Mapping anisotropy of the proximal femur for enhanced image based finite element analysis

Finite element (FE) models of bone derived from quantitative computed tomography (QCT) rely on realistic material properties to accurately predict bone strength. QCT cannot resolve bone microarchitecture, therefore QCT-based FE models lack the anisotropy apparent within the underlying bone tissue. This study proposes a method for mapping femoral anisotropy using high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of human cadaver specimens. Femur HR-pQCT images were sub-divided into numerous overlapping cubic sub-volumes and the local anisotropy was quantified using a ‘direct-mechanics’ method. The resulting directionality reflected all the major stress lines visible within the trabecular lattice, and provided a realistic estimate of the alignment of Harvesian systems within the cortical compartment. QCT-based FE models of the proximal femur were constructed with isotropic and anisotropic material properties, with directionality interpolated from the map of anisotropy. Models were loaded in a sideways fall configuration and the resulting whole bone stiffness was compared to experimental stiffness and ultimate strength. Anisotropic models were consistently less stiff, but no statistically significant differences in correlation were observed between material models against experimental data. The mean difference in whole bone stiffness between model types was approximately 26%, suggesting that anisotropy can still effect considerable change in the mechanics of proximal femur models. The under prediction of whole bone stiffness in anisotropic models suggests that the orthotropic elastic constants require further investigation. The ability to map mechanical anisotropy from high-resolution images and interpolate information into clinical-resolution models will allow testing of new anisotropic material mapping strategies.     

Concept and development of an orthotropic FE model of the proximal femur

PURPOSE: In contrast to many isotropic finite-element (FE) models of the femur in literature, it was the object of our study to develop an orthotropic FE "model femur" to realistically simulate three-dimensional bone remodelling. METHODS: The three-dimensional geometry of the proximal femur was reconstructed by CT scans of a pair of cadaveric femurs at equal distances of 2mm. These three-dimensional CT models were implemented into an FE simulation tool. Well-known "density-determined" bony material properties (Young's modulus; Poisson's ratio; ultimate strength in pressure, tension and torsion; shear modulus) were assigned to each FE of the same "CT-density-characterized" volumetric group.In order to fix the principal directions of stiffness in FE areas with the same "density characterization", the cadaveric femurs were cut in 2mm slices in frontal (left femur) and sagittal plane (right femur). Each femoral slice was scanned into a computer-based image processing system. On these images, the principal directions of stiffness of cancellous and cortical bone were determined manually using the orientation of the trabecular structures and the Haversian system. Finally, these geometric data were matched with the "CT-density characterized" three-dimensional femur model. In addition, the time and density-dependent adaptive behaviour of bone remodelling was taken into account by implementation of Carter's criterion. RESULTS: In the constructed "model femur", each FE is characterized by the principal directions of the stiffness and the "CT-density-determined" material properties of cortical and cancellous bone. Thus, on the basis of anatomic data a three-dimensional FE simulation reference model of the proximal femur was realized considering orthotropic conditions of bone behaviour. CONCLUSIONS: With the orthotropic "model femur", the fundamental basis has been formed to realize realistic simulations of the dynamical processes of bone remodelling under different loading conditions or operative procedures (osteotomies, total hip replacements, etc).     

Mechanical significance of femoral head trabecular bone structure in Loris and Galago evaluated using micromechanical finite element models

Work on the interspecific and intraspecific variation of trabecular bone in the proximal femur of primates demonstrates important architectural variation between animals with different locomotor behaviors. This variation is thought to be related to the processes of bone adaptation whereby bone structure is optimized to the mechanical environment. Micromechanical finite element models were created for the proximal femur of the leaping Galago senegalensis and the climbing and quadrupedal Loris tardigradus by converting bone voxels from high-resolution X-ray computed tomography scans of the femoral head to eight-noded brick elements. The resulting models had approximately 1.8 million elements each. Loading conditions representing takeoff phase of a leap and more generalized load orientations were applied to the models, and the models were solved using the iterative "row-by-row" matrix-vector multiplication algorithm. The principal strain and Von Mises stress results for the leaping model were similar for both species at each load orientation. Similar hip joint reaction forces in the range of 4.9 x to 12 x body weight were calculated for both species under each loading condition, but the hip reaction values estimated for Loris were higher than predicted based on locomotor behavior. These results suggest that functional adaptation to hip joint loading may not fully explain the differences in femoral head trabecular bone structure in Galago and Loris. The finite element method represents a unique and useful tool for analyzing the functional adaptation of trabecular bone in a diversity of animals and for reconstructing locomotor behavior in extinct taxa.     

