1
|
Chahari M, Salman E, Stanacevic M, Willing R, Towfighian S. Hybrid triboelectric-piezoelectric nanogenerator for long-term load monitoring in total knee replacements. SMART MATERIALS & STRUCTURES 2024; 33:055034. [PMID: 38645721 PMCID: PMC11025032 DOI: 10.1088/1361-665x/ad3bfd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/29/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
A self-powered and durable pressure sensor for large-scale pressure detection on the knee implant would be highly advantageous for designing long-lasting and reliable knee implants as well as obtaining information about knee function after the operation. The purpose of this study is to develop a robust energy harvester that can convert wide ranges of pressure to electricity to power a load sensor inside the knee implant. To efficiently convert loads to electricity, we design a cuboid-array-structured tribo-pizoelectric nanogenerator (TPENG) in vertical contact mode inside a knee implant package. The proposed TPENG is fabricated with aluminum and cuboid-patterned silicone rubber layers. Using the cuboid-patterned silicone rubber as a dielectric and aluminum as electrodes improves performance compared with previously reported self-powered sensors. The combination of 10w t % dopamine-modified BaTiO3 piezoelectric nanoparticles in the silicone rubber enhanced electrical stability and mechanical durability of the silicone rubber. To examine the output, the package-harvester assemblies are loaded into an MTS machine under different periodic loading. Under different cyclic loading, frequencies, and resistance loads, the harvester's output performance is also theoretically studied and experimentally verified. The proposed cuboid-array-structured TPENG integrated into the knee implant package can generate approximately 15μ W of apparent power under dynamic compressive loading of 2200 N magnitude. In addition, as a result of the TPENG's materials being effectively optimized, it possesses remarkable mechanical durability and signal stability, functioning after more than 30 000 cycles under 2200 N load and producing about 300 V peak to peak. We have also presented a mathematical model and numerical results that closely capture experimental results. We have reported how the TPENG charge density varies with force. This study represents a significant advancement in a better understanding of harvesting mechanical energy for instrumented knee implants to detect a load imbalance or abnormal gait patterns.
Collapse
Affiliation(s)
- Mahmood Chahari
- State University of New York at Binghamton, Binghamton, NY, United States of America
| | - Emre Salman
- Stony Brook University, Stony Brook, NY, United States of America
| | | | - Ryan Willing
- University of Western Ontario, London, Ontario, Canada
| | - Shahrzad Towfighian
- State University of New York at Binghamton, Binghamton, NY, United States of America
| |
Collapse
|
2
|
Li J, Zhang F, Lyu H, Yin P, Shi L, Li Z, Zhang L, Di CA, Tang P. Evolution of Musculoskeletal Electronics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2303311. [PMID: 38561020 DOI: 10.1002/adma.202303311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 02/10/2024] [Indexed: 04/04/2024]
Abstract
The musculoskeletal system, constituting the largest human physiological system, plays a critical role in providing structural support to the body, facilitating intricate movements, and safeguarding internal organs. By virtue of advancements in revolutionized materials and devices, particularly in the realms of motion capture, health monitoring, and postoperative rehabilitation, "musculoskeletal electronics" has actually emerged as an infancy area, but has not yet been explicitly proposed. In this review, the concept of musculoskeletal electronics is elucidated, and the evolution history, representative progress, and key strategies of the involved materials and state-of-the-art devices are summarized. Therefore, the fundamentals of musculoskeletal electronics and key functionality categories are introduced. Subsequently, recent advances in musculoskeletal electronics are presented from the perspectives of "in vitro" to "in vivo" signal detection, interactive modulation, and therapeutic interventions for healing and recovery. Additionally, nine strategy avenues for the development of advanced musculoskeletal electronic materials and devices are proposed. Finally, concise summaries and perspectives are proposed to highlight the directions that deserve focused attention in this booming field.
Collapse
Affiliation(s)
- Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Fengjiao Zhang
- School of Chemical Sciences, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Houchen Lyu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Lei Shi
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Zhiyi Li
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Chong-An Di
- Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Organic Solids, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| |
Collapse
|
3
|
Crisco JJ, Henke JA, McDermott DG, Badida R, Morton AM, Kalshoven JM, Moore DC. Development of an implantable trapezium carpal bone replacement for measuring in vivo loads at the base of the thumb. J Biomech 2024; 165:112013. [PMID: 38401330 PMCID: PMC10956735 DOI: 10.1016/j.jbiomech.2024.112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/22/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
Understanding the loads that occur across musculoskeletal joints is critical to advancing our understanding of joint function and pathology, implant design and testing, as well as model verification. Substantial work in these areas has occurred in the hip and knee but has not yet been undertaken in smaller joints, such as those in the wrist. The thumb carpometacarpal (CMC) joint is a uniquely human articulation that is also a common site of osteoarthritis with unknown etiology. We present two potential designs for an instrumented trapezium implant and compare approaches to load calibration. Two instrumented trapezia designs were prototyped using strain gauge technology: Tube and Diaphragm. The Tube design is a well-established structure for sensing loads while the Diaphragm is novel. Each design was affixed to a 6-DOF load cell that was used as the reference. Loads were applied manually, and two calibration methods, supervised neural network (DEEP) and matrix algebra (MAT), were implemented. Bland-Altman 95% confidence interval for the limits of agreement (95% CI LOA) was used to assess accuracy. Overall, the DEEP calibration decreased 95% CI LOA compared with the MAT approach for both designs. The Diaphragm design outperformed the Tube design in measuring the primary load vector (joint compression). Importantly, the Diaphragm design permits the hermetic encapsulation of all electronics, which is not possible with the Tube design, given the small size of the trapezium. Substantial work remains before this device can be approved for implantation, but this work lays the foundation for further device development that will be required.
Collapse
Affiliation(s)
- Joseph J Crisco
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States.
| | - Julia A Henke
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Daniel G McDermott
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Rohit Badida
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Amy M Morton
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Josephine M Kalshoven
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Douglas C Moore
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, United States
| |
Collapse
|
4
|
Wang J, Chu J, Song J, Li Z. The application of impantable sensors in the musculoskeletal system: a review. Front Bioeng Biotechnol 2024; 12:1270237. [PMID: 38328442 PMCID: PMC10847584 DOI: 10.3389/fbioe.2024.1270237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application.
Collapse
Affiliation(s)
- Jinzuo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
| | - Jian Chu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Jinhui Song
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
| |
Collapse
|
5
|
Gong Y, Jin Z, Zhou H, Su H, Chen G, Zhong Y, Tong P. Modified osteochondral autograft transplantation for steroid-induced osteonecrosis of femoral head in idiopathic thrombocytopenic purpura: a case report and literature. BMC Musculoskelet Disord 2024; 25:19. [PMID: 38167054 PMCID: PMC10759329 DOI: 10.1186/s12891-023-07108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
Osteochondral autograft transplantation (OAT) has been commonly applied in the knee and ankle while the technique has not yet been a popularity in the femoral head. In this article, we present a 28-year-old female patient, who has a history of 1-year-use of glucocorticoid in the treatment of idiopathic thrombocytopenic purpura, with steroid-induced osteonecrosis of the femoral head (SONFH). She underwent surgical hip dislocation, osteochondroplasty, OAT, and internal fixation. Her Harris Hip Score improved from 64 to 82 in 36 months to follow-up. The case is valuable considering that a single, instead of several, 1.5 cm autograft was harvested from the non-bearing part of the same femoral head. This modification dispensed with the need of surgery for harvesting autograft from knee or ankle and reduced the structural vulnerability brought by the multihole donor part of the femoral head.
