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Betti V, Aldieri A, Cristofolini L. A statistical shape analysis for the assessment of the main geometrical features of the distal femoral medullary canal. Front Bioeng Biotechnol 2024; 12:1250095. [PMID: 38659643 PMCID: PMC11039873 DOI: 10.3389/fbioe.2024.1250095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
Statistical Shape Models (SSMs) are widely used in orthopedics to extract the main shape features from bone regions (e.g., femur). This study aims to develop an SSM of the femoral medullary canal, investigate its anatomical variability, and assess variations depending on canal length. The canals were isolated from 72 CT femur scans, through a threshold-based segmentation. A region of interest (ROI) was selected; sixteen segments were extracted from the ROI, ranging from 25% of the full length down to the most distal segment. An SSM was developed to identify the main modes of variation for each segment. The number of Principal Components (PCs) needed to explain at least 90% of the shape variance were three/four based on the length of the canal segment. The study examined the relationship between the identified PCs and geometric parameters like length, radius of curvature, ellipticity, mean diameter, and conicity, reporting range and percentage variation of these parameters for each segment. The SSMs provide insights into the anatomical variability of the femoral canal, emphasizing the importance of considering different segments to capture shape variations at various canal length. These findings can contribute for the design of personalized orthopedic implants involving the distal femur.
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Affiliation(s)
- Valentina Betti
- Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Alessandra Aldieri
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
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Galteri G, Palanca M, Alesi D, Zaffagnini S, Morellato K, Gruppioni E, Cristofolini L. Reliable in vitro method for the evaluation of the primary stability and load transfer of transfemoral prostheses for osseointegrated implantation. Front Bioeng Biotechnol 2024; 12:1360208. [PMID: 38576443 PMCID: PMC10991734 DOI: 10.3389/fbioe.2024.1360208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
Osseointegrated transfemoral prostheses experience aseptic complications with an incidence between 3% and 30%. The main aseptic risks are implant loosening, adverse bone remodeling, and post-operative periprosthetic fractures. Implant loosening can either be due to a lack of initial (primary) stability of the implant, which hinders bone ingrowth and therefore prevents secondary stability, or, in the long-term, to the progressive resorption of the periprosthetic bone. Post-operative periprosthetic fractures are most often caused by stress concentrations. A method to simultaneously evaluate the primary stability and the load transfer is currently missing. Furthermore, the measurement errors are seldom reported in the literature. In this study a method to reliably quantify the bone implant interaction of osseointegrated transfemoral prostheses in terms of primary stability and load transfer was developed, and its precision was quantified. Micromotions between the prosthesis and the host bone and the strains on the cortical bone were measured on five human cadaveric femurs with a typical commercial osseointegrated implant. To detect the primary stability of the implant and the load transfer, cyclic loads were applied, simulating the peak load during gait. Digital Image Correlation was used to measure displacements and bone strains simultaneously throughout the test. Permanent migrations and inducible micromotions were measured (three translations and three rotations), while, on the same specimen, the full-field strain distribution on the bone surface was measured. The repeatability tests showed that the devised method had an intra-specimen variability smaller than 6 μm for the translation, 0.02 degrees for the rotations, and smaller than 60 microstrain for the strain distribution. The inter-specimen variability was larger than the intra-specimen variability due to the natural differences between femurs. Altogether, the measurement uncertainties (intrinsic measurement errors, intra-specimen repeatability and inter-specimen variability) were smaller than critical levels of biomarkers for adverse remodelling and aseptic loosening, thus allowing to discriminate between stable and unstable implants, and to detect critical strain magnitudes in the host bone. In conclusion, this work showed that it is possible to measure the primary stability and the load transfer of an osseointegrated transfemoral prosthesis in a reliable way using a combination of mechanical testing and DIC.
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Affiliation(s)
- Giulia Galteri
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | | | | | | | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Sensini A, Stamati O, Marchiori G, Sancisi N, Gotti C, Giavaresi G, Cristofolini L, Focarete ML, Zucchelli A, Tozzi G. Full-field strain distribution in hierarchical electrospun nanofibrous poly-L(lactic) acid/collagen scaffolds for tendon and ligament regeneration: A multiscale study. Heliyon 2024; 10:e26796. [PMID: 38444492 PMCID: PMC10912460 DOI: 10.1016/j.heliyon.2024.e26796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Regeneration of injured tendons and ligaments (T/L) is a worldwide need. In this study electrospun hierarchical scaffolds made of a poly-L (lactic) acid/collagen blend were developed reproducing all the multiscale levels of aggregation of these tissues. Scanning electron microscopy, microCT and tensile mechanical tests were carried out, including a multiscale digital volume correlation analysis to measure the full-field strain distribution of electrospun structures. The principal strains (εp1 and εp3) described the pattern of strains caused by the nanofibers rearrangement, while the deviatoric strains (εD) revealed the related internal sliding of nanofibers and bundles. The results of this study confirmed the biomimicry of such electrospun hierarchical scaffolds, paving the way to further tissue engineering and clinical applications.
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Affiliation(s)
- Alberto Sensini
- Department of Complex Tissue Regeneration and cell Biology-Inspired Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
- Department of Industrial Engineering, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
| | | | - Gregorio Marchiori
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
| | - Carlo Gotti
- Advanced Mechanics and Materials – Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Cristofolini
- Department of Complex Tissue Regeneration and cell Biology-Inspired Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
- Health Sciences and Technologies—Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum—Università di Bologna, I-40064, Ozzano dell'Emilia, Bologna, Italy
| | - Maria Letizia Focarete
- Health Sciences and Technologies—Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum—Università di Bologna, I-40064, Ozzano dell'Emilia, Bologna, Italy
- Department of Chemistry 'G. Ciamician' and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum—Università di Bologna, Bologna, Italy
| | - Andrea Zucchelli
- Department of Industrial Engineering, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
- Advanced Mechanics and Materials – Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Gianluca Tozzi
- Centre for Advanced Manufacturing and Materials, School of Engineering, University of Greenwich, Chatham Maritime, United Kingdom
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Gould SL, Davico G, Liebsch C, Wilke HJ, Cristofolini L, Viceconti M. Variability of intervertebral joint stiffness between specimens and spine levels. Front Bioeng Biotechnol 2024; 12:1372088. [PMID: 38486868 PMCID: PMC10937554 DOI: 10.3389/fbioe.2024.1372088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction: Musculoskeletal multibody models of the spine can be used to investigate the biomechanical behaviour of the spine. In this context, a correct characterisation of the passive mechanical properties of the intervertebral joint is crucial. The intervertebral joint stiffness, in particular, is typically derived from the literature, and the differences between individuals and spine levels are often disregarded. Methods: This study tested if an optimisation method of personalising the intervertebral joint stiffnesses was able to capture expected stiffness variation between specimens and between spine levels and if the variation between spine levels could be accurately captured using a generic scaling ratio. Multibody models of six T12 to sacrum spine specimens were created from computed tomography data. For each specimen, two models were created: one with uniform stiffnesses across spine levels, and one accounting for level dependency. Three loading conditions were simulated. The initial stiffness values were optimised to minimize the kinematic error. Results: There was a range of optimised stiffnesses across the specimens and the models with level dependent stiffnesses were less accurate than the models without. Using an optimised stiffness substantially reduced prediction errors. Discussion: The optimisation captured the expected variation between specimens, and the prediction errors demonstrated the importance of accounting for level dependency. The inaccuracy of the predicted kinematics for the level-dependent models indicated that a generic scaling ratio is not a suitable method to account for the level dependency. The variation in the optimised stiffnesses for the different loading conditions indicates personalised stiffnesses should also be considered load-specific.
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Affiliation(s)
- Samuele L. Gould
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgio Davico
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Luca Cristofolini
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Galteri G, Cristofolini L. In vitro and in silico methods for the biomechanical assessment of osseointegrated transfemoral prostheses: a systematic review. Front Bioeng Biotechnol 2023; 11:1237919. [PMID: 37662439 PMCID: PMC10469938 DOI: 10.3389/fbioe.2023.1237919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
The amputee population according to the World-Health-Organization is about 40 million. However, there is a high abandon rate of socket prostheses for the lower limb (25%-57%). The direct connection between the external prosthesis and the patient's bone makes osseointegrated prostheses for transfemoral amputees advantageous (e.g., improvement of the motor control) compared to socket prostheses, which are currently the gold standard. However, similarly to other uncemented prostheses, the osseointegrated ones are at risk of aseptic loosening and adverse bone remodelling caused by stress-shielding. The preclinical assessment of these prostheses has already been evaluated using different methods which did not provide unanimous and comparable evidence. To compare data from different investigations, a clear and detailed overview of the methods used to assess the performance is necessary. In this review 17 studies investigating the primary stability, stress shielding and stress concentration of osseointegrated transfemoral prostheses are examined. Primary stability consists in the biomechanical stability upon implant insertion. Primary stability is assessed measuring extraction force (either with a pull-out or a push-out test) and micromotion at the interface between the implant and the host bone with LVDT (in vitro test) or numerical models. Stress-shielding causes adaptive changes in the bone density around metal implants, and thus in the bone strength and stiffness. Stress-shielding is assessed with strain gauges or numerical models measuring the load transfer and the strain distribution on the surface of the femur, and between the implant and the bone respectively. Stress concentration can lead to the formation of cracks inside the bone, resulting in fractures. The stress concentration is assessed measuring the load transfer and the strain energy density at the interface between the implant and the bone, using numerical models. As a result, a global view and consensus about the methods are missing from all these tests. Indeed, different setup and loading scenario were used in the in vitro test, while different model parameters (e.g., bone properties) were used in the numerical models. Once the preclinical assessment method is established, it would be important to define thresholds and acceptance criteria for each of the possible failure scenarios investigated.
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Affiliation(s)
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Montanari S, Griffoni C, Cristofolini L, Girolami M, Gasbarrini A, Barbanti Bròdano G. Correlation Between Sagittal Balance and Mechanical Distal Junctional Failure in Degenerative Pathology of the Spine: A Retrospective Analysis. Global Spine J 2023:21925682231195954. [PMID: 37562976 DOI: 10.1177/21925682231195954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to investigate the failure of the caudal end of lumbar posterior fixation in terms of pre-operative and post-operative spinopelvic parameters, correction performed, demographic and clinical data. METHODS The lumbar, thoraco-lumbar and lumbo-sacral posterior fixations performed with pedicle screws and rods in 2017-2019 were retrospectively analyzed. As 81% failures occurred within 4 years, an observational period of 4 years was chosen. The revision surgeries due to the failure in the caudal end were collected in the junctional group. Fixations which have not failed were gathered in the control group. The main spinopelvic parameters were measured for each patient on standing lateral radiographs with the software Surgimap. Demographic and clinical data were extracted for both groups. RESULTS Among the 457 patients who met the inclusion criteria, the junctional group included 101 patients, who required a revision surgery. The control group collected 356 primary fixations. The two most common causes of revision surgeries were screws pullout (57 cases) and rod breakage (53 cases). SVA, PT, LL, PI-LL and TPA differed significantly between the two groups (P = .021 for LL, P < .0001 for all the others). The interaction between the two groups and the pre-operative and post-operative conditions was significant for PT, SS, LL, TK, PI-LL and TPA (P < .005). Sex and BMI did not affect the failure onset. CONCLUSIONS Mechanical failure is more likely to occur in patients older than 40 years with a thoraco-lumbar fixation where PT, PI-LL and TPA were not properly restored.
