Bone Surrogate Research Articles

Investigating mechanical properties for developing a human infant cranial bone surrogate in pediatric craniofacial surgery

Investigating mechanical properties for developing a human infant cranial bone surrogate in pediatric craniofacial surgery

Elastic properties of 3D printed clavicles are closer to cadaveric bones of elderly donors than commercial synthetic bones

Synthetic bone models have increasing utility in orthopaedic research due to their low cost and low variability and have been shown to be biomechanically equivalent to human bones in a variety of ways. The rise in additive manufacturing (AM) for orthopaedic applications presents an opportunity to construct synthetic whole-bone models for biomechanical testing applications, but there is a lack of research comparing these AM models to cadaveric or commercially available bone surrogates. This study compares the mechanical properties of 3D printed clavicle models to commercially available (4th generation Sawbones) and human cadaveric clavicles via nondestructive cyclic 4-point bending, axial compression, and torsion, and a final axial compression test to failure. Commercially available synthetic clavicles had 57.8–203% higher superior-inferior bending rigidity (p < 0.0001), 80.9–198% higher axial stiffness (p < 0.001), and 314–557% higher torsional rigidity (p < 0.05) on average than AM and cadaveric clavicles. Cadaveric and AM clavicles printed from a BoneMatrix/VeroWhite composite material had similar failure mechanisms under axial compression while AM VeroWhite clavicles experienced catastrophic failure, but these groups did not have significantly different ultimate failure loads. Together, these results demonstrate that current commercially available synthetic clavicles may be too rigid to emulate the mechanical properties of elderly cadaveric clavicles, and that AM bone models can closely mimic these cadaveric bones in a variety of biomechanical loading schemes. These results show promising applications for future work using 3D printed bone surrogates for biomechanical analysis of orthopaedic implants and other surgical repair techniques.

Anatomic variability of the human femur and its implications for the use of artificial bones in biomechanical testing.

Aside from human bones, epoxy-based synthetic bones are regarded as the gold standard for biomechanical testing os osteosyntheses. There is a significant discrepancy in biomechanical testing between the determination of fracture stability due to implant treatment in experimental methods and their ability to predict the outcome of stability and fracture healing in a patient. One possible explanation for this disparity is the absence of population-specific variables such as age, gender, and ethnicity in artificial bone, which may influence the geometry and mechanical properties of bone. The goal of this review was to determine whether commercially available artificial bones adequately represent human anatomical variability for mechanical testing of femoral osteosyntheses. To summarize, the availability of suitable bone surrogates currently limits the validity of mechanical evaluations of implant-bone constructs. The currently available synthetic bones neither accurately reflect the local mechanical properties of human bone, nor adequately represent the necessary variability between various populations, limiting their generalized clinical relevance.

Development of bone surrogates by material extrusion-based additive manufacturing to mimic flexural mechanical behaviour and fracture prediction via phase-field approach

Background and objectiveThe limited availability of human bone samples for investigation leads to the demand for alternatives. Bone surrogates are crucial in promoting research on the intricate mechanics of osseous tissue. However, solutions are restricted to commercial brands, which frequently fail to faithfully replicate the mechanical response of bone, or oversimplified customised simulants designed for a specific application. The manufacturing and assessment of reliable bone surrogates made of polylactic acid via material extrusion-based additive manufacturing are presented in this work. MethodsAn experimental and numerical study with 3D-printed dog-bone and prismatic specimens was carried out to characterise the polymeric feedstock and analyse the influence of process parameters under three-point bending and quasi-static conditions. Besides, three porcine rib samples were considered as a reference for the development of the artificial bones. Bone surrogates were manufactured from the 3D-scanned real bone geometries. In order to reproduce the trabecular and cortical bone, a lattice structure for the infill and a compact shell surrounding the core were employed. Infill density and shell thickness were evaluated through different printing configurations. Additionally, a computational analysis based on the phase-field approach was conducted to simulate the experimental tests and predict fracture. The modelling considered homogenisation of the infill material. ResultsOutcomes demonstrated the potential of the presented methodology. Maximum force and flexural stiffness were compared to real bone properties to find the optimal printing configuration, replicating the flexural mechanical behaviour of bone tissue. Certain configurations accurately reproduce the studied properties. Regarding the numerical model, strength and stiffness prediction was validated with experimental results. ConclusionsThe presented methodology enables the manufacturing of artificial bones with accurate geometries and tailored mechanical properties. Furthermore, the described modelling strategy offers a powerful tool for designing bone surrogates.

