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ESB 2015

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5 8 JULY 2015

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21st CONGRESS
OF THE EUROPEAN SOCIETY
OF BIOMECHANICS
Clarion Congress Hotel Prague
Prague, Czech Republic

European Society
of Biomechanics

Book of Extended
Abstracts

Autor (editor):

Zdenk Hork, Matj Daniel, Karel Jeek

Nzev dla:

ESB 2015 Book of Extended Abstracts

Vydalo:

esk vysok uen technick v Praze

Zpracovala:

Fakulta strojn, stav mechaniky, biomechaniky a mechatroniky

Kontaktn adresa:

Technick 4, 166 07 Praha 6

Tel.:

+420 224 352 527

Tisk:

pouze on-line (pdf)

URL:

www.czech-in.org/ESB/ESB2015_Abstract_Book.pdf

Poet stran:

645

Poad vydn:

ISBN 978-80-01-05777-3

1.

Contents
Keynote Lectures

O 020 . . . . . 41

O 063 . . . . . 85

O 105 . . . . 132

O 147 . . . . 179

KL01 . . . . . . 1

O 021 . . . . . 42

O 064 . . . . . 87

O 106 . . . . 133

O 148 . . . . 180

KL02 . . . . . . 2

O 022 . . . . . 43

O 065 . . . . . 88

O 107 . . . . 134

O 149 . . . . 182

KL03 . . . . . . 3

O 023 . . . . . 44

O 066 . . . . . 89

O 108 . . . . 135

O 150 . . . . 183

O 024 . . . . . 45

O 067 . . . . . 90

O 109 . . . . 136

O 151 . . . . 184

Perspective Talks

O 025 . . . . . 46

O 068 . . . . . 91

O 110 . . . . 137

O 152 . . . . 185

PT 01 . . . . . 4

O 026 . . . . . 47

O 069 . . . . . 92

O 111 . . . . 138

O 153 . . . . 186

PT 02 . . . . . 5

O 027 . . . . . 48

O 070 . . . . . 93

O 112 . . . . 139

O 154 . . . . 187

PT 03 . . . . . 6

O 028 . . . . . 49

O 071 . . . . . 94

O 113 . . . . 141

O 155 . . . . 188

PT 04 . . . . 7

O 029 . . . . . 50

O 072 . . . . . 95

O 114 . . . . 142

O 157 . . . . 189

PT 05 . . . . . 8

O 030 . . . . . 51

O 073 . . . . . 96

O 115 . . . . 143

O 158 . . . . 190

PT 06 . . . . . 9

O 031 . . . . . 52

O 074 . . . . . 98

O 116 . . . . 144

O 159 . . . . 191

PT 07 . . . . . 11

O 032 . . . . . 53

O 075 . . . . 100

O 117 . . . . 145

O 160 . . . . 192

PT 08 . . . . . 12

O 033 . . . . . 54

O 076 . . . . 101

O 118 . . . . 146

O 161 . . . . 193

PT 09 . . . . . 13

O 034 . . . . . 55

O 077 . . . . 102

O 119 . . . . 147

O 162 . . . . 194

PT 10 . . . . . 14

O 035 . . . . . 56

O 078 . . . . 103

O 120 . . . . 148

O 163 . . . . 195

PT 11 . . . . . 15

O 036 . . . . . 57

O 079 . . . . 104

O 121 . . . . 149

O 164 . . . . 196

PT 12 . . . . . 16

O 037 . . . . . 58

O 080 . . . . 105

O 122 . . . . 150

O 165 . . . . 197

PT 13 . . . . . 17

O 038 . . . . . 59

O 081 . . . . 107

O 123 . . . . 151

O 166 . . . . 198

PT 14 . . . . . 18

O 039 . . . . . 60

O 082 . . . . 108

O 124 . . . . 152

O 167 . . . . 199

PT 15 . . . . . 19

O 040 . . . . . 61

O 083 . . . . 109

O 125 . . . . 153

O 168 . . . . 200

O 041 . . . . . 62

O 084 . . . . 110

O 126 . . . . 154

O 169 . . . . 201

Oral Presentations

O 042 . . . . . 63

O 085 . . . . 111

O 127 . . . . 156

O 170 . . . . 202

O 001 . . . . . 20

O 043 . . . . . 64

O 086 . . . . 112

O 128 . . . . 157

O 171 . . . . 204

O 002 . . . . . 21

O 044 . . . . . 65

O 087 . . . . 113

O 129 . . . . 158

O 172 . . . . 205

O 003 . . . . . 22

O 045 . . . . . 67

O 088 . . . . 115

O 130 . . . . 159

O 173 . . . . 206

O 004 . . . . . 24

O 046 . . . . . 68

O 089 . . . . 116

O 131 . . . . 160

O 174 . . . . 207

O 005 . . . . . 25

O 047 . . . . . 69

O 090 . . . . 117

O 132 . . . . 161

O 175 . . . . 208

O 006 . . . . . 26

O 048 . . . . . 70

O 091 . . . . 118

O 133 . . . . 162

O 176 . . . . 209

O 007 . . . . . 27

O 049 . . . . . 71

O 092 . . . . 119

O 134 . . . . 163

O 177 . . . . 210

O 008 . . . . . 28

O 050 . . . . . 72

O 093 . . . . 120

O 135 . . . . 164

O 178 . . . . 211

O 009 . . . . . 29

O 051 . . . . . 73

O 094 . . . . 121

O 136 . . . . 165

O 179 . . . . 213

O 010 . . . . . 30

O 052 . . . . . 74

O 095 . . . . 122

O 137 . . . . 166

O 180 . . . . 214

O 011 . . . . . 31

O 053 . . . . . 75

O 096 . . . . 123

O 138 . . . . 167

O 181 . . . . 215

O 012 . . . . . 32

O 055 . . . . . 76

O 097 . . . . 124

O 139 . . . . 169

O 182 . . . . 216

O 013 . . . . . 33

O 056 . . . . . 77

O 098 . . . . 125

O 140 . . . . 170

O 183 . . . . 217

O 014 . . . . . 34

O 057 . . . . . 78

O 099 . . . . 126

O 141 . . . . 171

O 184 . . . . 218

O 015 . . . . . 35

O 058 . . . . . 79

O 100 . . . . 127

O 142 . . . . 173

O 185 . . . . 220

O 016 . . . . . 36

O 059 . . . . . 80

O 101 . . . . 128

O 143 . . 1 7 4

O 186 . . . . 222

O 017 . . . . . 37

O 060 . . . . . 81

O 102 . . . . 129

O 144 . . . . 175

O 187 . . . . 223

O 018 . . . . . 38

O 061 . . . . . 83

O 103 . . . . 130

O 145 . . . . 176

O 188 . . . . 224

O 019 . . . . . 39

O 062 . . . . . 84

O 104 . . . . 131

O 146 . . . . 177

O 189 . . . . 225

O 190 . . . . 226

O 232 . . . . 269

O 274 . . . . 313

O 316 . . . . 355

P 038 . . . . 398

O 191 . . . . 227

O 233 . . . . 270

O 275 . . . . 314

O 317 . . . . 356

P 039 . . . . 399

O 192 . . . . 228

O 234 . . . . 271

O 276 . . . . 315

O 318 . . . . 357

P 040 . . . . 400

O 193 . . . . 229

O 235 . . . . 272

O 277 . . . . 316

O 194 . . . . 230

O 236 . . . . 273

O 2 7 8 . . . 317

Poster Presentations

P 042 . . . . 402

O 195 . . . . 231

O 237 . . . . 274

O 279 . . . . 318

P 001 . . . . 359

P 043 . . . . 403

O 196 . . . . 232

O 238 . . . . 275

O 280 . . . . 319

P 002 . . . . 360

P 044 . . . . 404

O 197 . . . . 233

O 239 . . . . 276

O 281 . . . . 320

P 003 . . . . 361

P 045 . . . . 405

O 198 . . . . 234

O 240 . . . . 277

O 282 . . . . 321

P 004 . . . . 362

P 046 . . . . 406
P 047 . . . . 407

P 041 . . . . 401

O 199 . . . . 235

O 241 . . . . 278

O 283 . . . . 322

P 005 . . . . 363

O 200 . . . . 236

O 242 . . . . 279

O 284 . . . . 323

P 006 . . . . 365

P 048 . . . . 409

O 201 . . . . 237

O 243 . . . . 280

O 285 . . . . 324

P 007 . . . . 366

P 049 . . . . 410

O 202 . . . . 238

O 244 . . . . 281

O 286 . . . . 325

P 008 . . . . 368

P 050 . . . . 411

O 203 . . . . 239

O 245 . . . 282

O 287 . . . . 326

P 009 . . . . 369

P 051 . . . . 412

O 204 . . . . 240

O 246 . . . . 283

O 288 . . . . 327

P 010 . . . . 370

P 052 . . . . 413

O 205 . . . . 241

O 247 . . . . 284

O 289 . . . . 328

P 011 . . . . 371

P 053 . . . . 414

O 206 . . . . 242

O 248 . . 2 8 5

O 290 . . . . 329

P 012 . . . . 372

P 054 . . . . 415
P 055 . . . . 416

O 207 . . . . 243

O 249 . . . . 286

O 291 . . . . 330

P 013 . . . . 373

O 208 . . . . 244

O 250 . . . . 287

O 292 . . . . 331

P 014 . . . . 374

P 056 . . . . 417

O 209 . . . . 246

O 251 . . . . 288

O 293 . . . . 332

P 015 . . . . 375

P 057 . . . . 418

O 210 . . . . 247

O 252 . . . . 289

O 294 . . . . 333

P 016 . . . . 376

P 058 . . . . 419

O 211 . . . . 248

O 253 . . . . 290

O 295 . . . . 334

P 017 . . . . 377

P 059 . . . . 420

O 212 . . . . 249

O 254 . . . . 291

O 296 . . . . 335

P 018 . . . . 378

P 060 . . . . 421

O 213 . . . . 250

O 255 . . . . 292

O 297 . . . . 336

P 019 . . . . 379

P 061 . . . . 422

O 214 . . . . 251

O 256 . . . . 293

O 298 . . . . 337

P 020 . . . . 380

P 062 . . . . 423

O 215 . . . . 252

O 257 . . . . 294

O 299 . . . . 338

P 021 . . . . 381

P 063 . . . . 424
P 064 . . . . 425

O 216 . . . . 253

O 258 . . . . 295

O 300 . . . . 339

P 022 . . . . 382

O 217 . . . . 254

O 259 . . . . 296

O 301 . . . . 340

P 023 . . . . 383

P 065 . . . . 426

O 218 . . . . 255

O 260 . . . . 298

O 302 . . . . 341

P 024 . . . . 384

P 066 . . . . 427

O 219 . . . . 256

O 261 . . . . 299

O 303 . . . . 342

P 025 . . . . 385

P 067 . . . . 428

O 220 . . . . 257

O 262 . . . . 300

O 304 . . . . 343

P 026 . . . . 386

P 068 . . . . 429

O 221 . . . . 258

O 263 . . . . 301

O 305 . . . . 344

P 027 . . . . 387

P 069 . . . . 430

O 222 . . . . 259

O 264 . . . . 302

O 306 . . . . 345

P 028 . . . . 388

P 070 . . . . 431

O 223 . . . . 260

O 265 . . . . 303

O 307 . . . . 346

P 029 . . . . 389

P 071 . . . . 432
P 072 . . . . 433

O 224 . . . . 261

O 266 . . . . 304

O 308 . . . . 347

P 030 . . . . 390

O 225 . . . . 262

O 267 . . . . 305

O 309 . . . . 348

P 031 . . . . 391

P 073 . . . . 434

O 226 . . . . 263

O 268 . . . . 306

O 310 . . . . 349

P 032 . . . . 392

P 074 . . . . 435

O 227 . . . . 264

O 269 . . . . 308

O 311 . . . . 350

P 033 . . . . 393

P 075 . . . . 436

O 228 . . . . 265

O 270 . . . . 309

O 312 . . . . 351

P 034 . . . . 394

P 076 . . . . 437

O 229 . . . . 266

O 271 . . . . 310

O 313 . . . . 352

P 035 . . . . 395

P 077 . . . . 438

O 230 . . . . 267

O 272 . . . . 311

O 314 . . . . 353

P 036 . . . . 396

P 078 . . . . 439

O 231 . . . . 268

O 273 . . . . 312

O 315 . . . . 354

P 037 . . . . 397

P 079 . . . . 440

ii

P 080 . . . . 441

P 119 . . . . 485

P 159 . . . . 526

P 198 . . . . 566

P 238 . . . . 608

P 081 . . . . 442

P 120 . . . . 486

P 160 . . . . 527

P 199 . . . . 567

P 239 . . . . 609

P 082 . . . . 443

P 121 . . . . 487

P 161 . . . . 528

P 200 . . . . 568

P 240 . . . . 610

P 083 . . . . 445

P 122 . . . . 489

P 162 . . . . 529

P 201 . . . . 569

P 241 . . . . 611

P 084 . . . . 446

P 123 . . . . 490

P 163 . . . . 530

P 202 . . . . 570

P 242 . . . . 612

P 085 . . . . 447

P 124 . . . . 492

P 164 . . . . 531

P 203 . . . . 572

P 243 . . . . 613

P 086 . . . . 448

P 125 . . . . 493

P 165 . . . . 532

P 204 . . . . 573

P 244 . . . . 614

P 087 . . . . 449

P 126 . . . . 494

P 166 . . . . 533

P 205 . . . . 574

P 245 . . . . 615

P 088 . . . . 450

P 127 . . . . 495

P 167 . . . . 534

P 206 . . . . 575

P 246 . . . . 616

P 089 . . . . 451

P 128 . . . . 496

P 168 . . . . 535

P 207 . . . . 576

P 247 . . . . 617

P 090 . . . . 452

P 129 . . . . 497

P 169 . . . . 536

P 208 . . . . 577

P 248 . . . . 618

P 091 . . . . 453

P 130 . . . . 498

P 170 . . . . 537

P 209 . . . . 578

P 249 . . . . 619

P 092 . . . . 454

P 131 . . . . 499

P 171 . . . . 538

P 210 . . . . 579

P 250 . . . . 620

P 093 . . . . 455

P 132 . . . . 500

P 172 . . . . 539

P 211 . . . . 580

P 251 . . . . 622

P 094 . . . . 456

P 133 . . . . 501

P 173 . . . . 540

P 212 . . . . 582

P 252 . . . . 624

P 095 . . . . 458

P 134 . . . . 502

P 174 . . . . 541

P 213 . . . . 583

P 253 . . . . 625

P 096 . . 4 5 9

P 135 . . . . 503

P 175 . . . . 542

P 214 . . . . 584

P 254 . . . . 626

P 097 . . . . 460

P 136 . . . . 504

P 176 . . . . 543

P 215 . . . . 585

P 255 . . . . 627

P 098 . . . . 461

P 137 . . . . 505

P 177 . . . . 544

P 216 . . . . 586

P 256 . . . . 628

P 099 . . . . 462

P 138 . . . . 506

P 178 . . . . 545

P 217 . . . . 587

P 257 . . . . 629

P 100 . . . . 463

P 139 . . . . 507

P 179 . . . . 546

P 218 . . . . 588

P 258 . . . . 630

P 101 . . . . 464

P 140 . . . . 508

P 180 . . . . 547

P 219 . . . . 589

P 259 . . . . 631

P 102 . . . . 465

P 141 . . . . 509

P 181 . . . . 548

P 220 . . . . 590

P 260 . . . . 632

P 103 . . . . 466

P 142 . . . . 510

P 182 . . . . 549

P 221 . . . . 591

P 261 . . . . 633

P 104 . . . . 467

P 143 . . . . 511

P 183 . . . . 550

P 222 . . . . 592

P 262 . . . . 634

P 105 . . . . 468

P 144 . . . . 512

P 184 . . . . 551

P 224 . . . . 593

P 263 . . . . 635

P 106 . . . . 469

P 145 . . . . 513

P 185 . . . . 552

P 225 . . . . 595

P 264 . . . . 636

P 107 . . . . 470

P 146 . . . . 514

P 186 . . . . 553

P 226 . . . . 596

P 265 . . . . 637

P 108 . . . . 471

P 147 . . . . 515

P 187 . . . . 554

P 227 . . . . 597

P 266 . . . . 639

P 109 . . . . 472

P 149 . . . . 516

P 188 . . . . 555

P 228 . . . . 598

P 267 . . . . 640

P 110 . . . . 473

P 150 . . . . 517

P 189 . . . . 556

P 229 . . . . 599

P 268 . . . . 641

P 111 . . . . 474

P 151 . . . . 518

P 190 . . . . 557

P 230 . . . . 600

P 269 . . . . 642

P 112 . . . . 475

P 152 . . . . 519

P 191 . . . . 558

P 231 . . . . 601

P 270 . . . . 643

P 113 . . . . 476

P 153 . . . . 520

P 192 . . . . 559

P 232 . . . . 602

P 271 . . . . 644

P 114 . . . . 478

P 154 . . . . 521

P 193 . . . . 561

P 233 . . . . 603

P 272 . . . . 645

P 115 . . . . 479

P 155 . . . . 522

P 194 . . . . 562

P 234 . . . . 604

P 116 . . . . 480

P 156 . . . . 523

P 195 . . . . 563

P 235 . . . . 605

P 117 . . . . 481

P 157 . . . . 524

P 196 . . . . 564

P 236 . . . . 606

P 118 . . . . 483

P 158 . . . . 525

P 197 . . . . 565

P 237 . . . . 607

iii

KL01

Joint lubrication: the molecular domain


J. Klein1
1

Weizmann Institute of Science, Department of Materials & Interfaces, Rehovot, Israel

Cartilage surfaces sliding past each other in


the major joints (such as hips and knees) exhibit
extremely low levels of friction under physiologically-high pressures, a lubricity which is essential for their
healthy performance. A detailed molecular-level
understanding of this could benefit treatments of
osteoarthritis (OA), as well as improved prosthetic
joint implants, where low friction may suppress
wear debris formation and the associated
periprosthetic osteolysis. Any insight must, first and
foremost, be able to account for the low friction
(coefficient of friction down to ca. 0.001) at the
high pressures (which can reach 100 atm or higher)
of the joints. Over the past decade, hydration
lubrication has emerged as a new paradigm for
extreme lubrication in aqueous systems1, which
may underlie also the very efficient boundary
lubrication of cartilage. According to this, the
hydration shells formed by dipolar water molecules
about charges in water (such as ions or zwitterions)
may be very tenaciously attached, so that they
resist being squeezed out even under large
pressures. At the same time, these same hydration
shells may behave very fluidly under shear. This
resistance to pressure together with low-friction
sliding makes them into excellent lubrication
elements. Very recently2, we discovered that
hyaluronan (HA) which is attached to a surface
to resemble its configuration at the outer cartilage
surface may complex with phosphatidylcholines

(PCs), lipids that are ubiquitous in synovial joints,


to form robust boundary layers. These layers act
synergistically to provide the very low friction
( 0.001) characteristic of cartilage, at the
highest physiological pressures, and contrast with
surface-attached HA on its own, which leads to
considerably higher friction. The very low friction
is ultimately due to the phosphocholine groups
exposed by the HA/PC surface complexes; these
groups are known to be strongly and highly-hydrated, and so they lubricate via the mechanism
described above. Our results thus point to a
scenario where HA, PCs and lubricin, each with a
very different role, act together synergistically to
reduce friction of cartilage in articulating joints.
Hyaluronan, anchored at the outer surface of
articular cartilage by lubricin molecules (which
are known to be present in the outer superficial
zone), complexes with joint phosphatidylcholines
to provide the extreme boundary lubrication
of synovial joints via the hydration-lubrication
mechanism.
1. Ma, L., Gaisinskaya, A., Kampf, N. and Klein, J.,
Origins of hydration lubrication, Nature Communications, | 6:6060 | DOI: 10.1038/ncomms7060 (2015)
2. Seror, J., Zhu, L., Goldberg, R., Day, A.J. and Klein
J., Supramolecular synergy in the boundary lubrication of synovial joints Nature Communications,
| 6:6497 | DOI: 10.1038/ncomms7497 (2015)

KL02

FEBio: Finite Elements for Biomechanics


J. A. Weiss1
1

University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, Utah

The motility and proliferation of angiogenic


neovessels are modulated by the material
properties of the extracellular matrix (ECM).
Neovessels also modify the material properties of
the ECM as they migrate through and interact with
the ECM. This creates a dynamic feedback loop in
which angiogenesis is coupled with deformation
and remodeling of the ECM. In this talk, I will
discuss our experimental and computational
research to investigate the this phenomenon. The
experimental aspects of the research are based
on a 3D in vitro organ culture model of sprouting
angiogenesis. The computational approach
is based on coupling a validated model of
angiogenic growth with the FEBio finite element
software framework developed in our laboratory.
In these studies we demonstrate that angiogenic
neovessels extensively deform and remodel the

ECM through a combination of cellular traction


forces, proteolytic activity and generation of new
cell-matrix adhesions. Sensitivity analysis using our
computational model demonstrated that cellgenerated traction during growth is the most
important parameter controlling the deformation
of the matrix and therefore angiogenic growth,
remodeling and morphometry of the resulting
microvascular bed. Live, large-scale mulitphoton
imaging elu cidated several neovessel behaviors
during angiogenesis that are poorly understood
such as episodic growth/regression, neovessel
co-location, and anastomosis. The combined
approach has allowed us demonstrate that
angiogenic growth and the resulting topology of
a vascular network can be manipulated directly
by altering the mechanical interactions between
cells and the ECM.

KL03

Musculoskeletal function in human locomotion


M. Pandy1
1

University of Melbourne, mechanical Engineering, Melbourne, Australia

Gait-analysis techniques have been used for


more than a century to provide information
on thekinematics and kinetics of human
locomotion, yet the ability of this approach
to evaluatemusculoskeletal function is limited
as it cannot be used to discern the actions
of individual muscles. Computational modelling
is the only practical method available to
determine musculoskeletal functionnon-invasively.
Rapid increases in computing power combined

with recent advances in medicalimaging, more


accurate methods for measuring muscle-tendon
and joint motion dynamically, andmore efficient
algorithms for modelling the neuromusculo
skeletal system have enabled detailedanalyses
of musculoskeletal function. This presentation will
illustrate how computational modellinghas been
used in conjunction with gait analysis experiments
to evaluate lower-limb muscle and jointfunction
during human walking and running.

PT 01

KNEE BIOMECHANICAL ANALYSIS AND


3D MODELING: TO CLOSE THE GAP BETWEEN
SURGEONS AND ENGINEERS.
B. Innocenti1, S. Pianigiani2
1
2

Universit Libre de Bruxelles ULB, BEAMS Department, Bruxelles, Belgium

IRCCS Istituto Ortopedico Galeazzi, Istituto Ortopedico Galeazzi, Milano, Italy

Introduction
Knee kinematics is a complex three-dimensional roto-translation movement, which is strongly correlated
to the patient anatomy. In particular, the shape of
the femurs condyles, the tibia plateau, the patella
proximal surface and the morphological and
mechanical properties and location of the soft tissue
envelope are fundamental to discriminate such
movement. For these reasons, each human being has
a different knee kinetics and kinematics. Therefore,
the study and understanding of the patient-specific
knee joint anatomy and functionality, through
dedicated methodologies for kinematic and kinetic
analyses and soft tissue mechanical properties
determination, is the key factor for closing the gap
between surgeons and engineers.

Numerical studies, validated using experimental


techniques, demonstrated how a close to real
model of the knee joint is fundamental. In particular,
the soft tissue envelope, if neglected, completely
altered the tibio-femoral interaction [14, 21].
DIS C USSION
As knee kinematics and kinetics is a results of a
musculo-skeletal interaction, not only the bone
anatomy need to be integrated in this analysis but
also information on soft tissues need to be provided.
Moreover, especially in analyzing patients with
knee prosthesis, results of several studies highlight
how kinematics is not the only and also not the
most relevant parameter to predict or explain knee
function but knee kinetics should be integrated in
the clinical follow-up.

METHODS
In the last years, several knee biomechanics
study were performed using robotic simulator
[111] showing how this technique could be
beneficially used to investigate accurately knee
joint kinematics, in terms of both rotations and
translation in healthy and in knee with implant.
Moreover, parts of these study were dedicated
not only on tibio-femoral kinematics [1, 3, 711]
but also on the investigation of the patello-femoral
joint [2, 46], currently, and unexpectedly, not well
investigated nowadays, together with collateral
ligament strain [810] and knee alignment [8].

Dedicated patient-specific experimental and


numerical methodologies showed to be the
promising tool to fill this gap surgeon and engineer
and to guide patients from recover from their disease.

RE F EREN C ES
1 Victor et al, J Orthop Res, 2010;
2 Luyckx et al, JBJS Br, 2009;
3 Innocenti et al, IFMBE Proc, 2009a;
4 Innocenti et al, IFMBE Proc, 2009b;
5 Didden et al JBJS Br, 2010;
6 Vanbiervliet et al, JBJS Br, 2011;
7 Labey et al, J Biomech, 2012;
8 Delport et al, KSSTA, in press;
9 Heesterbeek et al, KSSTA, 2013
10) Delport et al, Clinical Biomec, 2013
11) Heyse et al, KSSTA, in press;
12) Innocenti et al, JOSR, 2009;
13) Catani et al, CORR, 2010;
14) Van Jombergen et al, JOSR, 2012;
15) Innocenti et al, J Biomech, 2011;
16) Pianigiani et al, J Biomech, 2012;
17) Innocenti et al, Lubricant, 2014;
18) Pianigiani et al, J Biomech, 2012;
19) Pianigiani et al, KSSTA, in press;
20) Soenen et al, JOA 2013;
21) Innocenti et al, JOA, 2014.

Furthermore, the coupling of numerical analysis


to experimental activity [1220] show a huge
improvement in the results, allowing sensitivity
analysis [15, 16, 18, 19] providing accurate
information on contact forces and pressures
[13], investigating bone stress [12, 14, 20, 21], or
integrating with additional outcomes as risk of
fracture or ligament strain distribution [17, 20, 21].
RESU L TS
Results showed that the kinematic and kinetic knee
joint activity is highly patient dependent, both in
healthy and in patient with prosthesis [15, 11, 12],
moreover, a wrong position of the implant or a bad
choice of the soft tissue position during modeling
could induce high alteration of the joint force
(up to 60%) even if the change in kinematics could
be quite small (less than 5% compared with the
theoretical position) [1519].

PT 02

UNRAVELING THE ROLE OF DIFFERENT MECHANOCHEMICAL CONDITIONS ON 3D CELL MIGRATION:


FROM MICROFLUIDICS TO NUMERICAL SIMULATION
J.M. Garcia Aznar1, O. Moreno-Artozena1, F. Ribeiro2, J. Escribano1,
M. Cndor1, I. Gonzalez1, C. del Amo1, C. Valero1, C. Borau1, T. Rberg3
1
2

University of Zaragoza, Mechanical Engineering, Zaragoza, Spain

Instituto Superior Tecnolgico, Mechanical Engineering, Lisbon, Portugal


3

University of Graz, Mechanical Engineering, Graz, Austria

Results
Preliminary results of fibroblast migration in 3D are
shown in Figure 1. Three different conditions have been
imposed on the left channel for the growth factors: no
growth factor (control), PDGF-BB and TGF-b1.

Introduction
Cell migration is crucial to all morphogenetic and
regenerative processes. It also contributes to the
development of numerous diseases, including
cancer. Research in cell migration has mainly
focused on 2D; however, 3D migration assays, in
which cells are embedded within a physiological
network of fibers, represent much better the
extracellular matrix. All the processes that cells
develop to update and guide their directional
movement are regulated by environmental signals
arising from the surrounding microenvironment.
Unraveling the intrinsic mechanisms that cells
use to define their migration is an essential
element for advancing the development of new
technologies in regenerative medicine. For this
aim, we propose to combine 3D cell cultures on
microfluidics platforms and numerical simulations
to advance towards a better understanding of the
cell migration phenomena.

Figure 1: D
 irected cell migration in collagen gels under
control, PDGF-BB and TGF-1 conditions.1

Methods
We have developed microfluidic-based studies of
individual 3D fibroblast movement in biomimetic
microenvironments comprised by the matrix and
the biochemical factors that are moving through
the medium. In particular, we have analyzed
two physiologically relevant hydrogels (made
of collagen and fibrin) in combination with two
growth factors (PDGF-BB and TGF-b1).

These experimental results have been successfully


simulated predicting similar patterns. Additional
phenomena have been simulated in order to
understand how the effect of different local
properties of the microarchitecture can regulate
the migration of individual cells.
Discussion
In this work, we demonstrate that the local
microarchitecture of the hydrogels determines
the migratory properties of human fibroblasts
in response to controlled chemotactic and
haptotactic gradients. We are currently working
with this multidisciplinary approach to understand
3D migration of tumor cells.

At the same time, we are developing novel


numerical approaches to couple multiple
mechanisms
(protrusion,
contraction
and
adhesion) that regulate cell migration. These
numerical simulations will combine discrete and
continuous approaches that enable the design of
effective modeling strategies for each particular
event. Both approaches are combined together
with the experiments in order to improve the
understanding of 3D cell migration, based on a
continuous interactive methodology.

References
1 O. Moreno-Arotzena et al. Biomicrofluidics 8,
064122 (2014)
Ack n o wl e d g e m e n t s
This study was supported by the project
ERC-2012-StG 306751 and the Spanish Ministry
of Economy and Competitiveness
(DPI2012-38090-C03-01).

PT 03

IN SILICO CLINICAL TRIALS: REDUCE, REFINE AND


PARTIALLY REPLACE HUMAN EXPERIMENTATION.
M. Viceconti1
1

University of Sheffield, Insigneo institute for in silico medicine, Sheffield, United Kingdom

C o n cl u s i o n
With this perspective talk we hope to inspire new
research in an exciting and industrially relevant
direction.

Introduction
The Avicenna support action is roadmapping the
new research domain known as In silico Clinical
Trials, which refer to the use of individualised
computer simulation in the development or
regulatory evaluation of a medical intervention. In
this prospective talk we reflect on the difficulties
that the development of new medical devices
pose, and how in silico technologies may play an
important role in solving them.

References
A
 vicenna web site: http://www.avicenna-isct.org
V
 iceconti, M., 2014. Biomechanics-based in silico
medicine: The manifesto of a new science.
J Biomech Jan 21;48(2), 193194.
Coveney, P., Diaz, V., Hunter, P., Viceconti, M., Eds.,
2014. Computational Biomedicine. Oxford, Oxford
University Press.
Viceconti, M., 2011. Multiscale Modeling of the
Skeletal System. Cambridge University Press.

Exp e r i m e n t a l M e t h o d s
We will overview the current methods for the design
and assessment (both pre-clinical and clinical) of
new implantable medical devices, highlight the
main difficulties and shortcomings, and suggest
where in silico technologies could be used instead.

Ack n o wl e d g e m e n t s
This work was partially supported by the Avicenna
CSA funded by the European Commission as part
of the 7th Framework Program (FP7).

Results and discussion


The analysis will make evident the current
methodological
and
technological
gaps,
suggesting possible directions for research and
development in this area.

PT 04

WHAT IS THE RELEVANCE OF BONE MATERIAL


PROPERTIES FOR OSTEOPOROTIC FRACTURES?
P. Thurner1, O.L. Katsamenis2, T. Jenkins2, L.V. Coutts2, O.G. Andriotis1,
V. Nedelkovski1, D.G. Dunlop3 , R.O.C. Oreffo4 , C. Cooper5, N.C. Harvey5
1

Faculty of Engineering and the Environment, University of Southampton,


Southampton, United Kingdom

University Hospital Southampton NHS Trust, University Hospital Southampton NHS Trust,
United Kingdom
4

Institute for Lightweight Design and Structural Biomechanics,


Vienna University of Technology, Vienna, Austria

Institute for Developmental Sciences, University of Southampton,


Southampton, United Kingdom

MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom

Age-related bone fragility is a severe and


increasing problem. Every third woman over 50 is
expected to suffer an osteoporotic fracture during
her lifetime. With increasing life expectancy the
problem to screen and treat patients at risk prior
to experiencing a fracture becomes increasingly
important. Historically bone quantity, i.e. bone
mineral density (BMD) and clinical risk factors, i.e. the
FRAX tool, have most widely been used. Yet, these
diagnostic measures suffer from low specificity for a
given sensitivity. For over a decade the importance
of bone quality, i.e. all intrinsic properties of bone
relating fracture risk that are not bone quantity,
has been investigated. Among the parameters
encompassed by this term are also the material
properties of bone tissue, which are strongly linked
to micro- and nanostructural arrangement and
composition. From a materials science perspective
an important question is whether and which
structural and compositional changes do occur as a
consequence of aging and/or osteoporosis disease
and what the potential implications for fracture risk
might be. This perspective paper summarises work
on bone material properties by ourselves and others
in the field over the past decade primarily focussed
on these questions.

enriched in NCPs appear to be reduced with aging


when investigating bone from the femoral midshaft
and so are fracture toughness measures. While the
impairment of material properties with ageing has
been reported in the past there are currently no data
points comparing osteoporotic to age-matched,
healthy bone. Our ongoing work suggests that at
least at the infero-medial portion of the femoral
neck (where fracture toughness samples can be
manufactured) there are no significant differences in
terms of fracture toughness. Whether this is also true
for the supero-lateral (where fracture initiates) side
cannot be answered, although micromechanical
investigations may elucidate putative changes in
material properties within this part of the femoral
neck. Nevertheless reference point indentation (RPI)
experiments are performed in vitro and in vivo can
measure differences between osteoporotic and
age matched healthy controls. But it is still unclear
what this technique actually measures and to which
component changes in structural and material
properties are influencing these measurements. While
RPI may offer a way to potentially improve fracture
risk assessment there are still a number of unresolved
questions: Is osteoporosis simply an effect of ageing
or are distinctive pathological changes occrring?
Are there underlying changes in bone composition
in terms of NCPs? Could this potentially offer novel
ways for complementary therapy? Further research
is required to provide answers to these questions
and with a fuller picture new diagnosis, treatments
and therapies appear feasible in the future for an
increasing aging population.

Imaging studies employing AFM and SEM revealed


that, at the nanoscale, bone failure surfaces are
predominantly located at the interface between
individual mineralised collagen fibrils [14]. Additional
studies showed that this interfibrilar space consists
of noncollagenous proteins (NCPs) [5], which can
form molecular meshworks that can repeatedly
dissipate large amounts of energy [6, 7] and can
furthermore also be covalently cross-linked [8]. This
suggests that the expression of NCPs during bone
formation may have a significant influence on
specifying bone material properties and indeed
this was shown in mouse models targeting only
osteoblastic protein expression [9]. The presence
of NCPs also suggest that diffuse microdamage,
which does not invoke a remodelling response [10]
may re-heal itself through molecular self-healing
processes [11]. Further the deletion of NCPs such
as osteopontin and osteocalcin results in significant
reduction of fracture toughness [12, 13], which
was linked only to the absence of diffuse damage
[13]. Further micromechanical modulation within
cortical bone due to interlamellar areas [14] that are

References
1 Fantner, NatMater 2005.;
2 Thurner, EngFracMech, 2007.;
3 Kindt, Nanotechnology, 2007.;
4 Braidotti, JBiomech, 1997.;
5 Thurner, JAdhesion, 2009.;
6 Fantner, NanoLett, 2007.;
7 Zappone, BiophysJ, 2008.;
8 McKee, CellsTissuesOrgans, 2005.;
9 Balooch, PNAS, 2005.;
10 Herman, Bone, 2010.;
11 Seref-Ferlengez, JBMR, 2014.;
12 Thurner., Bone, 2010.;
13 Poundarik, PNAS, 2012.;
14 Katsamenis, JMBBM, 2013.
7

PT 05

BIOMECHANICS OF CELL MEMBRANE NANOSTRUCTURES


A. Iglic1
1

University of Ljubljana, Faculty of Electrical Engineering, Ljibljana, Slovenia

Introduction
Membrane nanodomains are important functional
building blocks of biological membranes. As
an addition to the pure lipid bilayer, they can
significantly increase the complexity and alter
the physical properties of biological membranes.
Flexible membrane nanodomains (Figure 1) are
supposed to be small complexes composed of
proteins and lipids, where the proteins are often
chain-like biopolymers that cross the membrane
bilayer several times. Membrane raft elements
of biological membranes may also fall into this
category. Membrane nanodomains (inclusions)
may also be induced by a single rigid globular
membrane protein, which can be described in
the first approximation as a rigid object of a simple
geometrical shape. Some membrane-embedded
peptides may induce such nanodomains.

Results and Discussion


We present a possible mechanism that may explain
experimentally
observed
detergent-induced
tubular budding of the erythrocyte membrane. The
proposed mechanism is based on the energetically
favourable self-assembly of anisotropic membrane
nanodomains (raft elements) into larger membrane
domains
forming
nanotubular
membrane
protrusions. This mechanism of the growth and
stability of erythrocyte membrane tubular
membrane protrusions may also be relevant for
stabilization of tubular membrane protrusions
in other cellular systems and for the stability of
tunneling nanotubes that connect cells, and
could be important in intracellular and intercellular
transport and communication.

Methods
The single-nanodomain energy is derived in this
chapter. In this chapter, we present a theoretical
approach to the study of membrane nanodomains.
We derive the contribution to the free energy of
the membrane bilayer including nanodomains
which are in general flexible. For flexible
membrane nanodomains the phenomenological
interaction constants that appear in the free
energy expression depend on the physical and
geometrical. properties of the molecules that
constitute the membrane. Special consideration is
devoted to membrane nanodomains induced by
rigid membrane-embedded proteins. The cases
of constrained and unconstrained local shape
perturbations of the membrane around a rigid
membrane inclusion are discussed. The total free
energy of the membrane bilayer with membrane
nanodomains is derived.

PT 06

EVIDENCE THAT ATHEROSCLEROSIS IS TRIGGERED


BY MULTIDIRECTIONAL NEAR-WALL FLOW
P. Weinberg1
1

Imperial College London, Bioengineering, London, United Kingdom

Introduction
A striking feature of atherosclerosis is its
predilection for certain well-defined arterial sites.
Anitschkow [1933] first showed that lesions develop
downstream of branch ostia in the cholesterol-fed
rabbit, and that arterial wall uptake of plasma
proteins is elevated in the same locations, prior to
the development of disease. Fry [1969] proposed
that this is caused by elevated haemodynamic wall
shear stress (WSS) in these regions. However, Caro
et al [1971] found in post mortem human aortas that
areas downstream of branches had a particularly
low frequency of disease. They proposed that high
WSS is protective and that disease is triggered
instead by low WSS. Subsequently Ku et al [1985]
provided evidence that human atherosclerosis
occurs in regions where near-wall flow is not only
low but oscillatory. The theory that low, oscillatory
WSS triggers atherosclerosis underlies much
current research. However, it leaves a central
contradiction unresolved: human disease occurs in
arterial locations that, according to animal studies,
have the lowest uptake of plasma lipoproteins.

lesion prevalence in young and mature rabbits


[Mohamied, 2015]. No correlations supported the
low, oscillatory WSS theory.
Discussion
The data support the view that multidirectional
near-wall flow is highly atherogenic. A recent
observation [Wang, 2013] that flow has proinflammatory effects when acting perpendicularly
to the long axis of EC but anti-inflammatory effects
when acting parallel to it provides a plausible
cellular mechanism.
References
Anitschkow NN. In: Cowdry EV (ed). New York:
MacMillan, 1933.
Barnes et al, Exp Mol Pathol, 71:161k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change170, 2001.
Caro et al. Proc R Soc Lond B, 177:109k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change159, 1971.
Fry, Circulation, 40:3857, 1969.
Ku et al, Arteriosclerosis, 5:293k assessment there
are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change302, 1985.
Mohamied et al, Ann Biomed Eng, 43:16k assessment there are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or
are distinctive pathological change25, 2015.
Peiffer et al, Atheroscler, 223:114k assessment there
are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change121, 2012.
Peiffer et al, J Biomech Eng, 135:021023, 2013a.
Peiffer et al, Cardiovasc Res, 99:242k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change250, 2013b.
Peiffer et al, J Biomech, 46:2651k assessment there
are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change2658, 2013c.
Sebkhi A et al, Arterioscler Thromb Vasc Biol,
1996;16:317k assessment there are still a number
of unresolved questions: Is osteoporosis simply an
effect of ageing or are distinctive pathological
change27.

Methods and Results


Our tracer studies showed that the pattern of uptake
by the wall changes with age [Sebkhi, 1996]. Hence
the apparent contradiction noted above could
have arisen because young animals were compared
with mature human subjects. Furthermore, we
showed that although cholesterol-induced lesions
occur downstream of aortic branch mouths in
young rabbits, this region is spared in older rabbits
[Barnes, 2001]. Furthermore, lipid deposition occurs
downstream of aortic branch mouths in immature
human aortas [Sinzinger, 1980]. When these changes
with age are taken into account, human lesion
location, rabbit lesion location and elevated uptake
of plasma macromolecules in rabbits all correlate.
Does the pattern of WSS also change with age,
or is there a change in the relation between WSS
and disease? Our CFD studies showed that the
pattern of WSS does change because tapering
of the aorta increases with age [Peiffer, 2012].
Despite this change, we were unable to show any
consistent spatial relation between low WSS and
lesion prevalence [Peiffer, 2013a]. Furthermore,
our systematic review [Peiffer, 2013b] found that
all five rigorous studies making a point-by-point
comparison between CFD-derived WSS and
lesion prevalence failed to support the theory.
We speculated instead that substantial changes
in the direction of WSS during the cardiac cycle
might be particularly atherogenic, and developed
a new metric, the transverse WSS (transWSS), to
capture multidirectionality [Peiffer, 2013c].TransWSS
correlated positively, strongly and significantly with

see the next page

S inzinger et al, Blood Vessels, 17:44k assessment


there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change52, 1980.
W
 ang et al, Arterioscler Thromb Vasc Biol, 33:2130k
assessment there are still a number of unresolved
questions: Is osteoporosis simply an effect of ageing
or are distinctive pathological change2136, 2013.

Weinberg, J Vasc Res, 2004;41:1k assessment there


are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change17.

10

PT 07

PIANISTS HAND BIOMECHANICS:HERITAGE


AND NEW KNOWLEDGE
S.H. Lee1, A. Luciano2, S. Carey3
1
2

University of South Florida, School of Music, Tampa, USA

University of South Florida, Department of Pediatrics Division of Neonatology, Tampa, FL, USA
3

University of South Florida, Mechanical Engineering, Tampa, USA

Introduction
Classical piano discipline has inherited the
keyboard tradition that had evolved from the 17thcentury finger technique to 19th-century arm weight
technique, relaxation technique, and the modern
science of physiological mechanics. We now
know that these techniques are used together to
coordinate the skilled pianists biomechanics that
are displayed ultimately at the dexterous finger
touch control. We examined hand/finger shape,
size, arm/hand weights, and finger and intra-finger
motion in order to understand the efficient hand-piano key biomechanics (as well as ergonomics)
in skilled pianists playing. Advantages of the large
handed pianists versus injury risks of small-handed
pianists are still a topic of debate. However, history
reveals that the most eminent pianists over the
centuries came in varied hand sizes and shapes.

There were, however, no significant differences


between male and female in finger spans 1-5, 2-4, 3-5,
ulnar deviation, and hand-arm weight ratio. In Legato
playing, artists, graduate and injured pianists were
similar in articulation evenness (p=0.83, p=0.523) as
well as in tempo evenness (p=0.60, p=0.15), while
undergraduate pianists showed significant differences
in both temporal and articulation evenness control
(p=0.045, p=0.045). But, both injured (p=0.024) and
undergraduate pianists (p=0.042) showed significant
differences in tempo evenness in Staccato playing.
An injured and healthy pianists mocap data showed
significant differences in both MCP and PIP joints.

The aim of this study was to examine the relationships


between hand biometrics that include finger length,
span, arm and hand weight ratio, and wrist mobility
and the performance data as measured by MIDI
(Musical Instrument Digital Information) equipped
hybrid electro-acoustic piano. We also wanted to
pilot test and compare finger and between-finger
motion captures of a healthy and an injured pianist.
METHOD
We tested four groups of skilled pianists (N=31)
applying comprehensive hand measurements,
motion capture at 14 finger joints, and quantified
performance outcomes to examine systematically
relationships among hand biomechanics, music
performance outcomes, and motion capture.
Skilled pianists are classified into four categories: artists
(n=9), graduate pianists (n=8), undergraduate pianists
(n=5), and injured professional pianists (n=9). We
defined hand biomechanics per hand length and
width, composite finger lengths, composite finger
spans, hand and arm weights, weight ratio between
them, and ulnar deviation at the wrist. Performance
outcomes in playing seven tasks were measured by
temporal and dynamic evenness touch control on
the piano keys, quantified in MIDI data generated
from a hybrid acoustic-electronic piano. DataGlove
5DT was used to capture motion at 14 finger joints
to compare an injured and a healthy pianists joints
motions in playing a rapid scale.

Discussion
Our study demonstrates high correlations between
various components of hand biomechanics and piano
touch control. We have used the hand biomechanics
data and MIDI outcomes to rehabilitate pianists
pain and injury. We were able to demonstrate the
effective use of this novel knowledge in prevention
and rehabilitation of piano-related pain and injury.

Results
There were NO differences in hand biomechanics
among the four pianist groups. Significant differences
in hand size, shape and weight were observed
between male (n=16) and female (n=15) pianists.

11

PT 08

CHANGES OF MECHANICAL SIGNALS AND TISSUE


COMPOSITION IN HUMAN INTERVERTEBRAL DISC
DURING DEGENERATIVE PROGRESSION
W. Gu1, Q. Zhu2, X. Gao3
1

University of Miami, Mechanical and Aerospace Engineering,


Biomedical Engineering, Coral Gables, USA

University of Miami, Tissue Biomechanics Lab., Dept. of Biomedical Engineering, Florida, USA
3

University of Miami, Department of Mechanical and Aerospace Engineering, Florida, USA

Introduction
Intervertebral
disc
degeneration
involves
complicated changes in the biological, chemical,
electrical and mechanical events within the
tissue. Knowledge of these events is crucial for
understanding the mechanobiology in the disc
as well as for developing new diagnostic and
therapeutic methods for degenerated discs.
Therefore, the objective of this study was to
quantitatively investigate the temporal changes in
tissue composition and mechanical signals within
human lumbar discs during the degenerative
progression.

composition, and tissue deformation over time.


The knowledge of the variations of temporal and
spatial distributions of tissue composition and
mechanical signals can provide a new insight into
the progression of disc degeneration. It can also
help develop new strategies for diagnosis and
treatment of degenerated discs.
Figure

Methods
The disc is modelled as an inhomogeneous, porous,
mixture consisting of a charged solid phase [with
cells and proteoglycan fixed to the solid phase], a
fluid phase, and a solute phase with multiple species
(sodium ion, chloride ion, glucose, oxygen, and
lactate). The theoretical model was extended from
the cell-activity coupled mechano-electrochemical
model [Zhu et al., 2012]. A 3D numerical model was
developed based on the finite element method [Gu
et al., 2014]. The disc degeneration was simulated
by the reduction of the nutrition supply at the disc
boundaries [Zhu et al., 2014]. The configuration of the
disc at the healthy condition before degeneration
was chosen as the reference configuration. The
changes in stresses between current and reference
configuration were calculated.

Figure 1: ( A) Schematic of the rightupper quarter of the L2-3


disc (from a healthy male) [Jackson et al., 2011,
Zhu et al., 2012]. (B) 3D distribution of fluid pressure
at the healthy state. (C) Fluid pressure at 20 years of
degeneration. (D) Fluid pressure distributions in the
sagittal direction (averaged over the disc thickness).
(E) Fluid pressure distributions in the coronal direction (averaged over the disc thickness).

Only one upper-right quarter of the disc was


simulated due to symmetry (Figure 1A).

References
Gu et al., Spine, 39: E1411k assessment there are still
a number of unresolved questions: Is osteoporosis
simply an effect of ageing or are distinctive
pathological change7, 2014.
Jackson et al, J Biomech Eng, 133: 091006k assessment there are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or
are distinctive pathological change091013, 2011.
Zhu et al., J Biomech, 47: 3734k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change3743, 2014.
Zhu et al., J Biomech, 45: 2769k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change2777, 2012.

Results
With the progression of disc degeneration (over
50 years), the cell density, fixed charge density,
fluid pressure, and water content decreased
significantly in the nucleus pulposus (NP) and the
inner to middle annulus fibrosus (AF) regions of
the disc. The Von Mises stress (relative to that at
healthy state) increased within the disc, with a
larger increase occurring in the outer AF region.
Both the disc volume and height decreased with
the degenerative progression. Due to limited
space, only a small portion of the results (e.g., fluid
pressure) were presented (Figure 1B-E).
Discussion
This study provided detailed information on how
the nutrition deprivation affects the cell viability,
swelling pressure, mechanical stresses, tissue

12

PT 09

COMPARISON BETWEEN PREOPERATIVE DIGITAL


PLANNING AND POSTOPERATIVE OUTCOMES IN 197
HIP ENDOPROSTHESIS CASES USING SHORT STEM
PROSTHESES
P. Hhle1, S.M. Schrder2, J. Pfeil3
1
2

Klinikum Worms, Traumatology and Orthopaedics, Worms, Germany

GP Hospital Rsselsheim, Department of Trauma, Hand and Reconstructive Surgery,


Rsselsheim, Germany
3

St. Josefs Hospital, Department of Orthopaedics and Orthopaedic Surgery,


Wiesbaden, Germany

Introduction
Preservation of hip geometry is important for
treatment success in endoprosthesis implantation.
Digital planning can be used to estimate
postoperative hip geometry. This study examined
whether digital planning accurately predicts
surgical outcomes for two femoral neck resecting
short stem implants, Mayo (Zimmer) and Metha
(Aesculap).

Results
Implantation of the planned short stem prostheses
resulted in a mean femoro-acetabular leg
lengthening of 4.2 mm (SD 5.8 mm) and a mean
femoro-acetabular offset-reduction of 4.2 mm
(SD 5.9 mm) in comparison with preoperative
planning. Implantation of both stems resulted
in increased valgization compared to planning
(Metha , mean 5.4 [SD 3.7]; Mayo, mean k
assessment there are still a number of unresolved
questions: Is osteoporosis simply an effect of
ageing or are distinctive pathological change 3.2
[SD 3.4]).

Methods
Preoperative digital planning of the short stem and
acetabular cup was performed for 191 patients
(197 endoprostheses) with hip osteoarthritis. Digital
planning was done with mediCAD II (Hectec)
to evaluate types of prosthesis stems and sizes,
leg lengthening and offset, and angle of stem
inclination within the femur. The predicted values
for these parameters were compared to the
postoperative measurements. A double coordinate
system was developed to measure pelvic and
femoral distances separately. Individual scale
factors were applied to minimize measurement
bias.

Discussion
Differences between preoperative planning and
postoperative outcomes were greater for femoroacetabular than for cup-related leg length and
offset. On average, leg length was longer than
predicted and there was loss of femoro-acetabular
offset. Compared with the planning, valgization of
the implanted stems was frequently observed.
Reference:
This Research is being published in the Journal of Clinical Biomechanics in February 2015
K e yw o r d s
Short stem prosthesis, hip, valgization, leg lengthening, femoro-acetabular offset, digital planning

13

P T 10

MECHANICAL STIMULATION IN TISSUE ENGINEERING


D. Pioletti1
1

EPFL/STI/IBI/LBO, Lausanne, Switzerland

Introduction
Mechanical stimulation has been demonstrated
to be one of the strategies to optimize tissue
engineering construct. However, it is challenging
to rationally determine the optimal mechanical
stimulation to control the tissue differentiation in
construct. For instance, Li and colleagues have
shown that the parameters of frequency and
amplitude during dynamic compression modulate
chondrogenesis of human bone MSC seeded in
polymeric scaffolds 1. Particular frequency and
amplitude may be optimal for one type of scaffold
but may not be for another type, since the scaffolds
would differ in their mechanical properties and
in their microstructure, inducing then a different
stimulus to the cells. This leads to the need of
identifying an overarching variable to generally
take into account those parameters.Hence, the
aim of this study is to evaluate if dissipation could
be correlated to a tissue differentiation and then
be considered as a mechanobiology variable.

All the scaffolds were coated with fibronectin in


order to uniform the cell-scaffold interface between
the different types of scaffold. Scaffolds were then
seeded with epiphyseal chondro-progenitor cells 2
at 3 mio cells/scaffold. Cell-scaffold constructs of
the different groups were subject to mechanical
stimulation 3. Dynamic compression of 1Hz and
10% strain (with 10% pre-strain) was applied to
scaffolds 2 h/day during 4 consecutive days. After
the 4th day of testing, immediately after mechanical
stimulation, gene expressions of TGF-beta, Sox9,
Col2a and Aggrecan were analyzed for the loading
group and the free-swelling group used as control.
Results and discussion
As a result, in general upregulation for all genes was
observed with dissipation close to the dissipation
of healthy cartilage, and downregulation was
observed for dissipation close to degenerated
cartilage. This study highlights then that there
is a sensitivity of chondrogenic expression to
dissipation. Dissipation could then be variable to
be considered in cartilage mechanobiology.

Exp e r i m e n t a l M e t h o d s
HEMA-based scaffolds have been developed
having different levels of dissipation when subject
to the same loading in terms of frequency
and amplitude of deformation. The levels of
dissipation where chosen to match the level of
dissipation of healthy and degenerated cartilage.

References
1 Li+, Tissue Eng Pt A, 2010
2 Darwiche+, Cell Medicine, 2012
3 Abdel-Sayed+, Biomaterials, 2014

14

P T 11

EXPLORING LUMBAR SPINE BIOMECHANICS AND


INTERVERTEBRAL DISC BIOPHYSICS THROUGH
MULTISCALE AND MULTIPHYSICS MODELLING
J. Noailly1,2
1

Universitat Pompeu Fabra UPF, Department of Information and Communication T


echnologies DTIC, Barcelona, Spain
2

Institute for Bioengineering of Catalonia, Biomechanics and Mechanobiology,


Barcelona, Spain

Introduction
Intervertebral disc (IVD) degeneration (DD) is an
intricate process. On one hand, disc cells respond
to mechanical, biochemical, and nutritional cues
that interact with pathway signalling. On the other
hand, the IVD is composed of different tissues that
interact mechanically and redistribute each cue
heterogeneously, depending on external load
transmissions. Still, numerical modelling allows
rational interpretations of complex interactions in
DD.

Results and discussion


Under compressive loads representative of human
daily activity, reductions of diffusion distances
competed with tissue consolidation, in terms
of solute transport. For standard disc heights
(c.a. 10 mm), consolidation mostly hindered
glucose diffusion, but mechanical overload or
endplate sclerosis were necessary to induce cell
death. Nutrition seemed to control, however, the
proteoglycan loss characteristic of ageing.
Simulated
NP
dehydration
with
healthy
proteoglycan contents already caused drops
of glucose in the inner AF, suggesting that
nutrition-induced catabolic activities in the
AF could precede the commonly reported NP
degeneration. However, in (e.g. 14 mm) thick IVDs,
increased diffusion distances affected directly the
NP cell viability independently on tissue condition
[Malandrino, 2015].

Methods
3D porohyperelastic IVD finite element (FE)
models incorporated the annulus fibrosus (AF)
composite structure and the nucleus pulposus (NP)
osmotic pressure, in function of tissue composition
and/or condition. Focusing on nutrition as an
influent indirect mechano-transduction path,
poromechanical calculations were coupled to
metabolic transport models that predicted the
diffusion of oxygen, glucose and lactate, in function
of coupled solute reactions and glucose- and
pH-dependent cell viability [Malandrino, 2015].
This framework was used to explore the effect of:
1) mechanical cues on the nutrition-dependent cell
viability, 2) tissue alterations and disc geometries
on cell nutrition and viability, and 3) local cell
nutrition on the proteoglycan turnover.

While in human disc models nutrition-induced


local glucose deprivation was always most critical,
simulation of bovine disc organ cultures [Chan,
2013] revealed that compression-torsion loads might
induce primary cell death through local pH drops.
Use of the FE-based concentrations of lactate,
oxygen and glucose in the ABM led to catabolic
activity, partly compensated by the hydrostatic
pressure effect. These results qualitatively followed
the balance of mRNA expressions experimentally
determined for the simulated in vitro experiments.

Starting from the IVD scale, explorations were


expanded to the system scale through the
integration of the disc models into FE models of
the musculoskeletal lumbar spine. Interactions
between external loads and disc multiphysics were
studied, using a predictive muscle model coupled
to a geometrical description of the most relevant
local and global muscles [Toumanidou, 2014].

The maintenance of the IVD swelling capacity led


to muscle fascicle activation during simulated night
rest. On one hand, such activation made muscles
mechanically counterbalance the anterior body
mass in standing position [Toumanidou, 2014].
On the other hand, overnight disc strengthening
and AF integrity limited the need of muscle force
development during standing, and seemed to
mechanically protect the lumbosacral IVD.

The different cues transmitted through the IVD


were further explored against their capacity to
promote anabolic or catabolic cell activities.
In order to capture the complexity of these
processes, Agent-Based Models (ABM) were locally
coupled to the FE calculations, with special focus
on the effect of nutritional and mechanical cues
on mRNA expression and cytokine-mediated cell
communication.

All in all, the different mechanical and biophysical


interplays identified might explain the diversity of disc
degeneration phenotypes, in function of specific
patient spine morphology and muscle function.
Ack n o wl e d g e m e n t s
My SPINE-269909
References
Toumanidou et al, VPH Conference, Paper #165,
2014; Malandrino et al, Frontiers in Bioeng Biotech
(in press); Chan et al, PLoS One, 8(8), 2013.

15

P T 12

BIOMECHANICAL ASPECTS OF SPINAL CORD INJURY


T. Oxland1, P. Cripton2
1
2

University of British Columbia, Orthopaedics, North Vancouver, Canada

University of British Columbia, Mechanical Engineering, Vancouver, Canada

clinically burst fracture and fracture-dislocation


result in different injury mechanisms to the spinal
cord and result in contrasting patterns of neural
injury in novel animal models. There remains much
to discover regarding the behavior of the spinal
column and spinal cord during the traumatic
event and how this affects the pathophysiological
degradation of the spinal cord.

Spinal cord injury (SCI) begins with mechanical


insult to the cord (i.e. primary injury), followed by
a myriad of biological events such as ischemia,
inflammation, etc. that further damage the
cord (i.e. secondary injury). The biomechanical
aspects of the spinal column injury (i.e. vertebrae,
disc, ligaments) and the subsequent insult to the
spinal cord may inform the development of novel
preventative and treatment strategies. Cadaveric
experimentation, animal model development and
computational simulations continue to provide
insight into the relation between spinal column
injury and spinal cord damage.

Learning Objectives
At the end of this presentation, you should be able to:
i) differentiate between injury to the spinal column
(i.e. vertebrae, disc, ligaments) and injury to the
spinal cord;
ii) describe how an understanding of spinal column
injury can help inform the design of devices to
prevent spinal injury;
iii) describe the pathological changes in the spinal
cord damage after the most common patterns
of spinal column injury (i.e. burst fracture,
fracture-dislocation) in novel animal models;

This presentation will highlight the research work


being done at our institution and elsewhere in these
three research areas to address the biomechanical
aspects of SCI. Our work in prevention uses new
and existing knowledge of spinal column damage
patterns to inform the development of a novel
helmet. Our SCI-focused efforts demonstrated that
two of the most common injury types observed

16

P T 13

UNRAVELING THE MYSTERIES OF RESPIRATORY


AIRFLOWS IN THE ACINAR AIRWAY DEPTHS
J. Sznitman1
1

Technion Israel Institute of Technology, Biomedical Engineering, Haifa, Israel

Introduction
Over the past 30 years, our understanding of
the fluid mechanics in the pulmonary acinus of
the lungs has been fundamentally revisited. In
this perspective talk, we will review our current
knowledge of convective acinar airflows and their
role in determining the fate of inhaled aerosols in
the distal regions of the lungs where sub-millimetre
airways are densely populated with pulmonary
alveoli [Sznitman 2013]. We will briefly review the
influential studies following the seminal experiments
of Heyder et al. (1988) who demonstrated in
inhalation studies in human subjects that fine
inhaled particles mix significantly with residual gas;
the deeper the inhaled bolus penetrates the lungs
the more dispersed it becomes upon exhalation,
suggesting that convective mixing occurs in the
acinar depths. This shift of paradigm began a
revolution in our understanding of the complex
nature of respiratory acinar flows.

To go beyond the state-of-the-art, we have


designed and microfabricated acinus-on-chip
platforms that mimic the physiological acinar
airway milieu at true scale. We have developed
the first ever prototypes of artificially-breathing
microfluidic in vitro acinar networks [Fishler et al.
2013] and obtained time-resolved quantitative
flow measurements, confirming for the first time
the broad range of alveolar airflow structures long
hypothesized to exist. Recently, we have begun
tracking time-resolved aerosol kinematics; to this
day, aerosol dynamics in the acinus had never
been experimentally demonstrated whether in
vitro, in situ or in vivo.
A n Ey e t o w a r d s t h e F u t u r e
Despite progress, including the integration of human
cellular airway barrier functions within our biomimetic
microfluidic devices [Tenenbaum-Katan et al. 2015],
we are still in the infancy of fully grasping the
complexity of transport phenomena at the acinar
scale. Crucially, we are unable to assess reliably the
outcomes of inhaling aerosols and predict ensuing
acinar deposition patterns. Our ongoing efforts are
paving the way to unravel quantitatively the fate
of inhaled aerosols in the acinus. Microfluidic in
vitro platforms of microscale alveolar cavities within
mesoscale respiratory acinar lung structures provide
for the first time the opportunity to interrogate in realtime and at true scale the underlying mechanisms
of respiratory phenomena under physiological
breathing conditions.

In silico Strategies
Using advanced computational fluid dynamics (CFD)
simulations [Hofemeier & Sznitman 2014, Hofemeier
et al. 2014], our group has delivered leading efforts in
developing some of the most physiologically-realistic
models emulating the pulmonary acinus, from the
microscale alveolar level, to more complex models,
from alveolated airways to multi-generation tree
networks [Sznitman et al. 2009].
Our in silico studies have helped shed light on the
range of complex oscillatory microflow topologies
that exist locally in alveolar cavities and describe the
ensuing convective mechanisms acknowledged to
generate kinematic irreversibility in the pulmonary
acinus, despite low-Reynolds-number airflows
(Re<1). These results, combined with dimensional
analysis, allow the physical interpretation of the
coupling that arises in the pulmonary acinus
between diffusive, convective and sedimentation
mechanisms for aerosol transport and deposition.

References
F ishler et al. J Biomech 46:2817k assessment there
are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change2823, 2013.
H
 eyder et al. J Appl Physiol 64:1273k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change1278. 1988.
H
 ofemeier and Sznitman. J Biomech Eng
136:061007, 2014.
H
 ofemeier et al. Fluid Dyn Res 46:041407, 2014.
M
 a et al. J. Aerosol Sci. 40:403k assessment there
are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change414, 2009.
S znitman et al. J Biomech Eng 131:031010, 2009.
S znitman, J Biomech, 37:1k assessment there are still
a number of unresolved questions: Is osteoporosis
simply an effect of ageing or are distinctive pathological change10, 2013.
T enenbaum-Katan et al. Biomicrofl in press, 2015.

In vitro Strategies
Traditionally, experimental approaches have
revolved around the use of scaled-up systems.
Yet, the fabrication of realistic models that
integrate features such as breathing motion in
multi-airway generations has proven delicate.
Moreover, scaled-up experiments are limited in
their applicability to investigate acinar aerosol
dynamics [Ma et al. 2009] due to the challenges
in matching both dimensionless flow (e.g. Re) and
particle numbers (e.g. Stokes number).

17

P T 14

ANTHROPOLOGICAL ASSESSMENT
OF BIOMECHANICALLY MEANINGFUL UNILATERAL
SHORTENING OF LEGS AND SOLUTION BY DRILLING
EPIPHYSIODESIS: LONG-TERM RESULTS
I. Marik1, D. Zemkova2, 3 , R. Myslivec4, 5, S. Petraskova1, J. Culik1
1

Ambulant Centre for Defects of Locomotor Apparatus l.l.c., orthopaedic,


Prague, Czech Republic

University Hospital Motol, Prague, Czech Republic, Paediatrics, Prague 5, Czech Republic
3
4

Dept. of Paediatrics University Hospital Motol Prague Czech Republic

Orthopaedic and Traumatology Department, Hospital Pribram, Czech Republic


5

Faculty of Medical Studies, West Bohemia University Pilsen, Czech Republic

Introduction
Shortenings and deformities of legs at children are
symptoms of genetic skeletal disorders, congenital
limb defects, consequence of inflammation
and injury of growth plates and/or the result of
neurological diseases. Shortening 2 cm and more
causes a limping and implicates asymmetrical
overloading of the leg joints and spine, too. It is
known that this overloading causes premature
degenerative changes not only of big joints like
gonarthrosis and coxarthrosis but also spondylosis
and spondylarthrosis. We talk chain formation
of disorder underneath and biomechanically
meaningful shortentings represent so-called preosteoarthritis. Regulation of growth at the knee
region by drilling epiphyseodesis [Macnicol, 1992]
belongs to miniinvasive procedures in comparison
with corrective osteotomies and lengthening of
long bones. Epiphysiodesis carried out at the knee
region is a method of choice for the equalization
of shortenings 25 cm in growth period. Our
contribution summarizes our many years ongoing
experience with anthropological prediction of
remaining growth of the leg lengths discrepancies
and apropriate timing of the surgery.

RESU L TS
The final abbreviation ranged between 02.0 cm
(median 1 cm).
DIS C USSION
Drilling epiphyseodesis is an appropriate method
for the equalization of shortenings 25 cm. It is a
mini-invasive surgical procedure that is indicated
with the aim not only to prevent premature
degenerative changes of leg big joints and spine
but it improves the walking stereotype, posture
and visual aspect, too. Regular follow-up of
affected children from the beginning of puberty is
necessary for proper timing of surgery. We proved
that the remaining growth data by Anderson,
Green and Messner [1963] are enough precise for
our population.
RE F EREN C ES
A
 nderson M et al, M. B. J Bone Joint Surg Am. 45:
1k assessment there are still a number of unresolved
questions: Is osteoporosis simply an effect of ageing
or are distinctive pathological change14, 1963.
Macnicol M F et al, Seminars in Orthopaedics (the
Princess Margaret Rose Orthopaedic Hospital,
Edinburgh) 7 (3): 201k assessment there are still a
number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive pathological change206, 1992.
M
 oseley C F, J Bone and Joint Surg 70A(4):
520525, 1988.
S hapiro F J, Bone and Joint Surg 64-A (5):
63965, 1982.
T anner J M et al. Assessment of skeletal maturity
and prediction of adult height (TW3 method).
London: Saunders, 2001.

Methods
Prediction
method
combines
auxology,
anthropometry and radiology [Moseley, 1988,
Shapiro, 1982]. Bone age was evaluated before
surgery [Tanner, 2001] and remaining growth
was predicted according to Anderson, Green
and Messner [1963]. Resultant shortening was
compared with prediction and remaining growth
after epiphyseodesis. Total epiphyieodesis was
carried out by drilling of growth plate in the knee
region according to Macnicol technique. Total
permanent epiphysiodesis of distal femoral physis
and/or proximal tibia was carried out in a cohort of
49 children with predicted abbreviation 25,5 cm
in age 10.616,5 years. Totally were made 39 distal
femoral and 41 proximal tibial epiphysiodesis.

18

P T 15

SKELETAL SYSTEMS MECHANOBIOLOGY


R. Mller1
1

ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland

Introduction
Cyclic mechanical loading is perhaps the most
important physiological factor regulating bone
mass and shape in a way which balances optimal
strength with minimal weight[1]. This skeletal
adaptation process spans multiple length and time
scales. Forces resulting from physiological exercise
at the organ scale are sensed at the cellular scale
by osteocytes, which reside inside the bone matrix.
Via biochemical pathways, osteocytes orchestrate
the local remodeling action of osteoblasts (bone
formation) and osteoclasts (bone resorption).
Together these local adaptive remodeling activities
sum up to strengthen the skeleton globally at the
organ scale. To resolve the underlying mechanisms
it is required to identify and quantify both cause
and effect across the different scales.

for osteocytes would undoubtedly enhance our


understanding of their role in bone remodelling.
RESU L TS AND DIS C USSION
As part of this presentation, emerging as well as
state-of-the-art experimental and computational
techniques will be discussed and how these
techniques are used in a mechanical systems
biology approach to further our understanding of
the mechanisms governing load induced bone
adaptation, i.e. ways will be outlined in which
experimental and computational approaches
could be coupled, in a quantitative manner to
create more reliable multiscale models of the
skeleton.
C ON C L USION
Systems mechanobiology allows coupling of the
biochemical information with the mechanical
microenvironment of osteocytes. In the future,
this will facilitate better understanding of the
biochemical signaling cascade in load induced
skeletal adaptation.

E X P ERIMENTA L METHODS
Progress has been made at the different scales
experimentally. Computational models of bone
adaptation have been developed to piece
together various experimental observations at
the different scales into coherent and plausible
mechanisms [2]. However additional quantitative
experimental validation is still required to build upon
the insights which have already been achieved.
A systems biology approach to understanding
biological systems demands the development of
high-throughput experimental methods which are
capable of yielding spatiotemporal information
at single cell resolution[3]. Given the diverse micromechanical environment which exists in loaded
trabecular bone, the availability of such data

RE F EREN C ES
1 Wolff J., Hirschwald, 1892.
2 Trssel A. et al., Ann. Biomed. Eng., 40:24752487,
2012.
3 Levchuk A. et al., Clin. Biomech., 29:355362, 2014.
A C K NO W L ED G MENTS
The author gratefully acknowledges funding from
SystemsX.ch (51PH-0_131370/1).

19

O 0 01

IN VIVO LOADS AT THE ARTIFICAL


ACETABULUM DURING WALKING
P. Damm1, A. Bender1, G. Bergmann1
1

Julius Wolff Institute Charit Universitaetsmedizin Berlin, Instrumented Implants,


Berlin, Germany

Introduction
Friction induced moments and subsequent cup
loosening are common reasons for failures of total
hip joint replacements (THR); in 26 % to 48 % of all
cases (1) polyethylene wear and aseptic loosening
cause revisions of THR. Only in vitro studies have been
performed so far to determine friction in THR, using
different head diameters and lubricants in simulators
or examining explanted prostheses. The aim of our
study was to determine in vivo the loading of the
artificial cup during walking as a basis for future wear
analyses.

ageing or are distinctive pathological change


0,37 to +0,2%BWm. In figure B, the average
contact pattern is shown for H2R, in figure C the
average of all patients.

Methods
Gait data and simultaneous in vivo loads were
measured in 6 subjects during walking. The
contact forces and moments were captured
with an instrumented implant (2) with Al 2O 3/XPE
pairing. From individual CT scans and marker
movements, the 3D positions of femur and cup
were calculated (3). The femur-based joint
loads were then transformed to the cup and the
patterns of the contact point in the cup surface
were calculated. The forces are given in % of the
patients bodyweight (%BW) and the moments
in %BWm.
Results
Figure A shows the average loads of subject H2R.
The highest force Fx = k assessment there are still
a number of unresolved questions: Is osteoporosis
simply an effect of ageing or are distinctive
pathological change 235% BW was acting in
medial direction, followed by Fz = 125%BW and
F y = 69%BW. The inter-individual ranges were
large: Fx = k assessment there are still a number
of unresolved questions: Is osteoporosis simply an
effect of ageing or are distinctive pathological
change187 to k assessment there are still a number
of unresolved questions: Is osteoporosis simply an
effect of ageing or are distinctive pathological
change 289% KG; Fy = 56 to 162% KG; Fz = 103
to 172% KG. The highest friction moment was
Mz = 0.19%BWm, followed by M y = k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change 0.18%BWm and
Mx = 0.1%BWm. The inter-individual ranges were:
Mx = k assessment there are still a number of
unresolved questions: Is osteoporosis simply an effect
of ageing or are distinctive pathological change
0,13 to +0,11%BWm; My=k assessment there are still
a number of unresolved questions: Is osteoporosis
simply an effect of ageing or are distinctive
pathological change 0,19 to +0,19%BWm; Mz = k
assessment there are still a number of unresolved
questions: Is osteoporosis simply an effect of

Figure: (A) in vivo loading of the artificial acetabulum


during walking (H2R); course of the contact point
on the cup surface during walking, (B) subject H2R
and (C) all subjects

Discussion
The in vivo forces and moments and the contact
point patterns varied between individuals. The
courses mainly depend on (i) the type of movement,
(ii) the range of motion and especially (iii) the
alignment of the implant components. During
walking the cup surface was mainly anteriorly
loaded in all investigated patients. The real in
vivo patterns indicate that contact pattern of the
ISO-14242 wear test standard does not define a
realistic cup loading. The contact pattern of the
AMTI wear test standard (4), however, provides
nearly realistic test conditions.
References
(1) C
 JRR, Report of the Can. Inst. of Health Inf., 2008
(2) D
 amm et. al, 2010
(3) T repczynski et. al, 2012 (4) Calonius & Saikko, 2003
This project was supported by DFG (Be 804/19-1) and
Deutsche Arthrose-Hilfe e.V.
20

O 002

COMPLETE DISTRIBUTION OF MICROMOTION MEASURED


AROUND A CEMENTLESS FEMORAL STEM
V. Malfroy Camine1, H. Rdiger2, D. Pioletti1, A. Terrier1
1

EPFL, Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland


2

Schulthess Klinik, Muskulo-Skelettal Zentrum, Zrich, Switzerland

Introduction
A good primary stability of the femoral stem is
essential for the long-term success of a cement
-less total hip arthroplasty. Indeed, excessive
micromotion at the bone-implant interface
endangers the implant primary stability and
promotes
aseptic
loosening
[Engh,
1992].
Currently available techniques to evaluate the
primary stability of cementless stems rely mainly
on LVDT sensors [Viceconti, 2000]. Despite their
good precision, these sensors allow only a limited
number of measurement points around the stem
and include the bone deformation between the
device fixation point and the measurement site.
The aim of this study was to develop a CT-based
technique to measure micromotion around the
complete femoral stem.

Results
Over 550 measurement points were uniformly
dispersed around the whole stem. The measure
ments accuracy was below 20 m for 90 % of the
measurement points, and
was uniformly distributed. The amplitude of micro
motion varied from 5.5 m to 50.7 m, mainly in
the vertical direction, as expected for an axial
compression. The maximum was on the distal part
of the stem.

Methods
This method extends a previous study [Gortchacow,
2011][Gortchacow, 2012]. A cadaveric femur
conserved in formalin was prepared for implantation
by a senior orthopaedic surgeon. 1000 stainless steel
microspheres were press-fitted in the endosteal bone
cavity to serve as bone markers. 30 tantalum markers
were stuck on a straight cementless femoral stem
(Corail, Depuy Synthes, USA). The stem was inserted
into the femur according to the usual technique
by the surgeon. A custom-made loading device
was developed to apply 1800 N axial compressive
load on the stem, corresponding to walking activity.
This loading device was designed to fit inside
a CT scanner (Skyscan 1076, Bruker, Belgium). We
performed 2 scans (36 m resolution) successively:
during loading and after loading. Bone and implant
markers were identified and located on the 2 CT
scans. The unloaded scan was used as a reference. All
markers of the loaded scan were rigidly transformed
so that implant markers coincide. Micromotion was
defined in 3D as the displacement of bone markers
from the unloaded scan to the loaded scan. The
measurement accuracy was determined from two
successive unloaded scans. The measurement points
were interpolated to provide a continuous map
micromotion on the stem surface.

Discussion
The developed technique provided the complete
map of micromotion around a cementless stem.
The accuracy was below the reported limit for
primary stability. The method allowed identifying
a distal region with higher micromotion. This shows
the importance of the complete map of micro
motion around the stem, for an analysis of implant
primary stability. This technique is currently applied
to compare different implants designs and to
validate FE element models.
References
Engh et al, Clin Orthop Relat Res, 285:1329, 1992.
Gortchacow et al, J Biomech, 44:557560, 2011.
Gortchacow et al, J Biomech, 45:12321238, 2012.
Viceconti et al, J Biomech, 33:16111618, 2000.

21

O 003

STRESS ANALYSIS OF CERAMIC ACETABULAR LINERS


DEPENDING ON DIFFERENT ANGULAR GAPS UNDER
IN VIVO LIKE LOADING CONDITIONS
K. L. Huler1, C. Kruse1, M. Flohr1, R. Preu1, R. Streicher2, M. Morlock3
1

CeramTec GmbH, Medical Products Division, Plochingen, Germany


2

Dr. Streicher GmbH, Dr. Streicher GmbH, Feusisberg, Switzerland

Hamburg University of Technology, Institute of Biomechanics, Hamburg, Germany

Introduction
Modular acetabular liners are fixed in metal shells
by a taper locking mechanism. Male tapers of
the liner and female tapers of the metal shell
have different taper angles resulting in an angular
gap. Depending on the specific manufacturing
tolerances varying angular gaps may result
and, thus, different contact mechanics may be
generated that could alter the stresses within the
acetabular liner. Therefore, the aim of the current
study was to experimentally determine stresses in a
ceramic liner depending on different angular gaps
under in vivo like loading conditions.

Strain data were converted to stresses and


compared using a paired 2-sided Wilcoxon Rank
Sum Test at an -level of 0.05.

Materials and Methods


Two ceramic liners were instrumented at the outer
contour with five strain gauge (SG) rosettes each
(Fig.1). First, metal shells were axially seated in an
asymmetric press-fit model with 0.5 mm underreaming, then liners were assembled with a 2 kN
axial load. SG5 was placed at the flat area of the
liner, the other four were placed circumferentially
in 90 degrees offset on the rear side. SG2 and SG4
were mounted opposite to each other in press-fit
direction while SG1 and SG3 were placed in the
non-supported direction. Three inclination angles
(0, 30, 45) were tested under in vivo relevant
loads of 4.5 and 11 kN. Four positive angular
gaps
(A1=0.1620.007,
A2=0.0840.002,
A3=0.0540.004, A4=0.0120.005) and one
negative angular gap (A5=-0.0690.006) were
examined. For all tests a mid-tolerance clearance
between liner and ball head of 70 m was chosen.

Results
Generally, similar stress distributions under the two
loads were found (Fig.2). Stresses for SG1 increased
with increasing inclination angle while stresses for
the other strain gauges decreased. Highest stresses
were found for 0 inclination in press-fit direction
(SG2, SG4) and at the bottom of the liner (SG5).
Almost no effect of the different angular gaps
on the stresses was found for SG5 while for SG1,
SG2, SG3 and SG4 significantly lower stresses with
decreasing angular gap were found.
see the next page

22

Discussion
This study showed that the in vivo stress state of
acetabular liners strongly depends on acetabular
component orientation. Higher stresses for larger
angular gaps are attributed to the contact zone of
the liner with respect to the metal shell resulting in
larger lever arms and, thus, leading to higher bending
moments acting on the liner. The contact zone shifts

downward with decreasing angular gap. Due to the


dimension of strain gauges the strain measurements
are limited to a defined region and, thus, no
complete strain map of the whole component could
be determined. Nevertheless, current results are very
useful to calibrate numerical studies concerning
ceramic components of a total hip arthroplasty.

23

O 004

GEOMETRICAL OPTIMIZATION OF A SHORT-STEM


HIP IMPLANT FOR THE REDUCTION OF PROXIMAL
STRESS SHIELDING
E. Borgiani1, S. Checa1, J. Martinez2, G. Duda1, M. Cilla1
1
2

Charite, Julius Wolff Institute, Berlin, Germany

Centro Universitario de la Defensa, Academia General Militar, Zaragoza, Spain

Introduction
An increasing number of young patients receive a
hip replacement. This, together with increasing live
expectations, raises the risk of revision surgery. The
insertion of a hip implant stimulates a peri-prosthetic
bone remodeling response, which usually results in
a net loss of bone material. This is of major concern,
particularly in the proximal Gruen zones, which
are considered critical for implant stability and
longevity. Nowadays, different implant designs
(e.g. long and short stems) exist in the market;
however there is not a clear understanding of what
are the best implant design parameters to achieve
mechanical conditions. The aim of this study was
to investigate the effect of different implant design
parameters on the bone after implant insertion and
to determine which ranges of those parameters
lead to the most physiological conditions.

under in-vivo patient-specific muscle, ligaments


and joint contact forces which were calculated
during the specific patients walking gait cycle
using a validated musculoskeletal model.
Physiological boundary conditions which balance
the whole set of forces without leading to relevant
reaction forces throughout load cycles were
applied (Speirs et al 2007). The 256 FE models were
then used to train the network (Garijo et al. 2014)
and to determine the best range of parameters to
reduce stress shielding.
Results
All implant designs led to a reduction of the
mechanical strains induced within the bone relative
to the intact femur (i.e. strain shielding), however
the amount of bone volume under strain shielding
was considerably different in the different designs.
Implant length (L) was not the only parameter
playing a determinant role in stress shielding. For
a given length, reduced distance between the
implant neck and the central-stem surface (d) led
to more physiological loading of the bone (Fig. 2).

Methods
Machine Learning Techniques (MLT) in combination
with Finite Element (FE) analyses were used to
determine optimal implant design parameters
to minimize stress shielding. A 3D femur was
reconstructed from Computed Tomography
(CT) images. Thereafter, a 3D parametric CAD
implant model was placed in the bone following
clinical guidelines (Fig. 1.a). The selected implant
geometrical parameters were: total stem length
(L), thickness in the lateral femur side (R1), thickness
in the medial femur side (R2) and the distance
between the implant neck and the central-stem
surface (d) (Fig. 1.b).

Figure 2: M
 ean strain difference between intact and
implanted bone for different stem lengths (L) and
relative position of central surface (d).

Discussion
Our optimization approach has the potential
to investigate new and innovative possibilities
for the design of hip implants never explored
before. Future studies will focus on extending the
methodology to take into account bigger value
ranges for the parameters.
Figure 1: a
 ) Geometry and b) parameters

References
Speirs et al, J. Biomech. 40: 23182323, 2007
Garijo et al, Comput. Methods Appl. Mech. Eng.
268: 437450, 2014

A total of 256 FE models were computed and the


difference of strains between the healthy and
implanted bone was determined for each case
24

O 005

DEVELOPMENT OF A COMPUTATIONAL TOOL


FOR EFFICENT PREDICTION OF FEMORAL STEM
MICROMOTION ACROSS THE SPECTRUM
OF PATIENT MORPHOLOGY
M. Bah1
1

Bioengineering Science Research Group, Faculty of Engineering & the Environment,


Southampton, United Kingdom

Introduction
Variability in patient anatomy, implant design and
positioning or loading can significantly affect the
performance of Total Hip Replacements (THRs). This
study proposes a novel tool that can pre-clinically
assess the suitability of implants in a wide range
of patients in terms of possible biomechanical
performance.

Results
The low offset 126-CCD angle stem, size 13,
matched most femur anatomies (36 males and
20females). The average micromotion was 147m
with a [1m, 42m] range. No significant differences
were found in recorded micromotions between
males and females. High micromotions were found
medially (Figure 2). The percentage of implant
area with micromotions greater than reported
critical values of 50m, 100m and 150m never
exceeded 15%.

Methods
A tool is developed that automatically selects
and positions the most suitable stem out of
12 FURLONG EVOLUTION designs; E=105GPA,
=0.3) for each of the 109 CT-based femur models
(Figure 1), based on anatomical measurements
and implant design parameters. The resulting Finite
Element (FE) contact models of reconstructed hips
were simulated during stair climbing (coefficient of
friction 0.4; interference-fit of 50m (Abdul-Kadir et
al., 2008) using physiological boundary constraints
(Speirs et al., 2007). To ease the computational
burden,
an
efficient
substructuring-based
technique is developed that condenses the linear
part of the model (implant and bone) to form
a superelement and iterates through the interfacial
degrees-of-freedom alone.

Figure 2: S tem micromotion (mm) in a selected patient


aged 25 implanted with a 126 CCD angle and
standard offset stem. Canal Flare Index: 2.93. Maximum micromotion: 0.16mm.

Discussion
Overall, the primary stability and the tolerance
of the short stem to variability in patient anatomy were high, suggesting no patient stratification is necessary for the considered cementless
stem. The average micromotion nonlinearly decreased with bone density in the Gruen zones and
the 3D metaphyseal canal flare index (MCFI). All
remaining parameters (periosteal and endosteal), body size or BMI showed no clear effects.
The largest micromotions occurred in femurs with
low bone density and MCFI. In conclusion, the proposed tool, based on morphological analysis and
accurate implant match and selection can be a
valuable tool to support implant design and planning of femoral reconstructive surgery.
References
Bah et al., 2015, J Biomech,
DOI: 10.1016/j.jbiomech.2015.01.037
Abdul-Kadir et al., 2008, J Biomech, 41:587594.
Speirs et al., 2007, J Biomech, 40:23182323.

Figure 1: V
 ariability in Patients, Stem Design and Positioning.

25

O 006

PATIENT-SPECIFIC FE STRENGTH AS PREDICTOR


OF THE RISK OF HIP FRACTURE: THE EFFECT
OF METHODOLOGICAL DETERMINANTS
M. Qasim1, X. Li1, E. DallAra1, R. Eastell2, M. Viceconti1
1

INSIGNEO University of Sheffield, Mechanical Engineering, Sheffield, United Kingdom


2

INSIGNEO University of Sheffield, Department of Human Metabolism, Sheffield,


United Kingdom

Introduction
Osteoporosis is characterized by the loss of bone
mineral density (BMD) and is associated with
increased risk of fracture. The current clinical
standard to estimate the risk of hip fracture is
based on areal BMD measured by dual-energy
absorptiometry (DXA). Quantitative computed
tomography (CT) based Finite element (FE)
models have been shown to predict with excellent
accuracy the femoral strength as measured in
vitro. We present a retrospective case-control
study employing FE strength estimates to predict
hip fracture risk.

for each predictor. The effect of different FE modelling techniques on the predictive ability of FE
strength was studied.
Results
Total BMD, neck BMD and MPS were significantly
different (p < 0.001) between the fracture and
control groups. Difference between the mean
MPS of control and fracture groups was lowest for
Model-I and highest for Model-IV (Figure 1). Logistic
regression analyses showed total BMD, neck BMD
and MPS to be significantly (p < 0.001) associated
with the fracture status. AUC for total BMD and
neck BMD were 0.74 and 0.75 respectively. AUC
for MPS increased from 0.59 to 0.65, 0.72 and 0.75
for Models I, II, III and IV respectively. Age and
BMD adjusted regression analyses for model IV
showed the MPS to remain significantly (p=0.004,
AUC=0.80) associated with the fracture status.

Methods
The study was conducted on a retrospective
cohort of 98 postmenopausal women, of whom
49 with proximal femur fractures and 49 selected
to be age, height and weight pair-matched controls. All patients received a DXA examination and
a proximal femur CT scan. One femur in each
patient was segmented using ITK-Snap. Segmented bone surface was meshed with 10-node tetrahedral elements using, i) a morphing procedure
based on the anatomical landmarks on the femur
surface [Grassi, 2011] and ii) an automatic algorithmfor mesh fitting (Icem CFD 14.0, Ansys Inc.,
PA, USA). Anatomy of the full femur was estimated
for each patient by employing a statistical shape
model from Melbourne femur collection based on
214 femurs using MapClient [Zhang, 2014]. Femur
orientation in neutral stance position was achieved
by A) defining a plane that passed through the
centres of the femoral head, the neck and the
diaphysis in the proximal femur and B) defining
a plane tangent to the condyles, passing through
the centre of the femoral head. In total four
FE models were developed for each patient;
Model-I: Morphed mesh/Proximal femur orientation, Model-II: Automatic mesh/Proximal femur
orientation, Model-III: Morphed mesh/Full femur
orientation and Model-IV: Automatic mesh/Full
femur orientation. The FE strength was estimated
for each patient in 12 different stance loading
conditions using an already validated procedure
[Schileo, 2008]. The minimum physiological FE
strength (MPS) among all loading conditions was
predicted for each patient. Total BMD, Neck BMD
and MPS were employed as predictors for hip fracture. Logistic regression analyses (SPSS v21) were
carried out to test the ability of each predictor to
classify cases and controls. Receiver operating
characteristics (ROC) curve was developed and
areas under the ROC curve (AUC) were compared

Figure 1: M
 PS predicted by different FE models for control
and fracture groups

Discussion
MPS did not perform better than the areal BMD
in classifying the fracture and control groups.
However, BMD adjusted regression analyses showed
that FE models contain information not included
in the areal BMD. Current study emphasised the
sensitivity of the FE based predictors to the meshing
techniques and the reference system.
References
Grassi et al, Med Eng Phys, 3:112120, 2011.
Zhang et al, Comp Meth Biomech Biomed Eng,
2(3):176185, 2014.
Schileo et al, J Biomech, 41:356367, 2008.

26

O 0 07

BONE FRACTURE AT BLAST LOADING RATES


A. Karunaratne1, A. M. J. Bull1
1

Imperial College London, United Kingdom, The Royal British Legion Centre for Blast
Injury Studies Bioengineering Department, London, United Kingdom

Introduction
Bone tissue is a composite material with a highly
anisotropic
hierarchical
structure
featuring
different toughening mechanisms at multiple
length scales. There is a known strain rate
dependency of the deformation, fracture and
toughening mechanisms, however, mechanical
properties have mainly been reported under
quasi-static loading rates, which does not reflect
physiological loading. Therefore, the aim of this
study is to investigate toughening mechanisms of
cortical bone at multiple length scales at strain
rates ranging from physiological to high speed as
seen in extreme loading such as blast.

C o n cl u s i o n
Multiscale imaging methods combined with
compact tension fracture experiments of bone
demonstrate crack deflection, microdamage
accumulation, collagen fibrillar stretching and
fibrillar sliding specifically at slow strain rates.
Their inverse relation to strain rate leads to the
decreasing fracture toughness at 1/s to 1000/s.

Exp e r i m e n t a l M e t h o d s
Compact tension experiments were performed on
pre notched cortical bone specimens (Fig 1 top)
at strain rates from 0.001/s to 1000/s. Strain was
measured using high speed videography. The
whitening intensity, a surrogate for microcrack
accumulation was determined from the high speed
videography. The following parameters were
measured: strain sensitivity of fracture toughness
properties, crack deflection and microcracking.
The same tests were conducted at strain rates from
0.001/s to 1/s combined with synchrotron small
angle X-ray diffraction with post fracture surface
analysis utilizing synchrotron micro-computed
tomography (microCT) and scanning electron
microscopy (SEM) to investigate interactions of
growing cracks with the osteons.

