular bone. Principal directions show to be consistent with experimental data from ultrasound measurements. Regarding the material mapping from voxel to FE model, the developed strategies show to be reliable, leading to marginal errors (lower than 10%) for most of CT voxels (more than 90%). The computational analyses of typical structural loading conditions lead to strain values that are comparable with results from strain gauges experimentations. The development and the exploitation of FE models of different bony structures allow assessing the reliability of the procedure for cortical bone. CONCLUSIONS The results highlight the potentialities of the procedure in providing accurate patient-specific biomechanical models of bony structures starting from CT data. The accuracy and the automatism of the procedure are important factors for the development of real time clinical tools. The main limitations of this work remain the not fully automatism and the reliability assessment, which is based mainly on cortical bone regions only.
Collapse
Affiliation(s)
- Ilaria Toniolo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Industrial Engineering, University of Padova, Italy.
| | - Claudia Salmaso
- Department of Industrial Engineering, University of Padova, Italy
| | - Giovanni Bruno
- Department of Neurosciences, University of Padova, Italy
| | | | - Cesare Stefanini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| |
Collapse
|
|
25
|
Laurent CP, Böhme B, Verwaerde J, Papeleux L, Ponthot JP, Balligand M. Effect of orthopedic implants on canine long bone compression stiffness: a combined experimental and computational approach. Proc Inst Mech Eng H 2019; 234:255-264. [PMID: 31608817 DOI: 10.1177/0954411919882603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteosynthesis for canine long bones is a complex process requiring knowledge of biology, surgical techniques and (bio)mechanical principles. Subject-specific finite element analysis constitutes a promising tool to evaluate the effect of surgical intervention on the global properties of a bone-implant construct, but suffers from a lack of validation. In this study, the biomechanical behavior of 10 canine humeri was compared before and after creation of a 10 mm bone defect stabilized with an eight-hole locking compression plate (Synthes®) and two locking screws on each fragment. The response under compression of both intact and plated samples was measured experimentally and reproduced with a finite element model. The experimental stiffness ratio between plated and intact bone was equal to 0.39 ± 0.06. A subject-specific finite element analysis including density-dependent elasto-plastic material properties for canine bone and automatic generation of orthopedic implants was then conducted to recover these experimental results. The stiffness of intact and plated samples could be predicted, with no significant differences with experimental data. The simulated stiffness ratio between plated and intact canine bone was equal to 0.43 ± 0.03. This study constitutes a first step toward the building of a virtual database of pre-computed cases, aiming at helping the veterinary surgeons to make decisions regarding the most suited orthopedic solution for a given dog and a given fracture.
Collapse
Affiliation(s)
| | - Béatrice Böhme
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Jolanthe Verwaerde
- CNRS, LEMTA, UMR 7563, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Luc Papeleux
- Department of Aerospace & Mechanical Engineering, University of Liège, Liège, Belgium
| | - Jean-Philippe Ponthot
- Department of Aerospace & Mechanical Engineering, University of Liège, Liège, Belgium
| | - Marc Balligand
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| |
Collapse
|
|
26
|
Bahia MT, Hecke MB, Mercuri EG. Image-based anatomical reconstruction and pharmaco-mediated bone remodeling model applied to a femur with subtrochanteric fracture: A subject-specific finite element study. Med Eng Phys 2019; 69:58-71. [DOI: 10.1016/j.medengphy.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 04/17/2019] [Accepted: 05/19/2019] [Indexed: 01/25/2023]
|
|
27
|
Chen X, Zhu B, Mao Z, Geng W. Construction of restored model of fractured femurs based on anatomic features. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2019.1637277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Xiaozhong Chen
- Department of Information, School of Intelligent Manufacturing, Changzhou Vocational Institute of Engineering, Jiangsu, People’s Republic of China
| | - Baosheng Zhu
- Department of Information, School of Intelligent Manufacturing, Changzhou Vocational Institute of Engineering, Jiangsu, People’s Republic of China
| | - Zhijian Mao
- Department of Information, School of Intelligent Manufacturing, Changzhou Vocational Institute of Engineering, Jiangsu, People’s Republic of China
| | - Weizhong Geng
- Department of IOT, College of Computer and Information Engineering, XinXiang University, Henan, People’s Republic of China
| |
Collapse
|
|
28
|
In vitro experimental and numerical study on biomechanics and stability of a novel adjustable hemipelvic prosthesis. J Mech Behav Biomed Mater 2018; 90:626-634. [PMID: 30500700 DOI: 10.1016/j.jmbbm.2018.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/19/2018] [Accepted: 10/30/2018] [Indexed: 10/28/2022]
Abstract
Hemipelvic prostheses are used to reconstruct the damaged pelvis due to bone tumors and traumas. However, biomechanical properties of the reconstructed pelvis remain unclear, causing difficulties to implant development and prediction of surgical outcome. In this study, a novel adjustable hemipelvic prosthesis for the Type 1-3 pelvis resection was used to reconstruct the intact pelvic ring. Two types of Pedicle Screw Rod Systems were proposed to improve the stability of fixation between the prosthesis and the bone. Finite Element models of the reconstructed pelvis were built to analyze the performance of the prosthesis and PSRS. Moreover, an in vitro experimental study was performed to measure the deformation of the human reconstructed pelvis. Numerical results agree well with the experimental data. It was found that displacements and stresses bilaterally transferred more evenly in the reconstructed pelvis enhanced by bilateral Pedicle Screw Rod System. The load-transfer function of the pelvis under double-leg standing stance could be recovered. The bilateral pedicle system has better biomechanical performance than the unilateral pedicle system.
