Accuracy of photon-counting computed tomography for the measurement of bone quality in the knee.

Visualization and quantification of bone microarchitecture in the human knee allows gaining insight into normal bone structure, and into the structural changes occurring in the onset and progression of bone diseases such as osteoporosis and osteoarthritis. However, current imaging modalities have limitations in capturing the intricacies of bone microarchitecture. Photon counting computed tomography (PCCT) is a promising imaging modality that presents high-resolution three-dimensional visualization of bone with a large field of view. However, the potential of PCCT in assessing trabecular microstructure has not been investigated yet. Therefore, this study aimed to evaluate the accuracy of PCCT in quantifying bone microstructure and bone mechanics in the knee. Five human cadaveric knees were scanned ex vivo using a PCCT scanner (Naetom alpha, Siemens, Germany) with an in-plane resolution of 146.5 µm and slice thickness of 100 µm. To assess accuracy, the specimens were also scanned with a high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT II, Scanco Medical, Switzerland) with a nominal isotropic voxel size of 60.7 µm as well as with micro-computed tomography (micro-CT; TESCAN UniTOM XL, Czech Republic) with a nominal isotropic voxel size of 25 µm which can be considered gold standards for in vivo and ex vivo scanning, respectively. The thickness and porosity of the subchondral bone and the microstructure of the underlying trabecular bone were assessed in the load bearing regions of the proximal tibia and distal femur. The apparent Young's modulus was determined by micro-finite element (µFE) analysis of subchondral trabecular bone (STB) in the load bearing regions of the proximal tibia using PCCT, HR-pQCT and micro-CT images. The correlation between PCCT measurements and micro-CT and HR-pQCT, respectively, was calculated. The coefficients of determination (R2) between PCCT and micro-CT based parameters, ranged from 0.69 to 0.87. The coefficients of determination between PCCT and HR-pQCT were slightly higher and ranged from 0.71 to 0.91. Apparent Young's modulus, assessed by µFE analysis of PCCT images, correlated well with that of micro-CT (R2 = 0.80, mean relative difference = 19 %). However, PCCT overestimated the apparent Young's modulus by 47 %, but the correlation (R2 = 0.84) remained strong when compared to HR-pQCT. The results of this study suggest that PCCT can be used to quantify bone microstructure in the knee.

Effect of inelastic deformation on strain rate-dependent mechanical behaviour of human cortical bone.

In this study, the role of inelastic deformation of bone on its strain rate-dependent mechanical behaviour was investigated. For this, human cortical bone samples were cyclically loaded to accumulate inelastic strain and subsequently, mechanical response was investigated under compressive loading at different strain rates. The strain rate behaviour of fatigued samples was compared with non-loaded control samples. Furthermore, cyclic loading-induced microdamage was quantified through histological analysis. The compression test results show that the strength of fatigue-loaded bone reduced significantly at low strain rates but not at high strain rates. The difference in microcrack density was not significant between fatigued and control groups. The results indicate that the mechanism of load transfer varies between low strain rate and high strain rate regimes. The inelastic deformation mechanisms are more prominent at low strain rates but not at high strain rates. This study shed light on the role of inelastic deformation on the rate-dependent behaviour of cortical bone.

A Novel Pedicle Screw Design with Variable Thread Geometry: Biomechanical Cadaveric Study with Finite Element Analysis.

BACKGROUND: Pedicle screw fixation provides one of the most stable spinal constructs. Their designs together with osseous characteristics have been known to influence the screw-bone interplay during surgical maneuvers and thereafter the fusion process. Various technical modifications to enhance screw performance have been suggested. This study evaluated the pull-out strength and axial stiffness of a novel pedicle screw design with variable thread geometry and pitch. METHODS: The newly designed triple threaded pedicle screw is tapered, and has unique out-turned flanges to hold the cancellous bone and a finer pitch at its distal and proximal end to engage the cortical bone. Five lumbar and 4 lower thoracic cadaveric vertebrae were divided into hemivertebrae. A standard cancellous pedicle screw and the newly designed pedicle screw were inserted into each hemivertebra. Axial stiffness and peak pull-out force between the screw types were compared; a finite element analysis was also performed to additionally compare the pull out under toggle forces. RESULTS: In cadaveric study, the axial stiffness of the new screw was significantly better than that of the standard screw. However, the peak load between the screws was not statistically different. Finite element analyses suggested lesser stress at bone-implant interface for the new screw along with better axial stiffness under both co-axial and toggle forces. CONCLUSIONS: Our novel pedicle screw design with variable thread geometry demonstrates greater axial stiffness compared with the standard screws, and therefore is likely to withstand a greater surgical manipulation.

Investigation on the sensitivity of indentation devices for detection of fatigue loading induced damage in bovine cortical bone.