Fig 1: T op Schematic diagrams of compact tension cortical bone specimen showing the direction of osteons
and crack direction. Bottom MicroCT of bone samples tested at 0.001/s and 1000/s loading rates show
3D images of the crack growth from a razor-sharpened notch (red)(Yellow tubes Haversian canals)

Results and Discussion


The compact tension experiments showed a significant
(p<0.05) increase in fracture toughness (16.2%),
maximum load (11.1%) and stiffness (94.1%) from
quasi-static (0.001/s) to intermediate strain rates
(1/s), due to the transition from ductile to brittle
failure. Beyond the critical strain rate (~1/s), an
overall reduction in fracture toughness of 86.4% was
found as strain rate increased to 1000/s (p<0.05).
Synchrotron microCT imaging of post fracture
specimens showed that at slow strain rates (0.001 to
0.1/s) the crack deflects by 98.4 from the pre notch
and propagates along the osteon when it reaches
a Haversian system. In contrast, at dynamic loading
rates the angle of the fracture moves further away
from the Harvesian canal direction (122.5 from
the pre notch direction; Fig 1 bottom) The overall
whitening intensity around the crack just before the
total fracture, reduces by 96% from 0.001/s to 1000/s
(p<0.05). The scanning synchrotron X-ray diffraction
experiments showed a reduction in mineralised
collagen fibrillar tensile strain in the crack wake
(0.001/s = 0.35% and 1/s = 0.05%; p < 0.05),
demonstrating that there is lower energy dissipation
due to fibril deformation at higher strain rates.

References
Zioupos, P. et al, J Biomech, 41(14):29322939, 2008,
Thurner, P. J., et al., Eng Fract Mech, 74(12):
19281941, 2007.

27

O 008

WHOLE BODY VIBRATION HAS NEGATIVE EFFECTS ON


FRACTURE HEALING IN AGED MICE BUT PROMOTES
BONE REPAIR IN AGED, OVARIECTOMIZED MICE
E. Wehrle1, M. Haffner-Luntzer1, A. Liedert1, A. Heilmann1, T. Wehner1, R. Bindl1,
F. Jakob2, M. Amling3 , T. Schinke3 , A. Ignatius1
1

University Medical Center Ulm, Institute of Orthopaedic Research and Biomechanics,


Ulm, Germany
2

University of Wuerzburg, Orthopaedic Department, Wuerzburg, Germany

University Medical Center Hamburg Eppendorf, Institute of Osteology and Biomechanics,


Hamburg, Germany

Introduction
One potential therapeutic approach to improve
compromised fracture healing in aged and
osteoporotic individuals might be the application
of mechanical stimuli during the fracture healing
period, e.g. low-magnitude high-frequency
vibration [LMHFV; Rubin, 2004]. LMHFV was
reported to provoke anabolic effects in intact
and osteoporotic bone [Slatkovska, 2010],
whereas inconsistent results were obtained in few
preclinical fracture healing studies conducted
so far [Leung, 2009; Stuermer, 2010] with the
underlying molecular mechanisms still remaining
elusive. Therefore, this study examines the effect
of LMHFV on fracture healing with a major focus
on aged and osteoporotic bone as these are
conditions of clinical relevance. In order to better
understand the underlying mechanisms of LMHFV,
callus expression analyses were also included.

Results
LMHFV significantly impaired fracture repair in
nonOVX animals (bending stiffness: 174 vs. 901 Nmm 2;
BV/TV: 16 vs. 47 %; bone fraction in callus: 14 vs. 44 %)
which was associated with increased expression
of ER (3.2-fold) and sclerostin (2.9-fold) in the
callus, indicating inhibition of osteoanabolic
Wnt-signalling. In contrast, LMHFV significantly
improved the compromised fracture healing in OVX
animals (bending stiffness: 689 vs. 47 Nmm 2; BV/TV:
36 vs. 9 %; bone fraction in callus: 49 vs. 7 %) which
was associated with increased expression of ER
(1.6-fold) and osteocalcin (4.5-fold) in the callus,
indicating increased osteogenic differentiation.
Discussion
Vibration provoked distinct effects on fracture
healing outcome dependent on OVX. LMHFV
significantly improved the compromised fracture
healing process in aged OVX mice as evaluated
by an increase in biomechanical and structural
callus properties, whereas it significantly impaired
fracture healing in non-OVX animals of the same
age. On a molecular level we were able to show
a significant regulation of oestrogen receptors in
the fracture callus indicating involvement of the
mechanoresponsive oestrogen receptor signalling
in the observed vibration-mediated effects on
fracture healing.

Methods
Female C57BL/6NCrl mice (n=81) were either
ovariectomized
(OVX)
or
sham
operated
(nonOVX) at an age of 41 weeks. Eight weeks later
all animals received an osteotomy of the femur,
which was stabilized using an external fixator.
Starting on the third postoperative day, the mice
were placed on vibration platforms (20 min/d;
5d/week), and received mechanical intervention
therapy (nonOVX/OVX vibrated: f=45 Hz, a peak-to-peak=0.3 g). The animals were sacrificed on
d10 and d21 and the femora were analyzed by
immunohistochemistry
(d10),
biomechanical
testing (d21), micro-computed tomography (CT,
d21) and histomorphometry (d10, d21). On d10
callus homogenates were obtained for gene
expression analyses by RT-PCR. Statistics: Data
were tested for normal distribution (Shapiro-Wilk
normality test) as well as homogeneity of variance
(Levene test). Dependent on test outcome student
T-Test or Mann-Whitney-U tests were applied to
assess the influence of vibration on fracture healing
in nonOVX and OVX groups. Level of significance
was set at p < 0.05.

The findings of the present study indicate that there


is a therapeutic potential for LMHFV in osteoporotic
fracture healing, however the effects of vibration
on fracture healing may be highly dependent on
the estrogen status of the patient.
References
Leung et al, J Orthop Res, 2009: 458465, 2009.
Rubin et al, J Bone Miner Res, 19: 343351, 2004.
Slatkovska et al, Osteoporos Int, 21: 19691980, 2010.
Stuermer et al, Calcif Tissue Int, 87: 168180, 2010.

28

O 009

ASSESSMENT OF A FINITE ELEMENT MODEL TO


REPRODUCE AN EX-VIVO FORWARD FALL PROTOCOLE
LEADING TO FRACTURED AND NON-FRACTURED RADII
E. Zapata1,2,3,4 , H. Follet1,3,4 , J.B. Pialat4,5, D. Mitton1,2,3
1
2

Universit de Lyon, Lyon, France

IFSTTAR UMR_T9406, LBMC Laboratoire de Biomcanique et Mcanique des Chocs, Bron, France
3
4

Universit Claude Bernard, Lyon 1 , Lyon, France

INSERM UMR 1033, Team Bone Quality and Biological Markers, Lyon, France
5

Hpital E. Herriot Hospices Civils de Lyon, Radiology, Lyon, France

Introduction
Forward falls represent a risk of injury for the elderly.
The risk is increased in elderly suffering from bone
diseases, such as osteoporosis. Finite element
models have been proposed to improve the bone
strength prediction. However, these models have
considered quasi-static loadings and a loading
orientation along the longitudinal axis of the radius
whereas the real loading conditions in case of a fall
are non-axial loadings (in most of the cases) and
the loading speed could reach 2m/s in average.

experiment conditions. Bone was considered as


linear elastic and isotropic, with a Youngs moduli
of 10 GPa and a Poissons ratio of 0.3. Measured
velocity of the impactor in the experiment was
imposed in the model at the loading region.
Reaction loads from the experiment were
compared with the results from the simulation.
Results
Among the 6 radii, 4 fractured and 2 did not,
as expected in the design of the protocol.
Experimental peak forces are in agreement with
those reported in the literature [Burkhart, 2014].
Comparison between model and experiment is
shown in Figure 1

The goals of this study were 1) to design an ex vivo


protocol to load the radii with the same loading case
expecting that some of them will fracture and others
will not and 2) to assess subject-specific finite element
models (FEM) using these experimental data.
Methods
For the ex vivo protocol, six left radii from elderly
donors (50 to 96 y.o.) were considered. Distal third
of the radius was cut and cleaned of soft tissues.
Samples were then potted in a polyurethane resin
on a steel cylinder. Radii were placed with an
alignment of 15 between the frontal anatomical
plane and the anterior face of the radius, without
any tilt in any other plane. This position reproduces
alignment of the radius in the most common
forward fall [Greenwald, 1998]. Each sample was
then attached to 12.5 kg-mass (simulating part of
the body mass) free to slide along the loading axis.
A rigid polyurethane mold was made for each radius.
This mold is a simplified reproduction of the joint
contact to spread the loading during the impact
and was attached to the distal end of the radius.

Figure 1: C
 orrelation between model and experiment.

The radius was then loaded trough the mold


at 2 m/s using a hydraulic testing machine (LF
technologies, France). Loads, acceleration and
displacement were recorded. In addition, four
high speed videos (Photron SA3, Japan) recorded
the impact. Specimen-specific FEM reproducing
these conditions were developed. Previously
acquired cone beam CT scans (NewTom 5G, QR,
Verona, Italy) were used to create the models.
Bone was segmented using CTAn (Bruker, Belgium).
An adaptive threshold was defined to select bone
from DICOM images. Then, hexahedral meshes
were generated using an in-house software.
Element size was 0.45mm.

Discussion
Peak forces are overestimated in a 2.2 factor. The
resolution of the model certainly overestimates
the trabecular bone. Nevertheless, the correlation
R2=0.91 is encouraging on this subset of radii.
Experiments and subject-specific models will be
performed on 24 additional radii. This methodology
will be useful to assess the capability of subject-specific model to distinguish fractured and non-fractured radii.
References
Burkhart et al, Proc Inst Mech Eng H, 228(3): 25871,
2014.
Boutroy et al, J Bone Miner Res. 23(3):3929. 2008.
Greenwald et al, J Sports Sci Med, 26: 82530, 1998.

Models were exported to Hypermesh (Altair


Engineering, USA) in order to reproduce all
29

O 010

FE MODELS TO PREDICT FEMUR STRAIN AND


STRENGTH: VALIDATION AGAINST DIGITAL IMAGE
CORRELATION MEASUREMENTS
L. Grassi1, S.P. Vnnen2, M. Ristinmaa3 , J.S. Jurvelin2, H. Isaksson1
1
2

Lund university, Department of Biomedical Engineering, Lund, Sweden

University of Eastern Finland, Department of Applied Physics, Kuopio, Finland


3

Lund University, Division of Solid Mechanics, Lund, Sweden

Introduction
Finite element (FE) modelling was proposed as a
tool to overcome limitations of Dual Energy X-ray
absorptiometry-based methods in predicting
fracture risk. A thorough validation of such FE
models in terms of strain and strength prediction
accuracy is advocated before application in
clinical trials. Digital image correlation (DIC)
can be used to derive full-field strain distribution
from ex-vivo experiments, and provide a more
comprehensive validation benchmark for FE
models than traditional strain gage measurements.
The aim of the present study was to develop a
subject-specific FE modelling procedure to predict
bone strength, and validate it against experimental
DIC measurements.

RESU L TS
A good agreement between predicted and
measured strains was obtained (Figure 1, three
bones pooled) when a force of 4-times the
body weight was applied. The fracture load was
predicted with an error < 10% for two specimens,
but was underestimated by 50% for the third one.

METHODS
Three unpaired, fresh-frozen, proximal cadaver
femora were harvested and CT scanned
(0.4x0.4x0.6 mm voxels). The specimens were
tested under compression, and simultaneously
recorded with high-speed imaging and DIC
[Grassi, 2014]. Subject-specific FE models were
built using a published procedure [Grassi, 2012].
Briefly, a triangulated geometry was obtained
through segmentation and converted to nonuniform rationale B-splines. A tetrahedral mesh
was created, and isotropic Youngs modulus (E)
assigned based on the grayscale values from the
CT images.

Figure 1: Regression analysis of predicted Vs. measured strains

DIS C USSION
A FE modelling procedure was developed and
extensively validated in terms of its strain and
bone strength prediction accuracy. By adopting
DIC measurements, thousands of points over
the anterior femoral surface were validated. An
in-house developed code allowed automatic
validation by registering and averaging the
DIC measurements, thus also accounting for
the different spatial resolution of FE models and
DIC data. Strain prediction accuracy was close
to those previously reported based on a few
measurements from strain gages. Bone strength
was accurately predicted for two specimens,
but grossly underestimated for the third one. For
that specimen the fracture originated in the neck
close to a vein insertion spot, which might have
produced an unrealistically low Youngs modulus
for the corresponding elements. This could explain
the low predicted strength; further investigation
will confirm whether this speculation is correct.

The bones post-elastic modulus was modified


such that an element was considered yielded
(E=5.5%Eorig) when the strain was greater than
7300 in tension or 10400 in compression
[Bayraktar, 2004]. An element was considered
failed (E=1%Eorig) when the strains exceeded
27000 in tension or 21000 in compression
[Reilly and Burstein, 1974]. The whole bone was
considered to be fractured when an element
failed in tension. The predicted bone strength was
compared with the experiments. Strain prediction
accuracy was assessed by registering the DIC
cloud of measurements over the FE model using
iterative closest point. For each surface node, a
cylindrical volume-of-interest (VOI) with radius
equal to its average distance from the connected
surface nodes was defined. All DIC data inside this
VOI were averaged, and the result was compared
to the predicted nodal strain. Linear regression was
performed to assess the strain prediction accuracy.

RE F EREN C ES
Bayraktar et al, J Biomech, 37:2735, 2004.
Grassi et al, J Biomech Eng, 136, 2014.
Grassi et al, J Biomech, 45:394399, 2012.
Reilly and Burstein, J Bone Jt Surg, 56, 1974.
30

O 0 11

QUANTIFICATION OF THE EFFECTIVENESS OF THE


NEURO-IMPLANT ACTIGAIT IN PATIENTS WITH FOOT
LIFTING PARESIS BY INSTRUMENTED GAIT ANALYSIS
H. Boeth1, A. Agres1, G.N. Duda1, L. Haubold1, S. Weichelt2,
G. Schackert2, D. Martin2
1
2

Charit Universittsmedizin Berlin, Julius Wolff Institut, Berlin, Germany

Carl-Gustav-Carus Universittsklinik der Technischen Universitt Dresden,


Klinik und Poliklinik fr Neurochirurgie, Dresden, Germany

Introduction
20 % of stroke patients and an undetermined
number of multiple sclerosis patients suffer from
drop foot gait, in which paresis of the foot disallows
dorsiflexion in terminal stance. This gait abnormality
is the primary factor in limiting mobility, resulting in
pathological compensatory movement patterns
and an increased risk of falls [Lyons, 2002].
Superficial stimulation of the peroneal nerve has
been recently shown to improve the gait pattern
and to therefore increase the quality of life
[Kluding, 2013]. However, implementation of this
technology includes complex electrode fixation
and implementation, which frequently results in
imprecise fixation leading to inferential pain for the
patient. Therefore this study aims to quantify the
effectiveness of a newly developed neuro-implant
ActiGait by investigating patients affected with
a foot lifting paresis before and after receiving this
device.

Figure 1: S agittal food ankle angle of a sample patient


during a gait cycle with the surface stimulator
switched off (blue) and on (pink).

METHODS
Five patients presenting with neurologicallyrelated drop foot gait pre operatively underwent
instrumented gait analysis with the superficial
stimulation of the peroneal nerve randomly
being switched on and off. At least five walking
trials will be recorded each in order to assess
both kinematic and spatiotemporal parameters.
The measurements will be repeated 10 weeks and
6 months after ActiGait implantation.
RESU L TS
The preliminary data show increased dorsiflexion in
the swing phase of the gait cycle when the surface
stimulator is switched on in comparison to walking
trials where the stimulator is switched off (Figure 1).
In addition, our data show that the average speed
and step length is increased in all five patients
(Figure 2).
DIS C USSION
Though just a few patients have been investigated to
date, our results already show a clear improvement
in gait during walking when the surface stimulator
is switched on. We expect a similar outcome after
the implantation of ActiGait and therefore aim to
obtain a crucial enhancement of patients life quality.

Figure 2: S tep length (top) and average speed (bottom)


of all five patients with the surface stimulator
turned off and on.

RE F EREN C ES
1 Kluding PM et al., Stroke, 2013 Jun;44(6):16609.doi:
10.1161/STROKEAHA.111.000334, Epub 2013 May 2.
2 Lyons G et al., IEEE Trans Neural Syst Rehab Eng,
2002;10:26079.

31

O 012

IMPORTANCE OF SUPERFICIAL HIP FLEXORS OVER LARGE


MUSCLES FOR JOINT LOADING DURING WALKING
A. Trepczynski1, P. Damm1, G. Bergmann1, P. von Roth2, G. Duda1
1
2

Charit Universittsmedizin Berlin, Julius Wolff Institut, Berlin, Germany

Charit Universittsmedizin Berlin, Centrum fr Muskuloskeletale Chirurgie, Berlin, Germany

Introduction
It is generally accepted that soft tissue damage
needs to be minimized during total joint
replacement. However, the consequences of
damage to the smaller superficial hip flexors
remain unclear. Assuming minimal possible muscle
activation, the deep hip flexors with greater
physiological cross sectional areas (PCSA) would be
used preferably, but would also need to produce
higher forces due to their small lever arms. Our aim
was to determine which muscle activation strategy
allows achieving the hip contact forces measured
in vivo. We hypothesized that the advantage
of the longer lever arms can outweigh the one of
a greater PCSA.
METHODS
So far, motion analysis was performed in 2 total
hip arthroplasty (THA) patients with telemetric
hip implants while recording the in vivo forces
during walking [Damm 2010]. Patient specific
musculoskeletal models were used to estimate
the muscle and joint contact forces [Trepczynski,
2012], using two muscles activation strategies:
(i) minimizing the sum of muscle stresses squared
(MMS) and (ii) minimizing the sum of joint contact
forces at the ankle, knee and hip (MJF). The
resultant forces are reported in bodyweight (BW).
RESU L TS
The peak hip contact forces yielded by MJF in
the second half of the stance of 2.470.11 BW
(meanSD) were lower than the 3.330.31 BW
yielded by MMS, and also closer to the in vivo
measurement of 2.550.24 BW (Fig. 1a). Compared
to MMS, which activated mainly the deep and
intermediate hip flexors (iliacus, psoas major and
rectus femoris), the MJF strategy led to more
activity of the superficial hip flexors (sartorius
and tensor fasciae latae), with smaller PCSAs but
greater lever arms (Fig. 1b).

Figure 1: F orces during the stance phase of walking for two


optimization criteria.

RE F EREN C ES
Damm et al, Med Eng Phys., 32(1):95100, 2010.
Trepczynski et al, J Orthop Res., 30(3):40815, 2012.
Frye et al, Clin Orthop Relat Res., 473(2):6328,
2015.

DIS C USSION
While sparing the large muscles is often in the
focus of minimally invasive measures, our study
demonstrates the importance of smaller superficial
hip flexors for joint
contact forces. Thus, damage to these muscles can
have substantial biomechanical consequences.
Surgical measures like tendon harvesting from the
gracilis, semitendinosus and tractus iliotibialis should
therefore avoid compromising the functionality of the
sartorius and tensor fasciae latae. During THA using the
direct anterior approach any damage of the tensor
fasciae latae should be avoided [Frye 2015].

32

O 013

FEMOROACETABULAR IMPINGEMENT SYNDROME IS


ASSOCIATED WITH ALTERATIONS IN FOOT MECHANICS
M. Ayalon1, S. Funk1, D. Ben-Sira1, E. Palmanovitch2, M. Nyska2, I. Hetsroni2
1

Zinman College of Physical Education and Sport Sciences at Wingate Institute,


Biomechanics, Natanya, Israel
2

Meir Medical Center, Orthopedic Surgery, Kfar Saba, Israel

Introduction
Femoroacetabular impingement syndrome (FAI)
is reportedly associated with abnormalities in
hip mechanics. This may be associated with
abnormalities in foot mechanics as a consequence
of a closed kinematic chain mechanism during
the stance as suggested by some investigators,
but it has never been investigated in patients
with FAI. The purpose of this study was therefore
to investigate whether FAI syndrome is associated
with alterations in foot mechanics.

Discussion
The results can be attributed to several
mechanisms. The most straightforward one would
be that subtalar inversion at heel strike in patients
with FAI syndrome was a direct consequence of
decrease in hip abduction at that moment, both of
which take place in the coronal plane. Decrease
in hip abduction is in accordance with previous
investigations and may be related to decrease
electromyography activity of the tensor fascia
lata [1] or weakness of hip abductors in general
which characterizes patients with chronic hip pain
[2]. Another potential mechanism which could
be related to the excessively inverted subtalar
alignment at the moment of heel strike and
decrease in maximum subtalar eversion is based
on the linkage between subtalar eversion, internal
tibia and femur rotation, and anterior pelvic tilt.
Since impingement between the femoral neck and
the anteromedial acetabular rim is provoked by
excessive femur internal rotation in this syndrome
[3], reduction in subtalar eversion which is linked to
reduction in femur internal rotation may represent
a protective mechanism these patients may have
been acquired in order to reduce femoral neck
abutment against the acetabular rim, and to
eventually alleviate hip symptoms. The finding that
abnormal hip mechanics were linked to alterations
in subtalar eversion in patients with FAI syndrome
is new to the best of our knowledge, but whether
these alterations in subtalar mechanics have
clinical significance is yet unknown. Viewing the
role of the subtalar joint in load attenuation during
the stance phase, a possible clinical impact of this
observation on elaborating treatment strategies
for FAI syndrome merits further investigations.

Methods
Fifteen symptomatic limbs of 15 male patients
(age, 2145 years) with cam-type FAI (alpha
angle 72 8) were compared to 30 limbs of
15 normal control male subjects (age, 2137 years).
All subjects had a physical examination, followed
by level walking 3-dimensional (3D) gait analysis
from foot to hip level, using 6 camera optical
stereometric system (Vicon) sampling at 120Hz.
Results
Tegner score before symptoms appearance in the
FAI population was similar to the control group
(range, 510 vs. 59, respectively, p=ns). During
the study examination, Tegner score was 17 in
the FAI group and Hip Outcome Sports-subset
score was 5925, compared to 100 in the control
group. On physical examination, hip flexion was
12214 and hip internal rotation was 189 in
the FAI hips, compared to 140 7 and 33 6,
respectively, in the normal control hips (p<0.01). 3D
gait analysis demonstrated similar walking speed,
cadence, and stance time in the groups. At heel
strike, subtalar joint angle was 33 inversion in
the FAI group, and 0 4 in the normal control
group (p = 0.01). During the stance, maximum
subtalar joint angle was 33 eversion in the FAI
group, and 6 4 eversion in the normal control
group (p = 0.04). Foot out-toeing angle at heel
strike was 16 8 in the FAI group, and 12 6
in the normal control group (p = 0.05). At the hip
level, FAI patients demonstrated a more adducted
position compared to control subjects (p = 0.01)
and a slightly further anterior tilted pelvis (p=0.01).

References
1 Casartelli et.al, Osteoarthritis Cartilage 2011;
19: 816821.
2 Harris-Hayes et.al., J Orthop Sports Phys Ther. 2014;
44: 890898.
3 Bedi et.al., Am J Sports Med 2011 Jul;
39 Suppl: 43S9S.

33

O 014

COMPUTATIONAL MODELING OF CELLULAR


MOTILITY: CHEMOTAXIS AND MOVEMENT
IN CONFINED ENVIRONMENTS
A. Moure1, H. GOMEZ1
1

University of A Coruna, Mathematical Methods, A Coruna, Spain

Introduction
One of the features of eukaryotic cells is their
ability to move. This motility emerges in several
phenomena such as, for example, cellular
nourishment, wound healing, tissue growth,
pathogen removal or cancer metastasis. Here, we
focus on a simple experimental setup [Keren, 2008]
and model the movement of a single healthy cell
over a substrate. We propose a 2D model which
can represent cell crawling, chemotaxis and
movement between barriers.
METHODS
Our model has common features with that
proposed in [Shao, 2012]. The cell membrane is
tracked by a phase-field which moves according
to the actin filament network velocity. The actin
filament network is treated as a viscous fluid, whose
behavior is governed by a Stokes-type equation
that includes the forces acting into the cell,
namely, surface tension, adhesion to the substrate,
myosin contraction and actin filament protrusion.

Figure 1: S napshot of a cell moving towards the chemoattractant (green). Actin filament density in
a red-blue scale. Cell membrane in black.

We use reaction-diffusion equations to model


the kinetics of myosin, actin filaments and the
chemoattractant. Since the cell is polarized when
moving [Mori, 2008], we get this polarization
using a bistable equation. Furthermore, we are
able to introduce obstacles to the model by
adding up a repulsive potential [Zhang, 2009].
This set of equations is solved numerically by using
Isogeometric Analysis [Hughes, 2005].
RESU L TS
We perform two types of simulations: 1) Persistent
movement: the cell polarizes spontaneously and
keeps moving. 2) Chemotaxis: a chemoattractant
is added to the model and the cell moves in the
direction of maximum gradient. Obstacles are
introduced into the domain, for both cases.

Figure 2: S napshot of a cell moving between obstacles


(white lines). The cell is plotted in red.

DIS C USSION
We are able to reproduce single-cell motility over
a substrate for different cases, getting results that
agree with experiments. We think our model can
be extended to represent other phenomena such
as cell-substrate interaction, three-dimensional
motility and interaction with the extracellular matrix.

For these simulations, quantities as cell velocity,


area and aspect ratio are compared to
experiments [Keren, 2008], resulting in good match.
Figures 1 and 2 show a snapshot of a cell moving
by chemotaxis, and another cell moving between
barriers, respectively.

RE F EREN C ES
Hughes et al, Comp Meth Appl Mech Eng,
194:41354195, 2005.
Keren et al, Nature, 453:475480, 2008.
Mori et al, Biophysical J, 94:36843697, 2008.
Shao et al, PNAS, 109:68516856, 2012.
Zhang et al, J Comp Physics, 228:78377849, 2009.

34

O 0 15

INVESTIGATION OF MECHANICAL AND VISCOELASTIC


PROPERTIES OF BREAST CANCER CELLS RESISTANT TO
HORMONE THERAPY VIA MICROPIPETTE TECHNIQUE
G. Athanassiou1, K. Siatis2, D. Metsiou1, E. Giannopoulou2, A. Koutras2, H. Kalofonos2
1

University of Patras, Department of Mechanical Engineering & Aeronautics, Patras, Greece


2

University of Patras, Department of Medicine Clin Oncol Lab, Patras, Greece

Introduction
Biomechanical factors influenced by mechanical
processes, may lead to micro-structural changes
of cells such as alteration in gene expression,
proliferation, viability, deformability and motility[1].
The elastic moduli and viscosity are measures
which may determine alterations of the cells
mechanical and rheological properties under
treatment stress which may reflects crucial stages
of their transition to cancer cell. In this study we
investigated the mechanical and rheological
properties of MCF-7 breast cancer cell line, using
micropipette aspiration technique. The aim of
this work was to correlate changes of these
mechanical parameters among cells resistant to
typical hormone therapy; tamoxifen (tam) and
fulvestran (fulv) and untreated cells (con), with cell
migration and invasion.

Results
The elastic shear modulus G was found to
be Gcon=56.085.58 (Pa), Gtam=98.04817.71 (Pa)
and Gfulv=75.958.25 (Pa). The viscosity of
MCF-7 was determined as ncon=325.2832.4 (Pas),
ntam=853.02154.11 (Pas) and nfulv=220.2523.40
(Pas)(Fig 2.).The resistance of cells in two agents
increased both cell migration and invasion. This
increase was more potent in case of cells resistant to
fulv compared to cells resistant to tam. SEM analysis
revealed that untreated cells and cells resistant to
tam formatted multilayers among cells whereas cells
resistant to fulv demonstrated monolayers.

Exp e r i m e n t a l M e t h o d s
The in vitro experiments were performed using MCF-7
breast cancer cell line. Clones of MCF-7 cells were
developed in order to gain resistance to tam or
fulv. Scratch-wound assay and modified boyden
chamber assay were applied for studying cell
migration and cell invasion, respectively. Scanning
electron microscope (SEM) was performed for
cell morphological observation. The micropipette
technique was used to apply negative pressure, P, on
individual cells through the pipette and to measure
the length of the aspirated cell tongue, L (Fig.1). The
elastic shear modulus (G), was determined by the
equation P=4G(L/Dp) and the cell viscosity was
calculated by the equation n=E, where is the
characteristic relaxation time[2].

Figure 2: C
 ell viscosity response of MCF-7 cancer cell line

Discussion
The results might indicate that the resistance of
MCF-7 cells to hormone therapy increased their
stiffness (p<0.05). In addition, the resistant cells
exerted increased ability to migrate and invade.
However, the cells resistant to fulv were more
aggressive compared to cells resistant to tam. SEM
analysis was in line with the changes in cell viscosity.
In case of fulv cell viscosity was decreased while in
case of tam it was increased. Our data show that
the resistance of MCF-7 cells to hormone therapy
altered their mechanical behavior in a way that
favors the cell aggressiveness and it seemed that
changes in cell viscosity determined which clone
was more aggressive[3].
References
[1] S. Suresh, Biomechanics and biophysics of cancer
cells, Acta Biomaterialia, 3: 413438, 2007.
[2] C.T. Lim et al, J Biomech, 39:195216, 2006.
[3] E. Giannopoulou et. al, Biochim Biophys Acta,
1853(2): 32837, 2015.

Fig1. Cancer cell during the aspiration into micropipette.

35

O 0 16

A MECHANICAL MODEL OF SINGLE CELL MIGRATION


ON A VISCOELASTIC SUBSTRATE
T. Heck1, T. Odenthal2, B. Smeets2, P. Van Liedekerke3 , A. Jorge Peas1, A. IzquierdoAlvarez1, H. Ramon2, H. Van Oosterwyck1
1

KU Leuven, Department of Mechanical Engineering Biomechanics Section,


Leuven, Belgium
2

KU Leuven, Department of Biosystems MeBioS, Leuven, Belgium

Institut National de Recherche en Informatique et en Automatique, INRIA, Paris, France

Introduction
Cell migration is an important process for tissue
development and regeneration. In order to
migrate, cells adhere to the extracellular matrix
(ECM) by binding of integrins to extracellular
ligands and apply protrusive (lamellipodium) and
contractile (stress fibers) forces to the ECM. Integrin-mediated adhesions serve as mechanotransducers
that convert mechanical forces into biological
signals that regulate adhesion stability and
cytoskeleton remodelling, making it a complex
mechanobiological process. Therefore, a correct
implementation of cell and ECM mechanics as well
as the mechanical cell-ECM coupling is important
in computational modelling of single cell migration.

Discussion
By using a mechanical description for both cell
and ECM in computational modelling of single
cell migration, a mechanical validation through
comparison with traction force microscopy is
possible. This allows getting a better understanding of
the mechanical processes underlying cell migration.

Methods
A computational model of single cell migration
on a viscoelastic substrate has been developed.
As a cell model, an earlier model developed for
passive cell spreading has been used [Odenthal,
2013]. This particle-based model captures the
physics (viscoelasticity and bending rigidity) of
the actin cortex and contact (elastic repulsive
and adhesional) and frictional forces with the
environment. Protrusive forces are applied to the
front of the cell (representing lamellipodial forces)
as a first step towards an active migrating cell.
The substrate has been modelled with non-inertial
smoothed particle hydrodynamics (NSPH), a
mesh-free numerical method that describes the
substrate as a collection of points that contain
physical properties as mass, density, velocity
and pressure [Van Liedekerke, 2013]. By discrete
convolution with a smoothing kernel, this method
allows to implement continuum mechanics in a
discrete manner. In this way, cell migration through
a viscoelastic substrate can be modelled without
the need for time consuming remeshing.

Figure 1: V
 on Mises stress (left) and substrate deformation
(right) during cell migration simulation.

References
Odenthal et al, PLoS Comput. Biol., 9(10):
e1003267, 2013.
Van Liedekerke et al, Comp. Phys. Commun.,
184(7):16861696, 2013.

Results
Simulations have been performed of single cell
migration on a flat viscoelastic substrate. The
effects of substrate elasticity and viscosity, cellsubstrate adhesion and protrusive force magnitude
on cell migration speed and substrate deformation
have been investigated. Orders of magnitude
of substrate stresses and deformations (Figure 1)
agree with our traction force microscopy data for
endothelial cell migration on polyacrylamide gels.

Funding
The research leading to these results has received
funding from the European Research Council under
the European Unions Seventh Framework Programme (FP7/20072013)/ ERC Grant Agreement
no 308223) and from the Research Fund Flanders
(FWO-Vlaanderen, grant number G.0821.13). Tommy
Heck is a PhD fellow of FWO-Vlaanderen.

36

O 0 17

MOLECULAR RESPONSE OF COLLAGEN UNDER


UNIAXIAL TENSILE STRESS STUDIED BY IN SITU RAMAN
SPECTROSCOPY IMPACT OF MINERALISATION
K. Chatzipanagis1, C. Baumann2, M. Sandri3 , E. Savini3 , A. Tampieri3 , R. Krger1

University of York, Physics, York, United Kingdom

University of York, Biology, York, United Kingdom

CNR Istituto di Scienza e Tecnologia dei Materiali Ceramici, CNR Istituto di Scienza
e Tecnologia dei Materiali Ceramici, Faenza, Italy

Introduction
Collagen is the most abundant protein in the
human body1. The collagen molecule is composed
of three peptide chains twisted in a right handed
triple helix 1. The main amino acid sequence of a
single peptide chain contains proline, glycine and
hydroxyproline1. The mineralisation of collagen
leads to the formation of bone and cartilage,
found in every living organism. Thus, the interaction
of collagen and mineral can provide valuable
information on the mechanism by which the load
is transferred in these biocomposite materials.

RESU L TS AND DI C USSION


The change of the Raman peak position assigned
to proline2 (855cm -1) was studied as a function of
strain, for 0% and 50% MgHA mineralised collagen
fibres respectively (fig 2). The Raman shift of the
peak showed that the molecular response of
collagen becomes more prominent with the
addition of MgHA nanocrystals (~2cm-1), indicating
that the mineral phase plays an important role for
the investigation of the mechanical properties at
the molecular level.

E X P ERIMETA L METHODS
To correlate mechanical properties and molecular
response to stress, we developed and employed a
novel piezo-driven device that can be coupled to
a confocal Raman microscope (Fig. 1). This device
contains a stiffness calibrated flexible needle
(assigned 1 in Fig 1.) that is attached to a piezo
drive and a static needle (assigned 2) is fixed
to a plastic block. The fibre to be investigated is
attached to the two needles and the displacement
of the flexible needle by the piezo (assigned by 1)
exerts uniaxial stress. Equine type I collagen fibres
with and without the addition of mineral content
were studied by this technique. The mineral phase
consisted of magnesium doped hydroxyapatite
(MgHA) nanocrystals.

Figure 2: R
 aman shift of proline as a function of strain for 0%
and 50% MgHA mineralised collagen fibres. Four
Raman measurements were considered at each
strain level and the error bars represent the variation from the mean value.

RE F EREN C ES
1 Carcamo J.J. et al., Spectrochimica Acta Part A.
86:360365, 2012.
2 Gasior-Glogowska M. et al., Acta of Bioengineering
and Biomechanics. 12:5562, 2010.

Figure 1: S chematic view of the experimental set-up used


for in situ mechanical studies. The green component represents the laser beam pointing on the
fibre during the experiment.

37

O 018

THE EFFECT OF HYDRATION ON THE MACROSCOPIC


ELASTIC MODULUS OF TYPE I COLLAGEN
AND ELASTIN FIBRES
R. Edginton1, F. Palombo1, E. Green1, N. Stone1, C.P. Winlove1
1

University of Exeter, Physics and Astronomy, Exeter, United Kingdom

Results

Introduction
The extracellular matrix (ECM) is a protein rich
viscoelastic network formed dominantly by the
structural fibrous proteins collagen and elastin
[Muiznieks, 2013]. Collagen forms the framework
of the ECM in tissues such as bone, tendon and
skin [Gosline, 2002], whilst elastin provides elasticity
and resilience to tissues subjected to repeated
distension and physical stress [Vrhovski, 1998].
Characterisation of the individual contribution of
elastin and collagen fibres to the biomechanics
of the ECM as a function of hydration, has been
the focus of our study, using a multi-frequency
mechanical approach. In a previous analysis
[Palombo, 2014], we used Brillouin light scattering
(BLS) spectroscopy to measure the complete
elasticity tensor of purified elastin fibres from
bovine nuchal ligament, and type I collagen
fibres from Sprague Dawley rat tails. We obtained
the Youngs modulus, which was found to be
6.1 (0.4) GPa for dried elastin fibres and
10.2 (0.3) GPa for dried collagen fibres. In this
work, we use a bespoke tensile testing stage in
which the relative humidity (RH) of the sample
compartment can be altered to analyse the
same samples and obtain a macroscopic Youngs
modulus as a function of the tissue hydration.

Samples

Relative
Humidity (%RH)

Macroscopic
Youngs
Modulus (MPa)

100

1 (0.04)

Elastin

85

5.01 (0.4)

(05% Strain)

66

10.0 (5)

46

27.4 (4)

Elastin

100

0.89 (0.02)

(510% Strain)

85

5.97 (-0.9)

66

47.9 (8)

46

88.6 (6)

Table 1: m
 acroscopic elastic moduli with standard error for
elastin fibres over a range of RHs.

Discussion
Elastin fibres were found to have two distinct moduli in
a 10% strain extension cycle, with a gradual inflection
in the 45% strain region, indicating a change in the
biomechanics and structure of the fibre as it takes
up the strain. A negative correlation is seen to exist
between the elastic modulus of elastin and the
hydration of the sample (Table 1), which is as expected,
due to an increase in the stiffness of the fibre at lower
humidity. In contrast to this, collagen fibres presented
a uniform mechanical behaviour throughout the
stress-strain experiment in the measured range. The
Youngs modulus obtained for collagen showed a
more complex dependence on the RH which will be
further explored in combination with structural analysis
(Raman microscopy). The comparison between
low-frequency macroscopic and high-frequency
BLS results [Palombo, 2014], suggests a viscoelastic
behaviour of the studied materials, with the Brillouin
moduli of both protein fibres being two to three orders
of magnitude greater than the macroscopic moduli.
This is in agreement with previous results taken using
similar approaches and applied to ocular tissues
[Vaughan, 2006, Scarcelli, 2012].

Methods
RHs generated at 30 C using a bath containing
saturated salt solutions in deionised water:
sodium chloride, sodium bromide and sodium
iodide, producing 85 ( 5)%RH, 66 ( 5)%RH and
46 (5)%RH respectively. 100%RH achieved using
deionised water alone. Fibre bundles of ~10mm in
length where suspended ~5mm above the solution
level in the bath and allowed 30 mins (collagen)
to 80 mins (elastin) to equilibrate to the local RH.
Force response measured as fibres where stretched
at 0.25 mm min -1 to strains of 7% for collagen
and 10% for elastin, within their observed Hooke
ranges. Stress-strain plots were recorded at the
same RH over periods of 90120 mins, taking
extension/relaxation cycles every 10 mins. Elastic
moduli are calculated as an average of the
accumulated gradients of three individual sample
repeats for each RH, using fibre mass and fibre
densities to find the cross-sectional area.

References
J. Gosline, M. Lillie et al, Philos Trans R Soc Lond B
Biol Sci, 357:12132, 2002.
L.D. Muiznieks, F.W. Keeley, Biochimica et
Biophysica Acta, 1832: 866875, 2013.
F. Palombo, C.P. Winlove, R.S.Edginton et al,
J R Soc Interface, 11: 20140739, 2014.
G. Scarcelli, R. Pineda and S.H. Yun, Invest
Ophthalmol Vis Sci, 53:18590, 2012.
J.M. Vaughan and J.T. Randall, Nature, 284:
489491, 1980.
B. Vrhovski and A.S. Weiss, European Journal of
Biochemistry, 258:118, 1998.

38

O 0 19

CONTRIBUTION OF COLLAGEN FIBERS


TO TEMPOROMANDIBULAR JOINT DISC
COMPRESSIVE PROPERTIES
S. Fazaeli1, S. Ghazanfari2, V. Everts1, T. Smit2, J.H. Koolstra1
1

Academic Center for Dentistry Amsterdam ACTA, Oral Cell Biology and Functional Anatomy,
Amsterdam, Netherlands
2

VU Univercity Medical Center VUmc, Department of Orthopaedic Surgery,


Amsterdam, Netherlands

METHODS
Intact porcine TMJ discs were enzymatically digested
with collagenase to disrupt the collagenous network of
the cartilage. The digested and non-digested articular
discs, were analyzed mechanically, biochemically
and histologically in five different regions which possess
a different quantity and alignment of collagen fibers.
These tests included (1) cyclic compression tests, (2)
biochemical quantification of the hydroxyproline and
sulfated glycosaminoglycan (sGAG) content and (3)
visualization of collagen fibers alignment by polarized
light microscopy (PLM).

Introduction
The Temporomandibular Joint (TMJ) is a bilateral
diarthrodial joint consisting of a mandibular
condyle, resting against the temporal bone.
A TMJ disc is located between these articular
surfaces facilitating smooth jaw movements.
Thepathophysiology of TMJ disc has led to a variety
of TMJ disorders affecting up to a quarter of the
population. Nonetheless, the poor understanding
of the mechanobiology of the TMJ disc has made it
challenging to engineer a functional replacement.
The anisotropic fibrous protein structure of articular
disc plays a crucial role in load distribution and
shock absorbance during the jaw movement. The
low amount of proteoglycans in the extracellular
matrix of TMJ disc has shifted the focus to the
most dominant component, fibrillar collagen as
the main contributor in reinforcing the disc under
dynamic compressive loads. Although it is believed
that fibrillar collagen only resists tensile loads, there
is a lack of understanding on how it could resist
against intermittent compressive loads. Therefore,
in this study, the contribution of the amount and
structure of fibrillar collagen in compressive
mechanical properties of TMJ disc, was evaluated.

RESU L TS
The instantaneous compressive moduli of the
articular discs were reduced up to an average of 70%
in all regions after the collagenase treatment. The
energy dissipation properties of the digested discs
showed a similar tendency. Biochemical analysis of
all regions of the digested samples demonstrated
an average of 14% and 35% loss in hydroxyproline
and sGAG respectively. Despite the low reduction of
hydroxyproline, the PLM images clearly indicated the
degradation ofcollagenous network of the disc after
the enzymatic treatment (Fig. 1).

Figure 1: Representative PLM images of the control and digested group of TMJ discs showing the region-specific alignment of fibrillar
collagen before and after enzymatic treatment. Five regions are labelled as follows: AB (anterior band), PB (posterior
band), IZ (intermediate zone), L (lateral) and M (medial). The * images are taken after the enzymatic digestion of the disc.
see the next page

39

DIS C USSION
The results indicate that not only the abundance,
but also the structural alignment of fibrillar collagen
plays a significant role in mechanical properties
and therefore functionality of TMJ disc under
physiological loading conditions. Disruption of the
fibrous network of TMJ disc may compromise its

role in resisting the swelling and stretching of the


disc under compressive loads. Overall, this study
suggests that alteration of the collagenous network
could be considered as a primary factor initiating
the TMJ disc deterioration which could potentially
contribute to the further severe condition namely,
internal derangement and osteoarthritis.

40

O 020

THE EFFECT OF COLLAGEN FIBRIL ORIENTATION ON THE


MECHANICS OF ARTICULAR CARTILAGE
Q. Meng1, S. An1, R.A. Damion1,2, A. Jones1, R. Wilcox1, Z. Jin1,3 , J. Fisher1
1

Institute of Medical and Biological Engineering, School of Mechanical Engineering.


University of Leeds, Leeds, United Kingdom
2

Soft Matter Physics Group, School of Physics and Astronomy ,


University of Leeds, Leeds, United Kingdom

School of Mechanical Engineering, Xian Jiaotong University, Xian, China Peoples Republic

Introduction
Collagen fibrils play an important role in the
mechanics of articular cartilage (AC). The
distribution of collagen fibrils in AC is highly
inhomogeneous. It is not only depth-dependent,
but also location-dependent [Clark, 1991].
The effect of the inhomogeneous distribution
of collagen has been investigated mainly by
simplified finite element models, in which collagen
fibrils were assumed to be perfectly parallel to the
articular surface in the superficial zone (SZ); evenly
distributed in the middle zone; and perpendicular
to the cartilage-bone interface in the deep zone
[Dabiri, 2013]. The effect of the realistic orientation
of collagen fibrils on the biphasic mechanics of
cartilage is still not clear. The aim of this study was
to investigate this effect.

RESU L TS
FEBio and Abaqus produced similar results for all the
five models. The fluid load support of Models 2 and
3 was very close to that of Model 1. The comparison
between Models 4 and 5 showed that including
the SZ collagen fibrils produced a considerable
increase in the fluid load support. The peak values
of the 1 st principal stress and maximum shear stress
of Model 1 were substantially larger than the other
models. The peak 1st principal stress of Model 1
occurred at the articular surface, while that of the
other models occurred at the edge between the
articular surface and the peripheral surfaces. The
peak maximum shear stress of Models 1-4 occurred
at the articular surface while that of Model 5 at
the cartilage-bone interface. Moreover, Model
1 produced considerably larger values for the 1st
principal strain and the maximum shear strain than
Models 2 and 3 on the articular surface.

METHODS
Five 3D cuboid cartilage models with the same
dimensions (5.18 mm x 2 mm x 1.19 mm) were
solved. The fibril orientation in Model 1 was based
on diffusion tensor magnetic resonance imaging
data. A simplified three-layered orientation was
used for Model 2. In Model 3, collagen fibrils were
assumed to be uniform through the cartilage.
In Model 4, only the SZ was fibril-reinforced and
the remaining part was isotropic. Collagen fibrils
were not considered in Model 5. A ramp load of
0.6 N was applied to a rigid plate, which was in
contact with the articular surface of the cartilage.
The ramp duration was 2 seconds and then the
load was kept constant for 1200 seconds. All the
models were solved using both Abaqus (6.13,
Dassault Systems Simulia Corp, USA) and FEBio 1.6.0
(www.febio.org).

Discussion
The agreement between the results from FEBio and
Abaqus provides confidence that the solutions for
the five models were computationally correct. The
comparison of the fluid load support between the
five models showed the importance of considering
collagen fibrils in all the three layers.
Tensile stress, tensile strain, shear stress and
shear strain may all be the potential criteria of
mechanically induced cartilage damage [Kelly,
1996; Wilson, 2003; Wilson, 2006]. Since Model 1
produced considerably larger values than Models
2 and 3 on the articular surface (for the 1st principal
stress and strain, and the maximum shear stress
and strain), incorporating the realistic orientation
of collagen fibrils may have an important effect on
cartilage damage prediction.
Although the widely used three-layered model of
AC is able to predict fluid load support close to
that of the model with the realistic fibril orientation,
an accurate prediction of damage may require
the inclusion of the realistic fibril orientation.
References
Clark, J Orthop Res, 9:246257, 1991.
Dabiri et al, Med Eng Phys, 35: 15911598, 2013.
Kelly et al, J Eng Med, 210: 2737, 1996.
Wilson et al, J Biomech, 36:845851, 2003.
Wilson et al, J Orthop Res, 14:11961202, 2006.

41

O 021

THE INFLUENCE OF LOADING MAGNITUDE AND RATE


ON DAMAGE OF STRUCTURE AND COLLAGEN
IN ARTICULAR CARTILAGE
L. Henao Murillo1, K. Ito1, C.C. van Donkelaar1
1

Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands

Introduction
Cartilage damage may occur under adverse
mechanical or biological conditions [Torzilli, 2010].
Macroscopic, structural damage such as surface
fibrillation is one of the earliest signs of cartilage
damage [Morel, 2006]. However, it has been
shown that collagen damage may precede such
structural damage [Wilson, 2006]. We hypothesize
that these effects may have different causes, and
could occur depending on the magnitude or rate
of loading. The aim of this study was therefore to
evaluate the influence of loading magnitude and
loading rate on the development of macroscopic
structural damage and collagen type II damage in
articular cartilage.

Figure 1: Images of cartilage after col 23/4m staining.


Brown stain: mechanically induced collagen fibre
damage. Red arrows: structural damage at the
surface (b, g) or clefts (d). Black arrows: collagen
fibre damage areas in (d, f-l).

Methods
72 osteochondral plugs were harvested from 1 year
old cows. The plugs were cyclically loaded 5 times
at various magnitudes (15 (n=18), 25 (n=18),
35 (n=18) and 45 N (n=18)) and loading rates
(5 (n=24), 60 (n=24) and 120 (n=24) mm/min).
Immediately
after
loading,
cartilage
was
cryosectioned and stained with col 23/4m
antibody for collagen damage. Damage was
graded on a scale of 05 for both structural and
collagen damage by four observers (inter- and
intra-observer reliability were k=0.69 and k =0.9,
respectively).
Results
Cartilage surface fibrillation occurred under
loading regimes (N;mm/min) of 25;5 and 35;60
(Fig. 1b, g, j); clefts on the surface at 35;120
(Fig. 1k); and clefts to the transitional zone at
45;5 (p=0.002, Fig. 1d). Collagen fibre damage
occurred under loading regimes of 25;60, 35;60
(Fig. 1f, g), and it was more severe at 45;60
(Fig. 1h), 25;120 (p=0.046), 35;120 (p=0.019)
and 45;120 N (p=0.001) (Fig. 1j-l). The nominal
strain at each cycle increased with high loading
magnitudes and with low loading rates. Loading
magnitude and loading rate interacted with each
other to produce more damage (p=0.004, Fig. 2).

Figure 2: Degree of total damage based on validated scoring system of histological data (see Fig. 1). *p<0.05

Discussion
Interestingly, internal collagen damage depended
mainly on loading rate, while the development of
macroscopic surface damage depended more on
loading magnitude. This finding implies that considering superficial cartilage roughening is not sufficient to
evaluate the grade of osteoarthritis in a joint; internal
collagen damage may also contribute. Also, these
locations of damage may independently develop
following different mechanisms. Understanding such
mechanisms may be important for understanding
the aetiology of osteoarthritis.
References
Morel et al, J Biomech, 39:924930, 2006.
Torzilli et al, OA Cart, 18:97105, 2010.
Wilson et al, JOR, 24 (2): 220228, 2006.
42

O 022

THE INFLUENCE OF WALL MOTION ON COMPUTATIONAL


MODELLING OF AORTIC DISSECTION
M. Alimohammadi1, J. Sherwood2, M. Karimpour3 , O. Agu4 , S. Balabani5,
V. Daz-Zuccarini5
1

University College London, Mechanical Engineering, London, United Kingdom


2

Imperial College London, Bioengineering, London, United Kingdom

Imperial College London, Mechanical Engineering, London, United Kingdom


4

University College Hospital, Vascular Unit, London, United Kingdom

Mechanical Engineering, University College London, London, United Kingdom

Introduction
Aortic dissection (AD) is a cardiovascular disease,
in which a tear in the aortic wall allows blood to
flow between the intimal and medial layers[1], forming a false lumen (FL) and a true lumen (TL). The
choice of interventional approach for AD retains
a degree of subjectivity[1] and CFD has the potential to provide information that is otherwise inaccessible to clinicians. A trade-off between model
complexity and efficiency is required. Although
commonly modelled as rigid[2], the vessel wall motion including the flap between the lumina adds
complexity and its influence on haemodynamics is
yet to be fully elucidated. In the present study, we
carried out a fluid-structure interaction (FSI) study
of a patient-specific AD, so as to establish whether
the additional computational expense required for
FSI is feasible and necessary.

Results
FSI and rigid wall simulations were carried out.
Fig1b shows the vessel wall motion at peak systole.
Wall displacements of up to 0.8 mm compare
favourably with imaging data [5]. Figs. 1c and d
show the time-averaged wall shear stress (TAWSS)
and oscillatory shear index (OSI). In the proximal
and distal FL, there is high OSI and low TAWSS,
which is indicative of a pathological environment
for endothelial cells[6]. Figure 2a compares the flow
through the distal FL for FSI and rigid wall models.
The rigid wall model shows no flow, compared to
the complex behaviour shown by the FSI model.
Streamlines in the distal FL are present in Figure 2b;
this highlights the interesting and complicated flow
patterns in this region.

Exp e r i m e n t a l M e t h o d s
The study was ethically approved and consent
obtained. A CT scan from a patient with AD was
used and the fluid domain (Fig. 1a) was generated
as described previously [2]. The solid domain (Fig. 1b)
was generated by extruding the fluid domain
such that the wall thickness was 2.5 mm, except
between the two lumina, where the gap was filled.
FSI simulations were carried out with ANSYS-CFX.
Blood was modelled as an incompressible fluid with
density 1056 kgm-3, dynamic viscosity described
by the Carreau-Yasuda model [3] and turbulence
approximated by the shear stress transport model.
An inlet flow wave from a previous study was
used. Outlet boundaries were modelled via 3D-0D
coupling to three-element Windkessel models,
with parameters tuned based on invasive pressure
measurements from the same patient [2]. The vessel
wall was modelled as hyperelastic [4] and motion
at the domain boundaries was restricted to the
horizontal plane.

Discussion
The FSI simulation took 14 times as long as the rigid
wall model, but the haemodynamics in the TL and
FL, which are potentially critical, were not captured
in the latter; meaning that despite the additional
complexity and expense, modelling the vessel wall
motion is essential in these simulations if intended
for use as a clinical interventional planning tool.
References
1 Capoccia L. et al., Vascular. 22(6): 439447, 2014.
2 Alimohammadi M et al., Med Eng Phys,
36:275284, 2014.
3 Gijsen F. et al., J. Biomech, 32:601608, 1999.
4 Raghavan ML. et al., J. Biomech, 33:475482, 2000.
5 Ganten M-K et al., Eur J. Radiol, 72:146153, 2009.
6 Meng H. et al., Am J. Neuroradiol,
35(7):12541262, 2014

43

O 023

LONGITUDINAL AND CIRCUMFERENTIAL MECHANICAL


BEHAVIOUR OF HUMAN CEREBRAL ARTERY
D. Ambard1, E. Omer2, L.F. Simon1, C. Vincent2, S. Mathieu1, J. Franck1
1
2

Universite Montpellier 2, LMGC, Montpellier, France

Hpital Gui de Chauliac CHRU Montpellier, Service de Neuroradiologie, montpellier, France

Introduction
The prevalence of unruptured intracranial
aneurysms in the general population, as reported
by a recent review [Wardlaw, 2000], ranges
between 3% and 6.6%. However, the incidence
of ruptured aneurysms is low, with approximately
0.5% per year, suggesting that very few aneurysms
rupture. Clearly, new patient-specific indexes
predicting aneurysm risk of rupture should be
proposed, in order to guide therapeutic decision
for unruptured aneurysm.

was carried out on the sample within the warmed


(40C) physiological liquid. This testing device was
composed of a Texture Analyzer with a 50 N load
cell and two digital video camera to compute a
DIC analysis (Fig.1).
To obtain the strain/stress relation, we proceed
to a mathematical matching to determine
the corresponding hyperelastic model and its
coefficients. In our cases, the best match was
obtained with a 2 parameters Yeoh model (eq. 1):

Previously, we showed that aneurismal pulsatility


might be a relevant patient-specific predictor
of aneurysm risk of rupture [Sanchez, 2013], as
the pulsability showed to provide information on
the degradation of the mechanical properties
of ruptured aneurism tissue. However, the
biomechanical properties of healthy arteries of
circle of Willis are poorly reported. In this study,
we attempted to identify the biomechanical
behaviour of healthy intracranial artery.

W(I1)= C1.(I1-3) + C 2(I 1-3)^2

(1)

Results
The mechanical behaviours in the longitudinal and
circumferential directions are significantly different
(Tab. 1) for healthy arteries, indicating a fibrous,
structured soft tissue. Indeed, the mechanical
behaviour is stiffer in the longitudinal direction than
in the circumferential direction, in agreement with
other studies [Hu, 2007].

Methods
Five circle of Willis were taken from 5 autopsied
subjects who died from an extra-cranial cause.
Their ages ranges from 30 to 80 years. This research
study protocol was approved by the local ethic
committee. From all circle of Willis, 16 segment of
artery was used in this study.

We also compared the mean stiffnesss of the


healthy arteries to the stiffnesss of the aneurysmal
tissue. We found a significant difference (p=0.01),
with a mean reduction factor of 2.8 on parameter
C2 between healthy artery and aneurysmal
tissue, suggesting a more linear behaviour in the
aneurysmal tissue.
Direction

C1[Mpa]

C2[Mpa]

Longitudinal

0.2 0.11

12.3 7.35

Circumferential

0.1 0.06

4.4 3.21

p value

0.1152

0.0365 *

Table 1: C
 1 and C2 coefficients from human cerebral artery
with interval confidence (95%).

Discussion
Variations of the biomechanical properties was
found between aneuvrysmal tissue and healthy
artery tissue. First, a significant reduction of the
stiffness was found, in particular concerning the
C2 parameter in the Yeoh model used between
healhty and degradated tissue, suggesting that
the aneurysm has a more linear behaviour then
healthy tissue. Second, the mechanical behaviour
of degrated tissue is close to the mechanical
behaviour of circumferential direction of healthy
arteries.

Figure 1: G
 reen Lagrange strain from DIC.

Under microscopy, the aneurysmal wall samples


were dissected in a longitudinal direction and
circumferential direction to obtain two regular
rectangular pieces (Fig.1). A uniaxial stretch test

References
Wardlaw et al, Brain, 123:205221, 2000
Sanchez et al, Ann. Biomed. Eng., 41:2840, 2013
Hu et al, J. Biomechanics, 40:25592563, 2007

44

O 024

A NOVEL APPROACH TO THE QUANTIFICATION OF


AORTIC ROOT IN VIVO STRUCTURAL MECHANICS
E. Votta1, M. Presicce1, A. Della Corte2, C. Bancone2, F. Sturla1, A. Redaelli1
1

Politecnico di Milano, Dept. of Electronics Information and Bioengineering, Milano, Italy


2

Seconda Universit di Napoli, Department of Cardiothoracic and Respiratory Sciences,


Napoli, Italy

Introduction
Understanding aortic root (AR) biomechanics is
pivotal in elucidating the mechanisms underlying
socially relevant and lethal pathologies, and in
designing surgical devices and procedures to
restore AR function. Computational models can
provide useful information, but, to yield reliable
results, should account for in vivo AR anatomical
features and tensions. To this goal, we set an imagebased framework for the structural analysis of the
AR, which allows for capturing patient-specific
anatomy, while accounting for tissue stresses acting
on the AR also in the initial configuration of the
numerical analysis. To the best of our knowledge,
only one study tackled both these issues, although
through a different approach [Labrosse, 2014].
Methods
The framework consists of five steps (Fig. 1):
i) acquisition of cine-cardiac magnetic resonance
(CMR) sequences, ii) manual tracing of AR structures
in the end-diastolic (ED) frame, iii) automated
reconstruction and dicretization of AR 3D anatomy,
iv) numerical computation of tissue stresses at
ED, assuming 80 mmHg ventricular and aortic
pressure, v) dynamic simulation of AR structural
mechanics throughout two cardiac cycles,
characterized by physiological time-dependent
aortic and ventricular pressures, starting from the
image-based ED geometry, pre-stressed based
on the results from step iv). AV leaflet tissue was
modelled as hyperelastic and transversely isotropic
[Lee, 2014], aortic wall tissue was assumed linear
elastic and isotropic. ABAQUS/Explicit 6.10 (SIMULIA,
Dassault Systmes) was used to run simulations.

Figure 1: M
 odelling framework exemplified for a healthy AR.
A) CMR plane acquired at ED; manually traced
AR structures are highlighted. B) reconstructed
AR geometry. C) computation of ED stresses. D)
maximum principal stress computed at maximal
transvalvular pressure load in the final dynamic
simulation.

Discussion
Preliminary results are encouraging, and suggest
that the method might be suitable to analyze
pathologic AR conditions, in which patientspecific morphological details are a key factor.
In particular, the method will be soon applied to
the biomechanical analysis of a small cohort of
patients affected by bicuspid aortic valve disease,
i.e. different patterns of fusion of two out of the
three aortic leaflets.

Results
Preliminary results obtained on 4 healthy volunteers
highlighted that accounting for ED pre-stresses was
crucial to obtain consistency between computed
AR configuration and CMR ground truth data,
and to avoid unrealistic AR dilation and AV
insufficiency. Also, patient-specific morphological
features impacted on biomechanical variables.

Ack n o wl e d g e m e n t s
This study was funded by the Italian Ministry of Health
Young Researchers 2009 program (Grant number:
GR-2009-1580434).
References
Labrosse et al, Med Image Anal, 2014, published
on line and in press.
Lee et al, J Biomech 47:20552063, 2014.

45

O 025

OF MICE AND MEN: IS ALLOMETRIC SCALING


APPLICABLE TO THE FLOW IN THE AORTA?
T. Schenkel1
1

Sheffield Hallam University, Department of Engineering and Mathematics, Sheffield,


United Kingdom

Introduction
Due to the long time-scales for the development
of the disease in humans, longitudinal studies on
arteriosclerosis are routinely performed on the
mouse model. This follows from the assumption
that allometric scaling laws[1] can be applied to
hemodynamics.
Previous studies have shown evidence that this
assumption is valid for mean Wall Shear Stress
(WSS) distributions and that scaling laws can be
derived for mean WSS in the aorta and following
branches[2].
Recently the usefulness of mean WSS as the
sole indicator of arteriosclerotic risk has been
questioned and unsteady indicators have been
proposed. Furthermore, hydrodynamic scaling
laws predict, that the complex flow in the aortic
arch cannot follow the simple allometric scaling.
Methods
Dimensional analysis is used to find dimensionless
numbers to describe aortic flow. A high resolution,
unsteady, three-dimensional numerical model of
a mouse aorta is scaled geometrically to the size of
a typical human aorta.

Figure 1: C
 omparison of time-dependent WSS

C o n cl u s i o n
In the light of these results from a higher resolution
model, resolving the dynamics of the separation on
the inner curvature, many conclusions transferred
from the mouse model to humans are questionable.
While the mean and average WSS as well as the
local average WSS on the outer curvature follow
allometric scaling the time-dependent local
average WSS on the inner curvature shows a
distinctively different behaviour caused by higher
dynamics in the flow separation. As this is a key
region for arteriosclerosis the development of
lesions in humans may differ considerably from the
mouse model.

Results and discussion


While the mean WSS and the time-dependent
overall average WSS agree well within the
assumptions of allometric scaling, scaling breaks
down for local evaluation of time-dependent WSS
and oscillatory shear stress index (OSI).
Figure 1 Compares WSS for mouse and human
aorta averaged over the whole aortic surface and
over ROI on inner and outer curvature.
While the overall average WSS and the WSS on
the outer curvature show a similar behaviour,
with higher WSS in the mouse as expected, the
influence of the larger geometry scale and resulting
dynamics on the WSS development is obvious on
the inner curvature.

References
1 West, G., Brown, J. & Enquist, B. A general model
for the origin of allometric scaling laws in biology.
Science (80-.). 276, 122126 (1997).
2 Greve, J. M. et al. Allometric scaling of wall shear
stress from mice to humans: quantification using
cine phase-contrast MRI and computational fluid
dynamics. Am. J. Physiol. Heart Circ. Physiol. 291,
H17008 (2006).

46

O 026

ANEURYSM FORMATION: THE ROLE OF SAMPLE


THICKNESS IN THE EXPERIMENTAL DATA COLLECTION
S. de Gelidi1, G. Tozzi1, A. Bucchi1
1

University of Portsmouth, School of Engineering, Portsmouth, United Kingdom

Introduction
In order to determine the stress achieved in the
stretched materials, measurement of sample
thickness represents a crucial step. Typically, the
thickness is measured for each specimen by laser
micrometer (Di Martino et al. 2006) or assumed
constant for all samples tested (Choudhury et al.
2009). This study aims at investigating the formation
of aneurysm, using uniaxial tensile tests performed
on healthy porcine descending aortas. The impact
of current practice in thickness estimation is
assessed by means of finite element predictions.

(Shi & Moita 1996) in Abaqus (Dassault Systmes


S.A., France). Four node shell elements with
reduced integration (S4R) were adopted to mesh
the tube. As boundary conditions, both ends were
fully constrained and an internal inflating pressure
of 1kPa was applied. Elastic instability, representing
aneurysm formation, was investigated by modified
Riks method (Wriggers 2010).
Results
No critical pressure was obtained for the Yeoh
strain-energy function, although this fits all the
experimental data. Critical pressure values for the
other two strain-energy functions are reported in
Table 1.

Methods
Dumb-bells shapes were cut out by means of a
custom made die, ISO 37:2005(E), type 4, from
porcine thoracic aortas. Thickness and initial length
were optically determined using a customised
Matlab script (Mathworks, Massachusetts, US) for
each sample. In both cases, Sobel edge detection
method is applied on the ROI, which was manually
selected (Figure 1).

Table 1: C
 ritical pressure values [kPa] obtained for the
stiffest and softest stress-strain behaviour calculated
for three different thickness values: sample specific,
1.5mm and 3.5mm. When no critical pressure is
reached, no CP is reported.

Discussion
A novel method to estimate the sample specific
thickness is presented. Differently from other works,
the thickness value is computed as the average of
all points included in the ROI (Figure 1). Comparing
results related to the stiffest and the softest data
for each thickness, the minimum scatter (~1 kPa)
is obtained for the sample specific thickness.
Therefore, the most accurate prediction seems to
be related to a precise thickness determination
(Matlab script) as proposed in this work.
Extension of this work will include biaxial tensile
tests combined with FE simulations on a model
of descending aorta, as a refinement of the
presented tube.

Figure 1: S teps of Matlab script: ROI selection and application of Sobel edge detection method.

References
Di Martino et al., J. Vasc. Surg., vol. 43, no. 3, pp.
5706; discussion 576, 2006.
Choudhury et al., Cardiovasc. Pathol., vol. 18, no.
2, pp. 8391, 2009.
Shi & Moita, Comput. Methods Appl. Mech. Eng.,
vol. 7825, no. 96, pp. 265281, 1996.
Wriggers, Nonlinear Finite Element Methods. Berlin:
Springer-Verlag, 2010.

Pixel conversion in mm is based on the grip


dimensions, previously measured by an electronic
calliper. Six samples were pre-conditioned by 5 cycles
performed at 1.2 Hz. Uniaxial tensile tests were
carried out onto a BOSE Electroforce (Model, Bose
Corporation, USA) equipped with a 250N load cell.
Three values of thickness were considered for
the stress evaluation: sample specific (through
MatLab script), 1.5 mm and 3.5 mm constant. For
each of them, the stiffest and the softest stressstrain responses were selected. Filtered stressstrain data were fitted by 1 st order Ogden, NeoHookean and Yeoh strain-energy functions and
imported in a simplified artery, modelled as a tube
47

O 027

COMPARATIVE COMPUTER-BASED RANGE OF MOTION


ANALYSIS OF DIFFERENT HIP IMPLANT SYSTEMS USING
PREOPERATIVE MRI AND POSTOPERATIVE RADIOGRAPHS
A. Wolf1, E. Mick1, D. Kluess1, A. Hartmann2, J. Ltzner2, R. Bader1
1

University Medicine Rostock Department of Orthopaedics, Biomechanics and Implant


technolgy research laboratory FORBIOMIT, Rostock, Germany

Technical University of Dresden, Department of Orthopedic Surgery, Dresden, Germany

Introduction
In clinical practice surgical planning of total hip
arthroplasty (THA) is commonly based on planar
radiographs orientated in the frontal plane and the
surgical instructions given by the manufacturer. The
aim of the present study was to establish a systematic
procedure for a computer-based ROM analysis and
compare surgical planning against the postoperative
situation by analysing their maximum ROM.

Results
The evaluation of postoperative radiographs
revealed inclination angles from 31.1 to 50.3
(mean SD = 41.6 6.3) and anteversion angles
from 13.3 to 32.8 (mean SD = 22.3 5.2)
ROM for the flexion, internal rotation and external
rotation were 5.4%, 12.1% and 4.5% respectively
higher for the implant orientation following
postoperative radiographs than the surgical
instruction.

Methods
Using MRI 3D geometrical data of pelvis and femur
from 11 patients were obtained pre-operatively.
CAD-models of each patient were reconstructed
and used for computer-based ROM analysis.
Pre- and postoperative radiographs were used for
comparison of surgery planning and real implant
positioning (Figure 1). Therefore, the inclination
angle of the cup was read out directly from the
planar radiograph and the anteversion angle was
calculated according to [Liaw 2009] eliminating
the error caused by oblique projection.

Discussion
The systematic procedure for a computer-based
ROM analysis presented has proved to be a useful and reproducible approach to determine and
compare the range of motion of total hip implants.
The individual 3D-reconstruction of pelvis and
femur enabled the comparison between real postoperative implant position and a preoperatively
planned position.
As shown by [Liaw, 2009 and Widmer, 2004] the
cup anteversion angle derived from the planar
radiograph has to be corrected by a factor
depending on the cup inclination and on the
position of the central ray. Considering this factor
an error of up to 5 was observed in present study
which corresponds with findings of other groups
[Ackland, 1986; Liaw, 2009].

3D bone model was virtually equipped with the


clinically used hip system in two implant positions
following both, the postoperative radiograph and
the preoperative surgical planning. For the latter
inclination and anteversion angle were set to 45
and 15, respectively.
The implant systems used were Metha short stem and
BiCONTACT stem (Aesculap, Tuttlingen, Germany).

Positioning of the hip stem in accordance with


one planar radiograph may not be as accurate
as needed. Within surgical planning based on the
preoperative radiograph and surgical instruction
given by the manufacturer no information about
positioning the stem in other than the frontal plane
is provided. Hence, several landmarks and axes
of the 3D femur model were defined for a proper
position of the stems in all three spatial directions.

ROM analysis was performed according to [Kluess,


2008]. Three hip movements were investigated:
maximum flexion
maximum internal rotation at 90 flexion
maximum external rotation at 15 adduction and
10 extension.

In conclusion, we could demonstrate the necessity


of considering both, pre- and postoperative data
to perform comparative computer-based ROM
analysis of total hip replacements. Virtually derived
ROM is being higher for postoperative conditions
than for implant positions according to the
preoperative planning indicates the significance
of experienced orthopaedic surgeons judgement
during operation in situ.
References
Ackland et al., J Bone J Surg, 68B(3):409413, 1986
Kluess et al., Acta Orthop, 79(6):748754, 2008.
Liaw et al., J Arthro, 24(3):468474, 2009
Widmer et al., J Arthro, 19(3):387390, 2004

Figure 1: P
 rocedure of computer-based ROM analysis

48

O 028

FIRST STEP FOR CLINICAL FALL RISK MONITORING:


ASSESSMENT OF SAMPLE FREQUENCY INFLUENCE
P. Tamburini1, R. Stagni1
1

University of Bologna, DEI Department of Electric Electronic and Information Engineering


Guglielmo Marconi, Bologna, Italy

Introduction
Falls represent a major community and public
health problem, with large clinical and economic
consequences. The understanding of locomotors
stability is a critical issue in clinical assessment
procedures. Clinicians use clinical rating scales for fall
risk assessment; but this approach highly relies on the
clinicians subjective judgment [Hamacher 2001].

Each index was calculated for the acquired signal


(at 128 Hz) and for other two signals obtained from
the original one by under-sampling at 64 and 32 Hz
and also for anterior-posterior (AP), medio-lateral
(ML) and vertical (V) acceleration directions.
Right heel strike instants were obtained from the
angular velocity measured by the sensor on the
ankle with wavelet analysis based method [Aminian
2001.] and stride time was calculated accordingly.

Several variability and stability indexes were


proposed in the literature for the subject specific
assessment of fall risk. Recent work [Riva 2014, Riva
2014] demonstrated that clustering appropriate
selected indexes can provide indication regarding
the specific subject alterations increasing fall risk.

The obtained indexes were testing with gaussianity


test (Kolmogorov-Smirnov test) in such way was
possible performed the right statistical analysis:
ANOVA test with a p-value of 5%.

The effective exploitation of this approach is


meant in its implementation on a portable device
for the continuous monitoring of subjects at risk,
either pathological (e.g. stroke subjects) or elderly.
The ideal device to maximize the exploitation, and
subject acceptance is a mobile phone. Although
the IMUs mounted on standard smart phones
have nothing to envy to other commercially
available devices, but sampling frequency at 100
or 200 Hz is not compatible with the computational
characteristics. The influence of reduced sampling
frequency on the assessment of variability and
stability indexes used for the monitoring must be
assessed, and this is the aim of the present work.

The statistical analysis compares the obtained


indexes by original signal (the reference) with the
indexes obtained by under-sampling from the
original one.
Results
CV, PSD2, HR, IH, lLE, maxFM, rr and MSE for the time
shifting 5 and 6 didnt show significantly differences
varying the sampling frequency.
SD, sLE, det, avg, max, div and MSE for time shifting
varying between 1 and 4 shown significantly
differences varying the sampling frequency.
NI, IV and PSD1 shown significantly differences only
for the sampling frequency at 32 Hz.

Methods
Ten healthy young subjects, 7 males and 3 females
(283 years, 17411 cm, 6713 kg), participated
to the study.

Discussion
The results show that the indexes calculated in
the frequency domain (HR and IH) and those that
describe the system as a whole (maxFM and lLE)
were not affected by the reduction of sampling
frequency, supporting the maintenance of the
performance of the method when implemented
on a portable device.

They performed a walking along a straight line at


self selected speed on 250 m long dead-end road
wearing 2 tri-axial accelerometers, one located
at the level of the fifth lumbar vertebra and one
on the right ankle. Acceleration and angular
velocity in vertical (V), medio-lateral (ML) and
antero-posterior (AP) were acquired with sample
frequency of 128 Hz.

MSE can be affected by reduction of sampling


frequency, depending on the amplitude of
selected time shift: the higher the time shift the least
the measure is sensitive to frequency changes.

Eleven gait variability and stability indexes were


calculated on stride time and trunk acceleration
data during gait.

References
Aminian et al., J. Biomech 35:689699, 2001.
Hamacher D et al., J R Soc Interface 8(65), 1682
1698, 2011.
Riva et al., conference proceeding SIAMOC-ESMAC 2014.

49

O 029

EXPLORING THE AETIOLOGY OF CONGENITAL


PSEUDARTHROSIS OF THE TIBIA WITH A LARGE
IN SILICO SENSITIVITY ANALYSIS
A. Carlier1, H. Brems2, J.M.A. Ashbourn3 , I. Nica4 , E. Legius2,
H. Van Oosterwyck1, L. Geris5
1
2
3

KU Leuven, Biomechanics Section, Leuven, Belgium

KU Leuven, Department of Human Genetics, Leuven, Belgium

University of Oxford, Department of Engineering Science, Oxford, United Kingdom


4
5

St Edmund Hall, St Edmund Hall, Oxford, United Kingdom

Universit de Lige, Biomechanics Research Unit, Lige, Belgium

Introduction
Congenital pseudarthrosis of the tibia (CPT) is a rare
disease which normally presents itself after birth by
anterolateral bowing of the tibia and spontaneous
tibial fractures [1]. Failure to maintain a bony union
is however frequent, resulting in multiple revision
surgeries and occasionally amputation. The exact
etiology of CPT is still highly debated. However, 4080%
of the CPT-patients are carriers of a mutation in the
Neurofibromatosis type 1 (NF1) gene potentially
resulting in an altered phenotype of the skeletal
cells and impaired bone healing. This study will use a
multiscale computational model of bone regeneration
to investigate the impaired healing in NF1 patients.
Exp e r i m e n t a l m e t h o d s
In order to examine the effect of the NF1 mutation on
bone fracture healing, the parameter values of the
factors describing the aberrant cellular behavior of
haploinsufficient cells were altered in a previously
established model of bone regeneration [2]
(Table 1). Next, a large sensitivity analysis using a
uniform design of 200 different parameter value
combinations was conducted to determine the
(relative) importance of the altered parameter
values on the callus tissue fractions. An additional
outcome CI (complication index) was defined
such that a high CI value corresponds to a high
degree of severity of CPT, i.e. the fracture healing
is severely impaired.

Factor

NF1 case

CI value

Fibroblast
invasion time

Fibroblastic
proliferation

Fibroblastic
differentiation

Osteogenic
differentiation

Endochondral
ossification

Cartilage
formation

Fibrous tissue
formation

Angiogenic
growth factor
production

Table 1: O
 verview of the factors describing the aberrant
cellular behavior of NF1 haploinsufficient cells and
their influence on the predicted CI value.

C o n cl u s i o n
In summary, we can conclude that a slower
endochondral ossification process, an increased
invasion of fibroblastic cells and a reduced rate
of cartilage formation are key elements for the
development of a congenital pseudarthrosis in the
computational model. Experimental research is
necessary to verify this hypothesis.

Results and discussion


A non-union resembling a CPT phenotype was
predicted by the computational model when the
parameter values were altered according to Table
1 (the NF1 case). From the sensitivity analysis the
following factors were found to be very influential
for the CI value: the rate of cartilage formation,
duration of fibroblast invasion and the rate of
endochondral ossification. Interestingly, many
combinations of altered parameter values resulted
in a similar CI value although the composition and
spatial distribution of the tissues within the fracture
callus was different. Moreover, the computational
model predicts a wide range (0.010.89) of CI
values, corresponding to different degrees of
severity by which the pseudarthrosis presents itself.

Ack n o wl e d g e m e n t s
LG and AC acknowledge the European Research
Council under the European Unions Seventh Framework Program ERC grant agreement n279100. AC
and HB are post-doctoral fellows of the Research
Foundation Flanders (FWO-Vlaanderen). This work is
part of Prometheus, the Leuven R&D Division of
Skeletal Tissue Engineering of the KU Leuven.
References
1 Pannier S (2011) Congenital pseudarthrosis of the
tibia. Orthopaedics & Traumatology-Surgery &
Research 97: 750761.
2 Carlier A, Geris L, Gastel NV, Carmeliet G,
Oosterwyck HV (2014) Oxygen as a critical determinant of bone fracture healing-A multiscale model.
J Theor Biol 365C: 247264. S0022-5193(14)00601-8
[pii];10.1016/j.jtbi.2014.10.012 [doi].
50

O 030

BIOMECHANICAL EVALUATION OF TAPE


AUGMENTATION REPAIR VS. CONVENTIONAL REPAIR
TECHNIQUES FOR RECONSTRUCTION OF THE ANTERIOR
TALOFIBULAR LIGAMENT
E. Benca1, R. Schuh1, M. Willegger1, L. Hirtler2, S. Zandieh3 ,
J. Holinka1, W. Reinhard1
1

Medical University of Vienna, Department of Orthopaedic Surgery, Vienna, Austria

Medical University of Vienna, Department for Systematic Anatomy, Vienna, Austria


3

Hanusch Hospital, Radiology Department, Vienna, Austria

Introduction
Ankle sprain trauma is the most common sports
injury, whereas the rupture of the anterior talofibular
ligament (ATFL) is a common pathology. Anatomic
repair techniques show good results, however they
require a period of immobilization and protected
rehabilitation to avoid failure of the repair.
Recently, tape augmentation for the traditional
Brostrm repair has been introduced in order to
improve the primary stability of the reconstructed
ATFL and allow earlier mobilization.

InternalBrace: 45.8 14.6 and InternalBrace


without Brostrm group: 45.8 12.2. Statistical
analysis did not show significant differences
between the groups neither for torque nor the
angle at failure. Modes of failure show inferiority in
the suture-ligament interface.
Discussion
The ATFL with tape augmentation is at least as
strong as the native ATFL in a biomechanical
model simulating ankle sprain trauma conditions,
suggesting a possible early mobilization and/or
excessive stresses (in patients with long-standing
lateral ankle instability with attenuated native
tissue, in cavovarus patients and/or elite athletes).

The biomechanical stability of tape augmentation


suture anchor repair is not known yet.
Methods
Thirty fresh-frozen human ankle specimens were
randomly assigned to five different groups: native
ATFL, reconstruction using SutureTak (Arthrex Inc,
Naples, FL, USA) Suture Anchor, traditional Brostrm
repair, Brostrm repair with InternalBrace (Arthrex
Inc, Naples, FL, USA) tape augmentation (Figure
1) and InternalBrace tape augmentation without
Brostrm repair. In vivo loading conditions in ankle
sprain trauma were carried out in a quasi-static
manner. Resisting torque, as well as the rotary
displacement () of the ankle joint were recorded.
Intergroup differences for age, bone mineral
density (BMD), failure angle, and failure torque
were analyzed using repeated measurement
ANOVA.

References
Brown CA, Hurwit D, Behn A, et al. Biomechanical
comparison of an all-soft suture anchor with
a modified Brostrm-Gould suture repair for lateral
ligament reconstruction. Am J Sports Med, 2014,
42(2) p. 41722
Giza EE, Nathe RR, Nathe TT, et al. Strength of bone
tunnel versus suture anchor and push-lock
construct in Brostrm repair. Am J Sports Med, 2012,
40(6) p. 141923
Gould N, Seligson D, Gassman J. Early and late
repair of lateral ligament of the ankle. Foot Ankle,
1980, 1(2) p. 849
Karlsson J, Lundin O, Lind K, et al. Early mobilization
versus immobilization after ankle ligament
stabilization. Scand J Med Sci Sports, 1999,
9(5) p.299303
Waldrop NE, Wijdicks CA, Jansson KS, et al.
Anatomic suture anchor versus the Brostrm
technique for anterior talofibular ligament repair:
a biomechanical comparison. Am J Sports Med,
2012, 40(11) p.25906

Results
Torque at failure reached 8.3 3.1 Nm for the native,
8.4 2.9 Nm for the SutureTak, 5.7 1.9 Nm for the
Brostrm, 10.7 3.3 Nm for the InternalBrace and
11.3 6.0 Nm for InternalBrace without Brostrm
group. Angle at failure reached following values:
native: 33.5 6.7, SutureTak: 35.7 8.6, Brostrm:
24.1 5.8,

51

O 0 31

EFFECTS OF BODY WEIGHT UNLOADING ON KINEMATICS,


KINETICS, MUSCLE ACTIVITY, AND CENTER OF PRESSURE
DURING OVERGROUND GAIT
A. Fischer1, A. Wolf1
1

Technion Israel Institute of Technology, Mechanical Engineering, Haifa, Israel

Introduction
Body weight unloading (BWU) on treadmills is a
common method of gait rehabilitation which by
alleviating loads on lower joints allows patients with
neurological and musculoskeletal impairments
to undergo treatment at the onset or right after
surgery (Lee, 2008). However, the effects of BWU on
gait parameters are hard to assess as long as the
walking modality (treadmill vs. overground) and/or
subjects speed variability during overground
walking are not controlled (Threlkeld, 2003; Van
Hedel, 2006). In this research a novel mechanical
device was designed to pull the BWU system at
a constant speed allowing healthy subjects to
maintain a comfortable speed during overground
walking. In so doing, this study could examine the
unique effects of BWU on gait kinematics, kinetics,
elecromyographic (EMG) activity and center of
pressure (COP) under conditions that approximate
daily walking.
Methods
Fifteen healthy male subjects walked overground
under various levels of BWU with a Biodex system.
An electric winch pulled the system at a constant
speed of 4 km/h. The procedure included
overground walking under a control (No vest),
and three 0%, 15%, and 30% BWU experimental
conditions. The kinematic and kinetic measures of
the hip, knee and ankle joints were obtained using
an eight-camera infrared Vicon motion tracking
system. The EMG activity of the Tibialis Anterior
(TA), Lateral Gastrocnimius (Lat GC), and Vastus
Lateralis (VL) were recorded with an EMG ZeroWire
system and the COP of the foot was calculated
using the force plate and marker data.

Figure 1: ( a) EMG signal of the Lateral Gastrocnemius and


(b) Center of Pressure under three 0% 15% and 30%
BWU conditions.

Discussion
This study showed that healthy subjects during
overground gait with BWU exhibit very specific
kinetic and kinematic patterns which the treadmill
may obscure. The observed reduction in joint
moments, the shift in COP and reduction in EMG
activity resulting from BWU have wide implications
in gait rehabilitation suggesting that BWU may
safely be applied with clinical patients undergoing
rehabilitation in situ, i.e., under conditions that
replicate daily walking. As lower joints regain their
functional activity with respect to balance, range
of motion and locomotor patterns, patients body
weight may be gradually increased until they
resume normal daily walking without any BWU.

Results
Findings show that healthy subjects gait under BWU
showed small albeit significant modifications in
flexion and extension kinematic parameters of the
hip and knee joints. Further, the increase in BWU
resulted in a significant decrease of peak moments
and impulses in the sagittal and frontal planes.
A significant inverse relationship was also observed
between BWU levels and EMG measures (Fig. 1a).
As the BWU level increased, the impulse and peak
activity of the TA, Lat GC and VL decreased. In
contrast, the BWU level did not affect the EMG
signal trajectories. Increasing the BWU level
resulted in modifications of the foot COP, with
a lateral shift in the coronal plane of the COP
(Fig. 1b) during stance.

References
Lee et al, J Appl Physiol, 1043:747755, 2008.
Threlkeld et al, Gait Posture, 173:235245, 2003.
Van Hedel et al, Gait and Posture, 241:3545, 2006.

52

O 032

EFFECT OF TDCS ASSOCIATED WITH FES IN THE TIBIALIS


ANTERIOR, IN THE STATIC BALANCE IN SUBJECTS
WITH HEMIPARESIS POST STROKE
C. Fernanda1, A.M.A. Fruhauf1, G.C. Costa1, L.C. Grecco1,
S.M. Silva1, J.C. Correa1
1

Nove de Julho University UNINOVE, Rehabilitation Science Master and PhD Program,
Sao Paulo, Brazil

Introduction
The increase in cortical activity induced by
brain stimulation, associated or not with other
physiotherapy techniques, could increase the
effects therapeutic engines and functional in
individuals with cerebrovascular accident (CVA).
The objective are to checking the effects obtained
with the combination of the two techniques are
superior to those identified with the techniques
applied in isolation.

tDCS shunt Protocol + FES Active + Active


contraction do mm. tibialis observed decrease in
the COP with open eyes in ML (-9.862/-7.148mm)
and closed eyes in ML (-8.277/3.827mm).
However, the same not observed in AP, obtaining
the value of (1,814/-8.318mm) for open eyes and
closed eyes values (4.326/8.112mm). Anodal
tDCS Protocol + FES shunt + Active contraction
mm. tibialis noted decreased COP: open
eyes in AP (-9.666/-3.983mm), closed eyes in
ML (-71.823/-49.965mm) and closed eyes in
ML (-55.721/-45.701mm). However, the same
was not observed with closed eyes in AP
(-3.860/-6.175 mm). tDCS shunt Protocol +
+ FES shunt + Active contraction do mm.
tibialis noted an decreased COP: with closed
eyes in ML (-30.386/15.902mm) and open
eyes in AP (20.663/5.255 mm). However the
same not observed for COP with open eyes in
ML (-5.790/-38.180) and to the COP with closed
eyes in AP (6.460/10.639mm). The media data
submitted a pre and post intervention after
each patient.

Methods
Cross-sectional study, a randomized, double blind,
crossover, individuals with hemiparesis post stroke,
who met the inclusion criteria. Static balance
assessment by stabilometry, before and after four
intervention periods: (Anodal tDCS + FES active +
+ active contraction mm tibialis) (tDCS shunt + FES
active + active contraction mm tibialis) (anodal
tDCS + FES shunt + active contraction mm. tibialis)
and (tDCS shunt + FES shunt + active contraction mm.
tibial). The tDCS was applied to the primary motor
cortex and the FES on the tibialis anterior muscle. The
order of protocols was by randomization, with the
evaluator and blind patients.

Discussion
The partial results of the study, are promising and
favorable with tDCS technique applied in isolation
and with the association of FES for improving static
balance of patients post stroke. However, the
study is still in progress with more patients to better
conclusion.

Results
There Anodal tDCS Protocol + FES Active + Active
contraction mm. tibialis noted decreased
Center of Postural (COP): With open eyes and in
anteroposterior direction (AP) (-197/823 mm),
With open eyes and in medium-lateral direction
(ML) (-78.460/-54.247 mm) and closed eyes in
ML (-74.602/-53.617 mm), however; the same
not observed in closed eyes in AP (954/9.273 mm).

References
Bolognini et al, J Neuroeng Rehabil. 2009
Nitsche et al. BrainStimulation. 206223, 2008

53

O 033

SUGGESTION OF BALANCE TRAINING STRATEGY


OPTIMIZED FOR THE ELDERLY WITH BALANCE
DISTURBANCE: A PILOT STUDY
D. Lim1, H. Jung1
1

Sejong University, Dept. Mechanical Engineering, Seoul, Korea, Republic of Korea

Introduction
It has been reported that the elderly with balance
disturbance has a high potential risk of falling as one of
major public health problems [Ambrose,2013]. Diverse
strategies for balance training have been therefore
recently suggested to recover effectively the balance
ability of the elderly [Galvarsson, 2011]. Little information
is, however, still available about the optimized strategy
for the elderly with balance disturbance. The aim of
the current study is to identify the optimized strategy
for the elderly with balance disturbance.

the balance index of the participants. The balance


index was then determined via quantification of
a degree of deviation of COM from BOS (Base of
Support) derived from COP.
Statistical Analysis One-way ANOVA test with
Scheffe post hoc multiple comparisons were used
(p< 0.05).
Results
The alteration patterns of the joint angles were
significantly different for each dynamic motion
generally (p<0.05). Maximum deviation of COM was
shown in AP (60.315.5%) and ML (58.613.5%)
dynamic motions, compared to LD (35.59.9%)
and RD (14.96.0%) dynamic motions (p<0.05)
(Fig. 1B). It was, however, that no significant
differences were shown among the dynamic
motions in a deviation frequency point of view
(AP: 17.86.9%, ML: 15.74.6%, LD: 14.12.9%,
RD: 5.92.9%) (p>0.05).

MATERIA L S AND METHODS


Participants Following Institutional Review Board
approval, seven healthy participants with no sign
of musculoskeletal pathology (gender: 7 male,
25.51.7 years, height: 173.96.4 cm, weight:
71.36.5 kg) were tested.
Experimental Configuration Four dynamic motions
(Anterior-Posterior (AP), Medial-Lateral (ML), Left
Diagonal (LD), Right Diagonal (RD), rotations) were
considered by a customized balance training
system with controllable and unstable base plate
(Fig. 1A). The balance characteristics of the
participants responded to the dynamic motions
by the customized balance training system were
then measured using 3D motion analysis system
with eight infrared cameras (T-10s, VICON Motion
System Ltd., UK) and insole pressure mapping
system (Pedar X, Novel gmbh, Germany).

