Measuring bone stiffness using spherical indentation

Implant Design and Cervical Spinal Biomechanics and Neurorehabilitation: A Finite Element Investigation

INTRODUCTION

The cervical spine, pivotal for mobility and overall body function, can be affected by cervical spondylosis, a major contributor to neural disorders. Prevalent in both general and military populations, especially among pilots, cervical spondylosis induces pain and limits spinal capabilities. Anterior Cervical Discectomy and Fusion (ACDF) surgery, proposed by Cloward in the 1950s, is a promising solution for restoring natural cervical curvature. The study objective was to investigate the impacts of ACDF implant design on postsurgical cervical biomechanics and neurorehabilitation outcomes by utilizing a biofield head-neck finite element (FE) platform that can facilitate scenario-specific perturbations of neck muscle activations. This study addresses the critical need to enhance computational models, specifically FE modeling, for ACDF implant design.

MATERIALS AND METHODS

We utilized a validated head-neck FE model to investigate spine-implant biomechanical interactions. An S-shaped dynamic cage incorporating titanium (Ti) and polyetheretherketone (PEEK) materials was modeled at the C4/C5 level. The loading conditions were carefully designed to mimic helmet-to-helmet impact in American football, providing a realistic and challenging scenario. The analysis included intervertebral joint motion, disk pressure, and implant von Mises stress.

RESULTS

The PEEK implant demonstrated an increased motion in flexion and lateral bending at the contiguous spinal (C4/C5) level. In flexion, the Ti implant showed a modest 5% difference under 0% activation conditions, while PEEK exhibited a more substantial 14% difference. In bending, PEEK showed a 24% difference under 0% activation conditions, contrasting with Ti's 17%. The inclusion of the head resulted in an average increase of 18% in neck angle and 14% in C4/C5 angle. Disk pressure was influenced by implant material, muscle activation level, and the presence of the head. Polyetheretherketone exhibited lower stress values at all intervertebral disc levels, with a significant effect at the C6/C7 levels. Muscle activation level significantly influenced disk stress at all levels, with higher activation yielding higher stress. Titanium implant consistently showed higher disk stress values than PEEK, with an orders-of-magnitude difference in von Mises stress. Excluding the head significantly affected disk and implant stress, emphasizing its importance in accurate implant performance simulation.

CONCLUSIONS

This study emphasized the use of a biofidelic head-neck model to assess ACDF implant designs. Our results indicated that including neck muscles and head structures improves biomechanical outcome measures. Furthermore, unlike Ti implants, our findings showed that PEEK implants maintain neck motion at the affected level and reduce disk stresses. Practitioners can use this information to enhance postsurgery outcomes and reduce the likelihood of secondary surgeries. Therefore, this study makes an important contribution to computational biomechanics and implant design domains by advancing computational modeling and theoretical knowledge on ACDF-spine interaction dynamics.

Horizontal Alveolar Ridge Splitting and Expansion

When considering placing dental implants in atrophic edentulous sites, there may be inadequate site width and little or no vertical bone loss. Any of several surgical procedures can augment these sites. Extracortical augmentation is done by applying graft material against the cortical bone. This technique expects progenitor cells to migrate outside the bony ridge's confines and form new bone. Another method entails ridge splitting and expansion to create space for osteogenesis and, when possible, implant placement. This may be a better method for horizontal ridge augmentation. The ridge is split, separating the facial and lingual cortices for a complete bone fracture. The patient's osseous cells can then migrate into the created space from the exposed medullary bone to form bone. The technique can be preferably performed flapless so the intact periosteum maintains a blood supply to ensure appropriate healing.

Severe plastic deformation: Nanostructured materials, metal-based and polymer-based nanocomposites: A review