Collapse
Affiliation(s)
- Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Haojin Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Ying Zhong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Province, Hangzhou, 310006, China.
| |
Collapse
|
6
|
Jeyaraman M, Jayakumar T, Jeyaraman N, Nallakumarasamy A. Sensor Technology in Fracture Healing. Indian J Orthop 2023; 57:1196-1202. [PMID: 37525725 PMCID: PMC10386990 DOI: 10.1007/s43465-023-00933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/08/2023] [Indexed: 08/02/2023]
Abstract
Introduction SMART sensor technology may provide the solution to bridge the gap between the current radiographic determination of fracture healing and clinical assessment. The displacement and rigidity between the fracture ends can be accurately measured using strain gauges. Progressively increasing stiffness is a sign of fracture consolidation which can be monitored using sensors. The design of standard orthopaedic implants can remain the same and needs no major modifications as the sensor can be mounted onto the implant without occupying much space. Data regarding various fracture morphologies and their strain levels throughout the fracture healing process may help develop AI algorithms that can subsequently be used to optimise implant design/materials. Materials and Methods The literature search was performed in PubMed, PubMed Central, Scopus, and Web of Science databases for reviewing and evaluating the published scientific data regarding sensor technology in fracture healing. Results and Interpretation SMART sensor technology comes with a variety of uses such as determining fracture healing progress, predicting early implant failure, and determining fractures liable for non-union to exemplify a few. The main limitations are that it is still in its inception and needs extensive refinement before it becomes widely and routinely used in clinical practice. Nevertheless, with continuous advances in microprocessor technology, research designs, and additive manufacturing, the utilisation and application of SMART implants in the field of trauma and orthopaedic surgery are constantly growing. Conclusion Mass production of such SMART implants will reduce overall production costs and see its use in routine clinical practice in the future and is likely to make a significant contribution in the next industrial revolution termed 'Industry 5.0' which aims at personalised patient-specific implants and devices. SMART sensor technology may, therefore, herald a new era in the field of orthopaedic trauma.
Collapse
Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600056 India
| | - Tarun Jayakumar
- Department of Orthopaedics, KIMS-Sunshine Hospital, Hyderabad, Telangana 500003 India
| | - Naveen Jeyaraman
- Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth, Chengalpattu, Tamil Nadu 603108 India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| |
Collapse
|
7
|
Sun T, Wang J, Suo M, Liu X, Huang H, Zhang J, Zhang W, Li Z. The Digital Twin: A Potential Solution for the Personalized Diagnosis and Treatment of Musculoskeletal System Diseases. Bioengineering (Basel) 2023; 10:627. [PMID: 37370558 DOI: 10.3390/bioengineering10060627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
Due to the high prevalence and rates of disability associated with musculoskeletal system diseases, more thorough research into diagnosis, pathogenesis, and treatments is required. One of the key contributors to the emergence of diseases of the musculoskeletal system is thought to be changes in the biomechanics of the human musculoskeletal system. However, there are some defects concerning personal analysis or dynamic responses in current biomechanical research methodologies. Digital twin (DT) was initially an engineering concept that reflected the mirror image of a physical entity. With the application of medical image analysis and artificial intelligence (AI), it entered our lives and showed its potential to be further applied in the medical field. Consequently, we believe that DT can take a step towards personalized healthcare by guiding the design of industrial personalized healthcare systems. In this perspective article, we discuss the limitations of traditional biomechanical methods and the initial exploration of DT in musculoskeletal system diseases. We provide a new opinion that DT could be an effective solution for musculoskeletal system diseases in the future, which will help us analyze the real-time biomechanical properties of the musculoskeletal system and achieve personalized medicine.
Collapse
Affiliation(s)
- Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Wentao Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| |
Collapse
|
8
|
Küpper JC, Sullivan ES, Coope RJN, Wilson DR. Design of a double acting pneumatic cartilage loading device for magnetic resonance imaging. J Mech Behav Biomed Mater 2023; 142:105810. [PMID: 37028122 DOI: 10.1016/j.jmbbm.2023.105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/20/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
Studies of osteoarthritis initiation and progression that measure strain in cartilage require physiological loading levels. Many studies use magnetic resonance (MR) imaging, which necessitates a MR-compatible loading device. In this study, the design and validation of a new device, the cartilage compressive actuator (CCA), is presented. The CCA is designed for high-field (e.g., 9.4 T) small-bore MR scanners, and meets a number of design criteria. These criteria include capability for testing bone-cartilage samples, MR compatibility, constant load and incremental strain application, a water-tight specimen chamber, remote control, and real time displacement feedback. The mechanical components in the final design include an actuating piston, a connecting chamber, and a sealed specimen chamber. An electro-pneumatic system applies compression, and an optical Fibre-Bragg grating (FBG) sensor provides live displacement feedback. A logarithmic relationship was observed between force exerted by the CCA and pressure (R2 = 0.99), with a peak output force of 653 ± 2 N. The relationship between FBG sensor wavelength and displacement was linear when calibrated both outside (R2 = 0.99) and inside (R2 = 0.98) the MR scanner. Average slope was similar between the two validation tests, with a slope of -4.2 nm/mm observed inside the MR scanner and -4.3 to -4.5 nm/mm observed outside the MR scanner. This device meets all design criteria and represents an improvement over published designs. Future work should incorporate a closed feedback loop to allow for cyclical loading of specimens.
Collapse
Affiliation(s)
- Jessica C Küpper
- Department of Orthopaedics, University of British Columbia, Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 2635 Laurel Street, Robert H.N. Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada.
| | - Emily S Sullivan
- School of Biomedical Engineering, University of British Columbia, Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 2635 Laurel Street, Robert H.N. Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Robin J N Coope
- Canada's Michael Genome Sciences Centre at BC Cancer, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - David R Wilson
- Department of Orthopaedics, University of British Columbia, Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 2635 Laurel Street, Robert H.N. Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada.
| |
Collapse
|
9
|
Kourouklis AP, Wahlsten A, Stracuzzi A, Martyts A, Paganella LG, Labouesse C, Al-Nuaimi D, Giampietro C, Ehret AE, Tibbitt MW, Mazza E. Control of hydrostatic pressure and osmotic stress in 3D cell culture for mechanobiological studies. BIOMATERIALS ADVANCES 2023; 145:213241. [PMID: 36529095 DOI: 10.1016/j.bioadv.2022.213241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Hydrostatic pressure (HP) and osmotic stress (OS) play an important role in various biological processes, such as cell proliferation and differentiation. In contrast to canonical mechanical signals transmitted through the anchoring points of the cells with the extracellular matrix, the physical and molecular mechanisms that transduce HP and OS into cellular functions remain elusive. Three-dimensional cell cultures show great promise to replicate physiologically relevant signals in well-defined host bioreactors with the goal of shedding light on hidden aspects of the mechanobiology of HP and OS. This review starts by introducing prevalent mechanisms for the generation of HP and OS signals in biological tissues that are subject to pathophysiological mechanical loading. We then revisit various mechanisms in the mechanotransduction of HP and OS, and describe the current state of the art in bioreactors and biomaterials for the control of the corresponding physical signals.