Fracture mechanics of the femoral neck in a composite bone model: Effects of platen geometry

Load applicator (platen) geometry used for axial load to failure testing of the femoral neck varies between studies and the biomechanical consequences are unknown. The purpose of this study was to determine if load application with a flat versus a conical platen results in differing fracture mechanics. Femurs were aligned in 25° of adduction and an axial compressive force was applied to the femoral heads at a rate of 6 mm/min until failure. Load application with the conical platen resulted in an average ultimate failure load, stiffness, and energy to failure of 9067 N, 4033 N/mm, and 12.12 J, respectively. Load application with the flat platen resulted in a significant (p<0.05) reduction in ultimate failure load (7620 N) and stiffness (2924 N/mm). Energy to failure (12.30 J) was not significantly different (p=0.893). Different fracture patterns were observed for the two platens and the conical platen produced fractures more similar to clinical observations. Use of a flat platen underestimates the strength and stiffness of the femoral neck and inaccurately predicts the associated fracture pattern. These findings must be considered when interpreting the results of prior biomechanical studies on femoral neck fracture and for the development of future femoral neck fracture models.     

尖顶距在股骨近端抗旋转髓内钉治疗股骨近端骨折中的应用

目的:探讨尖顶距在股骨近端抗旋转髓内钉治疗股骨近端骨折临床效果中的作用和意义,为骨外科手术疗效的评价提供可借鉴的方法。方法:对2006年8月-2007年10月期间在我院接受PFNA治疗的32例股骨近端骨折患者的临床资料进行回顾性分析。根据AO/ASIF国际内固定研究学会标准对骨折进行分类,应用术中和术后即刻X光射线照片对骨折复位情况、远端锁定类型和股骨头内刀片位置进行记录。患者术后常规X光照片观察切出情况,用Oxford髋关节评分系统评价临床疗效。结果:研究期间共有37例PFNA植入,纳入本研究的共32例,27例获得随访。其中,3例切出(2例内侧穿孔和1例内侧塌陷)TAD小于20mm。4例植入相关股骨骨折,2例不愈合,1例复位失败。结论:PFNA是治疗股骨近端不稳定型骨折的有效装置。我们认为TAD应尽量20 mm或30 mm以避免股骨头穿透。     

Reduction in wire tension caused by dynamic loading. An experimental Ilizarov frame study

Small diameter transosseous wires are main parts of the Ilizarov frame concept. Wire tensioning is essential to gain the necessary transversal stiffness, and the wire fixators are therefore important, coupling the wire to the ring. The ability of three different wire fixator designs to maintain wire tension under dynamic loading is described. The three fixator designs were combinations of two types of bolts and one washer. In a simplified frame set-up consisting of one ring and one wire, sixty wires were dynamically loaded in sequence with 200N for 450 times and wire tension was repeatedly measured. The tension loss employing the different fixator types at two wire pretension levels (883N, 1275N) was measured. Wire slippage in the fixators and the midpoint deflection angle of the wires were measured. Large differences in fixation ability were observed. Wire fixators holding a larger and rougher contact surface had significant smaller tension loss compared to fixators with a smaller and smother contact surface. Both plastic wire deformation and slippage causes tension loss with slippage as the main contributor. Wire fixators' design can be improved in order to maintain wire tension. Such improvement could be of clinical interest enhancing the mechanical stability of the fixator.     

Application of an anisotropic bone-remodelling model based on a damage-repair theory to the analysis of the proximal femur before and after total hip replacement

In this work, a new model for internal anisotropic bone remodelling is applied to the study of the remodelling behaviour of the proximal femur before and after total hip replacement (THR). This model considers bone remodelling under the scope of a general damage-repair theory following the principles of continuum damage mechanics. A "damage-repair" tensor is defined in terms of the apparent density and Cowin's "fabric tensor", respectively, associated with porosity and directionality of the trabeculae. The different elements of a thermodynamically consistent damage theory are established, including resorption and apposition criteria, evolution law and rate of remodelling. All of these elements were introduced and discussed in detail in a previous paper (García, J. M., Martinez, M. A., Doblaré, M., 2001. An anisotrophic internal-external bone adaptation model based on a combination of CAO and continuum damage mechanics technologies. Computer Methods in Biomechanics and Biomedical Engineering 4(4), 355-378.), including the definition of the proposed mechanical stimulus and the qualitative properties of the model. In this paper, the fundamentals of the proposed model are briefly reviewed and the computational aspects of its implementation are discussed. This model is then applied to the analysis of the remodelling behaviour of the intact femur obtaining densities and mass principal values and directions very close to the experimental data. The second application involved the proximal femoral extremity after THR and the inclusion of an Exeter prosthesis. As a result of the simulation process, some well-known features previously detected in medical clinics were recovered, such as the stress yielding effect in the proximal part of the implant or the enlargement of the cortical layer at the distal part of the implant. With respect to the anisotropic properties, bone microstructure and local stiffness are known to tend to align with the stress principal directions. This experimental fact is mathematically proved in the framework of this remodelling model and clearly shown in the results corresponding to the intact femur. After THR the degree of anisotropy decreases tending, specifically in the proximal femur, to a more isotropic behaviour.     

