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Migliorini F, Eschweiler J, Betsch M, Maffulli N, Tingart M, Hildebrand F, Lecouturier S, Rath B, Schenker H. Osteointegration of functionalised high-performance oxide ceramics: imaging from micro-computed tomography. J Orthop Surg Res 2024; 19:411. [PMID: 39026349 PMCID: PMC11256426 DOI: 10.1186/s13018-024-04918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/13/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND This study evaluated the osseointegration potential of functionalised high-performance oxide ceramics (HPOC) in isolation or coated with BMP-2 or RGD peptides in 36 New Zeeland female rabbits using micro-computed tomography (micro CT). The primary outcomes of interest were to assess the amount of ossification evaluating the improvement in the bone volume/ total volume (BV/TV) ratio and trabecular thickness at 6 and 12 weeks. The second outcome of interest was to investigate possible differences in osteointegration between the functionalised silanised HPOC in isolation or coated with Bone Morphogenetic Protein 2 (BMP-2) or RGD peptides. METHODS 36 adult female New Zealand white rabbits with a minimum weight of three kg were used. One-third of HPOCs were functionalised with silicon suboxide (SiOx), a third with BMP-2 (sHPOC-BMP2), and another third with RGD (sHPOC-RGD). All samples were scanned with a high-resolution micro CT (U-CTHR, MILabs B.V., Houten, The Netherlands) with a reconstructed voxel resolution of 10 µm. MicroCT scans were reconstructed in three planes and processed using Imalytics Preclinical version 2.1 (Gremse-IT GmbH, Aachen, Germany) software. The total volume (TV), bone volume (BV) and ratio BV/TV were calculated within the coating area. RESULTS BV/TV increased significantly from 6 to 12 weeks in all HPOCs: silanised (P = 0.01), BMP-2 (P < 0.0001), and RGD (P < 0.0001) groups. At 12 weeks, the BMP-2 groups demonstrated greater ossification in the RGD (P < 0.0001) and silanised (P = 0.008) groups. Trabecular thickness increased significantly from 6 to 12 weeks (P < 0.0001). At 12 weeks, BMP-2 promoted greater trabecular thickness compared to the silanised group (P = 0.07), although no difference was found with the RGD (P = 0.1) group. CONCLUSION Sinalised HPOC in isolation or functionalised with BMP-2 or RGD promotes in vivo osteointegration. The sinalised HOPC functionalised with BMP-2 demonstrated the greatest osseointegration.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy.
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedic and Trauma Surgery, University Hospital of Erlangen, 91054, Erlangen, Germany
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Rome, Italy.
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, ST4 7QB, Stoke On Trent, England.
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, E1 4DG, London, England.
| | | | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sophie Lecouturier
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | - Hanno Schenker
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
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Migliorini F, Maffulli N, Pilone M, Velaj E, Hofmann UK, Bell A. Demographic characteristics influencing the stem subsidence in total hip arthroplasty: an imaging study. Arch Orthop Trauma Surg 2024; 144:887-894. [PMID: 37770626 PMCID: PMC10822810 DOI: 10.1007/s00402-023-05054-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION The present study evaluated whether patient demographic characteristics influence the subsidence of the stem in total hip arthroplasty (THA). The following characteristics were evaluated: age, height, weight, and sex. The association between the time elapsed from the THA implantation and the amount of stem subsidence was also investigated. METHODS The records of patients who underwent THA in the period between 2016 and 2023 were accessed. All patients underwent two-staged bilateral THA using cementless DePuy collarless Corail (DePuy Synthes, Raynham, MA, USA) stems. The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the medial apex of the regular triangle built within the trochanter minor (point A); distance from the medial apex of the regular triangle built within the trochanter minor and the distal portion of the femoral stem (point B). RESULTS Overall, 294 patients were included. 62% (182 of 294 patients) were women. 45% (134 of 296 THAs) were on the right side. The mean age was 64.9 ± 10.4 years. The mean BMI was 28.3 ± 5.1 kg/m2. The mean length of the follow-up was 14.4 ± 11.0 months. The mean subsidence in point A was 2.1 mm (P < 0.0001), and that in point B was 3.1 mm (P < 0.0001). There was evidence of a weak positive association between patient weight (P < 0.0001), age (P = 0.03), follow-up (P = 0.002) and the amount of stem subsidence. Patient height did not demonstrate any association with the amount of stem subsidence (P = 0.07). There was no difference in stem subsidence between women and men (P = 0.9). CONCLUSION Stem subsidence in THA using cementless DePuy collarless Corail implants is approximately 2.6 mm after 14.4 months. Greater patient weight, age, and longer time elapsed from THA implantation were associated with greater stem subsidence. Patient height and sex did not demonstrate any influence on the amount of stem subsidence. These results must be considered in light of the limitations of the present study.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy.
