Computational Techniques to Predict Orthopaedic Implant Alignment and Fit in Bone

Among the broad palette of surgical techniques employed in the current orthopaedic practice, joint replacement represents one of the most difficult and costliest surgical procedures. While numerous recent advances suggest that computer assistance can dramatically improve the precision and long term outcomes of joint arthroplasty even in the hands of experienced surgeons, many of the joint replacement protocols continue to rely almost exclusively on an empirical basis that often entail a succession of trial and error maneuvers that can only be performed intraoperatively. Although the surgeon is generally unable to accurately and reliably predict a priori what the final malalignment will be or even what implant size should be used for a certain patient, the overarching goal of all arthroplastic procedures is to ensure that an appropriate match exists between the native and prosthetic axes of the articulation. To address this relative lack of knowledge, the main objective of this thesis was to develop a comprehensive library of numerical techniques capable to: 1) accurately reconstruct the outer and inner geometry of the bone to be implanted; 2) determine the location of the native articular axis to be replicated by the implant; 3) assess the insertability of a certain implant within the endosteal canal of the bone to be implanted; 4) propose customized implant geometries capable to ensure minimal malalignments between native and prosthetic axes. The accuracy of the developed algorithms was validated through comparisons performed against conventional methods involving either contact-acquired data or navigated implantation approaches, while various customized implant designs proposed were tested with an original numerical implantation method. It is anticipated that the proposed computer-based approaches will eliminate or at least diminish the need for undesirable trial and error implantation procedures in a sense that present error-prone intraoperative implant insertion decisions will be at least augmented if not even replaced by optimal computer-based solutions to offer reliable virtual “previews” of the future surgical procedure. While the entire thesis is focused on the elbow as the most challenging joint replacement surgery, many of the developed approaches are equally applicable to other upper or lower limb articulations

A virtual environment for the modelling, simulation and manufacturing of orthopaedic devices

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The objective of this work is to investigate whether the game physics based modelling is accurate enough to be used in modelling the motion of the human body, in particular musculoskeletal motion. Hitherto, the implementation of game physics in the medical field focused only on anatomical representation for education and training purposes. Introducing gaming platforms and physics engines into orthopaedics applications will help to overcome several difficulties encountered in the modelling of articular joints. Implementing a physics engine (PhysX), which is mainly designed for video games, handles intensive computations in optimized ways at an interactive speed. In this study, the capabilities of the physics engine (PhysX) and gaming platform for modelling and simulating articular joints are evaluated. First, a preliminary validation is carried out for mechanical systems with analytical solutions, before constructing the musculoskeletal model to evaluate the consistency of gaming platforms. The developed musculoskeletal model deals with the human joint as an unconstrained system with 6 DOF which is not available with other joint modeller. The model articulation is driven by contact surfaces and the stiffness of surrounding tissues. A number of contributions, such as contact modelling and muscle wrapping, have been made in this research to overcome some existing challenges in joint modelling. Using muscle segmentation, the proposed technique effectively handles the problem of muscle wrapping, a major concern for many; thus the shortest path and line of action are no longer problematic. Collision behaviour has also shown a stable response for colliding as well as resting objects, provided that it is based on the principles of surface properties and the conservation of linear and angular momentums. The precision of collision detection and response are within an acceptable tolerance controllable by varying the mesh density. An image based analysis system is developed in this thesis, mainly in order to validate the proposed physics based modelling solution. This minimally invasive method is based on the analysis of marker positions located at bony positions with minimal skin movement. The image based system overcomes several challenges associated with the currently existing methods, such as inaccuracy, complication, impracticability and cost. The analysis part of this research has considered the elbow joint as a case study to investigate and validate the proposed physics based model. Beside the interactive 3D simulation, the obtained results are validated by comparing them with the image based system developed within the current research to investigate joint kinematics and laxity and also with published material, MJM and results from experiments performed at the Brunel Orthopaedic Research and Learning Centre. The proposed modelling shows the advantageous speed, reliability and flexibility of the proposed model. It is shown that the gaming platform and physics engine provide a viable solution to human musculoskeletal modelling. Finally, this thesis considers an extended implementation of the proposed platform for testing and assessing the design of custom-made implants, to enhance joint performance. The developed simulation software is expected to give indicative results as well as testing different types of prosthetic implant. Design parameterization and sensitivity analysis for geometrical features are discussed. Thus, an integrated environment is proposed to link the real-time simulation software with a manufacturing environment so as to assist the production of patient specific implants by rapid manufacturing

