Duncan E.T. Shepherd

Spinous process strength.

Study Design. Mechanical testing of cadaveric lumbar spines and dual energy radiograph absorptiometry scanning were performed. Objectives. To devise a technique to measure the strength of lumbar spinous processes and to determine the bone mineral density of the vertebrae used. Summary of Background Data. The spinous process has been identified as the weakest part of the anatomy to which a flexible fixation device can be attached. It was unknown if the spinous processes could withstand the forces applied by the device. Methods. A hook was fitted to the spinous process of 32 lumbar vertebrae. A custom-built rig was designed to secure a vertebra to a materials testing machine. A loop of cord was passed over a bar mounted on the crosshead of the machine and around the two bollards of the hook. As the crosshead was raised, a tension was applied to the cord. Each vertebra was tested to failure. The bone mineral density of each vertebra was then measured using dual energy radiograph absorptiometry. Results. Failure of the specimens occurred by failure of the spinous process, pedicles, or vertebral body. The logarithm (base 10) of the load (N) at which failure occurred was 2.53 ± 0.3, which corresponded to a mean failure load of 339 N. The bone mineral density of each vertebral body varied between 0.263 and 0.997 g/cm2. A significant linear correlation was found between bone strength and bone mineral density (P < 0.0001). Conclusions. Specimens with a bone mineral density in the range of 0.263–0.997 g/cm2 failed at a mean load of 339 N when the load was applied through the spinous process hook of a flexible fixation device.

The effect of screw insertion angle and thread type on the pullout strength of bone screws in normal and osteoporotic cancellous bone models

Screw fixation can be extremely difficult to achieve in osteoporotic (OP) bone because of its low strength. This study determined how pullout strength is affected by placing different bone screws at varying angles in normal and OP bone models. Pullout tests of screws placed axially, and at angles to the pullout axis (ranging from 10° to 40°), were performed in 0.09 g cm(-3), 0.16 g cm(-3) and 0.32 g cm(-3) polyurethane (PU) foam. Two different titanium alloy bone screws were used to test for any effect of thread type (i.e. cancellous or cortical) on the screw pullout strength. The cancellous screw required a significantly higher pullout force than the cortical screw (p<0.05). For both screws, pullout strength significantly increased with increasing PU foam density (p<0.05). For screws placed axially, and sometimes at 10°, the observed mechanism of failure was stripping of the internal screw threads generated within the PU foam by screw insertion. For screws inserted at 10°, 20°, 30° and 40°, the resistance to pullout force was observed to be by compression of the PU foam material above the angled screw; clinically, this suggests that compressed OP bone is stronger than unloaded OP bone.

Investigation of techniques for the measurement of articular cartilage surface roughness.

Articular cartilage is the bearing surface of synovial joints and plays a crucial role in the tribology to enable low friction joint movement. A detailed understanding of the surface roughness of articular cartilage is important to understand how natural joints behave and the parameters required for future joint replacement materials. Bovine articular cartilage on bone samples was prepared and the surface roughness was measured using scanning electron microscopy stereoscopic imaging at magnifications in the range 500× to 2000×. The surface roughness (two-dimensional, R(a), and three-dimensional, S(a)) of each sample was then measured using atomic force microscopy (AFM). For stereoscopic imaging the surface roughness was found to linearly increase with increasing magnification. At a magnification of 500× the mean surface roughness, R(a), was in the range 165.4±5.2 nm to 174±39.3 nm; total surface roughness S(a) was in the range 183-261 nm. The surface roughness measurements made using AFM showed R(a) in the range 82.6±4.6 nm to 114.4±44.9 nm and S(a) in the range 86-136 nm. Values obtained using SEM stereo imaging were always larger than those obtained using AFM. Stereoscopic imaging can be used to investigate the surface roughness of articular cartilage. The variations seen between measurement techniques show that when making comparisons between the surface roughness of articular cartilage it is important that the same technique is used.