Collapse
Affiliation(s)
- Andreas P Kourouklis
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland.
| | - Adam Wahlsten
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Alberto Stracuzzi
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Anastasiya Martyts
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Lorenza Garau Paganella
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Celine Labouesse
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Dunja Al-Nuaimi
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Costanza Giampietro
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Alexander E Ehret
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Mark W Tibbitt
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Edoardo Mazza
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| |
Collapse
|
10
|
Sowers CB, Carrero AC, Cyrus JW, Ross JA, Golladay GJ, Patel NK. Return to Sports After Total Hip Arthroplasty: An Umbrella Review for Consensus Guidelines. Am J Sports Med 2023; 51:271-278. [PMID: 34668788 DOI: 10.1177/03635465211045698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations on safe return to sports (RTS) after total hip arthroplasty (THA) are subjective and based on studies of varying quality. PURPOSE The aim of this study was to synthesize systematic reviews and meta-analyses on post-THA RTS to propose practice guidelines identifying which sports can be resumed, when they can be resumed, and what risks are present. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This umbrella review followed the Joanna Briggs Institute (JBI) protocol and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Embase, Medline, and Cochrane databases were searched. Included studies were either systematic reviews or meta-analyses addressing primary or secondary outcomes. Outcomes of interest included safe sports after THA, time to RTS, prognostic indicators of RTS, reasons patients do not RTS, percentage of patients who RTS, implant complications, and objective classification of sports by impact level. Included reviews had data extracted and were assessed for methodological quality using the JBI protocol. The authors defined RTS as "returning to a sport the patient participated in at any point preoperatively." RESULTS Patients demonstrated a trend toward lower-impact sports postoperatively. Sports were classified as low (eg, walking), moderate (eg, downhill skiing), or high impact (eg, soccer). A total of 82% (range, 55%-104%) of patients were able to RTS at a mean time of 6 months (range, 4-7 months). The best prognostic indicator for RTS was previous experience in that sport. The main reason patients did not RTS was surgeon recommendation. Aseptic loosening was the most cited complication after RTS. CONCLUSION Most patients are able to return to preoperative levels of low- (eg, walking) and moderate-impact (eg, hiking) sports between 7 and 12 months after THA. Patients planning a return to high-impact (eg, singles tennis) sports should be counseled on the possible risks of traumatic injuries and aseptic loosening and monitored closely.
Collapse
Affiliation(s)
| | - Alberto C Carrero
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| | - John W Cyrus
- Virginia Commonwealth University, School of Medicine; Richmond, Virginia, USA
| | - Jeremy A Ross
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| | | | - Nirav K Patel
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| |
Collapse
|
11
|
Hansjee S, Giebaly DE, Shaarani SR, Haddad FS. Follow-up after arthroplasty surgery : a changing landscape. Bone Joint J 2022; 104-B:1104-1109. [PMID: 36177643 DOI: 10.1302/0301-620x.104b10.bjj-2022-0311.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We aim to explore the potential technologies for monitoring and assessment of patients undergoing arthroplasty by examining selected literature focusing on the technology currently available and reflecting on possible future development and application. The reviewed literature indicates a large variety of different hardware and software, widely available and used in a limited manner, to assess patients' performance. There are extensive opportunities to enhance and integrate the systems which are already in existence to develop patient-specific pathways for rehabilitation.Cite this article: Bone Joint J 2022;104-B(10):1104-1109.
Collapse
Affiliation(s)
- Shanil Hansjee
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Dia E Giebaly
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK.,The Bone & Joint Journal, London, UK
| |
Collapse
|
12
|
Díaz-Dilernia F, Astore F, Buttaro M, Zanotti G. Short-Term Results of Osteochondral Autologous Transfer and Femoral Neck Osteochondroplasty for the Treatment of Osteochondral Lesions of the Femoral Head and Concomitant Femoroacetabular Impingement Syndrome: A Case Series. Hip Pelvis 2022; 34:177-184. [PMID: 36299472 PMCID: PMC9577305 DOI: 10.5371/hp.2022.34.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022] Open
Abstract
This study aimed to analyse the initial results of five patients with symptomatic osteochondral lesions (OCL) and femoroacetabular impingement (FAI) who were treated successfully with osteochondral autologous transfer (OAT) and femoral neck osteochondroplasty (OCP) through surgical dislocation of the hip. Five patients with FAI and OCL of the femoral head who underwent surgery between 2015-2018 were studied retrospectively. All patients had a grade IV OCL, and the median defect size was 2 cm2 (interquartile range [IQR], 2-2). At the final follow-up, the modified Harris hip score showed a median value of 94 (IQR, 91-95) (P=0.04). Pain evaluation using the visual analogue scale showed a median value of 1 (IQR, 1-2) (P=0.04). Adequate graft union and healthy formation of the chondral surface were observed by magnetic resonance imaging. Although the procedure is demanding, the combination of OAT and femoral neck OCP appears to be an effective alternative in young patients.
Collapse
Affiliation(s)
- Fernando Díaz-Dilernia
- Sunnybrook Health Sciences Centre/Holland Orthopaedic & Arthritic Centre, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Franco Astore
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin Buttaro
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
13
|
Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
Collapse
Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
| |
Collapse
|
14
|
Nash KE, Ong KG, Guldberg RE. Implantable biosensors for musculoskeletal health. Connect Tissue Res 2022; 63:228-242. [PMID: 35172654 PMCID: PMC8977250 DOI: 10.1080/03008207.2022.2041002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE A healthy musculoskeletal system requires complex functional integration of bone, muscle, cartilage, and connective tissues responsible for bodily support, motion, and the protection of vital organs. Conditions or injuries to musculoskeeltal tissues can devastate an individual's quality of life. Some conditions that are particularly disabling include severe bone and muscle injuries to the extremities and amputations resulting from unmanageable musculoskeletal conditions or injuries. Monitoring and managing musculoskeletal health is intricate because of the complex mechanobiology of these interconnected tissues. METHODS For this article, we reviewed literature on implantable biosensors related to clinical data of the musculoskeletal system, therapeutics for complex bone injuries, and osseointegrated prosthetics as example applications. RESULTS As a result, a brief summary of biosensors technologies is provided along with review of noteworthy biosensors and future developments needed to fully realize the translational benefit of biosensors for musculoskeletal health. CONCLUSIONS Novel implantable biosensors capable of tracking biophysical parameters in vivo are highly relevant to musculoskeletal health because of their ability to collect clinical data relevant to medical decisions, complex trauma treatment, and the performance of osseointegrated prostheses.
