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Todaro M, Saponaro G, Perquoti F, Gasparini G, Signorelli F, Tartaglione T, Moro A. Bone Regeneration and Polyetheretherketone Implants in Maxillo-Facial Surgery and Neurosurgery: A Multidisciplinary Study. BIOLOGY 2024; 13:467. [PMID: 39056662 PMCID: PMC11273635 DOI: 10.3390/biology13070467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
Polyetheretherketone (PEEK) in the last few years has emerged as an exceedingly promising material for craniofacial defects due to its biocompatibility and mechanical properties. However, its utilization remains controversial due to its inertness and low osteoinductivity. This study aimed to investigate the postoperative outcomes of patients undergoing maxillo-facial and neurosurgical procedures with PEEK implants. The focus is on evaluating bone regrowth on the surface and edges of the implant, periosteal reactions, and implant positioning. A retrospective analysis of 12 maxillo-facial surgery patients and 10 neurosurgery patients who received PEEK implants was conducted. CT scans performed at least one year post operation were examined for bone regrowth, periosteal reactions, and implant positioning. In maxillo-facial cases, the analysis included mandibular angle and fronto-orbital reconstruction, while neurosurgical cases involved cranioplasty. In maxillofacial surgery, 11 out of 12 patients showed radiological evidence of bone regrowth around PEEK implants, with favorable outcomes observed in craniofacial reconstruction. In neurosurgery, 9 out of 10 patients exhibited minimal or none bone regrowth, while one case demonstrated notable bone regeneration beneath the PEEK implant interface. The study highlights the importance of implant design and patient-specific factors in achieving successful outcomes, providing valuable insights for future implant-based procedures.
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Affiliation(s)
- Mattia Todaro
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Gianmarco Saponaro
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Federico Perquoti
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Giulio Gasparini
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Francesco Signorelli
- Neurosurgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy;
| | - Tommaso Tartaglione
- Radiology Department, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy;
| | - Alessandro Moro
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
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2
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Papalexopoulos D, Partalis C, Lampropoulos P, Artopoulou II, Sykaras N. Incorporating Stud Attachments in the Bar Design for an Implant-Supported Overdenture. Case Rep Dent 2024; 2024:2818034. [PMID: 38933360 PMCID: PMC11208102 DOI: 10.1155/2024/2818034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Bone resorption following tooth loss might compromise retention, stability, and support of conventional removable prostheses, and for this reason, implant-supported overdentures are suggested as a viable alternative for completely edentulous patients. Bars, telescopic attachments, or stud attachments have been used to provide retention through a different mechanism of action based on specific design characteristics. The purpose of this report is to thoroughly describe the applied protocol for the fabrication of an implant overdenture supported by two bars incorporating stud attachments. A 67-year-old male patient presented to the Postgraduate Clinic of the National and Kapodistrian University in Athens seeking dental rehabilitation. The remaining teeth were characterized with poor prognosis, mainly due to their periodontal status. The proposed treatment plan included the placement of four implants in the maxilla and two implants in the mandible and the fabrication of implant-supported overdentures. The diagnostic stages revealed adequate prosthetic space that would enable the fabrication of a bar substructure for the maxillary overdenture. To combine the benefits of bars and stud attachments, two bars with four attachments were fabricated. Evaluation of the delivered prosthesis revealed adequate retention, support, and stability achieved with minimal palatal coverage. Patient's reported satisfaction and quality of life were increased. Recall appointments at one, six, and twelve months did not reveal any adverse effects or patient's complaints. According to the present case report, different types of attachments may be used after careful study of each case. More studies are needed to report on different aspects of the chosen treatment plan.
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Affiliation(s)
- Dimokritos Papalexopoulos
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Christos Partalis
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Panagiotis Lampropoulos
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Ioli-Ioanna Artopoulou
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Nikitas Sykaras
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
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3
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Józsa TI, Petr J, Payne SJ, Mutsaerts HJMM. MRI-based parameter inference for cerebral perfusion modelling in health and ischaemic stroke. Comput Biol Med 2023; 166:107543. [PMID: 37837725 DOI: 10.1016/j.compbiomed.2023.107543] [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: 03/07/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
Cerebral perfusion modelling is a promising tool to predict the impact of acute ischaemic stroke treatments on the spatial distribution of cerebral blood flow (CBF) in the human brain. To estimate treatment efficacy based on CBF, perfusion simulations need to become suitable for group-level investigations and thus account for physiological variability between individuals. However, computational perfusion modelling to date has been restricted to a few patient-specific cases. This study set out to establish automated parameter inference for perfusion modelling based on neuroimaging data and thus enable CBF simulations of groups. Magnetic resonance imaging (MRI) data from 75 healthy senior adults were utilised. Brain geometries were computed from healthy reference subjects' T1-weighted MRI. Haemodynamic model parameters were determined from spatial CBF maps measured by arterial spin labelling (ASL) perfusion MRI. Thereafter, perfusion simulations were conducted in 75 healthy cases followed by 150 acute ischaemic stroke cases representing an occlusion and CBF cessation in the left and right middle cerebral arteries. The anatomical fitness of the brain geometries was evaluated by comparing the simulated grey (GM) and white matter (WM) volumes to measurements in healthy reference subjects. Strong positive correlations were found in both tissue types (GM: Pearson's r 0.74, P<0.001; WM: Pearson's r 0.84, P<0.001). Haemodynamic parameter tuning was verified by comparing the total volumetric blood flow rate to the brain in healthy reference subjects and simulations (Pearson's r 0.89, P<0.001). In acute ischaemic stroke cases, the simulated infarct volume using a perfusion-based estimate was 197±25 ml. Computational predictions were in agreement with anatomical and haemodynamic values from the literature concerning T1-weighted, T2-weighted, and phase-contrast MRI measurements in healthy scenarios and acute ischaemic stroke cases. The acute stroke simulations did not capture small infarcts (left tail of the distribution), which could be explained by neglected compensatory mechanisms, e.g. collaterals. The proposed parameter inference method provides a foundation for group-level CBF simulations and for in silico clinical stroke trials which could assist in medical device and drug development.
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Affiliation(s)
- T I Józsa
- Centre for Computational Engineering Sciences, School of Aerospace, Transport and Manufacturing, Cranfield University, Cranfield, UK.
| | - J Petr
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany; Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - S J Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK; Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - H J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
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4
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Haque F, Luscher AF, Mitchell KAS, Sutradhar A. Optimization of Fixations for Additively Manufactured Cranial Implants: Insights from Finite Element Analysis. Biomimetics (Basel) 2023; 8:498. [PMID: 37887630 PMCID: PMC10603949 DOI: 10.3390/biomimetics8060498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
With the emergence of additive manufacturing technology, patient-specific cranial implants using 3D printing have massively influenced the field. These implants offer improved surgical outcomes and aesthetic preservation. However, as additive manufacturing in cranial implants is still emerging, ongoing research is investigating their reliability and sustainability. The long-term biomechanical performance of these implants is critically influenced by factors such as implant material, anticipated loads, implant-skull interface geometry, and structural constraints, among others. The efficacy of cranial implants involves an intricate interplay of these factors, with fixation playing a pivotal role. This study addresses two critical concerns: determining the ideal number of fixation points for cranial implants and the optimal curvilinear distance between those points, thereby establishing a minimum threshold. Employing finite element analysis, the research incorporates variables such as implant shapes, sizes, materials, the number of fixation points, and their relative positions. The study reveals that the optimal number of fixation points ranges from four to five, accounting for defect size and shape. Moreover, the optimal curvilinear distance between two screws is approximately 40 mm for smaller implants and 60 mm for larger implants. Optimal fixation placement away from the center mitigates higher deflection due to overhangs. Notably, a symmetric screw orientation reduces deflection, enhancing implant stability. The findings offer crucial insights into optimizing fixation strategies for cranial implants, thereby aiding surgical decision-making guidelines.
