High-resolution local trabecular strain within trabecular structure under cyclic loading

Trabecular bone structure is a complex microstructure consisting of rods and plates, which poses challenges for its mechanical characterization. Digital image correlation (DIC) offers the possibility to characterize the strain response on the surface of trabecular bone. This study employed DIC equipped with a telecentric lens to investigate the strain state of individual trabeculae within their trabecular structure by assessing the longitudinal strain of the trabeculae at both the middle and near the edges of the trabeculae. Due to the high-resolution of the used DIC system, local surface strain of trabeculae was analyzed too. Lastly, the correlation between longitudinal trabecular strain and the orientation and slenderness of the trabeculae was investigated. The results showed that the strain magnification close to the edge of the trabeculae was higher and reached up to 8-folds the strain along the middle of the trabeculae. On the contrary, no strain magnification was found for most of the trabeculae between the longitudinal trabecular strain along the middle of the trabeculae and the globally applied strain. High-resolution full-field strain maps were obtained on the surface of trabeculae showing heterogeneous strain distribution with increasing load. No significant correlation was found between longitudinal trabecular strain and its orientation or slenderness. These findings and the applied methodology can be used to broaden our understanding of the deformation mechanisms of trabeculae within the trabecular network.

Critical loss of primary implant stability in osteosynthesis locking screws under cyclic overloading

Primary implant stability, which refers to the stability of the implant during the initial healing period is a crucial factor in determining the long-term success of the implant and lays the foundation for secondary implant stability achieved through osseointegration. Factors affecting primary stability include implant design, surgical technique, and patient-specific factors like bone quality and morphology. In vivo, the cyclic nature of anatomical loading puts osteosynthesis locking screws under dynamic loads, which can lead to the formation of micro cracks and defects that slowly degrade the mechanical connection between the bone and screw, thus compromising the initial stability and secondary stability of the implant. Monotonic quasi-static loading used for testing the holding capacity of implanted screws is not well suited to capture this behavior since it cannot capture the progressive deterioration of peri‑implant bone at small displacements. In order to address this issue, this study aims to determine a critical point of loss of primary implant stability in osteosynthesis locking screws under cyclic overloading by investigating the evolution of damage, dissipated energy, and permanent deformation. A custom-made test setup was used to test implanted 2.5 mm locking screws under cyclic overloading test. For each loading cycle, maximum forces and displacement were recorded as well as initial and final cycle displacements and used to calculate damage and energy dissipation evolution. The results of this study demonstrate that for axial, shear, and mixed loading significant damage and energy dissipation can be observed at approximately 20 % of the failure force. Additionally, at this load level, permanent deformations on the screw-bone interface were found to be in the range of 50 to 150 mm which promotes osseointegration and secondary implant stability. This research can assist surgeons in making informed preoperative decisions by providing a better understanding of the critical point of loss of primary implant stability, thus improving the long-term success of the implant and overall patient satisfaction.

The deep trabecular structure of first metacarpals in extant hominids

OBJECTIVES

Recent studies have associated subarticular trabecular bone distribution in the extant hominid first metacarpal (Mc1) with observed thumb use, to infer fossil hominin thumb use. Here, we analyze the entire Mc1 to test for interspecific differences in: (1) the absolute volume of trabecular volume fraction, (2) the distribution of the deeper trabecular network, and (3) the distribution of trabeculae in the medullary cavity, especially beneath the Mc1 disto-radial flange.

MATERIALS AND METHODS

Trabecular bone was imaged using micro-computed tomography in a sample of Homo sapiens (n = 11), Pan paniscus (n = 10), Pan troglodytes (n = 11), Gorilla gorilla (n = 10) and Pongo sp., (n = 7). Using Canonical Holistic Morphometric Analysis (cHMA), we tested for interspecific differences in the trabecular bone volume fraction (BV/TV) and its relative distribution (rBV/TV) throughout the Mc1, including within the head, medullary cavity, and base.

RESULTS

P. paniscus had the highest, and H. sapiens the lowest, BV/TV relative to other species. rBV/TV distribution statistically distinguished the radial concentrations and lack of medullary trabecular bone in the H. sapiens Mc1 from all other hominids. H. sapiens and, to a lesser extent, G. gorilla also had a significantly higher trabecular volume beneath the disto-radial flange relative to other hominids.

DISCUSSION

These results are consistent with differences in observed thumb use in these species and may also reflect systemic differences in bone volume fraction. The trabecular bone extension into the medullary cavity and concentrations beneath the disto-radial flange may represent crucial biomechanical signals that will aid in the inference of fossil hominin thumb use.

Trabecular architecture of the distal femur in extant hominids

Extant great apes are characterized by a wide range of locomotor, postural and manipulative behaviours that each require the limbs to be used in different ways. In addition to external bone morphology, comparative investigation of trabecular bone, which (re-)models to reflect loads incurred during life, can provide novel insights into bone functional adaptation. Here, we use canonical holistic morphometric analysis (cHMA) to analyse the trabecular morphology in the distal femoral epiphysis of Homo sapiens (n = 26), Gorilla gorilla (n = 14), Pan troglodytes (n = 15) and Pongo sp. (n = 9). We test two predictions: (1) that differing locomotor behaviours will be reflected in differing trabecular architecture of the distal femur across Homo, Pan, Gorilla and Pongo; (2) that trabecular architecture will significantly differ between male and female Gorilla due to their different levels of arboreality but not between male and female Pan or Homo based on previous studies of locomotor behaviours. Results indicate that trabecular architecture differs among extant great apes based on their locomotor repertoires. The relative bone volume and degree of anisotropy patterns found reflect habitual use of extended knee postures during bipedalism in Homo, and habitual use of flexed knee posture during terrestrial and arboreal locomotion in Pan and Gorilla. Trabecular architecture in Pongo is consistent with a highly mobile knee joint that may vary in posture from extension to full flexion. Within Gorilla, trabecular architecture suggests a different loading of knee in extension/flexion between females and males, but no sex differences were found in Pan or Homo, supporting our predictions. Inter- and intra-specific variation in trabecular architecture of distal femur provides a comparative context to interpret knee postures and, in turn, locomotor behaviours in fossil hominins.

The 2-layer elasto-visco-plastic rheological model for the material parameter identification of bone tissue extended by a damage law

The response of bone tissue to mechanical load is complex and includes plastic hardening, viscosity and damage. The quantification of these effects plays a mayor role in bone research and in biomechanical clinical trials as to better understand related diseases. In this study, the damage growth in individual wet human trabeculae subjected to cyclic overloading is quantified by inverse rheological modeling. Therefore, an already published rheological material model, that includes linear elasticity, plasticity and viscosity is extended by a damage law. The model is utilized in an optimization process to identify the corresponding material parameters and damage growth in single human trabeculae under tensile load. Results show that the damage model is leading to a better fit of the test data with an average root-mean-square-error (RMSE) of 2.52 MPa compared to the non-damage model with a RMSE of 3.03 MPa. Although this improvement is not significant, the damage model qualitatively better represents the data as it accounts for the visible stiffness reduction along the load history. It returns realistic stiffness values of 11.92 GPa for the instantaneous modulus and 5.73 GPa for the long term modulus of wet trabecular human bone. Further, the growth of damage in the tissue along the load history is substantial, with values above 0.8 close to failure. The relative loss of stiffness per cycle is in good agreement with comparable literature. Inverse rheological modeling proves to be a valuable tool for quantifying complex constitutive behavior from a single mechanical measurement. The evolution of damage in the tissue can be identified continuously over the load history and separated from other effects.

Feasibility of aluminum phantom radiography for osteoporosis detection in postmenopausal women with a fragility fracture of the distal radius compared to DXA and HR-pQCT

Recently, promising results have been reported for detection of osteoporosis with use of an aluminum phantom. Therefore, the aim of this study was to evaluate the feasibility of radiography-based bone mineral density (BMD) measurement using a graded aluminum phantom. This study included 27 postmenopausal women with a distal radius fracture. Aluminum phantom radiography of the healthy radius was conducted as well as high-resolution peripheral quantitative computed tomography (HR-pQCT) measurement of the ultradistal radius and dual energy X-ray absorptiometry (DXA) of the radius, spine, and hip. A strong correlation was observed between aluminum phantom radiography-based mean gray value (mGV) and DXA-derived BMD, especially for the ultradistal radius (ρ = 0.75; p < 0.001). A moderate correlation for the femoral neck (ρ = 0.61 and p < 0.001) between modalities was found. Radius mGV and HR-pQCT-derived BMD only showed a moderate correlation (ρ = 0.48; p < 0.09). Aluminum phantom radiography might serve as a cost efficient, highly available, low-radiation dose screening, and diagnostic method for osteoporosis additively to DXA measurements. Especially, an application in areas with constrained DXA availability and such as preoperative trauma settings would be beneficial. However, further investigation and assessment of specificity and sensitivity is needed.