Daily physiological activities subject our skeletal system to cyclic loading with varying frequencies and magnitudes. These loadings interact with the microstructure of bone and create microdamage, which can cause stress-induced injuries if not repaired on the time. The early detection is required to prevent the complications associated with these fractures. In the present study, to examine fatigue loading-induced damage in cortical bone, the sensitivity of four different indentation devices was investigated. For this, cortical bone samples were fatigued in four-point bending configuration at 0.5 Hz, 2 Hz and 4 Hz frequencies. Following the fatigue loading, cyclic reference point indentation (cRPI), impact reference point indentation (iRPI), Vickers microhardness and nanoindentation tests were performed on the bone samples. Results show that indentation devices are sensitive to detect fatigue loading induced damage only in 0.5 Hz group samples on compressive region. On the other hand, the sensitivity of indentation devices for tensile stress-induced damage is not clear. Also, histological examination of fatigued bone samples shows a significant increase in the crack density and crack length with fatigue loading only for the 0.5 Hz group samples. The present study provides insight into the sensitivity of different indentation devices to fatigue loading induced damage, which could be helpful in the development of new devices for the early diagnosis of stress induced injuries.

Effect of organic matrix alteration on strain rate dependent mechanical behaviour of cortical bone.

The organic matrix phase of bone plays important role in its mechanical performance, especially in the post-yield regime. Also, the organic phase influences loading rate-dependent behaviour of bone which is relevant during the high-speed loading events. Many diseases, as well as aging, affect the matrix phase of bone which causes compromised mechanical properties. Improved understanding of alterations in the organic matrix phase on mechanical response of bone will be helpful in the mitigation of fractures associated with inferior matrix quality. In the present work, effect of alteration in organic matrix of cortical bone on its strain-rate dependent behaviour was investigated. To produce different amounts of collagen denaturation, bovine cortical bones were heated at the temperature of 180 °C and 240 °C. Further, compression testing was performed at quasi-static strain rates of 10-4 s-1 to 10-2 s-1 using a conventional testing machine whereas a modified Split Hopkinson Pressure Bar (SHPB) was used for high strain rate (∼103) testing. Thermal treatment-induced changes in the mineral and organic phases of bone were assessed using X-ray diffraction (XRD) and Fourier-transform infrared-attenuated total reflection (FTIR-ATR) techniques respectively. Compression test results show that thermal treatment of bone up to 180 °C did not affect mechanical properties significantly whereas treating at 240 °C significantly reduced elastic modulus, failure stress and failure strain. Also, thermal denaturation of collagen reduced the strain rate sensitivity of cortical bone at high strain rates. Similar to the compression test observations, nanoindentation results show a significant reduction in elastic modulus and hardness of denatured samples. Further, FTIR results revealed that with the heat treatment of bone, collagen structure undergoes conformational changes at the molecular level. The initial helix structure breakdowns into unordered/random coil structures which subsequently reduced the mechanical competence of bone. The present study provides insight into the effect of organic matrix modification on mechanical behaviour of cortical bone which could be helpful in understanding bone disorders associated with organic matrix phase and development of therapeutic interventions.

Anatomical variation in intracortical canal network microarchitecture and its influence on bone fracture risk.

Intracortical canals are a major contributor to cortical bone porosity and influence its mechanical response. Canal networks act as stress concentrators and the magnitude of which depends on the size and spatial distribution of canals. In the present study, we investigated site-dependent variation in intracortical canal network morphological indices and their effect on the mechanical response of bone. For this, mid-diaphysis of rat tibia bones were scanned using high-resolution micro-CT and morphological indices were measured for four main anatomical sites-anterior, posterior, medial and lateral. Further, a micro-finite element (µFE) model was developed to quantify the stress concentration regions in different cortices. The fracture risk was assessed using an effective strain approach. Results show that canal porosity, canal orientation and canal length are site-dependent whereas canal diameter and canal number density are independent of the site. The lateral cortex has significantly higher porosity compared to the posterior cortex (p < 0.05). The orientation of canals is found significantly different between endosteal and periosteal regions for anterior and medial quadrants. Canals are inclined at higher angles with bone axis in the endosteal region as compare to the periosteal region. The µ-FE results show that the regions with higher effective strain are concentrated around the canals. Further, failed element volume per unit bone volume is found highest for medial cortex whereas lowest for posterior cortex. The higher failed volume is associated with more radial canals in the medial cortex as compare to other cortices. The linear regression analysis shows that the volume of overstrained elements strongly depends on canal orientation (R2 = 0.73, p < 0.0001) and canal porosity (R2 = 0.61, p < 0.0001). The findings from this study suggest that along with vascular canal porosity, canal orientation and canal diameter can further improve the bone fracture risk assessment.

Effect of ageing on microstructure and fracture behavior of cortical bone as determined by experiment and Extended Finite Element Method (XFEM).