Collapse
Affiliation(s)
- Kylie E. Nash
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Keat Ghee Ong
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Robert E. Guldberg
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403,Corresponding Author: Robert E. Guldberg, Ph.D., 3231 University of Oregon, Eugene OR, 97403,
| |
Collapse
|
15
|
Kim SJ, Wang T, Pelletier MH, Walsh WR. 'SMART' implantable devices for spinal implants: a systematic review on current and future trends. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:117-131. [PMID: 35441100 DOI: 10.21037/jss-21-100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/28/2022] [Indexed: 01/18/2023]
Abstract
Background 'SMART' implants refer to modified orthopedic implants that combine the biomechanical safety and efficacy of traditional devices with the intelligence of data-logging sensors. This review aims to systematically assess the available literature on SMART spinal implants and present these findings in a clinically relevant manner. Methods A search of PubMed, Scopus, and Google Scholar databases was conducted by two separate reviewers. Information including sensor type, intended application, and sample size, was extracted from included studies. Risk of bias assessment was conducted using the Office of Health Assessment and Translation (OHAT) risk of bias tool. Results Eighteen studies were included for analysis. Eight studies involved SMART rods and ten studies used SMART vertebral body replacements (VBR). No more than 20 patients are reported to have received a SMART spinal implant. Including non-primary evidence, seven unique designs for SMART spinal implants were found. The majority of these used strain gauges with recent designs including thermometers and accelerometers. Discussion At present, SMART spinal implants have primarily focused on utilising strain gauges to report loading on the implant itself. This is a logical first step as it allows quantification of real-world requirements of an implant, detection of catastrophic failure, while also allowing researchers and clinicians to estimate changes in load sharing between newly forming bone and the implant itself, providing real-time information on the progression of healing and fusion. Future work includes documenting the correlation between data provided by these SMART implants and clinical findings, including complications such as pedicle screw loosening and interbody cage subsidence.
Collapse
Affiliation(s)
- Sihyong J Kim
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,Surgical and Orthopaedics Research Laboratory, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Tian Wang
- Surgical and Orthopaedics Research Laboratory, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedics Research Laboratory, Prince of Wales Hospital, Randwick, NSW, Australia
| | - William R Walsh
- Surgical and Orthopaedics Research Laboratory, Prince of Wales Hospital, Randwick, NSW, Australia
| |
Collapse
|
16
|
Rajamanthrilage A, Arifuzzaman M, Millhouse P, Pace T, Behrend C, DesJardins J, Anker J. Measuring Orthopedic Plate Strain to Track Bone Healing Using a Fluidic Sensor Read via Plain Radiography. IEEE Trans Biomed Eng 2021; 69:278-285. [PMID: 34181532 DOI: 10.1109/tbme.2021.3092291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We describe a fluidic X-ray visualized strain indicator under applied load (X-VISUAL) to quantify orthopedic plate strain and inform rehabilitative care. METHODS The sensor comprises a polymeric device with a fluidic reservoir filled with a radio-dense fluid (cesium acetate) and an adjoining capillary wherein the liquid level is measured. A stainless-steel lever attaches to the plate and presses upon the acrylic bulb with a displacement proportional to plate bending strain. The sensor was attached to a plate in a Sawbones composite tibia mimic and a human cadaveric tibia. An osteotomy model (5 mm gap) was used to simulate an unstable fracture, and allograft repair to simulate a stiffer healed fracture. The cadaveric and Sawbones tibia were cyclically loaded five times (0-400 N) using a mechanical test stand, and fluid displacement was measured from plain radiographs. RESULTS The sensor displayed reversible and repeatable behavior with a slope of 0.096 mm/kg and fluid level noise of 50-80 micrometer (equivalent to 5-10 N). The allograft-repaired composite fracture was 13 times stiffer than the unstable fracture. CONCLUSION An analysis of prior external fracture fixation studies and fatigue curves for internal plates indicates that the threshold for safe weight bearing should be 1/5th-1/10th of the initial bending for an unstable fracture. The precision of our device (<2% body weight) should thus be sufficient to track fracture healing from unstable through safe weight bearing. SIGNIFICANCE The X-VISUAL fluidic sensor enables orthopedic plate strain quantification to monitor facture healing via X-ray imaging.
Collapse
|
17
|
Anderson WD, Wilson SLM, Holdsworth DW. Development of a Wireless Telemetry Sensor Device to Measure Load and Deformation in Orthopaedic Applications. SENSORS 2020; 20:s20236772. [PMID: 33260821 PMCID: PMC7731148 DOI: 10.3390/s20236772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023]
Abstract
Due to sensor size and supporting circuitry, in-vivo load and deformation measurements are currently restricted to applications within larger orthopaedic implants. The objective of this study is to repurpose a commercially available low-power, miniature, wireless, telemetric, tire-pressure sensor (FXTH87) to measure load and deformation for future use in orthopaedic and biomedical applications. The capacitive transducer membrane was modified, and compressive deformation was applied to the transducer to determine the sensor signal value and the internal resistive force. The sensor package was embedded within a deformable enclosure to illustrate potential applications of the sensor for monitoring load. To reach the maximum output signal value, sensors required compressive deformation of 350 ± 24 µm. The output signal value of the sensor was an effective predictor of the applied load on a calibrated plastic strain member, over a range of 35 N. The FXTH87 sensor can effectively sense and transmit load-induced deformations. The sensor does not have a limit on loads it can measure, as long as deformation resulting from the applied load does not exceed 350 µm. The proposed device presents a sensitive and precise means to monitor deformation and load within small-scale, deformable enclosures.
Collapse
Affiliation(s)
- William D. Anderson
- School of Biomedical Engineering, Western University, London, ON N6A 3K7, Canada; (W.D.A.); (S.L.M.W.)
| | - Sydney L. M. Wilson
- School of Biomedical Engineering, Western University, London, ON N6A 3K7, Canada; (W.D.A.); (S.L.M.W.)
| | - David W. Holdsworth
- School of Biomedical Engineering, Western University, London, ON N6A 3K7, Canada; (W.D.A.); (S.L.M.W.)
