Mechanical and numerical investigations of biodegradable magnesium alloy screws for fracture treatment.

Small fracture treatment includes the use of so-called "Herbert screws". In the past years, novel resorbable materials were introduced as an alternative to the classical titanium implants. The purpose of this study was to evaluate the influence of ongoing resorption/corrosion processes on the mechanical stability screws made from the magnesium alloy MgYREZr®. Our samples consisted of two partly resorbed screws, explanted due to medical reasons after 6 and 12 weeks, respectively, and five unused reference screws. We performed three-point bending tests to determine the stability of all screws. Additionally, with FE-models of the screws based on µCT-scans, we investigated whether any differences in the bending behavior of the screws can be attributed to the reduction of the material volume due to resorption alone. Both partly resorbed screws failed at a lower force than the reference screws (178.6 ± 5.5 N for the reference screws, 72.5 N and 74.5 N for the screw explanted after 6 and 12 weeks, respectively). FE simulations performed with the three different geometries and original material parameters (Young's modulus Enew  = 45 GPa, yield limit σnew  = 235 MPa) showed that the early fracture could not be attributed to the changed geometry alone. Material parameters for the partly resorbed screws were determined by fitting the numerical to the experimental force-displacement curves (E6week  = 15 GPa, σ6week  = 135 MPa and E12week  = 8 GPa, σ12week  = 135 MPa, respectively). Our results showed that both geometry of the screws and different material properties contribute to the overall stability. Understanding and controlling these two factors throughout the resorption process could enhance treatment options.

Computational evaluation of psoas muscle influence on walking function following internal hemipelvectomy with reconstruction.

An emerging option for internal hemipelvectomy surgery is custom prosthesis reconstruction. This option typically recapitulates the resected pelvic bony anatomy with the goal of maximizing post-surgery walking function while minimizing recovery time. However, the current custom prosthesis design process does not account for the patient's post-surgery prosthesis and bone loading patterns, nor can it predict how different surgical or rehabilitation decisions (e.g., retention or removal of the psoas muscle, strengthening the psoas) will affect prosthesis durability and post-surgery walking function. These factors may contribute to the high observed failure rate for custom pelvic prostheses, discouraging orthopedic oncologists from pursuing this valuable treatment option. One possibility for addressing this problem is to simulate the complex interaction between surgical and rehabilitation decisions, post-surgery walking function, and custom pelvic prosthesis design using patient-specific neuromusculoskeletal models. As a first step toward developing this capability, this study used a personalized neuromusculoskeletal model and direct collocation optimal control to predict the impact of ipsilateral psoas muscle strength on walking function following internal hemipelvectomy with custom prosthesis reconstruction. The influence of the psoas muscle was targeted since retention of this important muscle can be surgically demanding for certain tumors, requiring additional time in the operating room. The post-surgery walking predictions emulated the most common surgical scenario encountered at MD Anderson Cancer Center in Houston. Simulated post-surgery psoas strengths included 0% (removed), 50% (weakened), 100% (maintained), and 150% (strengthened) of the pre-surgery value. However, only the 100% and 150% cases successfully converged to a complete gait cycle. When post-surgery psoas strength was maintained, clinical gait features were predicted, including increased stance width, decreased stride length, and increased lumbar bending towards the operated side. Furthermore, when post-surgery psoas strength was increased, stance width and stride length returned to pre-surgery values. These results suggest that retention and strengthening of the psoas muscle on the operated side may be important for maximizing post-surgery walking function. If future studies can validate this computational approach using post-surgery experimental walking data, the approach may eventually influence surgical, rehabilitation, and custom prosthesis design decisions to meet the unique clinical needs of pelvic sarcoma patients.

The correlation between osseointegration and bonding strength at the bone-implant interface: In-vivo & ex-vivo investigations on hydroxyapatite and hydroxyapatite/titanium coatings.

This study investigated the effects of hydroxyapatite (HA) and hydroxyapatite/titanium (HA/Ti) coatings on osseointegration and bonding strength at the bone-implant interface. The coatings were made using air plasma spray (APS), and three study groups were examined: 1) Uncoated commercial pure titanium (CP-Ti) rods; 2) HA-coated CP-Ti rods, and 3) Composite of 50 %wt HA + 50 %wt Ti coated CP-Ti rods. The rods were implanted into the distal femurs and proximal tibias of fifteen New Zealand white rabbits, and 8 weeks after the implantation, the samples were harvested. The results of pull-out tests showed that the ultimate strength of HA and HA/Ti coatings were significantly greater than the uncoated samples (P < 0.05). Moreover, even though the histological evaluations showed significantly greater osseointegration of HA/Ti composite coatings compared with HA coatings (P < 0.05), nonetheless, the composite of HA/Ti offers no significant increase in the ultimate strength, stiffness, and bonding strength at the bone-implant interface, compared with the HA group (P > 0.05). Thus, in an eight-week study, there was no linear correlation between the osseointegration and the bonding strength at the bone-implant interface. The results of this work may imply that the extent of osseointegration at the bone-implant interface does not necessarily determine the value of the bonding strength at the bone-implant interface. It is speculated that, in a longer-term study, a greater quality of bone formation may occur during osseointegration, between the implant and its adjacent bone, which can lead to a more enhanced bonding strength, compared with the 8-weeks post-surgery follow up.