Collapse
|
|
29
|
Martinez-Marquez D, Mirnajafizadeh A, Carty CP, Stewart RA. Application of quality by design for 3D printed bone prostheses and scaffolds. PLoS One 2018; 13:e0195291. [PMID: 29649231 PMCID: PMC5896968 DOI: 10.1371/journal.pone.0195291] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/20/2018] [Indexed: 12/14/2022] Open
Abstract
3D printing is an emergent manufacturing technology recently being applied in the medical field for the development of custom bone prostheses and scaffolds. However, successful industry transformation to this new design and manufacturing approach requires technology integration, concurrent multi-disciplinary collaboration, and a robust quality management framework. This latter change enabler is the focus of this study. While a number of comprehensive quality frameworks have been developed in recent decades to ensure that the manufacturing of medical devices produces reliable products, they are centred on the traditional context of standardised manufacturing techniques. The advent of 3D printing technologies and the prospects for mass customisation provides significant market opportunities, but also presents a serious challenge to regulatory bodies tasked with managing and assuring product quality and safety. Before 3D printing bone prostheses and scaffolds can gain traction, industry stakeholders, such as regulators, clients, medical practitioners, insurers, lawyers, and manufacturers, would all require a high degree of confidence that customised manufacturing can achieve the same quality outcomes as standardised manufacturing. A Quality by Design (QbD) approach to custom 3D printed prostheses can help to ensure that products are designed and manufactured correctly from the beginning without errors. This paper reports on the adaptation of the QbD approach for the development process of 3D printed custom bone prosthesis and scaffolds. This was achieved through the identification of the Critical Quality Attributes of such products, and an extensive review of different design and fabrication methods for 3D printed bone prostheses. Research outcomes include the development of a comprehensive design and fabrication process flow diagram, and categorised risks associated with the design and fabrication processes of such products. An extensive systematic literature review and post-hoc evaluation survey with experts was completed to evaluate the likely effectiveness of the herein suggested QbD framework.
Collapse
Affiliation(s)
| | - Ali Mirnajafizadeh
- Molecular Cell Biomechanics Laboratory, University of California, Berkeley, California, United States of America
| | - Christopher P. Carty
- School of Allied Health Sciences and Innovations in Health Technology, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Queensland Children's Gait Laboratory, Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rodney A. Stewart
- School of Engineering, Griffith University, Gold Coast, Queensland, Australia
- * E-mail:
| |
Collapse
|
|
30
|
Three-Dimensional Finite Element Analysis of Maxillary Sinus Floor Augmentation with Optimal Positioning of a Bone Graft Block. Symmetry (Basel) 2018. [DOI: 10.3390/sym10020033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
|
31
|
Alacreu E, Arana E, Moratal D. The use of subject-specific Finite Element analysis of L1-L4 vertebra to screening osteoporosis in postmenopausal women. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1832-1835. [PMID: 29060246 DOI: 10.1109/embc.2017.8037202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this work is to study Computed Tomography (CT)-based Finite Element (FE) modelling of lumbar vertebra to classify osteoporotic patients using dual-energy x-ray absorptiometry (DXA) as reference. Cohort comprised 15 postmenopausal female patients with CT-DXA pairs. Sixty subject-specific CT-based FE models were constructed of L1 to L4 vertebrae. Load-displacement in each node of the models was analyzed. Mean kurtosis values of displacement distributions between osteoporosis and healthy groups at L1 level showed a statistically significant difference (p<;0.005). The CT-based FE model of L1 vertebra with patient specific material properties can be used to identify osteoporosis patients.