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Affiliation(s)
- Sara Montanari
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Cristiana Griffoni
- Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Marco Girolami
- Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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Overgaard S, Grupp TM, Nelissen RG, Cristofolini L, Lübbeke A, Jäger M, Fink M, Rusch S, Achakri H, Benazzo F, Bergadano D, Duda GN, Kaddick C, Jansson V, Günther KP. Introduction of innovations in joint arthroplasty: Recommendations from the 'EFORT implant and patient safety initiative'. EFORT Open Rev 2023; 8:509-521. [PMID: 37395720 DOI: 10.1530/eor-23-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
With the implementation of the new MDR 2017/745 by the European Parliament, more robust clinical and pre-clinical data will be required due to a more stringent approval process. The EFORT Implant and Patient Safety Initiative WG1 'Introduction of Innovation', combined knowledge of orthopaedic surgeons, research institutes, orthopaedic device manufacturers, patient representatives and regulatory authorities to develop a comprehensive set of recommendations for the introduction of innovations in joint arthroplasty within the boundaries of MDR 2017/745. Recommendations have been developed to address key questions about pre-clinical and clinical requirements for the introduction of new implants and implant-related instrumentation with the participation of a steering group, invited by the EFORT Board in dialogue with representatives from European National Societies and Speciality Societies. Different degrees of novelty and innovation were described and agreed on in relation to when surgeons can start, using implants and implant-related instrumentation routinely. Before any clinical phase of a new implant, following the pre-market clinical investigation or the equivalent device PMCF pathway, it is a common understanding that all appropriate pre-clinical testing (regulatory mandatory and evident state of the art) - which has to be considered for a specific device - has been successfully completed. Once manufacturers receive the CE mark for a medical device, it can be used in patients routinely when a clinical investigation has been conducted to demonstrate the conformity of devices according to MDR Article 62 or full equivalence for the technical, biological and clinical characteristics has been demonstrated (MDR, Annex XIV, Part A, 3.) and a PMCF study has been initiated.
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Affiliation(s)
- Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas M Grupp
- Aesculap AG Research & Development & Medical Scientific Affairs, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | - Rob Ghh Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Technical University Delft, Delft, the Netherlands
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Anne Lübbeke
- Division of Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Switzerland
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Marcus Jäger
- Department of Orthopaedics, Trauma & Reconstructive Surgery St. Marien Hospital Mülheim an der Ruhr & Chair of Orthopaedics and Trauma Surgery University of Duisburg-Essen, Essen, Germany
| | - Matthias Fink
- TÜV Süd Product Service GmbH, Clinical Centre of Excellence, Munich Germany
| | - Sabine Rusch
- Aesculap AG Research & Development & Medical Scientific Affairs, Tuttlingen, Germany
| | - Hassan Achakri
- Zimmer Biomet, Clinical, Regulatory & Quality Affairs, Winterthur, Switzerland
| | - Francesco Benazzo
- IUSS Pavia, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Dario Bergadano
- Medacta International SA, Medical Affairs, Castel San Pietro, Switzerland
| | - Georg N Duda
- Julius Wolff Institute and Center for Muskuloskeletal Surgery, Berlin Institute of Health at Charité Universitätsmedizin Berlin, Germany
| | | | - Volkmar Jansson
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | - Klaus-Peter Günther
- University Clinic Carl Gustav Carus, Center for Orthopaedic & Trauma Surgery, Technical University Dresden, Dresden, Germany
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Grupp TM, Rusch S, Massin P, Blom A, Garcia-Rey E, Cristofolini L, Janssen D, Grimm B, Giurea A, Jäger M, Siccardi F, Overgaard S. 1st EFORT European Consensus "Medical & Scientific Research Requirements for the Clinical Introduction of Artificial Joint Arthroplasty Devices": Background, Delphi Methodology & Consensus process. EFORT Open Rev 2023; 8:499-508. [PMID: 37395678 DOI: 10.1530/eor-23-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
The objectives of the 1st EFORT European Consensus on 'Medical and Scientific Research Requirements for the Clinical Introduction of Artificial Joint Arthroplasty Devices' were foremost to focus on patient safety by establishing performance requirements for medical devices. The 1st EFORT European Consensus applied an a priori-defined, modified Delphi methodology to produce unbiased, high-quality recommendation statements, confirmed by consensus voting of a European expert panel. Intended key outcomes are practical guidelines justified by the current stage of knowledge and based on a broad European Expert Consensus, to maintain innovation and optimisation of orthopaedic devices within the boundaries of MDR 2017/745. Twenty-one main research areas of relevance were defined relying on input from the EFORT IPSI WG1 'Introduction of Innovation' recommendations and a related survey. A modified Delphi approach with a preparatory literature review and work in small groups were used to prepare answers to the research questions in the form of 32 draft Consensus statements. A Consensus Conference in a hybrid format, on-site in the Carl Gustav Carus University of Dresden was organised to further refine the draft statements and define consensus within the complete group of participants by final voting, intended to further quantify expert opinion knowledge. The modified Delphi approach provides practical guidelines for hands-on orientation for orthopaedic surgeons, research institutes and laboratories, orthopaedic device manufacturers, patient representatives, Notified Bodies, National Institutes and authorities. For the first time, initiated by the EFORT IPSI (WG1 'Introduction of Innovation'), knowledge of all related stakeholders was combined in the 1st EFORT European Consensus to develop guidelines and result in a comprehensive set of recommendations.
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Affiliation(s)
- Thomas M Grupp
- Aesculap AG, Research & Development & Medical Scientific Affairs, Tuttlingen, Germany
- Ludwig Maximilians University Munich, Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | - Sabine Rusch
- Aesculap AG, Research & Development & Medical Scientific Affairs, Tuttlingen, Germany
| | | | - Ashley Blom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Eduardo Garcia-Rey
- Hôpital Universitario La Paz-Idi Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, CIBER-BBN, Madrid, Spain
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Dennis Janssen
- Radboud University Medical Center, Radboud Research Institute, Orthopaedic Research Lab, Nijmegen, the Netherlands
| | - Bernd Grimm
- Luxembourg Institute of Health, Human Motion, Orthopaedics, Sports Medicine & Digital Methods Group, Transversal Activities, Luxembourg
| | - Alexander Giurea
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Jäger
- Department of Orthopaedics, Trauma & Reconstructive Surgery St. Marien Hospital Mülheim an der Ruhr & Chair of Orthopaedics and Trauma Surgery University of Duisburg-Essen, Essen, Germany
| | - Francesco Siccardi
- Medacta International SA, Research & Development & Medical Affairs, Castel San Pietro, Switzerland
| | - Søren Overgaard
- Copenhagen University Hospital, Department of Orthopaedic Surgery and Traumatology, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Arcobelli VA, Zauli M, Galteri G, Cristofolini L, Chiari L, Cappello A, De Marchi L, Mellone S. mCrutch: A Novel m-Health Approach Supporting Continuity of Care. Sensors (Basel) 2023; 23:4151. [PMID: 37112492 PMCID: PMC10146559 DOI: 10.3390/s23084151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
This paper reports the architecture of a low-cost smart crutches system for mobile health applications. The prototype is based on a set of sensorized crutches connected to a custom Android application. Crutches were instrumented with a 6-axis inertial measurement unit, a uniaxial load cell, WiFi connectivity, and a microcontroller for data collection and processing. Crutch orientation and applied force were calibrated with a motion capture system and a force platform. Data are processed and visualized in real-time on the Android smartphone and are stored on the local memory for further offline analysis. The prototype's architecture is reported along with the post-calibration accuracy for estimating crutch orientation (5° RMSE in dynamic conditions) and applied force (10 N RMSE). The system is a mobile-health platform enabling the design and development of real-time biofeedback applications and continuity of care scenarios, such as telemonitoring and telerehabilitation.
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Affiliation(s)
- Valerio Antonio Arcobelli
- Department of Electrical, Electronic and Information Engineering (DEI), Alma Mater Studiorum, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Matteo Zauli
- Department of Electrical, Electronic and Information Engineering (DEI), Alma Mater Studiorum, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Giulia Galteri
- Department of Industrial Engineering (DIN), Alma Mater Studiorum, University of Bologna, Via Umberto Terracini 24-28, 40131 Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering (DIN), Alma Mater Studiorum, University of Bologna, Via Umberto Terracini 24-28, 40131 Bologna, Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering (DEI), Alma Mater Studiorum, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
| | - Angelo Cappello
- Department of Electrical, Electronic and Information Engineering (DEI), Alma Mater Studiorum, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Luca De Marchi
- Department of Electrical, Electronic and Information Engineering (DEI), Alma Mater Studiorum, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering (DEI), Alma Mater Studiorum, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
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Cavazzoni G, Cristofolini L, Dall’Ara E, Palanca M. Bone metastases do not affect the measurement uncertainties of a global digital volume correlation algorithm. Front Bioeng Biotechnol 2023; 11:1152358. [PMID: 37008039 PMCID: PMC10060622 DOI: 10.3389/fbioe.2023.1152358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Measurement uncertainties of Digital Volume Correlation (DVC) are influenced by several factors, like input images quality, correlation algorithm, bone type, etc. However, it is still unknown if highly heterogeneous trabecular microstructures, typical of lytic and blastic metastases, affect the precision of DVC measurements.Methods: Fifteen metastatic and nine healthy vertebral bodies were scanned twice in zero-strain conditions with a micro-computed tomography (isotropic voxel size = 39 μm). The bone microstructural parameters (Bone Volume Fraction, Structure Thickness, Structure Separation, Structure Number) were calculated. Displacements and strains were evaluated through a global DVC approach (BoneDVC). The relationship between the standard deviation of the error (SDER) and the microstructural parameters was investigated in the entire vertebrae. To evaluate to what extent the measurement uncertainty is influenced by the microstructure, similar relationships were assessed within sub-regions of interest.Results: Higher variability in the SDER was found for metastatic vertebrae compared to the healthy ones (range 91-1030 με versus 222–599 με). A weak correlation was found between the SDER and the Structure Separation in metastatic vertebrae and in the sub-regions of interest, highlighting that the heterogenous trabecular microstructure only weakly affects the measurement uncertainties of BoneDVC. No correlation was found for the other microstructural parameters. The spatial distribution of the strain measurement uncertainties seemed to be associated with regions with reduced greyscale gradient variation in the microCT images.Discussion: Measurement uncertainties cannot be taken for granted but need to be assessed in each single application of the DVC to consider the minimum unavoidable measurement uncertainty when interpreting the results.
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Affiliation(s)
- Giulia Cavazzoni
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Enrico Dall’Ara
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Marco Palanca,
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11
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Fayad J, Eltes PE, Lazary A, Cristofolini L, Stagni R. Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review. BMC Musculoskelet Disord 2022; 23:1080. [PMID: 36503435 PMCID: PMC9743750 DOI: 10.1186/s12891-022-05925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Spine disorders are becoming more prevalent in today's ageing society. Motion abnormalities have been linked to the prevalence and recurrence of these disorders. Various protocols exist to measure thoracolumbar spine motion, but a standard multi-segmental approach is still missing. This study aims to systematically evaluate the literature on stereophotogrammetric motion analysis approaches to quantify thoracolumbar spine kinematics in terms of measurement reliability, suitability of protocols for clinical application and clinical significance of the resulting functional assessment. METHODS Electronic databases (PubMed, Scopus and ScienceDirect) were searched until February 2022. Studies published in English, investigating the intersegmental kinematics of the thoracolumbar spine using stereophotogrammetric motion analysis were identified. All information relating to measurement reliability; measurement suitability and clinical significance was extracted from the studies identified. RESULTS Seventy-four studies met the inclusion criteria. 33% of the studies reported on the repeatability of their measurement. In terms of suitability, only 35% of protocols were deemed suitable for clinical application. The spinous processes of C7, T3, T6, T12, L1, L3 and L5 were the most widely used landmarks. The spine segment definitions were, however, found to be inconsistent among studies. Activities of daily living were the main tasks performed. Comparable results between protocols are however still missing. CONCLUSION The literature to date offers various stereophotogrammetric protocols to quantify the multi-segmental motion of the thoracolumbar spine, without a standard guideline being followed. From a clinical point of view, the approaches are still limited. Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance.
