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2 pages, 166 KiB

Open AccessEditorial

Special Issue on Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases

by Bastian Welke and Frank Seehaus

Appl. Sci. 2022, 12(18), 8968; https://doi.org/10.3390/app12188968 - 7 Sep 2022

Viewed by 1097

Abstract

Musculoskeletal research deals with the effects of the orthopedic treatment of pathologies on the biomechanics of the affected areas and on the musculoskeletal system [...] Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

Research

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13 pages, 2267 KiB

Open AccessArticle

Does Pelvic Orientation Influence Wear Measurement of the Acetabular Cup in Total Hip Arthroplasty—An Experimental Study

by Junzhe Wu, Dominic Taylor, Raimund Forst and Frank Seehaus

Appl. Sci. 2021, 11(21), 10014; https://doi.org/10.3390/app112110014 - 26 Oct 2021

Cited by 4 | Viewed by 1539

Abstract

Roentgen stereophotogrammetric analysis (RSA) is the gold standard to detect in vivo material wear of the bearing couples in hip arthroplasty. Some surgical planning tools offer the opportunity to detect wear by using standard a.p. radiographs (2D_wear), whilst RSA (3D_wear [...] Read more.

Roentgen stereophotogrammetric analysis (RSA) is the gold standard to detect in vivo material wear of the bearing couples in hip arthroplasty. Some surgical planning tools offer the opportunity to detect wear by using standard a.p. radiographs (2D_wear), whilst RSA (3D_wear) needs a special radiological setup. The aims of this study are to prove the interchangeable applicability of a 2D_wear approach next to RSA and to assess the influence of different pelvic positions on measurement outcomes. An implant-bone model was used to mimic three different wear scenarios in seven pelvic-femur alignment positions. RSA and a.p. radiographs of the reference and a follow-up (simulated wear) pose were acquired. Accuracy and precision were worse for the 2D_wear approach (0.206 mm; 0.159 mm) in comparison to the 3D_wear approach (0.043 mm; 0.017 mm). Changing the pelvic position significantly influenced the 2D_wear results (4 of 7, p < 0.05), whilst 3D_wear results showed almost no change. The 3D_wear is superior to the 2D_wear approach, as it is less susceptible to changes in pelvic position. However, the results suggest that a 2D_wear approach may be an alternative method if the wear present is in the range of 100–500 µm and a.p. radiographs are available with the pelvis projected in a neutral position. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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10 pages, 2386 KiB

Open AccessFeature PaperArticle

Does Pressurized Carbon Dioxide Lavage Improve Bone Cleaning in Cemented Arthroplasty?

by Kevin Knappe, Christian Stadler, Moritz Innmann, Mareike Schonhoff, Tobias Gotterbarm, Tobias Renkawitz and Sebastian Jaeger

Appl. Sci. 2021, 11(13), 6103; https://doi.org/10.3390/app11136103 - 30 Jun 2021

Cited by 3 | Viewed by 2948

Abstract

Cemented implant fixation in total joint arthroplasty has been proven to be safe and reliable with good long-term results. However, aseptic loosening is one of the main reasons for revision, potentially caused by poor cementation with low penetration depth in the cancellous bone. [...] Read more.

Cemented implant fixation in total joint arthroplasty has been proven to be safe and reliable with good long-term results. However, aseptic loosening is one of the main reasons for revision, potentially caused by poor cementation with low penetration depth in the cancellous bone. Aim of this prospective laboratory study was, to compare impact pressure and cleaning effects of pulsatile saline lavage to novel carbon dioxide lavage in a standardized carbon foam setup, to determine whether or not additional use of carbon dioxide lavage has any impact on cleaning volume or cleaning depth in cancellous bone. Carbon specimens simulating human cancellous bone were filled with industrial grease and then underwent a standardized cleaning procedure. Specimens underwent computed tomography pre- and post-cleaning. Regarding the impact pressure, isolated carbon dioxide lavage showed significant lower pressure compared to pulsatile saline lavage. Even though the combination of carbon dioxide lavage and pulsatile saline lavage had a positive cleaning effect compared to the isolated use of pulsatile saline lavage or carbon dioxide lavage, this was not significant in terms of cleaning volume or cleaning depth. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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12 pages, 1337 KiB

Open AccessArticle

What Is the Impact of a CAM Impingement on the Gait Cycle in Patients with Progressive Osteoarthritis of the Hip?

by Eike Franken, Thilo Floerkemeier, Eike Jakubowitz, Alexander Derksen, Stefan Budde, Henning Windhagen and Nils Wirries

Appl. Sci. 2021, 11(13), 6024; https://doi.org/10.3390/app11136024 - 29 Jun 2021

Cited by 1 | Viewed by 1736

Abstract

(1) Background: The femoroacetabular impingement (FAI) type cam leads to a conflict between the acetabular rim and a bony thickening of the femoral neck junction. While maximal excursions in flexion, adduction and internal rotation provoke pain, the aim of this study was to [...] Read more.