Impact of bone density and integrated screw configuration on standalone anterior lumbar interbody construct strength

BackgroundIn anterior lumbar interbody fusion (ALIF), the use of integrated screws is attractive to surgeons because of the ease of implantation and no additional profile. However, the number and length of screws necessary for safe and stable implantation in various bone densities is not yet fully understood. The current study aims to determine how important both length and number of screws are for stability of ALIFs. MethodsThree bone models with densities of 10, 15, and 20 pounds per cubic foot (PCF) were chosen as surrogates. These were instrumented using the Z-Link lumbar interbody system with either 2, 3, or 4 integrated 4.5 × 20 mm screws or 4.5 × 25 mm screws (Zavation, LLC, Flowood, MS). The bone surrogates were tested with loading conditions resulting in spine extension to measure construct stiffness and peak force. ResultsThe failure load of the construct was influenced by the length of screws (p=.01) and density of the bone surrogate (p<.01). There was no difference in failure load between using 2 screws and 3 screws (p=.32) or when using four 20 mm screws versus three 25 mm screws (p=.295). ConclusionIn our study, both bone density and length of screws significantly affected the construct's load to failure. In certain cases where a greater number of screws are unable to be implanted, the same stability can potentially be conferred with use of longer screws. Future clinical studies should be performed to test these biomechanical results.

Developing Rib Bone Surrogates for High Dynamic Impact Assessment with Additive Manufacturing and Post-mortem Human Subjects (PMHS)-Based Evaluation

The conception of ballistic personal protective equipment requires a comprehensive understanding of the human body’s response to dynamic loads. The objective of this study is to develop rib bone surrogates enhancing new anthropomorphic test devices for personal protective equipment evaluation at high dynamic impacts. These are fabricated with additive manufacturing and compared to post-mortem human subjects (PMHS) data from literature. The 5th rib of the finite element Global Human Body Model Consortium (GHBMC) male 50th percentile (M50) model was extracted and transferred to a CAD model. This CAD model was divided into 30 sections with specific cortical bone thicknesses in all directions (caudal, cranial, cutaneous and pleural) from an equivalent rib of an M50 PMHS. Three different additive manufacturing technologies (direct metal laser melting, fused filament fabrication and multi jet modeling) were used to reproduce the M50 PMHS 5th rib surrogate. A total of 57 specimens were dynamically (500 mm/s) loaded to failure in a bending scenario imitating a frontal thoracic impact. Force, displacement, stiffness, and energy at failure were determined. Also, the strain distribution using 3D digital image correlation was recorded and compared to PMHS data from literature. The rib surrogates show deviations from the PMHS characteristic values. Nevertheless, there are also common characteristics in key variables to certain age groups of the PMHS data, which will facilitate the further development and improvement of adequate surrogates for a more realistic representation of the human body’s response to high dynamic loads.

