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Biomedical subjects

M Dalstra

Publications and source records attributed to M Dalstra.

At least 19 recordsLinked to original sources

A three-dimensional finite element model from computed tomography data: a semi-automated method.

Three-dimensional finite element analysis is one of the best ways to assess stress and strain distributions in complex bone structures. However, accuracy in the results may be achieved only when accurate input information is given. A semi-automated method to generate a finite element (FE) model using data retrieved from computed tomography (CT) was developed. Due to its complex and irregular shape, the glenoid part of a left embalmed scapula bone was chosen as working material. CT data were retrieved using a standard clinical CT scanner (Siemens Somatom Plus 2, Siemens AG, Germany). This was done to produce a method that could later be utilized to generate a patient-specific FE model. Different methods of converting Hounsfield unit (HU) values to apparent densities and subsequently to Young's moduli were tested. All the models obtained were loaded using three-dimensional loading conditions taken from literature, corresponding to an arm abduction of 90 degrees. Additional models with different amounts of elements were generated to verify convergence. Direct comparison between the models showed that the best method to convert HU values directly to apparent densities was to use different equations for cancellous and cortical bone. In this study, a reliable method of determining both geometrical data and bone properties from patient CT scans for the semi-automated generation of an FE model is presented.

Aged↗

Titanium-alloy enhances bone-pedicle screw fixation: mechanical and histomorphometrical results of titanium-alloy versus stainless steel.

Several types of pedicle screw systems have been utilized to augment lumbar spine fusion. The majority of these systems are made of stainless steel (Ss), but titanium-alloy (Ti-alloy) devices have recently been available on the market. Ti-alloy implants have several potential advantages over Ss ones. High bioactivity and more flexibility may improve bone ingrowth and mechanical fixation, and the material also offers superior magnetic resonance imaging (MRI) and computed tomography (CT) resolution and significantly less signal interference. However, no data are available from loaded spinal constructs regarding bony ingrowth and mechanical fixation. The aim of this study was to analyse the effect of Ti-alloy versus Ss pedicle screws on mechanical fixation and bone ingrowth in a loaded mini-pig model. Eighteen adult mini-pigs underwent total laminectomy and posterolateral spinal fusion at L3-L4, and were randomly selected to receive either Ss (n = 9) or Ti (n = 9) pedicle screw devices. In both groups, the device used was compact Cotrel-Dubousset instrumentation (Sofamore Danek) of an identical size and shape. The postoperative observation time was 3 months. Screws from L3 were used for histomorphometric studies. Mechanical testing (torsional tests and pull-out tests) was performed on the screws from L4. The Ti screws had a higher maximum torque (P < 0.05) and angular stiffness (P < 0.07), measured by torsional testing. In the pull-out tests, no differences were found between the two groups with respect to the maximum load, stiffness and energy to failure. No correlation between removal torque and the pull-out strength was found (r = 0.1). Bone ongrowth on Ti was increased by 33% compared with Ss (P < 0.04), whereas no differences in bone volume around the screws were shown. Mechanical binding at the bone-screw interface was significantly greater for Ti pedicle screws than for Ss, which was explained by the fact that Ti screws had a superior bone ongrowth. There was no correlation between the screw removal torque and the pull-out strength, which indicates that the peripheral bone structure around the screw was unaffected by the choice of metal.

Animals↗

Titanium-niobium, a new finishing wire alloy.

The mechanical properties of the newly introduced titanium-niobium finishing wires were investigated. Both in bending and torsional loading mode, the stiffness, yield point, post-yield behavior, and springback of titanium-niobium wires were experimentally determined and compared to those of equally sized stainless steel wires. The experimentally obtained values were also validated with theoretical values from engineering formulas of cantilever deformations. The ratios for these parameters for the two materials proved to be different in bending and torsion. The stiffness of titanium-niobium in bending is roughly half of that of stainless steel, whereas in torsion it is roughly one-third. These characteristics enable the clinician to use titanium-niobium for creative bends without the excessive force levels of steel wires. The springback of titanium-niobium in bending is 14% lower than that of steel, whereas in torsion it is about the same or even slightly higher than that of steel, thus making it possible to utilize the wire for even major third-order corrections. Finally, the weldability of titanium-niobium wires was found to be good, so it is possible to weld wires of different dimensions together for the generation of differentiated force systems.

Journal Article↗

The rate and the type of orthodontic tooth movement is influenced by bone turnover in a rat model.

