Multiobjective Design Optimization of a Biconcave Mobile-Bearing Lumbar Total Artificial Disk Considering Spinal Kinematics, Facet Joint Loading, and Metal-on-Polyethylene Contact Mechanics

Single-View Fluoroscopic X-Ray Pose Estimation: A Comparison of Alternative Loss Functions and Volumetric Scene Representations

Many tasks performed in image-guided procedures can be cast as pose estimation problems, where specific projections are chosen to reach a target in 3D space. In this study, we construct a framework for fluoroscopic pose estimation and compare alternative loss functions and volumetric scene representations. We first develop a differentiable projection (DiffProj) algorithm for the efficient computation of Digitally Reconstructed Radiographs (DRRs) from either Cone-Beam Computerized Tomography (CBCT) or neural scene representations. We introduce two innovative neural scene representations, Neural Tuned Tomography (NeTT) and masked Neural Radiance Fields (mNeRF). Pose estimation is then performed within the framework by iterative gradient descent using loss functions that quantify the image discrepancy of the synthesized DRR with respect to the ground-truth, target fluoroscopic X-ray image. We compared alternative loss functions and volumetric scene representations for pose estimation using a dataset consisting of 50 cranial tomographic X-ray sequences. We find that Mutual Information significantly outperforms alternative loss functions for pose estimation, avoiding entrapment in local optima. The alternative discrete (CBCT) and neural (NeTT and mNeRF) volumetric scene representations yield comparable performance (3D angle errors, mean ≤ 3.2° and 90% quantile ≤ 3.4°); however, the neural scene representations incur a considerable computational expense to train.

Combining the probabilistic finite element model and artificial neural network to study nutrient levels in the human intervertebral discs

BACKGROUND

Diffusion distance and diffusivity are known to affect nutrient transport rates, but the probabilistic analysis of these two factors remains vacant. There is a lack of effective tools to evaluate disc nutrient levels.

METHODS

Five-hundred-disc samples with different combinations of morphological and water content parameters were generated, which were used to evaluate nutrient levels in unloaded and loaded states. Spearman correlation coefficients between inputs and responses were calculated. Artificial neural networks were trained to predict nutrient concentrations based on the dataset generated by the probabilistic finite element model.

FINDINGS

In unloaded and loaded states, the minimum oxygen concentration of nucleus pulposus was negatively correlated with disc height (r = -0.83, p < 0.01 and r = -0.76, p < 0.01, respectively), and the minimum glucose concentration of annulus fibrosus was positively correlated with its water content (r = 0.68, p < 0.01 and r = 0.73, p < 0.01, respectively). The maximum lactate concentration of cartilage endplate was affected by endplate thickness (r = 0.94, p < 0.01 and r = 0.95, p < 0.01, respectively). For trained neural networks, nutrient concentrations could be well predicted, with coefficients of determination greater than 0.95 and mean absolute percentage errors less than 5 %.

INTERPRETATION

This study underscores the importance of disc height, annulus fibrosus water content, and endplate thickness in regulating nutrient levels, and precise control of these parameters should be prioritized in the design of tissue-engineered discs. Moreover, artificial neural networks might be a promising tool for evaluating nutrient levels.

Effect of patient-specific factors on regeneration in lumbar spine at healthy disc and total disc replacement. Computer simulation

BACKGROUND AND OBJECTIVE

Degenerative diseases of the spine have a negative impact on the quality of life of patients. This study presents the results of numerical modelling of the mechanical behaviour of the lumbar spine with patient-specific conditions at physiological loads. This paper aims to numerically study the influence of degenerative changes in the spine and the presence of an endoprosthesis on the creation of conditions for tissue regeneration.

METHODS

A numerical model of the mechanical behaviour of lumbar spine at healthy and after total disc replacement under low-energy impacts equivalent to physiological loads is presented. The model is based on the movable cellular automaton method (discrete elements), where the mechanical behaviour of bone tissue is described using the Biot poroelasticity accounting for the presence and transfer of interstitial biological fluid. The nutritional pathways of the intervertebral disc in cases of healthy and osteoporotic bone tissues were predicted based on the analysis of the simulation results according to the mechanobiological principles.

RESULTS

Simulation of total disc replacement showed that osseointegration of the artificial disc plates occurs only in healthy bone tissue. With total disc replacement in a patient with osteoporosis, there is an area of increased risk of bone resorption in the near-contact area, approximately 1 mm wide, around the fixators. Dynamic loads may improve the osseointegration of the implant in pathological conditions of the bone tissue.

