Bioengineering

Research

14 pages, 1281 KiB

Open AccessArticle

Development and Validation of an Artificial Intelligence Preoperative Planning and Patient-Specific Instrumentation System for Total Knee Arthroplasty

by Songlin Li, Xingyu Liu, Xi Chen, Hongjun Xu, Yiling Zhang and Wenwei Qian

Bioengineering 2023, 10(12), 1417; https://doi.org/10.3390/bioengineering10121417 - 13 Dec 2023

Viewed by 1147

Abstract

Background: Accurate preoperative planning for total knee arthroplasty (TKA) is crucial. Computed tomography (CT)-based preoperative planning offers more comprehensive information and can also be used to design patient-specific instrumentation (PSI), but it requires well-reconstructed and segmented images, and the process is complex and [...] Read more.

Background: Accurate preoperative planning for total knee arthroplasty (TKA) is crucial. Computed tomography (CT)-based preoperative planning offers more comprehensive information and can also be used to design patient-specific instrumentation (PSI), but it requires well-reconstructed and segmented images, and the process is complex and time-consuming. This study aimed to develop an artificial intelligence (AI) preoperative planning and PSI system for TKA and to validate its time savings and accuracy in clinical applications. Methods: The 3D-UNet and modified HRNet neural network structures were used to develop the AI preoperative planning and PSI system (AIJOINT). Forty-two patients who were scheduled for TKA underwent both AI and manual CT processing and planning for component sizing, 20 of whom had their PSIs designed and applied intraoperatively. The time consumed and the size and orientation of the postoperative component were recorded. Results: The Dice similarity coefficient (DSC) and loss function indicated excellent performance of the neural network structure in CT image segmentation. AIJOINT was faster than conventional methods for CT segmentation (3.74 ± 0.82 vs. 128.88 ± 17.31 min, p < 0.05) and PSI design (35.10 ± 3.98 vs. 159.52 ± 17.14 min, p < 0.05) without increasing the time for size planning. The accuracy of AIJOINT in planning the size of both femoral and tibial components was 92.9%, while the accuracy of the conventional method in planning the size of the femoral and tibial components was 42.9% and 47.6%, respectively (p < 0.05). In addition, AI-based PSI improved the accuracy of the hip–knee–ankle angle and reduced postoperative blood loss (p < 0.05). Conclusion: AIJOINT significantly reduces the time needed for CT processing and PSI design without increasing the time for size planning, accurately predicts the component size, and improves the accuracy of lower limb alignment in TKA patients, providing a meaningful supplement to the application of AI in orthopaedics. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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13 pages, 2369 KiB

Open AccessArticle

Biomechanical and Biological Assessment of Polyglycelrolsebacate-Coupled Implant with Shape Memory Effect for Treating Osteoporotic Fractures

by Suzy Park, Su-Jeong Lee, Kwang-Min Park and Tae-Gon Jung

Bioengineering 2023, 10(12), 1413; https://doi.org/10.3390/bioengineering10121413 - 12 Dec 2023

Cited by 1 | Viewed by 994

Abstract

Poly(glycerol sebacate) is a biocompatible elastomer that has gained increasing attention as a potential biomaterial for tissue engineering applications. In particular, PGS is capable of providing shape memory effects and allows for a free form, which can remember the original shape and obtain [...] Read more.

Poly(glycerol sebacate) is a biocompatible elastomer that has gained increasing attention as a potential biomaterial for tissue engineering applications. In particular, PGS is capable of providing shape memory effects and allows for a free form, which can remember the original shape and obtain a temporary shape under melting point and then can recover its original shape at body temperature. Because these properties can easily produce customized shapes, PGS is being coupled with implants to offer improved fixation and maintenance of implants for fractures of osteoporosis bone. Herein, this study fabricated the OP implant with a PGS membrane and investigated the potential of this coupling. Material properties were characterized and compared with various PGS membranes to assess features such as control of curing temperature, curing time, and washing time. Based on the ISO 10993-5 standard, in vitro cell culture studies with C2C12 cells confirmed that the OP implant coupled with PGS membrane showed biocompatibility and biomechanical experiments indicated significantly increased pullout strength and maintenance. It is believed that this multifunctional OP implant will be useful for bone tissue engineering applications. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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11 pages, 1362 KiB

