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• Various material mapping methods are used with subject-specific finite element models. • Key methods include: constant-E, element-based, and node-based. • Methods were compared in terms of accuracy, convergence-time, and run-time. • Element-based method converged with a larger element compared to other approaches. • Element-based method resulted in similar accuracy and shorter run-time. Quantitative computed tomography (QCT) based finite element (FE) modeling, referred to as QCT-FE, has seen rapid growth and application for modeling bone mechanics. With this approach, varying bone material properties are set via experimentally-derived density-modulus equations. One challenge though associated with QCT-FE is to identify the appropriate mapping strategy for assigning elastic moduli to elements. The goal of this study was to evaluate different QCT-FE mapping strategies to identify the optimum approach with fastest convergence rate and highest accuracy. Four proximal tibial medial compartments were imaged using QCT and experimentally tested to characterize proximal tibial subchondral bone stiffness at four surface points, resulting in a total of 16 indentation measures. Three material mapping methods were analyzed: (1) constant-E where an average elastic modulus was assigned to each element; (2) node-based where the material properties were first mapped on nodes then interpolated to Gaussian integration points; and (3) element-based in which the material properties were directly assigned to Gaussian integration points. Different element sizes were assessed with edge-lengths ranging from 0.9 to 3 mm. Results indicated that all converged models showed similar coefficient-of-determination (R2) and normalized root-mean-square errors (RMSE%). Though, the constant-E and node-based methods converged with the element edge-length of 1.5 mm (prediction error of 4.8% and 2.5%, respectively) whereas the element-based method converged with a larger element having an edge-length 2.5 mm (error = 4.9%). In conclusion, the element-based method, with a larger element size, resulted in similar predictive accuracy, faster convergence and shorter run-times relative to the constant-E and node-based approaches. As such, we recommend the element-based method for future subject-specific QCT-FE modeling. [ABSTRACT FROM AUTHOR]

• Application of a bone remodeling model that accounts mechanical and biological interactions in a 3D femur model. • Utilization of a classic daily mechanical stimulus to determine the cellular dynamics and bone volume adaptations. • Evolution of RANKL concentration after femoral prosthesis implantation. • Combination of biological aspects, such as the RANK/RANKL/OPG pathway, with the number of cycles for each stress amplitude. The present study focuses on a model for three-dimensional bone remodeling of the human femur that considers cellular dynamics to determine the volume fraction of new bone. The model considers the interaction among responsive osteoblasts, active osteoblasts, and osteoclasts, as well as signaling molecules and parathyroid hormone (PTH). The stimulus of the model has a systemic origin due to the PTH effect, and a local origin due to the action of cytokines, growth factors, and mechanical stimuli near the site of the bone cells. The present work considers that the mechanical stimulus that activates cellular activity is obtained from stresses acting on the bone tissue and the number of daily loading cycles. In addition to simulating the bone modeling process in an intact femur, the numerical model is used to simulate bone adaptation in relation to the stress shielding phenomenon after the implantation of a femoral prosthesis. The results showed that the simulations provide a distribution of bone density that is similar to a radiograph and, in addition, allows the visualization of osteoblast and osteoclast dynamics in bone adaptation response after prosthesis implantation. [ABSTRACT FROM AUTHOR]

• Current techniques for assessing vertebral fracture risk are limited in accuracy. • DTS-DVC allows for clinical assessment of vertebral bone deformation. • Displacement spatial distributions qualitatively agreed between DTS-DVC and μCT-DVC. • DTS-DVC derived displacement and stiffness were strongly correlated with μCT values. • Results support use of DTS-DVC for clinical evaluation of vertebral bone quality. Digital tomosynthesis (DTS) is a clinically available modality that allows imaging of a patient's spine in supine and standing positions. The purpose of this study was to establish the extent to which vertebral displacement and stiffness derived from DTS-based digital volume correlation (DTS-DVC) are correlated with those from a reference method, i.e., microcomputed tomography-based DVC (μCT-DVC). T11 vertebral bodies from 11 cadaveric donors were DTS imaged twice in a nonloaded state and once under a fixed load level approximating upper body weight. The same vertebrae were µCT imaged in nonloaded and loaded states (40 μm voxel size). Vertebral displacements were calculated at each voxel using DVC with pairs of nonloaded and loaded images, from which endplate-to-endplate axial displacement (D DVC) and vertebral stiffness (S DVC) were calculated. Both D DVC and S DVC demonstrated strong positive correlations between DTS-DVC and μCT-DVC, with correlations being stronger when vertebral displacement was calculated using the median (R2=0.80; p <0.0002 and R2=0.93; p <0.0001, respectively) rather than average displacement (R2=0.63; p <0.004 and R2=0.69; p <0.002, respectively). In conclusion, the demonstrated relationship of DTS-DVC with the μCT standard supports further development of a biomechanics-based clinical assessment of vertebral bone quality using the DTS-DVC technique. [ABSTRACT FROM AUTHOR]

The heat generated during orthopedic surgery can cause thermal damage to bone cells, leading to cell necrosis, death, and bone resorption. In this study, the drill-exit surface in cortical bone drilling was firstly investigated by infrared thermography to understand the thermal characteristics of bone cutting. In order to mimic the short-term thermal condition of high temperature during surgical cutting, the osteoblasts were exposed to heat shock for short periods of time to investigate the effect of cutting heat on the bone. Necrosis and apoptosis were investigated immediately after heat shock for 2 s, 5 s, and 15 s at 50 °C, 60 °C, 70 °C, and 80 °C, respectively. The cells were then incubated for 4 days at 37 °C and analyzed by fluorescein annexin V-FITC/PI double staining. The temperature and heat-duration were precisely controlled by a novel heating approach. In comparison to the control group (37 °C), immediate necrotic and apoptotic response to heat shock was found in cells exposed to 50 °C for 5 s (11.8%, p<0.05); however, the response was negligible in cells exposed to 50 °C for 2 s. In addition, recovery was found in the group exposed to 50 °C and 60 °C for 2 s (p ≤ 0.05) after incubation for 4 days. Cell damage depends on the magnitude and duration of heat exposure. These findings provide fundamental knowledge for future developments of surgical tool design and cutting methods. [ABSTRACT FROM AUTHOR]

• An innovative approach to model Achilles Tendon-bone insertion is proposed. • Microstructure and biomechanical function of tendon to bone insertion are correlated. • Mineral deposition and fiber orientation play complement roles in the interface. • The model correctly predicts the failure region away from interface in Achilles Tendon. • A transition zone is needed for efficient attachment of soft to hard tissues. The interface between the Achilles Tendon (AT) and calcaneus comprises soft and hard connective tissues. Such interfaces are vulnerable to mechanical damage. Tendon to Bone Insertion Region (TBIR) has unique microstructural characteristics for reinforcement. This region constitutes almost 10% of the AT's distal end. The rest of the tendon (tendon proper) has longitudinal fiber orientation with no mineral content. Although, the TBIR lacks longitudinally organized fibers and at the same time, incorporates mineral molecules. In this study, a 3D computational model of the TBIR proposed to underline several reinforcement mechanisms. The obtained results showed that off-axis alignment of fibers, when coupled with the mineral deposition, shifts the stress concentration region to the tendon proper. In the case of altering each parameter individually, probable failure observed in the bone interface, which causes complications in surgical procedure or during healing. A gradual increase of mineral compensates for the stiffness mismatch between the AT and calcaneus. The proposed computational framework illustrated the complementary roles of fiber orientation and mineral molecules: nearly transverse orientation of fibers alleviated the stress concentration locally, while mineral deposition directly enhanced the TBIR stiffness. [ABSTRACT FROM AUTHOR]

