1
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B Wrammerfors ET, Törnquist E, Pierantoni M, Sjögren A, Tengattini A, Kaestner A, Zandt RI', Englund M, Isaksson H. Exploratory neutron tomography of articular cartilage. Osteoarthritis Cartilage 2024; 32:702-712. [PMID: 38447631 DOI: 10.1016/j.joca.2024.02.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To investigate the feasibility of using neutron tomography to gain new knowledge of human articular cartilage degeneration in osteoarthritis (OA). Different sample preparation techniques were evaluated to identify maximum intra-tissue contrast. DESIGN Human articular cartilage samples from 14 deceased donors (18-75 years, 9 males, 5 females) and 4 patients undergoing total knee replacement due to known OA (all female, 61-75 years) were prepared using different techniques: control in saline, treated with heavy water saline, fixed and treated in heavy water saline, and fixed and dehydrated with ethanol. Neutron tomographic imaging (isotropic voxel sizes from 7.5 to 13.5 µm) was performed at two large scale facilities. The 3D images were evaluated for gradients in hydrogen attenuation as well as compared to images from absorption X-ray tomography, magnetic resonance imaging, and histology. RESULTS Cartilage was distinguishable from background and other tissues in neutron tomographs. Intra-tissue contrast was highest in heavy water-treated samples, which showed a clear gradient from the cartilage surface to the bone interface. Increased neutron flux or exposure time improved image quality but did not affect the ability to detect gradients. Samples from older donors showed high variation in gradient profile, especially from donors with known OA. CONCLUSIONS Neutron tomography is a viable technique for specialized studies of cartilage, particularly for quantifying properties relating to the hydrogen density of the tissue matrix or water movement in the tissue.
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Affiliation(s)
| | - Elin Törnquist
- Department of Biomedical Engineering, Lund University (LU), Sweden
| | - Maria Pierantoni
- Department of Biomedical Engineering, Lund University (LU), Sweden
| | - Amanda Sjögren
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, LU, Sweden
| | | | - Anders Kaestner
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institut (PSI), Switzerland
| | | | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, LU, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University (LU), Sweden
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2
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Markeviciute V, Puthia M, Arvidsson L, Liu Y, Törnquist E, Tengattini A, Huang J, Bai Y, Vater C, Petrolis R, Zwingenberger S, Krisciukaitis A, Smailys A, Lukosevicius S, Stravinskas M, Isaksson H, Tarasevicius S, Lidgren L, Tägil M, Raina DB. Systemically administered zoledronic acid activates locally implanted synthetic hydroxyapatite particles enhancing peri-implant bone formation: A regenerative medicine approach to improve fracture fixation. Acta Biomater 2024; 179:354-370. [PMID: 38490481 DOI: 10.1016/j.actbio.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/11/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
Fracture fixation in an ageing population is challenging and fixation failure increases mortality and societal costs. We report a novel fracture fixation treatment by applying a hydroxyapatite (HA) based biomaterial at the bone-implant interface and biologically activating the biomaterial by systemic administration of a bisphosphonate (zoledronic acid, ZA). We first used an animal model of implant integration and applied a calcium sulphate (CaS)/HA biomaterial around a metallic screw in the tibia of osteoporotic rats. Using systemic ZA administration at 2-weeks post-surgery, we demonstrated that the implant surrounded by HA particles showed significantly higher peri‑implant bone formation compared to the unaugmented implants at 6-weeks. We then evaluated the optimal timing (day 1, 3, 7 and 14) of ZA administration to achieve a robust effect on peri‑implant bone formation. Using fluorescent ZA, we demonstrated that the uptake of ZA in the CaS/HA material was the highest at 3- and 7-days post-implantation and the uptake kinetics had a profound effect on the eventual peri‑implant bone formation. We furthered our concept in a feasibility study on trochanteric fracture patients randomized to either CaS/HA augmentation or no augmentation followed by systemic ZA treatment. Radiographically, the CaS/HA group showed signs of increased peri‑implant bone formation compared with the controls. Finally, apart from HA, we demonstrated that the concept of biologically activating a ceramic material by ZA could also be applied to β-tricalcium phosphate. This novel approach for fracture treatment that enhances immediate and long-term fracture fixation in osteoporotic bone could potentially reduce reoperations, morbidity and mortality. STATEMENT OF SIGNIFICANCE: • Fracture fixation in an ageing population is challenging. Biomaterial-based augmentation of fracture fixation devices has been attempted but lack of satisfactory biological response limits their widespread use. • We report the biological activation of locally implanted microparticulate hydroxyapatite (HA) particles placed around an implant by systemic administration of the bisphosphonate zoledronic acid (ZA). The biological activation of HA by ZA enhances peri‑implant bone formation. •Timing of ZA administration after HA implantation is critical for optimal ZA uptake and consequently determines the extent of peri‑implant bone formation. • We translate the developed concept from small animal models of implant integration to a proof-of-concept clinical study on osteoporotic trochanteric fracture patients. • ZA based biological activation can also be applied to other calcium phosphate biomaterials.