The influence of bone metabolism on both the rate and the type of orthodontic tooth movement was investigated. A rat model in which high (n = 16) and low (n = 17) bone turnover was pharmacologically induced was used. A non-pharmacologically treated group (n = 19) served as the control. A mesially directed constant single force of 25 cN was applied to the upper left first molar for a period of 3 weeks. The study was performed as a split-mouth design, the contralateral side of each animal serving as its control. The displacement of the molar crown was measured with an electronic calliper, while changes in inclination of the teeth were measured from micro-CT scans of the excised maxillae. The bone turnover significantly affected the rate of tooth movement. In the case of high turnover, the rate of tooth movement was increased while it was reduced in the case of low turnover. A controlled mesial tipping in all three groups was observed, but the actual location of the centre of rotation seemed to be influenced by the metabolic state of the bone. Based on the results it can be concluded that deviations in bone turnover influence the response to orthodontic forces, and should be taken into consideration when planning orthodontic treatment in patients with metabolic bone disease or those on chronic medication influencing bone metabolism.

Analysis of Variance↗

The role of an effective isotropic tissue modulus in the elastic properties of cancellous bone.

Conceptually, the elastic characteristics of cancellous bone could be predicted directly from the trabecular morphology--or architecture--and by the elastic properties of the tissue itself. Although hardly any experimental evidence exists, it is often implicitly assumed that tissue anisotropy has a negligible effect on the apparent elastic properties of cancellous bone. The question addressed in this paper is whether this is actually true. If it is, then micromechanical finite element analysis (micro-FEA) models, representing trabecular architecture, using an 'effective isotropic tissue modulus' should be able to predict apparent elastic properties of cancellous bone. To test this, accurate multi-axial compressive mechanical tests of 29 whale bone specimens were simulated with specimen-specific micro-FEA computer models built from true three-dimensional reconstructions. By scaling the micro-FEA predictions by a constant tissue modulus, 92% of the variation of Young's moduli determined experimentally could be explained. The correlation even increased to 95% when the micro-FEA moduli were scaled to the isotropic tissue moduli of individual specimens. Excellent agreement was also found in the elastic symmetry axes and anisotropy ratios. The prediction of Poisson's ratios was somewhat less precise at 85% correlation. The results support the hypothesis; for practical purposes, the concept of an 'effective isotropic tissue modulus' concept is a viable one. They also suggest that the value of such a modulus for individual cases might be inferred from the average tissue density, hence the degree of mineralization. Future studies must clarify how specific the tissue modulus should be for different types of bone if adequate predictions of elastic behavior are to be made in this way.

Animals↗

Force systems developed by six different cantilever configurations.

OBJECTIVES: To describe the force systems developed by cantilevers with different configurations during incisor intrusion. DESIGN: A two-dimensional Finite Element model. SETTING AND SAMPLE STUDIED: Laboratories of the Department of Orthodontics, Royal Dental College, Aarhus University, Denmark. The materials studied comprised cantilevers made of 0.017" x 0.025" TMA wire. EXPERIMENTAL VARIABLE: Vertical activation of the six different modelled cantilever configurations. OUTCOME MEASURE: Force level and direction during activation and deactivation analysed at the point of force application. RESULTS: The force direction was dependent on the configuration of the cantilever. Only the cantilevers with a curvature produced combined retraction and intrusion forces. All other configurations resulted in combined protrusion and intrusion, which reversed into retraction and intrusion, according to the variations in deactivation. CONCLUSION: The choice of correct cantilever configuration is important when selecting the mechanics of intrusion for a particular patient.

Dental Stress Analysis↗

Changes in the stiffness of the human tibial cartilage-bone complex in early-stage osteoarthrosis.

Cylindrical human tibial cartilage-bone unit specimens were removed from 9 early-stage medial osteoarthrotic (OA) tibiae (mean age 74 years) and 10 normal age-matched tibiae (mean age 73 years). These specimens were divided into 4 groups: OA, lateral comparison, medial age-matched, and lateral age-matched and were tested to 0.5% bone strain with a novel technique to obtain the stiffnesses of both cartilage and bone simultaneously. We found a pronounced reduction in the stiffnesses of OA cartilage and subchondral bone when compared with the medial age-matched group. OA cartilage was significantly thinner than that of the lateral comparison and the medial age-matched control groups. However, this reduction in thickness was not correlated with the reduction in stiffness for OA cartilage. The stiffnesses did not correlate between OA cartilage and bone, whereas the stiffness relationships between cartilage and bone remained significant in the three control groups. Our findings suggest that both cartilage and bone in early-stage OA are mechanically inferior to normal, and that OA cartilage and bone have lost their unit function to mechanical loading.