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Affiliation(s)
- Fariha Haque
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA; (F.H.); (A.F.L.)
| | - Anthony F. Luscher
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA; (F.H.); (A.F.L.)
| | - Kerry-Ann S. Mitchell
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Alok Sutradhar
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA; (F.H.); (A.F.L.)
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5
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Jindal P, Bharti J, Gupta V, Dhami SS. Mechanical behaviour of reconstructed defected skull with custom PEEK implant and Titanium fixture plates under dynamic loading conditions using FEM. J Mech Behav Biomed Mater 2023; 146:106063. [PMID: 37556925 DOI: 10.1016/j.jmbbm.2023.106063] [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: 06/22/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
Skull reconstruction using cranial implants is often required for repairing skull defects caused due to trauma, diseases, or malignancy to protect intracranial structures. For relieving Intracranial Pressure (ICP) surgeons restore cranial defects either using natural bones or fabricated custom cranial implants. With the increase in Traumatic Brain Injuries (TBI) and challenges faced by TBI patients to regain normalcy, it is imperative to analyse the mechanical behaviour of skull-implant assemblies under some Head Injury Criteria (HIC). Medical grade materials including Titanium Alloys (Ti-6Al-4V) and Polyether-ether-ketone (PEEK) are used by fabricating Patient-Specific Implants (PSI) manufactured using 3D imaging, modelling and printing techniques. 3D technologies are preferred over conventional manufacturing methods, as they enable fabrication of custom shapes, sizes and properties for these PSI. For an effective attachment of PSI with a defective skull, a stable joint and plate arrangement as fixture plates is necessary at their interface. These fixtures can have variable numbers, design shapes, materials and location arrangements. This paper presents the Finite Element Method/Analysis (FEM/FEA) study of PSI attached to a defected skull for reconstruction, with linear shaped fixture configuration, when subjected to an external dynamic loading at 5 m/s, strain rate of 10s-1 to 243s-1 and ICP of 15mm Hg from three sides of the skull faces. Three different materials as Neoprene (soft), Concrete (medium rigid) and E-Glass (highly rigid) have been used, in the form of a rectangular thin cuboidal wall structure, at an angle of 45° with the skull face. Four linear shaped fixture plates which were simplest to design, were used to attach the PSI-skull assembly, to ensure that weight of the PSI-fixation assembly on the patient remains minimal, overall assembly has symmetrical fixations and efforts required by a surgeon for fitment of these plates remain minimal. Placement of these fixture plates has been optimized to encompass the complete PSI-skull interface section, due to which the stresses within all the assembly components (PSI, fixture plate and skull) reduced by nearly 2.5 times than the initial design and remained within yielding limits, thereby, averting any failure under heavy external dynamic loading.
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Affiliation(s)
- Prashant Jindal
- University Institute of Engineering & Technology, Panjab University, Chandigarh, 160014, India
| | - Jogendra Bharti
- Department of Mechanical Engineering, Government Polytechnic College Shajapur, Madhya Pradesh, 465001, India
| | - Vipin Gupta
- Department of Neurosurgery, Government Medical College and Hospital, Sector 32, Chandigarh, 160032, India
| | - S S Dhami
- Department of Mechanical Engineering, National Institute of Technical Teachers Training and Research, Chandigarh, 160019, India.
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6
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Pu F, Yu Y, Zhang Z, Wu W, Shao Z, Li C, Feng J, Xue L, Chen F. Research and Application of Medical Polyetheretherketone as Bone Repair Material. Macromol Biosci 2023; 23:e2300032. [PMID: 37088909 DOI: 10.1002/mabi.202300032] [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: 01/28/2023] [Revised: 04/01/2023] [Indexed: 04/25/2023]
Abstract
Polyetheretherketone (PEEK) can potentially be used for bone repair because its elastic modulus is similar to that of human natural bone and good biocompatibility and chemical stability. However, its hydrophobicity and biological inertness limit its application in the biomedical field. Inspired by the composition, structure, and function of bone tissue, many strategies are proposed to change the structure and functionality of the PEEK surface. In this review, the applications of PEEK in bone repair and the optimization strategy for PEEK's biological activity are reviewed, which provides a direction for the development of multifunctional bone repair materials in the future.
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Affiliation(s)
- Feifei Pu
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Yihan Yu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhicai Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Wei Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Chao Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jing Feng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Longjian Xue
- School of Power and Mechanical Engineering, Wuhan University, Wuhan, Hubei, 430072, China
| | - Fengxia Chen
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, China
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Moiduddin K, Mian SH, Elseufy SM, Alkhalefah H, Ramalingam S, Sayeed A. Polyether-Ether-Ketone (PEEK) and Its 3D-Printed Quantitate Assessment in Cranial Reconstruction. J Funct Biomater 2023; 14:429. [PMID: 37623673 PMCID: PMC10455463 DOI: 10.3390/jfb14080429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Three-dimensional (3D) printing, medical imaging, and implant design have all advanced significantly in recent years, and these developments may change how modern craniomaxillofacial surgeons use patient data to create tailored treatments. Polyether-ether-ketone (PEEK) is often seen as an attractive option over metal biomaterials in medical uses, but a solid PEEK implant often leads to poor osseointegration and clinical failure. Therefore, the objective of this study is to demonstrate the quantitative assessment of a custom porous PEEK implant for cranial reconstruction and to evaluate its fitting accuracy. The research proposes an efficient process for designing, fabricating, simulating, and inspecting a customized porous PEEK implant. In this study, a CT scan is utilized in conjunction with a mirrored reconstruction technique to produce a skull implant. In order to foster cell proliferation, the implant is modified into a porous structure. The implant's strength and stability are examined using finite element analysis. Fused filament fabrication (FFF) is utilized to fabricate the porous PEEK implants, and 3D scanning is used to test its fitting accuracy. The results of the biomechanical analysis indicate that the highest stress observed was approximately 61.92 MPa, which is comparatively low when compared with the yield strength and tensile strength of the material. The implant fitting analysis demonstrates that the implant's variance from the normal skull is less than 0.4436 mm, which is rather low given the delicate anatomy of the area. The results of the study demonstrate the implant's endurance while also increasing the patient's cosmetic value.
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Affiliation(s)
- Khaja Moiduddin
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | - Syed Hammad Mian
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | | | - Hisham Alkhalefah
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | - Sundar Ramalingam
- Department of Oral and Maxillofacial Surgery, College of Dentistry and Dental University Hospital, King Saud University Medical City, Riyadh 11545, Saudi Arabia
| | - Abdul Sayeed
- Department of Mechanical Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
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8
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Escarcega JD, Knutsen AK, Alshareef AA, Johnson CL, Okamoto RJ, Pham DL, Bayly PV. Comparison of Deformation Patterns Excited in the Human Brain In Vivo by Harmonic and Impulsive Skull Motion. J Biomech Eng 2023; 145:081006. [PMID: 37345977 PMCID: PMC10321146 DOI: 10.1115/1.4062809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
Noninvasive measurements of brain deformation in human participants in vivo are needed to develop models of brain biomechanics and understand traumatic brain injury (TBI). Tagged magnetic resonance imaging (tagged MRI) and magnetic resonance elastography (MRE) are two techniques to study human brain deformation; these techniques differ in the type of motion and difficulty of implementation. In this study, oscillatory strain fields in the human brain caused by impulsive head acceleration and measured by tagged MRI were compared quantitatively to strain fields measured by MRE during harmonic head motion at 10 and 50 Hz. Strain fields were compared by registering to a common anatomical template, then computing correlations between the registered strain fields. Correlations were computed between tagged MRI strain fields in six participants and MRE strain fields at 10 Hz and 50 Hz in six different participants. Correlations among strain fields within the same experiment type were compared statistically to correlations from different experiment types. Strain fields from harmonic head motion at 10 Hz imaged by MRE were qualitatively and quantitatively similar to modes excited by impulsive head motion, imaged by tagged MRI. Notably, correlations between strain fields from 10 Hz MRE and tagged MRI did not differ significantly from correlations between strain fields from tagged MRI. These results suggest that low-frequency modes of oscillation dominate the response of the brain during impact. Thus, low-frequency MRE, which is simpler and more widely available than tagged MRI, can be used to illuminate the brain's response to head impact.
