Estimating tissue-level properties of porcine talar subchondral bone

Tissue-level properties of bone play an important role when characterising apparent-level bone biomechanical behaviour and yet little is known about its effect at this hierarchical level. In combination with trabecular morphological data these properties can be used to predict bone strength, which becomes an invaluable tool for clinicians in patient treatment planning. This study developed specimen-specific micro-finite element (μFE) models using validated continuum-level models, containing grayscale-derived material properties, to indirectly establish tissue-level properties of porcine talar subchondral bone. Specimen-specific continuum finite element (hFE) models of subchondral trabecular bone were setup using μCT data of ten cylindrical specimens extracted from juvenile porcine tali. The models were validated using quasi-static uniaxial compression testing. Validated hFE models were used to calibrate the tissue modulus of corresponding μFE models by minimising the difference between the μFE and hFE stiffness values. Key trabecular morphological indices (BV/TV, DA, Conn.D, Tb.Th, EF) were evaluated. Good agreement was observed between hFE models and experiment (CCC = 0.66). Calibrated E_tiss was 504 ± 37.65 MPa. Average BV/TV and DA for μFE specimens were 0.37 ± 0.05 and 0.68 ± 0.11, respectively. BV/TV (r² = 0.667) correlated highly with μFE stiffness. The small intra-specimen variation to tissue-level properties suggests that variations to apparent-level stiffness originate from variations to microarchitecture rather than tissue mechanical properties.

Biological cells and coupled electro-mechanical effects: The role of organelles, microtubules, and nonlocal contributions

Biological cells are exposed to a variety of mechanical loads throughout their life cycles that eventually play an important role in a wide range of cellular processes. The understanding of cell mechanics under the application of external stimuli is important for capturing the nuances of physiological and pathological events. Such critical knowledge will play an increasingly vital role in modern medical therapies such as tissue engineering and regenerative medicine, as well as in the development of new remedial treatments. At present, it is well known that the biological molecules exhibit piezoelectric properties that are of great interest for medical applications ranging from sensing to surgery. In the current study, a coupled electro-mechanical model of a biological cell has been developed to better understand the complex behaviour of biological cells subjected to piezoelectric and flexoelectric properties of their constituent organelles under the application of external forces. Importantly, a more accurate modelling paradigm has been presented to capture the nonlocal flexoelectric effect in addition to the linear piezoelectric effect based on the finite element method. Major cellular organelles considered in the developed computational model of the biological cell are the nucleus, mitochondria, microtubules, cell membrane and cytoplasm. The effects of variations in the applied forces on the intrinsic piezoelectric and flexoelectric contributions to the electro-elastic response have been systematically investigated along with accounting for the variation in the coupling coefficients. In addition, the effect of mechanical degradation of the cytoskeleton on the electro-elastic response has also been quantified. The present studies suggest that flexoelectricity could be a dominant electro-elastic coupling phenomenon, exhibiting electric fields that are four orders of magnitude higher than those generated by piezoelectric effects alone. Further, the output of the coupled electro-mechanical model is significantly dependent on the variation of flexoelectric coefficients. We have found that the mechanical degradation of the cytoskeleton results in the enhancement of both the piezo and flexoelectric responses associated with electro-mechanical coupling. In general, our study provides a framework for more accurate quantification of the mechanical/electrical transduction within the biological cells that can be critical for capturing the complex mechanisms at cellular length scales.

A computational outlook on neurostimulation

Efficient identification of effective neurostimulation strategies is critical due to the growing number of clinical applications and the increasing complexity of the corresponding technology. In consequence, investigators are encouraged to accelerate translational research of neurostimulation technologies and move quickly to clinical applications. However, this process is hampered by rigorous, but necessary, regulations and lack of a mechanistic understanding of the interactions between electric fields and neural circuits. Here we discuss how computational models have influenced the field of neurostimulation for pain and movement recovery, deep brain stimulation, and even device regulations. Finally, we propose our vision on how computational models will be key to accelerate clinical developments through mechanistic understanding.

Lumbar stability following graded unilateral and bilateral facetectomy: A finite element model study

BACKGROUND

Excision of excessive amount of facet joint during lumbar discectomy or decompression can cause segmental instability of the lumbar spine. This study was performed to assess the segmental instability, facet joint loading and intradiscal pressure following graded lumbar facetectomy. This biomechanical study was performed using a verified and validated L3-S1 finite element model.

METHODS

Nine scenarios were analysed. Intact model as control, 30%, 45%, 60% and complete facet joint excision in unilateral and bilateral setting. The effect of progressive graded facetectomy of L4-L5 on the segmental mobility, facet loading and intradiscal pressure was assessed.

FINDINGS

In comparison with control 30% excision of the facet joint mainly caused increase in mediolateral mobility. With 45% excision of the facet joint there was increase in both anteroposterior and mediolateral mobility, this was worse in bilateral and unilateral models respectively. This worsened with larger facet excision scenarios. Facet load increased significantly on extension with excision of 45% & 60% unilaterally and 100% bilaterally. Flexion produced rise in intradiscal pressure in all scenarios.

INTERPRETATION

The increased spinal mobility, facet loading and intradiscal pressure with more than 30% facetectomy highlights the importance of preserving the facets during decompression thereby safeguarding accelerated degeneration of these segments and iatrogenic segmental instability. The findings from this study could also potentially explain the correlation between spinal instability, disc degeneration and facet joint arthrosis as noted in clinical studies.

Development of robust finite element models of porcine tibiofemoral joints loaded under varied flexion angles and tibial freedoms

The successful development of cartilage repair treatments for the knee requires understanding of the biomechanical environment within the joint. Computational finite element models play an important role in non-invasively understanding knee mechanics, but it is important to compare model findings to experimental data. The purpose of this study was to develop a methodology for generating subject-specific finite element models of porcine tibiofemoral joints that was robust and valid over multiple different constraint scenarios. Computational model predictions of two knees were compared to experimental studies on corresponding specimens loaded under several different constraint scenarios using a custom designed experimental rig, with variations made to the femoral flexion angle and level of tibial freedom. For both in vitro specimens, changing the femoral flexion angle had a marked effect on the contact distribution observed experimentally. With the tibia fixed, the majority of the contact region shifted to the medial plateau as flexion was increased. This did not occur when the tibia was free to displace and rotate in response to applied load. These trends in contact distribution across the medial and lateral plateaus were replicated in the computational models. In an additional model with the meniscus removed, contact pressures were elevated by a similar magnitude to the increase seen when the meniscus was removed experimentally. Overall, the models were able to capture specimen-specific trends in contact distribution under a variety of different loads, providing the potential to investigate subject-specific outcomes for knee interventions.

A seated human model for predicting the coupled human-seat transmissibility exposed to fore-aft whole-body vibration

Occupant discomfort, induced by vibration transmitted through a vehicle seat, can be evaluated by measuring vibration on the contact interface between the occupant and seat. In the previous study (Ittianuwat et al., 2016), measuring five contact points of the back-backrest, including centre point (ISO 2631-1), was considered as an important factor for assessing occupant comfort in frequencies where seat structure resonances occur. To enhance occupant vibration comfort in the early seat design stage, predicting the dynamic response of the coupled human-seat system on various contact locations is necessary. In this study, a low order seated human body Finite Element (FE) model was developed for predicting vibration transmissibility of the human-seat system in frequencies up to 30 Hz. Throughout the optimization process, the parameters of the model were obtained by comparing measured transmissibilities of the occupied vehicle seat system. The human-seat system vibration modes were also compared and verified with measured data by calculating MAC (Modal Assurance Criterion). The results showed that two human body vibration modes coupled with foam were observed below 10 Hz, and two coupled human and seat structure fore-aft modes were observed at around 20.1 Hz and 21.9 Hz. Fore-aft transmissibility of the model at various locations of contact provided reasonable correlation with the measured data. The developed low order human model enables the prediction of the fore-aft transmissibility on various back-backrest contact locations up to 30 Hz. This showed the capability of improving occupant's vibration comfort by predicting transmissibilities of the human-seat system in the early stage of developing a new vehicle seat.