Collapse
|
|
32
|
Ueda N, Takayama Y, Yokoyama A. Minimization of dental implant diameter and length according to bone quality determined by finite element analysis and optimized calculation. J Prosthodont Res 2017; 61:324-332. [DOI: 10.1016/j.jpor.2016.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/22/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
|
|
33
|
Nobakhti S, Katsamenis OL, Zaarour N, Limbert G, Thurner PJ. Elastic modulus varies along the bovine femur. J Mech Behav Biomed Mater 2017; 71:279-285. [DOI: 10.1016/j.jmbbm.2017.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/05/2017] [Accepted: 03/25/2017] [Indexed: 11/26/2022]
|
|
34
|
Kim HJ, Kang KT, Park SC, Kwon OH, Son J, Chang BS, Lee CK, Yeom JS, Lenke LG. Biomechanical advantages of robot-assisted pedicle screw fixation in posterior lumbar interbody fusion compared with freehand technique in a prospective randomized controlled trial-perspective for patient-specific finite element analysis. Spine J 2017; 17:671-680. [PMID: 27867080 DOI: 10.1016/j.spinee.2016.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 10/19/2016] [Accepted: 11/14/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There have been conflicting results on the surgical outcome of lumbar fusion surgery using two different techniques: robot-assisted pedicle screw fixation and conventional freehand technique. In addition, there have been no studies about the biomechanical issues between both techniques. PURPOSE This study aimed to investigate the biomechanical properties in terms of stress at adjacent segments using robot-assisted pedicle screw insertion technique (robot-assisted, minimally invasive posterior lumbar interbody fusion, Rom-PLIF) and freehand technique (conventional, freehand, open approach, posterior lumbar interbody fusion, Cop-PLIF) for instrumented lumbar fusion surgery. STUDY DESIGN This is an additional post-hoc analysis for patient-specific finite element (FE) model. PATIENT SAMPLE The sample is composed of patients with degenerative lumbar disease. OUTCOME MEASURES Intradiscal pressure and facet contact force are the outcome measures. METHODS Patients were randomly assigned to undergo an instrumented PLIF procedure using a Rom-PLIF (37 patients) or a Cop-PLIF (41), respectively. Five patients in each group were selected using a simple random sampling method after operation, and 10 preoperative and postoperative lumbar spines were modeled from preoperative high-resolution computed tomography of 10 patients using the same method for a validated lumbar spine model. Under four pure moments of 7.5 Nm, the changes in intradiscal pressure and facet joint contact force at the proximal adjacent segment following fusion surgery were analyzed and compared with preoperative states. RESULTS The representativeness of random samples was verified. Both groups showed significant increases in postoperative intradiscal pressure at the proximal adjacent segment under four moments, compared with the preoperative state. The Cop-PLIF models demonstrated significantly higher percent increments of intradiscal pressure at proximal adjacent segments under extension, lateral bending, and torsion moments than the Rom-PLIF models (p=.032, p=.008, and p=.016, respectively). Furthermore, the percent increment of facet contact force was significantly higher in the Cop-PLIF models under extension and torsion moments than in the Rom-PLIF models (p=.016 under both extension and torsion moments). CONCLUSIONS The present study showed the clinical application of subject-specific FE analysis in the spine. Even though there was biomechanical superiority of the robot-assisted insertions in terms of alleviation of stress increments at adjacent segments after fusion, cautious interpretation is needed because of the small sample size.
Collapse
Affiliation(s)
- Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 134 Sinchon-dong, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sung-Cheol Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Republic of Korea
| | - Oh-Hyo Kwon
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, 134 Sinchon-dong, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Choon-Ki Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Republic of Korea.
| | - Lawrence G Lenke
- Columbia University Department of Orthopedic Surgery, Division of Spinal Surgery, Spine Hospital at New York-Presbyterian/The Allen Hospital, 5141 Broadway, 3 Field West, New York, NY 10034, USA
| |
Collapse
|
|
35
|
Eschweiler J, Stromps JP, Fischer M, Schick F, Rath B, Pallua N, Radermacher K. Development of a biomechanical model of the wrist joint for patient-specific model guided surgical therapy planning: Part 1. Proc Inst Mech Eng H 2017; 230:310-25. [PMID: 26994117 DOI: 10.1177/0954411916632791] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The developed computational model features the two forearm bones radius and ulna, the eight wrist bones, the five metacarpal bones, and a soft tissue apparatus. Validation of the model was based on information taken from the literature as well as own experimental passive in vitro motion analysis of eight cadaver specimens. The computational model is based on the multi-body simulation software AnyBody. A comprehensive ligamentous apparatus was implemented allowing the investigation of ligament function. The model can easily patient specific personalized on the basis of image information. The model enables simulation of individual wrist motion and predicts trends correctly in the case of changing kinematics. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.