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Affiliation(s)
- Jennifer Fayad
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy ,National Centre for Spinal Disorders, Budapest, Hungary
| | - Peter Endre Eltes
- National Centre for Spinal Disorders, Budapest, Hungary ,In Silico Biomechanics Laboratory, National Centre for Spinal Disorders, Budapest, Hungary
| | - Aron Lazary
- National Centre for Spinal Disorders, Budapest, Hungary
| | - Luca Cristofolini
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy
| | - Rita Stagni
- grid.6292.f0000 0004 1757 1758Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, Alma Mater Studiorum – Università Di Bologna, Bologna, Italy
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12
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Techens C, Montanari S, Bereczki F, Eltes PE, Lazary A, Cristofolini L. Biomechanical consequences of cement discoplasty: An in vitro study on thoraco-lumbar human spines. Front Bioeng Biotechnol 2022; 10:1040695. [PMID: 36532589 PMCID: PMC9755512 DOI: 10.3389/fbioe.2022.1040695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 10/24/2023] Open
Abstract
With the ageing of the population, there is an increasing need for minimally invasive spine surgeries to relieve pain and improve quality of life. Percutaneous Cement Discoplasty is a minimally invasive technique to treat advanced disc degeneration, including vacuum phenomenon. The present study aimed to develop an in vitro model of percutaneous cement discoplasty to investigate its consequences on the spine biomechanics in comparison with the degenerated condition. Human spinal segments (n = 27) were tested at 50% body weight in flexion and extension. Posterior disc height, range of motion, segment stiffness, and strains were measured using Digital Image Correlation. The cement distribution was also studied on CT scans. As main result, percutaneous cement discoplasty restored the posterior disc height by 41% for flexion and 35% for extension. Range of motion was significantly reduced only in flexion by 27%, and stiffness increased accordingly. The injected cement volume was 4.56 ± 1.78 ml (mean ± SD). Some specimens (n = 7) exhibited cement perforation of one endplate. The thickness of the cement mass moderately correlated with the posterior disc height and range of motion with different trends for flexions vs. extension. Finally, extreme strains on the discs were reduced by percutaneous cement discoplasty, with modified patterns of the distribution. To conclude, this study supported clinical observations in term of recovered disc height close to the foramen, while percutaneous cement discoplasty helped stabilize the spine in flexion and did not increase the risk of tissue damage in the annulus.
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Affiliation(s)
- Chloé Techens
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
- Department of Spinal Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Sara Montanari
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
| | - Ferenc Bereczki
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
- Department of Spinal Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
- Department of Spinal Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
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13
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Techens C, Eltes PE, Lazary A, Cristofolini L. Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty. Front Surg 2022; 9:902831. [PMID: 35620196 PMCID: PMC9127498 DOI: 10.3389/fsurg.2022.902831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Interbody fusion is the gold standard surgery to treat lumbar disc degeneration disease but can be a high-risk procedure in elderly and polymorbid patients. Percutaneous Cement Discoplasty (PCD) is a minimally invasive technique developed to treat advanced stage of disc degeneration exhibiting a vacuum phenomenon. A patient-specific stand-alone spacer is created by filling the disc with polymethylmethacrylate cement, allowing to recover the disc height and improve the patient’s conditions. As it has recently been introduced in the lumbar spine, this review aims to present a transversal state-of-the-art of the surgery from its clinical practice and outcome to biomechanical and engineering topics. The literature was searched across multiple databases using predefined keywords over no limited period of time. Papers about vertebroplasty were excluded. Among 466 identified papers, the relevant ones included twelve clinical papers reporting the variations of the surgical technique, follow-up and complications, four papers reporting biomechanical ex vivo and numerical tests, and four letters related to published clinical papers. Papers presenting the operative practice are reported, as well as follow-ups up to four years. The papers found, consistently reported that PCD significantly improved the clinical status of the patients and maintained it after two years. Spine alignment was impacted by PCD: the sacral slope was significantly reduced, and disc height increased. The foramen opening correlated to the volume of injected cement. Substitutes to the acrylic cement exhibited better osteointegration and mechanical properties closer to bone tissue. Finally, limitations and risks of the surgery are discussed as well as potential improvements such as the development of new filling materials with better mechanical properties and biological integration or the investigation of the inner disc.
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Affiliation(s)
- Chloé Techens
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
- In silico Biomechanics Laboratory, National Center for Spinal Disorders, Budapest, Hungary
- Department of Orthopaedics, Department of Spine Surgery, Semmelweis University, Budapest, Hungary
| | - Peter Endre Eltes
- In silico Biomechanics Laboratory, National Center for Spinal Disorders, Budapest, Hungary
- Department of Orthopaedics, Department of Spine Surgery, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- In silico Biomechanics Laboratory, National Center for Spinal Disorders, Budapest, Hungary
- Department of Orthopaedics, Department of Spine Surgery, Semmelweis University, Budapest, Hungary
- Correspondence: Aron Lazary Luca Cristofolini
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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14
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Born P, Braibanti M, Cristofolini L, Cohen-Addad S, Durian DJ, Egelhaaf SU, Escobedo-Sánchez MA, Höhler R, Karapantsios TD, Langevin D, Liggieri L, Pasquet M, Rio E, Salonen A, Schröter M, Sperl M, Sütterlin R, Zuccolotto-Bernez AB. Soft matter dynamics: A versatile microgravity platform to study dynamics in soft matter. Rev Sci Instrum 2021; 92:124503. [PMID: 34972443 DOI: 10.1063/5.0062946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
We describe an experiment container with light scattering and imaging diagnostics for experiments on soft matter aboard the International Space Station (ISS). The suite of measurement capabilities can be used to study different materials in exchangeable sample cell units. The currently available sample cell units and future possibilities for foams, granular media, and emulsions are presented in addition to an overview of the design and the diagnostics of the experiment container. First results from measurements performed on ground and during the commissioning aboard the ISS highlight the capabilities of the experiment container to study the different materials.
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Affiliation(s)
- P Born
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170 Köln, Germany
| | - M Braibanti
- HE Space Operations BV for ESA, NL-2200AG Noordwijk, The Netherlands
| | - L Cristofolini
- CNR - Institute of Condensed Matter Chemistry and Technologies for Energy Unit of Genoa, 16149 Genova, Italy
| | - S Cohen-Addad
- Sorbonne Universités, UPMC Univ Paris 06, CNRS-UMR 7588, Institut des NanoSciences de Paris, 4 place Jussieu, 75005 Paris, France
| | - D J Durian
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - S U Egelhaaf
- Condensed Matter Physics Laboratory, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - M A Escobedo-Sánchez
- Condensed Matter Physics Laboratory, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - R Höhler
- Sorbonne Universités, UPMC Univ Paris 06, CNRS-UMR 7588, Institut des NanoSciences de Paris, 4 place Jussieu, 75005 Paris, France
| | - T D Karapantsios
- Department of Chemical Technology, School of Chemistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - D Langevin
- Laboratoire de Physique des Solides, CNRS UMR 8502, Université de Paris Saclay, 91405 Orsay, France
| | - L Liggieri
- CNR - Institute of Condensed Matter Chemistry and Technologies for Energy Unit of Genoa, 16149 Genova, Italy
| | - M Pasquet
- Laboratoire de Physique des Solides, CNRS UMR 8502, Université de Paris Saclay, 91405 Orsay, France
| | - E Rio
- Laboratoire de Physique des Solides, CNRS UMR 8502, Université de Paris Saclay, 91405 Orsay, France
| | - A Salonen
- Laboratoire de Physique des Solides, CNRS UMR 8502, Université de Paris Saclay, 91405 Orsay, France
| | - M Schröter
- Max Planck Institute for Dynamics and Self-Organization, 37077 Göttingen, Germany
| | - M Sperl
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170 Köln, Germany
| | - R Sütterlin
- Department TESXS Science Systems Engineering, Airbus Defence and Space, Claude Dornier Str., 88090 Immenstaad, Germany
| | - A B Zuccolotto-Bernez
- Condensed Matter Physics Laboratory, Heinrich Heine University, 40225 Düsseldorf, Germany
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15
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Marras D, Palanca M, Cristofolini L. Effects Induced by Osteophytes on the Strain Distribution in the Vertebral Body Under Different Loading Configurations. Front Bioeng Biotechnol 2021; 9:756609. [PMID: 34778229 PMCID: PMC8585771 DOI: 10.3389/fbioe.2021.756609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022] Open
Abstract
The mechanical consequences of osteophytes are not completely clear. We aimed to understand whether and how the presence of an osteophyte perturbs strain distribution in the neighboring bone. The scope of this study was to evaluate the mechanical behavior induced by the osteophytes using full-field surface strain analysis in different loading configurations. Eight thoracolumbar segments, containing a vertebra with an osteophyte and an adjacent vertebra without an osteophyte (control), were harvested from six human spines. The position and size of the osteophytes were evaluated using clinical computed tomography imaging. The spine segments were biomechanically tested in the elastic regime in different loading configurations while the strains over the frontal and lateral surface of vertebral bodies were measured using digital image correlation. The strain fields in the vertebrae with and without osteophytes were compared. The correlation between osteophyte size and strain alteration was explored. The strain fields measured in the vertebrae with osteophytes were different from the control ones. In pure compression, we observed a mild trend between the size of the osteophyte and the strain distribution (R2 = 0.32, p = 0.15). A slightly stronger trend was found for bending (R2 = 0.44, p = 0.075). This study suggests that the osteophytes visibly perturb the strain field in the nearby vertebral area. However, the effect on the surrounding bone is not consistent. Indeed, in some cases the osteophyte shielded the neighboring bone, and in other cases, the osteophyte increased the strains.
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Affiliation(s)
- Daniele Marras
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Marco Palanca
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.,Department of Oncology and Metabolism, INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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16
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Palanca M, Liebsch C, Hübner S, Marras D, Ruspi ML, Marconi F, Cristofolini L, Wilke HJ. Global and local characterization explains the different mechanisms of failure of the human ribs. J Mech Behav Biomed Mater 2021; 125:104931. [PMID: 34736031 DOI: 10.1016/j.jmbbm.2021.104931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Knowledge of the mechanics and mechanistic reasons inducing rib fracture is fundamental for forensic investigations and for the design of implants and cardiopulmonary resuscitation devices. A mechanical rationale to explain the different rib mechanisms of failure is still a challenge. The aim of this work was to experimentally characterize human ribs to test the hypothesis that a correlation exists between the ribs properties and the mechanism of failure. 89 ribs were tested in antero-posterior compression. The full-field strain distribution was measured through Digital Image Correlation. The fracture load ranged 7-132 N. Two main different mechanisms of failure were observed: brittle and buckling. The strain analysis showed that the direction of principal strains was either aligned with the ribs, or oblique, around 45°, with a rather uniform direction in the most strained area. The maximum principal strains were in the range between 1000 and 30000 microstrain and the minimum principal strain between -30000 and -800 microstrain. The ribs undergoing brittle fracture had significantly thicker cortical bone than those undergoing buckling. Also, larger tensile strains were observed in the specimens with brittle fracture than in the buckling ones. These findings support the focus of cortical thickness modelling which could help in sharpening computational models for the aforesaid purposes.