Vibration annoyance assessment of train induced excitations from tunnels embedded in rock

Train movements generate oscillations that are transmitted as waves through the track support system into its surroundings. The vibration waves propagate through the soil layers and reach to nearby buildings creating distractions for human activities and causing equipment malfunctioning. Not only the train components and the rails, but also the surrounding tunnel, soil and rock strata have dynamic characteristics that play significant roles in the vibration levels felt in a nearby structure. This paper presents a finite element study conducted to investigate the vibrations resulting from train movements in nearby subway tunnels. The subway line is located at an average horizontal distance of 50 ft (15.2 m) from the structure in assessment, which is a six-story office building. The main goal of the work is to assess the train-induced vibrations at the ground level of the building through a case study and sensitivity analysis. A plane strain finite element model is built to represent the railroad tunnel embedded in the rock and the soil stratum above it. The one train loading function is applied to the model as a point source at the track level and compared to the two-train scenario. Other simulations are undertaken for sensitivity analysis involving increased loading, decreased damping and decreased distance to tunnels. Even though there are several numerical studies on the propagation of train induced vibrations in the literature; a finite element model accompanied with a sensitivity analysis has not been discussed in detail in a technical publication before. The paper not only presents the finite element modeling but also compares the results with the criteria of Transit Noise and Vibration Impact Assessment Manual, which was published by the Federal Transit Administration (FTA) of the U.S. Department of Transportation.

Associations between voxel-level accumulated dose and rectal toxicity in prostate radiotherapy

Background and Purpose

Associations between dose and rectal toxicity in prostate radiotherapy are generally poorly understood. Evaluating spatial dose distributions to the rectal wall (RW) may lead to improvements in dose-toxicity modelling by incorporating geometric information, masked by dose-volume histograms. Furthermore, predictive power may be strengthened by incorporating the effects of interfraction motion into delivered dose calculations.Here we interrogate 3D dose distributions for patients with and without toxicity to identify rectal subregions at risk (SRR), and compare the discriminatory ability of planned and delivered dose.

Material and Methods

Daily delivered dose to the rectum was calculated using image guidance scans, and accumulated at the voxel level using biomechanical finite element modelling. SRRs were statistically determined for rectal bleeding, proctitis, faecal incontinence and stool frequency from a training set (n = 139), and tested on a validation set (n = 47).

Results

SRR patterns differed per endpoint. Analysing dose to SRRs improved discriminative ability with respect to the full RW for three of four endpoints. Training set AUC and OR analysis produced stronger toxicity associations from accumulated dose than planned dose. For rectal bleeding in particular, accumulated dose to the SRR (AUC 0.76) improved upon dose-toxicity associations derived from planned dose to the RW (AUC 0.63). However, validation results could not be considered significant.

Conclusions

Voxel-level analysis of dose to the RW revealed SRRs associated with rectal toxicity, suggesting non-homogeneous intra-organ radiosensitivity. Incorporating spatial features of accumulated delivered dose improved dose-toxicity associations. This may be an important tool for adaptive radiotherapy in the future.

Stress distribution in the humerus during elevation of the arm and external abduction

Objective

The purpose of this study is to estimate stress distribution occurring in the humerus during elevation and external rotation of the arm.Methods: contact forces and moments were estimated using telemeterized shoulder implants. An accurate three-dimensional (3D) finite element (FE) model of the natural scapula was developed, and loaded by data obtained by instrumented prosthesis.

Results

Stresses of about 40 MPa were found on the homerus during the elevation phase acting at 30° and 80°, while a peak of 60 MPa was found during the external rotation phase at 20°. The stress aging on scapula was of about 45 MPa, while the acromion was subjected at about 30 MPa. Stresses aging on ligaments were of about 15 MPa.

Conclusion

These results indicated that the transfer of major muscle and joint reaction take place predominantly through the thick bony ridges, and stresses induced can be dangerous especially for patients with shoulder problems or during the first post-operative weeks after shoulder fractures or joint replacements.

Predicting experimentally-derived failure load at the distal radius using finite element modelling based on peripheral quantitative computed tomography cross-sections (pQCT-FE): A validation study

Dual energy X-ray absorptiometry, the current clinical criterion method for osteoporosis diagnosis, has limitations in identifying individuals with increased fracture risk, especially at the distal radius. Peripheral quantitative computed tomography (pQCT) can provide volumetric bone density data, as well as information on bone geometry, which makes it possible to establish finite element (FE) models of the distal radius from which bone strength and stiffness can be calculated. In this study, we compared experimental mechanical failure load data of the forearm with pQCT- based FE (pQCT-FE) modelling properties. Sixteen cadaveric forearm specimens were experimentally loaded until failure. Estimated stiffness and strength variables of compression, shear, bending and torsion were calculated from pQCT-FE modelling of single cross-sections of 0.2 × 0.2 × 2.4 mm of the radius pQCT image. A moderate-to-strong coefficient of determination (r²) was observed between experimental failure load and pQCT-FE variables. The highest r² was observed for bending stiffness (r² = 0.83). This study validates the use of pQCT-FE in the assessment of distal radius bone strength for future studies.

Inflation experiments and inverse finite element modelling of posterior human sclera

The complexity of inverse finite element modelling methods used in ocular biomechanics research has significantly increased in recent years in order to produce material parameters that capture microscale tissue behaviour. This study presents a more accessible method for researchers to optimise sclera material parameters for use in finite element studies where macroscale sclera displacements are required. Five human donor sclerae aged between 36 and 72 years were subjected to cycles of internal pressure up to 61 mmHg using a custom-built inflation rig. Displacements were measured using a laser beam and two cameras through a digital image correlation algorithm. Specimen-specific finite element models incorporating regional thickness variation and sclera surface topography were divided into six circumferential regions. An inverse finite element procedure was used to optimise Ogden material parameters for each region. The maximum root mean squared (RMS) error between the numerical and experimental displacements within individual specimens was 17.5 µm. The optimised material parameters indicate a gradual reduction in material stiffness (as measured by the tangent modulus) from the equator to the posterior region at low-stress levels up to 0.005 MPa. The variation in stiffness between adjacent regions became gradually less apparent and statistically insignificant at higher stresses. The study demonstrated how inflation testing combined with inverse modelling could be used to effectively characterise regional material properties capable of reproducing global sclera displacements. The material properties were found to vary between specimens, and it is expected that age could be a contributing factor behind this variation.

A population-specific material model for sagittal craniosynostosis to predict surgical shape outcomes

Sagittal craniosynostosis consists of premature fusion (ossification) of the sagittal suture during infancy, resulting in head deformity and brain growth restriction. Spring-assisted cranioplasty (SAC) entails skull incisions to free the fused suture and insertion of two springs (metallic distractors) to promote cranial reshaping. Although safe and effective, SAC outcomes remain uncertain. We aimed hereby to obtain and validate a skull material model for SAC outcome prediction. Computed tomography data relative to 18 patients were processed to simulate surgical cuts and spring location. A rescaling model for age matching was created using retrospective data and validated. Design of experiments was used to assess the effect of different material property parameters on the model output. Subsequent material optimization-using retrospective clinical spring measurements-was performed for nine patients. A population-derived material model was obtained and applied to the whole population. Results showed that bone Young's modulus and relaxation modulus had the largest effect on the model predictions: the use of the population-derived material model had a negligible effect on improving the prediction of on-table opening while significantly improved the prediction of spring kinematics at follow-up. The model was validated using on-table 3D scans for nine patients: the predicted head shape approximated within 2 mm the 3D scan model in 80% of the surface points, in 8 out of 9 patients. The accuracy and reliability of the developed computational model of SAC were increased using population data: this tool is now ready for prospective clinical application.

A critical review on the three-dimensional finite element modelling of the compression therapy for chronic venous insufficiency

Compression therapy is an adjuvant physical intervention providing the benefits of calibrated compression and controlled stretch and consequently is increasingly applied for the treatment of chronic venous insufficiency. However, the mechanism of the compression therapy for chronic venous insufficiency is still unclear. To elaborate the mechanism of compression therapy, in recent years, the computational modelling technique, especially the finite element modelling method, has been widely used. However, there are still many unclear issues regarding the finite element modelling of compression therapy, for example, the selection of appropriate material models, the validation of the finite element predictions, the post-processing of the results. To shed light on these unclear issues, this study provides a state-of-the-art review on the application of finite element modelling technique in the compression therapy for chronic venous insufficiency. The aims of the present study are as follows: (1) to provide guidance on the application of the finite element technique in healthcare and relevant fields, (2) to enhance the understanding of the mechanism of compression therapy and (3) to foster the collaborations among different disciplines. To achieve these aims, the following parts are reviewed: (1) the background on chronic venous insufficiency and the computational modelling approach, (2) the acquisition of medical images and the procedure for generating the finite element model, (3) the definition of material models in the finite element model, (4) the methods for validating the finite element predictions, (5) the post-processing of the finite element results and (6) future challenges in the finite element modelling of compression therapy.

