Effect of the In Vitro Boundary Conditions on the Surface Strain Experienced by the Vertebral Body in the Elastic Regime.

The vertebral strength and strain can be assessed in vitro by both using isolated vertebrae and sets of three adjacent vertebrae (the central one is loaded through the disks). Our goal was to elucidate if testing single-vertebra-specimens in the elastic regime provides different surface strains to three-vertebrae-segments. Twelve three-vertebrae sets were extracted from thoracolumbar human spines. To measure the principal strains, the central vertebra of each segment was prepared with eight strain-gauges. The sets were tested mechanically, allowing comparison of the surface strains between the two boundary conditions: first when the same vertebra was loaded through the disks (three-vertebrae-segment) and then with the endplates embedded in cement (single-vertebra). They were all subjected to four nondestructive tests (compression, traction, torsion clockwise, and counterclockwise). The magnitude of principal strains differed significantly between the two boundary conditions. For axial loading, the largest principal strains (along vertebral axis) were significantly higher when the same vertebra was tested isolated compared to the three-vertebrae-segment. Conversely, circumferential strains decreased significantly in the single vertebrae compared to the three-vertebrae-segment, with some variations exceeding 100% of the strain magnitude, including changes from tension to compression. For torsion, the differences between boundary conditions were smaller. This study shows that, in the elastic regime, when the vertebra is loaded through a cement pot, the surface strains differ from when it is loaded through the disks. Therefore, when single vertebrae are tested, surface strain should be taken with caution.

Tribological and mechanical performance evaluation of metal prosthesis components manufactured via metal injection molding.

The increasing number of total joint replacements, in particular for the knee joint, has a growing impact on the healthcare system costs. New cost-saving manufacturing technologies are being explored nowadays. Metal injection molding (MIM) has already demonstrated its suitability for the production of CoCrMo alloy tibial trays, with a significant reduction in production costs, by holding both corrosion resistance and biocompatibility. In this work, mechanical and tribological properties were evaluated on tibial trays obtained via MIM and conventional investment casting. Surface hardness and wear properties were evaluated through Vickers hardness, scratch and pin on disk tests. The MIM and cast finished tibial trays were then subjected to a fatigue test campaign in order to obtain their fatigue load limit at 5 millions cycles following ISO 14879-1 directions. CoCrMo cast alloy exhibited 514 HV hardness compared to 335 HV of MIM alloy, furthermore it developed narrower scratches with a higher tendency towards microploughing than microcutting, in comparison to MIM CoCrMo. The observed fatigue limits were (1,766 ± 52) N for cast tibial trays and (1,625 ± 44) N for MIM ones. Fracture morphologies pointed out to a more brittle behavior of MIM microstructure. These aspects were attributed to the absence of a fine toughening and surface hardening carbide dispersion in MIM grains. Nevertheless, MIM tibial trays exhibited a fatigue limit far beyond the 900 N of maximum load prescribed by ISO and ASTM standards for the clinical application of these devices.

Strain distribution in the lumbar vertebrae under different loading configurations.

BACKGROUND CONTEXT: The stress/strain distribution in the human vertebrae has seldom been measured, and only for a limited number of loading scenarios, at few locations on the bone surface. PURPOSE: This in vitro study aimed at measuring how strain varies on the surface of the lumbar vertebral body and how such strain pattern depends on the loading conditions. METHODS: Eight cadaveric specimens were instrumented with eight triaxial strain gauges each to measure the magnitude and direction of principal strains in the vertebral body. Each vertebra was tested in a three adjacent vertebrae segment fashion. The loading configurations included a compressive force aligned with the vertebral body but also tilted (15°) in each direction in the frontal and sagittal planes, a traction force, and torsion (both directions). Each loading configuration was tested six times on each specimen. RESULTS: The strain magnitude varied significantly between strain measurement locations. The strain distribution varied significantly when different loading conditions were applied (compression vs. torsion vs. traction). The strain distribution when the compressive force was tilted by 15° was also significantly different from the axial compression. Strains were minimal when the compressive force was applied coaxial with the vertebral body, compared with all other loading configurations. Also, strain was significantly more uniform for the axial compression, compared with all other loading configurations. Principal strains were aligned within 19° to the axis of the vertebral body for axial-compression and axial-traction. Conversely, when the applied force was tilted by 15°, the direction of principal strain varied by a much larger angle (15° to 28°). CONCLUSIONS: This is the first time, to our knowledge, that the strain distribution in the vertebral body is measured for such a variety of loading configurations and a large number of strain sensors. The present findings suggest that the structure of the vertebral body is optimized to sustain compressive forces, whereas even a small tilt angle makes the vertebral structure work under suboptimal conditions.