Bone fracture is a severe health concern; therefore, understanding the causes of bone fracture are crucial. This paper investigates the microstructure and fracture behaviour of cadaveric cortical bone of two different groups (Young, n= 6; Aged, n=7). The microstructure is obtained from µ-CT images, and the material parameters are measured with nanoindentation. Fracture behaviour in transverse and longitudinal orientations is investigated experimentally and numerically. The results show that the Haversian canal (HC) size increases and the osteon wall thickness (OWT) decreases significantly in the aged group, whereas a nonsignificant difference is found in tissue properties. The crack initiation (Jic) and crack growth (Jgrow) toughness of the aged group are found to be significantly lower (p<0.01) than the young group in the transverse orientation; however, for the longitudinal orientation, only the value of Jic in the aged group is found significantly lower. Further, a 4-phase XFEM (based on micro-CT image) model is developed to investigate the crack propagation behaviour in both orientations. For the transverse orientation, results show that in the aged group, the crack initially follows the cementline and then penetrates the osteon, whereas, in the young group, it propagates along the cementline. These results are in agreement with experimental results where the decrease in Jgrow is more significant than the Jic in the aged group. This study suggests that ageing leads to a larger HC and reduced OWT, which weakens the crack deflection ability and causes fragility fracture. Further, the XFEM results indicate that the presence of a small microcrack in the vicinity of a major crack tip causes an increase in the critical stress intensity factor.

Prediction of mechanical properties of trabecular bone in patients with type 2 diabetes using damage based finite element method.

Type-2 diabetic (T2D) and osteoporosis (OP) suffered patients are more prone to fragile fracture though the nature of alteration in areal bone mineral density (aBMD) in these two cases are completely different. Therefore, it becomes crucial to compare the effect of T2D and OP on alteration in mechanical and structural properties of femoral trabecular bone. This study investigated the effect of T2D, OP, and osteopenia on bone structural and mechanical properties using micro-CT, nanoindentation and compression test. Further, a nanoscale finite element model (FEM) was developed to predict the cause of alteration in mechanical properties. Finally, a damage-based FEM was proposed to predict the pathological related alteration of bone's mechanical response. The obtained results demonstrated that the T2D group had lower volume fraction (-18.25%, p = 0.023), young's modulus (-23.47%, p = 0.124), apparent modulus (-37.15%, p = 0.02), and toughness (-40%, p = 0.001) than the osteoporosis group. The damage-based FE results were found in good agreement with the compression experiment results for all three pathological conditions. Also, nanoscale FEM results demonstrated that the elastic and failure properties of mineralised collagen fibril decreases with increase in crystal size. This study reveals that T2D patients are more prone to fragile fracture in comparison to OP and osteopenia patients. Also, the proposed damage-based FEM can help to predict the risk of fragility fracture for different pathological conditions.

Mimicking high strength lightweight novel structures inspired from the trabecular bone microarchitecture.

Nature's evolution of a billion years has advanced flawless functionality in limitless optimized structures like bone structural adaptation in various physiological behaviours. In this study, porous structures are designed and fabricated from the nature-inspired trabecular bone microarchitecture. A three-dimensional (3D) model of the porous trabecular architecture from the compressive proximal zone of the femoral head was constructed using the micro-computed tomography scanning tool. The model was modified to get porous structures of different volume fractions varying from 20 to 40% with an increment of 10%. The obtained porous structures were 3D printed and analysed for deformation-resistant behaviour. Quasi-static compressive loading was performed at different strain rates (0.001-1 s-1) to get an insight into lightweight, high strength structural behaviour. Mechanical parameters, such as specific modulus, specific strength and specific energy absorption, were analysed for the optimal volume fraction. The original volume fraction (30%) of the trabecular bone shows the highest value of mechanical parameters. This study can help engineers to select and design lightweight porous structures with high energy-absorbing capacity, mimicking the desired architecture and porosity available in nature. This article is part of the theme issue 'Bioinspired materials and surfaces for green science and technology (part 3)'.

Biomechanical Evaluation of Wasp and Honeybee Stingers.

In order to design a painless and mechanically durable micro syringe-needle system for biomedical applications, the study of insect stingers is of interest because of their elegant structures and functionalities. In the present work, the structure, mechanical properties and the mechanical behavior during insertion of wasp and honeybee stingers have been investigated. The non-invasive imaging tool, micro-computed tomography has been employed to reveal the 3D-structures of wasp and honeybee stingers. A quasi-static nanoindentation instrument was used to measure the nanomechanical properties. Both wasp and honeybee stingers have graded mechanical properties, decreasing along their longitudinal direction starting from the base. The computed tomography images and the measured material properties from nanoindentation were fed into a computational framework to determine the mechanical behavior of the stingers during penetration. The computation results predicted the penetration angle of +10° for the wasp stinger and -6° for the honeybee stinger, which mimics the practical insertion mechanism of both stingers. Based on this understanding, a wasp and honeybee stringer inspired micro syringe-needle design has also been proposed.