Implementation of Asymmetric Yielding in Case Specific Finite Element Models improves the Prediction of Femoral Fracture Risk

Item does not contain fulltextAlthough asymmetric yielding in bone is widely shown in experimental studies, previous case-specific non-linear finite element (FE) studies have mainly adopted material behaviour using the Von Mises yield criterion (VMYC), assuming equal bone strength in tension and compression. In this study, it was verified that asymmetric yielding in FE models can be captured using the Drucker-Prager yield criterion (DPYC), and can provide better results than simulations using the VMYC. A sensitivity analysis on parameters defining the DPYC (i.e. the degree of yield asymmetry and the yield stress settings) was performed, focusing on the effect on bone failure. In this study, the implementation of a larger degree of yield asymmetry improved the prediction of the fracture location; variations in the yield stress mainly affected the predicted failure force. We conclude that the implementation of asymmetric yielding in case-specific FE models improves the prediction of femoral bone strength

Estimating severity of sideways fall using a generic multi linear regression model based on kinematic input variables

Item does not contain fulltextMany research groups have studied fall impact mechanics to understand how fall severity can be reduced to prevent hip fractures. Yet, direct impact force measurements with force plates are restricted to a very limited repertoire of experimental falls. The purpose of this study was to develop a generic model for estimating hip impact forces (i.e. fall severity) in in vivo sideways falls without the use of force plates. Twelve experienced judokas performed sideways Martial Arts (MA) and Block ('natural') falls on a force plate, both with and without a mat on top. Data were analyzed to determine the hip impact force and to derive 11 selected (subject-specific and kinematic) variables. Falls from kneeling height were used to perform a stepwise regression procedure to assess the effects of these input variables and build the model. The final model includes four input variables, involving one subject-specific measure and three kinematic variables: maximum upper body deceleration, body mass, shoulder angle at the instant of 'maximum impact' and maximum hip deceleration. The results showed that estimated and measured hip impact forces were linearly related (explained variances ranging from 46 to 63%). Hip impact forces of MA falls onto the mat from a standing position (3650+/-916N) estimated by the final model were comparable with measured values (3698+/-689N), even though these data were not used for training the model. In conclusion, a generic linear regression model was developed that enables the assessment of fall severity through kinematic measures of sideways falls, without using force plates

Modelling Cyclic Walking in Femurs With Metastatic Lesions:Femur-Specific Accumulation of Plasticity

Introduction Clinical fracture risk assessment in metastatic bone disease is extremely difficult, but subject-specific finite element (FE) modelling may improve these assessments in the future [Derikx, 2015]. By coupling to musculoskeletal modelling, realistic loading conditions can be implemented in FE analysis. However, it is unknown whether such analyses require complex elastic-plastic material models, or whether a linear elastic calculation already provides a reasonable prediction of fracture. Moreover, plastic deformation may accumulate over time, which is ignored by linear elastic calculations. In this study we compared linear and non-linear fracture predictions under realistic loading conditions in two patients with metastatic bone disease. Methods Two patients (P1, P2) with lytic lesions were included. Patient-specific femoral geometry and bone density were retrieved from quantitative CT-scans; the latter was used for implementing element-specific material behaviour [Keyak, 2005]. Muscle forces and hip contact forces acting on the femur during walking were calculated using musculoskeletal modelling (one typical case, adapted from [Wesseling, 2014]), and subsequently normalized to the patient’s body weight. Muscle forces were applied to attachment points that were morphed onto the patient femurs. Hip contact forces were applied to a cup mimicking the acetabulum, via a control node in the hip joint centre. Two simulations were run for each patient: a linear elastic analysis simulating a single walk cycle and a non-linear elastic-plastic analysis simulating 10 subsequent walk cycles. The safety factor (SF; yield stress/Von Mises stress) and plasticity were studied as measures of femoral failure in the linear and non-linear simulations, respectively, and compared between patients. Results The volume of elements with SF<1 (Figure 1A) as well as the volume of elements that underwent plastic deformation (Figure 1B) was highest in the femur of P1. In P1 the volume of plastic deformation increased over the loading cycles and eventually exceeded the peak volume of elements with SF<1 in the linear analysis. In P2, the volume of plasticity more or less stabilized after two loading cycles, and eventually resembled the volume of elements with SF<1 in the linear analysis. Discussion These preliminary results suggest that accumulation of plasticity under cyclic loading is femur-specific. Due to the variable and local weakening of the bone strength by metastatic lesions, relatively small changes in magnitude or direction of loading may initiate local failure and catalyze progressive failure in subsequent loading cycles. Hence, in some cases a linear analysis is sufficient, while in others it is not. Non-linear material behaviour and cyclic loading conditions are therefore required to capture these phenomena

POLY(TRIMETHYLENE CARBONATE)AND POLY(D,L-LACTIC ACID) MODIFY HUMAN DENDRITIC CELL RESPONSES TO STAPHYLOCOCCI BUT DO NOT AFFECT Th1 AND Th2 CELL DEVELOPMENT

Biomaterial-associated infections (BAIs) are frequent complications in the use of medical devices (biomaterials) correlated with considerable patient discomfort and high treatment costs. The presence of a biomaterial in the host causes derangement of local immune responses increasing susceptibility to infection. Dendritic cells (DCs) have an important role in directing the nature of immune responses by activating and controlling CD4+ T helper (Th) cell responses. To assess the immunomodulatory effect of the combined presence of biomaterials and Staphylococcus aureus (S. aureus) or Staphylococcus epidermidis (S. epidermidis), DC-mediated T cell proliferation and Th1/Th2 cell development were measured using an in vitro human cell system. Poly(trimethylene carbonate) (PTMC) and poly(D,L-lactic acid) (PDLLA) modified the production of the DC pro-inflammatory cytokines TNF-α, IL-6 and IL-23 in response to S. aureus and S. epidermidis. However, this modified cytokine production did not cause differences in Th1/Th2 cell polarisation, showing a Th1 cell predominance. In the absence of staphylococci, neither of the biomaterials induced DC-mediated T cell proliferation or Th1/Th2 cell polarisation. Moreover, either in the absence or presence of the biomaterials, S. aureus was a more potent inducer of DC cytokine secretion, T cell proliferation and Th1 cell development than S. epidermidis. In conclusion, although PTMC and PDLLA modulated DC cytokine responses to staphylococci, this did not alter the resulting Th cell development. This result suggested that, in this human cell model, Th1/Th2 cell responses were mainly determined by the species of bacteria and that PTMC or PDLLA did not detectably influence these responses