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Chancharoen P, Tangpornprasert P, Amarase C, Tantavisut S, Virulsri C. Design of osteosynthesis plate for detecting bone union using wire natural frequency. Sci Rep 2024; 14:12569. [PMID: 38822126 PMCID: PMC11143194 DOI: 10.1038/s41598-024-63530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
We have developed a novel osteosynthesis plate with bone union detection using a wire's natural frequency (BUDWF) to provide the quantitative result of bone union detection. The concept for detecting bone union is measuring the rate of frequency change. The frequency is measured from sound generated from the wire attached to a modified plate. The plate is modified from a Syncera ADLER B0409.10 and attached with 0.3 mm diameter 316L stainless steel wire. The sound generation mechanism was created by PEEK and installed on the plate to generate the sound. The preliminary experiments were conducted on a Sawbones tibia composite mimic. We used the cut Sawbones to create fracture samples with a 0, 0.5, 1-, 2-, and 5-mm gap representing the fractured bone with different gap sizes and prepared uncut Sawbones as a union sample. These samples were tested five times, and the sound was recorded from a condenser microphone and analyzed. We found that the BUDWF can differentiate samples with a fracture gap above 2 mm from the union sample, as the differences in the rates of frequency change between samples with a fracture gap above 2 mm and union samples were statistically significant. However, there was a limitation that the BUDWF plate was still unable to differentiate the 0 mm fracture gap and the union sample in this study.
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Affiliation(s)
- Pisitpong Chancharoen
- Center of Excellence for Prosthetic and Orthopedic Implant, Chulalongkorn University, Bangkok, 10330, Thailand
- Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Pairat Tangpornprasert
- Center of Excellence for Prosthetic and Orthopedic Implant, Chulalongkorn University, Bangkok, 10330, Thailand.
- Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand.
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Chavarin Amarase
- Hip Fracture Research Unit, Department of Orthopedic, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Saran Tantavisut
- Hip Fracture Research Unit, Department of Orthopedic, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chanyaphan Virulsri
- Center of Excellence for Prosthetic and Orthopedic Implant, Chulalongkorn University, Bangkok, 10330, Thailand
- Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand
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2
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Janićijević Ž, Huang T, Bojórquez DIS, Tonmoy TH, Pané S, Makarov D, Baraban L. Design and Development of Transient Sensing Devices for Healthcare Applications. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307232. [PMID: 38484201 PMCID: PMC11132064 DOI: 10.1002/advs.202307232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/12/2023] [Indexed: 05/29/2024]
Abstract
With the ever-growing requirements in the healthcare sector aimed at personalized diagnostics and treatment, continuous and real-time monitoring of relevant parameters is gaining significant traction. In many applications, health status monitoring may be carried out by dedicated wearable or implantable sensing devices only within a defined period and followed by sensor removal without additional risks for the patient. At the same time, disposal of the increasing number of conventional portable electronic devices with short life cycles raises serious environmental concerns due to the dangerous accumulation of electronic and chemical waste. An attractive solution to address these complex and contradictory demands is offered by biodegradable sensing devices. Such devices may be able to perform required tests within a programmed period and then disappear by safe resorption in the body or harmless degradation in the environment. This work critically assesses the design and development concepts related to biodegradable and bioresorbable sensors for healthcare applications. Different aspects are comprehensively addressed, from fundamental material properties and sensing principles to application-tailored designs, fabrication techniques, and device implementations. The emerging approaches spanning the last 5 years are emphasized and a broad insight into the most important challenges and future perspectives of biodegradable sensors in healthcare are provided.
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Affiliation(s)
- Željko Janićijević
- Institute of Radiopharmaceutical Cancer ResearchHelmholtz‐Zentrum Dresden‐Rossendorf e. V.01328DresdenGermany
| | - Tao Huang
- Institute of Radiopharmaceutical Cancer ResearchHelmholtz‐Zentrum Dresden‐Rossendorf e. V.01328DresdenGermany
| | | | - Taufhik Hossain Tonmoy
- Institute of Radiopharmaceutical Cancer ResearchHelmholtz‐Zentrum Dresden‐Rossendorf e. V.01328DresdenGermany
| | - Salvador Pané
- Multi‐Scale Robotics Lab (MSRL)Institute of Robotics & Intelligent Systems (IRIS)ETH ZürichZürich8092Switzerland
| | - Denys Makarov
- Institute of Ion Beam Physics and Materials ResearchHelmholtz‐Zentrum Dresden‐Rossendorf e. V.01328DresdenGermany
| | - Larysa Baraban
- Institute of Radiopharmaceutical Cancer ResearchHelmholtz‐Zentrum Dresden‐Rossendorf e. V.01328DresdenGermany
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Wang J, Chu J, Song J, Li Z. The application of impantable sensors in the musculoskeletal system: a review. Front Bioeng Biotechnol 2024; 12:1270237. [PMID: 38328442 PMCID: PMC10847584 DOI: 10.3389/fbioe.2024.1270237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application.
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Affiliation(s)
- Jinzuo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
| | - Jian Chu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Jinhui Song
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
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Labus KM, Wolynski J, Easley J, Stewart HL, Ilic M, Notaros B, Zagrocki T, Puttlitz CM, McGilvray KC. Employing direct electromagnetic coupling to assess acute fracture healing: An ovine model assessment. Injury 2023; 54:111080. [PMID: 37802738 PMCID: PMC10843464 DOI: 10.1016/j.injury.2023.111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES This study explored the efficacy of collecting temporal fracture site compliance data via an advanced direct electromagnetic coupling (DEC) system equipped with a Vivaldi-type antenna, novel calibration technique, and multi-antenna setup (termed maDEC) as an approach to monitor acute fracture healing progress in a translational large animal model. The overarching goal of this approach was to provide insights into the acute healing dynamics, offering a promising avenue for optimizing fracture management strategies. METHODS A sample of twelve sheep, subjected to ostectomies and intramedullary nail fixations, was divided into two groups, simulating normal and impaired healing scenarios. Sequential maDEC compliance or stiffness measurements and radiographs were taken from the surgery until euthanasia at four or eight weeks and were subsequently compared with post-sacrifice biomechanical, micro-CT, and histological findings. RESULTS The results showed that the maDEC system offered straightforward quantification of fracture site compliance via a multiantenna array. Notably, the rate of change in the maDEC-measured bending stiffness significantly varied between normal and impaired healing groups during both the 4-week (p = 0.04) and 8-week (p = 0.02) periods. In contrast, radiographically derived mRUST healing measurements displayed no significant differences between the groups (p = 0.46). Moreover, the cumulative normalized stiffness maDEC data significantly correlated with post-sacrifice mechanical strength (r2 = 0.80, p < 0.001), micro-CT measurements of bone volume fraction (r2 = 0.60, p = 0.003), and density (r2 = 0.60, p = 0.003), and histomorphometric measurements of new bone area fraction (r2 = 0.61, p = 0.003) and new bone area (r2 = 0.60, p < 0.001). CONCLUSIONS These data indicate that the enhanced maDEC system provides a non-invasive, accurate method to monitor fracture healing during the acute healing phase, showing distinct stiffness profiles between normal and impaired healing groups and offering critical insights into the healing process's progress and efficiency.