Significant deformation of the metal structure can be achieved without breaking or cracking the metal. There are several methods for deformation of metal plastics. The most important of these methods are angular channel pressing process, high-pressure torsion, multidirectional forging process, extrusion-cyclic compression process, cumulative climbing connection process, consecutive concreting and smoothing method, high-pressure pipe torsion. The nanocomposite is a multiphase material which the size of one of its phases is less than 100 nm in at least one dimension. Due to some unique properties, metal-based nanocomposites are widely used in engineering applications such as the automotive and aerospace industries. Polymer-based nanocomposites are two-phase systems with polymer-based and reinforcing phases (usually ceramic). These materials have a simpler synthesis process than metal-based nanocomposites and are used in a variety of applications such as the aerospace industry, gas pipelines, and sensors. Severe plastic deformation (SPD) is known to be the best method for producing bulk ultrafine grained and nanostructured materials with excellent properties. Different Severe plastic deformation methods were developed that are suitable for sheet and bulk solid materials. During the past decade, efforts have been made to create effective Severe plastic deformation processes suitable for producing cylindrical tubes. In this paper, we review Severe plastic deformation processes intended to nanostructured tubes, and their effects on material properties and severe plastic deformation is briefly introduced and its common methods for bulk materials, sheets, and pipes, as well as metal background nanocomposites, are concisely introduced and their microstructural and mechanical properties are discussed. The paper will focus on introduction of the tube Severe plastic deformation processes, and then comparison of them based on their advantages and disadvantages from the viewpoints of processing and properties.

Mechanical bone strength decreases considerably after microwave ablation-Ex-vivo and in-vivo analysis in sheep long bones

BACKGROUND

Bone metastases are on the rise due to longer survival of cancer patients. Local tumor control is required for pain relief. Microwave ablation (MWA) is a technique for minimally invasive local tumor treatment. Tumor tissue is destroyed by application of local hyperthermia to induce necrosis. Given the most common setting of palliative care, it is generally considered beneficial for patients to start mobilizing directly following treatment. No data on mechanical strength in long bones after MWA have been published so far.

MATERIALS AND METHODS

In- and ex-vivo experiments on sheep tibias were performed with MWA in various combinations of settings for time and power. During the in-vivo part sheep were sacrificed one or six weeks after ablation. Mechanical strength was examined with a three-point bending test for ablations in the diaphysis and with an indentation test for ablations in the metaphysis.

RESULTS

MWA does not decrease mechanical strength in the diaphysis. In the metaphysis strength decreased up to 50% six weeks after ablation, which was not seen directly after ablation.

CONCLUSION

MWA appears to decrease mechanical strength in long bone metaphysis up to 50% after six weeks, however strength remains sufficient for direct mobilization. The time before normal strength is regained after the remodeling phase is not known.

Breast Cancer Cell Type and Biomechanical Properties of Decellularized Mouse Organs Drives Tumor Cell Colonization

Tissue engineering has emerged as an indispensable tool for the reconstruction of organ-specific environments. Organ-derived extracellular matrices (ECM) and, especially, decellularized tissues (DCL) are recognized as the most successful biomaterials in regenerative medicine, as DCL preserves the most essential organ-specific ECM properties such as composition alongside biomechanics characterized by stiffness and porosity. Expansion of the DCL technology to cancer biology research, drug development, and nanomedicine is pending refinement of the existing DCL protocols whose reproducibility remains sub-optimal varying from organ to organ. We introduce a facile decellularization protocol universally applicable to murine organs, including liver, lungs, spleen, kidneys, and ovaries, with demonstrated robustness, reproducibility, high purification from cell debris, and architecture preservation, as confirmed by the histological and SEM analysis. The biomechanical properties of as-produced DCL organs expressed in terms of the local and total stiffness were measured using our facile methodology and were found well preserved in comparison with the intact organs. To demonstrate the utility of the developed DCL model to cancer research, we engineered three-dimensional tissue constructs by recellularization representative decellularized organs and collagenous hydrogel with human breast cancer cells of pronounced mesenchymal (MDA-MB-231) or epithelial (SKBR-3) phenotypes. The biomechanical properties of the DCL organs were found pivotal to determining the cancer cell fate and progression. Our histological and scanning electron microscopy (SEM) study revealed that the larger the ECM mean pore size and the smaller the total stiffness (as in lung and ovary), the more proliferative and invasive the mesenchymal cells became. At the same time, the low local stiffness ECMs (ranged 2.8-3.6 kPa) did support the epithelial-like SKBR-3 cells' viability (as in lung and spleen), while stiff ECMs did not. The total and local stiffness of the collagenous hydrogel was measured too low to sustain the proliferative potential of both cell lines. The observed cell proliferation patterns were easily interpretable in terms of the ECM biomechanical properties, such as binding sites, embedment facilities, and migration space. As such, our three-dimensional tissue engineering model is scalable and adaptable for pharmacological testing and cancer biology research of metastatic and primary tumors, including early metastatic colonization in native organ-specific ECM.