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Affiliation(s)
- Vetra Markeviciute
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania; The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Manoj Puthia
- The Faculty of Medicine, Division of Dermatology and Venerology, Lund University, 221 84 Lund, Sweden
| | - Linnea Arvidsson
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Yang Liu
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, China
| | - Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Jintian Huang
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Yiguang Bai
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Cell, Tissue & Organ engineering laboratory, Department of Clinical Sciences Lund, Stem Cell Centre, Lund University, Lund, Sweden; Department of Orthopaedics, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College Nanchong, Sichuan, China
| | - Corina Vater
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedics, Trauma and Plastic Surgery, 01307 Dresden, Germany
| | - Robertas Petrolis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Stefan Zwingenberger
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedics, Trauma and Plastic Surgery, 01307 Dresden, Germany
| | - Algimantas Krisciukaitis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alfredas Smailys
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Lukosevicius
- Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Stravinskas
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sarunas Tarasevicius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lars Lidgren
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Magnus Tägil
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
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3
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Østergaard M, Naver EB, Schüpbach D, Kaestner A, Strobl M, Brüel A, Thomsen JS, Schmidt S, Poulsen HF, Kuhn LT, Birkedal H. Correlative study of liquid in human bone by 3D neutron microscopy and lab-based X-ray μCT. Bone 2023; 175:116837. [PMID: 37419297 DOI: 10.1016/j.bone.2023.116837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
Liquid plays an important role in bone that has a complex 3D hierarchical pore structure. However, liquid (water) is difficult to discern from e.g. an organic matrix by X-ray imaging. Therefore, we use a correlative approach using both high resolution X-ray and neutron imaging. Human femoral bone with liquid adsorbed into some of the pores was imaged with both the Neutron Microscope at the ICON beamline, SINQ at PSI, and by lab-based μCT using 2.7 μm voxel size. Segmentation of the two datasets showed that, even though the liquid was clearly distinguishable in the neutron data and not in the X-ray data, it remained challenging to segment it from bone due to overlaps of peaks in the gray level histograms. In consequence, segmentations from X-ray and neutron data varied significantly. To address this issue, the segmented X-ray porosities was overlaid on the neutron data, making it possible to localize the liquid in the vascular porosities of the bone sample and use the neutron attenuation to identify it as H2O. The contrast in the neutron images was lowered slightly between the bone and the liquid compared to the bone and the air. This correlative study shows that the complementary use of X-rays and neutrons is very favorable, since H2O is very distinct in the neutron data, while D2O, H2O, and organic matter can barely be distinguished from air in the X-ray data.
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Affiliation(s)
- Maja Østergaard
- Department of Chemistry and iNANO, Aarhus University, Aarhus, Denmark.
| | - Estrid Buhl Naver
- Department of Energy Conversion and Storage, Technical University of Denmark, Kongens Lyngby, Denmark.
| | - Delia Schüpbach
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institute, Villigen, Switzerland.
| | - Anders Kaestner
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institute, Villigen, Switzerland.
| | - Markus Strobl
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institute, Villigen, Switzerland; Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark.
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | | | - Søren Schmidt
- Data Management and Software Centre, European Spallation Source, Lund, Sweden.
| | | | - Luise Theil Kuhn
- Department of Energy Conversion and Storage, Technical University of Denmark, Kongens Lyngby, Denmark.
| | - Henrik Birkedal
- Department of Chemistry and iNANO, Aarhus University, Aarhus, Denmark.
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4
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Østergaard M, Naver EB, Kaestner A, Willendrup PK, Brüel A, Sørensen HO, Thomsen JS, Schmidt S, Poulsen HF, Theil Kuhn L, Birkedal H. Polychromatic neutron phase-contrast imaging of weakly absorbing samples enabled by phase retrieval. J Appl Crystallogr 2023; 56:673-682. [PMID: 37284268 PMCID: PMC10241042 DOI: 10.1107/s1600576723003011] [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: 09/30/2022] [Accepted: 04/01/2023] [Indexed: 06/08/2023] Open
Abstract
The use of a phase-retrieval technique for propagation-based phase-contrast neutron imaging with a polychromatic beam is demonstrated. This enables imaging of samples with low absorption contrast and/or improving the signal-to-noise ratio to facilitate e.g. time-resolved measurements. A metal sample, designed to be close to a phase pure object, and a bone sample with canals partially filled with D2O were used for demonstrating the technique. These samples were imaged with a polychromatic neutron beam followed by phase retrieval. For both samples the signal-to-noise ratios were significantly improved and, in the case of the bone sample, the phase retrieval allowed for separation of bone and D2O, which is important for example for in situ flow experiments. The use of deuteration contrast avoids the use of chemical contrast enhancement and makes neutron imaging an interesting complementary method to X-ray imaging of bone.