| | - Nicola Maffulli
- Department of Orthopaedic and Trauma Surgery, Hospital Sant'Andrea, University of Rome La Sapienza, Rome, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke On Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
| | - Marco Pilone
- Department of Orthopaedic and Trauma Surgery, Hospital Sant'Andrea, University of Rome La Sapienza, Rome, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Erlis Velaj
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany
| | - Andreas Bell
- Department of Orthopedics, Eifelklinik St. Brigida, 52152, Simmerath, Germany
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Ghosh R. A combined FE-hybrid MCDM framework for improving the performance of the conical stem tibial design for TAR with the addition of pegs. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 237:107574. [PMID: 37148636 DOI: 10.1016/j.cmpb.2023.107574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The conical stemmed design of the tibial component for total ankle replacement (TAR) (example Mobility design) uses a single intramedullary stem for primary fixation. Tibial component loosening is a common mode of failure for TAR. Primary causes of loosening are lack of bone ingrowth due to excessive micromotion at the implant-bone interface and bone resorption due to stress shielding after implantation. The fixation feature of the conical stemmed design can be modified with the addition of small pegs to avoid loosening. The aim of the study is to select the improved design for conical stemmed TAR using a combined Finite Element (FE) hybrid Multi-Criteria Decision-Making (MCDM) framework. METHODS The geometry and material properties of the bone for FE modeling were extracted from the CT data. Thirty-two design alternatives with varying pegs in number (one, two, four, eight), location (anterior, posterior, medial, lateral, anterior-posterior, medial-lateral, equally spaced), and height (5 mm, 4 mm, 3 mm, 2 mm) were prepared. All models were analyzed for dorsiflexion, neutral, and plantarflexion loading. The proximal part of the tibia was fixed. The implant-bone interface coefficient of friction was taken as 0.5. The implant-bone micromotion, stress shielding, volume of bone resection, and surgical simplicity were the important criteria considered for evaluating the performance of TAR. The designs were compared using a hybrid MCDM method of WASPAS, TOPSIS, EDAS, and VIKOR. The weight calculations were based on fuzzy AHP and the final ranks on the Degree of Membership method. RESULTS The addition of pegs decreased the mean implant-bone micromotions and increased stress shielding. There was a marginal decrease in micromotion and a marginal increase in stress shielding when the peg heights were increased. The results of hybrid MCDM indicated that the most preferable alternative designs were two pegs of 4 mm height in the AP direction to the main stem, two pegs of 4 mm height in the ML direction, and one peg of 3 mm height in the A direction. CONCLUSIONS Outcomes of this study suggest that the addition of pegs can reduce the implant-bone micromotions. Modified three designs would be useful by considering implant-bone micromotions, stress shielding, volume of bone resection, and surgical simplicity.
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Affiliation(s)
- Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India.
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Faria LGD, Minto BW, Shimano AC, Macedo AP, Diogo LMI, Dreibi RM, Nobile M, Santos Junior WS, Kawamoto FYK, Franco GG, Dias LGGG. Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model. Acta Cir Bras 2021; 36:e360506. [PMID: 34161433 PMCID: PMC8221799 DOI: 10.1590/acb360506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the biomechanical properties of a novel total hip replacement femoral stem. METHODS Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. RESULTS Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. CONCLUSIONS The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.