- Robarts Research Institute, Western University, London, ON N6A 5K8, Canada
- Department of Medical Biophysics, Western University, London, ON N6A 5C1, Canada
- Department of Surgery, Western University, London, ON N6A 4V2, Canada
- Correspondence:
| |
Collapse
|
18
|
Osteochondral autograft transplantation of the femoral head in sequelae of developmental dysplasia of hip: A case report and review of the literature. Jt Dis Relat Surg 2020; 31:619-625. [PMID: 32962599 PMCID: PMC7607946 DOI: 10.5606/ehc.2020.75135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although osteochondral autograft transplantation (OAT) in the knee and ankle has gained much popularity on the other hand the technique has rarely been applied in the femoral head. In this article, we present a 15-year-old female patient with unstable chondral lesion on the right femoral head. She had a history of open reduction for developmental dysplasia which resulted in avascular necrosis. She had coxa magna, breva and trochanteric overgrowth along with an unstable chondral lesion on the superolateral part of the femoral head. She underwent OAT for chondral lesion, femoral head reshaping and relative neck lengthening. Her Harris Hip Score improved from 55 to 90 in the 18 months of follow-up. The case is unique in a way that the autografts were harvested from the anterior part of the same femoral head that was already intended to be removed during osteochondroplasty.
Collapse
|
19
|
Compartmental force and contact location sensing in instrumented total knee replacements. Med Eng Phys 2020; 83:64-72. [PMID: 32807349 DOI: 10.1016/j.medengphy.2020.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/04/2020] [Accepted: 07/18/2020] [Indexed: 11/20/2022]
Abstract
For the past three decades, total knee replacement has become the main solution for progressed knee injuries and diseases. Due to a lack of postoperative in vivo data, a universal correlation between intra- and postoperative soft tissue balance in the knee joint has not been established. In this work, an instrumented knee implant design with six piezoelectric transducers embedded in the tibial bearing is proposed. The aim of the presented device is to measure the total and compartmental forces as well as to track the location of contact points on the medial and lateral compartments of the bearing. A numerical analysis using finite element software is first performed to obtain the best sensory system arrangement inside the bearing. The chosen design is then used to fabricate a prototype of the device. Several experiments are designed and performed using the prototype, and the ability of the proposed system to track the location and magnitude of applied compartmental forces on the bearing is evaluated. The experimental results show that the instrumented knee bearing is able to accurately measure the compartmental force quantities with a maximum error of 2.6% of the peak axial load, and the contact point locations with a maximum error of less than 1 mm.
Collapse
|
20
|
Almansour H, Sonntag R, Pepke W, Bruckner T, Kretzer JP, Akbar M. Impact of Electrocautery on Fatigue Life of Spinal Fusion Constructs-An In Vitro Biomechanical Study. MATERIALS 2019; 12:ma12152471. [PMID: 31382555 PMCID: PMC6696314 DOI: 10.3390/ma12152471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Abstract
Instrumentation failure in the context of spine surgery is attributed to cyclic loading leading to formation of fatigue cracks, which later propagate and result in rod fracture. A biomechanical analysis of the potential impact of electrocautery on the fatigue life of spinal implants has not been previously performed. The aim of this study was to assess the fatigue life of titanium (Ti) and cobalt-chrome (CoCr) rod-screw constructs after being treated with electrocautery. Twelve spinal constructs with CoCr and Ti rods were examined. Specimens were divided into four groups by rod material (Ti and CoCr) and application of monopolar electrocautery on the rods’ surface (control-group and electrocautery-group). Electrocautery was applied on each rod at three locations, then constructs were cyclically tested. Outcome measures were load-to-failure, total number of cycles-to-failure, and location of rod failure. Ti-rods treated with electrocautery demonstrated a significantly decreased fatigue life compared to non-treated Ti-rods. Intergroup comparison of cycles-to-failure revealed a significant mean decrease of almost 9 × 105 cycles (p = 0.03). No CoCr-rods failed in this experiment. Electrocautery application on the surface of Ti-rods significantly reduces their fatigue life. Surgeons should exercise caution when using electrocautery in the vicinity of Ti-rods to mitigate the risk of rod failure.
Collapse
Affiliation(s)
- Haidara Almansour
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Wojciech Pepke
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69118 Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| |
Collapse
|
21
|
Drazan JF, Abdoun OT, Wassick MT, Dahle R, Beardslee L, Marcus GA, Cady NC, Ledet EH. Simple implantable wireless sensor platform to measure pressure and force. Med Eng Phys 2018; 59:81-87. [PMID: 30064939 DOI: 10.1016/j.medengphy.2018.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/24/2018] [Accepted: 06/29/2018] [Indexed: 11/18/2022]
Abstract
Smart implants have the potential to enable personalized care regimens for patients. However, the integration of smart implants into daily clinical practice is limited by the size and cost of available sensing technology. Passive resonant sensors are an attractive alternative to traditional sensing technologies because they obviate the need for on-sensor signal conditioning or telemetry and are substantially simpler, smaller, less expensive, and more robust than other sensing methods. We have developed a novel simple, passive sensing platform that is adaptable to a variety of applications. Sensors consist of only two disconnected parallel Archimedean spiral coils and an intervening solid dielectric layer. When exposed to force or pressure, the resonant frequency of the circuit shifts which can be measured wirelessly. We fabricated prototype pressure sensors and force sensors and compared their performance to a lumped parameter model which predicts sensor behavior. The sensors exhibited a linear response (R2 > 0.91) to dynamic changes in pressure or force with excellent sensitivity. Experimental data were within 13.3% and 6.2% of the values predicted by the model for force and pressure respectively. Results demonstrate that the sensors can be adapted to measure various measurands through a span of sensitivities and ranges by appropriate selection of the intervening layer.
Collapse
Affiliation(s)
- John F Drazan
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, JEC 7044, Troy, NY, USA
| | - Omar T Abdoun
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, JEC 7044, Troy, NY, USA
| | - Michael T Wassick
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, JEC 7044, Troy, NY, USA
| | - Reena Dahle
- Department of Electrical Engineering, State University of New York at New Paltz, 1 Hawk Drive, New Paltz, NY, USA
| | - Luke Beardslee
- Department of Nanobioscience, State University of New York Polytechnic Institute, 257 Fuller Road, Albany, NY, USA
| | - George A Marcus
- Department of Physics, State University of New York at Geneseo, 1 College Circle, Geneseo, NY, USA
| | - Nathaniel C Cady
- Department of Nanobioscience, State University of New York Polytechnic Institute, 257 Fuller Road, Albany, NY, USA
| | - Eric H Ledet
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, JEC 7044, Troy, NY, USA; Research and Development Service, Stratton VA Medical Center, 113 Holland Avenue, Albany, NY, USA.
| |
Collapse
|
22
|
Abstract
Over the past few decades, sensors have been gaining a lot of popularity in the medical field. These sensors have helped shift the paradigm in medicine from having things done manually to digitalizing them. In the medical field, sensors have been manufactured in different forms and shapes including wearable and implantable wireless devices. With the aid of these sensors, healthcare professionals hope to revolutionize the system in a cost-effective way. In fact, this is already evident in most healthcare systems with the use of sensors for blood pressure, oxygen saturation, and arrhythmias on a daily basis. Also, more sophisticated sensors have made way into the medical field with a feedback loop, such as insulin pumps. On the other hand, similar technologies have been introduced in the orthopaedics world in the past decade. In this paper we summarize some of the sensors used in the medical field in general, and in orthopaedics in particular.