Aged↗

Fabric and elastic principal directions of cancellous bone are closely related.

Cancellous bone architecture and mechanics are intimately related. The trabecular architecture of cancellous bone is considered determined by its mechanical environment (Wolff's law), and the mechanical properties of cancellous bone are inversely determined by the trabecular architecture and material properties. Much effort has been spent in expressing these relations, but the techniques and variables necessary for this have not been fully identified. It is obvious, however, that some measure of architectural anisotropy (fabric) is needed. Within the last few years, volume-based measures of fabric have been introduced as alternatives to the mean intercept length method, which has some theoretical problems. This paper seeks to answer which of four different fabric measures best predicts finite element calculated mechanical anisotropy directions. Twenty-nine cancellous bone specimens were three-dimensionally reconstructed using the automated serial sectioning technique. A series of large-scale finite-element analyses were performed on each of the three-dimensional reconstructions to calculate the compliance matrix for each specimen, from which the mechanical principal directions were derived. The architectural anisotropy was determined in three-dimensional space for each specimen using mean intercept length (MIL), volume orientation (VO), star volume distribution (SVD) and star length distribution (SLD). Each of the architectural anisotropy results were expressed by a fabric tensor. Architectural main directions were determined from the fabric tensors and compared with the FE-calculated mechanical anisotropy directions. All architectural measures predicted the mechanical main directions rather well, which supports the assumption that mechanical anisotropy directions are aligned with fabric directions. MIL showed a significant, though very small (1.4 degrees), deviation from the primary mechanical direction. VO had difficulty in determining secondary and tertiary mechanical directions; its mean deviation was 8.9 degrees. SVD and SLD provided marginally better predictors of mechanical anisotropy directions than MIL and VO.

Animals↗

Age variations in the properties of human tibial trabecular bone.

We tested in compression specimens of human proximal tibial trabecular bone from 31 normal donors aged from 16 to 83 years and determined the mechanical properties, density and mineral and collagen content. Young's modulus and ultimate stress were highest between 40 and 50 years, whereas ultimate strain and failure energy showed maxima at younger ages. These age-related variations (except for failure energy) were non-linear. Tissue density and mineral concentration were constant throughout life, whereas apparent density (the amount of bone) varied with ultimate stress. Collagen density (the amount of collagen) varied with failure energy. Collagen concentration was maximal at younger ages but varied little with age. Our results suggest that the decrease in mechanical properties of trabecular bone such as Young's modulus and ultimate stress is mainly a consequence of the loss of trabecular bone substance, rather than a decrease in the quality of the substance itself. Linear regression analysis showed that collagen density was consistently the single best predictor of failure energy, and collagen concentration was the only predictor of ultimate strain.

Adolescent↗

Load transfer across the pelvic bone.

Earlier experimental and finite element studies notwithstanding, the load transfer and stress distribution in the pelvic bone and the acetabulum in normal conditions are not well understood. This hampers the development of orthopaedic reconstruction methods. The present study deals with more precise finite element analyses of the pelvic bone, which are used to investigate its basic load transfer and stress distributions under physiological loading conditions. The analyses show that the major part of the load is transferred through the cortical shell. Although the magnitude of the hip joint force varies considerably, its direction during normal walking remains pointed into the anterior/superior quadrant of the acetabulum. Combined with the fact that the principal areas of support for the pelvic bone are the sacro-iliac joint and the pubic symphysis, this caused the primary areas of load transfer to be found in the superior acetabular rim, the incisura ischiadaca region and, to a lesser extent, the pubic bone. Due to the 'sandwich' behavior of the pelvic bone, stresses in the cortical shell are about 50 times higher than in the underlying trabecular bone (15 to 20 MPa vs 0.3-0.4 MPa at one-legged stance). Highest intraarticular pressures are found to occur during one-legged stance and measured about 9 MPa. During the swing phase, these pressures decrease less than linearly with the magnitude of the hip joint force. Muscle forces have a stabilizing effect on the pelvic load transfer. Analysis without muscle forces show that at some locations stresses are actually higher than when muscle forces are included.

Acetabulum↗

Development and validation of a three-dimensional finite element model of the pelvic bone.