• An in silico model of bone remodeling is proposed. • The algorithm considers hypermineralized sites as prime targets for the bone remodeling process. • Imbalance between osteoclastic and osteoblastic activities is considered. • Representation of pathologies such as osteoporosis and pharmaceutical treatment is achieved. • The model predicts evolution of bone with time and effect of treatment. Pharmaceutical treatments can slow bone degradation, thus reducing the fracture risk inherent in osteoporosis. Antiresorptive treatments block the over-activation of osteoclasts vs osteoblasts, but the resulting decrease in bone remodeling frequency may weaken bone structure over time, with no gain in bone volume. Anabolic treatments, however, induce gain in bone volume. The quantitative results from existing studies on the effects of treatments over time are general and non-patient-specific, while numerical models simulating evolution of patient-specific bone microarchitecture consider a spatially random distribution of the remodeling process. Here, we propose a new approach to simulate the remodeling over decades of an individual patient's bone microarchitecture, based on the hypothesis that the oldest sites, which are hypermineralized and more brittle, are remodeled first. Taking these older sites as prime targets of remodeling, simulations show that severe osteoporosis profoundly degrades the mechanical properties of the bone structure, which can be restored and even improved by anabolic, more than by antiresorptive, therapies. [ABSTRACT FROM AUTHOR]

• Stiffness matrix is useful for describing the mechanical behaviour of functional spinal unit. • Characteristics of stiffness matrix obtained by loading through the "balance point" were shown. • Possible advantages of mechanical testing using "balance point" concept are discussed. The stiffness matrix is a useful way to describe the mechanical behaviour of the functional spinal unit, which is defined as the superior and inferior vertebrae, capsules and ligaments. This usefulness is extended by means of the concept of the "balance point". The balance point is the load application point where the coupling coefficients of the stiffness matrix are minimized. Theoretical considerations are used to demonstrate that the stiffness matrix varies with load point location and thus a single stiffness matrix does not fully characterize the motion segment as well as to derive the stiffness matrix at any one specified point from the stiffness matrix at some other specified point. Special characteristics of the stiffness matrix obtained by loading through the "balance point" were shown. Some possible advantages derived from mechanical testing using the "balance point" concept are discussed. This study validates an improved stiffness matrix model that enhances the understanding of pathological changes by setting the gold standard of the behaviour of a normal functional spinal unit. [ABSTRACT FROM AUTHOR]

• Study developed a method for automated FE analyses from clinical hip CT images. • FE model includes distinguished cortical bone with corrected partial volume effect. • Segmentation accuracy verified against clinical CT and ground-truth uCT. • FE model analyzed against experimental strains recorded with high-speed DIC. Finite element (FE) models based on quantitative computed tomography (CT) images are better predictors of bone strength than conventional areal bone mineral density measurements. However, FE models require manual segmentation of the femur, which is not clinically applicable. This study developed a method for automated FE analyses from clinical CT images. Clinical in-vivo CT images of 13 elderly female subjects were collected to evaluate the method. Secondly, proximal cadaver femurs were harvested and imaged with clinical CT (N = 17). Of these femurs, 14 were imaged with µCT and three had earlier been tested experimentally in stance-loading, while collecting surface deformations with digital image correlation. Femurs were segmented from clinical CT images using an automated method, based on the segmentation tool Stradwin. The method automatically distinguishes trabecular and cortical bone, corrects partial volume effect and generates input for FE analysis. The manual and automatic segmentations agreed within about one voxel for in-vivo subjects (0.99 ± 0.23 mm) and cadaver femurs (0.21 ± 0.07 mm). The strains from the FE predictions closely matched with the experimentally measured strains (R2 = 0.89). The method can automatically generate meshes suitable for FE analysis. The method may bring us one step closer to enable clinical usage of patient-specific FE analyses. [ABSTRACT FROM AUTHOR]

• The Sawbones company produces artificial bones for biomechanics research. • This article provides the first detailed survey of their biomechanical properties. • Characterization, validation, optimization, and application studies are included. • Data, trends, themes, and recommendations for future work are discussed. Biomedical engineers and physicists frequently use human or animal bone for orthopaedic biomechanics research because they are excellent approximations of living bone. But, there are drawbacks to biological bone, like degradation over time, ethical concerns, high financial costs, inter-specimen variability, storage requirements, supplier sourcing, transportation rules, etc. Consequently, since the late 1980s, the Sawbones® company has been one of the world's largest suppliers of artificial bones for biomechanical testing that counteract many disadvantages of biological bone. There have been many published reports using these bone analogs for research on joint replacement, bone fracture fixation, spine surgery, etc. But, there exists no prior review paper on these artificial bones that gives a comprehensive and in-depth look at the numerical data of interest to biomedical engineers and physicists. Thus, this paper critically reviews 25 years of English-language studies on the biomechanical properties of these artificial bones that (a) characterized unknown or unreported values, (b) validated them against biological bone, and/or (c) optimized different design parameters. This survey of data, advantages, disadvantages, and knowledge gaps will hopefully be useful to biomedical engineers and physicists in developing mechanical testing protocols and computational finite element models. [ABSTRACT FROM AUTHOR]

• The Capability of the simulated DXA-based 2D FE model for predicting vertebral failure loads was evaluated. • The simulated DXA-based 2D FE models have better capability than the densitometric measurements. • The DXA-based 2D FE models have the potential to be used for predicting vertebral failure loads in clinical practice. Prediction of the vertebral failure load is of great importance for the prevention and early treatment of bone fracture. However, an efficient and effective method for accurately predicting the failure load of vertebral bones is still lacking. The aim of the present study was to evaluate the capability of the simulated dual energy X-ray absorptiometry (DXA)-based finite element (FE) model for predicting vertebral failure loads. Thirteen dissected spinal segments (T11/T12/L1) were scanned using a HR-pQCT scanner and then were mechanically tested until failure. The subject-specific three-dimensional (3D) and two-dimensional (2D) FE models of T12 were generated from the HR-pQCT scanner and the simulated DXA images, respectively. Additionally, the areal bone mineral density (aBMD) and areal bone mineral content (aBMC) of T12 were calculated. The failure loads predicted by the simulated DXA-based 2D FE models were more moderately correlated with the experimental failure loads (R 2 = 0.66) than the aBMC (R 2 = 0.61) and aBMD (R 2 = 0.56). The 2D FE models were slightly outperformed by the HR-pQCT-based 3D FE models (R 2 = 0.71). The present study demonstrated that the simulated DXA-based 2D FE model has better capability for predicting the vertebral failure loads than the densitometric measurements but is outperformed by the 3D FE model. The 2D FE model is more suitable for clinical use due to the low radiation dose and low cost, but it remains to be validated by further in vitro and in vivo studies. [ABSTRACT FROM AUTHOR]

Highlights • This experiment is carried out based on patients with femoral head necrosis. • The accuracy of the experiment is at millimeter level. • This study mainly determined the relationship between density and elastic modulus for the entire femoral head. • The material properties of necrotic femoral heads and normal femoral heads are measured in this experiment using ultrasound scanning combined with CT scanning. Abstract Image-based finite element modelling has been commonly used to determine the biomechanical behaviours of human femora, particularly for the diagnosis of femoral head necrosis. One of the fundamental aspects of biomechanical modelling is the relationship between bone density, which is obtained from images, and elastic modulus. While there exist some empirical equations relating density with elastic modulus, the characterization of this relationship remains incomplete, especially for necrotic femoral heads. The objective of this study was to determine the relationship between density and elastic modulus by combining ultrasonic scanning and computed tomography (CT). Bone specimens were surgically removed from the femora of eight persons (seven females and one male in the age range of 55–68 years old) and underwent both ultrasonic and CT scanning. The images were processed with MATLAB scripts, and a bilinear interpolation algorithm was used to determine the relationship between the CT-measured densities and ultrasound-measured elastic moduli. The results showed different density–elastic modulus relations between the hardening strap of the necrotic region and non-hardening strap areas of the necrotic region. The uniqueness of this study is the characterization of mechanical properties (in the present study, the density–modulus relationship) from clinical images, which would be valuable in computational biomechanics used for the diagnosis and treatment evaluation of femoral head necrosis. [ABSTRACT FROM AUTHOR]