Hip joint load prediction using inverse bone remodeling with homogenized FE models: Comparison to micro-FE and influence of material modeling strategy

BACKGROUND AND OBJECTIVE

Measuring physiological loading conditions in vivo can be challenging, as methods are invasive or pose a high modeling effort. However, the physiological loading of bones is also imprinted in the bone microstructure due to bone (re)modeling. This information can be retrieved by inverse bone remodeling (IBR). Recently, an IBR method based on micro-finite-element (µFE) modeling was translated to homogenized-FE (hFE) to decrease computational effort and tested on the distal radius. However, this bone has a relatively simple geometry and homogeneous microstructure. Therefore, the objective of this study was to assess the agreement of hFE-based IBR with µFE-based IBR to predict hip joint loading from the head of the femur; a bone with more complex loading as well as more heterogeneous microstructure.

METHODS

hFE-based IBR was applied to a set of 19 femoral heads using four different material mapping laws. One model with a single homogeneous material for both trabecular and cortical volume and three models with a separated cortex and either homogeneous, density-dependent inhomogeneous, or density and fabric-dependent orthotropic material. Three different evaluation regions (full bone, trabecular bone only, head region only) were defined, in which IBR was applied. µFE models were created for the same bones, and the agreement of the predicted hip joint loading history obtained from hFE and µFE models was evaluated. The loading history was discretized using four unit load cases.

RESULTS

The computational time for FE solving was decreased on average from 500 h to under 1 min (CPU time) when using hFE models instead of µFE models. Using more information in the material model in the hFE models led to a better prediction of hip joint loading history. Inhomogeneous and inhomogeneous orthotropic models gave the best agreement to µFE-based IBR (RMSE% <14%). The evaluation region only played a minor role.

CONCLUSIONS

hFE-based IBR was able to reconstruct the dominant joint loading of the femoral head in agreement with µFE-based IBR and required considerably lower computational effort. Results indicate that cortical and trabecular bone should be modeled separately and at least density-dependent inhomogeneous material properties should be used with hFE models of the femoral head to predict joint loading.

Accuracy of osseointegrated screw-bone construct stiffness and peri-implant loading predicted by homogenized FE models relative to micro-FE models

Computational predictions of stiffness and peri-implant loading of screw-bone constructs are highly relevant to investigate and improve bone fracture fixations. Homogenized finite element (hFE) models have been used for this purpose in the past, but their accuracy has been questioned given the numerous simplifications, such as neglecting screw threads and modelling the trabecular bone structure as a continuum. This study aimed to investigate the accuracy of hFE models of an osseointegrated screw-bone construct when compared to micro-FE models considering the simplified screw geometry and different trabecular bone material models. Micro-FE and hFE models were created from 15 cylindrical bone samples with a virtually inserted, osseointegrated screw (fully bonded interface). Micro-FE models were created including the screw with threads (=reference models) and without threads to quantify the error due to screw geometry simplification. In the hFE models, the screws were modelled without threads and four different trabecular bone material models were used, including orthotropic and isotropic material derived from homogenization with kinematic uniform boundary conditions (KUBC), as well as from periodicity-compatible mixed uniform boundary conditions (PMUBC). Three load cases were simulated (pullout, shear in two directions) and errors in the construct stiffness and the volume average strain energy density (SED) in the peri-implant region were evaluated relative to the micro-FE model with a threaded screw. The pooled error caused by only omitting screw threads was low (max: 8.0%) compared to the pooled error additionally including homogenized trabecular bone material (max: 92.2%). Stiffness was predicted most accurately using PMUBC-derived orthotropic material (error: -0.7 ± 8.0%) and least accurately using KUBC-derived isotropic material (error: +23.1 ± 24.4%). Peri-implant SED averages were generally well correlated (R² ≥ 0.76), but slightly over- or underestimated by the hFE models and SED distributions were qualitatively different between hFE and micro-FE models. This study suggests that osseointegrated screw-bone construct stiffness can be predicted accurately using hFE models when compared to micro-FE models and that volume average peri-implant SEDs are well correlated. However, the hFE models are highly sensitive to the choice of trabecular bone material properties. PMUBC-derived isotropic material properties represented the best trade-off between model accuracy and complexity in this study.

Comparison of linear and nonlinear stepwise μFE displacement predictions to digital volume correlation measurements of trabecular bone biopsies

Digital volume correlation (DVC) enables to evaluate the ability of μFE models in predicting experimental results on the mesoscale. In this study predicted displacement fields of three different linear and materially nonlinear μFE simulation methods were compared to DVC measured displacement fields at specific load steps in the elastic regime (Step_El) and after yield (Step_Ult). Five human trabecular bone biopsies from a previous study were compressed in several displacement steps until failure. At every compression step, μCT images (resolution: 36 μm) were recorded. A global DVC algorithm was applied to compute the displacement fields at all loading steps. The unloaded 3D images were then used to generate homogeneous, isotropic, linear and materially nonlinear μFE models. Three different μFE simulation methods were used: linear (L), nonlinear (NL), and nonlinear stepwise (NLS). Regarding L and NL, the boundary conditions were derived from the interpolated displacement fields at Step_El and Step_Ult, while for the NLS method nonlinear changes of the boundary conditions of the experiments were captured using the DVC displacement field of every available load step until Step_El and Step_Ult. The predicted displacement fields of all μFE simulation methods were in good agreement with the DVC measured displacement fields (individual specimens: R²>0.83 at Step_El and R²>0.59 at Step_Ult; pooled data: R²>0.97 at Step_El and R²>0.92 at Step_Ult). At Step_El, all three simulation methods showed similar intercepts, slopes, and coefficients of determination while the nonlinear μFE models improved the prediction of the displacement fields slightly in all Cartesian directions at Step_Ult (individual specimens: L: R²>0.59 and NL, NLS: R²>0.68; pooled data: L: R²>0.92 and NL, NLS: R²>0.94). Damaged/overstrained elements in L, NL, and NLS occurred at similar locations but the number of overstrained elements was overestimated when using the L simulation method. Considering the increased solving time of the nonlinear μFE models as well as the acceptable performance in displacement prediction of the linear μFE models, one can conclude that for similar use cases linear μFE models represent the best compromise between computational effort and accuracy of the displacement field predictions.

The biomechanical behavior of 3D printed human femoral bones based on generic and patient-specific geometries

Background

Bone is a highly complex composite material which makes it hard to find appropriate artificial surrogates for patient-specific biomechanical testing. Despite various options of commercially available bones with generic geometries, these are either biomechanically not very realistic or rather expensive.

Methods

In this work, additive manufacturing was used for the fabrication of artificial femoral bones. These were based on CT images of four different commercially available femoral bone surrogates and three human bones with varying bone density. The models were 3D printed using a low-budget fused deposition modeling (FDM) 3D printer and PLA filament. The infill density was mechanically calibrated and varying cortical thickness was used. Compression tests of proximal femora simulating stance were performed and the biomechanical behavior concerning ultimate force, spring stiffness, and fracture pattern were evaluated as well as compared to the results of commercial and cadaveric bones.

Results

Regarding the ultimate forces and spring stiffness, the 3D printed analogs showed mechanical behavior closer to their real counterparts than the commercially available polyurethan-based surrogates. Furthermore, the increase in ultimate force with increasing bone density observed in human femoral bones could be reproduced well. Also, the fracture patterns observed match well with fracture patterns observed in human hip injuries.

Conclusion

Consequently, the methods presented here show to be a promising alternative for artificial generic surrogates concerning femoral strength testing. The manufacturing is straightforward, cheap, and patient-specific geometries are possible.

Predicting the trabecular bone apparent stiffness tensor with spherical convolutional neural networks

The apparent stiffness tensor is relevant for characterizing trabecular bone quality. Previous studies have used morphology-stiffness relationships for estimating the apparent stiffness tensor. In this paper, we propose to train spherical convolutional neural networks (SphCNNs) to estimate this tensor. Information of the edges, trabecular thickness, and spacing are summarized in functions on the unitary sphere used as inputs for the SphCNNs. The concomitant dimensionality reduction makes it possible to train neural networks on relatively small datasets. The predicted tensors were compared to the stiffness tensors computed by using the micro-finite element method (μFE), which was considered as the gold standard, and models based on fourth-order fabric tensors. Combining edges and trabecular thickness yields significant improvements in the accuracy compared to the methods based on fourth-order fabric tensors. From the results, SphCNNs are promising for replacing the more expensive μFE stiffness estimations.

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Characteristic stiffness tensors are derived from trabecular bone micro-CT samples.

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Previous approximation methods fall short on heterogeneous data-sets.

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The gradient, trabecular thickness and spacing are mapped to a spherical domain.

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Spherical convolutional neural networks are used for the prediction.

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The prediction error is significantly reduced compared to the state-of-the-art.