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Affiliation(s)
- Maja Østergaard
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, Aarhus, Denmark
| | - Estrid Buhl Naver
- Department of Energy Conversion and Storage, Technical University of Denmark, Fysikvej 310, Kongens Lyngby, Denmark
| | - Anders Kaestner
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institute, Villigen, Switzerland
| | - Peter K. Willendrup
- Department of Physics, Technical University of Denmark, Fysikvej 307, Kongens Lyngby, Denmark
- European Spallation Source ERIC, PO Box 176, Lund, Sweden
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Wilhelm Meyers Allé 3, Aarhus, Denmark
| | - Henning Osholm Sørensen
- Department of Physics, Technical University of Denmark, Fysikvej 307, Kongens Lyngby, Denmark
- Xnovo Technology ApS, Galoche Alle 15, 1, Køge, Denmark
| | | | - Søren Schmidt
- European Spallation Source ERIC, PO Box 176, Lund, Sweden
| | - Henning Friis Poulsen
- Department of Physics, Technical University of Denmark, Fysikvej 307, Kongens Lyngby, Denmark
| | - Luise Theil Kuhn
- Department of Energy Conversion and Storage, Technical University of Denmark, Fysikvej 310, Kongens Lyngby, Denmark
| | - Henrik Birkedal
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, Aarhus, Denmark
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5
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Törnquist E, Le Cann S, Tengattini A, Helfen L, Kok J, Hall SA, Isaksson H. The Hydration State of Bone Tissue Affects Contrast in Neutron Tomographic Images. Front Bioeng Biotechnol 2022; 10:911866. [PMID: 35782510 PMCID: PMC9247154 DOI: 10.3389/fbioe.2022.911866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/24/2022] [Indexed: 12/25/2022] Open
Abstract
Neutron tomography has emerged as a promising imaging technique for specific applications in bone research. Neutrons have a strong interaction with hydrogen, which is abundant in biological tissues, and they can penetrate through dense materials such as metallic implants. However, in addition to long imaging times, two factors have led to challenges in running in situ mechanical characterization experiments on bone tissue using neutron tomography: 1) the high water content in specimens reduces the visibility of internal trabecular structures; 2) the mechanical properties of bone are dependent on the hydration state of the tissue, with drying being reported to cause increased stiffness and brittleness. This study investigates the possibility of improving image quality in terms of neutron transmission and contrast between material phases by drying and rehydrating in heavy water. Rat tibiae and trabecular bovine bone plugs were imaged with neutron tomography at different hydration states and mechanical testing of the bone plugs was carried out to assess effects of drying and rehydration on the mechanical properties of bone. From analysis of image histograms, it was found that drying reduced the contrast between bone and soft tissue, but the contrast was restored with rehydration. Contrast-to-noise ratios and line profiles revealed that the contrast between bone tissue and background was reduced with increasing rehydration duration but remained sufficient for identifying internal structures as long as no free liquid was present inside the specimen. The mechanical analysis indicated that the proposed fluid exchange protocol had no adverse effects on the mechanical properties.
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Affiliation(s)
- Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sophie Le Cann
- CNRS, Université Paris Est Créteil, Université Gustave Eiffel, UMR 8208, MSME, F-94010, Créteil, France
| | - Alessandro Tengattini
- Institut Laue-Langevin, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP 3SR, Grenoble, France
| | | | - Joeri Kok
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- *Correspondence: Hanna Isaksson,
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6
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Törnquist E, Le Cann S, Tudisco E, Tengattini A, Andò E, Lenoir N, Hektor J, Raina DB, Tägil M, Hall SA, Isaksson H. Dual modality neutron and x-ray tomography for enhanced image analysis of the bone-metal interface. Phys Med Biol 2021; 66. [PMID: 34010812 DOI: 10.1088/1361-6560/ac02d4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
The bone tissue formed at the contact interface with metallic implants, particularly its 3D microstructure, plays a pivotal role for the structural integrity of implant fixation. X-ray tomography is the classical imaging technique used for accessing microstructural information from bone tissue. However, neutron tomography has shown promise for visualising the immediate bone-metal implant interface, something which is highly challenging with x-rays due to large differences in attenuation between metal and biological tissue causing image artefacts. To highlight and explore the complementary nature of neutron and x-ray tomography, proximal rat tibiae with titanium-based implants were imaged with both modalities. The two techniques were compared in terms of visualisation of different material phases and by comparing the properties of the individual images, such as the contrast-to-noise ratio. After superimposing the images using a dedicated image registration algorithm, the complementarity was further investigated via analysis of the dual modality histogram, joining the neutron and x-ray data. From these joint histograms, peaks with well-defined grey value intervals corresponding to the different material phases observed in the specimens were identified and compared. The results highlight differences in how neutrons and x-rays interact with biological tissues and metallic implants, as well as the benefits of combining both modalities. Future refinement of the joint histogram analysis could improve the segmentation of structures and tissues, and yield novel information about specimen-specific properties such as moisture content.