Biomechanical analysis of proximal tibia bone grafting and the effect of the size of osteotomy using a validated finite element model

Harvesting bone graft from the proximal tibia is gaining popularity, with lower complication rates and adequate quantity of cancellous bone. The amount of harvested bone is dependent on the size of the cortical window introduced via osteotomy onto the proximal tibia, and its mechanical strength after surgery could be compromised. The aim of the study was to investigate the proximal tibia's mechanical stability after bone harvesting and the effect of varying window sizes using a validated finite element model. Two cadaveric tibiae were tested with bone strains measured for different circular cortical window diameters (10-25 mm). Sixteen finite element models of the intact and harvested tibia were simulated and validated with experimental data. The experimental and predicted max/min principal bone strains were fitted into regression models and showed good correlations. It was predicted the maximum principal bone stresses were greatest and concentrated at postero-inferior and antero-superior regions of the cortical window. A stress line progressed from the edge of the window to the posterior side of the tibia, which became more prominent with the increase of size of the cortical window. It was found that large circular osteotomies for bone harvesting at the proximal tibia induced stress concentrations and stress lines which could lead to eventual failure. Graphical abstract The formation of a stress line in the harvested tibia initiated from the postero-inferior edge of the window and progressed to the medial side. The stress line became more prominent with the increase of the size of the cortical window from 10 to 25 mm in diameter.

Detailed structural assessment of healthy interventricular septum in the presence of remodeling infarct in the free wall - A finite element model

Purpose

Computational modelling may improve the fundamental understanding of various mechanisms of diseases more particularly related to clinical challenges. In this study the effect of remodeling infarct presence in the left ventricle on the interventricular septal wall is studied using the finite element methods.

Methods

In this study, two rat heart (one model with healthy myocardium and one model with remodeling free wall and healthy septal wall) with magnetic resonance imaging data was gathered to reconstruct three-dimensional (3D) rat heart models. 3D data points from Segment® were imported into SolidEdge® for creation of 3D rat heart models. Abaqus® was used for finite element modeling.

Results

The strain in the healthy interventricular septum of the infarcted left ventricle wall increased when compared to the healthy interventricular septum in the healthy left ventricle. Similarly, the average stress in the healthy left ventricle was observed to have increased on the healthy the interventricular septum where the free wall is subjected to remodeling infarct. When comparing the infarcted models to the healthy model, it was found that the average strain had greatly increased by up to 50.0 %.

Conclusions

The remodeling infarct in the left ventricle has an impact on the healthy interventricular septal wall. Even though the interventricular septal wall was modelled as healthy, it was observed that it has undergone considerable changes in stresses and strains in circumferential and longitudinal direction. The observed changes in myocardial stresses and strains may result in poor global functioning of the heart.

Numerical modelling of hip fracture patterns in human femur

BACKGROUND AND OBJECTIVE

Hip fracture morphology is an important factor determining the ulterior surgical repair and treatment, because of the dependence of the treatment on fracture morphology. Although numerical modelling can be a valuable tool for fracture prediction, the simulation of femur fracture is not simple due to the complexity of bone architecture and the numerical techniques required for simulation of crack propagation. Numerical models assuming homogeneous fracture mechanical properties commonly fail in the prediction of fracture patterns. This paper focuses on the prediction of femur fracture based on the development of a finite element model able to simulate the generation of long crack paths.

METHODS

The finite element model developed in this work demonstrates the capability of predicting fracture patterns under stance loading configuration, allowing the distinction between the main fracture paths: intracapsular and extracapsular fractures. It is worth noting the prediction of different fracture patterns for the same loading conditions, as observed during experimental tests.

RESULTS AND CONCLUSIONS

The internal distribution of bone mineral density and femur geometry strongly influences the femur fracture morphology and fracture load. Experimental fracture paths have been analysed by means of micro-computed tomography allowing the comparison of predicted and experimental crack surfaces, confirming the good accuracy of the numerical model.

Methods for evaluating effects of unloader knee braces on joint health: a review

The paper aims to provide a state-of-the-art review of methods for evaluating the effectiveness and effect of unloader knee braces on the knee joint and discuss their limitations and future directions. Unloader braces are prescribed as a non-pharmacological conservative treatment option for patients with medial knee osteoarthritis to provide relief in terms of pain reduction, returning to regular physical activities, and enhancing the quality of life. Methods used to evaluate and monitor the effectiveness of these devices on patients' health are categorized into three broad categories (perception-, biochemical-, and morphology-based), depending upon the process and tools used. The main focus of these methods is on the short-term clinical outcome (pain or unloading efficiency). There is a significant technical, research, and clinical literature gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments. Future research directions may complement existing methods with advanced quantitative imaging (morphological, biochemical, and molecular) and numerical simulation are discussed as they offer potential in assessing long-term and post-bracing effects on the knee joint.

The ionic contribution of proteoglycans to mechanical stiffness of the meniscus

Load transmission is an important function of the meniscus. In articular cartilage, proteoglycans help maintain hydration via negatively charged moieties. We aimed to investigate the influence of electrostatic effects on stiffness of meniscal tissue. Circular discs from bovine menisci of 8 mm diameter and 5 mm thickness were placed within a confined compression chamber. The apparatus was bathed in distilled water, 0.14 M PBS or 3 M PBS before being subjected to 5% ramp compressive strain and held for 300s. FEBio software was used to fit resultant relaxation curves to a non-linear poroviscoelastic model with strain dependent Holmes-Mow permeability. Analysis was conducted using one-way ANOVA with Tukey post-hoc analysis. 10 samples were tested in each solution. Significant differences (p < 0.05) were observed between the values for Young's modulus, zero strain dependent permeability and the viscoelastic coefficient for samples tested in 3 M PBS as compared to deionised water/0.14 M PBS. No significant differences were observed in the strain dependent/stiffening coefficients or the relaxation time. Approximately 79% of the stiffness of the meniscus appears attributable to ionic effects. Ionic effects play a significant role in the mechanical stiffness of the meniscus. It is important to include the influence of ionic effects when developing mathematical models of this tissue.

Head-to-nerve analysis of electromechanical impairments of diffuse axonal injury

The aim was to investigate mechanical and functional failure of diffuse axonal injury (DAI) in nerve bundles following frontal head impacts, by finite element simulations. Anatomical changes following traumatic brain injury are simulated at the macroscale by using a 3D head model. Frontal head impacts at speeds of 2.5-7.5 m/s induce mild-to-moderate DAI in the white matter of the brain. Investigation of the changes in induced electromechanical responses at the cellular level is carried out in two scaled nerve bundle models, one with myelinated nerve fibres, the other with unmyelinated nerve fibres. DAI occurrence is simulated by using a real-time fully coupled electromechanical framework, which combines a modulated threshold for spiking activation and independent alteration of the electrical properties for each three-layer fibre in the nerve bundle models. The magnitudes of simulated strains in the white matter of the brain model are used to determine the displacement boundary conditions in elongation simulations using the 3D nerve bundle models. At high impact speed, mechanical failure occurs at lower strain values in large unmyelinated bundles than in myelinated bundles or small unmyelinated bundles; signal propagation continues in large myelinated bundles during and after loading, although there is a large shift in baseline voltage during loading; a linear relationship is observed between the generated plastic strain in the nerve bundle models and the impact speed and nominal strains of the head model. The myelin layer protects the fibre from mechanical damage, preserving its functionalities.