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Affiliation(s)
- Jordan D. Escarcega
- Mechanical Engineering and Materials Science, Washington University, 1 Brookings Drive, MSC 1185-208-125, St. Louis, MO 63130
| | - Andrew K. Knutsen
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817
| | - Ahmed A. Alshareef
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817
| | | | - Ruth J. Okamoto
- Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130
| | - Dzung L. Pham
- Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD 20814
| | - Philip V. Bayly
- Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130
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9
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Smith JA, Petersmann S, Arbeiter F, Schäfer U. Optimization and manufacture of polyetheretherketone patient specific cranial implants by material extrusion - A clinical perspective. J Mech Behav Biomed Mater 2023; 144:105965. [PMID: 37343357 DOI: 10.1016/j.jmbbm.2023.105965] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
Polyetheretherketone (PEEK) is a high performing thermoplastic that has established itself as a 'gold-standard' material for cranial reconstruction. Traditionally, milled PEEK patient specific cranial implants (PSCIs) exhibit uniform levels of smoothness (excusing suture/drainage holes) to the touch (<1 μm) and homogenous coloration throughout. They also demonstrate predictable and repeatable levels of mechanical performance, as they are machined from isotropic material blocks. The combination of such factors inspires confidence from the surgeon and in turn, approval for implantation. However, manufacturing lead-times and affiliated costs to fabricate a PSCI are high. To simplify their production and reduce expenditure, hospitals are exploring the production of in-house PEEK PSCIs by material extrusion-based additive manufacturing. From a geometrical and morphological perspective, such implants have been produced with good-to-satisfactory clinical results. However, lack of clinical adoption persists. To determine the reasoning behind this, it was necessary to assess the benefits and limitations of current printed PEEK PSCIs in order to establish the status quo. Afterwards, a review on individual PEEK printing variables was performed in order to identify a combination of parameters that could enhance the aesthetics and performance of the PSCIs to that of milled implants/cranial bone. The findings from this review could be used as a baseline to help standardize the production of PEEK PSCIs by material extrusion in the hospital.
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Affiliation(s)
- James A Smith
- Research Unit Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 2(9), 8036, Graz, Austria.
| | - Sandra Petersmann
- Materials Science and Testing of Polymers, Montanuniversitaet Leoben, Otto Gloeckel-Straße 2, 8700, Leoben, Austria
| | - Florian Arbeiter
- Materials Science and Testing of Polymers, Montanuniversitaet Leoben, Otto Gloeckel-Straße 2, 8700, Leoben, Austria
| | - Ute Schäfer
- Research Unit Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 2(9), 8036, Graz, Austria; BioTechMed-Graz, Graz, Austria
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10
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Sadighi A, Taghvaei M, Taheri M, Oeth D, Siegler S, Schaer TP, R Najafi A. Numerical analysis of the mechanical response of novel swelling bone implants in polyurethane foams. J Mech Behav Biomed Mater 2023; 143:105871. [PMID: 37187154 DOI: 10.1016/j.jmbbm.2023.105871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/17/2023]
Abstract
In this study, a numerical framework was developed in order to analyze the swelling properties, mechanical response and fixation strength of swelling bone anchors. Using this framework, fully porous and solid implants, along with a novel hybrid design (consisting of a solid core and a porous sleeve), were modeled and studied. Free swelling experiments were conducted to investigate their swelling characteristics. The finite element model of swelling was validated using the conducted free swelling. Compared with the experimental data, results obtained from the finite element analysis proved the reliability of this frame-work. Afterwards, the swelling bone anchors were studied embedded in artificial bones with different densities with two different interface properties: considering frictional interface between the bone anchors and artificial bones (simulating the stages prior to osteointegration, when the bone and implant are not fully bonded and the surface of the implant can slide along the interface), and perfectly bonded (simulating the stages subsequent to osteointegration, when the bone and implant are fully bonded). It was observed that the swelling considerably decreases while the average radial stress on the lateral surface of the swelling bone anchor surges in the denser artificial bones. Ultimately, the pull-out experiments and simulations of the swelling bone anchors from the artificial bones were conducted to look into the fixation strength of the swelling bone anchors. It was found that the hybrid swelling bone anchor exhibits mechanical and swelling properties close to those of solid bone anchors, while also bone in-growth is expected to happen, which is an integral factor to these bone anchors.
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Affiliation(s)
- Amirreza Sadighi
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, 19104, USA
| | - Moein Taghvaei
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, 19104, USA
| | - Mehrangiz Taheri
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, 19104, USA
| | - Delaney Oeth
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, PA, 19348, USA
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, 19104, USA
| | - Thomas P Schaer
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, PA, 19348, USA
| | - Ahmad R Najafi
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, 19104, USA.
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11
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Ma T, Zhang J, Sun S, Meng W, Zhang Y, Wu J. Current treatment methods to improve the bioactivity and bonding strength of PEEK for dental application: A systematic review. Eur Polym J 2023. [DOI: 10.1016/j.eurpolymj.2022.111757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Padmos RM, Arrarte Terreros N, Józsa TI, Závodszky G, Marquering HA, Majoie CBLM, Payne SJ, Hoekstra AG. Modelling collateral flow and thrombus permeability during acute ischaemic stroke. J R Soc Interface 2022; 19:20220649. [PMID: 36195117 PMCID: PMC9532024 DOI: 10.1098/rsif.2022.0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The presence of collaterals and high thrombus permeability are associated with good functional outcomes after an acute ischaemic stroke. We aim to understand the combined effect of the collaterals and thrombus permeability on cerebral blood flow during an acute ischaemic stroke. A cerebral blood flow model including the leptomeningeal collateral circulation is used to simulate cerebral blood flow during an acute ischaemic stroke. The collateral circulation is varied to capture the collateral scores: absent, poor, moderate and good. Measurements of the transit time, void fraction and thrombus length in acute ischaemic stroke patients are used to estimate thrombus permeability. Estimated thrombus permeability ranges between 10-7 and 10-4 mm2. Measured flow rates through the thrombus are small and the effect of a permeable thrombus on brain perfusion during stroke is small compared with the effect of collaterals. Our simulations suggest that the collaterals are a dominant factor in the resulting infarct volume after a stroke.