The relationship between whole bone stiffness and strength is age and sex dependent

Accurately estimating whole bone strength is critical for identifying individuals that may benefit from prophylactic treatments aimed at reducing fracture risk. Strength is often estimated from stiffness, but it is not known whether the relationship between stiffness and strength varies with age and sex. Cadaveric proximal femurs (44 Male: 18–78 years; 40 Female: 24–95 years) and radial (36 Male: 18–89 years; 19 Female: 24–95 years) and femoral diaphyses (34 Male: 18–89 years; 19 Female: 24–95 years) were loaded to failure to evaluate how the stiffness-strength relationship varies with age and sex. Strength correlated significantly with stiffness at all sites and for both sexes, as expected. However, females exhibited significantly less strength for the proximal femur (58% difference, p < 0.001). Multivariate regressions revealed that stiffness, age and PYD were significant negative independent predictors of strength for the proximal femur (Age: M: p = 0.005, F: p < 0.001, PYD: M: p = 0.022, F: p = 0.025), radial diaphysis (Age: M = 0.055, PYD: F = 0.024), and femoral diaphysis (Age: M: p = 0.014, F: p = 0.097, PYD: M: p = 0.003, F: p = 0.091). These results indicated that older bones tended to be significantly weaker for a given stiffness than younger bones. These results suggested that human bones exhibit diminishing strength relative to stiffness with aging and with decreasing PYD. Incorporating these age- and sex-specific factors may help to improve the accuracy of strength estimates.     

The fixion proximal femur nailing system: biomechanical properties of the nail and a cadaveric study

The treatment of choice for early mobilization of hip fracture is surgery, which traditionally employs side plates and screws or intramedullary nails. We examined the biomechanical properties of a new proximal femoral nail system. The new expandable Fixion proximal femur nailing (PFN) system, made of stainless-steel alloy, consists of a nail, a peg and an anti-rotation pin. Upon positioning, the nail and peg are expanded to their maximal diameter. The current biomechanical study investigated: nail bending strength and stiffness, fatigue properties and hip peg strength. A cadaveric study that determined the effect of the expandable peg on the femoral head included subsidence testing, pull and torsion testing and intra-osseous pressure (IOP) measurements before and after expansion. Biomechanical properties of the new nail met ASTM F384 guideline requirements. The cadaver study yielded equivalent results for the pullout test between the peg and the hip screw, but found the peg superior in the torsion strength test. IOP during peg insertion and expansion was substantially lower than the threshold pressure that causes avascular necrosis. The biomechanical tests found the new system to be safe and able to provide good abutment of the nail to the bone. We conclude that the Fixion PFN system proved to be an effective proximal femur fracture fixation device.     

Strains and micromotions of press-fit femoral stem prostheses

Average femoral geometry was determined from sections of 25 human femurs. A 'stem design program' was used to determine the largest femoral stem that could be introduced into the canal. The stem was fine tuned by observations of fit in Plexiglass models of the 25 femurs. This stem was called the 'Exact-Fit'. Type 1 stem was formed by grinding the anterior and posterior faces flat. Type 2 stem was formed by additionally grinding the medial and lateral faces flat. Four fresh femurs were used for the experiments. Strain gages were located on the proximal medial area and level with the distal lateral tip. Displacement transducers were mounted proximally to measure stem-bone micromotion. Vertical and anterior-posterior forces were applied to the femoral head and normal strain data obtained. The stems were then inserted in sequence and the strains and micromotions were measured. After the uncemented stems had been tested, a smaller size of 'exact-fit' stem was cemented and the tests repeated. The strains with the uncemented stems were closer to normal than with the cemented stems. For example, compressive calcar strains averaged 56% of normal uncemented compared with 30% cemented for the different loadings. The micromotion was higher uncemented, but was still at a low level. The 'exact-fit' stem gave less resultant micromotion than the type 1 and type 2 stems. The high variation of the strain results was attributed to variations in stem-bone contact and fit. The study provided information of direct application to press-fit stems in hip replacement surgery.     