Discussion
It may be judged that AP or ML dynamic motion
should be dominantly considered in the balance
training for the elderly. Diagonal motions should
be, however, considered in the balance training
because we have to handle them shown
frequently in various activities of daily lives.
Optimized strategy for the balance training is not
concluded strongly in the current study because
all balance characteristics and clinical factors
are not considered fully. Those will be therefore
considered in our on-going study.

Data Analysis COM (Center of Body Mass) and COP


(Center of Pressure) were analysed dominantly to
identify the optimum dynamic motion based on

Figure.1 (A) Experimental configuration and (B) COM deviation from BOS in four dynamic motions

References
[1] Anne Felicia Ambrose, Maturitas 75 5161, 2013,
[2] Alexandra Halvarsson et al, Clinical Rehabilitation,
25(11) 10211031,2011

54

O 034

A LUMPED PARAMETER MODEL OF THE FLEXI-BAR:


TOWARDS INVESTIGATING THE EFFECT OF VIBRATION
TRAINING ON THE MUSCULOSKELETAL SYSTEM
K. Khalaf1, M. Abdollahi2, M. Parnianpour3 , M. Nikkhoo4 , M. Hoviattalab2,
M. Asghari2, S. Ashouri2, S. Nikpour2
1

Khalifa University of Science Technology and Research, Biomedical Engineering, Abu


Dhabi, United Arab Emirates
2

Sharif University of Technology, Mechanical Engineering, Tehran, Iran

University of Wisconsin, Industrial and Manufacturing engineeiring, Milwaukee, USA

Science and Research Branch Islamic Azad University, Department of Biomedical


Engineering, Tehran, Iran

Introduction
Vibration training is increasingly gaining popularity as
an effective warm-up/training modality for athletes
and as a therapeutic strategy in rehabilitation.
Several research studies have investigated the
effect of different exercises using flexible bars on
the musculoskeletal system [Gonalves et al, 2011].
Despite the abundance of studies on flexible poles,
such as FLEXI-BAR(FLEXI-SPORTS GmbH, DE), there
remains a gap in literature regarding the structural
modeling and simulation of the bars. The objectives
of this study are twofold: 1) to develop a lumped
parameter model of the FLEXI-BAR; and 2) to use the
model to simulate up-down exercises in AnyBody to
estimate the spinal loads at the L5/S1.

ration (C), while the 2 remaining tests (one free and


one forced vibration) were used for validation.
C. AnyBody Simulations
The robustness of the FLEXI-BAR developed
model was evaluated using simulations of the bar
implemented in AnyBody Modeling System (AMS)
(AnyBody Technology, Denmark). The optimized
model was coupled with the StandingModel in
the AnyBody Managed Model Repository (AMMR)
v.1.5. Up-down exercises were simulated such that
the system was moved up and down periodically
with specific amplitudes and frequencies.
The maximum compression and anterior shear
forces at the L5-S1 vertebral level were calculated
at five different frequencies, as depicted in Figure 2.

METHODS
The FLEXI-BAR has 3 parts: grip, flexible rod and
endpoint mass. A lumped parameter model was
developed for describing its mechanical behavior.
A. Lumped Parameter Model
The bar was divided into 3 segments. Two torsional
springs (stiffness K) and 2 torsional dashpots
(damping ratio C) were used to model the elastic
and damping behavior (Fig1).

Figure 1: L umped parameter model of the FLEXI-BAR

B. Experiments & Optimization Simulations


Two types of tests were conducted to evaluate
the dynamic behavior under different boundary
conditions. A digital camera was used in the first
test to observe the oscillation of the bar in a free
vibration setting, where the initial displacement was
fixed. The test was repeated 3 times using 3 different
initial displacements. The second test evaluated the
bar under forced vibration. The grip was vibrated
using a shaker. Two inertial sensors (Xsense, NL)
were placed on the grip and the endpoint of the
bar, respectively. The shaker induced vibrations
at five pre-specified frequencies: 2.86, 3.88, 4.25,
4.67, 7.33 Hz. In order to identify the mechanical
properties of the springs and dashpots, the two tests
were simulated in MATLAB (The Mathworks, MA)
using an optimal genetic algorithm that minimized
displacement. The outputs of 6 tests were then
used for optimizing the stiffness (K) and damping

Figure 2: M
 ax. L5/S1 Compression/Shear posterior forces (N)

DIS C USSION
The
presented
model
provides
adequate
accuracy for large scale modeling using Anybody
or SIMM systems. The effect of higher vibration that
increases muscle/joint forces can guide exercise
and rehabilitation therapists regarding imposing
optimal stress levels on the musculoskeletal system
while avoiding pain and suffering that may affect
compliance. Ongoing and future work include
further validation and simulation of different types
of exercise.
References
Gonalves et al., Journal of Back and Musculoskeletal Rehabilitation 24.4: 209214, 2011.

55

O 035

FINITE ELEMENT INVESTIGATION OF THE EFFECTS


OF THE CUP ORIENTATION ON IMPLANT LOAD-BEARING
IN TOTAL HIP RESURFACING
A. Komeili1, B. Vafaeian1, S. Adeeb1, R. Gudena2, M. El-Rich1
1
2

University of Alberta, Civil Engineering, Edmonton, Canada

University of Calgary, Department of Surgery, Calgary, Canada

Introduction
An alternative to Total Hip Arthroplasty (THA) is the
Total Hip Resurfacing which has been reported as
a more effective and beneficial method especially
in younger patients [Sharp D.J., 1985]. Metal-On-Metal hip resurfacing technique is becoming widely
accepted as a viable alternative to other forms of
total hip replacements. The technique has many
proven benefits in terms of ease of the surgical
operation, operation outcome and subsequent
revisions. However, recent reports suggest that there
is an effect caused by the different femoral implant
and acetabular cup relative orientations on the
release of debris into the blood stream. These reports
suggest that an optimum orientation needs to be
sought. The search for an optimum position to
reduce wear of the metallic components has been
explored clinically and experimentally, however,
there are no reports to explain the mechanical
mechanisms behind an optimum position or lack
thereof. In this paper, a finite element analysis (FEA)
was conducted to investigate the effect of the
acetabular cup orientation on the implant behavior
under weight-bearing load.

inclination higher than 25 or 45 respectively


[Biedermann, 2005]. Metal ions concentration is a
clinical concern not only depends on mechanical
circumstances (wear mechanism and surface
lubrication) but also depends on biological
variables. It has been reported that the cup
inclination angle greater than 50 increases the
concentration of cobalt and chromium ions in
a MOM hip resurfacing [Hart A.J., 2008]. Overall,
combining our FEA results with those considerations
suggests that the optimum range for anteversion
and inclination angles are 10 to 25 and 35 to
45 respectively. The proposed region is in good
agreement with the recommended safe region
reported in available clinical studies in which the
ions concentration, wear rate, fracture of the bone
and bone remodeling were the focus of the study.
References
Biedermann R. et al., J Bone Joint Surgery Br.,
87(6):7629, 2005.
Hart A.J. et al, Hip International, 18(3): 212219,
2008.
Sharp D.J. et al, Clinical Orthopaedics and Related Research, 201:5156, 1985.

Methods
The geometry of the bony structures was extracted
from the CT-Scan image of anonymous hip
joint. The FEA model incorporates half of the
right pelvis, related femoral head and neck,
and all the components of the Birmingham Hip
Resurfacing implant as shown in Figure 1. The final
model consisted of 42126 linear shell elements for
cortical bone, and 416980 linear solid elements
for cancellous bone, implant components,
and cement. A wide range of anteversion and
inclination angles were investigated and the effect
of these orientations on the contact and von Mises
stresses in the implant for a one-legged stance
position was studied.
Results
The results of this study suggest that in the one legged
stance loading configuration the safe range of the
cup orientation, based on the minimum values
of the MCP and von Mises stress, is 0 to 25 of
anteversion and 30 to 45 of inclination(Figure 2).
Discussion
In addition to the FEA factors, the following
three other considerations on the cup optimum
orientation are apparent in literatures: the risk of
impingement, the possibility of dislocation, and the
metal ions concentration. Dislocation and instability
of the implant is associated with anteversion and
56

O 036

SURFACE DAMAGE CHARACTERISATION OF TAPER


JUNCTION IN HIP JOINT IMPLANTS
H. Farhoudi1, R. Oskouei1, C. Jones2, M. Taylor1, L. Solomon3
1

Flinders University, School of Computer Science Engineering and Mathematics,


Adelaide, Australia

University of Adelaide and SA Pathology, School of Medicine & School of Mechanical


Engineering and Adelaide Centre for Spinal Research, Adelaide, Australia
3

Royal Adelaide Hospital and University of Adelaide, Department of Orthopaedics


and Trauma, Adelaide, Australia

Introduction
By-products resulting from fretting wear and corrosion
within the taper junction of hip joint implants can
lead to aggressive biological reactions such as
pseudotumours and bone loss in some patients.
There is typically evidence of visible damage to
the head-neck junction and corrosion products
around the junction [Fricka et al., 2012]. Previous
retrieval studies were mainly limited to macroscopic
visual inspections [Dyrkacz et al., 2013, Higgs et al.,
2013] where the severity of fretting and corrosion
damage was graded on a numeric scale based on
these visual inspections. More detailed analyses of
the surface topography, roughness and chemical
elements present on the neck and head surfaces
appear to be necessary to better understand the
fretting corrosion behaviour at the taper junction.

regions compared to the undamaged regions. This


was consistent for the whole surface of the neck
(different paths). As shown in Figure 1b, roughness
increased from 0.39 m (undamaged) to 0.61 m
(damaged). EDS analyses of the damaged regions
(e.g. red rectangle shown in Figure 1c) revealed
the presence of chromium and oxygen in high
weight percentages indicating that corrosion
caused chromium to be released from the implant
alloy and form oxidised compounds in the corrosion
products on the surface.

Methods
Ethical approval was granted by the Southern
Adelaide Clinical Human Research Ethics Committee
(485.13). Two retrieved modular implants with metalon-polyethylene (MOP) articulations were studied.
Both implants had a 28 mm diameter CoCrMo head
connected to a 316L stainless steel stem. Implant #1
was retrieved after 94 months from an 83-year old
male patient of 77.5 kg. Implant #2 had a 99-month
service life in a 53-year old male patient of 107 kg.
Surface topography and roughness along 8 paths
parallel to the neck surface (with 45 spacing) was
characterised using an optical microscope and
a surface profilometer (WYKO NT9100, Veeco, USA).
Fretting and corrosion damage in the form of surface
depressions and deposited debris were examined
using scanning electron microscopy (SEM, Inspect
F50, FEI, USA). Energy-dispersive spectroscopy (EDS)
was used to determine the elemental composition
of points of interest.

Figure 1: ( a) Neck of Implant #1; (b) Surface topography;


(c) SEM image.

Discussion
Fretting corrosion damage increased the surface
roughness of the neck by approximately 50%.
Mismatch angles between the head and neck
seem to cause the distal contacting rim and
provide a crevice for corrosion attack. Damage
due to the mechanically assisted crevice corrosion
was more severe in the distal area compared to
the proximal area. More research is needed to
identify corrosion product phases.

Results
In both implants, surface damage to the neck
was more severe in the distal area, adjacent to
the rim of the head bore. Material removal and
deposited debris were observed increasingly on
the last 2 mm region of the contacting rim (Figure
1a). Most threaded regions in the proximal area
remained undamaged. Generally, roughness
value (R a)was found to be higher in the damaged

References
Dyrkacz et al, J Arthroplasty, 28: 103640, 2013.
Fricka et al, J Arthroplasty, 27: 2631e1, 2012.
Higgs et al, J Arthroplasty, 28: 26, 2013.

57

O 037

STRESSED VOLUME AS INDICATOR OF LONG-TERM


FATIGUE DAMAGE IN CEMENTED HIP REPLACEMENTS
C. McBrien1, N. Dunne1, A. Lennon1
1

Queens University Belfast, School of Mechanical and Aerospace Engineering, Belfast,


United Kingdom

Introduction
Survival rates of cemented hip replacements can
be improved by mechanically enhancing bone
cement. Experimental studies show that multiwalled carbon nanotube (MWCNT) reinforcement
improves cement properties [Ormsby et al., 2012].
Although unreinforced cement fatigue material
models have been successfully applied to estimating
revision risk [Lennon et al., 2007], fatigue of implants
supported with reinforced cement has not been
modelled to date. This study investigates effect of
MWCNT reinforcement on clinically relevant cement
fatigue by relating computational stress analysis with
measured damage accumulation from a cemented
femoral implant study [Ormsby et al., 2013].

Figure 1: P
 redicted stress vs. damage.

Methods
Cemented implant computational models were
developed based on a previous experimental
model [Ormsby et al., 2013], with adapted
cement moduli to account for reinforcement. The
experimental model used a composite Sawbone
femur with an Exeter implant supported with
MWCNT reinforced bone cement. Femoral implant
and cement mantle positioning was reproduced
using bi-planar X-ray images. Cement voids were
incorporated, with implant-cement interfaces
modelled under both bonded and debonded
conditions. Maximum principal stress predictions
were compared to experimentally measured
damage, focusing on regional comparison of initial
stress and measured damage distributions.

Figure 2: V
 olumes 10MPa vs. damage.

In conclusion, initial computational results qualitatively agree with the experimental data.
Future model development is required to improve
quantitative comparison with the fatigue damage
evolution. Ongoing companion studies, evaluating fatigue behaviour of reinforced cement and
developing a new fatigue model, will enable
more detailed analysis of the influence of MWCNT
addition on cement mantle fatigue.

Results
Debonded contact interface models better
represented experimentally measured damage
(Figure 1). Considering volumes of cement stressed
10MPa as critical [Murphy and Prendergast, 2000],
debonded models predicted lower stressed volumes
for MWCNT reinforced cement, except in the medial
distal region (Figure 2). Measured damage occurred
mainly in the distal region for all cases. Relative to
controls, the number of cracks in MWCNT reinforced
cement decreased approx. 3% in the medial middle
region, but increased in the lateral middle (3%) and
medial distal (approx. 9%) regions.

References
Lennon, A.B. et al., J Orth Res, 25, 2007.
Murphy, B.P. and Prendergast, P.J., Int.
J. Fat., 22(10), 2000.
Ormsby, R. et al., Acta Biomat, 8, 2012.
Ormsby, R. et al., 25th ESB, Madrid, Spain, 2013.

Discussion
Overall,
stressed
volume
did
correspond
qualitatively with crack location, apart from the
lateral middle and medial distal regions. Any lack
of corroboration could be due to comparison
of initial model predictions with the final fatigue
cracks; detailed simulation of the fatigue damage
accumulation is needed to determine if this is the
case. Other contributing factors include implant
and void positioning.
58

O 038

EXPERIMENTAL SETUP AND METHOD TO MEASURE


LOCALLY THE MICROMOTION BETWEEN
HIP IMPLANT AND FEMUR
L.C. Pastrav1, S. Leuridan2, J. Roosen3 , Q. Goossens1, M. Mulier3 , W. Desmet4 ,
K. Denis1, J. Vander Sloten2
1

KU Leuven Campus Group T, Health Engineering, Leuven, Belgium


2

KU Leuven, Biomechanics Section, Heverlee, Belgium

University Hospitals KU Leuven, Department of Orthopaedics, Pellenberg, Belgium


4

KU Leuven, PMA Section, Heverlee, Belgium

Introduction
Micromotions are cyclic implant-bone relative
displacements induced by physiological loads. This
phenomenon may trigger the loosening process
or at least contribute to it if the relative micromovements exceed 150 m [Viceconti 2000].
Therefore, measuring the micromotion is a method
to assess the stability of the implant-bone structure.
The existing measuring systems consider the implant
as a rigid body and determine up to six components
of motion [An 2000]. The experimental setup and
method presented in this paper allow to measure
locally the relative displacement between the
femoral implant and the bone taking into account
the deformations of both components.
Methods
For the preliminary tests a Wright Profemur implant
and an artificial composite femur were used. Figure
1 shows the experimental setup. A supporting
structure used to hold either guiding bushings or
linear variable displacement transducers (LVDT) is
attached to the implant.

Figure 1: E
 xperimental setup

The micromotions are measured in proximal-distal,


medial-lateral or anterior-posterior directions at
four locations situated in two transverse planes.
At each location a pin is inserted in the implant
and a concentric bushing is inserted in the femur.
While the load is applied, four LVDTs are measuring
the displacements between the supporting plate
and the pin and, respectively, the bushing in two
perpendicular directions as indicated in Figure 2.
The whole system is installed on an Instron testing
machine. To simulate the hip abductors a cable
is used and its tension is measured with a force
cell. The cyclic load is similar to those used in other
experiments [Ostbyhaug 2010].

Figure 2: L VDTs positioning

Results
The
relative
bone-implant
micromotion
is
significantly bigger in the distal region than in the
proximal region.
Discussion
Preliminary tests generated significant and
promising results, proving the potential of the
proposed setup and method which could be used
to validate other stability assessing techniques (i.e.
vibration analysis). More experiments are needed
to evaluate the importance of the implant elastic
deformation.

References
An et al (editors), Mechanical testing of bone
and the bone-implant interface, 515526, 2000.
Ostbyhaug et al, Clin Biomech, 25:318324, 2010.
Viceconti et al, J Biomech, 33:16111618, 2000.

59

O 039

MONITORING OF THE REAMER SEATING USING


ACOUSTIC INFORMATION
Q. Goossens1, S. Leuridan2, J. Roosen3 , L.C. Pastrav1, M. Mulier3 , W. Desmet4 ,
K. Denis1, J. Vander Sloten2
1

KU Leuven Campus Group T, Health Engineering, Leuven, Belgium


2

KU Leuven, Biomechanics Section, Leuven, Belgium

University Hospitals KU Leuven, Department of Orthopaedics, Pellenberg, Belgium


4

KU Leuven, PMA Section, Leuven, Belgium

Introduction
A large number of cementless total hip arthroplasties
(THA) are performed every year, during which
the hip joint is replaced by an artificial implant.
The primary fixation of the femoral component
of a cementless THA is obtained by press-fitting
the implant in the femur. At present, this primary
fixation is determined by the subjective auditive
and tactile experiences of the orthopaedic
surgeon. This initial fixation is one of the most
important determining factors to obtain a long
lifetime of the implant [Gheduzzi 2006]. A major,
underestimated complication during THA is an
intra-operative femoral fracture, which occurs
when the implant is excessively press-fitted. 5 % of
the primary cementless THA has to deal with an
intra-operative fracture [Lindahl 2007] and up to
30 % during revision cementless THA [Meek 2004].

observed; only a sudden change was observed in


the percentage power (figure 2). Also this could be
explained by the reamer making proximal contact
in the femur.

This study explores the feasibility of an acoustic


method to obtain additional information on the
reamer seating during primary cementless THA
preparation of the femur. The results of this study give
a first indication of the possibility to assess the implant
fixation/seating by means of an acoustic based
method. An in vitro cadaveric study is pursued.
Methods
14 cadaveric femurs where prepared for primary
cementless THA by an orthopaedic surgeon.
Different sizes of femur where used, resulting
in implant sizes from 1 to 8 (Wright). During the
preparation the hammering sound of the reaming
was recorded with two microphones (PCB
Electronics) at a distance of 1 m. LMS TestLab
(Siemens) was used for the recording of the
acoustic signals. The recorded time signals were
analyzed using Matlab software to extract sensitive
features. The data was filtered and normalized.

Discussion
These reaming results show the possibility of
acoustics to detect proximal contact when the
implant is inserted in the femur. This point is currently
hard to detect for surgeons and is a crucial step
to obtain a good initial fixation of the implant and
prevent intra-operative fractures.

Results
Significant trends were observed in several
features that were calculated out of the sound of
each reaming hit. The most sensitive feature was
the percentage of spectral power in the range
of 100 Hz 1000 Hz. Two different patterns were
recognized:

References
Gheduzzi S., Miles A., Proc Inst Mec Eng Part H, Vol
221, No 1, pp 3946. 2007.
Lindahl H., 2007. Int. J. Care Injured. 38, 651654.
Meek R.M., Garbuz D.S., Masri B.A., Greidanus
N.V., Duncan C.P., 2004. J. Bone Joint Surg. [Am]
86-A, 480485.

1. The power increased every succeeding hammer


hit until a certain hit to stagnate afterwards
(figure 1). This point of stagnation could explained by
the reamer making proximal contact in the femur.
2. When a specific size of reamer was repeated,
a different trend in percentage power was
60

O 040

REFERENCE POINT MICROINDENTATION SUPPLEMENTS


CLINICAL MEASURES TO DISCRIMINATE OSTEOPOROTIC
FROM NON-FRACTURED BONE
T. Jenkins1, L. Coutts1, D. Dunlop2, R. Oreffo3 , C. Cooper4 , N. Harvey4 , P. Thurner5,6
1

University of Southampton, Co-First Author Bioengineering Sciences,


Southampton, United Kingdom
2

University of Southampton, Institute for Developmental Sciences,


Southampton, United Kingdom
4

University Hospital Southampton, Trauma and Orthopaedics,


Southampton, United Kingdom

University of Southampton, MRC Lifecourse Epidemiology Unit,


Southampton, United Kingdom

Vienna University of Technology, Institute of Lightweight Design and Structural Biomechanics,


Vienna, Austria
6

University of Southampton, Bioengineering Sciences, Southampton, United Kingdom

Introduction
Current fracture risk assessment tools, primarily bone
mineral density (BMD) and clinical risk factors (FRAX),
hold a number of limitations and do not identify a
large proportion of individuals who subsequently
present with a hip fracture [Schuit, 2006].

the Curve, ROC AUC = 0.89, close to a perfect


identifier, 1.0) with a high sensitivity (85%) for a
given specificity (80%) and 115 m threshold.
BMD (sensitivity = 37%, specificity = 94% for a t-score of
-2.5) and FRAX (sensitivity = 54%, specificity = 75% for
the age-dependent threshold [Kanis, 2008]), identify
only a small proportion of individuals who fracture.

Reference Point Indentation (RPI) has an outer


reference probe to identify the surface bone and
a test probe that cyclically indents to assess the
total indentation depth (TID). RPI has been applied
clinically and is proposed to improve fracture risk
assessment by assessing a material property of the
bone [Diez-Perez, 2010]. To reach clinical potential,
RPI must be able to distinguish osteoporotic from
non-fractured, healthy tissue. Furthermore, the
technique should supplement whilst remaining
distinct from existing BMD and FRAX measures.

These clinical measures correlate with TID (BMD:


r = -0.32, p = 0.06 and FRAX: r = 0.31, p = 0.03),
but are not all encompassing and explain less than
50% of the RPI measure.
Therefore, combining RPI with clinical measures can
improve the discriminative ability of the techniques
(ROC AUC = 0.99, 100% sensitivity for an 80%
specificity with clinical thresholds and a TID of 115 m).

Methods
RPI was applied (Biodent Hfc , Active Life Scientific)
to the femoral neck, the site of most clinically severe
fracture. Bone resected from hip fracture patients
(OP, 46) and non-fractured cadaveric controls
(C, 16) were assessed using RPI. 13 indents (10 N, 2
Hz, 10 cycles) were made at 20 spacing excluding
the superolateral quadrant. For comparison with
clinical measures: BMD was measured clinically
(19 OP: Hologic Discovery A) and in the laboratory
(16 C: 225 kV X-TEK/Nikon Metrology
HMX ST) and FRAX (37 OP, 16 C) was calculated
through clinical factors (age, sex, previous fracture
etc. [Kanis, 2008]).

TID in OP and C (Left). BMD-TID correlation with


existing and potential thresholds (Right)
Discussion
RPI can differentiate osteoporotic from healthy
tissue by assessing properties distinct from
BMD and FRAX. As a result, combining RPI and
existing clinical measures increases discriminative
ability and, hence, offers potential for improving
fracture risk assessment.

This study was carried out under Southampton REC A


ethical approval (12/SC/0325).
Results
TID is significantly higher (p < 0.001, t-test) in the
OP (131.3 m) than the control (105.9 m) group.
This remains significant when adjusted for test
location, time stored and number of measurements
(p < 0.001, linear regression) and further adjusted
for age, sex, height and BMI (p = 0.051). Hence,
TID can discriminate clearly between the groups
(Receiver Operator Characteristic Area Under

References
Diez-Perez et al, JBMR, 25(8): 187785, 2010;
Kanis et al, Osteoporos Int, 19: 285397;
Schuit et al, Bone, 34(1): 195202, 2006;

61

O 0 41

HOW TO AUGMENT THE OSTEOPOROTIC PROXIMAL


FEMUR? ASK THE BONE!
P. Varga1, J. Schwiedrzik2, P. Zysset2, B. Gueorguiev1, M. Blauth3 , W. Markus1
1
2

AO Research Institute Davos, Biomedical Services, Davos, Switzerland

University of Bern, Institute of Surgical Technology and Biomechanics, Bern, Switzerland


3

Medical University Innsbruck, Department of Trauma Surgery, Innsbruck, Austria

Results
Experimental F fx of the intact proximal femora
could be well predicted (R 2=0.87). ATB-based
augmentation provided 8545% increase in
the predicted Ffx compared to the intact case
(p<0.001) and required cement volumes of
3040 ml.

Introduction
The incidence of a secondary (contralateral) hip
fracture following an initial one is 820% [Ryg, 2009]
and these injuries are associated with manifold
increase of mortality. Drug-based treatment is
often applied too late and the effectiveness of
external protection devices is limited mainly by
patient compliance. Previous studies suggest that
internal augmentation of osteoporotic femora by
means of surgical intervention has a high potential
to help to avoid injuries in case of a fall. However,
there is a significant variation in the mechanical
benefit of the different approaches proposed so
far. Instead of relying on intuition, we choose in this
study to ask the bone (ATB) a s internal structure
in sideways fall load case, which may indicate the
optimal augmentation strategy. We hypothesized
that the bone cement geometry identified by the
ATB concept would provide significant increase in
fracture load (Ffx) in a fall compared to the intact
case.

Discussion
In contrast with previous approaches aiming at
improving the bending resistance of the femoral
neck, the main outcome of the ATBbased
augmentation concept was the establishment of a
compression bridge spanning between the femoral
head and the greater trochanter, integrating
the superior neck cortex. The resulting increase
in F fx was higher compared to recent studies
[Beckmann, 2011] and is within the aimed range of
prophylactic strengthening. While the used amount
of cement may be high and its geometry idealized,
the identified guidelines can serve as the basis for
the development of clinically feasible solutions.
Numerical results of the augmented models
require experimental validation. Despite these
limitations, outcomes of this study suggest that
augmentation of the proximal femur using PMMA
cement alone may provide sufficient improvement
in fracture load in sideways fall. This method may
therefore help to decrease the risk of a secondary
hip fracture, reduce the associated morbidity and
mortality, and moderate the increasing burden
on the health care system. However, the path to
clinical applicability will require addressing further
issues like the risk/gain ratio and ethical justification
of prophylactic augmentation.

Methods
Thirteen intact proximal femora were scanned
with high resolution pQCT (XtremeCT, Scanco) and
tested experimentally in sideway fall configuration
by means of a drop-tower setup [Fliri, 2012]. CT
image-based finite element (FE) model of each
femur was generated and subjected to a simplified
set of loads acting in sideways fall. The numerical
bone remodeling algorithm of Huiskes et al. [Huiskes,
1987] was adapted and used in these simulations
to identify the optimal density distribution within
the trabecular compartment for these boundary
conditions. The resulting high density region was
the basis for defining the domain to be augmented
with polymethylmetacrylate (PMMA).

References
Beckmann et al, J Orthop Res, 29:17531758, 2011.
Huiskes et al, J Biomech, 20:11351150, 1987.
Fliri et al, J Biomater App, 28:136143, 2012.
Kinzl et al, J Biomech, 44:27322736, 2011.
Luisier et al, J Mech Behav Biomed,
32:287299, 2014.
R
 yg et al, J Bone Miner Res, 24:12991307, 2009.

A fully automated numerical analysis framework


incorporating a validated nonlinear FE approach
[Luisier, 2014] was established and used to predict
Ffx in sideways fall for the intact and augmented
models. For the latter, the validated elasto-plastic
material properties of the bone-cement compound
were taken from previous studies investigating
vertebroplasty [Kinzl 2011].

62

O 042

FRACTURE TOUGHNESS OF CANCELLOUS BONE:


PREDICTIONS FROM MICRO-CT VALUES
G.J. Adams1, R.B. Cook2, C. Greenwood1, K.D. Rogers1, P. Zioupos1
1
2

Cranfield univeristy, Cranfield forensic institute, Swindon, United Kingdom

University of Southampton, National Centre for Advanced Tribology, Southampton,


United Kingdom

Introduction
Current protocol in determining if a patient is
osteoporotic and their fracture risk is based on
dual energy X-ray absorptiometry (DXA). DXA gives
an indication of their bone mineral density (BMD)
which is the product of both the porosity and
density of the mineralized bone tissue; this is usually
taken at the hip. The DXA results are assessed using
the fracture risk assessment tool as recommended
by the World Health Organization. While this
provides valuable data on a persons fracture risk
advancements in medical imagining technology
enables development of more robust and accurate
risk assessment tools. In order to develop such tools
in vitro analysis of bone is required to assess the
morphological properties of bone osteoporotic
bone tissue and how these pertain to the fracture
toughness (Kcmax) of the tissue.
Figure 1: B
 V/TV vs Fracture toughness of human cancellous
bone

Materials and Methods


In a previous study the Kcmax was determined in vitro
and compared with in-vitro apparent density and
in vivo DXA measurements (Cook 2009). Sixty one
samples were taken from 37 osteoporotic patients
ranging from ages 5996 years. The samples were
taken from the centre of the femoral head and cut
into a disks conforming to ASTM standard E399-90
to be used in determining the plane-strain fracture
toughness. These samples have been imaged
using CT (XT H 225, X-Tek Systems Ltd) and from
the 3D images various morphological parameters
could be determined.
Results
As the results obtained from DXA are representative
of BMD which is a function of the material density
and porosity of bone these two morphological
parameters have been focused on. Here we will
use BV/TV instead of porosity. Figure 1 shows a
significant correlation between BV/TV and Kcmax
(R 2 = 0.56; p<0.001), where Figure 2 shows that
material density and Kc max are much less correlated
(R2=0.10; p=0.027). Knowledge of material density
must add extra information in predicting Kcmax, but
we suspect that Kcmax by in large depends mostly
on bone density at the macroscopic level.

Figure 2: M
 aterial density vs Fracture toughness of human
cancellous bone

Discussion
The results have shown that measurement of BV/TV
and material density by micro-CT correlate
significantly with the fracture toughness of
excised samples in-vitro. Furthermore detailed
morphometric analysis of the samples promises to
reduce the noise in predicting Kcmax even further
and elucidate fully which structural features
bear more influence on fracture toughness, and
ultimately on bone fracture risk prediction.
References
Cook, R. B., & Zioupos, P. J Biomech, 42:
20542060, 2009
63

O 043

IMPROVING MUSCLE FORCE PREDICTION IN


MUSCULOSKELETAL SIMULATION USING STATISTICAL
SHAPE MODELLING
D. Nolte1, Z.Y. Ding1, C.K. Tsang1, K.Y. Zhang1, D. Rueckert2,
A.E. Kedgley1, A.M.J. Bull1
1

Imperal College London, Department of Bioengineering, London, United Kingdom


2

Imperal College London, Department of Computing, London, United Kingdom

Introduction
Musculoskeletal (MSK) simulation is an important
method to predict muscle forces. To achieve
realistic results, it is essential to use highly accurate
muscle geometries for origin, insertion and the line
of action. Creating subject specific geometries
manually by segmenting 3D scans is time consuming
and prone to errors. We propose a method to
create subject specific models by morphing bone
geometries using statistical shape modelling to
transform reference muscle geometries.
Methods
For statistical shape models (SSM) of tibia and
femur (Zhang et al. 2012) muscle geometries were
created by registration of manually segmented
geometries to the mean shapes of SSMs. Bone
surfaces were reconstructed using SSMs and nonrigid transformations were calculated (Schnabel
et al. 2001) by describing the deformation of the
mean shapes. The transformation was applied to
the reference muscle geometries to create subject-specific models. Muscle forces resulting from
three differently derived subject specific muscle
geometries are compared in a musculoskeletal
analysis of gait trials for 2 subjects: (1) muscle
geometries using SSM, (2) manual digitization
of points from MRI scans and (3) a linear scaling of
the Klein Horsman lower limb model (Cleather et
al. 2011).

Figure: C
 omparison of muscle forces of m. vastus lateralis for
three differently derived subject specific models of
subject 1.

Discussion
The presented method shows a significant
improvement to reconstruct subject specific
muscle geometries. Reconstruction quality of
points decreases with increasing distance to the
bone. Good agreement of muscle forces between
the SSM reconstructed model and the manually
digitized model were obtained. With many different
technological advances being applied to MSK
models, this approach might be the final piece of
puzzle to now allow such models to be customised
in a rapid, clinically-applicable way.

Results
Point-to-point distances of muscle origin and
insertion points between models (2) and (3) are on
average 3 times higher than distances between
models (1) and (2) (Table).

References
Cleather et al, Ann of Biomed Eng, 2011.
Schnabel et al, Med Image Computing, 2001.
Zhang et al., WCB, 2014.

Calculated muscle forces for muscle groups


with origin and insertion on the femur and tibia,
respectively, show a better agreement between
muscle activations using manual digitisation and
SSM reconstructed (1) than the linear scaled model
(3), see Figure.
Tibia

(mm)
Subject 1
Subject 2

Femur
(mm)

SSM

4 15

8 41

linear

60 91

11 58

SSM

4 15

9 13

linear

62 100

13 63

Table: RMS distance (with range) of origin/insertion points to


manual digitisation.

64

O 044

STOCHASTIC MODELLING OF MUSCLE FORCES


DURING MOTION
S. Martelli1, D. Calvetti2, E. Somersalo2, M. Viceconti3
1

Flinders University, School of Computer Science Engineering and Mathematics,


Tonsley, Australia

Case Western Reserve University, Department of Mathematics Applied Mathematics


and Statistics, Cleveland, USA

University of Sheffield, Department of Mechanical Engineering and INSIGNEO Institute


for in silico Medicine, Sheffield, United Kingdom

Introduction
Our central nervous system (CNS) recruits muscles
by targeting multiple and competing goals and it
is task and healthy condition dependent [Loeb,
2012]. However, the spectrum of muscle forces
driving motion is commonly studied focusing on
a single representative muscle force pattern,
typically determined by assuming a known
CNSs optimal behaviour. Statistical methods
can provide information about the spectrum
of muscle forces by taking in input the motion
equations, electromyography measurements, and
muscle constraints [Heino, 2010]. We combined
musculoskeletal models, Bayesian statistics and
EMG-driven modelling for calculating the spectrum
of muscle forces driving motion. In this work, the
model is demonstrated by calculating the muscle
force spectrum for a single walking cycle. The
spectrum is then compared to a common static
optimization solution.

The solution that most closely represented the


EMG-driven force pattern was compared to the
static optimization solution.
Physiologically possible muscle forces, defined
as muscle forces within physiological constraints,
were calculated by constraining the muscle
forces between zero and the peak isometric force.
Physiologically plausible muscle forces, defined as
muscle forces likely to occur, were calculated by
constraining muscle forces within the EMG-driven
force range.
Results
The average distance over gait and muscles
between the spectrum of possible solutions
and the EMG-driven force and was on average
20 N. The average distance per muscle over gait
increased from 0 N to 120 N for one to 15 EMG-driven forces input to the model. The best-fit
solution better represented (R2=0.94, RMSE=19 N)
the EMG-driven force than the static optimization
solution (R2 = 0.38, RMSE = 61 N). Physiologically
possible muscle forces ranged, for most muscles,
between zero and the peak isometric force
causing joint contact forces of up to 11.3 BW at
the hip. The boundaries of physiologically plausible
muscle forces closely matched the boundary of
EMG-driven muscle forces (Figure 1).

Methods
The equilibrium equations at the joints while
walking, the muscle force constraints and the
muscle force pattern calculated by minimizing
the squared sum of muscle activation were taken
from an earlier model, which has been shown to
yield joint angles, joint moments, muscle lever
arms, muscle and joint forces in good agreement
with
published
patterns
of
corresponding
quantities [Martelli, 2014]. The fifteen-channel
electromyography (EMG) recorded from the
principal lower-limb muscles, for seven walking
cycles, was taken from the Living Human Digital
Library [Testi, 2010]. The EMG signal was bandpass filtered (8 th order, Butterworth filter, 10400 Hz)
to minimize noise due to motion artefacts and
the signal amplifier, rectified and low-pass filtered
(2 nd order, Butterworth filter, 6 Hz). Muscle activa
tion was obtained by normalizing the processed EMG
signal to the peak muscle activation calculated
using static optimization. EMG-driven muscle forces
were calculated following the guidelines proposed
by Zajac, 1989. A muscle force spectrum of 200,000
samples per walking frame (102), solution of the
muscle load sharing problem, was calculated
using Metaboloica [Heino, 2010], software that
combines Bayesian statistics and Markov Chain
Monte Carlo sampling method. The average
distance between the solution of the muscle load
sharing problem and the EMG-driven force and
was used as an indicator of the model consistency.

Discussion
The calculated force spectrum closely followed the
EMG-driven force pattern and variability, without
assuming an optimal CNS behaviour. The statistical
method is therefore well suited to study the muscle
force spectrum for every neuromotor condition.
Ack n o wl e d g e m e n t s
Australian Research Council (DE140101530).
References
Heino et al, Comp Meth Bio 97:15167, 2010.
Loeb, Biol. Cybern. 106:75765, 2012.
Martelli et al, J Biomech. 47:178491, 2014.
Testi et al, Philos Trans A Math Phys Eng Sci
368:285361, 2010.
Zajac, Crit Rev Biomed Eng 17:359411, 1989
see the next page

65

Figure 1: The spectrum of muscle forces (shaded red) and the seven EMG repetitions.

66

O 045

CE OF MUSCLE ACTIVITY DETECTION


ON MUSCLE FORCE ESTIMATION
M.C. Bisi1, A. Botter2, R. Stagni1, T. Vieira2,3
1

University of Bologna, Department of Electrical, Electronic and Information


Engineering Guglielmo Marconi, Bologna, Italy

Politecnico di Torino, Laboratory for Engineering of the Neuromuscular System LISiN,


Department of Electronics and Telecommunications, Torino, Italy
3

Universidade Federal do Rio de Janeiro, Escola de Educao Fsica e Desportos,


Rio de Janeiro, Brazil

Introduction
Subject-specific muscle-skeletal models have
become widespread used in clinical diagnostic for
the possibility to estimate muscle force contributions
to joint moments. In EMG-driven muscle-skeletal
models, the estimation is driven by muscle activity
usually collected by Bipolar EMGs [Bisi, 2011].

Results
Figure 1 shows representative results of one
participant (a) and cross-correlation coefficients
for the group data (b).

Recent work [Vieira, 2011] indicates though that


Bipolar EMGs may not represent the entire muscle
activity and, in such case, lead to biased estimation
of muscle force. From EMGs collected with grids
of electrodes (HD EMGs), on the other hand, more
representative information on the whole muscle
activation dynamics may be obtained. The aim
of the present work was therefore to compare the
effect of the detection system, Bipolar EMGs and
HD EMGs, on muscle force estimation.
Methods
Eight subjects participated in the study (263y,
17211 cm, 6814 kg). A grid of 32 electrodes
(8x4; 1cm inter-electrode distance) was placed
on the participant right tibialis anterior (TA) muscle.
The right shoe was solidly attached to a Bertec
six-component load transducer. Surface EMGs and
ankle dorsi-flexion torque (W-EMG, Bitron s.p.a. and
LISiN-Politecnico di Torino, Italy) were collected
synchronously at 2441 Hz.
Participants performed dorsal flexion contractions
at their maximal effort (MVC) twice. Thereafter,
while provided with a visual-feedback of the
produced torque, they were asked to linearly
increase (5 s) and decrease (5 s) it up to 50% MVC
for five times.

Figure 1: a
 ) One participant representative results,
b) Group data (8 participants).

Discussion
The higher cross-correlation obtained with HD EMGs
was likely due to the larger muscle volume sampled
by the grid of electrodes when compared to the
traditional, bipolar derivation.

Muscle activation was assessed for EMGs


detected by two detection systems: HD EMGs and
bipolar EMGs. Bipolar EMGs were simulated by
considering HD EMGs detected at a skin region
typically considered in EMG-driven model studies
[Bisi, 2011]. Both HD EMGs and Bipolar EMGs were
rectified and low-pass filtered with the same
cut-off frequency considered to low-pass filter
ankle torque (8 Hz). Envelopes obtained for the
HD recordings were averaged across channels,
providing a representative TA signal.

The findings of these investigations will be useful


in order to define models and methods for
better evaluating the activity of a whole muscle
(e.g. methods for defying better electrodes position
and/or for defining muscle models).
References
Bisi et al, J Electromyogr Kinesiol, 21:107480, 2011.
Vieira et al, J Physiol, 589:43143, 2011

Cross-correlation coefficients were finally computed


between EMG envelopes and ankle torque, both
high-pass filtered at 1 Hz. Such cut-off frequency
ensures the cross-correlation estimates are mainly
associated with force fluctuation rather than with
the ramp profile.
67

O 046

THE EFFECT OF ARM MOTION ON THE REACTION


FORCES IN LUMBAR SPINE AND HIP JOINT
L. Angelini1, F. Di Puccio1, H. Schmidt2
1

University of Pisa, Department of Civil and Industrial Engineering, Pisa, Italy


2

Julius Wolff Institute, Charit Universittsmedizin Berlin, Berlin, Germany

Introduction
In computational models for gait inverse dynamic
(ID) problems, the arms and the trunk are often
considered as a single rigid body [Anderson et
al., 2001]. This simplification is assumed also when
their relative motion is not restricted during the
experimental trial. The aim of the present study
was to investigate the limit of such simplification
by comparing ID results obtained with two models,
including or not a normal arm motion (AM). In
particular, the attention was focused on the
estimates of the loads in the lumbar spine and hip joint.

Results
Figure 1a shows the mean value for all subjects of
the joint reaction force (JRF) in the lumbar spine
segment L4/L5 during walking with AM (dashed red
line) and without AM (solid red line). Differences in
load magnitude and in trend can be appreciated.
Without AM, the spinal loads are lower over the
entire stride and the maximum difference between
walking with and without AM is about 150 N.
However, during gait without AM, an increased
trunk musculature activation is required. Regarding
the hip JRFs (figure 1b), there is a good agreement
between the two models. At about 46% of the stride,
the mean value with AM is greater of about 200 N.

Methods
Five healthy males were included in this preliminary
study. A three-dimensional motion analysis was
performed using a 10 cameras motion capture
system (Vicon, Oxford, United Kingdom), setting the
frame rate at 150 Hz. Forty-seven reflective markers
were placed on specific anatomical landmarks
according to a custom full-body skin marker set.
Ground reaction forces (GRFs) were synchronously
measured using two AMTI force plates (AMTI, MA,
USA) at a rate of 900 Hz. For each subject, three
gait trials with normal AM were recorded. Marker
trajectories and GRFs were smoothed using a
second order, zero-phase, low-pass Butterworth
filter. The filter cut-off frequency was quantified for
each body segment by using the residual method
[Winter, 2005]. The filtered motion data were
imported into the Anybody Modeling System v. 6.
A musculoskeletal model was modified based on
the GaitFullBody model in the AnyBody Managed
Model Repository (AMMR) v.1.6.2. For each subject
and each gait trial, two kinds of simulations were
performed differing for the inclusion/exclusion of
AM. In both models, the segment lengths were
scaled according to the subject anthropometric
data. In addition, an optimization routine was
employed to improve both the segment scaling
and the marker position on the model in relation
to the experimental marker trajectories. Over the
entire gait trial, kinematic and inverse dynamics
analyses were carried out.

Discussion
A model with a single rigid arms-trunk segment
might be inaccurate for the investigation of
the spinal loads and trunk muscle forces. Even if
the influence of AM on hip joint forces is limited,
AM has a relevant impact on the spine. Thus, a
complete marker set of the upper extremities
appears not relevant when investigating loads in
lower extremity joints during normal gait.

Figure 1: M
 ean value of JRFs in the lumbar spine segment
L4/L5 (a) and hip joint (b) during walking with AM
(dashed red line) and without AM (solid red line).

References
Anderson et al, J Biomech Eng, 123:381390, 2001.
Winter D., Biomechanics and Motor Control of
Human Movement 3rd Ed. Hoboken, NJ: Wiley.

68

O 047

INTRODUCING FREEBODY: A MATLAB APP


INCORPORATING A MUSCULOSKELETAL MODEL
OF THE LOWER LIMB
D. Cleather1, P. Price2, A. Bull3
1

St Marys University, School of Sport Health and Applied Science, Twickenham,


United Kingdom

St Marys University, School of Sport Health and Applied Sciences, Twickenham,


United Kingdom
3

Imperial College London, Bioengineering, London, United Kingdom

Results
The model predictions showed a good agreement
with the reference values.

Introduction
The direct measurement of the forces experienced
by the muscles, joints and ligaments of the human
body is highly invasive. For this reason, there has
been interest in the development of musculoskeletal
models of the body that can provide an estimate
as to these internal forces based upon external
measurements of kinetics and kinematics.

Discussion

There are a number of musculoskeletal modelling


software packages that are commercially available however, these carry prohibitive licensing
fees. The number of open source solutions is limited
(a notable exception being the popular OpenSim
software). One barrier to the use of these packages
is the requirement for familiarity both with the software environment and the techniques of musculoskeletal modelling.
There is thus a need for open source models that
can bring musculoskeletal modelling technology
to a wider audience. This work describes a
musculoskeletal model of the lower limb that is
implemented as a user friendly MATLAB app.

Figure 1: V
 isualisation of muscle forces

Methods
The lower limb model implemented in the MATLAB
app described here is based upon the model that
we have described in our previous work [Cleather
et al., 2011]. Optical motion capture and force
plate technology are used to measure the external
kinematics and kinetics of the movement of the
lower limb. A representation of the musculoskeletal
geometry of the lower limb is created by scaling
the data set of Klein Horsman et al. [2007] to
the subject in question. The external mechanics
are then related to the internal mechanics and
geometry using the equations of Dumas et al.
[2004]. The equations of motion are then solved
simultaneously using an optimization approach to
find the most physiologically realistic solution.

The model described here is implemented within


a GUI in the MATLAB software environment. The
user interface is thus readily accessible, and the
software is easy to download and run. It is easy
for a new user to employ the model with their
own data to gain predictions of muscle and joint
contact forces they simply need to format it into
a limited number of input files. These predictions
can then be visualised within the app (Figure 1). It
is our hope that this app will bring state of the art,
validated, musculoskeletal modelling technology
to a new population of users.
References
Cleather et al, Ann Biomed Eng,
39:19251934, 2011.
Dumas et al, Com Method Biomech Biomed Eng,
7:159166, 2004.
Klein Horsman et al, Clin Biomech,
22:239247, 2007.

The model predictions were validated by


comparison of predictions to both direct
measurements and values from the literature, in
activities of daily living and vertical jumping, using
a quantitative metric.

69

O 048

NANOMECHANICAL BEHAVIORS OF SS-CATENIN


REVEALED BY SINGLE-MOLECULE AFM
K. Maki1,2, S.W. Han1,2, T. Adachi1,2
1

Institute for Frontier Medical Sciences Kyoto University, Department of Biomechanics,


Kyoto, Japan

Graduate School of Engineering Kyoto University, Department of Micro Engineering,


Kyoto, Japan

Introduction
-Catenin, a component of adherens junction
(AJ), is known to transmit forces between cells and
stabilize their balance, resulting in contribution
to AJ maturation 1. In spite of its mechanical
importance in intercellular mechanotransduction
as a tension transmitter2, the mechanical behaviors
of -catenin remain unclear at molecular level. In
our study, we analyzed the mechanical behaviors
of -catenin by employing single-molecule atomic
force microscopy (AFM) .

behaves as a nonlinear elastic material under


tension, i.e., a mechanical component with low
stiffness under low tension and with high stiffness
under high tension. The nonlinear elastic behavior
exhibited in our experiment suggests a mechanical
function of -catenin to serve as a tension
transmitter at AJs: 1) preserving links between
AJmolecules under low tension and 2) transmitting
high tension with high mechanical stability.

Discussion
In the present study, we showed the mechanical
behaviors of -catenin as a tension transmitter at AJs,
employing the method of AFM nanomechanical
testing. This direct measurement of molecular
behavior can offer new insights into force-induced
dynamical mechanisms in multicellular systems. In
future work, we will try to achieve an overall picture
of molecular mechanotransduction mechanisms
at AJs by analyzing the mechanical behaviors of
other constituent molecules such as cadherin and
-catenin.

Methods
AFM nanomechanical testing is a method for
analyzing mechanical behaviors of single-biomolecules by direct loading. In our research,
we performed two types of experiments, in which a
part and a whole structure of -catenin were loaded
under tension. AFM tip modified with -catenin
molecules at their N-terminus was contacted to
the substrate in order to allow molecules to interact
with NTA-Ni2+/NHS-ester, which were modified on
glass surface. Finally, the tip was moved upward
at constant speed of 200[nm/s] so that -catenin
molecules were directly loaded.

References
1 Yonemura S. et al., Nat. Cell Biol. 12:533542, 2010
2 Huber H. A. et al., Cell 90:871882, 1997
3 Popa I. et al., J. Am. Chem. Soc. 135:1276212771,
2013

Results
As a result of nanomechanical testing, we
obtained force (F) versus extension (dL) curves
that represent the nanomechanical behaviors of
-catenin molecules. Force curves showing single-molecule behaviors of -catenin were identified
with the rupture force FR, which was the peak value
of force F in the force curves. In both of two types
experiments, force curves showed that -catenin

A C K NO W L ED G EMENTS
This work was partly supported by the Platform for Dynamic Approaches to Living System from the MEXT,
Japan. Koichiro Maki was supported by the JSPS
Research Fellowships for Young Scientists from the
Japan Society for the Promotion of Science.

70

O 049

INTERACTION OF VINCULIN WITH F-ACTIN REGULATES


LAMELLIPODIUM PROTRUSION VELOCITY
C. Borau1, J.M. Garca-Aznar1, I. Thievessen2, B. Fabry2
1
2

University of Zaragoza, Mechanical Engineering, Zaragoza, Spain

Friedich-Alexander-University of Erlangen-Nuremberg, Physics, Erlangen, Germany

Introduction
The dynamics of lamellipodium (LP), lamellum and
focal adhesion (FA) structures of migrating cells
have been extensively studied [1, 2]; However,
their exact interactions are still unclear. We have
previously reported that the FA protein vinculin
regulates F-actin retrograde flow dynamics by
coupling F-actin flow to FA [3]. Here, we extend
our previous work and investigate, how actin
cytoskeleton-ECM coupling through vinculin
affects the protrusion of the LP (Fig.1).
Exp e r i m e n t a l M e t h o d s
Primary vinculin deficient murine embryonic
fibroblasts (MEF) were generated by cre/loxPmediated vinculin gene disruption from parental
vinculin floxed control MEF [3]. F-actin flow dynamics
were recorded using spinning disk confocal (SDC)
microscopy with mApple-actin as fluorescent
marker. Incorporation of X-Rhodamine labeled
G-actin into LP F-actin network was performed
using a mild detergent, saponin, and followed
by glutaraldehyde-fixation and epi-fluorescence
microscopy.Leading
edge
dynamics
was
monitored using differential interference contrast
(DIC) or SDC microscopy using mApple-actin as
marker and quantified using manual kymograph
analyses and/or custom written MatLab software
for the simultaneous analysis of LP F-actin flow
velocity. A one dimensional continuum model of
LP dynamics was developed, incorporating known
key LP parameters, i.e. actin polymerization, F-actin
density, F-actin flow velocity and friction at FA,
plasmamembrane tension, and myosin mediated
cyclic contractions

Figure 1: Q
 uantification of F-actin retrograde flow velocity
and leading edge protrusion dynamics on mApple-actin SDC time lapse image series.

C o n cl u s i o n
Our data demonstrate that vinculin, despite its role
in strengthening cytoskeleton-ECM coupling at FAs
to promote LP protrusion, effectively regulates LP
protrusion velocity. Our study suggests a regulatory
function of vinculin for leading edge protrusion in
migrating cells, through a mechanism involving the
direct interaction of vinculin with F-actin.
References
1 Giannone, G., et al.,Cell, 2007. 128(3): p. 56175.
2 Burnette, D.T., et al., Nat Cell Biol, 2011. 13(4):
p. 371U88.
3 Thievessen, I., et al., J Cell Biol, 2013. 202(1):
p. 16377
Ack n o wl e d g e m e n t s
This work was funded by a European Project Starting
Grant (306571).

Results and discussion


To test how vinculin affects LP dynamics, we
monitored LP protrusion/retraction of control and
vinculin deficient MEFs. In addition, we developed
a one-dimensional model to predict and analyze
how vinculin modulates LP F-actin flow and
protrusion. Combining experiments and model
predictions, we found that vinculin i) regulates
lamellipodium protrusion by restraining membrane
velocity specifically in the protrusion phase of
the LP protrusion/contraction cycle, ii) increases
lamellipodium F-actin density, but (iii) does not
affect the amount of G-actin incorporated into
lamellipodium F-actin over time, and (iv) limits LP
protrusion velocity through direct interaction with
F-actin.

71

O 050

MECHANICAL MODELLING OF FRACTIONAL-ORDER


HEREDITARINESS OF LIPID MEMBRANES
M. Zingales1, L. Deseri2
1

University of Palermo, Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale,


dei Materiali, Palermo, Italy

University of Trento, Dipartimento di Ingegneria Civile, Ambientale, dei Materiali, Italy

Introduction
The evaluation of the mechanical stress across the
membrane bilayer is a very challenging features
since large strain/displacements field of the bilayer
are involved and configurational changes of the
membranes may sensibly affect the stress distribution. The impressive amount of research in terms
of elastic free energy as well as of the membrane
stress must be supplemented by the hereditariness
of lipid membranes that affects the membrane
configurations as well as the lipid phase change.
Fractional-order calculus will be used.to introduce hereditariness of lipid bilayers by means of
a small-on-large approach investigating the possibilities arising for non-homogenous equilibria. Such
portfolio of configurations essentially depends on
the value of the underlying (constant) large strain
upon which the lipid bilayer is perturbed.

the fractional-order lipid membrane hereditariness


will be presented. The free energy is necessary
to obtain, by means of variational derivatives,
the Euler-Lagrange equations of the hereditary
membrane.
Results and discussion
It is shown that the onset of the loss of homogeneous
configuration is possible even in the purely elastic
case thanks to the interplay between the local and
the nonlocal part of the response. An evaluation
of the line tension at the very onset of the various
situations is given and a frequency analysis of
the lipid membrane behavior is discussed. This is
pursued considering lipid bilayers hereditariness in
terms of the Staverman Schwartzl free energy that
is the energy associated to power-law relaxation
[Deseri et al., 2014]. The results obtained show
under which conditions cases of necks, bulges or
rifts may be found in the cellular membrane.

Methods
The authors introduced the elastic behaviour of lipid
membranes in terms of the Helmoltz free energy
that accounts for the quasi-incompressibility as
well as for the flexural and gaussian curvatures of
the membrane during configurational changes.
The free energy function contains both local
and non-local terms of the control variables due
to the dimensionality reduction of the kinematic
fields. In this study an extension of the Heflrich
[Helfrich 1973] free energy for the lipid bilayer to

References
D
 eseri L. and Zurlo G., Biomech. Mod. Mech., 6:
12331242, 2006.
D
 eseri L., Di Paola M., Zingales M.: Int. J. Sol Str., 59:
31563167. 2014
D
 i Paola M. and Zingales M., J. Rheol., 56:
9831004, 2012.
H
 elfrich W., Z Nat., 28: 693703, 1973.

72

O 051

AUTOMATIZED PATIENT-SPECIFIC CORNEAL MODELING.


APPLICATION TO SIMULATION OF A GENERAL
NON-CONTACT TONOMETRY TEST
M.A. Ariza-Gracia1, D. Piero Llorens2, J. Zurita3 , B. Calvo Calzada1,
J.F. Rodrguez Matas1
1

Aragon Institute of Engineering Research I3A, Mechanical Engineering, Zaragoza, Spain


2

Medimar Internationl Hospital, Ophthalmology OFTALMAR, Alicante, Spain

University of Navarra, Mechanical Engineering Energetics and Materials, Pamplona, Spain

Introduction
The corneal shape is influenced by three main
factors: Intraocular Pressure (IOP), geometry
(Corneal Central ThicknessCCT and Curvature)
and corneal tissue [Roberts, 2014]. Despite former
average ocular models were suitable for developing
and understanding the main corneal behavior,
latest advances in imaging technology opened
new branches of personalized medicine allowing to
apply patient-specific models to finite element (FE)
analysis. However, an automatized methodology
amenable for implementation in commercial
devices has not been developed. This work proposes
a pipeline for building three-dimensional FE models
from patient-specific topographical data. The
methodology is demonstrated on the simulation of a
generic air-puff non-contact tonometry test (AP-NCT).

Biomarker

Healthy

KTC

LSK

Sample
CCT
[microns]

553.836.2

472.169.3

501.153.9

U [mm]
(no-ISC)

1.050.132

1.2130.191

1.1510.114

U [mm]
(ISC)

0.9330.110

1.0660.166

1.0330.097

CCT
[microns]
(Clinical)

52025

47538

52463

U [mm]
(Clinical)

1.040.10

1.130.12

1.080.14

Table 1: Statistics of the maximum apical displacement (U)


not accounting for the ISC (no-ISC), accounting for
it (ISC) and the reported results (Clinical)

MATERIA L AND METHODS


Point cloud anterior corneal surface and pachymetry
data obtained with a commercial topographer
(Pentacam,OCULUS) are used to model the anterior
and posterior surfaces of the patients cornea and,
afterwards, incorporated into a three-dimensional FE
eyeball model including the patient-specific cornea
and human average limbus and sclera. The cornea
is assumed as a hyper-elastic anisotropic material
with two families of collagen fibers [Lanchares, 2008;
Elsheikh, 2008]. Contrarily, one circumferential fibers
family is considered for the limbus, whereas sclera
is assumed to be isotropic. A pull-back algorithm to
account for the initial stress due to the IOP is also
incorporated into the modelling pipeline [Riveros,
2013] to take into account the influence of the IOP
on the initial geometry.

Figure 1: A
 verage Percentage Error U during the AP-NCT
(blue) and its dispersion (red) when initial stress
configuration (no-ISC) is not accounted respect
accounting for it (ISC).

C o n cl u s i o n
The automatic methodology has been developed
and validated over a large number of patients with
numerical results ranging within the clinical results.
No considering the initial stress-free configuration
(ISC) could lead to errors in the calculated apical
displacement above 10%. However, this error
could be corrected by using a penalty factor for
the Healthy and LSK cases resulting on a substantial
computation time reduction.

The proposed methodology has been applied to the


simulation of a generic AP-NCT on 127 eyes (52 Healthy,
60 KeratoconusKTC, 15 Post-LasikLSK). Maximum
apical displacement (U) has been compared with
reported clinical results. In addition, the impact of
considering the initial stress configuration (ISC) in the
computations is also addressed.

References
Roberts CJ,Cataract Refract Surg,40:862869,2014.
Lanchares E et al.,J Biomech,41:797805,2008.
Elsheikh A et al.,Exp Eye Res,86:783790,2008.
Riveros F et al.,Ann Biomed Eng,41(4):694708,2013.
Valbon BF et al.,Arq Bras Oftalmol,76:22932,2013.
Hassan Z et al.,Cont Lens Anterior Eye,37(5):
33741,2014.

Results and discussion


The displacements (U) were found to be within
the human range response when subjected to an
AP-NCT [Valbon, 2013; Hassan, 2014] (Table 1).
Regarding the influence of the ISC, the statistics
shows an average error of 15% in the calculated
U value (Figure 1), with a relative low dispersion
(c.o.v<2%) for Healthy and LSK eyes, whereas for
KTC eyes a larger dispersion was obtained.
73

O 052

A MECHANISTIC INSIGHT INTO THE MECHANICAL ROLE


OF THE STRATUM CORNEUM DURING STRETCHING
AND COMPRESSION OF THE SKIN
M. F Leyva-Mendidvil1, A. Page2, N.W. Bressloff3 , G. Limbert1
1

University of Southampton, National Centre of Advanced Tribology at Southampton nCATS


Bioengineering Research Group, Southampton, United Kingdom
2

University of Southampton, Biomedical Imaging Unit General Hospital.,


Southampton, United Kingdom

University of Southampton, Computational Engineering and Design Group,


Southampton, United Kingdom

Introduction
The skin is a complex hierarchical biological
structure featuring several layers with their own
distinct geometry and mechanical properties. Up
to now, no anatomically-based computational
models of the skin have simultaneously accounted
for these geometrical and material characteristics
to study and quantify their mechanical interactions
under particular macroscopic deformation modes.
The present study addresses these issues with
special emphasis of the role played by the stratum
corneum (SC).

Figure 1: R
 atio of minimum principal strains in each skin layer
over a 20% macroscopic strain applied to the skin
composite model (expressed in %) for the compression case. A1, A2, B1 and B2 cases correspond to
different sets of mechanical properties.

Methods
A sample of fresh mid-back skin from a female
patient was prepared and sliced into histological
sections, under given consent. These sections
were imaged using optical microscopy and
processed for segmentation of the skin layers.
From the segmented structures a 2D finite element
mesh of the skin composite model was created
and geometrically non-linear plane-strain finite
element analyses were conducted to study the
sensitivity of the model to variations in mechanical
properties. Skin layers were modelled as isotropic
neo-Hookean materials and published data was
used [Lvque and Audoly, 2013; MagnenatThalmann et al. 2012]. The mechanical effect of
humidity/dryness on the SC was simulated as well as
variations in the properties of the viable epidermis
(VE) while the properties of the dermis (DE) were
kept constant. A series of eight finite element
analyses was conducted, simulating macroscopic
in-plane compression and extension of the skin.
Particular attention was paid to local principal
strains at particular topographical features of the
skin (furrows and crests).

Despite the small thickness of the SC, its Youngs


modulus has a significant effect not only on the
strain magnitude and directions within the SC layer
but also on those of the underlying layers. This
effect is reflected in the deformed shape of the skin
surface in simulated compression and extension
and is intrinsically linked to the rather complex
geometrical characteristics of each skin layer.
Discussion
The imaged-based computational study has
highlighted and quantified the critical role of the
structural and mechanical characteristics of the
skin layers over their mechanical response as well
as on the global response of the skin as a composite
structure. Given that the skin is the human bodys
interface to the external environment, these results
have implications for a variety of mechanical
or mechanobiological processes [Limbert and
Simms, 2013] across many domains of application
including skin tribology in general, consumer goods,
cosmetics, pressure sores and wound healing.

Results
Through a complex non-linear interplay, the
geometry and mechanical characteristics of the
skin layers (and their relative balance), play a
critical role in conditioning the skin mechanical
response to macroscopic in-plane compression
and extension. Topographical features of the skin
surface such as furrows were shown to act as an
efficient means to deflect, convert and redistribute
strainand so stresswithin the layers (Figure 1).
Strain reduction and amplification phenomena
were also observed and quantified.

References
Lvque and Audoly. Skin Res Technol 19:
4246, 2013.
Limbert and Simms. J Mech Behav Biomed Mater
28:395396, 2013.
Magnenat-Thalmann et al. IEEE Trans Inf Technol
Biomed 6:317323, 2002.

74

O 053

NUMERICAL ANALYSIS OF THE HUMAN INNER EAR


WITH FINITE ELEMENT METHOD
J.L. Flores Espejo1, A. Duran Escalante1, A.L. Garcia Gonzalez1
1

Universidad de Mlaga, Departamento Ingeniera Civil Materiales y Fabricacin,


Mlaga, Spain

Introduction
The knowledge of fluid-mechanical behaviour
of the cochlea is important to understand the
overall operation of the human auditory system.
The cochlea consists of several cavities filled with
liquid and separated by membranes. One of
them is the basilar membrane. In this membrane is
innervated the hair cells that perform the sensory
and motor tasks. All things considered make
the experimental observation inner ear is very
invasive and expensive. It all leads to unknown the
functioning of the Inner ear exactly. For this reason
the numerical simulation is inappropriate.
This work presents a numerical analysis of the
human ear with finite element method (FEM). The
main objective is to validate a previous model
of the inner ear [A Durn Escalante et al, 2014].
Therefore the result of this analysis is compared with
dates from the literature. [R. Aibara et al, 2001] [X.
Wang, et al, 2014]

Figure 1: M
 odel inner ear

Methods
Numerical analysis have been performed in two
models; first, isolated inner ear model [A. Durn
Escalante et al, 2014] and; second, a full model of
the human auditory system.
In the first model ideal conditions of displacement
have been applied on the oval window, in order to
replace the effect produced by the external and
middle ear.

Figure 2: C
 omplete model of the human auditory system.

C o n cl u s i o n
In conclusion, inner ear model has been validated
with numerical analysis.

The second model is made up of the external


auditory canal, the tympani and the middle ear
model [A.Garcia-Gonzalez et al, 2013]; and the
inner ear model [A. Durn Escalante et al, 2014].
The boundary condition has been applied to the
complete model, is 1Pa at the entrance of the
external auditory canal. Numerical simulations
with the FEM have been made through harmonic
analysis in the frequency range 0.210kHz with an
interval of 100Hz.

As a result new studies can be developed on


the inner ear model. For instance research is to
determine what amount of energy that enters
the oval window is reflected and how much is
absorbed by the basilar membrane, vestibule,
semicircular canals, round window and how much
is returned to the tympanic cavity.
The study of the phenomena of otoacoustic
emissions is another interesting research. Viewing
the integrity of the cochlea to determine the
correct functioning of the auditory system without
requiring cooperation of the patient

The study includes an analysis of the following


results: displacement of the basilar membrane;
pressures in the medium scale depending on the
length of the cochlea and the transfer functions of
middle ear.

References
R. Aibara et al, Hearing Research, 152: 12, 2001.
A. Durn Escalante et al., cnim2014, 2014
A. Garcia-Gonzalez et al. The Journal of the Acoustical Society of America, 2013
X. Wang, et al. Computer Methods in Biomechanics and Biomedical Engineering, 17:10, 2014.

75

O 055

MECHANICAL PROPERTIES OF CORNEOSCLERAL RIM


OF HUMAN EYE OBTAINED BY NANOINDENTATION
J. Nohava1, G. Schlunck2, P. Eberwein3
1
2

Anton Paar TriTec, Peseux, Switzerland

University Eye Hospital, Department of Opthalmology, Freiburg, Germany


3

University Eye Hospital, Klinik fr Augenheilkunde, Freiburg, Germany

RESU L TS & DIS C USSION


The Youngs modulus values of the central cornea
was in the range of 19 kPa, while in the scleral
region we found 17 kPa and the limbal rim region
10 kPa. These results differed significantly from
the O&P approach, which yielded much higher
numbers for E. Considerable creep relaxation
occurred during the hold period at maximum
load, which scaled with the elastic modulus
of the different structures. Moreover, the three
tissues showed very low to almost no recovery.
Histological sections of the corneoscleral
rim showed an alignment of collagen bands
consistent to previous publications. The obtained
results revealed unique biomechanical properties
of the corneoscleral rim with distinct mechanical
properties for the three anatomical regions. The
almost complete absence of recovery coupled
with substantial creep resulted in different values
for E depending on the approach used for the
calculation. This brings up the question whether
these formulas are applicable in highly poroelastic
tissues where measurements may depend on
the ability of the fluid to be pushed through the
intercellular space.

Introduction
The corneoscleral rim of the eye represents a
region with unique anatomical properties due
to its location between the cornea and sclera /
conjunctiva. It harbors the corneal epithelial stem
cells in the rim structure (limbus), which are essential
for the regeneration of the corneal epithelium
and preventing the conjunctival epithelium
from growing onto the corneal surface. As a
consequence, a dysfunction of the cells results in a
visual decline. Survival and self-renewal properties
of stem cells depend on specific biological
and biomechanical properties of the stem cell
niche. We therefore aimed to measure the local
mechanical properties of the human corneoscleral
rim using a novel nanoindentation device.
Methods
Nanoindentation experiments were performed
using a spherical indenter of 0.5 mm radius and
maximal load of 30 N. Loading rate was set to
60 N/min and a penetration depth was up to
60 m. The hold period at maximum load was
180 seconds. Youngs modulus (E) was calculated
using a Hertzian fit to the loading data but also
using Oliver&Pharr (O&P) approach.

76

O 056

IN-VIVO MECHANICAL PROPERTIES OF AORTIC TISSUES


G. Martufi1, A. Satriano2, N. Merchant3 , J.J. Appoo4 , E.S. Di Martino5,
F. Bellacosa Marotti1
1
2
3

University of Calgary, Diagnostic Imaging, Calgary, Canada


4

University of Calgary, Civil Engineering, Calgary, Canada

University of Calgary, Cardiac Sciences, Calgary, Canada


University of Calgary, Cardiac Surgery, Calgary, Canada

University of Calgary, Civil Engineering and Centre for Bioengineering Research


and Education, Calgary, Canada

Introduction
Thoracic aortic aneurysm (TAA) is a localized
dilatation of the thoracic aorta resulting from
progressive structural damage of the aortic wall
[Koullias, 2004]. Focal weakening of the wall
plays key role in the evolution of the aneurysmal
disease and is a concomitant factor that leads to
aortic rupture. Mechanical characterization of the
aneurysmal wall is critically important to locate
spots of altered mechanical properties, which may
highlight areas at high risk of rupture.

The constitutive parameter was then identified


through a statistical parameter estimation procedure.
Finally, we validated our approach to estimate
local material properties on a virtual aneurysmal
vessel wall applying a known non-homogenous
material properties distribution.
Results
We found excellent agreement between the
material properties estimated from our method
and those imposed on the virtual mesh (median
error of 2.4%). The mechanical properties obtained
for the patient specific model were distributed in
a complex pattern with large local variability. The
results showed a remarkable spatial variation with
the descending aorta exhibiting stiffer behavior
than the ascending aorta. This mirrors earlier
observations that indicated that the collagenrich descending aorta is stiffer than the collagenpoor ascending aorta [Langewouters, 1984]. The
aneurysmal arch showed areas of stiffer tissue
together with areas with low shear modulus, which
may suggest severe inflammation or discordant
remodeling mechanisms.

Tissue characterization usually involves an invasive


procedure requiring tissue harvesting and tensile
testing [Martufi, 2015]. This procedure is not
only invasive, but also not ideal to provide local
constitutive properties.
In this work we combine medical imaging with
continuum mechanics principles to non-invasively
determine local wall material properties from
dynamic computed tomography (CT) images. As
a proof of concept, we applied the methodology
to a case study of TAA.
Methods
A triangular mesh of a patient-specific TAA wall
was obtained from a stack of low-dose dynamic
10-phase CT images.

Discussion
Our results demonstrate that local material
properties for complex vascular pathologies
may be reasonably predicted by our approach.
Areas with decreased mechanical properties (low
shear modulus) as identified using our approach
may indicate local wall weakening, which could
become a surrogate marker of aortic rupture risk.
Most importantly, the tissue properties estimation
is non-invasive in nature. Therefore, in-vivo focal
weakening evaluation for any given patient is
clinically feasible and cost effective.

An iterative grey-scale feature-tracking approach


was used to estimate velocities at each node of
the aortic surface. Displacements were derived
from the nodal velocities, which in turn allowed
the calculation of the principal strains for each
element throughout the whole cardiac cycle
[Satriano, 2015].
An estimate of the stress throughout the cardiac
cycle was obtained using the Law of Laplace,
where the local mean curvature was evaluated by
an extended quadratic fitting approach.

References
K
 oullias et al, Eur J Cardiothor Surg,
26:10981103, 2004.
M
 artufi et al, Ann Biomed Eng, 2015, on-line.
S atriano et al, J Biomech, 2015, on-line.
L angewouters et al, J Biomech, 17:425435, 1984.

Once the strains and the stresses are known, the


planar biaxial problem was solved analytically
using an Ogden-like strain energy function with the
shear modulus being the only unknown quantity.

77

O 057

EVALUATION OF MINIMALLY INVASIVELY OBTAINED


MATERIAL PARAMETERS OF ARTERIAL TISSUE FOR
CONSTITUTIVE MODELS
M. Smoljkic1, L. Janssens1, P. Verbrugghe2, M. Larsson3 , E. Widman3 ,
A. Jorge-Penas1, H. Fehervary1, J. Dhooge4 , J. Vander Sloten1, N. Famaey1
1

KU Leuven, Department of Mechanical Engineering Biomechanics Section,


Leuven, Belgium
2
3

KU Leuven, Experimental Cardiac Surgery, Leuven, Belgium

KTH Royal Institute of Technology, Department of Medical Engineering,


School of Technology and Health, Stockholm, Sweden

KU Leuven, Department of Cardiovascular Sciences Cardiovascular Imaging


and Dynamics, Leuven, Belgium

Introduction
A common way to obtain material parameters
for constitutive models is by means of mechanical
testing, e.g. biaxial testing. These techniques require
a sample to be excised and as such cannot be
applied in clinical practice. The alternative is to obtain
parameters via minimally invasive (MI) measurement
techniques. However, these techniques have the
disadvantage of providing only a limited amount of
information, such that certain assumptions need to
be taken into account to allow a full characterization
of the anisotropic properties [Smoljkic, 2015].

lsqnonlin routine and the trust-region-reflective


optimization algorithm. The results were compared
with a Mann-Whitney U-test in Statistica.
Results
As can be seen in Table 1, only k2 was significantly
different (p = 0.049) when comparing both
approaches.
Min.
Invasive

In Smoljkic 2015, a MI material parameter evaluation


technique is evaluated in silico. The goal of this
study is to evaluate the same method in vivo, by
comparing the constitutive model parameters
obtained for sheep common carotid artery (CAA)
from MI measurements with the ones obtained
invasively.

Invasive

Material and Methods


Three one-year-old female Swifter sheep were used
in this study. Prior to the in vivo measurements, the
animals were sedated and anesthetized. A Millar
Mikro-Tip catheter was inserted into the left CCA
for pressure measurements. To measure diameters
and the wall thickness echography images were
obtained with the VIVID7 system. After extraction,
the samples were frozen in PBS solution at -80 C.
Biaxial testing was performed using a BioTester 5000
with a force-controlled protocol. The sample size was
8x8mm. 5 markers were attached on each sample
and in-house developed marker tracking software
(Matlab, MathWorks) was used to calculate 2D
strains.

Sheep 1

Sheep 2

Sheep 3

[MPa]

0.0505

0.2964

0.1245

k 1[MPa]

0.1010

0.1100

0.0000

k2[-]*

0.001

0.002

0.012

[]

47

90

90

[-]

0.00

0.14

0.00

R2

0.99

0.89

0.99

[MPa]

0.0406

0.0582

0.0314

k 1[MPa]

0.0011

0.0018

0.0000

k2[-]*

5.62

10.50

10.64

[]

90

90

[-]

0.00

0.03

0.19

R2

0.86

0.96

0.95

* p < 0.05
Table 1: P
 arameters obtained from the minimally invasive
and invasive approach

Discussion
The difference in k2 could come from the fact that
only in vivo pressures can be used in MI approach.
Since k 2 is a parameter that expresses the stiffening
effect of the arterial tissue under high pressures, the
in vivo range might not be enough to characterize
it. Nevertheless, the lack of significant difference
for some parameters is an optimistic result which
indicates the possibility to obtain patient-specific
material properties in vivo. However, this conclusion
needs to be made with great caution. The intragroup variability can have a big influence on
statistical results and a bigger sample size would
be necessary to investigate this more thoroughly.

The constitutive material model used was


proposed in [Gasser, 2006]. The model contains
5 material parameters that are reported in Table 1.
The parameter identification approach consists of
a minimization of an objective function expressing
the difference between the measured and model
pressure (as a function of the arterial diameter) in
the MI approach. In the invasive approach, the
difference between the experimental and model
stresses (as a function of strain) is minimized. In the
MI case, extra terms were added to the objective
function as explained in [Smoljkic, 2015]. The
optimization was implemented in Matlab , using the

References
Smoljkic et al, accepted in J Biomech Mod
Mechanobiol, 2015.
Gasser et al, J R Soc Interface, 3, 1535, 2006.
78

O 058

PRACTICAL ASPECT OF BIAXIAL TESTING


OF VASCULAR TISSUE
V. Man1, P. Skacel1, S. Polzer1, V. Sevcik2, J. Bursa1
1

Brno University of Technology, Institute of Solid Mechanics Mechatronics


and Biomechanics, Brno, Czech Republic

Brno University of Technology, Institute of Automation and Computer Science,


Brno, Czech Republic

Introduction
In contrast to uniaxial testing, biaxial tests succumb
no standards, and their arrangement, specimen
shape and size or the way of load transmission on
the specimen (gripping) are fully chosen by the
staff or designer of the respective testing machine.
Because of this facts as well as some specific
features of soft living tissues there are many
problems with the realization of the tests and many
factors lowering the accuracy or even credibility
of results. Therefore sufficient experience with soft
tissue biaxial testing is decisive for its quality. At
our institute soft tissues have been tested for more
than 10 years. The aim of this paper is to present
the arrangement and capabilities of our in-house
biaxial testing rig and to summarize substantial
features of testing procedures influencing the
quality of the results.

Results
Application of clamps instead of hooks appears
to be more comfortable for operator and allows
him repeatable gripping of the specimen. Clamps
also generate less stress concentration compared
to hooks and eliminate risk of injury of operator
during manipulation with the specimen. Use of the
glass cover fully eliminates level waves and thus
improves the smoothness of obtained stress-strain
curves.

Methods
Square specimens (18 mm x 18 mm) are cut of
aorta or aneurysm wall so that the edges are
aligned with their circumferential and longitudinal
orientations. Then the specimen is placed into
the testing device. Contrary to most researchers
[Lally, 2004, Vande Geest, 2006] who use hooks
to fix a specimen, we use in-house made clamps
two per each side, see figure 1. Equibiaxial
preconditioning of the specimen is performed
using either displacement or force controlled
protocols until changes in response between two
consecutive cycles fall below a chosen tolerance.
Then the specimen is exempted from the rig and
the thickness is estimated as average of five
measurements in the central area using a specially
adjusted thickness gauge with only ca 1 kPa of
applied pressure. Finally, four markers are placed in
centre of the specimen and it is gripped again. An
additional glass is used then to eliminate waves and
other artefacts and thus improve the clarity of the
captured area. Then either displacement or force
ratio between axes is chosen, preconditioning is
performed again and the test is run. During the test
forces and corresponding images of the specimen
are stored at each time step. After testing the
results are analysed using in-house software Tibixus
to extract strains from the captured images and
thus to obtain experimental stress-strain curves.

Discussion
The proposed changes in biaxial experimental
device (clamps and glass coverage) are
inexpensive, decrease the overall time required
for performing large sets of tests (critical in testing
living tissues) and also increase confidence of the
obtained results.
Ack n o wl e d g e m e n t
This work was supported by Czech Science Foundation
project No.13-16304S.
References
Lally et al, Ann Biomed Eng, 32:13551364, 2004
Vande Geest et al, J BIOMECH, 39:13241334, 2006

79

O 059

A NONIVASIVE IN VIVO APPROACH FOR


THE IDENTIFICATION OF ELASTIC AAA WALL
PROPERTIES USING 3D ULTRASOUND DATA
A. Wittek1,2, W. Derwich3 , T. Schmitz-Rixen3 , C.P. Fritzen2, C. Blase1
1

Goethe University, Institute for Cell Biology and Neuroscience, Frankfurt/Main, Germany
2

University Siegen, Department of Mechanical Engineering, Siegen, Germany


3

Goethe University, Department of Vascular and Endovascular Surgery,


Frankfurt/Main, Germany

Results
The identified individual constitutive para-meters are:
= 0.2281 MPa, k1 = 4.7362 MPa, k2 = 1960.65 MPa,
= 0.207, = 4.6. The patient-individual model
shows a peak wall stress of 2.109 MPa, which is
close to the upper limit of the range of AAA wall
failure stresses (0.336 to 2.351 MPa) that is reported
in [Raghavan, 2006]. It exceeds the peak wall stress
of the population averaged model (0.912 MPa) by
more than 2 times.

Introduction
Computational biomechanical models of abdominal aortic aneurysms (AAA) aim at obtaining
patient-individual rupture risk predictors in addition
to the statistical diameter criterion. Despite the
great inter-individual variance of the parameters
determining the mechanical behavior of the AAA
wall, most of the approaches are patient-specific
only with regard to geometry and blood pressure.
In contrast, population averaged constitutive
equations are used in most cases [Humphrey,
2012]. In the present study we have determined
the individual nonlinear and orthotropic elastic
properties of the AAA wall noninvasively in vivo.
We have investigated the impact of the use of
patient-individual vs. population averaged constitutive behavior on the peak wall stress predicted
by a finite element analysis of the AAA wall.

Discussion
Both models predict increased peak wall stress for
an AAA that is not prone to rupture according to
the diameter criterion. The patient-individual model
indicates a much higher rupture risk according
to the peak wall stress criterion compared to the
population averaged model. Thus the presented in
vivo constitutive parameter identification method
is a promising step towards more patient-specific
computational models of AAA.

Methods
Three-dimensional volume data sets of a saccular
AAA with a maximum diameter of 32 mm were
acquired by use of a commercial real time
3D-echocardiography system (Artida, Toshiba
Medical Systems, Japan). A discrete field of 1080
material points on the aneurysm wall were obtained
for 19 geometrical configurations throughout the
pulse cycle by use of a customized commercial
speckle tracking algorithm (Advanced Cardiology
Package, Toshiba Medical Systems, Japan).
Diastolic and systolic blood pressure was measured
at the brachial artery.
In case of the model with the patient-individual
material properties (patient-individual model) the
constitutive parameters of a nonlinear orthotropic
strain-energy function (SEF) [Gasser, 2006] were
identified by use of an inverse finite element model
updating method that accounts for prestresses in
the imaged reference configuration [Wittek, 2013].
In case of the model with a population averaged
SEF (population averaged model) a 2 nd order
Yeoh constitutive equation with the parameters
c10 = 177 kPa and c20 = 1881 kPa was used [Polzer,
2013]. Finally, systolic wall stresses were calculated
for both models by applying hydrostatic transmural
pressure to the prestressed diastolic geometries.

Figure 1: V
 on Mises wall stress distributions [MPa] predicted
by the FEA with patient-individual orthotropic
constitutive behavior.

References
Gasser et al, J Roy Soc Interface 3: 1535, 2006
Humphrey et al, J Biomech 5: 805814, 2012
Polzer et al, Med Eng Phy 35: 12829, 2013
Raghavan et al, J Biomech 39: 301016, 2006
Wittek et al, JMBBM 27: 16783, 2013
80

O 060

DETERMINATION OF LAYER-SPECIFIC MECHANICAL


PROPERTIES OF PORCINE AORTA. DEPENDENCE
ON ARTERIAL LOCATION.
M.A. Martinez Barca1, J.A. Pea2, E. Pea1
1
2

University of Zaragoza, Aragn Institute of Engineering Research, Zaragoza, Spain

University of Zaragoza, Manufacturing and Engineering Design Department, Zaragoza, Spain

Introduction
The goal of this study is to evaluate the hypothesis
that the layer-separated residual stresses and
mechanical properties of layer-separated thoracic
arteries differ depending on arterial location in
the aorta. To test this, we measured the axial prestretch and opening angle and performed uniaxial
and biaxial tests (Zeinali-Davarani, 2013) to study
the mechanical behavior of both intact and layer
separated porcine aortic tissue samples under
physiological loads taken from thoracic region.
Few studies provides layer-specific properties of
vascular tissue (Weisbecker, 2012).
In addition, for completeness, we also provided
constitutive parameters for each layer that can
be used by biomedical engineers for investigating
better treatment methods and developing arteryspecific devices (Garca, 2012).

Figure 1: R
 epresentative image of the specimen mounted
in the biaxial tensile testing device. Several
randomized markers were placed in an on
the surface of the vessel.

Methods
Porcine aortas (n=10) were harvested postmorten
from approximately 3.5 months old female pigs,
sacrificed for other studies that did not interfere
with the aorta or the circulation system. Two arterial
rings and two longitudinal strips were cut from the
distal and proximal ends of the specimens. The
intimal layer of each ring and longitudinal strip pair
were separated very carefully with minimal force
using anatomical instruments, and then the media
was separated from the adventitia. Therefore four
samples (intact, intima, media and adventitia were
prepared for each test direction (circumferential
and axial) and arterial location (proximal and distal).

Results
We extracted a complete collection of layerspecific mechanical data from porcine aorta
artery also depending on axial location. This
information includes axial prestretch, opening
angle, uniaxial (Figure 2) and biaxial tensile tests.
Statistical significance was found for longitudinal
prestretch and opening angle between proximal
and distal location.
Discussion
Regional differences of layer-specific mechanical
properties of porcine aorta are measured and
compared. The relative location of the samples
highly affects the mechanical behavior of the
vessel, probably due to the transition of a pure
elastic vessel in the proximal zone to a more
muscular one in the distal position. A well-known
hyperelastic constitutive model (Holzapfel, 2000)
is fitted providing a good approximation to the
experimental data.

To measure the longitudinal in situ stretch,


separated 2 cm markers were fixed to the aorta
and axial lengths before and after harvesting
were determined by optical methods. Arterial rings
were cut from the distal and proximal ends of the
specimens for obtaining the layer-specific opening
angle (OA) measurements.
Simple tension tests of the circumferential and
axial aorta rectangular strips were performed in
a high precision drive Instron Microtester 5548
system adapted for biological specimens and
layer-specific stress-strain curves were extracted.
Square specimens were mounted in an Instron
BioPulsTM low-force planar-biaxial Testing System
via connecting four carriages by noddles clamps
and immersed into a bath filled with PBS and
maintained at 37C (Figure 1). Load controlled
tests were performed at peak tension ratios in
circumferential and longitudinal directions (Pc : Pl)
of 1:1, 2:1, 1:2, 2:2.

References
Garca et al, J Mech Behav Biomed 10,
166175, 2012.
Holzapfel et al, L Elasticity, 61:148, 2000.
Weisbecker et al, J Mech Behav Biomed,
12:93106, 2012.
Zeinali-Davarani et al, Ann Biomed Eng,
41:15281538, 2013.

81

Figure 2: E
 quibiaxial tensile stress-stretch curves for (a) upper thoracic aorta and (b) lower thoracic aorta.

82

O 0 61

IS THE TRAJECTORY OF THE CENTRE OF MASS


A LEADING FACTOR FOR GAIT CONTROL DYNAMICS?
VERIFICATION ON CHILDREN GAIT.
M.C. Bisi1, R. Stagni1
1

University of Bologna, Department of Electrical Electronic and Information Engineering


Guglielmo Marconi, Bologna, Italy

Introduction
When performing a motor task, the redundancy
of the musculoskeletal system virtually allows an
infinite number of possible patterns, among which,
it is hypothesized, that the control system chooses
one by optimizing a certain cost function. It is still
debated, what optimization criteria is adopted
and whether a sub-optimal solution could be
rather selected in full respect of the physiological
constraints [Martelli, 2011]. A recent study [Bisi, 2015]
showed that newly walking toddlers manifested
characteristics of the pendulum mechanism
already after one month of walking experience,
even if showing strategies and patterns far from the
adult-like gait. These results suggest that the control
of centre of mass (CoM) trajectory could be one of
the driving factors allowing the control system to
choose among the infinite available solutions, even
when not choosing the optimal one. Verifying this
hypothesis on adults is difficult because their gait is
highly structured and repeatable, indicating that
an optimal choice has been found; on the other
hand, toddlers are still too variable, unstable [Bisi,
2015] and far from showing an adult like gait. The
aim of this work is to verify this hypothesis on 6-year
old children: their gait can be considered stable
from the motor control point of view [Perry, 2010]
but still shows high segmental kinematic variability
[Stern, 2012]. If CoM trajectory leads gait control
dynamics, the variability of CoM kinematic should
be lower than that of other kinematic variables.

trajectory and CoM acceleration were obtained.


The relative standard deviation (std%) of each
variable was calculated between the 5 walks of
each test and among the repetitions of the 5-walktest (intra-test and inter-test variability).
Results
Joint angles results showed higher variability in
children than in adults both for the intra-test and
the inter-test conditions: in particular children hip
flexion/extension and intra/extra rotation, and
ankle flexion/extension angles showed std% 6 times
(or more) greater than adults ones. CoM trajectory
in the inter-test condition showed similar std%
results for the two groups, while, in the intra-test,
mediolateral std% was higher in the children group
(5 times). In both intra-test and inter-test conditions,
children CoM acceleration showed std% similar to
adults for the antero-posterior and the vertical axis,
while higher on the mediolateral axis.
Discussion
The results of the present study support the
hypothesis that the trajectory of the CoM is a
leading factor of the gait control dynamics:
children showed lower variability in the CoM
kinematics (trajectory and acceleration) than in
joint angles. Based on present results, it could be
argued that, during gait, the control is focused on
the progression of the CoM and not on its lateral
stabilization: children variability on the mediolateral
axis was always higher than adults one.

Methods
4 children [5.70.5y, 1165cm, 213kg] and 7 adults
[221y, 1616 cm, 566 kg] participated in
the study. Each participant performed 15 walks,
divided in groups of 5 by a 7-minute pause. 3D
kinematic (SmartD, Bts, Italy) was collected using
Plug-in-Gait protocol. One triaxial inertial sensor
(Opal, Apdm, US) was positioned at approximately
CoM level. For each walking test, joint angles, CoM

References
Martelli S, et al, J Biomech, 44:171621, 2011.
Bisi MC, et al, Gait Posture 2015 in press
Perry J, et al, Gait Analysis, Slack Incorporated,
2010
Stern KA, et al, Pediatr Phys Ther, 24:28590, 2012.