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Affiliation(s)
- Raymond M. Padmos
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands,Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands,Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Tamás I. Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK,Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Gábor Závodszky
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands
| | - Henk A. Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands,Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Charles B. L. M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Stephen J. Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK,Institute of Applied Mechanics, National Taiwan University, Taiwan
| | - Alfons G. Hoekstra
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands
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13
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Wu C, Zeng B, Deng J, Shen D, Wang X, Tan L, Liu X, Qiu G. Custom design and biomechanical clinical trials of 3D-printed polyether ether ketone femoral shaft prosthesis. J Biomed Mater Res B Appl Biomater 2022; 110:2006-2014. [PMID: 35297154 DOI: 10.1002/jbm.b.35055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 01/18/2023]
Abstract
During the surgical resection and reconstruction of a pathological femoral fracture, the removal of the femoral tumor leaves a large bone defect. Thus, it is necessary to reconstruct the defect and perform internal fixation. Polyether ether ketone (PEEK) has been widely used in spinal fusion and cranioplasty given its excellent biomechanical properties, biocompatibility, and stability. The typical design method of femoral prosthesis is based on the contralateral mirror image model (M-model), and we propose a novel method for designing femoral prosthesis, which is based on the cross section and centerline of the mirrored femur (C-model). In this study, the femoral shaft prostheses based on two models were manufactured using fused deposition modeling technology, and we use mechanical test and finite element analysis (FEA) to reveal the differences in mechanical properties of the two models. The mechanical results showed that the maximum loading force and yield strength were increased by 3% and 6% in the C-model prosthesis compared with the M-model prosthesis, respectively. In FEA, the results indicate that the C-model prosthesis could reduce the stress concentration by 5.4%-10.9% compared to the M-model prosthesis. Finally, the 3D-printed PEEK femoral shaft prosthesis based on C-model was implanted, no early complications occurred. Postoperative radiological examination indicated that the prosthesis and the femoral osteotomy end were closely matched and fixed well.
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Affiliation(s)
- Chao Wu
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, China.,Digital Medical Center, Zigong Fourth People's Hospital, Zigong, China
| | - Baifang Zeng
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, China.,Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiayan Deng
- Digital Medical Center, Zigong Fourth People's Hospital, Zigong, China
| | - Danwei Shen
- Digital Medical Center, Zigong Fourth People's Hospital, Zigong, China
| | - Xiangyu Wang
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, China
| | - Lun Tan
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, China
| | - Xin Liu
- Health Management Center, Zigong Fourth People's Hospital, Zigong, China
| | - Guigang Qiu
- Digital Medical Center, Zigong Fourth People's Hospital, Zigong, China
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14
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Siegel A, Sauter-Starace F, Laporte S. Insights into the mechanical interaction between an active cranial implant and the skull subjected to moderate impact loadings. J Mech Behav Biomed Mater 2022; 126:105048. [PMID: 34999489 DOI: 10.1016/j.jmbbm.2021.105048] [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: 09/20/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022]
Abstract
In the context of cochlear implants, which are now widely used, and innovative active devices, the cranial implantation of electronic devices raises new questions about the mechanical interactions between the implant and the skull. The aim of this study was to build a methodology using experimental data and numerical simulations to evaluate the mechanical interactions between the skull and the WIMAGINE® active cranial implant intended for use for tetraplegic patients. A finite element model of the implant housing and a simplified model of the three-layered skull were developed. 2.5 J-hammer impact tests were performed on implant housings and ovine cadaver heads for model calibration. The two models were then combined to analyze the interactions between the skull and the implant and compared against impact tests. The implant dissipates a certain amount of the impact energy which could be a parameter to include in implant design in addition to the implant integrity, tending to increase the implant stiffness. The non-implanted as well as the implanted lamb heads demonstrated an overall good resistance to the impact tests. The models correlated well with the experimental data, and improvements of the model through more realistic geometry (CT-scans) and more complex material behavior could now be implemented. Such a model could then be used with human head geometries and help for future implant design optimizations using numerical models of the implant-skull and even implant-head complex.
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Affiliation(s)
- Alice Siegel
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, 38000, Grenoble, France; Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France.
| | | | - Sébastien Laporte
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
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15
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Mechanical Strength Study of a Cranial Implant Using Computational Tools. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The human head is sometimes subjected to impact loads that lead to skull fracture or other injuries that require the removal of part of the skull, which is called craniectomy. Consequently, the removed portion is replaced using autologous bone or alloplastic material. The aim of this work is to develop a cranial implant to fulfil a defect created on the skull and then study its mechanical performance by integrating it on a human head finite element model. The material chosen for the implant was PEEK, a thermoplastic polymer that has been recently used in cranioplasty. A6 numerical model head coupled with an implant was subjected to analysis to evaluate two parameters: the number of fixation screws that enhance the performance and ensure the structural integrity of the implant, and the implant’s capacity to protect the brain compared to the integral skull. The main findings point to the fact that, among all tested configurations of screws, the model with eight screws presents better performance when considering the von Mises stress field and the displacement field on the interface between the implant and the skull. Additionally, under the specific analyzed conditions, it is observable that the model with the implant offers more efficient brain protection when compared with the model with the integral skull.
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16
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In silico trials for treatment of acute ischemic stroke: Design and implementation. Comput Biol Med 2021; 137:104802. [PMID: 34520989 DOI: 10.1016/j.compbiomed.2021.104802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 01/21/2023]
Abstract
An in silico trial simulates a disease and its corresponding therapies on a cohort of virtual patients to support the development and evaluation of medical devices, drugs, and treatment. In silico trials have the potential to refine, reduce cost, and partially replace current in vivo studies, namely clinical trials and animal testing. We present the design and implementation of an in silico trial for treatment of acute ischemic stroke. We propose an event-based modelling approach for the simulation of a disease and injury, where changes to the state of the system (the events) are assumed to be instantaneous. Using this approach we are able to combine a diverse set of models, spanning multiple time scales, to model acute ischemic stroke, treatment, and resulting brain tissue injury. The in silico trial is designed to be modular to aid development and reproducibility. It provides a comprehensive framework for application to any potential in silico trial. A statistical population model is used to generate cohorts of virtual patients. Patient functional outcomes are also predicted with a statistical model, using treatment and injury results and the patient's clinical parameters. We demonstrate the functionality of the event-based modelling approach and trial framework by running proof of concept in silico trials. The proof of concept trials simulate the same cohort of patients twice: once with successful treatment (successful recanalisation) and once with unsuccessful treatment (unsuccessful treatment). Ways to overcome some of the challenges and difficulties in setting up such an in silico trial are discussed, such as validation and computational limitations.
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17
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Józsa TI, Padmos RM, El-Bouri WK, Hoekstra AG, Payne SJ. On the Sensitivity Analysis of Porous Finite Element Models for Cerebral Perfusion Estimation. Ann Biomed Eng 2021; 49:3647-3665. [PMID: 34155569 PMCID: PMC8671295 DOI: 10.1007/s10439-021-02808-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
Computational physiological models are promising tools to enhance the design of clinical trials and to assist in decision making. Organ-scale haemodynamic models are gaining popularity to evaluate perfusion in a virtual environment both in healthy and diseased patients. Recently, the principles of verification, validation, and uncertainty quantification of such physiological models have been laid down to ensure safe applications of engineering software in the medical device industry. The present study sets out to establish guidelines for the usage of a three-dimensional steady state porous cerebral perfusion model of the human brain following principles detailed in the verification and validation (V&V 40) standard of the American Society of Mechanical Engineers. The model relies on the finite element method and has been developed specifically to estimate how brain perfusion is altered in ischaemic stroke patients before, during, and after treatments. Simulations are compared with exact analytical solutions and a thorough sensitivity analysis is presented covering every numerical and physiological model parameter. The results suggest that such porous models can approximate blood pressure and perfusion distributions reliably even on a coarse grid with first order elements. On the other hand, higher order elements are essential to mitigate errors in volumetric blood flow rate estimation through cortical surface regions. Matching the volumetric flow rate corresponding to major cerebral arteries is identified as a validation milestone. It is found that inlet velocity boundary conditions are hard to obtain and that constant pressure inlet boundary conditions are feasible alternatives. A one-dimensional model is presented which can serve as a computationally inexpensive replacement of the three-dimensional brain model to ease parameter optimisation, sensitivity analyses and uncertainty quantification. The findings of the present study can be generalised to organ-scale porous perfusion models. The results increase the applicability of computational tools regarding treatment development for stroke and other cerebrovascular conditions.