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Affiliation(s)
- Kevin M Labus
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jakob Wolynski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Holly L Stewart
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Milan Ilic
- University of Belgrade, School of Electrical Engineering, Belgrade, Serbia
| | - Branislav Notaros
- Electromagnetic Laboratory, Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Taylor Zagrocki
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
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Jeyaraman M, Jayakumar T, Jeyaraman N, Nallakumarasamy A. Sensor Technology in Fracture Healing. Indian J Orthop 2023; 57:1196-1202. [PMID: 37525725 PMCID: PMC10386990 DOI: 10.1007/s43465-023-00933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/08/2023] [Indexed: 08/02/2023]
Abstract
Introduction SMART sensor technology may provide the solution to bridge the gap between the current radiographic determination of fracture healing and clinical assessment. The displacement and rigidity between the fracture ends can be accurately measured using strain gauges. Progressively increasing stiffness is a sign of fracture consolidation which can be monitored using sensors. The design of standard orthopaedic implants can remain the same and needs no major modifications as the sensor can be mounted onto the implant without occupying much space. Data regarding various fracture morphologies and their strain levels throughout the fracture healing process may help develop AI algorithms that can subsequently be used to optimise implant design/materials. Materials and Methods The literature search was performed in PubMed, PubMed Central, Scopus, and Web of Science databases for reviewing and evaluating the published scientific data regarding sensor technology in fracture healing. Results and Interpretation SMART sensor technology comes with a variety of uses such as determining fracture healing progress, predicting early implant failure, and determining fractures liable for non-union to exemplify a few. The main limitations are that it is still in its inception and needs extensive refinement before it becomes widely and routinely used in clinical practice. Nevertheless, with continuous advances in microprocessor technology, research designs, and additive manufacturing, the utilisation and application of SMART implants in the field of trauma and orthopaedic surgery are constantly growing. Conclusion Mass production of such SMART implants will reduce overall production costs and see its use in routine clinical practice in the future and is likely to make a significant contribution in the next industrial revolution termed 'Industry 5.0' which aims at personalised patient-specific implants and devices. SMART sensor technology may, therefore, herald a new era in the field of orthopaedic trauma.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600056 India
| | - Tarun Jayakumar
- Department of Orthopaedics, KIMS-Sunshine Hospital, Hyderabad, Telangana 500003 India
| | - Naveen Jeyaraman
- Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth, Chengalpattu, Tamil Nadu 603108 India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
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Altering the course of fracture healing monitoring. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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7
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Rodham P, Giannoudis PV. Innovations in orthopaedic trauma: Top advancements of the past two decades and predictions for the next two. Injury 2022; 53 Suppl 3:S2-S7. [PMID: 36180258 DOI: 10.1016/j.injury.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/22/2022] [Accepted: 09/02/2022] [Indexed: 02/02/2023]
Abstract
The first Trauma and Orthopaedic unit dates back to 1780, originally dedicated to the treatment of children's deformities. The specialty has subsequently become multifaceted, with a plethora of subspecialty areas of which orthopaedic trauma is the most commonly practiced. Recently there has been a significant demand for an evidence base with more than 130,000 of the 162,000 publications in the last century occurring within the past 20 years. This narrative review will summarise some of the more landmark changes within orthopaedic trauma that have been made within the past 20 years, whilst also attempting to predict where the specialty will continue to develop as we move forward.
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Affiliation(s)
- Paul Rodham
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.
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8
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Sahm F, Freiin Grote V, Zimmermann J, Haack F, Uhrmacher AM, van Rienen U, Bader R, Detsch R, Jonitz-Heincke A. Long-term stimulation with alternating electric fields modulates the differentiation and mineralization of human pre-osteoblasts. Front Physiol 2022; 13:965181. [PMID: 36246121 PMCID: PMC9562827 DOI: 10.3389/fphys.2022.965181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Biophysical stimulation by electric fields can promote bone formation in bone defects of critical size. Even though, long-term effects of alternating electric fields on the differentiation of osteoblasts are not fully understood. Human pre-osteoblasts were stimulated over 31 days to gain more information about these cellular processes. An alternating electric field with 0.7 Vrms and 20 Hz at two distances was applied and viability, mineralization, gene expression, and protein release of differentiation factors were analyzed. The viability was enhanced during the first days of stimulation. A higher electric field resulted in upregulation of typical osteogenic markers like osteoprotegerin, osteopontin, and interleukin-6, but no significant changes in mineralization. Upregulation of the osteogenic markers could be detected with a lower electric field after the first days of stimulation. As a significant increase in the mineralized matrix was identified, an enhanced osteogenesis due to low alternating electric fields can be assumed.
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Affiliation(s)
- Franziska Sahm
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
- *Correspondence: Franziska Sahm, ; Anika Jonitz-Heincke,
| | - Vivica Freiin Grote
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
| | - Julius Zimmermann
- Chair of Theoretical Electrical Engineering, Institute for General Electrical Engineering, University of Rostock, Rostock, Germany
| | - Fiete Haack
- Institute for Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Adelinde M. Uhrmacher
- Institute for Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Ursula van Rienen
- Chair of Theoretical Electrical Engineering, Institute for General Electrical Engineering, University of Rostock, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
- Department Ageing of Individuals and Society, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
| | - Rainer Detsch
- Department of Materials Science and Engineering, Institute of Biomaterials, Friedrich Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Anika Jonitz-Heincke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Rostock, Germany
- *Correspondence: Franziska Sahm, ; Anika Jonitz-Heincke,
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Soares Dos Santos MP, Bernardo RMC. Bioelectronic multifunctional bone implants: recent trends. Bioelectron Med 2022; 8:15. [PMID: 36127721 PMCID: PMC9490885 DOI: 10.1186/s42234-022-00097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
The concept of Instrumented Smart Implant emerged as a leading research topic that aims to revolutionize the field of orthopaedic implantology. These implants have been designed incorporating biophysical therapeutic actuation, bone-implant interface sensing, implant-clinician communication and self-powering ability. The ultimate goal is to implement revist interface, controlled by clinicians/surgeons without troubling the quotidian activities of patients. Developing such high-performance technologies is of utmost importance, as bone replacements are among the most performed surgeries worldwide and implant failure rates can still exceed 10%. In this review paper, an overview to the major breakthroughs carried out in the scope of multifunctional smart bone implants is provided. One can conclude that many challenges must be overcome to successfully develop them as revision-free implants, but their many strengths highlight a huge potential to effectively establish a new generation of high-sophisticated biodevices.