Collapse
Affiliation(s)
- Sultan Aldebeyan
- Division of Orthopaedic Surgery, McGill University, Montreal, Canada; National Neuroscience Institute, King Fahad Medical City, Riyadh Saudi Arabia
| | - Ahmed Aoude
- Division of Orthopaedic Surgery, McGill University, Montreal, Canada
| | - Edward J Harvey
- Division of Orthopaedic Surgery, McGill University, Montreal, Canada.
| |
Collapse
|
23
|
Safaei M, Meneghini RM, Anton SR. Energy Harvesting and Sensing with Embedded Piezoelectric Ceramics in Knee Implants. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2018; 23:864-874. [PMID: 30853785 PMCID: PMC6404984 DOI: 10.1109/tmech.2018.2794182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The knee replacement is one of the most common orthopedic surgical interventions in the United States; however, recent studies have shown up to 20% of patients are dissatisfied with the outcome. One of the key issues to improving these operations is a better understanding of the ligamentous balance during and after surgery. The goal of this work is to investigate the feasibility of embedding piezoelectric transducers in the polyethylene bearing of a total knee replacement to act as self-powered sensors to aid in the alignment and balance of the knee replacement by providing intra- and postoperative feedback to the surgeon. A model consisting of a polyethylene disc with a single embedded piezoelectric ceramic transducer is investigated as a basis for future work. A modeling framework is developed including a biomechanical model of the knee joint, a finite element model of the knee bearing with encapsulated transducer, and an electromechanical model of the piezoelectric transducer. Model predictions show that a peak voltage of 2.3 V with a load resistance of 1.01 MΩ can be obtained from a single embedded piezoelectric stack, and an average power of 12 μW can be obtained from a knee bearing with four embedded piezoelectric transducers. Uniaxial compression testing is also performed on a fabricated sample for model validation. The results found in this work show promising potential of embedded piezoelectric transducers to be utilized for autonomous, self-powered in vivo knee implant force sensors.
Collapse
Affiliation(s)
- Mohsen Safaei
- Department of Mechanical Engineering, Tennessee Technological University, Cookeville, TN 38505 USA
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202 USA, and also with Indiana University Health Physicians Orthopedics and Sports Medicine, IU Health Saxony Hospital, Fishers, IN 46037 USA
| | - Steven R Anton
- Department of Mechanical Engineering, Tennessee Technological University, Cookeville, TN 38505 USA
| |
Collapse
|
24
|
Karipott SS, Nelson BD, Guldberg RE, Ong KG. Clinical potential of implantable wireless sensors for orthopedic treatments. Expert Rev Med Devices 2018; 15:255-264. [PMID: 29558820 DOI: 10.1080/17434440.2018.1454310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Implantable wireless sensors have been used for real-time monitoring of chemicals and physical conditions of bones, tendons and muscles to diagnose and study orthopedic diseases and injuries. Due to the importance of these sensors in orthopedic care, a critical review, which not only analyzes the underlying technologies but also their clinical implementations and challenges, will provide a landscape view on their current state and their future clinical role. AREAS COVERED By conducting an extensive literature search and following the leaders of orthopedic implantable wireless sensors, this review covers the battery-powered and battery-free wireless implantable sensor technologies, and describes their implementation for hips, knees, spine, and shoulder stress/strain monitoring. Their advantages, limitations, and clinical challenges are also described. EXPERT COMMENTARY Currently, implantable wireless sensors are mostly limited for scientific investigations and demonstrative experiments. Although rapid advancement in sensors and wireless technologies will push the reliability and practicality of these sensors for clinical realization, regulatory constraints and financial viability in medical device industry may curtail their continuous adoption for clinical orthopedic applications. In the next five years, these sensors are expected to gain increased interest from researchers, but wide clinical adoption is still unlikely.
Collapse
Affiliation(s)
| | - Bradley D Nelson
- a Biomedical Engineering , Michigan Technological University , Houghton , MI , USA
| | - Robert E Guldberg
- b George W. Woodruff School of Mechanical Engineering , Georgia Institute of Technology , Atlanta , GA , USA
| | - Keat Ghee Ong
- a Biomedical Engineering , Michigan Technological University , Houghton , MI , USA
| |
Collapse
|
25
|
Klosterhoff BS, Tsang M, She D, Ong KG, Allen MG, Willett NJ, Guldberg RE. Implantable Sensors for Regenerative Medicine. J Biomech Eng 2017; 139:2594421. [PMID: 27987300 DOI: 10.1115/1.4035436] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 01/05/2023]
Abstract
The translation of many tissue engineering/regenerative medicine (TE/RM) therapies that demonstrate promise in vitro are delayed or abandoned due to reduced and inconsistent efficacy when implemented in more complex and clinically relevant preclinical in vivo models. Determining mechanistic reasons for impaired treatment efficacy is challenging after a regenerative therapy is implanted due to technical limitations in longitudinally measuring the progression of key environmental cues in vivo. The ability to acquire real-time measurements of environmental parameters of interest including strain, pressure, pH, temperature, oxygen tension, and specific biomarkers within the regenerative niche in situ would significantly enhance the information available to tissue engineers to monitor and evaluate mechanisms of functional healing or lack thereof. Continued advancements in material and fabrication technologies utilized by microelectromechanical systems (MEMSs) and the unique physical characteristics of passive magnetoelastic sensor platforms have created an opportunity to implant small, flexible, low-power sensors into preclinical in vivo models, and quantitatively measure environmental cues throughout healing. In this perspective article, we discuss the need for longitudinal measurements in TE/RM research, technical progress in MEMS and magnetoelastic approaches to implantable sensors, the potential application of implantable sensors to benefit preclinical TE/RM research, and the future directions of collaborative efforts at the intersection of these two important fields.