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Affiliation(s)
- T I Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK.
| | - R M Padmos
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam, 1098 XH, The Netherlands
| | - W K El-Bouri
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK.,Liverpool Centre for Cardiovascular Science, Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Thomas Drive, Liverpool, L14 3PE, UK
| | - A G Hoekstra
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam, 1098 XH, The Netherlands
| | - S J Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK
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18
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Manzoor F, Golbang A, Jindal S, Dixon D, McIlhagger A, Harkin-Jones E, Crawford D, Mancuso E. 3D printed PEEK/HA composites for bone tissue engineering applications: Effect of material formulation on mechanical performance and bioactive potential. J Mech Behav Biomed Mater 2021; 121:104601. [PMID: 34077906 DOI: 10.1016/j.jmbbm.2021.104601] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
Polyetheretherketone (PEEK) is a biocompatible polymer widely used for biomedical applications. Because it is biologically inert, bioactive phases, such as nano-hydroxyapatite (HA), have been added to PEEK in order to improve its bioactivity. 3D printing (3DP) technologies are being increasingly used today to manufacture patient specific devices and implants. However, processing of PEEK is challenging due to its high melting point which is above 340 °C. In this study, PEEK-based filaments containing 10 wt% of pure nano-HA, strontium (Sr)- doped nano-HA and Zinc (Zn)-doped nano-HA were produced via hot-melt extrusion and subsequently 3D printed via fused deposition modelling (FDM), following an initial optimization process. The raw materials, extruded filaments and 3D printed samples were characterized in terms of physicochemical, thermal and morphological analysis. Moreover, the mechanical performance of 3D printed specimens was assessed via tensile tensing. Although an increase in the melting point and a reduction in crystallization temperature was observed with the addition of HA and doped HA to pure PEEK, there was no noticeable increase in the degree of crystallinity. Regarding the mechanical behavior, no significant differences were detected following the addition of the inorganic phases to the polymeric matrix, although a small reduction in the ultimate tensile strength (~14%) and Young's modulus (~5%) in PEEK/HA was observed in comparison to pure PEEK. Moreover, in vitro bioactivity of 3D printed samples was evaluated via a simulated body fluid immersion test for up to 28 days; the formation of apatite was observed on the surfaces of sample surfaces containing HA, SrHA and ZnHA. These results indicate the potential to produce bioactive, 3DP PEEK composites for challenging applications such as in craniofacial bone repair.
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Affiliation(s)
- Faisal Manzoor
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom.
| | - Atefeh Golbang
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom
| | - Swati Jindal
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom
| | - Dorian Dixon
- Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom
| | - Alistair McIlhagger
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom
| | - Eileen Harkin-Jones
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom
| | - Daniel Crawford
- Axial 3D, Alexander House, 17a Ormeau Ave, BT2 8HD, Belfast, United Kingdom
| | - Elena Mancuso
- Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Shore Road, BT37 0QB, Newtownabbey, United Kingdom.
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19
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Schroder A, Lawrence T, Voets N, Garcia-Gonzalez D, Jones M, Peña JM, Jerusalem A. A Machine Learning Enhanced Mechanistic Simulation Framework for Functional Deficit Prediction in TBI. Front Bioeng Biotechnol 2021; 9:587082. [PMID: 33748080 PMCID: PMC7965982 DOI: 10.3389/fbioe.2021.587082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Resting state functional magnetic resonance imaging (rsfMRI), and the underlying brain networks identified with it, have recently appeared as a promising avenue for the evaluation of functional deficits without the need for active patient participation. We hypothesize here that such alteration can be inferred from tissue damage within the network. From an engineering perspective, the numerical prediction of tissue mechanical damage following an impact remains computationally expensive. To this end, we propose a numerical framework aimed at predicting resting state network disruption for an arbitrary head impact, as described by the head velocity, location and angle of impact, and impactor shape. The proposed method uses a library of precalculated cases leveraged by a machine learning layer for efficient and quick prediction. The accuracy of the machine learning layer is illustrated with a dummy fall case, where the machine learning prediction is shown to closely match the full simulation results. The resulting framework is finally tested against the rsfMRI data of nine TBI patients scanned within 24 h of injury, for which paramedical information was used to reconstruct in silico the accident. While more clinical data are required for full validation, this approach opens the door to (i) on-the-fly prediction of rsfMRI alterations, readily measurable on clinical premises from paramedical data, and (ii) reverse-engineered accident reconstruction through rsfMRI measurements.
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Affiliation(s)
- Anna Schroder
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Tim Lawrence
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Natalie Voets
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | - Mike Jones
- Institute of Medical Engineering and Medical Physics, Cardiff University, Cardiff, United Kingdom
| | | | - Antoine Jerusalem
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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20
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Padmos RM, Terreros NA, Józsa TI, Závodszky G, Marquering HA, Majoie CBLM, Hoekstra AG. Modelling the leptomeningeal collateral circulation during acute ischaemic stroke. Med Eng Phys 2021; 91:1-11. [PMID: 34074460 DOI: 10.1016/j.medengphy.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
A novel model of the leptomeningeal collateral circulation is created by combining data from multiple sources with statistical scaling laws. The extent of the collateral circulation is varied by defining a collateral vessel probability. Blood flow and pressure are simulated using a one-dimensional steady state blood flow model. The leptomeningeal collateral vessels provide significant flow during a stroke. The pressure drop over an occlusion predicted by the model ranges between 60 and 85 mmHg depending on the extent of the collateral circulation. The linear transport of contrast material was simulated in the circulatory network. The time delay of peak contrast over an occlusion is 3.3 s in the model, and 2.1 s (IQR 0.8-4.0 s) when measured in dynamic CTA data of acute ischaemic stroke patients. Modelling the leptomeningeal collateral circulation could lead to better estimates of infarct volume and patient outcome.
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Affiliation(s)
- Raymond M Padmos
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098 XH, the Netherlands.
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Tamás I Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Gábor Závodszky
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098 XH, the Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Alfons G Hoekstra
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098 XH, the Netherlands
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21
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Padmos RM, Józsa TI, El-Bouri WK, Konduri PR, Payne SJ, Hoekstra AG. Coupling one-dimensional arterial blood flow to three-dimensional tissue perfusion models for in silico trials of acute ischaemic stroke. Interface Focus 2021; 11:20190125. [PMID: 33335706 PMCID: PMC7739918 DOI: 10.1098/rsfs.2019.0125] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
An acute ischaemic stroke is due to the sudden blockage of an intracranial blood vessel by an embolized thrombus. In the context of setting up in silico trials for the treatment of acute ischaemic stroke, the effect of a stroke on perfusion and metabolism of brain tissue should be modelled to predict final infarcted brain tissue. This requires coupling of blood flow and tissue perfusion models. A one-dimensional intracranial blood flow model and a method to couple this to a brain tissue perfusion model for patient-specific simulations is presented. Image-based patient-specific data on the anatomy of the circle of Willis are combined with literature data and models for vessel anatomy not visible in the images, to create an extended model for each patient from the larger vessels down to the pial surface. The coupling between arterial blood flow and tissue perfusion occurs at the pial surface through the estimation of perfusion territories. The coupling method is able to accurately estimate perfusion territories. Finally, we argue that blood flow can be approximated as steady-state flow at the interface between arterial blood flow and tissue perfusion to reduce the cost of organ-scale simulations.