MECHANICAL PROPERTIES OF CHORDAE TENDINEAE OF THE MITRAL HEART VALVE: YOUNG'S MODULUS, STRUCTURAL STIFFNESS, AND EFFECTS OF AGING

Youngs modulus and structural stiffness were determined for chordae tendineae of the mitral valve from young (18–26 weeks) and old (over 2 years) porcine hearts. For chordae from the posterior leaflet of the valve, the Youngs modulus values were significantly higher (p < 0.05) for the thinner marginal chordae (59 ± 31 MPa young; 88 ± 21 MPa old) than for the thicker basal chordae (31 ± 4 MPa young; 28 ± 9 MPa old). Marginal chordae (both anterior and posterior) had significantly higher (p < 0.05) value for their Youngs modulus in old (88 ± 21 MPa anterior and posterior) than in young (62 ± 17 MPa anterior, 59 ± 18 MPa posterior) pig hearts. There was no significant difference in structural stiffness between marginal and basal (anterior and posterior leaflets) or between strut chordae (that are associated with anterior the leaflet only) and marginal and basal chordae. However, the value of structural stiffness of chordae was significantly higher (p < 0.05) for old (2.2 ± 0.2 kN/m) than for young (2.0 ± 0.4 kN/m) chordae. These results show that aging affects the properties of chordae and that all chordae need to be included in finite element models of valve function.

Effect of mitral valve geometry on valve competence.

The aim of the investigation was to vary certain geometrical features of the mitral valve in vitro, in order to understand their role in valve function. Geometrical changes to mitral valve components are known to affect valve function, but complete understanding of how geometrical changes influence valve function is far from complete. Test apparatus has been used to apply pressure to porcine mitral valves. Porcine mitral valve specimens were tested both in their intact state and with a specific aspect of their geometry altered. The geometric parameters of the mitral valve varied were (1) the length between the papillary muscles and the mitral annulus (termed the annulo-papillary length), (2) the diameter of the left ventricle at the level of the papillary muscles, and (3) the mitral annular area. Six specimens were tested for each parameter investigated. A minimum annulo-papillary length was necessary to allow chordae tendineae to pull on the valve leaflets in order to prevent mitral valve failure; increasing this length further improved valve closure. Over the experimental range tested, left ventricular dilation at the level of the papillary muscles did not induce failure (P not significant). Increasing the mitral annular area was found to induce failure (P = 0.030 and P = 0.018 for medium and large annular diameters, respectively). The results demonstrate the importance of the geometry of mitral valve components on its function, and give insights into further experiments required to provide further understanding of the role of mitral valve geometry in its function. The results demonstrate that this in vitro method can be used to vary selected features of the geometry of the mitral valve.

Prediction of lubrication regimes in wrist implants with spherical bearing surfaces

The wrist joint is frequently affected by rheumatoid arthritis, resulting in wrist pain, deformity and ultimately loss of function. Artificial wrist implants have been introduced to treat the rheumatoid wrist, to attempt to alleviate pain and restore some function to the joint. The aim of this study was to predict the likely lubrication regimes that occur in wrist implants with spherical bearing surfaces. The implant was modelled as an equivalent ball-on-plane. Elastohydrodynamic lubrication theory was used to determine the minimum film thickness for the implant under different load, entraining velocity, lubricant viscosity, size of implant and material combinations. The results show that the highest film thickness is found in large implants, with high viscosity, high entraining velocity and low load. Hard-on-soft material combinations will operate with a boundary lubrication regime. Material combinations involving ceramic bearing surfaces have the potential to operate with a mixed lubrication regime.

The effect of the environment on the mechanical properties of medical grade silicones.

Silicone spacers have been in use as replacement joints in the human hand for over 30 years. Since they were first used there has been a number of designs all of which have had problems with fracture. This may be due to a defect in the material caused during implantation, or by bony intrusions within the arthritic hand after implantation. The aim of this research was to investigate the effect of the environment on the mechanical properties of medical grade silicones used for human implantation. The materials were subjected to static tensile testing after various forms of ageing. The environmental conditions included temperatures of 37 and 80 degrees C and the environments of Ringers solution, distilled water, and air. The environmental conditions employed resulted in reduced mechanical strength with ageing time of the silicones. This research supports the view that failure of silicone implants in the hand could be partly attributed to the effects of environmental ageing of the material.

