In Vivo Deformation and Strain Measurements in Human Bone Using Digital Volume Correlation (DVC) and 3T Clinical MRI

Quantifying bone compaction and implant-bone contact in uncemented total hip arthroplasty through μCT and digital volume correlation: A cadaveric study

BACKGROUND

The stability of uncemented implants during total hip arthroplasty (THA) depends on bone compaction and the bone-implant contact area achieved during the surgical process, particularly during broaching and implantation. However, the evaluation of these factors in actual hip is limited through experimental studies. Therefore, the aim of this study was to quantify bone compaction, and the bone-implant contact area achieved during uncemented THA through a μCT-based cadaveric study of three femur samples.

METHODS

Three cadaveric femur samples underwent uncemented THA, with μCT scans conducted at intermediate surgical steps. The bone compaction resulting from the surgical process was quantified using two parameters: (a) displacement and strain induced using Digital Volume Correlation (DVC), (b) changes in bone volume fraction (BV/TV) around the bone-implant interface. Furthermore, the bone-implant contact, and its location were evaluated, including an assessment of the robustness and sensitivity of the measurements.

RESULTS

The DVC showed that the trabecular bone deformed plastically, with a displacement of 0.09 ± 0.13 mm, a Von-Mises strain of 7082.28 ± 9162.73 με due to the surgical process. Broken trabecular bone accumulated around the bone-implant interface, increasing BV/TV from 3.31 % to 20.69 %. Bone-implant contact (BIC) was limited, ranging from 3.05 % to 5.22 %, but 75.26 %-82.27 % of the maximum potential contact area (PBICA) was achieved. All samples established a three-point contact, and sensitivity analysis revealed a robust BIC calculation with minimal variability of ±0.87 %.

CONCLUSION

The findings offer important insights into bone-implant behaviour during the uncemented THA process. These insights could be useful for physics-based pre-surgical planning to evaluate the stability of uncemented implants and help surgeons choose the most appropriate implants for their patients.

Biomechanics of the Human Osteochondral Unit: A Systematic Review

The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.

Comparison of two contrast-enhancing staining agents for use in X-ray imaging and digital volume correlation measurements across the cartilage-bone interface

OBJECTIVE

The pathogenesis of osteoarthritis (OA) is associated with subchondral bone changes, which is linked to abnormal strain distribution in the overlying articular cartilage. This highlights the importance of understanding mechanical interaction at the cartilage-bone interface. The aim of this study is to compare solutions of two contrast-enhancing staining agents (CESA) for combining high-resolution Contrast-Enhanced X-ray microfocus Computed Tomography (CECT) with Digital Volume Correlation (DVC) for full-field strain measurements at the cartilage-bone interface.

DESIGN

Bovine osteochondral plugs were stained with phosphotungstic acid (PTA) in 70% ethanol or 1:2 hafnium-substituted Wells-Dawson polyoxometalate (Hf-WD POM) in PBS. Mechanical properties were assessed using micromechanical probing and nanoindentation. Strain uncertainties (from CECT data) were evaluated following two consecutive unloaded scans. Residual strains were computed following unconfined compression (ex situ) testing.

RESULTS

PTA and Hf-WD POM enabled the visualisation of structural features in cartilage, allowing DVC computation on the CECT data. Residual strains up to ∼10,000 μɛ were detected up to the tidemark. Nanoindentation showed that PTA-staining caused an average ∼6-fold increase in articular cartilage stiffness, a ∼19-fold increase in reduced modulus and ∼7-fold increase in hardness, whereas Hf-WD POM-stained specimens had mechanical properties similar to pre-stain tissue. Micromechanical probing showed a 77% increase in cartilage surface stiffness after PTA-staining, in comparison to a 16% increase in stiffness after staining with Hf-WD POM.

CONCLUSION

Hf-WD POM is a more suitable CESA solution compared to PTA for CECT imaging combined with DVC as it allowed visualisation of structural features in the cartilage tissue whilst more closely maintaining tissue mechanical properties.

Digital image correlation techniques for motion analysis and biomechanical characterization of plants

Temporally and spatially complex 3D deformation processes appear in plants in a variety of ways and are difficult to quantify in detail by classical cinematographic methods. Furthermore, many biomechanical test methods, e.g. regarding compression or tension, result in quasi-2D deformations of the tested structure, which are very time-consuming to analyze manually regarding strain fields. In materials testing, the contact-free optical 2D- or 3D-digital image correlation method (2D/3D-DIC) is common practice for similar tasks, but is still rather seldom used in the fundamental biological sciences. The present review aims to highlight the possibilities of 2D/3D-DIC for the plant sciences. The equipment, software, and preparative prerequisites are introduced in detail and advantages and disadvantages are discussed. In addition to the analysis of wood and trees, where DIC has been used since the 1990s, this is demonstrated by numerous recent approaches in the contexts of parasite-host attachment, cactus joint biomechanics, fruit peel impact resistance, and slow as well as fast movement phenomena in cones and traps of carnivorous plants. Despite some technical and preparative efforts, DIC is a very powerful tool for full-field 2D/3D displacement and strain analyses of plant structures, which is suitable for numerous in-depth research questions in the fields of plant biomechanics and morphogenesis.

