Biomedical subjects

Markus O Heller

Publications and source records attributed to Markus O Heller.

10 recordsLinked to original sources

PubMed2006

A survey of formal methods for determining functional joint axes.

Axes of rotation e.g. at the knee, are often generated from clinical gait analysis data to be used in the assessment of kinematic abnormalities, the diagnosis of disease, or the ongoing monitoring of a patient's condition. They are additionally used in musculoskeletal models to aid in the description of joint and segment kinematics for patient specific analyses. Currently available methods to describe joint axes from segment marker positions share the problem that when one segment is transformed into the coordinate system of another, artefacts associated with motion of the markers relative to the bone can become magnified. In an attempt to address this problem, a symmetrical axis of rotation approach (SARA) is presented here to determine a unique axis of rotation that can consider the movement of two dynamic body segments simultaneously, and then compared its performance in a survey against a number of previously proposed techniques. Using a generated virtual joint, with superimposed marker error conditions to represent skin movement artefacts, fitting methods (geometric axis fit, cylinder axis fit, algebraic axis fit) and transformation techniques (axis transformation technique, mean helical axis, Schwartz approach) were classified and compared with the SARA. Nearly all approaches were able to estimate the axis of rotation to within an RMS error of 0.1cm at large ranges of motion (90 degrees ). Although the geometric axis fit produced the least RMS error of approximately 1.2 cm at lower ranges of motion (5 degrees ) with a stationary axis, the SARA and Axis Transformation Technique outperformed all other approaches under the most demanding marker artefact conditions for all ranges of motion. The cylinder and algebraic axis fit approaches were unable to compute competitive AoR estimates. Whilst these initial results using the SARA are promising and are fast enough to be determined "on-line", the technique must now be proven in a clinical environment.

Computer Simulation↗

PubMed2006

Physiologically based boundary conditions in finite element modelling.

Finite element analysis has been used extensively in the study of bone loading and implant performance, such as in the femur. The boundary conditions applied vary widely, generally producing excessive femoral deformation, and although it has been shown that the muscle forces influence femoral deflections and loading, little consideration has been given to the displacement constraints. It is hypothesised that careful application of physiologically based constraints can produce physiological deformation, and therefore straining, of the femur. Joint contact forces and a complete set of muscle forces were calculated based on the geometry of the Standardised Femur using previously validated musculoskeletal models. Five boundary condition cases were applied to a finite element model of the Standardised Femur: (A) diaphyseally constrained with hip contact and abductor forces; (B) case A plus vasti forces; (C) case A with complete set of muscle forces; (D) distally constrained with all muscle forces; (E) physiological constraints with all muscle forces. It was seen that only the physiological boundary conditions, case E, produced physiological deflections (< 2.0mm) of the femoral head in both the coronal and sagittal planes, which resulted in minimal reaction forces at the constrained nodes. Strains in the mid-diaphysis varied by up to 600 micro-strain under walking loads and 1000 micro-strain under stair climbing loads. The mode of loading, as indicated by the strain profiles on the cortex also varied substantially under these boundary conditions, which has important consequences for studies that examine localised bone loading such as fracture or bone remodelling simulations.

Compressive Strength↗

PubMed2006

Mechanical conditions in the initial phase of bone healing.

BACKGROUND: Bone healing is sensitive to the initial mechanical conditions with tissue differentiation being determined within days of trauma. Whilst axial compression is regarded as stimulatory, the role of interfragmentary shear is controversial. The purpose of this study was to determine how the initial mechanical conditions produced by interfragmentary shear and torsion differ from those produced by axial compressive movements. METHODS: The finite element method was used to estimate the strain, pressure and fluid flow in the early callus tissue produced by the different modes of interfragmentary movement found in vivo. Additionally, tissue formation was predicted according to three principally different mechanobiological theories. FINDINGS: Large interfragmentary shear movements produced comparable strains and less fluid flow and pressure than moderate axial interfragmentary movements. Additionally, combined axial and shear movements did not result in overall increases in the strains and the strain magnitudes were similar to those produced by axial movements alone. Only when axial movements where applied did the non-distortional component of the pressure-deformation theory influence the initial tissue predictions. INTERPRETATION: This study found that the mechanical stimuli generated by interfragmentary shear and torsion differed from those produced by axial interfragmentary movements. The initial tissue formation as predicted by the mechanobiological theories was dominated by the deformation stimulus.

Biomechanical Phenomena↗

PubMed2006

Tibio-femoral joint contact forces in sheep.