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Affiliation(s)
- Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sophie Le Cann
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, Creteil, France
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Lund, Sweden
| | - Alessandro Tengattini
- Institut Laue-Langevin (ILL), Grenoble, France.,Univ. Grenoble Alpes, CNRS, Grenoble INP, 3SR, Grenoble, France
| | - Edward Andò
- Univ. Grenoble Alpes, CNRS, Grenoble INP, 3SR, Grenoble, France
| | - Nicolas Lenoir
- Institut Laue-Langevin (ILL), Grenoble, France.,Univ. Grenoble Alpes, CNRS, Grenoble INP, 3SR, Grenoble, France
| | - Johan Hektor
- LUNARC-Centre for Scientific and Technical Computing at Lund University, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Magnus Tägil
- Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Lund, Sweden.,Lund Institute of Advanced Neutron and X-ray Science (LINXS), Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
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7
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Guillaume F, Le Cann S, Tengattini A, Törnquist E, Falentin-Daudre C, Albini Lomami H, Petit Y, Isaksson H, Haïat G. Neutron microtomography to investigate the bone-implant interface-comparison with histological analysis. Phys Med Biol 2021; 66. [PMID: 33831846 DOI: 10.1088/1361-6560/abf603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
Bone properties and especially its microstructure around implants are crucial to evaluate the osseointegration of prostheses in orthopaedic, maxillofacial and dental surgeries. Given the intrinsic heterogeneous nature of the bone microstructure, an ideal probing tool to understand and quantify bone formation must be spatially resolved. X-ray imaging has often been employed, but is limited in the presence of metallic implants, where severe artifacts generally arise from the high attenuation of metals to x-rays. Neutron tomography has recently been proposed as a promising technique to study bone-implant interfaces, thanks to its lower interaction with metals. The aim of this study is to assess the potential of neutron tomography for the characterisation of bone tissue in the vicinity of a metallic implant. A standardised implant with a bone chamber was implanted in rabbit bone. Four specimens were imaged with neutron tomography and subsequently compared to non-decalcified histology to stain soft and mineralised bone tissues, used here as a ground-truth reference. An intensity-based image registration procedure was performed to place the 12 histological slices within the corresponding 3D neutron volume. Significant correlations (p < 0.01) were obtained between the two modalities for the bone-implant contact (BIC) ratio (R = 0.77) and the bone content inside the chamber (R = 0.89). The results indicate that mineralised bone tissue can be reliably detected by neutron tomography. However, theBICratio and bone content were found to be overestimated with neutron imaging, which may be explained by its sensitivity to non-mineralised soft tissues, as revealed by histological staining. This study highlights the suitability of neutron tomography for the analysis of the bone-implant interface. Future work will focus on further distinguishing soft tissues from bone tissue, which could be aided by the adoption of contrast agents.