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Affiliation(s)
- Marco P Soares Dos Santos
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), Intelligent Systems Associate Laboratory (LASI), University of Aveiro, Aveiro, Portugal.
| | - Rodrigo M C Bernardo
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), Intelligent Systems Associate Laboratory (LASI), University of Aveiro, Aveiro, Portugal
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10
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Windolf M, Varjas V, Gehweiler D, Schwyn R, Arens D, Constant C, Zeiter S, Richards RG, Ernst M. Continuous Implant Load Monitoring to Assess Bone Healing Status—Evidence from Animal Testing. Medicina (B Aires) 2022; 58:medicina58070858. [PMID: 35888576 PMCID: PMC9321316 DOI: 10.3390/medicina58070858] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Fracture healing is currently assessed through qualitative evaluation of radiographic images, which is highly subjective in nature. Radiographs can only provide snapshots in time, which are limited due to logistics and radiation exposure. We recently proposed assessing the bone healing status through continuous monitoring of the implant load, utilizing an implanted sensor system, the Fracture Monitor. The device telemetrically transmits statistically derived implant parameters via the patient’s mobile phone to assist physicians in diagnostics and treatment decision-making. This preclinical study aims to systematically investigate the device safety and performance in an animal setting. Materials and Methods: Mid-shaft tibial osteotomies of different sizes (0.6–30 mm) were created in eleven Swiss mountain sheep. The bones were stabilized with either a conventional Titanium or stainless-steel locking plate equipped with a Fracture Monitor. Data were continuously collected over the device’s lifetime. Conventional radiographs and clinical CT scans were taken longitudinally over the study period. The radiographs were systematically scored and CTs were evaluated for normalized bone volume in the defect. The animals were euthanized after 9 months. The sensor output was correlated with the radiologic parameters. Tissue samples from the device location were histologically examined. Results: The sensors functioned autonomously for 6.5–8.4 months until energy depletion. No macroscopic or microscopic adverse effects from device implantation were observed. The relative implant loads at 4 and 8 weeks post-operation correlated significantly with the radiographic scores and with the normalized bone volume metric. Conclusions: Continuous implant load monitoring appears as a relevant approach to support and objectify fracture healing assessments and carries a strong potential to enable patient-tailored rehabilitation in the future.
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11
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Hu X, Huang J, Wei Y, Zhao H, Lin S, Hu C, Wang Z, Zhao Z, Zang X. Laser Direct-Write Sensors on Carbon-Fiber-Reinforced Poly-Ether-Ether-Ketone for Smart Orthopedic Implants. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105499. [PMID: 35142105 PMCID: PMC9009116 DOI: 10.1002/advs.202105499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Mechanically close-to-bone carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK)-based orthopedic implants are rising to compete with metal implants, due to their X-ray transparency, superior biocompatibility, and body-environment stability. While real-time strain assessment of implants is crucial for the postsurgery study of fracture union and failure of prostheses, integrating precise and durable sensors on orthopedic implants remains a great challenge. Herein, a laser direct-write technique is presented to pattern conductive features (minimum sheet resistance <1.7 Ω sq-1 ) on CRF-PEEK-based parts, which can act as strain sensors. The as-fabricated sensors exhibit excellent linearity (R2 = 0.997) over the working range (0-2.5% strain). While rigid silicon- or metal-based sensor chips have to be packaged onto flat surfaces, all-carbon-based sensors can be written on the complex curved surfaces of CFR-PEEK joints using a portable laser mounted on a six-axis robotic manipulator. A wireless transmission prototype is also demonstrated using a Bluetooth module. Such results will allow a wider space to design sensors (and arrays) for detailed loading progressing monitoring and personalized diagnostic applications.
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Affiliation(s)
- Xingjian Hu
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
| | - Jincai Huang
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
| | - Yanzhuo Wei
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
| | - Haiyan Zhao
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
| | - Shize Lin
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
| | - Chuxiong Hu
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
| | - Ze Wang
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
| | - Zhe Zhao
- Orthopedics DepartmentBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing100084China
| | - Xining Zang
- Department of Mechanical EngineeringTsinghua UniversityBeijing100084China
- Key Laboratory for Advanced Materials Processing TechnologyMinistry of EducationTsinghua UniversityBeijing100084China
- State Key Laboratory of TribologyTsinghua UniversityBeijing100084China
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12
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Multiscale Sensing of Bone-Implant Loosening for Multifunctional Smart Bone Implants: Using Capacitive Technologies for Precision Controllability. SENSORS 2022; 22:s22072531. [PMID: 35408143 PMCID: PMC9003018 DOI: 10.3390/s22072531] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 02/06/2023]
Abstract
The world population growth and average life expectancy rise have increased the number of people suffering from non-communicable diseases, namely osteoarthritis, a disorder that causes a significant increase in the years lived with disability. Many people who suffer from osteoarthritis undergo replacement surgery. Despite the relatively high success rate, around 10% of patients require revision surgeries, mostly because existing implant technologies lack sensing devices capable of monitoring the bone–implant interface. Among the several monitoring methodologies already proposed as substitutes for traditional imaging methods, cosurface capacitive sensing systems hold the potential to monitor the bone–implant fixation states, a mandatory capability for long-term implant survival. A multifaceted study is offered here, which covers research on the following points: (1) the ability of a cosurface capacitor network to effectively monitor bone loosening in extended peri-implant regions and according to different stimulation frequencies; (2) the ability of these capacitive architectures to provide effective sensing in interfaces with hydroxyapatite-based layers; (3) the ability to control the operation of cosurface capacitive networks using extracorporeal informatic systems. In vitro tests were performed using a web-based network sensor composed of striped and interdigitated capacitive sensors. Hydroxyapatite-based layers have a minor effect on determining the fixation states; the effective operation of a sensor network-based solution communicating through a web server hosted on Raspberry Pi was shown. Previous studies highlight the inability of current bone–implant fixation monitoring methods to significantly reduce the number of revision surgeries, as well as promising results of capacitive sensing systems to monitor micro-scale and macro-scale bone–interface states. In this study, we found that extracorporeal informatic systems enable continuous patient monitoring using cosurface capacitive networks with or without hydroxyapatite-based layers. Findings presented here represent significant advancements toward the design of future multifunctional smart implants.
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Evaluation of Bone Consolidation in External Fixation with an Electromechanical System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The monitoring of fracture or osteotomy healing is vital for orthopedists to help advise, if necessary, secondary treatments for improving healing outcomes and minimizing patient suffering. It has been decades since osteotomy stiffness has been identified as one main parameter to quantify and qualify the outcome of a regenerated callus. Still, radiographic imaging remains the current standard diagnostic technique of orthopedists. Hence, with recent technological advancements, engineers need to use the new branches of knowledge and improve or innovate diagnostic technologies. An electromechanical system was developed to help diagnose changes in osteotomy stiffness treated with the external fixator LRS Orthofix®. The concept was evaluated experimentally and numerically during fracture healing simulation using two different models: a simplified model of a human tibia, consisting of a nylon bar with a diameter of 30 mm, and a synthetic tibia with the anatomical model from fourth-generation Sawbones®. Moreover, Sawbones® blocks with different densities simulated the mechanical characteristics of the regenerated bone in many stages of bone callus growth. The experimental measurements using the developed diagnostic were compared to the numerically simulated results. For this external fixator, it was possible to show that the displacement in osteotomy was always lower than the displacement prescribed in the elongator. Nevertheless, a relationship was established between the energy consumption by the electromechanical system used to perform callus stimulus and the degree of osteotomy consolidation. Hence, this technology may lead to methodologies of mechanical stimulation for regenerating bone, which will play a relevant role for bedridden individuals with mobility limitations.