(1) Background: The femoroacetabular impingement (FAI) type cam leads to a conflict between the acetabular rim and a bony thickening of the femoral neck junction. While maximal excursions in flexion, adduction and internal rotation provoke pain, the aim of this study was to analyze if a cam morphology shows an impact on gait pattern. (2) Methods: Fifty-five patients with end-stage hip osteoarthritis performed gait analysis before hip replacement as well as three, six and 12 months postoperatively. Thirty-three (60%) of them presented an FAI type cam. An ANOVA was used to compare the hip angles in sagittal, frontal and transversal planes between patients with a FAI type cam (group “+cam”) and without (group “−cam”). (3) Results: Before surgery the patients of the +cam-group showed a tendency towards a reduced flexion and internal rotation at the heel strike (p > 0.05). Over time, the differences were adjusted by total hip arthroplasty. (4) Conclusions: We did not find any differences in the gait analysis of patients with a FAI type cam compared to patients without. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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11 pages, 2080 KiB

Open AccessArticle

The Rate of Correctly Planned Size of Digital Templating in Two Planes—A Comparative Study of a Short-Stem Total Hip Implant with Primary Metaphyseal Fixation and a Conventional Stem

by Johanna K. Buschatzky, Michael Schwarze, Nils Wirries, Gabriela von Lewinski, Henning Windhagen, Thilo Floerkemeier and Stefan Budde

Appl. Sci. 2021, 11(9), 3965; https://doi.org/10.3390/app11093965 - 27 Apr 2021

Cited by 1 | Viewed by 1996

Abstract

(1) Background: Preoperative templating is mainly conducted on an anteroposterior pelvic overview X-ray. For short stem hip arthroplasty, the choice of the optimal size is especially crucial to avoid complications. Thus, the study aimed to determine if there is an increased rate of [...] Read more.

(1) Background: Preoperative templating is mainly conducted on an anteroposterior pelvic overview X-ray. For short stem hip arthroplasty, the choice of the optimal size is especially crucial to avoid complications. Thus, the study aimed to determine if there is an increased rate of correctly planned sizes using two radiological planes. (2) Methods: 50 patients with a conventional stem and 100 with a short stem total hip arthroplasty were analyzed. Without knowing the implanted size, three independent orthopedic surgeons performed digital templating: once using the anteroposterior pelvic overview only and once using the lateral view in addition. (3) Results: The rate of correctly planned sizes (+/−1 size compared to the inserted size) of templating with one plane was 86.3% ± 9.5% in short stem hip arthroplasty and 88.4% ± 6.0% in conventional stem arthroplasty. By adding the lateral view, the rate of correctly planned sizes was 89.9% ± 12.0% for the short stem hip arthroplasty group and 89.4% ± 9.8% for the conventional group (p > 0.1). (4) A potential positive effect of preoperative templating using an additional lateral X-ray view for short stem implants may be suggested based on the results of this study, which did, however, not reach statistical significance. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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9 pages, 4633 KiB

Open AccessArticle

Biomechanical Analysis of Sagittal Plane Pin Placement Configurations for Pediatric Supracondylar Humerus Fractures

by Witit Pothong, Phichayut Phinyo, Yuddhasert Sirirungruangsarn, Kriengkrai Nabudda, Nattamon Wongba, Chatchawarl Sarntipiphat and Dumnoensun Pruksakorn

Appl. Sci. 2021, 11(8), 3447; https://doi.org/10.3390/app11083447 - 12 Apr 2021

Cited by 3 | Viewed by 3162

Abstract

Anterior to posterior (AP) pinning is the recommended sagittal pin configuration in divergent lateral entry coronal pinning of pediatrics supracondylar fractures. However, there was still a lack of evidence regarding alternative sagittal pins configurations. We aimed to compare the construct stiffness of alternative [...] Read more.

