Biomedical subjects

Rik Huiskes

Publications and source records attributed to Rik Huiskes.

12 recordsLinked to original sources

PubMed2007

Finite element-based preclinical testing of cemented total hip implants.

We developed a finite element model to preclinically test cemented hip implants for damage accumulation, including cement crack formation, creep, and stem migration. Using this model, we simulated the mechanical failure processes of four cemented total hip arthroplasty implants (Lubinus SPII, Mueller Curved, Exeter and Charnley, all with known clinical results) during cyclic normal walking and stair-climbing loads. These four implants were selected to ascertain whether the simulation predicted greater damage development around clinically inferior stems, whether clinically inferior designs could be identified by an initial stress analysis without the prediction of cement damage, and whether the simulation could predict high implant subsidence rates in combination with minimal cement damage. Based on the predicted cement crack patterns and crack formation rates, the simulation correctly identified the clinically inferior implant designs. Based only on the initial stress analysis under a stair-climbing load, it was not possible to identify clinically inferior designs. High subsidence values and minimal cement damage were predicted for the Exeter implant, similar to clinical findings. Our findings suggest the simulation may be effective in differentiating between a range of implants and design features.

Bone Cements↗

PubMed2006

Bone regeneration during distraction osteogenesis: mechano-regulation by shear strain and fluid velocity.

Corroboration of mechano-regulation algorithms is difficult, partly because repeatable experimental outcomes under a controlled mechanical environment are necessary, but rarely available. In distraction osteogenesis (DO), a controlled displacement is used to regenerate large volumes of new bone, with predictable and reproducible outcomes, allowing to computationally study the potential mechanisms that stimulate bone formation. We hypothesized that mechano-regulation by octahedral shear strain and fluid velocity can predict the spatial and temporal tissue distributions seen during experimental DO. Variations in predicted tissue distributions due to alterations in distraction rate and frequency could then also be studied. An in vivo ovine tibia experiment evaluating bone-segment transport (distraction, 1 mm/day) over an intramedullary nail was used for comparison. A 2D axisymmetric finite element model, with a geometry originating from the experimental data, was created and included into a previously developed model of tissue differentiation. Cells migrated and proliferated into the callus, differentiating into fibroblasts, chondrocytes or osteoblasts, dependent on the biophysical stimuli. Matrix production was modelled with an osmotic swelling model to allow tissues to grow at individual rates. The temporal and spatial tissue distributions predicted by the computational model agreed well with those seen experimentally. In addition, it was observed that decreased distraction rate (0.5 mm/d vs. 0.25 mm/d) increased the overall time needed for complete bone regeneration, whereas increased distraction frequency (0.5 mm/12 h vs. 0.25 mm/6 h) stimulated faster bone regeneration, as found in experimental findings by others. Thus, the algorithm regulated by octahedral shear strain and fluid velocity was able to predict the bone regeneration patterns dependent on distraction rate and frequency during DO.

Animals↗

PubMed2006

Causes of mechanically induced collagen damage in articular cartilage.

Osteoarthritis (OA) is a multifactorial disease, associated with articular cartilage degeneration and eventually joint destruction. The phases of the disease have been described in detail, and mechanical factors play an important role in the initiation of OA, but many questions remain about its etiology. Swelling of cartilage, one of the earliest signs of damage, is proportional to the amount of collagen damage. This strongly suggests that damage to the collagen network is an early event in cartilage degeneration. The goal of this study was to determine the mechanical cause of early collagen damage in articular cartilage after mechanical overloading. Both the shear strain along the fibrils and the maximum fibril strains were evaluated as possible candidates for causing collagen damage. This evaluation was done by comparing the locations of maximum shear and tensile strains with the locations of initial collagen damage after mechanical overloading in bovine explants as found using antibodies directed against denatured type II collagen (Col2-3/4M). Collagen damage could be initiated by excessive shear strains along the collagen fibrils, and by excessive fibrils strains. The locations of collagen damage after mechanical overloading were highly dependent on the cartilage thickness, with thinner cartilage being more susceptible to damage than thicker samples.