83

O 062

BIOMECHANICAL AND OBSERVATIONAL GAIT


ANALYSIS REASONING TO MAKE RELIABLE INFERENCES
ON FUNCTIONAL AND WALKING PATTERNS
IN ARCHEAOLOGY
P. Benaglia1, M. Licata2, A. Ruspi1, G. Armocida2, D. Piscitelli3
1
2
3

University of Insubria, Physical Therapy, Varese, Italy

University of Insubria, Biotechnologies and Life Sciences, Varese, Italy

University of Milano-Bicocca, Department of Translational Medicine and Surgery,


Milano, Italy

Introduction
In archaeological research investigation of sociocultural implications about traumatic lesions in
ancient populations is of growing interest(1). We
used systematic biomechanical and Observational
Gait Analysis (OGA) reasoning (2,3) to find out
injury mechanism, therapeutic interventions and
gait outcomes of an ancient femur fracture.

has been laying supine onto a soft surface with


lateral splints for 46 months and after, as proved
by the ossification structure, resumed weight
bearing and then progressively recovered his
gait function. Main gait kinematic compensations
were: homolateral Duchenne sign and/or
homolateral vaulting, trunk forward bending in
weight acceptance with abolition of homolateral
first rocker, absence of homolateral push-off, knee
hyperextension during stance.

Exp e r i m e n t a l M e t h o d s
The fracture was analysed by means of autoptic
examination and CT scan, the OGA process was
performed to deduct pathological standing and
gait kinematics, finally we used motion capture
system to visualise the resulting pathological gait
patterns.

C o n cl u s i o n
Biomechanical and OGA reasoning allow to draw
reliable reconstructions of gait and functional
outcomes in archaeological research.
References
1 Lovell N.C. et al., Am J Phys Anthrop.
S25:139170, 1997.
2 Marchi D. at al., Am J Phys Anthrop.
4:447455, 2006.
3 Kirtley C., Clinical Gait Analysis: Theory and
Practice. Churchill Livingstone 2005.

Results and discussion


Fracture was transverse, at proximal third of the
diaphysis due to a medial to lateral high energy
direct trauma. Fracture resulted in a large bone
callus, with shortening, posterior angulation and
external rotation of the distal fragment, without
misalignment on the frontal plane (fig 1). Subject

84

O 063

PREDICTION OF SPEED DEPENDENT GAIT KINEMATICS


USING LINEAR REGRESSION ANALYSES
S. Winiarski1, B. Pietraszewski1
1

University School of Physical Education in Wroclaw, Biomechanics Department,


Wroclaw, Poland

Introduction
Locomotive speed influences kinematic and
spatio-temporal parameters [1]. To account for
the effect of speed prediction methods based on
regression equations are provided [13]. However,
it has been shown that measurements on the
same population and environment provide better
prediction of gait kinematics and kinetics [1]. The
statistical relation between any speed-dependent
variable (y) and speed (v) may be expressed in
terms of linear relationship: y(v)=Av+B, where A
(the slope) and B (the intercept) are regression
coefficients. Therefore, reliable standardisation of
speed on gait data can be made with the single
linear regression approach.

BTS Smart-E motion analysis system equipped with 6


digital infrared cameras (1,1 mm) at 120Hz sampling
frequency, was used to record the variables of
kinematics and movement dynamics. 22 photoreflexive markers were placed on the subjects
body in accordance with the procedure for HayesDavis model. For each participant and gait variable
registration was carried out for three speeds: slow,
preferred and fast. The subject was to select the
speed individually and in random order. For each
parameter from the set of variables: (A) spatial, (B)
temporal and (C) angular kinematics, regression
analyses were conducted to evaluate potential
relationships between gait speed and each gait
variable. Angular joint motion was studied in all
three planes and reported in degrees. A linear
regression equation was fit to each parameter
and corresponding coefficient of determination
(R 2) derived.

The purpose of this study was to develop a set


of speed dependent regression equations for
kinematic parameters commonly used in the
analysis of human gait.
Method
Seventeen (17) healthy male university students
(22,01,0y, 77,859,03kg 1,790,13m) participated in this study. Detailed anthropometric
measurements of the lower limbs, necessary to
apply gait model, were conducted.

Results
The averaged speed for fast gait was
1,870,27m/s, preferred 1,360,17m/s and slow
1,160,17 m/s. The individual linear regression
coefficients for example angular gait parameters
are presented in Table 1.

Variable

Variable

Peak Pelvic
Tilt

3.409

3,611

0.89

Peak Hip
Flexion

15.678

24.092

0.71

Range of
Pelvic Tilt

0.644

0,712

0.83

Range of
Hip Flex/Ext

9.920

21.750

0,78

Peak Pelvic
Obliquity

3.145

2.598

0.79

Peak Hip
Abduction

0.568

1.355

0.78

Rang
of Pelvic
Obliquity

1.743

1.316

0.87

Range of
Hip Ab/Ad

5.304

4.937

0.68

Peak Pelvic
Rotation

4.508

1.171

0,98

Peak Hip
Rotation

1.018

1.410

0.51

Range
of Pelvic
Rotation

9.845

0.459

0.92

Range of Hip
Rotation

1.818

12.606

0.72

Peak Knee
Flexion

4.654

54.723

0.64

Peak Ankle
Dorsiflexion

-2.767

16.615

0.83

Range
of Knee
Fexion

6.323

48.947

0.79

Range
of Ankle
D/P-flex

0,982

25.829

0,72

Table 1: Example results of linear regression coefficients for angular gait parameters for n=17 males.
see the next page

85

References
[1] Schwartz MH, et al. 2008. J Biomech 41,
pp.163950.
[2] Stansfield BW, et al. 2006. Gait Posture 23,
pp.28894.
[3] Lelas JL, et al. 2003. Gait Posture 17(2):
pp.10612.

Discussion
In general, we found a good agreement of the
results with Lelas et al. [3]. The peak sagittal plane
kinematic parameters have stronger dependence
on gait speed (higher slope). Also the peak and
range of pelvic rotation is strongly influenced by
speed The speed-dependent relationships shown in
the table can be used as a reference for normal
gait parameter values. The speed-dependent
linear regression analyses allowed us to match
studied gait parameters to the data of predicted
reference group.

86

O 064

INFLUENCE OF KINEMATIC DATA ON THE ESTIMATION


OF GROUND REACTION FORCES DURING NORMAL GAIT
J. Ojeda1, J. Mayo1
1

University of Sevilla, Mechanical Engineering, Sevilla, Spain

Introduction
The
measurement
of
three-dimensional
lower body kinematics through the use of
stereophotogrammetry has been well tested and
validated over many years. Inverse gait analysis
now forms a major part of clinical decision making.
The challenge is developing a forward dynamics
algorithm which allows predicting the motion. The
use of predictive forward simulations is strongly
limited by the lack of a validated model that
describes the contact forces between the foot
and the ground. Several contact models as well as
procedures to adjust their parameters have been
discussed in the literature [Lugrs, 2013; PmiesVil, 2014]. The total contact force is divided into
the normal and tangential components. This work
analyzes the influence of the foot markers position
in the estimation of the contact forces.

Results
The local coordinates of the contact points were
defined by means of a trial and error optimization
procedure for one set of experimental data. Figure
1 shows the vertical coordinate of the contact
points which is the main kinematic variable to
define the normal force.

Figure 1: L eft: Vertical coordinates of the contact points.


Right: Location of the points.

Methods
Normal gait was measured in an adult male using
6 infrared Vicon cameras and a set of reflective
markers. Ground reaction forces were collected
with two AMTI force plates. An inverse dynamics
problem was solved. Ground reaction forces were
defined as a function of the contact laws and
the kinematics calculated from the markers data.
Data obtained from the force plates were used to
validate the ground reaction force estimated with
the models. The plantar surface was modelled as
5 contact points along the surface as shown in
Figure 1. Viscoelastic elements were defined on
each point to model the normal force [Wojtyra,
2003].

Figure 2 shows the normal contact force with


the ground of the right foot during a gait cycle
obtained with the optimized local coordinates of
the contact points and the two set of experimental
data.

Two set of data were recorded for the same


subject and the same technician in different days.
Plug-in-Gait protocol was applied to carry out the
body pose reconstruction.

Figure 2: V
 ertical ground reaction force estimated with two
set of data compared with data from the force
plate (Exp).

Discussion
Results highlighted the significant influence of
minimal disturbance on the location of the markers
in the estimation of the contact forces. A detailed
study of the markers protocol should be carried out
to improve the procedure.
References
Lugrs et al, Multibody Syst Dyn, 30:247263, 2013.
Pmies-Vil et al, Mech Mach Theory, 75:
107116, 2014.
Wojtyra, Mech Based Des Struc, 31:357379, 2003.

87

O 065

CAN MODELLING OF MUSCULOSKELETAL SYSTEM HELP


IN DIAGNOSTICS OF PATHOLOGICAL GAIT?
J. Ogrodnik1, M. Syczewska2, S. Piszczatowski1
1

Bialystok University of Technology, Department of Materials and Biomedical Engineering,


Bialystok, Poland
2

The Childrens Memorial Health Institute, Dept. Neurology, Epileptology and Paediatric
Rehabilitation, Warsaw, Poland

Results
A special attention was paid to the possibility of
evaluation of muscle elongation during a gait
cycle on the basis of modelling results (Tab.1). A
great advantage consists also in the possibility of
analysing muscles situated in deep layer.

Introduction
The complexity of the systems responsible for
human locomotion (neural system, muscles, skeleton, etc.) as well as their mutual interactions makes
the diagnostics of pathological gait very difficult.
Nowadays, very sophisticated equipment is used in
gait laboratories to collect data necessary for the
human movement evaluation. However, there is
still an actual problem in the interpretation of information obtained this way. A final diagnosis should
give an answer to the question what is the primary
reason of gait pathology whilst the other symptoms
should be defined as secondary effects (compensation of primary pathology) [Novacheck, 2007].
The aim of presented study is to evaluate whether
the computer modelling of the musculoskeletal
system can deliver new information, important for
the diagnostics of patients with gait pathology due
to muscle spasticity.
Methods
The modelling of the musculoskeletal system was
performed using the AnyBody system (AnyBody
Technology A/S, Denmark) [Damsgaard, 2006].
Some earlier data collected during gait analyses
made for diagnostic purposes in The Childrens
Memorial Health Institute in Warsaw (Vicon system,
Kistler force platforms, sEMG) were transferred to
AnyBody using c3d files. For modelling, the MoCap
LowerBody Model, consisting of 55 muscles divided
into 159 branches for each leg with 7 joint degrees
of freedom (Fig.1) was used.

Table 1: A
 nalysis of selected muscle elongation in
a gait cycle (girl, 12-years-old)

Discussion
The results of modelling allow finding an asymmetry
in the left/right side muscle branches elongation.
The differences in average muscle length make
it possible to evaluate muscle contractures. Such
data may help in a better interpretation of joint
angle and sEMG recordings and for this reason
the modelling should be more widely used in the
diagnostics of pathological gait.
References
Damsgaard M. et al, Simul Model Pract Th 14:
11001111, 2006
Novacheck T.F. et al, Childs Nerv Syst 23:
10151031, 2007.

Figure 1: V
 isualization of the right hip region
in the musculoskeletal model

Results obtained from modelling were compared


with conclusions formulated after the gait analysis
to find out whether any new information could be
found as a result of the model analysis.

88

O 066

DESIGN AND 3D PRINTING OF A DYNAMIC WRIST SPLINT


IN THE DART THROW MOTION PLANE
S. Portnoy1, A. Sayapin2, Y. Kaufman-Cohen3 , Y. Levanon3
1
2

Tel Aviv University, Tel Aviv, Israel

Afeka College of Engineering, Medical Engineering department, Tel Aviv, Israel


3

Tel Aviv University, Occupational Therapy, Tel Aviv, Israel

Introduction
Rehabilitation following a wrist fracture often
includes exercising flexio n-extension movements
with a dynamic splint. Current studies show
that these sagittal wrist movements are not
representative of the natural daily wrist movements.
We actually perform most of our daily functions,
with our wrist moving on a Dart Throw Motion (DTM)
plane, also defined as the plane between radialextension and ulnar-flexion. Today, no dynamic
splint exists which facilitates wrist exercise in the
DTM plane.

(N=36) (Fig. 1a). The geometry of the splint was


designed to fit to a 3D scan of the wrist (Fig. 1b).
The splint was attached to the wrist using Velcro
as two wires attached to two pulleys, situated on
a joint axis, pull the hand to move in the desired
calculated plane.
Results
The printed splint fits the wrist of the subject, is easy
to don and doff and constricts movement to the
desired DTM plane. Hooks were inserted on each
part to allow the addition of rubber bands for
resistance training towards muscle strengthening.

Aim
To design and 3D print a subject-specific dynamic
wrist splint that facilitates wrist exercise in the DTM
plane.

Discussion
Exercising in the natural plane of the DTM may
reduce the time of rehabilitation. The evaluation
of the clinical benefits of this method, compared
to conventional rehabilitation methods following
wrist fracture, are a part of a PhD work, currently
conducted by an occupational therapist.

Method
First, the DTM plane was calculated using a wrist
electrogoniometer placed on the wrist of healthy
subjects, performing several activities of daily living

89

O 0 67

DOES HIGH-IMPACT FUNCTIONAL ACTIVITY INCREASE


LOWER LIMB MISALIGNMENT IN WOMEN WITH
PATELLOFEMORAL PAIN SYNDROME?
J.C.F. Correa1, A. Curcio dos Reis1, A.S. Bley2, N.D.D.A. Rabelo2,
T.Y. Fukuda3 , P.R.G. Lucareli2

Nove de Julho University UNINOVE, Rehabilitation Science Master and PhD Program,
Sao Paulo, Brazil

Nove de Julho University UNINOVE, Rehabilitation Science Master and PhD Program,
Sao Paulo, Brazil

Irmandade Santa Casa de Misericrdia, Department of Physical Therapy, Sao Paulo, Brazil

Introduction
Patellofemoral pain syndrome (PFPS) is commonly
associated with misalignment of the lower limb
during closed kinetic chain activities and has been
recorded in both low and high-impact activities. To
determine if high-impact activities cause greater
biomechanical abnormalities in the lower limb
than low-impact activities.

Discussion
The present study has some limitations, particularly
in relation to the fact that the assessment of the
landing phase of the jump was only conducted
during the transition from the first to the second
jumping the SLTHT. However, this decision was
made due to the kinetic and kinematic values
found during the pilot study. In addition, the fact
that the volunteers performed the jump barefoot
needs to be considered. Since it was difficult
to standardize the footwear of all participants,
we believe that it was the right decision for the
present study. Using different footwear could have
affected the results. The most significant clinical
implication of the present study is that, unlike the
expected results, the greatest biomechanical
abnormalities were associated with low-impact
phases of the SLTHT. This finding should be taken
into consideration when assessing, treating and
releasing PFPS patients. Most professionals are
concerned about only assessing biomechanical
behavior during the phase of the test with the
highest impact. However, despite the results of
the present study, it is impossible to infer that the
preparation phase is more harmful or dangerous
to women with PFPS. Consequently, further studies
should be undertaken to assess these two phases
and investigate more variables, including muscle
activity during each phase. Women with PFPS
exhibit different kinematic and kinetic behavior
during the preparation and landing phases of the
SLTHT. Thus, high-impact activities do not increase
misalignment when compared with low-impact
activities.

Methods
Twenty women with PFPS, aged between 18 and
35, were instructed to perform the single-leg triple
hop test (SLTHT). Kinetic and kinematic data were
collected during the preparation phase prior to
the jump and during the landing phase between
the first and the second hop.
Results
The women exhibited the following during
the landing phase: greater range of anterior
(36.14.8 vs 14.94.4) and ipsilateral trunk flexion
(9.52.5 vs 5.64.9); greater hip internal extensor
(2.70.5 vs 1.80.8) and abductor moments
(2.20.2 vs 1.60.4); as well as greater knee
extensor (1.90.3 vs 0.80.2); and invertor moment
(0.60.2 vs [-]0.60.2). The following variables
were greater during the preparation phase:
contralateral pelvic drop (14.82.9 vs 7.02.1);
hip flexion (80.875.19 vs 54.145.7), adduction
(19.953.7
vs
10.332.12)
and
medial
rotation (19.516.3 vs 12.973.2); knee flexion
(63.53.5
vs
48.022.7);
and
dorsiflexion
(35.34.7 vs 26.92.8); knee internal abduction
moment (2.60.5 vs 2.10.4).

References
B
 arton et al, Gait Posture. 33(2):286291, 2011.
B
 ley et al, PLoS One, 9(5):e97606, 2014.
F ukuda et al, JOSPT, 42(10):823830, 2012.
W
 illson et al, Clin Biomech, 23(2):203211, 2008.

90

O 068

A SINGLE STEP ANALYSIS OF PLANTAR PRESSURE


DISTRIBUTION IN TENNIS SPECIFIC MOVEMENTS
P. Kornfeind1, A. Baca1
1

University of Vienna, Biomechanics/Kinesiology and Applied Computer Science,


Vienna, Austria

Introduction
An increasing number of sports facilities is equipped
with synthetic playing surfaces. Reasons, among
others, are their versatility, their durability and the
lower costs in maintenance [cf. Taylor et al., 2012].
Playing behaviour is affected by the surface layer.
Surface properties may thus increase injury rates.

regions defined by the forefoot and rear foot area.


Mean values and standard deviations were then
calculated for all variables on both surfaces for both
movements. A repeated measures 22 multivariate
analysis was performed with the surface and
the two regions as the repeated factors and mf,
pp and mp as the dependent variables. Paired
samples t-test was used to examine differences
in plantar loading parameters between surface
conditions for fore- and rear foot.

It is obvious that playing on different surfaces


results in different foot strike techniques, which,
as a consequence, requires wearing appropriate
footwear. Injuries mostly occur at deceleration
steps [Griffin et al., 2006], e.g. during a directional
change, which is typical during tennis play.
For plantar pressure distribution analyses in
tennis, different types of steps (acceleration/
deceleration) need therefore to be assessed for
obtaining revealing results.

Results
Significantly (p<0.05) higher loadings were
observed for the whole foot on clay for forefoot
strikes at forehand play. No significant differences
were found for baseline play. The multivariate
analysis revealed significant differences for both
repeated factors for ac as well as for dc steps
under both playing conditions. In the forefoot area
pp was significantly higher on clay for dc steps for
baseline play. This was also the case for mf, pp and
mp in ac steps during forehand play. In the rear
foot area significantly higher values on hard-court
for mf, pp and mp in dc steps during both types of
movement were found.

Methods
Eight right handed male tennis players with
an International Tennis Number of 6 or better
participated in the study. Players had to perform
two different tennis specific movements on the
two playing surfaces clay and hard-court: (1) eight
shuttle runs as described by [Girard et al., 2007] to
simulate baseline play and (2) a sequence of ten
forehand strokes.

Discussion
On hard court players have to absorbe a higher
impact when hitting the surface, while on clay the
foot has the ability to slide slightly. Using different
tread techniques might be useful when switching
surfaces, especially a controlled heel strike is
recommended on hard courts. The present study
also indicates that higher force values occur on
clay during acceleration. This would agree with the
assumption of an eventual need of higher force and
pressure to accelerate on the more slippery clay.

A Pedar-X insole measurement system (Novel


GmbH) was used for recording plantar pressure
distributions. The sensors were placed between the
foot and the plantar surface of the right shoe.
Steps were categorized either as forefoot strikes
(assuming acceleration) or heel strikes (assuming
deceleration). The respective classification was
based on the initial center of pressure (COP) during
impact (ac: COP at toes and forefoot; dc: COP at
heel). This was confirmed by the curve shape of
the vertical GRF and the path of the COP from the
impact until toe off event.

References
Girard et al, Br J Sports Med, 41: 733738, 2007.
Griffin et al, Am J Sports Med, 34 (9):
15121532, 2006.
Taylor et al, Phys Sportsmed, 40 (4): 6672, 2012.

Mean maximum force per step (mf), peak pressure


(pp) and mean peak pressure per step (mp)
were determined for the whole foot and for two

91

O 0 69

MUSCULOSKELETAL MODELLING FOR ERGONOMICS:


SHOULDER & LOWER BACK LOADING IN BRICKLAYING
S.H. Ismail1, A.E. Kedgley1, A.M.J. Bull1
1

Imperial College London, Bioengineering Department, London, United Kingdom

Introduction
Work-related musculoskeletal disorders (WMSDs)
have become an increasing problem, with a
significant socio-economic burden due to longterm disability. In 2011/2012 the total number
of WMSD cases was more than 40% of all workrelated illnesses across Britain [HSE, 2013]. WMSDs
are predominantly instigated by biomechanical
factors such as repetitive motion and loading,
as well as extreme loading and postures that
cause pain or functional loss [Michener et al.,
2003]. The building trade is one of trades that has
a high rate of WMSDs. WMSDs are multifactorial
conditions; they are produced by a complex web
of risk factors that cannot be unravelled by clinical
examination alone. Musculoskeletal modelling can
aid WMSD analysis [Lemieux et al., 2012]. The aim
of this study was to estimate shoulder muscle and
lower back loading during a bricklaying task under
occupational conditions.
Methods
A 10-camera optical motion tracking system
(Vicon, Oxford, UK) was used to measure the
kinematics of the trunk, scapula, humerus forearm
and pelvis. Two experienced and three trained
(inexperienced) bricklayers participated in the
experiment. An inverse dynamics musculoskeletal
model of the upper limb was used to quantify
muscle forces during bricklaying activities [Charlton
& Johnson, 2006]. The effects on muscle activation
and low back loading when lifting of two different
heights (ground level and 200 cm) were tested.
Additional code was custom-written in MATLAB
(The Mathworks, Natick, USA) to calculate the
inter-segmental forces and moments between the
pelvis and trunk.

Figure: Mean muscle activation for two shoulder muscles of


trained (TR) and experienced (EX) bricklayers over four trials
using 3kg brick.

Discussion
This measurement approach combined with
musculoskeletal modelling shows that experience
has an impact on shoulder and low back loading.
Changing the task by, for example, reducing task
mass and changing the lifting height, may reduce
low back loading. With further investigation,
this will lead to the quantification of parameters
associated with shoulder and low back pathology
produced in the workplace. This information can
be used to optimise the brick laying technique,
not only for performance, but also to reduce workrelated injuries through task design, equipment,
and/or training.

Results
In the case of placing bricks at ground level, higher
muscle activation was found in trained bricklayers
compared to experienced bricklayers (Figure). In
the case of placing bricks at 200cm, higher muscle
forces were found in experienced bricklayers
compared to trainees. For back loading, higher
moments were found when placing bricks at
ground level compared to placing the bricks at
200cm for both trained and experienced subjects.

References
Charlton & Johnson, Proc Inst Mech Eng H, 220:
80112, 2006.
HSE, http://www.hse.gov.uk/statistics/causdis/
musculoskeletal/msd.pdf, 2013.
Lemieux et al, Clin Biomech, 27:8016, 2012.
Michener et al, Clin Biomech,18:36979,2003.

92

O 070

POSTURAL DYNAMISM DURING COMPUTER MOUSE


AND KEYBOARD USE: A PILOT STUDY
Q.A. Louw1
1

Stellenbosch University, Physiotherapy, Cape Town, Republic of South Africa

Introduction
Postural dynamism (measured as the number of
postural changes in cervical and thoracic angles)
may vary between computer tasks (Van Dien et
al. 2001). Currently there is no knowledge about 3D
postural dynamism during different computer tasks.
The aim of this study was to measure 3D postural
dynamism during mouse use and keyboard typing.

D a t a a n a ly s i s
Descriptive statistics were used to describe the
postural dynamism (total number of cervical and
thoracic postural changes per minute). Graphs
were used to illustrate postural dynamism. A paired
t-test was performed to determine differences
(p >0.05) between the mouse clicking task and the
typing task.

METHODO L O G Y
Twelve freshman students participated. The
exclusion criteria included a history of spinal or
neurological pathology, a body mass index ratio
higher than 25 and/or a high waist-hip ratio less
than 0.8 in females and 0.9 in males.

Results
There were significant differences in 3D postural
dynamism (number of postural changes) between
the mouse and typing tasks for the cervical
(flexion/extension
(p=0.0003);
side
flexion
(p=0.0000); rotation (p=0.0002)) and thoracic
(flexion/extension
(p=0.0173);
side
flexion
(p=0.0163); rotation (p=0.0399)) spinal angles in
all three movement planes. Postural dynamism for
one participant is represented in Figure 2.

We determined that seven subjects were required


to detect a statistical difference between the two
computer tasks for an effect size of 1.66, using a
paired t-test (alpha level of 0.05).
The Vicon Motion Analysis system which consists
of eight (either wall-mounted or tripod-mounted)
T-10 MX cameras was used to film the participants.
Data was captured performing mouse clicking
and keyboard computer tasks. A custom-designed
computer program was used to give detailed
commands according to a specific time frame.

mov/min: Postural changes per minute

Postural dynamism was described as the total number


of postural changes that occurred during the data
capture period. A postural change is defined as the
difference in degrees between one turning point
(change in movement direction) and a successive
turning point in the data of a given angle (cervical
or thoracic angles) (Van Niekerk et al 2014; Figure 1).
As each angle is a continuous function, the derivative
of the data was used to calculate the turning points
concerned. The absolute difference between
successive turning points was calculated per subject.

Figure 2: E
 xample Postural Dynamism of one subject

Discussion
We found that postural dynamism is less during
mouse use compared to keyboard typing. However
both of these input devices lead to monotonous
sitting posture, which is sustained for prolonged
periods. The use of computers is inevitable in
the occupational and academic environment.
Therefore, futuristic alternatives to traditional
computer input devices should be developed.
Computer users should also be advised to use a
range of different input devices to encourage
postural dynamism whilst sitting.

Figure 1: Illustration of postural turning points

93

O 071

DEVELOPMENT OF A SIMPLIFIED METHOD TO ESTIMATE


IMPLANT DESIGN PERFORMANCE UNDER DYNAMIC
LOADING CONDITIONS IN TOTAL KNEE REPLACEMENT
SYSTEMS
A. Maas1, I. Kutzner2, R. Larranzar-Garijo3 , T.M. Grupp1
1
2
3

Aesculap AG, Research and Development, Tuttlingen, Germany

Julius Wolff Institute, Charit Universittsmedizin Berlin, Berlin, Germany

Orthopaedic and Traumatology Department, Infanta Leonor University Hospital,


Madrid, Spain

Introduction
Dynamic finite-element (FE) models of the knee joint
are rarely used during the implant design process
because of their complexity. Using a new approach
this study introduces a simple and versatile method
of modelling total knee replacement implant
systems under dynamic loading conditions using
averaged high load cycles [Bergmann, 2014] to
determine the influence of alignment parameters,
excessive load, design and size combinations
on implant lifetime reducing factors such as
mechanical failure and wear.

To estimate the suitability of this method different


alignments as well as an additional level walk
load cycle were analyzed and compared to their
corresponding in vivo datasets.
Results
Although the analyzed and instrumented implant
designs are slightly different the resulting reaction
moments show similarities in curve characteristics
and magnitude of the occurring maxima which
also indicates comparable knee kinematics (Fig.2).

Methods
The example ascending stairs averaged in vivo
dataset was transposed to start at the lowest
knee flexion angle and a curve fitting procedure
delivered time dependent load functions for the
tibial load components FX(t), FY(t), FZ(t) and the
femoral knee flexion angle (t) with an average
R of 0,9988. A 3D model of an implant system
with ultracongruent gliding surface was aligned
according to the flexion angle delivered by
the (t) function for t = 0 and transferred into the
FE-software. Determined equations were applied
to the nonlinear 6-DOF FE-model as external loads
and the analysis duration was set according to the
validity range of the used functions. The location
and orientation of the femoral coordinate system
was determined by comparing the reaction
moments delivered by the in vivo datasets to the
results of the FE-model (Fig.1).

Figure 2: R
 eaction moment over time of the original
HIGH100 stair climbing data (dotted lines) and
the results predicted by the FE-model (solid lines)

Discussion
This simplified approach may be an easy way
for implant designers to analyze their systems
in a variety of loading scenarios once the
corresponding load equations are determined or
published. The robustness of this technique allows
a fast estimation of implant performance under
scalable dynamic loading and different alignment
situations.
References
Bergmann G, Bender A, Graichen F, et al. Standardized Loads Acting in Knee Implants. Williams
BO, ed. PLoS ONE 2014;9(1):e86035. doi:10.1371/
journal.pone.0086035.

Figure 1: C
 oordinate system alignment and boundary
conditions of the FE-model at initial state

94

O 072

BIOMECHANICAL ANALYSIS OF
J-CURVE VS SINGLE-RADIUS FEMORAL
DESIGNS DURING DAILY ACTIVITIES:
A NUMERICAL STUDY.
B. Innocenti1, H. Robledo Yage1, R. Alario Bernab1, W. Pascale2, S. Pianigiani2
1
2

Universit Libre de Bruxelles ULB, BEAMS Department, Bruxelles, Belgium

IRCCS Istituto Ortopedico Galeazzi, Istituto Ortopedico Galeazzi, Milano, Italy

Introduction
The lack of awareness of the exact number of
instantaneous centers of knee flexion/extension
rotation leads to the presence in the market
of Total Knee Arthroplasty (TKA) with different
femoral components designs. Following condylar
anatomy, J-curve (JC) was introduced [1] aiming
to replicate the physiological shape of the
femoral bone; however this design could lead
to potential issues on the extensor mechanism
and on the collateral ligaments. Therefore, to
provide a constant lever arm for the patella and
isometry of the collateral ligaments, Single-Radius
(SR) designs were introduced [2]. This design is
based on the isometry of the superficial medial
collateral ligament, and that is widely accepted
as a basis of soft tissue tensioning in TKA. Although
these theoretical advantages, few difference was
founded clinically and controversial results were
identify during kinematics analysis [35]. However,
no biomechanical analysis during daily activities is
present in the literature. For these reasons, the aim
of this study is to compare the two solutions for the
same posterior stabilized (PS) TKA design under daily
activities using dynamic 3D finite element analysis.
Both contact forces and kinematic outputs have
been analyzed and compared.

Results
The results show that the two solutions did not
present significant differences for any of the
analyzed outputs for the low demanding task daily
activity (up to 60). On the other hand, significant
differences in the behavior are highlighted during
the squatting motion especially after 80 of knee
flexion. From this point, the contact areas and
forces, especially for the post-cam interaction,
change and also the kinematics is altered
presenting an anomalous drop for the SR design
both in antero-posterior translation and internalexternal rotation. Moreover, the stress on the
polyethylene insert present higher values on the
posterior part of the insert (up to 50%).
Discussion
In this study the single radius and J-curved femoral
design were investigated during walking and
squatting. For the gait cycle, in which the flexion
angle is always lower than 60, results show similar
behavior in terms of kinematics and contact
forces, with difference lower than 1%. During
squatting, after 80 of flexion, the single radius
design determines slight higher tibio-femoral forces
(with a maximum change up to 3.7%) that induced
higher polyethylene tibial stress (up to 50%). These
different outputs can be critical for a possible
prediction of medium-long term patients follow-up.

Methods
Starting from a conventional J-Curved femoral
design, the correspondent Single-Radius design
was developed. For the two analyzed solutions,
the same tibial component has been used.
According to literature, a standard gait cycle and
the flexion phase of a squatting activity up to 120
were investigated for both designs [6, 7]. The tibiofemoral contact force and kinematics have been
investigated comparing the contact area between
components, the internal-external rotation, the
position and magnitude of the contact forces and
the Von Misses stresses on the polyethylene.

RE F EREN C ES
1 Gunston, J Bone Joint Surg Br, 1971;
2 Pinskerova et al, Orthopade, 2000;
3 Hall et al, J Arthrop, 2008;
4 Tamaki et al, J Arthrop, 2013;
5 Ah-Reum et al, J Arthrop, 2014;
6 International Standards Organization. Standard
number 14243-1;
7 Victor et al, J Orthop Res, 2010.

95

O 073

STABILITY OF TIBIAL PLATEAUS UNDER DYNAMIC


COMPRESSION-SHEAR LOADING IN HUMAN
TIBIAE INFLUENCE OF KEEL LENGTH,
CEMENTATION AND TIBIAL STEM
T. Grupp1,2, K. J. Saleh3 , M. Holderied1, A. Pfaff1, C. Schilling1, C. Schrder4 ,
W.M. Mihalko5
1

Aesculap AG Tuttlingen, Research & Development, 78532 Tuttlingen, Germany


2

Ludwig Maximilians University Campus Grosshadern, Munich, Germany,


Clinic for Orthopaedic Surgery, Mnchen, Germany
3

Southern Illinois University School of Medicine Springfield, IL, USA,


Division of Orthopaedics, Springfield, USA

Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern,


Munich, Germany, Orthopaedic Surgery, Mnchen, Germany
5

Institute-University of Tennessee, TN, USA, Orthopaedic Reconstructive Research,


Tennessee, USA

Introduction
To assess the primary stability of tibial plateaus in
vitro, different approaches had been undergone:
cement penetration depth analysis [1, 2], static
tension [3, 4] or compression loading [5] until
interface failure. However, these test conditions
do not reflect the in vivo physiologic loading
modes, where the tibial plateau is predominantly
subjected to combined compression and shear
forces in a cyclic profile [69].

Results
In regard to the mean failure load there was no
significant difference (p > 0,22) between all tested
groups, whereas the failure load of Tibia&Stem
was highest and Tibia28 was lowest by trend
(Fig.2). A significant correlation between bone
mineral density and final failure load was solely
found for Tibia28 (p = 0.01).

The objective of the study was to evaluate the


impact of the tibial keel lenght, of a cemented
keel and of an additional stem on the primary
stability of a posterior stabilised tibial plateau under
dynamic compression-shear loading conditions in
human tibiae.
Methods
24 fresh-frozen human tibiae were divided into
four groups Tibia28, Tibia40, Tibia&Stem and
Tibia cemented keel based on the bone mineral
density of the tibial head. The implantations
were performed by experienced knee surgeons
(KJS,WMM) and after dissection the tibiae were
oriented on the test machine in a flexed position
to simulate peak joint loading during stair climbing
and loaded with a tibio-femoral load of 1800 N for
1000 cycles followed by a stepwise increase (steps
+300 N, 1000 cycles) until failure or termination
of the test at a demanding load level of 6000 N.
The motion of the implant relative to the tibia was
analysed by a 3D camera system (Pontos, GOM).
The cement layer and penetration into the bone
was assessed by CT-based segmentation (Fig. 1).

Figure 2: F ailure load of the test groups

Discussion
A method for evaluation of the implant-bone
interface stability of tibial plateaus in regards to
design parameters and cement fixation areas
was configured. The procedure enables to assess
surgical treatment options influencing the fixation
of implants in human donor tibiae.
References
1 Maistrelli,CORR312:2615,1995
2 Vanlommel,JOA 26:4926,2011
3 Schlegel,IntOrthop35:11659,2011
4 GebertdeUhlenbrock,ClinBiomech27:92935,2012
5 Clarius,Knee17:5760,2010
6 Kutzner,JBiomechanics43:216473,2010
7 Bergmann,PloSOne9:e86035,2014
8 Zhao,JOrthRes25:593602,2007
9 Grupp,ClinBiomech28:100613,2013

see the next page

96

Figure 1: E
 xample of CT data analysis of bone cement layers superposition of two cement layers: Tibia&Stem (grey) and
Tibia cemented keel (blue).

97

O 0 74

ASSESSING THE PRIMARY STABILITY OF UNCEMENTED


FEMORAL KNEE IMPLANT USING DIGITAL IMAGE
CORRELATION
S. Berahmani1, D. Janssen1, W. David2, M. de Waal Malefijt3 , N. Verdonschot1,4
1

Radboud university medical center, Orthopaedic Research Laboratory,


Nijmegen, Netherlands
2

DePuy Synthes Joint Reconstruction, Leeds, United Kingdom

Radboud university medical center, Department of Orthopaedics, Nijmegen, Netherlands


4

University of Twente, Laboratory for Biomechanical Engineering, Enschede, Netherlands

Introduction
The primary stability of uncemented implants can
be evaluated in experimental set-ups by monitoring
bone-implant micromotions. Digital image correlation
(DIC) is a relatively novel tool, which previously has
been applied mainly to explore full-field displacements

and strain fields, but is also very useful to calculate the


relative displacements between bone and implant.
In the current study, we aimed to assess the primary
stability of an uncemented femoral knee implant
using DIC, under two different loading configurations.

Figure 1: A
 ) Gait set-up. ROIs at the posterior condyles are indicated. B) Speckle pattern and displacement distribution.

Materials and Methods


Six femora were prepared following the normal
surgical procedure. Calibrated CT-scans of
the bones were obtained to measure bone
mineral density (BMD). After implantation of the
appropriate size uncemented LCS femoral knee
component (DePuy Synthes, IN, USA), a blackand-white speckle pattern was applied to each
specimen (Fig.1). The micromotion measurement
was repeated three times in nine regions of interest
(ROIs): the medial and lateral condyles from the
posterior view; anterior, distal, and posterior regions
from the medial and lateral views; the proximal tip
of the anterior flange. The reconstructions were
subjected to a gait load (2223N, 16 of flexion,
3565% lateral-medial ratio, Fig.1A) and a fraction
of the peak force of a deep knee bend (DKB) to
prevent fracture of the proximal femur (either 40%
or 50% of 2156 N based on the implant size, 90
of flexion, 4555% lateral-medial ratio). The loads
were derived from the Orthoload database using

implant-specific inverse dynamics [Fitzpatrick et al.,


2012]. To compare micromotions under gait and
DKB loads, the micromotions under gait load were
determined under load levels that were equally
reduced to the DKB load fraction by capturing
videos from three ROIs.
Results
A wide range of micromotions was found
(2442 m) due to the variation in the BMD
[89200 mg/cm 3] and differences between ROIs.
A non-linear correlation was found between the
load and micromotion for the gait load, while a
linear relationship was found for the DKB load
(Fig.2A). Significantly higher micromotions on
either the medial or lateral sides were found for the
gait and DKB loading configurations, respectively
(Fig.2B). Only in the lateral side significantly higher
micromotions were found under DKB load in
comparison with the gait load.
see the next page

98

important to measure micromotions in multiple ROIs.


Depending on the loading configuration different
correlations between load and micromotion were
found, possibly due to the lower level of the DKB
load. We have also found that the higher medial
load during gait resulted in a higher range of
medial micromotions, while this was not the case
for the DKB load, which indicates the differences
as a result of loading configuration. In addition,
the significant effect of BMD on the micromotion
indicates the role of patient bone quality on the
implant primary stability. The regional micromotion
results as measured can serve as validation data for
micromotion simulations based on finite element
analysis.

Figure 2: A) The correlation between micro-motion and load


for one bone (anterior and medial-posterior views)
B) Regional micro-motions for the two loading
conditions.

Discussion
Preclinical assessment of the primary stability
of orthopaedic implants is essential. This study
has shown that DIC is a suitable technique to
investigate the stability. We have found that to
capture the complex behaviour of the implant, it is

This research was sponsored by DePuy Synthes Joint


Reconstruction, Leeds, UK.
References
Fitzpatrick et al, Comput Methods Biomech Biomed
Engin, p. 360, 2012.

99

O 075

THE INFLUENCE OF TOTAL KNEE ARTHROPLASTY


ON PRESSURE OF THE PATELLOFEMORAL JOINT
T. Hidenori1, T. Mitsunori2, O. Ryo1, H. Kengo3 , N. Yasuo3 , O. Kazunari1, N. Takeo4
1

Saitama City Hospital, Department of Orthopaedic Surgery, Saitama, Japan


2

3
4

National Institute of Advanced Industrial Science and Technology,


Digital Human Research Centre, Tokyo, Japan

Keio University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan

Keio University School of Medicine, Department of Clinical Biomechanics, Tokyo, Japan

Introduction
Anterior knee pain is still an important complication
after total knee arthrplasty (TKA). It is assumed that
excessive postoperative retropatellar pressure
contributes to a great extent to postoperative
patella problems [Kulkarni SK, 2000]. It may be
possible to reduce the complication rate by
selecting TKA components that minimize patellar
load [Kainz H, 2012], however the retropatellar
pressure change in various TKA components
remains unclear. The aim of our study was to
evaluate the retropatellar pressure in the native
knee and with different types of TKA components.
Methods
Five fresh frozen knees were obtained from human
cadavers (age range between 82 and 94 years,
three females, two males). The experiment was
performed along with the guideline for clinical
education and research at Clinical Anatomy
Laboratory of our university. A customized patellar
component was made with a force sensor
(FlexiForce, Tekscan Inc., MA, USA). A standard
TKA surgery was performed using the Triathlon TKA
system (Stryker, MI, USA). After the patella was
resurfaced by the customized patellar component,
the knees were examined in the following order:
the native state, cruciate retaining type TKA
(CR-TKA), cruciate substitutin type TKA (CS-TKA),
and posterior stabilized type TKA (PS-TKA). An
optical three-demensional motion analysis system
(OptiTrack, NaturalPoint, OR, USA) was used to
measure the knee joint angle. Both kimematic data
and pressure data were corrected synchronously
in 120 Hz frequency. The retropatellar pressure
was calculated at knee flexion angles of every
10 degrees between 20 to 120 degrees. Statistical
comparisons were performed with SPSS Statistics
using one-way repeated measures ANOVA with
Bonferroni adjustment.

Figure 1: M
 ean retropatellar pressure under the various
tested configurations.* indicates significant
differences compared to the native knee (P < 0.05).

Discussion
The results of this study showed that the retropatellar
pressure increases after TKA and the type of TKA
components affects the retropatellar pressure.
The increasing retropatellar pressure in the TKA
knees, which reaches double the pressure of the
native knee at maximum knee flexion, is supported
by a previous study [Steinbruck A, 2013]. This
increasing retropatellar pressure might lead to the
anterior knee pain in vivo [Fuchs S, 2005]. Although
significant difference was not observed in this
study, possibly due to small sample size, our study
suggests that evaluating the retropatellar pressure
in different types of components might be useful to
estimate patellofemoral complications after TKA.
References
Fuchs S et al, Knee, 12:912, 2005.
Kulkarni SK et al, J Arthroplasty, 15:424429, 2000.
Kainz H et al, Int Orthop, 36:7378, 2012.
Steinbruck A et al, BioMed Eng Online, 12:58, 2013.

Results
The retropatellar pressure increased as the
knee flexion angle increased from 20 degrees to
120 degrees (Fig.1). The retropatellar pressure of
the native knee was significantly smaller than the
retropatellar pressures of CR-TKA and CS-TKA at
knee flexion angle of 110 and 120 degrees. The
CS-TKA exhibited greater retropatellar pressure
compared with CR-TKA and PS-TKA however
significant difference was not observed.

100

O 0 76

MICRO-CT BASED FINITE ELEMENT MODELS PREDICT


ACCURATE DISPLACEMENT FIELD MEASURED WITH
DEFORMABLE IMAGE REGISTRATION
Y. Chen1, E. DallAra2, K. Manda3 , E. Sales3 , R. Wallace4 , P. Pankaj3 , M. Viceconti1
1

INSIGNEO Institute for in silico Medicine, Department of Mechanical Engineering,


University of Sheffield, Sheffield, United Kingdom
2

INSIGNEO Institute for in silico Medicine, Department of Human Metabolism,


University of Sheffield, Sheffield, United Kingdom
3

Institute for Bioengineering, School of Engineering, University of Edinburgh,


Edinburgh, United Kingdom

Institute for Bioengineering, Department of Orthopaedics, University of Edinburgh,


Edinburgh, United Kingdom

Introduction
Non-destructive 3D micro-computed tomography
(CT)-based finite element model (microFE)
has become a popular tool for studying bone
mechanical properties at tissue level [Donaldson et
al. 2011]. However, while we can easily validate its
predictions of apparent properties (e.g. stiffness),
nobody has reported so far a proper validation of its
local response (e.g. displacement field). The goal
of this study was to use a digital volume correlation
(DVC) approach [DallAra et al. 2014] to validate
the local microFE displacement predictions for
human trabecular bone.

Max.err=0.0338mm,
Max.err%=15.75v%;
Z
direction:
y=0.9928x0.0083,
R2=0.999,
RMSE=0.0108mm, RMSE%=2.45%, Max.err=0.0214mm,
Max.err%=4.86%; magnitude: y=1.0035x-0.0131,
R 2=0.998, RMSE=0.0122mm, RMSE%=2.45%,
Max.err=0.0294mm, Max.err%=5.89%).

Methods
A cylindrical trabecular bone sample (height
11.5 mm, diameter 10.6 mm) was cut from human
femoral head and scanned using CT (Skyscan
1172) at the voxel size of 17.22 m. The sample
was compressed up to 1% global strain and rescanned. Following the procedure described in
[DallAra et al. 2014], a deformable registration
algorithm was applied to the undeformed and
deformed subsampled images (Nodal Spacing
12, equivalent to ~413 m) in order to measure
the local displacement map. The reconstructed
image dataset was subsampled to the voxel size of
34.44m and the solid phase was converted directly
into homogeneous microFE model using eight-node
hexahedral elements. The material properties of the
bone tissue were assumed to be isotropic and linear
elastic, with a uniform Youngs modulus of 17GPa
and a Poissons ratio of 0.3. The microFE boundary
conditions (top and bottom plane) were assigned
based on the experimental displacement values
using element shape functions. Local displacements
(along X, Y, Z and their magnitude) of microFE model
were calculated at the same spatial locations of
the experiment. Comparisons were made only in
the nodes of the experimental grid that lay on the
bone elements of the model.

Figure 1: C
 omparison between experimental and predicted
displacement magnitude

C o n cl u s i o n
There is a significant correlation between the
numerical predictions and the experiments.
It is concluded that, for the case considered,
homogeneous microFE model can predict
accurately the displacement field. Further analysis
will be performed on more samples and using
heterogeneous and nonlinear microFE models.
References
DallAra,E et al, J.Biomech., 47(12),
pp. 29562963,2014.
Donaldson FE et al, Proc IMechE, J Eng Med,
225(6), pp586596, 2011.
Ack n o wl e d g e m e n t
This study was partially supported by the FP7 European program MAMBO: PIEF-GA-2012-327357, the NC3R
funded project No. 113629 and the EPSRC funded
project MultiSim EP/K03877X/1; and by the EPSRC
funded project EP/K036939/1.

Results and discussion


Results show significant correlation between
the numerical prediction and the experiments
(X direction: y=1.0383x0.0072, R 2=0.911,
RMSE=0.0055mm, RMSE%=3.96%, Max.err=0.0345mm,
Max.err%=24.8%; Y direction: y=1.0299x0.0096,
R 2=0.983, RMSE=0.0059mm, RMSE%=2.75%,

101

O 077

LINKING PROXIMAL TIBIA BONE MICROARCHITECTURE


TO IN VIVO DYNAMIC JOINT LOADS IN END-STAGE
OSTEOARTHRITIS: PRELIMINARY RESULTS
E. Perilli1, B.C. Roberts1, D. Thewlis2, L.B. Solomon3 , G. Mercer4 , K.J. Reynolds1
1

Flinders University, Medical Device Research Institute, School of Computer Science,


Engineering and Mathematics, Adelaide, South Australia, Australia

University of South Australia, School of Health Sciences, Adelaide, South Australia, Australia
3

Royal Adelaide Hospital, Department of Orthopaedics and Trauma, Adelaide,


South Australia, Australia

Repatriation General Hospital, Department of Orthopaedic Surgery, Adelaide,


South Australia, Australia

Introduction
In human knee osteoarthritis (OA), local changes in
areal bone mineral density in the tibia, as measured
by dual X-ray absorptiometry, are suggested to be
related to abnormal in vivo joint loading [Thorp,
2006]. The relationship between in vivo measures
of knee joint loading and changes in subchondral
bone 3D microarchitecture, however, has not yet
been explored. The subchondral bone, a shock
absorber, protects the overlying cartilage against
damage due to excessive joint loading.

Results
Statistically significant differences (p<0.05) in
subchondral bone microarchitecture were found
among subregions. The AM ROI exhibited highest
BV/TV (+45% to +82%), trabecular number
(+40% to +49%), and lowest SMI (61% to 68%)
compared to the AL, PM and PL regions. BV/TV
in the AM region was negatively correlated with
the peak ERM (r= 0.72, p<0.05) (Fig. 1a) and peak
IRM (r= 0.68, p<0.05), and positively correlated
with the peak JCF (r=0.70, p<0.05) and KAM
impulse (r=0.76, p<0.05) (Fig. 1b). A positive
trend was observed for BV/TV AM vs. peak KAM
(r=0.55, p=0.124).

The aim of this ongoing study is to examine, on


end-stage OA patients undergoing total knee
replacement (TKR), the relationships between
knee joint loads measured in vivo using gait
analysis prior to surgery, and variations in bone
microarchitecture of their excised knees quantified
with 3D micro-computed tomography (micro-CT).
Methods
Nine knee-OA patients scheduled for TKR surgery
(age 676 years) underwent pre-operative gait
analysis. The kinetic variables, collected with
12 Vicon cameras and four force platforms, and
analysed with Visual3D v5.0, included the peak
external moments at the knee: external (ERM) and
internal rotation moments (IRM), knee adduction
moment (KAM) and knee adduction moment
impulse, all normalized by bodyweight (BW). The
peak tibio-femoral joint contact force (JCF) was
calculated with a musculoskeletal model in Matlab
[Delp, 1990].

Figure 1: ( a) scatter plot with best fit line of BV/TV AM vs.


peak ERMand (b) of BV/TV AM vs. KAM impulse.

Discussion
Our results suggest that, during stance, lower peak
ERM and IRM and higher JCF and KAM impulse are
significantly associated with higher BV/TV in the
AM tibial plateau. These associations with bone
volume fraction found in the AM tibial region could
be linked to an adaptation of the bone due to
altered loading patterns that generate increased
stresses in this condyle [Adouni, 2014]. Further
analysis is required to elucidate these relationships.
Patient recruitment is ongoing.

After surgery, the tibial plateaus were retrieved


and scanned with micro-CT (17 m pixel size). The
following subchondral bone 3D microarchitectural
parameters were analysed in four cylindrical
subregions of interest (ROIs, 10 mm diameter, 4 mm
length), selected via software in the antero-medial
(AM), antero-lateral (AL), postero-medial (PM) and
postero-lateral (PL) condyle: bone volume fraction
(BV/TV), trabecular thickness, trabecular number,
structure model index (SMI).

References
Adouni, M, et al, J Orthop Res, 32:6978, 2014.
Delp, SL, et al, IEEE Trans Biomed Eng,
37:757767, 1990.
Thorp, LE, et al, Bone, 39:11161122, 2006.

Subregional differences in bone microarchitectural


parameters were tested by Kruskal Wallis followed
by Mann-Whitney U tests. Associations between
measurements from gait analysis and bone microarchitecture were investigated using Pearsons
correlations.

102

O 078

CONTRIBUTION OF THE POROELASTIC BEHAVIOUR


OF BONE ULTRASTRUCTURE TO THE STRAIN RATE
DEPENDENT BEHAVIOUR OF BONE TISSUE
S. Le Pense1, E. Sales2, K. Manda2, R. Wallace3 , P. Pankaj2, Y. Chen1
1

Heriot-Watt University, School of Engineering and Physical Sciences,


Edinburgh, United Kingdom

The University of Edinburgh, Institute for Bioengineering, School of Engineering,


Edinburgh, United Kingdom

The University of Edinburgh, Department of Orthopaedic Surgery, Edinburgh, United Kingdom

Introduction
Current research to improve osteoporotic fractures
predictions mainly focuses on the influence
of microstructure on bone tissue mechanical
properties. However, although fracture often
happens during a fall, loading rate dependency
is rarely taken into account. It has been shown
that bone stiffness and strength increase for higher
strain rates [Carter, 1977].
The study of bone at the microscale shows that
bone ultrastructure, making up cancellous bone
trabeculae as well as cortical bone, is a porous
material, where porosity is made from the lacunar-canalicular network. A poroelastic approach can
be used to model this material [Cowin, 1999].
A few recent studies have used poroelasticity
for bone modelling [Sandino, 2015]. However,
the poroelastic properties found in the literature
showed a great variability, and the poroelastic
behaviour is expected to be sensitive to in situ
loading and boundary conditions.

Figure 1: E
 volution of the stress normalized by the stress
at low strain rate, as a function of strain rate,
for a confined compression test.

Results
Results are also shown to be sensitive to poroelastic
properties such as permeability and elasticity
parameters, for which accurate measurements
are challenging at this scale and considerable
variation can still be found from the literature. It is
also shown that poroelastic behaviour is strongly
affected, as expected, by bone microstructure.

The aim of this work is therefore to explore the


contribution of poroelasticity to the strain-rate
dependent behaviour of bone, while taking
into account the effect of material properties,
boundary conditions and microstructure.
Methods
In this study, we use bone tissue 3D images obtained
with X-ray microtomography, and assume the
solid part of this foam-like structure to be a porous
material filled with fluid. Bone microstructure is
segmented and meshed in ScanIP (Simpleware
Ltd, UK), and a poroelastic model, together with
a coupled pore fluid diffusion and stress analysis, is
used in Abaqus (Dassault Systmes, France).

Discussion
Results are very sensitive to boundary conditions,
which highlights the importance of carefully-chosen experimental settings used to study bone
mechanical properties. These should be as close
as possible to in vivo conditions, which are not yet
very well understood.

Several sets of parameters are applied, in order


to span the large range of values measured in
previous studies. Different fluid and solid boundary
conditions are utilised. The effect of bone
microstructure on poroelastic effects is also studied.

References
Carter and Hayes, J Bone Joint Surg,
59:954962, 1977.
Cowin, J Biomech, 32:217238, 1999.
Sandino et al, J Mech Behav Biomed, 44:19, 2015.

103

O 079

MASSIVE PARALLEL SIMULATIONS OF TRABECULAR BONE


F. Levrero Florencio1, L. Margetts2,3 , K. Manda1, P. Pankaj1
1
2

The University of Edinburgh, Institute for Bioengineering, Edinburgh, United Kingdom

University of Manchester, School of Earth Atmospheric and Environmental Sciences,


Manchester, United Kingdom
3

University of Oxford, Oxford e-Science Research Centre, Oxford, United Kingdom

Introduction
Bone is a hierarchical material, with complex
properties at each of its different working scales
[Schwiedrzik, 2013]. Within the bone microstructure,
the solid phase is generally assumed to be isotropic
elastoplastic [Niebur, 2000] while bone at the macroscale exhibits anisotropic elastoplasticity due to its
micro-architecture. Micro-FE (FE) simulations of
bone have been extensively used in the past to
evaluate its elastic properties [Donaldson, 2011]. In
these, the FE meshes are constructed from CT
images. Post-elastic behaviour is rarely simulated at
this scale. A non-linear problem with large RVE sizes
and high resolution meshes makes the simulations
computationally prohibitive even on large parallel
systems as iterations are required within each load
increment for implicit problems, and the meshes
may have more than tens of millions of degrees
of freedom (DOF). On parallel computing systems,
the time taken for solutions would ideally scale with
the number of cores used. In the context of FE, this
has been achieved with elastic problems but not
with those involving elastoplasticity. The aim of the
study was to develop an implicit FE solver within the
framework of the existing parallel solver ParaFEM
[Smith, 2014] to operate on parallel computing
systems and which is scalable with a large number
of cores for finite strain elastoplastic problems.

plasticity. Trilinear fully integrated hexahedra were


used. The scalability was tested using different
number of cores on an IBM BlueGene/Q.
Results
The time required to solve the two meshes with
different number of cores is given in Table 1.
DOF

Number
of cores

Time (s)

1,000,000

64

7,884

1,000,000

512

1,178

1,000,000

2,048

544

10,000,000

4,096

2,100

Table 1: R
 unning times for the test problems

Discussion
The simulation was performed using implicit FE,
in 100 load increments. Geometrical nonlinearity
initiates with loading and localised yielding started
very early in the loading process, requiring several
Newton-Raphson iterations for some load steps.
Running times show that the driver program is able
to scale with large number of cores when dealing
with these nonlinear problems. With this code,
massive non-linear simulations can be performed
within a reasonable time and new constitutive
laws can be introduced in a very simple manner.
Our ongoing work involves incorporation of other
realistic and complex nonlinear constitutive models
to simulate the post-elastic micromechanical
behaviour of bone.
Ack n o wl e d g e m e n t s
The authors would like to thank The Hartree Centre,
Science and Technology Facilities Council for access
to their IBM BlueGene/Q system through project
HCP010.
Ec t r o m y o g r K i n e s i o l , 2 1 : 1 0 7 4 8 0 , 2 0 1 1 .

Figure 1: 1
 0 million trabecular bone FE mesh

Vieira et al, J es
Schwiedrzik J.J. et al, Biomech Model Mechanobiol,
12: 11551168, 2013.
Niebur G.L. et al, J Biomech, 33: 15751583, 2000.
Eterovic, A.L. et al, Int J Numer Meth Engng,
30: 10991114, 1990.
Smith I.M., et al, Programming the Finite Element
Method, Wiley, 2014.
Donaldson F.E. et al, Proc Inst Mech Eng H J Eng
Med, 225: 585596, 2011.

Methods
A return-mapping format based on logarithmic
strains is used [Eterovic, 1990]. It permits use of
material subroutines that are very similar to ABAQUS
(Simulia, Providence USA) user material subroutines
(UMAT). Two test problems were created from
CT scanned ovine trabecular bone samples
comprising of 1 million and 10 million DOF.
The simulations consisted in a 2% apparent
compression with kinematic boundary conditions,
using 100 load steps. The constitutive law is elastic
(linear relationship between the Kirchhoff stress
and the logarithmic strain) followed by von Mises
104

O 080

MICROMECHANICAL THREE-POINT-BENDING TEST


OF LAMELLAE IN CORTICAL BONE
V. Nedelkovski1, O.G. Andriotis1, P.J. Thurner1
1

Vienna University of Technology, Institute of Lightweight Design and Structural Biomechanics,


Vienna, Austria

Introduction
Bone achieves its unique mechanical properties
due to a complex hierarchical architecture. To
understand bone mechanics, investigation of
deformation mechanisms at different length-scales
is required. At the macroscale, biomechanical
testing of bone has been performed for more than a
century, whereas investigating the microstructural
features, such as individual lamellae, remains
a challenge. Here we propose a method for
micromechanical testing of lamellar bone in the
form of a microbeam bending test.

Results
A beam with a total length of 80 m and a length
of 60.3 m between the supports, 11.9 m in width,
5.7 m in height was machined via FIB milling. SEM
images (Fig.1A) revealed an intact three-pointbending microstructure at the lamellar length scale.
Indentation modulus in transverse direction on the
supports was found to be 20.4 GPa (spherical tip)
and 26.8 GPa (Berkovich tip). Further the bending
modulus (elastic constant in the longitudinal
orientation of the beam/lamellae), was found to
be 20.67 GPa and the yield stress was found to be
0.36 GPa.

Methods
Transverse slices were initially cut from the distal
bovine femur with a diamond-coated band saw
(Exakt-300CP) and radial specimens were cut in
the anterior/posterior direction using a low-speed
saw (Buehler Isomet). To produce two smooth
and perpendicular surfaces with a sharp edge,
the superior cut was polished with a diamond
suspension and the anterior surface was ultramilled
with a diamond ultramiller (Leica-SP2600).
Subsequently, a 2 mm thick sample was prepared
with the low-speed saw. Finally, the sample was
mounted on a stage of a dual beam microscope
(FEI Quanta-200-3D-DBFIB) incorporating both
scanning electron microscopy (SEM) and focused
ion beam (FIB). FIB milling operated at 30 kV was
performed from two different sides of one of the
straight edges of the sample in several steps from
coarse to fine milling with ion beam currents ranging
20 nA to 1 nA, respectively. This way a three-pointbending geometry was produced consisting of 23
lamellae with the long axis of the beam parallel to
the long axis of the lamellae. Mechanical testing
was performed in air with a Nanoindenter (Hysitron
Triboindenter-TI900) using a diamond spherical
cone tip of 5 m tip radius and 65 cone angle to
minimize indentation depth. In addition to bending
of the beam, indentation measurements were
performed on both supports of the beam as well as
the surrounding bulk in the vicinity of the beam with
the same tip and with a conventional Berkovich
tip. Assuming that the bending measurement
consists of a pure bending and indentation part,
the displacement of the nanoindentation curve
was subtracted from the bending curve to obtain
a pure bending force vs. deflection curve (Fig. 1C).
A theoretical model of a beam clamped at both
ends was used to analyse the data. A straight line
was fitted to the linear portion shown in Figure 1C
to obtain a flexural stiffness value. Yield stress in
the longitudinal direction was computed at the
qualitatively estimated yield point of the bending
curve (data not shown). Nanoindentation data was
analysed according to the Oliver-Pharr Method.

Figure 1. ( A) SEM-image of cortical bone microbeam


after FIB-milling. (B) Schematic representation of
bending with spherical tip. (C) Force-displacement
curve from microbeam bending experiment

see the next page

105

Discussion
Values of the indentation modulus in transverse
direction, as well as of the bending modulus
and yield stress in longitudinal direction were
comparable to a recent study employing
micropillar compression [1]. Consequently, threepoint-bending testing at the microscopic level
of bone may provide similar, while offering fewer
experimental challenges. We envision that FIB
milling will further enable preparation of samples

for the direct mechanical characterisation of


individual lamellae, interlamellar areas and
cement lines in various loading modes. We expect
this to enhance our understanding of the origin of
bone quality at the nano- and microscale.
References
1 Schwiedrzik et al., 13, NatMater 2014

106

O 0 81

MUSCLE FORCES INFLUENCE THE TOPOLOGY


AND MAGNITUDE OF CONTACT JOINT FORCES
IN THE NATIVE AND PROSTHETIC ANKLCE
T. Natsakis1, J. Burg2, G. Dereymaeker1, J. Vander Sloten1, I. Jonkers2
1

KU Leuven, Mechanical engineering, Heverlee, Belgium


2

KU Leuven, Kinesiology deparment, Heverlee, Belgium

Introduction
Osteoarthritis (OA) is a common degenerative joint
disease in the ankle, with high economical and
societal impact. It is mainly of post-traumatic nature
[Valderrabano et al., 2009] and several reports link
it with aberrant loading. The loading conditions in
the joint are mainly affected by the gait kinematics
and kinetics; however, considerable loading is also
due to muscle forces. In this study, we investigated
the influence of individual muscle forces on the
load magnitude and distribution in the human
ankle. The investigation was performed before and
after performing a Total Ankle Arthroplasty (TAA).

Figure 1: C
 hanges on the peak pressure with increasing
muscle force from the Peronei, Tibialis Anterior,
Tibialis Posterior and Triceps surae muscle groups
for the native (red) and TAA (blue) joint.

Methods
10 cadaveric foot specimens, amputated midtibially, were used to perform muscle perturbations
before and after the insertion of a Hintegra three
component TAA. The force delivered to the
tendons of six muscle groups was controlled by a
custom built cadaveric gait simulator [Peeters et
al., 2013]. Prior to the measurements, a calibrated
Tekscan #5033 pressure sensor was inserted in the
ankle joint and was fixated to the distal end of
the tibia. The magnitude of the peak pressure and
centre of pressure (CoP) location was quantified
at three static positions during the perturbations.
The three positions were representative of the
beginning, middle and end of stance phase.
To quantify the influence of muscle force on the
measured parameters, linear mixed effect models
were calculated for each position and muscle for
the two measured parameters.

Figure 2: C
 hanges on the location of CoP with increasing
muscle force from the Peronei, Tibialis Anterior,
Tibialis Posterior and Triceps surae muscle groups
for the native (red) and TAA (blue) joint.

C o n cl u s i o n
We are able to quantify the influence of muscle
force on the loading conditions in the native and
TAA ankle joint. This information is useful when
designing muscle training strategies targeted at
relieving the articular surface areas that have
higher risk of OA. This is highly relevant as it has
been reported that the anterior and medial
regions of the talus have higher incidence of OA
[Koepp et al., 1999]. Furthermore, such information
is useful when designing TAA components, as the
compensations in muscle forces seen in patients
after surgery could affect the stability and wear of
the prosthetic components.

Results
For the native ankle joint in the beginning of stance,
a 100% increased force from triceps surae and
tibialis posterior muscles results in an increased peak
pressure in the joint by 17% and 18% respectively.
A decrease of 18% on peak pressure was measured
with increase of tibialis posterior. Similar influence
was measured for the TAA joint. Furthermore, the
location of the CoP was influenced with increase of
peroneal, tibialis posterior and triceps surae muscles,
shifting it towards the lateral and posterior direction.

References
Koepp et al., J Orthop Sci, 4:40712,1999
Peeters et al., P I Mech Eng H, 227:95567, 2013
Valderrabano et al., Clin Orthop Relat Res,
467:18006, 2009.

107

O 082

CONTACT PATTERNS IN THE TRAPEZIOMETACARPAL


JOINT DURING ISOMETRIC TASKS OBTAINED VIA
MATHEMATICAL MODELING
B. Dourthe1, P. DAgostino1, F. Stockmans2, E. Vereecke1
1

KU Leuven Kulak, Development and Regeneration, Kortrijk, Belgium


2

AZ Groeninge, Campus Loofstraat, Kortrijk, Belgium

Introduction
A clinically relevant way to investigate the
biomechanical behavior of the trapeziometacarpal
(TMC) joint is to evaluate its contact patterns
during isometric tasks. This will help us to obtain a
better understanding of the onset of osteoarthritis
(OA) and will eventually improve prevention and
treatment strategies of this highly disabling disease.
Methods
CT scans of the hand region of 20 female
volunteers (mean age: 60.8 years) were taken in
three different configurations: relaxed neutral,
lateral pinch and power grasp, using a radiolucent
jig with embedded load cell (Brown University,
USA). Four subjects showing radiological signs of
OA were excluded from the study. Scans were
segmented using Mimics (Materialise, Belgium)
and 3D models of the first metacarpal (MC1) and
the trapezium were created. The articular area
of each bone was quantified based on manual
measurements performed on the 3D bone models.
A custom-written Matlab code based on the
finite deformation biphasic theory 1 and cartilage
deformation properties 1, 2 was developed to
evaluate the contact area and stress distribution
of each bone. A quadrant division method 3 was
used to identify articular sub-regions subjected to
the highest stress.

Figure: Contact stress pattern of one subject during power


grasp: a) MC1; b) Trapezium (right hand)

Discussion
The findings suggest that a power grasp task
elicits higher contact stresses and might therefore
represent a more critical configuration for clinical
evaluation of the TMC joint. Lateral key pinch, on
the other hand, might create a higher joint instability
and is less reproducible. The mathematical model
presented in this paper offers the possibility to
predict contact patterns within the TMC joint
based on in vivo CT scans. Such a model can
provide relevant results which can help to achieve
a better understanding of joint functioning, and
is also particularly important in establishing new
prevention approaches.

Results
Measurements of the total articular area of the
MC1 and the trapezium presented no significant
difference (p > 0.1). A slightly smaller contact area
was calculated for the trapezium compared to the
MC1, however, this was only statistically significant
in the lateral pinch position (p < 0.05). Similar
amounts of stress were reported in the neutral and
lateral pinch configurations, while the power grasp
configuration displayed the highest stress levels.
Very consistent results for high stress location on
the volar/radial articular sub-region were found in
the neutral and power grasp configuration. More
variation was reported during lateral pinch.

References
[1] Kwan et al., J. Biomech, 23: 145155, 1990;
[2] Koff et al., J Hand Surg, 28A: 597604, 2003;
[3] Momose et al., J. Hand Surg, 24A: 491495, 1999

108

O 083

EXPLORING THE BIOMECHANICS OF FETAL MOVEMENT


S. Verbruggen1, J. Loo1, A. Phillips2, N. Nowlan1
1
2

Imperial College London, Bioengineering, London, United Kingdom

Imperial College London, Civil and Environmental Engineering, London, United Kingdom

Introduction
Kicking and movement in the womb are a
natural part of fetal development. Recent studies
have shown that mechanical forces generated
by fetal movement are important for prenatal
musculoskeletal development [Nowlan, 2010],
particularly joint shape [Kahn, 2009]. Significantly,
abnormal joint shape leads to increased risk of
osteoarthritis in later life [Muller, 1953]. A relatively
common example of abnormal joint shape is
developmental dysplasia of the hip (DDH) [Leck,
2000]. Risk factors for DDH include fetal breech
position [Muller, 1953], low amniotic fluid volume
(oligohydramnios) [Hinderaker, 1994], and neuro
muscular disorders [Homer, 2000]. In each of these
cases, the movement of the fetus is restricted.
However, the biomechanics of fetal movements
remain poorly understood.

Discussion
This study provides a novel insight into the
biomechanical environment of the womb, through
the use of cine-MRI data of fetal movements.
With the development of custom-designed
tracking software and computational models, we
characterised the deflection of the womb wall and
the force generated by a fetal kick. This research
represents the first quantification of forces in the
skeleton due to fetal movements, and these results
will be applied in a second set of FE models of fetal
joints to investigate the local biomechanical stimuli.
This computational pipeline will enable us to
identify environments which increase the risk of
joint malformations, helping clinicians to consider
interventions pre-natally, to perform more intensive
screening on at-risk infants after birth, or to prescribe
suitable post-natal physiotherapy. This research
may therefore inform future preventative measures
for neonatal joint conditions such as DDH, thereby
potentially reducing the risk of osteoarthritis in later life.

Therefore, the objective of this research is to


employ computational techniques to quantify
the mechanical forces due to fetal movements
on prenatal skeletal development, with particular
emphasis on the hip.

References
B
 uerzle et al, Biomech Model Mechanobiol,
12:4, 2011;
D
 elp et al, IEEE Trans Biomed Eng, 2007;
H
 inderaker et al, Acta Orthopaedia Scandinavia,
65:3, 1994;
H
 omer et al, Paediat, 105, 2000;
H
 ayat et al, Am J Neuroradiol, 32:2, 2011;
K
 ahn et al, Developmental Cell, 16:5, 2009;
L eck, Lancet, 355:9199, 2000;
M
 uller et al, J Bone Joint Surg, 35, 1953;
N
 owlan et al, Bone, 46:5, 2010

Methods
Using novel cine-MRI techniques to capture fetal
movements in utero [Hayat, 2011], we developed a
method to automatically track joint displacements
during fetal kicking. It was thus possible to elucidate
the displacement of the womb wall caused
by kicking of a 21-week old fetus (Figure 1A).
A finite element (FE) model of the uterine wall was
generated, comprising a thin fetal membrane
and a thick uterine wall with material properties
obtained from literature [Buerzle, 2012]. Using this
model, the reaction force was calculated resulting
from the movement observed in the cine-MRI
(Figure 1B).

Ack n o wl e d g e m e n t s
Access to fetal cine MRI scans courtesy of Profs
Rutherford & Hajnal (Kings College London);
assistance from A. Gopalakrishnan and A. Montanino
(Imperial College London) and funding from Arthritis
Research UK are gratefully acknowledged.

The data obtained from these two steps


were applied as boundary conditions for a
musculoskeletal model of the fetal leg in OpenSim
[Delp, 2007], scaled to the dimensions of the fetus
investigated (Figure 1C). Inverse dynamics and
static optimisation were performed, predicting
the intramuscular forces required to generate
observed motion.
Results
It was found that maximum displacement of the
uterine wall due to kicking was approximately
7.37 mm. This displacement, when applied in the
FE model, resulted in a maximum reaction force
of approximately 0.17 N. These conditions resulted
in predicted forces of 4.06 N, 6.06 N and 9.66 N
generated by the rectus femoris, gluteus medius
and biceps femoris muscles, respectively.

Figure 1: ( A) Tracking of fetal joint movements, (B) FE model


of effect of displacement on womb (stress shown)
and (C) musculoskeletal model of intramuscular
force

109

O 084

MUSCULAR ACTIVITY DURING ISOMETRIC INCISAL BITING


U. Santana-Mora1, A. Martnez-nsua1, U. Santana-Penn1, A. P. del Palomar2,
J. C. Banzo2, M.J. Mora1
1
2

University of Santiago de Compostela, Stomatology, Santiago de Compostela, Spain

Universidad de Zaragoza, Biomaterials Group, Aragon Institute of Engineering Research,


Zaragoza, Spain

Introduction
This study attempted to estimate TMJ loading
during incisal loading using a custom load-cell
device and surface electromyographic (sEMG)
recordings of the main jaw closers to assess the
outcome correlation.

Results
The mean (SD) submaximal incisal load recorded
was 498 (305.78) N, and the mean at 50% of the
submaximal load was 268.93 (147.37) N. Mean
(SD) sEMG activity during submaximal clenching
was 141.23 (87.76) V, with no significant differences
between the four muscles. During submaximal
voluntary
incisal
loading,
the
normalized
mean sEMG activity was 49.99 (34.54) mV %, and
27.17 (15.29) mV % during mean (50%) effort.

Methods
Study participants were 23 healthy volunteers. The
incisal loads having submaximal and mean intensity
were recorded using a calibrated electronic load-cell; simultaneously, surface electromyography
(sEMG) of the right and left masseter and
temporalis muscles was recorded. Readings of
the resting, clenching in maximal and submaximal
intercuspal positions and mean (50%) incisal loads
were recorded. Clenching sEMG activity was used
as a reference for normalization.

Discussion
The incisal load was generated mainly by the
masseter muscles, as these showed a positive
correlation during mean but not during submaximal
effort. In the edge-to-edge jaw position,the mean
incisal load effort seems to be physiological,
but excessive TMJ loads can be expected from
chronic or excessive incisal loading. In conclusion,
incisal loads require the activity of the masseter
muscles,which show a positive correlation between
sEMG activity and effective incisal loads during
mean,but not during submaximal, effort, and the
masseter muscles are dominant over the temporalis
muscles during submaximal incisal biting.

110

O 085

INFLUENCE OF HUMAN TMJ EMINENCE INCLINATION


ON THE MASTICATORY MUSCLES FORCES:
SENSITIVITY ANALYSIS
M. Markov1, L.M. Gallo1
1

University of Zrich, Center of Dental Medicine, Zrich, Switzerland

Results
With increasing eminence inclination, the muscle
forces on the working side increased considerably
for some muscles (anterior temporalis by 60%),
decreased for others (superficial masseter by 25 %),
or stayed at a similar level (anterior mylohyoid);
the muscle forces on the balancing side mostly
increased. With increasing eminence inclination,
the reaction force in the working TMJ increased
from 100 N for 30 to nearly 160 N for 70; in the
balancing TMJ the reaction force increased for
some inclinations and decreased for others.

Introduction
Inverse dynamic modeling is a valuable method
that helps calculating the activation of complex
muscle systems starting from kinematic and
anatomical data and is useful in several fields, such
as sports training, ergonomics, and even dentistry.
A major prerequisite for the use of a mathematical
model is that it is verified and validated (Anderson
et al., 2007; Hannam, 2011; Sargent, 2011).
Furthermore, sensitivity analysis should be held to
determine the relative significance of the various
input parameters and their influence on the
output (Hannam, 2011; Weiss et al., 2005). A large
set of musculoskeletal models of different parts
of the human body exists, but only few of these
models describe the temporomandibular joint
(TMJ) (Koolstra, 2002; Peck and Hannam, 2007).
Aim of this paper was to investigate the change in
masticatory muscle forces and temporomandibular
joint reaction forces when the steepness of the
anterior fossa slope was varied.

Discussion
With the change of eminence inclination from
30 to 70 the muscle forces during unilateral
clenching changed up to 166 % and the joint
forces up to 160 %. The eminence inclination in
mathematical models should be chosen consistently
with the CT/MRI-scan data used to create the
3D model and not only from literature data.

Methods
We used the model by Mark de Zee (de Zee et
al., 2007) created in AnyBody . The model was
equipped with 24 musculotendon actuators.
Mandibular movement was governed by the
trajectory of the incisor point during chewing. The
TMJ was modeled as a planar constraint canted
5 medially and the caudal inclination relative to
the occlusal plane was varied from 10 to 70

References
Anderson et al., 2007, Comput Method Biomec 10,
171184.
de Zee et al., 2007, J Biomech 40, 11921201.
Hannam, 2011, J Oral Rehabil 38, 217234.
Koolstra, 2002, Crit Rev Oral Biol M 13, 366376.
Peck and Hannam, 2007 Arch Oral Biol 52, 300304.
Sargent, 2011 In: Proceedings of the 2011 Winter
Simulation Conference, Phoenix, AZ, USA.
Weiss et al., 2005 Med Eng Phys 27, 845861.

111

O 086

WEAR MODE OF ARTIFICIALY AGED UHMWPE KNEE


BEARINGS EVALUATED BY THE SIMULATION OF DAILY
PATIENT ACTIVITIES
J. Schwiesau1, B. Fritz1, I. Kutzner2, G. Bergmann2, T.M. Grupp1,3
1
2
3

Aesculap AG, R&D, Tuttlingen, Germany

Charit-Universittsmedizin, Julius Wolff Institut, Berlin, Germany

Ludwig-Maximilians-University, Campus Grohadern, Orthopedic Department,


Munich, Germany

Results

Introduction
Abrasive wear and delamination are the
dominating wear phenomena observed in total
knee arthroplasty (TKA). The prevalence of the wear
mechanisms depends on the applied stress level
and the material properties of the bearing. With
increasing stress and reduced material properties
due to aging, delamination occurs more frequently.
To reduce the delamination risk of Ultra High
Molecular Weight Polyethylene (UHMWPE) knee
bearings, the aging resistance of the material should
be improved. Blending UHMWPE with Vitamin E is
one way to reduce oxidation, the dominant aging
process in the reduction of material properties of
knee bearings. To evaluate the influence of Vitamin
E blending on the wear behaviour, conditions
are simulated to induce clinically observed
delamination in the reference material.

Figure 1: A
 verage wear of the bearing materials during
5million test cycles

Methods
Daily patient activities [1] are applied on three
artificially aged UHMWPE knee bearings with and
without 0.1% Vitamin E. Artificial aging is applied
according to ASTM F2003-2 for two weeks on
the bearings after sterilization by irradiation with
30 2 kGy. A cruciate retaining TKA design with
a CoCr femoral counterpart was used. Medio
lateral load distribution and soft tissue restrain
was simulated. The application of high flexion
activities was increased compared to normal
patient activity (40% stairs ascending, 40% stairs
descent, 10% level walking, 8% chair raising,
2% deep squatting).[2] An estimated time of
30 years is necessary to accumulate the same
number of high flexion activities in vivo for a patient
with an average activity level. Environmental
test conditions from ISO 14243-1 are applied.
The specimens were evaluated according to
ISO14243-2 for the gravimetric wear and optically
analyzed for their wear mode.

Figure 2: R
 epresentative bearing contact area with the
femoral component after 5 million test cycles, left
UHMWPE + Vitamin E right UHMWPE (scaling 1mm)

References
[1] Bergmann G, Bender A, Graichen F, Dymke J,
Rohlmann A, et al. (2014) Standardized Loads
Acting in Knee Implants. PLoS ONE 9(1): e86035.
doi:10.1371/journal.pone.0086035
[2] Schwiesau J, Fritz B, Kutzner I, Bergmann G,
Grupp TM., CR TKA UHMWPE Wear Tested after
Artificial Aging of the Vitamin E Treated Gliding
Component by Simulating Daily Patient
Activities., Biomed Res Int. 2014;2014:567374. doi:
10.1155/2014/567374. Epub 2014 Nov 20.

Discussion
With the applied test protocol it is possible to
discriminate between the two bearing materials.
Delamination was not observed for the Vitamin E
blended material (Figure 2). Delamination began
after 2.0 million test cycles for the conventional
UHMWPE, indicated by the transition between
linear and exponential slope in Figure 1.

112

O 087

EFFECT OF SETUP AND INPUT CONDITIONS OF THE WEAR


OF A TOTAL KNEE REPLACEMENT: AN EXPERIMENTAL
AND COMPUTATIONAL STUDY
A. Abdelgaied1, C. Brockett1, T. Haythornthwaite1, C. Hardaker2,
J. Fisher1, L. Jennings1
1

University of Leeds, School of Mechanical Engineering, Leeds, United Kingdom


2

DePuy Synthes, Leeds, UK, DePuy Synthes, Leeds, United Kingdom

Introduction
Advancements in knee replacements design,
material and sterilisation properties have shown
improved clinical results. Further developments
are however on-going to address the needs of
the more demanding patient. The present study
investigated the effect of kinematics and femoral
centre of rotation setup on the wear performance
of a fixed bearing total knee replacement through
experimental and computational studies.

design, or according to the ISO specification


(ISO14243-3). Several test conditions were explored
through the study (Table 1). For the ISO setup, the
direction of the anterior-posterior displacement
was reversed with anterior translation of the
femoral component, preventing femoral roll back
and keeping the contact in the centre of the tibial
insert. The lubricant used was new-born calf serum,
diluted to 25%, and the wear was determined
gravimetrically. The computational framework
was adapted according to the experimental test
setup and was based on the contact area, sliding
distance and an independent experimentally
determined non-dimensional wear coefficient, a
function of cross-shear ratio (CS), to calculate the
volume wear loss. The computational framework is
described elsewhere [1].

Materials and Methods


Sigma fixed bearing cruciate retaining total
knee replacement (DePuy Synthes, Leeds, UK),
with GUR1020 UHMWPE inserts, was investigated
using a physiological six station Prosim knee wear
simulator. The femoral bearings were set up either
on the distal radius, as indicated by the device
Centre of Rotation

Distal Radius

Distal Radius

ISO

ISO

ISO

Kinematic Condition

High Kinematics

Intermediate
kinematics

Modified high
kinematics

Modified
intermediate

kinematics

ISO

Peak load/kN

2600

2600

2600

2600

2600

Anterior-posterior
displacement

0 to 10 mm

0 to 5 mm

0 to 10 mm

0 to 5 mm

0 to 5 mm

Internal-external
rotation

2 to +5.5

Flexion-extension

058

058

058

058

058

Table 1: Experimental test conditions:

Results
The wear rate measured on the distal centre of
rotation with high kinematics (9.2 2.9 mm 3/MC)
was found to be almost double the wear rate of the
ISO centre of rotation with modified high kinematics
(4.7 1.6mm3/MC; ANOVA, p<0.01). In addition,
increasing the kinematic level on distal centre of
rotation, from intermediate to high kinematics,
increased the measured wear rate, from 3.16 2
to 9.2 2.9 [mm 3/MC] respectively (ANOVA,
p>0.05). In contrary, increasing the kinematic

level on ISO centre of rotation, from intermediate


to high kinematics, decreased the measured wear
rate. There was a little difference between the high
and ISO kinematic conditions under ISO centre
of rotation setup (ANOVA p > 0.05), with a small
increase in wear rate observed under ISO input
kinematics (5.2 1.9mm3/MC) (Figure 1). Reversing
the intermediate kinematic inputs polarity under
the distal centre of rotation, in the computational
model, reduced the predicted wear rate from
6 to 4.8 [mm3/MC] respectively.
see the next page

113

D i s c u s s i o n a n d C o n cl u s i o n :
The current experimental and computational
studies have shown that the most important factor
influencing the wear of TKRs was the position of the
relative contact point at the femoral component
and tibial insert interface. The shift in the relative
contact position affected the contact area and
the resultant cross shear and therefore wear of
the polyethylene (Figure 1). Although the recently
revised version of ISO has reversed the kinematic
polarity (ISO 14243-3-2014), the results suggest a
need to revise the ISO centre of rotation setup
to match physiological setup and replicate the
wear rates found clinically. In addition, when
examining the wear performance of a total knee
replacement, it is critical to consider both the input
kinematics and the test setup conditions, and to
test a device under a combination of conditions
which yield the appropriate physiological relative
velocities and contact mechanics.

Figure 1: E
 xperimental (mean 95% CI) and computational
wear rates and CS for fixed bearing total knee
replacement, with GVF bearing material, under
different setup and kinematic conditions.

References
[1] Abdelgaied et al. J Biomechanics, 44,
11081116, 2011.

114

O 088

WEAR PREDICTION OF THE TKP UHMWPE TIBIAL INSERT


V. Florescu1, C. Lucian2, V. Luige2
1
2

University of Civil Engineering, Material Technologies, Bucharest, Romania

Institute of Solid Mechanics of the Romanian Academy, Biotribology Department,


Bucharest, Romania

Introduction
Clinical studies on the massive wear of the tibial
polyethylene insert caused by improper contact
gear for the artificial knee joint, have shown that
this is the main cause for the correction of the
knee prosthesis. Knight et al. reports that in all of
the 18th worn prosthesis (out of 209 cases of primary
arthroplasty for knee joint) we can observe wear
pits on the surface of the tibial insert (specific
to the adhesive wear) as well as delaminating.
Prosthesis life was about 80 months, close to the
time reported in [1] that is 72 months. There were
also studies on the massive delaminating of the
polyethylene occurred earlier [2, 3].

new control functions. The hybrid position-force


control in Cartesian coordinates, conceived as
a control system in open architecture (OAH), is
realized by processing in real time the Jacobean
matrix obtained from kinematics through Danevit
Hartenberg method with the calculus of the
inverse Jacobean matrix for back loop control. The
studying method is produced a control system for
knee prosthesis simulator on 5 degree of freedom
which maintains a constant force of vertical
pressure on the tibial component.
The fatigue wear was identified as the main
phenomenon on responsible for the polyethylene
tibial insert failure. Clinical studies show that even
tibial parts that are retrieved for other reasons
(implant loosening, misalignment, etc.) presented
markers of fatigue wear (cracks in the subsurface,
wear pits, delamination, and loss of large pieces of
polyethylene). The cumulative nature of the wear
fatigue phenomenon requires a qualitative and
quantitative evaluation of the transfer of loadings
through the joint and a summation technique that
is relevant for the variety of the human activities.
The first part was assessed by a combination
of dynamic finite element analyses of the joint
contact mechanism. For the second part, we
assumed that normal walking, stair ascending and
stair descending were the regular activities with a
dominant impact on the phenomenon.

Exp e r i m e n t a l M e t h o d s
It was analyzed the contact mechanism of
femoral condyle tibial insert, based on the ball
on flat contact. Were you set parameters for
wear of UHMWPE tibial insert. Was developed a
knee prosthesis simulator (KPS) control system,
a new method developed for hybrid position
force control on five degrees of freedom (DOF)
in an open architecture with PC interfaced multiprocessor PLC system, in order to obtain new
control functions.
Results and Discussion
The first experiments carried out, using only FE and
APT movements, led to a very small wear rate. The
wear is manifested by the appearance of wear pits
on the side surfaces of the polyethylene tibial insert
due to its cyclic mechanical loading.

C o n cl u s i o n
Appreciating the wear of the tibial tray of total
knee prosthesis is very difficult. Measuring the wear
becomes more challenging due to polyehylenes
considerable yield.
The initial polishing of the polyethylenes contact
surface is a sign certifying the adhesive nature of
wear. The results obtained lead to the conclusion
that many clinically reported failures of the tibial
tray are caused by the mechanisms of adhesive
and fatigue wear.

Figure 1: T he wear of tibial insert using only FE and APT


movements (left) and the its severe wear using FE,
APT and IOR movements.

Aiming to improve the performance of knee


prosthesis simulator (KPS) control system, a new
method has been developed for hybrid positionforce control on five degrees of freedom (DOF)
in an open architecture with PC interfaced
multi-processor PLC system, in order to obtain

References
1 Heck D.A., et al., Orthopedics, 15: 2328, 1992.
2 Engh G.A., et al., J Bone Joint Surg, 917, 1992.
3 Jones S.M.G., et al., J Bone Joint Surg, 74B,
1822, 1992.

115

O 089

WEAR SIMULATOR STUDY OF TOTAL KNEE REPLACEMENT


WITH ADVANCED LOAD AND KINEMATIC TEST
CONDITIONS
C. Zietz1, H. Dempwolf1, R. Dammer1, A. Wolf1, R. Bader1, E. Mick1
1

University Medicine Rostock, Department of Orthopaedics, Rostock, Germany

Introduction
Wear analyses for new knee implant designs or
materials were usually performed using standard
test conditions according to ISO 14243. This
standard defines the forces and movements
during the wear test corresponding to continuous
walking. But the activity of patients supplied with
a total knee replacement (TKR) is a sequence
of different activities besides walking [Morlock,
2001], so that despite of preclinical standard
wear tests implants fail in vivo. Furthermore, from
instrumented TKR realistic forces and movements
are available for application to wear simulator
tests [Bergmann, 2014]. The aim of this study was
to compare the wear of the UHMWPE inserts of a
TKR under standard and advanced test conditions.

Discussion
Based on instrumented TKR systems realistic
kinematics loading can be determined for
biomechanical studies as wear simulator tests.
Compared to standard wear simulator tests, the
application of increased load and expanded
kinematics leads to a decrease in UHMWPE wear
during the first million load cycles. The difference
in kinematics between both test setups resulting in
enlarged contact areas could cause the decrease
of wear [Cottrell, 2006]. Further tests with increased
load cycles have to be carried out investigating
long-term UHMWPE wear.
References
B
 ergmann et al, PLoS One, 9:e86035, 2014,
C
 ottrell et al, J Biomed Mater Res B Appl Biomater,
78:1519, 2006,
M
 orlock et al, J Biomech, 34:873881, 2001.

Methods
Wear testing was performed with a knee wear
simulator (EndoLab GmbH, Rosenheim, Germany),
using conventional UHMWPE tibial inserts combined
with a CoCr femoral component of the Multigen Plus
Knee System (Lima Corporate, San Daniele, Italy).
Loads and movements were applied according
to ISO standard 14243-1 for 5 million cycles (1) as
well as loads derived from data of instrumented
TKR by Bergmann et al. [Bergmann, 2014], in the
first instance for 1 million load cycles (2). Loads
and movements of the level walking are shown for
both test setups in Figure 1. Besides walking (94%)
the second wear test include ascending (2%) and
descending stairs (2%), sit down and stand up from
a chair (2%), simulating a body weight of 100 kg. The
maximum axial load during the standard wear test
was 2.60 kN. At the increased kinematic test setup
during walking 2.62 kN, for ascending 3.05 kN and
descending 3.36 kN, sit down and stand up from a
chair 2.83 kN were applied. The maximum flexion
angle was 58 for the standard test and maximum
83 under advanced test conditions respectively.
Amount of wear was determined gravimetrically.
Results
After 1 million load cycles wear of UHMWPE liner
amount to 10.1 1.4 mg and 2.4 1.6 mg at the
wear test according to standard ISO and under
advanced test conditions, respectively. The wear
regions on the inserts loaded with the expanded
kinematics and loading are extended in area and
on the medial condyle compared to the standard
test conditions.