Open the pores – Polydimethylsiloxane influences the porous structure of cancellous bone surrogates for biomechanical testing of osteosyntheses

Synthetic materials used for valid and reliable implant testing and design should reflect the mechanical and morphometric properties of human bone. Such bone models are already available on the market, but they do not reflect the population variability of human bone, nor are they open-celled porous as human bone is. Biomechanical studies aimed at cementing the fracture or an implant cannot be conducted with them.The aim of this study was to investigate the influence of a cell stabilizer on polyurethane-based cancellous synthetic bone in terms of morphology, compressive mechanics, and opening of the cancellous bone structure for bone cement application.Mechanical properties of cylindrical specimens of the bone surrogates were determined by static compression tests to failure. Furthermore, a morphometric analysis was performed using microcomputed tomography. To prove the open-cell nature of the bone surrogates, an attempt was made to apply bone cement.Effects on the mechanical properties of the polyurethane-based bone surrogates were observed by the addition of polydimethylsiloxane. All mechanical parameters like Young's modulus, ultimate stress and yield stress increased statistically significantly with increasing amounts of cell stabilizer (all p > 0.001), except for yield stress. The analysis of morphometric parameters showed a decrease in trabecular thickness, spacing and connectivity density, which was accompanied by an increase in trabecular number and an increase in pore size. The open-cell nature was proven by the application and distribution of bone cement in specimens with stabilizer, which was visualized by X-ray.In conclusion, the results show that by adding a cell stabilizer, polyurethane-based cancellous bone substrates can be produced that have an open-cell structure similar to human bone. This makes these bone surrogates suitable for biomechanical testing of osteosyntheses and for osteosynthesis cementation issues.

Method for CAD/CAM-based production of patient-specific anatomical bone surrogates from polyurethane rigid foams of different densities for various clinical applications

Abstract Physical models of bony areas are used in the medical environment for training, patient information or for various examinations. These are idealized average models which, however, do not reflect the individuality of a respective patient. Furthermore, the mechanical properties of the bony structure with cortical bone and cancellous bone are not considered in most models. A few manufacturers, such as SawBone, offer models and material blocks that approximate the properties of the bone. However, these are not patientspecific either. This paper presents a proposal for a method to create patient-specific physical bone models with CAD/CAM technologies that approximate shape and mechanical properties. The models are made of two different rigid polyurethane foams for cortical bone and cancellous bone. The methodical development includes the elaboration of a framework starting from the patient's CT data, through design derivation, to fabrication. Furthermore, a possible process for fabrication in the form of a demonstrator and its application in sawing tests will be demonstrated.

The Effect of Working Length, Fracture, and Screw Configuration on Plate Strain in a 3.5-mm LCP Bone Model of Comminuted Fractures

Abstract Introduction This study provides a comprehensive examination of plate strain under realistic fracture configurations. The effect of plate working length, plate contact, fracture length, and position on strain was evaluated using bone surrogates subjected to “load-controlled,” nondestructive conditions. Materials and Methods Five 3.5-mm locking compression plates (LCP) were instrumented with six strain gauges. The gauges were glued between holes in predetermined locations marked by laser engraving. Nine fracture models were created using bone surrogate, each representing a combination of the criteria under study: long versus short working length, degree of plate compression, fracture location, and fracture length. All five plates were tested under each of the nine configurations. The constructs were mounted in an Instron testing machine with a 5-kN load cell. Each specimen was cyclically loaded at a rate of 5 mm/min to 50, 100, and 200 N. Results Decreased plate strain was noted with a short plate working length in all fracture configurations (p &lt; 0.05). Increasing the plate working length increased the strain at higher loads and on the plate adjacent to the fracture gap. The size of the fracture gap and fracture location had minimal effects on plate strain (p &lt; 0.05). Elevation of the plate off the bone (1.5 mm) resulted in increased plate strain under all loading conditions (p &lt; 0.05). Conclusion Our null hypothesis was rejected in that a short plate working length resulted in decreased plate strain in all comminuted fracture configurations. Our secondary hypothesis was validated in that elevation of the plate from the bone resulted in increased strain in all configurations. As plate strain identifies regions of mechanical weakness whereby a construct may prematurely fail by acute overload or cyclic fatigue, identifying factors that may increase plate strain allows the surgeon to reduce these variables as much as possible to reduce the incidence of implant failure and subsequent fracture failure.

