Changes in Joint Contact Mechanics in a Large Quadrupedal Animal Model After Partial Meniscectomy and a Focal Cartilage Injury.

Acute mechanical damage and the resulting joint contact abnormalities are central to the initiation and progression of post-traumatic osteoarthritis (PTOA). Study of PTOA is typically performed in vivo with replicate animals using artificially induced injury features. The goal of this work was to measure changes in a joint contact stress in the knee of a large quadruped after creation of a clinically realistic overload injury and a focal cartilage defect. Whole-joint overload was achieved by excising a 5-mm wedge of the anterior medial meniscus. Focal cartilage defects were created using a custom pneumatic impact gun specifically developed and mechanically characterized for this work. To evaluate the effect of these injuries on joint contact mechanics, Tekscan (Tekscan, Inc., South Boston, MA) measurements were obtained pre-operatively, postmeniscectomy, and postimpact (1.2-J) in a nonrandomized group of axially loaded cadaveric sheep knees. Postmeniscectomy, peak contact stress in the medial compartment is increased by 71% (p = 0.03) and contact area is decreased by 35% (p = 0.001); the center of pressure (CoP) shifted toward the cruciate ligaments in both the medial (p = 0.004) and lateral (p = 0.03) compartments. The creation of a cartilage defect did not significantly change any aspect of contact mechanics measured in the meniscectomized knee. This work characterizes the mechanical environment present in a quadrupedal animal knee joint after two methods to reproducibly induce joint injury features that lead to PTOA.

Protrusio After Medial Acetabular Wall Breach in Total Hip Arthroplasty.

BACKGROUND: Medial protrusio is a recognized complication of total hip arthroplasty, but it is not known if a medial wall breach during cup implantation increases the risk. We thus investigated the effect of up to a 2 cm defect in the medial acetabular wall in a cadaveric model. Separately, we investigated the ability of acetabular screws to rescue the construct. METHODS: Nine human fresh-frozen hemipelves were reamed medially to create the defect, implanted with acetabular cups, and then loaded to failure. The nine contralateral hemipelves were reamed in a standard fashion and served as controls. Separately, nine hemipelves with a medial defect were augmented with two acetabular screws each, then loaded to failure, with the contralateral side as a control. Load-to-failure, stiffness, and energy were recorded. FINDINGS: The presence of a medial wall defect decreased the load-to-failure by a mean of 26% (5710 v. 4221 N, p=0.024). The addition of two acetabular screws did not rescue the construct (mean 27% decrease, 4082 v. 2985 N, p=0.024). The majority of specimens failed in a supra-physiologic range of force. Bone density correlated with failure loads (R(2) range of 0.54-0.78), and osteoporotic specimens were more likely to fail at a physiologic range, consistent with forces experienced during minor stumbles or falls. INTERPRETATION: Osteoporotic patients with a medial wall defect after hip arthroplasty may be susceptible to fracture during activities of daily living. Protected weight bearing with an assistive device may be reasonable in order to minimize fall risk until cup ingrowth is achieved.

Bearing-Foreign Material Deposition on Retrieved Co-Cr Femoral Heads: Composition and Morphology.

Bearing-foreign material deposition onto a femoral head can occur from contact with an acetabular shell due to dislocation, reduction, or subluxation. The purpose of this study was to comprehensively characterize deposit regions on retrieved cobalt-chrome femoral heads from metal-on-polyethylene total hip arthroplasties that had experienced such adverse events. The morphology, topography, and composition of deposition regions were characterized using macrophotography, optical profilometry, scanning electron microscopy, energy dispersive spectroscopy, and X-ray photoelectron spectroscopy. The deposit areas were relatively large, they were much rougher than the surrounding undamaged clean areas, and they displayed several distinct morphologies. Titanium alloy elements were the predominant constituents. Calcium and phosphorous were also detected within the deposit areas, in a composition that could nucleate abrasive hydroxyapatite. In addition, tungsten-rich particles, likely present as tungsten carbide, were observed on top of the titanium deposits. The increased roughness associated with these deposition features would be expected to accelerate damage and wear of the opposing liner and hence accelerate the development of osteolysis.