A novel musculoskeletal joint modelling for orthopaedic applications

This thesis was submitted for the degree of Docter of Philosophy and awarded by Brunel University.The objective of the work carried out in this thesis was to develop analytical and computational tools to model and investigate musculoskeletal human joints. It was recognised that the FEA was used by many researchers in modelling human musculoskeletal motion, loading and stresses. However the continuum mechanics played only a minor role in determining the articular joint motion, and its value was questionable. This is firstly due to the computational cost and secondly due to its impracticality for this application. On the other hand, there isn’t any suitable software for precise articular joint motion analysis to deal with the local joint stresses or non standard joints. The main requirement in orthopaedics field is to develop a modeller software (and its associated theories) to model anatomic joint as it is, without any simplification with respect to joint surface morphology and material properties of surrounding tissues. So that the proposed modeller can be used for evaluating and diagnosing different joint abnormalities but furthermore form the basis for performing implant insertion and analysis of the artificial joints. The work which is presented in this thesis is a new frame work and has been developed for human anatomic joint analysis which describes the joint in terms of its surface geometry and surrounding musculoskeletal tissues. In achieving such a framework several contributions were made to the 6DOF linear and nonlinear joint modelling, the mathematical definition of joint stiffness, tissue path finding and wrapping and the contact with collision analysis. In 6DOF linear joint modelling, the contribution is the development of joint stiffness and damping matrices. This modelling approach is suitable for the linear range of tissue stiffness and damping properties. This is the first of its kind and it gives a firm analytical basis for investigating joints with surrounding tissue and the cartilage. The 6DOF nonlinear joint modelling is a new scheme which is described for modelling the motion of multi bodies joined by non-linear stiffness and contact elements. The proposed method requires no matrix assembly for the stiffness and damping elements or mass elements. The novelty in the nonlinear modelling, relates to the overall algorithmic approach and handling local non-linearity by procedural means. The mathematical definition of joint stiffness is also a new proposal which is based on the mathematical definition of stiffness between two bodies. Based on the joint stiffness matrix properties, number of joint stiffness invariants was obtained analytically such as the centre of stiffness, the principal translational stiffnesses, and the principal rotational stiffnesses. In corresponding to these principal stiffnesses, their principal axes have been also obtained. Altogether, a joint is assessed by six principal axes and six principal stiffnesses and its centre of stiffness. These formulations are new and show that a joint can be described in terms of inherent stiffness properties. It is expected that these will be better in characterising a joint in comparison to laxity based characterisation. The development of tissue path finding and wrapping algorithms are also introduced as new approaches. The musculoskeletal tissue wrapping involves calculating the shortest distance between two points on a meshed surface. A new heuristic algorithm was proposed. The heuristic is based on minimising the accumulative divergence from the straight line between two points on the surface and the direction of travel on the surface (i.e. bone). In contact and collision based development, the novel algorithm has been proposed that detects possible colliding points on the motion trajectory by redefining the distance as a two dimensional measure along the velocity approach vector and perpendicular to this vector. The perpendicular distance determines if there are potentially colliding points, and the distance along the velocity determines how close they are. The closest pair among the potentially colliding points gives the “time to collision”. The algorithm can eliminate the “fly pass” situation where very close points may not collide because of the direction of their relative velocity. All these developed algorithms and modelling theories, have been encompassed in the developed prototype software in order to simulate the anatomic joint articulations through modelling formulations developed. The software platform provides a capability for analysing joints as 6DOF joints based on anatomic joint surfaces. The software is highly interactive and driven by well structured database, designed to be highly flexible for the future developments. Particularly, two case studies are carried out in this thesis in order to generate results relating to all the proposed elements of the study. The results obtained from the case studies show good agreement with previously published results or model based results obtained from Lifemod software, whenever comparison was possible. In some cases the comparison was not possible because there were no equivalent results; the results were supported by other indicators. The modelling based results were also supported by experiments performed in the Brunel Orthopaedic Research and Learning Centre

