Ameet Aiyangar

Mechanical characterization of injection-molded macro porous bioceramic bone scaffolds.

Bioactive ceramic materials like tricalcium phosphate (TCP) have been emerging as viable material alternatives to the current therapies of bone scaffolding to target fracture healing and osteoporosis. Both material and architectural characteristics play a critical role in the osteoconductive capacity and strength of bone scaffolds. Thus, the objective of this research was to investigate the sintering temperature effect of a cost-effective manufacturing process on the architecture and mechanical properties of a controlled macro porous bioceramic bone scaffold. In this study the physical and mechanical properties of β-TCP bioceramic scaffolds were investigated as a function of the sintering temperature in the range of 950-1150 °C. Physical properties investigated included bulk dimensions, pore size, and strut thickness; and, compressive mechanical properties were evaluated in air at room temperature and in saline solution at body temperature. Statistically significant increases in apparent elastic modulus were measured for scaffolds sintered at higher temperatures. Structural stiffness for all the specimens was significantly reduced when tested at body temperature in saline solution. These findings support the development of clinically successful bioceramic scaffolds that may stimulate bone regeneration and scaffold integration while providing structural integrity.

Determination of the translational and rotational stiffnesses of an L4–L5 functional spinal unit using a specimen-specific finite element model

The knowledge of spinal kinematics is of paramount importance for many aspects of clinical application (i.e. diagnosis, treatment and surgical intervention) and for the development of new spinal implants. The aim of this study was to determine the translational and rotational stiffnesses of a functional spinal unit (FSU) L4-L5 using a specimen-specific finite element model. The results are needed as input data for three-dimensional (3D) multi-body musculoskeletal models in order to simulate vertebral motions and loading in the lumbar spine during daily activities. Within the modelling process, a technique to partition the constitutive members and to calibrate their mechanical properties for the complex model is presented. The material and geometrical non-linearities originating from the disc, the ligaments and the load transfer through the zygapophysial joints were considered. The FSU was subjected to pure moments and forces in the three anatomical planes. For each of the loading scenarios, with and without vertical and follower preload, the presented technique provides results in fair agreement with the literature. The novel representation of the nonlinear behaviour of the translational and rotational stiffness of the disc as a function of the displacement can be used directly as input data for multi-body models.

Recovery of bone strength in young pigs from an induced short-term dietary calcium deficit followed by a calcium replete diet

This study investigated whether the deficits in bone strength of pre-pubertal pigs, induced by short-term deficits in dietary calcium can be recovered if followed by a calcium-fortified diet. Young pigs were divided into two groups based on diet: a marginal Ca diet (70% of established Ca requirements) or an excess Ca diet (150% of established Ca requirements) for 4 weeks. Each group was then randomly sub-divided into two groups and fed diets with either marginal or excess dietary Ca for 6 weeks in a cross-over design, resulting in four treatment groups: H150-H150, H150-L70, L70-H150, and L70-L70. Animals were DXA scanned at 2-week intervals during the 10-week period to obtain whole body bone mineral content (BMC) and density (BMD). After animals were euthanized, right femurs were collected for this study. Traits such as bone mineral density, mass, volume, area moment of inertia (MI) and the section modulus (SM) were computed from computed tomography (CT) data and failure load was measured from four-point bending tests. DXA results showed significant reduction in BMC (61.6%) and BMD (37.5%) in the (L70-L70) group compared to the (H150-H150) group. DXA results additionally showed that deficiencies induced by the 4-week marginal Ca diet in the (L70-H150) group were not recovered with a subsequent excess Ca diet. While mechanical test results also showed significant reduction (75%) in strength in the L70-L70 group, compared to the H150-H150 group, they revealed no differences between the failure loads of the (L70-H150) group and the (H150-H150) group. Similar results were also found for bone mineral mass and volume, indicating that recovery from a short-term dietary Ca deficiency is possible at the pre-pubertal stage. Furthermore, bone mineral content and bone volume calculated from CT data correlated highly with failure load (R(2)=0.78 and 0.84, respectively), while density, MI and SM only showed weak-to-moderate correlations (R(2)=0.40-0.56), implying that bone mineral mass and volume calculated from CT data are good non-invasive surrogates for strength of growing bones.