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Affiliation(s)
- Marco Palanca
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; INSIGNEO Institute for in Silico Medicine, University of Sheffield, Sheffield, UK; Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm ZTF, University Hospital Ulm, Ulm, Germany
| | - Shamila Hübner
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm ZTF, University Hospital Ulm, Ulm, Germany
| | - Daniele Marras
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Maria Luisa Ruspi
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesco Marconi
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm ZTF, University Hospital Ulm, Ulm, Germany
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17
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Palanca M, Barbanti-Bròdano G, Marras D, Marciante M, Serra M, Gasbarrini A, Dall'Ara E, Cristofolini L. Type, size, and position of metastatic lesions explain the deformation of the vertebrae under complex loading conditions. Bone 2021; 151:116028. [PMID: 34087385 DOI: 10.1016/j.bone.2021.116028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bone metastases may lead to spine instability and increase the risk of fracture. Scoring systems are available to assess critical metastases, but they lack specificity, and provide uncertain indications over a wide range, where most cases fall. The aim of this work was to use a novel biomechanical approach to evaluate the effect of lesion type, size, and location on the deformation of the metastatic vertebra. METHOD Vertebrae with metastases were identified from 16 human spines from a donation programme. The size and position of the metastases, and the Spine Instability Neoplastic Score (SINS) were evaluated from clinical Quantitative Computed Tomography images. Thirty-five spine segments consisting of metastatic vertebrae and adjacent healthy controls were biomechanically tested in four different loading conditions. The strain distribution over the entire vertebral bodies was measured with Digital Image Correlation. Correlations between the features of the metastasis (type, size, position and SINS) and the deformation of the metastatic vertebrae were statistically explored. RESULTS The metastatic type (lytic, blastic, mixed) characterizes the vertebral behaviour (Kruskal-Wallis, p = 0.04). In fact, the lytic metastases showed more critical deformation compared to the control vertebrae (average: 2-fold increase, with peaks of 14-fold increase). By contrast, the vertebrae with mixed or blastic metastases did not show a clear trend, with deformations similar or lower than the controls. Once the position of the lytic lesion with respect to the loading direction was taken into account, the size of the lesion was significantly correlated with the perturbation to the strain distribution (r2 = 0.72, p < 0.001). Conversely, the SINS poorly correlated with the mechanical evidence, and only in case of lytic lesions (r2 = 0.25, p < 0.0001). CONCLUSION These results highlight the relevance of the size and location of the lytic lesion, which are marginally considered in the current clinical scoring systems, in driving the spinal biomechanical instability. The strong correlation with the biomechanical evidence indicates that these parameters are representative of the mechanical competence of the vertebra. The improved explanatory power compared to the SINS suggests including them in future guidelines for the clinical practice.
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Affiliation(s)
- Marco Palanca
- Dept of Oncology and Metabolism, INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | | | - Daniele Marras
- Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Mara Marciante
- Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Michele Serra
- Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | | | - Enrico Dall'Ara
- Dept of Oncology and Metabolism, INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Luca Cristofolini
- Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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18
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Gould SL, Cristofolini L, Davico G, Viceconti M. Computational modelling of the scoliotic spine: A literature review. Int J Numer Method Biomed Eng 2021; 37:e3503. [PMID: 34114367 PMCID: PMC8518780 DOI: 10.1002/cnm.3503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
Scoliosis is a deformity of the spine that in severe cases requires surgical treatment. There is still disagreement among clinicians as to what the aim of such treatment is as well as the optimal surgical technique. Numerical models can aid clinical decision-making by estimating the outcome of a given surgical intervention. This paper provided some background information on the modelling of the healthy spine and a review of the literature on scoliotic spine models, their validation, and their application. An overview of the methods and techniques used to construct scoliotic finite element and multibody models was given as well as the boundary conditions used in the simulations. The current limitations of the models were discussed as well as how such limitations are addressed in non-scoliotic spine models. Finally, future directions for the numerical modelling of scoliosis were addressed.
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Affiliation(s)
- Samuele L. Gould
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Luca Cristofolini
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
| | - Giorgio Davico
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Marco Viceconti
- Department of Industrial EngineeringAlma Mater Studiorum‐University of Bologna (IT)BolognaItaly
- Medical Technology LabIRCCS Istituto Ortopedico RizzoliBolognaItaly
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19
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Cristofolini L, Focarete ML, Ramakrishna S, Sensini A, Zucchelli A. Editorial: Electrospinning of Bioinspired Materials and Structures for Bioengineering and Advanced Biomedical Applications. Front Bioeng Biotechnol 2021; 9:739613. [PMID: 34552918 PMCID: PMC8450358 DOI: 10.3389/fbioe.2021.739613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università, Bologna, Italy.,Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum-Università, Bologna, Italy
| | - Maria Letizia Focarete
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum-Università, Bologna, Italy.,Department of Chemistry "G. Ciamician", Alma Mater Studiorum-Università, Bologna, Italy
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers and Nanotechnology, National University of Singapore, Singapore, Singapore
| | - Alberto Sensini
- Applications in Mechanical Engineering and Materials Technology - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-Università, Bologna, Italy
| | - Andrea Zucchelli
- Department of Industrial Engineering, Alma Mater Studiorum-Università, Bologna, Italy.,Applications in Mechanical Engineering and Materials Technology - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-Università, Bologna, Italy
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20
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Seravalli L, Bosi M, Fiorenza P, Panasci SE, Orsi D, Rotunno E, Cristofolini L, Rossi F, Giannazzo F, Fabbri F. Gold nanoparticle assisted synthesis of MoS 2 monolayers by chemical vapor deposition. Nanoscale Adv 2021; 3:4826-4833. [PMID: 36134320 PMCID: PMC9418562 DOI: 10.1039/d1na00367d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/30/2021] [Indexed: 06/16/2023]
Abstract
The use of metal nanoparticles is an established paradigm for the synthesis of semiconducting one-dimensional nanostructures. In this work we study their effect on the synthesis of two-dimensional semiconducting materials, by using gold nanoparticles for chemical vapor deposition growth of two-dimensional molybdenum disulfide (MoS2). In comparison with the standard method, the employment of gold nanoparticles allows us to obtain large monolayer MoS2 flakes, up to 20 μm in lateral size, even if they are affected by the localized overgrowth of MoS2 bilayer and trilayer islands. Important modifications of the optical and electronic properties of MoS2 triangular domains are reported, where the photoluminescence intensity of the A exciton is strongly quenched and a shift to a positive threshold voltage in back-gated field effect transistors is observed. These results indicate that the use of gold nanoparticles influences the flake growth and properties, indicating a method for possible localized synthesis of two-dimensional materials, improving the lateral size of monolayers and modifying their properties.
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Affiliation(s)
- L Seravalli
- Institute for Materials for Electronics and Magnetism (IMEM-CNR) Parco Area delle Scienze 37/a 43124 Parma Italy
| | - M Bosi
- Institute for Materials for Electronics and Magnetism (IMEM-CNR) Parco Area delle Scienze 37/a 43124 Parma Italy
| | - P Fiorenza
- Institute for Microelectronics and Microsystems (CNR-IMM) Z. I. VIII Strada 5 95121 Catania Italy
| | - S E Panasci
- Institute for Microelectronics and Microsystems (CNR-IMM) Z. I. VIII Strada 5 95121 Catania Italy
| | - D Orsi
- Department of Mathematical, Physical and Computer Sciences, University of Parma Parco Area delle Scienze 7/a 43124 Parma Italy
| | - E Rotunno
- Istituto Nanoscienze-CNR via G Campi 213/a 41125 Modena Italy
| | - L Cristofolini
- Department of Mathematical, Physical and Computer Sciences, University of Parma Parco Area delle Scienze 7/a 43124 Parma Italy
| | - F Rossi
- Institute for Materials for Electronics and Magnetism (IMEM-CNR) Parco Area delle Scienze 37/a 43124 Parma Italy
| | - F Giannazzo
- Institute for Microelectronics and Microsystems (CNR-IMM) Z. I. VIII Strada 5 95121 Catania Italy
| | - F Fabbri
- NEST, Istituto Nanoscienze - CNR, Scuola Normale Superiore Piazza San Silvestro 12 56127 Pisa Italy
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Schierjott RA, Hettich G, Baxmann M, Morosato F, Cristofolini L, Grupp TM. Primary stability of a press-fit cup in combination with impaction grafting in an acetabular defect model. J Orthop Res 2021; 39:929-940. [PMID: 32691903 DOI: 10.1002/jor.24810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to (a) assess primary stability of a press-fit cup in a simplified acetabular defect model, filled with compacted cancellous bone chips, and (b) to compare the results with primary stability of a press-fit cup combined with two different types of bone graft substitute in the same defect model. A previously developed acetabular test model made of polyurethane foam was used, in which a mainly medial contained defect was implemented. Three test groups (N = 6 each) were prepared: Cancellous bone chips (bone chips), tricalciumphosphate tetrapods + collagen matrix (tetrapods + coll), bioactive glass S53P4 + polyethylene glycol-glycerol matrix (b.a.glass + PEG). Each material was compacted into the acetabulum and a press-fit cup was implanted. The specimens were loaded dynamically in the direction of the maximum resultant force during level walking. Relative motion between cup and test model was assessed with an optical measurement system. At the last load step (3000 N), inducible displacement was highest for bone chips with median [25th percentile; 75th percentile] value of 113 [110; 114] µm and lowest for b.a.glass + PEG with 91 [89; 93] µm. Migration at this load step was highest for b.a.glass + PEG with 868 [845; 936] µm and lowest for tetrapods + coll with 491 [487; 497] µm. The results show a comparable behavior under load of tetrapods + coll and bone chips and suggest that tetrapods + coll could be an attractive alternative to bone chips. However, so far, this was found for one specific defect type and primary stability should be further investigated in additional/more severe defects.
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Affiliation(s)
- Ronja A Schierjott
- Research & Development Department, Aesculap AG, Tuttlingen, Germany.,Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Ludwig-Maximilians University Munich, Munich, Germany
| | - Georg Hettich
- Research & Development Department, Aesculap AG, Tuttlingen, Germany
| | - Marc Baxmann
- Research & Development Department, Aesculap AG, Tuttlingen, Germany
| | - Federico Morosato
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Thomas M Grupp
- Research & Development Department, Aesculap AG, Tuttlingen, Germany.,Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Ludwig-Maximilians University Munich, Munich, Germany
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22
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Liebsch C, Hübner S, Palanca M, Cristofolini L, Wilke HJ. Experimental study exploring the factors that promote rib fragility in the elderly. Sci Rep 2021; 11:9307. [PMID: 33927313 PMCID: PMC8085244 DOI: 10.1038/s41598-021-88800-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
Rib fractures represent a common injury type due to blunt chest trauma, affecting hospital stay and mortality especially in elderly patients. Factors promoting rib fragility, however, are little investigated. The purpose of this in vitro study was to explore potential determinants of human rib fragility in the elderly. 89 ribs from 13 human donors (55–99 years) were loaded in antero-posterior compression until fracture using a material testing machine, while surface strains were captured using a digital image correlation system. The effects of age, sex, bone mineral density, rib level and side, four global morphological factors (e.g. rib length), and seven rib cross-sectional morphological factors (e.g. cortical thickness, determined by μCT), on fracture load were statistically examined using Pearson correlation coefficients, Mann–Whitney U test as well as Kruskal–Wallis test with Dunn-Bonferroni post hoc correction. Fracture load showed significant dependencies (p < 0.05) from bone mineral density, age, antero-posterior rib length, cortical thickness, bone volume/tissue volume ratio, trabecular number, trabecular separation, and both cross-sectional area moments of inertia and was significantly higher at rib levels 7 and 8 compared to level 4 (p = 0.001/0.013), whereas side had no significant effect (p = 0.989). Cortical thickness exhibited the highest correlation with fracture load (r = 0.722), followed by the high correlation of fracture load with the area moment of inertia around the longitudinal rib cross-sectional axis (r = 0.687). High correlations with maximum external rib surface strain were detected for bone volume/tissue volume ratio (r = 0.631) and trabecular number (r = 0.648), which both also showed high correlations with the minimum internal rib surface strain (r = − 0.644/ − 0.559). Together with rib level, the determinants cortical thickness, area moment of inertia around the longitudinal rib cross-sectional axis, as well as bone mineral density exhibited the largest effects on human rib fragility with regard to the fracture load. Sex, rib cage side, and global morphology, in contrast, did not affect rib fragility in this study. When checking elderly patients for rib fractures due to blunt chest trauma, patients with low bone mineral density and the mid-thoracic area should be carefully examined.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - Shamila Hübner
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università Di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università Di Bologna, Bologna, Italy
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany.