A novel musculoskeletal joint modelling for orthopaedic applications

The objective of the work carried out in this thesis was to develop analytical and computational tools to model and investigate musculoskeletal human joints. It was recognised that the FEA was used by many researchers in modelling human musculoskeletal motion, loading and stresses. However the continuum mechanics played only a minor role in determining the articular joint motion, and its value was questionable. This is firstly due to the computational cost and secondly due to its impracticality for this application. On the other hand, there isn’t any suitable software for precise articular joint motion analysis to deal with the local joint stresses or non standard joints. The main requirement in orthopaedics field is to develop a modeller software (and its associated theories) to model anatomic joint as it is, without any simplification with respect to joint surface morphology and material properties of surrounding tissues. So that the proposed modeller can be used for evaluating and diagnosing different joint abnormalities but furthermore form the basis for performing implant insertion and analysis of the artificial joints. The work which is presented in this thesis is a new frame work and has been developed for human anatomic joint analysis which describes the joint in terms of its surface geometry and surrounding musculoskeletal tissues. In achieving such a framework several contributions were made to the 6DOF linear and nonlinear joint modelling, the mathematical definition of joint stiffness, tissue path finding and wrapping and the contact with collision analysis. In 6DOF linear joint modelling, the contribution is the development of joint stiffness and damping matrices. This modelling approach is suitable for the linear range of tissue stiffness and damping properties. This is the first of its kind and it gives a firm analytical basis for investigating joints with surrounding tissue and the cartilage. The 6DOF nonlinear joint modelling is a new scheme which is described for modelling the motion of multi bodies joined by non-linear stiffness and contact elements. The proposed method requires no matrix assembly for the stiffness and damping elements or mass elements. The novelty in the nonlinear modelling, relates to the overall algorithmic approach and handling local non-linearity by procedural means. The mathematical definition of joint stiffness is also a new proposal which is based on the mathematical definition of stiffness between two bodies. Based on the joint stiffness matrix properties, number of joint stiffness invariants was obtained analytically such as the centre of stiffness, the principal translational stiffnesses, and the principal rotational stiffnesses. In corresponding to these principal stiffnesses, their principal axes have been also obtained. Altogether, a joint is assessed by six principal axes and six principal stiffnesses and its centre of stiffness. These formulations are new and show that a joint can be described in terms of inherent stiffness properties. It is expected that these will be better in characterising a joint in comparison to laxity based characterisation. The development of tissue path finding and wrapping algorithms are also introduced as new approaches. The musculoskeletal tissue wrapping involves calculating the shortest distance between two points on a meshed surface. A new heuristic algorithm was proposed. The heuristic is based on minimising the accumulative divergence from the straight line between two points on the surface and the direction of travel on the surface (i.e. bone). In contact and collision based development, the novel algorithm has been proposed that detects possible colliding points on the motion trajectory by redefining the distance as a two dimensional measure along the velocity approach vector and perpendicular to this vector. The perpendicular distance determines if there are potentially colliding points, and the distance along the velocity determines how close they are. The closest pair among the potentially colliding points gives the “time to collision”. The algorithm can eliminate the “fly pass” situation where very close points may not collide because of the direction of their relative velocity. All these developed algorithms and modelling theories, have been encompassed in the developed prototype software in order to simulate the anatomic joint articulations through modelling formulations developed. The software platform provides a capability for analysing joints as 6DOF joints based on anatomic joint surfaces. The software is highly interactive and driven by well structured database, designed to be highly flexible for the future developments. Particularly, two case studies are carried out in this thesis in order to generate results relating to all the proposed elements of the study. The results obtained from the case studies show good agreement with previously published results or model based results obtained from Lifemod software, whenever comparison was possible. In some cases the comparison was not possible because there were no equivalent results; the results were supported by other indicators. The modelling based results were also supported by experiments performed in the Brunel Orthopaedic Research and Learning Centre.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

