Novel Research about Biomechanics and Biomaterials Used in Hip, Knee and Related Joints

Joint replacement is a very successful medical treatment. However, the survivorship of hip, knee, shoulder, and other implants is limited. The degradation of materials and the immune response against degradation products or an altered tissue loading condition as well as infections remain key factors of their failure. Current research in biomechanics and biomaterials is trying to overcome these existing limitations. This includes new implant designs and materials, bearings concepts and tribology, kinematical concepts, surgical techniques, and anti-inflammatory and infection prevention strategies. A careful evaluation of new materials and concepts is required in order to fully assess the strengths and weaknesses and to improve the quality and outcomes of joint replacements. Therefore, extensive research and clinical trials are essential. The main aspects that are addressed in this Special Issue are related to new material, design and manufacturing considerations of implants, implant wear and its potential clinical consequence, implant fixation, infection-related material aspects, and taper-related research topics. This Special Issue gives an overview of the ongoing research in those fields. The contributions were solicited from researchers working in the fields of biomechanics, biomaterials, and bio- and tissue-engineering

Doctor of Philosophy

dissertationFemoroacetabular impingement (FAI) describes subtle structural abnormalities, including femoral asphericity and acetabular overcoverage, which reduce clearance in the hip joint. FAI is a common cause of hip pain for young, athletic adults. The first theme of this dissertation investigated if FAI morphology is more prevalent in athletes and if physical exams could be used to identify individuals with underlying FAI morphology. In a cohort of collegiate football players, 95% were found to have radiographic abnormalities consistent with those seen in FAI patients. This finding not only suggests that athletes, such as football players, may have an increased risk for developing symptomatic FAI, but also highlights that FAI morphology may frequently occur in asymptomatic subjects. In the same cohort, radiographic measures of femoral asphericity and femoral head-neck offset were mildly correlated to maximum internal rotation. As such, athletes with diminished internal rotation in whom hip pain develops should be evaluated for FAI. Altered articulation in FAI hips is believed to cause chondrolabral damage and may lead to osteoarthritis, but FAI kinematics have not been accurately quantified. To this end, the second theme of this dissertation focused on developing, validating, and applying a dual fluoroscopy and model-based tracking protocol to accurately quantify three-dimensional in vivo hip kinematics. In a cadaver experiment, model-based tracking was compared to the reference standard, dynamic radiostereometric analysis. Model-based tracking was found to have a positional error less than 0.48 mm and rotational error was less than 0.58°. The methodology was then applied to evaluate a cohort of asymptomatic control subjects and three patients with differing FAI morphology. The results, which represent the most accurate data collected on hip kinematics to date, demonstrate that hip articulation is a highly complex process, including translation, pelvic motion, no bone contact, and labrum involvement in large ranges of motion. Collected data provide necessary baseline results for future comparison studies and could be used to validate computer simulations of impingement, guide pre-operative planning, and serve as boundary conditions in finite element models investigating chondrolabral mechanics

Spatial Sensors for Quantitative Assessment of Retrieved Arthroplasty Bearings

Evaluation of retrieved joint arthroplasty bearings provides unique evidence related to the physiological environment in which bearing materials are expected to perform. This dissertation describes the development of novel spatial sensors and measurement strategies for standardized, quantitative assessments of arthroplasty bearings, including total knee replacements, unicompartmental knee replacements, and total hip replacements. The approach is to assess bearings that endured a finite duration of function in patients, with particular emphasis on expanding our understanding of the biomechanical conditions specific to bearing function and wear in the physiological environment. Several quantifiable parameters are identified that prove comparable to pre-clinical in vitro tibological evaluations, including knee wear simulation and analytical modeling. These comparisons provide clinical relevance to the existing methodologies, helping to verify that the biomechanical simulations accurately represent the in vivo conditions they are meant to simulate. The broad objective of this dissertation is to improve the longevity and function of arthroplasty bearing materials and designs. Assessments from the retrieved prostheses are discussed within the context of developing comprehensive approaches for the prospective evaluation of new materials and designs in joint replacements

Dynamics, Electromyography and Vibroarthrography as Non-Invasive Diagnostic Tools: Investigation of the Patellofemoral Joint