116

O 090

THE IMPACT OF THE INITIAL POSITIONING


OF THE ENDO-PROSTHESIS TO WEAR ITS PARTS
J. Ronda1
1

Cape Peninsula Univesity of Technology, Cape Town, Republic of South Africa

In recent decades, the development of materials


science and biomedical still poses new challenges
to engineers both in terms of design, technology,
and also materials. In addition to the selection
and improvement of endoprosthesis materials, an
important issue is joint arthroplasty. Many years
of experience in operation of implants allowed
to select materials for biomedical applications,
meeting the basic requirements concerning, inter
alia, wear resistance, corrosion resistance, with
suitable mechanical properties and, above all
biocompatibility. However, joint arthroplasty is also
associated with failures resulting from the surgery
performed. The hip joint endoprosthesis durability
from 10 to 15 years is clearly insufficient, especially
for young active patients. This short endoprosthesis
lifetime is caused by excessive frictional wear of
the node elements. It is one of the main reasons.
The causes include excessive wear maladjustment
prostheses elements, poorly planned and carried
out surgery, lack of biocompatibility between
elements of the prosthesis and the human body,
improper design of the prosthesis or improperly
selected prosthesis surfacing. In summary, the
analysis of the causes of failure indicates the
need to further increase the reliability of implants
and prolong their life time. Currently, the aim is to
reduce the consumption of node elements through
the use of newer methods of ultra-high vacuum
surface engineering such as DB IBAD. The life of
the implant can be increased by improving the
surface of the prosthesis friction node by applying
a wear-resistant coatings, e.g., using a diamond
like carbon (DLC), i.e. carbon hybrids SP2 and SP3.

The article deals with the contact problem and


wear issues for the polyethylene cup and metal
femoral head. The focus is on the impact of the
prosthesis kinematics on wear of endoprosthesis
which is treated as the tribological node where
Archards model of wear is applied. The problem
is solved by using of a commercial finite element
method (FEM) software: ABACUS, with modified
open-for-user subroutine UMESHMOTION. The
specified boundary conditions, reflecting: the
node geometry, kinematics and dynamics of a hip
joint, were proposed to imitate the normal human
gait enriched by effects suitable to walking up
the stairs and down. The results of numerical
calculations show the calculated strain and wear
performance of the polyethylene acetabulum
(cup) depending on its presetting in the patient
pelvis after a hip replacement surgery and the
combination of the patient activity defined as a
combination of the normal gait plus walking up
the stairs and down. In addition, the results of FEM
calculations are verified by comparing them with
experimental results available in the literature.
Calculations has shown that:
w ear decreases with increasing inner diameter
of the cup,
annual average wear depth increases with
increasing angle of anteversion, and decreases
with increasing angle of abduction,
a local maximum wear depth increases with
increasing angle of abduction and angle of
anteversion,
t he contact surface moves towards the edge,
when the abduction angle increases. For smaller
angles of abduction and greater angles of
anteversion the contact surface moves in the
direction of the cup centre.

117

O 091

MINIMUM INDENTATION DEPTH FOR PROPER


QUANTIFICATION OF PLANTAR SOFT TISSUE STIFFNESS
T. Lee1, J.C. Teoh2
1

Dongguk University, Department of Medical Biotechnology, Seoul, Korea, Republic of Korea


2

National University of Singapore, Department of Biomedical Engineering, Singapore,


Singapore

Introduction
Several studies have been conducted to study the
mechanical properties of plantar soft tissues using
in vivo indentation system (Chao, Zheng et al. 2010,
Kwan, Zheng et al. 2010, Mickle, Munro et al. 2011).
These properties of plantar soft tissue is dependent
on the extent of tissue deformation (Chao, Zheng
et al. 2010) as well as the configuration of the
metatarsophalangeal joint (MTPJ) (Garcia, Hoffman
et al. 2008), specifically for the forefoot region.
Thus, selecting proper indentation parameters is
important to obtain meaningful outcome.

As the probe tip indents deeper into the plantar


soft tissue beyond a threshold depth (i.e. Xs), the
force gradient increases notably (Fig. 1B and 1C).
As shown in Table 1, the absolute value of Xs was
approximately 2.23 mm and 2.14 mm at the heel
and 2 nd sub-MTH respectively. Indentation depths
which were less than this threshold depth might not
be representative of the nature of plantar soft tissue
nor reflect the critical deformation it experiences
during physical activities that expose the tissue to
risk of ulceration.

However, many indentation techniques used are


limited by the inadequate indentation depth on
the tissue. The purpose of this study is to investigate
and
determine
the
minimum
indentation
depth required to effectively characterize the
biomechanical properties of plantar soft tissue
under weight-bearing conditions.
Methods
20 young subjects (2025 years) participated in this
study. The test was conducted with equal weight
borne on each of the participants feet to mimic the
static standing. During the experiment, the indenter
probed the 2nd sub-metatarsal head (MTH) and
heel pad tissue at a constant rate of 12.3mm/s. The
maximum tissue deformation induced was varied
from 1.2 mm to 6.0 mm, in steps of 1.2 mm. The tissue
stiffness obtained from the tissue response curves was
compared and fitted to the proposed viscoelastic
model (Garcia, Hoffman et al. 2008) as shown in Fig.1A.

2 nd
sub-MTH

Heel

p-value

Average Tissue
Thickness (mm)

13.801.76

18.042.42

< 0.01*

Stiffness
coefficient, K1
(N/% tissue
thickness )

0.230 0.122

0.4920.151

< 0.01*

Stiffness
coefficient, K2
(N/% tissue
thickness)

0.4770.168

1.0150.406

< 0.01*

Xs
(% tissue thickness)

16.1771.909

11.8451.284

< 0.01*

Damping coefficient,C
(N/% change
in tissue
thickness
per second)

0.7670.667

1.8030.651

0.03*

Table 1: P
 lantar soft tissue properties of 2nd sub-MTH and
heel pad

C o n cl u s i o n
The results of this study demonstrate the existence
and significance of a minimum indentation
depth (Xs) required for investigating plantar soft
tissue properties. Adoption of an inappropriate
indentation parameter may result in erroneous
tissue stiffness measurements. Hence, a proper
quantifiable reference helps provide valuable
insights into plantar soft tissue behavior, which
can be used for computational modeling to
better understand complex foot mechanisms and
pathologies. Furthermore, the tissue properties
elicited provide valuable information and possible
indication of disease (Jahss, Michelson et al. 1992).
Hence, a rigorous description of plantar soft tissue
behavior is crucial and has good potential for
application in the diagnosis of foot abnormalities
related to diseases such as diabetes.

Results and Discussion


The viscoelastic model used in this is shown in Fig.
1A. K1 and K2 capture the elastic response of plantar
soft tissue at the initial and subsequent phases of
indentation.C characterizes the viscous behavior
of tissue which is only prominent at the latter stage
of indentation. Xs is the minimum indentation
depth beyond which the tissue exhibits nonlinear
viscoelastic behavior. The model suggests that
there is a need to indent the tissue beyond Xs in
order to assess both K1 and K2. This differs from the
paper by Garcia et. al. (2010), where there is no
mention of the reference value of Xs.

118

O 092

BIOMECHANICAL ANALYSIS OF THE PELVIC FLOOR


MUSCLES DURING THE INCREASE OF INTRA-ABDOMINAL
PRESSURE: THE STRESS MAPS
T. Da Roza1, S. Brando1, T. Mascarenhas2, R. Natal Jorge1
1
2

Faculty of Engineering, INEGI, Porto, Portugal

Faculty of Medicine / CHSJ-EPE, Department of Gynecology and Obstetrics ,


Centro Hospitalar de So Joo EPE, porto, Portugal

Introduction
Study the behaviour of the pelvic floor muscles
during increases of intra-abdominal pressure
(IAP) is relevant to understand the pelvic floor
dysfunction. It is recognized that during exercise
the increase in the IAP may result in stress urinary
incontinence if the pressure inside the abdomino-pelvic cavity is higher than the urethral closure
pressure [Haylen, 2010]. Since the pelvic floor
muscles are located inside the pelvis, it is difficult
to analyze the effects of the IAP. Accordingly, the
measures that are made by intra-vaginal devices
are indirect evaluations. The present study aims to
determine the stress maps on the insertion areas
of the pelvic floor muscles (coccyx, and in the
obturator fascia) according to different values of
IAP by using a computational model.
Methods
Five young nulliparous athletes were recruited. To
build the computational models, pelvic Magnetic
Resonance (MR) images were acquired at rest
(protocol: CES195/12). The images were used
to build 3D models of the pubovisceral muscle.
Boundary conditions were set in the nodes
corresponding the attachments in the coccyx and
also in the right and left sides of the obturator fascia
(Figure 1, orange points). The Abaqus software
was used to generate the finite element meshes.

Figure 1: C
 omputational model of the pubovisceral muscle.
The pink arrows represent the intra-abdominal
pressure in the elements of the inner surface
of the muscle, and the orange points represent
the boundary conditions in the coccyx and
the obturator fascia attachments.

Discussion
This computational model enabled to represent
the increment in IAP. As expected, for higher
values of IAP, the stress on the nodes of the
boundary conditions also increase. The nodes of
the pubovisceral muscle in the region of anterior
attachment suffered higher values of stress for
superior values of IAP, which is in agreement with
the evidence of muscle disruption that is seen on
clinical ultrasound or MR images.

After that, numerical simulation of different


values of IAP 56.1, 98.7 and 153.9 cmH 2O was
performed in the inner surface of the pubovisceral
muscle (Figure 1, pink arrows), assuming them as
representative of walking at 5.6 km/h, running at
9 km/h and jumping, respectively [Shaw, 2014].
Stress maps were obtained, and the values of the
stress on the boundary conditions were plotted to
evaluate the effects of the different levels of IAP.

This is useful information to detect the attachment


areas which are more prone to develop muscle
defects.

Results
The stress maps evidenced superior values for the
stress maps for higher values of IAP. The highest
stress values were found in the left side of the
boundary conditions in the pubovisceral muscle
(290.6%), while the coccyx presented the lowest
values of stress (281.4%). During the increase in IAP
it was observed that the points of highest values
of stress moved anteriorly to the insertion of the
pubovisceral muscle in the symphysis pubis.

References
Haylen, et al., Neurourol Urodyn, 29. 420, 2010.
Shaw, et al., J Sport Sci, 32:11761185.

119

O 093

HUMIDITY CONTROLLED STATIC AND DYNAMIC


NANOINDENTATION OF THE SECONDARY WOOD CELL
WALLS IN PICEA ABIES
I. Zlotnikov1, L. Bertinetti1, U. Hangen2, M. Eder1, P. Leibner1, P. Fratzl1
1

Max Planck Institute of Colloids and Interfaces, Biomaterials, Potsdam, Germany


2

Hysitron, Hysitron, Aachen, Germany

Nanoindentation is the leading technique to study


local mechanical properties of a wide range of
materials on the one-micron scale including the
fields of organic and biological materials. The
properties of the latter are known to be critically
affected by the absorbed moisture content,
thus, on the humidity and temperature of their
surroundings. Therefore, a better understanding of
the structure to function relationship in biological
materials in respect to the environmental setting
of their habitat requires the nanoindentation
experiment to be performed in a strictly controlled
relative humidity (RH) and temperature. In
the present study, an approach for measuring
local mechanical properties of materials using
nanoindentation
technique
in
controlled
environment was developed. The approach
employs a commercially available stage for

relatively high temperature nanoindentation in


inert gas setting adapted to produce a local
atmosphere by fitting a humidity generator to
the inert gas infrastructure. Static and dynamic
nanoindentation study in different RHs performed
on wood cell walls of Spruce wood (Picea abies)
was used to demonstrate our ability of humidity
and temperature controlled local mechanical
characterization and its significance in biological
materials. For example, the hardness of the
secondary wood cell walls exhibited a systematic
decrease from an average hardness of approx.
0.6 GPa in RH of 6% down to approx. 0.2 GPa in RH
of 79%, thus, showing a total remarkable decrease
of 67 %. The details of the experimental set-up
and the results of the Spruce wood study will be
discussed in detail.

120

O 094

VISCOELASTIC CHARACTERISATION OF SOFT


BIOMATERIALS BY NANOINDENTATION:
THE NANO-EPSILON DOT METHOD
G. Mattei1, G. Gruca2, E.J. Breel2, N. Rijnveld2, A. Ahluwalia1
1

University of Pisa, Research Center E. Piaggio, Pisa, Italy


2

Optics11, Optics11, Amsterdam, Netherlands

Introduction
Nanoindentation is emerging as a popular
technique for the mechanical characterisation
of biological and biomimetic materials [Oyen,
2013]. Typically, a probe is brought into contact
with a surface, pushed into the material and then
retracted, recording load (P) and displacement
(h) over time (t). The P-h-t data are then analysed
with a range of models to derive material
mechanical properties. Although soft materials
are generally viscoelastic, most published works
focus on extracting elastic properties by analysing
the unloading portion of the indentation curve
with the Oliver-Pharr method [Oliver, 1992]. Here
we propose a method (the nano-epsilon dot
method, nano-M), to derive material viscoelastic
properties by indenting samples at different strain
rates considering data from the loading curve.

(0.025, 0.05, 0.1, 0.25 s -1) while being submerged


in water at room temperature. Generalized
Maxwell models with one (GM1) or two (GM2)
spring--dashpot series arms in parallel to a spring
were used to globally fit experimental -t LVR
series collected at different?, as described in
[Tirella, 2014].
Results
The LVR extended to up to 10% strain for both samples.
Table 1 shows instantaneous (kinst) and equilibrium
(keq) moduli and characteristic relaxation times
(1=1/E1, 2=2/E2) estimated with the nano-M.
The results are consistent with those reported in
[Tirella, 2014] and suggest that the GM1 model is
sufficient to describe the viscoelastic behaviour of
both samples, while GM2 over-fits the data.

Methods
The nano-M stems from the epsilon dot method
[Tirella, 2014], originally developed for bulk
viscoelastic characterisation with no sample
pre-stress. In this study it was implemented on
the Optics11 Piuma Nanoindenter, which allows
accurate detection of the surface contact,
identified as the point where the load crosses the
P-h abscissa after the snap-to-contact negative
region. This avoids sample pre-stress and hence
measures unbiased material viscoelastic constants
[Mattei, 2014]. The following definitions (Eq. 1) of
indentation stress () and strain (), based on the
Hertzs contact model, were adopted to obtain
-t series at constant strain rate (?) from the loading
portion of P-h-t data at constant displacement rate(?):

Parameter

Gelatin
GM1

Gelatin
GM2

PDMS
GM1

PDMS
GM2

kinst[kPa]

14.12

14.12

1.0210 3

1.0210 3

keq[kPa]

0.54

0.54

6.2810

6.2810 2

1[s]

7.31

7.30

0.70

0.70

2[s]

7.32

3.5510 11

Table 1: E
 stimated viscoelastic parameters.

=P/(R(hR)) =4h/(3R*(1- 2 ))(1)

Discussion
The nano-M represents an easy-to-implement
and attractive method to characterise material
viscoelastic properties at cell length scales. The
use of - LVR data derived from the loading curve
(Eq. 1) has several advantages over the classical
Oliver-Pharr analysis which uses unloading P-h data
(see [Pathak, 2008]).

where R is the radius of the Piumas spherical


tip (70 m) and is the sample Poisson ratio
(assumed as 0.5). In this study, 5% w/v gelatin
(Gelatin Type A, G2500, Sigma Aldrich) and
PDMS (Sylgard 184, Dow Corning, 10:1 base to
catalyst w/w ratio) samples were tested at 4 different ?

References
Mattei et al, J Biomech 47:26416, 2014.
Oliver and Pharr, J Mat Res 7:156483, 1992.
Oyen et al, Exp. Tech. 37:7387, 2013.
Pathak et al, J Eur Cer Soc 28:221320,2008.
Tirella et al, JBMR Part A 102:332560, 2014.

121

O 095

FINITE ELEMENT BASED PARAMETRIC STUDY


OF INACCURACIES IN MECHANICAL TESTING
OF SOFT TISSUE
M. Slazansky1, S. Polzer1, J. Bursa1
1

Brno University of Technology, Institute of Solid Mechanic, Mechatronics and Biomechanics,


Brno, Czech Republic

Introduction
Computational, especially finite element models
(FEM) represent a relevant approach in biomechanics of soft tissues nowadays and help us to
simulate mechanical behaviour of soft tissues.
Quality of the model depends primarily on the
quality of input data which are obtained from
experiments. Credibility of the experiment thus
defines the quality and plausibility of the computational model.

Methods
A 3D FEM model is used to perform sensitivity
analyses on various parameters of the test. Those
are the type of load transmission via clamps
or hooks, their number and size and specimen
characteristics its size and stiffness. Both
equibiaxial and proportional displacement-driven
loads were simulated. The quality of simulated
stress-strain data was quantified by Coefficient
of Determination R2 using two data sets: virtually
measured data from the FEM analysis and
the assigned specimen stress-strain curve. The
measured data were described as plausible when
the values coincided with the assigned stress-strain
curve of the specimen material.

Soft tissues are often tested via biaxial tension


testing device. Biaxial tests succumb no standards,
and their arrangement, specimen shape and size
or the way of load transmission on the specimen
(gripping) are fully chosen by the staff or designer
of the respective testing machine. It was shown that
the chosen features can be decisive for accuracy
of the results, may cause significant errors in some
cases and thus negatively influence outputs of the
computational models.

Results
Numbers and sizes of hooks or clamps have
significant influence on the quality of measured
data. It is possible to specify such binding methods
and range of their parameters (specimen size,
stiffness), which can guarantee plausible measured
data.

In both uniaxial and biaxial testing of soft tissues,


stresses are calculated by dividing the total force
by undeformed cross section area. Intrinsically the
assumption of uniform stress distribution throughout
the specimen cross section is introduced here.
Strains, however, are calculated on the basis of the
(optically recorded) undeformed and deformed
positions of markers (contrast points) in the central
part of the specimen called region of interest
(ROI) below. Consequently, the calculated values
represent an average throughout the ROI. This
difference may have significant consequences on
the accuracy of the stress-strain curves obtained
from these tests.

Discussion
The results of the analyses are consistent with
previous analyses [Jacobs 2013; Sun, 2005;
Waldmann, 2002]. In all the presented analyses
perfectly symmetric and accurate positions of
clamps and hooks were assumed. Naturally,
the accuracy of positioning of clamps or hooks
represents another important operator dependent
factor influencing the quality of results. However
investigation of this dependency is out of scope of
this paper.

The non-uniform load distribution along the


specimen edges is not far enough from the ROI
in the sense of Saint Venants principle, therefore
the load distribution along the specimen edge
influences the measured data.

Ack n o wl e d g e m e n t
This work was supported by Czech Science Foundation
project No.13-16304S.
References
Jacobs, Cortes, Vresilovic, Elliot, J Biomech Eng
135 (2), 2013.
Sun, Sacks, Scott, J Biomech Eng,
127(4) 70915, 2005.
Waldman, Sacks, Lee, J. of Materials Science
Letters 21 12151221, 2002

The goal of the FEM simulations is to assess the


inaccuracy of the measured data, to determine
main influences on the measured data and to
design the best setting of the biaxial testing device.

122

O 096

TRACTION FORCE MICROSCOPY OF THE IMATINIB


SENSITIVE KINEASES IN ENDOTHELIUM REVEALS
A BARRIER PROTECTIVE FORCE PHENOTYPE
E.T. Valent1, J. Aman1, R. Krishnan2, V.W.M. van Hinsbergh1,
G.P. van Nieuw Amerongen1
1
2

VU University Medical Center, Department of Physiology, Amsterdam, Netherlands

Beth Israel Deaconess Medical Center, Center for Vascular Biology Research, Boston, USA

Results
Stimulation with thrombin resulted in a normalized
traction force increase which was ablated in the
imatinib treated condition (t=15 min 2.6 vs 1.6,
t=30 3.4 vs 1.9, p<0.009). This was accompanied
by a significant reduction in the number and
size
of
thrombin-induced
inter-endothelial
gaps and cell apoptosis (0.6 vs 3.7, p=0.026) by
imatinib. Interestingly, pretreatment with Imatinib
significantly increase the baseline traction forces
(vehicle 112.7 26.6 Pa vs Imatinib 260.4 56.5Pa,
p=0.047) and stabilized the natural occurring
force fluctuations (vehicle 26.6 1.2 Pa vs imatinib
22.1 0.8 Pa, p=0.003). Moreover, with a siRNA
depletion of the two important imatinib-sensitive
kinases Arg and c-abl, we studied the kinases specific
contribution to the observed effect. This resulted
into opposite effects during thrombin stimulation
in which Arg knockdown showed force lowering
and barrier protection (t=15 1.2 vs 1.8 scramble,
t=30 1.4 vs 2.4 scramble), c-abl raised the
traction forces and caused disruptive phenotype
(t=15 2.1, t=30 2.8).

Introduction
The endothelium is a dynamic monolayer of cells
lining the most interior part of the entire vascular
bed. This monolayer is able to form a barrier
which prevents blood fluids from leaking into
the surrounding tissues. However, during many
inflammatory diseases the endothelium becomes
activated and hyper permeable, resulting in
vascular leakage. Currently specific therapies
of this significant pathogenic phenomenon are
lacking. Interestingly, a recent study from our
lab demonstrated that the anticancer drug
Imatinib both in vitro as well as in vivo reduced
the hyperpermeability of the endothelium
by
RhoA-independent
inhibition
of
MLC
phosphorylation and F-actin stress fiber formation1.
We hypothesize therefore that Imatinib protects
the endothelial barrier through local changes in
force distribution over the F-actin cytoskeleton
hampering cellular contractility and intercellular
gap formation upon stimulation with the vaso-active
agent thrombin. Moreover, we will focus on the
specific roles of two major tyrosine kinases inhibited
by imatinib, namely Arg and c-abl.

Discussion
This study shows a specific force-related mechanism
though which Imatinib lowers thrombin induced
contractile forces and increases baseline forces.
This could result from the previously observation
that imatinib causes an enforcement of endothelial
cell adhesion to the extracellular matrix.1 Finally,
our results indicate that the imatinib sensitive
kinases Arg and c-abl have opposite roles in the
thrombin induced contractile force enhancement.
Better understanding of their specific function
could provide an even greater potential to treat
endothelial barrier dysfunction in the future.

Methods
With the previously published traction force
we
studied
primary
microscopy
method2,
human umbilical vein endothelial cells on
4kPa polyacrylamide hydrogels. Fluorescent
microspheres, embedded within these gel
substrates, were traced and used to calculated
cell displacements. The conversion to traction
forces was achieved using a constrained Fourier
transformation. Before the start of the experiment
all cells were pretreated for 1 hour with 10 M
Imatinib or with a DMSO vehicle.

References
1 Aman et al. Circulation, 2012
2 Krishnan et al. Am J Physiol Cell Physiol, 2011

123

O 097

IN-VITRO WALL SHEAR STRESS WAVEFORMS DERIVED


FROM ARTERIOVENOUS FISTULA ELICIT ENDOTHELIAL
CELL ACTIVATION AND NEOINTIMAL HYPERPLASIA
RELATED MOLECULE PRODUCTION
M. Franzoni1, I. Cattaneo1, B. Ene-Iordache1, A. Remuzzi2
1

IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bioengineering, Bergamo, Italy


2

University of Bergamo, Industrial Engineering, Dalmine, Italy

Results
HUVEC exposed to PP waveform displayed an
elongated shape and a preferential orientation in
the flow direction. On the contrary, HUVEC exposed
to R1, R2, or kept in static conditions, maintained
polygonal shape with no preferential orientation
(n=10). PP-stimulation elicits a 5-fold increase in
KLF2 mRNA expression in HUVEC compared to those
maintained in static conditions (n=5, p<0.05).
This increase is absent in HUVEC stimulated with R1
or R2 waveforms. HUVEC after exposure to R1 and
R2 have a significantly higher production if IL-8 as
compared to PP and static condition (1.270.76
and 1.340.73 vs 0.760.44 and 0.510.13,
ng/hr/106cells, n=5, p<0.05). R2 pattern elicited
also a significant increase in MCP1 production
compared to PP and static condition (5.542.65
vs 2.591.21 and 2.310.52, ng/hr/10 6cells, n=5,
p<0.05).

Introduction
Native arteriovenous fistula (AVF) is recommended
as first choice to create a vascular access (VA)
in dialysis patients 1. AVF outcome however is
affected by ? 40% failure rate within 2 years 2.
First cause of AVF failure is vessel stenosis caused
by intimal hyperplasia (IH). Disease location is
strongly related to local hemodynamics 4. High
risk stenosis areas of AVF, as the venous side near
the anastomosis, are exposed to reciprocating
and disturbed WSS waveforms 5-6. The aim of the
present study was to investigate the in-vitro effect
of AVF-derived WSS waveforms on morphological
adaptations, gene and protein expression of EC,
related to development of IH.
Methods
Human umbilical endothelial cells (HUVEC)
between 4/5th passage, were used at confluence.
For flow exposure experiments, complete growth
medium was added with high molecular weight
dextran. We used a cone-and-plate device to
expose for 48 hrs HUVEC monolayers to three WSS
patterns, derived from CFD analysis of an idealized
AVF 7. The unidirectional, pulsatile pattern (PP)
calculated at AVF venous side downstream
anastomosis (range 23 to 12 dyn/cm 2, average
16 dyn/cm2) was compared to reciprocating
WSS, derived from the anastomosis floor
(R1, range 16 to 13dyn/cm 2, average ? 0dyn/cm2)
and from the venous side of anastomosis
(R2, range 26 to 11 dyn/cm 2, average ?
0 dyn/cm 2). HUVEC maintained in static conditions
were used as control. We performed RT-PCR
to quantify Krppel-like factor 2 (KLF2) gene
expression and ELISA to quantify interleukin
8 (Il-8) and monocyte chemo-attractant protein
1 (MCP1) release. We used one-way ANOVA and
the post-hoc Bonferroni multiple comparisons test
for statistical analysis. Data are presented as mean
value SD.

Discussion
Our results indicate that WSS patterns derived
from high risk stenosis areas induced in-vitro EC
activation and pro-inflammatory signaling. These
results suggest that WSS is an important player in
AVF stenosis due IH development and VA failure.
References
[1] NKF-DOQI. New York, National Kidney
Foundation, 1997.
[2] A. Caroli et al. Kidney Int., vol. 84(6),
pp 123745, 2013.
[3] T. C. Rothuizen et al. Neph. Dial. Trans., vol.28(5),
pp. 108592, 2013.
[4] M. C. Riella et al. Nat. Rev. Neph., vol. 9 pp.
34857, 2013.
[5] A. Remuzzi et al. CJASN, vol. 8(12),
pp. 218693, 2013.
[6] B. Ene-Iordache et al. Endothelium, vol. 10(2),
pp. 95102.
[7] B. Ene-Iordache et al. NDT, vol. 27,
pp. 35868, 2012.

124

O 098

FLUID-STRUCTURE INTERACTION ANALYSIS OF BICUSPID


AORTOPATHY: THE ROLE OF AORTIC SHAPE
AND VALVE PHENOTYPE
S. Pasta1, A. Rinaudo2, G. Gentile3 , G. Raffa4 , A. Luca3 , M. Pilato4 , C. Scardulla4
1

Fondazione RiMED, Tissue Engineering & Regenerative Medicini, Palermo, Italy


2
3
4

UniPA, DICGIM, palermo, Italy

ISMETT, Radiology, Palermo, Italy

ISMETT, Cardiothoracic, Palermo, Italy

Introduction
The mechanism underlying the development
of aortic dilatation in individuals with bicuspid
aortic valve (BAV) is an ongoing debate with
remarkable implication for surgical treatment [1].
The phenotypic presentation of BAV may include
an anterior-posterior cusp-fusion pattern (BAV-AP)
or a right-left cusp-fusion pattern (BAV-RL). In BAV,
the aorta can enlarge at either the isolated aortic
root (AR) or tubular ascending aorta (TA). This study
aims to quantify hemodynamic and structural
parameters portending aortic dilatation in BAV.

risk of aortic enlargement in these individuals. For


patients with TA dilatation, WSS and OSI dictated
by BAV-RL were found higher in the anterior wall of
the ascending aorta compared to those observed
in BAV-AP. Local maxima of wall stress and blood
pressure occurred in the distal ascending aorta
for BAV-RL and closer to sino-tubular junction in
BAV-AP. This suggests that the risk of complications
related to the development of aortic dilatation
differs among individuals with BAV.
C o n cl u s i o n
Hemodynamic and wall stress in BAV reflect the
heterogeneity of both bicuspid phenotype and
patterns of aortic dilatation. These differences may
have a prognostic implication in the progression of
bicuspid aortopathy and may be used to stratify
subgroups of patients with BAV at greater risk of
aortic dilatation.

Methods
Two-way
fluid-structure
interaction
analyses
were performed on n.17 patients with different
BAV phenotypes and degree of aortic dilatation
underwent CT angiography in our hospital institution
from 2011 to 2014. Segmentation included
reconstruction of the aorta and its valve, including
the spatial position of valve leaflets. Patientspecific flow conditions were imposed considering
trans-aortic flow measurements gathered by
echocardiography. The biomechanical behavior
of the aorta was modeled with a fibre-reinforced
constitutive model, considering material properties
and collagen fiber distribution determined in our
previous study [2]. Parallel coupling was performed
with FLUENT sending the fluid-induced wall forces
to ABAQUS, and ABAQUS sending the deformed
nodal coordinates to FLUENT.
RESU L T AND DIS C USSION
BAV-AP was observed in n.12 patients (70%) and
was associated to TA dilatation as compared
to AR dilatation (n.8 with TA and n.4 with AR).
Differently, BAV-RL occurred in n.5 individuals
(30%), with only one case of AR dilatation. For
both BAV phenotypes, the flow exhibited a nested
right-handed helical pattern with the jet directed
toward the right-anterior wall of the ascending
aorta (Figure). In BAV-RL, the flow jet impinged the
aorta in a more distal region compared to that
observed in BAV-AP. Wall shear stress (WSS) and
oscillatory shear index (OSI) were found higher
in patients with TA dilatation compared to those
with AR dilatation (Figure), suggesting a greater

Figure: ( A) Flow streamlines for a BAV-AP with AR dilatation;


(B) comparison of WSS and OSI between AR and
TA dilatations for different BAV phenotype

References
[1] Verma et al. Aortic Dilatation in Patients with
Bicuspid Aortic Valve. N Engl J Med, 370,
19209, 2014.
[2] Pasta et al. Difference in Hemodynamic and Wall
Stress of Ascending Thoracic Aortic Aneurysms
with Bicuspid and Tricuspid Aortic Valve.
J Biomech, 46, 172938, 2013.

125

O 099

THE INFLUENCE OF HANDGRIP SIDE POSITIONS


ON THE STANDING UP MOVEMENT
A. Saade1, F. Gabrielli1, P. Pudlo1, M. Lempereur2, O. Rmy-Nris2
1

Universit de Valenciennes et du Hainaut-Cambrsis, LAMIH, 59313, Valenciennes, France


2

Mdecine physique et radaptation, CHRU Brest, Hpital Morvan, 29609, Brest, France

Introduction
The sit-to-stand (STS) transition is particularly
complicated for hemiplegic subjects. Loading
the paretic limb 1 or the use of techniques
aiming at improving body weight distribution is
recommended 2. In the current study, a handgrip
was chosen to help people with hemiplegia to
stand up. It is known, for healthy subjects, that a
laterally placed grab-rail introduces asymmetries
into the dynamics 3. Thus, the aim of this study is to
investigate if, and how, lateral handgrip positions
influence the asymmetrical weight-bearing of right
hemiplegic individuals.

on the middle or left position (Dm>0; no significant


difference between the middle and the left
handgrip positions), and lean almost evenly
when the handgrip is on the right side (Dm~0;
p<0.01 comparing to the middle). Only one
hemiplegic wasnt able to stand up when the
handgrip was on the right side. Thus, the right
handgrip position seems to encourage the use
of the affected lower limb and tend to create a
centric-behaviour (Dm~0).</dm

Methods
18 healthy and 11 right hemiplegic (112 6 FIM-Functional independance Measure) subjects
performed STS movements using a handgrip for
three different positions of the handgrip: middle (in
front of the subjects neck), left (middle 15 cm)
and right (middle +15 cm). Two force plates under
the feet, were used to measure the external
contact loads. The magnitude of external loads is
normalized to body mass and averaged over time.
The difference (Dm) of external loads magnitude
between both legs is compared. A positive value
of Dm means that subjects lean on their left lower
limb more than the right one and vice-versa for a
negative value. Distributed values around 0, means
that subjects bear weight almost evenly on both
legs. Two statistical (Wilcoxon and Mann-Whitney)
tests were used to determine the significance of
the studied variable.

Discussion
Handgrip positions seem to influence the weight-bearing of people suffering hemiplegia, but in
a different way from healthy subjects. Healthy
subjects adapt their weight-bearing consequently
to handgrip positions, while the hemiplegic seem
to change their weight-bearing only when they
are compelled to do so. Bearing more weight on
the affected lower limb while standing up seems to
be closer to the way therapists teach the patients.
Therefore, the right handgrip position could be used
for rehabilitation. Future works will include more
hemiplegic subjects with a broader range of FIM.

Results
Dm values are shown in Figure 1 for the 3 handgrip
positions, for healthy and right hemiplegic
subjects. Comparing both sides of the lower limbs,
healthy subjects lean almost evenly on both limbs
when the handgrip is in the middle (1.5<dm0;
p<0.001 comparing to the middle), and more on
their right lower limb when the handgrip is on the
right (Dm<0; p<0.001 comparing to the middle).
This result is coherent with the literature3. The result is
different for the hemiplegic subjects. They lean on their
un-affected left lower limb when the handgrip is

RE F EREN C ES
1 HAS, Haute Autorit de Sant. 2012
2 Creutzfeldt et al., J G Int Med. 27:85360. 2012
3 OMeara et al., Hum mouv Sc. 25:257274. 2006
A C K NO W L ED G EMENTS
VHIPOD project (ANR -12-TECS-0001).

126

O 10 0

THE INFLUENCE OF MUSCLE ATROPHY ON CENTRE


OF MASS TRAJECTORY FOR HEMIPLEGIA:
A PRELIMINARY STUDY
A. Saade1, F. Gabrielli1, P. Pudlo1, M. Lempereur2, O. Rmy-Nris2
1

Universit de Valenciennes et du Hainaut-Cambrsis, LAMIH, 59313, Valenciennes, France


2

Mdecine Physique et Radaptation, CHRU Brest, Hpital Morvan, 29609, Brest, France

Introduction
Hemiplegia leads to asymmetrical muscle atrophy.
Literature 1,2 shows that, given the reduction in
lean mass and in muscles section and volume,
paretic limbs can be lighter then non-paretic limbs
by a coefficient up to 25% (C). Consequently, it
could change segments mass and global centre
of mass (CoM) position. Several authors have
highlighted this limitation, and tried to improve
the anthropometric tables 3 for example for
infants, obese population or pregnant women.
It is also known that any method relying on
anthropometric tables will introduce errors in the
estimation of the CoM position, which are likely not
to be negligible3. However, none of the reviewed
studies, tried to neither adapt anthropometric
tables to hemiplegia nor quantify the level of error
that could be produced. The present study is a first
approach to investigate the influence of adapted
anthropometric tables to hemiplegia on CoM
trajectory. The chosen example concerns the Sitto-Stand (STS) movement.

trajectory. Dl varies over time in a way the


kinematic of the movement is taken into account.
Figure 1 (b) represents the distribution of Dl for
6 hemiplegic subjects. It appears that Dl increases
with C (p=0.03) and mean Dl values were 0.36, 0.76
and 1.2 cm for 10%, 20% and 30% of percentage
asymmetrical atrophy respectively. Present results
have the same order of magnitude than those in
CoM based studies such as 23 mm of difference
between hemiplegic and healthy children during
gait5 or 6 mm in elderly balance6.

METHODS
6 right hemiplegic subjects (112 6 FIM-Functional
Independence Measure) performed one natural
STS. Motion analysis VICON was used to record the
kinematic of bodys segments during STS. De Levas
anthropometric table 4 was used to compute
segments mass and CoM positions with modified
mass coefficients that match asymmetrical
atrophy. The variable retained for this paper is
the average centre of mass error (Dl) between
the mean baseline trajectory and the mean
modified trajectory corresponding to the different
percentage of asymmetrical muscle atrophy. The
non parametric Wilcoxon test was used to show
significant differences.

Discussion
As expected, adapting mass distribution to
hemiplegia has an impact on CoM trajectory,
results will have to be taken with caution when
comparing hemiplegic to healthy subjects.
As a consequence, the absence of adapted
anthropometric tables for hemiplegia leads to
either using existent tables and quantifying the
order of magnitude of the produced error, or
adapting the tables to this pathology. Future works
will explore other approaches, investigate the most
reliable one, and include more subjects.
References
1 Ryan et al., APMR. 12: 17037. 2000
2 Mtoki et al., APMR. 82: 86265. 2003
3 Cotton et al., Bionics&Biomech. 00: 122. 2010
4 De Leva et al., J Biomech. 9: 122330. 1996
5 Hsue et al., Gait&Posture. 29: 465470. 2009
6 Lafond et al., J Biomech. 37: 142126. 2004

Results
Preliminary tests showed that CoM lateral trajectory
was the more influenced among the three
components of CoM trajectory by asymmetrical
muscle atrophy. Figure 1 (a) shows an example
for one subject of how C influences CoM lateral

Ack n o wl e d g e m e n t s
VHIPOD project (ANR -12-TECS-0001).

127

O 101

AUTOMATIC CLASSIFICATION OF HEMIPLEGIA GAIT


PATTERN USING JOINT MOMENTS AND GREEDY METHOD
J. Pauk1, K. Minta-Bielecka1
1

Bialystok University of Technology, Automatics and Robotics, Bialystok, Poland

Introduction
The diversity of gait deviations observed in subjects
with lower limbs deformities has led to repeated
efforts to develop gait classification systems to
assist in diagnosis, clinical decision-making and
communication. To characterize gait pattern
some pattern recognitions and machine learning
techniques have been used to solve problem with
gait classification [Alaqtash, 2011]. The purpose
of the paper is to present the method, which can
be applied to analysis and to classify hemiplegia
gait patterns using joint moments data and greedy
algorithm. We suggest, that the proposed algorithms
will be applicable to provision of automated
guidance in support clinical decision-making.
Method
The study involved the gait patterns of 10 healthy,
and 43 hemiplegia subjects aged between
307.8 years. Clinical assessment of hemiplegia
patients was based on Barthel Index (BI).
Gait parameters were measured by using an
optoelectronic System ELITE 3D (BTS, Italy), and
2 KISTLER platforms. The measurement was
repeated to obtain a minimum of 4 valid walking
trials. 186 gait cycles of hemiplegia and 96 gait
cycles of typical subjects were captured. The
acquired joint moments data normalized to
body mass were represented as a matrix with
rows corresponding to patients and columns
corresponding to examination results. The goal was
to find subsets of rows and columns displaying high
similarity of their values and high row variance. In
the presented algorithm this was done iteratively
by first removing and then adding rows or columns
from and to the analyzed matrix until the defined
mean square residue score satisfied the supplied
threshold [Cheng, 2000].

Figure 1: 1
 st bicluster discovered by algorithm (=108, =1.2)
contains samples which correspond to the
moments at ankle joint. The similarity is observed
in 13 cycles (2 trials from distinct hemiplegia and
11 trials from 3 typical subjects): N is sample size,
is a threshold that limits the value of mean
square residue score, is a threshold describing
when the multiple node deletion step is used.

Results
Out of many biclusters discovered by the proposed
algorithm two, corresponding to hemiplegia
patients with mild degree of dependency based
on BI, are shown in fig. 12.

Figure 2: 2
 nd bicluster discovered by algorithm (=106, =1.2).
The similarity is observed at the ankle joint and in
the last phase of gait cycle in the knee joint.
The bicluster contains 36 cycles (7 trials from
5 hemiplegia and 29 trials from 7 typical subjects).

Discussion
We proposed the application of a new method,
biclustering, to gait data analysis. Proposed
solution is relevant to gait analysis because of the
complexity of the data. It can be used by clinicians
in diagnosis of human apparatus, supporting
decision making with respect to prescribing
orthotics, surgery, etc.

References
Alaqtash M. et al, Automatic classification of
pathological gait patterns using ground reaction
forces and machine learning algorithms,
Conf Proc IEEE Eng Med Biol Soc: 453457, 2011.
Cheng Y. et al, Biclustering of expression data,
American Association for Artificial Intelligence,
2000.

128

O 10 2

IMPACT OF BILATERAL, SEVERE KNEE OSTEOARTHRITIS


ON DYNAMIC BALANCING ABILITY
R. Kiss1, . Pethes2, G. Szab3
1

Budapest Univeristy of Technology and Economics, Mechatronics, Optics and Mechanical


Engineering Informatics, Budapest, Hungary
2

Szent Jnos Hospital, Department of Ortopeadics and Traumatology, Budapest, Hungary

Budapest Univerity of Technology and Economics, Mechatronics Optics and Mechanical


Engineering Informatics, Budapest, Hungary

Introduction
The gait parameters, the variability of gait, the
balancing ability are influenced by unilateral
knee osteoarthritis. Creaby et al 1 established
the gait parameters of patients with bilateral
knee osteoarthritis significantly differ from the
parameters of healthy, age-matched subjects,
however they are symmetrical. The aim of this
study is to analyze balancing ability after sudden
perturbation characterized Lehrs damping ratio
measured by provocation test stance on both
and on single limb at patient with bilateral knee
osteoarthritis.

Results and discussion


The lateral dominance did not influence the Lehrs
damping ratio in male controls
(p both-dominant = 0.21;
pdominant-nondominant = 0.37;
pboth-nondominant = 0.09);
and in female controls
(pboth-dominant = 0.21;
pdominant-nondominant = 0.37;
pboth-nondominant = 0.09) (Table 2).
The gender did not influence significant the Lehrs
damping ratio
(pboth = 0.13;
p dominant = 0.17;
pnon-dominant = 0.09) (Table 2).

Exp e r i m e n t a l M e t h o d s
Balancing ability after sudden unidirectional
perturbation of 20 controls (10 males, 10 females,
68.46.22 years, 81.515.6 kg, 1.680.12 m),
20 patients with bilateral knee osteoarthritis
(9 males, 11 females, 67.210.1 years, 90.419.7kg,
1.710.13m) was examined by provocation tests
during double leg and single leg stance, using the
platform of the PosturoMed device. 2 Balancing
ability was characterized by the Lehrs damping
ratio.2

The Lehrs damping ratio significant smaller in both


gender compared to healthy subjects
(p both < 0.00007;
p dominant < 0.000004;
pnon-dominant < 0.00007)
C o n cl u s i o n
For patients with bilateral knee osteoarthritis the
dynamic balancing ability did not influenced by
gender and lateral dominance. The balancing
capacity while stance on single limb was
symmetrical. This finding was similar to findings from
results of gait analysis 1. The lower Lehrs damping
ratio of patients means the dynamic balancing
ability is decreased compared to controls. This
could be taken into account in the use of different
aids and in compiling the conservative protocol.
References
1 Creaby, M.W. et al., Archives of Physical Medicine
and Rehabilitation 93:822827, 2012.
2 Kiss RM, Medical Engineering and Physics,
33: 11601166, 2011.
A C K NO W L E G MENTS
This project is supported by the Hungarian Scientific
Fund K083650.

129

O 10 3

SIT-TO-STAND TRANSITION PERFORMED BY HEALTHY


YOUNG PARTICIPANTS
I. Campos Padilla1, A. Walmsley2, D. Jimenez Cruz2, T. Alonso Rasgado2
1

The University of Manchester, School of Mechanical, Aerospace and Civil Engineering,


Manchester, United Kingdom
2

The University of Manchester, School of Materials, Manchester, United Kingdom

Results and Discussion


Successful STS depends on the participant
generating sufficient linear momentum of the
Centre of Mass in the antero-posterior and vertical
axes, accounting for 59% and 32% respectively of
the total variance. Angular momentum variables
account for only 4% of the overall variance and so
are much less important than the linear momentum
variables.

Introduction
Sit-to-Stand (STS) transition analysis is a common
test of human motion used to estimate the level of
mobility of the participant. While the STS movement
has been studied extensively, the contribution of
the individual limb segments and the musculature
responsible for their movement has not been
extensively investigated. Hence, the objective of
this study, to estimate the contribution of the lower
limb segments during the STS, and determine the
most important momentum variables for each
segment.

C o n cl u s i o n
The head, arms, and trunk (HAT) and pelvis
segments are essentially passive loads driven by
the lower limb segments. Although all the lower
limb segments and joints have a role in performing
STS, the knee joint torques appear to be the most
important factor in creating the linear and angular
momentum necessary to leave the chair.

Exp e r i m e n t a l M e t h o d s
Ten healthy participants, mean age 282 years old
years old were studied during the performance of
the STS transition. Kinematics data were captured
using a six-camera high speed from a VICON motion
capture system. Kinetic variables were calculated
using custom software (SMAS, Ren, L. and et al. [1])
and PCA was used to reduce the dimensionality of
the data and clarify the momentum variables that
took up most of the variance in the kinetics.

References
1 Ren, L., R.K. Jones, and D. Howard, Whole body
inverse dynamics over a complete gait cycle
based only on measured kinematics. Journal
of Biomechanics, 2008. 41(12): p. 27502759.

130

O 10 4

POSTURAL RISK FACTORS IN MANUAL


MEAT CUTTING IN INDIA
P. Mukhopadhyay1
1

Indian Institute of Information Technology Design and Manufacturing Jabalpur, Design,


Jabalpur, India

Introduction
Employees in unorganized occupational sectors
are at high risk of postural risk factors. Manual meat
cutters in India belong to such a sector, as they
may be especially prone to awkward postures 1
over long periods of time. This study investigated
the nature and magnitude of posture related risk
factors2 among manual meat cutters in India. The
aim was to estimate the nature and quantum of
postural risk factors among adult male manual
meat cutters working in this sector.

Results and discussion


Ovako working posture analysis indicated high
scores of 4 for the back in peeling, 6 for the arms
in cutting and 6 for the arms during mincing tasks.
REBA scores were extremely high at 10/10 for
deboning and mincing tasks, all associated with
awkward posture of the upper part of the body.
C o n cl u s i o n
The study indicates that majority of the
occupational tasks for meat cutters are in the highrisk category for occupation injury. Results suggest
that ergonomic intervention in the form of tool,
workstation and process design 3 would be useful
in reducing the number of injuries through postural
correction.

E X P ERIMENTA L METHOD :
Direct observation, activity analysis, questionnaires,
interviews, photography, and video to measure
the postural risk factors.

Ack n o wl e d g e m e n t
Acknowledgement is owed to all those who
volunteered for this project.
References
1 Kattel BP et al, Int Jr of Ind Erg. 18:423429, 1996.
2 Wiker FS et al, Erg. 32:211237, 1989.
3 Kumar S Erg. 44:1747, 2001.

131

O 10 5

EFFECTS OF PRELOAD, PERTURBATION LOAD, INITIAL


FLEXION AND ABDOMINAL PREACTIVATION ON SPINE
STABILITY IN SUDDEN PERTURBATIONS
A. Shahvarpour1, A. Shirazi-Adl1, C. Larivire2, B. Bazrgari3
1

Ecole Polytechnique, Mechanical Engineering, Montreal, Canada


2
3

IRSST, IRSST, Montreal, Canada

University of Kentucky, Mechanical Engineering, Lexington, USA

Introduction
Trunk stability margin in sudden perturbation
conditions is substantially improved by larger
agonist/antagonist exertions of paraspinal muscles
and greater spine passive stiffness associated with
larger flexion/compression. The objective here is to
quantify the role of passive, stationary active and
reflexive subsystems on the trunk stability in sudden
forward loads.

RESU L TS AND DIS C USSION


ANOVA P values

METHOD
Trunk displacement and perturbation load at the
T8 level and select surface EMG were recorded
in 12 asymptomatic volunteers. 1 Muscle forces
and spinal loads were estimated using a trunk
musculoskeletal FE model driven by measured
individual external load, kinematics and body
weight. 2 In stability analyses and at each time
step, each muscle has a stiffness K=q(F/L) with
F as the computed muscle force and L its length.
The critical stiffness coefficient, q cr taken the
same for all muscles, is subsequently sought as the
trunk smallest natural frequency approaches zero
(i.e., dynamic instability). The average q cr values
are evaluated over four separate time intervals;
1) Pre-q over 256 ms pre-perturbation, 2) Post-q1
over 60 ms post-perturbation set as the mean of
measured reflex latency 1, 3) Post-q2 during 60
to 240 ms post-perturbation in which the reflex
response translates into mechanical action 2, and
4) Post-q3 from 240 ms to 1 sec post-perturbation.
Smaller q cr indicates greater stability margin.

Variables

Pre-q

Post-q1

Post-q2

Post-q3

Preload (PL)

<0.001

0.634

0.393

0.348

Sudden load (SL)

0.314

0.082

0.004

<0.001

Preload _ Sudden
load

0.282

0.105

0.127

0.759

Initial flexion (IF)

<0.001

<0.001

<0.001

<0.001

Abdominal
Coactivation

<0.001

0.003

0.013

0.402

Higher preload markedly reduced the preperturbation qcr due to larger muscle exertion
and stiffness. Higher sudden load significantly
increased stability post-perturbation especially
after the back muscles reflex onset. With the
initial trunk flexion, trunk stability was substantially
improved. Abdominal preactivation increased the
trunk stiffness and stability (due to greater muscle
forces/stiffness) at all times except the final phase.
C ON C L USION
Results highlight the crucial role of the ligamentous
spine and muscles (passive/active) in augmenting
the trunk stiffness and hence stability at all phases,
a role much evident in the presence of initial trunk
flexion.
RE F EREN C ES
1 Shahvarpour, J Electro Kin, 24:394403, 2014. 2.
Shahvarpour, J Biomech, 48: 4452, 2015.
A C K NO W L E G MENT
Supported by NSERC-Canada and IRSST-Quebec

132

O 106

MECHANICAL PREDICTORS OF DISCOMFORT


DURING LOAD CARRIAGE
P.D. Wettenschwiler1, S. Lorenzetti2, R. Stmpfli1, R.M. Rossi1,
S.J. Ferguson2, S. Annaheim1
1

Empa- Swiss Federal Laboratories for Materials Science and Technology,


Laboratory for Protection and Physiology, St. Gallen, Switzerland
2

ETH Zurich, Institute for Biomechanics, Zurich, Switzerland

Introduction
Discomfort during load carriage is a major issue
for activities using backpacks (e.g. infantry
manoeuvres, children carrying school supplies, or
outdoor sports). Nevertheless, the discomfort related
to the mechanical interaction between the body
and load carriage system is poorly understood. As
contact pressure is known to influence discomfort
at the shoulder and hip region [Stevenson, 1997],
hip belts may play a crucial role in load carriage
system design to relieve pressure in the shoulder
region. For its optimization, it is necessary to
know the parameters strongly associated with
discomfort. Therefore, we investigated how much
subjective discomfort can be explained by body
surface pressure, strap forces, and relative motion
between body and load carriage system.

by questionnaire, using visual analogue scales.


The mean values of all subjects were used for
several multiple linear regressions in each region,
with discomfort as dependent variable and the
mechanical parameters as predictors. Entry
method was stepwise backwards with the exclusion
criterion p .05.
Results
The regression analysis with the mechanical
parameters that were measured directly on the
body (average and peak pressure, both static
and dynamic) revealed static peak pressure as
a significant predictor (p < .001) with R2 values
of 0.85 (shoulder) and 0.86 (hip).
The regression analysis with all mechanical
parameters (average pressure, peak pressure,
strap forces, and relative motion) revealed strap
tension for the static scenario (p < .001) and
strap tension and relative motion for the dynamic
scenario (p < .01) as significant predictors with
R2 values of 0.85 and above.

Methods
A commercially available backpack (Figure 1a)
was examined in 12 different configurations:
3 loads (15 kg, 20 kg, 25 kg) x 4 hip belt tensions
(30N, 60N, 90N, 120N).

Discussion
Static peak pressure is very well suited to predict
subjective discomfort and can be regarded as
an important mechanical parameter for future
optimization of load carriage system design. The
perception of static peak pressure on the body
does not depend on the type of load carriage
system; hence this finding can be applied to most
load carriage system types. Strap tension on the
other hand might well depend on the type of load
carriage system. Thus, applying strap tension as
a mechanical predictor of discomfort should be
limited to systems that are comparable to the one
used in this study, e.g. backpacks with hip belts.

Figure 1: B
 ackpack applied in this study (a), and location of
the Tekscan sensors on a subject (b) as well as on
the dummy (c).

Pressure sensors (Tekscan type 9811E, Tekscan,


USA) were placed on the skin of the subjects
(n = 10) in the shoulder and hip region (Figure 1b).
Force sensors were applied at the shoulder strap
and the hip belt to assess the average strap forces.
Polhemus Liberty sensors (Polhemus, USA) were
used to measure the cumulative relative motion
between body and backpack in both regions.
3 repeats were conducted for both static (standing)
and dynamic (walking at 4.5 km/h) measurements.
Discomfort was assessed in randomized order

A comparison with measurements on a dummy


(Figure 1c) is currently running to investigate to
which extent future measurements of discomfort
during load carriage are possible without human
subject studies. The option of evaluating different
concepts and designs of load carriage systems on
a dummy reduces effort and costs in the future
development of load carriage systems.
References
Stevenson et al, Techn Rep, 2001081, 1997.

133

O 107

HIP ABDUCTORS ONSET ALTERATIONS DURING RUNNING


IN ILIOTIBIAL BAND SYNDROME SUBJECTS
V.H. Munoz-Martel1, E. Opazo2, C. Rozbaczylo2
1
2

Universidad SEK, Kinesiology, Santiago, Chile

Universidad de Chile, Kinesiology, Santaigo, Chile

Introduction
Running practice is highly associated with overuse
injuries. Among these injuries Ilio-tibial band
syndrome (ITBS) is the main cause for lateral
knee pain in distance runners. The etiology
for these condition has been associated with
multiple mechanical factors (Louw and Deary
2014). Augmented knee internal rotation and
hip abduction are strongly related with ITBS
etiology (Hamill et al. 2008; Ferber et al. 2010).
These kinematic alterations migth be related
with muscular weakness (Fredericson et al. 2000),
altough it is still controversial (Grau et al. 2011).
Since pain is expressed during contact (Rene,
1970) and considering that kinetic and kinematics
variables are an expression of neuromuscular
strategies this study proposes that ITBS migth be
related with muscular hip frontal control during
stance phase, wich migth cause lateomedial
overload at the knee. Therefore the aim of the
present study is to compare hip abductors onset
during running in ITBS and healty subjects.

Results
Wilcoxon test resut shows signifficative differences
for Gluteos Medium between groups where ITBS
shown late activation for GM (Z=2.295, p =0.22).

Methods
28 male volunteers (14 ITBS, 14 control) were tested
at Universidad de Chile`s Human Performance
Laboratory. After given written consent reflectives
markers were placed bilateraly in acromion,
anterior superior iliac spine, greater trochanter,
lateral femoral epicondyle, lateral malleolus and
the head of the fifth metatarsal. EMG sensors were
placed in Tensor Fascia Latae and Gluteus Medium
according to SENIAM recomendations. Subjects
were asked to run on a treadmill at 10 Km/h with 1%
inclination, after a 5 minutes warm up, IR kinematic
at 120 fps (BTS SMART, BTS Bioingeneering) and
emg at 1000 Hz (BTS FreeEMG, BTS Bioingeneering)
data were collected for 30 seconds, 3 trials per
subjects were performed. EMG signals were
trimmed from 100 ms prior to initial contact to the
next initial contact in order to abtain information
on the prepration for the cicle and the entire
cicle itself. Signals were averaged and onset was
obtained using double threshold method for each
muscle by a blind investigation. Onset times were
then separated is respectives groups and tested
for differences between grupos by Wilcoxon Test
with signifficance of 0.05.

References
F erber, R., Noehren, B., Hamill, J., & Davis, I. S.
(2010). Competitive female runners with a history of
iliotibial band syndrome demonstrate atypical hip
and knee kinematics. Journal of Orthopaedic
& Sports Physical Therapy, 40(2), 52e58.
F redericson, M., Cookingham, C. L., Chaudhari,
A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann,
S. A. (2000). Hip abductor weakness in distance
runners with iliotibial band syndrome. Clinical
Journal of Sport Medicine, 10(3), 169e175.
Grau, S., Krauss, I., Maiwald, C., Best, R., & Horstmann, T. (2008). Hip abductor weakness is not the
cause for iliotibial band syndrome. International
Journal of Sports Medicine, 29(7), 579e583
Hamill, J., Miller, R., Noehren, B., & Davis, I. (2008).
A prospective study of iliotibial band strain in
runners. Clinical Biomechanics, 23(8), 1018e1025
Louw, M., & Deary, C., The biomechanical variables
involved in the aetiology of iliotibial band syndrome
in distance runners e A systematic review
of the literature, Physical Therapy in Sport (2013),
http://dx.doi.org/10.1016/j.ptsp.2013.07.002
Renne, J. W. (1975). Iliotibial band friction
syndrome. Journal of Bone and Joint
Surgery-American, 57(8), 1110e1111

Spearman`s correlation test shown a positive


correlation between delayed onset and ITBS
laterality (rho =0.570, Sig =0.002).
Discussion
The results of the present study suggest that there
is an alteration of neuromuscular control strategies
for hip frontal plane during stance phase, whereas
healty subjects show activation prior to initail
contact for all hip abductors, ITBS subject shows
a late activation where many activate GM
posterior to initial contact.
These result may copntribute to a neuromuscular
approach to overuse injuries, since it appear that
while healty subjects use a feedforward strategy to
control hip and knee mechanics during the ground
collision ITBS use a feedback strategy.

Considering the later.Key words


Running biomechanics, onset detection,
electromyography, knee pain, hipabductors.

134

O 10 8

COMPARISON OF DIFFERENT PROSTHETIC FEET AND


RUNNING STYLES IN A MACHINERY TEST SETUP FOR THE
MECHANICAL CHARACTERIZATION OF RUNNING SHOES
F. Starker1, A. Steck1, F. Blab1, F. Dennerlein1, U. Schneider1
1

Fraunhofer IPA, Biomechatronic Systems, Stuttgart, Germany

Introduction
Aim of this study was to investigate various
mechanical influences for the characterization of
running shoes with a prosthetic foot test machine
(ISO 22675) to mimic human running kinetics and
kinematics [Starker et al. 20141, 2014 2].
Methods
Human motion data of running was captured
from one subject (m, 27 y., 74 kg, UK 8.5) on
a 12 m runway in a motion lab. 3 different shoes
were worn (Vivo Barefoot Evo Pure, adidas
Gore-Tex XCR, Asics Gel DS Trainer). 10 consecutive
running trials were performed with each shoe.
Kinetic (AMTI AccuGait, 2400 Hz) and kinematic
data (Qualisys QTM, 9 cameras, 240 Hz) were
captured. One specific step of each shoe trial
was selected and processed to be feed into
the test machine software. The test machine
(Shore Western KS2-07, see Fig. 1) was equipped
with different prosthetic foot models (College
Park Soleus, Endolite Navigator, Otto Bock 1D10,
ssur Variflex Evo).

Figure 2: S implified Ishikawa diagram to break down


influences evaluated for cross comparison
for the simulation.

Results
Individual motion data could be applied
successfully to the machine. Captured data
needed to be filtered and fitted by a polynomial
(11 th order) aiming for a smooth automatic
adaptation of the force levels by the test machine.
The shoe models showed differences in resulting
moments by keeping input forces (Fzm) and
movement data similar. Hence anterior/posterior
forces are a result thereof. The prosthetic foot
model Navigator was modified at the metatarsal
region to reach a higher range of motion in toe
flexion. Thus, machine test results with Navigator
were most similar to human foot data during motion
lab running. Variances in shoe characteristics due
to their different mechanical designs could be
clearly shown in force, moment and calculated
supporting lever arm data.

The test machine was programmed with four


motion data sets. Each motion test was performed
with each shoe and each foot in overall 64 trials
(see Fig. 2). Forces and moments are acquired
with a 6 degrees of freedom load cell. Furthermore
machine sensor data (shank angle, axial height,
acceleration, force) is recorded for comparison.
The machine is displacement controlled and
consequently adapts after several steps to the
preferred force in axial piston direction (Fzm).
Other forces and moments are produced as results
of the test setup.

Discussion
This method can be used to characterize
mechanical properties of shoes based on individual
subject based biomechanical data. Endurance
tests up to 2 million movement cycle are possible.
Further research is needed to clarify the meaning
of acquired machine test data and its potential
effects to the human runner.
References
1 Starker, F. et al., Proc Eng 72, 405410, 2014
2 Starker, F., et al., Int. Calgary Running Symposium,
130131, 2014.

Figure 1: T est machine setup

135

O 109

ANALYSIS OF THE PLANTAR PRESSURE DISTRIBUTION


DURING RUNNING AFTER CYCLE SECTION OF SIMULATED
TRIATHLON RACE
D. Gerych1,2, A. Tvrznik2, K. Jelen1
1

Charles University in Prague, Faculty of Physical Education and Sport, Department of


Anatomy and Biomechanics, Prague, Czech Republic

Sports Research Institute of Czech Armed Forces, Department of Kinathropology, Prague,


Czech Republic

Results
A significant reduction of plantar pressure and
force under the toes 2.5. and significant reduction
of contact area under lateral forefoot were found
during running at the race intensity following the
cycling part of the competition simulated loading
in the observed group of triathletes. Furthermore,
there was a tendency for the peak pressure and
force to be higher under the medial and lateral
forefoot. However, these differences were not
statistically significant. No significant changes of
stride frequency and foot contact time were found
in the observed group of triathletes.

Purpose
The purpose of this study is to indicate the changes
in plantar pressure distribution, maximal force and
contact area during the stance phase of running
that may occur in triathletes during the run section
of a triathlon race as a consequence of altered
locomotion after previous cycling.
Methods
A group of 10 competitive triathletes (8 male
and 2 female) at age 2246 years participated
in this study. All subjects underwent competition
simulated
laboratory
test
which
included
10 minutes of running, 50 minutes of cycling and
10 minutes of running at intensities corresponding to
their race pace. Peak pressure, maximal force and
contact area during the stance phase of running
were detected at 7 regions of the foot (medial
heel, lateral heel, midfoot, medial forefoot, lateral
forefoot, big toe and other toes) during running
before and after cycling using Pedar-X Novel
tensometric system. All resulting values including
foot contact time and stride frequency were
obtained through an analysis of the 200 step period
selected from the record provided by the Novel
Pedar-X system during initial and final running.

C o n cl u s i o n
The results of this study indicate a shift of the
load from toes to the metatarsal area during
running after cycling segment of a triathlon race.
This change is supposed to result from altered
neuromuscular coordination and general, as well
as, local muscular fatigue after previous cycling.

136

O 11 0

RELIABILITY OF INERTIAL MEASUREMENT UNITS APPLIED


TO VIBRATION SIGNAL DURING RUNNING
T. Provot1, G. Vitry1, F. Bolaers2, X. Chiementin2
1
2

neXXtep Technologies, Reims, France

Universit de Reims Champagne Ardenne, GRESPI, Reims, France

Introduction
Sports domain present an interest about a
detailed description of human kinematic to assess
performance and injury risk. However today to
determine the athlete performance, kinematic
must be completed by vibration assessment
[Friesenbichler, 2011], [Giandolini, 2013]. The
outdoor measure of kinematic is usually carried
out using use inertial measurement units (IMU)
[Horvais, 2013], [Lee, 2010]. Moreover some of
these IMU present high sampling frequency. But
these sampling frequency are they enough to
make the IMU adapted to vibration assessment?
This study aimed to validate the use of an IMU
for vibration measurement during running using
two different sampling frequency. The validation
is done through a comparison with a calibrated
industrial accelerometer defined as gold standard.

Results
CV for both IMU were weak (2% and 3%) and similar
from references CV. For both IMU, the first range of
frequency were good correlated (p<0.001). Past
a threshold (90Hz for IMU1 and 30Hz for IMU2) the
correlation shows significant difference (Figure 1).
No differences were reported by changing speed
even if this parameter have impact on vibration
amplitude and spectrum staggering.

Methods
One male subject was recruited. He was equipped
on each leg with an IMU (Hikob, Fox system,
France) and a calibrated industrial sensor as gold
standard (Bruel&Kjaer, 4525B, Denmark, 2560Hz).
IMUs were securely placed on the body through
an elastic band, and references were attached
on the leg using double sided tape. Sensors were
placed on skin over the tibia near the center of
gravity of the leg. IMUs were sampled at 1344Hz
(IMU1) and 400Hz (IMU2) respectively for the right
and the left leg. Subject performs 15 randomized
measures on a treadmill divided in two studies.
A first study of reproducibility was composed
of 10 measures at 12 km/h. A second study of
speed influence was composed by 6 measures
at 81012141618 km/h (12 km/h was common
to both studies). Total acceleration was computed
for every sensors and presented as Root Mean
Square (RMS). Mean, standard deviation and
coefficient of variation (CV) were calculated on
the RMS to judge reproducibility of the 10 measures
at 12km/h. Correlation coefficient r was calculated
for a sliding windows of 10Hz between each
IMU and its reference on a range of 150Hz. Test of
Bravais-Pearson (p<0.05) was applied on r coefficient.

Figure 1: r coefficient for IMU1 for 16km/h (black line p=0.05).

Discussion
IMU Hikob Fox shows a good reproducibility in
running. The signal of IMU2 (sampled at 400Hz)
does not allows representing a complete running
spectrum, but the good correlation of the first
range of frequency can be used for movement
assessment. The signal of IMU1 (sampled at 1344Hz)
present a larger range of frequency and represent
an important part of a running spectrum. The IMU
present advantages for running assessment like
autonomy and lightness but it can be limited for
a complete representation of running spectrum.
The efficiency IMU is apparently not impacted by
change of speed, amplitude and frequency.
References
Friensenbichler et al, J Biomech, 44(1):11620, 2011.
Giandolini et al, Footwear Sci, 5(1):1415, 2013.
Horvais et al, Footwear Sci, 50(1):2627, 2013.
Lee et al, J Sci Med Sports, 13(5):55963, 2010.

137

O 111

SIMILAR EXPERIMENTAL CONDITIONS DECREASE


INTER-SUBJECT VARIABILITY OF RUNNING GAIT
D. Villeger1, A. Costes2, B. Watier3 , P. Moretto4

Universit de Toulouse, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9,
France, Toulouse, France

Universit de Toulouse, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9,
France, F2SMH, Toulouse, France

CNRS, LAAS, 7 avenue du colonel Roche, F-31400 Toulouse, France, GEPETO, Toulouse, France
4

CNRS, Centre de Recherche sur la Cognition Animale, 118 route de Narbonne, F-31062
Toulouse Cedex 9, France, Dynactom, Toulouse, France

Introduction
Originally used in the fluid mechanics field,
the concept of dynamic similarity enables two
different-sized systems to be considered as scaled
models by setting them in equivalent Experimental
Conditions (EC). This paper aims to use this concept
for comparing locomotion between subjects of
different sizes.
Human locomotion is commonly modelled by
a Spring Mass Model (SMM) which takes into
account an elastic component. By the pi theorem
[Buckingham, 1914], the SMM motion can be
reduced to 4 dimensionless variables. Two of them
are the Froude (Nfr = v2/ gl; with v the speed, g the
gravity and l the center of mass height) and the
Strouhal (Str = fl / v; with f the oscillation frequency)
dimensionless numbers.
The aim of this study is to induce dynamic similarity
among different-sized subjects with particular EC
dependent on Nfr and Str.

Figure 1: T he three experimental condition


(from top to bottom: ECSPEED, ECNFR and ECMOD).

METHODS
19 participants (height from 1.68 m to 1.94 m) ran
at six speed stages (1.67, 2.22, 2.78, 3.33, 3.89,
4.44 ms -1) in three different EC on a treadmill embed
to a forceplate sampled at 1 kHz (AMTI, Watertown,
MA, USA) surrounded by 12 optoelectronic
cameras sampled at 200 Hz (VICON, Oxfords
metrics, Oxford, UK).

RESU L TS
For all speed stages, the dynamic similarity was
met for 16 (mean r = 0.51), 32 (mean r = 0.49)
and 52 (mean r = 0.60) parameters out of 54 GRF
parameters in ECSPEED, ECNFR and EC MOD, respectively.
The variability of the dimensionless preceding
parameters and joint angles was significantly lower
in the third condition.

The three EC (figure 1) consisted of imposing


(i) EC SPEED: a constant speed, (ii) EC NFR: a fixed Froude
(similar speed) and (iii) EC MOD: a fixed combination
of Froude and Strouhal called Modela-r [Delattre,
2008] (similar speed and similar step frequency).

DIS C USSION
This study shows that the combination of Nfr and
Str (Modela-r) ensures dynamic similarity between
different-sized subjects. The relevance of using
similar experimental conditions (EC MOD) to compare
mechanical dimensionless parameters is also
proved and could highlight the study of running
techniques, or equipment, and could allow the
identification of abnormal and pathogenic running
patterns. On this basis, Modela-r have been
adapted for walking [Villeger, 2015] and may be
adapted to study other abilities requiring bounces
in human or animal locomotion or to conduct
investigations in comparative biomechanics.

For each speed stage the dynamic similarity was


evaluated from the comparison of theoretical
and measured scale factors [Villeger, 2014] for
9 Ground Reaction Forces (GRF) parameters (time,
force, impulse and loading rate). Moreover, the
effect of the EC on the inter-subject variability was
also tested for these dimensionless parameters
and for the ankle, the knee and the hip angles
throughout the running cycle.

RE F EREN C ES
Buckingham, E. Phys.Rev, 4: 345376, 1914.
Delattre et al. J. Biomech, 41: 28958, 2008.
Villeger et al. J. Biomech 47: 38627, 2014.
Villeger et al. Gait Posture 41: 2405, 2015.
138

O 11 2

TIBIAL STRAIN DISTRIBUTION FOLLOWING RTKR


SURGERY USING PRECISE COMPARTMENTAL
PHYSIOLOGICAL LOADING
S. Wright1, S. Gheduzzi1, A. Miles1
1

University of Bath, Centre for Orthopaedic Biomechanics Mechanical Engineering,


Bath, United Kingdom

Introduction
The implantation of stemmed tibial components
during revision total knee replacement (RTKR)
surgery is believed to alter the strain distribution
through the tibia and lead to proximal bone
resorption and patient reported pain at the stem
tip. Additionally, the in vivo use of instrumented
tibial components has demonstrated that the
compartmental load share across the tibial
condyles changes during daily living activities
[Mundermann, 2008]. Despite this, compartmental
load share is not directly measured or controlled
in experimental studies that assess load transfer
through the tibia.

The strain gauge results were processed to


calculate the principal strain values and averaged
across the five specimens. An example of the
results for a single gauge is presented in Figure 2.
The implantation of a tibial component produced
a significant reduction in strain in the three proximal
gauges and at the mid stem region (Within Subjects
ANOVA p<0.0125). There was also a significant
increase in strain at the stem tip with 0 flexion after
implant insertion.
Discussion
The significant reduction in strain in the proximal
tibia aligned with the proximal bone resorption
that has been reported post-RTKR. The increase
in strain around the stem tip correlates with the
pain that can be reported by patients after
surgery. These results should guide future implant
design to improve how load is transferred through
the tibia and advance clinical outcomes. The
specific design to adjust for physiological loading
also highlights the importance of incorporating
the compartmental load share into pre-clinical
assessment techniques.

The aim of this study was to assess the load


distribution through the tibia before and after
implantation of RTKR components, whilst monitoring
compartmental load distribution. An experimental
rig was developed that replicated physiological
loading through the knee, including a method
to measure and control the compartmental load
share across the tibial condyles. The investigation
employed force sensors to measure compartmental
load and strain gauges to provide the cortical
strains in a composite tibia as an indication of load
transfer through the bone. This investigation will
further understanding of the effect of stemmed
tibial components on the strain levels through the
tibia and guide future implant designs to improve
patient outcomes.
Methods
An experimental rig was developed to replicate
knee loading conditions and allow the adjustment
of the compartmental load share in the tibial
condyles (Figure 1). Five composite tibias (4 th
Generation Sawbones) were prepared with five
strain gauge rosettes (HBM) and tested under
physiological loading. The loading through the
medial and lateral compartments was measured
using two force sensors in the condyles (Tekscan)
and adjusted prior to each test. The cortical strains
were recorded under a 500 N load applied at 0
and 10 of flexion by a hydraulic test machine. The
five tibias were then implanted with Stryker Triathlon
components according to surgical protocol and
testing was repeated.

Figure 1: T he experimental rig capable of physiological


loading through the knee with a RTKR to measure
the strain distribution through the tibia.

Results
Preliminary test results verified the use of the force
sensors to measure the load share and illustrated
the relationship between compartmental loading
and strain distribution through the tibia.

see the next page

139

Figure 2: T his example shows the principal strain measured


at the mid stem gauge averaged across all five
specimens during four loading scenarios.

References
Mundermann, A., et al. J Orthop Res, 26(9):
116772, 2008

140

O 11 3

EFFECT OF VARUS-VALGUS MALALIGNMENT ON STRESS


DISTRIBUTION OF TIBIA USING FINITE ELEMENT ANALYSIS
C.H. Moon1, K.M. Kim1, O.S. You2, H.J. Chun1
1
2

Yonsei Univ., Mechanical Engineering, Seoul, Korea, Republic of Korea

CORENTEC Co.-Ltd, Central R&D center, Seoul, Korea, Republic of Korea

Introduction
Unicompartmental Knee Replacement (UKR) is
a great surgical option for knee reconstruction.
However, some patients felt postoperative
unexplained pain in their proximal tibia.
Unexplained pain is a controversial issue and is one
of the most critical causes of revision.[Pandit,2006]
Researchers suggest a high bone strain as a main
factor causing postoperative pain. It is believed
that bone strain would be affected by varusvalgus malalignment on tibia. Therefore, the effect
of varus-valgus malalignment on tibia bone strain
was investigated.
Methods
In this research, the influence of varus-valgus
malalignment on tibia using three-dimensional
validated finite element models was investigated.
The FE models representing generalized Asian
tibia and varus-valgus malalignment on tibia were
developed.[Dai,2013][Kwak,2007] The UKR design
were implanted and tibial inserts representing a
neutral alignment from 0 to 10 in 2.5 increments
varus and valgus alignments were modeled,
respectively and the transvers cut was made
with 3 posterior slope.[Cho, 2014] Each model
was simulated in flexion angles of 0, 45 and 60
respectively and compression loads of 1150N,
3200N and 2800N were applied to proximal tibia
in each flexion.[Villa,2004] In the 0 flexion model,
690N was applied to medial condyle and 460N to
lateral condyle.The 1920N and 1280N in flexion
45 were applied to medial condyle and lateral
condyle respectively. The 1680N and 1120N in
flexion 60 were also applied to medial condyle
and lateral condyle respectively.[Daley,1975]

Figure 1: P
 osition of the region A

Figure 2: R
 esults for principal strain of region A by tilt
of varus-valgus.

References
Cho et al, Springer-Verlag Berlin
Heidelberg 2014, 2014
Cobb et al, JBJS, 90:10321038, 2008
Dai et al, J Orthp. Res., 31:16431652, 2013
Daley et al, Unpub. Doc. Diss.,1975
Kwak et al, The Knee, 14:295300, 2007
Pandit et al, JBJS,88:5460
Villa et al, J of Biomech, 37:4553,2004

Results
The region A was observed because it is where
patients felt pain [Figure 1]. In neutral position, the
principal strains were 592, 1541 and 1336 in
flexion 0, 45 and 60 respectively. The maximum
strain was 1674 at varus 10 in flexion 45.
The minimum strain was 525 at valgus 10 in
flexion 0 [Figure 2]
Discussion
The changes of bone strains in tibia due to The
varus and valgus malalignments show opposite
tendency. Principal strain were reduced in valgus
malalignment. Therefore, varus malalignment of
prostheses could lead the negative effect on bone
strain, on the contrary to valgus malalignment.
However, valgus malalignment also has many
negative effects like increasing contact stress,
wear, early loosening and etc. on UKR. Both
malalignments of UKR should be avoided.
141

O 11 4

PATELLA IN PLACE GAP BALANCING MORE ACURATELY


RECREATES KNEE JOINT CENTER OF ROTATION
S. Lynch1, B. Fleischer1, M. Ettinger1, C. Hurschler1, T. Calliess1
1

Hannover Medical School, Orthopaedic Clinic, Hannover, Germany

Introduction
Total knee replacement involves removal of
damaged tissue and implantation of an artificial
surface. Conventional surgical technique is
measured resection (MR) defined through
anatomical
landmarks
(Victor,
2009).
The
conventional MR has proven to establish femoral
rotation however there is prevalence of joint gap
asymmetry that can be attributed to bone landmark
detection and repeatability (Dennis, 2010). Patella
in-place gap balancing (PIPB) establishes equal
ligament loads, thusly less dependent on anatomy
and is suggested to provide a more reproducible
flexion gap (Daines, 2014). The purpose of this
study is to investigate the ability of PIPB to return
natural knee function and its repeatability, whilst
additionally comparing PIPB to MR.

Discussion
This study presents that the COR for PIPB more closely
represents that of the native condition compared
to MR. Additionally, this paper supports the claims
of previous work (Daines, 2014) with a reduced
standard error and increased repeatability using
PIPB (Figure 1).

Methods
Freshly frozen cadaver specimens were randomly
assigned to MR or PIPB. Each group completed
six extensions, three prior and three post total
knee replacement. The specimen was fitted to a
specifically designed isokinetic in vitro knee flexionextension simulator. The femur was fixed in place
whilst the tibia was fitted to a force-feedback
lever arm that allows freedom of movement with
exception to flexion-extension under physiological
loading. The helical axis was referenced to the fixed
femoral bone and calculated using adaptations
from (Spoor, 1980) and (Metzger, 2010), per six
degrees of motion a centre of rotation (COR)
and axis of rotation was calculated. Results are
presented as the difference from the native COR.
Figure : A
 nterior-Posterior (top) and superior-inferior
(bottom) shift of COR from native equivalent.

Results
Shift of native COR after MR was located
3.414.66 mm (MeanSE) and 5.7710.25 mm
posteriorly at 120 and 20, 13.091.47, 1.270.76,
12.236.59, 19.952.86 and 11.142.35 mm
anteriorly at 100, 80, 60, 40 and 5 respectively,
whilst PIPB was 3.481.37, 3.990.01, 3.760.03
and 11.898.08mm posteriorly at 120, 80, 60, and
20, and 3.780.31, 5.461.33 and 3.050.75
anteriorly at 100, 40 and 5 respectively (Figure
1). Furthermore the COR after MR was located
16.519.39, 2.231.39, 18.923.23, 31.6719.41,
17.267.97 and 29.164.26mm inferiorly at 120, 80,
60, 40, 20 and 5 respectively and 0.730.80 mm
superiorly at 100, whilst PIPB was 1.841.86,
17.587.44, 19.802.74 mm inferiorly at 80, 20
and 5 respectively and 2.232.20, 4.781.63,
6.280.21 and 10.730.16 mm superiorly at 120,
100, 60 and 40 respectively (Figure 1).

References
Daines, et al, Clin Orthop Surg, 6:18, 2014.
Dennis, et al, Clin Orthop Relat Res, 468:1027, 2010.
Metzger, et al, J Biomech, 43:28229, 2010.
Spoor, et al, J Biomech, 13:3913, 1980.
Victor, Orthop Traumatol Surg Res, 95:36572, 2009.

142

O 115

FEMORAL BONE STRAIN ASSESSMENT FOLLOWING


TOTAL KNEE REPLACEMENT USING DIGITAL
IMAGE CORRELATION
K. Rankin1, A. Dickinson1, M. Browne1
1

University of Southampton, Bioengineering Science Research Group,


Southampton, United Kingdom

Introduction
Periprosthetic bone remodelling after Total Knee
Replacement (TKR) [Abu Rajab, 2005] may be
attributed to local changes in the mechanical
strain field of the supporting bone due to the
implant-bone stiffness mismatch [Huiskes, 1987].
Experimental evaluation of the induced strain
field from different implant designs may indicate
stress shielding effects [Scott, 2013]. Digital
Image Correlation (DIC) is increasingly used
in biomechanics for full-field 3D surface strain
measurement. Test setup and selection of suitable
analysis parameters are essential for meaningful
results, but not always reported. The present study
aims to investigate the practicalities of applying
the technique to cadaveric bone for reliable
assessment of the effect of implant material on
femoral bone strain.

Figure 1: 2
 nd Principal Bone Strain Maps

Methods
Two distally sectioned cadaveric femurs (2 donors)
were potted in resin at stance; a speckle pattern
was applied to the surfaces, after which they
were subjected to quasi-static loading. Images of
the speckle pattern were acquired using stereo
DIC in six repeated tests. Reference data were
obtained from the intact femora, before each
was implanted with a PEEK-OPTIMA (Invibio Ltd)
or CoCr TKR femoral component of the same size
and geometry, and the test repeated. DIC analysis
was performed using Vic-3D (Correlated Solutions
Inc.) with parameters (subset, step and filter size)
selected for maximum strain gradient sensitivity
vs noise on each model. The measurement bias
and resolution (mean+SD) were assessed under
nominally zero strain conditions and the principal
strains under load were recorded.

Discussion
For the cadaver model, using the same speckle
pattern for correlation before and after
implantation reduced intra-model uncertainty in
strain measurement, but the reduced repeatability
highlights the influence of other variables. The
strain distribution on cadaver bone compared to
the matched analogue models could be affected
by variability in test setup parameters due to
differences in femoral geometry, such as potting
angle, tibio-femoral contact, surgical cuts and
cement mantle thickness. In addition, the difference
in femur aspect ratio vs. implant size and bone
density can influence strain. Moisture formation
on the cadaveric bone must be eliminated to
prevent reflections that introduce measurement
uncertainty from pixel saturation. Correlation
criterion and lighting on the uneven cadaveric
surface are also important considerations. A large
population of cadaveric donors would be required
to determine the absolute effect of TKR implant
material on bone strain; however, paired bone
models would be a suitable way forward for a
comparative study.

Results
Using a subset, step and filter size of 31px, 7px and
15 data points, the lowest strain resolution was
71+56, and the highest measurement variability
(+3SD) was +137 for the cadaveric bone, almost
twice as high as that observed for a similar study
on artificial bone [Rankin, 2014]. Although the
qualitative strain distributions appear similar for both
the intact analogue and cadaver bone (Figure 1),
the change in strain magnitude for the implanted
case was greater in the cadaveric model.

References
Abu-Rajab et al, J Bone Joint Surg, 88, 2006
Huiskes et al, J Biomech, 20, 1987
Rankin et al, ICEM16, Cambridge, July 2014
Scott et al, Bone Joint J, 95, 2013

143

O 116

QUANTITATIVE PARAMETERS USED TO DESCRIBE


THE P-A STABILITY OF THE HUMAN KNEE:
A REVIEW OF IN VITRO DATA
A. Mor1, J. Becker1, C. Roesler1
1

Universidade Federal de Santa Catarina, Biomechanical Engineering Laboratory,


Florianpolis, Brazil

Introduction
Considering both the anatomical and the
functional design philosophy of total knee
prostheses, the knee stability can be see as
an important parameter during designing and
pre-clinical evaluation stages of total knee
prostheses. The ASTM International supplies
standards on the establishment of a database
of total knee replacement (TKR) motion
characteristics with the intent of developing
guidelines for the assignment of constraint of TKR
designs in an experimental in vitro environment.
The test methodology relies on apply a
compressive pre-load at the TKR and move them
in a pre-defined direction, like posterior-anterior
(P-A) displacement, and measure the range
of motion and the reaction force generated
for this direction. Its rationale attempts to the
fact that different individual have distinct soft
tissue capacities for knee stabilization resulting
that different prostheses designs will best fit
each patients needs. There is no acceptance
criterion against which the testing results may be
confronted. The aim of this paper is review and
group the literature data on the limiting values
measured for the P-A passive movement of the
knee on in vitro cadaveric testing. We believe
these data could serve as a preliminary indicative
for setting acceptance criteria when judging the
admissibility of new TKR designs.

after knee tranlation, (4) specify the applied force


as well as its direction and sense to have the range
of motion and (5) shows the degree of knee flexion
for each measure.
Results
Fig. (1) shows the tibial anterior translation values
for different knee angles. Each force value applied
and the corresponding author was represented by
a curve.

Figure 1: A
 nterior tibial translation for different knee angles
and postero-anterior loading.

Discussion
The collected data allows a group view of the
AP passive knee stability behavior. These limiting
values can be used to judge the results from preclinical testing of the motion characteristics of TKR
designs.

Methods
The search of data was done at an online database
disponibilized by brazilian government, named
portal peridicos CAPES. The terms used in the
search were: biomechanical human knee laxity in
vitro. The result of the research was refined with
inclusion of articles containing the term: ACL,
in vitro, laxity, PCL, joint instability, knee,
biomechanics, knee joint, and exclusion of
articles with the following topics: patellofemoral
joint, pattela, injury, total knee artroplasty,
tissue engineering, cartilage, reconstruction,
osteoarthritis, tendons and knee injuries. The
articles found in the survey were submitted to
the following selection criteria: (1) is written in the
English language, (2) to analyze human knees in
vitro, (3) provide quantitative parameter before or

References
Anderson et al., Am J Sports Med. 38, 2010.
Kondo et al., Am J Sports Med. 38, 2010.
Piziali et al., J Biomechanics 13, 1980.
Schlepckow, Arch Orthop Trauma Surg. 111, 1992.
Suggs et al., The Journal of Arthroplasty. 19: 2, 2004.
Tsai et al., Am J Sports Med. 38, 2010.
Xu et al., Am J Sports Med. 39, 2011.
Zantop et al., Arch Orthop Trauma Surg. 127, 2007.
Zantop et al., Am J Sports Med. 36, 2008.

144

O 117

ANALYTICAL HOMOGENIZATION SCHEME REVEALING


THE NATURE OF BONE POROSITY PERMEABILITY
RELATIONS
C. Hellmich1, S. Scheiner1, T. Abdalrahman1
1

Vienna University of Technology TU Wien, Institute for Mechanics of Materials and Structures,
Vienna, Austria

Introduction
It is generally agreed on that trabecular bone
permeability,
a
physiologically
important
quantity, is governed by the material?s (vascular
or intertrabecular) porosity as well as by the
viscosity of the pore-filling fluids. Still, there is less
agreement on how these two key factors govern
bone permeability. In order to shed more light
onto this somewhat open issue, we here present
a random homogenization scheme for upscaling
Poiseuille flow in the vascular porosity, up to
Darcy-type permeability of the overall porous
medium trabecular bone [Abdalrahman, 2015].
Methods
The underlying representative volume element
of the macroscopic bone material contains
two types of phases: a spherical, impermeable
extravascular bone matrix phase interacts with
interpenetrating cylindrical pore channel phases
that are oriented in all different space directions.
This type of interaction is modeled by means of a
self-consistent homogenization scheme. While the
permeability of the bone matrix equals to zero, the
permeability of the pore phase is found through
expressing the classical HagenPoiseuille law for
laminar flow in the format of a micro-Darcy law.
The upscaling scheme contains pore size and
porosity as geometrical input variables; however,
they can be related to each other, based on
well-known relations between porosity and specific
bone surface [Martin, 1984].

Figure 1: E
 xperimental model validation

Discussion
The new analytical model, a careful theoretical
extension of the famous Carmann-Kozeny relations
[Kozeny, 1927; Carman, 1937], which have often
been applied in the present context, is able to
explain key permeability features which were
assigned to scattering so far. This holds the promise
for soon arriving at more precise and reliable
ways to compute transport processes throughout
bony organs, in particular when combining the
new method with recent evaluation schemes for
computed tomographs [Blanchard, 2013].

Results
As two key results, validated through comprehensive
experimental data [Grimm, 1997; Baroud, 2004;
Naumann, 1999; Kohles, 2001], see Figure 1, it
appears (i) that the famous KozenyCarman
constant (which relates bone permeability to the
cube of the porosity, the square of the specific
surface, as well as to the bone fluid viscosity)
needs to be replaced by an again porosity-dependent rational function, and (ii) that the
overall bone permeability is strongly affected by
the pore fluid viscosity, which, in case of polarized
fluids, is strongly increased due to the presence of
electrically charged pore walls.

References
Abdalrahman et al., J Theor Biol 365, 433444, 2015.
Baroud et al, J Biomech. 2, 189196, 2004.
Blanchard et al, J Biomech 46, 27102721, 2013.
Carman, J Agric Sci.29, 262273, 1937.
Grimm et al, J Biomech. 30,743745, 1997.
Kohles et al, J Biomech. 34,11971202, 2001.
Kozeny, Sitzber Akad Wiss Wien, 136,271306, 1927.
Martin, Crit Rev Biomed Eng 10, 179222, 1984.
Naumann et al, Ann Biomed Eng 4,517524, 1999.

145

O 11 8

EFFECT OF MICRO-FE BOUNDARY CONDITIONS ON


QUADRIC YIELD CRITERIA OF HUMAN TRABECULAR BONE
J. Panyasantisuk1, D. Pahr2, P. Zysset1
1
2

University of Bern, Institute for Surgical Technology and Biomechanics, Bern, Switzerland

Vienna University of Technology, Institute of Lightweight Design and Structural Biomechanics,


Vienna, Austria

Introduction
Hip fractures lead to high mortality and morbidity,
as well as high costs for our health care systems.
Finite element analysis of whole bones can deliver
improved fracture risk assessment but requires an
appropriate yield criterion for trabecular bone.
Identification of a full yield criterion is nearly
impossible in vitro but can be achieved in silico
by using micro-finite element (microFE) analysis
[Bayraktar, 2004] on cubical trabecular volume
elements.
Nevertheless, the influence of boundary conditions
on the obtained fitting parameters of a yield
criterion remains unknown.

Figure 1: L eft: a tri-axial tension on cubical bone region; upper right: the tri-axial tension on 1-3 plane applying
KUBCs; lower right: the tri-axial tension on 1-3 plane
applying PMUBCs.

Accordingly, the aim of this study is to compare


the fabric-based quadric yield criteria of human
femoral trabecular bone computed with classical
kinematic uniform boundary conditions (KUBCs)
and a new set of mixed uniform BCs, namely
periodicity-compatible mixed uniform boundary
conditions (PMUBCs).