Bending and fracture of the femoral component in cemented total hip replacement

A computer method was used to make 41 measurements on the geometry of insertion of the femoral component in 200 Charnley total hip replacements. Surgery had been performed at least 12 years before, giving results which were classified as: success (90); fracture (56); or loose (54), according to rigid selection criteria. Fracture was associated with heavier patients in which there was poor proximal fixation of the femoral component but adequate distal fixation. Stems with a medial disposition proximally were more common in the fracture group than in the successful or loose groups. Sequential measurements of bending and subsequent fracture were made on the follow-up radiographs of 24 of the 200 cases (6 fracture and 18 successful). These measurements allowed bending to be detected at an earlier stage than by simple inspection of the radiographs.     

Modelling the fibrous tissue layer in cemented hip replacements: experimental and finite element methods

The long-term fixation of cemented femoral components may be jeopardised by the presence of a fibrous tissue layer at the bone-cement interface. This study used both experimental and finite element (FE) methods to investigate the load transfer characteristics of two types of cemented hip replacements (Lubinus SPII and Müller-Curved) with a fibrous tissue layer.The experimental part investigated six stems of each type, where these were implanted in composite femurs with a specially selected silicone elastomer modelling the soft interfacial layer. Two fibrous tissue conditions were examined: a layer covering the full cement mantle, representing a revision condition; and a layer covering the proximal portion of the cement mantle, representing a non-revised implant with partial debonding and fibrous tissue formation. The FE method was used to model the full fibrous tissue layer condition, for both implants. The layer was modelled as a homogeneous, linearly isotropic material. A cross-comparison was performed of the experimental and FE findings.Agreement between experimental and FE models was verified to be within 15%. Varying the stiffness parameter of the FE soft tissue layer had little influence on the cortical bone strains, though had considerable effect on the cement strains. Stress shielding occurred for both stems under both fibrous tissue conditions, with the greatest reduction around the calcar. However, the cortical bone strains were generally larger than those for the equivalent well-fixed stems. The fibrous tissue layer was not found to increase the general strain pattern of the cement mantle, though localised regions of high stress were detected.     

Stiffening of the femoral head due to inter-trabecular fluid and intraosseous pressure

The mechanical properties of cancellous bone, as measured from bone plug samples have been widely documented. However, few tests have been attempted to explore the effects the intertrabecular contents may have on the load bearing capabilities. In this study, canine femoral heads were subjected to dynamic compressive strain cycles. The femoral heads were tested intact, as well as with disrupted boundary conditions of the continuous, intraosseous fluid space. A significant reduction in mechanical stiffness was observed when the fluid compartment boundary was disrupted by drilling a hole part way into the femoral neck. A finite element model of a typical femoral head showed that the stiffness change was not due to removal of material from the neck, hydraulic effects notwithstanding. Refilling the hole in the neck with saline solution and sealing the boundary restored the stiffness to the intact baseline level. However, an increase in the fluid pressure did not cause a statistically significant increase in the stiffness of the femoral head.     

Novel methods to study functional loading micromechanics at the stem–cement and cement–bone interface in cemented femoral hip replacements

We have developed a technique to directly observe the micromechanics of the stem–cement and cement–bone interfaces of cemented femoral stems under physiologically relevant loading conditions. Thick transverse sections of a stem–cement–femur construct were fixed to the base of a test frame. Ante- and retro-verting torques were applied to the femoral stem by screwing the stem (via a pair of through holes) to an axle, which was turned using a lever arm actuated by the test frame cross-head. The surface of each transverse section was serially digitally imaged during loading. The displacements of the stem, cement and bone were determined using digital image correlation. These data were then used to calculate the relative displacements across the interfaces. This method provides a path to more thorough understanding of load-transfer from femoral stem to femur.     

Numerical-experimental method for the validation of a controlled stiffness femoral prosthesis

The aim of this paper is to describe a new numerical-experimental method to determine the stiffness of a conceptual proximal femoral prototype. The methodology consists of the comparison of the numerical and experimental displacement distributions of the prosthesis loaded as a cantilever beam to validate a design concept: controlled stiffness prosthesis. The manufactured prototype used to test the applicability of the numerical-experimental procedure integrates a stiff metal core bonded to a composite material made of an epoxy resin reinforced with carbon-glass braided pre-forms. The prosthesis with an embedded controlled stiffness concept was obtained by varying the geometry of the core with the composite layer thickness.     

