Predictive modelling of cervical disc implant wear

A comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements

A more robust pre-clinical wear simulation framework is required in order to simulate wider and higher ranges of activities, observed in different patient populations such as younger more active patients. Such a framework will help to understand and address the reported higher failure rates for younger and more active patients (National_Joint_Registry, 2016). The current study has developed and validated a comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements (TKR).

The input mechanical (elastic modulus and Poisson’s ratio) and wear parameters of the moderately cross-linked ultra-high molecular weight polyethylene (UHMWPE) bearing material were independently measured from experimental studies under realistic test conditions, similar to the loading conditions found in the total knee replacements. The wear predictions from the computational wear simulation were validated against the direct experimental wear measurements for size 3 Sigma curved total knee replacements (DePuy, UK) in an independent experimental wear simulation study under three different daily activities; walking, deep squat, and stairs ascending kinematic conditions.

The measured compressive mechanical properties of the moderately cross-linked UHMWPE material were more than 20% lower than that reported in the literature under tensile test conditions. The pin-on-plate wear coefficient of moderately cross-linked UHMWPE was significantly dependant of the contact stress and the degree of cross-shear at the articulating surfaces.

The computational wear predictions for the TKR from the current framework were consistent and in a good agreement with the independent full TKR experimental wear simulation measurements, with 0.94 coefficient of determination of the framework. In addition, the comprehensive combined experimental and computational framework was able to explain the complex experimental wear trends from the three different daily activities investigated. Therefore, such a framework can be adopted as a pre-clinical simulation approach to optimise different designs, materials, as well as patient’s specific total knee replacements for a range of activities.

Four decades of finite element analysis of orthopaedic devices: where are we now and what are the opportunities?

Finite element has been used for more than four decades to study and evaluate the mechanical behaviour total joint replacements. In Huiskes seminal paper "Failed innovation in total hip replacement: diagnosis and proposals for a cure", finite element modelling was one of the potential cures to avoid poorly performing designs reaching the market place. The size and sophistication of models has increased significantly since that paper and a range of techniques are available from predicting the initial mechanical environment through to advanced adaptive simulations including bone adaptation, tissue differentiation, damage accumulation and wear. However, are we any closer to FE becoming an effective screening tool for new devices? This review contains a critical analysis of currently available finite element modelling techniques including (i) development of the basic model, the application of appropriate material properties, loading and boundary conditions, (ii) describing the initial mechanical environment of the bone-implant system, (iii) capturing the time dependent behaviour in adaptive simulations, (iv) the design and implementation of computer based experiments and (v) determining suitable performance metrics. The development of the underlying tools and techniques appears to have plateaued and further advances appear to be limited either by a lack of data to populate the models or the need to better understand the fundamentals of the mechanical and biological processes. There has been progress in the design of computer based experiments. Historically, FE has been used in a similar way to in vitro tests, by running only a limited set of analyses, typically of a single bone segment or joint under idealised conditions. The power of finite element is the ability to run multiple simulations and explore the performance of a device under a variety of conditions. There has been increasing usage of design of experiments, probabilistic techniques and more recently population based modelling to account for patient and surgical variability. In order to have effective screening methods, we need to continue to develop these approaches to examine the behaviour and performance of total joint replacements and benchmark them for devices with known clinical performance. Finite element will increasingly be used in the design, development and pre-clinical testing of total joint replacements. However, simulations must include holistic, closely corroborated, multi-domain analyses which account for real world variability.

Parameters that effect spine biomechanics following cervical disc replacement

Total disc replacement (TDR) is expected to provide a more physiologic alternative to fusion. However, long-term clinical data proving the efficacy of the implants is lacking. Limited clinical data suggest somewhat of a disagreement between the in vitro biomechanical studies and in vivo assessments. This conceptual paper presents the potential biomechanical challenges affecting the TDR that should be addressed with a hope to improve the clinical outcomes and our understanding of the devices. Appropriate literature and our own research findings comparing the biomechanics of different disc designs are presented to highlight the need for additional investigations. The biomechanical effects of various surgical procedures are analyzed, reiterating the importance of parameters like preserving uncinate processes, disc placement and its orientation within the cervical spine. Moreover, the need for a 360° dynamic system for disc recipients who may experience whiplash injuries is explored. Probabilistic studies as performed already in the lumbar spine may explore high risk combinations of different parameters and explain the differences between "standard" biomechanical investigations and clinical studies. Development of a patient specific optimized finite element model that takes muscle forces into consideration may help resolve the discrepancies between biomechanics of TDR and the clinical studies. Factors affecting long-term performance such as bone remodeling, subsidence, and wear are elaborated. In vivo assessment of segmental spine motion has been, and continues to be, a challenge. In general, clinical studies while reporting the data have placed lesser emphasis on kinematics following intervertebral disc replacements. Evaluation of in vivo kinematics following TDR to analyze the quality and quantity of motion using stereoradiogrammetric technique may be needed.