Biomechanical Performance of a Novel Implant Design in Simulated Extraction Sites and Sinuslift Procedures

With increasing experience and in an attempt to shorten overall treatment times, implant placement in combination with tooth extractions and sinus lift procedures has become popular. In both cases, primary stability has to be achieved by either engaging apical and oral regions of trabecular bone or by engaging residual host bone beneath the sinus cavity. Extraction sites were formed by pressing a root analog into homogeneous low density polyurethane foam which was used as bone surrogate while a 3 mm thick sheet of medium density foam was used for mimicking a sinus lift situation. Two types (n = 10) of bone level implants with a conventional tapered design and a cervical back taper (NobelActive; control) and a novel design characterized by a shift in core diameter and thread geometry (AlfaGate; test) were placed in these models following conventional osteotomy preparation. Insertion torque was measured using a surgical motor and primary stability was determined by resonance frequency analysis. Statistical analysis was based on Welch two sample t tests with the level of significance set at α = 0.05. In sinuslifting, NobelActive implants required significantly higher insertion torques as compared to AlfaGate (p = 0.000) but did not achieve greater implant stability (p = 0.076). In extraction sites, AlfaGate implants showed both, significantly higher insertion torques (p = 0.004) and significantly greater implant stability (p = 0.000). The novel implant design allowed for greater primary stability when being placed in simulated extraction sockets and sinuslift situations. While in extraction sockets the position of condensing threads in combination with an increase in core diameter is beneficial, the deep cervical threads of the novel implant lead to superior performance in sinuslift situations.

Development and characterization of modular mouse phantoms for end-to-end testing and training in radiobiology experiments

Objective. In radiation oncology, experiments are often carried out using mice as a model for in vivo research studies. Due to recent technological advances in the development of high-precision small-animal irradiation facilities, the importance of quality assurance for both dosimetry and imaging is increasing. Additive manufacturing (AM) offers the possibility to produce complex models from a three-dimensional data set and to build cost-effective phantoms that can easily be adapted to different purposes. The aim of this work was therefore to develop detailed anatomical mouse models for quality assurance and end-to-end testing of small-animal irradiation and imaging by means of AM. Approach. Two mouse phantom concepts were designed, constructed, and examined for this purpose. The first model includes cavities corresponding to the most important organs. The final solid model was constructed using AM in two separate parts that can be attached with a plug connection after filling these cavities with tissue-equivalent mixtures. Moreover, different radiation dosimeters can be placed in the lower part of the model. For the second concept, AM was used for building modules like the phantom outer shell and bones, so that different mixtures can be used as a filling, without modifying the phantom structure. Main results. CT as well as Micro-CT scans of both concepts showed an excellent quality and adequate image contrast, with material attenuation properties close to those of mouse tissues, apart from the current bone surrogates. Radiation dose measurements with radiochromic films were, with some exceptions in areas with larges bone volumes, in agreement with calculations within less than ±4%. Significance. AM shows great potential for the development of mouse models that are inexpensive, easy to adapt, and accurate, thus enabling their use for quality assurance in small-animal radiotherapy and imaging. The introduction of such 3D-printable mouse phantoms in the workflow could also significantly reduce the use of living animals for optimization and testing of new imaging and irradiation protocols.

Acetabular Wall Weakening in Total Hip Arthroplasty: A Pilot Study

Total hip arthroplasty is a widely performed operation allowing disabled patients to improve their quality of life to a degree greater than any other elective procedure. Planning for a THA requires adequate patient assessment and preoperative characterizations of acetabular bone loss via radiographs and specific classification schemes. Some surgeons may be inclined to ream at a larger diameter thinking it would lead to a more stable press-fit, but this could be detrimental to the acetabular wall, leading to intraoperative fracture. In the attempt to reduce the incidence of intraoperative fractures, the current study aims to identify how increased reaming diameter degrades and weakens the acetabular rim strength. We hypothesized that there is proportionality between the reaming diameter and the reduction in acetabular strength. To test this hypothesis, this study used bone surrogates, templated from CT scans, and reamed at different diameters. The obtained bone surrogate models were then tested using an Intron 8874 mechanical testing machine (Instron, Norwood, MA) equipped with a custom-made fixture. Analysis of variance (ANOVA) was used to identify differences among reamed diameters while linear regression was used to identify the relationship between reamed diameters and acetabular strength. We found a moderate correlation between increasing reaming diameter that induced thinning of the acetabular wall and radial load damage. For the simplified acetabular model used in this study, it supported our hypothesis and is a promising first attempt in providing quantitative data for acetabular weakening induced by reaming.

