Force track analysis of contemporary hip simulators

In an earlier paper, the authors presented the first verified method of computation of slide tracks in the relative motion between femoral head and acetabular cup of total hip prostheses. The method was applied for gait and for two hip simulator designs, and in a subsequent paper, for another eight designs. In the present paper, the track drawn by the resultant contact force, the so-called force track, was studied in depth. The variations of sliding distance, sliding velocity and direction of sliding during a cycle, all of which are important with respect to wear, were computed for gait and for 11 hip simulator designs. Moreover, the product of the instantaneous load and increment of sliding distance was numerically integrated over a cycle. This integral makes it possible to compare clinical wear rates with those produced by hip simulators in terms of a wear factor. For the majority of contemporary hip simulators, the integral has so far been unknown. The computations revealed considerable differences, which are likely to explain the substantial differences in wear produced by the simulators. With the most common head diameter, 28 mm, the ranges for sliding distance per cycle, mean sliding velocity, total change of direction of sliding and integral were: 19.7-34.3 mm, 19.7-49.0 mm/s, 360-1513 degrees, and 17.4-43.5 Nm, respectively.     

A direct comparison of patient and force-controlled simulator total knee replacement kinematics

The need to critically evaluate the efficacy of current total knee replacement (TKR) wear testing methodologies is great. Proposed international standards for TKR wear simulation have been drafted, yet their methods continue to be debated. The "gold standard" to which all TKR wear testing methodologies should be compared is measured in vivo TKR performance in patients. The current study compared patient TKR kinematics from fluoroscopic analysis and simulator TKR kinematics from force-controlled wear testing to quantify similarities in clinical ranges of motion and contact bearing kinematics and to evaluate the proposed ISO force-controlled wear testing methodology. The treadmill walking kinematics from eight well-functioning, 13 month average post-op patients were compared to the 2 million cycle interval walking cycle kinematics from a force-controlled (Instron/Stanmore Knee Joint Simulator, Instron, Canton, MA) knee simulator using identical implant designs (Natural Knee II, Standard Congruent, Zimmer, Warsaw, IN). The in vivo and simulator data showed good agreement in kinematic patterns and ranges of clinical motion. Tribologically the data sets showed similar contact pathway ranges of motion and wear travel distances per cycle. Surgical and simulator alignments of the implant systems were determined to be a contributing factor in observed kinematic differences. This study's statistical findings offer supporting evidence that the simulation of in vivo walking cycle wear kinematics can be accurately reproduced with a force controlled testing methodology.     

Slide track analysis of eight contemporary hip simulator designs

In an earlier paper, the authors presented a new method of computation of slide tracks in the relative motion between femoral head and acetabular cup of total hip prostheses. For the first time, computed tracks were verified experimentally and with an alternative method of computation. Besides being an efficient way to illustrate hip kinematics, the shapes of the slide tracks are known to be of fundamental importance regarding the wear behaviour of prostheses. The verified method was now applied to eight contemporary hip simulator designs. The use of correct motion waveforms and an Euler sequence of rotations in each case was again found to be essential. Considerable differences were found between the simulators. For instance, the shapes of the tracks drawn by the resultant contact force included a circle, ellipse, irregular oval, leaf, twig, and straight line. Computation of tracks correctly for the most widely used hip simulator, known as biaxial, was made possible by the insight that the device is actually three-axial. Slide track patterns have now been computed for virtually all contemporary hip simulators, and both for the heads and for the cups. This comparative analysis forms a valuable basis for studies on the relationship between the type of multidirectional motion and wear. These studies can produce useful information for the design of joint simulators, and improve the understanding of wear phenomena in prosthetic joints.     