Although the sheep has become a standard model for understanding the mechanical conditions that occur after injury and investigating surgical treatments such as osteochondral defect healing and ligament reconstruction, no study has yet evaluated the contact forces that occur in the sheep tibio-femoral joint in vivo. In this study, bone pins, together with reflective markers, were used to measure the 3D kinematics of three sheep hind limbs, simultaneously with the ground reaction forces during repetitions of gait trials. Joint contact forces were then calculated using inverse dynamics and optimisation techniques. Whilst average peak axial tibio-femoral contact forces of 2.1 body weight (BW) were calculated across the 3 sheep, only small medio-lateral and antero-posterior shear forces, averaging 0.7 BW, were determined. Average knee flexion angles ranging from 49 degrees to 70 degrees were observed. From the forces determined in this study, we have provided a better understanding of the mechanical loading environment that occurs in sheep. This has important implications for the interpretation of knee studies in quadrupeds and their relevance to the clinical situation.

Animals↗

PubMed2005

A survey of formal methods for determining the centre of rotation of ball joints.

The determination of an accurate centre of rotation (CoR) from segment marker positions is of interest across a wide range of applications, but particularly for clinical gait analysis and for estimating the hip joint centre during surgical intervention of the knee, for limb alignment purposes. For the first time in this survey of formal methods, we classify, analyse and compare different methods (geometric, algebraic, bias compensated algebraic, and Pratt sphere fit methods, as well as the centre transformation technique, the Holzreiter approach, the helical pivot technique, the Schwartz transformation techniques, the minimal amplitude point method and the Stoddart approach) for the determination of spherical joint centres from marker position data. In addition, we propose a new method, the symmetrical CoR estimation or SCoRE, in which the coordinates of the joint centre must only remain constant relative to each segment, thus not requiring the assumption that one segment should remain at rest. For each method, 1000 CoR estimations were analysed with the application of isotropic, independent and identically distributed Gaussian noise (standard deviation 0.1cm) to each of the marker positions, to all markers on the segment simultaneously and the two in combination. For the test conditions used here, most techniques were capable of determining the CoR to within 0.3 cm, as long as the spherical range of motion (RoM) of the joint was 45 degrees or more. Under the most stringent conditions tested, however, the SCoRE was capable of best determining the CoR, to within approximately 1.2mm with a RoM of 20 degrees . The correct selection and application of these methodologies should help improve the accuracy of surgical navigation and clinical kinematic measurement.

Biomechanical Phenomena↗

PubMed2005

On the influence of soft tissue coverage in the determination of bone kinematics using skin markers.

Accurate measurement of underlying bone positions is important for the understanding of normal movement and function, as well as for addressing clinical musculoskeletal or post-injury problems. Non-invasive measurement techniques are limited by the analysis technique and movement of peripheral soft tissues that can introduce significant measurement errors in reproducing the kinematics of the underlying bones when using external skin markers. Reflective markers, skeletally mounted to the right hind limb of three Merino-mix sheep were measured simultaneously with markers attached to the skin of each segment, during repetitions of gait trials. The movement of the skin markers relative to the underlying bone positions was then assessed using the Point Cluster Technique (PCT), raw averaging and the Optimal Common Shape Technique (OCST), a new approach presented in this manuscript. Errors in the position of the proximal joint centre, predicted from the corresponding skin markers, were shown to be phasic and strongly associated with the amount soft tissue coverage, averaging 8.5 mm for the femur, 2.8 for the tibia and 2.0 for the metatarsus. Although the results show a better prediction of bone kinematics associated with the Optimal Common Shape Technique, these errors were large for all three assessment techniques and much greater than the differences between the various techniques. Whilst individual markers moved up to 4 mm from the optimal marker set configuration, average peak errors of up to 16, 5 and 3 mm (hip, knee and tibio-metatarsal joints respectively) were observed, suggesting that a large amount of kinematic noise is produced from the synchronous shifting of marker sets, potentially as a result of underlying muscle firing and the inertial effects of heel impact. Current techniques are therefore limited in their ability to determine the kinematics of underlying bones based on skin markers, particularly in segments with more pronounced soft tissue coverage.

Animals↗

PubMed2005

Stair climbing is more critical than walking in pre-clinical assessment of primary stability in cementless THA in vitro.

Pre-clinical testing of hip endoprostheses is a mandatory requirement before clinical release. Inadequate loading conditions may lead to lower elastic and plastic interface movements than those occurring post-operatively in vivo. This study investigated the influence of patient activity on the primary stability of cementless prostheses with a special emphasis on active simulation of muscle forces. A loading setup, based on validated musculo-skeletal analyses, was used to generate the hip contact force during walking and stair climbing by transmitting muscle forces through the femur. In addition, a loading configuration which only generated the hip contact force occurring during stair climbing at the prosthesis head was simulated. CLS prostheses were implanted in 18 composite femora and subjected to cyclical loading. The relative micro-movements at the bone-prosthesis interface were determined and appeared to be extremely sensitive to the specific patient activity. Compared to walking, stair climbing generated higher micro-movements, with pronounced axial and rotational components. Stair climbing with the femur loaded by the resultant hip contact force only exhibited a characteristic valgus tilt of the stem with significantly lower interface micro-movements than under active simulation of muscle forces. The analyses suggest that stair climbing induced the highest mechanical instability at the bone-prosthesis interface, a level which may compromise the necessary osseointegration process. Active simulation of muscle forces considerably affects the primary stability of cementless hip endoprostheses. Pre-clinical in vitro tests should therefore simulate stair climbing and include muscle activity in the assessment of initial implant stability, otherwise micro-movements may be underestimated and the primary stability overestimated.