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Iyengar KP, Kariya AD, Botchu R, Jain VK, Vaishya R. Significant capabilities of SMART sensor technology and their applications for Industry 4.0 in trauma and orthopaedics. SENSORS INTERNATIONAL 2022. [DOI: 10.1016/j.sintl.2022.100163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Wolynski JG, Ilić MM, Notaroš BM, Labus KM, Puttlitz CM, McGilvray KC. Vivaldi Antennas for Contactless Sensing of Implant Deflections and Stiffness for Orthopaedic Applications. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 10:1151-1161. [PMID: 35873899 PMCID: PMC9307137 DOI: 10.1109/access.2021.3137718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The implementation of novel coaxial dipole antennas has been shown to be a satisfactory diagnostic platform for the prediction of orthopaedic bone fracture healing outcomes. These techniques require mechanical deflection of implanted metallic hardware (i.e., rods and plates), which, when loaded, produce measurable changes in the resonant frequency of the adjacent antenna. Despite promising initial results, the coiled coaxial antenna design is limited by large antenna sizes and nonlinearity in the resonant frequency data. The purpose of this study was to develop two Vivaldi antennas (a.k.a., "standard" and "miniaturized") to address these challenges. Antenna behaviors were first computationally modeled prior to prototype fabrication. In subsequent benchtop tests, metallic plate segments were displaced from the prototype antennas via precision linear actuator while measuring resultant change in resonant frequency. Close agreement was observed between computational and benchtop results, where antennas were highly sensitive to small displacements of the metallic hardware, with sensitivity decreasing nonlinearly with increasing distance. Greater sensitivity was observed for the miniaturized design for both stainless steel and titanium implants. Additionally, these data demonstrated that by taking resonant frequency data during implant displacement and then again during antenna displacement from the same sample, via linear actuators, that "antenna calibration procedures" could be used to enable a clinically relevant quantification of fracture stiffness from the raw resonant frequency data. These improvements mitigate diagnostic challenges associated with nonlinear resonant frequency response seen in previous antenna designs.
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Affiliation(s)
- Jakob G Wolynski
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Milan M Ilić
- School of Electrical Engineering, University of Belgrade, 11120 Belgrade, Serbia
| | - Branislav M Notaroš
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Kevin M Labus
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Kirk C McGilvray
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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de Sousa BM, Correia CR, Ferreira JAF, Mano JF, Furlani EP, Soares Dos Santos MP, Vieira SI. Capacitive interdigitated system of high osteoinductive/conductive performance for personalized acting-sensing implants. NPJ Regen Med 2021; 6:80. [PMID: 34815414 PMCID: PMC8611088 DOI: 10.1038/s41536-021-00184-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
Replacement orthopedic surgeries are among the most common surgeries worldwide, but clinically used passive implants cannot prevent failure rates and inherent revision arthroplasties. Optimized non-instrumented implants, resorting to preclinically tested bioactive coatings, improve initial osseointegration but lack long-term personalized actuation on the bone-implant interface. Novel bioelectronic devices comprising biophysical stimulators and sensing systems are thus emerging, aiming for long-term control of peri-implant bone growth through biointerface monitoring. These acting-sensing dual systems require high frequency (HF) operations able to stimulate osteoinduction/osteoconduction, including matrix maturation and mineralization. A sensing-compatible capacitive stimulator of thin interdigitated electrodes and delivering an electrical 60 kHz HF stimulation, 30 min/day, is here shown to promote osteoconduction in pre-osteoblasts and osteoinduction in human adipose-derived mesenchymal stem cells (hASCs). HF stimulation through this capacitive interdigitated system had significant effects on osteoblasts' collagen-I synthesis, matrix, and mineral deposition. A proteomic analysis of microvesicles released from electrically-stimulated osteoblasts revealed regulation of osteodifferentiation and mineralization-related proteins (e.g. Tgfb3, Ttyh3, Itih1, Aldh1a1). Proteomics data are available via ProteomeXchange with the identifier PXD028551. Further, under HF stimulation, hASCs exhibited higher osteogenic commitment and enhanced hydroxyapatite deposition. These promising osteoinductive/conductive capacitive stimulators will integrate novel bioelectronic implants able to monitor the bone-implant interface and deliver personalized stimulation to peri-implant tissues.
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Affiliation(s)
- Bárbara M de Sousa
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal
| | - Clara R Correia
- Department of Chemistry, CICECO - Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Jorge A F Ferreira
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193, Aveiro, Portugal
| | - João F Mano
- Department of Chemistry, CICECO - Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Edward P Furlani
- Department of Chemical and Biological Engineering, Department of Electrical Engineering, University at Buffalo (SUNY), Buffalo, NY, 14260, USA
| | - Marco P Soares Dos Santos
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193, Aveiro, Portugal.
- Faculty of Engineering, Associated Laboratory for Energy, Transports and Aeronautics (LAETA), University of Porto, 4200-465, Porto, Portugal.
| | - Sandra I Vieira
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal.
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Wolynski JG, Labus KM, Easley JT, Notaroš BM, Ilić MM, Puttlitz CM, McGilvray KC. Diagnostic prediction of ovine fracture healing outcomes via a novel multi-location direct electromagnetic coupling antenna. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1223. [PMID: 34532360 PMCID: PMC8421979 DOI: 10.21037/atm-21-1853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
Background Expedient prediction of adverse bone fracture healing (delayed- or non-union) is necessary to advise secondary treatments for improving healing outcome to minimize patient suffering. Radiographic imaging, the current standard diagnostic, remains largely ineffective at predicting nonunions during the early stages of fracture healing resulting in mean nonunion diagnosis times exceeding six months. Thus, there remains a clinical deficit necessitating improved diagnostic techniques. It was hypothesized that adverse fracture healing expresses impaired biological progression at the fracture site, thus resulting in reduced temporal progression of fracture site stiffness which may be quantified prior to the appearance of radiographic indicators of fracture healing (i.e., calcified tissue). Methods A novel multi-location direct electromagnetic coupling antenna was developed to diagnose relative changes in the stiffness of fractures treated by metallic orthopaedic hardware. The efficacy of this diagnostic was evaluated during fracture healing simulated by progressive destabilization of cadaveric ovine metatarsals treated by locking plate fixation (n=8). An ovine in vivo comparative fracture study (n=8) was then utilized to better characterize the performance of the developed diagnostic in a clinically translatable setting. In vivo measurements using the developed diagnostic were compared to weekly radiographic images and postmortem biomechanical, histological, and micro computed tomography analyses. Results For all cadaveric samples, the novel direct electromagnetic coupling antenna displayed significant differences at the fracture site (P<0.05) when measuring a fully fractured sample versus partially intact and fully intact fracture states. In subsequent in vivo fracture models, this technology detected significant differences (P<0.001) in fractures trending towards delayed healing during the first 30 days post-fracture. Conclusions This technology, relative to traditional X-ray imaging, exhibits potential to greatly expedite clinical diagnosis of fracture nonunion, thus warranting additional technological development.