A novel formulation for scratch-based wear modelling in total hip arthroplasty.

Damage to the femoral head in total hip arthroplasty often takes the form of discrete scratches, which can lead to dramatic wear acceleration of the polyethylene (PE) liner. Here, a novel formulation is reported for finite element (FE) analysis of wear acceleration due to scratch damage. A diffused-light photography technique was used to globally locate areas of damage, providing guidance for usage of high-magnification optical profilometry to determine individual scratch morphology. This multiscale image combination allowed comprehensive input of scratch-based damage patterns to an FE Archard wear model, to determine the wear acceleration associated with specific retrieval femoral heads. The wear algorithm imposed correspondingly elevated wear factors on areas of PE incrementally overpassed by individual scratches. Physical validation was provided by agreement with experimental data for custom-ruled scratch patterns. Illustrative wear acceleration results are presented for four retrieval femoral heads.

Encoding scratch and scrape features for wear modeling of total joint replacements.

Damage to hard bearing surfaces of total joint replacement components typically includes both thin discrete scratches and broader areas of more diffuse scraping. Traditional surface metrology parameters such as average roughness (R a) or peak asperity height (R p) are not well suited to quantifying those counterface damage features in a manner allowing their incorporation into models predictive of polyethylene wear. A diffused lighting technique, which had been previously developed to visualize these microscopic damage features on a global implant level, also allows damaged regions to be automatically segmented. These global-level segmentations in turn provide a basis for performing high-resolution optical profilometry (OP) areal scans, to quantify the microscopic-level damage features. Algorithms are here reported by means of which those imaged damage features can be encoded for input into finite element (FE) wear simulations. A series of retrieved clinically failed implant femoral heads analyzed in this manner exhibited a wide range of numbers and severity of damage features. Illustrative results from corresponding polyethylene wear computations are also presented.

MRI-apparent localized deformation of the median nerve within the carpal tunnel during functional hand loading.

In MR images, the median nerve of carpal tunnel syndrome (CTS) patients frequently appears flatter than in healthy subjects. The purpose of this work was to develop a metric to quantify localized median nerve deformation rather than global nerve flattening, the hypothesis being that localized median nerve deformation would be elevated in CTS patients. Twelve patients with CTS and 12 matched normals underwent MRI scanning in eight isometrically loaded hand conditions. 2D cross sections of the proximal and distal tunnel were analyzed for nerve cross sectional area, flattening ratio, and a position shift to the dorsal side of the tunnel. Additionally, new metrics based on the angulation of the nerve perimeter in 0.5-mm lengths around the boundary were calculated. The localized deformation metrics were able to detect differences between CTS patients and healthy subjects that could not be appreciated from the flattening ratio. During most hand activities, normal subjects had a higher average percentage of locally deformed nerve boundary than did CTS patients, despite having a rounder overall shape. Less local nerve deformation in the CTS patient group resulting from its interaction with flexor tendons suggests that the nerve may be less compliant in CTS patients.

Enhancing damage visibility on metallic bearing surfaces: a simple technique for photography and viewing.

Damage to metallic bearing surfaces typically involves scratches, scrapes, metal transfer, and organic deposits. This damage can cause accelerated wear of the opposing surface and subsequent implant failure. Photography and viewing of metallic bearing surfaces, for documenting this damage, are hindered by optical reflectivity. This note demonstrates a simple, practical technique for metallic bearing surface photography and viewing that minimizes this reflectivity problem, that does not involve any modification of the bearing surface, and that allows for improved observation and documentation of overall damage. When the metallic bearing surface is placed within a tube of translucent material, the appearance of damage on that bearing surface is dramatically enhanced, showing up against a smooth, even background with excellent contrast and with fine detail achievable.

Volar/dorsal compressive mechanical behavior of the transverse carpal ligament.