当代水族男性的牙齿磨耗特点及其成因

一直以来,有关人类牙齿磨耗的研究主要集中在年龄判定和生业方式比较方面。然而,很多研究因样本人群来源复杂、忽视个体牙齿磨耗的特殊性及缺乏足够的个人信息,很难进一步解释其牙齿磨耗特点的成因。本文基于对当代水族男性牙齿磨耗的记录和相关信息,通过梳理该人群牙齿磨耗的一般特点和特殊磨耗形式,探讨了有关影响该人群牙齿磨耗的可能因素。笔者发现,总体来说,该人群的牙齿磨耗较轻,牙齿磨耗水平与其年龄分布呈正相关关系,符合人类牙齿面随年龄增长而发生退行性生理磨耗的规律。牙齿磨耗等级在不同年龄中呈镶嵌式分布,某些个体存在越位磨耗现象。从本文的结果看,这些现象的产生除了退行性生理磨耗的原因外,还可能与口腔健康状况、饮食结构和少餐习惯等因素密切相关。     

A novel computational method to determine subject-specific bite force and occlusal loading during mastication

The evaluation of three-dimensional occlusal loading during biting and chewing may assist in development of new dental materials, in designing effective and long-lasting restorations such as crowns and bridges, and for evaluating functional performance of prosthodontic components such as dental and/or maxillofacial implants. At present, little is known about the dynamic force and pressure distributions at the occlusal surface during mastication, as these quantities cannot be measured directly. The aim of this study was to evaluate subject-specific occlusal loading forces during mastication using accurate jaw motion measurements. Motion data was obtained from experiments in which an individual performed maximal effort dynamic chewing cycles on a rubber sample with known mechanical properties. A finite element model simulation of one recorded chewing cycle was then performed to evaluate the deformation of the rubber. This was achieved by imposing the measured jaw motions on a three-dimensional geometric surface model of the subject’s dental impressions. Based on the rubber’s deformation and its material behaviour, the simulation was used to compute the resulting stresses within the rubber as well as the contact pressures and forces on the occlusal surfaces. An advantage of this novel modelling approach is that dynamic occlusal pressure maps and biting forces may be predicted with high accuracy and resolution at each time step throughout the chewing cycle. Depending on the motion capture technique and the speed of simulation, the methodology may be automated in such a way that it can be performed chair-side. The present study demonstrates a novel modelling methodology for evaluating dynamic occlusal loading during biting or chewing.     

Individual tooth macrowear pattern guides the reconstruction of Sts 52 (Australopithecus africanus) dental arches

The functional restoration of the occlusal relationship between maxillary and mandibular tooth rows is a major challenge in modern dentistry and maxillofacial surgery. Similar technical challenges are present in paleoanthropology when considering fragmented and deformed mandibular and maxillary fossils. Sts 52, an Australopithecus africanus specimen from Sterkfontein Member 4, represents a typical case where the original shape of the dental arches is no longer preserved. It includes a partial lower face (Sts 52a) and a fragmented mandible (Sts 52b), both incomplete and damaged to such an extent to thwart attempts at matching upper and lower dentitions. We show how the preserved macrowear pattern of the tooth crowns can be used to functionally reconstruct Sts 52's dental arches. High‐resolutiondental stone casts of Sts 52 maxillary and mandibular dentition were mounted and repositioned in a dental articulator. The occlusal relationship between antagonists was restored based on the analysis of the occlusal wear pattern of each preserved tooth, considering all dental contact movements represented in the occlusal compass. The reconstructed dental arches were three‐dimensional surface scanned and their occlusal kinematics tested in a simulation. The outcome of this contribution is the first functional restoration of A. africanus dental arches providing new morphometric data for specimen Sts 52. It is noteworthy that the method described in this case study might be applied to several other fossilspecimens. Am J Phys Anthropol, 2013. © 2013 Wiley Periodicals, Inc.     