A parameter reduced adaptive quasi-linear viscoelastic model for soft biological tissue in uniaxial tension

Mechanical characterisation of soft viscous materials is essential for many applications including aerospace industries, material models for surgical simulation, and tissue mimicking materials for anatomical models. Constitutive material models are, therefore, necessary to describe soft biological tissues in physiologically relevant strain ranges. Hereby, the adaptive quasi-linear viscoelastic (AQLV) model enables accurate modelling of the strain-dependent non-linear viscoelastic behaviour of soft tissues with a high flexibility. However, the higher flexibility produces a large number of model parameters. In this study, porcine muscle and liver tissue samples were modelled in the framework of the originally published AQLV (3-layers of Maxwell elements) model using four incremental ramp-hold experiments in uniaxial tension. AQLV model parameters were reduced by decreasing model layers (M) as well as the number of experimental ramp-hold steps (N). Leave One out cross validation tests show that the original AQLV model (3M4N) with 19 parameters, accurately describes porcine muscle tissue with an average R² of 0.90 and porcine liver tissue, R² of 0.86. Reducing the number of layers (N) in the model produced acceptable model fits for 1-layer (R² of 0.83) and 2-layer models (R² of 0.89) for porcine muscle tissue and 1-layer (R² of 0.84) and 2-layer model (R² of 0.85) for porcine liver tissue. Additionally, a 2 step (2N) ramp-hold experiment was performed on additional samples of porcine muscle tissue only to further reduce model parameters. Calibrated spring constant values for 2N ramp-hold tests parameters k₁ and k₂ had a 16.8% and 38.0% deviation from those calibrated for a 4 step (4N) ramp hold experiment. This enables further reduction of material parameters by means of step reduction, effectively reducing the number of parameters required to calibrate the AQLV model from 19 for a 3M4N model to 8 for a 2M2N model, with the added advantage of reducing the time per experiment by 50%. This study proposes a 'reduced-parameter' AQLV model (2M2N) for the modelling of soft biological tissues at finite strain ranges. Sequentially, the comparison of model parameters of soft tissues is easier and the experimental burden is reduced.

Experimental validation of a micro-CT finite element model of a human cadaveric mandible rehabilitated with short-implant-supported partial dentures

PURPOSE

This study aimed to address the predictive value of a micro-computed tomography (μCT)-based finite element (μFE) model of a human cadaveric edentulous posterior mandible, rehabilitated by short dental implants. Hereby, three different prosthetic/implant configurations of fixed partial dentures ("Sp"-3 splinted crowns on 3 implants, "Br" - Bridge: 3 splinted crowns on 2 implants, and "Si"- 3 single crowns) were analysed by comparing the computational predictions of the global stiffness with experimental data.

METHODS

Experimental displacement of the bone/implant/prosthesis system was measured under axial and oblique loads of 100 N using an optical deformation system (GOM Aramis) and the overall movement of the testing machine (Zwick Z030). Together with the measured machine force, an "Aramis" (optical markers) and "Zwick" (test machine) stiffness were calculated. FE models were created based on μCT-scans of the cadaveric mandible sample (n = 1) before and after implantation and using stl-files of the crowns. The same load tests and boundary conditions were simulated on the models and the μFE-results were compared to experimental data using linear regression analysis.

RESULTS

The regression line through a plot of pooled stiffness values (N/mm) for the optical displacement recording (true local displacement) and the test machine (machine compliance included) had a slope of 0.57 and a correlation coefficient R² of 0.82. The average pooled correlation of global stiffness between the experiment and FE-analysis (FEA) showed a R² of 0.80, but the FEA-stiffness was 7.2 times higher. The factor was highly dependent on the test configuration. Sp-configuration showed the largest stiffness followed by Br-configuration (17% difference in experiment and 21% in FEA).

CONCLUSIONS

The current study showed good qualitative agreement between the experimental and predicted global stiffness of different short implant configurations. It could be deduced that 1:1 splinting of the short implants by the crowns is most favorable for the stiffness of the implant/prosthesis system. However, in the clinical context, the absolute in silico readings must be interpreted cautiously, as the FEA showed a considerable overestimation of the values.

Effects of anti-resorptive treatment on the material properties of individual canine trabeculae in cyclic tensile tests

Osteoporosis is defined as a decrease of bone mass and strength, as well as an increase in fracture risk. It is conventionally treated with antiresorptive drugs, such as bisphosphonates (BPs) and selective estrogen receptor modulators (SERMs). Although both drug types successfully decrease the risk of bone fractures, their effect on bone mass and strength is different. For instance, BP treatment causes an increase of bone mass, stiffness and strength of whole bones, whereas SERM treatment causes only small (4%) increases of bone mass, but increased bone toughness. Such improved mechanical behavior of whole bones can be potentially related to the bone mass, bone structure or material changes. While bone mass and architecture have already been investigated previously, little is known about the mechanical behavior at the tissue/material level, especially of trabecular bone. As such, the goal of the work presented here was to fill this gap by performing cyclic tensile tests in a wet, close to physiologic environment of individual trabeculae retrieved from the vertebrae of beagle dogs treated with alendronate (a BP), raloxifene (a SERM) or without treatments. Identification of material properties was performed with a previously developed rheological model and of mechanical properties via fitting of envelope curves. Additionally, tissue mineral density (TMD) and microdamage formation were analyzed. Alendronate treatment resulted in a higher trabecular tissue stiffness and strength, associated with higher levels of TMD. In contrast, raloxifene treatment caused a higher trabecular toughness, pre-dominantly in the post-yield region. Microdamage formation during testing was not affected by either anti-resorptive treatment regimens. These findings highlight that the improved mechanical behavior of whole bones after anti-resorptive treatment is at least partly caused by improved material properties, with different mechanisms for alendronate and raloxifene. This study further shows the power of performing a mechanical characterization of trabecular bone at the level of individual trabeculae for better understanding of clinically relevant mechanical behavior of bone.

Effects of Osteoporosis on Bone Morphometry and Material Properties of Individual Human Trabeculae in the Femoral Head

Osteoporosis is the most common bone disease and is conventionally classified as a decrease of total bone mass. Current diagnosis of osteoporosis is based on clinical risk factors and dual energy X‐ray absorptiometry (DEXA) scans, but changes in bone quantity (bone mass) and quality (trabecular structure, material properties, and tissue composition) are not distinguished. Yet, osteoporosis is known to cause a deterioration of the trabecular network, which might be related to changes at the tissue scale—the material properties. The goal of the current study was to use a previously established test method to perform a thorough characterization of the material properties of individual human trabeculae from femoral heads in cyclic tensile tests in a close to physiologic, wet environment. A previously developed rheological model was used to extract elastic, viscous, and plastic aspects of material behavior. Bone morphometry and tissue mineralization were determined with a density calibrated micro‐computed tomography (μCT) set‐up. Osteoporotic trabeculae neither showed a significantly changed material or mechanical behavior nor changes in tissue mineralization, compared with age‐matched healthy controls. However, donors with osteopenia indicated significantly reduced apparent yield strain and elastic work with respect to osteoporosis, suggesting possible initial differences at disease onset. Bone morphometry indicated a lower bone volume to total volume for osteoporotic donors, caused by a smaller trabecular number and a larger trabecular separation. A correlation of age with tissue properties and bone morphometry revealed a similar behavior as in osteoporotic bone. In the range studied, age does affect morphometry but not material properties, except for moderately increased tissue strength in healthy donors and moderately increased hardening exponent in osteoporotic donors. Taken together, the distinct changes of trabecular bone quality in the femoral head caused by osteoporosis and aging could not be linked to suspected relevant changes in material properties or tissue mineralization. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Prediction of the Inelastic Behaviour of Radius Segments: Damage-based Nonlinear Micro Finite Element Simulation vs Pistoia Criterion

The Pistoia criterion (PC) is widely used to estimate the failure load of distal radius segments based on linear micro Finite Element (μFE) analyses. The advantage of the PC is that a simple strain-threshold and a tissue volume fraction can be used to predict failure properties. In this study, the PC is compared to materially nonlinear μFE analyses, where the bone tissue is modelled as an elastic, damageable material. The goal was to investigate for which outcomes the PC is sufficient and when a nonlinear (NL) simulation is required. Three types of simulation results were compared: (1) prediction of the failure load, (2) load sharing of cortical and trabecular regions, and (3) distribution of local damaged/overstrained tissue at the maximum sustainable load. The failure load obtained experimentally could be predicted well with both the PC and the NL simulations using linear regression. Although the PC strongly overestimated the failure load, it was sufficient to predict adequately normalized apparent results. An optimised PC (oPC) was proposed which uses experimental data to calibrate the individual volume of overstrained tissue. The main areas of local over-straining predicted by the oPC were the same as estimated by the NL simulation, although the oPC predicted more diffuse regions. However, the oPC relied on an individual calibration requiring the experimental failure load while the NL simulation required no a priori knowledge of the experimental failure load.