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Affiliation(s)
| | | | | | | | | | | | - Matheus Nobile
- Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil
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Ellenrieder M, Souffrant R, Schulze C, Kluess D, Mittelmeier W, Bader R. Primary stability of a cementless modular revision hip stem in relation with the femoral defect size: A biomechanical study. J Orthop Surg (Hong Kong) 2021; 28:2309499020948991. [PMID: 32909886 DOI: 10.1177/2309499020948991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cementless modular fluted hip stems are commonly used in revision arthroplasty. Nevertheless, there is a wide spectrum of recommendations concerning the minimum bone stock required to enable osseous ingrowth and implant-bone micromotions <100 µm. This experimental study investigated the primary stability of a tapered cementless fluted revision stem depending on different types of bone defects. METHODS Implant-bone interface movements with a bimodular stem were examined under cyclic axial and torsional loading using composite femora. In four degrees of freedom, the implant subsidence and micromotions were captured with linear variable differential transformers for the intact femora and seven different defects ranging from Paprosky type I to type IIIB. RESULTS With a 7-cm length of intact diaphysis proximal to the isthmus (Paprosky IIIA), mean implant-bone micromotions of 66 µm occurred. An implant-bone contact zone of only 5 cm (Paprosky IIIA) resulted in micromotions notably over 100 µm and significantly increased subsidence (p < 0.05). With a Paprosky IIIB defect (3 cm of intact diaphysis) rotational instability occurred in all specimens. CONCLUSIONS Aside from critically increased interfacial micromotions (>100 µm), rotational instability emerged as a mechanism of fixation failure when the implant-bone contact zone was only 5 cm or less. Hence, future studies investigating the implant fixation in the case of femoral bone defects should consider both axial and torsional loading. With regard to the clinical application, our data suggest maintaining 7 cm of diaphyseal implant-bone contact for a safe anchorage of cementless fluted hip revision stems.
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Affiliation(s)
- Martin Ellenrieder
- Department of Orthopaedics, 9187University Medicine Rostock, Rostock, Germany
| | - Robert Souffrant
- Department of Orthopaedics, 9187University Medicine Rostock, Rostock, Germany
| | - Christian Schulze
- Department of Orthopaedics, 9187University Medicine Rostock, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, 9187University Medicine Rostock, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, 9187University Medicine Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, 9187University Medicine Rostock, Rostock, Germany
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Leuridan S, Goossens Q, Pastrav LC, Mulier M, Desmet W, Vander Sloten J, Denis K. Development of an Instrument to Assess the Stability of Cementless Femoral Implants Using Vibration Analysis During Total Hip Arthroplasty. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021; 9:2500210. [PMID: 35103118 PMCID: PMC8791654 DOI: 10.1109/jtehm.2021.3128276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 11/06/2022]
Abstract
Objective: The level of primary implant fixation in cementless total hip arthroplasty is a key factor for the longevity of the implant. Vibration-based methods show promise for providing quantitative information to help surgeons monitor implant fixation intraoperatively. A thorough understanding of what is driving these changes in vibrational behavior is important for further development and improvement of these methods. Additionally, an instrument must be designed to enable surgeons to leverage these methods. This study addresses both of these issues. Method: An augmented system approach was used to develop an instrument that improves the sensitivity of the vibrational method and enables the implementation of the necessary excitation and measurement equipment. The augmented system approach took into account the dynamics of the existing bone-implant system and its interaction with the added instrument. Results: Two instrument designs are proposed, accompanied by a convergence-based method to determine the insertion endpoint. The modal strain energy density distribution was shown to affect the vibrational sensitivity to contact changes in certain areas. Conclusion: The augmented system approach led to an instrument design that improved the sensitivity to changes in the proximal region of the combined bone-implant-instrument system. This fact was confirmed both in silico and in vitro. Clinical Impact: The presented method and instruments address practical intraoperative challenges and provide perspective to objectively support the surgeon’s decision-making process, which will ensure optimal patient treatment.