Time analysis of hard and soft bolus processing

Objective: Clinical observations and mathematical models show that dental implants are influenced by the magnitude of loading. Therefore, the knowledge of mandible movement during mastication is important to assess occlusal and masticatory force vectors. The purpose of this study was to detect the path of movement of the lower jaw and to distinguish stages of mastication, duration of bolus processing and peak amplitude of mastication. Method: Motion analysis was used to record three-dimensional mandible movements. Individualized sensors were rigidly attached to the mandible of 51 study participants. At the beginning of the measurement, all subjects were asked to move the mandible in extreme positions (maximal opening and maximal lateral movements). Then, each subject masticated a bite of hard and soft food. Duration of bolus mastication and peak amplitude of mastication movement in mesio-distal, cranio-caudal and vestibulo-oral axes related to peak amplitude of marginal movements were evaluated for each subject. The chewing record of each subject was divided into three phases (chopping, grinding and swallowing), and the duration of mastication and number of closing movements were evaluated. Results: The findings of this pilot study suggest that masticatory movements vary in individuals. Bolus character influences the process duration, but not the frequency of closing movements. Neither gender nor age had any influence on either the time or frequency of bolus processing. Conclusion: Relationships to directions and magnitudes of acting chewing force should be more precisely examined since transversally acted forces during grinding are important factors in tooth/implant overloading.     

Analysis of the Biotribological Behavior for the Stainless Steel/Polyethylene Contact Using a Knee Prosthesis Simulator

In this work,a friction and wear simulator was used to reproduce the Anterior-Posterior (AP) sliding and the Flexion-Extension (FE) rotation generated in the knee joint during human gait cycle.We chose to simplify the contact geometry between the Total Knee Arthroplasty (TKA) femoral component and tibial insert.A 304L stainless steel cylinder which replaces the femoral component was loaded onto a flat High Density Polyethylene (HDPE) block which replaces the tibial insert.The tribological behavior of the considered contact was analyzed by tracking the number of cycles,the friction coefficient,the roughness of the wear track on HDPE,the HDPE weight loss and the damage mechanisms.The friction coefficient shows a gradual increase with the number of cycles for both AP and FE kinematics.The evolution of friction coefficient with the number of cycles is not affected by the value of the imposed normal load in the case of AP sliding.For the FE rotation,decreased friction coefficient is obtained when the imposed normal load increases.For both considered AP and FE kinematics,the roughness of the wear track on the HDPE is not affected by the imposed normal load.It shows a progressive decrease when the number of cycles increases.The wear of HDPE obeys the Archard law and the wear coefficient increases with the normal force.For a given value of normal load,the obtained wear coefficient for the AP sliding is larger than that obtained for FE rotation.A predominant adhesive wear mechanism was identified for both AP and FE kinematics.Under the same normal load,damage development in terms of plastic deformation,micro-cracking and debonding is more pronounced for the AP sliding if compared with the FE rotation.For a given kinematics,the damage severity increases with the normal load.This finding is in good agreement with the predicted values of the wear coefficient according to the Archard law.     

Enhanced computational prediction of polyethylene wear in hip joints by incorporating cross-shear and contact pressure in additional to load and sliding distance: Effect of head diameter

A new definition of the experimental wear factor was established and reported as a function of cross-shear motion and contact pressure using a multi-directional pin-on-plate wear testing machine for conventional polyethylene in the present study. An independent computational wear model was developed by incorporating the cross-shear motion and contact pressure-dependent wear factor into the Archard's law, in additional to load and sliding distance. The computational prediction of wear volume was directly compared with a simulator testing of a polyethylene hip joint with a 28 mm diameter. The effect of increasing the femoral head size was subsequently considered and was shown to increase wear, as a result of increased sliding distance and reduced contact pressure.     

Chewing pattern and muscular activation in open bite patients

Different studies have indicated, in open bite patients, that masticatory muscles tend to generate a small maximum bite force and to show a reduced cross-sectional area with a lower EMG activity. The aim of this study was to evaluate the kinematics parameters of the chewing cycles and the activation of masseters and anterior temporalis muscles of patients with anterior dental open bite malocclusion. There have been no previous reports evaluating both kinematic values and EMG activity of patients with anterior open bite during chewing. Fifty-two young patients (23 boys and 29 girls; mean age±SD 11.5±1.2 and 10.2±1.6years, respectively) with anterior open bite malocclusion and 21 subjects with normal occlusion were selected for the study. Kinematics parameters and surface electromyography (EMG) were simultaneously recorded during chewing a hard bolus with a kinesiograph K7-I Myotronics-Usa. The results showed a statistically significant difference between the open bite patients and the control group for a narrower chewing pattern, a shorter total and closing duration of the chewing pattern, a lower peak of both the anterior temporalis and the masseter of the bolus side. In this study, it has been observed that open bite patients, lacking the inputs from the anterior guidance, that are considered important information for establishing the motor scheme of the chewing pattern, show narrower chewing pattern, shorter lasting chewing cycles and lower muscular activation with respect to the control group.     