Highlights • A finite element model of resonant frequency analysis of dental implants. • Peri-implant interface of varying stiffness and thickness to mimic bone remodeling. • Sensitivity analysis of the RFA. • Results show an increased sensitivity for wider and softer peri-implant layers. • Upon peri-implant bone stiffening, the sensitivity of RFA decreases rapidly. Abstract Dental implant stability influences the decision on the determination of the duration between implant insertion and loading. This work investigates the resonant frequency analysis by means of a numerical model. The investigation is done numerically through the determination of the eigenfrequencies and performing steady state response analyses using a commercial finite element package. A peri-implant interface, of simultaneously varying stiffness, density and layer thickness is introduced in the numerical 3D model in order to probe the sensitivity of the eigenfrequencies and steady state response to an evolving weakened layer, in an attempt to identify the bone reconstruction around the implant. For the first two modes, the resonant frequency is somewhat insensitive to the healing process, unless the weakened layer is rather large and compliant, like in the very early stages of the implantation. A "Normalized Healing Factor" is devised in the spirit of the Implant Stability Quotient, which can identify the healing process especially at the early stages after implantation. The sensitivity of the resonant frequency analysis to changes of mechanical properties of periprosthetic bone tissue seems relatively weak. Another indicator considering the amplitude as well as the resonance frequency might be more adapted to bone healing estimations. However, these results need to be verified experimentally as well as clinically. [ABSTRACT FROM AUTHOR]

Highlights • The influence of uncertainty in bone material property on bone mechanical environment was investigated. • The bounds of the 1st and 3rd principal strains and the strain energy density are determined by the bounds of the bone density-modulus relationship. • The relative percentage differences caused by the bone material uncertainty are up to 28%, 28% and 21% for the 1st and 3rd principal strains and the strain energy density, respectively. Abstract Finite element (FE) analysis can be used to predict bone mechanical environments that can be used for many important applications, such as the understanding of bone mechano-regulation mechanisms. However, when defining the FE models, uncertainty in bone material properties may lead to marked variations in the predicted mechanical environment. The aim of this study is to investigate the influence of uncertainty in bone material property on the mechanical environment of bone. A heterogeneous FE model of a mouse tibia was created from micro computed tomography images. Axial compression loading was applied, and all possible bone density-modulus relationships were considered through stochastic analysis. The 1st and 3rd principal strains (ε 1 and ε 3) and the strain energy density (SED) were quantified in the tibial volume of interest (VOI). The bounds of ε 1 , ε 3 , and SED were determined by the bounds of the density-modulus relationship; the bone mechanical environment (ε 1 , ε 3 , and SED) and the bone density-modulus relationship exhibit the same trend of change; the relative percentage differences caused by bone material uncertainty are up to 28%, 28%, and 21% for ε 1 , ε 3 , and SED, respectively. These data provide guidelines on the adoption of bone density-modulus relationship in heterogeneous FE models. [ABSTRACT FROM AUTHOR]

Highlights • The full thickness of cartilage sample was imaged. • Axial strain distribution was quantified in the dynamic state during the compression. • Axial strain distribution was more uniform in the dynamic state compared to the static state. • Local axial strains increased during the stress relaxation. Abstract The biological activities of chondrocytes are influenced by the mechanical characteristics of their environment. The overall real-time mechanical response of cartilage has been investigated earlier. However, the instantaneous local mechano-biology of cartilage has not been investigated in detail under dynamic loading conditions. In order to address this gap in the literature, we designed a compression testing device and implemented a dual photon microscopy technique with the goal of measuring local mechanical and biological responses of articular cartilage under dynamic loading conditions. The details of the compression system and results of a pilot study are presented here. A 15% ramp compression at a rate of 0.003/s with a subsequent stress relaxation phase was applied to the cartilage explant samples. The extra cellular matrix was imaged throughout the entire thickness of the cartilage sample, and local tissue strains were measured during the compression and relaxation phase. The axial compressive strains in the middle and superficial zones of cartilage were observed to increase during the relaxation phase: this was a new finding, suggesting the importance of further investigations on the real-time local behavior of cartilage. The compression system showed promising results for investigating the dynamic, real-time mechanical response of articular cartilage, and can now be used to reveal the instantaneous mechanical and biological responses of chondrocytes in response to dynamic loading conditions. [ABSTRACT FROM AUTHOR]

It is established that bone tissue adapts and responds to mechanical loading. Several studies have suggested an existence of positive influence of vibration on the bone mass maintenance. Thus, some bone regeneration therapies are based on vibration of bone tissue under circumstances of disease to stimulate its formation. Frequency of loading should be properly selected and therefore a correct characterization of the dynamic properties of this tissue may be critical for the success of such orthopedic techniques. On the other hand, many studies implement vibration techniques with in silico models. Numerical results are exclusively dependent on properties of bone tissue, i.e. geometry, density distribution and stiffness, as well as boundary conditions. In the present study, the influence of boundary conditions and material properties on the dynamic characteristics of bone tissue was explored in a human femur. Bone shape and density were directly reconstructed from computer tomographies, whereas natural frequencies and modes of vibration were obtained for different boundary conditions including physiological and mechanical ones. Results of this study show the moderate effect of material properties compared to the much substantial effect of boundary conditions. A factor of 2 in the natural frequency was obtained depending on imposed boundary conditions, highlighting the importance in the selection of appropriate conditions in the analysis of the bone organ. [ABSTRACT FROM AUTHOR]

• Development of mechanobiological model of bone remodeling coupled with breast cancer growth model. • Modeling of chemotherapy, tamoxifen, and aromatase inhibitors pharmacokinetics in the mechanobiological bone remodeling model. • Implementation and simulation of the proposed mathematical model in MATLAB code. • Study the chemotherapy action on bone cells growth and hormonal therapies action on estrogen-estrogen receptor concentration. • Prediction of relative bone volume fraction under different breast cancer treatments scenarios. Breast Cancer (BC) treatments have been proven to interfere with the health of bones. Chemotherapy and endocrinal treatment regimens such as tamoxifen and aromatase inhibitors are frequently prescribed for women with BC. However, these drugs increase bone resorption and reduce the Bone Mineral Density (BMD), thus increasing the risk of bone fracture. In the current study, a mechanobiological bone remodeling model has been developed by coupling cellular activities, mechanical stimuli, and the effect of breast cancer treatments (chemotherapy, tamoxifen, and aromatase inhibitors). This model algorithm has been programmed and implemented on MATLAB software to simulate different treatment scenarios and their effects on bone remodeling and also predict the evolution of Bone Volume fraction (BV/TV) and the associated Bone Density Loss (BDL) over a period of time. The simulation results, achieved from different combinations of Breast Cancer treatments, allow the researchers to predict the intensity of each combination treatment on BV/TV and BMD. The combination of chemotherapy, tamoxifen, and aromatase inhibitors, followed by the combination of chemotherapy and tamoxifen remain the most harmful regimen. This is because they have a strong ability to induce the bone degradation which is represented by a decrease of 13.55% and 11.55% of the BV/TV value, respectively. These results were compared with the experimental studies and clinical observations which showed good agreement. The proposed model can be used by clinicians and physicians to choose the most appropriate combination of treatments, according to the patient's case. [ABSTRACT FROM AUTHOR]

Subchondral lucency (SCL), also referred to as subchondral bone cysts, can cause clinical problems in horses and humans. In humans, SCLs occur in youths and adolescents [1] due to mechanical factors (often related to athletics) and in skeletally mature individuals secondary to osteoarthritis (OA). In horses, SCL most commonly occurs in the medial femoral condyle (MFC) of growing horses (without OA), and causes lameness. The cause of equine SCL is debated, but bone trauma due to overload is the likely mechanism. Investigating the biomechanics of the healthy and cystic MFC is important to understand cyst growth and to provide a foundation for new treatment strategies. We hypothesize that SCL alters the mechanical environment of surrounding bone, which in the presence of continued loading, may lead to enlargement of the SCL. In this study, we developed and validated a finite element model of an equine stifle joint and investigated the stresses associated with varying sizes of SCL. We found substantial differences in tensile and shear stress at various stages of SCL development that suggest further bone damage leading to SCL enlargement. These data provide a first step in understanding of the altered mechanics of subchondral bone surrounding a SCL. Additional studies may provide the basis for improved treatment strategies for SCL in young horses, and may improve the understanding of SCL in humans. [ABSTRACT FROM AUTHOR]