Animals↗

PubMed2006

Corroboration of mechanoregulatory algorithms for tissue differentiation during fracture healing: Comparison with in vivo results.

Several mechanoregulation algorithms proposed to control tissue differentiation during bone healing have been shown to accurately predict temporal and spatial tissue distributions during normal fracture healing. As these algorithms are different in nature and biophysical parameters, it raises the question of which reflects the actual mechanobiological processes the best. The aim of this study was to resolve this issue by corroborating the mechanoregulatory algorithms with more extensive in vivo bone healing data from animal experiments. A poroelastic three-dimensional finite element model of an ovine tibia with a 2.4 mm gap and external callus was used to simulate the course of tissue differentiation during fracture healing in an adaptive model. The mechanical conditions applied were similar to those used experimentally, with axial compression or torsional rotation as two distinct cases. Histological data at 4 and 8 weeks, and weekly radiographs, were used for comparison. By applying new mechanical conditions, torsional rotation, the predictions of the algorithms were distinguished successfully. In torsion, the algorithms regulated by strain and hydrostatic pressure failed to predict healing and bone formation as seen in experimental data. The algorithm regulated by deviatoric strain and fluid velocity predicted bridging and healing in torsion, as observed in vivo. The predictions of the algorithm regulated by deviatoric strain alone did not agree with in vivo data. None of the algorithms predicted patterns of healing entirely similar to those observed experimentally for both loading modes. However, patterns predicted by the algorithm based on deviatoric strain and fluid velocity was closest to experimental results. It was the only algorithm able to predict healing with torsional loading as seen in vivo.

Animals↗

PubMed2005

Comparison of biophysical stimuli for mechano-regulation of tissue differentiation during fracture healing.

Most long-bone fractures heal through indirect or secondary fracture healing, a complex process in which endochondral ossification is an essential part and bone is regenerated by tissue differentiation. This process is sensitive to the mechanical environment, and several authors have proposed mechano-regulation algorithms to describe it using strain, pore pressure and/or interstitial fluid velocity as biofeedback variables. The aim of this study was to compare various mechano-regulation algorithms' abilities to describe normal fracture healing in one computational model. Additionally, we hypothesized that tissue differentiation during normal fracture healing could be equally well regulated by the individual mechanical stimuli, e.g. deviatoric strain, pore pressure or fluid velocity. A biphasic finite element model of an ovine tibia with a 3mm fracture gap and callus was used to simulate the course of tissue differentiation during normal fracture healing. The load applied was regulated in a biofeedback loop, where the load magnitude was determined by the interfragmentary movement in the fracture gap. All the previously published mechano-regulation algorithms studied, simulated the course of normal fracture healing correctly. They predicted (1) intramembranous bone formation along the periosteum and callus tip, (2) endochondral ossification within the external callus and cortical gap, and (3) creeping substitution of bone towards the gap from the initial lateral osseous bridge. Some differences between the effects of the algorithms were seen, but they were not significant. None of the volumetric components, i.e. pore pressure or fluid velocity, alone were able to correctly predict spatial or temporal tissue distribution during fracture healing. However, simulation as a function of only deviatoric strain accurately predicted the course of normal fracture healing. This suggests that the deviatoric component may be the most significant mechanical parameter to guide tissue differentiation during indirect fracture healing.

Algorithms↗

PubMed2005

In vivo assessment of regenerate axial stiffness in distraction osteogenesis.

