Patient-specific finite element analysis for assessing hip fracture risk in aging populations.

The femur is one of the most important bone in the human body, as it supports the body's weight and helps with movement. The aging global population presents a significant challenge, leading to an increasing demand for artificial joints, particularly in knee and hip replacements, which are among the most prevalent surgical procedures worldwide. This study focuses on hip fractures, a common consequence of osteoporotic fractures in the elderly population. To accurately predict individual bone properties and assess fracture risk, patient-specific finite element models (FEM) were developed using CT data from healthy male individuals. The study employed ANSYS 2023 R2 software to estimate fracture loads under simulated single stance loading conditions, considering strain-based failure criteria. The FEM bone models underwent meticulous reconstruction, incorporating geometrical and mechanical properties crucial for fracture risk assessment. Results revealed an underestimation of the ultimate bearing capacity of bones, indicating potential fractures even during routine activities. The study explored variations in bone density, failure loads, and density/load ratios among different specimens, emphasizing the complexity of bone strength determination. Discussion of findings highlighted discrepancies between simulation results and previous studies, suggesting the need for optimization in modelling approaches. The strain-based yield criterion proved accurate in predicting fracture initiation but required adjustments for better load predictions. The study underscores the importance of refining density-elasticity relationships, investigating boundary conditions, and optimizing models throughin vitrotesting for enhanced clinical applicability in assessing hip fracture risk. In conclusion, this research contributes valuable insights into developing patient-specific FEM bone models for clinical hip fracture risk assessment, emphasizing the need for further refinement and optimization for accurate predictions and enhanced clinical utility.

Finite element analysis of elliptical shaped stem profile of hip prosthesis using dynamic loading conditions.

Patient-specific dynamic loadings are seldom considered during the evaluation of hip implants. The primary objective of this study is to check for the feasibility of the use of UHMWPE as the material for an acetabular cup o CoCr Alloy that is reported to produce a squeaking sound after replacement. An elliptical shaped stem with three different cross-sectional profiles is considered for simulation. Using a commercial finite element method, patient-specific dynamic forces were applied for the quantitative analysis. The loading and boundary conditions are used as per ISO and ASTM standards. The walking gait cycle is used with two widely used biocompatible materials: titanium and cobalt-chromium. Initially, only the stem is considered for the analysis to finalize the best out of the three profiles, along with the better material for the stem. Later the complete implant is used for the analysis. Profile 1 exhibits 1.25 and 1.17 times greater stress than Profile 2 for CoCr Alloy and Ti-6Al-4V, respectively. Similarly, Profile 3 displays stresses 1.26 and 1.25 times greater than Profile 2 for CoCr Alloy and Ti-6Al-4V, respectively. Comparatively, displacement in stem Profile 2 is 1.75 times higher in Ti-6Al-4V than CoCr Alloy. The full implant displacement at 14% gait cycle is 1.15% higher for the CoCr-acetabular column material combination when compared to UHMWPE. It can be concluded that UHMWPE can be used as the acetabular cup material instead of CoCr for the Profile 2 elliptical shaped hip implant to prevent squeaking after replacement.

Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial.

INTRODUCTION: Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP. METHODS: This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1. DISCUSSION: If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2020/01/022934 . Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry - India.

Epidemiology, resistance characteristics, virulence determinants, and treatment outcomes of Staphylococcus aureus bone and joint infections: a one-year prospective study at a tertiary care hospital in India.

PURPOSE: The study was aimed to explore the differences between the Staphylococcus aureus osteosynthesis-associated infection (OAI) and non-implant related infections (NIRI) in terms of epidemiology, resistance characteristics, virulence determinants, treatment, risk factors, and outcome. METHODS: A prospective study was conducted from 2018 through 2019. The phenotypic and genotypic characterization of S. aureus, risk factors, treatment, and outcome were compared. RESULTS: A total of 60 patients were included. 50% had OAIs (70%) (p = .045). Overall, MRSA (OR 0.69; p = .020) and old age (OR 0.95; p = 0.035) were the important risk factors. Implanted patients presented with the features of chronic osteomyelitis (93.3%, p = 0.01). NIRI cases composed of only 66.7% of OM, and 55% of them were acute. OAI isolates were more frequently luk gene positives (50%) than isolates from the NIRI group (33.3%). Patients with OAI by luk positive isolates significantly had prolonged hospital stay (p = 0.043; OR-0.96, CI-0.91-1.0). Most of the NIRIs (60%) managed with antibiotics, but frequent surgical intervention (OR 10.68; p = .024) with prolonged systemic antibiotics (OR 1.07; p = .029) helped all OAIs to recover. Patients without implants were recovered in a higher number (83.3%). CONCLUSION: Our study highlighted that the differences exist between the OAI and NIRI, specifically in terms of clinical features, distribution of luk genes, treatment approach, and outcome. Risk factors for both types of infection remained the same.

