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Application of Computational Models in Optimizing Orthopedic Surgical Treatment

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A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biosignal Processing".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 22832

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Dr. Clare Fitzpatrick

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Guest Editor

Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA
Interests: finite element analysis; orthopaedics; knee; neuromuscular simulation; predictive models

Special Issue Information

Dear Colleagues,

Computational modeling is becoming an increasingly functional tool in the design of orthopedic devices and evaluation of prospective surgical treatment pathways. Historically, it has been difficult for orthopedic surgeons to rely on in silico models to guide clinical decisions. However, recent advances in automated algorithms to efficiently develop patient-specific models, experimental tools to support robust model validation, and increased computational power mean that simulations may offer clinical insight and guidance that is unfeasible to extract from clinical or experimental analyses.

This Special Issue of Bioengineering on “Application of Computational Models in Optimizing Orthopedic Surgical Treatment” will focus on the development and application of recent computational tools to assist with orthopedic problems. This includes but is not limited to preclinical tools to optimize new surgical devices, patient-specific pre-operative assessment of treatment, statistical shape models to understand surgical outcomes at the population scale, and intraoperative tools to assist with real-time decision making.

Dr. Clare Fitzpatrick
Guest Editor

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Keywords

computational modeling
rigid body musculoskeletal modeling
finite element analysis
patient-specific
statistical shape modeling
orthopedics
data-driven surgical treatment

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Published Papers (9 papers)

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12 pages, 2820 KiB

Open AccessArticle

Effect of Sextant Fixating Angle of Spiral Clavicle Plate on Biomechanical Stability—A Preliminary Finite Element Study

by Ming-Hsien Hu, Po-Feng Su, Kun-Jhih Lin, Wen-Chuan Chen and Shun-Ping Wang

Bioengineering 2024, 11(7), 713; https://doi.org/10.3390/bioengineering11070713 - 13 Jul 2024

Viewed by 1500

Abstract

Introduction: A spiral clavicle plate has been accepted for its superior multidirectional compatibility in the treatment of midshaft clavicle fractures from a biomechanical perspective. However, the influence of the sextant angle (spiral level) definition on biomechanical performance has not been clarified. A conceptual finite element analysis was conducted to identify the advantages and drawbacks of spiral clavicle plates with various sextant angle definitions. Methods: Conventional superior and three different conceptual spiral plates with sextant angle definitions ranging from 45 to 135 degrees were constructed to restore an OTA 15-B1.3 midshaft clavicle fracture model. Three major loading scenarios (cantilever downward bending, axial compression, and axial torsion) were simulated to evaluate the reconstructed structural stiffness and the stress on the clavicle plate and bone screws. Results: The spiral clavicle plate demonstrated greater capability in resisting cantilever downward bending with an increase in sextant angle and showed comparable structural stiffness and implant stress compared to the superior clavicle plate. However, weakened resistance to axial compression load was noted for the spiral clavicle plate, with lowered stiffness and increased stress on the clavicle plate and screws as the spiral level increased. Conclusion: The spiral clavicle plate has been reported to offer multidirectional compatibility for the treatment of midshaft clavicle fractures, as well as geometric advantages in anatomical matching and reduced skin prominence after surgery. The current study supports that remarkable cantilever bending strength can be achieved with this plate. However, users must consider the potential drawback of lowered axial compression resistance in safety considerations. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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11 pages, 1748 KiB

Open AccessArticle

Dynamic Acetabular Cup Orientation during Gait: A Study of Fast- and Slow-Walking Total Hip Replacement Patients

by Ksenija Vasiljeva, David Lunn, Graham Chapman, Anthony Redmond, Lin Wang, Jonathan Thompson, Sophie Williams, Ruth Wilcox and Alison Jones

Bioengineering 2024, 11(2), 151; https://doi.org/10.3390/bioengineering11020151 - 2 Feb 2024

