3D Printed Anatomy-Specific Fixture for Consistent Glenoid Cavity Position in Shoulder Simulator.

Purpose: Fixation methods for consistent anatomical structure positioning in biomechanical testing can be challenging. Image-based 3D printing is an attractive method for fabrication of biomechanical supports of anatomical structure due to its ability to precisely locate anatomical features with respect to the loading system. Method: A case study is presented to provide a design guide for fixation block fabrication. The anatomy of interest was CT scanned and reconstructed in 3D. The model was imported into commercially available CAD software and modified into a solid object and to create the fixture block. The CAD fixture block is standardized such that anatomical features are always in the same position for the testing system by subtracting the anatomy from a base fixture block. Results: This method allowed a strong immobilization of anatomical specimens and a controlled and consistent positioning feature with respect to the testing system. Furthermore, the fixture block can be easily modified and adapted to anatomical structures of interest using CAD software. Conclusion: This approach allows preservation of the bony anatomy integrity and provides a repeatable and consistent anatomical positioning with respect to the testing system. It can be adapted for other anatomical structures in various other biomechanical settings.

Effect of implant geometry on range of motion in reverse shoulder arthroplasty assessed using glenohumeral separation distance.

BACKGROUND: Whereas reverse shoulder arthroplasty has been successful in treating patients with cuff tear arthropathy, implant impingement after the procedure often causes complications, including reduced range of motion, bone loss, and instability. Attempts to simulate this problem in vitro typically rely on subjective visual methods to detect impingement. The purpose of this study was to determine the effect of humeral neck-shaft angle, implant diameter, humeral cup depth, and glenoid component eccentricity on minimum abduction angle and range of motion using an implant-tracking method for impingement detection. METHODS: Tests were performed in a kinematic shoulder simulator with actuated cables representing the deltoid. The humerus was manually adducted and abducted past the point of impingement in either direction. Centers of the implant components were tracked with optical motion capture and processed with a thresholding algorithm to determine the minimum abduction angle where impingement occurred. RESULTS: Humeral cup depth had the largest effect on minimum abduction angle and range of motion, with a retentive cup reducing range of motion by 26°. A decreased neck-shaft angle reduced minimum abduction angle by 10° but had little effect on overall range of motion. Diameter and eccentricity had little effect. CONCLUSION: A reduced neck-shaft angle reduces minimum abduction angle but does not improve overall range of motion. A more retentive humeral cup increases minimum abduction angle significantly. Although retentive cups are intended to improve joint stability, the reduced range of motion that they impart to the joint may partly counteract the benefits of increased constraint.

Estimating the density of femoral head trabecular bone from hip fracture patients using computed tomography scan data.

The purpose of this study was to compare computed tomography density (ρCT ) obtained using typical clinical computed tomography scan parameters to ash density (ρash ), for the prediction of densities of femoral head trabecular bone from hip fracture patients. An experimental study was conducted to investigate the relationships between ρash and ρCT and between each of these densities and ρbulk and ρdry . Seven human femoral heads from hip fracture patients were computed tomography-scanned ex vivo, and 76 cylindrical trabecular bone specimens were collected. Computed tomography density was computed from computed tomography images by using a calibration Hounsfield units-based equation, whereas ρbulk, ρdry and ρash were determined experimentally. A large variation was found in the mean Hounsfield units of the bone cores (HUcore) with a constant bias from ρCT to ρash of 42.5 mg/cm3. Computed tomography and ash densities were linearly correlated (R 2 = 0.55, p < 0.001). It was demonstrated that ρash provided a good estimate of ρbulk (R 2 = 0.78, p < 0.001) and is a strong predictor of ρdry (R 2 = 0.99, p < 0.001). In addition, the ρCT was linearly related to ρbulk (R 2 = 0.43, p < 0.001) and ρdry (R 2 = 0.56, p < 0.001). In conclusion, mineral density was an appropriate predictor of ρbulk and ρdry , and ρCT was not a surrogate for ρash . There were linear relationships between ρCT and physical densities; however, following the experimental protocols of this study to determine ρCT , considerable scatter was present in the ρCT relationships.

Factors affecting the stability of reverse shoulder arthroplasty: a biomechanical study.

BACKGROUND: Despite the success of reverse shoulder arthroplasty (RSA) in treating patients with painful pseudoparalytic shoulders, instability is a common complication and currently the factors affecting stability are not well understood. The objective of this study was to investigate a number of factors as well as the interactions between factors to determine how they affect the stability of the prosthesis. These factors included: active arm posture (abduction and abduction plane angles), loading direction, glenosphere diameter and eccentricity, and humeral socket constraint. METHODS: Force required to dislocate the joint, determined using a biomechanical shoulder simulator, was used as a measure of stability. A factorial design experiment was implemented to examine the factors and interactions. RESULTS: Actively increasing the abduction angle by 15° leads to a 30% increase in stability and use of an inferior-offset rather than a centered glenosphere improved stability by 17%. Use of a more constrained humeral socket also increased stability; but the effect was dependent on loading direction, with a 88% improvement for superior loading, 66% for posterior, 36% for anterior, and no change for inferior loading. Abduction plane angle and glenosphere diameter had no effect on stability. CONCLUSION: Increased glenohumeral abduction and the use of an inferior-offset glenosphere were found to increase the stability of RSA. Additionally, use of a more constrained humeral socket increased stability for anterior, posterior, and superior loading. These identified factor effects have the potential to decrease the risk of dislocation following RSA.

Kinematic geometry of osteotomies.

This paper presents a novel method for defining an osteotomy that can be used to represent all types of osteotomy procedures. In essence, we model an osteotomy as a lower-pair mechanical joint to derive the kinematic geometry of the osteotomy. This method was implemented using a commercially available animation software suite in order to simulate a variety of osteotomy procedures. Two osteotomy procedures are presented for a femoral malunion in order to demonstrate the advantages of our kinematic model in developing optimal osteotomy plans. The benefits of this kinematic model include the ability to evaluate the effects of various kinds of osteotomy and the elimination of potentially error-prone radiographic assessment of deformities.

Development and assessment of the Canadian personal load carriage system using objective biomechanical measures.

The Defence Research and Development Canada--Toronto managed a collaborative team of designers, biomechanists, ergonomists and military stakeholders in the development of a new personal load carriage (LC) system for the Canadian Forces. Ergonomics design principles using objective measurement tools and user-centred feedback from soldiers were considered essential to system development. The purpose of this study was to provide a detailed report of contributions by biomechanical testing to the final design of the final Canadian LC system. The Load Carriage Simulator and Compliance Tester were used to test design iterations of: three fragmentation vests, seven tactical vests and three iterations of the backpack. Test data were compared to a data pool of seventeen previously tested systems. Results indicated that the objective measures helped the design team by: (1) quantifying and understanding the consequences of various design changes; (2) predicting soldiers' responses to design changes in skin contact pressure, force and relative motion; (3) objectively comparing design iterations to other systems; and (4) providing information quickly so that ideas and recommendations could be incorporated into the next design iteration. It was concluded that objective assessments added valuable information not easily interpreted from human trials. However, objective assessments cannot replace human trials for feedback on functionality and features.