Articular human joint modelling

Copyright @ Cambridge University Press 2009.The work reported in this paper encapsulates the theories and algorithms developed to drive the core analysis modules of the software which has been developed to model a musculoskeletal structure of anatomic joints. Due to local bone surface and contact geometry based joint kinematics, newly developed algorithms make the proposed modeller different from currently available modellers. There are many modellers that are capable of modelling gross human body motion. Nevertheless, none of the available modellers offer complete elements of joint modelling. It appears that joint modelling is an extension of their core analysis capability, which, in every case, appears to be musculoskeletal motion dynamics. It is felt that an analysis framework that is focused on human joints would have significant benefit and potential to be used in many orthopaedic applications. The local mobility of joints has a significant influence in human motion analysis, in understanding of joint loading, tissue behaviour and contact forces. However, in order to develop a bone surface based joint modeller, there are a number of major problems, from tissue idealizations to surface geometry discretization and non-linear motion analysis. This paper presents the following: (a) The physical deformation of biological tissues as linear or non-linear viscoelastic deformation, based on spring-dashpot elements. (b) The linear dynamic multibody modelling, where the linear formulation is established for small motions and is particularly useful for calculating the equilibrium position of the joint. This model can also be used for finding small motion behaviour or loading under static conditions. It also has the potential of quantifying the joint laxity. (c) The non-linear dynamic multibody modelling, where a non-matrix and algorithmic formulation is presented. The approach allows handling complex material and geometrical nonlinearity easily. (d) Shortest path algorithms for calculating soft tissue line of action geometries. The developed algorithms are based on calculating minimum ‘surface mass’ and ‘surface covariance’. An improved version of the ‘surface covariance’ algorithm is described as ‘residual covariance’. The resulting path is used to establish the direction of forces and moments acting on joints. This information is needed for linear or non-linear treatment of the joint motion. (e) The final contribution of the paper is the treatment of the collision. In the virtual world, the difficulty in analysing bodies in motion arises due to body interpenetrations. The collision algorithm proposed in the paper involves finding the shortest projected ray from one body to the other. The projection of the body is determined by the resultant forces acting on it due to soft tissue connections under tension. This enables the calculation of collision condition of non-convex objects accurately. After the initial collision detection, the analysis involves attaching special springs (stiffness only normal to the surfaces) at the ‘potentially colliding points’ and motion of bodies is recalculated. The collision algorithm incorporates the rotation as well as translation. The algorithm continues until the joint equilibrium is achieved. Finally, the results obtained based on the software are compared with experimental results obtained using cadaveric joints

Soft tissue structure modelling for use in orthopaedic applications and musculoskeletal biomechanics

We present our methodology for the three-dimensional anatomical and geometrical description of soft tissues, relevant for orthopaedic surgical applications and musculoskeletal biomechanics. The technique involves the segmentation and geometrical description of muscles and neurovascular structures from high-resolution computer tomography scanning for the reconstruction of generic anatomical models. These models can be used for quantitative interpretation of anatomical and biomechanical aspects of different soft tissue structures. This approach should allow the use of these data in other application fields, such as musculoskeletal modelling, simulations for radiation therapy, and databases for use in minimally invasive, navigated and robotic surgery

IMAGE-BASED MODELING AND SIMULATION OF THE SHOULDER DURING BASEBALL PITCHING

The imaged-based modeling and simulation such as the virtual, interactive, musculoskeletal system (VIMS) software provides accurate muscle orientations and their relative moment arms. An imaged-based biomechanical model of upper extremity can be used for understanding of neuromuscular control and simulation of sports activities and surgery reconstruction after injuries. The relative movement of the skeletal segments cause a change of muscle orientation and its moment arm, and then affect the role of the muscle loading during the motion. This paper reviews studies in applying three-dimensional shoulder model for investigation of the multi-joint muscle function. An image based and graphic-enhanced, quantitative model of the musculoskeletal system would be utilized for dynamic shoulder analysis with accurate muscle line of action incorporating bone movement and muscle wrapping around the joint

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

Lower-extremity musculoskeletal geometry affects the calculation of patellofemoral forces in vertical jumping and weightlifting

The calculation of the patellofemoral joint contact force using three-dimensional (3D) modelling techniques requires a description of the musculoskeletal geometry of the lower limb. In this study, the influence of the complexity of the muscle model was studied by considering two different muscle models, the Delp and Horsman models. Both models were used to calculate the patellofemoral force during standing, vertical jumping, and Olympic-style weightlifting. The patellofemoral forces predicted by the Horsman model were markedly lower than those predicted by the Delp model in all activities and represented more realistic values when compared with previous work. This was found to be a result of a lower level of redundancy in the Delp model, which forced a higher level of muscular activation in order to allow a viable solution. The higher level of complexity in the Horsman model resulted in a greater degree of redundancy and consequently lower activation and patellofemoral forces. The results of this work demonstrate that a well-posed muscle model must have an adequate degree of complexity to create a sufficient independence, variability, and number of moment arms in order to ensure adequate redundancy of the force-sharing problem such that muscle forces are not overstated. (Author's abstract

Mechanics of Psoas Tendon Snapping. A Virtual Population Study.