The knee joint plays an essential role in the human musculoskeletal system. It has evolved to withstand extreme loading conditions, while providing almost frictionless joint movement. However, its performance may be disrupted by disease, anatomical deformities, soft tissue imbalance or injury. Knee disorders are often puzzling, and accurate diagnosis may be challenging. Current evaluation approach is usually limited to a detailed interview with the patient, careful physical examination and radiographic imaging. The X-ray screening may reveal bone degeneration, but does not carry sufficient information of the soft tissue conditions. More advanced imaging tools such as MRI or CT are available, but expensive, time consuming and can be used only under static conditions. Moreover, due to limited resolution the radiographic techniques cannot reveal early stage arthritis. The arthroscopy is often the only reliable option, however due to its semi-invasive nature, it cannot be considered as a practical diagnostic tool. Therefore, the motivation for this work was to combine three scientific methods to provide a comprehensive, non-invasive evaluation tool bringing insight into the in vivo, dynamic conditions of the knee joint and articular cartilage degeneration. Electromyography and inverse dynamics were employed to independently determine the forces present in several muscles spanning the knee joint. Though both methods have certain limitations, the current work demonstrates how the use of these two methods concurrently enhances the biomechanical analysis of the knee joint conditions, especially the performance of the extensor mechanism. The kinetic analysis was performed for 12 TKA, 4 healthy individuals in advanced age and 4 young subjects. Several differences in the knee biomechanics were found between the three groups, identifying age-related and post-operative decrease in the extensor mechanism efficiency, explaining the increased effort of performing everyday activities experienced by the elderly and TKA subjects. The concept of using accelerometers to assess the cartilage degeneration has been proven based on a group of 23 subjects with non-symptomatic knees and 52 patients suffering from knee arthritis. Very high success (96.2%) of pattern classification obtained in this work clearly demonstrates that vibroarthrography is a promising, non-invasive and low-cost technique offering screening capabilities

An Investigation into an All Polymer Knee Joint Replacement

My thesis describes a series of tests aimed at investigating the suitability of polyetheretherketone (PEEK), carbon fibre reinforced polyetheretherketone (CFR-PEEK), polyethylene and acetal in an all polymer, metal free total knee replacement. Central to this study was the investigation of the wear performance of these polymers as bearing materials under two different loading conditions and in comparison, to contemporary metal on polyethylene (MoP) bearings. The concept of an all polymer total knee replacement (TKR) is intended to realise physiological stress distribution within periprosthetic bone, reduce stress shielding and bone loss and eliminate biological activity to particulate metal alloy. The hypothesis was that an all polymer bearing will generate reduced or similar amounts of wear when compared with the traditional metal-on-plastic bearing and may provide an alternate metal-free method of replacement. Following unidirectional pin on plate testing, wear of the different bearing combinations was assessed using gravimetric analysis, digital photography, surface profilometry and scanning electron microscopy (SEM). Characterization of wear particles generated from these bearing combinations was conducted following digestion of the particle containing lubricant fluid using an acid digestion method with isolated particles subjected to SEM analysis and an automated image analysis sequence. Subsequently, the inflammatory response of depyrogenated, endotoxin free wear particles retrieved from the pin-on-plate test was cultured with monocytes and cytokine production (TNF-α, IL-1β and Il-6) quantified as measured using ELISA. The key findings from my thesis were that using a pin on plate test setup designed to simulate a simplified knee couple, PEEK pins articulated against moderately cross-linked polyethylene plate exhibited comparable wear loss, a similar wear quantity, morphology and inflammatory potential to the contemporary metal on polyethylene articulations. CFR-PEEK was found unsuitable as a bearing surface in an all polymer TKR. Based on this, my hypothesis can be accepted as it may be possible to replace CoCr in TKR. However, before translation to clinical use, exhaustive appraisal of new bearing components is necessary to confer confidence in their appropriateness and safety. An all polymeric PEEK-on-a highly crosslinked polyethylene (XLPE) bearing may be a promising alternative to MoP in total knee arthroplasty