In vivo evaluation of ankle kinematics and tibiotalar joint contact strains using digital volume correlation and 3 T clinical MRI

BACKGROUND

In vivo evaluation of ankle joint biomechanics is key to investigating the effect of injuries on the mechanics of the joint and evaluating the effectiveness of treatments. The objectives of this study were to 1) investigate the kinematics and contact strains of the ankle joint and 2) to investigate the correlation between the tibiotalar joint contact strains and the prevalence of osteochondral lesions of the talus distribution.

METHODS

Eight healthy human ankle joints were subjected to compressive load and 3 T MRIs were obtained before and after applying load. The MR images in combination with digital volume correlation enabled non-invasive measurement of ankle joint kinematics and tibiotalar joint contact strains in three dimensions.

FINDINGS

The total translation of the calcaneus was smaller (0.48 ± 0.15 mm, p < 0.05) than the distal tibia (0.93 ± 0.16 mm) and the talus (1.03 ± 0.26 mm). These movements can produce compressive and shear joint contact strains (approaching 9%), which can cause development of lesions on joints. 87.5% of peak tensile, compressive, and shear strains in the tibiotalar joint took place in the medial and lateral zones.

INTERPRETATION

The findings suggested that ankle bones translate independently from each other, and in some cases in opposite directions. These findings help explain the distribution of osteochondral lesions of the talus which have previously been observed to be in medial and lateral regions of the talar dome in 90% of cases. They also provide a reason for the central region of talar dome being less susceptible to developing osteochondral lesions.

An in vitro comparison of three nucleus pulposus removal techniques for partial intervertebral disc replacement: An ultra-high resolution MRI study

Background

Nuclectomy, also known as nucleotomy, is a percutaneous surgical procedure performed to remove nucleus material from the center of the disc. Multiple techniques have been considered to perform a nuclectomy, however, the advantages and disadvantages of each are not well understood.

Aims

This in vitro biomechanical investigation on human cadaveric specimens aimed to quantitatively compare three nuclectomy techniques performed using an automated shaver, rongeurs, and laser.

Material & Methods

Comparisons were made in terms of mass, volume and location of material removal, changes in disc height, and stiffness. Fifteen vertebra-disc-vertebra lumbar specimens were acquired from six donors (40 ± 13 years) and split into three groups. Before and after nucleotomy axial mechanical tests were performed and T2-weighted 9.4T MRIs were acquired for each specimen.

Results

When using the automated shaver and rongeurs similar volumes of disc material were removed (2.51 ± 1.10% and 2.76 ± 1.39% of the total disc volume, respectively), while considerably less material was removed using the laser (0.12 ± 0.07%). Nuclectomy using the automated shaver and rongeurs significantly reduced the toe-region stiffness (p = 0.036), while the reduction in the linear region stiffness was significant only for the rongeurs group (p = 0.011). Post-nuclectomy, 60% of the rongeurs group specimens showed changes in the endplate profile while 40% from the laser group showed subchondral marrow changes.

Discussion

From the MRIs, homogeneous cavities were seen in the center of the disc when using the automated shaver. When using rongeurs, material was removed non-homogeneously both from the nucleus and annulus regions. Laser ablation formed small and localized cavities suggesting that the technique is not suitable to remove large volumes of material unless it is developed and optimized for this application.

Conclusion

The results demonstrate that both rongeurs and automated shavers can be used to remove large volumes of NP material but the reduced risk of collateral damage to surrounding tissues suggests that the automated shaver may be more suitable.

A novel tool to quantify in vivo lumbar spine kinematics and 3D intervertebral disc strains using clinical MRI

Medical imaging modalities that calculate tissue morphology alone cannot provide direct information regarding the mechanical behaviour of load-bearing musculoskeletal organs. Accurate in vivo measurement of spine kinematics and intervertebral disc (IVD) strains can provide important information regarding the mechanical behaviour of the spine, help to investigate the effects of injuries on the mechanics of the spine, and assess the effectiveness of treatments. Additionally, strains can serve as a functional biomechanical marker for detecting normal and pathologic tissues. We hypothesised that combining digital volume correlation (DVC) with 3T clinical MRI can provide direct information regarding the mechanics of the spine. Here, we have developed a novel non-invasive tool for in vivo displacement and strain measurement within the human lumbar spine and we used this tool to calculate lumbar kinematics and IVD strains in six healthy subjects during lumbar extension. The proposed tool enabled spine kinematics and IVD strains to be measured with errors that did not exceed 0.17 mm and 0.5%, respectively. The findings of the kinematics study identified that during extension the lumbar spine of healthy subjects experiences total 3D translations ranging from 1 mm to 4.5 mm for different vertebral levels. The findings of strain analysis identified that the average of the maximum tensile, compressive, and shear strains for different lumbar levels during extension ranged from 3.5% to 7.2%. This tool can provide base-line data that can be used to describe the mechanical environment of healthy lumbar spine, which can help clinicians manage preventative treatments, define patient-specific treatments, and to monitor the effectiveness of surgical and non-surgical interventions.