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Affiliation(s)
- Raymond M. Padmos
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - Tamás I. Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Wahbi K. El-Bouri
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Praneeta R. Konduri
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Stephen J. Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Alfons G. Hoekstra
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
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22
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Józsa TI, Padmos RM, Samuels N, El-Bouri WK, Hoekstra AG, Payne SJ. A porous circulation model of the human brain for in silico clinical trials in ischaemic stroke. Interface Focus 2021; 11:20190127. [PMID: 33343874 PMCID: PMC7739914 DOI: 10.1098/rsfs.2019.0127] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 12/30/2022] Open
Abstract
The advancement of ischaemic stroke treatment relies on resource-intensive experiments and clinical trials. In order to improve ischaemic stroke treatments, such as thrombolysis and thrombectomy, we target the development of computational tools for in silico trials which can partially replace these animal and human experiments with fast simulations. This study proposes a model that will serve as part of a predictive unit within an in silico clinical trial estimating patient outcome as a function of treatment. In particular, the present work aims at the development and evaluation of an organ-scale microcirculation model of the human brain for perfusion prediction. The model relies on a three-compartment porous continuum approach. Firstly, a fast and robust method is established to compute the anisotropic permeability tensors representing arterioles and venules. Secondly, vessel encoded arterial spin labelling magnetic resonance imaging and clustering are employed to create an anatomically accurate mapping between the microcirculation and large arteries by identifying superficial perfusion territories. Thirdly, the parameter space of the problem is reduced by analysing the governing equations and experimental data. Fourthly, a parameter optimization is conducted. Finally, simulations are performed with the tuned model to obtain perfusion maps corresponding to an open and an occluded (ischaemic stroke) scenario. The perfusion map in the occluded vessel scenario shows promising qualitative agreement with computed tomography images of a patient with ischaemic stroke caused by large vessel occlusion. The results highlight that in the case of vessel occlusion (i) identifying perfusion territories is essential to capture the location and extent of underperfused regions and (ii) anisotropic permeability tensors are required to give quantitatively realistic estimation of perfusion change. In the future, the model will be thoroughly validated against experiments.
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Affiliation(s)
- T. I. Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - R. M. Padmos
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098 XH, The Netherlands
| | - N. Samuels
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam 3015 GD, The Netherlands
| | - W. K. El-Bouri
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - A. G. Hoekstra
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098 XH, The Netherlands
| | - S. J. Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
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23
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MISRA JC, DANDAPAT S, ADHIKARY SD. WAVE PROPAGATION IN THE CRANIUM AND THE CEREBROSPINAL FLUID. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519420500451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, wave propagation in head generated by a local axisymmetric impact on its outer surface is studied. The skull material is treated as isotropic and homogeneous, but presence of the cerebrospinal fluid (considered as a compressible but inviscid irrotational fluid) inside the cranium has been accounted for in the analysis. Some numerical results obtained on the basis of the analytical study, are also presented.
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Affiliation(s)
- J. C. MISRA
- Centre for Healthcare Science and Technology, Indian Institute of Engineering Science and Technology, Howrah 711103, India
| | - S. DANDAPAT
- Indian Institute of Technology, Kharagpur, India
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24
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Fu Q, Gabriel M, Schmidt F, Müller WD, Schwitalla AD. The impact of different low-pressure plasma types on the physical, chemical and biological surface properties of PEEK. Dent Mater 2020; 37:e15-e22. [PMID: 33148448 DOI: 10.1016/j.dental.2020.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Plasma treatment can be used as surface treatment of PEEK (poly-ether-ether-ketone) to increase the bonding strength between veneering composite and dental prosthetic frameworks of PEEK or enhance biocompatibility of PEEK implants. These improvements are probably based on chemical changes of the PEEK surface. However, the aim of the study was to evaluate the impact of different low-pressure plasma treatments on surface properties of PEEK, such as roughness, hydrophilicity, micro-hardness, crystallinity and biological activity of PEEK. METHODS Due to different plasma treatments, 143 disc-shaped specimens of pure implantable PEEK were divided into 4 groups: PEEK (no plasma treatment, n = 29), H-PEEK (hydrogen plasma treatment, n = 38), O-PEEK (oxygen plasma treatment, n = 38), H/O-PEEK (hydrogen/oxygen plasma treatment with a gas mix ratio of 2:1, n = 38). Subsequently, surface roughness, surface contact angle, surface crystallinity, surface micro-hardness and human osteoblast cell coverage area of each group were examined. RESULTS The hydrophilicity, crystallinity and micro-hardness of the plasma-treated groups increased significantly compared to the untreated group, whereas significant differences in the results of the micro-hardness tests could be shown between all groups up to a test force of 0.02N. Cell density was significantly higher on treated vs. untreated PEEK surfaces. Oxygen and H/O plasma treatments revealed to be most effective, whereas H/O plasma worked ten times faster to achieve the same effects. SIGNIFICANCE The hydrogen-oxygen, 2/1-mixed plasma treatment combines the effect of hydrogen and oxygen plasma which strongly improve the surface properties of PEEK implant material, such as hydrophilicity, crystallinity, surface micro-hardness and HOB cell adhesion.
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Affiliation(s)
- Qian Fu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Matthias Gabriel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Franziska Schmidt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Wolf-Dieter Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Andreas Dominik Schwitalla
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
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Lewin S, Fleps I, Neuhaus D, Öhman-Mägi C, Ferguson SJ, Persson C, Helgason B. Implicit and explicit finite element models predict the mechanical response of calcium phosphate-titanium cranial implants. J Mech Behav Biomed Mater 2020; 112:104085. [PMID: 33080431 DOI: 10.1016/j.jmbbm.2020.104085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
The structural integrity of cranial implants is of great clinical importance, as they aim to provide cerebral protection after neurosurgery or trauma. With the increased use of patient-specific implants, the mechanical response of each implant cannot be characterized experimentally in a practical way. However, computational models provide an excellent possibility for efficiently predicting the mechanical response of patient-specific implants. This study developed finite element models (FEMs) of titanium-reinforced calcium phosphate (CaP-Ti) implants. The models were validated with previously obtained experimental data for two different CaP-Ti implant designs (D1 and D2), in which generically shaped implant specimens were loaded in compression at either quasi-static (1 mm/min) or impact (5 kg, 1.52 m/s) loading rates. The FEMs showed agreement with experimental data in the force-displacement response for both implant designs. The implicit FEMs predicted the peak load with an underestimation for D1 (9%) and an overestimation for D2 (11%). Furthermore, the shape of the force-displacement curves were well predicted. In the explicit FEMs, the first part of the force-displacement response showed 5% difference for D1 and 2% difference for D2, with respect to the experimentally derived peak loads. The explicit FEMs efficiently predicted the maximum displacements with 1% and 4% difference for D1 and D2, respectively. Compared to the CaP-Ti implant, an average parietal cranial bone FEM showed a stiffer response, greater energy absorption and less deformation under the same impact conditions. The framework developed for modelling the CaP-Ti implants has a potential for modelling CaP materials in other composite implants in future studies since it only used literature based input and matched boundary conditions. Furthermore, the developed FEMs make an important contribution to future evaluations of patient-specific CaP-Ti cranial implant designs in various loading scenarios.