Multi-modal Image Registration

In different areas, particularly medical image analysis, there is a vital need to access and analyse dynamic three dimensional (3D) images of the anatomical structures of the human body. This can enable specialists to track events as well as clinically conduct and evaluate surgical and radio therapeutical procedures. For example, measuring the 3D kinematics of knee joints in a dynamic manner is essential for understanding their normal functions and diagnosing any pathology, such as ligament injury and osteoarthritis. For evaluations of subsequent treatments, such as surgery and rehabilitation, and designs of joint replacements, having knowledge of the movements of knee joints is necessary. Image registration is increasingly being applied to medical image analysis. Whereas in mono-modal registration, the images to be registered are acquired by the same sensor, in multi-modal image registration, they can be taken from different devices or imaging protocols which makes this registration process much more challenging. The invasive or non-invasive nature of the registration method used, the computational time it requires as well as its accuracy and robustness against a large range of initial displacements are the most important features used for its evaluation. As currently available approaches have limited capabilities to register images with large initial displacements and are either not sufficiently accurate or very computationally expensive, the objective of this research is to propose new registration methods, that provide dynamic 3D images, to address these issues. In the first part of this study, I conducted research on registering an individuals’ natural knee bones that can provide 3D information of knee joint kinematics which can be very helpful for improving the accuracy of diagnosis and enabling targeted treatments. A fast, accurate and robust hybrid rigid body registration method based on two different multi-modal similarity measures, the edge position difference (EPD) and sum-of-conditional variance (SCV), is proposed. It uses a gradient descent optimisation technique to register multi-modal images and determine the best transformation parameters. It helps to achieve a trade-off among different challenges, including time complexity, accuracy and robustness against a large range of initial displacements. To evaluate it, several experiments were performed on two different databases: one collected from the knee bones of four patients and the other from three knee cadavers installed on a mechanical positioning system, with the results showing that this method is accurate, fast and robust against large initial displacement. Then, I conducted research on registering implanted human knee joints and proposed a non-invasive, robust 3D-to-2D registration method which can be used for 3D evaluations of the status of knee implants after joint replacement surgeries. In this method, 3D models of the implants for an individual with the relevant post-operative fluoroscopy frames are able to be used in the registration process. As a result, it is possible to perform 3D analysis at any time after a surgery by simply taking single-plane radiographs. This approach uses the EPD multi-modal similarity measure together with a steepest descent optimisation method. It applies coarse-to-fine registration steps to determine the transformation parameters that lead to the best alignment between the model used and X-ray images to be registered. The experimental results showed that not only does the proposed registration method have a high success rate but that it is also much faster than the most relevant competitive approach. Although the experiments were designed for a 3D analysis of total knee arthroplasty (TKA) components, this proposed method can be applied to other joints such as the ankle or hip. In the final part of my research, I developed a multi-frame 2D fluoroscopy to 3D model registration method for measuring the kinematics of post-operative knee joints. It uses a coarse-to-fine approach and applies the normalised EPD (NEPD) and SCV similarity measures together with a gradient descent optimisation method and an interpolation estimation one. In order to measure the kinematics of post- operative knee joints, after a TKA surgery, a 3D knee implant model can be registered with a number of single-plane fluoroscopy frames of the patient’s knee. Generally, when this number is quite high, the computational cost for registering the frames and a 3D model is expensive. Therefore, in order to speed up the registration process, a cubic spline interpolation prediction method is applied to initialise and estimate the 3D positions of the 3D model in each fluoroscopy frame instead of applying a registration algorithm on all the frames, one after the other. The estimated 3D positions are then tuned using a registration improvement step. The experimental results demonstrated that the proposed registration method is much faster than the best existing one and achieves almost the same accuracy. It also provides smooth registration results which can lead to more natural 3D modelling of joint movements