Measurement of bone damage caused by quasi-static compressive loading-unloading to explore dental implants stability: Simultaneous use of in-vitro tests, μ-CT images, and digital volume correlation

Primary stability of dental implants is the initial mechanical engagement of the implant with its adjacent bone. Implantation and the subsequent loading may cause mechanical damage in the peripheral bone, which ultimately reduces the stability of the implant. This study aimed at evaluating primary stability of dental implants through applying stepwise compressive displacement-controlled, loading-unloading cycles to obtain overall stiffness and dissipated energy of the bone-implant structure; and quantifying induced plastic strains in surrounding bone using digital volume correlation (DVC) method, through comparing μCT images in different loading steps. To this end, dental implants were inserted into the cylindrical trabecular bones, then the bone-implant structure was undergone step-wise loading-unloading cycles, and μCT images were taken in some particular steps, then comparison was made between undeformed and deformed configurations using DVC to quantify plastic strain within the trabecular bone. Comparing stiffness reduction and dissipated energy values in different loading steps, obtained from the force-displacement curve in each loading step, revealed that the maximum displacement of 0.16 mm can be deemed as a safe threshold above which damages in peri-implant bone started to increase considerably (p < 0.05). In addition, it was found here that peri-implant bone strain linearly increased with decreasing bone-implant stiffness (p < 0.05). Moreover, strain concentration in peri-implant bone region showed that the plastic strain in trabecular bone spread up to a distance of about 2.5 mm away from the implant surface. Research of this kind can be used to optimize the design of dental implants, with the ultimate goal of improving their stability, also to validate in-silico models, e.g., micro-finite element models, which can help gain a deeper understanding of bone-implant construct behavior.

Digital volume correlation for the characterization of musculoskeletal tissues: Current challenges and future developments

Biological tissues are complex hierarchical materials, difficult to characterise due to the challenges associated to the separation of scale and heterogeneity of the mechanical properties at different dimensional levels. The Digital Volume Correlation approach is the only image-based experimental approach that can accurately measure internal strain field within biological tissues under complex loading scenarios. In this minireview examples of DVC applications to study the deformation of musculoskeletal tissues at different dimensional scales are reported, highlighting the potential and challenges of this relatively new technique. The manuscript aims at reporting the wide breath of DVC applications in the past 2 decades and discuss future perspective for this unique technique, including fast analysis, applications on soft tissues, high precision approaches, and clinical applications.

High resolution three-dimensional strain measurements in human articular cartilage

An unresolved challenge in osteoarthritis research is characterising the localised intra-tissue mechanical response of articular cartilage. The aim of this study was to explore whether laboratory micro-computed tomography (micro-CT) and digital volume correlation (DVC) permit non-destructive quantification of three-dimensional (3D) strain fields in human articular cartilage. Human articular cartilage specimens were harvested from the knee, mounted into a loading device and imaged in the unloaded and loaded states using a micro-CT scanner. Strain was measured throughout the cartilage volume using the micro-CT image data and DVC analysis. The volumetric DVC-measured strain was within 5% of the known applied strain. Variation in strain distribution between the superficial, middle and deep zones was observed, consistent with the different architecture of the material in these locations. These results indicate DVC method may be suitable for calculating strain in human articular cartilage.

The Effect of Degeneration on Internal Strains and the Mechanism of Failure in Human Intervertebral Discs Analyzed Using Digital Volume Correlation (DVC) and Ultra-High Field MRI

The intervertebral disc (IVD) plays a main role in absorbing and transmitting loads within the spinal column. Degeneration alters the structural integrity of the IVDs and causes pain, especially in the lumbar region. The objective of this study was to investigate non-invasively the effect of degeneration on human 3D lumbar IVD strains (n = 8) and the mechanism of spinal failure (n = 10) under pure axial compression using digital volume correlation (DVC) and 9.4 Tesla magnetic resonance imaging (MRI). Degenerate IVDs had higher (p < 0.05) axial strains (58% higher), maximum 3D compressive strains (43% higher), and maximum 3D shear strains (41% higher), in comparison to the non-degenerate IVDs, particularly in the lateral and posterior annulus. In both degenerate and non-degenerate IVDs, peak tensile and shear strains were observed close to the endplates. Inward bulging of the inner annulus was observed in all degenerate IVDs causing an increase in the AF compressive, tensile, and shear strains at the site of inward bulge, which may predispose it to circumferential tears (delamination). The endplate is the spine's “weak link” in pure axial compression, and the mechanism of human vertebral fracture is associated with disc degeneration. In non-degenerate IVDs the locations of failure were close to the endplate centroid, whereas in degenerate IVDs they were in peripheral regions. These findings advance the state of knowledge on mechanical changes during degeneration of the IVD, which help reduce the risk of injury, optimize treatments, and improve spinal implant designs. Additionally, these new data can be used to validate computational models.