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Affiliation(s)
- Florian Guillaume
- Département de génie mécanique, École de technologie supérieure, Montréal, Canada.,MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, F-94010 Creteil, France
| | - Sophie Le Cann
- MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, F-94010 Creteil, France
| | - Alessandro Tengattini
- Institut Laue Langevin, Grenoble, France.,Laboratoire 3SR, Université Grenoble Alpes, Gières, France
| | - Elin Törnquist
- Department of Biomedical Engineering, Lund University, SE-221 00 Lund, Sweden
| | - Céline Falentin-Daudre
- LBPS/CSPBAT, UMR CNRS 7244, Institut Galilée, Université Sorbonne Paris Nord, 99 avenue JB Clément 93430- Villetaneuse, France
| | - Hugues Albini Lomami
- MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, F-94010 Creteil, France
| | - Yvan Petit
- Département de génie mécanique, École de technologie supérieure, Montréal, Canada
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, SE-221 00 Lund, Sweden
| | - Guillaume Haïat
- MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, F-94010 Creteil, France
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8
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Le Cann S, Tudisco E, Tägil M, Hall SA, Isaksson H. Bone Damage Evolution Around Integrated Metal Screws Using X-Ray Tomography - in situ Pullout and Digital Volume Correlation. Front Bioeng Biotechnol 2020; 8:934. [PMID: 32850760 PMCID: PMC7419699 DOI: 10.3389/fbioe.2020.00934] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022] Open
Abstract
Better understanding of the local deformation of the bone network around metallic implants subjected to loading is of importance to assess the mechanical resistance of the bone-implant interface and limit implant failure. In this study, four titanium screws were osseointegrated into rat tibiae for 4 weeks and screw pullout was conducted in situ under x-ray microtomography, recording macroscopic mechanical behavior and full tomographies at multiple load steps before failure. Images were analyzed using Digital Volume Correlation (DVC) to access internal displacement and deformation fields during loading. A repeatable failure pattern was observed, where a ∼300–500 μm-thick envelope of bone detached from the trabecular structure. Fracture initiated close to the screw tip and propagated along the implant surface, at a distance of around 500 μm. Thus, the fracture pattern appeared to be influenced by the microstructure of the bone formed closely around the threads, which confirmed that the model is relevant for evaluating the effect of pharmacological treatments affecting local bone formation. Moreover, cracks at the tibial plateau were identified by DVC analysis of the tomographic images acquired during loading. Moderate strains were first distributed in the trabecular bone, which localized into higher strains regions with subsequent loading, revealing crack-formation not evident in the tomographic images. The in situ loading methodology followed by DVC is shown to be a powerful tool to study internal deformation and fracture behavior of the newly formed bone close to an implant when subjected to loading. A better understanding of the interface failure may help improve the outcome of surgical implants.
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Affiliation(s)
- Sophie Le Cann
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
| | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Lund, Sweden.,Lund Institute for Advanced Neutron and X-ray Science, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
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9
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An effective gamma white spots removal method for CCD-based neutron images denoising. FUSION ENGINEERING AND DESIGN 2020. [DOI: 10.1016/j.fusengdes.2019.111375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Raina DB, Larsson D, Sezgin EA, Isaksson H, Tägil M, Lidgren L. Biomodulation of an implant for enhanced bone-implant anchorage. Acta Biomater 2019; 96:619-630. [PMID: 31301423 DOI: 10.1016/j.actbio.2019.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022]
Abstract
Aseptic loosening of implants is the major cause for revision surgery. By modulating the bone-implant interface, early bone-implant anchorage could be improved. Implant surface manipulation by the addition of osteopromotive molecules locally and systemically to promote implant integration has been described with limited success. This study describes a novel approach by making the implant capable of biologically modulating its surroundings. It was hypothesized that the early implant fixation would improve by filling the interior of the implant with a carrier providing spatio-temporal release of bone active drugs with known osteogenic effect. The implant consisted of a threaded polyether ether ketone (PEEK) hollow chamber with holes at the bottom. The implant was filled with a calcium sulphate (CaS)/hydroxyapatite (HA) carrier, delivering two bone active molecules; zoledronic acid (ZA) and bone morphogenic protein-2 (BMP-2). At first, a rat abdominal muscle pouch model indicated a sustained in-vivo release of both 125I-rhBMP-2 (57%) and 14C-ZA (22%) from the CaS/HA carrier over a period of 4-weeks. The biomodulated implant was then inserted in the proximal tibia in rats with the following experimental groups: G1) Empty implant, G2) Implant + CaS/HA, G3) Implant + CaS/HA + ZA and G4) Implant + CaS/HA + ZA + rhBMP-2. Significantly higher bone volume (BV) was seen around the implant in groups G3 (3.3 ± 0.7 mm3) and G4 (3.1 ± 0.7 mm3) compared to the control (1.3 ± 0.4 mm3) using micro-computed tomography and qualitative histology. Group G3, also exhibited significantly higher pull-out force and absorbed energy when compared to the control group G1. These findings indicate that a low dose of ZA alone, released in a controlled manner from within a fenestrated implant is enough to improve implant anchorage without the need of adding rhBMP-2. This simple method of using a fenestrated implant containing a ceramic carrier releasing bone active molecules improved bone anchorage and could clinically reduce prosthetic failure. STATEMENT OF SIGNIFICANCE: Aseptic loosening remains as a major cause for implant revisions and early reaction of surrounding bone to the prosthesis is important for longevity. A novel approach to enhance early bone-implant anchorage is presented. The implant is filled with a carrier providing controlled release of bone active molecules. In an animal model, a calcium sulphate (CaS)/hydroxyapatite (HA) carrier was used to provide a spatio-temporal release of bone morphogenic protein-2 (BMP-2) and zoledronic acid (ZA). Significantly better bone-implant integration was achieved using ZA alone, thereby eliminating the need for adding BMP-2. The developed method of implant biomodulation holds potential to prevent implant loosening and is an alternative to prosthetic coatings or systemic drug treatment. Importantly, all constituents are approved for clinical use.
