The effect of periprosthetic bone loss on the failure risk of tibial total knee arthroplasty

The effect of long-term periprosthetic bone loss on the process of aseptic loosening of tibial total knee arthroplasty (TKA) is subject to debate. Contradicting studies can be found in literature, reporting either bone resorption or bone formation before failure of the tibial tray. The aim of the current study was to investigate the effects of bone resorption on failure of tibial TKA, by simulating clinical postoperative bone density changes in finite element analysis (FEA) models and FEA models were created of two tibiae representing cases with good and poor initial bone quality which were subjected to a walking configuration and subsequently to a traumatic stumbling load. Bone failure was simulated using a crushable foam model incorporating progressive yielding. Repetitive loading under a level walking load did not result in failure of the periprosthetic bone in neither the good nor poor bone quality tibia at the baseline bone densities. When applying a stumble load, a collapse of the tibial reconstruction was noticed in the poor bone quality model. Incorporating postoperative bone loss led to a significant increase of the failure risk, particularly for the poor bone quality model in which subsidence of the tibial component was substantial. Our results suggest bone loss can lead to an increased risk of a collapse of the tibial component, particularly in case of poor bone quality at the time of surgery. The study also examined the probability of medial or lateral subsidence of the implant and aimed to improve clinical implications. The FEA model simulated plastic deformation of the bone and implant subsidence, with further validation required via mechanical experiments.</p

3D ultrasound imaging of soft tissue deformation in the lower extremity:methods and initials results

The aetiology of many musculoskeletal (MS) diseases is related to biomechanical factors. However, the tools used by clinicians and researchers to assess the biomechanical condition of structures in the lower extremity are often crude and subjective, leading to non-optimal patient analyses and care. We aim to develop advanced diagnostic, pre-planning and outcome tools which yield detailed biomechanical information about abnormal tissue deformations. Quantification of deformations within the tissues can assist clinicians in judging pathologies and can be used to validate and improve biomechanical models. This will open possibilities for more sensitive and objective ways to diagnose and follow-up patients and to perform research on the MS system of humans. Ultrasound is a clinically attractive imaging modality and can assess local tissue displacement by correlating segments of ultrasound data acquired sequentially. This technique has been successfully used during dynamic loading of tissue, and was also applied in actively deforming tissue, such as the heart [1]. Only few studies report on ultrasound strain imaging in skeletal muscles; Lopata et al. applied a bi-planar acquisition to assess deformation of the biceps during contraction in three orthogonal directions [2]. However, to account for out-of-plane motion and for a comprehensive mapping of the 3D muscle contraction, a full 3D technique is needed. In this study we want to assess the improvement of 3D displacement estimation using 3D phantom data compared to conventional 2D techniques, and to apply the technique to quantify the deformation of the m. gastrocnemius in vivo. The results illustrate a better agreement between the estimated displacement and ground truth using 3D segments compared to 2D segments. Root mean squared errors (RMSE) for a plane with out-of-plane motion, were 0.62 mm and 0.13 mm for the 2D and 3D techniques respectively. For a plane without out-of-plane motion, the RMSE values were 0.17 mm and 0.07 mm respectively. Application of the technique in vivo is feasible and results in high quality displacement images. Optimization of the cross-correlation window settings might improve the displacement estimation even further

Oxygen consumption and gait dynamics in transfemoral bone-anchored prosthesis users compared to socket-prosthesis users:A cross-sectional study

Background: A transfemoral bone-anchored prosthesis (BAP) is an alternative for the conventional socket-suspended prosthesis (SSP) in persons suffering from socket-related problems. In these persons, it has been demonstrated to reduce oxygen consumption during walking, which could be related to centre of mass (CoM) and trunk dynamics. However, it remains uncertain whether the same comparative findings are found in SSP-users without any socket-related problems. Research question: Do oxygen consumption, CoM and trunk dynamics during walking differ between satisfied transfemoral SSP- and BAP-users and able-bodied individuals (AB); and are CoM and trunk dynamics and pistoning potential determinants of oxygen consumption? Methods: Oxygen consumption was measured while participants walked on a treadmill at preferred speed, 30 % slower, and 30 % faster. At preferred speed, we also evaluated CoM deviation, root-mean-square values (RMS) of mediolateral (ML) CoM and trunk excursions, and pistoning. In the prosthetic users, we evaluated whether oxygen consumption, CoM and trunk dynamics, and pistoning were associated. Results: We included BAP-users (n = 10), SSP-users (n = 10), and AB (n = 10). SSP-users demonstrated higher oxygen consumption, CoM and trunk RMS ML in comparison to AB during walking. BAP-users showed intermediate results between SSP-users and AB, yet not significantly different from either group. Greater CoM and trunk excursions were associated with higher oxygen consumption; in the SSP-users a greater degree of pistoning, in turn, was found to associate with larger trunk RMS ML. Significance: Our results indicate that satisfied SSP-users have increased oxygen consumption compared to AB subjects and use compensatory movements during walking. An assessment of CoM and trunk dynamics, and pistoning during walking may be considered for evaluating whether an individual SSP-user could possibly benefit from a BAP, in addition to the currently used functional tests for evaluating eligibility. This might lead to a larger group of persons with a transfemoral SSP benefiting from this technology.</p