• Printing parameters (speed, nozzle temperature, and layer thickness) have a statistically significant influence on the compressive viscoelastic properties of PLA parts. • MFCC scaffolds are superior to traditional OCS scaffolds from stiffness, yield strength, yield strain, and toughness perspectives. • Viscoelastic properties of natural bone tissue can be achieved by the variation of FDM parameters of PLA bone scaffolds. Bone tissue engineering has been recognized as a promising strategy to repair or replace damaged bone tissues. The mechanical properties of bone scaffolds play a critical role in successful bone regeneration, as it is essential to match the mechanical properties of the scaffold with the surrounding bone tissue. In this study, we investigated the effects of fused deposition modeling (FDM) process parameters, including printing speed, printing temperature, and layer thickness, on the compressive viscoelastic properties of polylactic acid (PLA) scaffolds. The compressive viscoelastic properties of bulk PLA specimens were characterized using a Zhu-Wang-Tang (ZWT) constitutive model under different compressive strain rates. A comprehensive statistical analysis comprising multivariate and univariate analysis of variance (MANOVA and ANOVA) and Tukey's post hoc analysis was utilized to quantify the effect of each FDM parameter on the viscoelastic mechanical properties of the PLA specimens. Subsequently, we fabricated modified face-centered cubic (MFCC) scaffolds using FDM and varied the FDM process parameters to achieve a compressive viscoelastic response that matched the natural trabecular bone tissue. The viscoelastic performance of the MFCC scaffolds was compared with traditional orthogonal cylindrical struts (OCS) scaffolds. Our methodology contributes to the design of bone-mimetic scaffolds with optimized mechanical properties by controlling FDM process parameters. [ABSTRACT FROM AUTHOR]

Computational simulation of electrical bone stimulation of the electrical and dielectric parameters of osteoarthritic bone tissue is useful for an exact patient-individual adaptation of the bone models. Therefore, we investigated electrical and dielectric parameters at a frequency of 20 Hz of cancellous and subchondral human femoral head bone samples. Furthermore, the mechanical properties and the bone mineral density (BMD) were determined. Finally, these data were compared with the electrical and dielectric parameters. The bone samples were taken from patients with hip osteoarthritis. Electrical conductivity and dielectric permittivity of cancellous bone amounted to 0.043 S/m and 8.1⋅10 6 . BMD of the bone samples determined by dual-x-ray-absorptiometry (DXA) and ashing resulted in 193 ± 70 mg/cm² and 286 ± 59 mg/cm³ respectively. Structural modulus ( E S ) and ultimate compression strength ( σ max ) were measured with 227 ± 94 N/mm² and 6.5 ± 3.4 N/mm². No linear correlation of the electrical and dielectric parameters compared with BMD and mechanical properties of cancellous bone samples was found. Electrical conductivity and dielectric permittivity of subchondral bone resulted in 0.029 S/m and 8.97 × 10 6 . [ABSTRACT FROM AUTHOR]

Implant loosening – commonly linked with elevated initial micromotion – is the primary indication for total ankle replacement (TAR) revision. Finite element modelling has not been used to assess micromotion of TAR implants; additionally, the biomechanical consequences of TAR malpositioning – previously linked with higher failure rates – remain unexplored. The aim of this study was to estimate implant-bone micromotion and peri-implant bone strains for optimally positioned and malpositioned TAR prostheses, and thereby identify fixation features and malpositioning scenarios increasing the risk of loosening. Finite element models simulating three of the most commonly used TAR devices (BOX ® , Mobility ® and Salto ® ) implanted into the tibia/talus and subjected to physiological loads were developed. Mobility and Salto demonstrated the largest micromotion of all tibial and talar components, respectively. Any malpositioning of the implant creating a gap between it and the bone resulted in a considerable increase in micromotion and bone strains. It was concluded that better primary stability can be achieved through fixation nearer to the joint line and/or while relying on more than a single peg. Incomplete seating on the bone may result in considerably elevated implant-bone micromotion and bone strains, thereby increasing the risk for TAR failure. [ABSTRACT FROM AUTHOR]

Patellar fracture and anterior knee pain remain major complications after Total Knee Arthroplasty (TKA). Patient-specific finite element (FE) models should help improve understanding of these complications through estimation of joint and bone mechanics. However, sensitivity of predictions on modeling techniques and approaches is not fully investigated. In particular, the importance of patellar bone anisotropy, usually omitted in FE models, on strain prediction is still unknown. The objective of this study was thus to estimate the influence of modeling patellar trabecular anisotropy on prediction of patellar strain in TKA models. We compared FE-derived strain predictions with isotopic and anisotropic material properties using 17 validated FE models of the patella after TKA. We considered both non-resurfaced and resurfaced patellae, in a load-bearing TKA joint. We evaluated and compared the bone volume above a strain threshold and, in addition, estimated if the difference in isotopic and anisotropic predictions was consistent between patellae of different average bone volume fraction. Compared to the anisotropic reference, the isotropic prediction of strained volume was 3.7 ± 1.8 times higher for non-resurfaced patellae and 1.5 ± 0.4 times for resurfaced patellae. This difference was higher for patellae with lower average bone volume fraction. This study indicates that strain predictions acquired via isotropic patellar FE models should be interpreted with caution, especially when patellae of different average bone volume fraction are compared. [ABSTRACT FROM AUTHOR]

Biostable fiber-reinforced composites (FRC) prepared from bisphenol-A-glycidyldimethacrylate (BisGMA)-based thermosets reinforced with E-glass fibers are promising alternatives to metallic implants due to the excellent fatigue resistance and the mechanical properties matching those of bone. Bioactive glass (BG) granules can be incorporated within the polymer matrix to improve the osteointegration of the FRC implants. However, the creation of a viable surface layer using BG granules is technically challenging. In this study, we investigated the potential of Excimer laser ablation to achieve the selective removal of the matrix to expose the surface of BG granules. A UV–vis spectroscopic study was carried out to investigate the differences in the penetration of light in the thermoset matrix and BG. Thereafter, optimal Excimer laser ablation parameters were established. The formation of a calcium phosphate (CaP) layer on the surface of the laser-ablated specimens was verified in simulated body fluid (SBF). In addition, the proliferation of MG63 cells on the surfaces of the laser-ablated specimens was investigated. For the laser-ablated specimens, the pattern of proliferation of MG63 cells was comparable to that in the positive control group (Ti6Al4V). We concluded that Excimer laser ablation has potential for the creation of a bioactive surface on FRC-implants. [ABSTRACT FROM AUTHOR]

Computational multibody musculoskeletal models of the elbow joint that are capable of simultaneous and accurate predictions of muscle and ligament forces, along with cartilage contact mechanics can be immensely useful in clinical practice. As a step towards producing a musculoskeletal model that includes the interaction between cartilage and muscle loading, the goal of this study was to develop subject-specific multibody models of the elbow joint with discretized humerus cartilage representation interacting with the radius and ulna cartilages through deformable contacts. The contact parameters for the compliant contact law were derived using simplified elastic foundation contact theory. The models were then validated by placing the model in a virtual mechanical tester for flexion-extension motion similar to a cadaver experiment, and the resulting kinematics were compared. Two cadaveric upper limbs were used in this study. The humeral heads were subjected to axial motion in a mechanical tester and the resulting kinematics from three bones were recorded for model validation. The maximum RMS error between the predicted and measured kinematics during the complete testing cycle was 2.7 mm medial-lateral translation and 9.7° varus–valgus rotation of radius relative to humerus (for elbow 2). After model validation, a lateral ulnar collateral ligament (LUCL) deficient condition was simulated and, contact pressures and kinematics were compared to the intact elbow model. A noticeable difference in kinematics, contact area, and contact pressure were observed for LUCL deficient condition. LUCL deficiency induced higher internal rotations for both the radius and ulna during flexion and an associated medial shift of the articular contact area. [ABSTRACT FROM AUTHOR]