Open AccessArticle

Interactive Game-Based Platform System for Assessing and Improving Posture Control in the Elderly

by Pi-Chang Sun, Chen-Yang Kao, Chung-Lan Kao and Shun-Hwa Wei

Bioengineering 2023, 10(11), 1291; https://doi.org/10.3390/bioengineering10111291 - 8 Nov 2023

Cited by 1 | Viewed by 1115

Abstract

Inadequate response to balance perturbations lead to posture instability in the elderly. The fall risks are increased by a reduced capacity to control the center of pressure (COP) displacement within the safety limit of the supporting base. This study developed an interactive evaluation [...] Read more.

Inadequate response to balance perturbations lead to posture instability in the elderly. The fall risks are increased by a reduced capacity to control the center of pressure (COP) displacement within the safety limit of the supporting base. This study developed an interactive evaluation and training platform. The system incorporated a computerized program with instantaneous force plate evaluation. Ten young subjects underwent a baseline evaluation and twenty-nine community-dwelling elderly received pre- and post-intervention testing. The ability to reach the stability limit was assessed by measuring the maximum voluntary excursion of the COP in anterior–posterior and medial–lateral directions. Functional mobility tests including Berg Balance Scale, Timed-Up-and-Go and functional reach were used as functional outcomes. The experimental group (n = 15) received a 40 min intervention three times a week for six weeks. The interactive game-based training focused on multi-directional weight shifting by tracing a COPcontrolled target to challenge an individual’s stability limit. The control group (n = 14) maintained daily activities as usual. The young group revealed a superior COP displacement through active ankle control than the elderly, especially in the anterior–posterior direction. The experimental group improved their COP displacement control more in the medial–lateral direction due to the predominant side-to-side gameplay movement. The functional outcome measures were also significantly improved after training. Using the COPcontrolled game-based program, the stability limit was challenged to facilitate dynamic posture control by an incremental increase in self-initiated perturbations. The platform system could assist in transferring the immediate training effects into daily functional mobility in the elderly. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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15 pages, 4340 KiB

Open AccessArticle

Development and Validation of a Novel In Vitro Joint Testing System for Reproduction of In Vivo Dynamic Muscle Force

by Yangyang Yang, Yufan Wang, Nan Zheng, Rongshan Cheng, Diyang Zou, Jie Zhao and Tsung-Yuan Tsai

Bioengineering 2023, 10(9), 1006; https://doi.org/10.3390/bioengineering10091006 - 25 Aug 2023

Viewed by 990

Abstract

In vitro biomechanical experiments utilizing cadaveric specimens are one of the most effective methods for rehearsing surgical procedures, testing implants, and guiding postoperative rehabilitation. Applying dynamic physiological muscle force to the specimens is a challenge to reconstructing the environment of bionic mechanics in [...] Read more.

In vitro biomechanical experiments utilizing cadaveric specimens are one of the most effective methods for rehearsing surgical procedures, testing implants, and guiding postoperative rehabilitation. Applying dynamic physiological muscle force to the specimens is a challenge to reconstructing the environment of bionic mechanics in vivo, which is often ignored in the in vitro experiment. The current work aims to establish a hardware platform and numerical computation methods to reproduce dynamic muscle forces that can be applied to mechanical testing on in vitro specimens. Dynamic muscle loading is simulated through numerical computation, and the inputs of the platform will be derived. Then, the accuracy and robustness of the platform will be evaluated through actual muscle loading tests in vitro. The tests were run on three muscles (gastrocnemius lateralis, the rectus femoris, and the semitendinosus) around the knee joint and the results showed that the platform can accurately reproduce the magnitude of muscle strength (errors range from −6.2% to 1.81%) and changing pattern (goodness-of-fit range coefficient ranges from 0.00 to 0.06) of target muscle forces. The robustness of the platform is mainly manifested in that the platform can still accurately reproduce muscle force after changing the hardware combination. Additionally, the standard deviation of repeated test results is very small (standard ranges of hardware combination 1: 0.34 N~2.79 N vs. hardware combination 2: 0.68 N~2.93 N). Thus, the platform can stably and accurately reproduce muscle forces in vitro, and it has great potential to be applied in the future musculoskeletal loading system. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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8 pages, 1624 KiB