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11
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Gao X, Fraulob M, Haïat G. Biomechanical behaviours of the bone-implant interface: a review. J R Soc Interface 2019; 16:20190259. [PMID: 31362615 PMCID: PMC6685012 DOI: 10.1098/rsif.2019.0259] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023] Open
Abstract
In recent decades, cementless implants have been widely used in clinical practice to replace missing organs, to replace damaged or missing bone tissue or to restore joint functionality. However, there remain risks of failure which may have dramatic consequences. The success of an implant depends on its stability, which is determined by the biomechanical properties of the bone-implant interface (BII). The aim of this review article is to provide more insight on the current state of the art concerning the evolution of the biomechanical properties of the BII as a function of the implant's environment. The main characteristics of the BII and the determinants of implant stability are first introduced. Then, the different mechanical methods that have been employed to derive the macroscopic properties of the BII will be described. The experimental multi-modality approaches used to determine the microscopic biomechanical properties of periprosthetic newly formed bone tissue are also reviewed. Eventually, the influence of the implant's properties, in terms of both surface properties and biomaterials, is investigated. A better understanding of the phenomena occurring at the BII will lead to (i) medical devices that help surgeons to determine an implant's stability and (ii) an improvement in the quality of implants.
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Affiliation(s)
- Xing Gao
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
- Research Centre for Medical Robotics and Minimally Invasive Surgical Devices, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Manon Fraulob
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
| | - Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
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12
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Le Cann S, Tudisco E, Turunen MJ, Patera A, Mokso R, Tägil M, Belfrage O, Hall SA, Isaksson H. Investigating the Mechanical Characteristics of Bone-Metal Implant Interface Using in situ Synchrotron Tomographic Imaging. Front Bioeng Biotechnol 2019; 6:208. [PMID: 30719433 PMCID: PMC6348316 DOI: 10.3389/fbioe.2018.00208] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/18/2018] [Indexed: 12/18/2022] Open
Abstract
Long-term stability of endosseous implants depends on successful bone formation, ingrowth and adaptation to the implant. Specifically, it will define the mechanical properties of the newly formed bone-implant interface. 3D imaging during mechanical loading tests (in situ loading) can improve the understanding of the local processes leading to bone damage and failure. In this study, titanium screws were implanted into rat tibiae and were allowed to integrate for 4 weeks with or without the addition of the growth factor Bone Morphogenetic Protein and the bisphosphonate Zoledronic Acid. Samples were subjected to in situ pullout using high-resolution synchrotron x-ray tomography at the Tomcat beamline (SLS, PSI, Switzerland) at 30 keV with 25 ms exposure time, resulting in a total acquisition time of 45 s per scan, with a 3.6 μm isotropic voxel size. Using a custom-made loading device positioned inside the beamline, screws were pulled out with 0.05 mm increment, acquiring multiple scans until rupture of the sample. The in situ loading protocol was adapted to ensure short imaging time, which enabled multiple samples to be tested with short loading steps, while keeping the total testing time low and reducing dose deposition. Higher trabecular bone content was quantified in the surrounding of the screw in the treated groups, which correlated with increased mechanical strength and stiffness. Differences in screw implantation, such as contact between threads and cortex as well as minor tilt of the screw were also correlated to the mechanical parameters. In situ loading enabled the investigation of crack propagation during the pullout, highlighting the mechanical behavior of the interface. Three typical crack types were observed: (1) rupture at the interface of trabecular and cortical bone tissues, close to the screw, (2) large crack inside the cortex connected to the implant, and (3) first failure away from the screw with cracks propagating toward the screw-bone interface. Mechanical properties of in vivo integrated bone-metal screws rely on a combination of multiple parameters that are difficult to identify and separate one from the other.
