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Rajaeirad M, Karimpour M, Hairi Yazdi MR. Comparative finite element analysis of contact and stress distribution in tibiotalar articular cartilage: Healthy versus varus ankles. J Orthop 2024; 55:16-22. [PMID: 38646467 PMCID: PMC11026722 DOI: 10.1016/j.jor.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Background The distribution of forces within the ankle joint plays a crucial role in joint health and longevity. Loading disorders affecting the ankle joint can have significant detrimental effects on daily life and activity levels. This study aimed to enhance our understanding of the mechanical behavior of tibiotalar joint articular cartilages in the presence of varus deformity using finite element analysis (FEA) applied to patient-specific models. Methods Two personalized ankle models, one healthy and another with varus deformity, were created based on CT scan images. Four static loading scenarios were simulated at the center of pressure (COP), coupled to the hindfoot complex. The contact area, contact pressure, and von Mises stress were computed for each cartilage. Results It was found that the peak contact pressure increased by 54% in the ankle with varus deformity compared to the healthy ankle model. Furthermore, stress concentrations moving medially were observed, particularly beneath the medial malleolus, with an average peak contact pressure of 3.5 MPa and 4.7 MPa at the tibial and talar articular cartilages, respectively. Conclusion Varus deformities in the ankle region have been consistently linked to elevated contact pressure, increasing the risk of thinning, degeneration, and eventual onset of osteoarthritis (OA), emphasizing the need for prompt interventions aimed at mitigating complications.
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Affiliation(s)
- Mohadese Rajaeirad
- School of Mechanical Engineering, University of Tehran, Tehran, Iran
- Department of Biomedical Engineering, University of Isfahan, Isfahan, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, University of Tehran, Tehran, Iran
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Vaziri AS, Moradkhani G, Karimpour M, Tahmasebi MN, Esfandiary S, Vosoughi F, Hosseini SR. Management of tibial nonunion and osteoarthritis using a 3D-printed titanium cone: A case report. Trauma Case Rep 2023; 48:100937. [PMID: 37810537 PMCID: PMC10550753 DOI: 10.1016/j.tcr.2023.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
The use of customized 3D-printed structures has been gaining popularity in non-union management, as it allows for bypassing the defect while promoting osseointegration. Additionally, porous titanium implants minimize stress shielding due to their stiffness and elastic modulus being closer to that of bone. The interconnected channels increase the surface area and provide space for cell adhesion and proliferation. This study presents the case of a 62-year-old female patient with concomitant knee osteoarthritis recalcitrant aseptic atrophic nonunion in the tibial proximal metaphysis. Due to the small distance between the nonunion site and the joint line, nonunion treatment had to be included in the treatment plan, as it would result in a lack of mechanical stability of the tibial component, and techniques such as plating were not an option. A customized 3D-printed porous titanium cone was used to bypass the fracture site and support the stem used with the CCK prosthesis, allowing for simultaneous nonunion and osteoarthritis management.
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Affiliation(s)
- Arash Sharafat Vaziri
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Moradkhani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Naghi Tahmasebi
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran
| | - Soodabeh Esfandiary
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Reihaneh Hosseini
- Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran
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Vaziri AS, Karimpour M, Tahmasebi MN, Hosseini SR, Moradkhani G, Javidmehr S, Vosoughi F. Ipsilateral Concurrent Knee Arthroplasty and Tibial Osteotomy with 3D-Printed Patient-Specific Instrumentation: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00021. [PMID: 37917765 DOI: 10.2106/jbjs.cc.23.00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
CASE A 70-year-old woman presented with knee pain and instability and was diagnosed with advanced knee osteoarthritis and bifocal tibial deformities. The complexity of the case challenged our team to perform a significant sagittal correction (>60°) and restore her ability to walk independently. We performed ipsilateral total knee arthroplasty and anterior closed wedge tibial osteotomy using virtual planning and 3D-printed patient-specific instrumentation. CONCLUSION Using 2 separate 3D-printed patient-specific cutting guides for this patient with a complex deformity and managing the whole planning process in close collaboration between the surgeons and engineers resulted in a satisfactory postoperative outcome, optimal implant positioning and leg alignment, and minimal soft-tissue damage.