Models that incorporate spinal structures predict better wear performance of cervical artificial discs

BACKGROUND CONTEXT

Wear simulators and their corresponding wear predictive models provide limited information on wear characteristics of artificial discs. Analyses in previous studies that controlled loading profiles according to International Standards Organization (ISO)/American Society for Testing and Materials standards did not account for factors such as the influence of anatomic structures. Retrieval analyses reveal failure modes that are not observed in benchtop simulations and thus indicate deficiencies associated with existing approaches.

PURPOSE

To understand the impact of the adjoining spinal structures of a ligamentous segment on the wear of an artificial cervical disc.

STUDY DESIGN

Prediction of wear in artificial disc implants (total disc replacement [TDR]) in situ using finite element modeling.

METHODS

A novel predictive finite element model was used to evaluate wear in a simulated functional spinal unit (FSU). A predictive finite element wear model of the disc alone (TDR Only) was developed, along the lines of that proposed in the literature. This model was then incorporated into a ligamentous C5-C6 finite element model (TDR+FSU). Both of these models were subjected to a motion profile (rotation about three axes) with varying preloads of 50 to150 N at 1 Hz, consistent with ISO 18192. A subroutine based on Archard law simulated abrasive wear on the polymeric core up to 10 million cycles. The TDR+FSU model was further modified to simulate facetectomy, sequential addition of ligaments, and compressive load; simulations were repeated for 10 million cycles.

RESULTS

The predicted wear patterns in the isolated disc (TDR Only) and in TDR+FSU were completely inconsistent. The TDR+FSU model predicted localized wear in certain regions, in contrast to the uniformly distributed wear pattern of the TDR-only model. In addition, the cumulative volumetric wear for the TDR-only model was 10 times that of the TDR+FSU model. The TDR+FSU model also revealed a separation at the articulating interface during extension and lateral bending. After facetectomy, the wear pattern remained lopsided, but linear wear increased eightfold, whereas volumetric wear almost tripled. This was accompanied by a reduction in observed liftoff. The addition of anterior longitudinal ligament/posterior longitudinal ligament did not affect volumetric or linear wear. On the removal of all ligaments and facet forces, and replacement of follower load with a compressive load, the wear pattern returned to an approximation of the TDR-only test case, whereas the cumulative volumetric wear became nearly equivalent. In this case, the liftoff phenomenon was absent.

CONCLUSIONS

Anatomic structures and follower load mitigate the wear of an artificial disc. The proposed model (TDR+FSU) would enable further study of the effects of clinical parameters (eg, surgical variables, different loading profiles, different disc designs, and bone quality) on wear in these implants.

Simbody: multibody dynamics for biomedical research

Multibody software designed for mechanical engineering has been successfully employed in biomedical research for many years. For real time operation some biomedical researchers have also adapted game physics engines. However, these tools were built for other purposes and do not fully address the needs of biomedical researchers using them to analyze the dynamics of biological structures and make clinically meaningful recommendations. We are addressing this problem through the development of an open source, extensible, high performance toolkit including a multibody mechanics library aimed at the needs of biomedical researchers. The resulting code, Simbody, supports research in a variety of fields including neuromuscular, prosthetic, and biomolecular simulation, and related research such as biologically-inspired design and control of humanoid robots and avatars. Simbody is the dynamics engine behind OpenSim, a widely used biomechanics simulation application. This article reviews issues that arise uniquely in biomedical research, and reports on the architecture, theory, and computational methods Simbody uses to address them. By addressing these needs explicitly Simbody provides a better match to the needs of researchers than can be obtained by adaptation of mechanical engineering or gaming codes. Simbody is a community resource, free for any purpose. We encourage wide adoption and invite contributions to the code base at https://simtk.org/home/simbody.

A New Formulation for the Prediction of Polyethylene Wear in Artificial Hip Joints

Artificial joints employing ultra-high molecular weight polyethylene (UHMWPE) are widely used to treat joint diseases and trauma. Wear of the polymer bearing surface largely limits the use of these joints in younger and more active patients. Previous studies have shown the wear factor used in Archard's law for the conventional polyethylene to be highly dependent on contact pressure and this has produced variability in experimental data and has constrained the reliability and applicability of previous computational predictions. A new wear law is proposed, based on wear volume being dependent on, and proportional to, the product of the sliding distance and contact area. The dimensionless proportional constant, wear coefficient, which was independent of contact pressure, was determined from a multi-directional pin on plate study. This was used in computational predictions of the wear of the conventional UHMWPE hip joints. The wear of the polyethylene cup was independently experimentally determined in physiological full hip joint simulator studies. The predicted wear rate from the new computational model was generally increased, with an improved agreement with the experimental measurement compared with the previous computational model. It was shown that wear in the UHMWPE hip joints increased as head size and contact area increased. This resulted in a much larger increase in the wear rate as the head size increased, compared with the previous computational model, and is consistent with clinical observations. This new understanding of the wear mechanism in artificial joints using the UHMWPE bearing surfaces, and the improved ability to predict wear independently and to address previously described discrepancies offer new opportunities to optimize design parameters.