Development and evaluation of ligament phantoms targeted for shear wave tensiometry.

Developing a shear wave tensiometer capable of non-invasively measuring ligament tension holds promise for enhancing research and clinical assessments of ligament function. Such development would benefit from tunable test specimens fabricated from well-characterized and consistent materials. Although previous work found that yarn can replicate the mechanical behavior of collateral ligaments, it is not obvious whether yarn-based phantoms would be suitable for development of a shear wave tensiometer for measuring ligament tension. Accordingly, the primary objective of this study was to characterize the mechanical properties and shear wave speed - stress relationships of ligament phantoms fabricated from yarn and silicone, and compare these results to published data from biological ligaments. We measured the mechanical properties and shear wave speeds during axial loading in nine phantoms with systematically varied material properties. We performed a simple linear regression between shear wave speed squared and axial stress to determine the shear wave speed - stress relationship for each phantom. We found comparable elastic moduli, hysteresis, and shear wave speed squared - stress regression parameters between the phantoms and collateral ligaments. For example, the ranges of the coefficients of determination (R2) and slopes across the nine phantoms were 0.84-0.95, and 0.78-1.27 kPa/m2/s2, respectively, which overlapped with the ranges found in a prior study in porcine collateral ligaments (0.84-0.996 and 0.34-1.18 kPa/m2/s2, respectively). Additionally, the shear wave speed squared - stress regression parameters varied predictably with the density of the phantom and the shear modulus of the silicone. In summary, we found that yarn-based phantoms serve as mechanical analogs for ligaments (i.e., are ligament mimicking), and thus, should prove beneficial for investigations into ligament structure-function relationships and in the development of a shear wave tensiometer for measuring ligament tension.

Effect of random variation of input and various daily activities on wear in a hip joint simulator.

The ISO 14242-1 standard specifies fixed, simplified, sinusoidal motion and double-peak load cycles for wear testing of total hip prostheses. In order to make the wear simulation more realistic, random variation was added for the first time to the motion and load control signals of a hip joint simulator. For this purpose and for the simulation of various daily activities, computer-controlled, servo-electric drives were mounted on a biaxial hip simulator frame and successfully introduced. Random variation did not result in a statistically significant difference in the wear factor of large diameter VEXLPE liners compared with fixed sinusoidal waveforms. However, level walking according to biomechanical literature surprisingly resulted in a 134 per cent higher, and jogging in a 57 per cent lower wear factor compared with the fixed sinusoidal waveforms. These wear phenomena were likely to be caused by a variation in the lubrication conditions and frictional heating. Simplified motion waveforms may result in an underestimation of wear in walking.

Effect of inward-outward rotation on hip wear simulation.

The ISO 14242-1 standard specifies a three-axis motion for the wear testing of prosthetic hips. Multidirectionality of the relative motion and serum-based lubrication are known to be necessary for the reproduction of clinical wear mechanisms. For multidirectionality however, biaxial motion has been shown to be sufficient. To a biaxial hip joint simulator that incorporated flexion-extension (FE, range 46°) and abduction-adduction (AA, range 12°), a third motion component, inward-outward rotation (IOR, range 12°) was added according to the ISO 14242-1 standard. Due to the addition of the IOR, the wear rate of vitamin E stabilized, extensively cross-linked polyethylene (VEXLPE) liners decreased by 50 per cent. This was probably attributable to the increased linearity of the relative motion in the stance phase, caused by the simplified motion waveforms and their relative phases specified in the standard. In order not to underestimate the wear rate, the established biaxial motion is preferred.

Biomechanical evaluation of a novel dynamic posterior cruciate ligament brace.

BACKGROUND: Use of a rigid brace or cast immobilization is recommended in conservative treatment or postoperative rehabilitation after a posterior cruciate ligament injury. To prevent the loss of knee joint function and muscle activity often associated with this, a flexible knee brace has been developed that allows an adjustable anteriorly directed force to be applied to the calf in order to prevent posterior tibial translation. The purpose of this biomechanical study was to evaluate the impact of this novel dynamic brace on posterior tibial translation after posterior cruciate ligament injury and reconstruction. METHODS: A Telos stress device was used to provoke posterior tibial translation in seven human lower limb specimens, and stress radiographs were taken at 90° of knee flexion. Posterior tibial translation was measured in the native knees with an intact posterior cruciate ligament; after arthroscopic posterior cruciate ligament dissection with and without a brace; and after posterior cruciate ligament reconstruction with and without a brace. The force applied with the brace was measured using a pressure sensor. FINDINGS: Posterior tibial translation was significantly reduced (P=0.032) after application of the brace with an anteriorly directed force of 50N to the knees with the dissected posterior cruciate ligament. The brace also significantly reduced posterior tibial translation after posterior cruciate ligament reconstruction in comparison with reconstructed knees without a brace (P=0.005). INTERPRETATION: Posterior tibial translation was reduced to physiological values using this dynamic brace system that allows an anteriorly directed force to be applied to the calf.