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Affiliation(s)
- Steven Leuridan
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Quentin Goossens
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Leonard Cezar Pastrav
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Michiel Mulier
- University Hospital LeuvenDepartment of Orthopaedics 3000 Leuven Belgium
| | - Wim Desmet
- KU LeuvenDepartment of Mechanical EngineeringLMSD Section 3000 Leuven Belgium
| | - Jos Vander Sloten
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Kathleen Denis
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
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Ellenrieder M, Souffrant R, Schulze C, Mittelmeier W, Bader R. Micromotion and subsidence of a cementless conical fluted stem depending on femoral defect size - A human cadaveric study. Clin Biomech (Bristol, Avon) 2020; 80:105202. [PMID: 33129564 DOI: 10.1016/j.clinbiomech.2020.105202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cementless modular endoprostheses with tapered fluted stems cover a wide spectrum of femoral defects in reconstructive surgery of the hip. Nevertheless, for these hip stems the recommendations concerning the minimum diaphyseal anchorage distance differ widely. The present experimental study investigated the primary stability of a conical fluted revision stem depending on different types of femoral bone defects. METHODS Using six fresh frozen human femora, the relative movement of a bi-modular revision stem within the implant-bone interface was examined under cyclic loading conditions. Implant subsidence as well as micromotions at the bone-implant interface were captured with linear variable differential transformers for the intact femora and three different defects ranging from Paprosky type II to type IIIB. FINDINGS Compared to the intact femur, the infliction of a Paprosky type IIIB defect (3 cm of intact diaphysis) notably increased mean stem subsidence (13-389 μm per 500 load cycles; P = 0.116) but the mean interface micromotion vector sum remained unchanged (50 μm vs. 53 μm). In Paprosky IIIB defects the subsidence component resulting from rotation (horizontal plane) was significantly higher than with the intact femur and a Paprosky II defect (P ≤ 0.041). INTERPRETATION With optimal bone quality and ideal femur preparation a 3 cm conical fixation was sufficient to meet the set criteria of bony ingrowth in vitro. A conical fixation of 7 cm should be recommended to limit rotational subsidence, especially in case of impaired diaphyseal bone quality or expected difficulties with partial weight-bearing.
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Affiliation(s)
- Martin Ellenrieder
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, D-18057 Rostock, Germany.
| | - Robert Souffrant
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, D-18057 Rostock, Germany.
| | - Christian Schulze
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, D-18057 Rostock, Germany.
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, D-18057 Rostock, Germany.
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, D-18057 Rostock, Germany.
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Levadnyi I, Awrejcewicz J, Zhang Y, Gu Y. Comparison of femur strain under different loading scenarios: Experimental testing. Proc Inst Mech Eng H 2020; 235:17-27. [PMID: 32811293 DOI: 10.1177/0954411920951033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bone fracture, formation and adaptation are related to mechanical strains in bone. Assessing bone stiffness and strain distribution under different loading conditions may help predict diseases and improve surgical results by determining the best conditions for long-term functioning of bone-implant systems. In this study, an experimentally wide range of loading conditions (56) was used to cover the directional range spanned by the hip joint force. Loads for different stance configurations were applied to composite femurs and assessed in a material testing machine. The experimental analysis provides a better understanding of the influence of the bone inclination angle in the frontal and sagittal planes on strain distribution and stiffness. The results show that the surface strain magnitude and stiffness vary significantly under different loading conditions. For the axial compression, maximal bending is observed at the mid-shaft, and bone stiffness is also maximal. The increased inclination leads to decreased stiffness and increased magnitude of maximum strain at the distal end of the femur. For comparative analysis of results, a three-dimensional, finite element model of the femur was used. To validate the finite element model, strain gauges and digital image correlation system were employed. During validation of the model, regression analysis indicated robust agreement between the measured and predicted strains, with high correlation coefficient and low root-mean-square error of the estimate. The results of stiffnesses obtained from multi-loading conditions experiments were qualitatively compared with results obtained from a finite element analysis of the validated model of femur with the same multi-loading conditions. When the obtained numerical results are qualitatively compared with experimental ones, similarities can be noted. The developed finite element model of femur may be used as a promising tool to estimate proximal femur strength and identify the best conditions for long-term functioning of the bone-implant system in future study.