Collapse
Affiliation(s)
- Jörg Eschweiler
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany Department of Orthopaedic, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jan-Philipp Stromps
- Department of Plastic Surgery, Hand and Burns Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Maximilian Fischer
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Fabian Schick
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedic, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Norbert Pallua
- Department of Plastic Surgery, Hand and Burns Surgery, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Helmholtz-Institute for Biomedical Engineering, Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
|
36
|
Hamid KS, Scott AT, Nwachukwu BU, Danelson KA. The Role of Fluid Dynamics in Distributing Ankle Stresses in Anatomic and Injured States. Foot Ankle Int 2016; 37:1343-1349. [PMID: 27530984 DOI: 10.1177/1071100716660823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 1976, Ramsey and Hamilton published a landmark cadaveric study demonstrating a dramatic 42% decrease in tibiotalar contact area with only 1 mm of lateral talar shift. An increase in maximum principal stress of at least 72% is predicted based on these findings though the delayed development of arthritis in minimally misaligned ankles does not appear to be commensurate with the results found in dry cadaveric models. We hypothesized that synovial fluid could be a previously unrecognized factor that contributes significantly to stress distribution in the tibiotalar joint in anatomic and injured states. METHODS As it is not possible to directly measure contact stresses with and without fluid in a cadaveric model, finite element analysis (FEA) was employed for this study. FEA is a modeling technique used to calculate stresses in complex geometric structures by dividing them into small, simple components called elements. Four test configurations were investigated using a finite element model (FEM): baseline ankle alignment, 1 mm laterally translated talus and fibula, and the previous 2 bone orientations with fluid added. The FEM selected for this study was the Global Human Body Models Consortium-owned GHBMC model, M50 version 4.2, a model of an average-sized male (distributed by Elemance, LLC, Winston-Salem, NC). The ankle was loaded at the proximal tibia with a distributed load equal to the GHBMC body weight, and the maximum principal stress was computed. RESULTS All numerical simulations were stable and completed with no errors. In the baseline anatomic configuration, the addition of fluid between the tibia, fibula, and talus reduced the maximum principal stress computed in the distal tibia at maximum load from 31.3 N/mm2 to 11.5 N/mm2. Following 1 mm lateral translation of the talus and fibula, there was a modest 30% increase in the maximum stress in fluid cases. Qualitatively, translation created less high stress locations on the tibial plafond when fluid was incorporated into the model. CONCLUSIONS The findings in this study demonstrate a meaningful role for synovial fluid in distributing stresses within the ankle that has not been considered in historical dry cadaveric studies. The increase in maximum stress predicted by simulation of an ankle with fluid was less than half that projected by cadaveric data, indicating a protective effect of fluid in the injured state. The trends demonstrated by these simulations suggest that bony alignment and fluid in the ankle joint change loading patterns on the tibia and should be accounted for in future experiments. CLINICAL RELEVANCE Synovial fluid may play a protective role in ankle injuries, thus delaying the onset of arthritis. Reactive joint effusions may also function to additionally redistribute stresses with higher volumes of viscous fluid.
Collapse
Affiliation(s)
| | - Aaron T Scott
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | |
Collapse
|
|
37
|
Knowles NK, Reeves JM, Ferreira LM. Quantitative Computed Tomography (QCT) derived Bone Mineral Density (BMD) in finite element studies: a review of the literature. J Exp Orthop 2016; 3:36. [PMID: 27943224 PMCID: PMC5234499 DOI: 10.1186/s40634-016-0072-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/30/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Finite element modeling of human bone provides a powerful tool to evaluate a wide variety of outcomes in a highly repeatable and parametric manner. These models are most often derived from computed tomography data, with mechanical properties related to bone mineral density (BMD) from the x-ray energy attenuation provided from this data. To increase accuracy, many researchers report the use of quantitative computed tomography (QCT), in which a calibration phantom is used during image acquisition to improve the estimation of BMD. Since model accuracy is dependent on the methods used in the calculation of BMD and density-mechanical property relationships, it is important to use relationships developed for the same anatomical location and using the same scanner settings, as these may impact model accuracy. The purpose of this literature review is to report the relationships used in the conversion of QCT equivalent density measures to ash, apparent, and/or tissue densities in recent finite element (FE) studies used in common density-modulus relationships. For studies reporting experimental validation, the validation metrics and results are presented. RESULTS Of the studies reviewed, 29% reported the use of a dipotassium phosphate (K2HPO4) phantom, 47% a hydroxyapatite (HA) phantom, 13% did not report phantom type, 7% reported use of both K2HPO4 and HA phantoms, and 4% alternate phantom types. Scanner type and/or settings were omitted or partially reported in 31% of studies. The majority of studies used densitometric and/or density-modulus relationships derived from different anatomical locations scanned in different scanners with different scanner settings. The methods used to derive various densitometric relationships are reported and recommendations are provided toward the standardization of reporting metrics. CONCLUSIONS This review assessed the current state of QCT-based FE modeling with use of clinical scanners. It was found that previously developed densitometric relationships vary by anatomical location, scanner type and settings. Reporting of all parameters used when referring to previously developed relationships, or in the development of new relationships, may increase the accuracy and repeatability of future FE models.