Anterior to posterior (AP) pinning is the recommended sagittal pin configuration in divergent lateral entry coronal pinning of pediatrics supracondylar fractures. However, there was still a lack of evidence regarding alternative sagittal pins configurations. We aimed to compare the construct stiffness of alternative sagittal pin configurations by using synthetic bone models. Sixty synthetic pediatric humeri were osteotomized to create a supracondylar fracture. After the fracture reduction, all specimens were fixed in the coronal plane with divergent lateral entry pin configurations in four different patterns in the sagittal plane: AP, crossed, divergent and parallel sagittal pin configuration. Each configuration was tested with five loading patterns. The AP sagittal pin had significantly lower construct stiffness than the divergent (p = 0.003) and the parallel sagittal pin configuration (p = 0.005) in external rotation loading tests. The divergent sagittal pin had the highest construct stiffness in extension, valgus, and external rotation loads, but the parallel sagittal pin had lower construct stiffness under extension load than the divergent and crossed sagittal pin configurations. The divergent sagittal pin configuration provides greater construct stiffness than other sagittal pin configurations due to the maximal pin spreading distance at the fracture site and the pin angle lock mechanism. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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11 pages, 2722 KiB

Open AccessArticle

Different ISO Standards’ Wear Kinematic Profiles Change the TKA Inlay Load

by Leandra Bauer, Manuel Kistler, Arnd Steinbrück, Katrin Ingr, Peter E. Müller, Volkmar Jansson, Christian Schröder and Matthias Woiczinski

Appl. Sci. 2021, 11(7), 3161; https://doi.org/10.3390/app11073161 - 1 Apr 2021

Cited by 3 | Viewed by 2338

Abstract

Wear is an important factor in the long-term success of total knee arthroplasty (TKA). Therefore, wear testing methods have become standard in implant research and development. In the EU, these are based on two simulation concepts, which are defined in standards ISO 14243-1 [...] Read more.

Wear is an important factor in the long-term success of total knee arthroplasty (TKA). Therefore, wear testing methods have become standard in implant research and development. In the EU, these are based on two simulation concepts, which are defined in standards ISO 14243-1 and 14243-3, differentiated by the control mode—force-controlled or displacement-controlled. The aim of this study was to compare the mechanical stresses within the different ISO concepts using a finite element model (the newest displacement-controlled norm from 2014 compared with force-controlled). The in silico model showed strong correlation with the experimental data (r > 0.8). The adapted force-controlled ISO showed higher mechanical stress during the gait cycle, which also might lead to higher wear rates (14243-1 (2009): 11.15 MPa, 10.15 MPa and 9.16 MPa). The displacement-controlled ISO led to higher mechanical stress because of the constraint at the end of the stance phase (14243-3: 20.59 MPa and 17.19 MPa). Future studies should analyse different inlay designs within the same ISO standards to guarantee comparability. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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19 pages, 2203 KiB

Open AccessArticle

An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

by Maeruan Kebbach, Christian Schulze, Christian Meyenburg, Daniel Kluess, Mevluet Sungu, Albrecht Hartmann, Klaus-Peter Günther and Rainer Bader

Appl. Sci. 2021, 11(6), 2852; https://doi.org/10.3390/app11062852 - 23 Mar 2021

Cited by 6 | Viewed by 2818

Abstract

The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging [...] Read more.

The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging (MRI)-based computational framework was generated; this enabled the estimation of patient-specific ROM and type of impingement (bone-to-bone, implant-to-bone, and implant-to-implant) postoperatively, using a three-dimensional computer-aided design (CAD) to visualize typical clinical joint movements. Hence, patient-specific CAD models from 19 patients were generated from MRI scans and a conventional total hip system (Bicontact^® hip stem and Plasmacup^® SC acetabular cup with a ceramic-on-ceramic bearing) was implanted virtually. As a verification of the framework, the ROM was compared between preoperatively planned and the postoperatively reconstructed situations; this was derived based on postoperative radiographs (n = 6 patients) during different clinically relevant movements. The data analysis revealed there was no significant difference between preoperatively planned and postoperatively reconstructed ROM (∆_ROM) of maximum flexion (∆_ROM = 0°, p = 0.854) and internal rotation (∆_ROM = 1.8°, p = 0.917). Contrarily, minor differences were observed for the ROM during maximum external rotation (∆_ROM = 9°, p = 0.046). Impingement, of all three types, was in good agreement with the preoperatively planned and postoperatively reconstructed scenarios during all movements. The calculated ROM reached physiological levels during flexion and internal rotation movement; however, it exceeded physiological levels during external rotation. Patients, where implant-to-implant impingement was detected, reached higher ROMs than patients with bone-to-bone impingement. The proposed framework provides the capability to predict postoperative ROM of THRs. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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9 pages, 2289 KiB

Open AccessArticle

The Effect of Cement Aging on the Stability of a Cement-in-Cement Revision Construct

by Mareike Schonhoff, Therese Bormann, Kevin Knappe, Tobias Reiner, Linda Stange and Sebastian Jaeger

Appl. Sci. 2021, 11(6), 2814; https://doi.org/10.3390/app11062814 - 22 Mar 2021

Cited by 7 | Viewed by 2675

Abstract

A revision surgery can be a complicated procedure. The prevention of the removal of a well-integrated cement mantle can minimize intraoperative complications. With the cement-in-cement technique, the implant will be fixated with a layer of bone cement onto the remaining cement mantle. In [...] Read more.