Shape and function of the diaphysis of the human tibia.

There is an agreement about the principle that bones are optimized to resist daily loads. This has never been ascertained for the human tibia. One of the main load components in the tibia in vivo is a cantilever load (with a linearly varying bending moment, with its largest component in the sagittal plane). investigated if the cross-section of the diaphysis and its variation along the tibia make it an optimized structure with respect to such loads. Six cadaveric tibias were CT-scanned. The geometry and material properties were extracted from the CT-scans, and analyzed along the tibias. A linear variation along the tibia was found for the second moments of area and inertia, and the section modulus in the sagittal plane (slightly less linear in the frontal plane). Conversely, the other properties (polar moments and cross-section are) were much less linear. This suggests that the structure is optimized to resist a bending moment that varies linearly along the tibia. The tibias were instrumented with 28 triaxial straingauges each. Strain was measured under cantilever loading in the sagittal and frontal planes, under quasi-constant-bending in the sagittal and frontal planes, under torsional loading, and with an axial force. The strain distribution was remarkably uniform when cantilever loading was applied in the sagittal plane and slightly less uniform when cantilever loading was applied in the frontal plane. Strain variations were one order of magnitude larger for all other loading configurations. This shows that the tibia is a uniform-stress structure (i.e. optimized) for cantilever loading.

Accurate in vitro identification of fracture onset in bones: failure mechanism of the proximal human femur.

Bone fractures have extensively been investigated, especially for the proximal femur. While failure load can easily be recorded, and the fracture surface is readily accessible, identification of the point of fracture initiation is difficult. Accurate location of fracture initiation is extremely important to understand the multi-scale determinants of bone fracture. In this study, a recently developed technique based on electro-conductive lines was applied to the proximal femoral metaphysis to elucidate the fracture mechanism. Eight cadaveric femurs were prepared with 15-20 electro-conductive lines (crack-grid) covering the proximal region. The crack-grid was connected to a dedicated data-logger that monitored electrical continuity of each line at 700 kHz. High-speed videos (12,000 frames/s, 0.1-0.2 mm pixel size) of the destructive tests were acquired. Most crack-grid-lines failed in a time-span of 0.08-0.50 ms, which was comparable to that identified in the high-speed videos, and consistent with previous video recordings. However, on all specimens 1-3 crack-grid-lines failed significantly earlier (2-200 ms) than the majority of the crack-grid-lines. The first crack-grid-line to fail was always the closest one to the point of fracture initiation identified in the high-speed videos (superior-lateral neck region). Then the crack propagated simultaneously, at comparable velocity on the anterior and posterior sides of the neck. Such a failure pattern has never been observed before, as spatial resolution of the high-speed videos prevented from observing the initial opening of a crack. This mechanism (fracture onset, time-lag, followed by catastrophic failure) can be explained with a transfer of load to the internal trabecular structure caused by the initial fracture of the thin cortical shell. This study proves the suitability of the crack-grid method to investigate bone fractures associated to tensile stress. The crack-grid method enables significantly faster sampling than high-speed cameras. The present findings elucidate some aspects of the failure mechanism of the proximal human femoral metaphysis.

The human proximal femur behaves linearly elastic up to failure under physiological loading conditions.