Collapse
Affiliation(s)
- Nikolas K. Knowles
- Graduate Program in Biomedical Engineering, The University of Western Ontario, 1151 Richmond St, London, ON Canada
- Roth|McFarlane Hand and Upper Limb Centre, Surgical Mechatronics
Laboratory, St. Josephs Health Care, 268 Grosvenor St, London, ON Canada
- Collaborative Training Program in Musculoskeletal Health Research, and
Bone and Joint Institute, The University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Jacob M. Reeves
- Roth|McFarlane Hand and Upper Limb Centre, Surgical Mechatronics
Laboratory, St. Josephs Health Care, 268 Grosvenor St, London, ON Canada
- Collaborative Training Program in Musculoskeletal Health Research, and
Bone and Joint Institute, The University of Western Ontario, 1151 Richmond St, London, ON Canada
- Department of Mechanical and Materials Engineering, The University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Louis M. Ferreira
- Graduate Program in Biomedical Engineering, The University of Western Ontario, 1151 Richmond St, London, ON Canada
- Roth|McFarlane Hand and Upper Limb Centre, Surgical Mechatronics
Laboratory, St. Josephs Health Care, 268 Grosvenor St, London, ON Canada
- Collaborative Training Program in Musculoskeletal Health Research, and
Bone and Joint Institute, The University of Western Ontario, 1151 Richmond St, London, ON Canada
| |
Collapse
|
|
38
|
Liu D, Hua Z, Yan X, Jin Z. Biomechanical analysis of a novel hemipelvic endoprosthesis during ascending and descending stairs. Proc Inst Mech Eng H 2016; 230:962-75. [PMID: 27587536 DOI: 10.1177/0954411916663970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
In this study, the biomechanical characteristic of a newly developed adjustable hemipelvic prosthesis under dynamic loading conditions was investigated using explicit finite element method. Both intact and reconstructed pelvis models, including pelvis, femur and soft tissues, were established referring to human anatomic data using a solid geometry of a human pelvic bone. Hip contact forces during ascending stairs and descending stairs were imposed on pelvic models. Results showed that maximum von Mises stresses in reconstructed pelvis were 421.85 MPa for prostheses and 109.12 MPa for cortical bone, which were still within a low and elastic range below the yielding strength of Ti-6Al-4V and cortical bone, respectively. Besides, no significant difference of load transferring paths along pelvic rings was observed between the reconstructed pelvis and natural pelvis models. And good agreement was found between the overall distribution of maximum principal stresses in trabecular bones of reconstructed pelvis and natural pelvis, while at limited stances, principal stresses in trabecular bone of reconstructed pelvis were slightly lower than natural pelvis. The results indicated that the load transferring function of pelvis could be restored by this adjustable hemipelvic prosthesis. Moreover, the prosthesis was predicted to have a reliable short- and long-term performance. However, due to the occurrence of slightly lower principal stresses at a few stances, a porous structure applied on the interface between the prosthesis and bone would be studied in future work to obtain better long-term stability.
Collapse
Affiliation(s)
- Dongxu Liu
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, P.R. China
| | - Zikai Hua
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, P.R. China
| | - Xinyi Yan
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, P.R. China
| | - Zhongmin Jin
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, P.R. China School of Mechanical Engineering, University of Leeds, Leeds, UK
| |
Collapse
|
|
39
|
Kim Y, Na YH, Xing L, Lee R, Park S. Automatic deformable surface registration for medical applications by radial basis function-based robust point-matching. Comput Biol Med 2016; 77:173-81. [PMID: 27567399 DOI: 10.1016/j.compbiomed.2016.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
Deformable surface mesh registration is a useful technique for various medical applications, such as intra-operative treatment guidance and intra- or inter-patient study. In this paper, we propose an automatic deformable mesh registration technique. The proposed method iteratively deforms a source mesh to a target mesh without manual feature extraction. Each iteration of the registration consists of two steps, automatic correspondence finding using robust point-matching (RPM) and local deformation using a radial basis function (RBF). The proposed RBF-based RPM algorithm solves the interlocking problems of correspondence and deformation using a deterministic annealing framework with fuzzy correspondence and RBF interpolation. Simulation tests showed promising results, with the average deviations decreasing by factors of 21.2 and 11.9, respectively. In the human model test, the average deviation decreased from 1.72±1.88mm to 0.57±0.66mm. We demonstrate the effectiveness of the proposed method by presenting some medical applications.
Collapse
Affiliation(s)
- Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States.
| | - Yong Hum Na
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States.
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States.
| | - Rena Lee
- Department of Radiation Oncology, Ewha Woman's University College of Medicine, Seoul, South Korea.
| | - Sehyung Park
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea.
| |
Collapse
|
|
40
|
Xu C, Silder A, Zhang J, Hughes J, Unnikrishnan G, Reifman J, Rakesh V. An Integrated Musculoskeletal-Finite-Element Model to Evaluate Effects of Load Carriage on the Tibia During Walking. J Biomech Eng 2016; 138:2537122. [DOI: 10.1115/1.4034216] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/08/2022]
Abstract
Prior studies have assessed the effects of load carriage on the tibia. Here, we expand on these studies and investigate the effects of load carriage on joint reaction forces (JRFs) and the resulting spatiotemporal stress/strain distributions in the tibia. Using full-body motion and ground reaction forces from a female subject, we computed joint and muscle forces during walking for four load carriage conditions. We applied these forces as physiological loading conditions in a finite-element (FE) analysis to compute strain and stress. We derived material properties from computed tomography (CT) images of a sex-, age-, and body mass index-matched subject using a mesh morphing and mapping algorithm, and used them within the FE model. Compared to walking with no load, the knee JRFs were the most sensitive to load carriage, increasing by as much as 26.2% when carrying a 30% of body weight (BW) load (ankle: 16.4% and hip: 19.0%). Moreover, our model revealed disproportionate increases in internal JRFs with increases in load carriage, suggesting a coordinated adjustment in the musculature functions in the lower extremity. FE results reflected the complex effects of spatially varying material properties distribution and muscular engagement on tibial biomechanics during walking. We observed high stresses on the anterior crest and the medial surface of the tibia at pushoff, whereas high cumulative stress during one walking cycle was more prominent in the medioposterior aspect of the tibia. Our findings reinforce the need to include: (1) physiologically accurate loading conditions when modeling healthy subjects undergoing short-term exercise training and (2) the duration of stress exposure when evaluating stress-fracture injury risk. As a fundamental step toward understanding the instantaneous effect of external loading, our study presents a means to assess the relationship between load carriage and bone biomechanics.
