J. Vander Sloten

Individualised, micro CT-based finite element modelling as a tool for biomechanical analysis related to tissue engineering of bone

Load-bearing tissues, like bone, can be replaced by engineered tissues or tissue constructs. For the success of this treatment, a profound understanding is needed of the mechanical properties of both the native bone tissue and the construct. Also, the interaction between mechanical loading and bone regeneration and adaptation should be well understood. This paper demonstrates that microfocus computer tomography (microCT) based finite element modelling (FEM) can have an important contribution to the field of functional bone engineering as a biomechanical analysis tool to quantify the stress and strain state in native bone tissue and in tissue constructs. Its value is illustrated by two cases: (1) in vivo microCT-based FEM for the analysis of peri-implant bone adaptation and (2) design of biomechanically optimised bone scaffolds. The first case involves a combined animal experimental and numerical study, in which the peri-implant bone adaptive response is monitored by means of in vivo microCT scanning. In the second case microCT-based finite element models were created of native trabecular bone and bone scaffolds and a mechanical analysis of both structures was performed. Procedures to optimise the mechanical properties of bone scaffolds, in relation to those of native trabecular bone are discussed.

Medical rapid prototyping applications and methods

Purpose – Aims to investigate medical rapid prototyping (medical RP) technology applications and methods based on reverse engineering (RE) and medical imaging data.Design/methodology/approach – Medical image processing and RE are applied to construct three‐dimensional models of anatomical structures, from which custom‐made (personalized) medical applications are developed.Findings – The investigated methods were successfully used for design and manufacturing of biomodels, surgical aid tools, implants, medical devices and surgical training models. More than 40 medical RP applications were implemented in Europe and Asia since 1999.Research limitations/implications – Medical RP is a multi‐discipline area. It involves in many human resources and requires high skills and know‐how in both engineering and medicine. In addition, medical RP applications are expensive, especially for low‐income countries. These practically limit its benefits and applications in hospitals.Practical implications – In order to transfe...

Accuracy assessment of CT-based outer surface femur meshes

Objectives: Computer-aided bone surgery planning and implant design applications require accurate and compact representations of the patients bone. The accuracy of bone segmentation from medical images has been studied extensively, with each study using a specific ground truth and a specific type and number of accuracy measurements. However, for convenience and practical reasons these three specifications have always been limited. The goal of this study is to thoroughly assess the absolute 3D accuracy of CT-based bone outer surface meshes, using femora as the examples. Materials and Methods: Using dense and very accurate optical surface scans of 15 dried femora as an absolute ground truth, this paper reports on the absolute 3D geometric accuracy of triangulated bone outer surface meshes, which were segmented from the CT scans of the corresponding formalin-fixed intact cadaver specimens using the authors previously presented contour-based segmentation algorithm on the one hand, and the commercially available Mimics® software (Materialise N.V., Leuven, Belgium) on the other. The study incorporates the effect of soft tissue presence on hard tissue segmentation and simultaneously reveals the accuracy shift introduced as a result of boiling the cadaver bones by processing extra CT scans of the dried bones. Results: The presented study demonstrates that, when using the optimal parameter settings for the respective segmentation procedures, sub-voxel mesh accuracies can be attained. Compact surface representations of femora can be generated with mean absolute accuracies of up to one fifth of the voxel size and Root Mean Square (RMS) error of half the voxel size. Conclusions: The 3D accuracy of the contour-based segmentation previously presented by the author makes it most suitable for generating outer bone surface meshes for use in the aforementioned applications. The optimal parameter settings for this segmentation procedure have been identified. For the Mimics® bone surface meshes, a single, but excellent, pre-defined set of parameters was identified.

Design for medical rapid prototyping of cranioplasty implants

Design methods for medical rapid prototyping (RP) of personalized cranioplasty implants are presented in this paper. These methods are applicable to model cranioplasty implants for all types of the skull defects including beyond‐midline and multiple defects. The methods are based on two types of anatomical data, solid bone models (STereoLithography files – STL) and bone slice contours (Initial Graphics Exchange Specification – IGES and StrataSys Layer files – SSL). The bone solids and contours are constructed based on computed tomography scanning data, and these data are generated in medical image processing and STL slicing packages.

Connecting biology and mechanics in fracture healing: an integrated mathematical modeling framework for the study of nonunions

Both mechanical and biological factors play an important role in normal as well as impaired fracture healing. This study aims to provide a mathematical framework in which both regulatory mechanisms are included. Mechanics and biology are coupled by making certain parameters of a previously established bioregulatory model dependent on local mechanical stimuli. To illustrate the potential added value of such a framework, this coupled model was applied to investigate whether local mechanical stimuli influencing only the angiogenic process can explain normal healing as well as overload-induced nonunion development. Simulation results showed that mechanics acting directly on angiogenesis alone was not able to predict the formation of overload-induced nonunions. However, the direct action of mechanics on both angiogenesis and osteogenesis was able to predict overload-induced nonunion formation, confirming the hypotheses of several experimental studies investigating the interconnection between angiogenesis and osteogenesis. This study shows that mathematical models can assist in testing hypothesis on the nature of the interaction between biology and mechanics.