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Sensini A, Santare MH, Eichenlaub E, Bloom E, Gotti C, Zucchelli A, Cristofolini L. Tuning the Structure of Nylon 6,6 Electrospun Bundles to Mimic the Mechanical Performance of Tendon Fascicles. Front Bioeng Biotechnol 2021; 9:626433. [PMID: 33889568 PMCID: PMC8056020 DOI: 10.3389/fbioe.2021.626433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Tendon and ligament injuries are triggered by mechanical loading, but the specific mechanisms are not yet clearly identified. It is well established however, that the inflection and transition points in tendon stress-strain curves represent thresholds that may signal the onset of irreversible fibrillar sliding. This phenomenon often results in a progressive macroscopic failure of these tissues. With the aim to simulate and replace tendons, electrospinning has been demonstrated to be a suitable technology to produce nanofibers similar to the collagen fibrils in a mat form. These nanofibrous mats can be easily assembled in higher hierarchical levels to reproduce the whole tissue structure. Despite the fact that several groups have developed electrospun tendon-inspired structures, an investigation of the inflection and transition point mechanics is missing. Comparing their behavior with that of the natural counterpart is important to adequately replicate their behavior at physiological strain levels. To fill this gap, in this work fascicle-inspired electrospun nylon 6,6 bundles were produced with different collector peripheral speeds (i.e., 19.7 m s–1; 13.7 m s–1; 7.9 m s–1), obtaining different patterns of nanofibers alignment. The scanning electron microcopy revealed a fibril-inspired structure of the nanofibers with an orientation at the higher speed similar to those in tendons and ligaments (T/L). A tensile mechanical characterization was carried out showing an elastic-brittle biomimetic behavior for the higher speed bundles with a progressively more ductile behavior at slower speeds. Moreover, for each sample category the transition and the inflection points were defined to study how these points can shift with the nanofiber arrangement and to compare their values with those of tendons. The results of this study will be of extreme interest for the material scientists working in the field, to model and improve the design of their electrospun structures and scaffolds and enable building a new generation of artificial tendons and ligaments.
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Affiliation(s)
- Alberto Sensini
- Advanced Applications in Mechanical Engineering and Materials Technology - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Michael H Santare
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.,Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Emily Eichenlaub
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Ellen Bloom
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Carlo Gotti
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Andrea Zucchelli
- Advanced Applications in Mechanical Engineering and Materials Technology - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-Università di Bologna, Bologna, Italy.,Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.,Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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24
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Sensini A, Massafra G, Gotti C, Zucchelli A, Cristofolini L. Tissue Engineering for the Insertions of Tendons and Ligaments: An Overview of Electrospun Biomaterials and Structures. Front Bioeng Biotechnol 2021; 9:645544. [PMID: 33738279 PMCID: PMC7961092 DOI: 10.3389/fbioe.2021.645544] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
The musculoskeletal system is composed by hard and soft tissue. These tissues are characterized by a wide range of mechanical properties that cause a progressive transition from one to the other. These material gradients are mandatory to reduce stress concentrations at the junction site. Nature has answered to this topic developing optimized interfaces, which enable a physiological transmission of load in a wide area over the junction. The interfaces connecting tendons and ligaments to bones are called entheses, while the ones between tendons and muscles are named myotendinous junctions. Several injuries can affect muscles, bones, tendons, or ligaments, and they often occur at the junction sites. For this reason, the main aim of the innovative field of the interfacial tissue engineering is to produce scaffolds with biomaterial gradients and mechanical properties to guide the cell growth and differentiation. Among the several strategies explored to mimic these tissues, the electrospinning technique is one of the most promising, allowing to generate polymeric nanofibers similar to the musculoskeletal extracellular matrix. Thanks to its extreme versatility, electrospinning has allowed the production of sophisticated scaffolds suitable for the regeneration of both the entheses and the myotendinous junctions. The aim of this review is to analyze the most relevant studies that applied electrospinning to produce scaffolds for the regeneration of the enthesis and the myotendinous junction, giving a comprehensive overview on the progress made in the field, in particular focusing on the electrospinning strategies to produce these scaffolds and their mechanical, in vitro, and in vivo outcomes.
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Affiliation(s)
- Alberto Sensini
- Advanced Applications in Mechanical Engineering and Materials Technology – Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Gabriele Massafra
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Carlo Gotti
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Andrea Zucchelli
- Advanced Applications in Mechanical Engineering and Materials Technology – Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-Università di Bologna, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
- Health Sciences and Technologies – Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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25
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Cristofolini L, Marino M, Luraghi G, Palanca M. Editorial: Special Issue of the Italian Chapter of the European Society of Biomechanics dedicated to "Biomechanics for in silico clinical trials". Med Eng Phys 2021; 89:12-13. [PMID: 33608120 DOI: 10.1016/j.medengphy.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Luraghi
- Department of Chemistry, Materials and Chemical Engineering ''Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Marco Palanca
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy; Department of Oncology and Metabolism, and INSIGNEO Institute for in silico medicine, University of Sheffield, UK
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Montroni D, Palanca M, Morellato K, Fermani S, Cristofolini L, Falini G. Hierarchical chitinous matrices byssus-inspired with mechanical properties tunable by Fe(III) and oxidation. Carbohydr Polym 2021; 251:116984. [DOI: 10.1016/j.carbpol.2020.116984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
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Morosato F, Cristofolini L, Castagnini F, Traina F. Effect of cup medialization on primary stability of press-fit acetabular cups. Clin Biomech (Bristol, Avon) 2020; 80:105172. [PMID: 32927407 DOI: 10.1016/j.clinbiomech.2020.105172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Appropriate restoration of the native centre of rotation is of paramount importance in total hip arthroplasty. Reconstruction of the centre of rotation depends on reaming technique: conventional approaches require more cup medialization than anatomical preparations. To date, the influence of cup medialization on socket stability in cementless implants is still unknown. METHODS Ten cadaveric hemipelvises were sequentially reamed using anatomical technique (only subchondral bone removal with restoration of the native centre of rotation) and conventional preparation (reaming to the lamina and medializing the cup). A biomechanical test was performed on the reconstructions. Implant motions were measured with digital image correlation while a cyclic load of increasing magnitude was applied. FINDINGS No significant difference was measured between the two implantation techniques in terms of permanent cup migrations. The only significant difference was found for the cup inducible rotations, where the conventional technique was associated with larger rotations. INTERPRETATION Conventional reaming and cup medialization do not improve initial cup stability. Beyond the recently questioned concerns about medialization and hip biomechanics, this is another issue to bear in mind when reaming the acetabulum.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | | | - Francesco Traina
- Chirurgia Protesica, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Università di Bologna, Italy
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Cristofolini L, Ruspi ML, Marras D, Cavallo M, Guerra E. Reconstruction of proximal humeral fractures without screws using a reinforced bone substitute. J Biomech 2020; 115:110138. [PMID: 33288210 DOI: 10.1016/j.jbiomech.2020.110138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
Multi-fragment fractures are still a challenge: current clinical practice relies on plates and screws. Treatment of fractures of the proximal humerus has the intra-operative risk of articular damage when inserting multiple screws. Distal-varus collapse of the head is a frequent complication in osteoporotic patients. The aim of this biomechanical study was to investigate if an Innovative-cement-technique (the screws are replaced by injection of cement) provides the same or better stability of the reconstructed head compared to the Standard-technique (locking screws). A four-fragment fracture was simulated in twelve pairs of humeri, with removal of part of the cancellous bone to simulate osteoporotic "eggshell" defect. One humerus of each pair was repaired either with a Standard-technique (locking plate, 2 cortical and 6 locking screws), or with the Innovative-cement-technique (injection of a partially-resorbable reinforced bone substitute consisting of PMMA additivated with 26% beta-TCP). Cement injection was performed both in the lab and under fluoroscopic monitoring. The reconstructed specimens were tested to failure with a cyclic force of increasing amplitude. The Innovative-cement-technique withstood a force 3.57 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative-cement-technique was 3.56 times larger than the contralateral Standard-technique. These differences were statistically significant. The Innovative-cement-technique, based on the reinforced bone substitute, demonstrated better biomechanical properties compared to the Standard-technique. These findings, along with the advantage of avoiding the possible complications associated with the locking screws, may help safer and more effective treatment in case of osteoporotic multi-fragment humeral fractures.
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Affiliation(s)
- Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | - Maria Luisa Ruspi
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Daniele Marras
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Guerra
- Shoulder and Elbow Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Morosato F, Traina F, Schierjott RA, Hettich G, Grupp TM, Cristofolini L. Primary Stability of Revision Acetabular Reconstructions Using an Innovative Bone Graft Substitute: A Comparative Biomechanical Study on Cadaveric Pelvises. Materials (Basel) 2020; 13:ma13194312. [PMID: 32992567 PMCID: PMC7579522 DOI: 10.3390/ma13194312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Hip implant failure is mainly due to aseptic loosening of the cotyle and is typically accompanied by defects in the acetabular region. Revision surgery aims to repair such defects before implantation by means of reconstruction materials, whose morselized bone graft represents the gold standard. Due to the limited availability of bone tissue, synthetic substitutes are also used. The aim of this study was to evaluate if a synthetic fully resorbable tri-calcium phosphate-based substitute can provide adequate mechanical stability when employed to restore severe, contained defects, in comparison with morselized bone graft. Five cadaveric pelvises were adopted, one side was reconstructed with morselized bone graft and the other with the synthetic substitute, consisting of dense calcium phosphate granules within a collagen matrix. During the biomechanical test, cyclic load packages of increasing magnitude were applied to each specimen until failure. Bone/implant motions were measured through Digital Image Correlation and were expressed in terms of permanent and inducible translations and rotations. The reconstruction types exhibited a similar behavior, consisting of an initial settling trend followed by failure as bone fracture (i.e., no failure of the reconstruction material). When 2.2 Body Weight was applied, the permanent translations were not significantly different between the two reconstructions (p = 0.06–1.0) and were below 1.0 mm. Similarly, the inducible translations did not differ significantly (p = 0.06–1.0) and were below 0.160 mm. Rotations presented the same order of magnitude but were qualitatively different. Overall, the synthetic substitute provided adequate mechanical stability in comparison with morselized bone graft, thus representing a reliable alternative to treat severe, contained acetabular defects.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, Alma Mater Studiorum, Università di Bologna, 40131 Bologna, Italy;
| | - Francesco Traina
- Chirurgia Protesica, IRCCS Rizzoli Orthopaedic Institute, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Università di Bologna, 40126 Bologna, Italy
| | - Ronja A. Schierjott
- Aesculap AG, Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (R.A.S.); (G.H.); (T.M.G.)
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, Ludwig Maximilian University, 81377 Munich, Germany
| | - Georg Hettich
- Aesculap AG, Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (R.A.S.); (G.H.); (T.M.G.)
| | - Thomas M. Grupp
- Aesculap AG, Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (R.A.S.); (G.H.); (T.M.G.)
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, Ludwig Maximilian University, 81377 Munich, Germany
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum, Università di Bologna, 40131 Bologna, Italy;
- Correspondence:
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30
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Gislason MK, Lupidio F, Jónsson H, Cristofolini L, Esposito L, Bifulco P, Fraldi M, Gargiulo P. Three dimensional bone mineral density changes in the femur over 1 year in primary total hip arthroplasty patients. Clin Biomech (Bristol, Avon) 2020; 78:105092. [PMID: 32590143 DOI: 10.1016/j.clinbiomech.2020.105092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare the bone mineral density changes between unmatched patients undergoing total hip arthroplasty receiving uncemented and cemented type of implants. Previous studies have used DEXA or a two dimensional analysis to estimate the bone quality following total joint replacement, whereas this study presents the changes in three dimensions. METHODS Fifty subjects both male and females receiving both cemented and uncemented type of implant were recruited. Two CT scans were taken of each subject, the first at 24 h post surgery and the second one 1 year after surgery. The scans were calibrated using a phantom converting the Hounsfield units to bone mineral density values in g/cm3. The two scans were registered together using anatomical landmarks and resliced to compare the two femurs in the identical frame of reference. The bone density gain and loss was calculated by comparing density values between the two sets of scans. FINDINGS The results showed that most of the bone loss was located around the Lesser Trochanter and some bone density gain at the distal tip of the implant. The three dimensional density changes occur differently between individuals and the study showed no correlation of bone loss with age. INTERPRETATION The bone loss occurred mostly at the proximal femur, which is in agreement with previously presented studies. By carrying out three dimensional analysis on the bone gain and loss on the femur, it is possible to identify the patients that are showing high degree of bone loss.