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Affiliation(s)
- Sophie Le Cann
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Lund, Sweden
| | - Mikael J Turunen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | | | | | - Magnus Tägil
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
| | - Ola Belfrage
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
| | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
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13
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Ashkar R, Bilheux HZ, Bordallo H, Briber R, Callaway DJE, Cheng X, Chu XQ, Curtis JE, Dadmun M, Fenimore P, Fushman D, Gabel F, Gupta K, Herberle F, Heinrich F, Hong L, Katsaras J, Kelman Z, Kharlampieva E, Kneller GR, Kovalevsky A, Krueger S, Langan P, Lieberman R, Liu Y, Losche M, Lyman E, Mao Y, Marino J, Mattos C, Meilleur F, Moody P, Nickels JD, O'Dell WB, O'Neill H, Perez-Salas U, Peters J, Petridis L, Sokolov AP, Stanley C, Wagner N, Weinrich M, Weiss K, Wymore T, Zhang Y, Smith JC. Neutron scattering in the biological sciences: progress and prospects. ACTA CRYSTALLOGRAPHICA SECTION D-STRUCTURAL BIOLOGY 2018; 74:1129-1168. [PMID: 30605130 DOI: 10.1107/s2059798318017503] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022]
Abstract
The scattering of neutrons can be used to provide information on the structure and dynamics of biological systems on multiple length and time scales. Pursuant to a National Science Foundation-funded workshop in February 2018, recent developments in this field are reviewed here, as well as future prospects that can be expected given recent advances in sources, instrumentation and computational power and methods. Crystallography, solution scattering, dynamics, membranes, labeling and imaging are examined. For the extraction of maximum information, the incorporation of judicious specific deuterium labeling, the integration of several types of experiment, and interpretation using high-performance computer simulation models are often found to be particularly powerful.
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Affiliation(s)
- Rana Ashkar
- Department of Physics, Virginia Polytechnic Institute and State University, 850 West Campus Drive, Blacksburg, VA 24061, USA
| | - Hassina Z Bilheux
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | | | - Robert Briber
- Materials Science and Engineeering, University of Maryland, 1109 Chemical and Nuclear Engineering Building, College Park, MD 20742, USA
| | - David J E Callaway
- Department of Chemistry and Biochemistry, The City College of New York, 160 Convent Avenue, New York, NY 10031, USA
| | - Xiaolin Cheng
- Department of Medicinal Chemistry and Pharmacognosy, Ohio State University College of Pharmacy, 642 Riffe Building, Columbus, OH 43210, USA
| | - Xiang Qiang Chu
- Graduate School of China Academy of Engineering Physics, Beijing, 100193, People's Republic of China
| | - Joseph E Curtis
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - Mark Dadmun
- Department of Chemistry, University of Tennessee Knoxville, Knoxville, TN 37996, USA
| | - Paul Fenimore
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - David Fushman
- Department of Chemistry and Biochemistry, Center for Biomolecular Structure and Organization, University of Maryland, College Park, MD 20742, USA
| | - Frank Gabel
- Institut Laue-Langevin, Université Grenoble Alpes, CEA, CNRS, IBS, 38042 Grenoble, France
| | - Kushol Gupta
- Department of Biochemistry and Biophysics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Frederick Herberle
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Frank Heinrich
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - Liang Hong
- Department of Physics and Astronomy, Institute of Natural Sciences, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China
| | - John Katsaras
- Neutron Scattering Science Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Zvi Kelman
- Institute for Bioscience and Biotechnology Research, National Institute of Standards and Technology and the University of Maryland, Rockville, MD 20850, USA
| | - Eugenia Kharlampieva
- Department of Chemistry, University of Alabama at Birmingham, 901 14th Street South, Birmingham, AL 35294, USA
| | - Gerald R Kneller
- Centre de Biophysique Moléculaire, CNRS, Université d'Orléans, Chateau de la Source, Avenue du Parc Floral, Orléans, France
| | - Andrey Kovalevsky
- Biology and Soft Matter Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Susan Krueger
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - Paul Langan
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Raquel Lieberman
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Yun Liu
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - Mathias Losche
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Edward Lyman
- Department of Physics and Astrophysics, University of Delaware, Newark, DE 19716, USA
| | - Yimin Mao
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - John Marino
- Institute for Bioscience and Biotechnology Research, National Institute of Standards and Technology and the University of Maryland, Rockville, MD 20850, USA
| | - Carla Mattos
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts, USA
| | - Flora Meilleur
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Peter Moody
- Leicester Institute of Structural and Chemical Biology, Department of Molecular and Cell Biology, University of Leicester, Leicester LE1 9HN, England
| | - Jonathan D Nickels
- Department of Physics, Virginia Polytechnic Institute and State University, 850 West Campus Drive, Blacksburg, VA 24061, USA
| | - William B O'Dell