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Affiliation(s)
- Susanne Lewin
- Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden.
| | - Ingmar Fleps
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Caroline Öhman-Mägi
- Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Persson
- Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
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Lewin S, Åberg J, Neuhaus D, Engqvist H, Ferguson SJ, Öhman-Mägi C, Helgason B, Persson C. Mechanical behaviour of composite calcium phosphate-titanium cranial implants: Effects of loading rate and design. J Mech Behav Biomed Mater 2020; 104:103701. [PMID: 32174441 DOI: 10.1016/j.jmbbm.2020.103701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
Cranial implants are used to repair bone defects following neurosurgery or trauma. At present, there is a lack of data on their mechanical response, particularly in impact loading. The aim of the present study was to assess the mechanical response of a recently developed composite calcium phosphate-titanium (CaP-Ti) implant at quasi-static and impact loading rates. Two different designs were tested, referred to as Design 1 (D1) and Design 2 (D2). The titanium structures in the implant specimens were additively manufactured by a powder-bed fusion process and subsequently embedded in a self-setting CaP material. D1 was conceptually representative of the clinically used implants. In D2, the titanium structure was simplified in terms of geometry in order to facilitate the manufacturing. The mechanical response of the implants was evaluated in quasi-static compression, and in impact using a drop-tower. Similar peak loads were obtained for the two designs, at the two loading rates: 808 ± 29 N and 852 ± 34 for D1, and 840 ± 40 N and 814 ± 13 for D2. A strain rate dependency was demonstrated for both designs, with a higher stiffness in the impact test. Furthermore, the titanium in the implant fractured in the quasi-static test (to failure) but not in the impact test (to 5.75 J) for D1. For D2, the displacement at peak load was significantly lower in the impact test than in the quasi-static test. The main difference between the designs was seen in the quasi-static test results where the deformation zones, i.e. notches in the titanium structure between the CaP tiles, in D1 likely resulted in a localization of the deformation, compared to in D2 (which did not have deformation zones). In the impact test, the only significant difference between the designs was a higher maximum displacement of D2 than of D1. In comparison with other reported mechanical tests on osteoconductive ceramic-based cranial implants, the CaP-Ti implant demonstrates the highest reported strength in quasi-static compression. In conclusion, the titanium structure seems to make the CaP-Ti implant capable of cerebral protection in impact situations like the one tested in this study.
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Affiliation(s)
- Susanne Lewin
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden.
| | - Jonas Åberg
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Håkan Engqvist
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Caroline Öhman-Mägi
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Persson
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
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Bing Y, Garcia-Gonzalez D, Voets N, Jérusalem A. Medical imaging based in silico head model for ischaemic stroke simulation. J Mech Behav Biomed Mater 2020; 101:103442. [DOI: 10.1016/j.jmbbm.2019.103442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022]
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Franceskides C, Gibson M, Zioupos P. Evaluation of bone excision effects on a human skull model-II: Finite element analysis. Proc Inst Mech Eng H 2019; 234:346-355. [PMID: 31814513 DOI: 10.1177/0954411919892799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient-specific computational models are powerful tools which may assist in predicting the outcome of invasive surgery on the musculoskeletal system, and consequently help to improve therapeutic decision-making and post-operative care. Unfortunately, at present the use of personalized models that predict the effect of biopsies and full excisions is so specialized that tends to be restricted to prominent individuals, such as high-profile athletes. We have developed a finite element analysis model to determine the influence of the location of an ellipsoidal excision (14.2 mm × 11.8 mm) on the structural integrity of a human skull when exposed to impact loading, representing a free fall of an adult male from standing height. The finite element analysis model was compared to empirical data based on the drop-tower testing of three-dimensional-printed physical skull models where deformations were recorded by digital image correlation. In this bespoke example, we found that the excision site did not have a major effect on the calculated stress and strain magnitudes unless the excision was in the temporal region, where the reduction in stiffness around the excision caused failure within the neighboring area. The finite element analysis model allowed meaningful conclusions to be drawn for the implications of using such a technique based on what we know about such conditions indicating that the approach could be both clinically beneficial and also cost-effective for wider use.
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Affiliation(s)
- Constantinos Franceskides
- Musculoskeletal and Medicolegal Research Group, Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, UK
| | - Michael Gibson
- Centre for Simulation & Analytics, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, UK
| | - Peter Zioupos
- Musculoskeletal and Medicolegal Research Group, Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, UK
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29
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Biomechanical performance of cranial implants with different thicknesses and material properties: A finite element study. Comput Biol Med 2019; 109:43-52. [DOI: 10.1016/j.compbiomed.2019.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/20/2022]
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30
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Polydimethylsiloxane and poly(ether) ether ketone functionally graded composites for biomedical applications. J Mech Behav Biomed Mater 2019; 93:130-142. [DOI: 10.1016/j.jmbbm.2019.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/26/2019] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
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31
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Siegel A, Sauter-Starace F, Laporte S. Insights into the effect of a craniotomy on the impact resistance of the skull. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. Siegel
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France
- Institut de Biomécanique Humaine Georges Charpak, ENSAM, Paris, France
| | | | - S. Laporte
- Institut de Biomécanique Humaine Georges Charpak, ENSAM, Paris, France
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32
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Long-Term Safety and Performance of a Polymeric Clamplike Cranial Fixation System. World Neurosurg 2019; 126:e758-e764. [PMID: 30853518 DOI: 10.1016/j.wneu.2019.02.146] [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: 12/21/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE After a craniotomy procedure to access the brain, neurosurgeons have several options to fix the bone flap to the skull. The aim of this study was to assess if a polymeric clamplike fixation system (Cranial LOOP) is a safe and reliable system that maintains over time an appropriate alignment of the bone flap. METHODS This is an observational, retrospective, case series study of 60 patients who underwent a craniotomy and were subject to cranial bone flap fixation with the Cranial LOOP fixation system. Baseline clinical parameters, surgical variables, medical records, and all postoperative medical images available were reviewed to assess the bone flap alignment and potential adverse events. RESULTS A total of 182 Cranial LOOPs were implanted in the 60 patients (56.01 ± 20.21 years, 55% women) included in the study. The cranial fixation system maintained a good bone flap alignment in 95% of the patients studied immediately after surgery and in up to 96.7% of them at the end of follow-up. No intraoperative complications were reported. An ulcer potentially related to a device was detected, which was solved without the need for device removal. No artifacts were observed in any of the 219 medical images analyzed. CONCLUSIONS Cranial LOOP is a safe and reliable postoperative long-term cranial bone flap fixation system. This device can fix the bone flap after a wide range of craniotomy procedures, performed in multiple locations, and provides good bone flap alignment. Cranial LOOP does not interfere in patient follow-up through medical imaging.
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33
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Tomoglu S, Caner G, Arabaci A, Mutlu I. Production and sulfonation of bioactive polyetheretherketone foam for bone substitute applications. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1539985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Saitali Tomoglu
- Metallurgical and Materials Engineering Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulnihal Caner
- Metallurgical and Materials Engineering Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aliye Arabaci
- Metallurgical and Materials Engineering Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilven Mutlu
- Metallurgical and Materials Engineering Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
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34
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Head-to-nerve analysis of electromechanical impairments of diffuse axonal injury. Biomech Model Mechanobiol 2018; 18:361-374. [PMID: 30430371 DOI: 10.1007/s10237-018-1086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
The aim was to investigate mechanical and functional failure of diffuse axonal injury (DAI) in nerve bundles following frontal head impacts, by finite element simulations. Anatomical changes following traumatic brain injury are simulated at the macroscale by using a 3D head model. Frontal head impacts at speeds of 2.5-7.5 m/s induce mild-to-moderate DAI in the white matter of the brain. Investigation of the changes in induced electromechanical responses at the cellular level is carried out in two scaled nerve bundle models, one with myelinated nerve fibres, the other with unmyelinated nerve fibres. DAI occurrence is simulated by using a real-time fully coupled electromechanical framework, which combines a modulated threshold for spiking activation and independent alteration of the electrical properties for each three-layer fibre in the nerve bundle models. The magnitudes of simulated strains in the white matter of the brain model are used to determine the displacement boundary conditions in elongation simulations using the 3D nerve bundle models. At high impact speed, mechanical failure occurs at lower strain values in large unmyelinated bundles than in myelinated bundles or small unmyelinated bundles; signal propagation continues in large myelinated bundles during and after loading, although there is a large shift in baseline voltage during loading; a linear relationship is observed between the generated plastic strain in the nerve bundle models and the impact speed and nominal strains of the head model. The myelin layer protects the fibre from mechanical damage, preserving its functionalities.