Virtual trial to evaluate the robustness of cementless femoral stems to patient and surgical variation

Primary stability is essential for the success of cementless femoral stems. In this study, patient specific finite element (FE) models were used to assess changes in primary stability due to variability in patient anatomy, bone properties and stem alignment for two commonly used cementless femoral stems, Corail® and Summit® (DePuy Synthes, Warsaw, USA). Computed-tomography images of the femur were obtained for 8 males and 8 females. An automated algorithm was used to determine the stem position and size which minimized the endo-cortical space, and then span the plausible surgical envelope of implant positions constrained by the endo-cortical boundary. A total of 1952 models were generated and ran, each with a unique alignment scenario. Peak hip contact and muscle forces for stair climbing were scaled to the donor's body weight and applied to the model. The primary stability was assessed by comparing the implant micromotion and peri-prosthetic strains to thresholds (150 μm and 7000 µε, respectively) above which fibrous tissue differentiation and bone damage are expected to prevail. Despite the wide range of implant positions included, FE prediction were mostly below the thresholds (medians: Corail®: 20-74 µm and 1150-2884 µε, Summit®: 25-111 µm and 860-3010 µε), but sensitivity of micromotion and interfacial strains varied across femora, with the majority being sensitive (p < 0.0029) to average bone mineral density, cranio-caudal angle, post-implantation anteversion angle and lateral offset of the femur. The results confirm the relationship between implant position and primary stability was highly dependent on the patient and the stem design used.

Cancellous bone and theropod dinosaur locomotion. Part II-a new approach to inferring posture and locomotor biomechanics in extinct tetrapod vertebrates

This paper is the second of a three-part series that investigates the architecture of cancellous bone in the main hindlimb bones of theropod dinosaurs, and uses cancellous bone architectural patterns to infer locomotor biomechanics in extinct non-avian species. Cancellous bone is widely known to be highly sensitive to its mechanical environment, and therefore has the potential to provide insight into locomotor biomechanics in extinct tetrapod vertebrates such as dinosaurs. Here in Part II, a new biomechanical modelling approach is outlined, one which mechanistically links cancellous bone architectural patterns with three-dimensional musculoskeletal and finite element modelling of the hindlimb. In particular, the architecture of cancellous bone is used to derive a single 'characteristic posture' for a given species-one in which bone continuum-level principal stresses best align with cancellous bone fabric-and thereby clarify hindlimb locomotor biomechanics. The quasi-static approach was validated for an extant theropod, the chicken, and is shown to provide a good estimate of limb posture at around mid-stance. It also provides reasonable predictions of bone loading mechanics, especially for the proximal hindlimb, and also provides a broadly accurate assessment of muscle recruitment insofar as limb stabilization is concerned. In addition to being useful for better understanding locomotor biomechanics in extant species, the approach hence provides a new avenue by which to analyse, test and refine palaeobiomechanical hypotheses, not just for extinct theropods, but potentially many other extinct tetrapod groups as well.

Cancellous bone and theropod dinosaur locomotion. Part III-Inferring posture and locomotor biomechanics in extinct theropods, and its evolution on the line to birds

This paper is the last of a three-part series that investigates the architecture of cancellous bone in the main hindlimb bones of theropod dinosaurs, and uses cancellous bone architectural patterns to infer locomotor biomechanics in extinct non-avian species. Cancellous bone is highly sensitive to its prevailing mechanical environment, and may therefore help further understanding of locomotor biomechanics in extinct tetrapod vertebrates such as dinosaurs. Here in Part III, the biomechanical modelling approach derived previously was applied to two species of extinct, non-avian theropods, Daspletosaurus torosus and Troodon formosus. Observed cancellous bone architectural patterns were linked with quasi-static, three-dimensional musculoskeletal and finite element models of the hindlimb of both species, and used to derive characteristic postures that best aligned continuum-level principal stresses with cancellous bone fabric. The posture identified for Daspletosaurus was largely upright, with a subvertical femoral orientation, whilst that identified for Troodon was more crouched, but not to the degree observed in extant birds. In addition to providing new insight on posture and limb articulation, this study also tested previous hypotheses of limb bone loading mechanics and muscular control strategies in non-avian theropods, and how these aspects evolved on the line to birds. The results support the hypothesis that an upright femoral posture is correlated with bending-dominant bone loading and abduction-based muscular support of the hip, whereas a crouched femoral posture is correlated with torsion-dominant bone loading and long-axis rotation-based muscular support. Moreover, the results of this study also support the inference that hindlimb posture, bone loading mechanics and muscular support strategies evolved in a gradual fashion along the line to extant birds.

Modular femoral neck failure after revision of a total hip arthroplasty: a finite element analysis

The authors report on a case of modular femoral neck fracture which appeared 21 months after revision of acetabular component. The revision surgery was performed 8 years after the primary total hip arthroplasty due to aseptic loosening of the acetabular component. During acetabular revision, the primary implanted short (S, - 3.5 mm) femoral head was also exchanged with extra-long (XL, + 7.0 mm) femoral head fitting the modular femoral neck with a longer lever arm. Numerical analysis has shown that this has resulted in a 19.9% increase in tensile stress at the neck-stem coupling during normal walking cycle. This could result in microcrack initiation and propagation and finally lead to modular neck failure of the otherwise well-fixed stem. Surgeons should avoid excessive loading of the exchangeable neck (dual-modular) femoral stem designs as the stem-neck couplings are subject to corrosion and are not as reliable as monoblock stems.

A three-dimensional visco-hyperelastic FE model for simulating the mechanical dynamic response of preloaded phalanges

This study lays the groundwork for a multi-scale strategy that will lead to a better understanding and prediction of the effects of vibration on the digital arterial network. This is accomplished by modelling the mechanical and biological factors that could disturb the basal vasoconstriction balance in the fingertip. The first stage of this novel approach involved building and validating an original dissipative constitutive law for the fingertip soft tissue for the purpose of finite element modelling of the mechanical response of preloaded phalanges in vibration. This visco-hyperelastic constitutive law was established by means of a two-stage procedure for combining a classical pure static nonlinear law with an original dissipative model. First, the parameters of an Ogden-Hill pure static nonlinear constitutive law were identified using a constrained optimisation algorithm. Second, an original viscous dissipation model was proposed in the spectral domain. This model is based on the linearization of the nonlinear quasi-linear viscoelasticity law and the use of a viscoelastic relaxation modulus, expressed as a continuous distribution of relaxation spectra suitable for living tissues. The experimental data used to fit this model were the static and dynamic stiffnesses of preloaded fingertips acquired from a group of 20 subjects. The relative errors between the measured and simulated stiffnesses were less than 5% in the static procedure and approximately 8% using dynamic analysis. The computed mechanical pressure and maximal tangential stress within the fingertip were high in the soft tissues close to the vibration excitation and also in the bones and interphalangeal cartilages far from the vibration source. Mechanical power was only dissipated significantly in the immediate vicinity of the contact area between the probe and the finger. The main contribution of this study was to implement and identify the parameters of a new spectral dissipative law for fingertip soft tissues. This work may apply in occupational health for modifying the vibration dose assessment or for the follow-up and screening of connective tissue diseases.

Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage

PURPOSE

The purpose of this study was to analyse the resultant stress induced by joint-line obliquity after HTO for varus knee deformity using a three-dimensional (3D) finite element model analysis.

METHODS

The geometrical bone data used in this study were derived from commercially available human bone digital anatomy media. The 3D knee models were developed using 3D computer-aided design software. The articular surface was overlaid with a 2-mm-thick cartilage layer for both femoral and tibial condyles. Ligament structures were simulated based on properties reported in previous anatomical studies. Regarding the loading condition, isolated axial loads of 1200 N with lateral joint-line inclinations of 2.5°, 5°, 7.5°, and 10° in reference to the horizontal axis were applied to the femur to simulate the mechanical environment in a knee with joint-line obliquity.

RESULTS

A steep rise of shear stress in the medial compartment was noted in the model with obliquity of 5° or more. This laterally directed shear stress exhibited an incremental increase in accordance with the obliquity angle. The maximum shear stress value in the medial cartilage increased from 1.6 MPa for the normal knee to 3.3, 5.2, and 7.2 MPa in the joint-line obliquity models with 5°, 7.5°, and 10° of obliquity, respectively.

CONCLUSIONS

The effects of HTO for varus knee deformity on the amount/distribution of stresses in the articular cartilage were analysed using a 3D finite element model. It was shown that joint-line obliquity of more than 5° induced excessive shear stress in the tibial articular cartilage. A large amount of correction in OWHTO with a resultant joint-line obliquity of 5° or more may induce detrimental stress to the articular cartilage. Double-level osteotomy should be considered as a surgical option in this situation.

Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?: Towards computational modelling in daily clinical practice

OBJECTIVES

In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians.

METHODS

A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians.

RESULTS

In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments.

CONCLUSION

FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines.Cite this article: F. Eggermont, L. C. Derikx, N. Verdonschot, I. C. M. van der Geest, M. A. A. de Jong, A. Snyers, Y. M. van der Linden, E. Tanck. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians? Towards computational modelling in daily clinical practice. Bone Joint Res 2018;7:430-439. DOI: 10.1302/2046-3758.76.BJR-2017-0325.R2.

Influence of geometry on proximal femoral shaft strains: Implications for atypical femoral fracture

INTRODUCTION

Atypical femoral fractures (AFF) are characterized as low-energy fractures of the femoral shaft or subtrochanteric region. Femoral geometry is known to play a role in AFF risk; it is hypothesized that high-risk geometries are associated with elevated femoral shaft strain. However, it is not well known which geometric parameters have the greatest effect on strain, or whether interaction between parameters is significant. The purpose of this study was to thoroughly quantify the relationship between femoral geometry and diaphyseal strain, using patient specific finite element (FE) modelling in concert with parametric mesh morphing.

METHODS

Ten FE models were generated from computed tomography (CT) images of cadaveric femora. Heterogeneous material properties were assigned based on average CT intensities at element locations and models were subject to loads and boundary conditions representing the stance phase of gait. Mesh morphing was used to manipulate 8 geometric parameters: neck shaft angle (NSA), neck version angle (NV), neck length (NL), femoral length (FL), lateral bowing angle (L.Bow), anterior bowing angle (A.Bow), shaft diameter (S.Dia), and cortical bone thickness (C·Th). A 2-Level full factorial analysis was used to explore the effect of different combinations of physiologically realistic minimum and maximum values for each parameter. Statistical analysis (Generalized Estimating Equations) was used to assess main effects and first order interactions of each parameter.

RESULTS

Six independent parameters and seven interaction terms had statistically significant (p<0.05) effects on peak strain and strained volume. For both measures, the greatest changes were caused by S.Dia, L.Bow, and A.Bow, and/or first order interactions involving two of these variables.

CONCLUSIONS

As hypothesized, a large number of geometric measures (six) and first order interactions (seven) are associated with changes in femoral shaft strain. These measures can be evaluated radiographically, which may have important implications for future studies investigating AFF risk in clinical populations.

Multi-speed sedimentation velocity implementation in UltraScan-III

A framework for the global analysis of multi-speed analytical ultracentrifugation sedimentation velocity experiments is presented. We discuss extensions to the adaptive space-time finite element fitting methods implemented in UltraScan-III to model sedimentation velocity experiments where a single run is performed at multiple rotor speeds, and describe extensions in the optimization routines used for fitting experimental data collected at arbitrary multi-speed profiles. Our implementation considers factors such as speed dependent rotor stretching, the resulting radial shifting of the finite element solution's boundary conditions, and changes in the associated time-invariant noise. We also address the calculation of acceleration rates and acceleration zones from existing radial acceleration and time records, as well as utilization of the time state object available at high temporal resolution from the new Beckman Optima AUC instrument. Analysis methods in UltraScan-III support unconstrained models that extract reliable information for both the sedimentation and the diffusion coefficients. These methods do not rely on any assumptions and allow for arbitrary variations in both sedimentation and diffusion transport. We have adapted these routines for the multi-speed case, and developed optimized and general grid based fitting methods to handle changes in the information content of the simulation matrix for different speed steps. New graphical simulation tools are presented that assist the investigator to estimate suitable grid metrics and evaluate information content based on edit profiles for individual experiments.

Population-specific material properties of the implantation site for transcatheter aortic valve replacement finite element simulations

Patient-specific computational models are an established tool to support device development and test under clinically relevant boundary conditions. Potentially, such models could be used to aid the clinical decision-making process for percutaneous valve selection; however, their adoption in clinical practice is still limited to individual cases. To be fully informative, they should include patient-specific data on both anatomy and mechanics of the implantation site. In this work, fourteen patient-specific computational models for transcatheter aortic valve replacement (TAVR) with balloon-expandable Sapien XT devices were retrospectively developed to tune the material parameters of the implantation site mechanical model for the average TAVR population. Pre-procedural computed tomography (CT) images were post-processed to create the 3D patient-specific anatomy of the implantation site. Balloon valvuloplasty and device deployment were simulated with finite element (FE) analysis. Valve leaflets and aortic root were modelled as linear elastic materials, while calcification as elastoplastic. Material properties were initially selected from literature; then, a statistical analysis was designed to investigate the effect of each implantation site material parameter on the implanted stent diameter and thus identify the combination of material parameters for TAVR patients. These numerical models were validated against clinical data. The comparison between stent diameters measured from post-procedural fluoroscopy images and final computational results showed a mean difference of 2.5 ± 3.9%. Moreover, the numerical model detected the presence of paravalvular leakage (PVL) in 79% of cases, as assessed by post-TAVR echocardiographic examination. The final aim was to increase accuracy and reliability of such computational tools for prospective clinical applications.

A methodological framework for detecting ulcers' risk in diabetic foot subjects by combining gait analysis, a new musculoskeletal foot model and a foot finite element model

Diabetic foot is one of the most debilitating complications of diabetes and may lead to plantar ulcers. In the last decade, gait analysis, musculoskeletal modelling (MSM) and finite element modelling (FEM) have shown their ability to contribute to diabetic foot prevention and suggested that the origin of the plantar ulcers is in deeper tissue layers rather than on the plantar surface. Hence the aim of the current work is to develop a methodology that improves FEM-derived foot internal stresses prediction, for diabetic foot prevention applications. A 3D foot FEM was combined with MSM derived force to predict the sites of excessive internal stresses on the foot. In vivo gait analysis data, and an MRI scan of a foot from a healthy subject were acquired and used to develop a six degrees of freedom (6 DOF) foot MSM and a 3D subject-specific foot FEM. Ankle kinematics were applied as boundary conditions to the FEM together with: 1. only Ground Reaction Forces (GRFs); 2. OpenSim derived extrinsic muscles forces estimated with a standard OpenSim MSM; 3. extrinsic muscle forces derived through the (6 DOF) foot MSM; 4. intrinsic and extrinsic muscles forces derived through the 6 DOF foot MSM. For model validation purposes, simulated peak pressures were extracted and compared with those measured experimentally. The importance of foot muscles in controlling plantar pressure distribution and internal stresses is confirmed by the improved accuracy in the estimation of the peak pressures obtained with the inclusion of intrinsic and extrinsic muscle forces.

The development of a new artificial model of a finger for assessing transmitted vibrations

Prolonged exposure of the hand to tool-induced vibrations is associated with the occurrence of conditions such as vibration white finger. This study involves the development of a new artificial model that approximates both loading and vibration behaviour of the human finger. The layered system uses polypropylene "bones", encased in a cylinder of low modulus, room-temperature curing silicone gel (to replicate subcutaneous tissues), with an outer layer of latex (to replicate the dermis and epidermis). A protocol for manufacture was developed and dynamic mechanical analysis was carried out on a range of gels in order to choose a range close to the mechanical properties of the human finger. The load-deflection behaviour under quasi-static loading was obtained using an indenter. The indentation measurements were then compared with a set of validation data obtained from human participant testing under the same conditions. A 2-D FE model of the finger was also used to assess vibration responses using existing parameters for a human finger and those obtained from the tested materials. Vibration analysis was conducted under swept sinusoidal excitations ranging from 10 to 400Hz whilst the FE finger model was pressed 6mm toward the handle. Results were found to compare well. This synthetic test-bed and protocol can now be used in future experiments for assessing finger-transmitted vibrations. For instance, it can aid in assessing anti-vibration glove materials without the need for human subjects and provide consistent control of test parameters such as grip force.