In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL in full-extension, the knee was flexed from 0° to 150° at 15° increments, during which the ACL tension was measured. At each angle the ACL was subsequently elongated and shortened under displacement control, while measuring the ACL tension. In this manner, the pre-tension or the slackness, and the mechanical response of the ACL were measured. All ACL's displayed a higher tension at low (0°–60°) and high (120°–150°) flexion angles. The ACL slackness depended on flexion angle, with the highest slackness found at 75°–90°. Additionally, the ACL stiffness also varied with flexion angle, with the ACL behaving stiffer at low and high flexion angels. In general, the ACL was stiffest at 150°, and most compliant at 90°. The results of this study contribute to understanding the mechanical behavior of the ACL in-situ , and may help tuning and validating computational knee models studying ACL function. [ABSTRACT FROM AUTHOR]

Pedicle screws with polymethyl methacrylate (PMMA) cement augmentation have been shown to significantly improve the fixation strength in a severely osteoporotic spine. However, the efficacy of screw fixation for different cement augmentation techniques remains unknown. This study aimed to determine the difference in pullout strength between different cement augmentation techniques. Uniform synthetic bones simulating severe osteoporosis were used to provide a platform for each augmentation technique. In all cases a polyaxial screw and acrylic cement (PMMA) at medium viscosity were used. Five groups were analyzed: I) only screw without PMMA (control group); II) retrograde cement pre-filling of the tapped area; III) cannulated and fenestrate screw with cement injection through perforation; IV) injection using a standard trocar of PMMA (vertebroplasty) and retrograde pre-filling of the tapped area; V) injection through a fenestrated trocar and retrograde pre-filling of the tapped area. Standard X-rays were taken in order to visualize cement distribution in each group. Pedicle screws at full insertion were then tested for axial pullout failure using a mechanical testing machine. A total of 30 screws were tested. The results of pullout analysis revealed better results of all groups with respect to the control group. In particular the statistical analysis showed a difference of Group V ( p = 0.001) with respect to all other groups. These results confirm that the cement augmentation grants better results in pullout axial forces. Moreover they suggest better load resistance to axial forces when the distribution of the PMMA is along all the screw combining fenestration and pre-filling augmentation technique. [ABSTRACT FROM AUTHOR]

The scaphoid is the most often fractured carpal bone. Scaphoid fracture repair with a headless compression screw allows for early functional recovery. The rotational stability of a single screw may be limited, having a potential negative impact on the healing process. Two novel screws have been designed to provide improved rotational stability compared to the existing ones. Using a computational finite element model of a scaphoid osteotomy, we compared the efficacy of one simple screw and the two new screws in restricting inter-fragmentary motion (IFM) in three functional positions of the wrist and as a function of inter-fragmentary compression force. The in-plane IFM was primary rotational and was better restricted by the new screws compared to the conventional one when the inter-fragmentary compression force was below 15–20 N, but provided no clear benefit in total flexion independently of the compression force. To better understand the differences in the non-compressed case, we analyzed the acting moments and investigated the effects of the bending and torsional screw stiffness on IFM. By efficiently restricting the inter-fragmentary shear, the new screws may be clinically advantageous when the inter-fragmentary compression force is partially or completely lost and may provide further benefits toward earlier and better healing of transverse waist fractures of the scaphoid. [ABSTRACT FROM AUTHOR]

The dynamic hip–screw (DHS) system is a common implant for fixation of proximal femur fractures. During assembly, it has been recommended to remove the compression screw after initial compression has been obtained; however, related complications had been reported. So far, the role of compression screw in the reconstructed stability of hip fractures as well as the mechanical strength of the DHS system has rarely been mentioned. This study investigated the function of this screw in the DHS system during fracture healing. Based on the FE method, six numerical models of proximal femur were employed to analyze the mechanical response of a DHS implant with various fracture types and different fixation strategies (with or without a compression screw). The displacement of the femur head and peak von Mises stress were selected as indices of the stability of a fractured femur stabilized by a DHS device and of the risk of implant failure, respectively. Our results showed that a retained compression screw increased reconstructed structural stiffness, reducing the displacement of the femur head. This screw also helped to lessen mechanical failure of side plate by reducing the peak von Mises stress around the connection between the barrel and side plate. Both findings were evident in the proximal femur fracture involving the intertrochanteric part, and even more obvious in the setting of bony defects. Thus, we recommend the maintenance of compression screw in the DHS system while treating the intertrochanteric fracture, particularly in cases with bony defects. [ABSTRACT FROM AUTHOR]

Deformable joint contact models can be used to estimate loading conditions for cartilage–cartilage, implant–implant, human–orthotic, and foot–ground interactions. However, contact evaluations are often so expensive computationally that they can be prohibitive for simulations or optimizations requiring thousands or even millions of contact evaluations. To overcome this limitation, we developed a novel surrogate contact modeling method based on artificial neural networks (ANNs). The method uses special sampling techniques to gather input–output data points from an original (slow) contact model in multiple domains of input space, where each domain represents a different physical situation likely to be encountered. For each contact force and torque output by the original contact model, a multi-layer feed-forward ANN is defined, trained, and incorporated into a surrogate contact model. As an evaluation problem, we created an ANN-based surrogate contact model of an artificial tibiofemoral joint using over 75,000 evaluations of a fine-grid elastic foundation (EF) contact model. The surrogate contact model computed contact forces and torques about 1000 times faster than a less accurate coarse grid EF contact model. Furthermore, the surrogate contact model was seven times more accurate than the coarse grid EF contact model within the input domain of a walking motion. For larger input domains, the surrogate contact model showed the expected trend of increasing error with increasing domain size. In addition, the surrogate contact model was able to identify out-of-contact situations with high accuracy. Computational contact models created using our proposed ANN approach may remove an important computational bottleneck from musculoskeletal simulations or optimizations incorporating deformable joint contact models. [ABSTRACT FROM AUTHOR]

Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis. [ABSTRACT FROM AUTHOR]

Sequentially drilling multiple holes in bone is used clinically for surface preparation to aid in fusion of a joint, typically under non-irrigated conditions. Drilling induces a significant amount of heat and accumulates after multiple passes, which can result in thermal osteonecrosis and various complications. To understand the heat propagation over time, a 3D finite element model was developed to simulate sequential bone drilling. By incorporating proper material properties and a modified bone necrosis criteria, this model can visualize the propagation of damaged areas. For this study, comparisons between a 2.0 mm Kirschner wire and 2.0 mm twist drill were conducted with their heat sources determined using an inverse method and experimentally measured bone temperatures. Three clinically viable solutions to reduce thermally-induced bone damage were evaluated using finite element analysis, including tool selection, time interval between passes, and different drilling sequences. Results show that the ideal solution would be using twist drills rather than Kirschner wires if the situation allows. A shorter time interval between passes was also found to be beneficial as it reduces the total heat exposure time. Lastly, optimizing the drilling sequence reduced the thermal damage of bone, but the effect may be limited. This study demonstrates the feasibility of using the proposed model to study clinical issues and find potential solutions prior to clinical trials. [ABSTRACT FROM AUTHOR]