Finite element study of trochanteric gamma nail for trochanteric fracture

A three-dimensional finite element study of trochanteric fracture fixation by a trochanteric gamma nail (TGN) was investigated in this study. The analyses were performed under one-legged stance load boundary conditions to study the stress distribution and displacements. The influence of material properties (E-modulus) of the implant, the bone and contact condition in the fracture zone was determined. The results show that the stresses in the implant were lower in case of titanium alloy implant material but at the same time higher displacements occurred. The results also indicate that the stresses in the TGN gradually reduced throughout the healing process of the bone in the fracture zone.

In silico biology of bone modelling and remodelling: regeneration

Bone regeneration is the process whereby bone is able to (scarlessly) repair itself from trauma, such as fractures or implant placement. Despite extensive experimental research, many of the mechanisms involved still remain to be elucidated. Over the last decade, many mathematical models have been established to investigate the regeneration process in silico. The first models considered only the influence of the mechanical environment as a regulator of the healing process. These models were followed by the development of bioregulatory models where mechanics was neglected and regeneration was regulated only by biological stimuli such as growth factors. The most recent mathematical models couple the influences of both biological and mechanical stimuli. Examples are given to illustrate the added value of mathematical regeneration research, specifically in the in silico design of treatment strategies for non-unions. Drawbacks of the current continuum-type models, together with possible solutions in extending the models towards other time and length scales are discussed. Finally, the demands for dedicated and more quantitative experimental research are presented.

Development of an above-knee prosthesis equipped with a microcomputer-controlled knee joint : first test results

The shortcomings of conventional above-knee prostheses are due to their lack of adaptive control. Implementation of a microcomputer controlling the knee joint in a passive way has been suggested to enhance the patients gait comfort, safety and cosmesis. This approach was used in the design of a new prosthetic system for the above-knee amputee, and tested on one patient. The knee joint of a conventional, modular prosthesis was replaced by a knee joint mechanism, equipped with a controllable brake on the knee joint axis. Sensors and a microcomputer were added, keeping the system self-contained. The modularity of the design permits the use of an alternative, external, PC-based control unit, emulating the self-contained one, and offering extended data monitoring and storage facilities. For both units an operating environment was written, including sensor/actuator interfacing and the implementation of a real-time interrupt, executing the control algorithm. A double finite state approach was used in the design of the control algorithm. On a higher level, the mode identification algorithm reveals the patients intent. Within a specific mode (lower level), the relevant mode control algorithm looks for the current phase within the gait cycle. Within a particular phase, a specific simple control action with the brake replaces normal knee muscle activity. Tests were carried out with one prosthetic patient using a basic control algorithm for level walking, allowing controlled knee flexion during stance phase. The technical feasibility of such a concept is illustrated by the test results, even though only flexion during early stance phase was controlled during the trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Adhesion of new bioactive glass coating.

A valuable alternative to the existing biomedical implant coatings is a bioactive glass (BAG) coating that is produced by reactive plasma spraying. A mechanical performance requirement that is of the utmost importance is the adhesion strength of the coating. Considering the application as dental implant, a new adhesion test (shear test), which was close to the service conditions, was designed. A Ti6Al4V rod (3 mm) with a sprayed BAG coating of 50 microm was glued with an epoxy glue to a hollow cylindrical counterpart and was used as such in the tensile machine. This test was evaluated by finite element analysis (FEA). Preliminary experiments showed that a conversion from shear to tensile adhesion strength is possible by using the Von Mises criterion (sigma = 3(1/2)tau), indicating that thin coatings of brittle materials can behave as a ductile material. The new coating technique was proved to produce a high quality coating with an adhesion strength of 40.1 +/- 4.8 MPa in shear and 69.4 +/- 8.4 MPa in tension. The FEA revealed that no one homogeneously distributed shear stress is present but several nonhomogeneously distributed stress components (shear and tensile) are present in the coating. This analysis indicated that real service conditions are much more complicated than standard adhesion tests.

Semi-automated segmentation and visualisation of outer bone cortex from medical images

Good segmentation of the outer bone cortex from medical images is a prerequisite for applications in the field of finite element analysis, surgical planning environments and personalised, case dependent, bone reconstruction. However, current segmentation procedures are often unsatisfactory. This study presents an automated filter procedure to generate a set of adapted contours from which a surface mesh can be deduced directly. The degree of interaction is user determined. The bone contours are extracted from the patients CT data by quick grey value segmentation. An extended filter procedure then only retains contour information representing the outer cortex as more specific internal loops and shape irregularities are removed, tailoring the image for the above-mentioned applications. The developed medical image based design methodology to convert contour sets of multiple bone types, from tibia tumour to neurocranium, is reported and discussed.