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Affiliation(s)
- Ievgen Levadnyi
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Research Academy of Grand Health Interdisciplinary, Ningbo University, Ningbo, China.,Department of Automation, Biomechanics and Mechatronics, Lodz University of Technology, Lodz, Poland
| | - Jan Awrejcewicz
- Department of Automation, Biomechanics and Mechatronics, Lodz University of Technology, Lodz, Poland.,Institute of Vehicles, Warsaw University of Technology, Warsaw, Poland
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Research Academy of Grand Health Interdisciplinary, Ningbo University, Ningbo, China.,Department of Automation, Biomechanics and Mechatronics, Lodz University of Technology, Lodz, Poland
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Research Academy of Grand Health Interdisciplinary, Ningbo University, Ningbo, China
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李 永, 何 荣, 张 谦, 安 明, 祁 辉, 马 文, 宋 兴, 孙 俊. [Bone remodeling after total hip arthroplasty with anatomic medullary locking prosthesis and its long-term effectiveness]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:689-695. [PMID: 32538557 PMCID: PMC8171526 DOI: 10.7507/1002-1892.201910033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty (THA) with anatomic medullary locking (AML) prosthesis. METHODS The clinical data of 24 cases (26 hips) who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed. There were 12 males and 12 females with an age of 32-69 years (mean, 53.7 years). There were 5 cases (5 hips) of avascular necrosis of the femoral head, 6 cases (7 hips) of secondary osteoarthritis of the hip dysplasia, 6 cases (6 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 3 cases (3 hips) of revision surgery, 1 case (2 hips) of ankylosing spondylitis, 1 case (1 hip) of femoral head fracture. The patients were followed up at immediate, 6 weeks, 3 months, 6 months, 1 year, and then every year after operation for imaging evaluation (X-ray film was taken immediately after operation to evaluate the femoral isthmus compression, Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis, and Brooker method was used to evaluate the occurrence of heterotopic ossification); bone reconstruction evaluation [reconstruction of prosthesis and bone interface (type of bone reaction, Gruen zone, incidence, and occurrence time were recorded), reconstruction of bone around prosthesis (proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods, and bone mineral density change rate was measured)]; clinical efficacy evaluation [Harris score for efficacy, visual analogue scale (VAS) score for thigh pain]. RESULTS All patients were followed up 15 years and 2 months to 20 years and 4 months, with a median of 16 years and 6 months. At immediate after operation, 24 hips (92.3%) had good femoral isthums compression, 24 hips (92.3%) had good bone ingrowth. Heterotopic ossification occurred in 2 patients with degree 1, 2 patients with degree 2, and 1 patient with degree 3 at 3-6 months after operation. Hyperplastic bone reactions were more common in Gruen 2, 3, 4, 5, 6, 10, 11, and 12 zones, mainly occurring at 6-20 months after operation, with the incidence of 3.8%-69.2%, with the highest incidence of spot welding. All absorptive bone reactions were osteolysis, which was common in Gruen 1 and 7 zones, and mainly occurred at 8 years after operation, with an incidence of 42.3%. No clear line (area) or enlarged sign of medullary cavity was observed. Twenty-one hips (80.8%) had 1 degree stress shieding, and 5 hips (19.2%) had 2 degree stress shieding. It mainly occurred at 10-24 months after operation in Gruen 1 and 7 zones. Dual energy X-ray absorptiometry showed that bone mineral density mainly decreased in Gruen 1, 2, 6, and 7 zones, mainly increased in Gruen 3, 4, and 5 zones. Bone mineral density loss progressed slowly after 2 years of operation, and it was stable in 5-8 years, but decreased rapidly in 8-9 years, and stabilized after 10 years. The Harris score increased from 51.1±6.2 before operation to 88.3±5.1 at last follow-up ( t=-21.774, P=0.000). Mild thigh pain occurred in only 2 cases (7.7%) with the VAS score of 2. No aseptic loosening or revision of femoral prosthesis occurred during the follow-up. CONCLUSION The application of AML prosthesis in THA has a good bone remodeling and a good long-term effectiveness.
