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Patellar bone strain after total knee arthroplasty is correlated with bone mineral density and body mass index. Med Eng Phys 2019; 68:17-24. [PMID: 30979584 DOI: 10.1016/j.medengphy.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/20/2022]
Abstract
Patella-related complications after total knee arthroplasty (TKA) remain a major clinical concern. Previous studies have suggested that increased postoperative patellar bone strain could be related to such complications, but there is limited knowledge on patellar strain after TKA. The objective of this study was to predict patellar bone strain after TKA and evaluate correlations with various preoperative data. Fourteen TKA patients with a minimum follow-up of one year were included in this study. Using preoperative CT datasets, preoperative planning, and postoperative X-rays, a method is presented to generate patient-specific finite element models after virtual TKA. Patellar kinematics and forces were predicted during a squat movement, and patellar bone strain was evaluated at 60° of knee flexion. Strain varied greatly among patients, but was strongly negatively correlated (r = -0.85, p < 0.001) with bone mineral density (BMD) and moderately positively (r = 0.54, p = 0.05) with body mass index (BMI). The BMI/BMD ratio explained 87% of strain, and should be further investigated as a potential risk factor for clinical complications. This study represents a preliminary step towards the identification of patients at risk of patellar complications after TKA.
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Knowles NK, Langohr GDG, Faieghi M, Nelson AJ, Ferreira LM. A comparison of density-modulus relationships used in finite element modeling of the shoulder. Med Eng Phys 2019; 66:40-46. [PMID: 30833224 DOI: 10.1016/j.medengphy.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 11/29/2018] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
Subject- and site-specific modeling techniques greatly improve the accuracy of computational models derived from clinical-resolution quantitative computed tomography (QCT) data. The majority of shoulder finite element (FE) studies use density-modulus relationships developed for alternative anatomical locations. As such, the objectives of this study were to compare the six most commonly used density-modulus relationships in shoulder finite element (FE) studies. To achieve this, ninety-eight (98) virtual trabecular bone cores were extracted from uCT scans of scapulae from 14 cadaveric specimens (7 male; 7 female). Homogeneous tissue moduli of 20 GPa, and heterogeneous tissue moduli scaled by CT-intensity were considered. Micro finite element models (µ-FEMs) of each virtual core were compressively loaded to 0.5% apparent strain and apparent strain energy density (SEDapp) was collected. Each uCT virtual core was then co-registered to clinical QCT images, QCT-FEMs created, and each of the 6 density-modulus relationships applied (6 × 98 = 588 QCT-FEMs). The loading and boundary conditions were replicated and SEDapp was collected and compared to µ-FEM SEDapp. When a homogeneous tissue modulus was considered in the µ-FEMs, SEDapp was best predicted in QCT-FEMs with the density-modulus relationship developed from pooled anatomical locations (QCT-FEM SEDapp = 0.979µ-FEM SEDapp + 0.0066, r2 = 0.933). A different density-modulus relationship best predicted SEDapp (QCT-FEM SEDapp = 1.014µ-FEM SEDapp + 0.0034, r2 = 0.935) when a heterogeneous tissue modulus was considered. This study compared density-modulus relationships used in shoulder FE studies using an independent computational methodology for comparing these relationships.
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Affiliation(s)
- Nikolas K Knowles
- School of Biomedical Engineering, The University of Western Ontario, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, Surgical Mechatronics Laboratory, St. Josephs Health Care, 268 Grosvenor St., London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - G Daniel G Langohr
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, Surgical Mechatronics Laboratory, St. Josephs Health Care, 268 Grosvenor St., London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - Mohammadreza Faieghi
- School of Biomedical Engineering, The University of Western Ontario, London, ON, Canada
| | - Andrew J Nelson
- Department of Anthropology, The University of Western Ontario, London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada; Department of Chemistry, The University of Western Ontario, London, ON, Canada
| | - Louis M Ferreira
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, Surgical Mechatronics Laboratory, St. Josephs Health Care, 268 Grosvenor St., London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.
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Chandran V, Maquer G, Gerig T, Zysset P, Reyes M. Supervised learning for bone shape and cortical thickness estimation from CT images for finite element analysis. Med Image Anal 2019; 52:42-55. [DOI: 10.1016/j.media.2018.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/24/2018] [Accepted: 11/02/2018] [Indexed: 01/31/2023]
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Wili P, Maquer G, Panyasantisuk J, Zysset PK. Estimation of the effective yield properties of human trabecular bone using nonlinear micro-finite element analyses. Biomech Model Mechanobiol 2017. [DOI: 10.1007/s10237-017-0928-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hosseini HS, Maquer G, Zysset PK. μCT-based trabecular anisotropy can be reproducibly computed from HR-pQCT scans using the triangulated bone surface. Bone 2017; 97:114-120. [PMID: 28109918 DOI: 10.1016/j.bone.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
The trabecular structure can be assessed at the wrist or tibia via high-resolution peripheral quantitative computed tomography (HR-pQCT). Yet on this modality, the performance of the existing methods, evaluating trabecular anisotropy is usually overlooked, especially in terms of reproducibility. We thus proposed to compare the TRI routine used by SCANCO Medical AG (Brüttisellen, Switzerland), the classical mean intercept length (MIL), and the grey-level structure tensor (GST) to the mean surface length (MSL), a new method for evaluating a second-order fabric tensor based on the triangulation of the bone surface. The distal radius of 24 fresh-frozen human forearms was scanned three times via HR-pQCT protocols (61μm, 82μm nominal voxel size), dissected, and imaged via micro computed tomography (μCT) at 16μm nominal voxel size. After registering the scans, we compared for each resolution the fabric tensors, determined by the mentioned techniques for 182 trabecular regions of interest. We then evaluated the reproducibility of the fabric information measured by HR-pQCT via precision errors. On μCT, TRI and GST were respectively the best and worst surrogates for MILμCT (MIL computed on μCT) in terms of eigenvalues and main direction of anisotropy. On HR-pQCT, however, MSL provided the best approximation of MILμCT. Surprisingly, surface-based approaches (TRI, MSL) also proved to be more precise than both MIL and GST. Our findings confirm that MSL can reproducibly estimate MILμCT, the current gold standard. MSL thus enables the direct mapping of the fabric-dependent material properties required in homogenised HR-pQCT-based finite element models.
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Affiliation(s)
- Hadi S Hosseini
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstr. 78, CH-3014 Bern, Switzerland.
| | - Ghislain Maquer
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstr. 78, CH-3014 Bern, Switzerland.
| | - Philippe K Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstr. 78, CH-3014 Bern, Switzerland
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Musy SN, Maquer G, Panyasantisuk J, Wandel J, Zysset PK. Not only stiffness, but also yield strength of the trabecular structure determined by non-linear µFE is best predicted by bone volume fraction and fabric tensor. J Mech Behav Biomed Mater 2017; 65:808-813. [DOI: 10.1016/j.jmbbm.2016.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/20/2016] [Accepted: 10/13/2016] [Indexed: 12/11/2022]
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Latypova A, Pioletti D, Terrier A. Importance of trabecular anisotropy in finite element predictions of patellar strain after Total Knee Arthroplasty. Med Eng Phys 2017; 39:102-105. [DOI: 10.1016/j.medengphy.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
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Daszkiewicz K, Maquer G, Zysset PK. The effective elastic properties of human trabecular bone may be approximated using micro-finite element analyses of embedded volume elements. Biomech Model Mechanobiol 2016; 16:731-742. [DOI: 10.1007/s10237-016-0849-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
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