A Review on Recent Advances in the Constitutive Modeling of Bone Tissue

PURPOSE OF REVIEW

Image-based finite element analysis (FEA) to predict and understand the biomechanical response has become an essential methodology in musculoskeletal research. An important part of such simulation models is the constitutive material model of which recent advances are summarized in this review.

RECENT FINDINGS

The review shows that existing models from other fields were introduced, such as cohesion zone (cortical bone) or phase-field models (trabecular bone). Some progress has been made in describing cortical bone involving physical mechanisms such as microcracks. Problems with validations at different length scales remain a problem. The improvement of recent constitutive models is partially obscured by uncertainties that affect overall predictions, such as image quality and calibration or boundary conditions. Nevertheless, in vivo CT-based FEA simulations based on a sophisticated constitutive behavior are a very valuable tool for clinical-related osteoporosis research.

A two-layer elasto-visco-plastic rheological model for the material parameter identification of bone tissue

The ability to measure bone tissue material properties plays a major role in diagnosis of diseases and material modeling. Bone's response to loading is complex and shows a viscous contribution to stiffness, yield and failure. It is also ductile and damaging and exhibits plastic hardening until failure. When performing mechanical tests on bone tissue, these constitutive effects are difficult to quantify, as only their combination is visible in resulting stress-strain data. In this study, a methodology for the identification of stiffness, damping, yield stress and hardening coefficients of bone from a single cyclic tensile test is proposed. The method is based on a two-layer elasto-visco-plastic rheological model that is capable of reproducing the specimens' pre- and postyield response. The model's structure enables for capturing the viscously induced increase in stiffness, yield, and ultimate stress and for a direct computation of the loss tangent. Material parameters are obtained in an inverse approach by optimizing the model response to fit the experimental data. The proposed approach is demonstrated by identifying material properties of individual bone trabeculae that were tested under wet conditions. The mechanical tests were conducted according to an already published methodology for tensile experiments on single trabeculae. As a result, long-term and instantaneous Young's moduli were obtained, which were on average 3.64 GPa and 5.61 GPa, respectively. The found yield stress of 16.89 MPa was lower than previous studies suggest, while the loss tangent of 0.04 is in good agreement. In general, the two-layer model was able to reproduce the cyclic mechanical test data of single trabeculae with an root-mean-square error of 2.91 ± 1.77 MPa. The results show that inverse rheological modeling can be of great advantage when multiple constitutive contributions shall be quantified based on a single mechanical measurement.

Hyperelastic and viscoelastic characterization of hepatic tissue under uniaxial tension in time and frequency domain

In order to create accurate anatomical models for medical training and research, mechanical properties of biological tissues need to be studied. However, non-linear and viscoelastic behaviour of most soft biological tissues complicates the evaluation of their mechanical properties. In the current study, a method for measuring hyperelasticity and viscoelasticity of bovine and porcine hepatic parenchyma in tension is presented. First, non-linear stress-stretch curves resulting from ramp loading and unloading, were interpreted based on a hyperelastic framework, using a Veronda-Westmann strain energy function. Strain-specific elastic moduli, such as initial stiffness E_I, were thereupon defined in certain parts of the stress-stretch curves. Furthermore, dissipated and stored energy density were calculated. Next, the viscoelastic nature of liver tissue was examined with two different methods: stress relaxation and dynamic cyclic testing. Both tests yielded dissipated and stored energy density, as well as loss tangent (tanδ), storage modulus (E^'), and loss modulus (E^''). In tension, stress relaxation was experimentally more convenient than dynamic cyclic testing. Thus we considered whether relaxation could be used for approximating the results of the cyclic tests. Regarding the resulting elastic moduli, initial stiffness was similar for porcine and bovine liver (E_I∼30kPa), while porcine liver was stiffer for higher strains. Comparing stress relaxation with dynamic cyclic testing, tanδ of porcine and bovine liver was the same for both methods (tanδ=0.05-0.25 at 1 Hz). Storage and loss moduli matched well for bovine, but not as well for porcine tissue. In conclusion, the utilized Veronda-Westmann model was appropriate for representing the hyperelasticity of liver tissue seen in ramp tests. Concerning viscoelasticity, both chosen testing methods - stress relaxation and dynamic cyclic testing - yielded comparable results for E^', E^'', and tanδ, as long as elasticity non-linearities were heeded. The here presented method provides novel insight into the tensile viscoelastic properties of hepatic tissue, and provides guidelines for convenient evaluation of soft tissue mechanical properties.

Effect of CT imaging on the accuracy of the finite element modelling in bone

The finite element (FE) analysis is a highly promising tool to simulate the behaviour of bone. Skeletal FE models in clinical routine rely on the information about the geometry and bone mineral density distribution from quantitative computed tomography (CT) imaging systems. Several parameters in CT imaging have been reported to affect the accuracy of FE models. FE models of bone are exclusively developed in vitro under scanning conditions deviating from the clinical setting, resulting in variability of FE results (< 10%). Slice thickness and field of view had little effect on FE predicted bone behaviour (≤ 4%), while the reconstruction kernels showed to have a larger effect (≤ 20%). Due to large interscanner variations (≤ 20%), the translation from an experimental model into clinical reality is a critical step. Those variations are assumed to be mostly caused by different “black box” reconstruction kernels and the varying frequency of higher density voxels, representing cortical bone. Considering the low number of studies together with the significant effect of CT imaging on the finite element model outcome leading to high variability in the predicted behaviour, we propose further systematic research and validation studies, ideally preceding multicentre and longitudinal studies.

The position of Australopithecus sediba within fossil hominin hand use diversity

The human lineage is marked by a transition in hand use, from locomotion towards increasingly dexterous manipulation, concomitant with bipedalism. The forceful precision grips used by modern humans probably evolved in the context of tool manufacture and use, but when and how many times hominin hands became principally manipulative remains unresolved. We analyse metacarpal trabecular and cortical bone, which provide insight into behaviour during an individual's life, to demonstrate previously unrecognized diversity in hominin hand use. The metacarpals of the palm in Australopithecus sediba have trabecular morphology most like orangutans and consistent with locomotor power-grasping with the fingers, while that of the thumb is consistent with human-like manipulation. This internal morphology is the first record of behaviour consistent with a hominin that used its hand for both arboreal locomotion and human-like manipulation. This hand use is distinct from other fossil hominins in this study, including A. afarensis and A. africanus.

Comparison of different microCT-based morphology assessment tools using human trabecular bone

MicroCT-based morphological parameters are often used to quantify the structural properties of trabecular bone. Various software tools are available for calculating these parameters. Studies that examine the comparability of their results are rare. Four different software tools were used to analyse a set of 701 microCT images from human trabecular bone samples. Bone volume to total volume (BV/TV), bone surface (BS), trabecular thickness (Tb. Th.) and degree of anisotropy (DA) were evaluated. BV/TV shows very low difference (-0.18 ± 0.15%). The difference in BS could be reduced below 5% if artificial cut surfaces are not included. Tb. Th. and Tb. Sp. show differences of maximal -12% although the same theoretical background is used. DA is most critical with differences from 4.75 ± 3.70% (medtool vs. Scanco), over -38.61 ± 13.15% (BoneJ vs. Scanco), up to 80.52 ± 50.04% (medtool vs. BoneJ). Quantitative results should be considered with caution, especially when comparing different studies. Introducing standardization procedures and the disclosure of underlying algorithms and their respective implementations could improve this issue.

Metacarpophalangeal joint loads during bonobo locomotion: model predictions versus proxies

The analysis of internal trabecular and cortical bone has been an informative tool for drawing inferences about behaviour in extant and fossil primate taxa. Within the hand, metacarpal bone architecture has been shown to correlate well with primate locomotion; however, the extent of morphological differences across taxa is unexpectedly small given the variability in hand use. One explanation for this observation is that the activity-related differences in the joint loads acting on the bone are simply smaller than estimated based on commonly used proxies (i.e. external loading and joint posture), which neglect the influence of muscle forces. In this study, experimental data and a musculoskeletal finger model are used to test this hypothesis by comparing differences between climbing and knuckle-walking locomotion of captive bonobos (Pan paniscus) based on (i) joint load magnitude and direction predicted by the models and (ii) proxy estimations. The results showed that the activity-related differences in predicted joint loads are indeed much smaller than the proxies would suggest, with joint load magnitudes being almost identical between the two locomotor modes. Differences in joint load directions were smaller but still evident, indicating that joint load directions might be a more robust indicator of variation in hand use than joint load magnitudes. Overall, this study emphasizes the importance of including muscular forces in the interpretation of skeletal remains and promotes the use of musculoskeletal models for correct functional interpretations.