Viewed by 1824

Abstract

The dynamic orientation of total hip replacement acetabular cups during walking may vary substantially from their assumed position at surgical implantation and may vary between individuals. The scale of this effect is of interest for both pre-clinical device testing and for pre-operative surgical planning. This work aimed to evaluate (1) patient variation in dynamic cup orientation; (2) whether walking speed was a candidate proxy measure for the dynamic cup orientation; and (3) the relationships between dynamic cup orientation angles and planar pelvic angles. Pelvic movement data for patients with fast (20 patients) and slow (19 patients) self-selected walking speeds were used to calculate acetabular cup inclination and version angles through gait. For aim 1, the range and extremes of acetabular cup orientation angles were analysed for all patients. A large patient-to-patient variation was found in the ranges of both inclination angle (1° to 11°) and version angle (4° to 18°). The version angle was typically retroverted in comparison to the implantation position (greatest deviation 27°). This orientation is substantially different to the static, 0° version, simplifying assumptions in pre-clinical ‘edge loading’ testing. For aim 2, the cup orientation angles were compared between the fast- and slow-walking groups using statistical parametric mapping. The only significant differences observed were for cup version angle, during ~12% of the gait cycle before toe-off (p < 0.05). Therefore, self-selected walking speed, in isolation, is not a sufficient proxy measure for dynamic acetabular orientation. For aim 3, correlations were recorded between the acetabular cup orientation angles and the planar pelvic angles. The cup inclination angle during gait was strongly correlated (Spearman’s coefficient −1) with pelvic obliquity alone, indicating that simple planar assessment could be used to anticipate inclination angle range. The cup version angle was correlated with both pelvic rotation and tilt (Spearman’s coefficient 0.8–1), indicating that cup version cannot be predicted directly from any single pelvic movement. This complexity, along with the interaction between inclination angle and range of version angle, supports the use of computational tools to aid clinical understanding. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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17 pages, 6124 KiB

Open AccessArticle

Instantaneous Generation of Subject-Specific Finite Element Models of the Hip Capsule

by Ahilan Anantha-Krishnan, Casey A. Myers, Clare K. Fitzpatrick and Chadd W. Clary

Bioengineering 2024, 11(1), 37; https://doi.org/10.3390/bioengineering11010037 - 28 Dec 2023

Cited by 1 | Viewed by 1865

Abstract

Subject-specific hip capsule models could offer insights into impingement and dislocation risk when coupled with computer-aided surgery, but model calibration is time-consuming using traditional techniques. This study developed a framework for instantaneously generating subject-specific finite element (FE) capsule representations from regression models trained with a probabilistic approach. A validated FE model of the implanted hip capsule was evaluated probabilistically to generate a training dataset relating capsule geometry and material properties to hip laxity. Multivariate regression models were trained using 90% of trials to predict capsule properties based on hip laxity and attachment site information. The regression models were validated using the remaining 10% of the training set by comparing differences in hip laxity between the original trials and the regression-derived capsules. Root mean square errors (RMSEs) in laxity predictions ranged from 1.8° to 2.3°, depending on the type of laxity used in the training set. The RMSE, when predicting the laxity measured from five cadaveric specimens with total hip arthroplasty, was 4.5°. Model generation time was reduced from days to milliseconds. The results demonstrated the potential of regression-based training to instantaneously generate subject-specific FE models and have implications for integrating subject-specific capsule models into surgical planning software. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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14 pages, 4298 KiB

Open AccessArticle

Screw Stress Distribution in a Clavicle Fracture with Plate Fixation: A Finite Element Analysis

by Angelo Alito, Domenico Fenga, Giada Tropeano, Demetrio Milardi, Danilo Leonetti, Alba Migliorato, Adriana Tisano, Danilo D’Andrea and Vincenzo Filardi

Bioengineering 2023, 10(12), 1402; https://doi.org/10.3390/bioengineering10121402 - 7 Dec 2023