Analytical and numerical analysis of human dental occlusal contact

The knowledge of contact forces in teeth surfaces during mastication or para-functional movements can help to understand processes related to friction and wear of human dental enamel. The development of a numerical model for analysis of the occlusal contact between two antagonistic teeth is proposed, which includes three basic steps: the characterisation of the surface roughness, its homogenisation using an assumed distribution function and the numerical determination of the resulting forces. Finite element strain results for the main different asperities are statistically combined, deriving the predicted macroscopic behaviour of the interface. Axisymmetric and 3D numerical models with an elasto-plastic constitutive law are used to simulate micro-indentations and micro-contacts, respectively. The contact is allowed to occur locally in planes not necessarily parallel to the surface's mean plane, a problem for which there is no analytical solution. The three identified parameters, homogenised surface hardness (3.68 GPa), surface yield stress (3.08 GPa) and static friction coefficient (0.23), agree with the experimental values reported in the literature.     

Movement behavior of teeth and dental implants in periotest measurement in occlusion--an in vitro study]

Early diagnosis of periodontal disease is essential for the planning of restorative, prosthetic and surgical treatment. The usual clinical methods are mostly subjective. Although the Periotest device has been specially developed for the diagnosis of periodontal disease, it can also be used to aid occlusal adjustment after insertion of inlays or artificial crowns. To investigate this application of the Periotest, a jaw model with idealized dental crowns incorporating motion and force sensors has been constructed. Motion and force are recorded during measurements with the Periotest. The maximum amplitudes in the apical (vertical) direction obtained with unpolished occlusal points increased with increasing occlusal load. With polished contact points, the maximum values in the apical direction revealed no dependence on occlusal load. The maximum amplitudes of movement and force in the oral (horizontal) direction decrease with increasing occlusal load both with polished and unpolished contact points. With the first, the teeth appear to slide one upon the other such that the overall distance between them remains unchanged, and no additional apical forces develop. In the case of rough contact points, additional forces develop, and falsify Periotest measurements.     

Slide track analysis of the relative motion between femoral head and acetabular cup in walking and in hip simulators

Joint simulators are important tools in wear studies of prosthetic joint materials. The type of motion in a joint simulator is crucial with respect to the wear produced. It is widely accepted that only multidirectional motion yields realistic wear for polyethylene acetabular cups. Multidirectionality, however, is a wide concept. The type of multidirectional motion varies considerably between simulators, which may explain the large differences in observed wear rates. At present, little is known about the relationship between the type of multidirectional motion and wear. One illustrative way to compare the motions of various hip simulators is to compute tracks made on the counterface by selected points of the surface of the femoral head and acetabular cup due to the cyclic relative motion. A new computation method, based on Euler angles, was developed, and used to compute slide tracks for the three-axis motion of the hip joint in walking, and for two hip simulators, the HUT-3 and the biaxial rocking motion. The slide track patterns resulting from the gait waveforms were found to be similar to those produced by the HUT-3 simulator. This paper is the first to include a verification of the computed simulator tracks. The tracks were verified in the two simulators using sharp pins, embedded in acetabular cups, engraving distinct grooves onto the femoral heads. The engravings were identical to the computed tracks. The results clearly differed from earlier computations by another research group. This study is intended to start a thorough investigation of the relationship between the type of multidirectional motion and wear.     