Open AccessArticle

Pullout Strength of Pedicle Screws Inserted Using Three Different Techniques: A Biomechanical Study on Polyurethane Foam Block

by Lien-Chen Wu, Yueh-Ying Hsieh, Fon-Yih Tsuang, Yi-Jie Kuo, Chia-Hsien Chen and Chang-Jung Chiang

Bioengineering 2023, 10(6), 660; https://doi.org/10.3390/bioengineering10060660 - 30 May 2023

Cited by 1 | Viewed by 2404

Abstract

Pullout strength is an important indicator of the performance and longevity of pedicle screws and can be heavily influenced by the screw design, the insertion technique and the quality of surrounding bone. The purpose of this study was to investigate the pullout strength [...] Read more.

Pullout strength is an important indicator of the performance and longevity of pedicle screws and can be heavily influenced by the screw design, the insertion technique and the quality of surrounding bone. The purpose of this study was to investigate the pullout strength of three different pedicle screws inserted using three different strategies and with two different loading conditions. Three pedicle screws with different thread designs (single-lead-thread (SLT) screw, dual-lead-thread (DLT) screw and mixed-single-lead-thread (MSLT) screw) were inserted into a pre-drilled rigid polyurethane foam block using three strategies: (A) screw inserted to a depth of 33.5 mm; (B) screw inserted to a depth of 33.5 mm and then reversed by 3.5 mm to simulate an adjustment of the tulip height of the pedicle screw and (C) screw inserted to a depth of 30 mm. After insertion, each screw type was set up with and without a cyclic load being applied to the screw head prior to the pullout test. To ensure that the normality assumption is met, we applied the Shapiro–Wilk test to all datasets before conducting the non-parametric statistical test (Kruskal–Wallis test combined with pairwise Mann–Whitney-U tests). All screw types inserted using strategy A had a significantly greater pullout strength than those inserted using strategies B and C, regardless of if the screw was pre-loaded with a cyclic load prior to testing. Without the use of the cyclic pre-load, the MSLT screw had a greater pullout strength than the SLT and DLT screws for all three insertion strategies. However, the fixation strength of all screws was reduced when pre-loaded before testing, with the MSLT screw inserted using strategy B producing a significantly lower pullout strength than all other groups (p < 0.05). In contrast, the MSLT screw using insertion strategies A and C had a greater pullout strength than the SLT and DLT screws both with and without pre-loading. In conclusion, the MSLT pedicle screw exhibited the greatest pullout strength of the screws tested under all insertion strategies and loading conditions, except for insertion strategy B with a cyclic pre-load. While all screw types showed a reduced pullout strength when using insertion strategy B (screw-out depth adjustment), the MSLT screw had the largest reduction in pullout strength when using a pre-load before testing. Based on these findings, during the initial screw insertion, it is recommended to not fully insert the screw thread into the bone and to leave a retention length for depth adjustment to avoid the need for screw-out adjustment, as with insertion strategy B. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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14 pages, 3648 KiB

Open AccessArticle

Larger Medial Contact Area and More Anterior Contact Position in Medial-Pivot than Posterior-Stabilized Total Knee Arthroplasty during In-Vivo Lunge Activity

by Diyang Zou, Jiaqi Tan, Nan Zheng, Zhi Ling, Wanxin Yu, Ming Han Lincoln Liow, Yunsu Chen and Tsung-Yuan Tsai

Bioengineering 2023, 10(3), 290; https://doi.org/10.3390/bioengineering10030290 - 23 Feb 2023

Cited by 1 | Viewed by 1836

Abstract

This study aimed to compare the in-vivo kinematics and articular contact status between medial-pivot total knee arthroplasty (MP-TKA) and posterior stabilized (PS) TKA during weight-bearing single-leg lunge. 16 MP-TKA and 12 PS-TKA patients performed bilateral single-leg lunges under dual fluoroscopy surveillance to determine [...] Read more.