Apportionment of lumbar L2–S1 rotation across individual motion segments during a dynamic lifting task

Segmental apportionment of lumbar (L2-S1) rotation is a critical input parameter for musculoskeletal models and a candidate metric for clinical assessment of spinal health, but such data are sparse. This paper aims to quantify the time-variant and load-dependent characteristics of intervertebral contributions to L2-S1 extension during a dynamic lifting task. Eleven healthy participants lifted multiple weights (4.5, 9.1, and 13.6 kg) from a trunk-flexed to an upright position while being imaged by a dynamic stereo X-ray system at 30 frames/s. Vertebral (L2-S1) motion was tracked using a previously validated volumetric model-based tracking method that employs 3D bone models reconstructed from subject-specific CT images to obtain high-accuracy (≤0.26°, 0.2 mm) 3D vertebral kinematics. Individual intervertebral motions as percentages of the total L2-S1 extension were computed at each % increment of the motion to show the segmental apportionment. Results showed L3-L4 (25.8±2.2%) and L4-L5 (31±3.1%) together contributed a larger share (∼60% combined) compared to L2-L3 (21.7±3.7%) and L5-S1 (22.6±4.7%); L4-L5 consistently provided the largest contribution of the measured segments. Relative changes over time in L3-L4 (6±12.5%) and L4-L5 (0.5±10.2%) contribution were minimal; in contrast, L2-L3 (18±20.1%) contribution increased while L5-S1 (-33±22.9%) contribution decreased in a somewhat complementary fashion as motion progressed. No significant effect of the magnitude of load lifted on individual segmental contribution patterns was detected. The current study updated the knowledge regarding apportionment of lumbar (L2-S1) motion among individual segments, serving both as input into musculoskeletal models and as potential biomechanical markers of low back disorders.

Instantaneous centers of rotation for lumbar segmental extension in vivo

The study aimed to map instantaneous centers of rotation (ICRs) of lumbar motion segments during a functional lifting task and examine differences across segments and variations caused by magnitude of weight lifted. Eleven healthy participants lifted loads of three different magnitudes (4.5, 9, and 13.5kg) from a trunk-flexed (~75°) to an upright position, while being imaged by a dynamic stereo X-ray (DSX) system. Tracked lumbar vertebral (L2-S1) motion data were processed into highly accurate 6DOF intervertebral (L2L3, L3L4, L4L5, L5S1) kinematics. ICRs were computed using the finite helical axis method. Effects of segment level and load magnitude on the anterior-posterior (AP) and superior-inferior (SI) ICR migration ranges were assessed with a mixed-effects model. Further, ICRs were averaged to a single center of rotation (COR) to assess segment-specific differences in COR AP- and SI-coordinates. The AP range was found to be significantly larger for L2L3 compared to L3L4 (p=0.02), L4L5 and L5S1 (p<0.001). Average ICR SI location was relatively higher - near the superior endplate of the inferior vertebra - for L4L5 and L5SI compared to L2L3 and L3L4 (p≤0.001) - located between the mid-transverse plane and superior endplate of the inferior vertebra - but differences were not significant amongst themselves (p>0.9). Load magnitude had a significant effect only on the SI component of ICR migration range (13.5kg>9kg and 4.5kg; p=0.049 and 0.017 respectively). The reported segment-specific ICR data exemplify improved input parameters for lumbar spine biomechanical models and design of disc replacements, and base-line references for potential diagnostic applications.

A new bone surrogate model for testing interbody device subsidence.

Study Design. An in vitro biomechanical study investigating interbody device subsidence measures in synthetic vertebrae, polyurethane foam blocks, and human cadaveric vertebrae. Objective. To compare subsidence measures of bone surrogates with human vertebrae for interbody devices varying in size/placement. Summary of Background Data. Bone surrogates are alternatives when human cadaveric vertebrae are unavailable. Synthetic vertebrae modeling cortices, endplates, and cancellous bone have been developed as an alternative to polyurethane foam blocks for testing interbody device subsidence. Methods. Indentors placed on the endplates of synthetic vertebrae, foam blocks, and human vertebrae were subjected to uniaxial compression. Subsidence, measured with custom-made extensometers, was evaluated for an indentor seated either centrally or peripherally on the endplate. Failure force and indentation stiffness were determined from force-displacement curves. Results. Subsidence measures in human vertebrae varied with indentor placement: failure forces were higher and indentors subsided less with peripheral placement. Subsidence measures in foam blocks were insensitive to indentor size/placement; they were similar to human vertebrae for centrally placed but not for peripherally placed indentors. Although subsidence measures in synthetic vertebrae were sensitive to indentor size/placement, failure force and indentation stiffness were overestimated, and subsidence underestimated, for both centrally placed and peripherally placed indentors. Conclusion. The synthetic endplate correctly represented the human endplate geometry, and thus, failure force, stiffness, and subsidence in synthetic vertebrae were sensitive to indentor size/placement. However, the endplate was overly strong and thus synthetic vertebrae did not accurately model indentor subsidence in human cadaveric vertebrae. Foam blocks captured subsidence measures more accurately than synthetic vertebrae for centrally placed indentors, but because of their uniform density were not sufficiently robust to capture changes generated from different indentor sizes/placements. The current bone surrogates are not accurate enough in terms of material property distribution to completely model subsidence in human cadaveric vertebrae.