Deep tissue loads in the seated buttocks on an off-loading wheelchair cushion versus air-cell-based and foam cushions: finite element studies

For wheelchair users, a common injury is a sitting-acquired pressure ulcer (PU) which typically onsets near the interface between the ischial tuberosity (IT) and the overlying soft tissues. The risk of developing PUs can be reduced considerably if an adequate cushion is placed on the wheelchair in order to protect tissues from PUs by minimising interface mechanical loads between the body and cushion and also, exposure to internal soft tissue loads. In this work, we studied the biomechanical performances of an off-loading (OL) cushion with limited adjustability, in comparison to a standard foam cushion and a fully adjustable air-cell-based (ACB) cushion. These different cushion design approaches were methodologically and quantitatively analysed and compared here using a finite element (FE) modelling framework. We determined the internal mechanical deformations, strains and stresses in soft tissues of the seated buttocks during symmetric sitting, in a specific anatomy of a person with a spinal cord injury that was acquired during sitting in an open, magnetic resonance imaging configuration. Our results have shown that strains and stresses in muscle, fat and skin tissues are orders of magnitude lower for the ACB cushion with respect to the standard foam and OL cushions. The OL cushion design has taken the approach of protecting at-risk sites of the buttocks by transferring local internal tissue loads away from the ITs and towards the greater trochanters, at the price of increasing exposure to internal tissue loads at sites other than the ITs. The ACB cushion design, however, has taken a different approach, that is, immersion and envelopment of the entire buttocks structure, which is useful for minimising the exposure to internal tissue loads throughout the whole buttocks. Quantifying performances of wheelchair cushions using FE modelling provides insights into deep tissue loads, which is essential for informed decision-making in developing sitting solutions for individuals at risk, as well as for patient groups.

Chamber music: an unusual Helmholtz resonator for song amplification in a Neotropical bush-cricket (Orthoptera, Tettigoniidae)

Animals use sound for communication, with high-amplitude signals being selected for attracting mates or deterring rivals. High amplitudes are attained by employing primary resonators in sound-producing structures to amplify the signal (e.g. avian syrinx). Some species actively exploit acoustic properties of natural structures to enhance signal transmission by using these as secondary resonators (e.g. tree-hole frogs). Male bush-crickets produce sound by tegminal stridulation and often use specialised wing areas as primary resonators. Interestingly, Acanthacara acuta, a Neotropical bush-cricket, exhibits an unusual pronotal inflation, forming a chamber covering the wings. It has been suggested that such pronotal chambers enhance amplitude and tuning of the signal by constituting a (secondary) Helmholtz resonator. If true, the intact system - when stimulated sympathetically with broadband sound - should show clear resonance around the song carrier frequency which should be largely independent of pronotum material, and change when the system is destroyed. Using laser Doppler vibrometry on living and preserved specimens, microcomputed tomography, 3D-printed models and finite element modelling, we show that the pronotal chamber not only functions as a Helmholtz resonator owing to its intact morphology but also resonates at frequencies of the calling song on itself, making song production a three-resonator system.

Cellular mechanosensitivity to substrate stiffness decreases with increasing dissimilarity to cell stiffness

Computational modelling has received increasing attention to investigate multi-scale coupled problems in micro-heterogeneous biological structures such as cells. In the current study, we investigated for a single cell the effects of (1) different cell-substrate attachment (2) and different substrate modulus [Formula: see text] on intracellular deformations. A fibroblast was geometrically reconstructed from confocal micrographs. Finite element models of the cell on a planar substrate were developed. Intracellular deformations due to substrate stretch of [Formula: see text], were assessed for: (1) cell-substrate attachment implemented as full basal contact (FC) and 124 focal adhesions (FA), respectively, and [Formula: see text]140 KPa and (2) [Formula: see text], 140, 1000, and 10,000 KPa, respectively, and FA attachment. The largest strains in cytosol, nucleus and cell membrane were higher for FC (1.35[Formula: see text], 0.235[Formula: see text] and 0.6[Formula: see text]) than for FA attachment (0.0952[Formula: see text], 0.0472[Formula: see text] and 0.05[Formula: see text]). For increasing [Formula: see text], the largest maximum principal strain was 4.4[Formula: see text], 5[Formula: see text], 5.3[Formula: see text] and 5.3[Formula: see text] in the membrane, 9.5[Formula: see text], 1.1[Formula: see text], 1.2[Formula: see text] and 1.2[Formula: see text] in the cytosol, and 4.5[Formula: see text], 5.3[Formula: see text], 5.7[Formula: see text] and 5.7[Formula: see text] in the nucleus. The results show (1) the importance of representing FA in cell models and (2) higher cellular mechanical sensitivity for substrate stiffness changes in the range of cell stiffness. The latter indicates that matching substrate stiffness to cell stiffness, and moderate variation of the former is very effective for controlled variation of cell deformation. The developed methodology is useful for parametric studies on cellular mechanics to obtain quantitative data of subcellular strains and stresses that cannot easily be measured experimentally.

Impact of anchor type on porcine lumbar biomechanics: Finite element modelling and in-vitro validation

BACKGROUND

Rigid posterior implants used for spinal stabilization can be anchored to the vertebrae using pedicle screws or screws combined with transverse process hooks. In the present study, a finite element model of a porcine lumbar spine instrumented with screws and hooks is presented and validated.

METHODS

The porcine lumbar spine model was validated using in-vitro measurements on six porcine specimens. Validation metrics included intervertebral rotations (L1 to L6) and nucleus pressure in the topmost cranial instrumented disc. The model was used to compare the biomechanical effect of anchor types.

FINDINGS

Good agreement was observed between the model and validation experiments. For upper transverse hooks construct, intervertebral rotations increased at the upper instrumented vertebra and decreased at the adjacent level. Additionally, nucleus pressures and stress on the annulus decreased in the adjacent disc and increased in the upper instrumented disc. The pull-out forces predicted for both anchor configurations were significantly lower than the pull-out strength found in the literature.

INTERPRETATION

These numerical observations suggest that upper transverse process hooks constructs reduce the mobility gradient and cause less stress in the adjacent disc, which could potentially reduce adjacent segment disease and proximal junction kyphosis incidence without increasing the risk of fixation failure. Future work needs to assess the long-term effect of such constructs on clinical and functional outcomes.

Total ankle replacement design and positioning affect implant-bone micromotion and bone strains

•

A finite element model was developed to calculate micromotion of ankle implants.

•

Both optimally-positioned and malpositioned cases were considered.

•

Fixation nearer to the joint line relying on plural pegs improved implant stability.

•

Gaps between the implant and bone greatly increased micromotion and bone strains.

Implant loosening – commonly linked with elevated initial micromotion – is the primary indication for total ankle replacement (TAR) revision. Finite element modelling has not been used to assess micromotion of TAR implants; additionally, the biomechanical consequences of TAR malpositioning – previously linked with higher failure rates – remain unexplored. The aim of this study was to estimate implant-bone micromotion and peri-implant bone strains for optimally positioned and malpositioned TAR prostheses, and thereby identify fixation features and malpositioning scenarios increasing the risk of loosening. Finite element models simulating three of the most commonly used TAR devices (BOX^®, Mobility^® and Salto^®) implanted into the tibia/talus and subjected to physiological loads were developed. Mobility and Salto demonstrated the largest micromotion of all tibial and talar components, respectively. Any malpositioning of the implant creating a gap between it and the bone resulted in a considerable increase in micromotion and bone strains. It was concluded that better primary stability can be achieved through fixation nearer to the joint line and/or while relying on more than a single peg. Incomplete seating on the bone may result in considerably elevated implant-bone micromotion and bone strains, thereby increasing the risk for TAR failure.

A finite element model of a six-year-old child for simulating pedestrian accidents

Child pedestrian protection deserves more attention in vehicle safety design since they are the most vulnerable road users who face the highest mortality rate. Pediatric Finite Element (FE) models could be used to simulate and understand the pedestrian injury mechanisms during crashes in order to mitigate them. Thus, the objective of the study was to develop a computationally efficient (simplified) six-year-old (6YO-PS) pedestrian FE model and validate it based on the latest published pediatric data. The 6YO-PS FE model was developed by morphing the existing GHBMC adult pedestrian model. Retrospective scan data were used to locally adjust the geometry as needed for accuracy. Component test simulations focused only the lower extremities and pelvis, which are the first body regions impacted during pedestrian accidents. Three-point bending test simulations were performed on the femur and tibia with adult material properties and then updated using child material properties. Pelvis impact and knee bending tests were also simulated. Finally, a series of pediatric Car-to-Pedestrian Collision (CPC) were simulated with pre-impact velocities ranging from 20km/h up to 60km/h. The bone models assigned pediatric material properties showed lower stiffness and a good match in terms of fracture force to the test data (less than 6% error). The pelvis impact force predicted by the child model showed a similar trend with test data. The whole pedestrian model was stable during CPC simulations and predicted common pedestrian injuries. Overall, the 6YO-PS FE model developed in this study showed good biofidelity at component level (lower extremity and pelvis) and stability in CPC simulations. While more validations would improve it, the current model could be used to investigate the lower limb injury mechanisms and in the prediction of the impact parameters as specified in regulatory testing protocols.

