Preliminary exploration of the biomechanical properties of three novel cervical porous fusion cages using a finite element study

BACKGROUND

Porous cages are considered a promising alternative to high-density cages because their interconnectivity favours bony ingrowth and appropriate stiffness tuning reduces stress shielding and the risk of cage subsidence.

METHODS

This study proposes three approaches that combine macroscopic topology optimization and micropore design to establish three new types of porous cages by integrating lattices (gyroid, Schwarz, body-centred cubic) with the optimized cage frame. Using these three porous cages along with traditional high-density cages, four ACDF surgical models were developed to compare the mechanical properties of facet articular cartilage, discs, cortical bone, and cages under specific loads.

RESULTS

The facet joints in the porous cage groups had lower contact forces than those in the high-density cage group. The intervertebral discs in all models experienced maximum stress at the C5/6 segment. The stress distribution on the cortical bone surface was more uniform in the porous cage groups, leading to increased average stress values. The gyroid, Schwarz, and BCC cage groups showed higher average stress on the C5 cortical bone. The average stress on the surface of porous cages was higher than that on the surface of high-density cages, with the greatest difference observed under the lateral bending condition. The BCC cage demonstrated favourable mechanical stability.

CONCLUSION

The new porous cervical cages satifies requirements of low rigidity and serve as a favourable biological scaffold for bone ingrowth. This study provides valuable insights for the development of next-generation orthopaedic medical devices.

A facile, semi-automatic protocol for the design and production of 3D printed, anatomical customized orthopedic casts for forearm fractures

Closed fractures of distal radius and ulna are one of the most common skeletal injuries, occurring at all ages. Temporary arm immobilization through cast is part of the standard treatments. However, traditional casting procedures are time consuming, operator's skill dependent and do not always guarantee a satisfactory outcome. From a clinical perspective, casts are often considered uncomfortable and can be associated to skin lesions. To overcome these limitations, the recent growth of 3D technologies has enabled new standardized casting procedures: additive manufacturing (AM) is a technique that creates highly customized cast models from anatomical 3D data by using digitally controlled and operated material laying tools. Compared with conventional casts, those produced with AM technique could potentially reduce skin complications and satisfy both mechanical and clinical requirements of functionality, comfort, and aesthetics. The objective of this study is to describe the new practical methodology to produce a 3D printable cast for upper arm immobilization. The parametric modelling tool, employed to develop a semi-automatic design system for generating the printable cast model, reduces the complex process of orthosis design to a few minutes and all the manufacturing operations remain unaffected by CAD skills of the operator. Specific hardware and software tools (3D scanner, modelling software and FDM technology) were chosen to mitigate design and production costs while guaranteeing suitable levels of data accuracy, process efficiency and design versatility. To highlight the effectiveness of the proposed solution, a finite element analysis simulation was performed on models with different geometry, highlighting the mechanical strength of generated structures. The final result is a personalized 3D printed cast with a highly ventilated structure that is lightweight but still maintains a high level of strength and provides hygienic benefits, reducing the risk of cutaneous complications, potentially improving treatment efficacy and increasing patient satisfaction.

Designing an anatomical contour titanium 3D-printed oblique lumbar interbody fusion cage with porous structure and embedded fixation screws for patients with osteoporosis

This study aimed to design an anatomical contour metal three-dimensional (3D)-printed oblique lateral lumbar interbody fusion (OLIF) cage with porous (lattices) structure and embedded screw fixation to enhance bone ingrowth to reduce the risk of cage subsidence and avoid the stress-shielding effect. Finite element (FE) analysis and weight topology optimization (WTO) were used to optimize the structural design of the OLIF cage based on the anatomical contour morphology of patients with osteoporosis. Two oblique embedded fixation screws and lattice design with 65% porosity and average pore size of 750 μm were equipped with the cage structure. The cage was fabricated via metal 3D printing, and static/dynamic compression and compressive-shear tests were performed in accordance with the ASTM F2077-14 standard to evaluate its mechanical resistance. On FE analysis, the OLIF cage with embedded screw model had the most stability, lowest stress values on the endplate, and uniform stress distribution versus standalone cage and fixed with lateral plate under extension, lateral flexion, and rotation. The fatigue test showed that the stiffnesses/endurance limits (pass 5 million dynamic test) were 16,658 N/mm/6000 N for axial load and 19,643 N/mm/2700 N for compression shear. In conclusion, an OLIF cage with embedded fixation screws can be designed by integrating FE and WTO analysis based on the statistical results of endplate morphology. This improves the stability of the OLIF cage to decrease endplate destruction. The complex contour and lattice design of the OLIF cage need to be manufactured via metal 3D printing; the dynamic axial compression and compressive-shear strengths are greater than that of the U.S. Food and Drug Administration (FDA) standard.