In vivo mechanical assessment of human elbow kinematics using a six axis parallel mechanism developed in house

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel UniversityElbow joint laxity is a problem that normally comes with age; it increases up to critical levels due to rupture or damage to the ligaments of the elbow and affects the stability and capacities of the joint, interfering even with daily activities. This work investigates the kinematics of the elbow through in-vivo experimental measurement. To this end, a platform based on Stewart Platform mechanism was built and used at the bioengineering labs of Brunel University in West London, the UK, to measure the six degrees of freedom of the joint. This thesis aims to develop a method to simulate such motion which could be used for elbow implant design and manufacture. This work contributes to both the basic science of joint movement measurement and to the clinical applications of diagnosing elbow illness. In addition this research presents the preliminary results for a design for elbow implants. Tracking system developed in house was used to measure the degrees of freedom in healthy elbow motion. A pilot study was performed to assess the joint motion and its repeatability. A group of volunteers with normal elbow movement was used to carry out this study. A Stewart Platform mechanism based on the tracking system was used in this study as a non-invasive tool to capture elbow joint motion and track the trajectory and pattern of the motion in three-dimensional space. This thesis aimed to develop a method to simulate the elbow joint motion that could potentially be used for the elbow implants design and there manufacture. The goal of this study was achieved by in vivo measurement of the elbow movement. It was found that the results vary from person to person, but a healthy pattern of motion can be distinguished from an abnormal pattern. To ensure the result, the motion of the right and left hand of each person was compared,allowing the behaviour of the elbow motion to be judged and the results can help surgeons to analyze the motion of the elbow joint and follow up suspicions of abnormal behaviour in the joint or trace any possible joint laxity. Furthermore, the errors involved with the mechanism were calculated and appropriate factors were applied to correct them. As part of this study the manufacturing of medical implants was reviewed and discussed.Public Authority for Applied Education and Training (PAAET) in the State of Kuwait

Functional Design and Analysis of a Linked Shoulder Prosthesis

Persistent shoulder instability following joint arthroplasty remains a concern with mixed outcomes following clinical and surgical intervention. Thus, a linked universal joint implant was developed and functionally analyzed. A virtual model of the linked implant was developed and implanted in a 3D bony specimen to measure the available circumduction range of motion. Stresses in the implant were estimated using finite element analysis based on joint loads during activities of daily life. The glenoid fixation stress was evaluated using finite element analysis. The implant was capable of restoring normal range of motion, and withstanding expected joint loads without yield or fatigue failure. Bone fixation stress remains a concern, depending on the implant configuration and aggressive joint loading