This paper presents an in vivo test for assessment of regenerate axial stiffness after the distraction phase of lengthening therapy. The test result supplements radiography in evaluating bone healing and assists in determining when the regenerate stiffness is sufficient for removal of the external fixator. The test is non-invasive and does not require fixator removal. The theoretical basis for the method is that an externally applied load is shared between the fixator and the regenerating bone. The amount of load carried by the regenerate depends on its axial stiffness, which increases with advanced mineralization. By measuring the force in the fixator while applying a known external load to the limb, the load-share ratio between fixator and limb can be assessed. A load-share ratio of 100% indicates that the entire load is carried by the fixator. The ratio decreases as the regenerate structure gradually stiffens. In a clinical trial of 22 individuals with tibial lengthening, the fixator was removed when the load-share ratio dropped below 10%. None of the patients experienced fracture after removal of the fixator.

Biomechanical Phenomena↗

PubMed2003

The dependence of the elastic properties of osteoporotic cancellous bone on volume fraction and fabric.

Osteoporosis is a progressive systemic skeletal condition characterized by low bone mass and microarchitectural deterioration, with a consequent increase in susceptibility to fracture. Hence, osteoporosis would be best diagnosed by in vivo measurements of bone strength. As this is not clinically feasible, our goal is to estimate bone strength through the assessment of elastic properties, which are highly correlated to strength. Previously established relations between morphological parameters (volume fraction and fabric) and elastic constants could be applied to estimate cancellous bone stiffness in vivo. However, these relations were determined for normal cancellous bone. Cancellous bone from osteoporotic patients may require different relations. In this study we set out to answer two questions. First, can the elastic properties of osteoporotic cancellous bone be estimated from morphological parameters? Second, do the relations between morphological parameters and elastic constants, determined for normal bone, apply to osteoporotic bone as well? To answer these questions we used cancellous bone cubes from femoral heads of patients with (n=26) and without (n=32) hip fractures. The elastic properties of the cubes were determined using micro-finite element analysis, assuming equal tissue moduli for all specimens. The morphological parameters were determined using microcomputed tomography. Our results showed that, for equal tissue properties, the elastic properties of cancellous bone from fracture patients could indeed be estimated from morphological parameters. The morphology-based relations used to estimate the elastic properties of cancellous bone are not different for women with or without fractures.

Bone and Bones↗

PubMed2003

Can finite element models detect clinically inferior cemented hip implants?

Rigorous preclinical testing of cemented hip prostheses against the damage accumulation failure scenario will reduce the incidence of aseptic loosening. For that purpose, a finite element simulation is proposed that predicts damage accumulation in the cement mantle and prosthetic migration. If the simulation is to become a convincing preclinical test, it should be able to distinguish between implants in a clinically relevant way, based on accurate predictions of long-term failure mechanisms of cemented hip prostheses. The algorithm was used to simulate long-term fatigue experiments on femoral reconstructions with Mueller Curved and Lubinus SPII stems. Clinically, the Mueller Curved system performs inferior to the Lubinus SPII system. The finite element simulation predicted much more cement damage around the Mueller Curved stem and showed that the entire cement mantle was involved in the failure process, which was not the case around the Lubinus SPII stem. In addition, the Mueller Curved stem was predicted to migrate more than the Lubinus SPII. The predictions showed excellent agreement with the experimental findings: similar damage locations in the cement, more damage for the Mueller Curved, similar prosthetic migration directions, and more migration for the Mueller Curved stem. This is the first time that a finite element simulation is able to differentiate between a clinically superior and an inferior implant, based on accurate simulation of the long-term failure mechanisms in a cemented reconstruction. Its use for preclinical testing purposes is corroborated.

Cementation↗

PubMed2003

A 3-dimensional computer model to simulate trabecular bone metabolism.

Mechanical loading of trabecular bone affects the bone architecture. Bone mass is correlated to the magnitude of the external load and trabeculae are aligned to the loading direction. Physical exercise increases bone mass while disuse or microgravity decreases it. In previous work we have presented a mathematical model of bone metabolism that could explain the emergence, maintenance and adaptation of trabecular bone under influence of the load imposed, using a 2-dimensional computer model (Huiskes et al., Nature 404 (2000), 704-706). This model was based on hypothetical mathematical descriptions of bone formation by osteoblastic cells, and resorption by osteoclastic cells, both as governed by mechanical stimuli. In order to quantitatively compare the behavior of the proposed regulation mechanism to real trabecular bone metabolism we present a 3-dimensional computer simulation model. The first 3-dimensional simulation results show that the regulatory rules proposed earlier mimic trabecular bone metabolism in a robust way.