Internal snapping of the psoas tendon is a frequently reported condition, especially in young adolescents involved in sports. It is defined as an increased tendon excursion over bony or soft tissue prominence causing local irritation and inflammation of the tendon leading to groin pain and often is accompanied by an audible snap. Due to the lack of detailed dynamic visualization means, the exact mechanism of the condition remains poorly understood and different theories have been postulated related to the etiology and its location about the hip. In the present study we simulated psoas tendon behavior in a virtual population of 40,000 anatomies and compared tendon movement during combined abduction, flexion and external rotation and back to neutral extension and adduction. At risk phenotyopes for tendon snapping were defined as the morphologies presenting with excess tendon movement. There were little differences in tendon movement between the male and female models. In both populations, abnormal tendon excursion correlated with changes in mainly the femoral anatomy (male r = 0.72, p < 0.001, female r = 0.66, p < 0.001): increased anteversion and valgus as well as a decreasing femoral offset and ischiofemoral distance. The observed combination of shape components correlating with excess tendon movement in essence presented with a medial positioning of the minor trochanter. This finding suggest that psoas snapping and ischiofemoral impingement are possibly two presentations of a similar underlying rotational dysplasia of the femur

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

Combined musculoskeletal and finite element modelling of the lumbar spine and lower limbs

Bone health deterioration is a major public health issue increasing the risk of fragility fracture with a substantial associated psychosocioeconomic impact. In the lumbar spine, physical deconditioning associated with ageing and chronic pain is a potential promoter of bone structural degradation. General guidelines for the limitation of bone loss and the management of pain have been issued, prescribing a healthy lifestyle and a minimum level of physical activity. However, there is no specific recommendation regarding targeted activities that can effectively maintain lumbar spine bone health in populations at risk. The aim of this thesis was to develop a new predictive computational modelling framework for the study of bone structural adaptation to healthy and pathological conditions in the lumbar spine. The approach is based on the combination of a musculoskeletal model of the lumbar spine and lower limbs with structural finite element models of the lumbar vertebrae. These models are built with bone and muscle geometries derived from healthy individuals. Based on daily living activities, musculoskeletal simulations provide physiological loading conditions to the finite element models. Cortical and trabecular bone are modelled with shell and truss elements whose thicknesses and radii are adapted to withstand the physiological mechanical environment using a strain driven optimisation algorithm. This modelling framework allows to generate healthy bone architecture when a loading envelope representative of a healthy lifestyle is applied to the vertebrae, and identify influential activities. Prediction of bone remodelling under altered loading scenarios characteristic of lumbar pathologies can also be achieved. The modelling approach developed in this thesis is a powerful tool for the investigation of bone remodelling in the lumbar spine. Preliminary results indicate that locomotion activities are insufficient to maintain lumbar spine bone health. Specific recommendations to limit the effect of physical deconditioning related to muscle weakening back pain are suggested. The approach is also promising for the investigation of other lumbar pathologies such as age related osteoporosis and scoliosis.Open Acces

Development and Biomechanical Analysis toward a Mechanically Passive Wearable Shoulder Exoskeleton

Shoulder disability is a prevalent health issue associated with various orthopedic and neurological conditions, like rotator cuff tear and peripheral nerve injury. Many individuals with shoulder disability experience mild to moderate impairment and struggle with elevating the shoulder or holding the arm against gravity. To address this clinical need, I have focused my research on developing wearable passive exoskeletons that provide continuous at-home movement assistance. Through a combination of experiments and computational tools, I aim to optimize the design of these exoskeletons. In pursuit of this goal, I have designed, fabricated, and preliminarily evaluated a wearable, passive, cam-driven shoulder exoskeleton prototype. Notably, the exoskeleton features a modular spring-cam-wheel module, allowing customizable assistive force to compensate for different proportions of the shoulder elevation moment due to gravity. The results of my research demonstrated that this exoskeleton, providing modest one-fourth gravity moment compensation at the shoulder, can effectively reduce muscle activity, including deltoid and rotator cuff muscles. One crucial aspect of passive shoulder exoskeleton design is determining the optimal anti-gravity assistance level. I have addressed this challenge using computational tools and found that an assistance level within the range of 20-30% of the maximum gravity torque at the shoulder joint yields superior performance for specific shoulder functional tasks. When facing a new task dynamic, such as wearing a passive shoulder exoskeleton, the human neuro-musculoskeletal system adapts and modulates limb impedance at the end-limb (i.e., hand) to enhance task stability. I have presented development and validation of a realistic neuromusculoskeletal model of the upper limb that can predict stiffness modulation and motor adaptation in response to newly introduced environments and force fields. Future studies will explore the model\u27s applicability in predicting stiffness modulation for 3D movements in novel environments, such as passive assistive devices\u27 force fields

MULTI-OBJECTIVE DESIGN OPTIMIZATION OF REVERSE TOTAL SHOULDER ARTHROPLASTY TO MAXIMIZE RANGE OF MOTION AND JOINT STABILITY

Reverse total shoulder arthroplasty was developed to restore range of motion (ROM) and joint stability to patients with pre-operative conditions that are not addressed by conventional replacements. Although reverse total shoulder arthroplasty is the current gold standard for treating a range of indications, the effects of varying its design on functional outcomes of the procedure are still not well understood. To that end, it is not yet clear which configurations, in terms of both design and surgical placement parameters, maximize range of motion and stability of the joint. It was hypothesized that there is trade-off between the two. These types of relationships may be elucidated using multi-objective design optimization to generate a Pareto front. Pareto optimal points represent those where neither performance metric can be further improved without detriment to the other. Multi-objective optimization requires 1) metrics to characterize the objectives to be optimized and 2) an automated computational framework capable of assessing the metrics for any candidate implant design. As such, the pre-cursory goals to performing multi-objective optimization involved the development, validation, and automation of computational tools to predict the performance of reverse should designs with respect to range of motion and joint stability. Characterization of the Pareto front with multi-objective optimization confirmed that there is in fact a trade-off between range of motion and stability. Designs that maximize one functional outcome differ from those that maximize the other. Designs that resulted in intermediate performance in terms of both objectives were variable. This indicates that functional factors other than range of motion and stability, such as mechanical implant stability (fixation) and avoidance of inferior impingement, could serve as deciding factors between implant configurations that achieve similar range of motion and stability results