• Elucidates geometrical features of microarchitecture in cancellous bone mechanics. • Compression testing for 5-mm cubes of bovine femoral cancellous bone. • Combinations of geometrical features accurately expressed cancellous stiffness. • Significant contribution of bifurcation characteristics to cancellous stiffness. • Contributions of trabecular shape and orientation to cancellous stiffness. This study aims to describe the geometrical features of single trabeculae and their network to explain cancellous stiffness as a representative mechanical function from a strength of materials perspective. Compression tests were performed on cancellous bone specimens dissected from a bovine femur as 5-mm cubes to measure cancellous stiffness. The microarchitecture was determined by microfocus X-ray computed tomography, and conventional morphological indicators were analyzed. The length, orientation, and bifurcation characteristics of each trabecula were analyzed by skeletonizing and linearizing the cancellous bone volume. Multiple regression analyses revealed a significant contribution made to cancellous stiffness by the compressive shape factor of the stiffness of single trabeculae, the trabecular orientation, and the bifurcation count, which evaluated the mean number of connected trabeculae at bifurcation points. Bifurcation count made the most significant contribution to cancellous stiffness. The combination of these geometrical indicators expressed the cancellous stiffness (R 2 = 0.85), which indicated as high accuracy as that explained by bone volume fraction, in specific bones that were not affected by bone disease or aging. The present study demonstrated mechanically important geometrical features of the microarchitecture and indicated their complex contributions to cancellous stiffness underlying the contribution of bone volume fraction. [Display omitted] [ABSTRACT FROM AUTHOR]

In this paper, delamination of bone associated with drilling is investigated using design of experiments. Experiments have been planned based on L 25 design of the orthogonal arrays with different conditions of drill bit, spindle speed and feed rate. Regression analysis is used to develop a mathematical model of delamination as a function of bone drilling process parameters. Analysis of variance (ANOVA) is carried out to find the significance of the developed model along with the percentage contribution of each factor on delamination. Optimum setting of bone drilling parameters for minimum delamination is determined using Taguchi optimization methodology. Finally, the results obtained are validated by conducting confirmation experiments. [ABSTRACT FROM AUTHOR]

Bone-attached robots and microstereotactic frames, intended for deep brain stimulation and minimally invasive cochlear implantation, typically attach to a patient’s skull via bone anchors. A rigid and reliable link between such devices and the skull is mandatory in order to fulfill the high accuracy demands of minimally invasive procedures while maintaining patient safety. In this paper, a method is presented to experimentally characterize the mechanical properties of the anchor–bone linkage. A custom-built universal testing machine is used to measure the pullout strength as well as the spring constants of bone anchors seated in four different bone substitutes as well as in human cranial bone. Furthermore, the angles at which forces act on the bone anchors are varied to simulate realistic conditions. Based on the experimental results, a substitute material that has mechanical properties similar to those of cranial bone is identified. The results further reveal that the pullout strength of the investigated anchor design is sufficient with respect to the proposed application. However, both the measured load capacity as well as the spring constants vary depending on the load angles. Based on these findings, an alternative bone anchor design is presented and experimentally validated. Furthermore, the results serve as a basis for stiffness simulation and optimization of bone-attached microstereotactic frames. [ABSTRACT FROM AUTHOR]

Statistical appearance models have recently been introduced in bone mechanics to investigate bone geometry and mechanical properties in population studies. The establishment of accurate anatomical correspondences is a critical aspect for the construction of reliable models. Depending on the representation of a bone as an image or a mesh, correspondences are detected using image registration or mesh morphing. The objective of this study was to compare image-based and mesh-based statistical appearance models of the femur for finite element (FE) simulations. To this aim, (i) we compared correspondence detection methods on bone surface and in bone volume; (ii) we created an image-based and a mesh-based statistical appearance models from 130 images, which we validated using compactness, representation and generalization, and we analyzed the FE results on 50 recreated bones vs. original bones; (iii) we created 1000 new instances, and we compared the quality of the FE meshes. Results showed that the image-based approach was more accurate in volume correspondence detection and quality of FE meshes, whereas the mesh-based approach was more accurate for surface correspondence detection and model compactness. Based on our results, we recommend the use of image-based statistical appearance models for FE simulations of the femur. [ABSTRACT FROM AUTHOR]

This paper demonstrates an optical segment tracking (OST) approach for assessing the in vivo bone loading regimes in humans. The relative movement between retro-reflective marker clusters affixed to the tibia cortex by bone screws was tracked and expressed as tibia loading regimes in terms of segment deformation. Stable in vivo fixation of bone screws was tested by assessing the resonance frequency of the screw-marker structure and the relative marker position changes after hopping and jumping. Tibia deformation was recorded during squatting exercises to demonstrate the reliability of the OST approach. Results indicated that the resonance frequencies remain unchanged prior to and after all exercises. The changes of Cardan angle between marker clusters induced by the exercises were rather minor, maximally 0.06°. The reproducibility of the deformation angles during squatting remained small (0.04°/m-0.65°/m). Most importantly, all surgical and testing procedures were well tolerated. The OST method promises to bring more insights of the mechanical loading acting on bone than in the past. [ABSTRACT FROM AUTHOR]

The elastic response of the knee joint in various loading and pathological conditions has been investigated using anatomically accurate geometry. However, it is still challenging to predict the poromechanical response of the knee in realistic loading conditions. In the present study, a viscoelastic, poromechanical model of the knee joint was developed for soft tissues undergoing large deformation. Cartilages and menisci were modeled as fibril-reinforced porous materials and ligaments were considered as fibril-reinforced hyperelastic solids. Quasi-linear viscoelasticty was formulated for the collagen network of these tissues and nearly incompressible Neo-Hookean hyperelasticity was used for the non-fibrillar matrix. The constitutive model was coded with a user defined FORTRAN subroutine, in order to use ABAQUS for the finite element analysis. Creep and stress relaxation were investigated with large compression of the knee in full extension. The contact pressure distributions were found similar in creep and stress relaxation. However, the load transfer in the joint was completely different in these two loading scenarios. During creep, the contact pressure between cartilages decreased but the pressure between cartilage and meniscus increased with time. This led to a gradual transfer of some loading from the central part of cartilages to menisci. During stress relaxation, however, both contact pressures decreased monotonically. [ABSTRACT FROM AUTHOR]

• Power insertion saves time during bone screw insertion. • Power insertion of bone screws at high-speed produces greater heat than low-speed. • Thermal profile of manual screw insertion is similar to high-speed power insertion. • Bone screw self-tapping flute geometry may not influence temperature generation. Power insertion of screws using high-speed saves time during operative fixation of fractures compared to manual insertion. Heat production during screw insertion may cause thermal damage at the critical bone-screw interface, reducing fixation strength, delaying healing, or increasing infection risk. Currently, the thermal impact of screw insertion is incompletely understood. This study investigated the thermal profiles of self-tapping screws at varying insertion speeds, utilizing manual versus power insertion, and with differing cutting flute geometries to determine which variables may save time while mitigating thermal injury. Thermal and mechanical force profiles were obtained during insertion of 24 mm length, 3.5 mm stainless steel screws into 50 PCF polyurethane after pre-drilling. Power insertion at low (30RPM) and high (300RPM) speed, manual screwdriver insertion versus high-speed power insertion, and two different cutting flute geometries were compared. Infrared thermography was used to measure maximum surface temperatures and mean temperature change (°C). Time (s) was measured to compare manual and power insertion. Means were compared using a two-tailed independent t -test. Maximum surface temperature of high-speed insertion (55.42 ± 5.58 °C) was significantly greater (p < 0.001) than low-speed (41.07 ± 2.33 °C). Similarly, mean temperature rise of high-speed insertion (29.52 ± 5.39 °C) was greater than that of low-speed (15.13 ± 2.63 °C) (p < 0.001). There was no statistical difference in maximum surface temperature between manually inserted screws (56.58 ± 5.53 °C) and high-speed power inserted screws (55.42 ± 5.58 °C) (p = 0.155), while insertion speeds were almost 5 times faster with high-speed power insertion (6.75 ± 1.84 s) than with manual insertion (30.3 ± 4.06 s) (p < 0.001). There were no differences detected between the geometry groups in any outcome measure tested. High speeds for screw insertion generate significantly greater maximum temperatures and greater temperature rise than slower speeds. Surprisingly, the thermal profile of manual insertion was similar to high-speed insertion, while requiring significantly longer for insertion. Low-speed insertion generated significantly lower maximal temperatures and temperature rise. Surgeons could consider utilizing low-speed when inserting orthopaedic screws with a power driver to minimize thermal impact to bone while optimizing efficiency. [ABSTRACT FROM AUTHOR]