Bone Remodeling↗

PubMed2002

Why mechanobiology? A survey article.

The central paradigm of skeletal mechanobiology is that mechanical forces modulate morphological and structural fitness of the skeletal tissues-bone, cartilage, ligament and tendon. Traditionally, skeletal biomechanics has focussed on how these tissues perform the structural and locomotory functions of the vertebrate skeleton. In mechanobiology the central question is how these same load-bearing tissues are produced, maintained and adapted by cells as an active response to biophysical stimuli in their environment. The idea that 'form follows function' is not new, but we now believe that the scientific community has the knowledge and tools to prove, understand and use functional adaptation to benefit medicine and human health. In this Survey Article the philosophy and progress of skeletal mechanobiology are discussed. The revival of this science, with roots dating back to the 19th Century, is now driven by new developments in cellular, molecular and computational technologies. These developments are still in an early stage of application, but if modern mechanobiology fulfills the promises of its ambitions, the results will bring great benefits to tissue engineering and to the treatment and prevention of skeletal conditions such as congenital deformities, osteoporosis, osteoarthritis and bone fractures.

Animals↗

PubMed2002

Stemmed femoral knee prostheses: effects of prosthetic design and fixation on bone loss.

Although the revision rates for modern knee prostheses have decreased drastically, the total number of revisions a year is increasing because many more primary knee replacements are being done. At the time of revision, bone loss is common, which compromises prosthetic stability. To improve stability, intramedullary stems are often used. The aim of this study was to estimate the effects of a stem, its diameter and the interface bonding conditions on patterns of the bone remodeling in the distal femur. We created finite element models of the distal half of a femur in which 4 types of knee prostheses were placed. The bone remodeling process was simulated using a strain-adaptive bone remodeling theory. The amount of such remodeling was determined by calculating the changes in bone mineral density in 9 regions of interest from simulated DEXA scans. The computer simulation model showed that revision prostheses tend to cause more bone resorption than primary ones, especially in the most distal regions. Predicted long-term bone loss due to a revision prosthesis with a thin stem equalled that around a prosthesis with an intercondylar box. However, strong regional differences were found--the stemmed prostheses having more bone loss in the most distal areas and some bone gain in the more proximal ones. A prosthesis with a thick stem led to an increase in bone loss. When the prosthesis-cement interface was bonded, more bone loss was predicted than with an unbonded interface. These results suggest that a stem which increases stability initially may reduce stability in the long term. This is due to an increase in stress shielding and bone resorption.

Bone Remodeling↗

PubMed2002

Stair climbing is more detrimental to the cement in hip replacement than walking.

Stair climbing may be detrimental to cemented total hip arthroplasties, because it subjects the reconstruction to high torsional loads. The current study investigated how stair climbing contributes to damage accumulation in the cement around a femoral stem compared with walking, taking into account the different frequencies of these activities during patient functioning. In finite element analyses, the damage accumulation process in the cement mantle around a Lubinus SPII stem was simulated for three different loading histories: (1) isolated walking, representative for patients who climb no stairs; (2) isolated stair climbing; (3) alternating walking and stair climbing in a ratio of nine to one cycles, representative for patients who climb many stairs. Relative to isolated walking, isolated stair climbing increased the amount of cement damage by a factor of 6. Inclusion of 10% stair climbing cycles in the loading history increased the amount of damage by 47% relative to isolated walking. Stair climbing produced damage along the entire stem, whereas isolated walking produced damage proximomedially and around the tip only. This study confirmed that stair climbing is more risky for failure of cemented femoral stems than walking. A few stair climbing cycles during daily patient functioning increases the amount of cement damage dramatically.

Biomechanical Phenomena↗