Results
Yield surfaces for both BCs have an ellipsoidal
shape and their fitting parameters are shown in
Table 1. PMUBCs induce yield at substantially lower
stresses than KUBCs (Table 1), but the quadric
criteria [Schwiedrzik, 2013] can be well predicted
from volume fraction and fabric.

Methods
Sixteen trabecular cubic regions with a side length
of 5.3 mm were extracted from microCT images
with a resolution of 36 m of 3 human proximal
femora. Image voxels were converted directly
to finite elements with an approximated
Drucker-Prager plasticity model [Schwiedrzik, 2013].
Three uni-axial tensile, three uni-axial compressive,
three shear and eight multi-axial normal load
cases were applied on the trabecular cubes
using the non-linear ParFEAP program for both
KUBCs and PMUBCs (Fig. 1). The yield points of the
stress-strain curve were determined using a 0.2%
offset of the strain and stress norms. Subsequently,
quadric yield surfaces were fitted in stress space
using an optimization scheme in PYTHON.

KUBCs

PMUBCs*

PMUBCs

49.70

35.38

56.07

65.26

44.82

70.84

31.93

18.63

28.56

0.30

0.23

0.26

1.52

1.52*

1.81

0.71

0.71*

0.97

SEE

6.50%

11.49%

0.98

0.97

Table 1: F itting parameters for the volume fraction and fabric-based quadric yield criteria [Schwiedrzik, 2013].
In *, for comparison, the exponents of PMUBCs
were fixed to the same values as those of KUBCs.

Discussion
The obtained elliptic yield surfaces are in line with a
previous microFE study in the spine [Wolfram, 2012].
Additional samples will be necessary to consolidate
this preliminary analysis. The identification of these
yield parameters is expected to help improve
homogenized FE analysis of whole bones and the
assessment of hip fracture risk.
References
Bayraktar et al, JBME, 126(6):677684, 2004.
Schwiedrzik et al, BMMB, 12(6):11551168, 2013.
Wolfram et al, J Mech Behav Biomed Mater,
15:218228, 2012.

146

O 119

A COMBINED NONLINEAR VISCOELASTIC-VISCOPLASTIC


MODEL FOR TRABECULAR BONE
K. Manda1, R. Wallace2, S. Xie1, E. Sales1, F. Levrero Florencio1, P. Pankaj1
1
2

The University of Edinburgh, Institute for Bioengineering, Edinburgh, United Kingdom

The University of Edinburgh, Department of Orthopaedic Surgery, Edinburgh, United Kingdom

Introduction
As a material trabecular bone has been investigated extensively, but its time dependent creep
behaviour has not been well predicted. The
time-dependent behaviour of the trabecular
bone is extremely important to better understand
its response to dynamic loads such as those due
to fall. Yamamoto et al., (2006) reported that the
irrecoverable deformations arise from the time
dependent loading and remain there for very long
time after the unloading irrespective of load type
and levels. The aim of this study was to develop
a nonlinear viscoelastic-viscoplastic constitutive
model that can be used to simulate the dynamic
response of the bone using parameters derived
from creep-recovery experiments.

Results
The nonlinear stress dependent parameters from
Eq. (1) and parameters of viscoplasticity from
Eqs. (2)(5) were determined from the decoupled
experimental creep-recovery data. The predictions
from the developed constitutive model were in
good agreement with the experiments.

Methods
A recursive-iterative time integration algorithm [Kim
and Muliana, 2009, Huang, 2011] was developed
to model the nonlinear recoverable (viscoelastic)
and irrecoverable (viscoplastic) strain behaviour
of the trabecular bone, shown in Fig.1. Schaperys
integral model was used for viscoelastic response
while viscoplastic component follows Perzyna
model having an extended Drucker-Prager yield
criteria with non-associated flow and exponential
hardening function. Consistent tangent stiffness
matrix was formulated along with predictorcorrector iterative algorithm. The model was
used to analyse the nonlinear behaviour of the
trabecular bone at different loading conditions.
The recoverable strain of Schapery integral,
irrecoverable viscoplastic strain rate, yield
function, hardening function and rate-dependent
yield function are given by the following equations
(1)(5), respectively.

Figure 1: Integration algorithm for the nonlinear incremental


viscoelastic-viscoplastic constitutive model.

Discussion
The main objective of this study is to couple the
nonlinear viscoelasticity and Perzyna viscoplasticity
to model the time-dependent nonlinear behaviour
of the trabecular bone. A systematic methodology
was developed for identifying the parameters
associated with viscoelastic model and viscoplastic
model from creep-recovery experimental data.

Creep-recovery compressive tests were performed


on the cylindrical bovine trabecular bone samples
over a range of stress levels. The total strain
response from the creep-recovery curves was
decoupled into recoverable and irrecoverable
strain components.

References
Yamamoto et al, J Biomech 39:18121818, 2006
Kim and Muliana, Int J Numer Meth Eng,
79:550575, 2009
Huang et al, Int. J. Pavement Eng, 12:433447, 2011

147

O 12 0

COMPARISON OF PATELLAR BONE STRAIN


PREDICTIONS AFTER TKA: ISOTROPIC VS ANISOTROPIC
MATERIAL MODELS
A. Latypova1, G. Maquer2, P. Zysset2, D.P. Pioletti1, A. Terrier1
1

cole polytechnique fdrale de Lausanne, Laboratory of Biomechanical Orthopedics,


Lausanne, Switzerland

University of Bern, Institute for Surgical Technology and Biomechanics, Bern, Switzerland

Introduction
Prediction of patellar strain after total knee
arthroplasty (TKA) in both resurfaced and nonresurfaced cases could help in understanding
postoperative complications such as anterior
knee pain (AKP) or patellar fracture. Numerical
modelling could be used to estimate strain within
patellar volume. However, literature is lacking
a model identified for the patellar bone, which
includes the anisotropy of the trabecular structure.
Moreover, the importance of the trabecular
structure in the estimation of patellar bone strain
has not been studied yet.

Two cases were tested for each patella: nonresurfacing (with cartilage) and resurfacing
(with polyethylene implant). We analysed and
compared bone octahedral shear strain at 70 of
knee flexion.
Results
The constitutive law identification was better for
anisotropy (R2 = 0.94) than isotropy (R 2 = 0.85). At 70
of knee flexion, the strain distributions of isotropic
and anisotropic laws were not significantly different
(K-S test). However, the isotropic law predicted
higher strain, especially for non-resurfaced patella
with low BV/TV (Fig.1).

Therefore, the first aim of this study was to identify


isotropic and anisotropic constitutive laws for
patellar trabecular bone. In a second step, bone
strain predictions of the whole patella after TKA
modelled with isotropic and anisotropic laws were
compared during a loaded knee flexion.
Methods
Twenty fresh-frozen cadaveric patellae were
scanned with a CT (Skyscan 1076, Belgium). We
extracted 10 cubes (5.3 mm side length) from each
patella and segmented bone with Medtool (www.
dr-pahr.at). These cubes were converted into microfinite element (FE) models with isotropic linear
elastic voxel elements for bone tissue (E = 12 GPa,
v = 0.3). Three compressions and three shear tests
were simulated with ParFE (parfe.sourceforge.
net). The elasticity tensor of each cube was
computed by means of stress and strain averages
of the FE results. In parallel, bone volume fraction
(BV/TV) and anisotropy (MIL fabric tensor) of each
cube were measured from the segmented CT
images. The elastic constants of the isotropic and
anisotropic constitutive laws were identified with
regression analyses [Zysset, 2003].

aDiscussion
This study confirmed that the prediction of apparent
elastic properties of patellar trabecular bone from
BV/TV is improved with the inclusion of fabric. The
isotropic model overestimates strain likely due to
a higher stiffness of the anisotropic model along
the physiological principal stress directions.
Modelling anisotropy is more critical for low
BV/TV patellae. Resurfaced patellae are less
sensitive to adding fabric information probably
due to the higher BV/TV of the remaining anterior
part of the bone. These preliminary conclusions
remain to be confirmed for the 20 patellae.

Two patellae (high/low BV/TV) were chosen


for the comparative study. Bone geometry
was extracted from CT. Homogenized finite
element (hFE) models of the entire patellae
were created in Abaqus (abaqus.com) with
tetrahedral elements. Material properties were
assigned with the two identified laws. BV/TV and
anisotropy were extracted from the CT images.
The patellar cortex was modelled with isotropic
shell elements (E = 12 GPa, v = 0.3, thickness =
= 0.5 mm). A TKA knee model was used to simulate
a loaded squat movement [Latypova, 2013].

References
Zysset P, J Biomech, 36(10):146985, 2003.
Latypova A et al, ORS 2013: 1709.

148

O 121

IMPLEMENTATION AND VALIDATION OF NONLINEAR


ANISOTROPIC VISCOELASTIC MODEL
FOR TRABECULAR BONE
K. Manda1, R. Wallace2, E. Sales1, F. Levrero Florencio1, P. Pankaj1
1
2

The University of Edinburgh, Institute for Bioengineering, Edinburgh, United Kingdom

The University of Edinburgh, Department of Orthopaedic Surgery, Edinburgh, United Kingdom

Introduction
Most musculoskeletal simulations assume that
the bone to be linear time-independent elastic
material though it has been previously recognized
that in reality its mechanical response is
time-dependent [Deligianni, 1994]. Predicting the
time-dependent behaviour of the trabecular bone
is a significant step towards better understanding
of the mechanical behaviour of the normal and
diseased bone including fracture. In the present
work we modelled the trabecular bone with
a nonlinear anisotropic viscoelastic material
model and developed a numerical recursive
iterative algorithm and thereby predicted the
time-dependent behaviour of the trabecular bone.

Results
The stress relaxation curves of trabecular bone
samples at different strain levels were obtained
from series of compressive relaxation experiments
and the viscoelastic parameters were determined
for each sample. The nonlinear parameters were
determined and expressed as a polynomial function
of effective stress, shown in Fig. 1(A). The predicted
relaxation response from the developed nonlinear
viscoelastic model was in good agreement with
the experimental data, Fig. 1(B).

Methods
An
implicit
recursive
iterative
numerical
algorithm was developed by extending nonlinear
Schapery integral to represent the anisotropic
time-dependent behaviour of the trabecular
bone based on [Haj-Ali,2004, Poon, 1999]. The
numerical algorithm was implemented as a user
defined material subroutine (UMAT) to be used
with ABAQUS (Simulia, RI, USA) interface. The
nonlinear stress dependent parameters were
expressed as polynomial function of effective
stress based on the experimental data, Fig. 1(A).
Human femoral heads were harvested and the
trabecular bone samples were cored-out to the
size of 10.64 mm diameter. The compression tests
were performed using a loading stage mounted in
a micro-CT Skyscan 1172 (SkyScan, Kontich,
Belgium)
and
simultaneously
scanned
at
intermittent stopping points. The observed stress
relaxation curves for one of the samples are shown
in Fig. 1(B) at two different strain levels equivalent
to 20% and 40% of yield strain respectively,
ensuring that it remains in the elastic regime. The
relaxation curve at 20% of yield strain was treated
as a master curve and the nonlinear parameters
were obtained by shifting this master curve to
match with other curves at higher strains using
nonlinear curve fitting procedures.

Figure 1: ( A) Nonlinear stress dependent parameters,


(B) Relaxation stress response of a cylindrical
trabecular bone sample (diameter = 10.64mm,
height = 12.27mm) at two different strain levels.

Discussion
The time-dependent behaviour of the trabecular
bone, observed from the experiments, was
significant and the linear viscoelastic models were
not sufficient to predict this behaviour. Hence, the
more general anisotropic nonlinear viscoelastic
material model was developed and was validated
with the experiments.
References
Deligianni et al, J Biomech. 27(12): 14691476, 1994
Haj-Ali et al, Int J Numer Meth Eng, 59(1): 2545, 2004
Poon et al, Int J Numer Meth Eng, 46(12):
20272041, 1999

149

O 12 2

STABILOMETRY AS A USEFUL TOOL IN ASSESSING


BALANCE CAPACITY.
C. Piqueras1
1

BAASYS, Clinical biomechanics, Barcelona, Spain

Introduction
Stabilometry, which measures the bodys center
of pressure (COP) movements, during relaxed
standing, has been used to distinguish individuals
with vestibular and neurologic dysfunctions from
normal subjects. It is a reliable and non-invasive
technique to evaluate equilibrium function and
is useful to quantify the vestibulospinal symptoms
such as dizziness, vertigo or truncal ataxia. Anlysis
of several parameters could asses in several
postural disorders and discriminate between
healthy and pathological subjects. Patients with
whiplash injury might exaggerate their symptoms
or be malingerers because of the potential gain
associated with insurance claims. We designed
a study to screen putative malingerers. We
compare ratio between two Romberg tests with
different difficulty in the performance, increasing
the ability. The purpose of this study was to
determine whether mathematical differences in
the magnitudes of the COP obtained from four
somatosensory testing conditions (Romberg tests)
could be used to discriminate between different
types of balance deficits, normal subjects and
feigned patients.

Feigned

156

69

189

Feigned

2.71

2.82

SR FCE-CE

3.67

5.39

2.79

SR FCE-OA

9.47

12.1

7.26

C o n cl u s i o n
The measures of anterior-posterior COP movements
provided the greatest discrimination. Malingering
must be diagnosed carefully and posturography could
be a helpful supplementary tool for differentiating
whiplash-associated vertigo from malingering, but
more investigation and development of the analysis
system is required to obtain more specific results.
References
Static stabilometry and repeated testing in
a normal population.Nordahl S. Space Environ
Med. 2000 Sep;71(9):88993.
Clinical stabilometry standardization: basic
definitionsacquisition intervalsampling frequency.
Scoppa F. Gait Posture. 2013 Feb;37(2):2902.
Vestibular and stabilometric findings in whiplashinjury
and minor head trauma. A. Nacci,.Acta Otorhinolaryngol Ital 2011;31:378389
Multivariate statistical analysis in stabilometry
in human upright standing-pattern recognition
of a stabilogram. Nihon Ji. 1989 Jun;92(6):90922.
Quantitative evaluation of disorders of upright
posture using stabilometry. Cesk Neurol Neurochir.
1991 Jan;54(1):1421.[ Saling M.F.
Static stabilometry and repeated testing in
a normal population. Aviat Space Environ Med.
2000 Sep;71(9):88993. Nordahl S.

Results and discussion


According with database patients were classified in
order of their anterior-posterior and mediolateral COP
movement in normal, pathological and feigned.
Pathological

Pathologic

2.30

Statisitics Kruskal Wallis is P < 0.05. When comparing


the ratio average in different group in there was a
statiscally significant difference.Both the simulated
and pathological posturographic SR values differed
from normal under all test conditions. The average
in pathological group is greater than normal or
feigned. The differences are increasing at the same
time that increases complication in performance.
Static stabilometry is fundamental for assessing
postural deficits following a cervical proprioceptive
disorder. Analysis of the different parameters and
the indices referring to cervical interference not only
permits evaluation of altered postural performance,
but also detects and quantifies destabilisation activity
within the cervical proprioceptive component.

Exp e r i m e n t a l M e t h o d s
414 patients, 179 females (1865 years) y 235 males
(1869 years). Body Max Index females: 26.3 Body
Max Index males 28.4. Symptom at least during one
month. Quantitative evaluation of the stability of
posture was done under four conditions: with open
eyes (OE), with closed eyes(CE), and standing on
a 10 cm foam rubber mat with open (FOE) and
closed eyes (FCE), measurement of sways for
30s every condition. Using a computerized force
platform according to a standard protocol. The
stabilometry uses vertical force transducers to
determine instantaneous fluctuations in the center
of pressure. We use the parameter body sway area
of ellipse (BSE). It is the approximate area in which
subject balancing takes place. We tested twice
every condition and calculated the average.

Control

Control
SR CE-OE

Control Group criteria are test resulting in OE >95%,


CE>90%, FOE>90% and FCE >85%.
Stability Ratio (SR) is a body sway area of ellipse in mm2
coefficient between two tests with different ability in
the performance: SR CE-OE, SR FCE-CE, SR FCE-OA
150

O 12 3

HUMAN BALANCE CONTROL:


TIME DELAY AND INTERMITTENCY
T. Insperger1, J. Milton2, G. Stepan1
1

Budapest University of Technology and Economics, Department of Applied Mechanics,


Budapest, Hungary
2

The Claremont Colleges, Keck Science Department, Claremont, USA

Introduction
The observation that time-delayed feedback
can stabilize an inverted pendulum motivates the
formulation of models of human balance control in
terms of delay differential equations [Stepan, 2009].
Recently the intermittent, digital-like nature of the
neural feedback control of balance has become
evident [Loram, 2012]. In this work, we analyse
a simplified one dimensional model of human
balancing, which is a discrete time-counterpart of
the model used in [Eurich, 1996].
Methods
The model under analysis is a discrete map of the form

Figure 1: C
 losed invariant set for the discrete map.

which models the following features of human


balance control: (1) an unstable upright position
in the absence of feedback; (2) stabilizing timedelayed feedback; (3) and a sensory dead zone.
Parameters a and b are related to the feedback
delay and time-constant of the system. Although
this system is a simplified model of the Newtonian
mechanics of inverted pendulum-like structures, it
still presents their main feature, namely, instability
occurs as an exponential fall (and not oscillatory).

Discussion
The prevention of falls in the elderly, and their
accompanying mortality and morbidity, are major
challenges faced by aging industrialized societies.
Surprisingly there is little mathematical insight into
why falls occur. Are falls simply the response to
external perturbations, such as slips and trips or can
falls occur as a result of the intrinsic dynamics of
balance control regulation? Although stochastic
explanations for falling have been proposed,
our observations demonstrate that escape from
a bounded time-dependent state can occur in
a deterministic model for balance control. The
possible association of balance control with issues
related to micro-chaos and transient micro-chaos
may motivate a re-evaluation of strategies based
on the control of chaos and stochastic resonance
to minimize the risk of falling in the elderly.

The conditions for permanent and temporary


bounded solutions associated with sustained and
transient micro-chaos are analysed [Haller, 1996,
Lai, 2010].
Results
Three types of different behaviours are distinguished,
each one is associated to a particular motion of
the continuous-time counterpart shown in [Eurich,
1996]. While the different motions in [Eurich, 1996]
are periodic, the discrete-time model analysed
here presents chaotic and transiently chaotic
motions for certain parameters combinations
(see, e.g., Figure 1).

References
C. W. Eurich and J. G. Milton, Phys Rev E,
54: 66816684, 1996.
G. Haller and G. Stepan, J Nonlin Sci,
6:415448, 1996.
Y-C. Lai and T. Tel, Springer, 2010.
I. D. Loram et al, J Roy Soc Interface,
9:20702084, 2012.
G. Stepan, Phil Trans R Soc A, 367: 11951212, 2009.

151

O 12 4

BIOMECHANICAL APPROACH TO TAI-CHI.


RELAXATION AND STABILITY
S. Tassani1, J.M. Font-Llagunes2, J. Noailly3
1

Institut de Bioenginyeria de Catalunya, Biomechanics and mechanobiology,


Barcelona, Spain

Biomedical Engineering Research Centre, Universitat Politcnica de Catalunya, Department


of Mechanical Engineering, Barcelona, Spain
3

Universitat Pompeu Fabra, Department of Information and Communication Technologies,


Barcelona, Spain

Introduction
Tai Chi is an ancient martial art based on stability
and elasticity and it is usually suggested as physical
activity for the wellbeing of elder people. The multiple
aspects of the discipline can suggest its applicability
to several forms of musculoskeletal or neurological
diseases. In the last few years several studies were
presented about the beneficial effect of Tai Chi.
Nonetheless, the variability of teaching methods
within this discipline creates difficulties in the univocal
evaluation of the discipline and its effects [Lauche,
2013]. Different styles teach different sequences for a
total of more than 100 different recognized forms.
Nonetheless, the study of the discipline reveals that
all styles and forms aim to teach 8 basic movements,
usually known as Ba Gua (Fig 1). All of them are
based on the concept of relaxation in order to teach
both stability and elasticity.

with particular attention to the gluteus, shoulders,


and deep diaphragmatic breathe. Four different
parameters were computed for each subject:
mean distance, RMS distance, mean velocity
and 95% confidence circle area. Non-parametric
Kruskal-Wallis test (significance 0.05) was applied
to the analysis of each parameter. For significant
results a Wilcoxon paired non-parametric test was
used to compare results of different condition.
Results and Discussions
The only parameter showing a difference of
variance was the mean velocity (p<0.001).

Figure 1: T he 8 trigrams around the Dao represent the 8


fundamental movements of Tai Chi.

Accordingly, the present study aims to measure the


effect of relaxation over the stability of the subjects.

Figure 2: B
 ox-plot of the mean velocity related to the three
different conditions.

Methods
The statokinesigram of 10 subjects was acquired.
Foot-ground contact forces were recorded by using
a force plate (100Hz sampling). Subjects were asked
to stand over the force-plate for at least one minute
looking at a target painted on the wall approximately
at the height of the eyes. Each subject was analysed
three times to simulate different conditions: control,
tense and relaxed conditions. Control-condition
aimed to simulate standard daily situation. The
subject was asked to stand over the force-plate
without any additional information. Tense-condition
was simulated asking the subject to continuously
contract the body muscles with particular attention
to the contraction of the gluteus and shoulders (rising
of the shoulders). Additionally subjects were asked
to keep thoracic breathing. After tense analysis
subjects were guided through few exercises to relax
neck, shoulders, hips and ankles. Relaxed-condition
during the statokinesigram acquisition was then
simulated, asking the subject to relax the whole body

Velocity of both control and relaxed condition


were found significantly smaller than the tense one,
suggesting a reduced stability of the latter. This
preliminary results show not statistically difference
between control and relaxed condition. Nonetheless,
it is important to notice how the extremely common
task of standing can be influenced by the simulation
of a tense stance. Moreover, standing is a posture
that people is supposed to keep in a relaxed way,
but the closely significant result of the test (p=0.06)
suggests that more data could reveal the contrary.
Ack n o wl e d g e m e n t s
This work was partially supported by the European
Community and the autonomous region of Catalonia
(acronym sMART-O, project number 2013-BP-B-00096).
References
Lauche R. et al. Complement Ther Med
2013;21:396406.

152

O 12 5

GAIT SPEED AND POSTURAL STABILITY DURING STAIR


NEGOTIATION: EFFECTS OF DUAL TASKS AND POSTURAL
TASK DIFFICULTY
F. Madehkhaksar1, A. Egges1
1

Utrecht University, Information and Computing Sciences Virtual worlds Research Group,
Utrecht, Netherlands

Introduction
Dual task interference occurs when the introduction
of a secondary task during a cognitive or motor
performance leads to a competition between
the attentional resources available, resulting in
a decreased performance in either task. The
attentional demands of a task and the interference
effects of concurrent tasks are influenced by
several factors, such as subjects age, skill
level, task difficulty and the nature of the tasks
involved (Woollacott, 2002). Two different types of
secondary tasks, a mental task and a manual task,
have been used in dual task studies (Woollacott,
2002; Asai, 2014). However, most postural control
studies only address dual-task interference with
and extra mental task. It is interesting to investigate
dual-task interference in the context of more
complex postural tasks, such as stair negotiation.
We study how secondary mental and manual tasks
interfere with stair negotiation and how attention
is allocated between tasks when a person
concurrently performs multiple tasks with different
levels of complexity.

Results
In mental and manual tasks, no significant main
effect of postural task was observed. In contrast,
results for gait speed and COM RoMs showed
a significant main effect of postural task and
secondary task (p<0.05). There also was a
significant effect of postural task by secondary
task interaction in gait speed (p<0.001). However,
no interaction effect was found in results for COM
RoMs. Overall, increasing difficulty of postural
tasks and secondary tasks lead to decreased gait
speed and increased AP-COM RoM. No systematic
change was observed in ML-COM RoM.
Discussion
Postural tasks did not have an effect on performance
of the secondary tasks. The secondary tasks did
however affect gait speed and postural stability:
more complex secondary tasks compromise the
postural stability and decrease the gait speed.
When there is competition between two motor tasks,
one of which is postural control, the maintenance
of stability has priority. Method and results of this
study can be used to evaluate postural stability
and gait in order to predict a possible fall. Also,
our results are useful for improving rehabilitation
and treatment procedures where the relationship
between attention demands and the control of
posture and gait is important.

Methods
Gait kinematic parameters and secondary task
performance were obtained from fifteen normal
subjects while ascending and descending a fourstep staircase at three inclinations (17.7, 29.4,
and 41.5) as well as level walking. They performed
a mental task, backward digit recall (Maylor,
1996), a manual task, holding a cup of water
and a combination of the two tasks concurrently.
Kinematic data was recorded by a 14-camera
three-dimensional motion capture system and
kinematic data of the lower extremities as well as
the body COM were collected by using the Plug-in
gait model. Gait performance was measured by
gait speed. Postural stability was assessed by CoM
RoMs in medial-lateral (ML-COM RoM) and anteriorposterior (AP-COM RoM) directions, separately.
Also, the performance of each secondary task
was measured. Two-way repeated measures of
ANOVA was performed for gait speed and CoM
RoMs as well as for secondary tasks performance.

Ack n o wl e d g e m e n t
This work is supported by the Dutch research project
COMMIT Virtual Worlds for Well-Being.
References
A
 sai, et al., Gait & posture 39(1): 5459, 2014.
M
 aylor, et al., J Gerontology Series B:
Psychological Sciences and Social Sciences 51(3):
P143P154, 1996.
W
 oollacott, et al., Gait & posture 16(1): 114, 2002.

153

O 12 6

DYNAMICS ANALYSIS OF PATIENT-SPECIFIC RIGID


BODY MODELS DERIVED FROM MRI IMAGES
M. Sreenivasa1, C.J.G. Chamorro1, D.G. Alvarado1, S. Wolf2
1

University of Heidelberg, Optimization in Robotics & Biomechanics Interdisciplinary Center


for Scientific Computing, Heidelberg, Germany

Heidelberg University Hospital, Department of Orthopedics and Traumatology, Heidelberg,


Germany

Introduction
Patient-Specific Models (PSM) are interesting for
a range of biomechanical applications such as
quantifying pathological presentation and avoiding
the approximation errors typical in Generalized
Scaled Models (GSM). Current methods to generate
PSMs are time-consuming and their impact on the
final results unclear. Here, we present results from
an on-going project that automatically generates
kinematic and dynamic properties of PSMs from
imaging scans, and compares the differences
between using PSM, GSM, and the Vicon Plug-In-Gait
(VPIG) models, for gait analysis.

Estimating Limb Mass & Inertia: The segmented


data on bone, muscle and fat content were used
to compute accurate limb masses, Center of Mass
(CoM) and the inertial parameters, Fig. 1c.
Inverse Dynamics Computations: The kinematic
and dynamic information from the previous steps
were used to create the PSM. Inverse dynamics
analysis [Felis 2012] was then used to compute
the joint torques during a gait cycle, Fig. 2a. We
compare the PSM results to those computed
by using a GSM based on De Leva parameters
[deLeva 1996], as well as the VPIG model.
Results
We found several differences between the
kinematic and dynamic parameters of the PSM and
GSM models. For example; the femoral anteversion
of the PSM (estimated from bone landmarks on
the optimized mesh) was 4 more than that of the
default mesh; as well, the estimated mass of the
PSM left upper leg was 8% less than the GSM model,
with a CoM displacement of 4cm and additional
non-diagonal inertial terms. Consequently, we
found significant differences between the inverse
kinematics and dynamics results based on the
PSM, GSM and VPIG models, Fig. 2b.

Figure 1: P
 atient-specific lower body model from MRI images using a) Affine mesh optimization b) Femoral
morphing c) 3D mass properties of bone, muscle
and fat

Methods
A PSM was developed from MRI scans of a 10-yr
old female diagnosed with Multiple Epiphyseal
Dysplasia.
Estimating Skeletal Kinematics: Figs. 1a & c show the
point clouds corresponding to the bone, muscle
and fat in each MRI slice. First, MRI segmentation
was performed using the Ilastik image processing
toolkit [Sommer 2011]. Second, the segmented
data were used to morph a generic skeletal mesh
[Arnold 2010] using custom built software and the
IsoMesh toolkit [Fang 2009], Fig. 1a. Additionally,
femoral characteristics were refined by allowing
for a larger morphing range, Fig. 1b.

Figure 2: a
 ) Sample gait trial with computation of b) sagittal
plane joint kinematics and dynamics
see the next page

154

Discussion
Our results show that development of patientspecific models from imaging data is achievable
and can have a significant impact on the results
of gait analysis. This has important consequences
for the planning of rehabilitation and orthopedic
interventions. Our current efforts are aimed at
improving the robustness of the segmentation
methods and making then available to the
biomechanics community as open-source tools.

References
Arnold et al, Annals Biomed Engg, 38:269279, 2010.
Sommer et al, IEEE ISBI:230233, 2011.
Fang et al, IEEE ISBI: 11421145, 2009.
Felis M, rbdl.bitbucket.org, 2012. de Leva P,
J Biomech, 29(9):122330, 1996.

155

O 12 7

EVALUATION OF 2-METHACRYLOYLOXYETHYL
PHOSPHORYLCHOLINE (MPC) NANOCOATINGS
FOR IMPROVED TRIBOLOGICAL FUNCTION
OF ORTHOPAEDIC DEVICES
M. Parkes1, P. Milner1, P. Cann2, J. Jeffers1
1

Orthopaedic Biomechanics, Mechanical Engineering Imperial College London,


London, United Kingdom
2

Tribology Group, Mechanical Engineering Imperial College London,


London, United Kingdom

Introduction
2-methacryloyloxyethyl phosphorylcholine (MPC)
nanocoatings offer a promising solution to reduce
friction and improve wear-life of orthopaedic
devices by mimicking the mechanisms of biological
lubrication [Moro, 2004]. On model surfaces such
nanocoatings have reduced friction to levels
as low as those found in natural synovial joints
under reciprocating sliding tests [Chen, 2009].
These simple tests do not replicate the complex
loading patterns or kinematics experienced in
vivo and so the functional envelope of such
nanocoatings is yet to be determined. In this work
the tribological performance of MPC coatings on
UHMWPE substrates was systematically evaluated
for changes in contact pressure and sliding
kinematics, relevant to the human knee.

Results
MPC nanocoatings successfully reduced the sliding
friction coefficient in a proteinaceous lubricant
from 0.15 to 0.02. At high contact pressures, this
low friction coefficient was not maintained over
time and the underlying polymer demonstrated
significant wear. Low friction at the macroscale
was also found to be dependent on generation of
a homogenous coating at the nanoscale.
Discussion
The use of a custom tribometer allowed MPC
nanocoatings fabricated on a typical orthopaedic
material to be tested using a range of contact
pressures and physiological kinematics. From these
results a functional envelope has been defined in
which MPC is successful at reducing friction and
wear. This information can be used to determine
for which applications such nanocoatings can
be used to improve tribological performance of
orthopaedic materials in vivo.

Methods
MPC coatings were prepared on UHMWPE substrates
using
surface-initiated
photopolymerisation
[Kyomoto, 2007]. The macroscale friction coefficient
of both coated and uncoated samples sliding
against a glass counter surface was assessed using
a custom tribometer. Surfaces were lubricated
with solution of 25% Bovine Calf Serum in deionised
water at room temperature (20 C). Experiments
were conducted with translation only or translation
and rotation over a range of contact pressures
(216 MPa). Wear of both the sample and coating
was assessed using stylus profilometry, atomic
force microscopy and fluorescence microscopy.

References
C
 hen at al, Science, 323:16981701,2009.
K
 yomoto et al, J Biomed Mater Res A, 82:
107, 2007.
Moro et al, Nature Materials, 3:829 836, 2004.

156

O 12 8

SYNTHESIS OF ULTRA-LOW WEAR AND FRICTION


POLYMERIC SURFACES FOR ORTHOPAEDIC
APPLICATIONS
P.E. Milner1, R. Chapman2, M. Parkes1, P.M. Cann1, M.M. Stevens2, J. Jeffers1
1
2

Imperial College London, Mechanical Engineering, London, United Kingdom

Imperial College London, Department of Materials, Department of Bioengineering


and Institute for Biomedical Engineering, London, United Kingdom

Results
Post-polymerisation, all the substrates showed an
increased hydrophilicity, as measured by contact
angle goniometry, suggesting that pMPC had
successfully polymerised from the surface for
all materials. The reduction in contact angle of
the new materials was similar and in some cases
greater than that of the pMPC-UHMWPE. The
presence of pMPC on the surface of the polymers
was confirmed by ATR-FTIR, with the characteristic
phosphate and nitrate groups of pMPC clearly
identifiable. Fluorescence microscopy and AFM
indicated that there was not always homogeneous
growth of the pMPC across the substrates.

Introduction
Wear and the associated aseptic loosening are
primary failure modes of orthopaedic implants
[NJR, 2013]. Cartilage is able to reduce its own
wear through two mechanisms: interstitial fluid
pressurisation [Soltz, 2000] and boundary lubrication
[Hills, 1984]. By grafting lubricating polymers such
as poly(2-methacryloyloxyethyl phosphorylcholine)
(pMPC) from the surface of implants, orthopaedic
materials that mimic the boundary lubrication
of cartilage have become a possibility. Indeed,
pMPC has been successfully grown on UHMWPE
for applications in total joint replacement [Moro,
2014]. In this work we aim to extend the number of
materials functionalised with pMPC and compare
these to pMPC coated UHMWPE (pMPC-UHWMPE).

Discussion
We have found evidence that covalently
bound pMPC polymer chains have been grown
on the surface of various polymers that have
applications in orthopaedics. The inhomogeneity
in some samples detected by fluorescence and
AFM indicate the importance of optimising the
polymerisation variables for the different materials,
and this will be investigated in future work. Future
work will also investigate the tribological function
of these materials.

Methods
Substrates of several polymer materials with
potential applications in orthopaedics were
functionalised with pMPC in a custom built reaction
chamber and subsequently washed thoroughly
to remove any non-bonded pMPC. Specimens
were then investigated for pMPC coverage using
water contact angle, attenuated reflectance
Fourier transform infrared (ATR-FTIR) spectroscopy,
atomic force microscopy (AFM) and fluorescence
microscopy and compared to pMPC-UHMWPE.

References
H
 ills, B. A. & Butler, B. D. (1984). Ann Rheum Dis,
43(4), 641648.
M
 oro, T. et al. (2014). J Orthop Res, 32(3), 369376.
N
 ational Joint Registry for England, Wales and
Northern Ireland (NJR). Annual report 2013.
S oltz, M. A. & Ateshian, G. A. (2000). Ann Biomed
Eng, 28(2), 150159.

157

O 12 9

IMPROVING THE LUBRICITY OF MUCINS


BY COMPLEXATION WITH POLYMERS
S. Lee1
1

Technical University of Denmark, Department of Mechanical Engineering, Kgs. Lyngby,


Denmark

Introduction
Mucins are a major macromolecular component
of mucus gels that are known to protect underlying
epithelial
surfaces
against
pathogen
and
mechanical insult. Mucins and mucus gels are
renowned for their unique lubricity, not only for
biological tissues, but also for various engineering
materials in aqueous environment. While previous
studies have mainly focused on elucidation of the
generic lubricating properties of mucins [S. Lee et
al 2005, G.E. Yakubov et al 2009, N. Nikogeorgos et
al 2014], we demonstrate that the lubricity of mucin
films can be further improved by complexation with
synthetic polymers, in particular mucoadhesive
polymers, in this study.
Methods
Porcine gastric mucin (PGM) and bovine
submaxillary mucin (BSM) were purchased from
Sigma Aldrich and dialyzed against water prior to
use. Chitosan, polyacrylic acid (PAA), and polyallyl
amine (PAAm), polyethylene imine (PEI) were used
as received. Various aqueous solutions of mucinpolymer mixture were prepared (0.1 to 1 mg/
mL in PBS with varying pH). Pin-on-disk tribometry
was employed to assess the lubricity of mucins,
polymers, and their mixtures. Silicone rubbers
(PDMS) employed as tribopair. Other analytical
techniques include dynamic light scattering (DLS),
zeta potential, and optical waguide lightmode
spectroscopy (OWLS).

Figure 1: C
 oefficient of friction vs. speed plots for PGM,
chitosan, and their mixture (1:1), showing an
extensive synergetic lubricating effect between
PGM and chitosan.

Discussion
The synergetic lubricating effect between mucins
and mucoadhesive polymers can be explained
by the complexation of mucin with mucoadhesive
polymer
by
forming
physically
crosslinked
aggregates, resulting in higher cohesion and
lower interlayer chain interpenetration and
bridging. A simple electrostatic attraction, without
mucoadhesive interaction, was somewhat inferior
in synergetic lubricating effects. Meanwhile,
mucoadhesive complexation with electrostatic
repulsion, for example between PGM and PAA at
neutral pH, showed synergetic lubricating effect to
a certain extent.

Results
A synergetic lubricating effect between porcine
gastric mucin (PGM) and chitosan based on
their mucoadhesive interaction was observed [N.
Nikogeorgos et al 2015]. In acidic solution (pH 3.2)
and low concentrations (0.1 mg/mL), the interaction
of PGM with chitosan led to surface recharge and
size shrinkage of their aggregates. This resulted
in higher mass adsorption on the PDMS surface
with an increasing weight ratio of [chitosan]/
[PGM + chitosan] up to 0.50. While neither PGM
nor chitosan exhibited slippery characteristics, the
coefficient of friction being close to 1, their mixture
improved considerably the lubricating efficiency
(the coefficient of friction is 0.011 at an optimum
mixing ratio) and wear resistance of the adsorbed
layers. Other pairs between mucin and polymers
also showed similar, yet varying magnitude of
synergetic effect of lubrication. A representative
friction coefficient vs speed plot is shown in Figure 1.

References
G.E Yakubov et al, Langmuir, 25:23132321, 2009.
J.B. Madsen et al, Prep. Biochem. Biotech.,
45: 8499, 2015.
N. Nikogeorgos et al, Colloids and Surfaces B,
122:760766, 2014.
N. Nikogeorgos et al, Soft Matter, 11:489498, 2015.
S. Lee et al, Langmuir, 21:83448353, 2005.

158

O 13 0

OPTIMIZING THE THICKNESS OF CERAMIC COATINGS


TO PROTECT THE PLASTIC INSERT IN JOINT PROSTHESES:
A FINITE ELEMENT ANALYSIS
G. Marchiori1, N. Lopomo1,2, M. Bianchi1, M. Boi1, A. Visani2, A. Russo1,
M. Marcacci1,2, C. Signorelli2
1
2

Istituto Ortopedico Rizzoli, Laboratorio di NanoBiotecnologie, Bologna, Italy

Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica,


Bologna, Italy

Introduction
Wear of the plastic insert remains one of the
main causes of long-term joint implant failure.
Within this issue, permanent deformations greatly
affect mechanical properties and durability of
polymeric implant devices as well [Takahashi,
2015]. Innovative Pulsed Plasma Deposition (PPD)
technique has been proven to improve surface
properties by providing hard ceramic thin films
(i.e. zirconia) even onto polyethylene (UHMWPE)
components [Bianchi, 2013]. The main issues in
depositing a brittle film on a soft substrate are
related to prevent the cracking of the film and,
at the same time, the yielding of the bulk material
[Miranda, 2003]. The purpose of this study was to
use the Finite Element Analysis (FEA) to optimize
zirconia film thickness aiming both to protect the
UHMWPE under unusual local pressure phenomena
and to improve the local strength of the coating
itself.

Figure 1: M
 ax Principal Stress in the coating subsurface.

Methods
Since third-body effect can be simulated via
nanoindentation [Sun, 2009], a corresponding Finite
Element Model (FEM) was implemented, exploiting
an axial-symmetric 2D geometry. The Berkovich
tip was modeled as a rigid cone, whereas the
sample was modeled as a 100x100 m square.
UHMWPE was implemented as visco-elasto-plastic
material, while the zirconia was considered linear
elastic. Several mechanical tests served both to
obtain the material constitutive parameters and,
changing the boundary conditions, to validate the
FEM. Once validated, the FEM was used to predict
the effect of different film thicknesses, 0.5123
45 m, simulated on the indented samples. Max
Principal Stress in the coating and creep behavior
(with 360 holding time) were used as assessment
parameters.

Figure 2: C
 reep: indenter deeping at constant load
(holding time 360 s).

Discussion
A ceramic coating with thickness equal or above
4m shows a Max Principal Stress below the Zirconia
strength (supposed equal to 1.45 GPa [Miranda,
2003]). This thickness has been reported to be
commonly used in commercial joint replacements
[Liu, 2013] and can be easily achieved even with
PPD technique. Future work will assess and design
the implementation of multilayer films, aiming at
a better compliance of the coating to the loads
and, at the same time, favoring the use of lower
thicknesses, which are technologically less expensive
and, thence, more attractive for the industry.

Results
The FEA outputs chosen as critical showed an
exponential dependency on film thickness. In
particular the thickness increase reduced the
Max Principal Stress in the coating subsurface
(fig. 1), responsible of the radial crack formation,
preserved the film adhesion and limited the
indenter penetration, and so deformation, of the
substrate (fig. 2).

References
Bianchi et al, J Mater Chem B, 1: 310, 2013.
Liu et al, Mat Sci And Eng C 33, 27882794, 2013.
Miranda et al, Acta Mater 51, 43574365, 2003.
Sun et al, Wear, 267: 1845, 2009.
Takahashi et al, Acta Biomater 14, 595599, 2015.

159

O 131

FUNCTIONAL EVALUATION OF SYNTHETIC MESHES USED


IN REPAIR OF ABDOMINAL WALL
M. Kirilova-Doneva1,2, D. Pashkouleva3 , N. Gerassimov4 , S. Sopotensky5,
E. Moutafova6 , G. Petrova1, V. Kavardzhikov3
1

Medical University Sofia, Faculty of Pharmacy, Department of Social Pharmacy


and Pharmacoeconomics, Sofia, Bulgaria
2
3

Institute of Mechanics BAS, Department of Biomechanics, Sofia, Bulgaria

Institute of Mechanics BAS, Department of Solid Mechanics, Sofia, Bulgaria


4

Pharmacy Supernova, Dobrich, Dobrich, Bulgaria

UHATEM N.I.Pirogov, Urgent adoption and advisory department, Sofia, Bulgaria


6

MU Varna, Faculty of Public Health, Varna, Bulgaria

Introduction
The synthetic meshes have many applications
in a surgery. Because of the variety of mesh
brands available in the surgical practice, the
suitable choice of hernia meshes will lead to
better postoperative results, will decrease level
of complications and health care expenditures.
The relationships between the brand of implanted
meshes and outcomes of hernia therapy for
patients in Bulgaria have not properly investigated
yet. This has stimulated our interest on the problem.
The aim of this study is to compare mechanical
compatibility of the most applicable hernia
meshes in our country according to their elasticity
and orthotropy.

Results
The mechanical compatibility between fascia and
hernia meshes was accessed on the basis of their
orthotropy and elasticity. The elastic properties
of hernia meshes SP (E=4,36 1,04 MPa) and VP
(E=3,92 0,54 MPa) in L-direction approach the
elastic properties of the fascia from up to 65 years old
donors in the same direction (E=4,94 2,05MPa)
and the elastic properties of the fascia from
6580 years old donors in the transversal direction
(E=3,53 1,76 MPa) The elastic modulus of
SM in both directions (E L=7,06 1,09 MPa;
E T=7,46 1,34 MPa) is close to elastic
properties of the abdominal fascia of group B
(E=8,49 3,43 MPa) and C (E=8,1 3,86 MPa) in
L direction. The level of orthotropy of VP and PX
(LO=0,4) approaches the level of orthotropy of
the fascia samples in the group B (LO=0,42).

Materials and methods


A multi-centre study which included 88 surgeons
from different geographical regions was conducted
and reasons for the choice of implanted meshes
were investigated. The results showed that the
preferred brands of meshes nowadays in Bulgaria
are Surgimesh (SM), Surgipro (SP), VyproII (VP) and
Parietex (PX). Variations in elasticity and orthotropy
of SM, SP and VP meshes were revealed using
tensile experiments while data from PX were taken
from the literature [1]. Tensile tests were applied
to mesh specimens cut along the rows of loops
(T direction) and parallel to the column of loops
(L direction). From the stress stretch ratio curves
the secant modulus at 5% strain (E) and samples
level of orthotropy (LO) at 5%, 10% and 15% strain
were calculated. The results were compared
with the elasticity and orthotropy of the human
abdominal fascia samples, divided into three
age groups up to 64 years (group A), between
6580 years (group B) and between 8190 years
(group C) [2].

Discussion
Functional evaluation of synthetic meshes used
un repair of abdominal wall is important for
good postoperative results. The presented results
will help to assess the mesh ability to match
abdominal elasticity and orthotropy. The data for
the mechanical properties of hernia meshes will
be applied in mathematical model of implanted
meshes.
References
1 Saberski E., Orenstein S., Novitsky Y., Anisotropic
evaluation of synthetic surgical meshes. Hernia,
2011, 15:4752.
2 Kirilova, M., D. Pashkouleva, V. Kavardzhikov.
A long-term elastic behaviour of hernia meshes,
Series on Biomechanics, 2013, 28 (34), 2428.

160

O 13 2

FLUID-STRUCTURE INTERACTION AND


OPTIMIZATION-BASED APPROACH FOR
HOMOGENIZATION OF SOFT TISSUE VISCOELASTICITY
Y. Chen1, B. Esfandiar Jahromi1, J. Palacio-Torralba1, R.L. Reuben1
1

Heriot-Watt University, Institute of Mechanical Process and Energy Engineering,


Edinburgh, United Kingdom

Introduction
Biological soft tissue often presents highly nonlinear
mechanical behaviour, with certain anisotropy and
heterogeneity, and undergoes large deformation
when fulfilling its functionality or being tested
[Phipps, 2005b]. Physiopathological conditions of
soft tissue cause changes in the microstructure
and extracellular matrix (ECM). These influence
organs functionality and mechanical properties
[Gill & West, 2013]. Standard linear homogenization
has been widely used in evaluating the effective
properties of heterogeneous materials but may
become unsuitable for biological materials. In
this study we propose a method for multiscale
modelling of tissue to determine the influence
of different testing parameters on mechanical
properties of tissue.
Figure 1: Influence of strain rate in relaxation test.

Methods
In this study, we present an optimisation based
approach for homogenisation method that
integrates fluid-structure interaction (FSI) to
evaluate the viscoelastic nonlinear behaviour
of soft tissue. The microstructures of soft tissue
are treated as bi-phase materials, solid material
representing the cells and fluid phase for the
extracellular
fluid.
Homogenisation
method
is used here, together with an embedded
optimisation process taking into account different
boundary conditions that mimic the in vivo tissue
environment under various physiological and
pathological conditions. Variations in strain rate,
viscosity of extracellular fluid and different tissue
microstructures are assessed under the proposed
framework, where the viscoelastic behaviour
of the soft tissue is quantitatively linked to the
abovementioned factors. Such proposed method
would be beneficial for quantitative assessment
of mechanical properties of soft tissue, as well as
understanding the role of multiscale architectural
features of soft tissues in its biological functionality.

Figure 2: V
 ariation in the time constant of the tissue for different viscosity and strain rates.

Discussion
The framework presented here allows the
homogenisation of nonlinear multi-phase soft
materials. This would allow determining the
dynamic mechanical properties of different
tissues in different physio-pathological conditions
therefore improving the methodologies for tissue
quality assessment. Results show that viscosity,
strain rate and tissue microstructure have a
significant influence on the viscoelastic behaviour
of soft tissue.

Results
Multi-phase modelling of soft tissue shows the
influence of strain rate in the apparent stiffness
of the tissue as shown in Fig.1. The viscoelastic
behaviour of the tissue is nonlinear with decreasing
time constants for increasing strain rates. Fluid
viscosity and microstructure of tissue has a
significant influence in the relaxation of the
material.

References
Phipps et al, Urology, 66:44750, (2005b).
Gill, B. J., & West, J. L. Journal of Biomechanics,
110.(2013).

161

O 13 3

TEMPERATURE INCREASE IN ARTICULAR CARTILAGE


INDUCED BY VISCOUS DISSIPATION
P. Abdel-Sayed1, M. Nassajian Moghadam1, R. Salomir2, D. Tchernin2, D. Pioletti1
1

Ecole Polytechnique Fdrale de Lausanne, Bioengineering, Lausanne, Switzerland


2

University Hospitals of Geneva, Radiology, Geneva, Switzerland

Introduction
Temperature measurement of the knee joint has a
long history in medical thermometry, attempting
to correlate articular disease with temperature
alteration. Temperature of a healthy knee joint is
33 C at rest 1. Given that articular knee cartilage
has viscoelastic properties, a local temperature
increase in the cartilage could be obtained due to
dissipation following a cyclic mechanical loading.
This is especially interesting for cartilage since it has
been shown that the rate of proteoglycan synthesis
and glycolysis chondrocytes are enhanced at
37C compC 2. The aim of this study was to assess
the temperature increase in articular cartilage
subsequent to mechanical loading of healthy and
degenerated cartilage, advocating a correlation
of the temperature alteration with the tissue
homeostasis.

Exp e r i m e n t a l M e t h o d s
In order to determine the temperature increase
in cartilage under mechanical loading due to its
intrinsic viscoelastic properties, a mathematical
model was developed. The model encompassed
three parameters determined experimentally
(Fig.1). The first parameter was the power of energy
dissipated subsequent to a mechanical loading,
which was quantified in vitro on human healthy
and degenerated cartilage samples. The second
parameter was the cartilage heat capacity, which
was measured in vitro on human cartilage samples
with Differential Scanning Calorimetry. Finally,
the third parameter was the time constant of
cartilage heat transfer, which was determined on
4 volunteers by Magnetic Resonance Thermometry.
Results and discussion
For healthy cartilage samples, the model shows that
dissipation may be sufficient to raise the temperature
in articular cartilage from 33C to 36.7C after
a one hour walking. However, for degenerated
cartilage the temperature augmentation did
not exceed 1 C. Indeed, a significant (p < 0.01)
decrease in the energy dissipation can be
observed in degenerated samples, as it
drops from 12.82 1.18 to 2.82 0.97 mJ/g.
Thus this decrease in dissipation implied also a
reduced temperature increase during mechanical
loading
C o n cl u s i o n
The results of this study show that the thermal
aspect of cartilage mechanics may be related to
cartilage degeneration.
References
1 Becher+, BMC Musculoskelet Disord, 2008;
2 Brand+, Connect Tissue Res, 1991;
A C K NO W L ED G EMENTS
This project was supported by the Inter-Institutional
Center for Translational Biomechanics EPFL-CHUV-DAL.

Figure 1: F lowchart of the experiments.

162

O 13 4

IMPACT OF CANITIES ON VISCOELASTIC


PARAMETERS OF HUMAN HAIR
L. Simkova1, M. Skrontova2, J. Zeman3 , B. Chalupa3 , K. Jelen1
1

Faculty of Physical Education and Sports, Charles University in Prague,


Department of Anatomy and Biomechanics, Prague, Czech Republic

Faculty of Physical Education and Sports, Department of Anatomy and Biomechanics,


Prague, Czech Republic
3

Faculty of Engineering, Czech University of Life Sciences, Department of Physics,


Prague, Czech Republic

Methods
Hair diameter D had been ascertained optically
in 15 positions on each fibre. Young modulus
E, yield strength Yield, ultimate strength max
and maximum elongation max were determined
from the deformation curve. The strain went on
at 20 %/min speed.

Introduction
The text deals with comparison of viscoelastic
parameters of grey hair and hair of natural
colour, taken from the same persons heads. Most
works dealing with hair fibres, e.g. Robbins (2002)
describe the hair as an elastic material and work
with an analysis obtainable from the deformation
curve. Even in this case, no consensus is found in
the description parameters. While some authors
prefer establishing of the hair firmness and give
its diameter as an independent parameter, see
Hay (2011), most authors, much like Benzarti et al.
(2011), calculate strictly with the true stress and
evaluation of the Young modulus of elasticity.
Some authors plunge into a raw characterisation
of relaxation properties, using, however, a linear
model relying on two elasticities and one viscosity
at most. We use three viscous elements, keeping
the third one equal for all hairs.

Viscous characteristics, i.e. relaxation times 1 and


2 and their relevances F1 and F2 were determined
from the relaxation curve. Hair samples had been
cut from the occiput area just above the skin
surface.
All measurements have been carried out at
27 C 3 C temperature and 30 % 3 % relative
humidity.
Results
Summary of the results from 50 hairs can be seen
in the table.

VALUE

D [m]

E [GPa]

max[MPa]

max[%]

Yield[MPa]

color

79 19

4 0,8

323 76

48 5

100 19

41

gray

70 7

51

348 57

39 4

118 43

3,1 0,8

VALUE

F0 [%]

F1 [%]

F2 [%]

1 [s]

2 [s]

D [m]

color

42 6

94

10 2

91

101 38

57 2

gray

45 5

84

72

10 2

143 40

80 13

Discussion
Given the lack of homogeneity of the hair,
thinner hairs, containing higher percentage of
the more firm cortex, appear as hairs with higher
Young modulus. Furthermore, thickness increase
of 10 % on average as a result of canities can
be observed at most people. Comparison of
the results listed in the table leads us to a strong
belief that particular types of molecular bonds are
differently represented in particular hairs, resulting
in proportionally differently strong relaxation
effect. The most pronounced difference between
the original and the grey hair is always seen (w/o
exceptions!) at the 2 parameter, i.e. the long-term
relaxation. The parameter increases by 35 % on
average due to canities; grey hairs thus relax more
slowly. The long-term relaxation effect is however
smaller; generally it decreases from 10 % to 8 % of
the initial force, apparently due to a change in the
representation of particular tertiary bonds.

Yield[%]

Ack n o wl e d g e m e n t s
This project was co-financed by the grant GAUK
884214.
References
B
 enzarti, M., Tkaya, M. B., Mattei, C. P. & Zahouani,
H. (2011). Hair Mechanical Properties Depending
on Age and Origin. World Academy of Science,
Engineering and Technology 74, 471 477.
H
 ay, J. & Wall, C. (2011). Mechanical Characterization of Brown and Grey Hair. Agilent Technologies,
Inc. 2011. 5990-8681EN.
R
 obbins, R. C. (2002). Chemical and Physical
Behavior of Human Hair, 4th ed. ISBN 0-387-95094-X.

163

O 13 5

NONLINEAR COMPRESSION-RATE DEPENDENT


RESPONSE OF PORCINE KNEE JOINT
M. Rodriguez1, L. Li1
1

University of Calgary, Mechanical and Manufacturing Engineering, Calgary, Canada

Introduction
Cartilage response to load is extensively investigated
both computationally and experimentally using
relatively simple geometries, such as cartilage discs.
This relationship is characterized to be nonlinear
and viscoelastic by nature with a fluid load support
of 90% when a uniform compression is applied
rapidly [1, 2]. It is also known that cartilage response
is different when it is healthy or degenerated. In
the former, the reaction force can be up to 10
times greater than that of a slow compression
of the same magnitude [2, 3]. In the latter case
these differences related to compression-rates are
less significant. The objective of the present study
is to quantify the compression-rate dependent
mechanical response of a knee joint. We are
interested in the poromechanical response of the
human knee, but used porcine joints for lab tests
as a first step.

Our study will aid to understand the load share


between the fluid pressure and tissue matrices
within the healthy knee joint. We will use this
approach to further study how the load share
changes with compression rate for injured and
degenerated knees.
References
1 Atheshian GA, Hung CT, 2005, Clinical Orthopaedics & Related Research 81, 8190.
2 Li LP, Herzog W, 2005, Computer Methods Biomechanics Biomedical Engineering 8, 8391.
3 Li LP, Buschmann MD, Shirazi-Adl A, 2003, Journal of
Biomechanical Engineering 125, 161168.
4 Dabiri Y, Li LP, 2013, Medical Engineering & Physics
35, 15911598.

Methods
Compression tests of porcine knees were
performed on a Mini Bionix II (MTS, Minnesota).
Fresh porcine stifle joints with intact joint capsule
were obtained within 24h of slaughter. An 800-m
ramp compression was applied while the knee was
in its natural angle. Six compression rates, 10, 50,
100, 500, 1000 and 2000 m/s, respectively, were
used for the ramp compression followed by a 20
min relaxation period. Hydration was maintained
during testing. Fourteen joints have been tested so
far.
Results
Reaction force varied two times between the
smallest and fastest compression rates. The force
depends on compression rate but approaches to
the same value (~30 N) at long time (a complete
equilibrium was not reached). The fluid load support
was up to ~70% (Figure 1), because the equilibrium
load for the test shown here is approximately 30%
(~30/108) of the peak load (Figure 2).

Figure 1: L oad and compression relationship of the knee


joint.

Discussion
Reaction force highly depends on the rate of
compression for most healthy pig knee joints.
Conditions such as freezing and hydration were
found to affect the results significantly. The
difference between the peak and equilibrium load
is believed to contribute by the fluid pressure in
cartilage and menisci. In our case, the fluid pressure
can support 6070% of the total loading in most
pig knee joints, when the joint is subjected to a fast
compression. In the human knee joint computer
modeling, the equilibrium load was ~33% of the
peak load [4].

Figure 2: R
 elaxation of the joint at different compression
rates.

164

O 13 6

CERVICAL REMODELLING DURING PREGNANCY:


MULTISCALE NUMERICAL SIMULATION
OF VISCOELASTICITY
L. Peralta1, G. Rus1, N. Bochud1, F.S. Molina2
1
2

University of Granada, Estructural Mechanics, Granada, Spain

San Cecilio University Hospital, Obstetrics and Gynecology, Granada, Spain

RESU L TS
Results show that the excitation frequency determines
which rheological model can be representative for
the tissue, and the simplest model that best describes
the simulated dispersion curves in cervical tissue is
the Maxwell law. Figure 1 shows the plausibility of the
proposed rheological model to describe cervical
tissue for an excitation frequency range.

Introduction
During the cervical ripening several changes occur
progressively in the structure of the tissue, such as
an increase in the hydration, decrease in elasticity
and disorganisation of the collagen network1. The
viscoelastic properties are recently being reported
to be particularly sensitive to the gestation process,
and to be intimately related to the microstructure
of the cervical tissue2. However, this link is not fully
understood yet
In this work, we explore the possibility of quantifying
both cervical elasticity and viscosity from shear
waves velocity. To this end, a numerical histomechanical model is proposed to link variations
in the microscopic histo-biomechanical processes
with shear waves propagation characteristics.
After determining the most convenient excitation
frequency and the best rheological law to describe
the micro-structure of the cervix, parametric
simulations are carried out for a broad range of
mechanical and geometrical parameters that
mimic gestational age.

Figure 1: P
 lausibility of the proposed rheological models
for the excitation frequency range.

METHODS
We propose a model that quantitatively describes
the relationship between histological variables
and ultrasonic mechanical properties.

Results from the parametric study show a direct


relationship between the histological and morphological changes during pregnancy and the viscoelastic
behaviour of the tissue. An elasticity drop is shown for
all the morphological variables studied here, supporting that collagen fibres are mainly responsible for the
mechanical behavior of cervical tissue.

Shear waves propagation through cervical tissue


at the micro-scale is simulated by a heterogeneous
finite difference time-domain (FDTD) numerical
model. The cervical tissue is described by a
parameterized morphology model, which is able
to capture the collagen organization. Chemical
changes that happen during pregnancy are
incorporated to the cervical model by a mixture
theory-based model of mechanical properties.

DIS C USSION
This work highlights the role of collagen architecture in
soft tissue mechanics, and specifically, in the cervical
tissue. It has been demonstrated that firstly, the best
rheological model with less parameters to describe
cervical tissue is Maxwells law; secondly, results
suggest convergence at high frequency; and finally
it is worth pointing out that the elasticity offers a good
characterisation of the morphological changes in the
microstructure that occurs during gestation.

To finally connect with the macro-scale,


rheological properties are studied through the
dispersion curves by a phase difference algorithm
combined with a model-based inverse problem
(IP) to reconstruct the evolution of macroscopic
viscoelastic properties in the tissue. Three standard
rheological models (Voigt, Maxwell and Zener) are
evaluated regarding their ability to reproduce the
simulated dispersion curves, and their plausibility to
describe cervical tissue is ranked by a stochastic
model-class selection formulation 3. Finally, the
relationships between viscoelastic properties and
microstructure of the tissue are analysed by a
parametric study.

RE F EREN C ES
1 Mahendroo, Reproduction 143:429438, 2012.
2 Barone et al., ASME 2010 Summer Bioengineering
Conference 697698, 2010.
3 Bochud et al., IEEE T ULTRASON FERR, 59:
14431456, 2012.
A C K NO W L ED G MENTS
Spanish Ministerio de Economa for project DPI2010-17065, Spanish Junta de Andaluca for projects
P11-CTS-8089 and GGI3000IDIB, and the European
Union for program Programa Operativo FEDER
de Andaluca 20072013.
165

O 137

REGION-SPECIFIC UNIXIAXIAL TENSILE PROPERTIES


OF SINGLE LAMELLAE IN THE INTERVERTEBRAL DISC
G. Marini1, E. van Haaften2, F. Passini1, S. Ferguson1
1

ETH Zrich, Health Sciences and Technology, Zrich, Switzerland

TU Eindhoven, Biomedical Engineering, Eindhoven, Netherlands

Introduction
Numerical studies [Marini, 2014] have shown that
the heterogeneous stiffness distribution of the outer
ring of intervertebral discs (annulus fibrosus, AF)
represent an optimum in order to reduce the local
stress, especially in compression. These studies
modelled the AF by assuming a direct correlation
between the mechanical properties and the local
biochemical composition of the tissue. However,
the link between these characteristics is still unclear,
in particular with respect to the local position in
the tissue. This information is relevant for designing
replacements that resemble natural tissue
[Mizuno, 2004] and could enhance substantially
the biofidelity of numerical analyses of the spine.
The aim of the current study was therefore to
characterize the uniaxial tensile response of single
lamellae with respect to their radial position within
the AF.

Figure 2: D
 istribution of Elow (white), Emid (grey) and Ehigh
(black) vs the relative radial position in the AF (0
outer region, n=104)

Methods
Single lamellae were harvested from lumbar
bovine discs (n=13). The distance (x) from the
outer edges of the adjacent vertebrae was
noted. Before testing, the specimens were
immersed for 30 minutes in a physiological bath
(0.15 M NaCl). Afterwards, the lamellae were cut
into a rectangular shape and the size measured.
For the test, the specimens were sandwiched in
fabric and clamped in a testing machine (Instron
ElectroPuls). Microbeads were blown on the
surface to serve as reference points for subsequent
video strain analysis. After preconditioning
(0.1 N, 5 cycles at 0.05 Hz), the lamellae were
allowed to relax for 60s. The specimens were then
stretched at a constant speed (1 mm/min) to failure.

Slipping of the lamellae was assessed by post-test


analysis of the videos. The mechanical response
was characterized for regions between 0 MPa and
the yield stress (s g). The modulus was defined as the
maximum of the first derivative of the stress-strain
curve [Marini, 2012]. Three moduli were defined:
E low (00.1s g), E mid (0.1s g0.5s g) and E high (0.5s gs g)
(Figure 1).
Results
In general, outer lamellae were stiffer than lamellae
from the inner AF (Figure 2). This is reflected by
the radial changes of the tensile moduli and is in
agreement with previous studies [Skaggs, 1994].
The interpolation of each moduli distribution
with a linear function showed a high correlation,
R>0.53 (p<0.001).
Discussion
The present study investigated the tensile properties
of single lamellae with respect to their radial position
in the AF. The results suggest a corresponding
variation in biochemical composition, which will
be the focus in a future study.
References
Marini et al, Ann Bio Eng, 42:17601772, 2014
Marini et al, Int J Num Met Bio Eng, 28:8799, 2012
Mizuno et al, Spine, 29: 12901298, 2004
Skaggs et al, Spine, 19:13101319, 1994

Figure 1: S tress-strain curve of a single AF lamella

166

O 13 8

OUTER AND INNER ANTERIOR ANNULUS FIBROSUS


HAVE DIFFERENT STIFFNESS AND FAILURE STRENGTH
IN RADIAL TENSION
M. Mengoni1, A.C. Jones1, V.N. Wijayathinga1, R.K. Wilcox1
1

University of Leeds, institute of Medical and Biological Engineering, Leeds, United Kingdom

Introduction
The annulus fibrosus (AF) is the outer part of the
intervertebral disc. It comprises a series of lamellae,
composed of collagen fibres embedded in a ground
matrix. Secondary structures such as bridges across
the lamellae are also present [Schollum, 2008].
This complex composite architecture contributes
to the highly non-linear anisotropic behaviour
of the intervertebral disc. The aim of the present
study was to examine the damage occurrence
and failure strength of the anterior AF under radial
tension. This is a first step towards modelling failure
mechanisms to understand the effects of needle
puncture, for which there is evidence that it may
cause damage leading to degeneration.

Results
No significant differences between groups were
found for the strain level at which apparent
damage or failure occurred (Figure 1). As a result
of the difference in stiffness, the stress level at
occurrence of apparent damage was significantly
different between each group. No significant
difference was observed within each group
between the stress levels at the occurrence of first
failure and at macroscopic failure.

Methods
All discs used in this study were extracted from
frozen mature ovine thoracolumbar spines. Cuboid
AF specimens were divided into three groups:
outer annulus (N=6), inner annulus (N=8), and
specimens across the whole annulus thickness
(N=12). Tensile radial tests were performed at
1 mm/min and load was recorded. The linear
modulus was evaluated as the slope of the linear
fit of the stress between 0.5% and the strain value
for which the curvature of the stress/strain curve
deviates from zero. Occurrence of apparent
damage was defined as the stress and strain values
for which the residual of a linear fit is 15% higher
than the residual of the linear fit used to compute
the linear modulus. Initial local failure was defined
where the tangential modulus was negative for
at least 0.5% consecutive strain. Macroscopic
failure was defined as a drop of stress below 90%
its current value in less than 1% increase in strain.
The mechanical values were compared with
a Kruskal-Wallis test and Mann-Whitney tests.

Figure 1: M
 echanical parameters (mean and std)

The optimization process converged to damage


values reproducing the sample secant stiffness
within 10% of the experimental value (Figure 2). At
a given strain level, the predicted damage of the
lamellae was higher than that of the inter-lamellar
space.

A 1D variable-stiffness spring model was designed


to represent the damage part of the experimental
data. Springs were assembled in series representing
either
the
lamellae
or
the
inter-lamellar
connections. Each spring was given an initial
stiffness value derived from an inverse FEA linear
model [Mengoni, 2014]. The damage variation
of the springs was derived for each group of
specimens with an optimization process to
minimize the difference between in-vitro and
in-silico secant stiffness.

Figure 2: S tiffness variation for the experimental data (,


mean and std) and the 1D model
see the next page

167

Discussion
The experimental data suggests that, in radial
loading, the annulus has an almost linear behaviour
up to about 20% strain followed by a modulus
decrease until the first instance of local failure.
Several local failures follow at similar stress levels
before macroscopic failure. The stress level at the
occurrence of damage and failure depends on
the radial location of the samples.

The in-silico results suggest the damage of the


lamellae is predominant in the damage mechanism
of the samples. This observation is supported by
microscopic imaging.
In conclusion, this study demonstrated that
damage can be adequately modelled using 1D
variable-stiffness springs, and this approach can
now be applied to models of the whole annulus to
examine clinical interventions.
References
M
 engoni et al., WCB2014 Schollum et al. 2008 Spine
33(5) 2702-10

168

O 13 9

SECOND HARMONIC GENERATION IMAGING


AND NANOINDENTATION OF CARTILAGINOUS TISSUES
J. Sepitka1, Z. Burdikova2, E. Filova3 , J. Lukes1
1

Czech Technical University in Prague, Department of Mechanics Biomechanics


and Mechatronics, Prague, Czech Republic

Academy of Sciences of the Czech Republic, Department of Biomathematics,


Prague, Czech Republic
3

Institute of Experimental Medicine, Department of Tissue Engineering,


Prague, Czech Republic

Introduction
Interest on mechanical properties of a cartilaginous
endplate (CEP) seems to be more actual at present
spine biomechanics. Endplate is a transition zone
between intervertebral disc (IVD) and vertebral
body which plays undeniable role of a force
transmission. Poroelastic structure of CEP assures
nutrients delivery into and from the avascular
IVD. Knowledge of this amazing a few hundreds
micrometres thick indispensable cartilaginous slice
could explain basic steps of nature evolution. We
are not a first team who tried to study mechanical
properties of CEP. Surprisingly, we found alarming
anticoincidence in present papers. Mechanical
properties of the CEP are presented in literature
with large range of values. Elastic moduli are given
in the range from 5 MPa to 10 GPa. Which raises
the following questions: What causes this large
range of values? Is it an erroneously performed
experiment? Is it a poorly identified endplate?
Is it a non-sensitive macroscopic experiment to
inner microstructure of the endplate that causes
large range of measured values? We decided to
investigate mechanical properties depending on
inner microstructure of CEP and thereby detect
possible source of scattering of results. Second
Harmonic Generation imaging method (SHG) was
used to identify CEP area and its inner structure
in native state. Nanoscale Dynamic Mechanical
Analysis (nanoDMA) was used to investigate
structural dependent mechanical properties
afterwards. This work presents combination of a
nanoindentation technique and SHG imaging
to determine an influence of the cartilaginous
endplate microstructure on its local mechanical
properties.

Ready to move to SHG imaging and nanoindentation


afterwards. SHG signal was detected in two
ways: (1) the backward descanned mode when
the signal passed through the scanning head of
the confocal microscope and (2) the backward
non-descanned mode when the signal was
collected directly behind the objective. For
collagen detection the laser was tuned at the
wavelength of 860 nm, hence the SHG signal was
expected at 430 nm. In the descanned mode, the
SHG signal was detected in the range of 420 to
440 nm. In a nondescanned configuration, which
is supposed to improve the signal to noise ratio in
the acquired images, the external detector was
placed behind a 700-nm short-pass filter, which
attenuates IR light, followed by a 430-nm bandpass
filter with a bandwidth of 15 nm. Nanoscale
dynamic mechanical analysis (nanoDMA) was
performed with Hysitron TriboIndenter TI950
system with Diamond Fluid Cell Conical tip (angle
of tip 90, 10 m radius). Harmonic loading with
dynamic load amplitude P 0 = 1 N was specified
for the harmonic frequency range 5300 Hz. During
nanoDMA experiment was applied static load with
maximum force Pmax = 200 N. Specimen was glued
to the bottom of the Petri dish and surrounded
by physiological solution. The surface was under
physiological solution and ready to be indented
under a water level.
Results and discussion
We identified two types of the cartilaginous
structures within the cartilaginous endplate
(unorganized and organized). Organized structure
has horizontal, vertical and cross oriented collagen
fibers. Mechanical properties represent by means
of storage modulus of cartilaginous endplate are
in the range from 2 to 35 MPa at frequency 5 Hz.
Values depend on a type of the structure and a
density of collagen fibers. Mechanical properties
of the native cartilaginous endplate depend on
loading rate.

Methods
A porcine cartilaginous endplate of lumbar spine
L3 was used in our study. The specimen of endplate
was cut from fresh porcine vertebra, dissected
from 1216 month animals. The lumbar spine
motion segments were immediately dissected and
five millimetre thick plates of vertebral body, end
plate and annulus fibrosus were cut and polished
under running water condition. Samples were
placed into the physiological solution right after.

References
Sepitka et al. Comput Method Biomech, 15:
335336, 2012.

169

O 14 0

A NEW STRAIN ENERGY FUNCTION


FOR THE HYPERELASTIC MODELLING
OF LIGAMENTS AND TENDONS
T. Shearer1
1

University of Manchester, School of Mathematics, Manchester, United Kingdom

Introduction
Ligaments and tendons are fundamental structures
in the musculoskeletal systems of vertebrates.
Ligaments connect bone to bone to provide stability
and allow joints to function correctly, whereas
tendons connect bone to muscle to facilitate the
transfer of the forces generated by muscles to
the skeleton. The distinct roles played by different
ligaments and tendons require differing mechanical
responses to forces, and their differing stress-strain
behaviours have been well documented.

Results
It will be shown that the new model gives a better
match to stress-strain data for human patellar
tendon [3] than the HGO model, with the average
relative error being 0.053 (compared with 0.57 for
the HGO model), and the average absolute error
being 0.12MPa (compared with 0.31MPa for the
HGO model).
Discussion
The majority of SEFs in the literature behave linearly
in the small-strain limit in order to be consistent with
linear elasticity. In this talk, however, I will show
that materials with the microstructure I will describe
should not be expected to behave linearly in that
limit. The SEF I derive is non-linear in the small-strain
limit, allowing it to match experimental data in the
toe-region of the stress-strain curve better than
those models which are linear under small strains.
Additionally, all of the parameters in the new SEF
can be directly measured via experiments, giving
it more predictive power than phenomenological
models.

Ligaments and tendons consist of collagenous


fibres organised in a hierarchical structure. Their
main subunit is the fascicle, which consists of fibrils
arranged in a crimped pattern. In this talk I will derive
a new strain energy function (SEF) for the hyperelastic
modelling of ligaments and tendons based on the
geometrical arrangement of their fibrils, and will
compare the ability of the new model to reproduce
experimental data with that of the commonly-used Holzapfel-Gasser-Ogden (HGO) model [1].
There are many models of the non-linear elastic
behaviour of ligaments and tendons; however, the
majority of these (including the HGO model) are
phenomenological. A microstructurally based model
will allow us to understand how the mechanical
response of ligaments and tendons arises from the
arrangement of their constituent subunits.

References
[1] Holzapfel, G.A. Gasser, T.C. Ogden, R.W., 2000.
A new constitutive framework for arterial wall
mechanics and a comparative study of material
models. Journal of Elasticity 61, 148.
[2] Kastelic, J. Paller, I. Baer, E., 1980. A structural
model for tendon crimping. Journal of Biomechanics 13, 887893.
[3] Johnson, G.A. Tramaglini, D.M. Levine, R.E.
Ohno, K. Choi N-Y. Woo, S.L-Y., 1994. Tensile and
viscoelastic properties of human patellar tendon.
Journal of Orthopaedic Research 12, 796803.

Methods
Kastelic et al. [2] derived the stress-strain response
of a fascicle under tension as a function of
the microstructural arrangement of its fibrils.
Unfortunately, however, an error in that paper
led to the derived stress-strain relationship being
incorrect. In this talk, I will correct the mistake in [2]
and use a new functional form for the radial crimp
angle distribution to derive an expression for the
stress-strain response of a single fascicle, which I
will use to derive the new SEF.

170

O 141

MECHANICAL CHARACTERIZATION OF ABDOMINAL


MUSCLE BY INVERSE ANALYSIS ON AN ANIMAL MODEL
R. Simn-Allu1, B. Calvo1, J.M.M. Montiel1, A. Oberai2
1

Aragn Institute of Engineering Research / University of Zaragoza, Mechanical Engineering,


Zaragoza, Spain
2

Scientific Research Computation Center SCOREC / Rensselaer Polytechnic Institute,


Department of Mechanical, Aerospace and Nuclear Engineering, Troy, NY, USA

Introduction
In this work we develop a methodology to
characterize in vivo the passive mechanical
behavior of abdominal muscle, using for that finite
element simulations combined with inverse analysis
and optimization algorithms.

p = D1 [exp (D 2 (I 1)) 1]
These parameters were obtained by inverse analysis,
posing the inverse problem as a minimization
problem and seeking the distribution of material
parameters that yields the displacement fields that
best match the experimental measures2.

The knowledge of the mechanical response of the


abdominal muscle is needed to determine the
features of the surgical mesh in cases of hernia
surgery.

Results (Fig. 2) showed that D 1 takes higher values


in the central zone of the surface, corresponding
to the muscle rectus abdominis. Same happened
with D 2. Maximum displacement values obtained in
the simulation were similar to experimental results.

E X P ERIMENTA L METHODS
Inflation test were performed on New Zealand rabbits,
increasing the inner pressure from 0 to 12 mmHg
(see Fig. 1 (a)). Experimental tests were recorded
using a stereo imaging system to obtain 3D
measurements of the abdominal surface along the
experiment.

C ON C L USIONS
Rectus seemed to be more rigid than the obliques.
The method worked properly to determine the
material parameters of the tissue.
RE F EREN C ES
1 Hernndez et al., J. Mech. Behav. Biomed. Mater.,
4(3):392404, 2011
2 Goenezen S. et al., Comput. Methods Appl. Mech.
Engrg., 200:14061420, 2011

RESU L TS AND DIS C USSION


The 3D measurements allowed us to reconstruct the
whole cavity for different pressures, which was lately
used for a finite element simulation (see Fig. 1 (b)).
For the FE analysis a quasi-incompressible isotropic
hyperelastic material model was proposed,
specifically Demirays model, dependent on two
material parameters (D1, D2) 1.

A C K NO W L ED G MENTS
Spanish Ministry of Economy and Competitiveness,
through the grant BES-2012-053422 and the project
DPI2011-27939-C02-01.

Figure 1: a
 ) Experimental arrangement of the specimen at P=12 mmHg. b) Displacement field from a FEM simulation.
see the next page

171

Figure 2: a
 ) Distribution of D1 over the abdominal surface. b) Final deformed shape for the distribution of parameters chosen.

172

O 14 2

EXPERIMENTAL AND NUMERICAL ANALYSIS OF FIBERED


SOFT TISSUES CONSIDERING VISCOELASTICITY
AND MULLINS EFFECTS
E.A. Fancello1, O.T. Pinto1, C.R.M. Roesler1, J.M. Vassoler2
1

Federal University of Santa Catarina, Mechanical Engineering Department,


Florianpolis, Brazil

Federal University of Rio Grande do Sul, Mechanical Department, Porto Alegre, Brazil

Introduction
Soft biological fibered soft tissues like ligaments,
tendons or artery walls are mainly formed by
arrangements of collagen fibers and elastin
embedded in a ground substance. Their main
mechanical properties like anisotropy, high
nonlinear response, rate strain dependence
(viscosity), dependence on the maximum strain
attained (Mullins effect), are frequently related to
the mechanical adaptation to functional loadings.
The inclusion of some or all of these phenomena
in the numerical simulation of biomechanical
problems is important to achieve significant results.
To exemplify, the addition of the correct viscous
response of an arterial wall will produce a significant
influence on the pressure wave propagation
during a fluid-structure simulation. Despite several
models have been proposed to represent these
materials [12] the present work follows a unified
variational approach to represent isotropic and
fibered viscoelastic response coupled with the socalled Mullins effect and softening at excessive
strains [35]. In order to evaluate the capabilities
of the proposed model an experimental work using
pig tendons submitted to cyclic loadings was set
up and real stress-strain curves were obtained. The
model was finally used to find the best correlation
among simulated and experimental observations.

and decouple tissue relaxation (viscous effects)


from damaging effects. Local strains (axial and
transversal) were registered by digital image
correlation (DIC), allowing the construction of real
stress-strain loading curves.
Results
Figure 1 shows the loading history and the experimental versus numerical curves after parameter identification.

C o n cl u s i o n s
Experiments showed expected rate dependence
and softening effects depending on the maximum
strain achieved. The model on the other side was
successful enough to follow these phenomena
with excellent correlation values and turning it
candidate to reproduce similar behaviors in other
relevant soft tissues.

Method
The constitutive model is based on a variational
framework for inelastic materials proposed by Ortiz
and coworkers and specialized for viscoelasticity,
anisotropy and damaging phenomena in [46].
Within this framework a pseudo-potential energy
Incremental Potential is defined at each time
step in such a way the first Piola-Kichhoff can be
computed analogously to hyperelastic materials.
Anisotropy is modeled in the classical simplified
way of splitting the Incremental Potential in
isotropic and anisotropic contributions. The internal
variables updates including viscous flow and
damage are obtained by a minimization problem
within the time increment, providing the variational
character of the model.

References
[1] Pea E., Calvo B., Martinez M.A., Doblar M., On
finite-strain damage of viscoelastic-fibred materials.
Application to soft biological tissues. International
Journal for Numerical Methods in Engineering,
74:11981218, 2008.
[2] Maher E., Creane A., Lally C., and Kelly D. J.
Journal of the mechanical behavior of biomedical
materials, 12:919, 2012.
[3] Fancello, E.A., Ponthot, J.P., and Stainier, L.,A
variational formulation of constitutive models
and updates in non-linear finite viscoelasticity.
International Journal for Numerical Methods
in Engineering, 65:18311864, 2006.
[4] Vassoler, J.M., Reips, L., and Fancello, E.A.,
A variational framework for fiber-reinforced
viscoelastic soft tissues. International Journal for
Numerical Methods in Engineering,
89:16911706, 2012.
[5] Vassoler, J.M., Fancello, E.A., Stainier,
L. A variational framework for fiber-reinforced
viscoelastic soft tissues including damage.
Submitted.

The experimental work was performed using


pig flexor tendons submitted to displacementcontrolled cyclic increasing loadings. The
maximum strain value of each cycle was kept
constant during a short period in order to enhance

173

O 14 3

HOMOGENIZATION METHODS FOR THE MULTISCALE


CONSTITUTIVE DESCRIPTION OF SOFT
CONNECTIVE TISSUES
M. Marino1, P. Wriggers1
1

Leibniz Universitt Hannover, Institut fr Kontinuumsmechanik, Hannover, Germany

Introduction
Soft connective tissues share a peculiar histological structure, characterized by a hierarchical organization from the nanoscale (molecules) up to
the microscale (crimped collagen fibers). The mechanical behaviour of collagenous tissues affects
a number of both micro (e.g., mechano-regulated
tissue remodelling) and macro (e.g., mechanics of
joints or vessels) physiological systems. Moreover,
many physiopathological processes, which are
strictly related to experimentally observable histological or biochemical alterations, affect collagenous tissues mechanics and, therefore, the functional role of a number of anatomical structures
(e.g., joints or blood vessels). Accordingly, modeling the mechanical behaviour of collagenous
tissues is a challenging open problem [Holzapfel,
2007] and the choice of a multiscale approach
based on tissue structure enables to analyze macroscopic effects as a function of diseased histological features at different scales.

Results
The effects of collagen-related diseases, linking
histological evidences with mechanical alterations,
is analyzed. For instance, alterations in collagen
metabolism, in microscale crimp morphology and
in fiber arrangements are addressed. Moreover,
the physiological or pathological tuning of tissue
mechanics with collagen cross-linking enzymatic
activity is discussed. Furthermore, the effects of
remodeling mechanisms and/or pharmacological
treatments on the evolution of tissue mechanical
response is addressed.
Discussion
Proposed approach is effective and accurate for
different regular soft collagenous tissues (such as
tendons, periodontal ligament and aortic media)
as proved by the comparison between available
experimental data and computed results.
Moreover, the value of model parameters straight
follows histo-chemical evidences opening to the
analysis of the mechanics of diseased tissues or
organs. Finally, results highlight the key role of the
nanomechanics in tissue macroscale response.

Methods
In the present work, the mechanics of soft
connective tissues is modeled by employing
multiscale homogenization methods [Marino,
2013]. Crimped collagen fibers own a non-linear
mechanical behaviour due to their geometric
arrangement as well as to molecular kinks (i.e.,
labile domains) within molecular structure.
Analytical and computational approaches are
coupled in order to the obtain the macroscale
tissue response in function of both nanoscale
mechanisms [Uzel, 2011] and microscale nonlinearities [Maceri, 2010]. Parameters governing
polyconvex anisotropic strain energies are set on the
basis of computational models of curvilinear fiberlike structures and analytical entropic/energetic
molecular descriptions.

C o n cl u s i o n
Homogenization methods for the multiscale
constitutive description of soft collagenous
tissues is a powerful tool for characterizing the
mechanics of biological structures under physiopathological conditions. The coupling of analytical
and computational approaches allows to conduct
parametric analyses with low-cost computing efforts.
References
H
 olzapfel et al, J Biomech Eng, 126:26475, 2004
M
 aceri et al, J Biomech 43:355363, 2010
M
 arino et al, Stud Mech Tis Eng Biomat,
14:73102, 2013
U
 zel et al, J Mech Behav Biomed Mat,
4:4153161, 2011

174

O 14 4

FE-COMPATIBLE REFORMULATION OF A CONSTITUTIVE


MODEL OF THE ARTERIAL WALL EXPLICITLY ACCOUNTING
FOR COLLAGEN FIBER RECRUITMENT
G. Fernndez Collazo1, N. Debusschere2, F. Iannaccone2, M. De Beule2,
P. Segers2, T. Rodrguez3 , B. Verhegghe2
1

IbiTech-bioMMeda and Instituto Superior Politcnico Jos Antonio Echevarra Cujae,


Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
2

IbiTech-bioMMeda, Department of Electronics and Information Systems,


Ghent University, Ghent, Belgium

Instituto Superior Politcnico Jos Antonio Echevarra, Cujae, Tecnologa de Construccin


de Maquinarias, La Habana, Cuba

RESU L TS AND DIS C USSON


Results show that the model can accurately
reproduce
the
non-linear
pressure-radius
relationship. Figure 1a displays how the analytical
description of the new material model can
excellently fit (chi-square=0.026) carotid pressuredistension data measured in a rat using a simple
(pre-stretched) cylindrical tube. Figure 1b shows
the response obtained from the numerical model
for the simulation of the pressure-distension
response of a simplified artery with diameter and
thickness taken for the rat carotid artery.

Introduction
Several constitutive models have been presented
in literature to describe the complex response of the
arterial wall to mechanical loading 1. One important
contribution to the description of the passive
response of blood vessels using a constituentsbased approach was proposed by Zulliger et
al. 2 However, this model presents a complex
formulation of the collagen fiber recruitment as the
load is applied (including a convolution integral),
which limits the implementation of the structural
model in finite element (FE) codes. In this study we
propose a modification of the above mentioned
model to account for a more implementationfriendly formulation for FE programs.
METHODS
We propose the following modification to the
mathematical description of the collagen
fiber recruitment presented in Zulliger et al. 2
The convolution of the individual fiber strain
energy function (SEF) with the fiber probabilistic
distribution function (PDF) (log-logistic) is replaced
by a simple multiplication of the individual fiber
SEF with the fiber cumulative distribution function
(CDF) (log-logistic). The modified constitutive
model contains the same parameters of the
original formulation. Validation of our strategy was
based upon fitting the material model parameters
to data obtained from ex-vivo rat carotid artery
measurements 3. We further verified that our new
SEF is a convex function of the stretch ratios, with
a global zero minimum when the material does
not experience deformation. We also checked
material incompressibility and the adequate
description of the experimental data. Then, the
novel constitutive model was implemented in a
user defined subroutine (UMAT) to be compatible
with the commercial FE solver Abaqus (Dassault
Systmes Simulia Corp., USA). Performances were
investigated by comparison of the numerical
results with the experimental data.

Figure 1: C
 omparison of increase in radius measured experimentally (symbols) with the new mathematical
description of the collagen fiber recruitment (solid
line). Experimental mean curve fitted with the
analytical model (a) and Abaqus test to verify the
implementation (b).

C ON C L USION
We modified an existing arterial material model to
be applicable in FE analysis. This model explicitly
accounts for collagen fiber recruitment which
makes it more intuitive than traditionally used
strain energy based formulations. We were able
to extract material properties from experimental
data from rat carotid artery measurements
and successfully reproduced the experimental
outcome via FE simulation.
RE F EREN C ES
1 Holzapfel G. A. et al., Proc. R. Soc. A.
466:15511597, 2010
2 Zulliger M. A. et al., J. Biomech. 37:9891000, 2004
3 Fridez P. et al., J. Biomech. 36:671680, 2003

175

O 14 5

THE EFFECTS OF NITINOL STENT OVERSIZING


IN PATIENTS UNDERGOING FEMORO-POPLITEAL ARTERY
REVASCULARIZATION: A GEOMETRICALLY
PATIENT-SPECIFIC FINITE ELEMENT STUDY
C. Gokgol1, N. Diehm2, P. Buchler1
1

University of Bern, Institute for Surgical Technology and Biomechanics, Bern, Switzerland
2

Kantonsspital Aarau, Interventional Angiology, Aarau, Switzerland

Introduction
Nitinol stent oversizing is commonly performed
during
endovascular
procedures;
however,
currently, stent sizing mostly relies on the expertise
of the clinicians and is not defined by objective
criteria. While oversizing a stent will undoubtedly
increase acute luminal gain, it can also create a
hostile chronic environment for the artery through
stent-to-arterial wall interactions, which may
ultimately lead to arterial damage, neointimal
hyperplasia and restenosis.
Previous clinical studies reported controversial
findings on the clinical outcome of stent oversizing.
Therefore, a better description of the biomechanical
implications of oversizing on arterial tissues may
help to understand the mechanisms responsible
for restenosis and help the clinicians select the
appropriate stent size during intervention. The aim
of the present study was to quantify the effects of
Nitinol stent oversizing using numerical models of
healthy and calcified femoro-popliteal (FP) arteries
obtained from patients undergoing endovascular
revascularization.

Figure 1: C
 ut-views of a stent expansion in a healthy,
patient-specific artery (top) and a calcified artery
(bottom)

Results
For healthy arteries, adventitia was found to
be mechanically predominant, as well as the
most failure-prone arterial layer. For all cases,
the maximum circumferential stresses in this
layer increased non-linearly with respect to the
unconstrained stent diameters. Increasing the
oversizing ratio from 1.1 to 1.8 led to a 4.5% increase
of the lumen and a 66% increase of the wall
stresses. A gradual decrease in the safety factor
of the stent was found with increased oversizing
(5.28 0.1 to 1.18 0.11). Blood flow simulations
showed that localized areas affected by low WSS
increased with higher oversizing ratios and use of
the stiffer stent.

Methods
The anatomies of the FP arteries of five patients
were obtained via 3D rotational angiography.
Finite Element (FE) models of healthy and
calcified arteries were reconstructed around
arterial centerlines. The tissue was modelled as
hyperelastic with properties corresponding to
popliteal arteries [Gasser, 2006]. Damage models
for the calcification included plastic deformation
and stress softening.
Deployment simulations of two different Nitinol
stents, with diameters ranging from 5.5 to 9 mm,
were performed. For diseased arteries, the
simulations also included the clinical steps to
crack the calcification prior to stenting. Arterial
stresses, luminal gains and fatigue behavior of the
stents were analyzed. Furthermore, computational
fluid dynamics methods were used to simulate
the physiological blood flow inside the stented
healthy arteries to obtain wall shear stress (WSS)
parameters.