Wear estimation of trapezoidal and circular shaped hip implants along with varying taper trunnion radiuses using finite element method.

BACKGROUND AND OBJECTIVE: The hip joint is the vital joint that is responsible for the bodyweight transfer from the upper body to the lower body. Due to age these joints are worn out and need to be replaced by artificial hip implants. Wear is the predominant factor that is responsible for the loosening of hip implants. The wear occurs between the joints due to various reasons. The wear estimation at the design stage gives a clear idea about the life of the implants and also minor changes in the design may also significantly increase the life expectancy of the implant which can further reduce the rate of revision surgery. The linear wear rate is estimated in the taper trunnion surface. METHODS: In this study, the circular and trapezoidal-shaped stem implant is designed, and wear studies are performed at the trunnion junction. The femoral head of size 28 mm, acetabular cup thickness of 4 mm, and a backing cup of thickness 2 mm are considered for the study. The neck taper radiuses at the top surface are altered. Ansys is used to perform the simulations. RESULTS: At the time of assembly of the femoral head into the stem, the stresses were found to be increasing with an increase in the top surface radius of the neck taper junctions. However, when the walking conditions are considered for wear estimation of implants the circular implants with the 12/14 mm taper exhibited the lesser linear wear rate of 0.003 mm/year. The trapezoidal implants with the 10/14 mm taper exhibited a lesser linear wear rate of 0.032 mm/year. CONCLUSIONS: Wear is an important parameter that leads to the revision of implants due to loosening. It is found that with the decrease in the taper radius at the top surface against the standard 12/14 mm taper there is no significant decrease in the wear rate at the taper junction. Overall the circular implants exhibited less wear rate results over the trapezoidal-shaped stem implants. Due to the less linear wear rate, the circular implant has a higher life over the trapezoidal-shaped implant. Further, these implants can be manufactured to test using a hip simulator with the same conditions to validate the obtained results.

Corrigendum to "Static structural analysis of different stem designs used in total hip arthroplasty using finite element method" [Heliyon Volume 5, Issue 6, June 2019, Article e01767].

[This corrects the article DOI: 10.1016/j.heliyon.2019.e01767.].

Static structural analysis of different stem designs used in total hip arthroplasty using finite element method.

BACKGROUND: The Hip joint is the primary joint which gives stability to the human body. The wear and tear associated with age and other factors, require these joints to be replaced by implants using hip arthroplasty surgeries. Cobalt chromium alloy (CoCr), titanium alloy, stainless steel are some of the most common hip joint materials used for hip implants. The design requirement for hip joint implants are very stringent to avoid revision joint surgeries due to aseptic loosening. There are various choices in shapes and materials used for stem and acetabular designs. This makes it more difficult to make an informed decision on the type of design and material that can be used for hip implants. METHODS: Circular, Oval, ellipse and trapezoidal designs with three individual cross sections (defined as profile 1, profile 2 and profile 3) are considered for the study. All models are modeled using CATIA V-6. Static structural analysis is performed using ANSYS R-19 to arrive at the best possible design and material combination for stem and acetabular cup. RESULTS: It was found that, profile 2 of all the four designs has the lowest possible deformation and von Mises stress when compared to profile 1 and profile 2. In general, profile 2 with trapezoidal stem has best outcomes in terms of its mechanical properties. Besides, stem designed with material CoCr and its associated acetabular cup with CoC (ceramic on ceramic) material can produce an implant having better properties and longer durability. CONCLUSIONS: CoCr was found to be the preferred choice of material for stem design. It was also observed that, irrespective of material considered for the analysis profile 2 with trapezoidal stem showcased lesser deformation and von Mises stress over the other eleven models. For analysis involving acetabular cups, CoC implants exhibited better mechanical properties over the conventional CoPE (Ceramic on polyethylene) materials such as Ultra-high molecular weight polyethylene (UHMWPE). It is inferred from the findings of this study that, the profile 2 with trapezoidal stem design made of CoCr material and acetabular cup made of CoC material is best suited for hip joint implants.