A Case for Material Stiffness as a Design Parameter in Encapsulated Islet Transplantation

Diabetes is a disease that plagues over 463 million people globally. Approximately 40 million of these patients have type 1 diabetes mellitus (T1DM), and the global incidence is increasing by up to 5% per year. T1DM is where the body's immune system attacks the pancreas, specifically the pancreatic beta cells, with antibodies to prevent insulin production. Although current treatments such as exogenous insulin injections have been successful, exorbitant insulin costs and meticulous administration present the need for alternative long-term solutions to glucose dysregulation caused by diabetes. Encapsulated islet transplantation (EIT) is a tissue-engineered solution to diabetes. Donor islets are encapsulated in a semipermeable hydrogel, allowing the diffusion of oxygen, glucose, and insulin but preventing leukocyte infiltration and antibody access to the transplanted cells. Although successful in small animal models, EIT is still far from commercial use owing to necessary long-term systemic immunosuppressants and consistent immune rejection. Most published research has focused on tailoring the characteristics of the capsule material to promote clinical viability. However, most studies have been limited in scope to biochemical changes. Current mechanobiology studies on the effect of substrate stiffness on the function of leukocytes, especially macrophages-primary foreign body response (FBR) orchestrators, show promise in tailoring a favorable response to tissue-engineered therapies such as EIT. In this review, we explore strategies to improve the clinical viability of EIT. A brief overview of the immune system, the FBR, and current biochemical approaches will be elucidated throughout this exploration. Furthermore, an argument for using substrate stiffness as a capsule design parameter to increase EIT efficacy and clinical viability will be posed.

Mechanical influence of tissue scaffolding design with different geometries using finite element study

The mechanical properties of tissue scaffolds are essential in providing stability for tissue repair and growth. Thus, the ability of scaffolds to withstand specific loads is crucial for scaffold design. Most research on scaffold pores focuses on grids with pore size and gradient structure, and many research models are based on scaffolding with vertically arranged holes. However, little attention is paid to the influence of the distribution of holes on the mechanical properties of the scaffold. To address this gap, this research investigates the effect of pore distribution on the mechanical properties of tissue scaffolds. The study involves four types of scaffold designs with regular and staggered pore arrangements and porosity ranging from 30% to 80%. Finite element analysis (FEA) was used to compare the mechanical properties of different scaffold designs, with von-Mises stress distribution maps generated for each scaffold. The results show that scaffolds with regular vertical holes exhibit a more uniform stress distribution and better mechanical performance than those with irregular holes. In contrast, the scaffold with a staggered arrangement of holes had a higher probability of stress concentration. The study emphasized the importance of balancing porosity and strength in scaffold design.

Research on Determining Elastic-Plastic Constitutive Parameters of Materials from Load Depth Curves Based on Nanoindentation Technology

It is of great significance for structural design and engineering evaluation to obtain the elastic-plastic parameters of materials. The inverse estimation of elastic-plastic parameters of materials based on nanoindentation technology has been applied in many pieces of research, but it has proved to be difficult to determine the elastic-plastic properties of materials by only using a single indentation curve. A new optimal inversion strategy based on a spherical indentation curve was proposed to obtain the elastoplastic parameters (the Young's modulus E, yield strength σ_y, and hardening exponent n) of materials in this study. A high-precision finite element model of indentation with a spherical indenter (radius R = 20 µm) was established, and the relationship between the three parameters and indentation response was analyzed using the design of experiment (DOE) method. The well-posed problem of inverse estimation under different maximum indentation depths (h_max1 = 0.06 R, h_max2 = 0.1 R, h_max3 = 0.2 R, h_max4 = 0.3 R) was explored based on numerical simulations. The results show that the unique solution with high accuracy can be obtained under different maximum press-in depths (the minimum error was within 0.2% and the maximum error was up to 1.5%). Next, the load-depth curves of Q355 were obtained by a cyclic loading nanoindentation experiment, and the elastic-plastic parameters of Q355 were determined by the proposed inverse-estimation strategy based on the average indentation load-depth curve. The results showed that the optimized load-depth curve was in good agreement with the experimental curve, and the optimized stress-strain curve was slightly different from the tensile test, and the obtained parameters were basically consistent with the existing research.