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Affiliation(s)
- Jakob G Wolynski
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kevin M Labus
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Branislav M Notaroš
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO, USA
| | - Milan M Ilić
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
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18
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Ernst M, Richards RG, Windolf M. Smart implants in fracture care - only buzzword or real opportunity? Injury 2021; 52 Suppl 2:S101-S105. [PMID: 32980139 DOI: 10.1016/j.injury.2020.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
The assessment of fracture healing is still marked by a subjective and diffuse outcome due to the lack of clinically available quantitative measures. Without reliable information on the progression of healing and uniform criteria for union and non-union, therapeutic decision making, e.g. regarding the allowed weight bearing, hinges on the experience and the subjective evaluation of physicians. Already decades ago, fracture stiffness has been identified as a valid outcome measure for the maturity of the repair tissue. Despite early promising results, so far no method has made its way into practice beyond clinical studies. However, with current technological advancements and a general trend towards digital health care, measuring fracture healing seems to regain momentum. New generations of instrumented implants with sensoring capabilities, often termed as "smart implants", are under development. They target X-ray free and timely provision of reliable feedback upon the mechanical competence of the repair tissue and the healing environment to support therapeutic decision making and individualized after-care. With the gained experience from these devices, the next generations of smart implants may become increasingly sophisticated by internally analyzing the measured data and suggesting adequate therapeutic actions on their own.
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Affiliation(s)
- Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.
| | - R Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.
| | - Markus Windolf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.
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19
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Towards an effective sensing technology to monitor micro-scale interface loosening of bioelectronic implants. Sci Rep 2021; 11:3449. [PMID: 33568680 PMCID: PMC7876021 DOI: 10.1038/s41598-021-82589-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/13/2021] [Indexed: 12/25/2022] Open
Abstract
Instrumented implants are being developed with a radically innovative design to significantly reduce revision surgeries. Although bone replacements are among the most prevalent surgeries performed worldwide, implant failure rate usually surpasses 10%. High sophisticated multifunctional bioelectronic implants are being researched to incorporate cosurface capacitive architectures with ability to deliver personalized electric stimuli to peri-implant target tissues. However, the ability of these architectures to detect bone-implant interface states has never been explored. Moreover, although more than forty technologies were already proposed to detect implant loosening, none is able to ensure effective monitoring of the bone-implant debonding, mainly during the early stages of loosening. This work shows, for the first time, that cosurface capacitive sensors are a promising technology to provide an effective monitoring of bone-implant interfaces during the daily living of patients. Indeed, in vitro experimental tests and simulation with computational models highlight that both striped and circular capacitive architectures are able to detect micro-scale and macro-scale interface bonding, debonding or loosening, mainly when bonding is weakening or loosening is occurring. The proposed cosurface technologies hold potential to implement highly effective and personalized sensing systems such that the performance of multifunctional bioelectronic implants can be strongly improved. Findings were reported open a new research line on sensing technologies for bioelectronic implants, which may conduct to great impacts in the coming years.
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20
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Anderson WD, Wilson SLM, Holdsworth DW. Development of a Wireless Telemetry Sensor Device to Measure Load and Deformation in Orthopaedic Applications. SENSORS 2020; 20:s20236772. [PMID: 33260821 PMCID: PMC7731148 DOI: 10.3390/s20236772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023]
Abstract
Due to sensor size and supporting circuitry, in-vivo load and deformation measurements are currently restricted to applications within larger orthopaedic implants. The objective of this study is to repurpose a commercially available low-power, miniature, wireless, telemetric, tire-pressure sensor (FXTH87) to measure load and deformation for future use in orthopaedic and biomedical applications. The capacitive transducer membrane was modified, and compressive deformation was applied to the transducer to determine the sensor signal value and the internal resistive force. The sensor package was embedded within a deformable enclosure to illustrate potential applications of the sensor for monitoring load. To reach the maximum output signal value, sensors required compressive deformation of 350 ± 24 µm. The output signal value of the sensor was an effective predictor of the applied load on a calibrated plastic strain member, over a range of 35 N. The FXTH87 sensor can effectively sense and transmit load-induced deformations. The sensor does not have a limit on loads it can measure, as long as deformation resulting from the applied load does not exceed 350 µm. The proposed device presents a sensitive and precise means to monitor deformation and load within small-scale, deformable enclosures.
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Affiliation(s)
- William D. Anderson
- School of Biomedical Engineering, Western University, London, ON N6A 3K7, Canada; (W.D.A.); (S.L.M.W.)
| | - Sydney L. M. Wilson
- School of Biomedical Engineering, Western University, London, ON N6A 3K7, Canada; (W.D.A.); (S.L.M.W.)
| | - David W. Holdsworth
- School of Biomedical Engineering, Western University, London, ON N6A 3K7, Canada; (W.D.A.); (S.L.M.W.)
- Robarts Research Institute, Western University, London, ON N6A 5K8, Canada
- Department of Medical Biophysics, Western University, London, ON N6A 5C1, Canada
- Department of Surgery, Western University, London, ON N6A 4V2, Canada
- Correspondence:
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21
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Dinh T, Nguyen T, Phan HP, Nguyen NT, Dao DV, Bell J. Stretchable respiration sensors: Advanced designs and multifunctional platforms for wearable physiological monitoring. Biosens Bioelectron 2020; 166:112460. [PMID: 32862846 DOI: 10.1016/j.bios.2020.112460] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/21/2022]
Abstract
Respiration signals are a vital sign of life. Monitoring human breath provides critical information for health assessment, diagnosis, and treatment for respiratory diseases such as asthma, chronic bronchitis, and emphysema. Stretchable and wearable respiration sensors have recently attracted considerable interest toward monitoring physiological signals in the era of real time and portable healthcare systems. This review provides a snapshot on the recent development of stretchable sensors and wearable technologies for respiration monitoring. The article offers the fundamental guideline on the sensing mechanisms and design concepts of stretchable sensors for detecting vital breath signals such as temperature, humidity, airflow, stress and strain. A highlight on the recent progress in the integration of variable sensing components outlines feasible pathways towards multifunctional and multimodal sensor platforms. Structural designs of nanomaterials and platforms for stretchable respiration sensors are reviewed.