An Image-Based Tool to Examine Joint Congruency at the Elbow

Post-traumatic osteoarthritis commonly occurs as a result of a traumatic event to the articulation. Although the majority of this type of arthritis is preventable, the sequence and mechanism of the interaction between joint injury and the development of osteoarthritis (OA) is not well understood. It is hypothesized that alterations to the joint alignment can cause excessive and damaging wear to the cartilage surfaces resulting in OA. The lack of understanding of both the cause and progression of OA has contributed to the slow development of interventions which can modify the course of the disease. Currently, there have been no reported techniques that have been developed to examine the relationship between joint injury and joint alignment. Therefore, the objective of this thesis was to develop a non-invasive image-based technique that can be used to assess joint congruency and alignment of joints undergoing physiologic motion. An inter-bone distance algorithm was developed and validated to measure joint congruency at the ulnohumeral joint of the elbow. Subsequently, a registration algorithm was created and its accuracy was assessed. This registration algorithm registered 3D reconstructed bone models obtained using x-ray CT to motion capture data of cadaveric upper extremities undergoing simulated elbow flexion. In this way, the relative position and orientation of the 3D bone models could be visualized for any frame of motion. The effect of radial head arthroplasty was used to illustrate the utility of this technique. Once this registration was refined, the inter-bone distance algorithm was integrated to be able to visualize the joint congruency of the ulnohumeral joint undergoing simulated elbow flexion. The effect of collateral ligament repair was examined. This technique proved to be sensitive enough to detect large changes in joint congruency in spite of only small changes in the motion pathways of the ulnohumeral joint following simulated ligament repair. Efforts were also made in this thesis to translate this research into a clinical environment by examining CT scanning protocols that could reduce the amount of radiation exposure required to image patient’s joints. For this study, the glenohumeral joint of the shoulder was examined as this joint is particularly sensitive to potential harmful effects of radiation due to its proximity to highly radiosensitive organs. Using the CT scanning techniques examined in this thesis, the effective dose applied to the shoulder was reduced by almost 90% compared to standard clinical CT imaging. In summary, these studies introduced a technique that can be used to non-invasively and three-dimensionally examine joint congruency. The accuracy of this technique was assessed and its ability to predict regions of joint surface interactions was validated against a gold standard casting approach. Using the techniques developed in this thesis the complex relationship between injury, loading and mal-alignment as contributors to the development and progression of osteoarthritis in the upper extremity can be examined

To repair, reconstruct, replace & reduce: upper limb injuries amongst other orthopaedic problems

Injuries of the limbs are very common from many different causes, and can be devastating to the patient as it may lead to a range of functional deficits which unless managed properly, can result in death or loss of the limb. Injuries to the limb can be treated by skilful neglect or by performing various surgical procedures, ranging from simple debridement to complex reconstructive procedures or replacement of the defective part. Challenges in treating limb injuries include limited availability of operating theatre time for general anaesthesia, but for hand injuries this can sometimes be overcome by using local anaesthesia. Although there are problems with the use of local anaesthesia, there are ways to resolve these problems. The injured limb is often swollen, obscuring landmarks which locate the site of surgical incision. Sometimes direct repair of the injured part may not be possible, and the use of parts harvested from the patient may be required. It is important to know if the length of the harvested parts is adequate, and this can be estimated using a mathematical formula. The outcome of the treatment also has to be assessed to determine if the patient has improved following treatment. While injury can be caused by accidents, it can also be the result of improper use of a daily object, improper posture, and repetitive use of office equipment. Although rare, injuries can also be inflicted by the patient for various reasons. These self-inflicted injuries can mimic other pathological conditions, and could lead to a wrong diagnosis if not recognized. Injuries can also result in ganglion cyst, a benign condition which can occur in rare locations such as the proximal interphalangeal joint. Besides that, injuries from plant thorns and cat bites can result in fungal infections whereas squamous cell carcinoma of the nailbed is believed to be related to preceding trauma. Injuries that occur at the office are usually musculoskeletal disorders and can be prevented by proper measures. Exercises can help prevent and treat musculoskeletal disorders. Joints that cannot be repaired need to be replaced using joint prosthesis and the commonly used joint prosthesis are for the knee and hip. The use of different materials and configurations can affect the rate of wear and tear as well as loosening of the prosthesis. Meanwhile, understanding of the forces acting on the femoral femur bone is essential in developing a good prosthesis for the hip, whereas finite element analysis is used to study the stress acting on the bone. While the treatment of injuries is important, the prevention of injuries should be given just as much attention and importance. Injuries caused by motor vehicle accidents can be prevented by understanding the injury mechanism and by developing preventive strategies. This may be aided by the use of computer simulation using finite element models and crash test dummies which can help in understanding the mechanism of injury and designing better safety devices. Hence the study of limb injuries and musculoskeletal disorders is diverse in its requirements for solutions that range from treatment as well as prevention

Virtual Reality Based Environment for Orthopedic Surgery (Veos)