A revision surgery can be a complicated procedure. The prevention of the removal of a well-integrated cement mantle can minimize intraoperative complications. With the cement-in-cement technique, the implant will be fixated with a layer of bone cement onto the remaining cement mantle. In our experimental in vitro study, we investigated the effect of cement aging of a cement-in-cement revision construct and regular cement mantle on the bending strength. Two different types of bone cement were tested at four different stages of aging. The Palacos cement showed no significant difference in bending strength at any aging point, regardless of whether it was used primarily or as a cement-in-cement revision. In contrast, the SmartSet MV cement showed a significant difference between the primary and cement-in-cement applications depending on cement aging time. The comparison of the two cement-in-cement structures investigated showed significant differences between the manufacturers depending on the cement aging. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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15 pages, 8104 KiB

Open AccessArticle

Establishment of a Rolling-Sliding Test Bench to Analyze Abrasive Wear Propagation of Different Bearing Materials for Knee Implants

by Jessica Hembus, Felix Ambellan, Stefan Zachow and Rainer Bader

Appl. Sci. 2021, 11(4), 1886; https://doi.org/10.3390/app11041886 - 21 Feb 2021

Cited by 2 | Viewed by 2596

Abstract

Currently, new materials for knee implants need to be extensively tested but such tests are expensive in a knee wear simulator in a realized design. However, using a rolling-sliding test bench, these materials can be examined under the same test conditions, but with [...] Read more.

Currently, new materials for knee implants need to be extensively tested but such tests are expensive in a knee wear simulator in a realized design. However, using a rolling-sliding test bench, these materials can be examined under the same test conditions, but with simplified geometries. In the present study, the test bench was optimized, and forces were adapted to the physiological contact pressure in the knee joint using the available geometric parameters. Various polymers made of polyethylene and polyurethane, articulating against test wheels made of cobalt-chromium and aluminum titanate, were tested in the test bench using adapted forces based on ISO 14243–1. Polyurethane materials showed distinctly higher wear rates than polyethylene materials and showed inadequate wear resistance for use as knee implant material. Thus, the rolling-sliding test bench is an adaptable test setup to evaluate newly developed bearing materials for knee implants. It combines the advantages of screening and simulator tests and allows for the testing of various bearing materials under physiological load and tribological conditions of the human knee joint. The wear behavior of different material compositions and the influence of surface geometry and quality can be initially investigated without the need to produce complex implant prototypes of total knee endoprosthesis or interpositional spacers. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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9 pages, 1538 KiB

Open AccessArticle

Partial Threading of Pedicle Screws in a Standard Construct Increases Fatigue Life: A Biomechanical Analysis

by Fon-Yih Tsuang, Chia-Hsien Chen, Lien-Chen Wu, Yi-Jie Kuo, Yueh-Ying Hsieh and Chang-Jung Chiang

Appl. Sci. 2021, 11(4), 1503; https://doi.org/10.3390/app11041503 - 7 Feb 2021

Cited by 3 | Viewed by 2592

Abstract

This study proposed a pedicle screw design where the proximal 1/3 of the screw is unthreaded to improve fixation in posterior spinal surgery. This design was also expected to reduce the incidence of mechanical failure often observed when an unsupported screw length is [...] Read more.

This study proposed a pedicle screw design where the proximal 1/3 of the screw is unthreaded to improve fixation in posterior spinal surgery. This design was also expected to reduce the incidence of mechanical failure often observed when an unsupported screw length is exposed outside the vertebra in deformed or degenerated segments. The aim of this study was to evaluate the fatigue life of the novel pedicle screw design using finite element analysis and mechanical testing in a synthetic spinal construct in accordance with American Society for Testing and Materials (ASTM) F1717. The following setups were evaluated: (i) pedicle screw fully inserted into the test block (EXP-FT-01 and EXP-PU-01; full thread (FT), proximal unthread (PU)) and (ii) pedicle screw inserted but leaving an exposed shaft length of 7.6 mm (EXP-FT-02 and EXP-PU-02). Corresponding finite element models FEM-FT-01, FEM-FT-02, FEM-PU-01, and FEM-PU-02 were also constructed and subjected to the same loading conditions as the experimental groups. The results showed that under a 220 N axial load, the EXP-PU-01 group survived the full 5 million cycles, the EXP-PU-02 group failed at 4.4 million cycles on average, and both EXP-FT-01 and EXP-FT-02 groups failed after less than 1.0 million cycles on average, while the fatigue strength of the EXP-FT-02 group was the lowest at 170 N. The EXP-FT-01 and EXP-FT-02 constructs failed through fracture of the pedicle screw, but a rod fractured in the EXP-PU-02 group. In comparison to the FEM-FT-01 model, the maximum von Mises stress on the pedicle screw in the FEM-PU-01 and FEM-PU-02 models decreased by −43% and −27%, respectively. In conclusion, this study showed that having the proximal 1/3 of the pedicle screw unthreaded can reduce the risk of screw fatigue failure when used in deformed or degenerated segments. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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11 pages, 1685 KiB