Comparison of Two Bone Surrogates for Interbody Device Subsidence Testing

Bone surrogates are proposed alternatives to human cadaveric vertebrae for assessing interbody device subsidence. Polyurethane foam blocks are an accepted surrogate for cancellous bone but do not share their heterogeneous bone density distribution. Synthetic vertebrae have been recently developed as an alternative bone surrogate with representations of cortices, endplates, and cancellous bone. The efficacy of each surrogate was evaluated by uniaxially indenting it with an interbody device. The force-displacement curve profiles, failure forces, and depth of implant subsidence were compared for devices seated centrally and peripherally on the surrogates. The synthetic endplate mimicked human endplates through a gradually increasing endplate thickness toward the periphery. This enabled the synthetic vertebrae to provide additional subsidence resistance to implants seated at the periphery. By contrast, the foam block was insensitive to implant placement. Absence of failure in synthetic vertebrae from peripheral implant indentation suggests the synthetic endplate is stronger than human endplates but further study with human cadaveric vertebrae is needed.

Replicating interbody device subsidence with lumbar vertebrae surrogates

Bone surrogates are proposed alternatives to human cadaveric vertebrae for assessing interbody device subsidence. A synthetic vertebra with representations of cortices, endplates and cancellous bone was recently developed as an alternative surrogate to polyurethane foam blocks. The ability of the two surrogates to replicate subsidence has not been fully assessed, and was evaluated by indenting them with ring-shaped indenters and comparing their performance with human cadaveric vertebrae using qualitative characteristics and indentation metrics. The sensitivity of each surrogate to a centrally or peripherally placed indenter was of particular interest. Many indentation characteristics of the foam blocks were similar to those of human cadaveric vertebrae, except their insensitivity to centrally and peripherally placed indenters, owing to their homogeneous mechanical properties. This is distinctly different from the cadaveric vertebrae, where a peripherally placed indenter indented significantly less than a centrally placed indenter, because of endplates. By contrast, the synthetic vertebra was sensitive to peripherally placed indenters owing to its bi-material composition, including a thickened peripheral endplate. However, an overly strong synthetic endplate resulted in unrepresentative indentation shape and depth. Both surrogates produced similar results to human cadaveric vertebrae in certain respects, but neither is accurate enough in terms of material property distribution to model subsidence completely in human cadaveric vertebrae.

Preclinical Analysis to Assess Aseptic Loosening of Orthopaedic Implants

Although it is long accepted that aseptic loosening is the main reason for revision of total joint replacements, preclinical assessment methods of primary fixation are not well developed. Reasons for aseptic loosening are multifactorial including the patient, surgical approach, biological reactions, wear, micro-motion at the implant–bone interface, load transfer from the joint to the host bone, and bone adaptation. The objective of this study was to highlight a few preclinical methods to investigate orthopaedic implant primary fixation relative to the transfer of loads and displacements at the implant–bone interface. The last generation of metal-on-metal hip prostheses used a high-precision low clearance bearing to provide a low friction ball and socket joint. During implantation the acetabular component deforms under a press-fit; however, excessive deformation of the acetabular component can lead to premature failure of the joint replacement. It is therefore important to establish an accurate method of quantifying cup deformation and develop finite element models to better understand the effects of the press-fit. Methods to measure press-fit deformation of monoblock acetabular cups for metal-on-metal total hip arthroplasty and resurfacing were investigated. The purpose of the present study was to compare cup deformation with two experiments simulating press-fit of an acetabular cup into the pelvis. Rim deformation and cup strain were measured for two common tests: (1) a two-point pinching of the cup rim and (2) a press-fit implantation into a cavitated polyurethane foam block. In the pinch test, the rim displaced linearly and symmetrically with force. The press-fit test, ostensibly a closer representation of surgical procedure, produced more complex displacement and strain responses due to the foam block shape, and the cup surface-foam block interaction. The current study demonstrated two methods to measure real-time hip cup deformation and strain during press-fitting that may be used for preclinical assessment of primary fixation.

Lumbar Facet Joint Kinematics and Load Effects During Dynamic Lifting

Although extensive efforts have been dedicated to investigating the risk factors of low back pain in the workplace, a clear knowledge of their effects on the facet joint (FJ) mechanics is lacking. In this study, fourteen healthy participants performed dynamic lifting task with varying external load while a dynamic stereo-radiography system captured their lumbar motion continuously. The FJ kinematics in the lumbar spine were ascertained using a volumetric model-based tracking method. The FJ kinematics data from seven participants were processed and analyzed using non-parametric statistical test. The results indicated significant (p<0.05) effects of external load on the FJ flexion and superior-inferior translation at all segments, showing more consistent trends at the L2-L3, L3-L4, and L4-L5 joints during trunk flexion angles of approximately 20° and 40°. Findings of this study provide a preliminary but important foundation in elucidating facet-related injury mechanism due to strenuous exertions in workplaces.