Mechanical insult to the median nerve caused by contact with the digital flexor tendons and/or carpal tunnel boundaries may contribute to the development of carpal tunnel syndrome. Since the transverse carpal ligament (TCL) comprises the volar boundary of the carpal tunnel, its mechanics in part govern the potential insult to the median nerve. Using unconfined compression testing in combination with a finite element-based optimization process, nominal stiffness measurements and first-order Ogden hyperelastic material coefficients (µ and α ) were determined to describe the volar/dorsal compressive behavior of the TCL. Five different locations on the TCL were tested, three of which were deep to the origins of the thenar and hypothenar muscles. The average (± standard deviation) low-strain and high-strain TCL stiffness values in compression sites outside the muscle attachment region were 3.6 N/mm (±2.7) and 28.0 N/mm (±20.2), respectively. The average stiffness values at compression sites with muscle attachments were notably lower, with low-strain and high-strain stiffness values of 1.2 N/mm (±0.5) and 9.7 N/mm (±4.8), respectively. The average Ogden coefficients for the muscle attachment region were 51.6 kPa (±16.5) for µ and 16.5 (±2.0) for α, while coefficients for the non-muscle attachment region were 117.8 kPa (±86.8) for µ and 17.2 (±1.6) for α. These TCL compressive mechanical properties can help inprove computational models, which can be used to provide insight into the mechanisms of median nerve injury leading to the onset of carpal tunnel syndrome symptoms.

Mechanical behavior of carpal tunnel subsynovial connective tissue under compression.

Subsynovial connective tissue (SSCT) is a fluid-permeated loose connective tissue that occupies the majority of the space in the carpal tunnel not occupied by the digital flexor tendons or the median nerve. It is arranged in layers around these more discrete structures, presumably to assist with tendon gliding. As a result of this arrangement, the compressive behavior and the fluid permeability of this tissue may substantially affect the stresses in the median nerve resulting from contact with its neighboring tendons or with the walls of the tunnel itself. These stresses may contribute to damage of the median nerve and the development of carpal tunnel syndrome. In this study, the fluid permeability and the compressive behavior of the SSCT were investigated to better understand the mechanics of this tissue and how it may mediate mechanical insult to the median nerve. A custom experimental apparatus was built to allow simultaneous measurement of tissue compression and fluid flow. Using Darcy's law, the average SSCT fluid permeability was 8.78×10(15) m(4)/Ns. The compressive behavior of the SSCT demonstrated time dependence, with an initial modulus of 395kPa gradually decreasing to a value of 285kPa. These baseline tissue data may serve as a mechanical norm (toward which pathological tissue might be returned, therapeutically) and may serve as essential properties to include in future mechanical models of the carpal tunnel.

Organ-level histological and biomechanical responses from localized osteoarticular injury in the rabbit knee.

The processes of whole-joint osteoarthritis development following localized joint injuries are not well understood. To demonstrate this local-to-global linkage, we hypothesized that a localized osteoarticular injury in the rabbit knee would not only cause biomechanical and histological abnormalities in the involved compartment but also concurrent histological changes in the noninvolved compartment. Twenty rabbits had an acute osteoarticular injury that involved localized joint incongruity (a 2-mm osteochondral defect created in the weight-bearing area of the medial femoral condyle), while another 20 received control sham surgery. At the time of euthanasia at 8 or 16 weeks post-surgery, the experimental knees were subjected to sagittal-plane laxity measurement, followed by cartilage histo-morphological evaluation using the Mankin score. The immediate effects of defect creation on joint stability and contact mechanics were explored in concomitant rabbit cadaver experimentation. The injured animals had cartilage histological scores significantly higher than in the sham surgery group (p < 0.01) on the medial femoral, medial tibial, and lateral femoral surfaces (predominantly on the medial surfaces), accompanied by slight (mean 20%) increase of sagittal-plane laxity. Immediate injury-associated alterations in the medial compartment contact mechanics were also demonstrated. Localized osteoarticular injury in this survival animal model resulted in global joint histological changes.

Traveling-load calibration of grid-array transient contact stress sensors.