It has not been demonstrated whether the human proximal femur behaves linearly elastic when loaded to failure. In the present study we tested to failure 12 cadaveric femurs. Strain was measured (at 5000Hz) on the bone surface with triaxial strain gages (up to 18 on each femur). High-speed videos (up to 18,000frames/s) were taken during the destructive test. To assess the effect of tissue preservation, both fresh-frozen and formalin-fixed specimens were tested. Tests were carried out at two strain-rates covering the physiological range experienced during daily motor tasks. All specimens were broken in only two pieces, with a single fracture surface. The high-speed videos showed that failure occurred as a single abrupt event in less than 0.25ms. In all specimens, fracture started on the lateral side of the neck (tensile stress). The fractured specimens did not show any sign of permanent deformation. The force-displacement curves were highly linear (R(2)>0.98) up to 99% of the fracture force. When the last 1% of the force-displacement curve was included, linearity slightly decreased (minimum R(2)=0.96). Similarly, all force-strain curves were highly linear (R(2)>0.98 up to 99% of the fracture force). The slope of the first part of the force-displacement curve (up to 70% fracture force) differed from the last part of the curve (from 70% to 100% of the fracture force) by less than 17%. Such a difference was comparable to the fluctuations observed between different parts of the curve. Therefore, it can be concluded that the proximal femur has a linear-elastic behavior up to fracture, for physiological strain-rates.

Assessment of femoral neck fracture risk for a novel proximal epiphyseal hip prosthesis.

BACKGROUND: This study addresses the risk of femoral neck fracture associated with resurfacing hip prostheses. A novel cemented Proximal Epiphyseal Replacement (PER) featuring a short curved stem was investigated. METHODS: Seven pairs of femurs were in vitro tested. One femur of each pair was randomly assigned for PER implantation. The contralateral femur was tested intact. All femurs were loaded to failure in a validated, physiological configuration. High-speed videos (10,000-12,000 frames/s) were acquired to identify the location of fracture initiation. For comparison, data were included from Birmingham Hip Resurfacing previously tested in an identical fashion (N=3). FINDINGS: Relative to the contralateral intact femurs, the failure load of the PER and Birmingham implants was 15.4% higher and 10.0% lower, respectively. In six of the seven PER implants, fracture initiation (neck or inter-trochanteric) was similar to the contralateral intact femurs, suggesting comparable stress distribution. Conversely, fracture initiation in the Birmingham implants occurred at the lateral prosthesis rim, which differed substantially from the intact femurs. No correlation existed between bone quality and strengthening/weakening effect of the PER (failure load of implant as a percentage of intact: R^2=0.067). Conversely, Birmingham implantation weakened the femurs with lower density (R^2=0.92). Therefore, unlike most resurfacing prostheses, the PER seems suitable also for osteoporotic subjects. INTERPRETATION: This study seems to confirm that resurfacing with a Birmingham Hip tends to reduce the strength of the proximal femur. The opposite seemed to happen with the PER, which slightly reduced the risk of neck fracture, also in low-quality bones.

Mechanical testing of bones: the positive synergy of finite-element models and in vitro experiments.

Bone biomechanics have been extensively investigated in the past both with in vitro experiments and numerical models. In most cases either approach is chosen, without exploiting synergies. Both experiments and numerical models suffer from limitations relative to their accuracy and their respective fields of application. In vitro experiments can improve numerical models by: (i) preliminarily identifying the most relevant failure scenarios; (ii) improving the model identification with experimentally measured material properties; (iii) improving the model identification with accurately measured actual boundary conditions; and (iv) providing quantitative validation based on mechanical properties (strain, displacements) directly measured from physical specimens being tested in parallel with the modelling activity. Likewise, numerical models can improve in vitro experiments by: (i) identifying the most relevant loading configurations among a number of motor tasks that cannot be replicated in vitro; (ii) identifying acceptable simplifications for the in vitro simulation; (iii) optimizing the use of transducers to minimize errors and provide measurements at the most relevant locations; and (iv) exploring a variety of different conditions (material properties, interface, etc.) that would require enormous experimental effort. By reporting an example of successful investigation of the femur, we show how a combination of numerical modelling and controlled experiments within the same research team can be designed to create a virtuous circle where models are used to improve experiments, experiments are used to improve models and their combination synergistically provides more detailed and more reliable results than can be achieved with either approach singularly.

Structural behaviour and strain distribution of the long bones of the human lower limbs.