Association between nanoscale strains and tissue level nanoindentation properties in age-related hip-fractures

Measurement of the properties of bone as a material can happen in various length scales in its hierarchical and composite structure. The aim of this study was to test the tissue level properties of clinically-relevant human bone samples which were collected from donors belonging to three groups: ageing donors who suffered no fractures (Control); untreated fracture patients (Fx-Untreated) and patient who experienced hip fracture despite being treated with bisphosphonates (Fx-BisTreated). Tissue level properties were assessed by (a) nanoindentation and (b) synchrotron tensile tests (STT) where strains were measured at the 'tissue', 'fibril' and 'mineral' levels by using simultaneous Wide-angle - (WAXD) and Small angle- X-ray diffraction (SAXD). The composition was analysed by thermogravimetric analysis and material level endo- and exo-thermic reactions by differential scanning calorimetry (TGA/DSC3+). Irrespective of treatment fracture donors exhibited significantly lower tissue, fibril and mineral strain at the micro and nanoscale respectively and had a higher mineral content than controls. In nanoindentation only nanohardness was significantly greater for Controls and Fx-BisTreated versus Fx-Untreated. The other nanoindentation parameters did not vary significantly across the three groups. There was a highly significant positive correlation (p < 0.001) between organic content and tissue level strain behaviour. Overall hip-fractures were associated with lower STT nanostrains and it was behaviour measured by STT which proved to be a more effective approach for predicting fracture risk because evidently it was able to demonstrate the mechanical deficit for the bone tissue of the donors who had experienced fractures.

Delivering Mechanical Stimulation to Cells: State of the Art in Materials and Devices Design

Biochemical signals, such as growth factors, cytokines, and transcription factors are known to play a crucial role in regulating a variety of cellular activities as well as maintaining the normal function of different tissues and organs. If the biochemical signals are assumed to be one side of the coin, the other side comprises biophysical cues. There is growing evidence showing that biophysical signals, and in particular mechanical cues, also play an important role in different stages of human life ranging from morphogenesis during embryonic development to maturation and maintenance of tissue and organ function throughout life. In order to investigate how mechanical signals influence cell and tissue function, tremendous efforts have been devoted to fabricating various materials and devices for delivering mechanical stimuli to cells and tissues. Here, an overview of the current state of the art in the design and development of such materials and devices is provided, with a focus on their design principles, and challenges and perspectives for future research directions are highlighted.

Evaluation of femoral head bone quality by Hounsfield units: a comparison with dual-energy X-ray absorptiometry

BACKGROUND

Osteoporosis is associated with decreases in bone mineral density (BMD) and is diagnosed using dual-energy X-ray absorptiometry (DXA). Computed tomography (CT), performed in routine practice, can also be used to evaluate bone quality without additional cost.

PURPOSE

To determine whether Hounsfield units (HU), a standardized CT attenuation coefficient, measured from the femoral head correlated with DXA-measured BMD.

MATERIAL AND METHODS

We evaluated 82 patients (14 men, 68 women; mean age, 67 years) undergoing femoral DXA and CT (non-enhanced abdominopelvic and hip scans) with 130 kV to determine whether HU correlated with T-scores. HU were measured by two radiologists using the largest spherical region of interest including the medullary bone of the femoral head from the junction point of the most caudal section of the femoral head with the femoral neck in 5-mm axial sections. The correlations of both sides' HU values with their ages and DXA femur T-score were evaluated.

RESULTS

HU values obtained from both femoral heads showed significant variation between the osteoporotic and non-osteoporotic groups (both P = 0.000) and strongly correlated with each other and DXA femur T-scores (left r = 0.75, right r = 0.73, respectively). In ROC curve analysis, predictive power of left HU values in identifying patients with osteoporotic femur DXA T-score was 0.905, and for right HU values it was 0.924. Osteoporosis cutoff values were 198 HU and 204 HU for the left and right hips, respectively.

CONCLUSIONS

HU obtained from CT performed in routine practice correlated with the DXA scores, thus providing an alternative method to determine regional bone quality without additional cost. This may be useful when choosing a fixation method, especially in trauma cases with already-performed abdominopelvic or pelvic CT in emergency services.

High-performance bilayer composites for the replacement of osteochondral defects

Two novel bilayer constructs for the repair of osteochondral defects were developed from nanofibers and ceramic particles embedded into PVA matrices, exhibiting multiple promising properties similar to those of corresponding natural tissues.