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Affiliation(s)
| | - Francesca Lupidio
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; University of Bologna, Department of Industrial Engineering, Italy
| | - Halldór Jónsson
- Landspitali University Hospital, Department of Orthopaedics, Iceland
| | | | - Luca Esposito
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Bifulco
- University of Naples Federico II, Department of Electrical Engineering and Information Technologies, Italy
| | - Massimiliano Fraldi
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; Department of Science, Landspitali University Hospital, Iceland
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Cristofolini L, Morellato K, Cavallo M, Guerra E. Reconstruction of proximal humeral fractures with a reduced number of screws and a reinforced bone substitute. Med Eng Phys 2020; 82:97-103. [DOI: 10.1016/j.medengphy.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 02/04/2023]
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Ruta B, Hechler S, Neuber N, Orsi D, Cristofolini L, Gross O, Bochtler B, Frey M, Kuball A, Riegler SS, Stolpe M, Evenson Z, Gutt C, Westermeier F, Busch R, Gallino I. Wave-Vector Dependence of the Dynamics in Supercooled Metallic Liquids. Phys Rev Lett 2020; 125:055701. [PMID: 32794848 DOI: 10.1103/physrevlett.125.055701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
We present a detailed investigation of the wave-vector dependence of collective atomic motion in Au_{49}Cu_{26.9}Si_{16.3}Ag_{5.5}Pd_{2.3} and Pd_{42.5}Cu_{27}Ni_{9.5}P_{21} supercooled liquids close to the glass transition temperature. Using x-ray photon correlation spectroscopy in a previously uncovered spatial range of only a few interatomic distances, we show that the microscopic structural relaxation process mimics the structure and presents a marked slowing down at the main average interparticle distance. This behavior is accompanied by dramatic changes in the shape of the intermediate scattering functions, which suggest the presence of large dynamical heterogeneities at length scales corresponding to a few particle diameters. A ballisticlike mechanism of particle motion seems to govern the structural relaxation of the two systems in the highly viscous phase, likely associated with hopping of caged particles in agreement with theoretical studies.
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Affiliation(s)
- B Ruta
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622 Villeurbanne, France
- ESRF-The European Synchrotron, CS40220, 38043 Grenoble, France
| | - S Hechler
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622 Villeurbanne, France
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - N Neuber
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - D Orsi
- Dipartimento di Scienze Matematiche Fisiche ed Informatiche, Università degli Studi di Parma, Parma, Italy
| | - L Cristofolini
- Dipartimento di Scienze Matematiche Fisiche ed Informatiche, Università degli Studi di Parma, Parma, Italy
| | - O Gross
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - B Bochtler
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - M Frey
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - A Kuball
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - S S Riegler
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - M Stolpe
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - Z Evenson
- Heinz Maier-Leibnitz Zentrum (MLZ) and Physik Department, Technische Universität München, Lichtenbergstrasse 1, 85748 Garching, Germany
| | - C Gutt
- Department Physik, Universität Siegen, D-57072 Siegen, Germany
| | - F Westermeier
- Deutsches Elektronen Synchrotron DESY, D-22607 Hamburg, Germany
| | - R Busch
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
| | - I Gallino
- Chair of Metallic Materials, Department of Materials Science and Engineering, Saarland University, Campus C6.3, 66123 Saarbrücken, Germany
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Techens C, Palanca M, Éltes PE, Lazáry Á, Cristofolini L. Testing the impact of discoplasty on the biomechanics of the intervertebral disc with simulated degeneration: An in vitro study. Med Eng Phys 2020; 84:51-59. [PMID: 32977922 DOI: 10.1016/j.medengphy.2020.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/18/2022]
Abstract
Percutaneous Cement Discoplasty has recently been developed to relieve pain in highly degenerated intervertebral discs presenting a vacuum phenomenon in patients that cannot undergo major surgery. Little is currently known about the biomechanical effects of discoplasty. This study aimed at investigating the feasibility of modelling empty discs and subsequent discoplasty surgery and measuring their impact over the specimen geometry and mechanical behaviour. Ten porcine lumbar spine segments were tested in flexion, extension, and lateral bending under 5.4 Nm (with a 200 N compressive force and a 27 mm offset). Tests were performed in three conditions for each specimen: with intact disc, after nucleotomy and after discoplasty. A 3D Digital Image Correlation (DIC) system was used to measure the surface displacements and strains. The posterior disc height, range of motion (ROM), and stiffness were measured at the peak load. CT scans were performed to confirm that the cement distribution was acceptable. Discoplasty recovered the height loss caused by nucleotomy (p = 0.04) with respect to the intact condition, but it did not impact significantly either the ROM or the stiffness. The strains over the disc surface increased after nucleotomy, while discoplasty concentrated the strains on the endplates. In conclusion, this preliminary study has shown that discoplasty recovered the intervertebral posterior height, opening the neuroforamen as clinically observed, but it did not influence the spine mobility or stiffness. This study confirms that this in vitro approach can be used to investigate discoplasty.
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Affiliation(s)
- Chloé Techens
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Viale Risorgimento, 2, Bologna 40136, Italy
| | - Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Viale Risorgimento, 2, Bologna 40136, Italy
| | - Peter Endre Éltes
- R&D Department of National Center for Spinal Disorders, Budapest, Hungary
| | - Áron Lazáry
- R&D Department of National Center for Spinal Disorders, Budapest, Hungary
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Viale Risorgimento, 2, Bologna 40136, Italy.
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Pepe V, Oliviero S, Cristofolini L, Dall'Ara E. Regional Nanoindentation Properties in Different Locations on the Mouse Tibia From C57BL/6 and Balb/C Female Mice. Front Bioeng Biotechnol 2020; 8:478. [PMID: 32500069 PMCID: PMC7243342 DOI: 10.3389/fbioe.2020.00478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/24/2020] [Indexed: 01/03/2023] Open
Abstract
The local spatial heterogeneity of the material properties of the cortical and trabecular bone extracted from the mouse tibia is not well-known. Nevertheless, its characterization is fundamental to be able to study comprehensively the effect of interventions and to generate computational models to predict the bone strength preclinically. The goal of this study was to evaluate the nanoindentation properties of bone tissue extracted from two different mouse strains across the tibia length and in different sectors. Left tibiae were collected from four female mice, two C57BL/6, and two Balb/C mice. Nanoindentations with maximum 6 mN load were performed on different microstructures, regions along the axis of the tibiae, and sectors (379 in total). Reduced modulus (Er) and hardness (H) were computed for each indentation. Trabecular bone of Balb/C mice was 21% stiffer than that of C57BL/6 mice (20.8 ± 4.1 GPa vs. 16.5 ± 7.1 GPa). Moreover, the proximal regions of the bones were 13-36% less stiff than the mid-shaft and distal regions of the same bones. No significant differences were found for the different sectors for E r and H for Balb/C mice. The bone in the medial sector was found to be 8-14% harder and stiffer than the bone in the anterior or posterior sectors for C57BL/6 mice. In conclusion, this study showed that the nanoindentation properties of the mouse tibia are heterogeneous across the tibia length and the trabecular bone properties are different between Balb/C and C57BL/6 mice. These results will help the research community to identify regions where to characterize the mechanical properties of the bone during preclinical optimisation of treatments for skeletal diseases.
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Affiliation(s)
- Valentina Pepe
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.,Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Sara Oliviero
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Enrico Dall'Ara
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, United Kingdom.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
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Palanca M, Ruspi ML, Cristofolini L, Liebsch C, Villa T, Brayda-Bruno M, Galbusera F, Wilke HJ, La Barbera L. The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis. PLoS One 2020; 15:e0227210. [PMID: 31935225 PMCID: PMC6959510 DOI: 10.1371/journal.pone.0227210] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/14/2019] [Indexed: 12/26/2022] Open
Abstract
The role of the ligaments is fundamental in determining the spine biomechanics in physiological and pathological conditions. The anterior longitudinal ligament (ALL) is fundamental in constraining motions especially in the sagittal plane. The ALL also confines the intervertebral discs, preventing herniation. The specific contribution of the ALL has indirectly been investigated in the past as a part of whole spine segments where the structural flexibility was measured. The mechanical properties of isolated ALL have been measured as well. The strain distribution in the ALL has never been measured under pseudo-physiological conditions, as part of multi-vertebra spine segments. This would help elucidate the biomechanical function of the ALL. The aim of this study was to investigate in depth the biomechanical function of the ALL in front of the lumbar vertebrae and of the intervertebral disc. Five lumbar cadaveric spine specimens were subjected to different loading scenarios (flexion-extension, lateral bending, axial torsion) using a state-of-the-art spine tester. The full-field strain distribution on the anterior surface was measured using digital image correlation (DIC) adapted and validated for application to spine segments. The measured strain maps were highly inhomogeneous: the ALL was generally more strained in front of the discs than in front of the vertebrae, with some locally higher strains both imputable to ligament fibers and related to local bony defects. The strain distributions were significantly different among the loading configurations, but also between opposite directions of loading (flexion vs. extension, right vs. left lateral bending, clockwise vs. counterclockwise torsion). This study allowed for the first time to assess the biomechanical behaviour of the anterior longitudinal ligament for the different loading of the spine. We were able to identify both the average trends, and the local effects related to osteophytes, a key feature indicative of spine degeneration.
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Affiliation(s)
- Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum–Università di Bologna, Bologna, Italy
- * E-mail:
| | - Maria Luisa Ruspi
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum–Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum–Università di Bologna, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), University Hospital Ulm, Ulm, Germany
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, Politecnico di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Marco Brayda-Bruno
- Department of Spine Surgery III, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), University Hospital Ulm, Ulm, Germany
| | - Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, Politecnico di Milano, Milan, Italy
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Morosato F, Traina F, Cristofolini L. Effect of different motor tasks on hip cup primary stability and on the strains in the periacetabular bone: An in vitro study. Clin Biomech (Bristol, Avon) 2019; 70:137-145. [PMID: 31491739 DOI: 10.1016/j.clinbiomech.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive prosthesis/bone motions and the bone strains around the acetabulum may prevent osteointegration and lead to cup loosening. These two factors depend on post-operative joint loading. We investigated how Walking (which is often simulated) and Standing-Up from seated (possibly more critical) influence the cup primary stability and periacetabular strains. METHODS Twelve composite hemipelvises were used in two test campaigns. Simplified loading conditions were adopted to simulate Walking and Standing-Up. For each motor task, a single-direction force was applied in load packages of increasing amplitude. Stable and unstable uncemented cups were implanted. Digital image correlation was used to measure implant/bone motions (three-dimensional translations and rotations, both permanent and inducible), and the strain distribution around the acetabulum. FINDINGS When stable implants were tested, higher permanent cranial translations were found during Walking (however the resultant migrations were comparable with Standing-Up); higher rotations were found for Standing-Up. When unstable implants were tested, motions were 1-2 order of magnitude higher. Strains increased significantly from stable to unstable implants. The peak strains were in the superior aspect of the acetabulum during Walking and in the superior-posterior aspect of the acetabulum and at the bottom of the posterior column during Standing-Up. INTERPRETATION Different cup migration trends were caused by simulated Walking and Standing-Up, both similar to those observed clinically. The cup mobilization pattern depended on the different simulated motor tasks. Pre-clinical testing of new uncemented cups could include simulation of both motor tasks. Our study could also translate to indication of what tasks should be avoided.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesco Traina
- Second Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
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Ruspi ML, Chehrassan M, Faldini C, Cristofolini L. In Vitro Experimental Studies and Numerical Modeling to Investigate the Biomechanical Effects of Surgical Interventions on the Spine. Crit Rev Biomed Eng 2019; 47:295-322. [PMID: 31679261 DOI: 10.1615/critrevbiomedeng.2019029498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper offers a comprehensive systematic review of biomechanical research on the spine and on in vitro and numerical methods of investigation. This review focuses on interventions on the ligaments, on the facets, and on the lamina (facetectomies, laminectomies, and laminoplasties). Surgical interventions on the facets and lamina in some cases yield dissatisfactory clinical follow-up. Patient outcome is strongly related to the effects that such interventions have on the biomechanical functionality of the spine. The papers examined include those addressing the untreated spine (range of motion and stiffness), but the focus is on experimental and numerical investigations studying the role of the ligaments and of the posterior structures (including their role in granting spine stability and the biomechanical behavior of each ligament). The papers were classified based on the different investigation approaches. In vitro experiments exploit dedicated biomechanical spine testers to measure the mechanical properties of physical specimens. Numerical modeling (multibody dynamics, finite-element analysis) allows predicting the effect of different conditions. All the papers indicate that interventions on the ligaments, facets, and lamina increase range of motion and decrease stability. The quantitative results show great variability across studies. This review shows how it is possible to use in vitro and numerical methods to investigate the biomechanical effects of surgical interventions.