This study aimed to compare the in-vivo kinematics and articular contact status between medial-pivot total knee arthroplasty (MP-TKA) and posterior stabilized (PS) TKA during weight-bearing single-leg lunge. 16 MP-TKA and 12 PS-TKA patients performed bilateral single-leg lunges under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The closest point between the surface models of the femoral condyle and the polyethylene insert was used to determine the contact position and area. The nonparametric statistics analysis was performed to test the symmetry of the kinematics between MP-TKA and PS-TKA. PS-TKA demonstrated a significantly greater range of AP translation than MP-TKA during high flexion (p = 0.0002). Both groups showed a significantly greater range of lateral compartment posterior translation with medial pivot rotation. The contact points of PS-TKA were located significantly more posterior than MP-TKA in both medial (10°–100°) and lateral (5°–40°, 55°–100°) compartments (p < 0.0500). MP-TKA had a significantly larger contact area in the medial compartment than in the lateral compartment. In contrast, no significant differences were observed in PS-TKA. The present study revealed no significant differences in clinical outcomes between the MP and PS groups. The PS-TKA demonstrated significantly more posterior translations than MP-TKA at high flexion. The contact points are located more posteriorly in PS-TKA compared with MP-TKA. A larger contact area and medial pivot pattern during high flexion in MP-TKA indicated that MP-TKA provides enhanced medial pivot rotation. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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Review

Jump to: Research, Other

19 pages, 2343 KiB

Open AccessReview

Gait Analysis to Monitor Fracture Healing of the Lower Leg

by Elke Warmerdam, Marcel Orth, Tim Pohlemann and Bergita Ganse

Bioengineering 2023, 10(2), 255; https://doi.org/10.3390/bioengineering10020255 - 15 Feb 2023

Cited by 5 | Viewed by 2337

Abstract

Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier [...] Read more.

Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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Other

Jump to: Research, Review

16 pages, 1581 KiB

Open AccessSystematic Review

Inconsistency in Shoulder Arthrometers for Measuring Glenohumeral Joint Laxity: A Systematic Review

by Eluana Gomes, Renato Andrade, Cristina Valente, J. Victor Santos, Jóni Nunes, Óscar Carvalho, Vitor M. Correlo, Filipe S. Silva, J. Miguel Oliveira, Rui L. Reis and João Espregueira-Mendes

Bioengineering 2023, 10(7), 799; https://doi.org/10.3390/bioengineering10070799 - 4 Jul 2023

Viewed by 1386

Abstract

There is no consensus on how to measure shoulder joint laxity and results reported in the literature are not well systematized for the available shoulder arthrometer devices. This systematic review aims to summarize the results of currently available shoulder arthrometers for measuring glenohumeral [...] Read more.

There is no consensus on how to measure shoulder joint laxity and results reported in the literature are not well systematized for the available shoulder arthrometer devices. This systematic review aims to summarize the results of currently available shoulder arthrometers for measuring glenohumeral laxity in individuals with healthy or injured shoulders. Searches were conducted on the PubMed, EMBASE, and Web of Science databases to identify studies that measure glenohumeral laxity with arthrometer-assisted assessment. The mean and standard deviations of the laxity measurement from each study were compared based on the type of population and arthrometer used. Data were organized according to the testing characteristics. A total of 23 studies were included and comprised 1162 shoulders. Populations were divided into 401 healthy individuals, 278 athletes with asymptomatic shoulder, and 134 individuals with symptomatic shoulder. Sensors were the most used method for measuring glenohumeral laxity and stiffness. Most arthrometers applied an external force to the humeral head or superior humerus by a manual-assisted mechanism. Glenohumeral laxity and stiffness were mostly assessed in the sagittal plane. There is substantial heterogeneity in glenohumeral laxity values that is mostly related to the arthrometer used and the testing conditions. This variability can lead to inconsistent results and influence the diagnosis and treatment decision-making. Full article

(This article belongs to the Special Issue Advanced Engineering Technology in Orthopaedic Research)

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