Anthroengineering: an independent interdisciplinary field

In recent decades, funding agencies, institutes and professional bodies have recognized the profound benefits of transdisciplinarity in tackling targeted research questions. However, once questions are answered, the previously abundant support often dissolves. As such, the long-term benefits of these transdisciplinary approaches are never fully achieved. Over the last several decades, the integration of anthropology and engineering through inter- and multidisciplinary work has led to advances in fields such as design, human evolution and medical technologies. The lack of formal recognition, however, of this transdisciplinary approach as a unique entity rather than a useful tool or a subfield makes it difficult for researchers to establish laboratories, secure permanent jobs, fund long-term research programmes and train students in this approach. To facilitate the growth and development and witness the long-term benefits of this approach, we propose the integration of anthropology and engineering be recognized as a new, independent field known as anthroengineering. We present a working definition for anthroengineering and examples of how anthroengineering has been used. We discuss the necessity of recognizing anthroengineering as a unique field and explore potential novel applications. Finally, we discuss the future of anthroengineering, highlighting avenues for moving the field forward.

A combined physicochemical approach towards human tenocyte phenotype maintenance

During in vitro culture, bereft of their optimal tissue context, tenocytes lose their phenotype and function. Considering that tenocytes in their native tissue milieu are exposed simultaneously to manifold signals, combination approaches (e.g. growth factor supplementation and mechanical stimulation) are continuously gaining pace to control cell fate during in vitro expansion, albeit with limited success due to the literally infinite number of possible permutations. In this work, we assessed the potential of scalable and potent physicochemical approaches that control cell fate (substrate stiffness, anisotropic surface topography, collagen type I coating) and enhance extracellular matrix deposition (macromolecular crowding) in maintaining human tenocyte phenotype in culture. Cell morphology was primarily responsive to surface topography. The tissue culture plastic induced the largest nuclei area, the lowest aspect ratio, and the highest focal adhesion kinase. Collagen type I coating increased cell number and metabolic activity. Cell viability was not affected by any of the variables assessed. Macromolecular crowding intensely enhanced and accelerated native extracellular matrix deposition, albeit not in an aligned fashion, even on the grooved substrates. Gene analysis at day 14 revealed that the 130 kPa grooved substrate without collagen type I coating and under macromolecular crowding conditions positively regulated human tenocyte phenotype. Collectively, this work illustrates the beneficial effects of combined physicochemical approaches in controlling cell fate during in vitro expansion.

Adapting the Pore Size of Individual, 3D-Printed CPC Scaffolds in Maxillofacial Surgery

Three dimensional (3D) printing allows additive manufacturing of patient specific scaffolds with varying pore size and geometry. Such porous scaffolds, made of 3D-printable bone-like calcium phosphate cement (CPC), are suitable for bone augmentation due to their benefit for osteogenesis. Their pores allow blood-, bone- and stem cells to migrate, colonize and finally integrate into the adjacent tissue. Furthermore, the pore size affects the scaffold’s stability. Since scaffolds in maxillofacial surgery have to withstand high forces within the jaw, adequate mechanical properties are of high clinical importance. Although many studies have investigated CPC for bone augmentation, the ideal porosity for specific indications has not been defined yet. We investigated 3D printed CPC cubes with increasing pore sizes and different printing orientations regarding cell migration and mechanical properties in comparison to commercially available bone substitutes. Furthermore, by investigating clinical cases, the scaffolds’ designs were adapted to resemble the in vivo conditions as accurately as possible. Our findings suggest that the pore size of CPC scaffolds for bone augmentation in maxillofacial surgery necessarily needs to be adapted to the surgical site. Scaffolds for sites that are not exposed to high forces, such as the sinus floor, should be printed with a pore size of 750 µm to benefit from enhanced cell infiltration. In contrast, for areas exposed to high pressures, such as the lateral mandible, scaffolds should be manufactured with a pore size of 490 µm to guarantee adequate cell migration and in order to withstand the high forces during the chewing process.

Clinical Importance of Bone Matrix Damage Mechanisms for Fracture Prevention

PURPOSE OF REVIEW

Bone matrix exhibits great complexity in its composition, structure and mechanics. Here, we provide a review of recent research articles and appraise the evidence that bone matrix quality is clinically important and possibly targetable for fracture prevention.