Influence of processing parameters on mechanical properties of a 3D-printed trabecular bone microstructure

Natural bone microstructure has shown to be the most efficient choice for the bone scaffold design. However, there are several process parameters involved in the generation of a microCT-based 3D-printed (3DP) bone. In this study, the effect of selected parameters on the reproducibility of mechanical properties of a 3DP trabecular bone structure is investigated. MicroCT images of a distal radial sample were used to reconstruct a 3D ROI of trabecular bone. Nine tensile tests on bulk material and 54 compression tests on 8.2 mm cubic samples were performed (9 cases × 6 specimens/case). The effect of input-image resolution, STL mesh decimation, boundary condition, support material, and repetition parameters on the weight, elastic modulus, and strength were studied. The elastic modulus and the strength of bulk material showed consistent results (CV% = 9 and 6%, respectively). The weight, elastic modulus, and strength of the cubic samples showed small intragroup variation (average CV% = 1.2, 9, and 5.5%, respectively). All studied parameters had a significant effect on the outcome variables with less effect on the weight. Utmost care to every step of the 3DP process and involved parameters is required to be able to reach the desired mechanical properties in the final printed specimen. © 2019 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:38-47, 2020.

Musculoskeletal models of a human and bonobo finger: parameter identification and comparison to in vitro experiments

Introduction

Knowledge of internal finger loading during human and non-human primate activities such as tool use or knuckle-walking has become increasingly important to reconstruct the behaviour of fossil hominins based on bone morphology. Musculoskeletal models have proven useful for predicting these internal loads during human activities, but load predictions for non-human primate activities are missing due to a lack of suitable finger models. The main goal of this study was to implement both a human and a representative non-human primate finger model to facilitate comparative studies on metacarpal bone loading. To ensure that the model predictions are sufficiently accurate, the specific goals were: (1) to identify species-specific model parameters based on in vitro measured fingertip forces resulting from single tendon loading and (2) to evaluate the model accuracy of predicted fingertip forces and net metacarpal bone loading in a different loading scenario.

Materials & Methods

Three human and one bonobo (Pan paniscus) fingers were tested in vitro using a previously developed experimental setup. The cadaveric fingers were positioned in four static postures and load was applied by attaching weights to the tendons of the finger muscles. For parameter identification, fingertip forces were measured by loading each tendon individually in each posture. For the evaluation of model accuracy, the extrinsic flexor muscles were loaded simultaneously and both the fingertip force and net metacarpal bone force were measured. The finger models were implemented using custom Python scripts. Initial parameters were taken from literature for the human model and own dissection data for the bonobo model. Optimized model parameters were identified by minimizing the error between predicted and experimentally measured fingertip forces. Fingertip forces and net metacarpal bone loading in the combined loading scenario were predicted using the optimized models and the remaining error with respect to the experimental data was evaluated.

Results

The parameter identification procedure led to minor model adjustments but considerably reduced the error in the predicted fingertip forces (root mean square error reduced from 0.53/0.69 N to 0.11/0.20 N for the human/bonobo model). Both models remained physiologically plausible after the parameter identification. In the combined loading scenario, fingertip and net metacarpal forces were predicted with average directional errors below 6° and magnitude errors below 12%.

Conclusions

This study presents the first attempt to implement both a human and non-human primate finger model for comparative palaeoanthropological studies. The good agreement between predicted and experimental forces involving the action of extrinsic flexors—which are most relevant for forceful grasping—shows that the models are likely sufficiently accurate for comparisons of internal loads occurring during human and non-human primate manual activities.

QCT-based finite element prediction of pathologic fractures in proximal femora with metastatic lesions

Predicting pathologic fractures in femora with metastatic lesions remains a clinical challenge. Currently used guidelines are inaccurate, especially to predict non-impeding fractures. This study evaluated the ability of a nonlinear quantitative computed tomography (QCT)-based homogenized voxel finite element (hvFE) model to predict patient-specific pathologic fractures. The hvFE model was generated highly automated from QCT images of human femora. The femora were previously loaded in a one-legged stance setup in order to assess stiffness, failure load, and fracture location. One femur of each pair was tested in its intact state, while the contralateral femur included a simulated lesion on either the superolateral- or the inferomedial femoral neck. The hvFE model predictions of the stiffness (0.47 < R² < 0.94), failure load (0.77 < R² < 0.98), and exact fracture location (68%) were in good agreement with the experimental data. However, the model underestimated the failure load by a factor of two. The hvFE models predicted significant differences in stiffness and failure load for femora with superolateral- and inferomedial lesions. In contrast, standard clinical guidelines predicted identical fracture risk for both lesion sites. This study showed that the subject-specific QCT-based hvFE model could predict the effect of metastatic lesions on the biomechanical behaviour of the proximal femur with moderate computational time and high level of automation and could support treatment strategy in patients with metastatic bone disease.

Trabecular architecture of the great ape and human femoral head

Studies of femoral trabecular structure have shown that the orientation and volume of bone are associated with variation in loading and could be informative about individual joint positioning during locomotion. In this study, we analyse for the first time trabecular bone patterns throughout the femoral head using a whole-epiphysis approach to investigate how potential trabecular variation in humans and great apes relates to differences in locomotor modes. Trabecular architecture was analysed using microCT scans of Pan troglodytes (n = 20), Gorilla gorilla (n = 14), Pongo sp. (n = 5) and Homo sapiens (n = 12) in medtool 4.1. Our results revealed differences in bone volume fraction (BV/TV) distribution patterns, as well as overall trabecular parameters of the femoral head between great apes and humans. Pan and Gorilla showed two regions of high BV/TV in the femoral head, consistent with hip posture and loading during two discrete locomotor modes: knuckle-walking and climbing. Most Pongo specimens also displayed two regions of high BV/TV, but these regions were less discrete and there was more variability across the sample. In contrast, Homo showed only one main region of high BV/TV in the femoral head and had the lowest BV/TV, as well as the most anisotropic trabeculae. The Homo trabecular structure is consistent with stereotypical loading with a more extended hip compared with great apes, which is characteristic of modern human bipedalism. Our results suggest that holistic evaluations of femoral head trabecular architecture can reveal previously undetected patterns linked to locomotor behaviour in extant apes and can provide further insight into hip joint loading in fossil hominins and other primates.

Inverse remodelling algorithm identifies habitual manual activities of primates based on metacarpal bone architecture

Previously, a micro-finite element (micro-FE)-based inverse remodelling method was presented in the literature that reconstructs the loading history of a bone based on its architecture alone. Despite promising preliminary results, it remains unclear whether this method is sensitive enough to detect differences of bone loading related to pathologies or habitual activities. The goal of this study was to test the sensitivity of the inverse remodelling method by predicting joint loading histories of metacarpal bones of species with similar anatomy but clearly distinct habitual hand use. Three groups of habitual hand use were defined using the most representative primate species: manipulation (human), suspensory locomotion (orangutan), and knuckle-walking locomotion (bonobo, chimpanzee, gorilla). Nine to ten micro-computed tomography scans of each species ([Formula: see text] in total) were used to create micro-FE models of the metacarpal head region. The most probable joint loading history was predicted by optimally scaling six load cases representing joint postures ranging from [Formula: see text] (extension) to [Formula: see text] (flexion). Predicted mean joint load directions were significantly different between knuckle-walking and non-knuckle-walking groups ([Formula: see text]) and in line with expected primary hand postures. Mean joint load magnitudes tended to be larger in species using their hands for locomotion compared to species using them for manipulation. In conclusion, this study shows that the micro-FE-based inverse remodelling method is sensitive enough to detect differences of joint loading related to habitual manual activities of primates and might, therefore, be useful for palaeoanthropologists to reconstruct the behaviour of extinct species and for biomedical applications such as detecting pathological joint loading.

A novel experimental design for the measurement of metacarpal bone loading and deformation and fingertip force

Background

Musculoskeletal and finite element modelling are often used to predict joint loading and bone strength within the human hand, but there is a lack of in vitro evidence of the force and strain experienced by hand bones.

Methods

This study presents a novel experimental setup that allows the positioning of a cadaveric digit in a variety of postures with the measurement of force and strain experienced by the third metacarpal. The setup allows for the measurement of fingertip force as well. We tested this experimental setup using three cadaveric human third digits in which the flexor tendons were loaded in two tendon pathways: (1) parallel to the metacarpal bone shaft, with bowstringing; (2) a semi-physiological condition in which the tendons were positioned closer to the bone shaft.

Results

There is substantial variation in metacarpal net force, metacarpal strain and fingertip force between the two tendon pathways. The net force acting on the metacarpal bone is oriented palmarly in the parallel tendon condition, causing tension along the dorsum of the metacarpal shaft, while the force increases and is oriented dorsally in the semi-physiological condition, causing compression of the dorsal metacarpal shaft. Fingertip force is also greater in the semi-physiological condition, implying a more efficient grip function. Inter-individual variation is observed in the radioulnar orientation of the force experienced by the metacarpal bone, the fingertip force, and the strain patterns on the metacarpal shaft.