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Analysis of polyethylene component wear and implant loosening in total knee arthroplasty (TKA) requires precise knowledge of in vivo articular motion and loading conditions. This study presents a simultaneous in vivo measurement of tibiofemoral articular contact forces and contact kinematics in three TKA patients. These measurements were accomplished via a dual fluoroscopic imaging system and instrumented tibial implants, during dynamic single leg lunge and chair rising-sitting. The measured forces and contact locations were also used to determine mediolateral distribution of axial contact forces. Contact kinematics data showed a medial pivot during flexion of the knee, for all patients in the study. Average axial forces were higher for lunge compared to chair rising-sitting (224% vs. 187% body weight). In this study, we measured peak anteroposterior and mediolateral forces averaging 13.3% BW during lunge and 18.5% BW during chair rising-sitting. Mediolateral distributions of axial contact force were both patient and activity specific. All patients showed equitable medial-lateral loading during lunge but greater loads at the lateral compartment during chair rising-sitting. The results of this study may enable more accurate reproduction of in vivo loads and articular motion patterns in wear simulators and finite element models. This in turn may help advance our understanding of factors limiting longevity of TKA implants, such as aseptic loosening and polyethylene component wear, and enable improved TKA designs.     

Experimental studies in human tooth wear. II

Studies of human tooth wear have been carried on for the past two years using a machine designed to approximate human chewing motions. During this time wear patterns that resemble those frequently found on the teeth of various American Indian skulls have been produced on casts of the definition. Noticeably among these patterns produced are examples of wear on the front end of the dental arches that result in an edge to edge bite. This type of wear was produced by wearing down casts of a modern dentition with a “normal” overbite. The forces applied to the casts mounted on the machine are variable over a wide range and numerous force combinations are possible. By noting these forces and the resulting vectors, the motions necessary to produce different wear patterns can be determined. This has especially aided in understanding the ways in which the oblique molar wear is produced.     

An improved method of computing the wear factor for total hip prostheses involving the variation of relative motion and contact pressure with location on the bearing surface

A new method of computing the wear factor for total hip prostheses is presented. In the conventional method, only the resultant contact force and the track drawn by the point of its application are considered so that the product of the instantaneous force and sliding increment is integrated over one motion cycle. In the present, improved, method the contact pressure distribution is discretized by a large number of smaller normal forces, and the contribution of each is summed. This is important because the relative motion and contact pressure vary strongly with location, and because the transverse pressure component is substantial. Hence, the present surface integral represents the large contact surface better than the conventional line integral. A prerequisite for the surface integral was the method of computing the relative motion correctly anywhere on the contact surface, developed and published earlier by the present authors. For the pressure discretization, the contact surface was divided into nearly equal-sized surface elements. The contact pressure was modelled with ellipsoidal, paraboloidal and sinusoidal distributions. Two load cases were studied, double-peak and static. When an ellipsoidal contact pressure distribution extending over a hemisphere was discretized by 1000 element forces, the computed wear factor for double-peak load in a biaxial hip wear simulator was 30% lower than in the conventional resultant force case. The present method can be later developed further to involve the temporal variation of size and location of the contact surface.     

In-vivo analysis of sliding distance and cross-shear in Bi-cruciate retaining total knee arthroplasty

Polyethylene remains the most popular bearing material for total knee arthroplasty (TKA). Despite its widespread use, wear continue to be one of major factors implicated in revision surgery. Sliding distance, cross-shear, and contact stress are the major factors influencing polyethylene wear. As previous studies have either relied on wear simulations, computational modeling, or in vitro measurements to quantify sliding distance and cross-shear, in vivo subject-specific sliding distance and cross-shear after bi-cruciate retaining (BCR) TKA has not been previously reported. The objective of this study was to quantify the 6°-of-freedom (6DOF) in vivo kinematics, sliding distance, and cross-shear in BCR TKA patients during gait. Twenty-nine unilateral BCR TKA patients performed level walking on a treadmill under dual fluoroscopic imaging system (DFIS) surveillance. Cumulative normalized sliding distances between the lateral and medial compartments did not change significantly (p > 0.05) during the gait cycle. Although the total normalized sliding distance was similar between the lateral and medial compartments, the cross-shear at the lateral compartment differed significantly from that at the medial compartment (p < 0.001). Significant differences in the relative length positions of the peak sliding distance and cross-shear were found between the lateral and medial bearing components. The flexion-extension motion of the reconstructed knee was more associated with the linear displacements (anterior-posterior, R² = 0.6; lateral-medial, R² = 0.8, proximal-distal, R² = 0.7) than the angular displacement (varus-valgus, R² = 0.18; internal-external rotation, R² = 0.28). Despite some differences in peak sliding distance and cross-shear positons, our results suggest similar articular contact patterns between the lateral and medial compartments in BCR TKA patients during gait. The data could provide insights into understanding the potential wear patterns in BCR TKAs.     