3D printed PEKK bone analogs with internal porosity and surface modification for mandibular reconstruction: An in vivo rabbit model study

Polyetheretherketone (PEEK) and its derivative polyetherketoneketone (PEKK) have been used as implant materials for spinal fusing and enjoyed their success for many years because of their mechanical properties similar to bone and their chemical inertness. The osseointegration of PEEKs is datable. Our strategy was to use custom-designed and 3D printed bone analogs with an optimized structure design and a modified PEKK surface to augment bone regeneration for mandibular reconstruction. Those bone analogs had internal porosities and a bioactive titanium oxide surface coating to promote osseointegration between native bone and PEKK analogs. Our workflow was 3D modeling, bone analog designing, structural optimization, mechanical analysis via finite element modeling, 3D printing of bone analogs and subsequently, an in vivo rabbit model study on mandibular reconstruction and histology evaluation. Our results showed the finite element analysis validated that the porous PEKK analogs provided a mechanical-sound structure for functional loadings. The bone analogs offered a perfect replacement for segmented bones in the terms of shape, form and volume for surgical reconstruction. The in vivo results showed that bioactive titanium oxide coating enhanced new bone in-growth into the porous PEKK analogs. We have validated our new approach in surgical mandibular reconstruction and we believe our strategy has a significant potential to improve mechanical and biological outcomes for patients who require mandibular reconstruction procedures.

Biomimetic Boundary-Based Scaffold Design for Tissue Engineering Applications

The design of optimized scaffolds for tissue engineering and regenerative medicine is a key topic of current research, as the complex macro- and micro-architectures required for scaffold applications depend not only on the mechanical properties but also on the physical and molecular queues of the surrounding tissue within the defect site. Thus, the prediction of optimal features for tissue engineering scaffolds is very important, for both its physical and biological properties.The relationship between high scaffold porosity and high mechanical properties is contradictory, as it becomes even more complex due to the scaffold degradation process. Biomimetic design has been considered as a viable method to design optimum scaffolds for tissue engineering applications. In this research work, the scaffold designs are based on biomimetic boundary-based bone micro-CT data. Based on the biomimetic boundaries and with the aid of topological optimization schemes, the boundary data and given porosity is used to obtain the initial scaffold designs. In summary, the proposed scaffold design scheme uses the principles of both the boundaries and porosity of the micro-CT data with the aid of numerical optimization and simulation tools.

A comparison of experimental compressive axial loading testing with a numerical simulation of topologically optimized cervical implants made by selective laser melting

In recent years, the number of cervical interventions has increased. The stress shielding effect is a serious complication in cervical spine interventions. Topological optimization is based on finite element method structural analysis and numerical simulations. The generated design of cervical implants is made from Ti6Al4V powder by selective laser melting while the optimized cage is numerically tested for compressive axial loading and the results are compared with experimental measurement. Additive manufacturing technologies and new software possibilities in the field of structural analysis, which use the finite element method tools, help to execute implant topological optimization that is useful for clinical practice. The inner structures of the implant would be impossible to make by conventional manufacturing technologies. The resulting implant design, after modification, must fulfill strict application criteria for the area of cervical spine with respect to its material and biomechanical properties. The aim of this work was to alter the mechanical properties of the cervical intervertebral cage to address the clinical concern of the stress shielding effect by topological optimization. A methodology of cervical implant compressive axial loading numerical simulation was created, and subsequent experimental testing was done to obtain real material properties after a selective laser melting process. The weight of the optimized implant was reduced by 28.92 %. Results of the experimental testing and numerical simulation of topologically optimized design showed 10-times lower stiffness compared to the solid cage design, and the real yield strength of the optimized structure is 843.8 MPa based on experimental results.

Analysis of biomechanical behavior of 3D printed mandibular graft with porous scaffold structure designed by topological optimization

BACKGROUND

Our long-term goal is to design and manufacture a customized graft with porous scaffold structure for repairing large mandibular defects using topological optimization and 3D printing technology. The purpose of this study is to characterize the mechanical behavior of 3D printed anisotropic scaffolds as bone analogs by fused deposition modeling (FDM).