Calorimeter measurements of absolute dose in aluminum, a surrogate of bone, to validate dose-to-medium in Acuros XB

Objective. While the accuracy of dose calculations in water with Acuros XB is well established, experimental validation of dose in bone is limited. Acuros XB reports both dose-to-medium and dose-to-water, and these values differ in bone, but there are no reports of measurements of validation in bone. This work compares Acuros XB calculations to measurements of absolute dose in aluminum (medium similar to bone). The validity of using selected relative dosimeters in aluminum is also investigated. Approach. A calorimeter with an aluminum core embedded in an aluminum phantom was selected as bone surrogate for the measurement of absolute dose. Matching the medium of the core to the medium of the phantom allowed eliminating the calculation of the conversion between media. The dose was measured at the fixed depth of 3.3 cm in aluminum (∼9 g·cm−2) with 6X, 10X, 6FFF and 10FFF photon beams from a TrueBeam Varian linac. In addition, experimental cross-calibration between water and aluminum was performed for an IBA CC13 ionization chamber, a PTW microDiamond and EBT3 Gafchromic film. Main results. Calculations with Acuros XB dose-to-medium in aluminum differed from the calorimetry data by −2.8% to −3.5%, depending on the beam. Use of dose-to-water would have resulted in about 39% discrepancy. The cross calibration coefficient between water and aluminum yielded values of about 0.87 for the CC13 chamber, 0.91 for the microDiamond, and 0.88 for the film, and independent of the beam within about ±1%. Significance. It was demonstrated the value of the dose-to-medium in aluminum (surrogate of bone) computed with Acuros XB is close to the value of the absolute dose measured with a calorimeter, and there is a significant discrepancy when dose-to-water is used instead. The use of an ionization chamber, a microDiamond and Gafchromic film in aluminum required a considerable correction from calibration in water.

Additive Manufacturing and Mechanical Characterization of PLA-Based Skull Surrogates.

Several occupational and leisure activities involve a high risk of head impacts, resulting in varying degrees of injuries with chronic consequences that adversely affect life quality. The design and manufacturing of effective head protections rely on proper head simulators to mimic the behavior to impact loading. 3D-printed human skulls are reported herein to address the need for reproducible, cost-effective, anatomically-correct surrogates. To demonstrate the viability of the investigated approach, surrogate bone sections and skulls were mechanically tested under quasi-static loading conditions. The 3D-printed bone sections were flexural tested, elucidating the effect of printing orientations and the sample geometry on their mechanical behavior. The printing orientation minimally influenced the results due to the high infill percentage, while the sample geometry played a major role in the flexural properties because of the change in the section properties. The surrogate skulls were submitted to lateral compression and frontal penetration tests to assess the impact of the sectioning strategy on the overall mechanical performance. Results indicate that PLA-based surrogates reasonably reproduce the behavior of skulls. In addition, the sectioning strategy elucidated the effect of skull sutures, while streamlining the additive manufacturing process. The outcomes lay the foundation for future research seeking a complete surrogate head.