Elbow helical axes of motion are not the same in physiologic and kinetic joint simulators

Physiologic and kinetic joint simulators have been widely used for investigations of joint mechanics. The two types of simulator differ in the way joint motion is achieved; through prescribed motions and/or forces in kinetic joint simulators and by tendon loads in physiologic joint simulators. These two testing modalities have produced important insights, as in elucidating the importance of soft tissue structures to joint stability. However, the equivalence of the modalities has not been tested. This study sequentially tested five cadaveric elbows using both a physiologic simulator and a robot/6DOF system. Using position data from markers on the humerus and ulna, we calculated and compared the helical axes of motion of the specimens as the elbows were flexed from full extension. Six step size increments were used in the helical axis calculation. Marker position data at each test's full extension and full flexion point were also used to calculate a datum (overall) helical axis. The angles between the datum axis and step-wise movements were computed and stored. Increasing step size monotonically decreased the variability and the average conical angle encompassing the helical axes; a repeated measures ANOVA using test type (robot or physiologic simulator) and step size found that both type and step caused statistically significant differences (p<0.001). The large changes in helical axis angle observed for small changes in elbow flexion angle, especially in the robot tests, are a caveat for investigators using similar control algorithms. Controllers may need to include increased joint compliance and/or C(1) continuity to reduce variability.     

Effect of joint laxity on polyethylene wear in total knee replacement

Experimental simulator studies are frequently performed to evaluate wear behavior in total knee replacement. It is vital that the simulation conditions match the physiological situation as closely as possible. To date, few experimental wear studies have examined the effects of joint laxity on wear and joint kinematics and the absence of the anterior cruciate ligament has not been sufficiently taken into account in simulator wear studies.The aim of this study was to investigate different ligament and soft tissue models with respect to wear and kinematics.A virtual soft tissue control system was used to simulate different motion restraints in a force-controlled knee wear simulator.The application of more realistic and sophisticated ligament models that considered the absence of anterior cruciate ligament lead to a significant increase in polyethylene wear (p=0.02) and joint kinematics (p<0.01). We recommend the use of more complex ligament models to appropriately simulate the function of the human knee joint and to evaluate the wear behavior of total knee replacements. A feasible simulation model is presented.     

Effects of dietary fracture toughness and dental wear on chewing efficiency in geladas (Theropithecus gelada)

Chewing efficiency has been associated with fitness in mammals, yet little is known about the behavioral, ecological, and morphological factors that influence chewing efficiency in wild animals. Although research has established that dental wear and food material properties independently affect chewing efficiency, few studies have addressed the interaction among these factors. We examined chewing efficiency, measured as mean fecal particle size, as a function of seasonal shifts in diet (and corresponding changes in food fracture toughness) in a single breeding population of a grazing primate, the gelada monkey, at Guassa, Ethiopia. We also measured dental topographic traits (slope, angularity, and relief index) and relative two‐ and three‐dimensional shearing crest lengths in a cross‐sectional wear series of gelada molars. Chewing efficiency decreased during the dry season, a pattern corresponding to the consumption of foods with higher fracture toughness. Older individuals experienced the most pronounced decreases in chewing efficiency between seasons, implicating dental wear as a causal factor. This pattern is consistent with our finding that dental topographic metrics and three‐dimensional relative shearing crest lengths were lowest at the last stage of wear. Integrating these lines of behavioral, ecological, and morphological evidence provides some of the first empirical support for the hypothesis that food fracture toughness and dental wear together contribute to chewing efficiency. Geladas have the highest chewing efficiencies measured thus far in primates, and may be analogous to equids in their emphasis on dental design as a means of particle size reduction in the absence of highly specialized digestive physiology. Am J Phys Anthropol 155:17–32, 2014. © 2014 Wiley Periodicals, Inc.