Cementation↗

PubMed2004

Tibio-femoral loading during human gait and stair climbing.

Surgical intervention of the knee joint routinely endeavors to recreate a physiologically normal joint loading environment. The loading conditions resulting from osteotomies, fracture treatment, ligament replacements, and arthroplasties of the knee are considered to have an impact on the long term clinical outcome; however, knowledge regarding in vivo loading conditions is limited. Using a previously validated musculoskeletal lower limb model, we predicted the tibio-femoral joint contact forces that occur in the human knee during the common daily activities of walking and stair climbing. The average resultant peak force during walking was 3.1 times body weight (BW) across four total hip arthroplasty patients. Inter-individual variations proved larger than the variation of forces for each patient repeating the same task. Forces through the knee were considerably larger during stair climbing than during walking: the average resultant peak force during stair climbing was 5.4 BW although peaks of up to 6.2 BW were calculated for one particular patient. Average anteroposterior peak shear components of 0.6 BW were determined during walking and 1.3 BW during stair climbing. These results confirm both the joint contact forces reported in the literature and the importance of muscular activity in creating high forces across the joint. The magnitudes of these forces, specifically in shear, have implications for all forms of surgical intervention in the knee. The data demonstrate that high contact and shear forces are generated during weight bearing combined with knee flexion angles greater than approximately 15 degrees. Clinically, the conditions that produce these larger contact forces should be avoided during post-operative rehabilitation.

Biomechanical Phenomena↗

PubMed2003

The influence of alignment on the musculo-skeletal loading conditions at the knee.

BACKGROUND AND AIM: High tibial osteotomies attempt to recreate physiologically normal joint loading. Previous studies have discussed the influence of mal-alignment on the distribution of static loads to the medial and lateral compartments of the knee. The aim of this study was to determine the influence of mal-alignment on the tibio-femoral loading conditions during dynamic activities. MATERIAL AND METHODS: Using a musculo-skeletal model of the lower limb, which had been previously validated with in vivo data, in this study we modified the alignment of the knee in four patients, from a normal position to the extremes of 8 degrees valgus and 10 degrees varus mal-alignment. The resulting tibio-femoral joint contact forces were examined while patients were walking and stair climbing. RESULTS: Varying the mal-alignment resulted in a highly individual response in joint loads. Deviations from the normal alignment produced an increase in loading, with valgus generating a more rapid increase in loading than a varus deformity of the same amount. Varus deformities of 10 degrees resulted in increases in peak contact force from an average of 3.3-times bodyweight (BW) up to a peak of 7.4 BW (+45% to +114%) while patients were walking, whilst increases of 15% up to 35% were determined for stair climbing. Increases of up to 140% were calculated at 8 degrees valgus during walking and up to 53% for stair climbing. CONCLUSION: This study demonstrated a clear dependence of the individual joint loads on axial knee alignment. Based on the sensitivity of joint loading to valgus mal-alignment, more than 3 degrees of over-correction of a varus deformity to valgus should be carefully reconsidered.

Biomechanical Phenomena↗

PubMed2003

THA loading arising from increased femoral anteversion and offset may lead to critical cement stresses.

Aseptic loosening of artificial hip joints is believed to be influenced by the design and orientation of the implant. It is hypothesised that variations in implant anteversion and offset lead to changes in the loading of the proximal femur, causing critical conditions to both the bone and cement. The goal of this study was therefore to analyse the role of these parameters on loading, bone strains and cement stresses in total hip arthroplasty (THA). A validated musculo-skeletal model was used for the analysis of muscle and joint contact forces during walking and stair climbing. Two different anteversion angles (4 degrees vs. 24 degrees ) and prostheses offsets (standard vs. long) were analysed. The loads for each case were applied to a cemented THA finite element model. Generally, stair climbing caused higher bone strains and cement stresses (max. +25%) than walking. Variations in anteversion and offset caused changes in the loading environment, bone strain distribution and cement stresses. Compared to the standard THA configuration, cement stresses were raised by increasing anteversion (max. +52%), offset (max. +5%) and their combination (max. +67%). Femoral anteversion, offset and their combination may therefore lead to an increased risk of implant loosening. Analyses of implant survival should consider this as a limiting factor in THA longevity. In clinical practice, implant orientation, especially in regard to pre- and post-operative anteversion, should be considered to be more critical.

Arthroplasty, Replacement, Hip↗