The biomechanical behavior of 3D printed human femoral bones based on generic and patient-specific geometries

BackgroundBone is a highly complex composite material which makes it hard to find appropriate artificial surrogates for patient-specific biomechanical testing. Despite various options of commercially available bones with generic geometries, these are either biomechanically not very realistic or rather expensive.MethodsIn this work, additive manufacturing was used for the fabrication of artificial femoral bones. These were based on CT images of four different commercially available femoral bone surrogates and three human bones with varying bone density. The models were 3D printed using a low-budget fused deposition modeling (FDM) 3D printer and PLA filament. The infill density was mechanically calibrated and varying cortical thickness was used. Compression tests of proximal femora simulating stance were performed and the biomechanical behavior concerning ultimate force, spring stiffness, and fracture pattern were evaluated as well as compared to the results of commercial and cadaveric bones.ResultsRegarding the ultimate forces and spring stiffness, the 3D printed analogs showed mechanical behavior closer to their real counterparts than the commercially available polyurethan-based surrogates. Furthermore, the increase in ultimate force with increasing bone density observed in human femoral bones could be reproduced well. Also, the fracture patterns observed match well with fracture patterns observed in human hip injuries.ConclusionConsequently, the methods presented here show to be a promising alternative for artificial generic surrogates concerning femoral strength testing. The manufacturing is straightforward, cheap, and patient-specific geometries are possible.

Accuracy of an Apparatus for Measuring Glenoid Baseplate Micromotion in Reverse Shoulder Arthroplasty

Abstract Reverse shoulder arthroplasty (RSA) is used to treat patients with cuff tear arthropathy. Loosening remains to be one of the principal modes of implant failure and the main complication leading to revision. Excess micromotion contributes to glenoid loosening. This study sought to determine the predictive accuracy of an experimental system designed to assess factors contributing to RSA glenoid baseplate micromotion. A half-fractional factorial experiment was designed to assess 4 factors: central element type (screw versus peg), central element length (13.5 versus 23.5 mm), anterior-posterior peripheral screw type (locking versus nonlocking) and cancellous bone density (10 versus 25 pounds per cubic foot (pcf)). Four linear variable differential transducers (LVDTs) recorded micromotion from a stainless-steel disk surrounding a modified glenosphere. The displacements were used to interpolate micromotion at each peripheral screw position. The mean absolute percentage error (MAPE) was used to determine the predictive accuracy and error range of the system. The MAPE for each condition ranged from 6.8% to 12.9% for an overall MAPE of (9.5 ± 0.9)%. The system had an error range of 2.7 μm to 20.1 μm, which was lower than those reported by prior studies using optical systems. One of the eight conditions had micromotion that exceeded 150 μm. These findings support the use of displacement transducers, specifically LVDTs, as an accurate system for determining RSA baseplate micromotion in rigid polyurethane foam bone surrogates.

Characterizing the Mechanical Behavior of Bone and Bone Surrogates in Compression Using pQCT.

Many axial and appendicular skeleton bones are subjected to repetitive loading during daily activities. Until recently, the structural analysis of fractures has been limited to 2D sections, and the dynamic assessment of fracture progression has not been possible. The structural failure was analyzed using step-wise micro-compression combined with time-lapsed micro-computed tomographic imaging. The structural failure was investigated in four different sample materials (two different bone surrogates, lumbar vertebral bodies from bovine and red deer). The samples were loaded in different force steps based on uniaxial compression tests. The micro-tomography images were used to create three-dimensional models from which various parameters were calculated that provide information about the structure and density of the samples. By superimposing two 3D images and calculating the different surfaces, it was possible to precisely analyze which trabeculae failed in which area and under which load. According to the current state of the art, bone mineral density is usually used as a value for bone quality, but the question can be raised as to whether other values such as trabecular structure, damage accumulation, and bone mineralization can predict structural competence better than bone mineral density alone.

Gunshot trauma in human long bones: towards practical diagnostic guidance for forensic anthropologists.