Consideraciones en la definición del modelo específico al paciente de la tibia / Considerations about the definition of a patient specific model of the tibia

INTRODUCCIÓN: los análisis por elementos finitos se usan para entender y predecir los procesos biológicos. En la biomecánica ortopédica, los modelos específicos al paciente se generan a partir de Tomografía Computarizada y empleados en la toma de decisiones médicas. Algunos procesos correctivos ortopédicos pueden simularse a través, de los análisis por elementos finitos. Para obtener modelos biomecánicos confiables, es muy recomendable reducir los errores en la definición del modelo en la etapa de pre-procesamiento del análisis por elementos finitos. OBJETIVO: analizar la influencia de la densidad del mallado y las propiedades mecánicas durante la definición del modelo específico al paciente en los resultados del análisis por elementos finitos. MÉTODOS: se empleó el Método de Elementos Finitos en la simulación de la tibia a compresión. La geometría de la tibia del paciente se generó a partir de Tomografía Computarizada. Se emplearon mallas con tamaño de elementos no uniforme y uniforme. Al modelo se le aplicaron propiedades mecánicas homogéneas y no homogéneas. RESULTADOS: los elementos de bajo orden convergen a la solución, las tensiones para las mallas con estos elementos son inferiores a las correspondientes las mallas con elementos de tamaño uniforme y de alto orden. Por otra parte, las propiedades mecánicas no homogéneas reducen la diferencia en el cálculo de las tensiones. CONCLUSIONES: para obtener modelos específicos al paciente confiables se recomienda, generar la geometría del hueso con superficies suavisadas, controlar la calidad de la malla superficial, usar propiedades mecánicas no homogéneas, y utilizar la malla generada directo en Abaqus con elementos de bajo orden y tamaño no uniforme.

INTRODUCTION: finite element analysis is used to understand and predict biological processes. In orthopedic biomechanics patient specific models are generated by computed tomography and used for medical decision making. Some corrective orthopedic processes may be simulated by means of finite element analysis. In order to obtain reliable biomechanical models it is highly advisable to reduce the number of errors in the definition of the model during pre-processing of the finite element analysis. OBJECTIVE: analyze the influence of mesh density and mechanical properties on the results obtained by finite element analysis during the stage of definition of the patient specific model. METHODS: the finite element method was used to simulate tibial compression. The geometry of the patient's tibia was generated by computed tomography. Meshes were used with non-uniform and uniform element sizes. Homogeneous and non-homogeneous mechanical properties were applied to the model. RESULTS: low-order elements converge to the solution. Tensions for meshes with these elements are lower than those for meshes with uniform size and high-order elements. On the other hand, non-homogeneous mechanical properties reduce the difference in the estimation of tensions. CONCLUSIONS: to obtain reliable patient specific models it is recommended to generate the bone geometry with softened surfaces, control the quality of the surface mesh, use non-homogeneous mechanical properties, and use the mesh generated directly on Abaqus with low-order elements and non-uniform size.

Design and validation of a cadaveric knee joint loading device compatible with magnetic resonance imaging and computed tomography.

PURPOSE: Design and validation of a magnetic resonance and computed tomography compatible device capable of applying physiologically relevant muscle forces to cadaveric knee joints with high levels of repeatability and reproducibility. METHODS: Repeatability and reproducibility were assessed with two porcine stifle joints. Load was applied to joints at full extension, five and 15 degrees of flexion through two cables simulating the lines of action of the quadriceps and hamstrings muscles. Five repeatability and five reproducibility trials were performed at each flexion angle. Standard deviations (SDs) of joint angle and load were recorded. RESULTS: For repeatability, the maximum SDs for joint angle were 1.26° (flexion), 1.54° (ab/adduction) and 0.90° (in/external rotation). The maximum SDs for joint load were 4.60 N (anterior/posterior), 7.36 N (medial/lateral), and 42.6N (axial). For reproducibility, the maximum SDs for joint angle were 0.84° (flexion), 0.66° (ab/adduction) and 0.92° (in/external rotation). The maximum SDs for joint load were 6.40 N (anterior/posterior), 11.7 N (medial/lateral), and 39.7 N (axial). CONCLUSIONS: This level of repeatability and reproducibility is within intra-subject variability of measured gait kinematics. Therefore, this device is considered to be an effective tool for in vitro testing of knee soft tissue repair.