Open AccessArticle

Correlation of Biomechanical Alterations under Gonarthritis between Overlying Menisci and Articular Cartilage

by Johannes Pordzik, Anke Bernstein, Julius Watrinet, Hermann O. Mayr, Sergio H. Latorre, Hagen Schmal and Michael Seidenstuecker

Appl. Sci. 2020, 10(23), 8673; https://doi.org/10.3390/app10238673 - 4 Dec 2020

Cited by 8 | Viewed by 2129

Abstract

Just like menisci, articular cartilage is exposed to constant and varying stresses. Injuries to the meniscus are associated with the development of gonarthritis. Both the articular cartilage and the menisci are subject to structural changes under gonarthritis. The aim of this study was [...] Read more.

Just like menisci, articular cartilage is exposed to constant and varying stresses. Injuries to the meniscus are associated with the development of gonarthritis. Both the articular cartilage and the menisci are subject to structural changes under gonarthritis. The aim of this study was to investigate biomechanical alterations in articular cartilage and the menisci under gonarthritis by applying an indentation method. The study assessed 11 menisci from body donors as controls and 21 menisci from patients with severe gonarthritis. For the simultaneous examination of the articular cartilage and the menisci, we only tested the joint surfaces of the tibial plateau covered by the corresponding menisci. Over the posterior horn of the meniscus, the maximum applied load—the highest load registered by the load cell—of the arthritic samples of 0.02 ± 0.02 N was significantly greater (p = 0.04) than the maximum applied load of the arthritis-free samples of 0.01 ± 0.01 N. The instantaneous modulus (IM) at the center of the arthritic cartilage covered by the meniscus with 3.5 ± 2.02 MPa was significantly smaller than the IM of the arthritis-free samples with 5.17 ± 1.88 MPa (p = 0.04). No significant difference was found in the thickness of the meniscus-covered articular cartilage between the arthritic and arthritis-free samples. Significant correlations between the articular cartilage and the corresponding menisci were not observed at any point. In this study, the biomechanical changes associated with gonarthritis affected the posterior horn of the meniscus and the mid region of the meniscus-covered articular cartilage. The assessment of cartilage thickness as a structural characteristic of osteoarthritis may be misleading with regard to the interpretation of articular cartilage’s biomechanical properties. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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13 pages, 1667 KiB

Open AccessArticle

Model-Based Roentgen Stereophotogrammetric Analysis Using Elementary Geometrical Shape Models: Reliability of Migration Measurements for an Anatomically Shaped Femoral Stem Component

by Jing Xu, Han Cao, Stefan Sesselmann, Dominic Taylor, Raimund Forst and Frank Seehaus

Appl. Sci. 2020, 10(23), 8507; https://doi.org/10.3390/app10238507 - 28 Nov 2020

Cited by 1 | Viewed by 1828

Abstract

Elementary Geometrical Shape (EGS) models present an alternative approach to detect in vivo migration of total hip arthroplasty using model-based Roentgen Stereophotogrammetric Analysis (mbRSA). However, its applicability for an irregular-shaped femoral stem and the reliability of this mbRSA approach has not been proven [...] Read more.

Elementary Geometrical Shape (EGS) models present an alternative approach to detect in vivo migration of total hip arthroplasty using model-based Roentgen Stereophotogrammetric Analysis (mbRSA). However, its applicability for an irregular-shaped femoral stem and the reliability of this mbRSA approach has not been proven so far. The aim of this study is to assess the effect of multi-rater and an anatomically shaped femoral stem design onto resulting implant to bone migration results. The retrospective analysis included 18 clinical cases of anatomically shaped stem with 10-year RSA follow-ups. Three raters repeatedly measured all RSA follow-ups for evaluating the rater equivalence and intra-rater reliability. The results proved the equivalence between different raters for mbRSA using EGS models (mbRSA-EGS), hence it simplified the investigation of rater reliability to intra-rater reliability. In all in-plane migration measurements, mbRSA-EGS shows good intra-rater reliability and small intra-rater variability (translation: <0.15 mm; rotation: <0.18 deg). However, the reliability is worse in the out-of-plane measurements, especially the cranial-caudal rotation (intra-rater variability: 0.99–1.81 deg). Overall, mbRSA-EGS can be an alternative approach next to surface models while the in-plane migration of femoral stem (e.g., the implant subsidence for loosening prediction) have more research interested than other directions. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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14 pages, 709 KiB