QCT/FEA predictions of femoral stiffness are strongly affected by boundary condition modeling

Quantitative computed tomography-based finite element models of proximal femora must be validated with cadaveric experiments before using them to assess fracture risk in osteoporotic patients. During validation, it is essential to carefully assess whether the boundary condition (BC) modeling matches the experimental conditions. This study evaluated proximal femur stiffness results predicted by six different BC methods on a sample of 30 cadaveric femora and compared the predictions with experimental data. The average stiffness varied by 280% among the six BCs. Compared with experimental data, the predictions ranged from overestimating the average stiffness by 65% to underestimating it by 41%. In addition, we found that the BC that distributed the load to the contact surfaces similar to the expected contact mechanics predictions had the best agreement with experimental stiffness. We concluded that BC modeling introduced large variations in proximal femora stiffness predictions.     

The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

Background

The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures.

Methods

Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed.

Results

Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001). When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P≤0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture.

Conclusions

Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.     

动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效比较

目的:比较动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效和安全性。方法:收集我院收治的老年股骨近端骨折患者64例,随机分为DHS组和PFN组,每组各32例。DHS组患者给予动力髋螺钉的固定方式,PFN组给予股骨近端髓内钉的固定方式。手术后对患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症以及患者临床疗效进行检测并比较。结果:与治疗前相比,两组患者治疗后的Harris评分均显著下降(P0.05);与DHS组相比,PFN组患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症的发生率以及Harris评分均较低(P0.05)。结论:股骨近端髓内钉的固定治疗老年股骨近端骨折的临床疗效较好,安全性更高。     

Protective actions of green tea polyphenols and alfacalcidol on bone microstructure in female rats with chronic inflammation

This study investigated the effects of green tea polyphenols (GTP) and alfacalcidol on bone microstructure and strength along with possible mechanisms in rats with chronic inflammation. A 12-week study using a 2 (no GTP vs. 0.5%, w/v GTP in drinking water)×2 (no alfacalcidol vs. 0.05 μg/kg alfacalcidol orally, 5×/week) factorial design was employed in lipopolysaccharide (LPS)-administered female rats. A group receiving placebo administration was used to compare with a group receiving LPS administration only to evaluate the effect of LPS. Changes in tibial and femoral microarchitecture and strength of femur were evaluated. Difference in expression of tumor necrosis factor-α (TNF-α) in proximal tibia using immunohistochemistry was examined. Compared to the placebo group, the LPS-administered-only group had significantly lower femoral mass, trabecular volume, thickness and number in proximal tibia and femur, and lower periosteal bone formation rate in tibial shafts but had significantly higher trabecular separation and osteoclast number in proximal tibia and eroded surface in endocortical tibial shafts. Both GTP and alfacalcidol reversed these LPS-induced detrimental changes in femur, proximal tibia and endocortical tibial shaft. Both GTP and alfacalcidol also significantly improved femoral strength, while significantly suppressed TNF-α expression in proximal tibia. There were significant interactions in femoral mass and strength, trabecular separation, osteoclast number and TNF-α expression in proximal tibia. A combination of both showed to sustain bone microarchitecture and strength. We conclude that a protective impact of GTP and alfacalcidol in bone microarchitecture during chronic inflammation may be due to a suppression of TNF-α.     

TGATG vector: a new expression system for cloned foreign genes in Escherichia coli cells

A TGATG vector system was developed that allows for the construction of hybrid operons with partially overlapping genes, employing the effects of translational coupling to optimize expression of cloned cistrons in Escherichia coli. In this vector system (plasmid pPR-TGATG-1), the coding region of a foreign gene is attached to the ATG codon situated on the vector, to form the hybrid operon transcribed from the phage lambda PR promoter. The cloned gene is the distal cistron of this hybrid operon ('overlappon'). The efficiently translated cro'-cat'-'trpE hybrid cistron is proximal to the promoter. The coding region of this artificial fused cistron [the length of the corresponding open reading frame is about 120 amino acids (aa)] includes the following: the N-terminal portions of phage lambda Cro protein (20 aa), the CAT protein of E. coli (72 aa) and 3' C-terminal codons of the E. coli trpE gene product. At the 3'-end of the cro'-cat'-'trpE fused cistron there is a region for efficient translation reinitiation: a Shine-Dalgarno sequence of the E. coli trpD gene and the overlapping stop and start codons (TGATG). In this sequence, the last G is the first nucleotide of the unique SacI-recognition site (GAGCT decreases C) and so integration of the structural part of the foreign gene into the vector plasmid may be performed using blunt-end DNA linking after the treatment of pPR-TGATG-1 with SacI and E. coli DNA polymerase I or its Klenow fragment.(ABSTRACT TRUNCATED AT 250 WORDS)