Discussion
Stent oversizing increases the risks of chronic irritation
of the structural and hemodynamic properties of
the popliteal arteries. The damage inflicted onto
the arterial walls and continuous degradation
caused by critical flow parameters may create
circumstances for restenosis. Our numerical model
indicates that a maximum oversizing ratio of 1.1
is recommended for the healthy FP arterial tract.
On the other hand, the predominant arterial layer
and the stress distribution in the arteries change
drastically with the inclusion of calcification. These
changes showcase the importance of modeling
the calcified layer, which can directly impact the
appropriate oversizing ratio.
References
Gasser et al, J R Soc Interface, 3:1535, 2006.
176

O 14 6

BIOMECHANICAL EVALUATION OF A PULMONARY


ARTERY AUTOGRAFT IN THE ROSS PROCEDURE
WITH AND WITHOUT A PEARS REINFORCEMENT
H. Fehervary1, J. Vastmans1, J. Vander Sloten1, T. Verbelen2,
P. Verbrugghe2, T. Treasure3 , F. Rega2, N. Famaey1
1

KU Leuven, Mechanical Engineering, Heverlee, Belgium


2

KU Leuven, Cardiovascular Sciences, Leuven, Belgium

University College Londen, Clinical Operational Research Unit, London, United Kingdom

Introduction
The Ross procedure is a treatment for young adults
and children suffering from aortic valve disease. In
this surgical procedure the aortic root is replaced
with a pulmonary root autograft. This entails that
the pulmonary arterial tissue is exposed to systemic
pressures, which results in late root dilatation when
entirely unsupported. Different reinforcements to
support the autograft are proposed, but still remain
subject of debate [Stelzer, 2011].

parameters of UP and a reinforced postoperative


situation (S3) in which a 15 mm section has the
parameters of RP and two adjacent 10mm sections
have the parameters of RA.
Results
The preliminary material parameters of the four
different tissue types (Table 1) and maximum
principal Cauchy stresses for each simulation
(Figure 1) are shown.

This abstract evaluates from a biomechanical point


of view the Ross procedure without reinforcement
and with a Personalized External Aortic Root
Support (PEARS) [Pepper, 2010].
Methods
A simplified version of the Ross procedure is
performed on 7 Lovenaar sheep: a section of the
thoracic aorta descendens was replaced by a
section of the truncus pulmonalis, which was then
reinforced with the PEARS textile. After 6 months, the
animals were sacrificed and the tissue harvested.
Four tissue types were collected for mechanical
testing: unreinforced pulmonary arterial tissue
(UP), reinforced pulmonary arterial tissue that was
placed in aortic position (RP), unreinforced aortic
tissue (UA) and reinforced aortic tissue (RA).

C10[MPa]

k 1[MPa]

k 2[-]

[]

[-]

UP

0.004

0.004

2.569

0.3

RP

0.006

0.019

2.115

60

0.0

UA

0.019

0.013

3.251

45

0.3

RA

0.006

0.019

2.115

60

0.0

Table 1: T he material parameters of the four tissue types


for the constitutive material model proposed in
[Gasser, 2006].

The BioTester (Cellscale) device was used to perform


planar biaxial tests on 7x7 mm samples using rakes.
The sample was immersed in physiological solution
of 37C. Forces were acquired with 23N load cell
(0.2 full scale accuracy) at 30 Hz and deformation
was tracked using markers and a CCD camera
(1280x960 pixels) also at 30Hz.

Figure 1: M
 aximum principal Cauchy stresses in the aorta
loaded at systolic pressure for the preoperative
situation (S1), the unreinforced (S2) and the reinforced (S3) postoperative situation.

The constitutive model proposed in [Gasser, 2006]


was fitted to the data in a nonlinear optimization
process minimizing the model and experimental
stresses using Matlab 2013a.

Discussion
Figure 1 shows that pulmonary arterial tissue is stiffer
than aortic tissue when loaded to systemic pressures
and that no immediate dilatation is apparent.
However, these higher stresses in aortic position
compared to the physiological stresses in native
position, will trigger remodelling phenomena. On
the other hand, Figure 1 also shows a compliance
mismatch between the native aorta and the
section of reinforced pulmonary. The stresses are

A finite element simulation of an aorta under


systemic loading pressure and out-of-plane
boundary conditions at the edge was performed
using Abaqus Standard 6.12-2. The geometry was
a thick-walled aorta with dimensions realistic for
the sheep under study, meshed with 9000 C3D8RH
elements. The material model of [Gasser, 2006]
was assigned, using the parameters obtained from
the experimental data above. Three situations
are considered: the preoperative physiological
situation (S1) in which the whole tissue has
parameters of UA, the unreinforced postoperative
situation (S2) in which a 15 mm section has the

see the next page

177

References

reduced compared to the unreinforced pulmonary


section, but high stresses still occur at the border
between native and reinforced aortic tissue.
Further model refinement (e.g. calculation of
average material parameters and incorporation
of residual stresses) and first validation (e.g. visual
comparison with CT images) are required for a full
biomechanical evaluation of the Ross procedure
and the PEARS reinforcement.

P
 . Stelzer et al, Semin. Thorac. Cardiovasc. Surg.,
23(2):115123, 2011.
J . Pepper et al, Interact. Cardiovasc. Thorac. Surg.,
10(3):360365, 2010.
T .C. Gasser et al, J. R. Soc. Interface.,
3(6):1535, 2006.

178

O 14 7

BIOMECHANICAL FINITE ELEMENT ASSESSMENT OF


NEOCHORDAL TECHNIQUES IN MITRAL PROLAPSE REPAIR
F. Sturla1, E. Votta1, F. Onorati2, O. Pappalardo2, G. Puppini2,
G. Faggian2, A. Redaelli1
1

Politecnico di Milano, Department of Electronics Information and Bioengineering,


Milano, Italy
2

Universit degli Studi di Verona, Division of Cardiovascular Surgery, Verona, Italy

Introduction
Neochordal implantation (NCI) is an established
technique for degenerative mitral valve (MV)
posterior prolapse (PP) repair [Adams, 2006],
although requiring a long-standing experience
to select the appropriate NCI configuration and
precisely assess neochordal length. At this aim
we have recently proposed patient-specific
finite element (FE) models, derived from cardiac
magnetic resonance (CMR), to assess the effects
of routine NCIs [Sturla, 2014] and the impact of
surgical precision in setting neochordal length, on
postoperative MV biomechanics.
Methods
Four patient-specific FE structural MV models
were derived through segmentation of cine
CMR long-axis planes, providing 3D end-diastolic
MV
configuration,
realistic
annular
and
papillary muscles (PMs) kinematic boundary
conditions, and accounting for anisotropic MV
mechanical properties [Stevanella, 2009] and
non-linear response of ePTFE neochordae. Using
ABAQUS/Explicit, we simulated for each MV the
preoperative systolic prolapsing condition, the
physiological condition with an intact chordal
apparatus (i.e. providing the physiological
distance between the insertion of the ruptured
chordae and the corresponding PM tip) and
post-operative outcomes of single, double and
standard loop NCIs (Fig.1). For each technique,
different suture lengths were simulated, replicating
a correct, a shorter and a longer NCI repair (2mm
with respect to the physiological length). Also, the
effect of a stabilizing rigid equal-sized annuloplasty
was assessed.

Figure 1: S tudy workflow and example of FE results


computed for standard loop technique.

On the contrary, overloading of shorter NCIs was


noticed, providing a sufficient CoA, but markedly
increasing mechanical leaflet stress and inducing
asymmetric load redistribution in multiple NCIs
(Fig.1). In case of longer sutures, relevant forces
continued to act on the prolapsing MV region
and on native neochordae. Ring reshaping,
though reducing annular area, improved CoA and
mechanical stress redistribution on MV leaflet.
Discussion
The FE analyses quantitatively assessed MV
biomechanics and the efficacy of neochordal
repair in each patient-specific PP-scenario. In
particular, subtle defects in tuning NC length may
result in significant biomechanical drawbacks,
potentially
elucidating
recurrence
of
MV
regurgitation due to leaflet tearing or dehiscence
as well as mechanisms of ePTFE early failures.

Results
PP-related dysfunctions well compared to CMRdata (Fig. 1). Tested NCIs effectively fixed MV
prolapse with satisfactory levels of coaptation
area (CoA); the outcomes of MV repair proved to
be technique-dependent with multiple NCIs better
transferring tensions, thus improving mechanical
stress distribution on the repaired MV leaflet.

References
Adams et al, Heart Fail Rev, 11:24157, 2006.
Stevanella et al, J Biomech Eng, 131(12), 2009.
Sturla et al, JTCVS, 148(3):102534, 2014.

179

O 14 8

IN VITRO TESTING OF THREE DIFFERENT


IVC FILTERS EFFICIENCY
M. Nicolas Chueca1, M. Malv2, E. Pea1, M.A. Martnez1, R.L. Leask3
1
2

University of Zaragoza, Mechanical Engineering, Zaragoza, Spain

Public Univeristy of Navarra, Mechanical Engineering, Pamplona, Spain


3

McGill University, Chemical Engineering, Montreal, Canada

Introduction
Pulmonary embolism (PE) is a serious, potentially
life-threatening condition. The cause is usually
a blood clot that dislodges from the deep veins
in the lower extremities and travels to the lungs 1.
Inferior vena cava (IVC) filters are used to prevent
PE by intercepting and trapping large clots while
allowing clot-free blood to pass freely towards the
heart.

manometer. Students t-test for independent


samples was used to evaluate differences between
filtration capacities of each filter.
Numerical validation
Some numerical simulations were carried out
to validate the pressure dop measurements.
Rhinoceros (Robert McNeel & Associates) was used
to create the 3D geometries, Ansys Icem (Ansys
Inc. Software, Canonsburg, PA, USA) was used to
obtain the numerical grids (see Figure 2) and the
fluid dynamics computations were carried out
using Ansys CFX (Ansys Inc. Software, Canonsburg,
PA, USA).

Newer filter designs have appeared in the market


in the last years so there is a necessity to test their
efficiency. The aim of this in-vitro study is to evaluate
the clot capture efficiency of the Gnther Tulip
and Celect filters, under different conditions and
to prove, if possible, the superiority of one of the
filters over the others.

Results and discussion

Exp e r i m e n t a l M e t h o d s

Centered filter

In vitro set up

Filter

Small
clots

Large
clots

Small
Clots

Tilted filter
Large
clots

Modified
Gnther Tulip

5.5

21.2

NA

NA

Gnther Tulip

81.7 +

99.5 +

69.3*

99

Celect

78.5 +

98.8 +

57.8

99.3

Table 1: P
 ercentage of clots captured. + P<0.001 using t-test
when centered filters compared with Modified
Gunther. * P<0.01 using t-test when tilted filters
compared with Celect

Empty filter

Figure 1: T op:Experimental set-up, bottom: FE mesh used for


the pressure drop simulations

Figure 1 shows a summary of the in-vitro set up


used. The fluid used to mimic the blood had a
density of 1.091 g/cm3 and a dynamic viscosity of
0.0036Pa.s. The fluid was Newtonian, laminar and
fully developed.

Filter with 6 clots

Filter

In-vitro

Numerical

In-vitro

Numerical

Gnther Tulip

0.6

0.63

4.1

4.3

Celect

0.6

0.62

4.2

4.2

Table 2: P
 ressure drop in mmHg

Clot capture rates went from 5.5% to 99.5%. The


results show that the efficiency of the filters was
reduced as the size of the clots decreased and
as the position of the filter was tilted. The pressure
barely changed with the presence of the filter
alone, but higher pressures were recorded when
some clots were inserted. There was no significant
difference in the pressure drop recorded for
different filter models.

Testing procedures
Clot trapping capacity was assessed by placing
clots of various sizes into the flow system and
counting the number of clots passing through the
filter. The filters were tested at different positions
and with different clot volumes. The experiment
was repeated a total of 200 times, and a total
of 6000 clots were used. The pressure drop along
the system was also measured using a traceable

see the next page

180

References
1 Leask,R.L.,Johnston, K.W., Ojha,M. Hemodynamic
Effects of Clot Entrapment in the TrapEase Inferior
Vena Cava Filter. JVIR, 15(5), 485490

Figure 2: L eft: Celect filter in tilted position with some clots.


Right: centered Gnther Tulip with clots

C o n cl u s i o n s
The Modified Gunther Tulip filter has the lowest clot
capture efficiency, and cannot be used to prevent
PE. The most effective filter was the Gunther Tulip

Ack n o wl e d g e m e n t s
The authors gratefully acknowledge research support
from the Spanish Ministry of Science and Technology
through the research project DPI2013-44391-P and
the grant BES-2011-043471. Finally, we want to thank
Dr. Leask for his help and collaboration in this project

181

O 14 9

AN IN-VITRO PHANTOM STUDY ON THE ROLE


OF BIRD-BEAK CONFIGURATION ON ENDOGRAFT
INFOLDING IN THE AORTIC ARCH
A. Rinaudo1, S. Pasta2, F. Scardulla1, G. Raffa3 , G. DAncona4 ,
M. Pilato3 , C. Scardulla3
1
2

3
4

Universita di Palermo, DICGIM, Palermo, Italy

Fondazione RiMED, Tissue Enginnering & Regenerative Medicine, Palermo, Italy


ISMETT, CardioThoracic Surgery, Palermo, Italy

Vivantes Klinikum im Friedrichschein und Am Urban, Cardiovascular Medicine Clinical


and Research Unit, Berlin, Germany

Introduction
Endograft collapse is a potentially devastating
complication reported for the Gore TAG device
that can occur after endovascular repair of
traumatic thoracic aortic injuries [1]. Excessive
device oversizing and proximal bird-beaking are
the principal factors leading to endograft infolding
and, ultimately, collapse [2]. In this study, the
infolding of oversized endografts was assessed to
evaluate the hemodynamic conditions that may
predispose a bird-beak configuration to infolding.

at high systemic pressure. No complete collapse of


endograft was observed under chronic perfusion
testing maintained for 30 days at pulse pressure
of 100 mmHg, suggesting that physiological flows
cannot engender hemodynamic loads on the
proximal bird-beaking sufficient enough to cause
TAG collapse.
C o n cl u s i o n
These findings suggest that endograft infolding
depends primarily on the amount of aortic
pulsatility, and that physiological flows cannot
engender hemodynamic loads on the proximal
bird-beaking sufficient enough to cause TAG
collapse. Hemodynamic variables such as the
systolic to diastolic pressure change may allow for
identification of patients at high risk of endograft
infolding, and help guide preventive intervention
to avert its occurrence.

Methods
In-vitro studies were done using a mock circulation
loop in a patient-specific compliant phantom
model (see Fig.1) reconstructed from a patient who
presented with collapse of a Gore TAG thoracic
endoprosthesis (WL Gore and Assoc, Flagstaff, Ariz)
[3]. Device infolding was measured under different
flow (Q=3, 5 and 7 L/min) and systemic pressure
conditions (185/150 mmHg and 70/20 mmHg) for
three protrusion extensions (PE=13 mm, 19 mm,
and 24 mm) of the bird-beak configuration resulting
from two TAG endografts with oversizing of 11%
and 45%, respectively. TAG device displacements
of the bird-beak apex and TAG device rotation
with respect to the graft fixation point were used to
characterize infolding. Linear regression was done
to correlate hemodynamic variables with infolding
parameters. Chronic hemodynamic condition was
also assessed by maintaining perfusion upon 30
days.

References
[1] Kasirajan et al. Incidence and outcomes after
infolding or collapse of thoracic stent grafts.
J Vasc Surg, 55,6528, 2013.
[2] Tadros et al. A multicenter experience of the
management of collapsed thoracic endografts.
J Vasc Surg, 53, 121722, 2011.
[3] Pasta et al. Computer modeling for the prediction
of thoracic aortic stent graft collapse. J Vasc
Surg, 57,135361, 2013.

RESU L T AND DIS C USSION


The bird-beak configuration with the greatest PE
exhibited the maximum TAG device displacement
(0.70 mm), while the lowest PE configuration led
to the minimum amount of both displacement
and rotation parameters (0.20 mm and 0.4 deg,
respectively). The larger device led to infolding
parameters comparable to the smaller device
when perfusion was maintained at the same
hemodynamic conditions. An inverse relationship
was observed between the infolding parameters
and the flow circulating in the aorta and left
subclavian artery. Interestingly, TAG device
displacement was positively correlated with
systemic pressure, with significant p<0.05 for all birdbeak configurations and device sizes. This suggests
that that endograft infolding depends primarily on
the amount of aortic pulsatility, with a greater risk

Figure 1: Photographs

of phantom model with particulars
of bird-beak configurations (PE)

182

O 15 0

THE EVALUATION OF MAMMALIAN THROMBI MODELS


FOR THE INVESTIGATION OF VASCULAR OCCLUSION
IN ACUTE ISCHEMIC STROKE: A PRELIMINARY STUDY
F. Malone1, P. Delassus1, J. Thornton2, E. McCarthy3 , P. Fahy1, L. Morris1
1

Galway Mayo Institute of Technology, Mechanical and Industrial Engineering,


Galway, Ireland
2

Beaumont Hospital, Neuroradiology Department, Dublin 9, Ireland

Galway Mayo Institute of Technology, Marine and Freshwater Research Centre,


Galway, Ireland

Introduction
Stroke remains the third most common cause of
death and the leading cause of acquired long-term
disability worldwide. A lack of blood supply to any
part of the brain tissue for an unknown period of time
will deprive the brain tissue of oxygen, which can
lead to stroke. Over 80% of all strokes are ischaemic
that result from an occlusion of a major cerebral
artery. This occlusion can be caused by emboli,
which are thrombi that have originated elsewhere
in the cardiovascular system but have travelled
lodged in the cerebral vasculature.The retrieval of
thrombi from humans for the investigation of stroke is
expensive and highly regulated. Therefore, embolus
analogues
manufactured
from
mammalian
blood play a unique role in understanding the
pathophysiology, morphology and mechanical
characteristics of thrombi [Chueh, 2011]. This
project concerns the histological and mechanical
examination and characterisation of thrombin
induced, erythrocyte rich mammalian thrombi. The
thrombi models were then used to experimentally
model and simulate ischemic stroke using an inhouse cerebral test facility.

Results
The presence of nuclei and erythrocytes correlated
significantly with stained human thrombi samples
[Chueh, 2011] (Figure 1A). The presence of fibrin and
collagen was determined in high concentrations of
thrombin induced mammalian thrombi (Figure 1B).
Tensile and compression tests were conducted at
varying strain displacements. Initial results indicate
a change in stiffness with increase in thrombin
concentration.

Figure 1: H
 &E stain ovine thrombus(6NIH Units/ml blood) (A),
MSB stain bovine thrombus(9 NIH Units/ml blood) (B)

Discussion
The successful development of such thrombus
models and future clot flow studies may provide
a basis for the characterisation of post-operative
thrombi removed from humans. Knowledge about
the histological characteristics and lodgement
morphologies of thrombi may provide a means
for improving current endovascular therapies and
the development of new treatment strategies for
revascularisation in patients with acute ischemic
stroke. These findings could indicate that the
composition of thrombi is a potential key variable
regarding the selection of the appropriate
treatment options for ischemic stroke patients
and in predicting the performance of mechanical
thrombectomy devices and thrombolytics.

Methods
Mammalian blood of ovine and bovine origin
was harvested from a local abattoir and induced
immediately with bovine thrombin. To investigate
the effect of thrombin on thrombus composition,
the thrombin concentration was varied among the
samples (010 NIH units/ml blood). Haemotoxylin
and Eosin (H&E) and Martius, Scarlet and Blue (MSB)
stains were completed for compositional analysis.
Tensile (n=13) and compression tests (n=14)
were conducted on the corresponding thrombi
models and results were compared to literature
values [Krasokha, 2010]. 9 patient specific scans
of the aortic arch in DICOM format were imported
into Mimics Version 16.0 to generate 3D models
using segmentation techniques. Models were
geometrically characterised and differentiated
for flexible model production. These models
were incorporated into a cerebral test facility for
releasing the animal thrombi and tracking the
trajectory within the cerebral vasculature.

References
[1] Chueh, J.Y. et al, AJNR, 32:12371244, 2011.
[2] Krasokha N et al, Mat wiss u Werkstofftech,
41:10191024, 2010.

183

O 15 1

A TWO-LAYERED ARTERY WALL MODEL WITH COLLAGEN


DISPERSION FOR ARTERY BUCKLING ANALYSIS
H.C. Han1, M. Mottahedi2
1
2

University of Texas at San Antonio, Mechanical Eng, San Antonio, USA

University of Texas at San Antonio, Mechanical Engineering, San Antonio, USA

Results
Our results demonstrated that the critical buckling
pressure increased nonlinearly with increasing axial
stretch ratios. Compared to experimental critical
buckling pressures measured at axial stretch ratios
in the range of 1.01.7, both the single-layered
model and two-layered model demonstrated
similar level of accuracy (R 2 = 0.88 0.08 and
0.890.07, respectively). The measured and model
predicted critical buckling pressures obtained
from the one-layered and two-layered models at
the physiological axial stretch ratio (1.5 in vivo)
were 10.68 1.73 kPa, 9.93 3.56 kPa and
12.56 3.35 kPa, respectively. In the adventitia
layer, collagen fibers demonstrated two preferred
orientation, symmetrically aligned with respect
to circumferential direction (at 34.6 11.5);
however, in the media layer, only one preferred
fiber family, closely aligned with circumferential
direction (9.643.34), was present. Parametric
studies showed that with increasing fiber dispersion
parameter, the predicted critical buckling pressure
increases.

Introduction
Artery buckling has been proposed as a possible
mechanism of artery tortuosity which is associated
with aging, hypertension and atherosclerosis. Since
micro-structural of arterial wall remodels with aging
and diseases, it is necessary to understand how
artery buckling is linked to the micro-structural of
the arterial wall. The objective of this study was to
establish an artery buckling model based on a twolayered wall model with dispersed collagen matrix.
Methods
Five porcine carotid arteries were tested and
analyzed. Pressurized inflation test was performed
on intact arteries and separated intima-media layer
to determine the material constants. The critical
buckling pressures were measured for intact arteries
at series of axial stretch ratios in the range of 1.01.7.
Microstructural collagen distributions were obtained
through histological sections of adventitia and
media layers using an automated image processing
algorithm. The dispersion parameters quantifying
the collagen dispersion about the preferred
direction were determined by fitting a mixture of
modified von-Mises distributions. The arterial wall
was modeled as two layers with distinct material
properties for the intima-media and adventitia
layers. Buckling equations were developed using
two-fiber reinforced structural model that accounts
for collagen fiber dispersion to better represent the
anisotropic properties of the artery.

Discussion
We concluded that two-layered arterial wall
model with consideration of collagen dispersion in
each layer well described the buckling behavior of
arteries. This model improves our previous simplified
4-fiber model and sets a base for future studies to
examine the microstructural changes associated
with vascular diseases and its relationship to artery
tortuosity.
References
[1] A. Y. Lee, et al., Effects of elastin degradation
and surrounding matrix support on artery stability,
Am J Physiol Heart Circ Physiol,302 (4):
H873H884, 2012.
[2] Q. Liu, et al., Artery buckling analysis using
a four-fiber wall model, J Biomech, 47(11):
27902796, 2014.
[3] T. C. Gasser, et al., Hyperelastic modeling of
arterial layers with distributed collagen fiber
orientations, J R Soc Intf 3(6): 1535, 2006 3 (6):
1535, 2006.

184

O 15 2

ALGORITHM FOR INTRODUCING RESIDUAL STRESSES


INTO FINITE ELEMENT MODELS OF ANEURYSMS
J. Bursa1, S. Polzer1
1

Brno University of Technology, Institute of Solid Mechanics, Mechatronics and Biomechanics,


Brno, Czech Republic

Introduction
It is generally accepted that computational
models cannot give realistic estimation of
stresses in arterial wall without taking residual
stresses into consideration. This has been usually
performed on the basis of manifestation of residual
strains quantified by opening angles of arterial
segments (Vaishnav & Vossoughi, 1983). This
approach, however, is not feasible for irregular
arterial structures like abdominal aortic aneurysm
(AAA) nor for patient-specific models in general.
Therefore other approaches to computational
modelling of residual stresses have been proposed.
The algorithm published by [Polzer et al., 2013] and
implemented in finite element (FE) model reduces
the stress gradients in aortic wall substantially.
It applies the uniform stress hypothesis [Fung,
1991] by splitting the deformation gradient tensor
into elastic and growth deformation gradients.
Its applicability was shown not only for simple
geometrical shapes (e.g. hollow cylinder as model
of artery) but for patient-specific geometries of
AAAs as well. However, the optimization criterion
applied here is stress difference between the
corresponding FE nodes on the inner and outer
surfaces. Although this difference is set close to
zero after iterative calculations, the volumetric
growth is set in surface nodes only. Consequently,
the calculated stresses are not uniform throughout
the wall thickness and a significant difference in
stresses remains between surface and inner nodes
of the FE mesh thus still violating the assumption of
uniform stress.

the FE node and average stress throughout the


wall thickness in the given location. In order to
make the stress distribution closer to uniform stress
hypothesis, the volumetric growth is prescribed in
more nodes throughout the wall.
Results
Results obtained with the above model show
that the new algorithm is capable to reduce
the stress differences throughout the wall even
more effectively than that by [Polzer et al., 2013].
Specifically, under 20 kPa inner pressure, extreme
stresses in the most concave location of the wall
were 82/53 kPa after 12 iterations with the original
algorithm and 78/60 kPa after 15 iterations with the
new one.
Discussion
The results presented in this study have been
obtained using regular hexahedron mesh but the
new algorithm is applicable for patient-specific
AAA models as well because also here we prefer
hexahedron mesh. Moreover, the algorithm shows
potential of even more efficient reduction of stress
gradients by prescribing volumetric growth by a
smoother function. Due to more iterations needed,
however, it is more time consuming which might
become significant for large models. This drawback
could be reduced by a more sophisticated
programming of the algorithm. For AAA models
with irregular mesh (combining tetra-, penta-, as
well as hexahedrons), however, the algorithm may
require further modifications and become even
slower.

Methods
The analysis is performed using a FEM model with a
simple 3D geometry showing convex and concave
parts. For the material we apply hyperelastic Yeoh
model fitted to our own mean population data
for AAAs. When loaded by inner pressure, local
bending of convex and concave parts of the
model increases the stress gradients throughout
the wall thickness; these should be reduced by
residual stresses. In contrast to [Polzer et al., 2013],
however, the volumetric growth is applied here
on the basis of difference between local stress in

Ack n o wl e d g e m e n t
This work was supported by Czech Science
Foundation project No.13-16304S.
References
Fung, Ann Biomed Eng 19, 237-249, 1991.
Polzer, Bursa, Gasser, Staffa, Vlachovsky, Ann
Biomed Eng 41 (7), 1516-1527, 2013.
Vaishnav, Vossoughi, Biomedical Engineering II,
Recent Developments, Pergamon Press, Oxford,
330333, 1983.

185

O 15 3

BIOMECHANICAL RUPTURE RISK ASSESSMENT


OF ABDOMINAL AORTIC ANEURYSMS BASED
ON NOVEL PROBABILISTIC RUPTURE REISK INDEX
S. Polzer1, T.C. Gasser2
1

Brno University of Technology, Institute of solid mechanics, mechatronics and biomechanics,


Brno, Czech Republic
2

The Royal Institute of Technology, Department of Solid Mechanics, Stockholm, Sweden

Introduction
A rupture risk assessment is critical to the clinical
treatment of Abdominal Aortic Aneurysm (AAA)
patients. The biomechanical AAA rupture risk
assessment
quantitatively
integrates
many
known AAA rupture risk factors, such that it has
certain advantages over other risk assessment
methods. Despite encouraging results the
variability of risk predictions due to model input
uncertainties remains a challenging limitation of
the biomechanical AAA rupture risk assessment.

In contrast, calculated medians of PWWR were


0.568(SD0.149) and 0.774(SD0.453) for intact
and ruptured group respectively (p=0.128).
PRRI showed a high sensitivity and specificity
(discriminative power of 0.806) to discriminate
between ruptured and intact AAA cases.

Methods
The present study combined deterministic AAA
biomechanical modelling with probabilistic data
analysis in order to derive a Probabilistic Rupture
Risk Index (PRRI). Specifically, the uncertainties
in AAA wall thickness and wall strength were
considered [1], and wall stress was predicted with
a state-of-the-art deterministic biomechanical
model. The discriminative power of PRRI was tested
in a cohort of ruptured (n=6) and intact (n=6)
AAAs and compared to alternative risk assessment
method where software A4 clinics is used to
calculate deterministic criterion called peak wall
rupture risk (PWWR).

Discussion
Uncertainties in AAA wall stress predictions, the wide
range of reported wall strength and the stochastic
nature of failure motivate a probabilistic rupture
risk assessment. Advanced AAA biomechanical
modelling paired with a probabilistic rupture
index definition as known from engineering risk
assessment seem to have some advantages
over a purely deterministic approach as it shows
better discriminative power to distinguish between
ruptured and intact AAAs. Of course larger study is
needed for validation of proposed approach which
is however currently limited by long computational
times (approx. one week for one case).

Results
Prescribing a log-normal distribution of the AAA wall
thickness results in turn in a log-normal distribution
of the Peak Wall Stress predictions Medians of PRRI
were 1.86% (SD 6.82%) and 16.6% (SD 14.56%) for
intact and ruptured group respectively (p=0.045).

References
1R
 eeps C. et al., Biomech. Model. Mechanobiol.
12, 717733. 2013

186

O 15 4

MECHANICAL CHARACTERISATION OF VALVULAR


TISSUES USING INVERSE ANALYSIS
C. Laville1, V. Acosta2, O. Trabelsi2, S. Avril2, Y. Tillier1
1

MINES ParisTech, Centre de Mise en Forme des matriaux CEMEF, Sophia Antipolis, France
2

Ecole Nationale Suprieure des Mines, CIS-EMSE, Saint-Etienne, France

Results
The HGO (Gasser et al., 2006) and Prot (Prot
et al., 2007) material models were successfully
implemented using linear tetrahedral elements
and validated against published data (fig.1).

Introduction
The use of numerical simulation to investigate heart
and valvular mechanics is becoming increasingly
popular. In particular, finite element analysis is
often used to support the operation planning
procedure as well as the design of artificial valves.
The mechanical response of the aortic valve
(AV) tissue strongly depends on the composition
and interaction of different constituents, such as
collagen fibres and elastin network. Accordingly,
constitutive equations including non-linearity
and anisotropy are necessary. Many constitutive
models have been developed to describe arterial
tissue, but just a few of them have been calibrated
specifically for the AV. An inverse analysis procedure
based on the finite element computation of biaxial
tensile tests is proposed to estimate material and
structural properties of aortic valves (AV).
The obtained material parameters will be later
used to model heart valve tissues.
Methods
Experimental data: Samples were collected from
several leaflets of fresh native porcine AV. They
were tested at room temperature using a biaxial
testing device. To characterize the mechanical
properties over a wide range of conditions, each
sample was subjected to different test protocols
with different stretch ratios. Force vs. displacement
curves were plotted and strain fields were
measured using digital image correlation (DIC).

Thanks to the DIC data acquired during the


biaxial tensile tests, the inverse analysis was
run to identify simultaneously relevant material
constant parameters and fibers local orientations
(structural parameters). This allowed us to perform
numerical simulations of whole heart valves under
physiological mechanical loads.

Numerical simulation: In order to model the


AV tissue behavior, two transversely isotropic
hyperelastic material models were implemented
in the finite element code FORGE (based on
an updated Lagrangian formulation). Biaxial
tensile tests were accurately modeled: specimen
geometries were obtained from photogrammetry
data and boundary conditions were defined as
close as possible to the gripping conditions used
experimentally (suture strands).

Discussion
In this study we considered as a first approximation
that
heart
valve
leaflets
are
monolayer
homogenous materials. Furthermore, only one fiber
direction was assigned to each element. Actual
collagen fiber orientations are currently being
characterized using multiphoton microscopy
images in order to address this limitation.
References
Gasser et al, Journal of the Royal Society Interface
3, 1535, 2006.
Prot et al, International Journal for Numerical
Methods in Engineering 71, 9871008, 2007.

Parameters identification: An inverse analysis


identification was carried out with MOOPI, an
optimization platform developed in our laboratory.
A metamodel-assisted evolutionary algorithm was
used to identify the set of material parameters.

187

O 15 5

COMPARAISON BETWEEN SHANKS MOUNTED


ACCELEROMETER AND GYROSCOPE
FOR TEMPORAL GAIT PARAMETERS
K. Ben Mansour1, N. Rezzoug1, P. Gorce1
1

HandiBio EA4322, Universit de Toulon, BP 20132, 83957 La Garde Cedex, France, UFR STAPS,
La Garde, France

Introduction
Measurement of temporal parameters with a
high accuracy level at all walking speed is a
prerequisite for the gait analysis [Lee, 2010].
Contrary to the motion analysis systems, force
plates and instrumented treadmill which are
limited to indoor assessment, wearable inertial
sensors (accelerometers or gyroscope) located at
the shank allow reliable foot contact detection in
unstructured environments [Selles, 2005]. Different
sensor types are used and the question arises
whether one type is the most suitable. Thus, the
purpose of this study is to test the accuracy of
gait temporal parameters assessed by a shank
mounted accelerometer and gyroscope.

which is set as a gold standard. The accuracy of


inertial sensors methods was computed based on
deviations away from the reference values. Table1
illustrates the mean and standard deviation of Root
Mean Square Error (RMSE) and the percentage of
error between temporal parameters quantified
from the treadmill and inertial methods. The
accelerometer and gyroscope gait parameters
deviation away from the gold standard follows the
same trend and decreases according to the gait
velocities. Overall, the gyroscope produced the
lowest RMSE value.

Methods
Treadmill walking was studied with 10 able-bodied
subjects (age: 29 (6) years, height: 1.79 (0.08) m
and weight: 79 (9) kg). Measurements were made
at the following speeds: 2.7, 4.5 and 6.3kmh-1. After
a 30s warm up on a treadmill with dual integrated
forceplates (ADAL3D-F TECHMACHINE, Andrezieux,
France, 200Hz), movement data are recorded for
a period of 30 s corresponding to a steady state
walking speed with one inertial sensor fixed at
the distal edge lateral surface of each shank. The
detection of gait events was made as follows:
Force treadmill method: The vertical component
of ground reaction force (GRF) was selected to
estimate gait events. The Initial foot Contact (IC)
and Terminal foot Contact (TC) were detected as
the first frame at which the vertical component
of GRF is greater and less than 20N, respectively
[Zeni, 2008].

Table 1: M
 ean and Standard Deviation (SD) of RMSE
and percentage of error (%) between temporal
parameters quantified from the treadmill and
inertial methods

Shank accelerometer (MMA8453Q, Free scale Semi


conductor, Austin, Texas USA, 200Hz; 8g; 10bit):
The IC and TC were identified respectively from the
two main peaks of the acceleration norm pattern
[Lee, 2010].

Discussion
The obtained results from ANOVA showed that
shank gyroscope and shank accelerometer are
reliable tools to assess the temporal walking
parameters. Moreover, the RMSE and the percent
error revealed that shank gyroscope was more
accurate than shank accelerometer except for
stance, swing and double support at the highest
walking speed.

Shank Gyroscope (L3G4200D, STMicroelectronics,


Geneva, Switzerland, 200Hz; 250/s): Gait phases
were established based on the pattern of
mediolateral shank angular velocity. In fact,
per each step the TC and IC correspond to the
first and second negative peak respectively
[Salarian, 2004].

References
Lee et al, J Med Sys, 34:95966, 2010.
Selles et al, IEEE Trans Neural Syst Rehabil Eng;
13:818, 2005.
Zeni et al, Gait Posture, 27:7104, 2008.
Salarian et al, IEEE Trans Biomed Eng. 51:
14341443, 2004.

Results
For the set of treadmill walking speed, repeated
measures ANOVA showed no significant difference
between the basic temporal gait parameters (Stride,
step, stance, swing and double support duration)
computed from inertial sensors and treadmill
188

O 15 7

EXPOSURE OF FEMOROACETABULAR IMPINGEMENT


USING MULTI-BODY SIMULATION BASED
ON MOTION CAPTURE AND MRI
R. Cichon1, D. Raab1, S. Hewera2, A. Lazik3 , J. Theysohn3 ,
S. Landgraeber2, W. Kowalczyk1
1

Chair of Mechanics and Robotics, University of Duisburg-Essen, Duisburg, Germany


2

Department of Orthopaedics, University Hospital Essen, Essen, Germany

Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital
Essen, Essen, Germany

Introduction
In recent years, femoroacetabular impingement
(FAI) has become increasingly common. FAI is
caused by an abnormal contact between the
proximal femur and the acetabular rim, which
may lead to pain, limitation of movement, and
damage of the cartilage [1]. So far, FAI detection
and damage extension due to bone deformities
at the femoral head (cam deformity) and acetabular rim (pincer deformity) have been evaluated using physical and radiological examination.
A surgery is performed to correct the bone deformity, but this treatment is based exclusively on interpretations which is therefore a semi-quantitative
diagnosis. Computer-assisted techniques such as
multi-body simulations enable further evaluations,
thus allowing a more exact planning of the surgery.
Methods
In order to detect FAI, motion analysis is performed.
During the physical examination, the movement
of the lower body is recorded using a markerbased motion tracking, while pain is measured
with a chronological synchronism by using a
pressure-detecting device. Static and dynamic MRI
examinations are performed. The static MRI data
of the femur and the acetabulum are generated
with a comprehensive thin layer protocol and are
manually segmented using MIMICS (see Figure 1)
and a CAD model is generated. Finally, the CAD
model is synchronized with the gait labs motion data
and the motion and impact of the femur against
the acetabular rim is simulated using ANSYS (see
Figure 2). Afterwards the simulation is compared to
the dynamic MRI data. This allows a patient specific
pre-and post-operative FAI comparison.

Results and discussion


With this method, it is possible to visualize the
movement of the patient and the contact
between the bones. This supports a repeatable FAI
evaluation before and after therapy. Additionally,
the simulation of the movement supports a more
exact resection of the bone. An automated
segmentation will be the next step to upgrade
the diagnosis and to create new standards.
Subsequently, an improved planning of the surgical
intervention will be pursued with the purpose of
optimizing the removal of the bone deformities.
In this context, a computer controlled navigation
may be used to assist and guarantee an exact
removal.
References
[1] O. Marin Pena: Femoroacetabular Impingement,
Auflage 1, Springer Verlag, 2012

189

O 15 8

FUNCTIONAL SUBJECTIVE SCORE AND OBJECTIVE


CENTRE OF ROTATION MIGRATION ESTIMATE ARE
NON CORRELATED IN PATIENTS WITH RECONSTRUCTED
ANTERIOR CRUCIATE LIGAMENT
F. Simini1, D. Santos2, F. Massa3
1
2

Universidad de la Repblica, Hospital de Clnicas, Montevideo, Uruguay

Universidad de la Repblica, Rehabilitation and Medical Physics, Hospital de Clnicas,


Montevideo, Uruguay
3

Universidad de la Repblica, Instituto de Estadstica, Montevideo, Uruguay

Introduction
The migration of the Centre of Rotation (COR) of the
knee with respect to the tibial plateau is altered by
the rupture of the Anterior Cruciate Ligament (ACL)
and again changed after reconstructive surgery.
The Tibialfemoral Contact Point technique yields
an estimation of the migration of the COR location
during sequences of fluoroscopic Rx knee images
during extension. On the other hand, subjective
satisfaction of knee function is measured using the
Lysholm-Tegner Score. The combined subjective/
objective estimation of parameters may be of
help for patient rehabilitation follow-up after
ACL surgery, but to a limited extent because the
subjective score was found to be not correlated to
objective COR estimations.

References
B
 alzopoulos, V. (1995). A videofboroscopy method
for optical distortion correction and measurement
knee-joint kinematics. Clinical Biomechanics,
10(2), 8592.
Capozzo, A., Catani, F., Leardini, A., Benedetti, M. G.,
& Della Croce, D. (1996). Position and orientation in
space of bones during movement: experimental
artefacts. Clinical Biomechanics, 11(2), 90100.
M
 arx, R., Jones, E., Allen, A., Altchek, D., O`Brien, S.,
& Rodeo, S. (2001). Reliability, Validity, and Responsiveness of Four Knee Outcome Scales For athletic
Patients. THE JOURNAL OF BONE & JOINT SURGERY,
83(10), 14591469.
P
 anjabi, M. M., Goel, V. K., Walter, S. D., & Schick, S.
(1982). Errors in the center and angle of rotation
of a joint: an experimental study. Journal Of
Biomechanical Engineering, 104(3), 232237.
Santos, D., Francescoli, L., Loss, J., Arbo, F., & Simini, F.
(2013). A Tool to Assess Anterior Cruciate Ligament
Recostruction by Quantitative Localization of the
Knee Centre of Rotation. In 19th Congress of the
European Society of Biomechanics (ESB2013).
Patras; Greece.
Santos, D., Simini, F., Francescoli, L., Massa, F.,
Barquet, A., & Camarot, T. (2014). Beyond traditional
clinical evaluation of knee articulation movement
to physiological assesment of dynamic ACL funtion
during extension. In XIII International Symposium on
3D Analysis of Human Movement. cole Polytechnique Fdrale de Lausanne; Switzerland.
Lausanne Switzerland.
Simini, F., & Santos, D. (2014). Anterior Cruciate
Ligament Reconstruction Follow-up Instrumentation
based on Centre of Rotation Videofluoroscopy
Determination: Development of an original equipment, CINARTRO, and first clinical use. In Presented
at I2MTC Congress, Montevideo - Uruguay, May.
Tegner, Y., & Lysholm, J. (1985). Rating Systems in
the Evaluation of Knee Ligament Injuries. Clinical
Orthopaedics & Related Research, (196), 4349.

Method
To obtain the objective estimation we have
designed a new method and a subsequent new
equipment (CINARTRO) which operates with video
fluoroscopic images and creates clinical reports in
standard CDA format.
Results
For the first time in our region, the combination
of subjective score and clinical quantitative
assessment of the COR migration was assessed in
five patients, showing no correlation.
Discussion
The association of subjective and objective
measurements are complementary in clinical
practice and should both be considred when
designing new methods of evaluation.

190

O 15 9

VALIDATION OF THE MOTION ANALYSIS SOFTWARE


CVMOB FOR EVALUATION OF HUMAN GAIT.
A.P. Quixad1, K. S1, J.G.V. Miranda2
1

Bahia School of Medicine and Public Health, Physiotherapy, Salvador, Brazil


2

Federal University of Bahia, Nuclear Physics, Salvador, Brazil

Introduction
The evaluation systems of human movement has
been advancing exponentially in recent decades,
with exceptional software and hardware, as in the
example of three-dimensional systems. However,
the use of evaluation systems is not feasible for
clinical practice because it has a high cost and
scarcity of trained human resources to operate
them and interpret their results. For clinical
application, an ideal videogrammetry system
should be easy to use, low cost, with minimal
equipment and fast realization. Based on this
need, it was created the CvMob, a free tool for
dynamic evaluation of human movements that
express in figures, tables and graphs the results of
these measurements.

The image distortion caused by the camera lens


may have affected the plantarflexion range
of motion. The CvMob is a reliable tool for
two-dimensional evaluation of human gait in the
analysis of linear motion, lengths and angles.
References
A Williams G, Morris ME, Schache A, McCrory P.
Observational gait analysis in traumatic brain injury:
accuracy of clinical judgment. Gait Posture.
2009. 29(3):4549.
Ugbolue UC, Papi E, Kaliarntas KT, Kerr A, Earl L,
Pomeroy VM, et al. The evaluation of an inexpensive, 2D, video based gait assessment system for
clinical use. Gait Posture. 2013. 38(3):4839.
Bilney B, Morris M, Webster K. Concurrent related
validity of the GAITRite walkway system for quantification of the spatial and temporal parameters
of gait. Gait Posture 2003.17:6874.
Nielsen DB, Daugaard M. Comparison of angular
measurements by 2D and 3D gait analysis
[Internet]. Jnkping University; 2008.

Objective
To determine if CvMob is a reliable tool for the
evaluation of two-dimensional human gait.
Methods
An accuracy study with the sample of healthy
individuals who walked on a nine meters long
walkway, with anatomical points highlighted
by spheres adhered to the skin and were
simultaneously filmed by CvMob camera and
Vicon system, the studys gold standard. To
analyze the reliability between systems, trajectories
and angular measurements were compared, and
for the reproducibility, were related inter and
intra-rater findings. In order to test the reliability, it
was performed the Bland-Altman method and the
correlation of Spearman. The reproducibility inter
and intra-rater of the angles was tested by BlandAltman method and by the intraclass correlation
coefficient, and the one of the trajectories
was assessed by Spearman correlation. It was
considered an error margin of 5%.
Results
We found a high correlation ( = 0.988) of the
trajectories in both systems and in inter and
intra-rater analysis. According to the Bland-Altman
method, it had a good correlation, between the
systems, in the angle of flexion and full extension
(stance and swing) of the knee, dorsiflexion and
stride length.
Discussion
There are systems that analyze the spatial and
temporal parameters of gait, but their analysis are
limited to these variables and the CvMob system
is more complete, because it also gives the results
for angles and trajectories. The method chosen
for the evaluation of the hip angle may have
caused the lack of agreement between systems.
191

O 16 0

BIOMECHANICAL ASSESSMENT OF PITCHING


PERFORMANCE AND FATIGUE ON FOREARM MUSCLES
L.H. Wang1, K.C. Lo2, Y.S. Cheng3 , L.C. Kuo4 , I.M. Jou5, F.C. Su3
1

Cheng Kung university, Institute of Physical Education, Health & Leisure Studies, Tainan,
Taiwan Republic of China
2

Kun Shan University, Physical Education Office, Tainan, Taiwan Republic of China
3

Cheng Kung university, Department of Biomedical Engineering, Tainan,


Taiwan Republic of China

Cheng Kung university, Institute of Occupational Therapy, Tainan, Taiwan Republic of China
5

Cheng Kung university, Department of Orthopaedics, National Cheng Kung University


Hospital, College of Medicine, Tainan, Taiwan Republic of China

Introduction
Fatigue leads to uncoordinated, sudden or
unnatural motion and thus the ball speed and
muscle force would decrease1,2, and it discharges
the strength loading on the joint and muscle to
prevent injury 3. This study intended to investigate
the kinematic differences in upper extremity
before and after fatigue occurred on forearm
muscles along with electromyography examining
the forearm muscle activities and ultrasonographic
examination to see any changes at the medial
elbow during fatigue.

For the muscle activity of the forearm, larger FCU


activity was found in pre-fatigue (p=.017). After
intense activity, possible tendon swelling was
found in a previous study 5. The ulnar nerve runs
through the two heads of the FCU tendons and
FCU tendon swelling might occur due to larger
muscle activity after fatigue protocol. Moreover,
during acceleration phase, the elbow joint would
move to a peak angle of around 94 and drop
rapidly to around 20 at ball release (pre-fatigue:
18.2215.17, post-fatigue: 22.1115.18 and
p=.242). Larger elbow flexion would lead the ulnar
nerve to be compressed and flattened against the
hard convex floor of the tip of the epicondyle and
the fascia of the flexor-pronator group, leading to
possible inflammation chronically 6. In other words,
the ulnar nerve would be repeatedly compressed
in a very high speed in a long pitching duration.
Therefore, these two factors combined might
explain the larger nerve flattening (diameter) and
swelling (cross-sectional area) in post-fatigue.

Exp e r i m e n t a l M e t h o d s
15 elite baseball pitchers were recruited for a
full ultrasonographic examination at the medial
elbow under 4 elbow positions (0, 45, 90 and
120), respectively. Manual muscle testing were
conducted on the 3 muscles (flexor carpi radialis,
flexor carpi ulnaris (FCU) and extensor carpi radialis)
to normalize the dynamic muscle activity during
pitching. eight-camera motion analysis system
surrounded to collect the throwing motion data
of upper extremity with a sampling frequency of
300 Hz. The statistic software SPSS14.0 was utilized
to analyze each parameter. Significance level was
defined as p <.05.

C o n cl u s i o n
There might be higher potential to develop nerve
flattening and swelling after long time of pitching,
and thus increased ulnar nerve diameter and
area were shown. Larger FCU activity was found
after fatigue and indicated larger varus torque
was produced as a contribution to protecting our
elbow joint from injury.

Results and discussion


The prime analysis of this study was focused on the
acceleration phase which was considered the final
stage in which the energy bursts out to the upper
extremity to propel the ball. Pitching performance
was affected since the strike percentage showed
a significant difference after fatigue (pre-fatigue:
70.1117.79%, post-fatigue: 49.3317.24% and
p=.01). Larger long axis diameter and crosssectional area were found after fatigue at the
elbow flexion of 90 in the ultrasonographic
measurements. This phenomenon might display
larger ulnar nerve compression and possible
swelling 4. In both pre- and post-fatigue conditions,
the elbow joint angle would reach to a maximum
value of around 90. Since throwing over 90 or even
more than 100 pitches in a game is very common
for a starter in baseball, under such a longtime
circumstance of repetitive elbow motion to 90
during pitching might bring larger risk of negative
impact to the ulnar nerve.

References
[1] Blangsted K. et al., J Electromyogr Kinesiol. 15(2):
138-148, 2005.
[2] Kumar S., Ergonomics. 44(1): 17-47, 2001.
[3] Escamilla R.F. et al., Am J Sports Med. 35(1):
23-33, 2007.
[4] Shen P.C. et al., J Bone Joint Surg Br. 90(5):
657-661, 2008.
[5] van Drongelen S. et al., Arch Phys Med Rehabil.
88(3): 381-385, 2007.
[6] Tai T.W. et al., Ultrasound Med Biol. 40(1):
45-52, 2014.
Ack n o wl e d g e m e n t
The authors thank for the support by grant MOST
102-2410-H-006-110 from the Ministry of Science and
Technology.

192

O 161

NONTRADITIONAL MEANS OF THE HIGHLY


SKILLED SWIMMERS TRAINING
B. Dyshko1, A. Kochergin2
1
CEO of the scientific-practice firm Sport Technology member of the methodical Council
of the Centre of the Sports Training of the Russia Ministry of Sport, Centre of the Sport Training,
Moscow, Russia
2

Russian National Swimming team, Centre of the Sport Training of the Russian Ministry of Sport,
Moscow, Russia

Introduction
Comprehensive biomechanical training simulator
(hereinafter Simulator) is very intersted for
elite swimmers 1,2. The comprehensive effect
of the Simulator on the athletes functional
systems is stipulated by the simultaneous use
of physical, biomechanical and physiological
factors: regulated mechanical expiratory air
flow resistance, variable frequency vibration on
expiration, intensity of performed exercises.

The results of the experiment indicated that the


Simulator can be used for creating the artificial
controlled
hypoxic-hypercapnic
conditions
and faster, compared to standard conditions,
unwinding of the aerobic and anaerobic energy
support systems of athletes 1,3.
C o n cl u s i o n
The data showed in Table 1, 2 allow recommending
of the Simulator for training of skilled swimmers for
increasing of the aerobic and anaerobic energy
support systems in pool.

Exp e r i m e n t a l M e t h o d s
The research was aimed at studying of the influence
of the Simulator on features of the external
respiration with the work under the load with
constantly increasing power to failure for skilled
swimmers 9 men. The participants performed
exercise on the on bicycle ergo meter Monarch
using Simulator (Device) and without it (Br.mask).

References
1 Dyshko B.,et al.,Theory and practice of the physical
culture. Moscow, 122, 2012.
2 Dychko B., et al., Proceeding of XXVI International
Symposium on Biomechanics in Sport (ISBS):
343347, 2008.
3 Volkov N. Physical education and Sport. Moscow
162, 2000.

Results and discussion


The dinamics of the experatory CO2 concentration
and the the oxygen utilization coefficient show in
Table 1, 2.

T, min

10

11

12

Device

5,04

5,24

5,66

5,70

5,86

5,84

5,80

5,89

6,54

6,52

6,60

6,49

Br.mask

4,50

4,38

4,40

4,36

4,29

4,02

3,92

3,70

3,67

3,61

3,65

3,59

Table 1. The dynamics of the oxygen utilization coefficient in test. T, min time of working in test.

T, min

10

11

12

Device

4,36

4,72

5,22

5,48

5,93

6,03

5,97

6,41

6,90

7,06

7,09

7,11

Br.mask

3,58

3,72

4,00

3,96

4,04

3,95

3,87

3,81

3,72

3,70

3,86

3,74

Table 2: The dynamics of the expiratory CO2 concentration in test.

193

O 16 2

RELATIONSHIPS BETWEEN LEG STIFFNESS


AND DROP JUMP HEIGHT
A. Struzik1, J. Zawadzki2, B. Pietraszewski2, A. Rokita1
1

University School of Physical Education, Department of Team Sport Games, Wroclaw, Poland
2

University School of Physical Education, Department of Biomechanics, Wroclaw, Poland

Introduction
Leg stiffness is a quantitative measure of elastic
properties of lower limbs. However, relationships
between leg stiffness and sport movement
performance remain unknown [Brughelli, 2008;
Serpell, 2012]. Therefore, the purpose of this study
was to determine whether there are relationships
between leg stiffness and drop jump height. If so,
what are their character?

Discussion
The results imply that maximum drop jump height
is achieved at a relatively low value of leg stiffness
in the amortization and take off phases. This allows
for performing a deeper countermovement during
the amortization phase.

Methods
The study was conducted among 11 rugby players.
Measurements employed a Kistler force plate and
a BTS SMART system for complex motion analysis.
Each participant performed two drop jumps from
platforms with height 15, 30, 45 and 60 cm. The
analysis was based on a higher jump of the two
jumps of each platform for each participant. Leg
stiffness was determined as a ratio of changes in
ground reaction forces to the respective changes
in the height of greater trochanter of the femur
(used as a conventional upper end of lower limbs),
separately for amortization and take-off phases
[Struzik, 2013]. The jump height was calculated
based on the time of the flight phase.

K a(kN/m)

K t(kN/m)

h(m)

DJ15

9.5 4.7

5.9 3.9

0.38 0.07

DJ30

7.8 2.4

5.8 1.8

0.39 0.05

DJ45

7.1 2.6

5.4 2.4

0.41 0.05

DJ60

7.2 4

5.3 2

0.4 0.07

Table 1: M
 ean values (SD) of leg stiffness during the phases
of amortization (Ka) and take-off (Kt) and drop jump
height (h).

hDJ15

hDJ30

hDJ45

hDJ60

Ka

0.68*

0.64*

0.55**

0.49

Kt

0.72*

0.76*

0.57**

0.53**

Table 2: V
 alues of correlation coefficients between leg stiffness during the phases of amortization (Ka)
and take-off (Kt) and drop jump height (h).

The differences in the values of leg stiffness during


the phases of amortization and take-off were
analysed using a t-test for the significance of the
differences for independent variables, with the
level of significance set at = 0.05. The r-Pearson
coefficient and t-Student test was used to examine
the relationships between the selected variables.

* statistically significant for p < 0.05,


** statistically significant for p < 0.1.
C o n cl u s i o n
Leg stiffness in the amortization and take-off phases
is characterized by a negative relationships with
drop jump height.

Results
Table 1 contains mean values (SD) of leg stiffness
and drop jump heights performed from each
platform. Leg stiffness during amortization phase
was statistically significantly greater than in the
take-off phase for drop jumps performed from
platforms with height of 15, 30, 45 and 60 cm
(p < 0.01). Statistically significant relationships were
found between leg stiffness and drop jump height
(see Table 2).

References
Brughelli M. et al, Scand J Med Sci Sports,
18:417426, 2008.
Serpell B.G. et al, J Sport Sci, 30:13471363, 2012.
Struzik A. et al, Acta Bioeng Biomech,
15:113118, 2013.

194

O 16 3

A 3D KINEMATIC ANALYSIS OF THE SADDLE HEIGHT


INFLUENCE DURING CYCLYNG
J. Ojeda1, V. Chaves1, J.R. Romero1, A. Martnez1
1

University of Sevilla, Mechanical Engineering, Sevilla, Spain

Introduction
Cycling is a very popular activity at both
professional and amateur level. The number
of studies of the human body kinematics and
dynamics during pedalling has increased during
the last few years [Kautz, 1993; Carpes, 2009; Bini,
2010]. These studies pursue a better understanding
of the movements and force transmissions while
pedalling to improve its efficiency and the
avoidance of injuries. However, most of the works
found in the literature are 2D studies, mainly in the
sagittal plane. The goal of this work is to present a
3D study of the cycling kinematics to analyse the
influence of the seat height.

One adult male subject, amateur cyclist, was


asked to pedal as his preferred cadence. The
velocity remained relatively stable during the test.
Three different heights of the saddle were tried. The
first (normal test, NT) was defined as the optimal
height using the dynamic goniometer technique.
The other two heights were 4 cm higher than NT
(HT) and 4 cm lower than NT (LT).
Results
Figure 2 shows the temporal evolution of the knee
angles during one crank revolution for the three
saddle heights.

Methods
Pedalling on a stationary bike has been monitored
at 100 Hz using a six-camera motion capture
system (Vicon). The body pose reconstruction of
the lower limb has been carried out by means
of the Plug-in-Gait protocol [Davis, 1991]. Some
extra markers were added to the bike to obtain
the plane defined by the pedal axle and the crank
arm along the time (see Figure 1).

Figure 2: T emporal evolution of knee angles during one


crank revolution at different saddle heights.

Discussion
Regarding the results, it can be noticed the
influence of the saddle height on kinematic data.
Results in the coronal and transverse planes are
especially relevant for clinicians to evaluate the
risk of injuries on the knee. On the other hand, a
proper definition of the parameters of the bike
is crucial to improve the efficiency of the cyclist
during the activity.
References
Bini et al, Sport Biomech, 9:223235, 2010.
Carpes et al, Sport Biomech, 8:275283, 2009.
Davis et al, Hum Mov Sci, 10:575587, 1991.
Kautz et al, J Biomech, 26:155165, 1993.
Figure 1: S et up of the test and protocol of markers used in
this work.

195

O 16 4

EFFECT OF ADJUSTABILITY ON THE SAFETY OF THE SEATED


BICEPS CURL RESISTANCE TRAINING EXERCISE
C.J. Kat1, K. Nolte2
1

University of Pretoria, Mechanical and Aeronautical Engineering, Pretoria,


Republic of South Africa

University of Pretoria, Department of Physiology Division: Biokinetics and Sport Sciences,


Pretoria, Republic of South Africa

Results
The exercise resistance (mean SD) at which the
participants were able to safely perform the exercise
on set-up 1 was 64% 9% of the predicted one
repetition maximum and 52.5% 5% on set-up 2.

Introduction
Resistance training is used in training programs
to prevent injury [Myer, 2005 and Fleck, 1986]
and to enhance athletic performance [Kraemer,
1998]. In order for resistance training to be
effective it should not result in injury of the user.
It is therefore essential that exercise equipment
is designed appropriately and evaluated to
ensure safety of the equipment with respect to
the exerciser. Design of exercise equipment is a
complicated task and warrants consideration
of a series of biomechanical and ergonomic
factors [Nolte, 2011]. This study investigates the
effect of the adjustability of the seated biceps
curl machine on the safety of the exercise.

Discussion
The exercise resistance at which the participants
were able to safely perform the exercise was lower
on set-up 2. However, participants performed
the exercise with a larger elbow range of motion
(ROM) on set-up 2 than on set-up 1 for the same
exercise resistance. The difference between the
exercise resistances and the elbow ROM of the
participants on the two set-ups seem to indicate
that the preacher curl platform off-set has an
influence on the safety/performance of the
exerciser. The change in this dimension between
the two set-ups caused the force between the
preacher curl platform and the participants chest
to be larger on set-up 2 than on set-up 1 at higher
exercise resistances. This may be a reason for the
participants performing the exercise at a lower
resistance on set-up 2 as they might have been
less comfortable. Fatigue cannot be excluded
as a possible contributor to the lower exercise
resistance on set-up 2 as participants performed
the exercise on set-up 2 after they performed
the exercise on set-up 1. This should be further
investigated by using a larger sample size and
have participants perform the exercise on the
two set-ups randomly. The sample should also be
extended to include other anthropometric cases
and male participants. The relationship between
the different dimensions of the machine and the
effects on the safety/performance of the exerciser
needs to be further investigated as well as the
existence of optimal dimensions of the machine.
This would aid designers in improving the safety
and performance of the machine.

Method
Measures
of
kinetics,
kinematics
and
electromyography were taken on five (n=5)
females in the 5 th percentile female group
during the performance of the seated biceps
curl resistance training exercise on two different
machine set-ups. The difference between the two
set-ups is in the preacher curl platform off-set with
it being 105.6 mm closer to the exerciser for setup 1. The dimensions of set-up 2 are based on a
commercially available machine. Participants
performed 10 warm-up repetitions after which
they performed repetitions at increasingly higher
exercise resistances. After the participant reached
her maximum exercise resistance she rested for
approximately 10 minutes while the machine setup was changed. The participant then repeated
the process excluding the warm-up repetitions. The
participants posture on both set-ups was visually
evaluated and if no obvious problems and/or risk
could be identified the assessment commenced.

References
Fleck, S.J. and Falkel, J.E., Sport Medicine, 3(1):
6168, 1986
Kraemer, W.J., Duncan, N.D. and Volek, J.S.,
J Orthopaedic and Sports Physical Therapy,
28(2):110119, 1998
Myer, G.D., Ford, K.R., Palumbo J.P. and Hewett
T.E., J Strength Cond Res, 19(1):5160, 2005
Nolte, K., Krger, P.E. and Els, P.S., Sports
biomechanics, 10(2):146160, 2011.

196

O 16 5

TIME ELAPSED MICRO-CT IMAGING


OF THE BONE-IMPLANT INTERFACE DURING SCREW
INSERTION IN HUMAN FEMORAL HEADS
M.K. Ryan1, E. Perilli1, M. Gravier1, K.J. Reynolds1
1

Flinders University, Medical Device Research Institute, Adelaide, Australia

Introduction
Stripping during screw insertion occurs with an
incidence as high as 45% (Stoesz et al. 2014). With an
increase in age and osteoporosis, overtightening is
more likely as surgeons try to achieve torques similar
to that observed in young healthy bone. Stripping
torque can be predicted based on the torque at
head contact (Reynolds et al. 2013). The question
remains however, how tight is tight enough? This
ongoing study uses a custom developed computercontrolled screw insertion device to perform timeelapsed micro-CT imaging of the bone-implant
interface. The aim is to visualize the deformation
of the trabecular bone at each rotation step with
increased tightening torque.
Figure 1:
 Insertion torque vs. screw rotation. Screws were
inserted stepwise with micro-CT images taken
at 20% increments between head contact and
predicted Tmax.

Methods
Ten excised human femoral heads were used.
Cancellous lag screws (7.0 mm), commonly used
for fixation of intertrochanteric fractures, were
inserted to head contact. The torque measured at
head contact (THC) was used to predict stripping
torque (Tmax) (Reynolds, Cleek et al. 2013). Screws
were incrementally tightened using a novel testing
device within the micro-CT scanner (Ab-Lazid
et al. 2014). Micro-CT scans (isotropic pixel size
17m) were performed at 6 time points from head
contact to Tmax (Figure 1). 2D and 3D images were
reconstructed and visually inspected to identify
trabecular deformation around the screw threads.
Results
Ten tests were successfully completed in
conjunction with micro-CT image acquisition.
Preliminary visual image analysis demonstrated
that trabecular deformation was evident around
the top surface of the screw threads (Figure 2). The
majority of deformation appeared to occur after
the 80% step between head contact and Tmax.

Figure 2: 1
 mm slices through the bone (white colour) and
screw (grey) at head contact (a) and post-failure
(b). The complete perforation through trabecular
spicules is evident at the screw threads (indicated
by the blue arrows).

References
Ab-Lazid, R. et al. J Biomech 47:347353, 2014.
Reynolds, K. J. et al. J Biomech 46:12071210, 2013.
Stoesz, M. J. et al. J Orthop Trauma 28:e17, 2014.

Discussion
The screw insertion device detailed above
has provided time-elapsed visualization of the
deformation of the peri-implant bone at the microstructural level, at increasing insertion torque
levels. The image data obtained can be used
for quantification of the micro-strains induced
in the peri-implant bone with increasing load by
use of digital volume correlation or finite element
analysis. This will allow a better understanding of
the coupling between insertion torque and microstructural failure mechanics.

Ack n o wl e d g e m e n t s
This work was funded by an NHMRC Grant
(Grant ID 595933).

197

O 16 6

PARTIAL DATA RECONSTRUCTION USING


STATISTICAL SHAPE AND MATERIAL MODELLING
FOR DENTAL APPLICATIONS
C. Woods1, A. Taylor2, W. Pearson1, A. Dickinson1
1
2

University of Southampton, Bioengineering, Southampton, United Kingdom

Aurora Medical, Research and Development, Southampton, United Kingdom

Introduction
Understanding concealed dental geometry and
the position of teeth is essential for the effective
implementation of many dental/orthodontic
therapies. Statistical shape modelling (SSM) can
predict missing information using a database
of registered geometries [Buchaillard, 2007].
Methodologies exist for the virtual reconstruction
of geometry using SSM, but they do not distinguish
between crown and root anatomy. The aim of this
study was to predict missing crown data in teeth,
including a material identification parameter to
capture explicitly the cemento-enamel junction
(CEJ).

Results

Figure 2: P
 redictive capability. a)Influence of modes(+outliers, []25th&75th percentile, median) b)Influence of training samples (error bars =1SD)

Discussion
Exhaustive modal analysis reconstructed each
tooth in the dataset using an increasing number
of modes (Fig.2a). It was seen that the median
shape error reduced with each additional mode
added. However, it was also seen that the range
increased with the number of modes, possibly
due to noise, which suggests that there may be
an optimum number of modes. Also, it should be
noted that additional modes incur time penalties.
The number of modes which gave the minimum
error range varied between reconstruction trials.
This set of 15 trials indicated that if the target shape
is not known, between 5 and 7 modes would give a
satisfactory reconstruction.

Methods

Figure1: M
 ethodological procedure. a)SSM Compilation
b) bruxed tooth Introduction c)Optimisation
d)Optimisation quality check e)CEJ identification.

The Leave-One-Out (LOO) test reconstructed the


shape of a bruxed tooth that was excluded from
the training dataset. The size of the dataset was
increased until all teeth were included (Fig.2b).
From the LOO test it was seen that convergence
was achieved at approximately 12 training samples.
Convergence indicates that the dominant shape
characteristics have been captured.

A digital (.stl) database of 15 undamaged


mandibular canines was compiled from micro-CT.
A binary material operator was assigned to each
node. The data was registered to a baseline
model using elastic mesh-morphing, and principle
component analysis (PCA) was used to compile
the SSM. Each tooth was artificially bruxed to the
location of maximum distal crown width. A non-linear
sum of least squares algorithm was used to minimise a
non-rigid deformation objective function to predict
tooth geometry from partial data (E) (Eq.1&2),
where d and m are the target and the predicted
shapes respectively. is a vector containing the
weightings () for manipulating the eigenvectors
(e) with respect to the mean tooth (?) in rotation
(R) and translation (T). A smoothing algorithm
established the CEJ from a material probability
parameter (Fig.1).

The presented methodology was used to


reconstruct dental geometry and material location
from partial data. However, the optimisation
strategy, size of training set, number of modes and
computational resource must all be balanced
against reconstruction quality. This methodology
has the potential to improve prediction and
analysis within dentistry, bioengineering, forensic
medicine and osteo-archaeology, where dental
wear is scored qualitatively.
References
[1] S.I. Buchaillard, et al, Comp Biol Med,37:10,2007

198

O 16 7

A-MODE ULTRASOUND-BASED INTRAOPERATIVE


REGISTRATION ACCURACY ANALYSIS BASED
ON SIMULATION ENVIRONMENT
K. Niu1, J. Homminga2, N. Verdonschot3
1
2

University of Twente, Enschede, Netherlands

University of Twente, Department of Biomechanical Engineering, Enschede, Netherlands


3

Radboud University Medical Centre, Orthopaedic Research Laboratory, Nijmegen,


Netherlands

Introduction
In Computer-Aided Orthopedic Surgery (CAOS)
systems, A-Mode ultrasound has been proven
quite successful in experimental and clinical
environments, showing advantages, such as the
non-invasiveness and lower time requirements
[A.Mozes,
2010].
However
the
registration
accuracy and robustness still need to be improved
to provide reliable and stable registration results
[C.Amstutz, 2003]. A clearly defined registration
methodology/procedure is also important. The
number of detected points, the specific locations
that these points were obtained from, as well as the
amount of noise in the A-mode signal will influence
the accuracy of registration. To assess the effects
of these parameters and adjust them, a simulation
environment based on A-mode ultrasound
intraoperative registration procedure provides a
feasible way to repeat and to amend a certain
mode of ultrasound transducers palpation without
time-consuming in-vivo or in-vitro measurements
and validations. The quality of the resulting fit was
assessed by the error between the true location of
the bone and the registered results.

by randomly adding noise to the coordinates of


each point: no noise, 1 mm noise, or 2 mm noise.
Third, for every number of points in the sample point
set and for every level of noise, the simulation was
run 100 times over to capture the robustness of the
procedure. In total we thus ran 21 x 3 x 100 = 6300
simulations. After the full registration, the accuracy
of the registration was computed by determining
the root mean square error (RMSE) between the
registered points and the known true position of
those points.
Results
The addition of a pre-registration to the ICP
algorithm
improved
the
registration
quite
remarkably. After the registration procedure, the
average RMSE could be seen to improve with
increasing the number of sample points from
10 (RMSE: 1.23 mm) to 30 (RMSE: 0.11 mm). For
sample point sets of 27 points or more, the RMSE
reached zero in more than 75% of all cases. The
addition of noise to the positions of the points in
the sample point set, unsurprisingly, diminished the
accuracy of the registration. The RMSE for the case
of ten sample points, increased from 1.23 mm for
no noise, to 1.68 mm for 1 mm noise, to 2.39 mm for
2mm noise.

Methods
In this study, a surface mesh of a healthy subjects
femur was segmented based on CT scan[P.
Pellikaan, 2014] and to be used to generate a
number of various sample point sets to mimic the
actual detected points by A-mode ultrasound
in operating room. The sample point sets were
selected by following the proposed registration
methodology. The registration was implemented
by using a pre-registration (based on automatically
segmented anatomical landmarks on the bone
surface), followed by an accelerated Iterative
Closest Points (ICP) algorithm and Wobble
Optimizing algorithm. The procedures from point
selection to final registration was run several
times with different variations. First, the number of
points in the sample point set was varied between
10 and 30 to capture the needed number of sample
points for an accurate fit. Second, we simulated
the effect of uncertainty in the ultrasound position

Discussion
The registration accuracy will be improved with the
addition of sample points in proposed registration
methodology, which followed by restricting to
certain regions to ensure a good registration. The
influence of noise was assessed by simulation result
to provide the information to satisfy the certain
requirement of registration accuracy. The future
work will continue to test other bones.
References
A
 . Mozes et al, Int J Med robotics Compit Assist
Surg, 6: 91101, 2010.
C
 . Amstutz et al, Arch Otolaryngol Head Neck Surg,
129(12):13106, 2003.
P
 . Pellikaan et al, Biomech, 47(5):11441150. 2014.

199

O 16 8

NUMERICAL ANALYSIS OF THE INTERACTION BETWEEN


TRACHEAL TISSUE AND DIFFERENT TYPES OF STENTS
J. Chaure1, C. Serrano2, R. Fernndez-Parra2,3 , E. Pea1, M.A. De Gregorio2,
M.A. Martnez1, M. Malv4
1
2

Universidad de Zaragoza, Department of Mechanical Engineering, Zaragoza, Spain

Universidad de Zaragoza, Departamento de Patologa Animal Grupo GITMI, Zaragoza, Spain


3

Ecole Vtrinaire de Maison Alfort, Department of Anaesthesia & Analgesia,


Maison Alfort, France

Universidad Pblica de Navarra, Department of Mechanical Engineering, Energetics and


Materials, Pamplona, Spain

Introduction
Stenting is a common treatment for atherosclerotic
arteries and tracheal stenosis. Metallic stents
for treating both diseases have advantages
but are associated with restenosis due to reepithelialization of the treated area. Although
many types of stents are commercially available,
silicone and metallic stents are the most frequently
used [Dumon, 1990]. Inflammation, migration
and obstruction of silicone stents are reported
as common post-operative complications [Sun,
2008]. In contrast, implantation of metallic stents
is an efficient method to reestablish patency in
stenotic tracheas [Hautmann, 2000].
Methods
We built a numerical rabbit trachea model and
analyzed it before and after device insertion. In
particular, two types of commercial stent were
evaluated: a ZilverFlex Stent and a WallStent.
The numerical simulations were carried out using
the software package Adina R&D Inc. (Watertown,
MA, USA) which allowed a fluid-structure interaction
analysis. The models were built starting from CTimages of treated rabbits. First, the stents were
deployed into a healthy trachea, then patient
specific boundary conditions were applied, in
order to simulate the breathing cycle. In parallel,
these two types of stent were implanted into 30
New Zealand White rabbits divided into two groups
of 10 animals corresponding to each stent type
and a third group composed of 10 animals without
a stent. Endoscopy, CT imaging and histology
assessed the tracheal wall response 90 days after
stent deployment. The animal model was used to
validate the numerical results.

Figure: C
 omparison between numerical (maximum principal stress in [Pa]) and experimental findings (endoscopy and histology).

Discussion
Coupling histology and numerical simulations with CT
images allows the capture of highly correlated stimuli
between struts and the local biological response.
Further work is required to evaluate the consistency
of these correlations in restenosis models and whether
these effects are observed in a clinical context. The
outcomes from this study could be used to direct the
future design of prosthesis that consider the tissue
response at different levels of injury after implantation.
C o n cl u s i o n
The direct comparison of WSS and maximum principal stress with the biological response supports the hypothesis that these parameters may lead to a greater
tracheal epithelial response within the stented region.
This study may be helpful for improving stent design
and demonstrates the feasibility offered by the virtual
investigation of tracheal structural and fluid dynamics.

Results
Healthy tracheas were compared with stented
tracheas using the numerical analysis. Different
stress maps were found for the two stent types, due
to their dissimilar structures. Images from endoscopy
and histology associated with stent implantation
were compared with the numerical results. There
was a strong correlation between animal and
computational models (see Figure). Derived
numerical parameters such as wall shear stress
and maximum principal stress were correlated with
inflammation, re-epithalization and granuloma
formation assessed from the histomorphometric
analyses.

References
[1] F. Dumon, A Dedicated tracheobronchial stent,
Chest, 1990, 97:328332.
[2] F. Sun et al. Endotracheal stenting therapy in dogs
with tracheal collapse, The Veterinary Journal,
175:186193, 2008.
[3] H. Hautmann et al. Flexible bronchoscopy: a safe
method for metal stent implantation in bronchial disease, Annals of Thoracic Surgery, 69(2):398401, 2000.
200

O 16 9

ROBUST ENDOVASCULAR SURGERY SIMULATION:


TOWARDS CLINICAL VALIDATION
D. Perrin1, P. Badel1, L. Orgas2, C. Geindreau3 , J.N. Albertini4 , S. Avril1
1

Mines Saint-Etienne, Center for Biomedical and Healthcare Engineering,


Saint-Etienne, France
2
3

CNRS, 3SR Lab, Grenoble, France

Grenoble University, 3SR Lab, Grenoble, France

CHU Hoptial Nord Saint-Etienne, Cardiovascular Surgery Department, Saint-Etienne, France

Introduction
Endovascular
repair
of
abdominal
aortic
aneurysms (AAA) faces some adverse outcomes
which are difficult to predict and which restrain its
use although it is less invasive than open surgery.
Finite element simulations could make it become
prevalent by securing surgery planning, validating
patient eligibility and giving indications of possible
complications. The purpose of this work is therefore
to develop and validate in the clinical context a
numerical methodology predicting stent-graft (SG)
final shapes after surgery.

geometries, especially for proximal and distal stents


outside the aneurysm sac which are particularly
important for surgeons. Stent locations along the
vessel centerlines in the three simulations were
always within a few millimeters to actual stents
locations.

Methods
Three
patients,
whose
preoperative
and
postoperative scans were available, were included
in this study. Endosize software (Therenva, France)
was used to reconstruct the arterial geometries
that were then meshed with shell elements. The
mechanical behavior of the arterial wall was
considered as orthotropic linear elastic, linearized
from the data published in [Haskett, 2010].
Numerical geometries of SG main bodies and
limbs were provided by the manufacturer. Stents
and graft were meshed with linear beam and shell
elements respectively. The superelastic behavior
of Nitinol stents was implemented with parameters
provided by the manufacturer. Textile graft was
modeled as an orthotropic elastic material, with
parameters previously obtained by our group
[Demanget 2012].

Figure 1: E
 xample of a simulation result, compared to the
real postoperative CT-scan.

Discussion
The present study details a novel methodology
to predict the deployment of SGs in real AAA
geometries of patients. This is the first time to
our knowledge that several marketed SG are
numerically deployed inside patient-specific
AAAs and that the results are validated against
postoperative scans. An asset of this method
is the very limited manual intervention on the
patient-specific
part,
thanks
to
morphing
techniques. Several features are not included or
neglected to keep it computationally effective, for
instance thrombus and calcifications are absent.
Yet, the observed errors are within clinically-acceptable ranges for surgeons, making this
predictive method very relevant for the practice.

Our methodology, although different from the


actual surgical procedure, has the potential to be
used for any SG model and any aneurysm model,
and aims at simulating only the postoperative
state. In practice, the device is positioned in a
virtual tubular shell which is kinematically morphed
into the preoperative geometry of the patients
AAA, thus deforming the SG by contact. Then, the
virtual shell is ascribed AAA mechanical properties
and its constraints are released to compute the
final equilibrium of the SG in the AAA.
Results
Postoperative scans following real EVAR procedures
were used to assess the results of simulation (Fig. 1).
The position and average diameter of each stent
were compared. We observed relevant matching
between simulated and actual deployed stent

References
Haskett et al, Biomech Model Mechanobiol, 9:
72536, 2010.
Demanget et al, J Mech Behav Biomed Mat, 5:
27282, 2012.

201

O 17 0

ISOGEOMETRIC-BASED TOOLS FOR THE EVALUATION


OF CAROTID ARTERY STENT PERFORMANCE
M. Ferraro1, F. Auricchio1, M. Conti1, S. Morganti2, A. Reali1, R.L. Taylor3
1

University of Pavia, Department of Civil Engineering and Architecture, Pavia, Italy

University of Pavia, Department of Electrical, Computer and Biomedical Engineering,


Pavia, Italy

University of California Berkeley, Department of Civil and Environmental Engineering,


Berkeley, California, USA

Introduction
Computer-based procedures based on finite
element analyses (FEA) are nowadays widely
adopted for biomechanical analyses. Within this
context, isogeometric analysis (IgA) is rapidly
emerging as a novel promising alternative in this field
[Morganti, 2015]. The main feature of the method
consists of using typical CAD basis functions for both
geometric description and variable approximation
[Hughes, 2005]. This implies the exact description of
the domain geometry and the ability to obtain a
more accurate solution with respect to FEA.

while the proximal one is clamped (see Figure 1).


We implement 8 h-refined FEA meshes, while for
IgA 4 k-refined IgA meshes.
Results
Convergence of the resulting reaction force
for both Model A and B, combined with shape
memory alloy constitutive law, are considered in
Figure 2. The force-displacement diagrams for
model B referring to FEA, IgA, and most refined IgA
and FEA are depicted in Figure 3.

This work is aimed at developing a novel


computational framework based on IgA to evaluate
the flexibility performance of commercially
available carotid artery stents.

Discussion
The results suggest that IgA is able not only to
accurately represent the computational domain,
but also to get a better approximation of the
solution with a widely reduced number of degrees of
freedom with respect to traditional FEA. Moreover,
when geometrical instability is present like when we
consider the model B, IgA shows the capability to
accurately reproduce nonlinear local effects, i.e.,
local buckling, even with coarse meshes.

Methods
Two different shape memory alloy carotid stent
designs are considered. They correspond to two
commercially available stents used in the clinical
practice. Model A is classified as open-cell design,
while model B is a fully closed-cell design. The
bending test is simulated through a displacement-based analysis under large deformation regime.
A displacement of 11 mm is imposed for all control
points referring to the distal extremity of the stent,

References
Hughes et al, CMAME, 194: 41354195, 2005.
Morganti et al, CMAME, 284: 508520, 2015.

see the next page

202

203

O 17 1

THE EFFECTS OF STENT INTERACTION ON PORCINE


URINARY BLADDER MATRIX EMPLOYED
AS STENT-GRAFT MATERIALS
A. Callanan1, N. Davis2, T. Mcgloughlin3 , M. Walsh2
1

University of Edinburgh, Institute for BioEngineering, School of Engineering,


Edinburgh, United Kingdom

University of Limerick, Department of Mechanical and Aeronautical Engineering,


Limerick, Ireland

Khalifa University of Science, Technology & Research, Department of Biomedical


Engineering, Abu Dhabi, United Arab Emirates

Introduction
One of the most common causes of death in
the western world is cardiovascular disease.
An alternative treatment for these conditions is
endovascular surgery using stent and stent graft
devices. However these devices have problems
such as restenois, migration and stent fracture.
Improved design and drug elution have been
utilized to enhance the performance, with limited
success. The application of tissue engineering
scaffolds to enhance device performance has had
limited studies. A Number of studies have looked
at Small Intestine Submucosa (SIS) in stenting
applications [Nakata 2003, Yamada 2001]. The
studies found that implanted ECM (SIS) stent-grafts
successfully treated simple and ruptured AAAs
and that SIS coated stent preformed better than
that of PTFE covered stent.

Results
The experimental results showed no significant
influence on failure strength after stent loading for
24h (figure 1). SEM analysis of samples showed no
damage to the architecture of the material. The
stresses developed in the FEA models due to stent
compression did not reach the failure strength of
the UBM material.

To further investigate the possible utilisation of


ECM tissue materials this current study examines
an alternative ECM material Urinary Bladder Matrix
(UBM) for the application in stenting procedures.
UBM is an Extracellular matrix material, mainly
collagen-based derived from a porcine urinary
bladder. The aim of this study was to investigate
the implication of stent loading interaction on
the ECM material using experimental and finite
element analysis [Callanan 2014].

Figure 1: UBM tissue failure strength under static and dynamic


loading conditions, compared to an unloaded
control.

Discussion
This study has indicated that cyclic loading over a
24h period has no effect on the mechanical integrity
of the UBM material [Callanan 2014]. Based on
these findings using UBM as a stent cover to improve
the performance and patency of implanted stent
devices is promising method. Additionally with the
remodeling capabilities of UBM-ECM materials, this
should ensure better integration and performance
of the devices [Nakata 2003, Yamada 2001]. The
influence of prolonged periods of loading will
require further study to examine if the mechanical
strength may alter. Also ECM degradation rate may
have influences on the long-term performance of
the material under stent loading.

Methods
The UBM material was constructed into 4-ply
flat sheet scaffolds. The scaffolds were cut into
dumbbell tensile test specimens. The specimens
were places on a agarose gel flat scaffold to
mimic arterial wall compliance. A simplified stent
strut configuration was applied to the surface.
Loading was applied statically and dynamically to
the ECM material. Each specimen was loaded for
24h. Samples were tensile tested with an MTS tensile
tester and the samples were loaded to failure.
Analysis of the results was based on failure strength
of the UBM material. Scanning electron microscopy
(SEM) was carried out on some samples after 24h,
examining the UBM Architecture. A finite element
model was constructed using similar geometrical
constrains. Loading was applied to the surface
using a movement boundary condition. Material
properties were developed from tensile test data.

References
Nakata M. et al., Cardiovasc Intervent Radiol,
26; 459467, 2003.
Yamada K. et al., Cardiovasc Intervent Radiol,
24; 99105, 2001.
Callanan A. et al., J. Biomech. 2:511, 2011

204

O 17 2

COMPUTER SIMULATION OF THE MECHANICAL


BEHAVIOUR OF IMPLANTED BIODEGRADABLE STENTS
IN A REMODELLING ARTERY
E. Boland1, J.A. Grogan1, P.E. McHugh1
1

National University of Ireland, Galway, Biomechanics Research Centre BMEC, Biomedical


Engineering, Galway, Ireland

Introduction
Coronary stents have revolutionised the treatment of
coronary artery disease. While coronary artery stenting
is now relatively mature, significant scientific and
technological challenges still remain. One of the most
fertile technological growth areas is biodegradable
stents; here there is the possibility to generate stents
that will break down in the body once the initial
necessary scaffolding period is past (612 months)
[Grogan, 2011] and when the artery has remodelled
(including the formation of neo-intima).

damager parameter and c is a constant which


relates the damage parameter to cell proliferation
rate. Elements in the ghost mesh become activated
(assigned tissue mechanical properties) when the
local cell concentration reaches a threshold level.
This model is combined with a simplified
implementation of stent degradation where
uniform degradation is represented through the
linear reduction in the elastic properties of the
material (Youngs modulus) over a defined period
of time.

Current finite element (FE) stent degradation


models (validated using in vitro experiments)
tend to estimate complete magnesium stent
degradation in a period of days [Grogan, 2011],
while in vivo data estimates complete degradation
in a period of months.These current FE models do
not include a representation for the active response
of the arterial tissue following stent implantation,
i.e. neo-intimal remodelling. This may explain the
discrepancies between current stent degradation
models and clinical data.

Results
The results of the arterial neo-intimal remodelling
simulations with a biodegradable stent show that
neo-intimal remodelling around the stent struts
has a significant effect on the stent mechanical
response and should not be ignored when
considering stent in-vivo loading performance.

Methods
Stent degradation in the context of a remodelling
artery is simulated to explore how neo-intimal
remodelling influences the mechanics of a
degrading stent. The representation of neo-intimal
remodelling is based on the work of Lally [Lally,
2004] and here it is implemented in Abaqus software
(DS-SIMULIA, USA) through a thermal analogy
formulation. The arterial lumen is meshed with a
ghost mesh, with negligible initial mechanical
properties (see Figure 1).

Discussion
As shown in Figure 2, as degradation proceeds
over time the stent deforms (stent strain increases)
and scaffolding support is lost. However once
neo-intimal remodelling initiates, this deformation
is noticeably retarded with the remodelled tissue
generating a certain level of mechanical support
for the stent.This result could contribute to the
explanation as to why biodegradable metals
stents degrade and lose scaffolding capability
more slowly in-vivo (where tissue remodelling is
occurring) in comparison to in-vitro.

Stress in the artery due to stent deployment is used


to generate a damage parameter D, which acts
like a source term that results in a diffusion of cells
into the ghost mesh. If the concentration of cells in
a small region or element is denoted n, the change
in the cell concentration, dn/dt is computed by;
dn/dt = k2n + cD

References
Grogan et al, Acta Biomater., 7: 35233533, 2011.
Lally et al, PhD Thesis TCD, 2004.

(1)

where k is the diffusion coefficient of cells into


arterial tissue, 2 is the Laplace operator, D is the

205

O 17 3

STRAIN RATE INFLUENCE ON THE TOUGHNESS


OF HUMAN CORTICAL BONE
D. Mitton1, H. Follet2, R. Gauthier1
1

Universit de Lyon IFSTTAR, Laboratoire de Biomcanique et Mcanique des Chocs,


Lyon, France
2

Universit de Lyon INSERM, UMR 1033, Lyon, France

Results and discussion


The effect of strain rate on cortical toughness is
highlighted on Figure1 and Table 1.

Introduction
The number of fractures related to osteoporosis
is projected to increase by 30% by 2025 [Akesson
and Mitchell, 2012]. While most fracture-mechanics
investigations on bone have been performed at
low strain rates, in vivo strain rate can reach high
values during a fall [Fldhazy et al., 2005]. Only few
studies have been performed to assess the cortical
bone toughness at such strain rate [Zimmermann
et al., 2014]. Thus, the aim of the study is to observe
the effect of strain rate on human cortical bone
toughness.
Methods
Six human right distal tibias were obtained from
6 subjects (from 50 to 95 years old, 72.7 15.2).
25 mm-long rectangular specimens with a width
of 2 mm and a thickness of 1 mm were cut.
The samples were prepared in the transverse
orientation: the long side of the specimen was
parallel to the long axis of the bone. The samples
were then notched in there middle with an initial
crack length a~1.1mm. Two samples per bone were
obtained; one was tested at low strain rate (10-4s -1),
the other at high strain rate (10-1s -1) [Fldhazy
et al., 2005]. Fracture toughness measurements
were performed according to the standard ASTM
E-1820 [Zimmermann et al., 2014] for single-edge
notched bending specimens. We computed KIc
the critical linear-elastic stress intensity factor
that gives information on the elastic contribution
and K Jc including the nonlinear elastic J-integral
calculation to consider the plastic deformation
of the materials during the loading. Then, the KJc
term is related to this J-integral:
K Jc = (E*JIc)2

Figure 1: load-displacement curves of paired human cortical bone samples tested at high (blue) and low
(red, dotted) strain rate.

Strain rate (s1)

KIc(MPa.m1/2)

KJc(MPa.m1/2)

3.1 (0.5)

14.3 (1.7)

101

2.7 (0.5)

9.2 (1.1)

10

Table 1: T oughness values for human cortical bone samples


(n=6). The strain rate effect is significant for KJc,
p-value<0.05)

KIc values at the two strain rates are not statistically


different, meaning that the elastic behavior is not
affected by the strain rate. The strain rate has
a significant effect on the plastic contribution
quantified by K Jc. This result on the tibia confirms
those obtained on the femur of a single subject
[Zimmermann et al., 2014]. A larger number of
subjects and different anatomical sites should be
considered in future work.

(1)

References
Akesson, K., Mitchell, P. International Osteoporosis
Foundation, Switzerland, 2012
Fldhazy et al, J. Bone Joint Surg. Br. 87,
261266, 2005
Zimmermann et al, Biomaterials 35, 54725481, 2014

J Ic is an energy term that reports both elastic and


plastic contribution:

Where KIc is the critical linear-elastic stress intensity


factor that gives information on the elastic
contribution.

206

O 174

ANISOTROPIC PROPERTIES OF CHILDRENS CORTICAL


BONE MEASURED BY ULTRASONIC METHOD
E. Lefvre1, C. Payan2, C. Baron1, F. Launay3 , P. Lasaygues2, H. Follet4 , M. Pithioux1
1
2

Aix-Marseille Universit, CNRS ISM UMR 7287, Marseille, France

Laboratory of Mechanics and Acoustics, UPR CNRS 7051, Marseille, France


3

APHM, La Timone, Service de pdiatrie orthopdique, Marseille, France


4

Inserm UMR 1033, University of Lyon, Lyon, France

Introduction
Bone is a hierarchical and organized structure
with properties varying by successive stages from
juvenile to mature state. Numerous studies have
aimed to determine the mechanical properties of
cortical bone tissue collected from adult human
subjects, but few in growing bone. Few papers
study mechanicals properties of childrens bones
by different techniques. However, the notion
of anisotropy is poorly tackled. In this study, we
used ultrasonic wave velocities measured in the
three orthogonal bone axes (axial, radial and
circumferential) to evaluate elastic and shear
moduli (E ii and G ij). The aim of the study was to
bring new insights in growing bone and compare it
with adult bone.