Thin, pliant transducers with grid arrays of sensing elements (sensels) have been widely used for transient measurements of intra-articular contact stresses. Conventional calibration procedures for this class of sensors are based upon spatially uniform scaling of sensel output values so as to recover two known fiducial loads, physically applied with the sensor either compressed between platens or mounted in situ. Because of the nonlinearities involved, it is desirable to have the highest of those two calibration loadings be such that all individual sensels are engaged at/near the peak of their expected functional range. However, for many situations of practical interest, impracticably large total calibration forces would be required. We report development of a novel pneumatically actuated wringer-like calibration device, and companion iterative post-processing software, that bypasses this longstanding difficulty. Sensors passed through the rollers of this device experience constant-distribution traveling fiducial loads propagating across their surface, thus allowing efficient calibration of all sensels individually to contact stress levels that would be impracticably high to simultaneously apply to all sensels. Sensel-specific calibration curves are rapidly and easily generated using this new approach and compare favorably to those obtained with less expeditious conventional platen-based protocols.

Compliance-dependent load allocation between sensing versus non-sensing portions of a sheet-array contact stress sensor.

Piezoresistive array pressure sensors are widely used in orthopaedic research to determine contact stress distributions across articular joint surfaces. Experience with such sensors has shown there can be inaccuracies in how the sensor perceives applied load, depending on the material stiffnesses between which it is compressed experimentally, versus in calibration. A study was undertaken to quantify the relationship between load perception of one such sensor design (Tekscan) and the stiffness of the materials between which it is compressed. A three-dimensional finite element model of a 3x3 sensel portion of the sensing matrix was formulated, along with a layer of compression test material on each side of the sensor. The elastic modulus of the test material was varied across the range representative of cartilage (12 MPa) to hard plastic (10 GPa). Using the computed contact pressure results between contacting surfaces of the sensor layers, the percentage of load passing through the active conductor intersections was determined. The results revealed that with increase of the elastic modulus of the material between which the sensor was compressed, the percentage of load on the active conductor intersections increased monotonically. The highest sensitivity of perceived loading to test material modulus (0.1%/MPa) was seen at the low end of the modulus range. The more compliant the test material, the more the sensor layers conformed around each other's geometric incongruities, the larger the true contact areas, and the higher the fraction of the total load that passed through the intermediate (non-sensing) regions between the conductors.

Individual flexor tendon identification within the carpal tunnel: A semi-automated analysis method for serial cross-section MR images.

Carpal tunnel syndrome is commonly viewed as resulting from chronic mechanical insult of the median nerve by adjacent anatomical structures. Both the median nerve and its surrounding soft tissue structures are well visualized on magnetic resonance (MR) images of the wrist and hand. Addressing nerve damage from impingement of flexor digitorum tendons co-occupying the tunnel is attractive, but to date has been restricted by lack of means for making individual identifications of the respective tendons. In this image analysis work, we have developed a region-growing method to positively identify each individual digital flexor tendon within the carpal tunnel by tracking it from a more distal MR section where the respective tendon identities are unambiguous. Illustratively, the new method was applied to MRI scans from four different subjects in a variety of hand poses. Conventional shape measures yielded less discriminatory information than did evaluations of individual tendon location and arrangement. This new method of rapid identification of individual tendons will facilitate analysis of tendon/nerve interactions within the tunnel, thereby providing better information about mechanical insult of the median nerve.

Sliding direction dependence of polyethylene wear for metal counterface traverse of severe scratches.