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35
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Garcia-Gonzalez D, Race NS, Voets NL, Jenkins DR, Sotiropoulos SN, Acosta G, Cruz-Haces M, Tang J, Shi R, Jérusalem A. Cognition based bTBI mechanistic criteria; a tool for preventive and therapeutic innovations. Sci Rep 2018; 8:10273. [PMID: 29980750 PMCID: PMC6035210 DOI: 10.1038/s41598-018-28271-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023] Open
Abstract
Blast-induced traumatic brain injury has been associated with neurodegenerative and neuropsychiatric disorders. To date, although damage due to oxidative stress appears to be important, the specific mechanistic causes of such disorders remain elusive. Here, to determine the mechanical variables governing the tissue damage eventually cascading into cognitive deficits, we performed a study on the mechanics of rat brain under blast conditions. To this end, experiments were carried out to analyse and correlate post-injury oxidative stress distribution with cognitive deficits on a live rat exposed to blast. A computational model of the rat head was developed from imaging data and validated against in vivo brain displacement measurements. The blast event was reconstructed in silico to provide mechanistic thresholds that best correlate with cognitive damage at the regional neuronal tissue level, irrespectively of the shape or size of the brain tissue types. This approach was leveraged on a human head model where the prediction of cognitive deficits was shown to correlate with literature findings. The mechanistic insights from this work were finally used to propose a novel protective device design roadmap and potential avenues for therapeutic innovations against blast traumatic brain injury.
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Affiliation(s)
- Daniel Garcia-Gonzalez
- Department of Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK
| | - Nicholas S Race
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Natalie L Voets
- Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Damian R Jenkins
- Army Registrar in Neurology and Lecturer in Medicine and Physiology, St Hugh's College, St Margaret's Rd, Oxford, OX2 6LE, United Kingdom
| | - Stamatios N Sotiropoulos
- Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Glen Acosta
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Marcela Cruz-Haces
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Jonathan Tang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA.
- PULSe Interdisciplinary Life Science Program, Purdue University, West Lafayette, IN, USA.
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA.
| | - Antoine Jérusalem
- Department of Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK.
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36
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Impact response and energy absorption of human skull cellular bones. J Mech Behav Biomed Mater 2018; 81:106-119. [DOI: 10.1016/j.jmbbm.2018.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/06/2018] [Accepted: 02/17/2018] [Indexed: 11/18/2022]
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Weng L, Boda SK, Wang H, Teusink MJ, Shuler FD, Xie J. Novel 3D Hybrid Nanofiber Aerogels Coupled with BMP-2 Peptides for Cranial Bone Regeneration. Adv Healthc Mater 2018; 7:e1701415. [PMID: 29498244 PMCID: PMC6317907 DOI: 10.1002/adhm.201701415] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/15/2018] [Indexed: 12/30/2022]
Abstract
An ideal synthetic bone graft is a combination of the porous and nanofibrous structure presented by natural bone tissue as well as osteoinductive biochemical factors such as bone morphogenetic protein 2 (BMP-2). In this work, ultralight 3D hybrid nanofiber aerogels composed of electrospun PLGA-collagen-gelatin and Sr-Cu codoped bioactive glass fibers with incorporation of heptaglutamate E7 domain specific BMP-2 peptides have been developed and evaluated for their potential in cranial bone defect healing. The nanofiber aerogels are surgically implanted into 8 mm × 1 mm (diameter × thickness) critical-sized defects created in rat calvariae. A sustained release of E7-BMP-2 peptide from the degradable hybrid aerogels significantly enhances bone healing and defect closure over 8 weeks in comparison to unfilled defects. Histomorphometry and X-ray microcomputed tomography (µ-CT) analysis reveal greater bone volume and bone formation area in case of the E7-BMP-2 peptide loaded hybrid nanofiber aerogels. Further, histopathology data divulged a near complete nanofiber aerogel degradation along with enhanced vascularization of the regenerated tissue. Together, this study for the first time demonstrates the fabrication of 3D hybrid nanofiber aerogels from 2D electrospun fibers and their loading with therapeutic osteoinductive BMP-2 mimicking peptide for cranial bone tissue regeneration.
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Affiliation(s)
- Lin Weng
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Sunil Kumar Boda
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Hongjun Wang
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Matthew J. Teusink
- Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Franklin D. Shuler
- Department of Orthopaedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755 United States
| | - Jingwei Xie
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
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Deng X, Zeng Z, Peng B, Yan S, Ke W. Mechanical Properties Optimization of Poly-Ether-Ether-Ketone via Fused Deposition Modeling. MATERIALS 2018; 11:ma11020216. [PMID: 29385756 PMCID: PMC5848913 DOI: 10.3390/ma11020216] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/27/2018] [Accepted: 01/28/2018] [Indexed: 11/24/2022]
Abstract
Compared to the common selective laser sintering (SLS) manufacturing method, fused deposition modeling (FDM) seems to be an economical and efficient three-dimensional (3D) printing method for high temperature polymer materials in medical applications. In this work, a customized FDM system was developed for polyether-ether-ketone (PEEK) materials printing. The effects of printing speed, layer thickness, printing temperature and filling ratio on tensile properties were analyzed by the orthogonal test of four factors and three levels. Optimal tensile properties of the PEEK specimens were observed at a printing speed of 60 mm/s, layer thickness of 0.2 mm, temperature of 370 °C and filling ratio of 40%. Furthermore, the impact and bending tests were conducted under optimized conditions and the results demonstrated that the printed PEEK specimens have appropriate mechanical properties.
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Affiliation(s)
- Xiaohu Deng
- National Local Joint Engineering Laboratory of Intelligent Manufacturing Oriented Automobile Die & Mold, Tianjin University of Technology and Education, Tianjin 300222, China.
- Tianjin Key Laboratory of High Speed Cutting and Precision Machining, Tianjin University of Technology and Education, Tianjin 300222, China.
| | - Zhi Zeng
- School of Mechatronics Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Institute of Electronic and Information Engineering of UESTC in Guangdong, Dongguan 523808, China.
| | - Bei Peng
- School of Mechatronics Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Shuo Yan
- School of Mechatronics Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Wenchao Ke
- School of Mechatronics Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China.
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Vogel D, Dempwolf H, Baumann A, Bader R. Characterization of thick titanium plasma spray coatings on PEEK materials used for medical implants and the influence on the mechanical properties. J Mech Behav Biomed Mater 2017; 77:600-608. [PMID: 29096126 DOI: 10.1016/j.jmbbm.2017.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
Abstract
Coating poly-ether-ether-ketone (PEEK) with rough and porous titanium plasma spray (TPS) coatings is a technique which is commonly used to enhance the osseointegrative properties of medical implants. However, the influence of the TPS coating on the PEEK mechanical properties has not been sufficiently evaluated to date. In this study, PEEK samples were coated with a thick TPS layer with grains of 90µm and 180µm diameter. The coating characteristics and the adhesive strength of the coatings on the samples were determined and compared to coatings on titanium samples. The influence of the coating process on the mechanical and chemical-physical properties of PEEK was also evaluated. All TPS coatings on PEEK and titanium fulfilled the manufacturer's requirements for thickness (200 ± 50µm), porosity (30 ± 10%) and roughness (90µm grain diameter coating: 25 ± 5µm and 180µm grain diameter coating: 45 ± 15µm) and were able to meet the demands required for adhesive strength (> 22MPa) and shear strength (> 20MPa). However, the mechanical properties i.e. yield stress, fracture strain, flexural modulus and flexural stress, of the PEEK samples were influenced by the coating process, while the chemical-physical properties were not altered.
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Affiliation(s)
- Danny Vogel
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany.
| | - Henry Dempwolf
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; DOT GmbH, Charles-Darwin-Ring 1a, 18059 Rostock, Germany.
| | - Axel Baumann
- DOT GmbH, Charles-Darwin-Ring 1a, 18059 Rostock, Germany.
| | - Rainer Bader
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany.
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