Open AccessArticle

Determination of Leg Alignment in Hip Osteoarthritis Patients with the EOS^® System and the Effect on External Joint Moments during Gait

by Stefan van Drongelen, Hanna Kaldowski, Benjamin Fey, Timur Tarhan, Ayman Assi, Felix Stief and Andrea Meurer

Appl. Sci. 2020, 10(21), 7777; https://doi.org/10.3390/app10217777 - 3 Nov 2020

Cited by 7 | Viewed by 4975

Abstract

The present study considered the entire leg alignment and links static parameters to the external joint moments during gait in patients with hip osteoarthritis. Eighteen patients with unilateral hip osteoarthritis were measured using the EOS^® system. Clinical leg alignment and femoral parameters [...] Read more.

The present study considered the entire leg alignment and links static parameters to the external joint moments during gait in patients with hip osteoarthritis. Eighteen patients with unilateral hip osteoarthritis were measured using the EOS^® system. Clinical leg alignment and femoral parameters were extracted from the 3D reconstruction of the EOS images. A 3D gait analysis was performed and external knee and hip adduction moments were computed and compared to 18 healthy controls in the same age group. The knee adduction moments of the involved leg were strongly correlated to the femoral offset and the varus/valgus alignment. These parameters alone explained over 50% of the variance in the knee adduction moments. Adding the pelvic drop of the contralateral side increased the model of femoral offset and varus/valgus alignment and explained 78% of the knee adduction moment during the first half of the stance phase. The hip adduction moments were best associated with the hip kinematics and not the leg alignment. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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12 pages, 33196 KiB

Open AccessArticle

Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

by Soo-Bin Lee, Hwan-Mo Lee, Tae-Hyun Park, Sung Jae Lee, Young-Woo Kwon, Seong-Hwan Moon and Byung Ho Lee

Appl. Sci. 2020, 10(20), 7291; https://doi.org/10.3390/app10207291 - 19 Oct 2020

Cited by 6 | Viewed by 3013

Abstract

Background: There are a few biomechanical studies that describe posterior fixation methods with pedicle screws (PS) and lateral mass screws (LMS); the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown. Methods: [...] Read more.

Background: There are a few biomechanical studies that describe posterior fixation methods with pedicle screws (PS) and lateral mass screws (LMS); the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown. Methods: Finite element model (FEM) analyses were used to investigate the effects of a hybrid technique using posterior PS and LMS. Stress distribution and subsidence risk from a combination of screws under hybrid motion control conditions, including flexion, extension, axial rotation, and lateral bending, were investigated to evaluate the biomechanical characteristics of different six-screw combinations. Findings: The load sharing on the allograft spacer in flexion mode was highest in the LMS model (74.6%) and lowest in the PS model (35.1%). The likelihood of subsidence of allograft spacer on C6 was highest in the screws from the distal LMS (type 5) model during flexion and extension (4.902 MPa, 30.1% and 2.189 MPa, 13.4%). In lateral bending, the left unilateral LMS (type 4) model screws on C5 (3.726 MPa, 22.9%) and C6 (2.994 MPa, 18.4%) yielded the greatest subsidence risks, because the lateral bending forces were supported by the LMS. In counterclockwise axial rotation, the left unilateral LMS (type 4) model screws on C5 (3.092 MPa, 19.0%) and C6 (3.076 MPa, 18.9%) demonstrated the highest subsidence risks. Conclusion: The asymmetrical ipsilateral use of LMS and posterior PS in lateral bending and axial rotation demonstrated the lowest stability and greatest subsidence risk. We recommend bilateral symmetrical insertion of LMS or posterior PS and posterior PS on distal vertebrae for increased stability and reduced risk of allograft spacer subsidence. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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15 pages, 1362 KiB

Open AccessArticle

Characterization of Gait and Postural Regulation in Late-Onset Pompe Disease

by Ilka Schneider, Stephan Zierz, Stephan Schulze, Karl-Stefan Delank, Kevin G. Laudner, Richard Brill and René Schwesig

Appl. Sci. 2020, 10(19), 7001; https://doi.org/10.3390/app10197001 - 8 Oct 2020

Cited by 6 | Viewed by 3003

Abstract

Pompe disease is a multisystemic disorder with the hallmark of progressive skeletal muscle weakness that often results in difficulties in walking and balance. However, detailed characterization of gait and postural regulation with this disease is lacking. The objective of this investigation was to [...] Read more.