Third-body effects appear to be responsible for an appreciable portion of the wear rate variability within cohorts of patients with metal-on-polyethylene joint replacements. The parameters dominating the rate of polyethylene debris liberation by counterface scratches are not fully understood, but one seemingly contributory factor is the scratch's orientation relative to the direction of instantaneous local surface sliding. To study this influence, arrays of 550 straight parallel scratches each representative of the severe end of the clinical range were diamond stylus-ruled onto the surface of polished stainless steel plates. These ruled plates were then worn reciprocally against polyethylene pins (both conventional and highly cross-linked) at traverse angles varied parametrically relative to the scratch direction. Wear was measured gravimetrically, and particulate debris was harvested and morphologically characterized. Both of the polyethylene variants tested showed pronounced wear rate peaks at acute scratch traverse angles (15 deg for conventional and 5 deg for cross-linked), and had nominally comparable absolute wear rate magnitudes. The particulate debris from this very aggressive test regime primarily consisted of extremely large and elongated strands, often tens or even hundreds of microns in length. These data suggest that counterface damage regions with preferential scratch directionality can liberate large amounts of polyethylene debris, apparently by a slicing/shearing mechanism, at critical (acute) attack angles. However, the predominant manifestation of this wear volume was in the form of particles far beyond the most osteolytically potent size range.

Field variable associations with scratch orientation dependence of UHMWPE wear: a finite element analysis.

Scratches on the metal bearing surface of metal-on-polyethylene total joint replacements have been found to appreciably accelerate abrasive/adhesive wear of polyethylene, and constitute a source of the considerable variability of wear rate seen within clinical cohorts. Scratch orientation with respect to the local direction of relative surface sliding is presumably a factor affecting instantaneous debris liberation during articulation. A three-dimensional local finite element model was developed, of orientation-specific polyethylene articulation with a scratched metal counterface, to explore continuum-level stress/strain parameters potentially correlating with the orientation dependence of scratch wear in a corresponding physical experiment. Computed maximum stress values exceeded the yield strength of ultra-high molecular weight polyethylene (UHMWPE) for all scratch orientations but did not vary appreciably among scratch orientations. Two continuum-level parameters judged most consistent overall with the direction dependence of experimental wear were (1) cumulative compressive total normal strain in the direction of loading, and (2) maximum instantaneous compressive total normal strain transverse to the sliding direction. Such stress/strain metrics could be useful in global computational models of wear acceleration, as surrogates to incorporate anisotropy of local metal surface roughening.

Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface.

In total joint arthroplasty, third body particle access to the articulating surfaces results in accelerated wear. Hip joint subluxation is an under-recognized means by which third body particles could potentially enter the otherwise closely conforming articular bearing space. The present study was designed to test the hypothesis that, other factors being equal, even occasional events of femoral head subluxation greatly increase the number of third body particles that enter the bearing space and become embedded in the acetabular liner, as compared to level-walking cycles alone. Ten metal-on-polyethylene hip joint head-liner pairs were tested in a multi-axis joint motion simulator, with CoCrMo third body particles added to the synovial fluid analog. All component pairs were tested for 2h of level walking; half were also subjected to 20 intermittent subluxation events. The number and location of embedded particles on the acetabular liners were then determined. Subluxation dramatically increased the number of third body particles embedded in the acetabular liners, and it considerably increased the amount of scratch damage on the femoral heads. Since both third body particles and subluxation frequently occur in contemporary total hip arthroplasty, their potent synergy needs to be factored prominently into strategies to minimize wear.

The apparent critical isotherm for cryoinsult-induced osteonecrotic lesions in emu femoral heads.

Cryoinsult-induced osteonecrosis (ON) in the emu femoral head provides a unique opportunity to systematically explore the pathogenesis of ON in an animal model that progresses to human-like femoral head collapse. Among the various characteristics of cryoinsult, the maximally cold temperature attained is one plausible determinant of tissue necrosis. To identify the critical isotherm required to induce development of ON in the cancellous bone of the emu femoral head, a thermal finite element (FE) model of intraoperative cryoinsults was developed. Thermal material property values of emu cancellous bone were estimated from FE simulations of cryoinsult to emu cadaver femora, by varying model properties until the FE-generated temperatures matched corresponding thermocouple measurements. The resulting FE model, with emu bone-specific thermal properties augmented to include blood flow effects, was then used to study intraoperatively performed in vivo cryoinsults. Comparisons of minimum temperatures attained at FE nodes corresponding to the three-dimensional histologically apparent boundary of the region of ON were made for six experimental cryoinsults. Series-wide, a critical isotherm of 3.5 degrees C best corresponded to the boundary of the osteonecrotic lesions.