Collapse
Affiliation(s)
- Brett S Klosterhoff
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Melissa Tsang
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Didi She
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Keat Ghee Ong
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Mark G Allen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Nick J Willett
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332;Department of Orthopaedics, Emory University, Atlanta, GA 30303;Atlanta Veteran's Affairs Medical Center, Decatur, GA 30033;Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| |
Collapse
|
26
|
Rosa N, Marta M, Vaz M, Tavares S, Simoes R, Magalhães FD, Marques AT. Recent developments on intramedullary nailing: a biomechanical perspective. Ann N Y Acad Sci 2017; 1408:20-31. [DOI: 10.1111/nyas.13524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Natacha Rosa
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
| | - Miguel Marta
- Department of Orthopedics; Centro Hospitalar de São João; Porto Portugal
| | - Mário Vaz
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
- INEGI, Faculty of Engineering; University of Porto; Porto Portugal
| | - S.M.O. Tavares
- DEMec, Faculty of Engineering; University of Porto; Porto Portugal
| | - Ricardo Simoes
- Polytechnic Institute of Cávado and Ave; Barcelos Portugal
- Institute for Polymers and Composites IPC/I3N; University of Minho; Guimarães Portugal
| | | | | |
Collapse
|
27
|
Andreu-Perez J, Garcia-Gancedo L, McKinnell J, Van der Drift A, Powell A, Hamy V, Keller T, Yang GZ. Developing Fine-Grained Actigraphies for Rheumatoid Arthritis Patients from a Single Accelerometer Using Machine Learning. SENSORS 2017; 17:s17092113. [PMID: 28906437 PMCID: PMC5620953 DOI: 10.3390/s17092113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022]
Abstract
In addition to routine clinical examination, unobtrusive and physical monitoring of Rheumatoid Arthritis (RA) patients provides an important source of information to enable understanding the impact of the disease on quality of life. Besides an increase in sedentary behaviour, pain in RA can negatively impact simple physical activities such as getting out of bed and standing up from a chair. The objective of this work is to develop a method that can generate fine-grained actigraphies to capture the impact of the disease on the daily activities of patients. A processing methodology is presented to automatically tag activity accelerometer data from a cohort of moderate-to-severe RA patients. A study of procesing methods based on machine learning and deep learning is provided. Thirty subjects, 10 RA patients and 20 healthy control subjects, were recruited in the study. A single tri-axial accelerometer was attached to the position of the fifth lumbar vertebra (L5) of each subject with a tag prediction granularity of 3 s. The proposed method is capable of handling unbalanced datasets from tagged data while accounting for long-duration activities such as sitting and lying, as well as short transitions such as sit-to-stand or lying-to-sit. The methodology also includes a novel mechanism for automatically applying a threshold to predictions by their confidence levels, in addition to a logical filter to correct for infeasible sequences of activities. Performance tests showed that the method was able to achieve around 95% accuracy and 81% F-score. The produced actigraphies can be helpful to generate objective RA disease-specific markers of patient mobility in-between clinical site visits.
Collapse
Affiliation(s)
- Javier Andreu-Perez
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK.
- School of Computer Science and Electronic Engineering, University of Essex, Colchester CO4 3SQ, UK.
| | - Luis Garcia-Gancedo
- Clinical Innovation & Digital Platforms; Projects, Clinical Platforms & Sciences, GSK, Stevenage SG1 2NY, UK.
| | - Jonathan McKinnell
- Emerging Platforms, Platform Technology & Science, GSK, Stevenage SG1 2NY, UK.
| | | | - Adam Powell
- Tessella, Altran's World Class Center for Analytics, Stevenage SG1 3QP, UK.
| | - Valentin Hamy
- Clinical Innovation & Digital Platforms; Projects, Clinical Platforms & Sciences, GSK, Stevenage SG1 2NY, UK.
| | - Thomas Keller
- Emerging Platforms, Platform Technology & Science, GSK, Stevenage SG1 2NY, UK.
| | | |
Collapse
|
28
|
Schwartz AM, Schenker ML, Ahn J, Willett NJ. Building better bone: The weaving of biologic and engineering strategies for managing bone loss. J Orthop Res 2017; 35:1855-1864. [PMID: 28467648 DOI: 10.1002/jor.23592] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/24/2017] [Indexed: 02/04/2023]
Abstract
Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost-sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice-changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell-based strategies. Despite an ever-evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled "Building better bone: The weaving of biologic and engineering strategies for managing bone loss," was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering-clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855-1864, 2017.
Collapse
Affiliation(s)
| | - Mara L Schenker
- Department of Orthopaedics, Emory University, Decatur, Georgia
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nick J Willett
- Department of Orthopaedics, Emory University, Decatur, Georgia.,Atlanta Veteran's Affairs Medical Center, Decatur, Georgia.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| |
Collapse
|
29
|
Drazan JF, Abdoun OT, Wassick MT, Marcus GA, Dahle R, Beardslee LA, Cady NC, Ledet EH. Reducing the effect of parasitic capacitance on implantable passive resonant sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1930-1933. [PMID: 28268705 DOI: 10.1109/embc.2016.7591100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Passive, LC resonators have the potential to serve as small, robust, low cost, implantable sensors to wirelessly monitor implants following orthopedic surgery. One significant barrier to using LC sensors is the influence on the sensor's resonance of the surrounding conductive high permittivity media in vivo. The surrounding media can detune the resonant frequency of the LC sensor resulting in a bias. To mitigate the effects of the surrounding media, we added a "capping layer" to LC sensors to isolate them from the surrounding media. Several capping materials and thicknesses were tested to determine effectiveness at reducing the sensor's interaction with the surrounding media. Results show that a 1 mm glass capping layer on the outer surfaces of the sensor was sufficient to reduce the effects of the media on sensor signal to less than 1%.
Collapse
|
30
|
Fabbri N. CORR Insights ®: Which Sport Activity Levels Are Achieved in Patients After Resection and Endoprosthetic Reconstruction for a Proximal Femur Bone Sarcoma? Clin Orthop Relat Res 2017; 475:827-829. [PMID: 27193147 PMCID: PMC5289186 DOI: 10.1007/s11999-016-4875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/28/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Nicola Fabbri
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| |
Collapse
|
31
|
Assem Y, Pelletier MH, Mobbs RJ, Phan K, Walsh WR. Anterior Lumbar Interbody Fusion Integrated Screw Cages: Intrinsic Load Generation, Subsidence, and Torsional Stability. Orthop Surg 2017; 9:191-197. [PMID: 28067466 DOI: 10.1111/os.12283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To perform a repeatable idealized in vitro model to evaluate the effects of key design features and integrated screw fixation on unloaded surface engagement, subsidence, and torsional stability. METHODS We evaluated four different stand-alone anterior lumbar interbody fusion (ALIF) cages with two, three, and four screw designs. Polyurethane (saw-bone) foam blocks were used to simulate the vertebral bone. Fuji Film was used to measure the contact footprint, average pressure, and load generated by fixating the cages with screws. Subsidence was tested by axially loading the constructs at 10 N/s to 400 N and torsional load was applied +/-1 Nm for 10 cycles to assess stability. Outcome measures included total subsidence and maximal torsional angle range. RESULTS Cages 1, 2, and 4 were symmetrical and produced similar results in terms of contact footprint, average pressure, and load. The addition of integrated screws into the cage-bone block construct demonstrated a clear trend towards decreased subsidence. Cage 2 with surface titanium angled ridges and a keel produced the greatest subsidence with and without screws, significantly more than all other cages ( P < 0.05). Angular rotation was not significantly affected by the addition of screws ( P < 0.066). A statistically significant correlation existed between subsidence and reduced angular rotation across all cage constructs ( P = 0.018). CONCLUSION Each stand-alone cage featured unique surface characteristics, which resulted in differing cage-foam interface engagement, influencing the subsidence and torsional angle. Increased subsidence significantly reduced the torsional angle across all cage constructs.