Impact of material and morphological parameters on the mechanical response of the lumbar spine - A finite element sensitivity study

Finite element models are frequently used to study lumbar spinal biomechanics. Deterministic models are used to reflect a certain configuration, including the means of geometrical and material properties, while probabilistic models account for the inherent variability in the population. Because model parameters are generally uncertain, their predictive power is frequently questioned. In the present study, we determined the sensitivities of spinal forces and motions to material parameters of intervertebral discs, vertebrae, and ligaments and to lumbar morphology. We performed 1200 model simulations using a generic model of the human lumbar spine loaded under pure moments. Coefficients of determination and of variation were determined for all parameter and response combinations. Material properties of the vertebrae displayed the least impact on results, whereas those of the discs and morphology impacted most. The most affected results were the axial compression forces in the vertebral body and in several ligaments during flexion and the facet-joint forces during extension. Intervertebral rotations were considerably affected only when several parameters were varied simultaneously. Results can be used to decide which model parameters require careful consideration in deterministic models and which parameters might be omitted in probabilistic studies. Findings allow quantitative estimation of a model׳s precision.

Quantifying the competing relationship between adduction range of motion and baseplate micromotion with lateralization of reverse total shoulder arthroplasty

Lateralizing the center of rotation (COR) of reverse total shoulder arthroplasty (rTSA) could improve functional outcomes and mitigate scapular notching, a commonly occurring complication of the procedure. However, resulting increases in torque at the bone-implant interface may negatively affect initial fixation of the glenoid-side component, especially if only two fixation screws can be placed. Shoulder-specific finite element (FE) models of four fresh-frozen cadaveric shoulders were constructed. Scapular geometry and material property distributions were derived from CT data. Generic baseplates with two and four fixation screws were virtually implanted, after which superiorly-oriented shear loads, accompanied by a compressive load, were applied incrementally further from the glenoid surface to simulate lateralization of the COR. Relationships between lateralization, adduction range of motion (ROM), the number of fixation screws and micromotion of the baseplate (initial implant fixation) were characterized. Lateralization significantly increases micromotion (p=0.015) and adduction ROM (p=0.001). Using two, versus four, baseplate fixation screws significantly increases micromotion (p=0.008). The effect of lateralization and the number of screws on adduction ROM and baseplate fixation is variable on a shoulder-specific basis. Trade-offs exist between functional outcomes, namely adduction ROM, and initial implant fixation and the negative effect of lateralization on implant fixation is amplified when only two fixation screws are used. The possibility of lateralizing the COR in order to improve functional outcomes of the procedure should be considered on a patient-specific basis accounting for factors such as availability and quality of bone stock.

Material properties of bovine intervertebral discs across strain rates

The intervertebral disc (IVD) is a complex structure responsible for distributing compressive loading to adjacent vertebrae and allowing the vertebral column to bend and twist. To study the mechanical behaviour of individual components of the IVD, it is common for specimens to be dissected away from their surrounding tissues for mechanical testing. However, disrupting the continuity of the IVD to obtain material properties of each component separately may result in erroneous values. In this study, an inverse finite element (FE) modelling optimisation algorithm has been used to obtain material properties of the IVD across strain rates, therefore bypassing the need to harvest individual samples of each component. Uniaxial compression was applied to ten fresh-frozen bovine intervertebral discs at strain rates of 10^-3-1/s. The experimental data were fed into the inverse FE optimisation algorithm and each experiment was simulated using the subject specific FE model of the respective specimen. A sensitivity analysis revealed that the IVD's response was most dependent upon the Young's modulus (YM) of the fibre bundles and therefore this was chosen to be the parameter to optimise. Based on the obtained YM values for each test corresponding to a different strain rate (ε̇), the following relationship was derived:YM=35.5lnε̇+527.5. These properties can be used in finite element models of the IVD that aim to simulate spinal biomechanics across loading rates.

Vademecum-based approach to multi-scale topological material design

The work deals on computational design of structural materials by resorting to computational homogenization and topological optimization techniques. The goal is then to minimize the structural (macro-scale) compliance by appropriately designing the material distribution (microstructure) at a lower scale (micro-scale), which, in turn, rules the mechanical properties of the material. The specific features of the proposed approach are: (1) The cost function to be optimized (structural stiffness) is defined at the macro-scale, whereas the design variables defining the micro-structural topology lie on the low scale. Therefore a coupled, two-scale (macro/micro), optimization problem is solved unlike the classical, single-scale, topological optimization problems. (2) To overcome the exorbitant computational cost stemming from the multiplicative character of the aforementioned multiscale approach, a specific strategy, based on the consultation of a discrete material catalog of micro-scale optimized topologies (Computational Vademecum) is used. The Computational Vademecum is computed in an offline process, which is performed only once for every constitutive-material, and it can be subsequently consulted as many times as desired in the online design process. This results into a large diminution of the resulting computational costs, which make affordable the proposed methodology for multiscale computational material design. Some representative examples assess the performance of the considered approach.

Can finite element models of ballooning procedures yield mechanical response of the cardiovascular site to overexpansion?

Patient-specific numerical models could aid the decision-making process for percutaneous valve selection; in order to be fully informative, they should include patient-specific data of both anatomy and mechanics of the implantation site. This information can be derived from routine clinical imaging during the cardiac cycle, but data on the implantation site mechanical response to device expansion are not routinely available.

We aim to derive the implantation site response to overexpansion by monitoring pressure/dimensional changes during balloon sizing procedures and by applying a reverse engineering approach using a validated computational balloon model. This study presents the proof of concept for such computational framework tested in-vitro. A finite element (FE) model of a PTS-X405 sizing balloon (NuMed, Inc., USA) was created and validated against bench tests carried out on an ad hoc experimental apparatus: first on the balloon alone to replicate free expansion; second on the inflation of the balloon in a rapid prototyped cylinder with material deemed suitable for replicating pulmonary arteries in order to validate balloon/implantation site interaction algorithm.

Finally, the balloon was inflated inside a compliant rapid prototyped patient-specific right ventricular outflow tract to test the validity of the approach. The corresponding FE simulation was set up to iteratively infer the mechanical response of the anatomical model. The test in this simplified condition confirmed the feasibility of the proposed approach and the potential for this methodology to provide patient-specific information on mechanical response of the implantation site when overexpanded, ultimately for more realistic computational simulations in patient-specific settings.

Computing the stresses and deformations of the human eye components due to a high explosive detonation using fluid-structure interaction model

INTRODUCTION

In spite the fact that a very small human body surface area is comprised by the eye, its wounds due to detonation have recently been dramatically amplified. Although many efforts have been devoted to measure injury of the globe, there is still a lack of knowledge on the injury mechanism due to Primary Blast Wave (PBW). The goal of this study was to determine the stresses and deformations of the human eye components, including the cornea, aqueous, iris, ciliary body, lens, vitreous, retina, sclera, optic nerve, and muscles, attributed to PBW induced by trinitrotoluene (TNT) explosion via a Lagrangian-Eulerian computational coupling model.

MATERIALS AND METHODS

Magnetic Resonance Imaging (MRI) was employed to establish a Finite Element (FE) model of the human eye according to a normal human eye. The solid components of the eye were modelled as Lagrangian mesh, while an explosive TNT, air domain, and aqueous were modelled using Arbitrary Lagrangian-Eulerian (ALE) mesh. Nonlinear dynamic FE simulations were accomplished using the explicit FE code, namely LS-DYNA. In order to simulate the blast wave generation, propagation, and interaction with the eye, the ALE formulation with Jones-Wilkins-Lee (JWL) equation defining the explosive material were employed.

RESULTS

The results revealed a peak stress of 135.70kPa brought about by detonation upsurge on the cornea at the distance of 25cm. The highest von Mises stresses were observed on the sclera (267.3kPa), whereas the lowest one was seen on the vitreous body (0.002kPa). The results also showed a relatively high resultant displacement for the macula as well as a high variation for the radius of curvature for the cornea and lens, which can result in both macular holes, optic nerve damage and, consequently, vision loss.