Cited by 2 | Viewed by 2504

Abstract

Clavicle midshaft fractures are mostly treated surgically by open internal reduction with a superior or anteroinferior plate and screws or by intramedullary nailing. Screw positioning plays a critical role in determining the stress distribution. There is a lack of data on the screw position and the appropriate number of cortices required for plate fixation. The aim of this study is to evaluate the mechanical behavior of an anterior plate implanted in a fractured bone subjected to 120° of lateral elevation compared to a healthy clavicle using numerical simulations. Contact forces and moments used were obtained from literature data and applied to the healthy and fractured finite element models. Stresses of about 9 MPa were found on the healthy clavicle, while values of about 15 MPa were calculated on the plate of the fractured one; these stress peaks were reached at about 30° and 70° of elevation when the stress shielding on the clavicle sums all the three components of the solicitation: compression, flexion, and torsion. The stress distribution in a clavicle fracture stabilized with plates and screws is influenced by several factors, including the plate’s position and design, the type of screw, and the biomechanical forces applied during movements. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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12 pages, 2201 KiB

Open AccessArticle

Pre-Planning the Surgical Target for Optimal Implant Positioning in Robotic-Assisted Total Knee Arthroplasty

by Periklis Tzanetis, René Fluit, Kevin de Souza, Seonaid Robertson, Bart Koopman and Nico Verdonschot

Bioengineering 2023, 10(5), 543; https://doi.org/10.3390/bioengineering10050543 - 28 Apr 2023

Cited by 12 | Viewed by 3192

Abstract

Robotic-assisted total knee arthroplasty can attain highly accurate implantation. However, the target for optimal positioning of the components remains debatable. One of the proposed targets is to recreate the functional status of the pre-diseased knee. The aim of this study was to demonstrate the feasibility of reproducing the pre-diseased kinematics and strains of the ligaments and, subsequently, use that information to optimize the position of the femoral and tibial components. For this purpose, we segmented the pre-operative computed tomography of one patient with knee osteoarthritis using an image-based statistical shape model and built a patient-specific musculoskeletal model of the pre-diseased knee. This model was initially implanted with a cruciate-retaining total knee system according to mechanical alignment principles; and an optimization algorithm was then configured seeking the optimal position of the components that minimized the root-mean-square deviation between the pre-diseased and post-operative kinematics and/or ligament strains. With concurrent optimization for kinematics and ligament strains, we managed to reduce the deviations from 2.4 ± 1.4 mm (translations) and 2.7 ± 0.7° (rotations) with mechanical alignment to 1.1 ± 0.5 mm and 1.1 ± 0.6°, and the strains from 6.5% to lower than 3.2% over all the ligaments. These findings confirm that adjusting the implant position from the initial plan allows for a closer match with the pre-diseased biomechanical situation, which can be utilized to optimize the pre-planning of robotic-assisted surgery. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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13 pages, 8560 KiB

Open AccessArticle

Virtual Joint Motion Simulator Accurately Predicts Effects of Femoral Component Malalignment during TKA

by Liam Montgomery, Ryan Willing and Brent Lanting

Bioengineering 2023, 10(5), 503; https://doi.org/10.3390/bioengineering10050503 - 22 Apr 2023

Cited by 4 | Viewed by 2017

Abstract

Component alignment accuracy during total knee arthroplasty (TKA) has been improving through the adoption of image-based navigation and robotic surgical systems. The biomechanical implications of resulting component alignment error, however, should be better characterized to better understand how sensitive surgical outcomes are to alignment error. Thus, means for analyzing the relationships between alignment, joint kinematics, and ligament mechanics for candidate prosthesis component design are necessary. We used a digital twin of a commercially available joint motion simulator to evaluate the effects of femoral component rotational alignment. As anticipated, the model showed that an externally rotated femoral component results in a knee which is more varus in flexion, with lower medial collateral ligament tension compared to a TKA knee with a neutrally aligned femoral implant. With the simulation yielding logical results for this relatively simple test scenario, we can have more confidence in the accuracy of its predictions for more complicated scenarios. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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13 pages, 10136 KiB

Open AccessArticle

Biomechanical Investigation of Hallux Valgus Deformity Treated with Different Osteotomy Methods and Kirschner Wire Fixation Strategies Using the Finite Element Method

by Kao-Shang Shih, Ching-Chi Hsu and Guan-Ting Huang

Bioengineering 2023, 10(4), 499; https://doi.org/10.3390/bioengineering10040499 - 21 Apr 2023