RECENT FINDINGS

Deformation of mineralised collagen fibrils determines bone fracture mechanics. Slipping and separation at the mineral-fibril and fibril-fibril interfaces, respectively, are the structural mechanisms for plastic deformation and microcrack nucleation. Existing technologies for assessing bone tissue in vivo cannot measure matrix structure or fracture mechanics but have shown limited use in clinical settings for identifying fragility or following treatment outcomes based on composition. Matrix is biomechanically and clinically important, but the knowledge has not translated into clinical practice. The structural mechanisms by which a load is transferred from mineralised collagen fibrils to the whole bone via microcracking have been proven too complex to measure in vivo. The mineral-fibril or fibril-fibril interfaces might be suitable targets for diagnosing fragility or delivering molecules that reduce fracture risk by strengthening the mineral bonds while maintaining flexibility in the fibrils.

Endogenous Antioxidant Cocktail Loaded Hydrogel for Topical Wound Healing of Burns

The main goal of this work is the study of the skin wound healing efficacy of an antioxidant cocktail consisting of vitamins A, D, E and the endogenous pineal hormone melatonin (MLT), with all of these loaded into a thermosensitive hydrogel delivery system. The resulting formulation was characterized by scanning electron microscopy. The antioxidant efficacy and microbiological activity against Gram positive and Gram negative strains were also assayed. The skin healing efficacy was tested using an in vivo model which included histological evaluation. Furthermore, atomic force microscopy was employed to evaluate the wound healing efficacy of rat skin burns through the determination of its elasticity at the nanoscale using force spectroscopy analysis. The resulting hydrogel exhibited sol state at low temperature and turned into a gel at 30 ± 0.2 °C. The hydrogel containing the antioxidant cocktail showed higher scavenging activity than the hydrogel containing vitamins or MLT, separately. The formulation showed optimal antimicrobial activity. It was comparable to a commercial reference. It was also evidenced that the hydrogel containing the antioxidant cocktail exhibited the strongest healing process in the skin burns of rats, similar to the assayed commercial reference containing silver sulfadiazine. Histological studies confirmed the observed results. Finally, atomic force microscopy demonstrated a similar distribution of Young's modulus values between burned skin treated with the commercial reference and burned skin treated with hydrogel containing the antioxidant cocktail, and all these with healthy skin. The use of an antioxidant cocktail of vitamins and MLT might be a promising treatment for skin wounds for future clinical studies.

Comparison of different MyotonPRO probes for skin stiffness evaluation in young women

BACKGROUND

Stiffness of skin is widely used parameter in many research areas, for example cosmetic industry, dermatology or rheumatology for assessing of skin condition as well as changes occurring in skin. In this pioneering study, we conducted measurements of skin stiffness using MyotonPRO -novel tool, which was mainly used to evaluate biomechanical properties of muscles, ligaments and tendons. We expected that MyotonPRO , which shows great reproducibility in previous studies, will also be able to measure skin stiffness.

MATERIALS AND METHODS

Four replaceable probes designed by MyotonPRO (L-shape short and medium arm, standard cylindrical flat-end probe and the same standard probe with disc attachment ) were tested for measurement of skin stiffness in young women (30 healthy females) at three different locations (clavicula, volar forearm and shin).

RESULTS

There was no significant difference between stiffness values obtained with L-shape short and L-shape medium arm probes in all investigated areas. Stiffness values recorded by regular probe and regular probe with disc attachment differ significantly from those collected with L-shape probes. There was also significant difference between values of stiffness obtained by standard with disc attachment and standard probes.

CONCLUSION

Both L-shape probes show a great reliability for skin stiffness assessment. Therefore, MyotonPRO can be considered a reliable device for assessing skin stiffness.

Antibacterial infection and immune-evasive coating for orthopedic implants

Bacterial infection and infection-induced immune response have been a life-threatening risk for patients having orthopedic implant surgeries. Conventional biomaterials are vulnerable to biocontamination, which causes bacterial invasion in wounded areas, leading to postoperative infection. Therefore, development of anti-infection and immune-evasive coating for orthopedic implants is urgently needed. Here, we developed an advanced surface modification technique for orthopedic implants termed lubricated orthopedic implant surface (LOIS), which was inspired by slippery surface of Nepenthes pitcher plant. LOIS presents a long-lasting, extreme liquid repellency against diverse liquids and biosubstances including cells, proteins, calcium, and bacteria. In addition, we confirmed mechanical durability against scratches and fixation force by simulating inevitable damages during surgical procedure ex vivo. The antibiofouling and anti-infection capability of LOIS were thoroughly investigated using an osteomyelitis femoral fracture model of rabbits. We envision that the LOIS with antibiofouling properties and mechanical durability is a step forward in infection-free orthopedic surgeries.