Adjacent level vertebral fractures are common in patients with osteoporotic wedge fractures, but can theoretically be prevented with prophylactic vertebroplasty. Previous tests on prophylactic vertebroplasties have been performed under axial loading, while in vivo changes in spinal alignment likely cause off-axis loads. In this study we determined whether prophylactic vertebroplasty can also reduce the fracture risk under off-axis loads. In a previous study, we tested vertebral bodies that were loaded axially or 20° off-axis representing vertebrae in an unfractured spine or vertebrae adjacent to a wedge fracture, respectively. In the current study, vertebral failure load and stiffness of our previously tested vertebral bodies were compared to those of a new group of vertebral bodies that were filled with bone cement and then loaded 20° off-axis. These vertebral bodies represented adjacent-level vertebrae with prophylactic bone cement filling. Prophylactic augmentation resulted in failure loads that were comparable to those of the 0° group, and 32% greater than the failure loads of the 20° group. The stiffness of the prophylacticly augmented vertebrae was 21% lower than that of the 0° group, but 27% higher than that of the 20° group. We conclude that prophylactic augmentation can decrease the fracture risk in a malaligned, osteoporotic vertebra. Whether this is enough to actually prevent additional vertebral fractures in vivo remains subject of further study. [ABSTRACT FROM AUTHOR]

The in vivo quantification of rotational laxity of the knee joint is of importance for monitoring changes in joint stability or the outcome of therapies. While invasive assessments have been used to study rotational laxity, non-invasive methods are attractive particularly for assessing young cohorts. This study aimed to determine the conditions under which tibio-femoral rotational laxity can be assessed reliably and accurately in a non-invasive manner. The reliability and error of non-invasive examinations of rotational joint laxity were determined by comparing the artefact associated with surface mounted markers against simultaneous measurements using fluoroscopy in five knees including healthy and ACL deficient joints. The knees were examined at 0°, 30°, 60° and 90° flexion using a device that allows manual axial rotation of the joint. With a mean RMS error of 9.6°, the largest inaccuracy using non-invasive assessment was present at 0° knee flexion, whereas at 90° knee flexion, a smaller RMS error of 5.7° was found. A Bland and Altman assessment indicated that a proportional bias exists between the non-invasive and fluoroscopic approaches, with limits of agreement that exceeded 20°. Correction using average linear regression functions resulted in a reduction of the RMS error to below 1° and limits of agreement to less than ±1° across all knees and flexion angles. Given the excellent reliability and the fact that a correction of the surface mounted marker based rotation values can be achieved, non-invasive evaluation of tibio-femoral rotation could offer opportunities for simplified devices for use in clinical settings in cases where invasive assessments are not justified. Although surface mounted marker based measurements tend to overestimate joint rotation, and therefore joint laxity, our results indicate that it is possible to correct for this error. [ABSTRACT FROM AUTHOR]

Abstract: Finite element models of bones can be created by deriving geometry from an X-ray CT scan. Material properties such as the elastic modulus can then be applied using either a single or set of homogeneous values, or individual elements can have local values mapped onto them. Values for the elastic modulus can be derived from the CT density values using an elasticity versus density relationship. Many elasticity–density relationships have been reported in the literature for human bone. However, while ovine in vivo models are common in orthopaedic research, no work has been done to date on creating FE models of ovine bones. To create these models and apply relevant material properties, an ovine elasticity–density relationship needs to be determined. Using fresh frozen ovine tibias the apparent density of regions of interest was determined from a clinical CT scan. The bones were the sectioned into cuboid samples of cortical bone from the regions of interest. Ultrasound was used to determine the elastic modulus in each of three directions – longitudinally, radially and tangentially. Samples then underwent traditional compression testing in each direction. The relationships between apparent density and both ultrasound, and compression modulus in each direction were determined. Ultrasound testing was found to be a highly repeatable non-destructive method of calculating the elastic modulus, particularly suited to samples of this size. The elasticity–density relationships determined in the longitudinal direction were very similar between the compression and ultrasound data over the density range examined. A clear difference was seen in the elastic modulus between the longitudinal and transverse directions of the bone samples, and a transverse elasticity–density relationship is also reported. [Copyright &y& Elsevier]

Abstract: This paper presents a method of improving the accuracy of the tridimensional reconstruction of human bone biomodels by means of tomography, with a view to finite element modelling or surgical planning, and the subsequent manufacturing using rapid prototyping technologies. It is focused on the analysis and correction of the results obtained by means of cone beam computed tomography (CBCT), which is used to digitalize non-superficial biological parts along with a gauge part with calibrated dimensions. A correction of both the threshold and the voxel size in the tomographic images and the final reconstruction is proposed. Finally, a comparison between a reconstruction of a gauge part using the proposed method and the reconstruction of that same gauge part using a standard method is shown. The increase in accuracy in the biomodel allows an improvement in medical applications based on image diagnosis, more accurate results in computational modelling, and improvements in surgical planning in situations in which the required accuracy directly affects the procedure's results. Thus, the subsequent constructed biomodel will be affected mainly by dimensional errors due to the additive manufacturing technology utilized, not because of the 3D reconstruction or the image acquisition technology. [Copyright &y& Elsevier]

Abstract: Introduction: This study compared the initial viscoelastic properties of a segmental tibial defect stabilized with intramedullary nailing and impaction bone grafting to that of a transverse fracture stabilized with intramedullary nailing. Materials and methods: Seven sheep tibiae were tested in compression (1000N), bending and torsion (6Nm) in a six degree-of-freedom hexapod robot. Tests were repeated across three groups: intact tibia (Intact), transverse fracture stabilized by intramedullary nailing (Fracture), and segmental defect stabilized with a nail and impaction bone grafting (Defect). Repeated measures ANOVA on the effect of group on stiffness/phase angle were conducted for each loading direction. Results: The Intact group was significantly stiffer than the Fracture and Defect groups in bending and torsion (p <0.022 for both loading directions), and was marginal for the Defect group in compression (p =0.052). No significant differences were found between the Fracture and Defect groups (p >0.246 for all loading directions) for stiffness/phase angle. In compression and bending, phase angles were significantly greater for the Fracture and Defect groups compared to Intact (p <0.025), with no significant differences between groups in torsion (p =0.13). Sensitivity analyses conducted between the Fracture and Defect group differences found that they were not of clinical significance. Conclusion: The initial properties of a segmental defect stabilized with intramedullary nailing and impaction bone grafting was not clinically significantly different to that of a transverse fracture stabilized with intramedullary nailing. [Copyright &y& Elsevier]

Abstract: We observed an anomaly in the human electroencephalogram (EEG) associated with exposure to terrestrial trunked radio (TETRA) Radiofrequency Fields (RF). Here, we characterize the time and frequency components of the anomaly and demonstrate that it is an artefact caused by TETRA RF interfering with the EEG recording equipment and not by any direct or indirect effect on the brain. [Copyright &y& Elsevier]