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Affiliation(s)
- Arash Sharafat Vaziri
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Naghi Tahmasebi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Reihaneh Hosseini
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Moradkhani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Sina Javidmehr
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopaedic and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Mohseni-Motlagh SF, Dolatabadi R, Baniassadi M, Karimpour M, Baghani M. Tablet Geometry Effect on the Drug Release Profile from a Hydrogel-Based Drug Delivery System. Pharmaceutics 2023; 15:1917. [PMID: 37514103 PMCID: PMC10384981 DOI: 10.3390/pharmaceutics15071917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
In order to achieve the optimal level of effectiveness and safety of drugs, it is necessary to control the drug release rate. Therefore, it is important to discover the factors affecting release profile from a drug delivery system. Geometry is one of these effective factors for a tablet-shaped drug delivery system. In this study, an attempt has been made to answer a general question of how the geometry of a tablet can affect the drug release profile. For this purpose, the drug release process of theophylline from two hundred HPMC-based tablets, which are categorized into eight groups of common geometries in the production of oral tablets, was simulated using finite element analysis. The analysis of the results of these simulations was carried out using statistical methods including partial least squares regression and ANOVA tests. The results showed that it is possible to predict the drug release profile by knowing the geometry type and dimensions of a tablet without performing numerous dissolution tests. Another result was that, although in many previous studies the difference in the drug release profile from several tablets with different geometries was interpreted only by variables related to the surface, the results showed that regardless of the type of geometry and its dimensions, it is not possible to have an accurate prediction of the drug release profile. Also, the results showed that without any change in the dose of the drug and the ingredients of the tablet and only because of the difference in geometry type, the tablets significantly differ in release profile. This occurred in such a way that, for example, the release time of the entire drug mass from two tablets with the same mass and materials but different geometries can be different by about seven times.
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Affiliation(s)
| | - Roshanak Dolatabadi
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 1416634793, Iran
- Food and Drug Administration, Iran Ministry of Health and Medical Education, Tehran 1419943471, Iran
| | - Majid Baniassadi
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran 1439957131, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran 1439957131, Iran
| | - Mostafa Baghani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran 1439957131, Iran
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Hayatbakhsh Z, Farahmand F, Karimpour M. Is a Complete Anatomical Fit of the Tomofix Plate Biomechanically Favorable? A Parametric Study Using the Finite Element Method. Arch Bone Jt Surg 2022; 10:712-720. [PMID: 36258741 PMCID: PMC9569138 DOI: 10.22038/abjs.2022.60928.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/23/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The opening wedge high tibial osteotomy (HTO) fixation using the Tomofix system is at the risk of mechanical failure due to unstable fixation, lateral hinge fracture, and hardware breakage. This study aimed to investigate the effect of the level of anatomical fit (LOF) of the plate on the failure mechanisms of fixation. METHODS A finite element model of the HTO with a correction angle of 12 degrees was developed. The LOF of the TomoFix plate was changed parametrically by altering the curvature of the plate in the sagittal plane. The effect of the LOF on the fixation performance was studied in terms of the factor of safety (FOS) against failure mechanisms. The FOSs were found by 1) dividing the actual stiffness of the plate-bone construct by the minimum allowable one for unstable fixation, 2) dividing the compressive strength of the cortical bone by the actual maximum pressure at the lateral hinge for the lateral hinge fracture, and 3) the Soderberg criterion for fatigue fracture of the plate and screws. RESULTS The increase of the LOF by applying a larger bent to the plate changed the fixation stiffness slightly. However, it reduced the lateral hinge pressure substantially (from 182 MPa to 71 MPa) and increased the maximum equivalent stresses in screws considerably (from 187 MPa to 258 MPa). Based on the FOS-LOF diagram, a gap smaller than 2.3 mm was safe, with the highest biomechanical performance associated with a 0.5 mm gap size. CONCLUSION Although a high LOF is necessary for the Tomofix plate fixation to avoid mechanical failure, a gap size of 0.5mm is favored biomechanically over complete anatomical fit.