Due to both its shape and its structural architecture, the mechanics of the pelvic bone are complex. In Finite Element (FE) models, these aspects have often been (over)simplified, sometimes leading to conclusions which did not bear out in reality. The purpose of this study was to develop a more realistic FE model of the pelvic bone. This not only implies that the model has to be three-dimensional, but also that the thickness of the cortical shell and the density distribution of the trabecular bone throughout the pelvic bone have to be incorporated in the model in a realistic way. For this purpose, quantitative measurements were performed on computer tomography scans of several pelvic bones, after which the measured quantities were allocated to each element of the mesh individually. To validate this FE model, two fresh pelvic bones were fitted with strain gages and loaded in a testing machine. Stresses calculated from the strain data of this experiment were compared to the results of a simulation with the developed pelvic FE model.

Aged↗

Prestresses around the acetabulum generated by screwed cups.

Screwed acetabular cups, applied in total hip replacements, generate stresses in the surrounding bone during implantation (prestresses). The effect of these prestresses on the endurance of the hip replacement are unknown. The prestresses in the acetabulum were examined both experimentally, using strain gauge techniques, and numerically, using the finite element method. It was found that the prestresses were of the same order of magnitude, if not larger, than the stresses due to the hip reaction force during one-legged stance. In some cases, the prestresses even approximated the ultimate tensile strength of cortical bone. The prestresses seemed to have a strong dependence on the outer shape of the cup, rather than on the flexibility of the cup or whether the cup had a self-cutting thread or not. Furthermore, it was found that the prestresses are not very susceptible to stress relaxation due to the visco-elastic behaviour of bone. This means that prestresses will remain present over long periods of time. So even when a patient has resumed normal daily activities, the prestresses will still play an important role in the overall stress distributions around the acetabulum. Due to the interaction of prestresses and stresses due to normal loading, the primary stability of a metal-backed screwed cup is better guaranteed than the primary stability of an all-polyethylene screwed cup.

Acetabulum↗

Total hip reconstruction in acetabular dysplasia. A finite element study.

In acetabular dysplasia, fixation of the acetabular component of a cemented total hip prosthesis may be insecure and superolateral bone grafts are often used to augment the acetabular roof. We used finite element analysis to study the mechanical importance of the lateral acetabular roof and found that the lateral acetabular rim plays an important role in the load transfer of the pelvic bone. When the superlateral rim was lacking, the load shifted to the posterosuperior rim and to the area of pubic support, and the stresses in all materials, especially in the cement and in the trabecular bone, increased greatly. At the cement-bone interface the tilting component of the shear stress increased threefold. In a model in which the dysplastic acetabulum was augmented by a rigidly fixed, load-transmitting bone graft, the stresses were considerably diminished.

Acetabulum↗

Adaptive bone remodeling and biomechanical design considerations for noncemented total hip arthroplasty.

Clinical problems with noncemented total hip arthroplasty (THA) stems, directly or indirectly related to load transfer, include mid-thigh pain due to relative (micro) motions or excessive endosteal interface stresses, subsidence and loosening due to inadequate primary stability and fit, and proximal femoral bone atrophy due to stress shielding. In this article, the load-transfer mechanisms associated with noncemented THA stems and their resulting stress patterns are discussed in relation to design features, bonding characteristics, and materials choice. Nonlinear finite-element models and computer simulation programs for strain-adaptive bone remodeling have been used for this study. Canal-filling, fully bonded metal stems have been found likely to cause proximal bone atrophy, possibly leading to long-term failure of the implant/bone composite. The use of flexible (isoelastic) materials and/or press-fit fixation reduces stress shielding, but also reduces the potential for interface stability. The stem material, the stem shape, and the coating geometry interact in relation to the load-transfer mechanism, and it is suggested that optimal combinations of these characteristics can be determined through the computer simulation methods presented.

Adaptation, Physiological↗

Adaptive bone-remodeling theory applied to prosthetic-design analysis.

The subject of this article is the development and application of computer-simulation methods to predict stress-related adaptive bone remodeling, in accordance with 'Wolff's Law'. These models are based on the Finite Element Method (FEM) in combination with numerical formulations of adaptive bone-remodeling theories. In the adaptive remodeling models presented, the Strain Energy Density (SED) is used as a feed-back control variable to determine shape or bone density adaptations to alternative functional requirements, whereby homeostatic SED distribution is assumed as the remodeling objective. These models are applied to investigate the relation between 'stress shielding' and bone resorption in the femoral cortex around intramedullary prostheses, such as used in Total Hip Arthroplasty (THA). It is shown that the amount of bone resorption depends mainly on the rigidity and the bonding characteristics of the implant. Homeostatic SED can be obtained when the resorption process occurs at the periosteal surface, rather than inside the cortex, provided that the stem is adequately flexible.