METHODS

Cone beam computed tomography (CBCT) images were used to reconstruct a 3D mandible and finite element models. A virtual sectioned-block of the mandible was used as the control group and the trabecular portion of the block was modified by topological optimization methods as experimental groups. FDM (FDM) printed samples at 0, 45 and 90 degrees with Poly-lactic acid (PLA) material under a three-point bending test. Finite element analysis was also used to validate the data obtained from the physical model tests.

RESULTS

The ultimate load, yield load, failure deflection, yield deflection, stress, strain distribution, and porosity of scaffold structures were compared. The results show that the topological optimized graft had the best mechanical properties.

CONCLUSIONS

The results from mechanical tests on physical models and numerical simulations from this study show a great potential for topological optimization and 3D printing technology to be served in design and rapidly manufacturing of artificial porous grafts.

A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis

Background

The purpose of this study was to design a customized fixation plate for mandibular angle fracture using topological optimization based on the biomechanical properties of the two conventional fixation systems, and compare the results of stress, strain and displacement distributions calculated by finite element analysis (FEA).

Methods

A three-dimensional (3D) virtual mandible was reconstructed from CT images with a mimic angle fracture and a 1 mm gap between two bone segments, and then a FEA model, including volume mesh with inhomogeneous bone material properties, three loading conditions and constraints (muscles and condyles), was created to design a customized plate using topological optimization method, then the shape of the plate was referenced from the stress concentrated area on an initial part created from thickened bone surface for optimal calculation, and then the plate was formulated as “V” pattern according to dimensions of standard mini-plate finally. To compare the biomechanical behavior of the “V” plate and other conventional mini-plates for angle fracture fixation, two conventional fixation systems were used: type A, one standard mini-plate, and type B, two standard mini-plates, and the stress, strain and displacement distributions within the three fixation systems were compared and discussed.

Results

The stress, strain and displacement distributions to the angle fractured mandible with three different fixation modalities were collected, respectively, and the maximum stress for each model emerged at the mandibular ramus or screw holes. Under the same loading conditions, the maximum stress on the customized fixation system decreased 74.3, 75.6 and 70.6% compared to type A, and 34.9, 34.1, and 39.6% compared to type B. All maximum von Mises stresses of mandible were well below the allowable stress of human bone, as well as maximum principal strain. And the displacement diagram of bony segments indicated the effect of treatment with different fixation systems.

Conclusions

The customized fixation system with topological optimized structure has good biomechanical behavior for mandibular angle fracture because the stress, strain and displacement within the plate could be reduced significantly comparing to conventional “one mini-plate” or “two mini-plates” systems. The design methodology for customized fixation system could be used for other fractures in mandible or other bones to acquire better mechanical behavior of the system and improve stable environment for bone healing. And together with SLM, the customized plate with optimal structure could be designed and fabricated rapidly to satisfy the urgent time requirements for treatment.

Vademecum-based approach to multi-scale topological material design

The work deals on computational design of structural materials by resorting to computational homogenization and topological optimization techniques. The goal is then to minimize the structural (macro-scale) compliance by appropriately designing the material distribution (microstructure) at a lower scale (micro-scale), which, in turn, rules the mechanical properties of the material. The specific features of the proposed approach are: (1) The cost function to be optimized (structural stiffness) is defined at the macro-scale, whereas the design variables defining the micro-structural topology lie on the low scale. Therefore a coupled, two-scale (macro/micro), optimization problem is solved unlike the classical, single-scale, topological optimization problems. (2) To overcome the exorbitant computational cost stemming from the multiplicative character of the aforementioned multiscale approach, a specific strategy, based on the consultation of a discrete material catalog of micro-scale optimized topologies (Computational Vademecum) is used. The Computational Vademecum is computed in an offline process, which is performed only once for every constitutive-material, and it can be subsequently consulted as many times as desired in the online design process. This results into a large diminution of the resulting computational costs, which make affordable the proposed methodology for multiscale computational material design. Some representative examples assess the performance of the considered approach.

Current trends in the design of scaffolds for computer-aided tissue engineering

Advances introduced by additive manufacturing have significantly improved the ability to tailor scaffold architecture, enhancing the control over microstructural features. This has led to a growing interest in the development of innovative scaffold designs, as testified by the increasing amount of research activities devoted to the understanding of the correlation between topological features of scaffolds and their resulting properties, in order to find architectures capable of optimal trade-off between often conflicting requirements (such as biological and mechanical ones). The main aim of this paper is to provide a review and propose a classification of existing methodologies for scaffold design and optimization in order to address key issues and help in deciphering the complex link between design criteria and resulting scaffold properties.