Spherical depth-sensing nanoindentation of human anterior skull base bones: Establishment of a test protocol

The mechanical properties of anterior skull base (ASB) bones are not well understood due to their complex geometry and deep location. However, it is of particular interest for skull base surgeons to appraise the force range they can apply during procedures and know what kind of haptic feedback a simulation device should produce in order to be realistic for trainees. The aim of this study was to establish a measurement protocol to set the level of hydration state, temperature and curve analysis method for spherical depth sensing nanoindentation of ASB bones. A definitive screening design method was used to test the different possible combinations of these factors. Two samples of ASB bones from the heads of two human body donors (two specimens) were selected according to their microstructure as assessed by micro-CT (microtomography): low-porosity (16.87%, sphenoid bone) and high-porosity (79.85%, ethmoid bone). Depth measurement series of 36 nanoindentations (n = 288) were performed on specimen 1 according to the L8 Taguchi orthogonal array to study the effect of temperature (two levels: 20 or 37 °C), hydration state (dry or immerged in physiological saline sodium chloride), and loading curve analysis according to the Hertzian contact theory (fitting at the start or at the end). The mean values of reduced Young's (E*) modulus varied significantly depending on the hydration status and bone microstructure. In order to obtain the physiological properties of ASB bones, we thus propose performing immersion tests. To simplify the experimentation protocol, future experiments must include a room temperature level and a fit of the curve at the end of the load. A validation series was performed on the second specimen to assess the set of parameters. The E* in dry bone gave mean values of 994.68 MPa, versus 409.79 MPa in immerged bones (p < 0.00001). This is the first time a study has been carried out on ASB bones, defining the experimental parameters related to physiological conditions.

Architecture and design of a robotic mastication simulator for interactive load testing of dental implants and the mandible

STATEMENT OF PROBLEM

Determination of interactive loading between a dental prosthesis and the host mandible is essential for implant prosthodontics and to preserve bone.

PURPOSE

The purpose of this study was to develop and evaluate a robotic mastication simulator to replicate the human mastication force cycle to record the required interactive loading using specifically designed force sensors.

MATERIAL AND METHODS

This robotic mastication simulator incorporated a Stewart parallel kinematic mechanism (PKM) controlled in the force-control loop. The hydraulically operated PKM executed the wrench operation, which consisted of the combined effect of forces and moments exhibited by the mastication process. Principal design features of this robotic simulator included PKM kinematic modeling, static force analysis to realize the masticatory wrench characteristics, and the architecture of its hydraulic system. Additionally, the design of a load-sensing element for the mandible and implant interaction was also incorporated. This element facilitated the quantification of the load distribution between implants and the host bone during the masticatory operation produced by the PKM. These loading tests were patient-specific and required separate artificial mandibular models for each patient.

RESULTS

The simulation results demonstrated that the robotic PKM could replicate human mastication. These results validated the hydraulic system modeling for the required range of masticatory movements and effective forces of the PKM end-effector. The overall structural design of the robotic mastication simulator presented the integration of the PKM and its hydraulic system with the premeditated load-recording mechanism.

CONCLUSIONS

The developed system facilitated the teeth-replacement procedure. The PKM accomplished the execution of mastication cycle involving 6 degrees of freedom, enabling any translation and rotation in sagittal, horizontal, and vertical planes. The mechanism can simulate the human mastication cycle and has a force application range of up to 2000 N. The designed load-sensing element can record interactive forces within the range of 200 N to 2000 N with fast response and high sensitivity to produce a robotic mastication simulator with custom-made modules.