Conclusion

This study demonstrates a new method for measuring force and strain experienced by the metacarpal, and fingertip force in cadaveric digits that can, in turn, inform computation models. Inter-individual variation in loads experienced by the third digit suggest that there are differences in joint contact and/or internal bone structure across individuals that are important to consider in clinical and evolutionary contexts.

Trabecular bone patterning across the human hand

Hand bone morphology is regularly used to link particular hominin species with behaviors relevant to cognitive/technological progress. Debates about the functional significance of differing hominin hand bone morphologies tend to rely on establishing phylogenetic relationships and/or inferring behavior from epigenetic variation arising from mechanical loading and adaptive bone modeling. Most research focuses on variation in cortical bone structure, but additional information about hand function may be provided through the analysis of internal trabecular structure. While primate hand bone trabecular structure is known to vary in ways that are consistent with expected joint loading differences during manipulation and locomotion, no study exists that has documented this variation across the numerous bones of the hand. We quantify the trabecular structure in 22 bones of the human hand (early/extant modern Homo sapiens) and compare structural variation between two groups associated with post-agricultural/industrial (post-Neolithic) and foraging/hunter-gatherer (forager) subsistence strategies. We (1) establish trabecular bone volume fraction (BV/TV), modulus (E), degree of anisotropy (DA), mean trabecular thickness (Tb.Th) and spacing (Tb.Sp); (2) visualize the average distribution of site-specific BV/TV for each bone; and (3) examine if the variation in trabecular structure is consistent with expected joint loading differences among the regions of the hand and between the groups. Results indicate similar distributions of trabecular bone in both groups, with those of the forager sample presenting higher BV/TV, E, and lower DA, suggesting greater and more variable loading during manipulation. We find indications of higher loading along the ulnar side of the forager sample hand, with high site-specific BV/TV distributions among the carpals that are suggestive of high loading while the wrist moves through the 'dart-thrower's' motion. These results support the use of trabecular structure to infer behavior and have direct implications for refining our understanding of human hand evolution and fossil hominin hand use.

Trabecular bone patterning in the hominoid distal femur

BACKGROUND

In addition to external bone shape and cortical bone thickness and distribution, the distribution and orientation of internal trabecular bone across individuals and species has yielded important functional information on how bone adapts in response to load. In particular, trabecular bone analysis has played a key role in studies of human and nonhuman primate locomotion and has shown that species with different locomotor repertoires display distinct trabecular architecture in various regions of the skeleton. In this study, we analyse trabecular structure throughout the distal femur of extant hominoids and test for differences due to locomotor loading regime.

METHODS

Micro-computed tomography scans of Homo sapiens (n = 11), Pan troglodytes (n = 18), Gorilla gorilla (n = 14) and Pongo sp. (n = 7) were used to investigate trabecular structure throughout the distal epiphysis of the femur. We predicted that bone volume fraction (BV/TV) in the medial and lateral condyles in Homo would be distally concentrated and more anisotropic due to a habitual extended knee posture at the point of peak ground reaction force during bipedal locomotion, whereas great apes would show more posteriorly concentrated BV/TV and greater isotropy due to a flexed knee posture and more variable hindlimb use during locomotion.

RESULTS

Results indicate some significant differences between taxa, with the most prominent being higher BV/TV in the posterosuperior region of the condyles in Pan and higher BV/TV and anisotropy in the posteroinferior region in Homo. Furthermore, trabecular number, spacing and thickness differ significantly, mainly separating Gorilla from the other apes.

DISCUSSION

The trabecular architecture of the distal femur holds a functional signal linked to habitual behaviour; however, there was more similarity across taxa and greater intraspecific variability than expected. Specifically, there was a large degree of overlap in trabecular structure across the sample, and Homo was not as distinct as predicted. Nonetheless, this study offers a comparative sample of trabecular structure in the hominoid distal femur and can contribute to future studies of locomotion in extinct taxa.

Mapping anisotropy improves QCT-based finite element estimation of hip strength in pooled stance and side-fall load configurations

Hip fractures are one of the most severe consequences of osteoporosis. Compared to the clinical standard of DXA-based aBMD at the femoral neck, QCT-based FEA delivers a better surrogate of femoral strength and gains acceptance for the calculation of hip fracture risk when a CT reconstruction is available. Isotropic, homogenised voxel-based, finite element (hvFE) models are widely used to estimate femoral strength in cross-sectional and longitudinal clinical studies. However, fabric anisotropy is a classical feature of the architecture of the proximal femur and the second determinant of the homogenised mechanical properties of trabecular bone. Due to the limited resolution, fabric anisotropy cannot be derived from clinical CT reconstructions. Alternatively, fabric anisotropy can be extracted from HR-pQCT images of cadaveric femora. In this study, fabric anisotropy from HR-pQCT images was mapped onto QCT-based hvFE models of 71 human proximal femora for which both HR-pQCT and QCT images were available. Stiffness and ultimate load computed from anisotropic hvFE models were compared with previous biomechanical tests in both stance and side-fall configurations. The influence of using the femur-specific versus a mean fabric distribution on the hvFE predictions was assessed. Femur-specific and mean fabric enhance the prediction of experimental ultimate force for the pooled, i.e. stance and side-fall, (isotropic: r²=0.81, femur-specific fabric: r²=0.88, mean fabric: r²=0.86,p<0.001) but not for the individual configurations. Fabric anisotropy significantly improves bone strength prediction for the pooled configurations, and mapped fabric provides a comparable prediction to true fabric. The mapping of fabric anisotropy is therefore expected to help generate more accurate QCT-based hvFE models of the proximal femur for personalised or multiple load configurations.

Systemic patterns of trabecular bone across the human and chimpanzee skeleton

Aspects of trabecular bone architecture are thought to reflect regional loading of the skeleton, and thus differ between primate taxa with different locomotor and postural modes. However, there are several systemic factors that affect bone structure that could contribute to, or be the primary factor determining, interspecific differences in bone structure. These systemic factors include differences in genetic regulation, sensitivity to loading, hormone levels, diet, and activity levels. Improved understanding of inter-/intraspecific variability, and variability across the skeleton of an individual, is required to interpret properly potential functional signals present within trabecular structure. Using a whole-region method of analysis, we investigated trabecular structure throughout the skeleton of humans and chimpanzees. Trabecular bone volume fraction (BV/TV), degree of anisotropy (DA) and trabecular thickness (Tb.Th) were quantified from high resolution micro-computed tomographic scans of the humeral and femoral head, third metacarpal and third metatarsal head, distal tibia, talus and first thoracic vertebra. We found that BV/TV is, in most anatomical sites, significantly higher in chimpanzees than in humans, suggesting a systemic difference in trabecular structure unrelated to local loading regime. Differences in BV/TV between the forelimb and hindlimb did not clearly reflect differences in locomotor loading in the study taxa. There were no clear systemic differences between the taxa in DA and, as such, this parameter might reflect function and relate to differences in joint loading. This systemic approach reveals both the pattern of variability across the skeleton and between taxa, and helps identify those features of trabecular structure that may relate to joint function.

Plausibility and parameter sensitivity of micro-finite element-based joint load prediction at the proximal femur

A micro-finite element-based method to estimate the bone loading history based on bone architecture was recently presented in the literature. However, a thorough investigation of the parameter sensitivity and plausibility of this method to predict joint loads is still missing. The goals of this study were (1) to analyse the parameter sensitivity of the joint load predictions at one proximal femur and (2) to assess the plausibility of the results by comparing load predictions of ten proximal femora to in vivo hip joint forces measured with instrumented prostheses (available from www.orthoload.com ). Joint loads were predicted by optimally scaling the magnitude of four unit loads (inclined [Formula: see text] to [Formula: see text] with respect to the vertical axis) applied to micro-finite element models created from high-resolution computed tomography scans ([Formula: see text]m voxel size). Parameter sensitivity analysis was performed by varying a total of nine parameters and showed that predictions of the peak load directions (range 10[Formula: see text]-[Formula: see text]) are more robust than the predicted peak load magnitudes (range 2344.8-4689.5 N). Comparing the results of all ten femora with the in vivo loading data of ten subjects showed that peak loads are plausible both in terms of the load direction (in vivo: [Formula: see text], predicted: [Formula: see text]) and magnitude (in vivo: [Formula: see text], predicted: [Formula: see text]). Overall, this study suggests that micro-finite element-based joint load predictions are both plausible and robust in terms of the predicted peak load direction, but predicted load magnitudes should be interpreted with caution.