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Affiliation(s)
- Toan Dinh
- School of Mechanical and Electrical Engineering, University of Southern Queensland, Queensland, 4350, Australia.
| | - Thanh Nguyen
- Queensland Micro- and Nanotechnology Centre, Griffith University, Queensland, 4111, Australia
| | - Hoang-Phuong Phan
- Queensland Micro- and Nanotechnology Centre, Griffith University, Queensland, 4111, Australia
| | - Nam-Trung Nguyen
- Queensland Micro- and Nanotechnology Centre, Griffith University, Queensland, 4111, Australia
| | - Dzung Viet Dao
- Queensland Micro- and Nanotechnology Centre, Griffith University, Queensland, 4111, Australia
| | - John Bell
- School of Mechanical and Electrical Engineering, University of Southern Queensland, Queensland, 4350, Australia
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Cachão JH, Soares dos Santos MP, Bernardo R, Ramos A, Bader R, Ferreira JAF, Torres Marques A, Simões JAO. Altering the Course of Technologies to Monitor Loosening States of Endoprosthetic Implants. SENSORS 2019; 20:s20010104. [PMID: 31878028 PMCID: PMC6982938 DOI: 10.3390/s20010104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
Musculoskeletal disorders are becoming an ever-growing societal burden and, as a result, millions of bone replacements surgeries are performed per year worldwide. Despite total joint replacements being recognized among the most successful surgeries of the last century, implant failure rates exceeding 10% are still reported. These numbers highlight the necessity of technologies to provide an accurate monitoring of the bone–implant interface state. This study provides a detailed review of the most relevant methodologies and technologies already proposed to monitor the loosening states of endoprosthetic implants, as well as their performance and experimental validation. A total of forty-two papers describing both intracorporeal and extracorporeal technologies for cemented or cementless fixation were thoroughly analyzed. Thirty-eight technologies were identified, which are categorized into five methodologies: vibrometric, acoustic, bioelectric impedance, magnetic induction, and strain. Research efforts were mainly focused on vibrometric and acoustic technologies. Differently, approaches based on bioelectric impedance, magnetic induction and strain have been less explored. Although most technologies are noninvasive and are able to monitor different loosening stages of endoprosthetic implants, they are not able to provide effective monitoring during daily living of patients.
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Affiliation(s)
- João Henrique Cachão
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Marco P. Soares dos Santos
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
- Associated Laboratory for Energy, Transports and Aeronautics (LAETA), 4150-179 Porto, Portugal
- Correspondence:
| | - Rodrigo Bernardo
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Ramos
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Rainer Bader
- Department of Orthopedics, University Medicine Rostock, 18057 Rostock, Germany
| | - Jorge A. F. Ferreira
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Torres Marques
- Associated Laboratory for Energy, Transports and Aeronautics (LAETA), 4150-179 Porto, Portugal
- Mechanical Engineering Department, University of Porto, 4200-465 Porto, Portugal
| | - José A. O. Simões
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
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Wolynski JG, Sutherland CJ, Demir HV, Unal E, Alipour A, Puttlitz CM, McGilvray KC. Utilizing Multiple BioMEMS Sensors to Monitor Orthopaedic Strain and Predict Bone Fracture Healing. J Orthop Res 2019; 37:1873-1880. [PMID: 31042313 PMCID: PMC6688915 DOI: 10.1002/jor.24325] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/08/2019] [Indexed: 02/04/2023]
Abstract
Current diagnostic modalities, such as radiographs or computed tomography, exhibit limited ability to predict the outcome of bone fracture healing. Failed fracture healing after orthopaedic surgical treatments are typically treated by secondary surgery; however, the negative correlation of time between primary and secondary surgeries with resultant health outcome and medical cost accumulation drives the need for improved diagnostic tools. This study describes the simultaneous use of multiple (n = 5) implantable flexible substrate wireless microelectromechanical (fsBioMEMS) sensors adhered to an intramedullary nail (IMN) to quantify the biomechanical environment along the length of fracture fixation hardware during simulated healing in ex vivo ovine tibiae. This study further describes the development of an antenna array for interrogation of five fsBioMEMS sensors simultaneously, and quantifies the ability of these sensors to transmit signal through overlaying soft tissues. The ex vivo data indicated significant differences associated with sensor location on the IMN (p < 0.01) and fracture state (p < 0.01). These data indicate that the fsBioMEMS sensor can serve as a tool to diagnose the current state of fracture healing, and further supports the use of the fsBioMEMS as a means to predict fracture healing due to the known existence of latency between changes in fracture site material properties and radiographic changes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1873-1880, 2019.
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Affiliation(s)
- Jakob G. Wolynski
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Conor J. Sutherland
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Hilmi Volkan Demir
- LUMINOUS! Center of Excellence for Semiconductor Lighting and Displays, Microelectronics Division, School of Electrical and Electronics Engineering, and Physics and Applied Physics Division, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - Emre Unal
- Departments of Electrical and Electronics Engineering and Physics, UNAM-Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, Turkey
| | - Akbar Alipour
- School of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christian M. Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Kirk C. McGilvray
- Orthopaedic Bioengineering Research Laboratory, Departments of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA.,Corresponding Author: Kirk McGilvray, Ph.D.; ; 1374 Campus Delivery, Fort Collins, CO 80523. Office: 970-491-1319
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Lajevardi-Khosh A, Tresco B, Stuart A, Sinclair S, Ackerman M, Kubiak E, Petelenz T, Hitchcock R. Development of a step counting algorithm using the ambulatory tibia load analysis system for tibia fracture patients. J Rehabil Assist Technol Eng 2019; 5:2055668318804974. [PMID: 31191958 PMCID: PMC6531803 DOI: 10.1177/2055668318804974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction: Ambulation can be used to monitor the healing of lower
extremity fractures. However, the ambulatory behavior of tibia fracture patients
remains unknown due to an inability to continuously quantify ambulation outside
of the clinic. The goal of this study was to design and validate an algorithm to
assess ambulation in tibia fracture patients using the ambulatory tibial load
analysis system during recovery, outside of the clinic.
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Affiliation(s)
| | - Ben Tresco
- Department of Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Ami Stuart
- Department of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Sarina Sinclair
- Department of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Matt Ackerman
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Erik Kubiak
- Department of Orthopaedics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Tomasz Petelenz
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Hitchcock
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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Labus KM, Sutherland C, Notaros BM, Ilić MM, Chaus G, Keiser D, Puttlitz CM. Direct electromagnetic coupling for non-invasive measurements of stability in simulated fracture healing. J Orthop Res 2019; 37:1164-1171. [PMID: 30839117 DOI: 10.1002/jor.24275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/12/2019] [Indexed: 02/04/2023]
Abstract
Diagnostic monitoring and prediction of bone fracture healing is critical for the detection of delayed union or non-union and provides the requisite information as to whether therapeutic intervention or timely revision are warranted. A promising approach to monitor fracture healing is to measure the mechanical load-sharing between the healing callus and the implanted hardware used for internal fixation. The objectives of this study were to evaluate a non-invasive measurement system in which an antenna electromagnetically couples with the implanted hardware to sense deflections of the hardware due to an applied load and to investigate the efficacy of the system to detect changes in mechanical load-sharing in an ex vivo fracture healing model. The measurement system was applied to ovine metatarsal bones treated with osteotomies, resulting in four different levels of bone stability which simulated various degrees of fracture healing. Computational finite element simulations supplemented these ex vivo experiments to compare the osteotomy model of fracture healing to a more clinically applicable callus stiffening model of healing. In the ex vivo experiments, the electromagnetic coupling system detected significant differences between the four simulated degrees of healing with good repeatability. Computational simulations indicated that the experimental model of fracture healing provided a good surrogate for studying healing during the early time period as the callus stiffness is increasing as well as when diagnostic monitoring of the healing process is most critical. Based upon the data reported herein, the direct electromagnetic coupling method holds strong potential for clinical assessments and predictions of fracture healing. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kevin M Labus
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, ColoradoColorado, 80523-137
| | - Conor Sutherland
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, ColoradoColorado, 80523-137
| | - Branislav M Notaros
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, ColoradoColorado
| | - Milan M Ilić
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - George Chaus
- Orthopaedic Trauma Surgery, Front Range Orthopaedics and Spine, Longmont, ColoradoColorado
| | - David Keiser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch Central, New Zealand
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, ColoradoColorado, 80523-137
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26
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Rosa N, Marta M, Vaz M, Tavares SMO, Simoes R, Magalhães FD, Marques AT. Intramedullary nailing biomechanics: Evolution and challenges. Proc Inst Mech Eng H 2019; 233:295-308. [DOI: 10.1177/0954411919827044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article aims to review the biomechanical evolution of intramedullary nailing and describe the breakthrough concepts which allowed for nail improvement and its current success. The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary Küntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuition-based experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail ‘dynamization’ and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the bone–intramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.