- Institute for Bioscience and Biotechnology Research, National Institute of Standards and Technology and the University of Maryland, Rockville, MD 20850, USA
| | - Hugh O'Neill
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Ursula Perez-Salas
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | | | - Loukas Petridis
- Materials Science and Engineeering, University of Maryland, 1109 Chemical and Nuclear Engineering Building, College Park, MD 20742, USA
| | - Alexei P Sokolov
- Department of Chemistry, University of Tennessee Knoxville, Knoxville, TN 37996, USA
| | - Christopher Stanley
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Norman Wagner
- Department of Chemistry and Biochemistry, The City College of New York, 160 Convent Avenue, New York, NY 10031, USA
| | - Michael Weinrich
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - Kevin Weiss
- Neutron Sciences Directorate, Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Troy Wymore
- Graduate School of China Academy of Engineering Physics, Beijing, 100193, People's Republic of China
| | - Yang Zhang
- NIST Center for Neutron Research, National Institutes of Standard and Technology, 100 Bureau Drive, Mail Stop 6102, Gaithersburg, MD 20899, USA
| | - Jeremy C Smith
- Department of Medicinal Chemistry and Pharmacognosy, Ohio State University College of Pharmacy, 642 Riffe Building, Columbus, OH 43210, USA
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14
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Characterizing pearls structures using X-ray phase-contrast and neutron imaging: a pilot study. Sci Rep 2018; 8:12118. [PMID: 30108321 PMCID: PMC6092347 DOI: 10.1038/s41598-018-30545-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/29/2018] [Indexed: 11/08/2022] Open
Abstract
Some cultured and natural pearls can be reliably distinguished by visual inspection and by the use of lens and microscope. However, assessing the origin of the pearls could be not straightforward since many different production techniques can now be found in the pearl market, for example in salt or freshwater environments, with or without a rigid nucleus. This wide range of products requires the use of new effective scientific techniques. Indeed, X-ray radiography has been used by gemologists since last century as the only safe and non-destructive way to visually inspect the interior of a pearl, and recently, also X-ray computed micro-tomography was used to better visualize the inner parts of the gems. In this study we analyzed samples of natural and cultured pearls by means of two non-destructive techniques: the X-ray Phase-Contrast Imaging (PCI) and the Neutron Imaging (NI). PCI and NI results will be combined for the first time, to better visualize the pearls internal morphology, thus giving relevant indications on the pearl formation process.
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15
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Le Cann S, Tudisco E, Perdikouri C, Belfrage O, Kaestner A, Hall S, Tägil M, Isaksson H. Characterization of the bone-metal implant interface by Digital Volume Correlation of in-situ loading using neutron tomography. J Mech Behav Biomed Mater 2017; 75:271-278. [PMID: 28759839 DOI: 10.1016/j.jmbbm.2017.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/19/2017] [Accepted: 07/01/2017] [Indexed: 12/22/2022]
Abstract
Metallic implants are commonly used as surgical treatments for many orthopedic conditions. The long-term stability of implants relies on an adequate integration with the surrounding bone. Unsuccessful integration could lead to implant loosening. By combining mechanical loading with high-resolution 3D imaging methods, followed by image analysis such as Digital Volume Correlation (DVC), we aim at evaluating ex vivo the mechanical resistance of newly formed bone at the interface. X-rays tomography is commonly used to image bone but induces artefacts close to metallic components. Utilizing a different interaction with matter, neutron tomography is a promising alternative but has not yet been used in studies of bone mechanics. This work demonstrates that neutron tomography during in situ loading is a feasible tool to characterize the mechanical response of bone-implant interfaces, especially when combined with DVC. Experiments were performed where metal screws were implanted in rat tibiae during 4 weeks. The screws were pulled-out while the samples were sequentially imaged in situ with neutron tomography. The images were analyzed to quantify bone ingrowth around the implants. DVC was used to track the internal displacements and calculate the strain fields in the bone during loading. The neutron images were free of metal-related artefacts, which enabled accurate quantification of bone ingrowth on the screw (ranging from 60% to 71%). DVC allowed successful identification of the deformation and cracks that occurred during mechanical loading and led to final failure of the bone-implant interface.
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Affiliation(s)
- Sophie Le Cann
- Department of Biomedical Engineering, Lund University, 22100 Lund, Sweden.
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Sweden.
| | | | - Ola Belfrage
- Department of Orthopaedics, Lund University, Sweden.
| | - Anders Kaestner
- Swiss Spallation Source, Paul Sheerer Institute, Switzerland.
| | - Stephen Hall
- Division of Solid Mechanics, Lund University, Sweden.
| | - Magnus Tägil
- Department of Orthopaedics, Lund University, Sweden.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, 22100 Lund, Sweden; Department of Orthopaedics, Lund University, Sweden.
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