Pompe disease is a multisystemic disorder with the hallmark of progressive skeletal muscle weakness that often results in difficulties in walking and balance. However, detailed characterization of gait and postural regulation with this disease is lacking. The objective of this investigation was to determine if differences exist between the gait and postural regulation of LOPD patients and a matched control group. The gaits of 16 patients with LOPD were assessed using a gait analysis mobile system (RehaGait) and a dynamometric treadmill (FDM-T 1.8). The Interactive Balance System (IBS) was used to evaluate postural regulation and stability. All measures were compared to individual reference data. Demographic (age, gender), morphological (body height, body mass) and clinical data (muscle strength according to the Medical Research Council Scale (MRC Scale), as well as the 6-min walking test and a 10-m fast walk) were also recorded. Compared to individual reference data, LOPD patients presented with reduced gait velocity, cadence and time in single stand. A total of 87% of LOPD patients had abnormalities during posturographic analysis presenting with differences in postural subsystems. This study provides objective data demonstrating impaired gait and posture in LOPD patients. For follow-up analysis and as outcome measurements during medical or physiotherapeutic interventions, the findings of this investigation may be useful. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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19 pages, 1738 KiB

Open AccessArticle

Postural Stability and Regulation before and after High Tibial Osteotomy and Rehabilitation

by Kay Brehme, Thomas Bartels, Martin Pyschik, Manuel Jenz, Karl-Stefan Delank, Kevin G. Laudner and René Schwesig

Appl. Sci. 2020, 10(18), 6517; https://doi.org/10.3390/app10186517 - 18 Sep 2020

Cited by 6 | Viewed by 2624

Abstract

Knee osteoarthrosis (OA) is a widespread orthopedic problem and a high tibial osteotomy (HTO) is a common treatment to minimize degeneration of the affected compartment. The primary aim of this study was to evaluate the postural regulation and stability among patients who underwent [...] Read more.

Knee osteoarthrosis (OA) is a widespread orthopedic problem and a high tibial osteotomy (HTO) is a common treatment to minimize degeneration of the affected compartment. The primary aim of this study was to evaluate the postural regulation and stability among patients who underwent HTO and rehabilitation. This prospective study included 32 patients (55.3 ± 5.57 years) diagnosed with medial tibiofemoral OA. Each subject completed postural regulation and stability testing (Interactive Balance System), as well as pain intensity (visual analogue scale) and quality of life questionnaires (SF-36) prior to HTO (exam 1), and at six weeks (exam 2), twelve weeks (exam 3) and six months (exam 4) post HTO. For postural comparison, all patients were matched (sex, age, height) with asymptomatic subjects. Significant time effects (exam 1 vs. exam 4) were found for weight distribution index (WDI; η_p² = 0.152), mediolateral weight distribution η_p² = 0.163) and anterior–posterior weight distribution η_p² = 0.131). The largest difference (exam 3: η_p² = 0.251) and the most significant differences to the matched sample were calculated for the stability indicator (exam 1: η_p² = 0.237; exam 2: η_p² = 0.215; exam 3: η_p² = 0.251; exam 4: η_p² = 0.229). Pain intensity showed a significant reduction (η_p² = 0.438) from exam 1 (50.7 ± 20.0 mm) to exam 4 (19.3 ± 16.0 mm). Physical pain was the quality of life parameter with the largest improvement between exams 1 and 4 (η_p² = 0.560). HTO allows patients to improve their mediolateral weight distribution, whereas postural stability is consistently lower than in asymptomatic subjects. This surgery leads to marked improvements in quality of life and pain. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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11 pages, 2304 KiB

Open AccessArticle

Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model

by Ji-Won Kwon, Hwan-Mo Lee, Tae-Hyun Park, Sung Jae Lee, Young-Woo Kwon, Seong-Hwan Moon and Byung Ho Lee

Appl. Sci. 2020, 10(18), 6413; https://doi.org/10.3390/app10186413 - 15 Sep 2020

Cited by 7 | Viewed by 2628

Abstract

The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls [...] Read more.