Friction in metal-on-metal total disc arthroplasty: effect of ball radius.

Total disc arthroplasty (TDA) can be used to replace a degenerated intervertebral disc in the spine. There are different designs of prosthetic discs, but one of the most common is a ball-and-socket combination. Contact between the bearing surfaces can result in high frictional torque, which can then result in wear and implant loosening. This study was designed to determine the effects of ball radius on friction. Generic models of metal-on-metal TDA were manufactured with ball radii of 10, 12, 14 and 16 mm, with a radial clearance of 0.015 mm. A simulator was used to test each sample in flexion-extension, lateral bending and axial rotation at frequencies of 0.25, 0.5, 0.75, 1, 1.25, 1.5, 1.75 and 2 Hz under loads of 50, 600, 1200 and 2000 N, in new born calf serum. Frictional torque was measured and Stribeck curves were plotted to illustrate the lubrication regime in each case. It was observed that implants with a smaller ball radius showed lower friction and showed boundary and mixed lubrication regimes, whereas implants with larger ball radius showed boundary lubrication only. This study suggests designing metal-on-metal TDAs with ball radius of 10 or 12 mm, in order to reduce wear and implant loosening.

Development of a transient large strain contact method for biological heart valve simulations

A new 2D method to implement transient contact using Comsol Multiphysics (finite element analysis software that enables multiphysics simulations) is described, which is based on Hertzian contact. This method is compared to the existing (default) contact method that does not enable real transient simulations, but instead performs steady-state solutions where time is a constant. The two types of contact modelling have been applied to simple 2D biological heart valve models, undergoing strains in the region of 10% under 20 kPa pressure (applied over 0.3 s). Both the methods predicted comparable stress patterns, locations of peak stresses, deformations and directions of principal stress. The default contact method predicted slightly greater contact stresses, but spreads over a shorter surface length than the new contact method. The default contact method is useful for contact systems with little transient dependency, due to ease of use. However, where transient conditions are important the new contact method is preferred.

Effect of axial load on the flexural properties of an elastomeric total disc replacement.

Study Design. Twelve Cadisc-L devices were subjected to flexion (0°–6°) and extension (0° to −3°) motions at compressive loads between 500 N and 2000 N at a flexural rate between 0.25°/s and 3.0°/s. Objective. To quantify the change in flexural properties of the Cadisc-L (elastomeric device), when subjected to increasing magnitudes of axial load and at different flexural rates. Summary of Background Data. The design of motion preservation devices, used to replace degenerated intervertebral discs, is commonly based on a low-friction, ball-and-socket-articulating joint. Recently, elastomeric implants have been developed that attempt to provide mechanical and motion properties that resemble those of the natural disc more closely. Methods. Twelve Cadisc-L devices (MC-10 mm-9° and MC-10 mm-12° size) were supplied by Ranier Technology Ltd (Cambridge, United Kingdom). The devices were hydrated and tested using a Bose spinal disc-testing machine (Bose Corporation, ElectroForce Systems Group, Eden Prairie, MN) in Ringers solution at 37°C. A static load of 500 N was applied to a device and it was then subjected to motions of 0° to 6° to 0° (flexion) and 0° to −3° to 0° (extension) at a flexural rate of 0.25°/s, 0.5°/s, 1.0°/s, 1.5°/s, 2.0°/s, and 3.0°/s. Tests were repeated at 1000 N, 1500 N, and 2000 N. Results. Regression analyses showed a significant (R2 > 0.99, P < 0.05) linear increase in bending moment and flexural stiffness with flexion and extension angles (at 1000 N and higher loads)—a significant (R2 > 0.994, P < 0.05) linear decrease in flexural stiffness in flexion and extension as flexural rate increased. Conclusion. The bending moment of the Cadisc-L increased linearly with flexion and extension angles at 1000 N and higher loads. Flexural stiffness increased with compressive load but decreased with flexural rate.