Various ball and socket-type designs of cervical artificial discs are in use or under investigation. Many artificial disc designs claim to restore the normal kinematics of the cervical spine. What differentiates one type of design from another design is currently not well understood. In this study, authors examined various clinically relevant parameters using a finite element model of C3–C7 cervical spine to study the effects of variations of ball and socket disc designs. Four variations of ball and socket-type artificial disc were placed at the C5–C6 level in an experimentally validated finite element model. Biomechanical effects of the shape (oval vs. spherical ball) and location (inferior vs. superior ball) were studied in detail. Range of motion, facet loading, implant stresses and capsule ligament strains were computed to investigate the influence of disc designs on resulting biomechanics. Motions at the implant level tended to increase following disc replacement. No major kinematic differences were observed among the disc designs tested. However, implant stresses were substantially higher in the spherical designs when compared to the oval designs. For both spherical and oval designs, the facet loads were lower for the designs with an inferior ball component. The capsule ligament strains were lower for the oval design with an inferior ball component. Overall, the oval design with an inferior ball component, produced motion, facet loads, implant stresses and capsule ligament strains closest to the intact spine, which may be key to long-term implant survival.
Cases of fretting and corrosion at the taper junction have been reported in large metal-on-metal bearing combinations, and more recently, this concern has included metal-on-polyethylene bearing combinations. Many of these patients have been revised due to adverse local tissue reaction secondary to taper corrosion. This taper corrosion-related adverse local tissue reaction seems to be a multifactorial issue and difficult to assess. The aim of this study was to look at one potential variable, the impaction behavior (impaction force, number of blows, etc.) of orthopedic surgeons, and understand how this can affect the locking strength of tapers. A group of experienced orthopedic surgeons were asked to use their typical surgical approach to impact a femoral head onto a hip femoral stem using an Operating Room (OR)-simulated test setup. Impaction parameters such as impaction force, velocity, and energy, as well as the number of impacts, were characterized and applied in a bench-top study used to evaluate the effect of these parameters on the initial stability of the taper junction. High variation was found in the surgical impaction parameters, but overall it was determined that increased impaction force correlated to superior stability of the taper junction.
Constitutive laws that describe the mechanical responses of cardiac tissue under loading hold the key to accurately model the biomechanical behaviour of the heart. There have been ample choices of phenomenological constitutive laws derived from experiments, some of which are quite sophisticated and include effects of microscopic fibre structures of the myocardium. A typical example is the strain-invariant-based Holzapfel–Ogden 2009 model that is excellently fitted to simple shear tests. It has been widely used and regarded as the state-of-the-art constitutive law for myocardium. However, there has been no analysis to show if it has both adequate descriptive and predictive capabilities for other tissue tests of myocardium. Indeed, such an analysis is important for any constitutive laws for clinically useful computational simulations. In this work, we perform such an analysis using combinations of tissue tests, uniaxial tension, biaxial tension and simple shear from three different sets of myocardial tissue studies. Starting from the general 14-parameter myocardial constitutive law developed by Holzapfel and Ogden, denoted as the general HO model, we show that this model has good descriptive and predictive capabilities for all the experimental tests. However, to reliably determine all 14 parameters of the model from experiments remains a great challenge. Our aim is to reduce the constitutive law using Akaike information criterion, to maintain its mechanical integrity whilst achieving minimal computational cost. A competent constitutive law should have descriptive and predictive capabilities for different tissue tests. By competent, we mean the model has least terms but is still able to describe and predict experimental data. We also investigate the optimal combinations of tissue tests for a given constitutive model. For example, our results show that using one of the reduced HO models, one may need just one shear response (along normal-fibre direction) and one biaxial stretch (ratio of 1 mean fibre : 1 cross-fibre) to satisfactorily describe Sommer et al. human myocardial mechanical properties. Our study suggests that single-state tests (i.e. simple shear or stretching only) are insufficient to determine the myocardium responses. We also found it is important to consider transmural fibre rotations within each myocardial sample of tests during the fitting process. This is done by excluding un-stretched fibres using an “effective fibre ratio”, which depends on the sample size, shape, local myofibre architecture and loading conditions. We conclude that a competent myocardium material model can be obtained from the general HO model using AIC analysis and a suitable combination of tissue tests.
Background: There is no general consensus on the normal and pathological values for the posterior tibial slope (PTS). Purpose/Hypothesis: The primary aim of this study was to determine standard values for the PTS in healthy participants using 3-dimensional (3D) computed tomography (CT). A secondary aim was to determine the effect of demographic factors and coronal-plane lower limb alignment on the PTS measurement. The hypothesis was that the PTS would be significantly influenced by demographic factors and coronal-plane lower limb alignment. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A CT-based modeling and analytics system was used to examine and measure lower limb alignment and the PTS in 378 patients (193 male and 185 female; mean age, 58.3 ± 16.4 years [range, 18-92 years]; mean body mass index, 25.0 ± 4.4 kg/m2). The lateral, medial, and global PTS were measured for each patient. All measurements were constructed using algorithm-calculated landmarks, resulting in reproducible and consistent constructs for each specimen. The results were then evaluated based on ethnicity, sex, and hip-knee-ankle (HKA) angle. Results: The study population comprised 219 white and 159 Asian participants. The mean global, medial, and lateral PTS were 6.3° (range, –5.5° to 14.7°; 1% with ≥12°), 6.2° (range, –4.1° to 17.2°; 3% with ≥12°), and 5.3° (range, –4.7° to 16.2°; 2% with ≥12°), respectively. The lateral (Δ = –1.0° [95% CI, 0.6°-1.6°]; P < .0001) and global (Δ = –0.5° [95% CI, 0.0°-0.8°]; P = .0332) PTS were smaller in the female subpopulation. The global PTS was greater (Δ = 1.9° [95% CI, 1.5°-2.3°]; P < .0001) in the Asian subpopulation. The mean HKA angle was 179.6° (range, 170°-190°). The HKA angle was significantly correlated with the medial and global PTS. Specimens with a genu varum knee exhibited a significantly greater global (Δ = 1.2° [95% CI, 0.8°-1.7°]; P < .0001) and medial (Δ = 1.9° [95% CI, 1.3°-2.5°]; P < .0001) PTS. Conclusion: The present study gives a benchmark for the physiological values of the PTS in a healthy population and highlights several factors influencing the PTS, such as ethnicity, sex, and alignment. Anatomic variants with a PTS ≥12° were very uncommon (≤3%) in our Asian and white groups and thus could be considered as pathological. The PTS is a crucial anatomic factor for anterior cruciate ligament injuries and reconstruction. A general consensus is lacking regarding the cutoff for abnormal values, thus guiding standard of care. This study investigated the dispersion of global, medial, and lateral posterior plateau tibial angles in a large population representing a range of demographic diversity.
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