Collapse
Affiliation(s)
- Chun Xu
- Telemedicine and Advanced Technology Research Center, Department of Defense Biotechnology High Performance Computing Software Applications Institute, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD 21702-5012
| | - Amy Silder
- Department of Bioengineering, Stanford University, Stanford, CA 94305-6175
| | - Ju Zhang
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Julie Hughes
- U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760-5007
| | - Ginu Unnikrishnan
- Telemedicine and Advanced Technology Research Center, Department of Defense Biotechnology High Performance Computing Software Applications Institute, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD 21702-5012
| | - Jaques Reifman
- Telemedicine and Advanced Technology Research Center, Department of Defense Biotechnology High Performance Computing Software Applications Institute, U.S. Army Medical Research and Materiel Command, MCMR-TT, 504 Scott Street, Fort Detrick, MD 21702-5012 e-mail:
| | - Vineet Rakesh
- Telemedicine and Advanced Technology Research Center, Department of Defense Biotechnology High Performance Computing Software Applications Institute, United States Army Medical Research and Materiel Command, Fort Detrick, MD 21702-5012
| |
Collapse
|
|
41
|
Geometry reconstruction method for patient-specific finite element models for the assessment of tibia fracture risk in osteogenesis imperfecta. Med Biol Eng Comput 2016; 55:549-560. [DOI: 10.1007/s11517-016-1526-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
|
|
42
|
Pakdel A, Fialkov J, Whyne CM. High resolution bone material property assignment yields robust subject specific finite element models of complex thin bone structures. J Biomech 2016; 49:1454-1460. [DOI: 10.1016/j.jbiomech.2016.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
|
|
43
|
Pauchard Y, Fitze T, Browarnik D, Eskandari A, Pauchard I, Enns-Bray W, Pálsson H, Sigurdsson S, Ferguson SJ, Harris TB, Gudnason V, Helgason B. Interactive graph-cut segmentation for fast creation of finite element models from clinical ct data for hip fracture prediction. Comput Methods Biomech Biomed Engin 2016; 19:1693-1703. [PMID: 27161828 DOI: 10.1080/10255842.2016.1181173] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this study, we propose interactive graph cut image segmentation for fast creation of femur finite element (FE) models from clinical computed tomography scans for hip fracture prediction. Using a sample of N = 48 bone scans representing normal, osteopenic and osteoporotic subjects, the proximal femur was segmented using manual (gold standard) and graph cut segmentation. Segmentations were subsequently used to generate FE models to calculate overall stiffness and peak force in a sideways fall simulations. Results show that, comparable FE results can be obtained with the graph cut method, with a reduction from 20 to 2-5 min interaction time. Average differences between segmentation methods of 0.22 mm were not significantly correlated with differences in FE derived stiffness (R2 = 0.08, p = 0.05) and weakly correlated to differences in FE derived peak force (R2 = 0.16, p = 0.01). We further found that changes in automatically assigned boundary conditions as a consequence of small segmentation differences were significantly correlated with FE derived results. The proposed interactive graph cut segmentation software MITK-GEM is freely available online at https://simtk.org/home/mitk-gem .
Collapse
Affiliation(s)
- Yves Pauchard
- a Institute of Applied Information Technology , Zurich University of Applied Sciences , Winterthur , Switzerland
| | - Thomas Fitze
- a Institute of Applied Information Technology , Zurich University of Applied Sciences , Winterthur , Switzerland
| | - Diego Browarnik
- a Institute of Applied Information Technology , Zurich University of Applied Sciences , Winterthur , Switzerland
| | - Amiraslan Eskandari
- b Institute for Biomechanics , ETH Zürich , Zürich , Switzerland.,c Faculty of Industrial Engineering, Mechanical Engineering and Computer Science , School of Engineering and Natural Sciences, University of Iceland , Reykjavik , Iceland
| | - Irene Pauchard
- d McCaig Institute for Bone and Joint Health, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | | | - Halldór Pálsson
- c Faculty of Industrial Engineering, Mechanical Engineering and Computer Science , School of Engineering and Natural Sciences, University of Iceland , Reykjavik , Iceland
| | | | | | - Tamara B Harris
- f Laboratory of Epidemiology and Population Science, Intramural Research Program , National Institute on Aging , Bethesda , Maryland
| | - Vilmundur Gudnason
- e The Icelandic Heart Association Research Institute , Kopavogur , Iceland.,g Faculty of Medicine , University of Iceland , Reykjavik , Iceland
| | | |
Collapse
|
|
44
|
Jiménez-Delgado JJ, Paulano-Godino F, PulidoRam-Ramírez R, Jiménez-Pérez JR. Computer assisted preoperative planning of bone fracture reduction: Simulation techniques and new trends. Med Image Anal 2016; 30:30-45. [PMID: 26849422 DOI: 10.1016/j.media.2015.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 11/26/2015] [Accepted: 12/17/2015] [Indexed: 10/24/2022]
|
|
45
|
Abstract
The relationship between hip deformities and osteoarthritis has recently received a lot of attention. In particular, it has been shown that both osteoarthritis and its precursors, such as the hip deformities that lead to femoroacetabular impingement (FAI), are more prevalent in elite athletes compared with the general population. However, the etiology of the above-mentioned types of hip deformity is not currently well understood. Many recent studies have attempted to shed light on the etiology of this disease. In this article, the main clinical, radiological, mechanobiological, and biomechanical findings of relevance to understanding the etiology of hip deformities leading to FAI are reviewed. Based on these findings, a consistent biomechanical theory explaining the development of hip deformities in athletes is then presented. According to the presented theory, the repetitive, impact-like musculoskeletal loads that athletes experience, particularly when they undertake extreme ranges of hip motion, cause the development of hip deformities. According to this theory, these musculoskeletal loads trigger abnormal growth patterns during the years of skeletal development and cause the formation of hip deformities. A number of hypotheses based on the proposed theory are then formulated that could be tested in future studies to ascertain whether the proposed theory could sufficiently describe the development of hip deformities in athletes.