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Affiliation(s)
- 永旺 李
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 荣丽 何
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 谦 张
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 明 安
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 辉 祁
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 文海 马
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 兴建 宋
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
| | - 俊英 孙
- 保定市第一中心医院骨三科(河北保定 071000)Third Department of Orthopedics, Baoding Municipal First Center Hospital, Baoding Hebei, 071000, P.R.China
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Leuridan S, Goossens Q, Roosen J, Pastrav L, Denis K, Mulier M, Desmet W, Vander Sloten J. A biomechanical testing system to determine micromotion between hip implant and femur accounting for deformation of the hip implant: Assessment of the influence of rigid body assumptions on micromotions measurements. Clin Biomech (Bristol, Avon) 2017; 42:70-78. [PMID: 28110243 DOI: 10.1016/j.clinbiomech.2017.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate pre-clinical evaluation of the initial stability of new cementless hip stems using in vitro micromotion measurements is an important step in the design process to assess the new stem's potential. Several measuring systems, linear variable displacement transducer-based and other, require assuming bone or implant to be rigid to obtain micromotion values or to calculate derived quantities such as relative implant tilting. METHODS An alternative linear variable displacement transducer-based measuring system not requiring a rigid body assumption was developed in this study. The system combined advantages of local unidirectional and frame-and-bracket micromotion measuring concepts. The influence and possible errors that would be made by adopting a rigid body assumption were quantified. Furthermore, as the system allowed emulating local unidirectional and frame-and-bracket systems, the influence of adopting rigid body assumptions were also analyzed for both concepts. Synthetic and embalmed bone models were tested in combination with primary and revision implants. Single-legged stance phase loading was applied to the implant - bone constructs. FINDINGS Adopting a rigid body assumption resulted in an overestimation of mediolateral micromotion of up to 49.7μm at more distal measuring locations. Maximal average relative rotational motion was overestimated by 0.12° around the anteroposterior axis. Frontal and sagittal tilting calculations based on a unidirectional measuring concept underestimated the true tilting by an order of magnitude. INTERPRETATION Non-rigid behavior is a factor that should not be dismissed in micromotion stability evaluations of primary and revision femoral implants.
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Affiliation(s)
- Steven Leuridan
- Department of Mechanical Engineering, Biomechanics Division. KU Leuven, Celestijnenlaan 300c, Box 2419, 3001 Leuven, Belgium.
| | - Quentin Goossens
- Department of Mechanical Engineering, Smart Instrumentation, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Jorg Roosen
- Department of Orthopedic Surgery, Leuven University Hospitals, Weligerveld 1, 3212 Pellenberg, Belgium
| | - Leonard Pastrav
- Department of Mechanical Engineering, Smart Instrumentation, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Kathleen Denis
- Department of Mechanical Engineering, Smart Instrumentation, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
| | - Michiel Mulier
- Department of Orthopedic Surgery, Leuven University Hospitals, Weligerveld 1, 3212 Pellenberg, Belgium
| | - Wim Desmet
- Department of Mechanical Engineering, PMA, KU Leuven, Celestijnenlaan 300c, 3001 Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Biomechanics Division. KU Leuven, Celestijnenlaan 300c, Box 2419, 3001 Leuven, Belgium
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Reimeringer M, Nuño N. The influence of contact ratio and its location on the primary stability of cementless total hip arthroplasty: A finite element analysis. J Biomech 2016; 49:1064-1070. [DOI: 10.1016/j.jbiomech.2016.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 01/15/2023]
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12
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Garcia-Martin E, Calvo B, Malvè M, Herrero R, Fuertes I, Ferreras A, Larrosa JM, Polo V, Pablo LE. Three-dimensional geometries representing the retinal nerve fiber layer in multiple sclerosis, optic neuritis, and healthy eyes. Ophthalmic Res 2013; 50:72-81. [PMID: 23774269 DOI: 10.1159/000350413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND To represent and interpret the three-dimensional (3D) geometry and the distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON). METHODS MS patients (n = 122) and age-matched healthy subjects (n = 108) were enrolled. The Spectralis optical coherence tomography system was used to determine the circumpapillary RNFL thickness. The 768 RNFL thickness measurements were used to evaluate thickness measurements in patients with or without antecedent ON and to design a 3D reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes. RESULTS RNFL thickness was decreased in MS patients, and was higher in the MS group with previous ON. Statistical analysis and 3D RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area (101.77 µm in MS vs. 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in MS eyes and 149.26 µm in healthy eyes). CONCLUSIONS The 3D representation of RNFL thickness based on measurements allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.