Effect of simulated metastatic lesions on the biomechanical behavior of the proximal femur

Pathologic fractures of femora in patients with metastatic cancer are associated with high morbidity and mortality. Prediction of impending fractures is based on unspecific clinical criteria or past clinician's experience, which leads to underestimation or overtreatment. The aim of this study was to investigate the effect of the site of metastatic lesions on biomechanical behavior of the proximal femur. Sixteen pairs of human femora were scanned with quantitative computed tomography (QCT) to asses bone mineral density. One femur of each pair remained intact while a defined lesion was reamed out in either the superolateral or inferomedial portion of the femoral neck of the contralateral femur. All femora were loaded in a mechanical test setup mimicking one-legged stance and stiffness, failure load, and fracture location were determined. In the biomechanical experiments the superolateral lesion and the inferomedial lesion caused a stiffness reduction of 19% and 66%, respectively. The average failure load was 40% and 75% lower for specimens with the superolateral (4.53 ± 1.56 kN) and inferomedial (1.89 ± 1.73 kN) lesions, respectively, compared to intact specimens (7.66 ± 3.34 kN). Lesions in the femoral neck led to reduction in both stiffness and failure load of the proximal femur. Furthermore, the site of the lesion had a large effect on the magnitude of the reduction in biomechanical properties. The presented data emphasize the importance of differentiating between locations of the lesion in pathologic fracture prediction of the metastatic femur and underline the insufficient accuracy of current predictive guidelines. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2407-2414, 2017.

Trabecular and cortical bone structure of the talus and distal tibia in Pan and Homo

OBJECTIVES

Internal bone structure, both cortical and trabecular bone, remodels in response to loading and may provide important information regarding behavior. The foot is well suited to analysis of internal bone structure because it experiences the initial substrate reaction forces, due to its proximity to the substrate. Moreover, as humans and apes differ in loading of the foot, this region is relevant to questions concerning arboreal locomotion and bipedality in the hominoid fossil record.

MATERIALS AND METHODS

We apply a whole-bone/epiphysis approach to analyze trabecular and cortical bone in the distal tibia and talus of Pan troglodytes and Homo sapiens. We quantify bone volume fraction (BV/TV), degree of anisotropy (DA), trabecular thickness (Tb.Th), bone surface to volume ratio (BS/BV), and cortical thickness and investigate the distribution of BV/TV and cortical thickness throughout the bone/epiphysis.

RESULTS

We find that Pan has a greater BV/TV, a lower BS/BV and thicker cortices than Homo in both the talus and distal tibia. The trabecular structure of the talus is more divergent than the tibia, having thicker, less uniformly aligned trabeculae in Pan compared to Homo. Differences in dorsiflexion at the talocrural joint and in degree of mobility at the talonavicular joint are reflected in the distribution of cortical and trabecular bone.

DISCUSSION

Overall, quantified trabecular parameters represent overall differences in bone strength between the two species, however, DA may be directly related to joint loading. Cortical and trabecular bone distributions correlate with habitual joint positions adopted by each species, and thus have potential for interpreting joint position in fossil hominoids.

Finite Element-Based Mechanical Assessment of Bone Quality on the Basis of In Vivo Images

Beyond bone mineral density (BMD), bone quality designates the mechanical integrity of bone tissue. In vivo images based on X-ray attenuation, such as CT reconstructions, provide size, shape, and local BMD distribution and may be exploited as input for finite element analysis (FEA) to assess bone fragility. Further key input parameters of FEA are the material properties of bone tissue. This review discusses the main determinants of bone mechanical properties and emphasizes the added value, as well as the important assumptions underlying finite element analysis. Bone tissue is a sophisticated, multiscale composite material that undergoes remodeling but exhibits a rather narrow band of tissue mineralization. Mechanically, bone tissue behaves elastically under physiologic loads and yields by cracking beyond critical strain levels. Through adequate cell-orchestrated modeling, trabecular bone tunes its mechanical properties by volume fraction and fabric. With proper calibration, these mechanical properties may be incorporated in quantitative CT-based finite element analysis that has been validated extensively with ex vivo experiments and has been applied increasingly in clinical trials to assess treatment efficacy against osteoporosis.

The effect of the extensor mechanism on maximum isometric fingertip forces: A numerical study on the index finger

The extensor mechanism is a tendinous network connecting intrinsic and extrinsic muscles of the finger and its function has not yet been fully understood. The goal of this study was to assess the effect of the extensor mechanism on the maximum isometric fingertip forces - a parameter which is essential for grasping. For this purpose, maximum fingertip forces in all directions (i.e. feasible force sets) of two musculoskeletal models of the index finger were compared: the wEM model included a full representation of the extensor mechanism, whereas in the noEM model the extensor mechanism was replaced by a single extensor tendon without connectivity to intrinsic muscles. The feasible force sets were computed in the flexion-extension plane for nine postures. Forces in four predefined directions (palmar, proximal, dorsal, and distal), and the peak resultant forces were evaluated. Averaged forces in all four predefined directions were considerably larger in the wEM model (+187.6%). However, peak resultant forces were slightly lower in the wEM model (-4.3% on average). The general advantage of the wEM model could be explained by co-contraction of intrinsic and extrinsic extensor muscles which allowed reaching larger activation levels of the extrinsic flexors. Only within a narrow range of force directions the co-contraction of intrinsic muscles limited the fingertip forces and lead to lower peak resultant forces in the wEM model. Rather than maximizing peak resultant forces, it appears that the extensor mechanism is a sophisticated tool for increasing maximum fingertip forces over a broad range of postures and force directions - making the finger more versatile during grasping.

Predicting Trabecular Bone Stiffness from Clinical Cone-Beam CT and HR-pQCT Data; an In Vitro Study Using Finite Element Analysis

Stiffness and shear moduli of human trabecular bone may be analyzed in vivo by finite element (FE) analysis from image data obtained by clinical imaging equipment such as high resolution peripheral quantitative computed tomography (HR-pQCT). In clinical practice today, this is done in the peripheral skeleton like the wrist and heel. In this cadaveric bone study, fourteen bone specimens from the wrist were imaged by two dental cone beam computed tomography (CBCT) devices and one HR-pQCT device as well as by dual energy X-ray absorptiometry (DXA). Histomorphometric measurements from micro-CT data were used as gold standard. The image processing was done with an in-house developed code based on the automated region growing (ARG) algorithm. Evaluation of how well stiffness (Young’s modulus E3) and minimum shear modulus from the 12, 13, or 23 could be predicted from the CBCT and HR-pQCT imaging data was studied and compared to FE analysis from the micro-CT imaging data. Strong correlations were found between the clinical machines and micro-CT regarding trabecular bone structure parameters, such as bone volume over total volume, trabecular thickness, trabecular number and trabecular nodes (varying from 0.79 to 0.96). The two CBCT devices as well as the HR-pQCT showed the ability to predict stiffness and shear, with adjusted R²-values between 0.78 and 0.92, based on data derived through our in-house developed code based on the ARG algorithm. These findings indicate that clinically used CBCT may be a feasible method for clinical studies of bone structure and mechanical properties in future osteoporosis research.

Trabecular architecture in the thumb of Pan and Homo: implications for investigating hand use, loading, and hand preference in the fossil record

OBJECTIVES

Humans display an 85-95% cross-cultural right-hand bias in skilled tasks, which is considered a derived behavior because such a high frequency is not reported in wild non-human primates. Handedness is generally considered to be an evolutionary byproduct of selection for manual dexterity and augmented visuo-cognitive capabilities within the context of complex stone tool manufacture/use. Testing this hypothesis requires an understanding of when appreciable levels of right dominant behavior entered the fossil record. Because bone remodels in vivo, skeletal asymmetries are thought to reflect greater mechanical loading on the dominant side, but incomplete preservation of external morphology and ambiguities about past loading environments complicate interpretations. We test if internal trabecular bone is capable of providing additional information by analyzing the thumb of Homo sapiens and Pan.

MATERIALS AND METHODS

We assess trabecular structure at the distal head and proximal base of paired (left/right) first metacarpals using micro-CT scans of Homo sapiens (n = 14) and Pan (n = 9). Throughout each epiphysis we quantify average and local bone volume fraction (BV/TV), degree of anisotropy (DA), and elastic modulus (E) to address bone volume patterning and directional asymmetry.

RESULTS

We find a right directional asymmetry in H. sapiens consistent with population-level handedness, but also report a left directional asymmetry in Pan that may be the result of postural and/or locomotor loading.

CONCLUSION

We conclude that trabecular bone is capable of detecting right/left directional asymmetry, but suggest coupling studies of internal structure with analyses of other skeletal elements and cortical bone prior to applications in the fossil record.

The insufficiencies of risk analysis of impending pathological fractures in patients with femoral metastases: A literature review

Purpose

Pathologic fractures in patients with bone metastases are a common problem in clinical orthopaedic routine. On one hand recognition of metastatic lesions, which are at a high risk of fracture, is essential for timely prophylactic fixation, while on the other hand patients with a low risk of pathologic fractures should be spared from overtreatment.

The purpose of this review is to identify all methods for fracture risk evaluation in patients with femoral metastases in the literature and to evaluate their predictive values in clinical applications.

Methods

A MEDLINE database literature research was conducted in order to identify clinical scoring systems, conclusions from prospective and retrospective radiologic and/or clinical studies, as well as data from biomechanical experiments, numerical computational methods, and computer simulations.