Deep Learning based acoustic measurement approach for robotic applications on orthopedics

In Total Knee Replacement Arthroplasty (TKA), surgical robotics can provide image-guided navigation to fit implants with high precision. Its tracking approach highly relies on inserting bone pins into the bones tracked by the optical tracking system. This is normally done by invasive, radiative manners (implantable markers and CT scans), which introduce unnecessary trauma and prolong the preparation time for patients. To tackle this issue, ultrasound-based bone tracking could offer an alternative. In this study, we proposed a novel deep learning structure to improve the accuracy of bone tracking by an A-mode ultrasound (US). We first obtained a set of ultrasound dataset from the cadaver experiment, where the ground truth locations of bones were calculated using bone pins. These data were used to train the proposed CasAtt-UNet to predict bone location automatically and robustly. The ground truth bone locations and those locations of US were recorded simultaneously. Therefore, we could label bone peaks in the raw US signals. As a result, our method achieved sub millimeter precision across all eight bone areas with the only exception of one channel in the ankle. This method enables the robust measurement of lower extremity bone positions from 1D raw ultrasound signals. It shows great potential to apply A-mode ultrasound in orthopedic surgery from safe, convenient, and efficient perspectives

In Vitro Testing of Femoral Impaction Grafting With Porous Titanium Particles: A Pilot Study

The disadvantages of allografts to restore femoral bone defects during revision hip surgery have led to the search for alternative materials. We investigated the feasibility of using porous titanium particles and posed the following questions: (1) Is it possible to create a high-quality femoral graft of porous titanium particles in terms of graft thickness, cement thickness, and cement penetration? (2) Does this titanium particle graft layer provide initial stability when a femoral cemented stem is implanted in it? (3) What sizes of particles are released from the porous titanium particles during impaction and subsequent cyclic loading of the reconstruction? We simulated cemented revision reconstructions with titanium particles in seven composite femurs loaded for 300,000 cycles and measured stem subsidence. Particle release from the titanium particle grafts was analyzed during impaction and loading. Impacted titanium particles formed a highly interlocked graft layer. We observed limited cement penetration into the titanium particle graft. A total mean subsidence of 1.04 mm was observed after 300,000 cycles. Most particles released during impaction were in the phagocytable range (< 10 μm). There was no detectable particle release during loading. Based on the data, we believe titanium particles are a promising alternative for allografts. However, animal testing is warranted to investigate the biologic effect of small-particle release

The sensitivity of the stiffness and thickness of a titanium inlay in a cementless PEEK femoral component to the micromotions and bone strain energy density

Polyetheretherketone (PEEK) has been proposed as alternative material for total knee arthroplasty implants due to its low stiffness, which may reduce stress-shielding. In cementless fixation, a proper primary fixation is required for long-term fixation. Previous research showed that the lower stiffness of a cementless PEEK femoral component results in larger micromotions at the implant-bone interface compared to a cobalt-chrome femoral component. A titanium inlay on the PEEK implant surface may improve the primary fixation while maintaining the favourable stiffness properties. Therefore, the effect of thickness and stiffness of a titanium inlay on the primary fixation and stress-shielding was investigated. A finite element model of the femur and femoral component was created with five titanium inlay variants. The micromotions and strain energy density (SED) were quantified as outcome measures. The distal thin – proximal thick variant showed the largest resulting micromotions (51.2 µm). Relative to the all-PEEK femoral component, the addition of a titanium inlay reduced the micromotions with 30 % to 40 % without considerably affecting the stress-shielding capacity (strain energy difference of 6 % to 10 %). Differences in micromotions (43.0–51.2 µm) and SED between the variants were relatively small. In conclusion, the addition of a titanium inlay could lead to a reduction of the micromotions without substantially affecting the SED distribution.</p