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Affiliation(s)
- Maria Luisa Ruspi
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | | | - Cesare Faldini
- First Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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Salerni F, Orsi D, Santini E, Liggieri L, Ravera F, Cristofolini L. Diffusing wave spectroscopy for investigating emulsions: II. Characterization of a paradigmatic oil-in-water emulsion. Colloids Surf A Physicochem Eng Asp 2019. [DOI: 10.1016/j.colsurfa.2019.123724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Orsi D, Salerni F, Macaluso E, Santini E, Ravera F, Liggieri L, Cristofolini L. Diffusing wave spectroscopy for investigating emulsions: I. Instrumental aspects. Colloids Surf A Physicochem Eng Asp 2019. [DOI: 10.1016/j.colsurfa.2019.123574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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40
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Sensini A, Cristofolini L, Zucchelli A, Focarete ML, Gualandi C, DE Mori A, Kao AP, Roldo M, Blunn G, Tozzi G. Hierarchical electrospun tendon-ligament bioinspired scaffolds induce changes in fibroblasts morphology under static and dynamic conditions. J Microsc 2019; 277:160-169. [PMID: 31339556 DOI: 10.1111/jmi.12827] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/05/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
The regeneration of injured tendons and ligaments is challenging because the scaffolds needs proper mechanical properties and a biomimetic morphology. In particular, the morphological arrangement of scaffolds is a key point to drive the cells growth to properly regenerate the collagen extracellular matrix. Electrospinning is a promising technique to produce hierarchically structured nanofibrous scaffolds able to guide cells in the regeneration of the injured tissue. Moreover, the dynamic stretching in bioreactors of electrospun scaffolds had demonstrated to speed up cell shape modifications in vitro. The aim of the present study was to combine different imaging techniques such as high-resolution X-ray tomography (XCT), scanning electron microscopy (SEM), fluorescence microscopy and histology to investigate if hierarchically structured poly (L-lactic acid) and collagen electrospun scaffolds can induce morphological modifications in human fibroblasts, while cultured in static and dynamic conditions. After 7 days of parallel cultures, the results assessed that fibroblasts had proliferated on the external nanofibrous sheath of the static scaffolds, elongating themselves circumferentially. The dynamic cultures revealed a preferential axial orientation of fibroblasts growth on the external sheath. The aligned nanofibre bundles inside the hierarchical scaffolds instead, allowed a physiological distribution of the fibroblasts along the nanofibre direction. Inside the dynamic scaffolds, cells appeared thinner compared with the static counterpart. This study had demonstrated that hierarchically structured electrospun scaffolds can induce different fibroblasts morphological modifications during static and dynamic conditions, modifying their shape in the direction of the applied loads. LAY DESCRIPTION: To enhance the regeneration of injured tendons and ligaments cells need to growth on dedicated structures (scaffolds) with mechanical properties and a fibrous morphology similar to the natural tissue. In particular, the morphological organisation of scaffolds is fundamental in leading cells to colonise them, regenerating the collagen extracellular matrix. Electrospinning is a promising technique to produce fibres with a similar to the human collagen fibres, suitable to design complex scaffolds able to guide cells in the reconstruction of the natural tissue. Moreover, it is well established that the cyclic stretching of these scaffolds inside dedicated systems called bioreactors, can speed up cells growth and their shape modification. The aim of the present study was to investigate how hierarchically structured electrospun scaffolds, made of resorbable material such as poly(L-lactic acid) and collagen, could induce morphological changes in human fibroblasts, while cultured during static and dynamic conditions. These scaffolds were composed by an external electrospun membrane that grouped inside it a ring-shaped bundle, made of axially aligned nanofibres, resembling the morphological arrangement of tendon and ligament tissue. After 7 days of parallel cultures, the scaffolds were investigated using the following imaging techniques: (i) high-resolution X-ray tomography (XCT); (ii) scanning electron microscopy (SEM); (iii) fluorescence microscopy and (iv) histology. The results showed that fibroblasts were able to grow on the external nanofibrous sheath of the static scaffolds, by elongating themselves along their circumference. The dynamic cultures revealed instead a preferential axial orientation of fibroblasts grown on the external sheath. The aligned nanofibre bundles inside the hierarchical scaffolds allowed an axial distribution of the fibroblasts along the nanofibres direction. This study has demonstrated that the electrospun hierarchically structured scaffolds investigated can modify the fibroblasts morphology both in static and dynamic conditions, in relation with the direction of the applied loads.
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Affiliation(s)
- A Sensini
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - L Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - A Zucchelli
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Advanced Mechanics and Materials - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - M L Focarete
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Department of Chemistry 'G. Ciamician' and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - C Gualandi
- Department of Chemistry 'G. Ciamician' and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Advanced Mechanics and Materials - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - A DE Mori
- School of Pharmacy and Biomedical Science, University of Portsmouth - St Michael's Building, Portsmouth, U.K
| | - A P Kao
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, U.K
| | - M Roldo
- School of Pharmacy and Biomedical Science, University of Portsmouth - St Michael's Building, Portsmouth, U.K
| | - G Blunn
- School of Pharmacy and Biomedical Science, University of Portsmouth - St Michael's Building, Portsmouth, U.K
| | - G Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, U.K
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41
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Sensini A, Gotti C, Belcari J, Zucchelli A, Focarete ML, Gualandi C, Todaro I, Kao AP, Tozzi G, Cristofolini L. Morphologically bioinspired hierarchical nylon 6,6 electrospun assembly recreating the structure and performance of tendons and ligaments. Med Eng Phys 2019; 71:79-90. [PMID: 31262555 DOI: 10.1016/j.medengphy.2019.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/17/2019] [Accepted: 06/19/2019] [Indexed: 01/06/2023]
Abstract
Reconstructions of ruptured tendons and ligaments currently have dissatisfactory failure rate. Failures are mainly due to the mechanical mismatch of commercial implants with respect to the host tissue. In fact, it is crucial to replicate the morphology (hierarchical in nature) and mechanical response (highly-nonlinear) of natural tendons and ligaments. The aim of this study was to develop morphologically bioinspired hierarchical Nylon 6,6 electrospun assemblies recreating the structure and performance of tendons and ligaments. First, we built different electrospun bundles to find the optimal orientation of the nanofibers. A 2nd-level hierarchical assembly was fabricated with a dedicated process that allowed tightly joining the bundles one next to the other with an electrospun sheath, so as to improve the mechanical performance. Finally, a further hierarchical 3rd-level assembly was constructed by grouping several 2nd-level assemblies. The morphology of the different structures was assessed with scanning electron microscopy and high-resolution X-ray tomography, which allowed measuring the directionality of the nanofibers in the bundles and in the sheaths. The mechanical properties of the single bundles and of the 2nd-level assemblies were measured with tensile tests. The single bundles and the hierarchical assemblies showed morphology and directionality of the nanofibers similar to the tendons and ligaments. The strength and stiffness were comparable to that of tendons and ligaments. In conclusion, this work showed an innovative electrospinning production process to build nanofibrous Nylon 6,6 hierarchical assemblies which are suitable as future implantable devices and able to mimic the multiscale morphology and the biomechanical properties of tendons and ligaments.
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Affiliation(s)
- Alberto Sensini
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, I-40131 Bologna, Italy
| | - Carlo Gotti
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, I-40131 Bologna, Italy
| | - Juri Belcari
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, I-40131 Bologna, Italy
| | - Andrea Zucchelli
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, I-40131 Bologna, Italy
| | - Maria Letizia Focarete
- Department of Chemistry 'G. Ciamician' and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum-University of Bologna, I-40126 Bologna, Italy; Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum-University of Bologna, I-40064 Ozzano dell'Emilia, Bologna, Italy
| | - Chiara Gualandi
- Department of Chemistry 'G. Ciamician' and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum-University of Bologna, I-40126 Bologna, Italy; Advanced Mechanics and Materials - Interdepartmental Center for Industrial Research (CIRI-MAM), Alma Mater Studiorum-University of Bologna, I-40123 Bologna, Italy
| | - Ivan Todaro
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, I-40131 Bologna, Italy
| | - Alexander P Kao
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth PO1 3DJ, United Kingdom
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth PO1 3DJ, United Kingdom
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, I-40131 Bologna, Italy; Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-HST), Alma Mater Studiorum-University of Bologna, I-40064 Ozzano dell'Emilia, Bologna, Italy.
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Sensini A, Gualandi C, Focarete ML, Belcari J, Zucchelli A, Boyle L, Reilly GC, Kao AP, Tozzi G, Cristofolini L. Multiscale hierarchical bioresorbable scaffolds for the regeneration of tendons and ligaments. Biofabrication 2019; 11:035026. [DOI: 10.1088/1758-5090/ab20ad] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
In vitro evaluation of the load transfer of hip prostheses has been performed in recent years for the purpose of understanding the stress shielding phenomena. Over 200 papers were reviewed to determine if a standard exists to evaluate and compare the performance of hip stems. Surprisingly, it was found that little agreement exists in the testing protocol. This makes it very difficult to compare the results reported in different investigations. In several cases very incomplete data are reported about the testing conditions, thus making it impossible to compare the results. This article focuses on: (1) how the loading conditions should be chosen based on physiological loading in a way to give a reproducible setup; (2) how the femur should be constrained; (3) how to generate the same system of loads in the intact and the implanted femur; (4) how to define a reference system; (5) how the specimen type and sample size are chosen; (6) the advantages and limitations of the different strain measurement techniques; (7) how the testing parameters have been chosen in the literature; and (8) how the accuracy of the results has been reported in the literature.