3D porous chitosan-alginate scaffold stiffness promotes differential responses in prostate cancer cell lines

Prostate cancer (PCa) is a leading cause of death for men worldwide. Most PCa patients die from metastasis and bone is the most common metastatic site. Three dimensional (3D) porous chitosan-alginate (CA) scaffolds were developed for bone tissue engineering and demonstrated for culture of cancer cells and enrichment of cancer stem cells. However, only a single scaffold composition was studied. Three compositions of 3D porous CA scaffolds (2, 4, and 6 wt%) were used to investigate the effect of scaffold stiffness on PCa cell response with PC-3, C4-2B, and 22Rv1 cell lines. The PC-3 cells formed cell clusters while the C4-2B and 22Rv1 cells formed multicellular spheroids. The three cell lines demonstrated stiffness independent cell growth and expressed phenotypic PCa biomarkers. The osteoblastic PCa lines C4-2B and 22Rv1 mineralized in basal media, while the osteolytic PC-3 line did not, demonstrating that CA scaffold cultures revealed differences in PCa phenotypes. The CA scaffolds are a 3D culture platform that supports PCa growth and phenotypic expression with adjustable scaffold stiffness to mimic stages of metastatic progression. Further investigation of the scaffolds for co-culture of PCa cells with fibroblasts and primary PCa cell culture should be conducted to develop a platform for screening chemotherapies.

The Design and In Vivo Testing of a Locally Stiffness-Matched Porous Scaffold

An increasing volume of work supports utilising the mechanobiology of bone for bone ingrowth into a porous scaffold. However, typically during in vivo testing of implants, the mechanical properties of the bone being replaced are not quantified. Consequently there remains inconsistencies in the literature regarding 'optimum' pore size and porosity for bone ingrowth. It is also difficult to compare ingrowth results between studies and to translate in vivo animal testing to human subjects without understanding the mechanical environment. This study presents a clinically applicable approach to determining local bone mechanical properties and design of a scaffold with similar properties. The performance of the scaffold was investigated in vivo in an ovine model. The density, modulus and strength of trabecular bone from the medial femoral condyle from ovine bones was characterised and power-law relationships were established. A porous titanium scaffold, intended to maintain bone mechanical homeostasis, was additively manufactured and implanted into the medial femoral condyle of 6 ewes. The stiffness of the scaffold varied throughout the heterogeneous structure and matched the stiffness variation of bone at the surgical site. Bone ingrowth into the scaffold was 10.73±2.97% after 6 weeks. Fine woven bone, in the interior of the scaffold, and intense formations of more developed woven bone overlaid with lamellar bone at the implant periphery were observed. The workflow presented will allow future in vivo testing to test specific bone strains on bone ingrowth in response to a scaffold and allow for better translation from in vivo testing to commercial implants.

Computed tomography porosity and spherical indentation for determining cortical bone millimetre-scale mechanical properties

The cortex of the femoral neck is a key structural element of the human body, yet there is not a reliable metric for predicting the mechanical properties of the bone in this critical region. This study explored the use of a range of non-destructive metrics to measure femoral neck cortical bone stiffness at the millimetre length scale. A range of testing methods and imaging techniques were assessed for their ability to measure or predict the mechanical properties of cortical bone samples obtained from the femoral neck of hip replacement patients. Techniques that can potentially be applied in vivo to measure bone stiffness, including computed tomography (CT), bulk wave ultrasound (BWUS) and indentation, were compared against in vitro techniques, including compression testing, density measurements and resonant ultrasound spectroscopy. Porosity, as measured by micro-CT, correlated with femoral neck cortical bone's elastic modulus and ultimate compressive strength at the millimetre length scale. Large-tip spherical indentation also correlated with bone mechanical properties at this length scale but to a lesser extent. As the elastic mechanical properties of cortical bone correlated with porosity, we would recommend further development of technologies that can safely measure cortical porosity in vivo.

3D Imaging of Indentation Damage in Bone

Bone is a complex material comprising high stiffness, but brittle, crystalline bio-apatite combined with compliant, but tough, collagen fibres. It can accommodate significant deformation, and the bone microstructure inhibits crack propagation such that micro-cracks can be quickly repaired. Catastrophic failure (bone fracture) is a major cause of morbidity, particularly in aging populations, either through a succession of small fractures or because a traumatic event is sufficiently large to overcome the individual crack blunting/shielding mechanisms. Indentation methods provide a convenient way of characterising the mechanical properties of bone. It is important to be able to visualise the interactions between the bone microstructure and the damage events in three dimensions (3D) to better understand the nature of the damage processes that occur in bone and the relevance of indentation tests in evaluating bone resilience and strength. For the first time, time-lapse laboratory X-ray computed tomography (CT) has been used to establish a time-evolving picture of bone deformation/plasticity and cracking. The sites of both crack initiation and termination as well as the interconnectivity of cracks and pores have been visualised and identified in 2D and 3D.