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Affiliation(s)
- E Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.
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13
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Cristofolini L, Erani P, Viceconti M. Comments on 'Experimental versus computational analysis of micromotions at the implant-bone interface'. Proc Inst Mech Eng H 2012; 226:417-9; author reply 420-1. [PMID: 22720395 DOI: 10.1177/0954411912443012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Monea AG, Pastrav LC, Mulier M, Van der Perre G, Jaecques SV. Numerical simulation of the insertion process of an uncemented hip prosthesis in order to evaluate the influence of residual stress and contact distribution on the stem initial stability. Comput Methods Biomech Biomed Engin 2012; 17:263-76. [PMID: 22548243 DOI: 10.1080/10255842.2012.681644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The long-term success of a cementless total hip arthroplasty depends on the implant geometry and interface bonding characteristics (fit, coating and ingrowth) and on stem stiffness. This study evaluates the influence of stem geometry and fitting conditions on the evolution and distribution of the bone-stem contact, stress and strain during and after the hip stem insertion, by means of dynamic finite element techniques. Next, the influence of the mechanical state (bone-stem contact, stress and strain) resulted from the insertion process on the stem initial resistance to subsidence is investigated. In addition, a study on the influence of bone-stem interface conditions (friction) on the insertion process and on the initial stem stability under physiological loading is performed. The results indicate that for a stem with tapered shape the contact in the proximal part of the stem was improved, but contact in the calcar region was achieved only when extra press-fit conditions were considered. Changes in stem geometry towards a more tapered shape and extra press fit and variation in the bone-stem interface conditions (contact amount and high friction) led to a raise in the total insertion force. A direct positive relationship was found between the stem resistance to subsidence and stem geometry (tapering and press fit), bone-stem interface conditions (bone-stem contact and friction interface) and the mechanical status at the end of the insertion (residual stress and strain). Therefore, further studies on evaluating the initial performance of different stem types should consider the parameters describing the bone-stem interface conditions and the mechanical state resulted from the insertion process.
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Affiliation(s)
- Aida Georgeta Monea
- a Division of Experimental Neurosurgery and Neuroanatomy, Biomechanics Section , Katholieke Universiteit of Leuven , Celestijnenlaan 300, bus 2419, Heverlee , 3001 , Belgium
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Martelli S, Taddei F, Cristofolini L, Gill HS, Viceconti M. Extensive Risk Analysis of Mechanical Failure for an Epiphyseal Hip Prothesis: A Combined Numerical—Experimental Approach. Proc Inst Mech Eng H 2010; 225:126-40. [DOI: 10.1243/09544119jeim728] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There has been recent renewed interest in proximal femur epiphyseal replacement as an alternative to conventional total hip replacement. In many branches of engineering, risk analysis has proved to be an efficient tool for avoiding premature failures of innovative devices. An extensive risk analysis procedure has been developed for epiphyseal hip prostheses and the predictions of this method have been compared to the known clinical outcomes of a well-established contemporary design, namely hip resurfacing devices. Clinical scenarios leading to revision (i.e. loosening, neck fracture and failure of the prosthetic component) were associated with potential failure modes (i.e. overload, fatigue, wear, fibrotic tissue differentiation and bone remodelling). Driving parameters of the corresponding failure mode were identified together with their safe thresholds. For each failure mode, a failure criterion was identified and studied under the most relevant physiological loading conditions. All failure modes were investigated with the most suitable investigation tool, either numerical or experimental. Results showed a low risk for each failure scenario either in the immediate postoperative period or in the long term. These findings are in agreement with those reported by the majority of clinical studies for correctly implanted devices. Although further work is needed to confirm the predictions of this method, it was concluded that the proposed risk analysis procedure has the potential to increase the efficacy of preclinical validation protocols for new epiphyseal replacement devices.