Cited by 3 | Viewed by 4580

Abstract

The aim of this study was to propose a finite element method based numerical approach for evaluating various hallux valgus treatment strategies. We developed three-dimensional hallux valgus deformity models, with different metatarsal osteotomy methods and Kirschner wire fixation strategies, under two types of standing postures. Ten Kirschner wire fixations were analyzed and compared. The fixation stability, bone stress, implant stress, and contact pressure on the osteotomy surface were calculated as the biomechanical indexes. The results showed that the biomechanical indexes of the osteotomy and Kirschner wire fixations for hallux valgus deformity could be effectively analyzed and fairly evaluated. The distal metatarsal osteotomy method provided better biomechanical indexes compared to the proximal metatarsal osteotomy method. This study proposed a finite element method based numerical approach for evaluating various osteotomy and Kirschner wire fixations for hallux valgus deformity before surgery. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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17 pages, 4811 KiB

Open AccessArticle

Stress Distribution on Spinal Cord According to Type of Laminectomy for Large Focal Cervical Ossification of Posterior Longitudinal Ligament Based on Finite Element Method

by On Sim, Dongman Ryu, Junghwan Lee and Chiseung Lee

Bioengineering 2022, 9(10), 519; https://doi.org/10.3390/bioengineering9100519 - 2 Oct 2022

Cited by 9 | Viewed by 2810

Abstract

Most studies on the ossification of the posterior longitudinal ligament (OPLL) using the finite element method were conducted in the neutral state, and the resulting decompression was judged to be good. As these studies do not reflect the actual behavior of the cervical spine, this study conducted an analysis in the neutral state and a biomechanical analysis during flexion and extension behaviors. After validation via the construction of an intact cervical spine model, the focal OPLL model was inserted into the C4–C5 segment and a simulation was performed. The neutral state was shown by applying a fixed condition to the lower part of the T1 and Y-axis fixed condition of the spinal cord and simulating spinal cord compression with OPLL. For flexion and extension simulation, a ±30-degree displacement was additionally applied to the top of the C2 dens. Accordingly, it was confirmed that spinal cord decompression did not work well during the flexion and extension behaviors, but rather increased. Thus, if patients with focal OPLL inevitably need to undergo posterior decompression, additional surgery using an anterior approach should be considered. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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9 pages, 2632 KiB

Open AccessTechnical Note

Unbiased Method to Determine Articular Cartilage Thickness Using a Three-Dimensional Model Derived from Laser Scanning: Demonstration on the Distal Femur

by Valentina Campanelli and Maury L. Hull

Bioengineering 2024, 11(11), 1118; https://doi.org/10.3390/bioengineering11111118 - 6 Nov 2024

Viewed by 982

Abstract

Measuring articular cartilage thickness from 3D models developed from laser scans has the potential to offer high accuracy. However, this potential has not been fulfilled, since generating these models requires that the cartilage be removed, and previous methods of removal have led to systematic errors (i.e., bias) due to changes in the overall dimensions of the underlying bone. The objectives were to present a new method for removing articular cartilage, quantify the bias error, and demonstrate the method on the distal (i.e., 0° flexion) and posterior (i.e., 90° flexion) articular surfaces of example human femurs. The method consisted of creating a 3D articular cartilage model from high-accuracy (i.e., precision = 0.087 mm) laser scans before and after cartilage removal using dermestid beetles to remove the cartilage. Fiducial markers were used to minimize errors in registering surfaces generated from the two laser scans. To demonstrate the method, the cartilage thickness was computed in distal and posterior subregions of each femoral condyle for three example cadaveric specimens. The use of dermestid beetles did not introduce measurable bias, and the previously reported precision achieved in 3D cartilage models with the laser scanner was 0.13 mm. For the different subregions, the cartilage thickness ranged from 1.5 mm to 2.0 mm. A method of imaging by means of laser scanning, cartilage removal by means of dermestid beetles, and 3D model registration by means of fiducial markers ensured that cartilage thickness on the articular surface of the long bones of the knee was determined with negligible bias and a precision of 0.13 mm. With this method, the potential to measure cartilage thickness with high accuracy based on 3D models developed from laser scans can be fully realized. Full article

(This article belongs to the Special Issue Application of Computational Models in Optimizing Orthopedic Surgical Treatment)

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