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Affiliation(s)
- Natacha Rosa
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Miguel Marta
- Department of Orthopaedics, Centro Hospitalar de São João, Porto, Portugal
| | - Mário Vaz
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
- INEGI, Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Ricardo Simoes
- Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
- Institute for Polymers and Composites IPC/I3N, University of Minho, Guimarães, Portugal
| | - Fernão D Magalhães
- LEPABE–Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, Portugal
| | - Antonio Torres Marques
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
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27
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Lin MC, Hu D, Marmor M, Herfat ST, Bahney CS, Maharbiz MM. Smart bone plates can monitor fracture healing. Sci Rep 2019; 9:2122. [PMID: 30765721 PMCID: PMC6375940 DOI: 10.1038/s41598-018-37784-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/07/2018] [Indexed: 11/08/2022] Open
Abstract
There are currently no standardized methods for assessing fracture healing, with physicians relying on X-rays which are only useful at later stages of repair. Using in vivo mouse fracture models, we present the first evidence that microscale instrumented implants provide a route for post-operative fracture monitoring, utilizing electrical impedance spectroscopy (EIS) to track the healing tissue with high sensitivity. In this study, we fixed mouse long bone fractures with external fixators and bone plates. EIS measurements taken across two microelectrodes within the fracture gap were able to track longitudinal differences between individual mice with good versus poor healing. We additionally present an equivalent circuit model that combines the EIS data to classify fracture repair states. Lastly, we show that EIS measurements strongly correlated with standard quantitative µCT values and that these correlations validate clinically-relevant operating frequencies for implementation of this technique. These results demonstrate that EIS can be integrated into current fracture management strategies such as bone plating, providing physicians with quantitative information about the state of fracture repair to guide clinical decision-making for patients.
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Affiliation(s)
- Monica C Lin
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA.
| | - Diane Hu
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Meir Marmor
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Safa T Herfat
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Chelsea S Bahney
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, CO, 81657, USA
| | - Michel M Maharbiz
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
- Department of Electrical Engineering and Computer Science, University of California, Berkeley, CA, 94720, USA
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA
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28
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Easley J, Puttlitz CM, Seim H, Ramo N, Abjornson C, Cammisa FP, McGilvray KC. Biomechanical and histologic assessment of a novel screw retention technology in an ovine lumbar fusion model. Spine J 2018; 18:2302-2315. [PMID: 30075298 DOI: 10.1016/j.spinee.2018.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Screw loosening is a prevalent failure mode in orthopedic hardware, particularly in osteoporotic bone or revision procedures where the screw-bone engagement is limited. PURPOSE The objective of this study was to evaluate the efficacy of a novel screw retention technology (SRT) in an ovine lumbar fusion model. STUDY DESIGN/SETTING This was a biomechanical, radiographic, and histologic study utilizing an ovine lumbar spine model. METHODS In total, 54 (n=54) sheep lumbar spines (L2-L3) underwent posterior lumbar fusion (PLF) via pedicle screw fixation, connecting rod, and bone graft. Following three experimental variants were investigated: positive control (ideal clinical scenario), negative control (simulation of compromised screw holes), and SRT treatments. Biomechanical and histologic analyses of the functional spinal unit (FSU) were determined as a function of healing time (0, 3, and 12 months postoperative). RESULTS Screw pull-out, screw break-out, and FSU stability of the SRT treatments were generally equivalent to the positive control group and considerably better than the negative control group. Histomorphology of the SRT treatment screw region of interest (ROI) observed an increase in bone percentage and decrease in void space during healing, consistent with ingrowth at the implant interface. The PLF ROI observed similar bone percentage throughout healing between the SRT treatment and positive control. Less bone formation was observed for the negative control. CONCLUSIONS The results of this study demonstrate that the SRT improved screw retention and afforded effective FSU stabilization to achieve solid fusion in an otherwise compromised fixation scenario in a large animal model.
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Affiliation(s)
- Jeremiah Easley
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374, USA
| | - Howard Seim
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Nicole Ramo
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374, USA
| | - Celeste Abjornson
- Integrated Spine Research Program, Hospital for Special Surgery, New York, NY, USA
| | - Frank P Cammisa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374, USA.
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29
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Klosterhoff BS, Ghee Ong K, Krishnan L, Hetzendorfer KM, Chang YH, Allen MG, Guldberg RE, Willett NJ. Wireless Implantable Sensor for Noninvasive, Longitudinal Quantification of Axial Strain Across Rodent Long Bone Defects. J Biomech Eng 2018; 139:2654844. [PMID: 28975256 DOI: 10.1115/1.4037937] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Indexed: 11/08/2022]
Abstract
Bone development, maintenance, and regeneration are remarkably sensitive to mechanical cues. Consequently, mechanical stimulation has long been sought as a putative target to promote endogenous healing after fracture. Given the transient nature of bone repair, tissue-level mechanical cues evolve rapidly over time after injury and are challenging to measure noninvasively. The objective of this work was to develop and characterize an implantable strain sensor for noninvasive monitoring of axial strain across a rodent femoral defect during functional activity. Herein, we present the design, characterization, and in vivo demonstration of the device's capabilities for quantitatively interrogating physiological dynamic strains during bone regeneration. Ex vivo experimental characterization of the device showed that it possessed promising sensitivity, signal resolution, and electromechanical stability for in vivo applications. The digital telemetry minimized power consumption, enabling extended intermittent data collection. Devices were implanted in a rat 6 mm femoral segmental defect model, and after three days, data were acquired wirelessly during ambulation and synchronized to corresponding radiographic videos, validating the ability of the sensor to noninvasively measure strain in real-time. Together, these data indicate the sensor is a promising technology to quantify tissue mechanics in a specimen specific manner, facilitating more detailed investigations into the role of the mechanical environment in dynamic bone healing and remodeling processes.