Development of a hierarchical electrospun scaffold for ligament replacement

2018 Spring.Includes bibliographical references.The anterior cruciate ligament (ACL) is a dense collagenous structure that connects the femur to the tibia and is vital for joint stability. The ACL possesses complex time-dependent viscoelastic properties and functions primarily to prevent excessive translations and rotations of the tibia relative to the femur. It is estimated that 400,000 ACL tears occur in the United States annually and the monetary burden of these injuries and their subsequent treatment is approximately $1 billion annually. After injury allografts and autografts are commonly implanted to reconstruct the torn ACL in an attempt to restore joint stability, prevent pain, and limit damage to surrounding tissues. However surgical reconstructions fail to completely restore knee functionality or prevent additional injury and regardless of intervention technique radiographic osteoarthritis is present in 13% of patients 10 years after ACL rupture. Drawbacks to traditional treatments for ACL ruptures motivate the development of a synthetic ACL replacement. Tissue engineering is the use of a scaffold, cells, and signaling molecules to create a replacement for damaged tissue. The goal of this work is to develop a polymer scaffold that can be utilized as a replacement for the ACL. A tissue engineered ACL replacement should replicate the hierarchical structure of the native ACL, possess reasonable time zero mechanical properties, and promote the deposition of de novo collagenous tissue in vitro. Additionally, the scaffold should be implantable using standard surgical techniques and should maintain in situ tibiofemoral contact mechanics. Thus, four specific aims are proposed: 1) Fabricated and characterize an aligned 3-dimensional electrospun scaffold for ACL replacement. 2) Assess the in vitro behavior of ovine bone marrow-derived stems cells seeded on the scaffold in the presence of conjugated growth factor. 3) Evaluate the performance of the electrospun scaffold using uniaxial mechanical testing. 4) Assess the effect of the electrospun scaffold on ovine stifle joint contact mechanics. Development of a tissue engineered ACL replacement that mimics the structure and function of the native ACL would provide a novel treatment to improve outcomes of ACL injuries

Master of Science

thesisTotal knee arthroplasty (TKA) is the gold-standard treatment for degenerative and arthritic knee diseases. TKA replaces the damaged knee articular surfaces with a prosthetic knee joint composed of a metal femoral component and polyethylene tibial insert. In 2013, approximately 650,000 primary TKA procedures were performed in the U.S., with approximately 10% requiring revision surgery necessitated by the 10 - 15 years limited lifetime of the prosthetic knee joint. A major limiting factor to the longevity of a prosthetic knee joint is fatigue crack damage of the tibial insert. The objective of this work is to address the problem of fatigue crack damage through: (1) experimentally quantifying fatigue crack damage in polyethylene tibial inserts and (2) predicting fatigue crack damage through finite element modeling. We have developed a novel subsurface fatigue crack damage measurement method based on specimen transillumination and used this method to measure fatigue crack damage in two tibial inserts. We have also developed a dynamic finite element simulation of the stress in the tibial insert under knee simulator wear test conditions, for an entire gait cycle. Two polyethylene material models, linear elastic and linear viscoelastic, were compared. It was observed that choice of material model has a substantial effect on the maximum von Mises stress. The location of maximum von Mises, principal, and shear stress in the tibial insert were compared to the experimentally measured fatigue crack damage to determine whether the simulation accurately predicts fatigue crack damage in the tibial insert. It was observed that the von Mises stress alone is a poor predictor of fatigue crack damage, while the locations of maximum tensile principal stress and shear stress correspond closely to the locations where fatigue crack damage occurred

Book of Abstracts 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering and 3rd Conference on Imaging and Visualization

In this edition, the two events will run together as a single conference, highlighting the strong connection with the Taylor & Francis journals: Computer Methods in Biomechanics and Biomedical Engineering (John Middleton and Christopher Jacobs, Eds.) and Computer Methods in Biomechanics and Biomedical Engineering: Imaging and Visualization (JoãoManuel R.S. Tavares, Ed.). The conference has become a major international meeting on computational biomechanics, imaging andvisualization. In this edition, the main program includes 212 presentations. In addition, sixteen renowned researchers will give plenary keynotes, addressing current challenges in computational biomechanics and biomedical imaging. In Lisbon, for the first time, a session dedicated to award the winner of the Best Paper in CMBBE Journal will take place. We believe that CMBBE2018 will have a strong impact on the development of computational biomechanics and biomedical imaging and visualization, identifying emerging areas of research and promoting the collaboration and networking between participants. This impact is evidenced through the well-known research groups, commercial companies and scientific organizations, who continue to support and sponsor the CMBBE meeting series. In fact, the conference is enriched with five workshops on specific scientific topics and commercial software.info:eu-repo/semantics/draf