Abstract: The objective of the study was to obtain helmet-to-head contact forces from experiments, use a human head finite element model to determine regional responses, and compare outputs to skull fracture and brain injury thresholds. Tests were conducted using two types of helmets (A and B) fitted to a head-form. Seven load cells were used on the head-form back face to measure helmet-to-head contact forces. Projectiles were fired in frontal, left, right, and rear directions. Three tests were conducted with each helmet in each direction. Individual and summated force- and impulse-histories were obtained. Force-histories were inputted to the human head–helmet finite element model. Pulse durations were approximately 4ms. One-third force and impulse were from the central load cell. 0.2% strain and 40MPa stress limits were not exceeded for helmet-A. For helmet-B, strains exceeded in left, right, and rear; pressures exceeded in bilateral directions; volume of elements exceeding 0.2% strains correlated with the central load cell forces. For helmet-A, volumes exceeding brain pressure threshold were: 5–93%. All elements crossed the pressure limit for helmet-B. For both helmets, no brain elements exceeded peak principal strain limit. These findings advance our understanding of skull and brain biomechanics from helmet–head contact forces. [Copyright &y& Elsevier]

Abstract: Bone sawing simulators with force feedback represent a cost effective means of training orthopedic surgeons in various surgical procedures, such as total knee arthroplasty. To develop a machine with accurate haptic feedback, giving a sensation of both cutting force and rate of material removal, algorithms are required to forecast bone sawing forces based on user input. Presently, studies on forces generated while machining bone are not representative of the high cutting speeds and low depths of cut common to the bone sawing process. The objective of this research was to quantify sawing forces in cortical bone as a function of blade speed and depth of cut. A fixture was developed to simulate linear bone sawing over a range of speeds comparable to surgical reciprocating and oscillating (sagittal) bone saws. A single saw blade tooth was isolated and used to create a slotted cut in bovine cortical bone. Over a range in linear sawing speed from 1700 to 7000mm/s, a t-test (α =0.05) revealed there was no statistically significant effect of blade speed on either cutting or thrust force. However, an increase in depth of cut from 2 to 10μm resulted in a 30% increase in thrust force, while cutting force remained constant. The increase in thrust force with depth of cut was relatively linear, R 2 =0.80. Using a two factor, two level design of experiments approach, regression equations were developed to relate sawing forces to changes in blade speed and depth of cut. These equations can be used to predict forces in a haptic feedback model. [Copyright &y& Elsevier]

Abstract: During knee flexion, the muscles of the upper leg impose various loads on the underlying femoropopliteal artery resulting in radial compression, bending, torsion, axial extension and axial compression. Measuring the dynamic force environment of the femoropopliteal artery and quantifying its resulting deformation characteristics is an essential input to peripheral device design. The goal of this study was to create an anatomically accurate, three dimensional finite element model capable of capturing the loading conditions and deformation characteristics of the femoropopliteal artery during knee flexion. Three dimensional geometries of the muscle, bone, arterial and soft tissues of the leg were constructed from CT scan data and meshed for finite element analysis. Knee flexion was simulated and deformation characteristics of length change (axial compression), curvature, radial compression and axial twist were quantified and compared to previous experimental studies. The model predicts 8.23% shortening and an average curvature of 0.294±0.26cm−1 in the vessel after knee flexion, with maximum stresses of 61.17kPa and maximum strains of 0.16%. The model created replicates known in vivo deformation characteristics seen previously in angiographic images and for the first time associates femoropopliteal artery deformation characteristics with stress and strain levels within the arterial tissue. [Copyright &y& Elsevier]

Abstract: Precise diagnosis of loosening of endoprosthetic implants plays an important role in timely, adequate treatment. However, today's diagnostic tools, mainly radiological evaluation, do not yield satisfactory results. Therefore, a new approach based on the transmission of an internally generated combined acoustic and vibration signal, was investigated. For signal generation, a magnetic oscillator which impinges inside an implant component, can be used. The signal can be detected by an external accelerometer being positioned on the skin surface. Differences in the signal generated result from varying degrees of implant fixation. This principle was tested in seven porcine foreleg specimens with a custom implant. Influence of the measurement location at the porcine skin and different levels of fixation were investigated (pressfit, slight loosening, advanced loosening), with regard to the pull-out strength. Evaluation of different parameters, especially the frequency spectrum resulted in differences of up to 12% for the comparison between pressfit and slight loosening, and 30% between pressfit and advanced loosening. A significant correlation between the measured frequency and the pull-out strength for different levels of fixation was found. Thus, the novel diagnostic method shows potential for the precise detection of implant loosening. Further work is required to determine the sensitivity and specificity of the proposed system in animal experiments. [Copyright &y& Elsevier]

Abstract: Anthropometric tables are not applicable to calculate the scoliotic trunk mass and center of mass (COM). The purposes of this study were: (1) to estimate the head and trunk mass and COM in able-bodied and scoliotic girls using a force plate method, (2) to estimate head and trunk COM offset compared to those of the body, and (3) the use of mean ratios to estimate the head and trunk COM calculated in this study and that calculated according to a conventional three-dimensional (3D) method compared to the measured values. Twenty-one scoliotic and twenty able-bodied girls participated. The subjects stood upright with arms beside the trunk on a force plate that collected data at 60Hz for a period of 5s. The anteroposterior and mediolateral positions of the body COM were obtained from the mean center of pressure values. The height of the body COM was estimated by the reaction board method. Afterwards a body segment was displaced and changes in force plate readings were recorded and applied to estimate the head and trunk mass and COM. Trunk offset was defined as the difference between the COM of the body and head and trunk. The measured head and trunk COM was compared to values obtained by the mean ratios calculated from this study and given by the conventional 3D method. The relative head and trunk mass and the anteroposterior trunk offset were larger in scoliotic girls. The force plate method gave similar results to measured COM values for both groups underlying its capability to provide a more accurate estimation of COM related values. Thus, the use of mean ratios of 0.5538 and 0.6438 obtained in this study to estimate the head and trunk mass and COM position in scoliotic girls can overcome the main drawbacks of current anthropometric methods, if direct measurements cannot be taken. [Copyright &y& Elsevier]

Abstract: The stress distribution and plastic deformation of peri-prosthetic trabecular bone during press-fit tibial component implantation in total knee arthroplasty is investigated using experimental and finite element techniques. It is revealed that the computed stress distribution, implantation force and plastic deformation in the trabecular bone is highly dependent on the plasticity formulation implemented. By incorporating pressure dependent yielding using a crushable foam plasticity formulation to simulate the trabecular bone during implantation, highly localised stress concentrations and plastic deformation are computed at the bone–implant interface. If the pressure dependent yield is neglected using a traditional von Mises plasticity formulation, a significantly different stress distribution and implantation force is computed in the peri-prosthetic trabecular bone. The results of the study highlight the importance of: (i) simulating the insertion process of press-fit stem implantation; (ii) implementing a pressure dependent plasticity formulation, such as the crushable foam plasticity formulation, for the trabecular bone; (iii) incorporating friction at the implant–bone interface during stem insertion. Simulation of the press-fit implantation process with an appropriate pressure dependent plasticity formulation should be implemented in the design and assessment of arthroplasty prostheses. [Copyright &y& Elsevier]

Abstract: The aim of this study was to evaluate the ability of dual energy X-rays absorptiometry (DXA) areal bone mineral density (aBMD) measured in different regions of the proximal part of the human femur for predicting the mechanical properties of matched proximal femora tested in two different loading configurations. 36 pairs of fresh frozen femora were DXA scanned and tested until failure in two loading configurations: a fall on the side or a one-legged standing. The ability of the DXA output from four different regions of the proximal femur in predicting the femoral mechanical properties was measured and compared for the two loading scenarios. The femoral neck DXA BMD was best correlated to the femoral ultimate force for both configurations and predicted significantly better femoral failure load (R 2 =0.80 vs. R 2 =0.66, P <0.05) when simulating a side than when simulating a standing configuration. Conversely, the work to failure was predicted similarly for both loading configurations (R 2 =0.54 vs. R 2 =0.53, P >0.05). Therefore, neck BMD should be considered as one of the key factors for discriminating femoral fracture risk in vivo. Moreover, the better predictive ability of neck BMD for femoral strength if tested in a fall compared to a one-legged stance configuration suggests that DXA's clinical relevance may not be as high for spontaneous femoral fractures than for fractures associated to a fall. [Copyright &y& Elsevier]