Adaptation, Physiological↗

Mechanical and textural properties of pelvic trabecular bone.

So far, virtually nothing is known about the mechanical properties of pelvic trabecular bone. In this study, several techniques have been used to establish some insight in these properties. Dual-energy quantitative computer tomography (DEQCT) was used to look at the distribution of bone densities throughout the pelvic bone and nondestructive mechanical testing was used to obtain Young's moduli and Poisson's ratios in three orthogonal directions for cubic specimens of pelvic trabecular bone. The same specimens were then used for stereological measurements to obtain volume fractions and the spatial orientations of the mean intercept lengths. The combined data on the mechanical tests and the stereological measurements made it possible to calculate Young's moduli and Poisson's ratios for the specimens' principal material axes. DEQCT showed that bone densities within a pelvic bone are significantly higher in the superior part of the acetabulum, extending to the sacroiliac joint area and, secondly, in the area of the pubic symphysis. Volume fractions found for the specimens did not exceed 20%. This may be considered rather low when compared to values reported in the literature for trabecular bone of femoral or tibial origin, but the values do lie in the same range as vertebral trabecular bone. With the volume fraction as its primary predictor, values of Young's moduli were also low. For most specimens these values were not higher than 100 MPa, with an occasional peak of 250 MPa. Looking at the ratio of the highest and lowest Young's modulus or at the components of the fabric tensor, it can be concluded that pelvic trabecular bone is not highly anisotropic. On an average, Poisson's ratio was found to be closer to 0.2 rather than 0.3, which is in accordance with other studies on Poisson's ratio of trabecular bone.

Acetabulum↗

Kinematics of the lateral ligamentous constraints of the elbow joint.

Thirty osteoligamentous elbow joint specimens were included in a study of the lateral collateral ligament complex (LCLC). The morphologic characteristics of the LCLC were examined, and then three-dimensional kinematic measurements were undertaken after selective ligament dissections were performed. Isolated sectioning of the annular ligament (AL) or the lateral ulnar collateral ligament (LUCL) induced only minor laxity to the elbow joint with a maximum of 2.2 degrees and 4.4 degrees during forced varus and external rotation (supination), respectively. Transsection of the lateral collateral ligament (LCL) caused a maximal laxity of 15.4 degrees and 22.8 degrees during forced varus and external rotation (supination), respectively. Combined ligament dissections showed that total transection of the LCLC at the ulnar or the humeral insertion was important for joint laxity. Total transection of the LCLC at the humeral or the ulnar insertion induced a maximal laxity of 24.5 degrees and 37 degrees during forced varus and external rotation (supination), respectively. This study suggests the AL and the LUCL are of minor importance as constraints when cut separately, whereas the LCL is a significant preventer of elbow joint laxity. The LCLC was observed to be a complex structure of ligamentous fibers rather than discreet bands. The LCLC forms a ligamentous constraint between the lateral humeral epicondyle and the ulna, stabilizing the elbow joint and forming a base for radial head stability and rotation.

Aged↗

Bone strength and material properties of the glenoid.

The quality of the glenoid bone is important to a successful total shoulder replacement. Finite element models have been used to model the response of the glenoid bone to an implanted prosthesis. Because very little is known about the bone strength and the material properties at the glenoid, these models were all based on assumptions that the material properties of the glenoid were similar to those of the tibial plateau. The osteopenetrometer was used to assess the topographic strength distribution at the glenoid. Strength at the proximal subchondral level of the glenoid averaged 66.9 MPa. Higher peak values were measured posteriorly, superiorly, and anteriorly to the area of maximum concavity of the glenoid joint surface known as the bare area. One millimeter underneath the subchondral plate, average strength decreased by 25%, and at the 2 mm level strength decreased by 70%. The contribution of the cortical bone to the total glenoid strength was assessed by compression tests of pristine and cancellous-free glenoid specimens. Strength decreased by an average of 31% after the cancellous bone was removed. The material properties of the glenoid cancellous bone were determined by axial compression tests of bone specimens harvested from the central part of the glenoid subchondral area. The elastic modulus varied from approximately 100 MPa at the glenoid bare area to 400 MPa at the superior part of the glenoid. With the elastic constants used a predictor of the mechanical anisotropy, the average anisotropy ratio was 5.2, indicating strong anisotropy. The apparent density was an average 0.35 gr. cm-3, and the Poisson ratio averaged 0.263. According to our findings the anisotropy of the glenoid cancellous bone, details concerning the strength distribution, and the load-bearing function of the cortical shell should be considered in future finite element models of the glenoid.

Adult↗