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Affiliation(s)
- Luca Cristofolini
- Laboratory for Biomaterials Technology, Rizzoli Orthopaedic Institutes, Bologna, Italy, and Engineering Faculty, University of Bologna, Italy
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44
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Comini F, Palanca M, Cristofolini L, Dall'Ara E. Uncertainties of synchrotron microCT-based digital volume correlation bone strain measurements under simulated deformation. J Biomech 2019; 86:232-237. [DOI: 10.1016/j.jbiomech.2019.01.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/18/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
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45
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Ruspi M, Palanca M, Faldini C, Cristofolini L. Full-field in vitro investigation of hard and soft tissue strain in the spine by means of Digital Image Correlation. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2017.08] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M.L. Ruspi
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - M. Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - C. Faldini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Italy
- 2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute
| | - L. Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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46
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Montroni D, Fermani S, Morellato K, Torri G, Naggi A, Cristofolini L, Falini G. β-Chitin samples with similar microfibril arrangement change mechanical properties varying the degree of acetylation. Carbohydr Polym 2018; 207:26-33. [PMID: 30600008 DOI: 10.1016/j.carbpol.2018.11.069] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022]
Abstract
Chitin is widespread in nature and is increasingly used in synthetic process for the production of new biomaterials. Chitin degree of acetylation, crystalline structure and microfibril arrangement differentiate chemical, physical and mechanical properties. Nevertheless, no information are available on the relationship between the mechanical properties and the degree of acetylation (DA) in chitin samples in which the microfibril arrangement does not change. Here, samples of β-chitin with decreasing DA, up to chitosan, were prepared using the squid pen of Loligo vulgaris. These samples were characterized by CP-MAS NMR spectroscopy, scanning electron microscopy, thermal analyses, synchrotron X-ray fiber diffraction and tensile tests. The results showed a similar microfibril arrangement decreasing the DA, except for the chitosan sample. The mechanical properties showed an increase of the maximum strain and a reduction of the maximum stress and Young's modulus, decreasing the DA. These changes, not linear with the DA, were related to structural changes at molecular structure level. The knowledge deriving from this study is of interest both for the understanding of the mechanical properties of chitinous biological samples, but also for the design and synthesis of new biomacromolecular materials.
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Affiliation(s)
- Devis Montroni
- Department of Chemistry "Giacomo Ciamician", Alma Mater Studiorum - Università di Bologna, via Selmi 2, I-40126, Bologna, Italy
| | - Simona Fermani
- Department of Chemistry "Giacomo Ciamician", Alma Mater Studiorum - Università di Bologna, via Selmi 2, I-40126, Bologna, Italy
| | - Kavin Morellato
- Department of Industrial Engineering (DIN), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Giangiacomo Torri
- Istituto di Ricerche Chimiche e Biochimiche "G. Ronzoni" Milano, via Giuseppe Colombo 81, 20133, Milano, Italy
| | - Annamaria Naggi
- Istituto di Ricerche Chimiche e Biochimiche "G. Ronzoni" Milano, via Giuseppe Colombo 81, 20133, Milano, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering (DIN), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Giuseppe Falini
- Department of Chemistry "Giacomo Ciamician", Alma Mater Studiorum - Università di Bologna, via Selmi 2, I-40126, Bologna, Italy.
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47
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Sensini A, Gualandi C, Zucchelli A, Boyle LA, Kao AP, Reilly GC, Tozzi G, Cristofolini L, Focarete ML. Tendon Fascicle-Inspired Nanofibrous Scaffold of Polylactic acid/Collagen with Enhanced 3D-Structure and Biomechanical Properties. Sci Rep 2018; 8:17167. [PMID: 30464300 PMCID: PMC6249227 DOI: 10.1038/s41598-018-35536-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022] Open
Abstract
Surgical treatment of tendon lesions still yields unsatisfactory clinical outcomes. The use of bioresorbable scaffolds represents a way forward to improve tissue repair. Scaffolds for tendon reconstruction should have a structure mimicking that of the natural tendon, while providing adequate mechanical strength and stiffness. In this paper, electrospun nanofibers of two crosslinked PLLA/Collagen blends (PLLA/Coll-75/25, PLLA/Coll-50/50) were developed and then wrapped in bundles, where the nanofibers are predominantly aligned along the bundles. Bundle morphology was assessed via SEM and high-resolution x-ray computed tomography (XCT). The 0.4-micron resolution in XCT demonstrated a biomimetic morphology of the bundles for all compositions, with a predominant nanofiber alignment and some scatter (50-60% were within 12° from the axis of the bundle), similar to the tendon microstructure. Human fibroblasts seeded on the bundles had increased metabolic activity from day 7 to day 21 of culture. The stiffness, strength and toughness of the bundles are comparable to tendon fascicles, both in the as-spun condition and after crosslinking, with moderate loss of mechanical properties after ageing in PBS (7 and 14 days). PLLA/Coll-75/25 has more desirable mechanical properties such as stiffness and ductility, compared to the PLLA/Coll-50/50. This study confirms the potential to bioengineer tendon fascicles with enhanced 3D structure and biomechanical properties.
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Affiliation(s)
- Alberto Sensini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, 40131, Bologna, Italy
| | - Chiara Gualandi
- Department of Chemistry "G. Ciamician" and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum - Università di Bologna, 40126, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum - Università di Bologna, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - Andrea Zucchelli
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, 40131, Bologna, Italy
| | - Liam A Boyle
- INSIGNEO Institute for in silico Medicine, Department of Materials Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Alexander P Kao
- ZEISS Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK
| | - Gwendolen C Reilly
- INSIGNEO Institute for in silico Medicine, Department of Materials Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Gianluca Tozzi
- ZEISS Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, 40131, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum - Università di Bologna, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - Maria Letizia Focarete
- Department of Chemistry "G. Ciamician" and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum - Università di Bologna, 40126, Bologna, Italy.
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum - Università di Bologna, 40064, Ozzano dell'Emilia, Bologna, Italy.
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48
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Sensini A, Cristofolini L. Biofabrication of Electrospun Scaffolds for the Regeneration of Tendons and Ligaments. Materials (Basel) 2018; 11:E1963. [PMID: 30322082 PMCID: PMC6213815 DOI: 10.3390/ma11101963] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022]
Abstract
Tendon and ligament tissue regeneration and replacement are complex since scaffolds need to guarantee an adequate hierarchical structured morphology, and non-linear mechanical properties. Moreover, to guide the cells' proliferation and tissue re-growth, scaffolds must provide a fibrous texture mimicking the typical of the arrangement of the collagen in the extracellular matrix of these tissues. Among the different techniques to produce scaffolds, electrospinning is one of the most promising, thanks to its ability to produce fibers of nanometric size. This manuscript aims to provide an overview to researchers approaching the field of repair and regeneration of tendons and ligaments. To clarify the general requirements of electrospun scaffolds, the first part of this manuscript presents a general overview concerning tendons' and ligaments' structure and mechanical properties. The different types of polymers, blends and particles most frequently used for tendon and ligament tissue engineering are summarized. Furthermore, the focus of the review is on describing the different possible electrospinning setups and processes to obtain different nanofibrous structures, such as mats, bundles, yarns and more complex hierarchical assemblies. Finally, an overview concerning how these technologies are exploited to produce electrospun scaffolds for tendon and ligament tissue applications is reported together with the main findings and outcomes.
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Affiliation(s)
- Alberto Sensini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, 40131 Bologna, Italy.
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, 40131 Bologna, Italy.
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum-Università di Bologna, 40064 Ozzano dell'Emilia, Bologna, Italy.
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49
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Morellato K, Grupp TM, Bader U, Sungu M, Fink B, Cristofolini L. Standard and line-to-line cementation of a polished short hip stem: Long-term in vitro implant stability. J Orthop Res 2018; 36:2736-2744. [PMID: 29727032 DOI: 10.1002/jor.24036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
The current trend is toward shorter hip stems. While there is a general agreement on the need for a cement mantle thicker than 2 mm, some surgeons prefer line-to-line cementation, where the mantle has only the thickness provided by the cement-bone interdigitation. The aim of this study was to assess if a relatively short, polished hip stem designed for a standard cementation can also be cemented line-to-line without increasing the risk of long-term loosening. Composite femurs with specific open-cell foam to allow cement-bone interdigitation were used. A validated in-vitro biomechanical cyclic test replicating long-term physiological loading was applied to femurs where the same stem was implanted with the Standard-mantle (optimal stem size) and Line-to-line (same rasp, one-size larger stem). Implant-bone motions were measured during the test. Inducible micromotions never exceeded 10 μm for both implant types (differences statistically not-significant). Permanent migrations ranged 50-300 μm for both implant types (differences statistically not-significant). While in the standard-mantle specimens there was a pronounced trend toward stabilization, line-to-line had less tendency to stabilize. The cement cracks were observed after the test by means of dye penetrants: The line-to-line specimens included the same cracks of the standard-mantle (but in the line-to-line specimens they were longer), and some additional cracks. The micromotions and cement damage were consistent with those observed in-vitro and clinically for stable stems, confirming that none of the specimens became dramatically loose. However, it seems that for this relatively short polished stem, standard-mantle cementation is preferable, as it results in less micromotion and less cement cracking. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2736-2744, 2018.
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Affiliation(s)
- Kavin Morellato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Thomas M Grupp
- Aesculap AG Research and Development, Am Aesculap-Platz, Tuttlingen, Germany.,Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
| | - Uwe Bader
- Aesculap AG Research and Development, Am Aesculap-Platz, Tuttlingen, Germany
| | - Mevluet Sungu
- Aesculap AG Research and Development, Am Aesculap-Platz, Tuttlingen, Germany
| | - Bernd Fink
- Orthopädische Klinik Markgröningen, Clinic for Joint Replacement, General and Rheumatic Orthopaedics, Ludwigsburg, Germany
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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50
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Gargiulo P, Edmunds KJ, Gíslason MK, Latour C, Hermannsson Þ, Esposito L, Bifulco P, Cesarelli M, Fraldi M, Cristofolini L, Jónsson H. Patient-specific mobility assessment to monitor recovery after total hip arthroplasty. Proc Inst Mech Eng H 2018; 232:1048-1059. [PMID: 30191747 DOI: 10.1177/0954411918797971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Total hip arthroplasty is a ubiquitously successful orthopedic surgical procedure, whose prevalence is rising worldwide. While many investigations focus on characterizing periprosthetic pathophysiology, the objective of our research is to develop and describe multi-metric assemblies as a first step toward creating a patient-specific mobility index that rehabilitators and orthopedic surgeons can utilize for prescribing their respective procedures. In total, 48 total hip arthroplasty patients (both cemented and uncemented) undergoing unilateral, primary surgery went through computed tomographic scans and gait analysis measurements both before and 1 year following their surgery. Altogether, the reported quantitative metrics include 11 spatial and temporal gait parameters, muscle density, and electromyography signals from the rectus femoris, vastus lateralis, and vastus medialis, and bone mineral density values from bioimage analysis around the implant stem. We found that measured parameters from a subgroup were sensitive to changes observed during patient recovery, implicating the predictive sensitivity of these patient conditions. Most post-operative gait parameters changed significantly, while electromyography data indicated few significant differences. Moreover, results from bioimage analyses indicate a general reduction of periprosthetic bone mineral density after 1 year, in association with increasing density of the quadriceps muscles. Furthermore, this work identifies which quantitative metrics undergo the greatest variation after total hip arthroplasty and demonstrates the clinical feasibility of a multimodal approach to mobility assessment that may ultimately support decision-making for post-surgical rehabilitation protocols.
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Affiliation(s)
- Paolo Gargiulo
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland.,2 Department of Science, Landspítali University Hospital, Reykjavík, Iceland
| | - Kyle Joseph Edmunds
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
| | - Magnús K Gíslason
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
| | - Chase Latour
- 3 Washington University in St. Louis, St. Louis, MO, USA
| | - Þröstur Hermannsson
- 1 Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
| | - Luca Esposito
- 4 Department of Structures for Engineering and Architecture, University of Naples Federico II, Naples, Italy
| | - Paolo Bifulco
- 5 Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy
| | - Mario Cesarelli
- 5 Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy
| | - Massimiliano Fraldi
- 4 Department of Structures for Engineering and Architecture, University of Naples Federico II, Naples, Italy.,6 Interdisciplinary Research Centre for Biomaterials, University of Naples Federico II, Naples, Italy
| | - Luca Cristofolini
- 7 Department of Industrial Engineering, University of Bologna, Bologna, Italy
| | - Halldór Jónsson
- 8 Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,9 Orthopedic Clinic, Landspítali University Hospital, Reykjavík, Iceland
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