In contrast to cranial gunshot trauma, diagnosis and interpretation of gunshot trauma to long bones remains difficult and controversial. The aim of this study is to review the published literature on fracture patterns resulting from gunshot trauma in human long bones, and to use the described characteristics to provide practical guidance for the forensic anthropologist. In order to achieve this, medical and forensic publications on this topic were reviewed. Several types of fractures, such as linear, oblique, comminuted and butterfly fractures, have been observed in either the shaft or the ends of long bones. Indirect fractures that are not caused by bullets striking bone directly but by bullet-induced forces to the surrounding soft tissue have been found as well. Some of these fractures are related to a specific context or mechanism which might help in the forensic reconstruction of events. It is recommended that future research should focus on available medical data to provide more detailed descriptions on fracture patterns for forensic purposes. Experimentation with bone surrogates and computer modelling might also provide better and more realistic reconstructions of gunshot trauma in the future and provide valuable insights for its diagnosis and interpretation in forensic anthropology.

Mechanical and morphometric characterization of custom-made trabecular bone surrogates

Synthetic bones for biomechanical testing and surgeon training have become more important due to their numerous advantages compared to human bones. Several bone models are already available on the market, but most of them do not reflect the full range of versatile properties that characterize human bone like population-level influences, size, stiffness, bone-implant-interface or morphometry. Thus, the objectives of this study were to develop synthetic trabecular bone surrogates from polyurethane and varying additives and to determine their elastic and plastic mechanical compressive and additionally morphometric properties. Another aim was to investigate the influence of varying additives on aforementioned properties and finally compare the results with published data from human trabecular bone. Additives used were blowing agents to create a porous structure, mineral fillers to manipulate the basic polyurethane resin, and cell stabilizers to achieve an open porous composition. Mechanical properties were obtained from static compression tests until failure while morphometric analysis was carried out using microcomputed tomography. Thereby, the blowing agent showed the strongest influence on mechanical and morphometric properties with mean Young’s moduli ranging from 627 ± 37 MPa (0% blowing agent) to 154 ± 15 MPa (0.25% blowing agent) while the variation of mineral filler content resulted in small standard deviations of approximately 10–20 MPa with a constant proportion of blowing agent. The achieved mechanical properties of the developed synthetic bones, such as the Young’s modulus, ultimate stress and yield stress were in accordance with human trabecular bone, while yield strain for all groups was noticeably higher compared to human trabecular bone. Additionally, morphometric analysis showed results indicating similar morphometry of the custom-made synthetic bone and human cancellous bone. Although recreating bone structures in physiological conditions is not simple, the results of the current study show the possibility of developing synthetic bone materials with characteristics like human trabecular bone.

Initial Assessments of a Handheld Indentation Probe's Correlation With Cancellous Bone Density, Stiffness, and Strength: An Objective Alternative to “Thumb Testing”

Abstract Objective: During shoulder arthroplasty, surgeons must select the optimal implant for each patient. The metaphyseal bone properties affect this decision; however, the typical resection “thumb test” lacks objectivity. This investigation's purposes were to determine the correlation strength between the indentation depth of a handheld mechanism and the density, compressive strength, and modulus of a bone surrogate; as well as to assess how changing the indenter tip shape and impact energy may affect the correlation strengths. Methods: A spring-loaded indenter was developed. Four tip shapes (needle, tapered, flat, and radiused cylinders) and four spring energies (0.13 J–0.76J) were assessed by indenting five cellular foam bone surrogates of varying density, every five times. After each indentation, the indentation depth was measured with a separate probe and correlated with manufacturer specifications of the apparent density, compressive strength, and modulus. Results: indentation depth plateaued as the bone surrogate's material properties increased, particularly for indentation tips with larger footprints and the 0.13 J spring. All tip shapes produced strong (R2≥0.7) power-law relationships between the indentation depth metric and the bone surrogate's material properties (density: 0.70 ≤ R2 ≤ 0.95, strength: 0.75 ≤ R2 ≤ 0.97, modulus: 0.70 ≤ R2 ≤ 0.93); though the use of the needle tip yielded the widest indentation depth scale. Interpretation: these strong correlations suggest that a handheld indenter may provide objective intra-operative evidence of cancellous material properties. Further investigations are warranted to study indenter tip shape and spring energy in human tissue; though the needle tip with spring energy between 0.30 J and 0.76 J seems the most promising.