CONCLUSION

These results may have implications not only for understanding the value of stresses and strains in the human eye components but also giving an outlook about the process of PBW triggers damage to the eye.

Mechanical testing and modelling of the Universal 2 implant

Understanding the load mechanics of orthopaedic implants is important to be able to predict their behaviour in-vivo. Much research, both mechanical and clinical, has been carried out on hip and knee implants, but less has been written about the mechanics of wrist implants. In this paper, the load mechanics of the Universal 2 wrist implant have been measured using two types of measuring techniques, strain gauges and Fibre Bragg Grating measurements to measure strains. The results were compared to a finite element model of the implant. The results showed that the computational results were in good agreement with the experimental results. Better understanding of the load mechanics of wrist implants, using models and experimental results can catalyse the development of future generation implants.

An Image-Based Model of Fluid Flow Through Lymph Nodes

The lymphatic system returns fluid to the bloodstream from the tissues to maintain tissue fluid homeostasis. Lymph nodes distributed throughout the system filter the lymphatic fluid. The afferent and efferent lymph flow conditions of lymph nodes can be measured in experiments; however, it is difficult to measure the flow within the nodes. In this paper, we present an image-based modelling approach to investigating how the internal structure of the node affects the fluid flow pathways within the node. Selective plane illumination microscopy images of murine lymph nodes are used to identify the geometry and structure of the tissue within the node and to determine the permeability of the lymph node interstitium to lymphatic fluid. Experimental data are used to determine boundary conditions and optimise the parameters for the model. The numerical simulations conducted within the model are implemented in COMSOL Multiphysics, a commercial finite element analysis software. The parameter fitting resulted in the estimate that the average permeability for lymph node tissue is of the order of magnitude of [Formula: see text]. Our modelling shows that the flow predominantly takes a direct path between the afferent and efferent lymphatics and that fluid is both filtered and absorbed across the blood vessel boundaries. The amount that is absorbed or extravasated in the model is dependent on the efferent lymphatic lumen fluid pressure.

Transmission of force to the hyoid bone during manual strangulation: Simulation using finite element numerical models

INTRODUCTION

Strangulation is a medicolegal form of mechanical asphyxia, and can be difficult to identify if cutaneous damage to the neck is limited. We began by creating a numerical model of a hyoid bone with adjustable anthropometric parameters and then subjected our model to compression simulating a precision grip on the neck from the front.

MATERIALS AND METHODS

We selected six bones from the 77 hyoid bones contained in the database we created during a previous study led by our laboratory, in which we demonstrated the sexual dimorphism of this bone and identified the minimal force required for fracture. The anthropometric characteristics of these six bones (angle, length and width) corresponded to those of the 10th, 50th and 90th percentiles from cluster 1 (male individuals) and cluster 2 (female individuals), respectively. After enhancing, developing and meshing the selected 3D models, we analysed and reproduced simulation conditions that were as close as possible to the in vivo conditions of neck strangulation from the front (area of pressure on the bone, tissue environment, and biological variability of this bone).

RESULTS

We modelled the six numerical hyoid bone models using the finite element method. For all models, the simulation of mechanical pressure applied to simulate anterior strangulation resulted in fractures. The forces required to produce these fractures matched the results obtained in the experimental testing of dissected hyoid bones.

CONCLUSION

Six finite element numerical models were created, covering the anthropometric morphological variability of the hyoid bone. These six models enabled numerical simulation of the in vivo behaviour of a hyoid bone subjected to one-handed strangulation.

Consideration of multiple load cases is critical in modelling orthotropic bone adaptation in the femur

Functional adaptation of the femur has been investigated in several studies by embedding bone remodelling algorithms in finite element (FE) models, with simplifications often made to the representation of bone's material symmetry and mechanical environment. An orthotropic strain-driven adaptation algorithm is proposed in order to predict the femur's volumetric material property distribution and directionality of its internal structures within a continuum. The algorithm was applied to a FE model of the femur, with muscles, ligaments and joints included explicitly. Multiple load cases representing distinct frames of two activities of daily living (walking and stair climbing) were considered. It is hypothesised that low shear moduli occur in areas of bone that are simply loaded and high shear moduli in areas subjected to complex loading conditions. In addition, it is investigated whether material properties of different femoral regions are stimulated by different activities. The loading and boundary conditions were considered to provide a physiological mechanical environment. The resulting volumetric material property distribution and directionalities agreed with ex vivo imaging data for the whole femur. Regions where non-orthogonal trabecular crossing has been documented coincided with higher values of predicted shear moduli. The topological influence of the different activities modelled was analysed. The influence of stair climbing on the properties of the femoral neck region is highlighted. It is recommended that multiple load cases should be considered when modelling bone adaptation. The orthotropic model of the complete femur is released with this study.

Numerical analysis of the relationship between the area of target tissue necrosis and the size of target tissue in liver tumours with pulsed radiofrequency ablation

PURPOSE

Radiofrequency ablation (RFA) is currently restricted to the treatment of target tissues with a small size (<3 cm in diameter). To overcome this problem with RFA, some phenomena need to be understood first. The study presented in this paper investigated the relationship between the area of target tissue necrosis (TTN) and the size of target tissue in pulsed radiofrequency ablation (PRFA).

MATERIALS AND METHODS

Liver tumour, one of the common targets of RFA in clinical practice, was used as the target tissue in this study. Two types of pulsed RF power supply methods (half-square and half-sine) and three target tissues with different sizes (25 mm, 30 mm and 35 mm in diameter) were studied using finite element modelling. The finite element model (FEM) was validated by using an in vitro experiment with porcine liver tissue. The first roll-off occurrence or 720 s, whichever occurs first, was chosen as the ablation termination criterion in this study.

RESULTS

For each target tissue size, the largest TTN area was obtained using the maximum voltage applied (MVA) without roll-off occurrence. In this study, target tissues with a 25 mm diameter can be ablated cleanly but target tissues with 30-mm and 35-mm failed to be ablated.

CONCLUSIONS

The half-square PRFA could achieve a larger TTN area than the half-sine PRFA. The MVA decreases with an increase in the target tissue diameter in both the half-square PRFA and the half-sine PRFA. The findings of this study are in agreement with the clinical results that lesions (≥ 3 cm in diameter) have less favourable results from RFA.

Microstructure and micromechanics of the heart urchin test from X-ray tomography

The microstructure of many echinoid species has long fascinated scientists because of its high porosity and outstanding mechanical properties. We have used X-ray microtomography to examine the test of Echinocardium cordatum (heart urchin), a burrowing cousin of the more commonly known sea urchins. Three dimensional imaging demonstrates that the bulk of the test is composed of only two distinct, highly porous, fenestrated regions (stereom), in which the thickness of the struts is constant. Different degrees of porosity are achieved by varying the spacing of the struts. Drawing an analogy to vertebrate trabecular bone, where for example, human bone has a connectivity density of ≈1/mm(3), we measure up to 150,000 strut connections per mm(3). Simulations of mechanical loading using finite element calculations indicate that the test performs at very close to the optimum expected for foams, highlighting the functional link between structure and mechanical properties.

Biomechanical properties of the Marfan's aortic root and ascending aorta before and after personalised external aortic root support surgery

Marfan syndrome is an inherited systemic connective tissue disease which may lead to aortic root disease causing dilatation, dissection and rupture of the aorta. The standard treatment is a major operation involving either an artificial valve and aorta or a complex valve repair. More recently, a personalised external aortic root support (PEARS) has been used to strengthen the aorta at an earlier stage of the disease avoiding risk of both rupture and major surgery. The aim of this study was to compare the stress and strain fields of the Marfan aortic root and ascending aorta before and after insertion of PEARS in order to understand its biomechanical implications. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance images in three Marfan patients. For the post-PEARS model, two scenarios were investigated-a bilayer model where PEARS and the aortic wall were treated as separate layers, and a single-layer model where PEARS was incorporated into the aortic wall. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Results from our FE models with patient-specific geometries show that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, these peak values were shifted to the aortic arch, particularly at the interface between the supported and unsupported aorta. Further studies are required to assess the statistical significance of these findings and how PEARS compares with the standard treatment.