The traditional way of teaching surgery involves students observing a �live� surgery and then gradually assisting experienced surgeons. The creation of a Virtual Reality environment for orthopedic surgery (VEOS) can be beneficial in improving the quality of training while decreasing the time needed for training. Developing such virtual environments for educational and training purposes can supplement existing approaches. In this research, the design and development of a virtual reality based environment for orthopedic surgery is described. The scope of the simulation environment is restricted to an orthopedic surgery process known as Less Invasive Stabilization System (LISS) surgery. The primary knowledge source for the LISS surgical process was Miguel A. Pirela-Cruz (Head of Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center (TTHSC)). The VEOS was designed and developed on a PC based platform. The developed VEOS was validated through interactions with surgical residents at TTHSC. Feedback from residents and our collaborator Miguel A. Pirela-Cruz was used to make necessary modifications to the surgical environment.Industrial Engineering & Managemen

Robotic implantation of intracerebral electrodes for deep brain stimulation

Dissertação de mestrado integrado em Engenharia BiomédicaThe objective of this dissertation is to develop an initial approach of a robotic system to play an assistive role in Deep Brain Stimulation (DBS) stereotactic neurosurgery. The robot is expected to position and manipulate several surgical instrumentation in a passive or semi-active role according to pre-operative directives and to medical team instructions. The current impact of neurological disorders sensitive to DBS, the underlying knowledge of neurostimulation and neuroanatomy, and practical insight about DBS surgery is studied to understand the ultimate goal of our project. We elaborated a state of the art search on neurosurgery robots to get the picture of what was done and what could be improved. Upon determining the optimal robotic system characteristics for DBS surgery, we conducted a search on industrial robotic manipulators to select the best candidates. The geometric and differential kinematic equations are developed for each robotic manipulator. To test the kinematic equations and the control application in a virtual operating room environment, we used the CoopDynSim simulator. Being this simulator oriented to mobile robots, we introduced the serial manipulator concept and implemented the selected robots with all specifications. We designed a control application to manoeuvre the robot and devised an initial interface towards positioning/manipulation of instrumentation along surgical trajectories, while emphasizing safety procedures. Although it was impossible to assess the robot’s precision in simulation, we studied how and where to place the manipulator to avoid collisions with surrounding equipment without restricting its flexibility.O objectivo desta dissertação é o desenvolvimento de uma abordagem inicial a um sistema robótico para desempenhar um papel de assistência em neurocirurgia estereotáxica de Estimulação Cerebral Profunda (DBS). O robô deve posicionar e manipular variados instrumentos cirúrgicos de uma forma passiva ou semi-ativa de acordo com diretivas pré-operativas ou com as instruções da equipa médica. O impacto atual dos distúrbios neurológicos sensíveis a DBS, o conhecimento subjacente de neuro-estimulação e neuro-anatomia, e conhecimento prático sobre a cirurgia de DBS são estudados para concluir sobre o objectivo final do nosso projeto. Nós elaborámos uma pesquisa sobre o estado da arte em robots neurocirúrgicos para perceber o que tem sido feito e o que pode ser melhorado. Após determinar o conjunto óptimo de características de um sistema robótico para cirurgia de DBS, nós procuramos manipuladores robóticos industriais para escolher os melhores candidatos. As cinemáticas geométricas e diferenciais são desenvolvidas para cada manipulador robótico. Para testar as equações cinemáticas e a aplicação de controlo num ambiente virtual de uma sala de operações, nós usamos o simulador CoopDynSim. Sendo este manipulador orientado a robôs móveis, nós introduzimos o conceito de manipuladores em série e implementamos os robôs selecionados com todas as especificações. Nós projetamos uma aplicação de controlo para manobrar os robôs e desenvolvemos uma interface inicial no sentido do posicionamento/manipulação de instrumentação ao longo de trajetórias cirúrgicas, enfatizando os procedimentos de segurança. Embora não tenha sido possível avaliar a precisão do robô em simulação, nós estudamos como e onde posicionar o manipulador de forma a evitar colisões com o equipamento circundante sem restringir a sua flexibilidade