Collapse
Affiliation(s)
- Yusuf Assem
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia.,Neurospine Clinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Ralph J Mobbs
- Neurospine Clinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia
| | - Kevin Phan
- Neurospine Clinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
| |
Collapse
|
32
|
Long-term result of mosaicplasty for femoral head osteochondral lesion: a case report with 8 years follow-up. Hip Int 2016; 25:589-92. [PMID: 25952916 DOI: 10.5301/hipint.5000244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Treatment of the chondral lesions of the hip joint is problematic due to its deep anatomy and complex biomechanical demands. The purpose of the study is to present the long-term result of a deep, large femoral head cartilage defect treated successfully with surgical safe dislocation of the hip and autologous osteochondral grafting. METHODS A 27-year-old male patient was admitted to our clinic with left hip pain. On assessment, a large femoral head osteochondral defect was detected in his left hip. An open safe hip dislocation and autologous osteochondral grafting was performed due to the large size of the lesion and subchondral bone involvement. RESULTS Using a Kocher-Langenbeck incision, the hip was dislocated after a trochanteric flip osteotomy. The defect was reconstructed with 3 x 13 mm and 1 x 11 mm osteochondral plug from the ipsilateral knee. We have not encountered any complication at the postoperative period. After 8 years follow-up his left hip range of motion was preserved and The Harris Hip Score was qualified as excellent with 96 points. CONCLUSIONS Chondral defects of the femoral head are still a challenging problem in orthopaedic practice. Mosaicplasty of the femoral head is a demanding procedure with safe dislocation of the hip. However, if successful it can provide satisfactory functional and radiological results in the long-term.
Collapse
|
33
|
Wang X, Peng J, Li D, Zhang L, Wang H, Jiang L, Chen X. Does the optimal position of the acetabular fragment should be within the radiological normal range for all developmental dysplasia of the hip? A patient-specific finite element analysis. J Orthop Surg Res 2016; 11:109. [PMID: 27716351 PMCID: PMC5050724 DOI: 10.1186/s13018-016-0445-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/27/2016] [Indexed: 01/12/2023] Open
Abstract
Background The success of Bernese periacetabular osteotomy depends significantly on how extent the acetabular fragment can be corrected to its optimal position. This study was undertaken to investigate whether correcting the acetabular fragment into the so-called radiological “normal” range is the best choice for all developmental dysplasia of the hip with different severities of dysplasia from the biomechanical view? If not, is there any correlation between the biomechanically optimal position of the acetabular fragment and the severity of dysplasia? Methods Four finite element models with different severities of dysplasia were developed. The virtual periacetabular osteotomy was performed with the acetabular fragment rotated anterolaterally to incremental center-edge angles; then, the contact area and pressure and von Mises stress in the cartilage were calculated at different correction angles. Results The optimal position of the acetabular fragment for patients 1, 2, and 3 was when the acetabular fragment rotated 17° laterally (with the lateral center-edge angle of 36° and anterior center-edge angle of 58°; both were slightly larger than the “normal” range), 25° laterally following further 5° anterior rotation (with the lateral center-edge angle of 31° and anterior center-edge angle of 51°; both were within the “normal” range), and 30° laterally following further 10° anterior rotation (with the lateral center-edge angle of 25° and anterior center-edge angle of 40°; both were less than the “normal” range), respectively. Conclusions The optimal corrective position of the acetabular fragment is severity dependent rather than within the radiological “normal” range for developmental dysplasia of the hip. We prudently proposed that the optimal correction center-edge angle of mild, moderate, and severe developmental dysplasia of the hip is slightly larger than the “normal” range, within the “normal” range, and less than the lower limit of the “normal” range, respectively. Electronic supplementary material The online version of this article (doi:10.1186/s13018-016-0445-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xuyi Wang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De Li
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Linlin Zhang
- Department of Biomedical Engineering, Shanghai University of Technology, Shanghai, China
| | - Hui Wang
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leisheng Jiang
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
34
|
Navacchia A, Rullkoetter PJ, Schütz P, List RB, Fitzpatrick CK, Shelburne KB. Subject-specific modeling of muscle force and knee contact in total knee arthroplasty. J Orthop Res 2016; 34:1576-87. [PMID: 26792665 PMCID: PMC5502084 DOI: 10.1002/jor.23171] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
Understanding the mechanical loading environment and resulting joint mechanics for activities of daily living in total knee arthroplasty is essential to continuous improvement in implant design. Although survivorship of these devices is good, a substantial number of patients report dissatisfaction with the outcome of their procedure. Knowledge of in vivo kinematics and joint loading will enable improvement in preclinical assessment and refinement of implant geometry. The purpose of this investigation was to describe the mechanics of total knee arthroplasty during a variety of activities of daily living (gait, walking down stairs, and chair rise/sit). Estimates of muscle forces, tibial contact load, location, and pressure distribution was performed through a combination of mobile fluoroscopy data collection, musculoskeletal modeling, and finite element simulation. For the activities evaluated, joint compressive load was greatest during walking down stairs; however, the highest contact pressure occurred during chair rise/sit. The joint contact moment in the frontal plane was mainly varus for gait and walking down stairs, while it was valgus during chair rise/sit. Excursion of the center of pressure on the tibial component was similar during each activity and between the medial and lateral sides. The main determinants of center of pressure location were internal-external rotation, joint load, and tibial insert conformity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1576-1587, 2016.
Collapse
Affiliation(s)
- Alessandro Navacchia
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - Paul J. Rullkoetter
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - Pascal Schütz
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Renate B. List
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Clare K. Fitzpatrick
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - Kevin B. Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| |
Collapse
|
35
|
Simkin PA, Snitily BK. Impact-driven, pulmonary emboli of osseous fat in exercise-induced bronchospasm. Med Hypotheses 2015; 85:694-8. [PMID: 26328480 DOI: 10.1016/j.mehy.2015.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/05/2015] [Accepted: 08/20/2015] [Indexed: 11/19/2022]
Abstract
Exercise induced bronchospasm (EIB) affects approximately 10% of normal individuals with higher prevalence rates among children, obese adults, and competitive athletes. Although hyperpnea with dry air is the best known cause, the problem is multifactorial with atopy, asthma and chlorine all playing established roles. To date, no clear mechanism has connected musculoskeletal loading with the ensuing pulmonary compromise. This paper reviews evidence that impact-driven pulses in subchondral bone pressure may push osseous fat cells into the local venous sinusoids. The resultant showers of microemboli must then travel to the lung where lysis of membrane phospholipids leads to leukotriene formation with resultant inflammation and bronchial hypersensitivity. Concurrently, the same emboli deliver triglyceride fuels for further physical activity. Thus, pulmonary microemboli derived from osseous fat may resolve the seeming paradox of athletic excellence in persons afflicted with exercise-induced bronchospasm.
Collapse
Affiliation(s)
- Peter A Simkin
- Departments of Medicine and Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Brian K Snitily
- Departments of Medicine and Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|