Polyethylene wear of dual mobility cups: a comparative analysis based on patient-specific finite element modeling.

PURPOSE: Concerns remain about potential increased wear with dual mobility cups related to the multiple articulations involved in this specific design of implant. This finite element analysis study aimed to compare polyethylene (PE) wear between dual mobility cup and conventional acetabular component, and between the use of conventional ultra-high molecular weight PE (UHMWPE) and highly cross-linked PE (XPLE). METHODS: Patient-specific finite element modeling was developed for 15 patients undergoing primary total hip arthroplasty (THA). Five acetabular components were 3D modeled and compared in THA constructs replicating existing implants: a dual mobility cup with a 22.2-mm-diameter femoral head against UHMWPE or XLPE (DM22PE or DM22XL), a conventional cup with a 22.2-mm-diameter femoral head against UHMWPE (SD22PE) and a conventional cup with a 32-mm-diameter femoral head against UHMWPE or XLPE (SD32PE or SD32XL). RESULTS: DM22PE produced 4.6 times and 5.1 times more volumetric wear than SD32XL and DM22XL (p < 0.0001, Cohen's d = 6.97 and 7.11; respectively). However, even if significant, the differences in volumetric wear between DM22XL and SD32XL as well as between DM22PE and SD22PE or SD32PE were small according to their effect size (p < 0.0001, Cohen's |d|= 0.48 to 0.65) and could be therefore considered as clinically negligible. CONCLUSION: When using XLPE instead of UHMWPE, dual mobility cup with a 22.2-mm-diameter femoral head produced a similar amount of volumetric wear than conventional acetabular component with a 32-mm-diameter femoral head against XLPE. Therefore, XLPE is advocated in dual mobility cup to improve its wear performance.

Muscle co-contraction in an upper limb musculoskeletal model: EMG-assisted vs. standard load-sharing.

Estimation of muscle forces in over-actuated musculoskeletal models involves optimal distributions of net joint moments among muscles by a standard load-sharing scheme (SLS). Given that co-contractions of antagonistic muscles are counterproductive in the net joints moments, SLS might underestimate the co-contractions. Muscle co-contractions play crucial roles in stability of the glenohumeral (GH) joint. The aim of this study was to improve estimations of muscle co-contractions by incorporating electromyography (EMG) data into an upper limb musculoskeletal model. To this end, the model SLS was modified to develop an EMG-assisted load-sharing scheme (EALS). EMG of fifteen muscles were measured during arm flexion and abduction on a healthy subject and fed into the model. EALS was compared to SLS in terms of muscle forces, GH joint reaction force, and a stability ratio defined to quantify the GH joint stability. The results confirmed that EALS estimated higher muscle co-contractions compared to the SLS (e.g., above 50 N higher forces for both triceps long and biceps long during arm flexion).

A Matlab toolbox for scaled-generic modeling of shoulder and elbow.

There still remains a barrier ahead of widespread clinical applications of upper extremity musculoskeletal models. This study is a step toward lifting this barrier for a shoulder musculoskeletal model by enhancing its realism and facilitating its applications. To this end, two main improvements are considered. First, the elbow and the muscle groups spanning the elbow are included in the model. Second, scaling routines are developed that scale model's bone segment inertial properties, skeletal morphologies, and muscles architectures according to a specific subject. The model is also presented as a Matlab toolbox with a graphical user interface to exempt its users from further programming. We evaluated effects of anthropometric parameters, including subject's gender, height, weight, glenoid inclination, and degenerations of rotator cuff muscles on the glenohumeral joint reaction force (JRF) predictions. An arm abduction motion in the scapula plane is simulated while each of the parameters is independently varied. The results indeed illustrate the effect of anthropometric parameters and provide JRF predictions with less than 13% difference compared to in vivo studies. The developed Matlab toolbox could be populated with pre/post operative patients of total shoulder arthroplasty to answer clinical questions regarding treatments of glenohumeral joint osteoarthritis.

Feasibility of an alternative method to estimate glenohumeral joint center from videogrammetry measurements and CT/MRI of patients.

Videogrammetry is commonly used to record upper limb motions. However, it cannot track the glenohumeral joint center (GH). GH is required to reconstruct upper limb motions. Therefore, it is often estimated by separately measuring scapular motions using scapular kinematics measurements devices (SKMD). Applications of SKMD are neither straightforward nor always noninvasive. Therefore, this work investigates the feasibility of an alternative method to estimate GH from videogrammetry using a CT/MRI image of subject's glenohumeral joint and without requiring SKMD. In order to evaluate the method's accuracy, its GH estimations were compared to reference GH trajectories. The method was also applied to estimate scapular configurations and reconstruct an abduction motion measured by videogrammetry. The accuracy of GH estimations were within 5 mm, and the reconstructed motion was in good agreement with reported in vivo measurements.

A simulation framework for humeral head translations.

Humeral head translations (HHT) play a crucial role in the glenohumeral (GH) joint function. The available shoulder musculoskeletal models developed based on inverse dynamics however fall short of predicting the HHT. This study aims at developing a simulation framework that allows forward-dynamics simulation of a shoulder musculoskeletal model with a 6 degrees of freedom (DOF) GH joint. It provides a straightforward solution to the HHT prediction problem. We show that even within a forward-dynamics simulation addressing the HHT requires further information about the contact. To that end, a deformable articular contact is included in the framework defining the GH joint contact force in terms of the joint kinematics. An abduction motion in the scapula plane is simulated. The results are given in terms of HHT, GH joint contact force, contact areas, contact pressure, and cartilage strain. It predicts a superior-posterior translation of the humeral head followed by an inferior migration.