CONCLUSIONS

The results obtained in the case of healthy spine and osteoporotic bone tissues correspond to the experimental data on biomechanics and possible methods of IVD regeneration from the position of mechanobiological principles. The results obtained with an artificial disc (with keel-type fixation) showed that the use of this type of endoprosthesis in healthy bone tissues allows to reproduce the function of the natural intervertebral disc and does not contribute to the development of neoplastic processes. In the case of an artificial disc with osteoporosis of bone tissues, there is a zone with increased risk of tissue resorption and development of neoplastic processes in the area near the contact of the implant attachment. This circumstance can be compensated by increasing the loading level.

Current Knowledge on Biomaterials for Orthopedic Applications Modified to Reduce Bacterial Adhesive Ability

A significant challenge in orthopedics is the design of biomaterial devices that are able to perform biological functions by substituting or repairing various tissues and controlling bone repair when required. This review presents an overview of the current state of our recent research into biomaterial modifications to reduce bacterial adhesive ability, compared with previous reviews and excellent research papers, but it is not intended to be exhaustive. In particular, we investigated biomaterials for replacement, such as metallic materials (titanium and titanium alloys) and polymers (ultra-high-molecular-weight polyethylene), and biomaterials for regeneration, such as poly(ε-caprolactone) and calcium phosphates as composites. Biomaterials have been designed, developed, and characterized to define surface/bulk features; they have also been subjected to bacterial adhesion assays to verify their potential capability to counteract infections. The addition of metal ions (e.g., silver), natural antimicrobial compounds (e.g., essential oils), or antioxidant agents (e.g., vitamin E) to different biomaterials conferred strong antibacterial properties and anti-adhesive features, improving their capability to counteract prosthetic joint infections and biofilm formation, which are important issues in orthopedic surgery. The complexity of biological materials is still far from being reached by materials science through the development of sophisticated biomaterials. However, close interdisciplinary work by materials scientists, engineers, microbiologists, chemists, physicists, and orthopedic surgeons is indeed necessary to modify the structures of biomaterials in order to achieve implant integration and tissue regeneration while avoiding microbial contamination.

Characterizing the trade-off between range of motion and stability of reverse total shoulder arthroplasty

BACKGROUND

The trade-off between range of motion (ROM) and stability of reverse total shoulder arthroplasty (RSA) has long been hypothesized to exist but has not yet been well characterized. The goal of this study was to use design optimization techniques to obtain a Pareto curve, which quantifies the trade-off between 2 competing objectives and is defined by the performance of optimum designs that maximize one surgical outcome without sacrificing the other.

METHODS

Multi-objective design optimization techniques were used; 4 design and surgical parameters including glenoid lateralization (GLat), neck-shaft angle (NSA), inferior offset of the center of rotation (COR_inf), and humerus lateralization (HLat) were tuned simultaneously. The ROM and stability, the objectives to be optimized, of any candidate design were characterized computationally using a combination of finite element models, musculoskeletal models, analytical equations, and surrogate models. Optimum designs and Pareto curves were determined separately for a standard cup depth and a shallow cup depth. The performance of the optimum designs, in terms of ROM and stability, was compared with a representative commercially available design.

RESULTS

A Pareto curve was obtained for each cup depth, confirming there is a trade-off between ROM and stability of RSA. In comparison to the commercially available design (cup depth, 8.1 mm; GLat, 5 mm; NSA, 155°; COR_inf, 0 mm; HLat, 0 mm), the designs optimized for ROM offered 38.8% (cup depth, 6 mm; GLat, 16 mm; NSA, 163.6°; COR_inf, 4 mm; HLat, 0.6 mm) and 35.2% (cup depth, 8.1 mm; GLat, 16 mm; NSA, 160.5°; COR_inf, 4 mm; HLat, -0.2 mm) improvement in ROM. The designs optimized for stability (cup depth of 6 mm with GLat of 16 mm, NSA of 170°, COR_inf of 4 mm, and HLat of 3 mm and cup depth of 8.1 mm with GLat of 16 mm, NSA of 170°, COR_inf of 4 mm, and HLat of 3 mm) both offered 12.4% improvement in stability over the commercially available design. Designs in the toe region of the Pareto curve offered between 75% and 90% of the maximum possible improvement over the commercially available design for both objectives.

CONCLUSION

It was confirmed that a trade-off exists between ROM and stability of RSA, in which maximizing one outcome requires a sacrifice in the other. The relative gains and sacrifices in the competing outcomes when traversing the Pareto front could aid in understanding clinically optimum designs based on patient-specific needs.