Collapse
Affiliation(s)
- Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands,
| |
Collapse
|
|
46
|
Huang H, Xiang C, Zeng C, Ouyang H, Wong KKL, Huang W. Patient-specific geometrical modeling of orthopedic structures with high efficiency and accuracy for finite element modeling and 3D printing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:743-53. [PMID: 26577713 DOI: 10.1007/s13246-015-0402-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
Abstract
We improved the geometrical modeling procedure for fast and accurate reconstruction of orthopedic structures. This procedure consists of medical image segmentation, three-dimensional geometrical reconstruction, and assignment of material properties. The patient-specific orthopedic structures reconstructed by this improved procedure can be used in the virtual surgical planning, 3D printing of real orthopedic structures and finite element analysis. A conventional modeling consists of: image segmentation, geometrical reconstruction, mesh generation, and assignment of material properties. The present study modified the conventional method to enhance software operating procedures. Patient's CT images of different bones were acquired and subsequently reconstructed to give models. The reconstruction procedures were three-dimensional image segmentation, modification of the edge length and quantity of meshes, and the assignment of material properties according to the intensity of gravy value. We compared the performance of our procedures to the conventional procedures modeling in terms of software operating time, success rate and mesh quality. Our proposed framework has the following improvements in the geometrical modeling: (1) processing time: (femur: 87.16 ± 5.90 %; pelvis: 80.16 ± 7.67 %; thoracic vertebra: 17.81 ± 4.36 %; P < 0.05); (2) least volume reduction (femur: 0.26 ± 0.06 %; pelvis: 0.70 ± 0.47, thoracic vertebra: 3.70 ± 1.75 %; P < 0.01) and (3) mesh quality in terms of aspect ratio (femur: 8.00 ± 7.38 %; pelvis: 17.70 ± 9.82 %; thoracic vertebra: 13.93 ± 9.79 %; P < 0.05) and maximum angle (femur: 4.90 ± 5.28 %; pelvis: 17.20 ± 19.29 %; thoracic vertebra: 3.86 ± 3.82 %; P < 0.05). Our proposed patient-specific geometrical modeling requires less operating time and workload, but the orthopedic structures were generated at a higher rate of success as compared with the conventional method. It is expected to benefit the surgical planning of orthopedic structures with less operating time and high accuracy of modeling.
Collapse
Affiliation(s)
- Huajun Huang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics · Guangdong Province), Guangzhou, 510630, China.
| | - Chunling Xiang
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Canjun Zeng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics · Guangdong Province), Guangzhou, 510630, China.,Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, North-1838, Guangzhou, 510515, China
| | - Hanbin Ouyang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, North-1838, Guangzhou, 510515, China
| | - Kelvin Kian Loong Wong
- Engineering Computational Biology, School of Computer Science and Software Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6000, Australia
| | - Wenhua Huang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, North-1838, Guangzhou, 510515, China.
| |
Collapse
|
|
47
|
The influence of bone density and anisotropy in finite element models of distal radius fracture osteosynthesis: Evaluations and comparison to experiments. J Biomech 2015; 48:4116-4123. [PMID: 26542787 DOI: 10.1016/j.jbiomech.2015.10.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022]
Abstract
Continuum-level finite element (FE) models can be used to analyze and improve osteosynthesis procedures for distal radius fractures (DRF) from a biomechanical point of view. However, previous models oversimplified the bone material and lacked thorough experimental validation. The goal of this study was to assess the influence of local bone density and anisotropy in FE models of DRF osteosynthesis for predictions of axial stiffness, implant plate stresses, and screw loads. Experiments and FE analysis were conducted in 25 fresh frozen cadaveric radii with DRFs treated by volar locking plate osteosynthesis. Specimen specific geometries were captured using clinical quantitative CT (QCT) scans of the prepared samples. Local bone material properties were computed based on high resolution CT (HR-pQCT) scans of the intact radii. The axial stiffness and individual screw loads were evaluated in FE models, with (1) orthotropic inhomogeneous (OrthoInhom), (2) isotropic inhomogeneous (IsoInhom), and (3) isotropic homogeneous (IsoHom) bone material and compared to the experimental axial stiffness and screw-plate interface failures. FE simulated and experimental axial stiffness correlated significantly (p<0.0001) for all three model types. The coefficient of determination was similar for OrthoInhom (R(2)=0.807) and IsoInhom (R(2)=0.816) models but considerably lower for IsoHom models (R(2)=0.500). The peak screw loads were in qualitative agreement with experimental screw-plate interface failure. Individual loads and implant plate stresses of IsoHom models differed significantly (p<0.05) from OrthoInhom and IsoInhom models. In conclusion, including local bone density in FE models of DRF osteosynthesis is essential whereas local bone anisotropy hardly effects the models׳ predictive abilities.