Results

The search identified 441 articles of which 18 articles met the inclusion criteria; 4 more articles were identified from citations of the primarily found studies. In principle there are two distinct methodologies, namely fracture risk prediction factors based on clinical and radiological data such as the most deployed the Mirels' score and fracture risk prediction based on engineering methods. Fracture risk prediction using Mirels' score, based on pure clinical data, shows a negative predictive value between 86 and 100%, but moderate to poor results in predicting non-impending fractures with a positive predictive value between 23 and 70%. Engineering methods provide a high accuracy (correlation coefficient between ex vivo and results from numerical calculations: 0.68 < r² < 0.96) in biomechanical lab experiments, but have not been applied to clinical routine yet.

Conclusion

This review clearly points out a lack of adequate clinical methods for fracture risk prediction in patients with femoral metastases. Today's golden standard, the Mirels' score leads to an overtreatment. Whereas, engineering methods showed high potential but require a clinical validation. In future definition of patient-specific, quantitative risk factor based modelling methods could serve as useful decision support for individualized treatment strategies in patients with a metastatic lesion.

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There is a lack of adequate clinical methods for fracture risk prediction in patients with femoral metastases.

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Mirels' score fails to recognise non-impending fractures and leads to an overtreatment.

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Engineering methods showed high potential but require a clinical validation.

Comparison of mixed and kinematic uniform boundary conditions in homogenized elasticity of femoral trabecular bone using microfinite element analyses

Mechanical properties of human trabecular bone play an important role in age-related bone fragility and implant stability. Microfinite element (lFE) analysis allows computing the apparent elastic properties of trabecular bone for use in homogenized FE (hFE) analysis,but the results depend unfortunately on the type of applied boundary conditions(BCs). In this study, 167 human femoral trabecular cubic regions with a side length of 5.3mm were extracted from three proximal femora and analyzed using lFE analysis to compare systematically their stiffness with kinematic uniform BCs (KUBCs) and periodicity-compatible mixed uniform BCs (PMUBCs). The obtained elastic constants were then used in the volume fraction and fabric-based orthotropic Zysset–Curnier model to identify their respective model parameters. As expected, PMUBCs lead to more compliant apparent elastic properties than KUBCs, especially in shear. The differences in stiffness decreased with bone volume fraction and mean intercept length (MIL). Unlike KUBCs, PMUBCs were sensitive to heterogeneity of the biopsies. The Zysset–Curnier model fitted the apparent elastic constants successfully in both cases with adjusted coefficients of determination (r2adj) of 0.986 for KUBCs and 0.975 for PMUBCs. The proper use of these BCs for hFE analysis of whole bones will need to be investigated in future work.

Effect of boundary conditions on yield properties of human femoral trabecular bone

Trabecular bone plays an important mechanical role in bone fractures and implant stability. Homogenized nonlinear finite element (FE) analysis of whole bones can deliver improved fracture risk and implant loosening assessment. Such simulations require the knowledge of mechanical properties such as an appropriate yield behavior and criterion for trabecular bone. Identification of a complete yield surface is extremely difficult experimentally but can be achieved in silico by using micro-FE analysis on cubical trabecular volume elements. Nevertheless, the influence of the boundary conditions (BCs), which are applied to such volume elements, on the obtained yield properties remains unknown. Therefore, this study compared homogenized yield properties along 17 load cases of 126 human femoral trabecular cubic specimens computed with classical kinematic uniform BCs (KUBCs) and a new set of mixed uniform BCs, namely periodicity-compatible mixed uniform BCs (PMUBCs). In stress space, PMUBCs lead to 7-72 % lower yield stresses compared to KUBCs. The yield surfaces obtained with both KUBCs and PMUBCs demonstrate a pressure-sensitive ellipsoidal shape. A volume fraction and fabric-based quadric yield function successfully fitted the yield surfaces of both BCs with a correlation coefficient [Formula: see text]. As expected, yield strains show only a weak dependency on bone volume fraction and fabric. The role of the two BCs in homogenized FE analysis of whole bones will need to be investigated and validated with experimental results at the whole bone level in future studies.

Human evolution. Response to Comment on "Human-like hand use in Australopithecus africanus"

Almécija and colleagues claim that we apply a simplified understanding of bone functional adaptation and that our results of human-like hand use in Australopithecus africanus are not novel. We argue that our results speak to actual behavior, rather than potential behaviors, and our functional interpretation is well supported by our methodological approach, comparative sample, and previous experimental data.

Human evolution. Human-like hand use in Australopithecus africanus

The distinctly human ability for forceful precision and power "squeeze" gripping is linked to two key evolutionary transitions in hand use: a reduction in arboreal climbing and the manufacture and use of tools. However, it is unclear when these locomotory and manipulative transitions occurred. Here we show that Australopithecus africanus (~3 to 2 million years ago) and several Pleistocene hominins, traditionally considered not to have engaged in habitual tool manufacture, have a human-like trabecular bone pattern in the metacarpals consistent with forceful opposition of the thumb and fingers typically adopted during tool use. These results support archaeological evidence for stone tool use in australopiths and provide morphological evidence that Pliocene hominins achieved human-like hand postures much earlier and more frequently than previously considered.

Micro-finite element (μFE) modeling of the siamang (Symphalangus syndactylus) third proximal phalanx: the functional role of curvature and the flexor sheath ridge

Phalangeal curvature is a commonly used morphological feature for the interpretation of extant and fossil primate locomotor behaviour. Here, we build on a recent biomechanical study (Richmond, 2007) in two ways: first, we use a 3D micro-FE model, which models the real internal microstructure (i.e., cortical thickness and trabecular bone structure) and, second, we model four siamang third proximal phalanges. We test identical 2D homogenized FE models and two 3D micro-FE phalanx models that are mathematically straightened to isolate the biomechanical significance of curvature. We further investigate how varying the loading configuration (e.g., boundary constraints) and modeling (e.g., 2D versus 3D) affects the biomechanical behaviour of the phalanx. Finally, we examine how intraspecific variation in external and internal bony morphology affects the biomechanical behaviour of the phalanx. Simulation results demonstrate that the general pattern of strain and displacement is similar between the 3D micro-FE and 2D homogenized FE models but the absolute values differ substantially. The biomechanical behaviour of the 3D FE models more closely match the relative strain patterns from the validation experiment than the 2D homogenized FE models, indicating the 3D microstructure model is preferable. Varying the loading configuration can have dramatic effects on the biomechanical behaviour of the phalanx depending on individual morphology, but overall a cantilevered beam model is an equally valid, if not better, configuration for modeling the phalanx as other previously-proposed models. Variation in flexor ridge morphology has a substantial effect on phalanx strain; the taller the ridge, the less strain incurred by other regions of the palmar shaft. Finally, phalangeal curvature reduces overall strain experienced by the phalanx, but does not necessarily reduce bending or increase the compression-to-tension ratio. These results confirm the adaptive role of phalangeal curvature during flexed-finger grasping postures and demonstrate that modeling variation in cortical thickness and flexor ridge morphology improves the behaviour of the FE model, which has important implications for the functional interpretation of phalanx form.

Trabecular bone structure correlates with hand posture and use in hominoids

Bone is capable of adapting during life in response to stress. Therefore, variation in locomotor and manipulative behaviours across extant hominoids may be reflected in differences in trabecular bone structure. The hand is a promising region for trabecular analysis, as it is the direct contact between the individual and the environment and joint positions at peak loading vary amongst extant hominoids. Building upon traditional volume of interest-based analyses, we apply a whole-epiphysis analytical approach using high-resolution microtomographic scans of the hominoid third metacarpal to investigate whether trabecular structure reflects differences in hand posture and loading in knuckle-walking (Gorilla, Pan), suspensory (Pongo, Hylobates and Symphalangus) and manipulative (Homo) taxa. Additionally, a comparative phylogenetic method was used to analyse rates of evolutionary changes in trabecular parameters. Results demonstrate that trabecular bone volume distribution and regions of greatest stiffness (i.e., Young's modulus) correspond with predicted loading of the hand in each behavioural category. In suspensory and manipulative taxa, regions of high bone volume and greatest stiffness are concentrated on the palmar or distopalmar regions of the metacarpal head, whereas knuckle-walking taxa show greater bone volume and stiffness throughout the head, and particularly in the dorsal region; patterns that correspond with the highest predicted joint reaction forces. Trabecular structure in knuckle-walking taxa is characterised by high bone volume fraction and a high degree of anisotropy in contrast to the suspensory brachiators. Humans, in which the hand is used primarily for manipulation, have a low bone volume fraction and a variable degree of anisotropy. Finally, when trabecular parameters are mapped onto a molecular-based phylogeny, we show that the rates of change in trabecular structure vary across the hominoid clade. Our results support a link between inferred behaviour and trabecular structure in extant hominoids that can be informative for reconstructing behaviour in fossil primates.