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Affiliation(s)
- Zahra Hayatbakhsh
- Department of Biomedical Engineering, Science and Research branch, Islamic Azad University, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, University of Tehran, Tehran, Iran
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Hadizadeh H, Hadizadeh H, Ganjiani M, Karimpour M. Influence of the angle between tibial and prosthesis mechanical axes on tibial bone remodeling in total knee arthroplasty. Proc Inst Mech Eng H 2022; 236:1093-1099. [DOI: 10.1177/09544119221107744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Osteoarthritis of the knee is one of the most common diseases that affect the quality of life in the elderly population, and Total Knee Arthroplasty is considered the only real treatment for it, and as with any other surgery, a suboptimal technique may lead to an undesirable outcome. This paper aims to investigate the effects of the angle between mechanical axes of the tibia and the implant on the bone remodeling process. A 3D model was reconstructed using CT images, which was then used in an ABAQUS model with a USDFLD subroutine to simulate bone remodeling post TKA. The USDFLD subroutine compares the strain energy density from each increment to that of the previous increment to determine how the bone density will change. Simulation results suggest that when the prosthesis is inclined to one side, stress and density distribution increase, whereas stress and bone density decrease substantially on the opposite side. This decrease in bone density can be as much as 35% in the coronal plane. Sagittal malalignment results suggest that the effect would be relatively localized to the vicinity of the cutting plane. Results suggest uniform load distribution may be achieved when the two mechanical axes are kept parallel, which in turn can lead to decreased prosthesis loosening and bone fractures.
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Affiliation(s)
- Hossein Hadizadeh
- Department of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Hasan Hadizadeh
- Department of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mehdi Ganjiani
- Department of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Morad Karimpour
- Department of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Hadizadeh H, Hadizadeh H, Ganjiani M, Karimpour M, Hosseinpour A. Investigation of the effect of the angle between femoral and prosthesis mechanical axes on bone remodeling of femur in total knee arthroplasty. Proc Inst Mech Eng H 2021; 235:976-984. [PMID: 33985375 DOI: 10.1177/09544119211016128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The bone remodeling is the process in which the bone adapts its structure to the variation of environmental loads. The joint might be broken or damaged as a result of aging or an accident. To remedy this situation, Total Knee Arthroplasty (TKA) and prosthesis implantation is recommended. The main goal of this research is to investigate the effects of femur implanting angle on the bone remodeling process after TKA in the Coronal, Sagittal and horizontal planes over seven years. First, the 3D CAD model from CT images is created then the bone behavior is simulated using a model with a USDFLD subroutine. The results show that as the implant rotates in one direction, the stress and density distribution increases in the same direction whereas the load and consequently the bone density decrease substantially in the opposite direction. Consequently, the bone density might even decrease 77 and 31 percent in the coronal and sagittal plane respectively, so in the total knee arthroplasty, the mechanical axes of prosthesis and femur should be parallel. The active bone which occurs as a result of mechanical axes of prosthesis and femur parallelism and consequently uniform load distribution, can protect the implant from prosthesis loosening and fracture.
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Affiliation(s)
- Hasan Hadizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Hossein Hadizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mehdi Ganjiani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Abolfazl Hosseinpour
- Department of Mechanical Engineering, University of North Carolina, Charlotte, NC, USA
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Sadeghian F, Zakerzadeh MR, Karimpour M, Baghani M. Numerical study of patient-specific ankle-foot orthoses for drop foot patients using shape memory alloy. Med Eng Phys 2019; 69:123-133. [PMID: 31176522 DOI: 10.1016/j.medengphy.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/29/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
Drop foot is a nerve-muscle disorder that affects the muscles that lift the foot. The two main side effects of drop foot are slapping/kicking the foot after heel strike (foot) and dragging the foot during the swing (toe drag). Treatment methods such as ankle-foot orthoses (AFO) have some biomechanical benefits, but are not applicable to all walking conditions and cannot mitigate significant gait complications. This study introduces the design of a passive AFO system, which combines an ordinary AFO and a shape memory alloy (SMA) element. OpenSim was used to simulate patients with muscle weakness and to calculate the torque needed to imitate normal ankle joint stiffness. The calculated torque was then reproduced for different levels of muscle weakness by the superelasticity of SMAs. The study showed that the normal joint stiffness profile for each patient with a certain level of muscle weakness can be restored by designing a patient-specific orthosis.
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Affiliation(s)
- Farshid Sadeghian
- School of Mechanical Engineering, College of Engineering, University of Tehran, P.O.B. 11155-4563, Tehran, Iran
| | - Mohammad Reza Zakerzadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, P.O.B. 11155-4563, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, P.O.B. 11155-4563, Tehran, Iran.