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Affiliation(s)
- S Martelli
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - F Taddei
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Cristofolini
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
- Engineering Faculty, University of Bologna, Italy
| | - H S Gill
- Nuffield Department Of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - M Viceconti
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Zeman ME, Sauwen N, Labey L, Mulier M, Van der Perre G, Jaecques SVN. Assessment of the primary rotational stability of uncemented hip stems using an analytical model: comparison with finite element analyses. J Orthop Surg Res 2008; 3:44. [PMID: 18817544 PMCID: PMC2570665 DOI: 10.1186/1749-799x-3-44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 09/25/2008] [Indexed: 11/26/2022] Open
Abstract
Background Sufficient primary stability is a prerequisite for the clinical success of cementless implants. Therefore, it is important to have an estimation of the primary stability that can be achieved with new stem designs in a pre-clinical trial. Fast assessment of the primary stability is also useful in the preoperative planning of total hip replacements, and to an even larger extent in intraoperatively custom-made prosthesis systems, which result in a wide variety of stem geometries. Methods An analytical model is proposed to numerically predict the relative primary stability of cementless hip stems. This analytical approach is based upon the principle of virtual work and a straightforward mechanical model. For five custom-made implant designs, the resistance against axial rotation was assessed through the analytical model as well as through finite element modelling (FEM). Results The analytical approach can be considered as a first attempt to theoretically evaluate the primary stability of hip stems without using FEM, which makes it fast and inexpensive compared to other methods. A reasonable agreement was found in the stability ranking of the stems obtained with both methods. However, due to the simplifying assumptions underlying the analytical model it predicts very rigid stability behaviour: estimated stem rotation was two to three orders of magnitude smaller, compared with the FEM results. Conclusion Based on the results of this study, the analytical model might be useful as a comparative tool for the assessment of the primary stability of cementless hip stems.
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Affiliation(s)
- Maria E Zeman
- Katholieke Universiteit Leuven (K,U,Leuven), Division of Biomechanics and Engineering Design (BMGO), Celestijnenlaan 300C, 3001 Heverlee, Belgium
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Sigal IA, Flanagan JG, Tertinegg I, Ethier CR. Predicted extension, compression and shearing of optic nerve head tissues. Exp Eye Res 2007; 85:312-22. [PMID: 17624325 DOI: 10.1016/j.exer.2007.05.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 05/21/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
Glaucomatous optic neuropathy may be in part due to an altered biomechanical environment within the optic nerve head (ONH) produced by an elevated intraocular pressure (IOP). Previous work has characterized the magnitude of the IOP-induced deformation of ONH tissues but has not focused specifically on the mode of deformation (strain), i.e. whether the ONH tissues and cells are stretched, compressed or sheared. Circumstantial evidence indicates that the mode of deformation has biological consequences. Here we use computational models to study the different modes of deformation that occur in an ONH as a result of an increase in IOP. One generic and three individual-specific 3D models of the human ONH were reconstructed as previously described. Each model consisted of five tissue regions: pre and post-laminar neural tissue, lamina cribrosa, sclera and pia mater. Finite element methods were then used to predict the biomechanical response to changes in IOP. For each model we computed six local measures of strain, including the magnitude and direction of maximum stretching, maximum compression and maximum shearing strain. We compared the spatial and population distributions of the various measures of strain by using semi-quantitative (contour plots) and quantitative (histograms) methods. For all models, as IOP increased, the tissues of the ONH were subjected simultaneously to various modes of strain, including compression, extension and shearing. The highest magnitudes of all modes of strain occurred within the neural tissue regions. There were substantial differences in the magnitudes of the various modes of strain, with the largest strains being in compression, followed by shearing and finally by extension. The biomechanical response of an individual-specific ONH to changes in IOP is complex and cannot be fully captured by one measure of deformation. We predict that cells within the ONH are subjected to very different modes of deformation as IOP increases. The largest deformations are compressive, followed by shearing and stretching. Models of IOP-induced RGC damage need to be further refined by characterizing the cellular response to these different modes of strain.
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Affiliation(s)
- Ian A Sigal
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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