Figure 1: C
 omparison of the mean ( SD) elastic moduli with
age class.

Mean and SD are presented in Table 1. The elastic


coefficients for adult fibulae are similar to these
from the literature on femur [Hoffmeister, 2000].
Values from children, especially for femur, are
lower than these from adults.

Methods
15 fibula and 7 femur samples from 22 children
(118 y.o., mean age: 9.7 5.8 y.o.) were extracted
from the lower limb surgery. 16 fibula samples
from 16 elderly donors (5095 y.o., mean age:
76.2 13.5y.o.) were extracted from the same
location. Samples were cut with a water cooled
low-speed diamond saw into cubic parallelepiped
(dimensions: 2x2x2 mm3). The faces of the
specimen were oriented according to the radial
(axis 1), tangential (axis 2) and longitudinal (axis 3)
directions of bone. Elastic and shear moduli
were measured for each specimen in each of
the three orthogonal directions using ultrasonic
compressional and shear waves velocities
[Pithioux, 2002].

This study revealed a transverse isotropy in both


child and adult bone. Results showed that elastic
and shear moduli were highly correlated with age
in children (R>0.56, p<0.01) but less in adult. This
age-related increase in elastic and shear moduli
which could be explained by changes in structure
and material composition of load-bearing bones
[Bala, 2015].
References
Pithioux et al, J.Biomech, 35:9618, 2002.
Hoffmeister et al, Med. Biol. Eng. Comput,
38:3338, 2000.
Bala et al, Abstract ESB meeting, 2015.

Results and discussion


E1

E2

E3

G23

G31

G12

12.9
(3.6)

16.4
(2.8)

15.9
(3.1)

23.9
(5.2)

4.2
(0.8)

4.0
(0.7)

3.1
(0.4)

76.2
(13.5)

17.7
(2.9)

17.7
(5.3)

28.0
(3.7)

4.8
(0.6)

4.6
(0.6)

3.6
(0.7)

12.2
(2.4)

12.9
(3.2)

19.0
(5.5)

3.6
(0.8)

3.3
(0.9)

2.8
(0.7)

Age
FIBULA

FEMUR
3.6
(5.3)

Table 1: Mean and SD of elastic (E) and shear (G) moduli,


per age class.

207

O 17 5

CORTICAL BONE ANISOTROPIC VISCOELASTICITYDENSITY RELATIONSHIPS ASSESSED FROM RESONANT


ULTRASOUND SPECTROSCOPY
S. Bernard1, J. Schneider2, P. Varga2, K. Raum2, P. Laugier1, Q. Grimal1
1
2

UPMC, CNRS 7371, INSERM 1146, LIB, Paris, France

Charit-Universittsmedizin, Berlin Brandenburg School for Regenerative Therapies,


Berlin, Germany

Introduction
Cortical bone tissue is an anisotropic material
characterized by typically five independent elastic
coefficients (for transverse isotropy) governing
shear and longitudinal deformations in the different
anatomical directions. It is well-established that the
Youngs modulus in the direction of the axis of long
bones has a strong relationship with mass density.
It is not clear, however, if relationships of similar
strength exist for the other elastic coefficients:
shear coefficients, poissons ratios, Youngs moduli
in the direction transverse to the bone axis. Elastic
coefficients other than the axial Youngs modulus
have been relatively little investigated. The results
of the few studies reporting on the variations
of anisotropic elasticity with mass density are
contradictory (Rho, Ultrasonics 34:777, 1996; Dong
and Guo, 37:1281, 2004).
RUS also measures the viscous part of the stiffness
tensor. An anisotropy ratio close to 2 was found for
damping coefficients and damping was found to
increase as the mass density decreased.

Methods
Resonant ultrasound spectroscopy (RUS) was used
to measure the transverse isotropic stiffness tensor
of 55 cortical bone cuboid tibia specimens from
19 donors.The anisotropic elastic coefficients (all
the terms of the stiffness tensor) were measured
with a precision varying from less than 3% (shear
coefficients and Youngs moduli) to 10% (poissons
ratios and non disagonal stiffness coefficient).

Discussion
The data suggests that a relatively accurate
estimation of all the mid-tibia elastic coefficients
can be derived from mass density. This is of
particular interest (1) to design organ scale bone
models in which anisotropic elastic coefficients
could be mapped according to Hounsfield
values from computed tomography scans as a
surrogate for mass density; (2) to model ultrasound
propagation at the midtibia, which is an important
site for the ultrasound assessment of bone status
with axial transmission techniques.

Results
Strong linear correlations were found between most
of the elastic coefficients (0.7 < R2 < 0.99). Strong
linear correlations were also found between these
coefficients and mass density (0.79 < R2 < 0.89).
The Table below presents the results of the linear
regression analysis. Comparison with previously
published data from femur specimens suggests
that the strong correlations evidenced in this study
may not only be valid for the mid-tibia.

208

O 176

BONE TISSUE ENGINEERING: THE NEED TO SEE INSIDE


S. Hofmann1,2, J. Vetsch2, J. Melke1, M. Ralph2, K. Ito1
1

Eindhoven University of Technology, Department of Biomedical Engineering,


Eindhoven, Netherlands

ETH Zrich, Department of Health Sciences and Technology, Zrich, Switzerland

Introduction
In bone tissue engineering, it is believed that cells
subjected to a certain load will either proliferate
or differentiate. However, studies about optimal
loading regimes are contradictory due to the
complexity of applied parameters [El Haj, 2010].
Most importantly, many studies do not take local
cellular conditions into account. When cells deposit
a matrix, they become embedded shielding
themselves from the applied load [Fig. 1]. Which
in turn means that if there is an optimal loading
condition for a certain cell type, loading regimes
on the tissue construct need to be adapted
taking into account the deposited matrix. In order
to do so, we need to be able to simultaneously
visualize scaffold morphology and the matrix that is
produced by the cells. We herewith describe such
an approach using micro-computed tomography
for bone tissue engineering.

Methods
Micro-computed
tomography
(CT)
was
investigated as a non-invasive tool to determine
both scaffold morphology as well as mineralized
matrix deposited by human mesenchymal stem
cells (hMSC) seeded on porous silk fibroin scaffolds.

Discussion
CT allows imaging of both the scaffold and newly
deposited mineralized matrix. However, this is
the first time that they have been simultaneously
visualised. In an in vitro culture, this will enable
us to set up a feedback mechanism to adapt
mechanical loading regimes, such as flow perfusion
through the scaffold pores, to maintain a local
mechanostimulatory environment. Only by applying
such non-destructive monitoring technology it will
be possible to identify and quantify parameters that
influence cell behaviour in vitro.

Results
Protein silk fibroin scaffolds take up water in a
physiological environment and are invisible to
CT. However, the incorporation of hydroxyapatite
powder enabled visualization of these scaffolds
(data not shown). Similarly, mineralized extracellular
matrix deposited by hMSC could be monitored
over time [Hagenmller, 2007] and enabled the
visualization of detailed structures at a resolution
of a few micrometers [Fig. 2].

References
El Haj et al, Proc Inst Mech Eng H, 224(12), 2010;
Hagenmller et al, Ann Biomed Eng, 35(10), 2007
Ack n o wl e d g m e n t s
The authors tehank Trudel Inc for providing silk and
funding from the European Unions 7th Framework
Programme (FP/20072013) / EU Project No. FP7NMP-2010-LARGE-4: 262948 and grant agreements
No. PCIG13-GA-2013-618603 and No. ERC-2013-StG:
336043.
209

O 17 7

FATIGUE-FRACTURE INTERACTION MECHANISMS


FOR LONGITUDINAL AND TRANSVERSE CRACK GROWTH
IN BOVINE CORTICAL BONE
L. Fletcher1, J. Codrington1, I. Parkinson2
1
2

The University of Adelaide, School of Mechanical Engineering, Adelaide, Australia

The University of Adelaide, Discipline of Anatomy and Pathology, Adelaide, Australia

Introduction
Fatigue microdamage accumulates in the skeletal
system due to everyday use (e.g. walking). This
accumulation of fatigue damage is thought to
contribute to the occurrence of fragility fractures in
the elderly [Burr, 1997]. However, the mechanisms
that are responsible for the interaction of fatigue
damage and the fracture resistance of bone are
not well understood. Therefore the aim of this study
is to analyse the effects of fatigue microdamage on
the longitudinal and transverse fracture resistance
of cortical bone.
Methods
Twenty longitudinal compact tension specimens
were machined from the cortical shaft of a
bovine femur. A further twenty transverse singled
edge notched bend specimens were machined
from another bovine femur. Ten specimens from
each femur were allocated as controls while the
remaining specimens underwent a cyclic loading
protocol to induce fatigue microdamage. Both
control and damaged specimens were imaged
using fluorescence microscopy to assess the fatigue
damage. All specimens were fracture resistance
tested to obtain the J-integral resistance curve
with further analysis undertaken on the elastic and
plastic components of the J-integral. After fracture
resistance testing the crack path toughening
mechanisms were assessed using fluorescence
microscopy. The method used for this study is
similar to our previous work, see [Fletcher, 2014] for
further detail.

Figure 1: F racture resistance curve confidence intervals for


the longitudinal (a) and damaged (b) groups

Discussion
For the longitudinal fracture group, fatigue
microdamage caused a decrease in both the
fracture initiation toughness and the rate of
toughening. This decrease was attributed to the
fatigue damage saturating weak interfaces of
the microstructure that would normally form new
damage during crack growth and absorb fracture
energy. For the transverse group, the effect of
fatigue microdamage was minimal with no observed
change in the fracture initiation toughness or rate of
toughening. The dominant toughening mechanism
for the transverse group was crack deflection. This
mechanism is controlled by the microstructure and
was unaffected by the fatigue damage.
The results of this study show that fatigue
microdamage is detrimental to the longitudinal
toughening behaviour of healthy bone. In aged
bone the crack deflection mechanism has been
shown to be suppressed for transverse cracking
[Koester, 2011]. Thus, the effects of fatigue
microdamage would become significant for crack
growth in this direction. Overall, it is therefore likely
that microdamage is detrimental to both the
longitudinal and transverse fracture behaviour of
aged bone.

Results
The 95% confidence intervals for the fracture
resistance curves of the longitudinal and
transverse groups are shown in Figure 1 (a) and (b)
respectively. The fracture initiation toughness J0
for the longitudinal control was 1.230.21 kJ/m2
and damaged 0.960.23 kJ/m 2. For the transverse
group the control fracture initiation toughness
was 2.320.44 kJ/m 2 and the damaged fracture
initiation toughness was 2.340.46 kJ/m2.

References
Burr et al, J Bone Miner Res,12:615, 1997
Fletcher et al, J Mater Sci: Mater Med, 25:
16611670, 2014
Koester et al, J Mech Behav Biomed Mater,
4:15041513, 2011

210

O 17 8

CREATING SUBJECT-SPECIFIC MUSCULOSKELETAL


MODELS FROM ANATOMICAL MRI SCANS
S. Menon1, K. Yan1, O. Khatib1
1

Stanford University, Computer Science, Stanford, USA

Introduction
Virtual simulations of musculoskeletal models are
a valuable tool for reconstructing dynamic human
motions and estimating neuromuscular control.
While the degree of biological plausibility required
depends on a studys specific goals, it is common
to use articulated body models with piece-wise
linear muscle kinematics. Such models are derived
from cadaver studies and are linearly scaled to
individual subject physiology. As a more precise
alternative, we present a tool-chain to recreate
exact subject-specific musculoskeletal kinematics
by building models based on segmented magnetic
resonance imaging (MRI) data. We used volumetric
bone data to create a subject-specific skeletal
articulated body system, and approximated
volumetric muscles with cylindrical segments that
represent fiber bundles. A comparison of our MRIbased model with a canonical cadaver model
from the OpenSim software system suggests that
subject-specific models can provide greater
kinematic accuracy. In addition, such models
also establish kinematic ground truth, which can
be used to estimate errors in further dynamics
reconstruction analyses.

canonical OpenSim (Delp, 2007) bone models. The


canonical muscle models kinematics were greatly
simplified, however, which prevented a direct
comparison with our exact MRI-based model.
We used a custom volume alignment method to
align bones since landmark based affine fitting
methods performed poorly. We first selected a
finite number of control points in each bone using
a volume filling algorithm. Each successive control
point was picked to maximize its distance from
the closest among the previously selected control
points. We then estimated point-correspondence
between the subject-specific and canonical models
using the Hungarian algorithm (Kuhn, 1955). Finally,
we fit an affine transformation to collectively warp
all the points in one bone to the other.
Results
We successfully created subject-specific full arm
musculoskeletal models from anatomical MRI scans
using our methods. The musculoskeletal volume
generation and articulation joint specification
presently requires some manual intervention.
Muscle fiber generation, however, is automated.

Methods
To extract musculoskeletal kinematics, we first
scanned subjects with MRI (T1, 0.8*0.8*0.8 mm
voxels, GE MR950 3T scanner) and extracted
volumetric data by manually segmenting the bones
and muscles (Fig. 1A). To capture each muscles
volume, we split it into slices, packed circles in
each slice, and connected corresponding circle
centroids and circumferences across slices. These
swept circles provided a decomposition analogous
to bundles of muscle fibers. Finally, muscle fiber
segments were attached to their corresponding
bones to obtain full musculoskeletal kinematics.

Discussion
Our MRI-based subject-specific musculoskeletal
models provide kinematic ground truth and are
potentially useful in analyses that are sensitive to
muscle structure and muscle-bone attachment
location. Our approach alleviates errors due
to mismatch between subject physiology and
canonical models, which affects existing marker
based human motion reconstruction methods.
References
Delp e.a., IEEE Tr. Biomed. Eng., 54:11, 2007
Demircan e.a., Springer Adv. Rob. Kinematics,
283292, 2010
Khatib e.a., J. Physiol, 103(3), 211219, 2009
Kuhn, Naval Res. Logistics Qtr., 2:8397, 1955

To
estimate
whether
our
subject-specific
models offer an advantage for human motion
reconstruction (Khatib, 2009, Menon 2015), we
performed a fit between the subject-specific and

see the next page

211

Figure 1: A
 , Starting with segmented MRI scans, the pipeline creates bone (Stage 1) and muscle volumes (S2), then subdivides
muscles into fibers (S4), and finally creates a biomechanical model (S5,6). Colors in MRI scans (top) indicate different
bones. B, Subject-specific models avoid fitting errors in canonical model pipelines.

212

O 17 9

WORKING TOWARDS PATIENT-SPECIFIC LOCKING


PLATE SELECTION FOR BONE FRACTURE TREATMENT:
WHAT MATTERS?
A. MacLeod1, H. Simpson2, P. Pankaj1
1
2

The University of Edinburgh, School of Engineering, Edinburgh, United Kingdom

The University of Edinburgh, Department of Orthopaedic Surgery, Edinburgh, United Kingdom

Introduction
Plating functions very differently depending upon
the type of screws used and the placement
of those screws (Gautier, 2009). Choosing a
patient-optimised plate and screw configuration
is not straightforward as there are many
interdependent variables relating to device
configuration. Moreover, every patient presents
a unique fracture pattern and has different
bone quality. Fracture healing is known to be
sensitive to interfragmentary movement (IFM)
produced by a device, and this is affected by
screw placement. Additionally, many modes of
plate failure such as screw loosening/cut-out
and plate breakage have been attributed to
inappropriate device configuration (Button 2004,
Gardner, 2009). Recent studies have shown that
there is wide variability in the screw configurations
used by different surgeons even when using similar
devices (Fitzpatrick, 2009) and when treating similar
fracture patterns (Button, 2004, Hoffman, 2013).
This highlights the demand for greater guidance.

Figure 1: T he different screw positioning variables examined


in the study and the regions of high strain around
screw holes.

Results
The study found that the main determinants of
IFM and plate stress were: the plate material and
geometry, and distance between the two screws
closest to the fracture (working length).

This study aimed to evaluate the influence of


different aspects of device configuration on IFM,
and the risk of screw loosening and plate breakage.
Additionally, the study aimed to evaluate that
effect that bone quality has on these variables.

The regions of high strain around screws were


influenced by additional variables including the
number of screws used and the spacing of the
screws. Interestingly, total plate span did not
influence predictions. Osteoporotic bone was
found to be more sensitive to the choice of screw
configuration and the use of different screw types.

Methods
Three-dimensional finite element models were
created and validated experimentally using
sawbones models. The analyses used nonlinear
screw-bone contact interfaces and included
nonlinear geometrical effects. The influence of screw
placement in osteoporotic bone was investigated
by including anisotropic and inhomogeneous
bone properties and the associated geometrical
changes. The IFM, plate stress and the level of
strain around screws was examined for a range of
screw positioning variables (Figure 1), plate types
and screw types.

Discussion
Based on this study, the approach to patientspecific locking plate configuration was derived
as follows:
(1) T he ideal IFM for the fracture pattern should be
determined.
(2) IFM and plate stress can then be optimised using
a combination of working length and choice of
plate material and geometry.
(3) F inally, loosening risk can be mitigated by the
placement of remaining screws. Bone quality
should be taken into account at this stage.
References
Gautier, AO Dialogue 2427. 2009.
Button et al, J Orth Trauma 18:565570. 2004.
Gardner et al, J Am Acad Orthop Surg 17:647657.
2009.
Fitzpatrick et al, OTC workshop on Trauma care,
Boston. 2009
Hoffmann et al. J Orthop Surg Res 8:843. 2013.

213

O 18 0

A TOTAL HIP REPLACEMENT TOOLBOX: FROM CT-SCAN


TO PATIENT-SPECIFIC FE ANALYSIS
D. Ferreira de Almeida1, R. B. Ruben2, J. Folgado1, P. R. Fernandes1,
M. De Beule3 , B. Verhegghe3
1
2

Instituto Superior Tcnico, IDMEC, Lisboa, Portugal

Instituto Politcnico de Leiria, CDRsp-ESTG, Leiria, Portugal


3

University of Gent, bioMMeda, Ghent, Belgium

Introduction
The hip joint has one of the most physically
demanding roles in the human body, carrying
up to 85% of the body weight in a single stance
and up to eight times the body weight when
running. The most common solution to the
numerous complications in the hip joint is its
replacement for a synthetic prosthesis Total Hip
Replacement (THR). In the scope of this paper a
pipeline for the femur segmentation, alignment
and prosthesis coupling was developed. Hence,
the orthopaedic surgeon will be provided with
quantitative information about the performance
of the different and prosthesis designs and
constituting materials in the patient-specific
femur prior to the surgical intervention and without
requiring extensive knowledge of the technique.

The femur volumes were then discretized in a


triangulated surface and oriented according to their
principal axis of inertia. Together with the orthopaedic
department at the UZ Gent, the automatic extraction
of key anatomical landmarks is also included in the
toolbox, in order to plan the femur neck osteotomy and
prosthesis insertion. The sizing and fitting optimization
was also addressed, developing methodologies that
optimize the alignment of the prosthesis axis in red
on Fig. 2. The segmentation of the medullar canal
green on Fig.2 will allow the physician to estimate
beforehand the optimal size of the stem.
Results
The methodologies developed avoid the trial-anderror stem size estimation and ultimately reduce the
amount of breaching at the time of the prosthesis
insertion, as shown in Fig. 2.

Methods
The first step of the pipeline is the segmentation of
the femur. For this purpose, an Active Shape Model
(ASM) [Cootes, 1994] was created from images
made available at the Universitair Ziekenhuis (UZ)
Gent, in Belgium. Briefly, the statistical shape model
is obtained by learning patterns of variability of a
training set of previously segmented femurs. The
ASM algorithm aims to deform the model to a new
scan Fig 1.

Figure 2: E
 xample of a prosthesis optimal fitting to a patient-specific femur.

Discussion
A framework for planning a THR was successfully
developed. The computational procedure is
capable to automatically segment the patients
femur, orient it within a standardized coordinate
system, optimize the osteotomy based on
anatomical landmark extraction and surface
curvature and provide the tools for an optimal
prosthesis placement.
Figure 1: E
 xample of the ASM segmentation results.

References
Cootes et al, J Computer Vision and Image
Understanding, 61:3859, 1994.

214

O 181

PERSONALIZED 3D FINITE ELEMENT MODELS OF THE HIP


FROM 2D RADIOGRAPHS BASED ON ANATOMICAL
MEASUREMENTS AND TEXTURE ANALYSIS
J. Thevenot1, J. Koivumki1, V. Kuhn2,3 , F. Eckstein3,4 , S. Saarakkala1,5, T. Jms1,5
1

University of Oulu, Department of Medical Technology, Oulu, Finland

Innsbruck Medical University, Department of Trauma Surgery and Sports Medicine,


Innsbruck, Austria

Paracelsus Medical University, Institute of Anatomy and Musculoskeletal Research,


Salzburg, Austria

Ludwig-Maximilians-University, Institute of Anatomy, Munich, Germany

Oulu University Hospital, Department of Radiology, Oulu, Finland

Introduction
Finite element (FE) modelling has often been
proposed as a tool for estimating fracture
risk. However, patient-specific FE models are
commonly based on computed tomography (CT)
and require high computing time to obtain both
geometry and material properties. It has been
suggested that radiographic texture analysis can
provide information on bone quality [Thevenot,
2013]. Thus, we present here a novel method to
automatically create a personalised 3D models
from standard 2D hip radiographs [Thevenot, 2014],
based on anatomical measurements to generate
the geometry and texture analysis to estimate the
material properties.

Discussion
This novel method for automatically constructing
a patient-specific 3D finite element model from
standard 2D radiographs shows encouraging
results in estimating patient-specific failure loads.
The compressive system in the neck area is the most
relevant location to estimate an overall distribution
of the material properties within the model, based
on texture analysis.

Methods
A set of geometrical parameters of the femur were
determined from seven a-p hip radiographs and
compared to the 3D femoral shape obtained from
CT as training material; the error in reconstructing
the 3D model from the 2D radiographs was
assessed. Using the geometry parameters as the
input, the 3D shape of another 21 femora was
built and meshed. Both trabecular and cortical
compartments were separated during the process.
Personalized material properties were derived from
the homogeneity index assessed by texture analysis
of the radiographs, with a focus on the principal
tensile and compressive trabecular systems, as
suggested previously [Thevenot, 2013]. In order
to estimate the material properties from texture
analysis, the homogeneity index was correlated to
CT scans-based elastic modulus from the training
set as reference. The ability of these patientspecific FE models to predict failure load was
determined by a comparison with an experimental
biomechanical test simulating a fall on the greater
trochanter.

Figure 1: C
 ut of a generated model showing the typical
distribution of material properties based on texture
analysis of the radiograph.

References
Thevenot et al, J Biomech, 47:438444, 2014.
Thevenot et al, J Bone Miner Res, 28:
25842591, 2013.

Results
The average reconstruction error of the 3D models
was 1.77 mm (1.17 mm), with the error being
smallest in the femoral head and neck, and greatest
in the trochanter. Homogeneity index assessed in
the principal compressive system provided the best
information to affect material properties within the
generated FE model (Figure 1). The FE model was
able to predict the experimental failure load with
R2=64% accuracy.
215

O 18 2

SCALED-GENERIC MUSCULOSKELETAL MODELS


OVERESTIMATE THE KNEE MEDIAL CONTACT FORCE
Z.Y. Ding1, A.E. Kedgley1, C.K. Tsang1, A.M.J. Bull1
1

Imperial College London, Department of Bioengineering, London, United Kingdom

Introduction
Estimation of knee contact forces is important in
understanding the initiation and progression of
musculoskeletal conditions such as osteoarthritis.
Musculoskeletal modelling of the lower limb
provides a practicable approach to predict these
forces. However, the development and validation
of these models are challenging due to the knee
joint complexity and subject variability. The aim
of this study was to investigate the influence of
personalised anatomical parameters of lower limb
musculoskeletal models on the knee medial and
lateral contact force predictions.
Methods
Scaled-generic and MR-based musculoskeletal
models were developed for 2 male subjects. Scaled
models were achieved by scaling each segment
of the generic model (male, 1.74 m, 105 kg) [1]
to the subjects dimensions. Medial and lateral
contact points were located 20 mm medially
and laterally from the knee centre of rotation [2].
MR-based models were developed from MRI scans
of the subjects whole lower limbs. Subject-specific
medial/lateral contact locations were directly
measured from the MR images. Two models were
varied at bony landmarks, joint centres of rotation,
medial/lateral contact points, muscle geometry
and patella ligaments geometry. Kinematic and
ground reaction force data were collected for
each subject during gait. The contact forces
including the forces in the medial and lateral
compartments were predicted using a segment
based optimisation approach [3].

Figure 1: K
 nee force predictions for two subjects.

Figure 2: M
 edial and lateral contact forces

Results
The knee contact force predictions are shown
in the Figure 1. The total knee contact force
distribution patterns during the stance phase are
similar between cases; however, scaled-generic
models had greater estimates of knee contact
forces for the two subjects, by up to 1.07BW and
1.26BW, respectively. Moreover, the MR-based
models cause a decrease in the medial contact
force and an increase in the lateral contact force.

Discussion
This MR-based model predictions are in better
agreement with in-vivo measurements from the
literature ([4] Figure 2). Differences in lower limb
anatomical model were addressed for knee contact
force predictions. However, the sensitivity of these
knee contact forces to those subject-specific
anatomical parameters (e.g., the medial/lateral
contact locations, muscle and ligament geometry)
remains unknown. With more subject-specific
anatomical models available in our group, we are
now carrying out investigations to better quantify the
accuracy of the knee contact force estimations in
terms of different anatomical modelling techniques.
References
1 Klein Horsman MD. Et al., Clin Biomech,
22(2):239247, 2007
2 Cleather DJ. et al., Plos One, 9(12):e115670
3 Cleather D.J. et.al, Ann Biomed Eng, 39(1):
147169, 2011
4 Zachary FL. et al., J Biomech, (In Press)
216

O 18 3

3D-SCAFFOLD-FREE CARTILAGE TRANSPLANTATS (SFCT)


AS A NEW WAY IN CARTILAGE TISSUE ENGINEERING
I. Ponomarev1, T. Reuter2, C. Hauspurg3 , A. Kammel3 , D. Barnewitz1
1
2

fzmb GmbH, Veterinarian Clinic, Bad Langensalza, Germany

fzmb GmbH, Bioinstruments and Device Development, Bad Langensalza, Germany


3

TITK, Textile and Materials Research, Rudolstadt, Germany

Introduction
The limited self-repair capability of damaged
hyaline cartilage is the main cause of joint arthrosis.
Therefore, different tissue-engineering methods
have been developed to address this particular
problem. We focused on the development of a
new technology to produce a 3D-scaffold-free
cartilage trans-plantat (SFCT) by intermittent
mechanical stimulating chondrocytes of pellet
cultures.

Also, histochemical findings reveal clear proteoglycan and collagen staining. Even though immunohistological analyses indicate the presence
of collagen type I, collagen type II was the main
component of extracellular matrix in SFCTs. All
SFCTs exhibit a remarkable size (Figure 1).

Methods
For the production of SFCTs equine chondrocytes
of the stifle joint were used. After cultivation
and proliferation in monolayer cultures, cells
were
transferred
into
a
three-dimensional
structure without any artificial matrix, growth
or differentiation factors. In order to produce
scaffold-free transplants and extracellular matrix,
the samples were exposed to undifferentiated
mechanical pressure (manual) [1]. The SFCTs
were analysed after 46 weeks of cultivation.
Chondrogenesis in SFCTs was documented by
macroscopic, biochemical, immunohistological
and biomechanical analysis. For biomechanical
investigations, the E-modulus of samples was
determined using a material testing machine
INSTRON 4466 (100 N). The uniaxial compression of
the specimens was effected with a testing velocity
of v = 1 mm/s, with an initial load of F = 0.1 N and
with a strain of 30%. Native equine joint cartilage
was used as a control.

Figure 1: M
 acroscopically presentation of Scaffold-free 3D
cartilage constructs (SFCTs).

Specimens

Collagen

E-modulus

SFCT

30,11,9 g

0,260,12 MPa

native

64,95,0 g

0,890,11 MPa

Table 1: C
 haracterisation of native cartilage and SFCTs.

Discussion
The presented results allow the conclusion that tissue
engineered constructs created by scaffold-free
technology can be applied in the rehabilitation
of articular cartilage damages in veterinary and
human medicine.

Results
The biochemical results clearly demonstrate
that SFCTs have a high amount of proteoglycan
and collagen (20% and 45% of the native tissue,
respectively). The biomechanical results show
that the E-modulus of SFCTs was about 30% of the
native tissue E-modulus.

References
[1] Ponomarev I., Wilke I., Manufacturing process of
three dimensional tissue structures and structures
obtainable thereby, EP 1 550 716 B1, 2004.

217

O 18 4

MSC ALIGNMENT, PROLIFERATION AND ECM SYNTHESIS


IN 3D FIBRIN HYDROGELS IS REGULATED BY THE
MAGNITUDE AND FREQUENCY OF TENSILE STRAIN
S. Carroll1, D. Kelly1, C. Buckley1
1

Trinity College Dublin, Trinity Centre for Bioengineering, Dublin, Ireland

Introduction
Multipotent stromal cells (MSCs) can be isolated
from numerous different tissues and induced to
differentiate towards a chondrogenic lineage
[Vinardell (2012)], making them an attractive
alternative to autologous chondrocyte implantation
for articular cartilage repair strategies. However,
the in vivo phenotypic stability of cartilaginous
tissues engineered using such cells, irrespective
of their origin, is by no means assured. Previous
studies have demonstrated that joint specific
environmental cues, such as mechanical loading,
can significantly influence MSC differentiation
[Carroll (2014), Connelly (2010)]. A key challenge
when developing successful tissue engineering
strategies is to elucidate the influence of such
biophysical cues on stem cell fate. Here, we present
a novel bioreactor capable of controlling the
magnitude and frequency of tensile strain applied
to 3D cell laden hydrogels. This bioreactor is then
used to explore how cyclic tensile strain regulates
the alignment, proliferation and phenotype of
MSCs encapsulated into fibrin hydrogels.

Figure 1: A
 novel tension bioreactor was developed to
apply uniaxial tensile strain to 3D hydrogels.

Methods
A novel bioreactor (Fig.1) was developed to
facilitate application of precise uniaxial tensile
strains to 3-dimensional hydrogels under controlled,
sterile conditions. Furthermore, this system was
able to control the local oxygen levels within the
bioreactor chamber via an aeration system which
introduced oxygen at a controlled partial pressure.
Expanded porcine bone marrow derived MSCs were
encapsulated at a final density of 10x10 6cells/mL in
fibrin hydrogels, which were moulded in recesses
in silicone strips and maintained in the tension
bioreactors in media containing factors known to
promote chondrogenic/myogenic differentiation.
Cyclic tensile strain was applied for 4 hours per
day for 16 days at various strain magnitudes and
frequencies.
Results
MSCs remained viable in all groups for the duration
of the study. MSCs within the hydrogels appeared to
align parallel to the direction of the applied tensile
strain, particularly for the 10% strain, 0.5Hz group
(Fig. 2a). A more developed actin-cytoskeleton
was observed with the application of this loading
regime. This group was also found to promote
cellular proliferation, as evident by a significant
increase in construct DNA content (Fig. 2b). An
increase in total extra-cellular matrix accumulation
was also observed in this group.

Figure 2: F -actin staining (a) and biochemical analysis


(b) of samples after 16 days culture in tensile
strain bioreactors. Direction of loading is left
to right in images.

Discussion
This study presents a novel bioreactor capable of
controlling the external mechanical environment
and oxygen tension of MSCs encapsulated in
3D hydrogels. The altered cytoskeletal structure
see the next page

218

References
Carroll, et al., J Biomech, 47: 211521 (2014).
Connelly, et al., Tissue Eng Part A, 16: 191323 (2010).
Vinardell, et al., Tissue Eng Part A, 18: 116170 (2012).

and cellular alignment in response to tensile


loading, coupled with increases in proliferation
and collagen matrix synthesis, suggest that the
MSCs are adopting a more myogenic phenotype
in response to this biophysical stimulation. We are
currently exploring how the application of such
cues regulates the specific matrix components
synthesised by MSCs in response to altered
magnitudes of cyclic tensile strain.

219

O 18 5

DAMAGE MECHANISMS OF FOCAL CARTILAGE DEFECTS:


NEW INSIGHTS USING FINITE ELEMENT MODELING
A. Heuijerjans1, W. Wilson1, K. Ito1, C.C. van Donkelaar1
1

Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands

Introduction
Focal cartilage defects are common [Hjelle, 2002],
cause severe pain and disability [Heir, 2010; Solheim,
2014] and generally progress into osteoarthritis
[Hunziker, 2001]. This study investigated the underlying biomechanical mechanisms of damage
progression surrounding such defects using a finite
element model of a cartilage-cartilage contact
interface. We hypothesized that elevated collagen
strains would occur at the surface of tissue adjacent
to a defect, especially after sustained loading, as
a result of tissue deformation into the defect.

Figure 2: M
 aximum principal strain after fast axial loading
(left) and creep loading (right) in intact and defect cartilage-cartilage contact.

Methods
A finite element geometry of cartilage-cartilage
contact was developed for an intact and defect
state. Due to symmetry, only half of the geometry
was simulated. The size of the defect was set to 8
mm, thickness of cartilage was 1.5 mm. The upper
cartilage-bone interface was fixed in all directions,
while the lower cartilage-bone interface was
only fixed in the horizontal direction. Fast loading
was performed on the lower cartilage-bone
interface by a load increase to 2 MPa in 1 ms and
prolonged loading was performed by a constant
load of 0.5 MPa for 900 s. Healthy cartilage tissue
was described using a validated fibril-reinforced
poroviscoelastic swelling model [Wilson, 2005].

Discussion
In accordance with the hypothesis, collagen strains
increased adjacent to a defect. Superficial fibers,
aligned parallel to the surface, were strained due
to horizontal stretch of the surfaces caused by the
defect. Similarly, vertical deformations of opposing
tissue caused increased collagen fiber strains
in the middle and deep zone where the fibers
were perpendicular to the surface (Fig 1). Sites of
elevated collagen strains in the surface adjacent
to a defect agree with previously reported sites of
high contact pressure [Manda, 2011] and might be
related to surface fibrillation.
Lateral deformations caused substantial increases
in maximum principal strains in the middle and
deep zone of tissue near the defect edge (Fig 2).
This site correlated with locations where cartilage
separation from underlying bone, also called
delamination, blistering or peel-off tearing, occurs
clinically [Beaul, 2003; Beck, 2005; Sekiya, 2009].

Results
Elevated fiber strains occurred opposing the
defect after fast loading and in superficial zones
adjacent to a defect after a sustained load (Fig 1).
Maximum principal strains increased at the edge of
the defect and the cartilage-bone interface after
fast loading (Fig 2). Prolonged loading caused
major increases in maximum principal strains close
to the defect edge, in the deep and middle zone.
These strains were mirrored in the opposing tissue.

Due to joint incongruence and motion in vivo, no


fluid entrapment in the defect was assumed. Future
3D modeling would allow studying effects of motion
and geometry. Whether the computed strains
induce damage is the subject of future study using
a damage progression model [Hosseini, 2014].
In conclusion, the present study demonstrated that
sites of high strains occur as a result of a cartilage
defect, at locations which concur with areas in
which damage is known to occur clinically. High
collagen strains close to the surface may be a
mechanism for surface fibrillation, whereas high
principal strains deep in the tissue may be a
mechanism for blistering.

Figure 1: M
 aximum primary collagen fiber strains after fast
axial loading (left) and creep loading (right) in intact and defect cartilage-cartilage contact. In the
zoomed area the fibers are represented in black.

see the next page

220

References
Beaul et al., Can J Surg 46:4634. 2003;
Beck et al, JBJS Br 87:10128. 2005;
Heir et al, Am J Sports Med 38:231237, 2010
Hjelle et al, Arthroscopy 18(7):7304, 2002;
Hosseini et al OA Cart 22:95103, 2014;
Hunziker, OA Cart 10:43263, 2001;

Manda et al, J Biomech 44:794801, 2011;


Sekiya et al, Orthop 32, 2009;
Solheim et al, Knee Surg Sports Traumatol Arthrosc
2014 (Epub)
Wilson et al, J Biomech 38:1195204, 2005;

221

O 18 6

THE EFFECT OF DEHYDRATION ON THE MECHANICAL


PROPERTIES OF ARTICULAR CARTILAGE
A. Cederlund1, R. Aspden1
1

University of Aberdeen, Musculoskeletal Research Programme, Aberdeen, United Kingdom

Introduction
Articular cartilage is an anisotropic, non-linear
viscoelastic material that provides a low-friction
bearing surface while transmitting loads to the
underlying bone. It exhibits both stress relaxation
and creep behaviour when compressed. It has
a remarkably high water content, about 6080 %
of the tissue weight is water. This decreases with
ageing [Goodfellow, 1967] but increases with the
onset of osteoarthritis [Maroudas & Venn, 1977].
Viscoelasticity is often characterised by isochronal
stress-strain curves calculated from creep or stress
relaxation data, and stiffness or compliance
spectra [Ferry, 1970]. Creep and stress relaxation
are related if the viscoelasticity is linear [Ferry,
1970]. The role of water content in these spectra
has been little explored. In this study we investigate
the viscoelastic properties of articular cartilage in
relation to tissue water content.

(RH=100%) and 16.0 5.6 MPa (RH=96%) (Figure 1).


The elastic modulus at 200 s increased from
0.7 0.8 MPa (fully hydrated) to 1.7 2.3 MPa
(RH=100%) and 5.2 4.6 MPa (RH=96%).

Exp e r i m e n t a l m e t h o d s
Stress relaxation (SR) tests were performed on 5 mm
diameter, full-thickness cores of bovine articular
cartilage (n=16). Each core was dehydrated in two
stages (equilibration 3 hours in relative humidities
(RH) of 100% and 96%). Total water content was
analysed by drying the cores at 110 C. Cores were
compressed to 5%, 10%, 15% and 20% at 60 mm
/ min and stress recorded for 240 seconds at a
rate of 0.02 s/signal. Creep tests were also done
and analysed for comparisons with SR. Isochronal
stress-strain curves were derived at selected
time points (10s, 200s) from SR curves and data
were Fourier transformed for dynamic analysis.
Differential Scanning Calorimetry (DSC) was used
to investigate the water behaviour in the tissue
during freezing and melting.

Figure 1: R
 epresentative isochronals at two time points
(10 s and 200s) and three levels of hydration
(PBS, 100%, 96%).

No relationship could be found between creep


and SR data. The dynamic analysis indicates
that the tissue response is more viscous at higher
frequencies.
Discussion
Isochronal stress-strain relationships show the tissue
to be non-linear viscoelastic. A consequence is
that it becomes impossible to derive a relationship
between stiffness and creep compliance.
Decreasing water content increases the elastic
modulus of the tissue. These data indicate
that control of water content is crucial if tissue
engineered implants are to have the appropriate
mechanical properties.

Results
DSC showed that the water froze in one process
with a sharp onset at 14 C but melted in several
stages. The relative enthalpies depended on the
rate of warming. Dehydration reduced the water
content in the tissue from 78 3% (fully hydrated)
to 61 4% (RH=100%) and 45% 3% (RH=96).
The elastic modulus of the tissue at 10 s increased
from 9.6 6.8 MPa (fully hydrated) to 15.0 8.1 MPa

References
Ferry, D., Viscoelastic Properties of Polymers, 1970
Maroudas, A. & Venn, M. Ann Rheum Dis
36:399, 1977
Goodfellow, J. W., et al, J. Bone Joint Surg. Br,
49:175181, 1967

222

O 187

SITE-SPECIFIC CHANGES IN CELL BIOMECHANICS AND


CARTILAGE COMPOSITION IN MATURE RABBIT KNEE
JOINTS 3 DAYS AFTER A PARTIAL MENISCECTOMY
A. Ronkainen1, J. Fick1, A. Sawatsky2, W. Herzog2, R. Korhonen1
1
2

University of Eastern Finland, Department of Applied Physics, Kuopio, Finland

University of Calgary, Human Performance Laboratory, Faculty of Kinesiology,


Calgary, Canada

Introduction
Surgical operations that cause instabilities in the
knee joint, such as partial menisectomy (PM),
are commonly used in studying the progression
of osteoarthritis [Colombo, 1983]. It is not known
whether changes in chondrocyte biomechanics
and tissue composition occur 3 days after a PM in
the rabbit knee joint.
Methods
Fifteen New Zealand White rabbits (131 month)
were divided into surgery (n=10) and control
(n=5) groups. A PM of the meniscus in the
lateral compartment of the rabbit knee joint was
performed in a randomly chosen knee for each
surgery group rabbit, and these knee joint tissues
were harvested 3 days after surgery. All control
group rabbit knees were harvested. Harvested sites
included the patella, groove, femoral condyles
and tibial plateaus. Confocal laser scanning
microscopy (CLSM) with a custom-build indentation
system enabled capturing optical sections from
cartilages before and after indentation at steady
state (2 MPa for 20 minutes) using conjugated
Dextran as matrix stain. The chondrocytes were
cropped, reconstructed, and their volumes were
calculated [Han, 2009], and relative cell volume
changes due to compression were analyzed.
After CLSM, histological sections of all tissue sites
were prepared, and regions of indentation were
analyzed with digital densitometry [Kiviranta, 1985]
and polarized light microscopy [Rieppo, 2008] for
proteoglycan (PG) content and collagen fibril
orientation, respectively. Profiles were acquired
from the tissue surface to the bone. Profiles were
interpolated to 100 points and means from the first
20 points were calculated. Group comparisons
were performed with Students T-tests (p < 0.05).

Figure 1: A
 ) Relative cell volume changes due to indentation
from each site. B) Superficial PG content up to 20%
of tissue depth (from surface). A clear relationship
between PG loss and altered cell biomechanics is
observed. Black bars denote significant differences
between groups (p < 0.05)

C o n cl u s i o n
These results demonstrate that biomechanical
responses of chondrocytes are highly site-specific
and are affected as early as 3 days following a
PM. The results further suggest that the changes in
cell biomechanics reflect alterations occurring in
the PG content, whereas the collagen orientation
remains unaltered due to the surgery. The lateral
plateau was the only site where no changes were
observed. Without intervention, alterations in cell
biomechanics and PG loss may lead to more
severe degenerative changes in cartilage and the
development of osteoarthritis.

Results
Chondrocyte biomechanics were altered in a
highly site-dependent manner (figure 1A). Only in
the lateral plateau, cell volume change was not
affected by the surgery. The collagen orientation
remained unchanged at all sites (p > 0.05),
whereas the superficial PG content (up to 20 % of
tissue depth) was decreased in all but one location
of the knee joint, the lateral plateau (figure 1B).

References
Colombo et al, Arthritis Rheum, 26(7):87586, 1983.
Han et al, J R Soc Inter, 7(47):895903, 2009.
Kiviranta et al, Histochem, 82(3):24955, 1985.
Rieppo et al, Microsc Res Tech, 71(4):27987, 2008.

223

O 18 8

EFFECT OF DECELLULARISATION ON THE TENSILE


BIOMECHANICAL PROPERTIES OF PORCINE MENISCUS
A. Abdelgaied1, M. Stanley1, M. Galfe2, H. Berry2, E. Ingham1, J. Fisher1
1

University of Leeds, School of Mechanical Engineering, Leeds, United Kingdom


2

Tissue Regenix Group Plc, York, Tissue Regenix, York, United Kingdom

Introduction
Partial meniscus replacement can maintain the
functional role of the meniscus and prevent early
degenerative joint disease. A potential solution to
the current lack of meniscal replacements is the
use of an acellular biological scaffold produced
from xenogeneic meniscus. This study investigated
the effects of decellularisation on the tensile
biomechanical properties of the porcine medial
meniscus.

scaffold showed lower initial elastic modulus


(9.41 1.38MPa) (ANOVA, p<0.05, n15).
The measured elastic modulus (133 11MPa),
ultimate strength (354.5MPa), transition stress
(1.660.23MPa), and transition strain (5.32 0.58)
for the decellularised porcine meniscus were,
however, not significantly different (ANOVA,
p>0.05, n15), compared to that of native
meniscus (Figure 1).

Materials and Methods


The animals used in the current study were typically
six months old and weighed between 90 to 105
kg. Native porcine meniscus was decellularised
by Tissue Regenix Group Plc, York, UK, according
to the developed decellularisation protocol by
Stapleton et al. [1]. The dumbbell-shaped tensile
test specimens were cut from the middle portion.
Five different native meniscal specimens were
tested to represent different meniscal regions (with
different structures) [2]. However, based on the
sensitivity study on native meniscus, decellularised
meniscal tensile specimens of 3x3 [mm] crosssectional area were used. Mechanical uniaxial
tensile tests were conducted at 20 C and strain
rate of 0.00167s -1, using an Instron uniaxial testing
instrument, to determine the tensile initial elastic
modulus (the slope of the linear curve fit up to
1% strain), elastic modulus (the slope of the linear
part of the curve), transition stress, transition strain
and ultimate tensile strength of each specimen. A
pre-load of 0.5N was applied and marker points
were added at the tissue grips edges to monitor
the tissue slippage. The meniscal specimens were
kept hydrated for the duration of the tests using
phosphate buffered saline (PBS) spray.

Figure 1: T ensile mechanical properties for native and decellularised menisci (3.0x3.0x10 [mm] specimens,
mean 95% CI, n 15) at a strain rate of 0.00167s-1.

D i s c u s s i o n a n d C o n cl u s i o n :
The dependence of the tensile biomechanical
properties on cross-sectional area and position
can be explained by the nature of the collagen
fibre arrangement in the structure of the
meniscus, with different regions having different
arrangements with varied fibre densities and
orientations. A decellularised scaffold derived
from the porcine medial meniscus maintained the
tensile biomechanical properties of the native
meniscus, but had a lower initial elastic modulus.
Moreover, the predicted biomechanical properties
of decellularised medial porcine meniscus were
within the reported range for the human meniscus.
The decellularised porcine meniscus therefore has
potential as a partial meniscus replacement device.

Results
The native meniscus results showed a dependence
of the tensile biomechanical properties on the
cross-sectional area of the tensile specimen. The
measured initial elastic modulus, elastic modulus,
ultimate tensile strength, and transition stress for
the native porcine meniscus were in the ranges
14 to 26, 113 to 142, 23 to 33, and 2 to 3.2 [MPa]
respectively. The corresponding transition strain
ranged between 4.6 and 6.4% strain, depending
on the cross-sectional area of the meniscal
samples. However, this dependence was found
not to be statistically significant in the majority of
the comparisons of the groups. The decellularised

References
[1] Stapleton et al. J Tissue Engineering Part A,
14, 505518, 2008.
[2] Fox et al. J Sports Health, 4, 340351, 2012.
[3] Proctor et al. J Orthopaedic Research,
7, 771782, 1989.

224

O 189

AN IN VITRO MODEL TO ASSESS THE BIOMECHANICAL


FUNCTION OF MENISCUS REPAIR METHODS
M. Stanley1, J. Fisher1, E. Ingham1, L. Jennings1
1

Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom

Introduction
The menisci are integral parts of the knee joint,
distributing loads, providing shock absorbance and
providing stability. Due to their avascular nature,
damage to the meniscus often requires surgical
intervention, although the effectiveness of many
current methods is debatable [1]. As such there is much
interest in developing new devices and techniques
to assist in the repair. However, new devices are not
often assessed for their restorative biomechanical
function prior to animal or clinical trials.
Methods
An in vitro model using porcine knee joints is
proposed in order to allow new devices and/or
repair techniques to be functionally assessed to
establish their likely performance in vivo. Initial
investigations focussed on the porcine knee due
to its anatomical and geometrical similarity to that
of human knee. Specimens were mounted in a
custom rig and loaded with a uniaxial compression
tester (Instron 3365) (Fig. 1a) Pressure sensors
(Tekscan I-scan) were placed between the tibia
plateau and the inferior surfaces of the menisci.
The knee was loaded with 500N for 1000s and the
pressures transmitted to the tibal plateau were
recorded. The contact area was also recorded.

Figure 1: Images of the experimental setup (a) and typical


pressure (MPa) distribution maps (b).

Discussion
We have demonstrated that the in vitro porcine
model can distinguish between the three meniscus
conditions and while similar results have been
reported in human cadaveric knees [2], it has not
previously been shown that porcine knees produce
results comparable to human. We therefore
propose that this model can be useful in pre-clinically assessing the restorative biomechanical
function of meniscal repair devices. Additionally,
using porcine tissue has several advantages
including increased availability and reduced
variability when compared to human cadaveric
tissue, thus allowing easier testing of novel and
innovative repair devices.

The aim of this study was to obtain control


data to which repair devices and techniques
could be compared to assess their restorative
biomechanical function. Two control states were
identified, a negative control consisting of an
intact knee complete with cruciate and collateral
ligaments and both menisci, and a positive control
consisting of the intact knee with a total medial
meniscectomy. A third state of a partial medial
meniscectomy was also investigated.

References
[1] Sihvonen, R., et al., Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative
Meniscal Tear. New England Journal of Medicine,
2013. 369(26): p. 25152524.
[2] Fukubayashi, T. and H. Kurosawa, The Contact
Area and Pressure Distribution Pattern of the Knee
A Study of Normal and Osteoarthrotic Knee
Joints. Acta Orthopaedica Scandinavica, 1980.
51(6): p. 871879.

Results
Results demonstrated that transmitted pressures
were lowest and contact areas highest in the
intact knee, with highest contact pressures
and lowest contact areas found in the total
medial meniscectomy condition. The partial
meniscectomy condition showed values between
the two control conditions (Fig. 1b). Time dependant
studies demonstrated the biphasic nature of
both the cartilage and menisci with decreased
contact pressures and increased contact areas
for all conditions at 1000s when compared to their
respective conditions at 0s.

225

O 19 0

A NON-INVASIVE AND PATIENT-SPECIFIC METHOD


TO ASSESS SPINAL STIFFNESS IN ADOLESCENT
IDIOPATHIC SCOLIOSIS
S. Berger1, H. Carol2, D. Studer2, P. Bchler1
1
2

University of Bern, ISTB, Bern, Switzerland

Universitts-Kinderspital beider Basel, Orthopedy, Basel, Switzerland

Introduction
Adolescent Idiopathic Scoliosis (AIS) is a three
dimensional deformation of the spine which
develops during adolescence and is associated
with difficulties in carrying out physical activities
(lifting, running, standing and carrying), with
back pain problems and an affected self-image.
Spinal fusion surgery is generally indicated when
thoracic curve is expected to reach at least 50 by
skeletal maturity. To plan the surgery and predict
its outcome, spinal flexibility has to be evaluated
pre-operatively.

segment to represent the spinal flexibility along the


main anatomical directions: flexion, axial rotation
and bending. The vertebrae were considered as
rigid bodies. The boundary conditions correspond
to the experimental test: the lower vertebra has
been fixed while a vertical force was applied to
the most cranial vertebra. The Nealder-Mead
optimization algorithm was used to find the stiffness
parameters which best match our experimental
measurements.
Results
The Spinal Suspension Test has been applied on
5 AIS patients. For all these patients, a reduction of
the curve has been observed during the traction
test. In addition, the displacement of the vertebras
induced by the loading was in average 12 times
larger than the three-dimensional reconstruction
precision. The parameter identification showed
a prediction error on the vertebral position less
than 5[mm]. In addition, important variations of
the stiffness parameters were observed between
patients, while being comparable with previous
intra-operative measurements [Reutlinger, 2012]

Several techniques are used clinically to evaluate


spinal flexibility such as side bending or fulcrum
bending. All these methods use medical imagery
to compare the shape of the spine before and
after loading, but none report the amount of forces
used to provoke the observed motion. Therefore,
only reducibility (change of spine shape) can be
determined and not the flexibility of the spine,
which could explain the large variability in surgical
planning proposed by several experts for the same
patients [Robitaille, 2007].
Method
For these reasons, an alternative pre-operative
test has been developed, which combines an
axial suspension of the patient with inverse finite
element calculations [Bchler, 2014]. The Spinal
Suspension Test is based on the application of an
axial traction force on the patients spines using
a commercial head halter. The three-dimensional
displacement of the vertebras is assessed with
calibrated orthogonal radiographic images.
The spinal shape is measured before and after
application of a load corresponding to 30% of the
patients body weight. A numerical model of the
spine is proposed to quantify the patient-specific
mechanical properties. The model consists of
rotational springs to model the flexible components
of the spine. Three linear spring were used for each

Discussion
Since the spinal shape and mechanical properties
showed important variation across patients, this
quantitative information provided by the proposed
pre-operative test is critical for the development
of planning solutions that consider patient-specific
biomechanics. Such tools will become increasingly
important in the future due to the ever-increasing
complexity of the surgical instrumentation and
procedures and to provide a better understanding of
the complex biomechanical properties of the spine.
References
Bchler et al, Eur Spine J, 2014
Reutlinger et al, Eur Spine J, 21:8607, 2012
Robitaille et al, Eur Spine J, 16:160414, 2007

226

O 19 1

ANTERIOR OFFSET OF COMPRESSIVE LOAD


SIGNIFICANTLY AFFECTS INTERVERTEBRAL DISC
AND IMPLANT LOADS IN THE LUMBAR SPINE:
A FINITE ELEMENT ANALYSIS
L. Venancio P C Lima1, P. Rouch1, W. Skalli1
1

Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak,


Paris, France

Introduction
Although posterior pedicle screw implant systems are
widely used in the lumbar spine in order to achieve
fusion, clinical outcomes are variable, with possible
related drawbacks such as implant failures including
screw breakage, screw loosening or Adjacent
Segment Degeneration (ASD). Clinical studies often
report a relationship between postural disorders and
clinical outcomes, which may be due to an alteration
in the applied loads (Kumar et al., 2001).

different ligaments from the spine. Non linearities


related to large displacements, contacts and
material properties were taken into account.
Posterior implants consisted of 3 pairs of pedicle
screws inserted in L4, L5 and S1, linked by two
longitudinal rods. These were modeled by
beam elements. S1 was rigidly fixed and a 400N
compression load was applied to L1 with three
different anterior offsets values relative to the
center of the superior endplate\string: 0 mm
(no offset Case I), 57 mm (moderate offset Case II),
and 114 mm (large offset Case III). Screw and
intervertebral disc loadings were computed.

Erect posture represents a complex mechanical


structure: the lever arm of weight forces in relation
to the articular center of rotation creates a bending
moment at each vertebral segment. To keep both
static and dynamic balance, muscles apply passive
and active forces. Moreover, subject specific spinal
alignment as different upper spinal kyphosis may
influence spinal loads. Because of the large number
of related parameters, muscular modeling can be
complex however modeling the effect of a deviated
compression load can bring better understanding
between spinal loads and alignment. The aim of this
study is to investigate the effect of deviated loads
using a finite element model.

Results
The highest screw loads were found in S1. The magnitudes of these loads were correlated to the level
arm effect.
Table 1 presents screws bending moment and
maximum shear forces. Disc annular fiber forces
increased 4 times from Case I to Case II. For those forces,
further increases in loads from the Case II (57 mm)
to the Case III (114 mm) were between 2036%.
Max Moment de Flexion (Nm)
Offset

Case I (0 mm)

Case II (57 mm)

Case III (114


mm)

L4

1.2

3.2

3.9

L5

0.5

2.0

2.7

S1

0.6

7.0

8.7

Max Shear Force (N)


Offset

Case I (0 mm)

Case II (57 mm)

Case III (114


mm)

L4

88

255

294

L5

40

166

228

S1

90

701

876

Discussion
Sagittal load offset appears to be an important
factor affecting loads on screws and adjacent discs.
This could explain why restoring spinal alignment
seems important for good clinical outcome. Further
exploration using muscular models should yield
progress in understanding the relationship between
postural troubles and clinical outcome.

Methods
A FE model of a L1-S1 lumbar spine was used. This
model was validated against in-vitro data from L1 to
S1 levels. Hexahedral elements modeled vertebrae
and intervertebral discs. Two node tension-only link
elements were used to model annulus fibers and

References
Kumar et al., Eur Spine J, 2001

227

O 19 2

VERTEBRAL STRENGTH PREDICTION UNDER ANTERIOR


COMPRESSIVE FORCE USING A FINITE ELEMENT MODEL
J. Choisne1, J.M. Valiadis1, C. Travert1, P. Rouch1, W. Skalli1
1

Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak,


Paris, France

Results
Experimental strength was 3145 N 1573 and
models strength was 3074 N 1423. Vertebral
strength determined by the FE model was strongly
correlated to the experimental vertebral strength
(R=0.95, p < 0.0001, Figure 1). Mean difference
in vertebral strength was 71 N 346 [min = 423;
max = 758] with a RMSE of 11% (347 N) and a SEE of
11.9% (374N). Experimental and models stiffness
were highly correlated (R=0.85, p<0.0001) as well
as experimental strength and stiffness (R=0.85,
p<0.0001). The FE models strength and stiffness
were strongly correlated (R=0.94, p<0.0001).

Introduction
Patient-specific finite element (FE) models derived
from quantitative computed tomography (QCT)
scans are used to predict failure strength of
vertebral bodies [Crawford, 2003; Buckley, 2007;
Imai, 2006]. Most of these models were validated
under axial compressive forces to the vertebral
body while vertebral fractures are more associated
with eccentric compression [Granhed, 1989]. The
purpose of this study is to validate a FE model
for vertebral strength prediction under anterior
compressive force with experimental data.
Methods
11 lumbar spines (5M and 6F aged: 82 yo 7) were
scanned on a QCT machine (Scanner ICT 256, Philips
Healthcare, Cleveland, OH, 120 Kv, 1489mA/s and
a slice thickness of 0.33 mm) along with the ESP
calibration phantom. The 28 vertebrae (L1L3)
were then cleaned from all soft tissue and the
posterior elements were transected. The vertebral
bodies were potted in PMMA for parallelism before
anterior compressive tests were conducted using a
spherical seating loading platen (Instron Ltd., High
Wycombe, UK) with the centre of rotation aligned
with the anterior third of the vertebral body.
Specimens were destructively tested in compression
at 1 mm/min. Vertebral strength was defined as
the ultimate load achieved and axial stiffness was
calculated as the slope of the force-displacement
curve. A FE model was built based on the QCT
images using a hexahedral mesh generated with
a custom-built algorithm (190306 nodes). Material
properties for each element were assigned using
density-modulus relationship [Kopperdahl, 2002].
PMMA was modelled (E = 2.5 GPa, ? = 0.3) with
the lower layer constrained and the upper layer
used to apply an anterior compressive force at the
anterior third of the vertebra. Vertebral strength
was defined when 1 mm 3 of elements reached
1.5% deformation [Sapin, 2012].

Discussion
With a strong correlation of 0.98, the FE model can
predict vertebral strength in anterior compressive
force. The next step would be to validate this
model in vivo.
References
Crawford et al, Bone, 33:744750, 2003.
Buckley et al, Bone, 40:767774, 2007.
Granhed et al, Acta Ortho., 60:10509, 1989
Imai et al, Spine, 31: 17891794, 2006
Kopperdahl et al., J. of Ortho. Res.,
20:801805, 2002
Sapin et al, Spine, 37:E156E162, 2012
Ack n o wl e d g e m e n t :
The authors are greatful to the Banque Public
dInvestissement for financial support through the
dexEOS project part of the FUI14 program

Figure 1: F E and experimental vertebral strength are strongly


correlated

228

O 19 3

STRAIN UNCERTAINTIES IN DIGITAL VOLUME


CORRELATION OF NATURAL
AND AUGMENTED VERTEBRAE
G. Tozzi1, V. Danesi2, M. Palanca2, R. Soffiatti3 , E. DallAra4 ,
M. Viceconti4 , L. Cristofolini2
1

University of Portsmouth, School of Engineering, Portsmouth, United Kingdom


2

University of Bologna, Industrial Engineering, Bologna, Italy


3

Tecres Spa, R&D, Verona, Italy

University of Sheffield, Mechanical Engineering, Sheffield, United Kingdom

Introduction
Digital
volume
correlation
(DVC)
recently
emerged as a powerful tool to investigate the
internal strain distribution in biological structures,
including vertebral bodies [Hussein et al., 2012].
However, the reliability of DVC strongly depends
on many factors such as computation strategy,
image quality, tissue microstructure (i.e. cortical vs
trabecular) and imaging settings [Palanca et al.,
submitted]. Furthermore, injectable biomaterials,
used in vertebral augmentation, could introduce
an additional source of strain uncertainties in the
DVC computation. The main aim of this study was to
evaluate the accuracy and precision errors when
computing strains in the trabecular/cortical bone
and in the injected cement for the augmented
vertebra.

Results
The preliminary accuracy and precision errors
calculated for the selected volumes of interest are
reported in Fig. 1.
Discussion
Preliminary results seem to indicate how in
absence of rigid registration and background
masking, the overall strain error produced is high
and unacceptable for many biomechanical
applications. In addition, most of the uncertainty
is localised in the trabecular-cortical transition.
Conversely, the fully augmented region had the
best accuracy and precision. Future work includes:
Optimization of the registration procedure by
including pre-elastic registration and masking of
the images between repeated scans.
Implementation of a different global DVC
approach (ShIRT) on the same images.
Evaluation of possible preferential direction in
the strain components.

Methods
Six single thoracic porcine vertebrae (T1, T2, T3 and T4)
were divided in two groups:
Prophylactic augmentation with Mendec (Tecres, IT)
was performed on 3 vertebrae.
T he remaining 3 specimens acted as untreated
control.

Ack n o wl e d g e m e n t s
The authors would like to thank the European Society
of Biomechanics (ESB mobility award 2014) and the
Royal Society (RG130831).

For each specimen, repeated microCT imaging


was carried out (voxel size: 3339 micrometers)
in the unloaded state. Preliminary DVC analysis
(LaVision, UK) of one augmented vertebra was
performed on the two reconstructed volumes
obtained from the repeated scans, without
any rigid registration or masking of the images.
A central slice (887639481 voxels) was cropped
from the two scans. Moreover, to evaluate
the specific effect of materials and structures
on the strain uncertainty, four parallelepipeds
(150150310 voxels) containing regions with
only augmentation material (Cem), cement-bone
interface (Cem-Trab), only trabecular bone (Trab)
and trabecular-cortical combination (Trab-Cort),
were isolated from the slices. DVC computation
relied on iterative adjustment of the sub-volume
size: the final sub-volume size of 323232 voxels
overlapped by 75% was reached after successive
(predictor) passes using sub-volumes of 888888
voxels, 767676 voxels and 404040 voxels.
Strain accuracy and precision were evaluated
following [Liu & Morgan, 2007].

References
Hussein et al, Proc IUTAM 4: 11625.
Liu & Morgan, J Biomech 40: 351620.
Palanca et al, J Biomech Eng, submitted.

Figure 1: A
 ccuracy and precision errors in the different
zones of the central slice isolated from
the augmented specimen.

229

O 19 4

COMPARISON OF THREE DIFFERENT DIGITAL VOLUME


CORRELATION APPROACHES ON BONE
M. Palanca1, G. Tozzi2, L. Cristofolini1, M. Viceconti3 , E. DallAra3

University of Bologna, School of Engineering and Architecture, Bologna, Italy

University of Portsmouth, School of Engineering, Portsmouth, United Kingdom

University of Sheffield, INSIGNEO institute for in silico medicine, Sheffield, United Kingdom

Introduction
An intrinsic difficulty in validating digital volume
correlation (DVC) is that no other experimental
technique allows measuring the internal strain
distribution. The aim of this study was to compare the
accuracy and precision of three DVC approaches.
Two local and one global algorithms were tested,
using trabecular and cortical specimens in a 3D
zero-strain condition.

C o n cl u s i o n
This work highlighted the importance of a quantitative and qualitative analysis of different DVC
approaches by using the same set of images.
The outputs demonstrated than the integration
between the DVC and a FE code provides the
lowest accurate and precise errors. However,
the local approaches, as a single software package, show reasonable results for large sub-volumes.

Materials and methods


Two specimens (trabecular and cortical) were
extracted from a bovine femur. They were scanned
twice with a micro-CT (voxel size 9.96 micrometers)
[DallAra, 2014] in a zero-strain-condition, in which
small unknown displacement are present.

References
B
 arber et al, Med Image Anal 11(6): 648662
D
 allAra et al, J Biomech 47(12): 29562963
L iu et al, J Biomech 40(15): 35163520
P
 alanca et al, J Biomech Eng In press
R
 oberts et al, J Biomech 47(5): 923934.

Three DVC strategies were tested:


L ocal approach, based on Fast-Fourier-Transform
(DaVis-FFT, LaVision, Goettingen, Germany)
L ocal approach, based on Direct-Correlation
(DaVis-DC),
Global approach based on elastic registration
and
a
finite
element
solver
(ShIRT-FE,
home-written [Barber, 2007])
A range of different computation sub-volumes (or
element sizes), from 5 to 50 voxels, was tested. The
accuracy and precision errors for the strains were
computed as scalars [Liu, 2007], and for each
component of strain, in order to identify possible
preferential directions [Palanca, 2015]

Figure1: Trend of the accuracy of the DVC-computed


strain (expressed as a scalar average of the components)
for trabecular bone, as a function of the sub-volume size

Results
The accuracy and precision in computing strain was
consistently better for trabecular bone. For each
algorithm, the errors decreased asymptotically
for larger sub-volumes (Fig. 1). The accuracy error
obtained with ShIRT-FE was approximately half of
the DaVis-DC. In terms of precision, the errors shown
by DaVis-DC were closer to the ones computed by
ShIRT-FE. DaVis-FFT had the worst accuracy and
precision.
No systematic difference was observed between the
errors for the different strain components (Fig. 2).
Figure2: Accuracy of the six components of strain in the
cortical and trabecular bone, for the largest sub-volume
size considered.

230

O 19 5

NOVEL INSIGHTS INTO POROSITY BONE SPECIFIC


SURFACE RELATION IN HUMAN CORTICAL BONE
C. Lerebours1, D. Thomas2, J. Clement2, P. Buenzli1, P. Pivonka3
1

Monash University, School of Mathematical Sciences, Melbourne, Australia


2

University of Melbourne, Melbourne Dental School, Melbourne, Australia

University of Melbourne, Australian Institute of Musculoskeletal Science, Melbourne, Australia

Introduction
A characteristic relationship for bone between
bone volume fraction (BV/TV) and specific surface
(BS/TV) has previously been proposed based on 2D
histological measurements [Martin, 1984][Fyhrie et
al., 1995]. This relationship has been suggested to
be bone intrinsic, i.e., to not depend on bone type,
bone site and health state. In these studies, only
limited data comes from cortical bone. The aim
of this paper was to investigate the relationship
between BV/TV and BS/TV in human cortical bone
using high-resolution micro-CT imaging and the
correlations with subject-specific biometric data
such as height, weight, age and sex. Images from
femoral cortical bone samples of the Melbourne
Femur Collection were obtained using synchrotron
radiation micro-CT (SPring8, Japan). Sixteen bone
samples from thirteen individuals were analysed in
order to find bone volume fraction values ranging
from 0.20 to 1. Finally, morphological models of
the tissue microstructure were developed to help
explain the relationship between BV/TV and BS/TV
[Lerebours et al., 2015].

measured. Based on information on pore density,


sex, age at death, body height and body weight,
we studied the patient-specificity of the maximum
of the curve and the initial slope with respect of
these factors. Body height, body weight and age
at death were not correlated (p > 0.05). But pore
density and sex seem to be correlated with the
position of the curve. The upper curves in Fig.1(b)
come from males while the lower curves are from
females. The statistical correlation of this trend is
only such as: p = 0.041. Pore density was extracted
from the microCT images and put into relation
with the computed pore density. The correlation
between these values was p = 0.038.

Methods
The study samples consisted of 16 blocks of femoral
mid-shaft specimens from the right legs of 13
individuals ranging in age from 45 to 84 years old.
Individuals were considered healthy at the time of
their death, no pathology was revealed in blood
tests. This material came from the Melbourne Femur
Collection (MFC, acquired from the Victorian
Institute of Forensic Medicine with informed
consent of the next-of-kin of the donors). Blocks of
bone approximately 16 mm long axially were cut
from the anterior and posterior quadrants of each
specimen and were imaged using synchrotron
radiation micro-CT at beamline 20B2 of the SPring8
synchrotron, Hyogo Prefecture, Japan (Fig. 1(a)).

Figure 1: ( a) SR-microCT image of cortical bone specimen


and (b) BV/TV vs BS/TV relation.

Discussion
Our experimental findings indicate that the BV/TV
vs BS/TV relationship is subject specific. Sex and
pore density were statistically correlated with
the individual curves. However, no correlation
was found with body height, weight or age.
Experimental cortical data points deviate from
interpolating curves previously proposed in the
literature. However, these curves are largely based
on data points from trabecular bone samples. This
finding challenges the universality of the curve:
highly porous cortical bone is significantly different
to trabecular bone of the same porosity. Finally,
our morphological models suggest that changes in
BV/TV within the same sample can be explained by
an increase in pore area rather than in pore density.
This is consistent with the proposed mechanisms
of age-related endocortical bone loss.

Results
In Fig. 1(b), data points of different individuals have
been interpolated separately (using the same
interpolation function). The goodness of the fit is
r2 = 0.84, when interpolating the entire data set by
this root function. When interpolating data points
from each individual high coefficients of variations
are obtained (0.87 r 0.98) (Fig. 1(b)). The shape
of the interpolation function decreases rapidly
for high bone volume fractions, BV/TV > 0.85.
For lower bone volume fractions the bone
specific surface gradually increases while BV/TV
decreases. Only few experimental data points
below bone volume factions of 0.40 could be

References
Martin, Crit Rev Biomed Eng, 10:179222, 1984.
Fyhrie et al., Bone, 17:287291, 1995.
Lerebours et al., Bone, 72:109117, 2015.

231

O 19 6

FIRST 3D IMAGING OF OSTEOCYTES USING SERIAL


BLOCK-FACE SCANNING ELECTRON MICROSCOPY
P. Goggin1, K. Zygalakis2, R.O.C. Oreffo3 , P. Schneider1
1

University of Southampton, Bioengineering Science Research Group / Faculty of Engineering


and the Environment, Southampton, United Kingdom

University of Southampton, Mathematical Sciences / Faculty of Social and Human Sciences,


Southampton, United Kingdom
3

University of Southampton, Institute for Developmental Sciences / Faculty of Medicine,


Southampton, United Kingdom

Results
Figure 1 shows a single slice from an SBF SEM stack
and 3D ON&LCN reconstructions.

Introduction
Osteocytes, the most abundant bone cells, are embedded within hard bone matrix. By sensing and integrating local mechanical and chemical signals, they
play a key role for bone homeostasis by regulating
bone modeling and remodeling1. Abnormalities of the
osteocyte network and the encasing lacuno-canalicular network (ON&LCN) have been associated with
metabolic bone diseases such as osteoporosis2,3. However, there remains significant controversy as to how
mechanical loading is actually transferred to osteocytes. Thus, to characterise the ON&LCN in health and
disease and to better understand osteocyte function
through in silico modelling of bone mechanotransduction, high-resolution 3D imaging techniques for bone
at a cellular level and below are urgently needed.
However, high-resolution 3D examination of the
ON&LCN is still in its infancy4. Serial block-face scanning electron microscopy (SBF SEM) offers a promising 3D imaging approach on a sub-cellular level
since initial work in the neuroscience field a decade
ago 5. Using a remotely controlled ultramicrotome
within an SEM, nanoscopic layers are removed from
the tissue block, which is consecutively assessed by
a back-scattered electron detector to extract neuron morphologies from 3D SBF SEM stacks with resolutions comparable to transmission EM 6. SBFSEM can
cover large fields of view (~1 mm2) and in principle,
provides imaging contrast for soft and hard tissues at
the same time, such as the ON and the LCN, respectively. Therefore, this study was to adapt and extend
SBF SEM to assess the ON&LCN.

Figure 1: ( Left) A slice from a SBF SEM stack showing an osteocyte including nucleus, mitochondria and cell
processes, surrounded by pericellular space and
decalcified bone matrix (scale bar = 2m). The
Inset shows a cell process (yellow) and the pericellular space (green). (Right) Osteocyte derived
from 250 SBF SEM sections.

Discussion
We have demonstrated for the first time that SBF
SEM can produce high-resolution 3D images of the
osteocyte and the lacuno-canalicular network.
SBF SEM offers automation of sectioning and image
collection, while complex sample preparation
has to be noted, along with the destructive
nature of this emerging imaging method.
Importantly, SBF SEM allows for simultaneous
3D assessment of the ON (soft tissue) and the
LCN (hard tissue), not achieved with other
microscopy techniques to date. SBF SEM will
enable the assessment of hallmarks of healthy
and diseased bone in a quantitative fashion on
a cellular and sub-cellular level. ON&LCN models
based on experimental 3D data will allow more
realistic computational models in the field of
mechanobiology. These data will enhance the
knowledge of osteocyte involvement in bone
health, development and pathology, leading to
the identification of new targets for the diagnosis
and treatment of bone diseases.

Methods
A 2mm3 block from a tibia of a 10-week-old C57BL/6
mouse tibia was fixed, decalcified and prepared for
SBF SEM using a modified Ellisman protocol 7 which
permeates the tissue with heavy metals, providing
electrical conductivity and image contrast. The
tissue block was mounted on an aluminium pin
and a 500 m-thick section was cut and stained
with toluidine blue. An approximate area of
interest of 100 m 2 was chosen, which contained
several osteocytes. The block was retrimmed to
remove excess tissue and the surface sputtercoated with a layer of Au/Pd to further enhance
conductivity. The 3View system of Gatan Inc.
(Pleasanton, USA) within an FEI Quanta 250 FEG-SEM
was used to produce a stack of 600 images
at 2.5 kV, spot size 3, slice thickness 50nm and
vacuum 40Pa. A median filter was applied to
reduce noise and Reconstruct 8 was employed to
trace the surfaces of the ON&LCN by hand.

References
1 Schaffler et al., Calc Tiss Int 94(1):524,2014
2 Tatsumi et al, Cell Metab 5(6):46475,2007
3 Neve et al, Acta Physiologica 204(3):31730,2012
4 Webster et al, Bone 54(2):28595,2013
5 Denk et al, Nat Rev Neurosci13(5):3518,2012
6 Denk et al, PLoS Biol 2(11):e329,2004.
7 Deerinck et al., Microsc Microanal 16(S2):
11389,2010
8 Fiala JC, J Microsc 218(1):5261,2005
232

O 19 7

INCLUDING ANISOTROPIC INFORMATION OF


TRABECULAR BONE USING IMAGE REGISTRATION
E. Taghizadeh1, A. Latypova2, G. Maquer1, M. Reyes1, P. Bchler1
1

Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
2

Biomechanical Orthopedics Laboratory, cole polytechnique fdrale de Lausanne,


Lausanne, Switzerland

Introduction
Image-based modelling is a popular approach to
perform patient-specific biomechanical simulations.
Accurate modelling is critical for orthopaedic
application to evaluate implant design and
surgical planning. It has been shown that the bone
strength can be estimated from the Bone Mineral
Density (BMD) and the structure of the trabecular
bone. However, these findings cannot directly be
transferred to patient-specific modelling since only
BMD values can be derived from calibrated clinical
CT, but no information about the trabecular bone
structure is accessible by the clinician.

Results
We propose to test the method on two different
bone anatomies, patella and femur. CT and CT
of 10 patellae and 10 femurs from different donors
were acquired. From each database one bone
was chosen as a reference and the other bones
were defined as test samples.
The registration accuracy was high and the
morphed image provided a good approximation of
the trabecular bone structure in the patients bone
(Fig. 1). Our method predicted the displacement
and force values at failure with 2.7% and 3.8% error
respectively, while predictions obtained with an
isotropic material results in error of 7.4% and 6.5%.

The objective of this study is to propose a method


that predicts the structure of the patients
trabecular bone using a template CT image and
image registration.
Method
Our proposed approach consists of morphing the
bone architecture extracted from the CT of a
cadaveric patella to the patients clinical CT. As
CT scans can be very large, applying the nonrigid image registration is extremely demanding in
terms of computational resources and is practically
intractable. Instead of using the original CT images,
we down-sampled the CT of the template patella
and then registered the new image to the clinical
image. The registration was performed in three steps.
First, a coarse rigid registration was applied, then an
iterative affine registration with Normalized Mutual
Information metric, was performed and finally a
non-rigid registration using a Bspline registration
(elastix; Klein, 2010) was applied to the images. In
the next step, the resulting deformation fields were
applied to the original high-resolution CT image.
The anisotropic information was then extracted
from this high-resolution registered image.

Figure 1: T ypical result of the image registration. The ground


truth CT scan and the registered image are
overlapped.

Discussion
The results showed that our method improves the
bone strength calculated with FE compared to
an isotropic material model. It is possible to adapt
this method to use several bones as reference, for
instance using one reference for male and one for
female bone, which can improve the prediction
results. Exploring the impact of the selection of the
reference bone is part of our future research.

We evaluated the mechanical outcome of the


proposed method by comparing the finite element
(FE) strength calculated for bones, where the
material properties were assigned to the mesh i) using
anisotropic material from the original CT (groundtruth) ii) anisotropic properties from the registered
image and iii) using an isotropic material model.
Physiological loads were applied to these models.
Bone strength as well as failure were evaluated.

References
S. Klein, M. Staring, K. Murphy, M. Viergever, and
J. P. W. Pluim, Elastix: A toolbox for intensity-based
medical image registration, Medical Imaging,
IEEE Transactions on, 29:1, 2010.

233

O 19 8

IMPROVEMENT OF BITING FORCES WITH IMPLANTSUPPORTED OVERDENTURES FOR THE LOWER JAW:
NUMERICAL AND CLINICAL STUDIES
I. Hasan1, L. Keilig1, F. Heinemann2, H. Stark3 , C. Bourauel4
1

University of Bonn, Oral Technology Department of Prosthetic Dentistry, Preclinical


Education and Materials Science, Bonn, Germany

University of Greifswald, Department of Prosthodontics, Gerodontology and Biomaterials,


Greifswald, Germany

University of Bonn, Department of Prosthetic Dentistry, Preclinical Education and Materials


Science, Bonn, Germany
4

University of Bonn, Oral Technology, Bonn, Germany

Introduction
Treatment of edentulous patients with implant-supported removable dentures has the advantage
of improving the stability of dentures and the
adaptation of the patient to the new conditions in
the oral cavity. The improvement of biting forces is
obvious shortly after the treatment. However, the
difference in the improvement degree between the
different kinds of supporting implants is still unclear.
Hence, it was the aim of this study to analyse the
diversity in the improvement of the biting forces
for nine patients who received lower overdentures
supported by two to four conventional dental
implants ( 3.33.7 mm) and fourteen patients who
received four to five mini-implants ( 2.12.4 mm)
in the interforaminal region.

created by means of Finite Element Method (Marc


Mentat 2010, MSC.Software, Santa Ana, CA-USA)
based on Computed Tomography data. The
magnitudes of the measured biting forces were
applied in the numerical models vertically on the
denture. Denture displacements and stresses in the
bone bed around the implants were analysed and
compared for the different models.
RESU L TS
The total forces for patients who received two or
four conventional implants increased from 233 N
and 393 N to 611 N and 565, respectively. While
for patients who received four to five mini-implants
the increase ranged from 222 N and 269 N to 316 N
and 442, respectively. For all patients, the largest
part of the force prior to insertion of implants was
concentrated at the molar region and after the
insertion of implants the concentration of forces
was at the anterior region (interforaminal region).

METHODS
Biting forces were measured for 23 patients with
the existing complete denture prior to the insertion
of implants and after receiving the final implantsupported denture using special pressure sheets
(Two-sheet Low Type Prescale Measurement
Film, Fujifilm). The measuring time was 2 min. The
measured sheets were later on analysed using
FPD-8010E Software to record the forces and
pressures at the different biting regions. Numerical
individual models of three patients (model 1: two
conventional implants, model 2: four conventional
implants, and model 3: five mini-implants) were

DIS C USSION
The use of implant-supported overdentures instead
of complete dentures improves the biting ability
of the patients and reduces the risk of progressive
resorption of the residual ridge at the posterior
region. However, the improvement of biting forces
with conventional implants remains more obvious
than with mini-implants.

234

O 19 9

DEVELOPMENT OF ORAL IMPLANT SURGERY TRAINING


SIMULATOR WITH DRILLING FORCE SENSING CAPABILITY
M.A.A. bin Kamisan1, N. Takano2, Y. Yajima3 , A. Shinichi4
1

Keio University, Graduate School of Science and Technology, Yokohama, Japan


2

Keio University, Department of Mechanical Engineering, Yokohama, Japan


3

Tokyo Dental College, Department of Oral Implantology, Tokyo, Japan


4

Tokyo Dental College, Department of Anatomy, Tokyo, Japan

Introduction
To decrease the medical accidental cases in oral
implant surgery, which are increasing recently in
Japan, a new educational system focusing on
drilling mandibular trabecular bone has been
developed mainly for dental college students. It
consists of force sensing device and drilling force
database that is calculated by finite element
analysis. This paper presents the developed oral
implant surgery training simulator, numerical
method and the results of evaluation by clinicians
with comparison with the results of drilling polymeric
models.
Methods
The main feature of the developed system is that
the users can experience the force sense during
drilling jawbone using real handpiece as shown
in Fig. 1. The force sensing device consists of an
actuator and load cell, and the drilling speed
is controlled by the drilling force database
[N. Takano, 2014]. The drilling force was calculated
by micro-CT image-based 3D finite element
method using cadaver in order to consider
the bone quality of trabecular bone, and was
calibrated by measurement using fresh cadaver
[M. Nagahata et al, 2013].

Figure 1: O
 verview of the developed oral implant surgery
training simulator.

Results and discussion


8 clinicians at Tokyo Dental College tested the
developed system for 3 samples. All clinicians
could identify the differences among 3 samples,
and gave positive evaluation telling that the
system was realistic and close to real surgery. An
expert clinician could recognize the slight change
of required force clearly by 1N. By comparing
the impressions between young clinician and
expert one after testing the same sample, clear
difference was found. More quantitatively, the
relation between the drilling speed and input force
was obtained as shown in Fig. 2. The required force
shown is the force calculated and implemented
as the drilling force database. The input force of
8 clinicians ranged from 3N to 9N in the trabecular
bone region and the drilling speed ranged from 0.3
mm/s to 0.9 mm/s. By comparing this speed with
that measured for polymeric jawbone models, it
was found that the polymeric models were much
softer than real jawbone in the trabecular bone
region especially near the mandibular canal.

Figure 2: E
 xample of measured input force and drilling
speed by an expert clinician for sample 1

References
M. Nagahata et al, Asia Pacific Cong on Comp
Mechanics (APCOM), 2013.
N. Takano, J Jpn Soc of Oral Implantology,
27:104, 2014.

235

O 200

NUMERICAL ANALYSIS OF THE BIOMECHANICAL


PROPERTIES OF DIFFERENT PROSTHODONTIC
RESTORATIONS
L. Keilig1, S.M. Schneider1, I. Hasan1, C. Bourauel1
1

University of Bonn, Oral Technology, Bonn, Germany

Introduction
There is a large number of different anchorage
concepts available to connect a removable
partial dental denture to the remaining teeth. These
concepts differ in the required preparation of the
anchorage tooth as well as in the biomechanical
load transfer between the prosthesis and the
remaining teeth under functional load. It was the
aim of this study to characterise the biomechanical
characteristics of three different anchorage
concepts for removable partial dentures in the
lower jaw using the finite elements method (FEM).

stresses and strains were compared between the


different attachment systems. The simulations
were performed using the FE package MSC.Marc/
Mentat 2010.
RESU L TS
Depending on the simulated attachment concept,
the dentures showed clearly different loading
behaviour. Upon loading the denture near teh
anchoring canine, the movability of the denture
were clearly reduced for the extra-coronal
attachment (attachment: 0.31 mm, telescopic
crown; 0.39 mm, clasp: 0.4 mm), however this also
resulted in increased strains in the periodontal
ligament of the anchorage teeth as well as stresses
in the alveolar bone around the anchorage
teeth. Highest denture movements of 0.7 mm
were determined for the clasp-anchored denture.
This resulted in strains of up to 60% in the mucosa
underneath the prosthesis. In some simulations,
loading the posterior part of the prosthesis only on
one side resulted in a dislocation of the prosthesis
base on the contra-lateral side.

MATERIA L S AND METHODS


Based on a commercially available dataset of
an idealised dental arch in the lower jaw (teeth
with roots and gum, Viewpoint Data Labs [now
Digimation]), a three-dimensional model of the
following clinical situation was created: only the
anterior teeth from the left canine to the right first
premolar remained, and a marginal bone atrophy
was modelled in the posterior, now tooth-less
regions left and right. Periodontal ligament with
an assumed constant thickness of 0.2 mm was
modelled around the remaining teeth, and the
bone was covered with mucosa with a thickness of
1.0 to 2.4 mm [Schrder, 1992]. In the molar region
of this model, a denture with a sublingual arch was
modelled to replace the missing teeth. A perfect fit
between the base of the dentures and the mucosa
was assumed.

DIS C USSION
A distinct mechanical behaviour for each of the
investigated anchorage concepts was determined.
Generally, the movability of the dentures increased
from the attachment to the telescopic crown
and to the clasp. With this increased movability,
loading of the periodontal ligament and the bone
surrounding anchorage teeth decreased. This
might be of importance if the anchorage teeth
suffer from periodontal diseases or in case of a
misfit of the denture due to ongoing bone atrophy
in the mandibular bone below the prosthesis.

For each of the following anchorage systems


a separate FE model was generated: clasp,
telescopic crown, extra-coronal attachment
system. All anchorage systems were connected to
the canine on the left side and the first premolar
on the right side. Forces of up to 500 N were
applied on different parts of the dentures and on
the anchorage teeth. The resulting movements,

RE F EREN C ES
Schrder, Orale Strukturbiologie [in German]. 4th
revised edition. Thime Verlag Stuttgart 1992.

236

O 2 01

NUMERICAL ANALYSIS OF DENTAL IMPLANT


FATIGUE LIFE FOR VARIOUS LOAD CASES
K. Szajek1, M. Wierszycki1
1

Poznan University of Technology, Civil and Environmental Engineering, Poznan, Poland

Introduction
Dental implant designing is complex process which
considers many limitations both nature biological
and mechanical. The complete procedure for
improvement of two-component dental implant
along with a few optimal designs for various
objectives was proposed by Szajek [Szajek, 2012].
This paper deals with design verification for fatigue
life maximization in context of representative load
case assumed in the optimization. The main goal
is to answer the question if the assumed load
scenario (solely horizontal occlusal load) leads to
the design which is also safe for oblique occlussal
loads regardless the angle from an implant axis.

5e6 cycles for 60N of solely horizontal load. The


implant failure within presented unsafe zone
is clearly the result of screw bending, yet, the
previously describe stabilization due compressive
loading make the allowed transverse load higher.
Assuming load which is less than 20 degrees off the
implant axis there is no unsafe zone within the
analyzed design space while for 30 degrees still a
high magnitude of 135,5N is allowed.
a)

Methods
Series of numerical analysis (Finite Element Method)
was used with simple design of experiment scheme
and full factorial pattern. Two parameters are
introduces, vertical and horizontal load component
magnitudes.
Fully
spatial
model
including
asymmetry geometry, elastic-plastic material and
contact condition is considered. All analysis were
carried out using Abaqus suite (v6.13). The fatigue
life estimation utilizes stress based approach with
linear Goodman theory.
Results
The maximal Mises stresses and normalized effective
stress amplitude (according to Goodman theory)
were registered for all load cases. The results were
visualized in form of contour plots presenting
cycles to fatigue failure in dependence to occlusal
load magnitude/angle (Figure 1). The limit of
5e6 cycles suggested by standard ISO 14801:2007
is indicated with thick isoline. The dashed trapeze
represents areas of physiologically justified loads
[Mericske-Stern et al., 2000, Morneburg et al., 2003].

b)

Discussion
Considering the screw in the initial design, a
safe value of transverse load can be estimated
at the level of 18N. Figure 1a presents an effect
of abutment stabilization when the vertical
load component is present. An allowed value of
transverse load exceeds 30N if it acts together with
a vertical load of 100N. The safe limit is almost
horizontal for higher value of vertical load. It is a
result of small stiffness of implant in axial direction
[Alkon et al., 2002] and, in turn, screw preload
reduction in response to compressive load. It is
important to note that the implant is entirely in
safe zone for the load which is in coincident with
an implant axis or is maximally 5 degrees off it. In
the optimal design the screw is able to withstand

Figure 1: C
 ontour plot of cycles to fatigue for an abutment
screw in dependence to load angle/magnitude
for initial (a) and optimal (b) design.

References
Szajek, Optimization of a two-component implantology system using genetic algorithm, PhD, 2012
Mericske-Stern et al, J Prosthet Dent,
84:53547, 2000.
Morneburg et al, Int J Prosthodont, 16:48186, 2003.
Alkon et al, Int J Prosthet Dent, 15:3842, 2002.

237

O 202

QUANTITATIVE ANALYSIS OF TOOTH MOBILITY FOR


ASSESSMENT OF ORTHODONTIC TREATMENTS
V. Colombo1, F. Chakroun1, M. zcan1, L.M. Gallo1
1

University of Zurich, Dental School, Zurich, Switzerland

Introduction
Fixed lingual retainers are appliances extensively
used in orthodontic treatment for the prevention
of relapses when the inter-canine width has to be
maintained for long time. These appliances can be
fabricated from multi-stranded stainless steel (SS) wires
or fibre-reinforced composites (FRC) and commonly
bonded to all the six teeth forming the lower anterior
arch. The multi-stranded wires provide the advantage
of mechanical retention of the luting composite
material onto the wire and they are claimed to
allow physiological tooth movement. The fibrereinforced composite (FRC) retainers are bonded to
all the teeth in the bonding range providing a more
rigid support compared to stainless steel wires. Their
advantage is their relative thinner profile. The limits of
the biomechanical performances of these materials
have never been examined [Sam Foek, 2013].

Figure 1: S chematic of the modelled teeth arch positioned


in the loading device for testing.

Results
Measured teeth movement was