Although stiffness and strength of lower limb bones have been investigated in the past, information is not complete. While the femur has been extensively investigated, little information is available about the strain distribution in the tibia, and the fibula has not been tested in vitro. This study aimed at improving the understanding of the biomechanics of lower limb bones by: (i) measuring the stiffness and strain distributions of the different low limb bones; (ii) assessing the effect of viscoelasticity in whole bones within a physiological range of strain-rates; (iii) assessing the difference in the behaviour in relation to opposite directions of bending and torsion. The structural stiffness and strain distribution of paired femurs, tibias and fibulas from two donors were measured. Each region investigated of each bone was instrumented with 8-16 triaxial strain gauges (over 600 grids in total). Each bone was subjected to 6-12 different loading configurations. Tests were replicated at two different loading speeds covering the physiological range of strain-rates. Viscoelasticity did not have any pronounced effect on the structural stiffness and strain distribution, in the physiological range of loading rates explored in this study. The stiffness and strain distribution varied greatly between bone segments, but also between directions of loading. Different stiffness and strain distributions were observed when opposite directions of torque or opposite directions of bending (in the same plane) were applied. To our knowledge, this study represents the most extensive collection of whole-bone biomechanical properties of lower limb bones.

Comparison of three standard anatomical reference frames for the tibia-fibula complex.

Definition of anatomical reference frames is necessary both for in vitro biomechanical testing, and for in vivo human movement analyses. Different reference frames have been proposed in the literature for the lower limb, and in particular for the tibia-fibula complex. The scope of this work was to compare the three most commonly referred proposals (proposed by [Ruff, C.B., Hayes, W.C., 1983. Cross-sectional geometry at Pecos Pueblo femora and tibiae -A biomechanical investigation: I. method and general patterns of variation. American Journal of Physical Anthropology 60, pp. 359-381.], by [Cappozzo, A., Catani, F., Della Croce, U., Leardini, A., 1995. Position and orientation in space of bones during movement: anatomical frame definition and determination. Clinical Biomechanics (Bristol, Avon) 10, pp. 171-178.], and by the Standardization and Terminology Committee of the International Society of Biomechanics, [Wu, G., Siegler, S., Allard, P., Kirtley, C., Leardini, A., Rosenbaum, D., Whittle, M., D'Lima, D.D., Cristofolini, L., Witte, H., Schmid, O., Stokes, I., 2002. ISB recommendation on definitions of joint coordinate system of various joints for reporting of human joint motion-part I: ankle, hip and spine. International Society of Biomechanics. Journal of Biomechanics 35, pp. 543-548.]). These three frames were identified on six cadaveric tibia-fibula specimens based on the relevant anatomical landmarks, using a high-precision digitizer. The intra-operator (ten repetitions) and inter-operator (three operators) repeatability were investigated in terms of reference frame orientation. The three frames had similar intra-operator repeatability. The reference frame proposed by Ruff et al. had a better inter-operator repeatability (this must be put in relation with the original context of interest, i.e. in vitro measurements on dissected bones). The reference frames proposed by Ruff et al. and by ISB had a similar alignment; the frame proposed by Cappozzo et al. was considerably externally rotated and flexed with respect to the other two. Thus, the reference frame proposed by Ruff et al. is preferable when the full bone surface is accessible (typically during in vitro tests). Conversely, no advantage in terms of repeatability seems to exist between the reference frames proposed by Cappozzo et al. and ISB.

In vitro replication of spontaneous fractures of the proximal human femur.

Spontaneous fractures (i.e. caused by sudden loading and muscle contraction, not by trauma) represent a significant percentage of proximal femur fractures. They are particularly relevant as may occur in elderly (osteoporotic) subjects, but also in relation to epiphyseal prostheses. Despite its clinical and legal relevance, this type of fracture has seldom been investigated. Studies concerning spontaneous fractures are based on a variety of loading scenarios. There is no evidence, nor consensus on the most relevant loading scenario. The aim of this work was to develop and validate an experimental method to replicate spontaneous fractures in vitro based on clinically relevant loading. Primary goals were: (i) repeatability and reproducibility, (ii) clinical relevance. A validated numerical model was used to identify the most critical loading scenario that can lead to head-neck fractures, and to determine if it is necessary to include muscle forces when the head-neck region is under investigation. The numerical model indicated that the most relevant loading scenario is when the resultant joint force is applied to the head at 8 degrees from the diaphysis. Furthermore, it was found that it is not essential to include the muscles when investigating head-neck fractures. The experimental setup was consequently designed. The procedure included high-speed filming of the fracture event. Clinically relevant fracture modes were obtained on 10 cadaveric femurs. Failure load should be reported as a fraction of donor's body-weight to reduce variability. The proposed method can be used to investigate the reason and mechanism of failure of natural and operated proximal femurs.