Hip joint contact force in the emu (Dromaius novaehollandiae) during normal level walking.

The emu is a large, (bipedal) flightless bird that potentially can be used to study various orthopaedic disorders in which load protection of the experimental limb is a limitation of quadrupedal models. An anatomy-based analysis of normal emu walking gait was undertaken to determine hip contact forces for comparison with human data. Kinematic and kinetic data captured for two laboratory-habituated emus were used to drive the model. Muscle attachment data were obtained by dissection, and bony geometries were obtained by CT scan. Inverse dynamics calculations at all major lower-limb joints were used in conjunction with optimization of muscle forces to determine hip contact forces. Like human walking gait, emu ground reaction forces showed a bimodal distribution over the course of the stance phase. Two-bird averaged maximum hip contact force was approximately 5.5 times body weight, directed nominally axially along the femur. This value is only modestly larger than optimization-based hip contact forces reported in literature for humans. The interspecies similarity in hip contact forces makes the emu a biomechanically attractive animal in which to model loading-dependent human orthopaedic hip disorders.

Effects of implant design parameters on fluid convection, potentiating third-body debris ingress into the bearing surface during THA impingement/subluxation.

Aseptic loosening from polyethylene wear debris is the leading cause of failure for metal-on-polyethylene total hip implants. Third-body debris ingress to the bearing space results in femoral head roughening and acceleration of polyethylene wear. How third-body particles manage to enter the bearing space between the closely conforming articulating surfaces of the joint is not well understood. We hypothesize that one such mechanism is from convective fluid transport during subluxation of the total hip joint. To test this hypothesis, a three-dimensional (3D) computational fluid dynamics (CFD) model was developed and validated, to quantify fluid ingress into the bearing space during a leg-cross subluxation event. The results indicated that extra-articular joint fluid could be drawn nearly to the pole of the cup with even very small separations of the femoral head (<0.60mm). Debris suspended near the equator of the cup at the site of maximum fluid velocity just before the subluxation began could be transported to within 11 degrees from the cup pole. Larger head diameters resulted in increased fluid velocity at all sites around the entrance to the gap compared to smaller head sizes, with fluid velocity being greatest along the anterosuperolateral cup edge, for all head sizes. Fluid pathlines indicated that suspended debris would reach similar angular positions in the bearing space regardless of head size. Increased inset of the femoral head into the acetabular cup resulted both in higher fluid velocity and in transport of third-body debris further into the bearing space.

Incongruity-dependent changes of contact stress rates in human cadaveric ankles.

Cartilage biosynthetic transduction and injury characteristics have been shown to be particularly sensitive to changes in contact stress rates. This study investigated incongruity-associated changes in contact stress rates that resulted from an articular surface stepoff of the distal tibia in human cadaveric ankles. Ten human cadaveric ankles were subjected to quasi-physiologic stance-phase motion and loading and instantaneous contact stresses were captured at 132 Hz over the entire articular surface using a custom-fabricated stress transducer. An osteoarticular fragment consisting of the anterolateral 25% of the distal tibia was osteotomized. Testing was repeated after displacing the fragment proximally between 0.0 mm to 4.0 mm in 1.0 mm increments. Transient contact stress measurements were used to calculate contact stress rates. Compared to intact ankles, the anatomic configuration had modest increases in global and peak postitive and negative contact stress rates throughout the motion cycle. In contrast, stepoff specimens had significant increases in global and complete motion cycle peak positive and negative contact stress rates, as high as 3.1X intact values in specimens with a 4.0 mm stepoff. Contour plots of contact stress rates also demonstrated an instability event during motion. An anterolateral stepoff of the distal tibia caused significant changes in positive and negative contact stress rates in cadaveric ankles. Incongruity-associated changes in contact stress rates and incongruity-associated instability events may be important pathomechanical determinants of post-traumatic arthritis.