Collapse
|
|
48
|
Imai K. Computed tomography-based finite element analysis to assess fracture risk and osteoporosis treatment. World J Exp Med 2015; 5:182-187. [PMID: 26309819 PMCID: PMC4543812 DOI: 10.5493/wjem.v5.i3.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/23/2014] [Accepted: 05/08/2015] [Indexed: 02/06/2023] Open
Abstract
Finite element analysis (FEA) is a computer technique of structural stress analysis and developed in engineering mechanics. FEA has developed to investigate structural behavior of human bones over the past 40 years. When the faster computers have acquired, better FEA, using 3-dimensional computed tomography (CT) has been developed. This CT-based finite element analysis (CT/FEA) has provided clinicians with useful data. In this review, the mechanism of CT/FEA, validation studies of CT/FEA to evaluate accuracy and reliability in human bones, and clinical application studies to assess fracture risk and effects of osteoporosis medication are overviewed.
Collapse
|
|
49
|
VAN DEN MUNCKHOF SVEN, NIKOOYAN ALIASADI, ZADPOOR AMIRABBAS. ASSESSMENT OF OSTEOPOROTIC FEMORAL FRACTURE RISK: FINITE ELEMENT METHOD AS A POTENTIAL REPLACEMENT FOR CURRENT CLINICAL TECHNIQUES. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415300033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Femoral fracture risk prediction is a necessary step preceding effective pharmacological intervention or pre-operative planning. Current clinical methods for fracture risk prediction rely on 2D imaging methods and have limited predictive value. Researchers are therefore trying to find improved methods for fracture prediction. During last few decades, many studies have focused on integration of 3D imaging techniques and the finite element (FE) method to improve the accuracy of fracture assessment techniques. In this paper, we review the recent advances in FE and other techniques for predicting the risk of femoral fractures. Based on a number of selected studies, the different steps that are involved in generation of patient-specific FE models are reviewed with particular emphasis on the fracture criteria. The inaccuracies that might arise due to the imperfections of the involved steps are also discussed. It is concluded that compared to image- and geometry-based techniques, FE is a more promising approach for prediction of fracture loads. However, certain technological advancements in FE modeling protocols are required before FE modeling can be recruited in clinical settings.
Collapse
Affiliation(s)
- SVEN VAN DEN MUNCKHOF
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
| | - ALI ASADI NIKOOYAN
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309, USA
| | - AMIR ABBAS ZADPOOR
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
| |
Collapse
|
|
50
|
Ahmadi SM, Yavari SA, Wauthle R, Pouran B, Schrooten J, Weinans H, Zadpoor AA. Additively Manufactured Open-Cell Porous Biomaterials Made from Six Different Space-Filling Unit Cells: The Mechanical and Morphological Properties. MATERIALS 2015; 8:1871-1896. [PMID: 28788037 PMCID: PMC5507048 DOI: 10.3390/ma8041871] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/02/2023]
Abstract
It is known that the mechanical properties of bone-mimicking porous biomaterials are a function of the morphological properties of the porous structure, including the configuration and size of the repeating unit cell from which they are made. However, the literature on this topic is limited, primarily because of the challenge in fabricating porous biomaterials with arbitrarily complex morphological designs. In the present work, we studied the relationship between relative density (RD) of porous Ti6Al4V EFI alloy and five compressive properties of the material, namely elastic gradient or modulus (Es20–70), first maximum stress, plateau stress, yield stress, and energy absorption. Porous structures with different RD and six different unit cell configurations (cubic (C), diamond (D), truncated cube (TC), truncated cuboctahedron (TCO), rhombic dodecahedron (RD), and rhombicuboctahedron (RCO)) were fabricated using selective laser melting. Each of the compressive properties increased with increase in RD, the relationship being of a power law type. Clear trends were seen in the influence of unit cell configuration and porosity on each of the compressive properties. For example, in terms of Es20–70, the structures may be divided into two groups: those that are stiff (comprising those made using C, TC, TCO, and RCO unit cell) and those that are compliant (comprising those made using D and RD unit cell).
Collapse
Affiliation(s)
- Seyed Mohammad Ahmadi
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
| | - Saber Amin Yavari
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
- Department of Orthopedics and Department of Rheumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | | | - Behdad Pouran
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
- Department of Orthopedics and Department of Rheumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Jan Schrooten
- Department of Metallurgy and Materials Engineering, KU Leuven, Kasteelpark Arenberg 44, PB 2450, 3001 Leuven, Belgium.
| | - Harrie Weinans
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
- Department of Orthopedics and Department of Rheumatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Amir A Zadpoor
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
| |
Collapse
|