| | - Mostafa Baghani
- School of Mechanical Engineering, College of Engineering, University of Tehran, P.O.B. 11155-4563, Tehran, Iran
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Karimpour M, Parsaei H, Rojhani-Shirazi Z, Sharifian R, Yazdani F. An Android Application for Estimating Muscle Onset Latency using Surface EMG Signal. J Biomed Phys Eng 2019; 9:243-250. [PMID: 31214530 PMCID: PMC6538912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/03/2017] [Indexed: 10/28/2022]
Abstract
BACKGROUND Electromyography (EMG) signal processing and Muscle Onset Latency (MOL) are widely used in rehabilitation sciences and nerve conduction studies. The majority of existing software packages provided for estimating MOL via analyzing EMG signal are computerized, desktop based and not portable; therefore, experiments and signal analyzes using them should be completed locally. Moreover, a desktop or laptop is required to complete experiments using these packages, which costs. OBJECTIVE Develop a non-expensive and portable Android application (app) for estimating MOL via analyzing surface EMG. MATERIAL AND METHODS A multi-layer architecture model was designed for implementing the MOL estimation app. Several Android-based algorithms for analyzing a recorded EMG signal and estimating MOL was implemented. A graphical user interface (GUI) that simplifies analyzing a given EMG signal using the presented app was developed too. RESULTS Evaluation results of the developed app using 10 EMG signals showed promising performance; the MOL values estimated using the presented app are statistically equal to those estimated using a commercial Windows-based surface EMG analysis software (MegaWin 3.0). For the majority of cases relative error <10%. MOL values estimated by these two systems are linearly related, the correlation coefficient value ~ 0.93. These evaluations revealed that the presented app performed as well as MegaWin 3.0 software in estimating MOL. CONCLUSION Recent advances in smart portable devices such as mobile phones have shown the great capability of facilitating and decreasing the cost of analyzing biomedical signals, particularly in academic environments. Here, we developed an Android app for estimating MOL via analyzing the surface EMG signal. Performance is promising to use the app for teaching or research purposes.
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Affiliation(s)
- M. Karimpour
- School of Management & Medical Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - H. Parsaei
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
,Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z. Rojhani-Shirazi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R. Sharifian
- School of Management & Medical Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - F. Yazdani
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Alimohammadi M, Sherwood JM, Karimpour M, Agu O, Balabani S, Díaz-Zuccarini V. Aortic dissection simulation models for clinical support: fluid-structure interaction vs. rigid wall models. Biomed Eng Online 2015; 14:34. [PMID: 25881252 PMCID: PMC4407424 DOI: 10.1186/s12938-015-0032-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management and prognosis of aortic dissection (AD) is often challenging and the use of personalised computational models is being explored as a tool to improve clinical outcome. Including vessel wall motion in such simulations can provide more realistic and potentially accurate results, but requires significant additional computational resources, as well as expertise. With clinical translation as the final aim, trade-offs between complexity, speed and accuracy are inevitable. The present study explores whether modelling wall motion is worth the additional expense in the case of AD, by carrying out fluid-structure interaction (FSI) simulations based on a sample patient case. METHODS Patient-specific anatomical details were extracted from computed tomography images to provide the fluid domain, from which the vessel wall was extrapolated. Two-way fluid-structure interaction simulations were performed, with coupled Windkessel boundary conditions and hyperelastic wall properties. The blood was modelled using the Carreau-Yasuda viscosity model and turbulence was accounted for via a shear stress transport model. A simulation without wall motion (rigid wall) was carried out for comparison purposes. RESULTS The displacement of the vessel wall was comparable to reports from imaging studies in terms of intimal flap motion and contraction of the true lumen. Analysis of the haemodynamics around the proximal and distal false lumen in the FSI model showed complex flow structures caused by the expansion and contraction of the vessel wall. These flow patterns led to significantly different predictions of wall shear stress, particularly its oscillatory component, which were not captured by the rigid wall model. CONCLUSIONS Through comparison with imaging data, the results of the present study indicate that the fluid-structure interaction methodology employed herein is appropriate for simulations of aortic dissection. Regions of high wall shear stress were not significantly altered by the wall motion, however, certain collocated regions of low and oscillatory wall shear stress which may be critical for disease progression were only identified in the FSI simulation. We conclude that, if patient-tailored simulations of aortic dissection are to be used as an interventional planning tool, then the additional complexity, expertise and computational expense required to model wall motion is indeed justified.
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Affiliation(s)
- Mona Alimohammadi
- Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
| | - Joseph M Sherwood
- Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK. .,Bioengineering, Imperial College London, South Kensington Campus, London, SW7 2BP, UK.
| | - Morad Karimpour
- Mechanical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Obiekezie Agu
- Vascular Unit, University College Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - Stavroula Balabani
- Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
| | - Vanessa Díaz-Zuccarini
- Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
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