The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls with a cancellous center bone) and three lengths (11, 12, 14 mm) of allograft spacers under the condition of hybrid motion control, including flexion, extension, axial rotation, and lateral bending,. A detailed finite element model of a previously validated, three-dimensional, intact C3–7 segment, with C5–6 segmental fusion using allograft spacers without fixation, was used in the present study. Findings: Among the three types of cervical allograft spacers evaluated, cortical lateral walls with a cancellous center bone exhibited the highest stress on the cortical bone of spacers, as well as the endplate around the posterior margin of the spacers. The likelihood of allograft spacer failure was highest for 14 mm spacers composed of cortical lateral walls with a cancellous center bone upon flexion (PVMS, 270.0 MPa; 250.2%) and extension (PVMS: 371.40 MPa, 344.2%). The likelihood of allograft spacer subsidence was also highest for the same spacers upon flexion (PVMS, 4.58 MPa; 28.1%) and extension (PVMS: 12.71 MPa, 78.0%). Conclusion: Cervical spacers with a smaller cortical component and of longer length can be risk factors for allograft spacer failure and subsidence, especially in flexion and extension. However, further study of additional fixation methods, such as anterior plates/screws and posterior screws, in an actual clinical setting is necessary. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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7 pages, 1556 KiB

Open AccessFeature PaperArticle

Fixation Stability and Stiffness of Two Implant Systems for Proximal Femoral Varization Osteotomy

by Kerstin Radtke, Fabian Goede, Michael Schwarze, Peter Paes, Max Ettinger and Bastian Welke

Appl. Sci. 2020, 10(17), 5867; https://doi.org/10.3390/app10175867 - 25 Aug 2020

Cited by 5 | Viewed by 2275

Abstract

Proximal femoral varization osteotomy is a well-established surgical procedure in children with severe hip problems. This study aimed to evaluate the fixation stability and stiffness of two new implant systems. A biomechanical testing model was created with a total of 12 synthetic femora. [...] Read more.

Proximal femoral varization osteotomy is a well-established surgical procedure in children with severe hip problems. This study aimed to evaluate the fixation stability and stiffness of two new implant systems. A biomechanical testing model was created with a total of 12 synthetic femora. Proximal femoral varization osteotomy was performed in every femur, and the synthetic femora were fixed with two different implant systems (PediLoc Locking Proximal Femur Plate System versus PediLoc Locking Cannulated Blade Plate System; OrthoPediatrics, Warsaw, IN, USA). The average torsional stiffness of the locking plate group was higher than for the cannulated blade plate group. Differences in internal and external rotations were seen between the two groups, but they were not significant. Using the tested implants in severe osteoporotic bones might show other results. Therefore, it might be helpful to use the locking plate system in osteoporotic bones and in cases of revision operations where stability is of critical focus. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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18 pages, 2220 KiB

Open AccessArticle

Intra- and Interobserver Reliability Comparison of Clinical Gait Analysis Data between Two Gait Laboratories

by René Schwesig, Regina Wegener, Christof Hurschler, Kevin Laudner and Frank Seehaus

Appl. Sci. 2020, 10(15), 5068; https://doi.org/10.3390/app10155068 - 23 Jul 2020

Cited by 3 | Viewed by 2405

Abstract

Comparing clinical gait analysis (CGA) data between clinical centers is critical in the treatment and rehabilitation progress. However, CGA protocols and system configurations, as well as choice of marker sets and individual variability during marker attachment, may affect the comparability of data. The [...] Read more.

Comparing clinical gait analysis (CGA) data between clinical centers is critical in the treatment and rehabilitation progress. However, CGA protocols and system configurations, as well as choice of marker sets and individual variability during marker attachment, may affect the comparability of data. The aim of this study was to evaluate reliability of CGA data collected between two gait analysis laboratories. Three healthy subjects underwent a standardized CGA protocol at two separate centers. Kinematic data were captured using the same motion capturing systems (two systems, same manufacturer, but different analysis software and camera configurations). The CGA data were analyzed by the same two observers for both centers. Interobserver reliability was calculated using single measure intraclass correlation coefficients (ICC). Intraobserver as well as between-laboratory intraobserver reliability were assessed using an average measure ICC. Interobserver reliability for all joints (ICC_total = 0.79) was found to be significantly lower (p < 0.001) than intraobserver reliability (ICC_total = 0.93), but significantly higher (p < 0.001) than between-laboratory intraobserver reliability (ICC_total = 0.55). Data comparison between both centers revealed significant differences for 39% of investigated parameters. Different hardware and software configurations impact CGA data and influence between-laboratory comparisons. Furthermore, lower intra- and interobserver reliability were found for ankle kinematics in comparison to the hip and knee, particularly for interobserver reliability. Full article

(This article belongs to the Special Issue Musculoskeletal Research: Biomechanics and Biomaterials for the Treatment of Orthopedic Diseases)

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