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Affiliation(s)
- Brett S Klosterhoff
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Keat Ghee Ong
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Laxminarayanan Krishnan
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Kevin M Hetzendorfer
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Young-Hui Chang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332
| | - Mark G Allen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332.,Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Nick J Willett
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332.,Department of Orthopaedics, Emory University, Atlanta, GA 30303.,Atlanta Veteran's Affairs Medical Center, Department of Orthopaedics, Decatur, GA 30033.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
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30
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Advances in Materials for Recent Low-Profile Implantable Bioelectronics. MATERIALS 2018; 11:ma11040522. [PMID: 29596359 PMCID: PMC5951368 DOI: 10.3390/ma11040522] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Abstract
The rapid development of micro/nanofabrication technologies to engineer a variety of materials has enabled new types of bioelectronics for health monitoring and disease diagnostics. In this review, we summarize widely used electronic materials in recent low-profile implantable systems, including traditional metals and semiconductors, soft polymers, biodegradable metals, and organic materials. Silicon-based compounds have represented the traditional materials in medical devices, due to the fully established fabrication processes. Examples include miniaturized sensors for monitoring intraocular pressure and blood pressure, which are designed in an ultra-thin diaphragm to react with the applied pressure. These sensors are integrated into rigid circuits and multiple modules; this brings challenges regarding the fundamental material’s property mismatch with the targeted human tissues, which are intrinsically soft. Therefore, many polymeric materials have been investigated for hybrid integration with well-characterized functional materials such as silicon membranes and metal interconnects, which enable soft implantable bioelectronics. The most recent trend in implantable systems uses transient materials that naturally dissolve in body fluid after a programmed lifetime. Such biodegradable metallic materials are advantageous in the design of electronics due to their proven electrical properties. Collectively, this review delivers the development history of materials in implantable devices, while introducing new bioelectronics based on bioresorbable materials with multiple functionalities.
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31
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Gadomski BC, McGilvray KC, Easley JT, Palmer RH, Jiao J, Li X, Qin YX, Puttlitz CM. An investigation of shock wave therapy and low-intensity pulsed ultrasound on fracture healing under reduced loading conditions in an ovine model. J Orthop Res 2018; 36:921-929. [PMID: 28762588 DOI: 10.1002/jor.23666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023]
Abstract
The use of shock wave therapy (SWT) and low-intensity pulsed ultrasound (LIPUS) as countermeasures to the inhibited fracture healing experienced during mechanical unloading was investigated by administering treatment to the fracture sites of mature, female, Rambouillet Columbian ewes exposed to partial mechanical unloading or full gravitational loading. The amount of fracture healing experienced by the treatment groups was compared to controls in which identical surgical and testing protocols were administered except for SWT or LIPUS treatment. All groups were euthanized after a 28-day healing period. In vivo mechanical measurements demonstrated no significant alteration in fixation plate strains between treatments within either partial unloading group. Similarly, DXA BMD and 4-point bending stiffness were not significantly altered following either treatment. μCT analyses demonstrated lower callus bone volume for treated animals (SWT and LIPUS, p < 0.01) in the full gravity group but not between reduced loading groups. Callus osteoblast numbers as well as mineralized surface and bone formation rate were significantly elevated to the level of the full gravity groups in the reduced loading groups following both SWT and LIPUS. Although no increase in 4-week mechanical strength was observed, it is possible that an increase in the overall rate of fracture healing (i.e., callus strength) may be experienced at longer time points under partial loading conditions given the increase in osteoblast numbers and bone formation parameters following SWT and LIPUS. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:921-929, 2018.
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Affiliation(s)
- Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Ft Collins, Colorado
| | - Ross H Palmer
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Ft Collins, Colorado
| | - Jian Jiao
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Xiaofei Li
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Yi-Xian Qin
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
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32
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Klosterhoff BS, Tsang M, She D, Ong KG, Allen MG, Willett NJ, Guldberg RE. Implantable Sensors for Regenerative Medicine. J Biomech Eng 2017; 139:2594421. [PMID: 27987300 DOI: 10.1115/1.4035436] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 01/05/2023]
Abstract
The translation of many tissue engineering/regenerative medicine (TE/RM) therapies that demonstrate promise in vitro are delayed or abandoned due to reduced and inconsistent efficacy when implemented in more complex and clinically relevant preclinical in vivo models. Determining mechanistic reasons for impaired treatment efficacy is challenging after a regenerative therapy is implanted due to technical limitations in longitudinally measuring the progression of key environmental cues in vivo. The ability to acquire real-time measurements of environmental parameters of interest including strain, pressure, pH, temperature, oxygen tension, and specific biomarkers within the regenerative niche in situ would significantly enhance the information available to tissue engineers to monitor and evaluate mechanisms of functional healing or lack thereof. Continued advancements in material and fabrication technologies utilized by microelectromechanical systems (MEMSs) and the unique physical characteristics of passive magnetoelastic sensor platforms have created an opportunity to implant small, flexible, low-power sensors into preclinical in vivo models, and quantitatively measure environmental cues throughout healing. In this perspective article, we discuss the need for longitudinal measurements in TE/RM research, technical progress in MEMS and magnetoelastic approaches to implantable sensors, the potential application of implantable sensors to benefit preclinical TE/RM research, and the future directions of collaborative efforts at the intersection of these two important fields.
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Affiliation(s)
- Brett S Klosterhoff
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Melissa Tsang
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Didi She
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Keat Ghee Ong
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Mark G Allen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Nick J Willett
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332;Department of Orthopaedics, Emory University, Atlanta, GA 30303;Atlanta Veteran's Affairs Medical Center, Decatur, GA 30033;Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
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33
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Rosa N, Marta M, Vaz M, Tavares S, Simoes R, Magalhães FD, Marques AT. Recent developments on intramedullary nailing: a biomechanical perspective. Ann N Y Acad Sci 2017; 1408:20-31. [DOI: 10.1111/nyas.13524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Natacha Rosa
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
| | - Miguel Marta
- Department of Orthopedics; Centro Hospitalar de São João; Porto Portugal
| | - Mário Vaz
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
- INEGI, Faculty of Engineering; University of Porto; Porto Portugal
| | - S.M.O. Tavares
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
| | - Ricardo Simoes
- Polytechnic Institute of Cávado and Ave; Barcelos Portugal
- Institute for Polymers and Composites IPC/I3N; University of Minho; Guimarães Portugal
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34
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Schwartz AM, Schenker ML, Ahn J, Willett NJ. Building better bone: The weaving of biologic and engineering strategies for managing bone loss. J Orthop Res 2017; 35:1855-1864. [PMID: 28467648 DOI: 10.1002/jor.23592] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/24/2017] [Indexed: 02/04/2023]
Abstract
Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost-sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice-changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell-based strategies. Despite an ever-evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled "Building better bone: The weaving of biologic and engineering strategies for managing bone loss," was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering-clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855-1864, 2017.
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Affiliation(s)
| | - Mara L Schenker
- Department of Orthopaedics, Emory University, Decatur, Georgia
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nick J Willett
- Department of Orthopaedics, Emory University, Decatur, Georgia.,Atlanta Veteran's Affairs Medical Center, Decatur, Georgia.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
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