Human Proximal Femur Research Articles

Anatomical comparison and evaluation of human proximal femurs modeling via different devices and FEM analysis

Breuckmann optical scanning, Metris laser scanning and CT are general devices used for modeling hard or soft tissues in the biomedical field. Whereas the CT device is able to model internal and external structures of hard tissues, Breuckmann and Metris devices can only model the exterior portions of tissues. In this study, a human proximal femur was modeled using these devices, and the matching accuracy thereof is presented. The human proximal femur was modeled by scanning with Breuckmann optical scanning, Metris laser scanning and CT devices. The 3D/3D registration method was performed in two ways: coordinate to coordinate based, and 2D contour based matching. Matching accuracies of the three models were developed with statistical deviation and local deviation. To determine the significance value between the deviations obtained, one way ANOVA, and for intragroup comparisons Tukey and Thamhane tests were used. After statistical analysis, stresses on the models were evaluated using ANSYS software taking boundary conditions on human standing position into consideration. In this study, the value of the 2D contour based accuracy deviation of the femur head zone between CT and Metris models was obtained as 0.4 ± 0.2 mm while it was 0.3 ± 0.1 mm between CT and Breuckmann. The highest matching deviation obtained as a result of the ANOVA test among these three models was found in the femur trochanter region (0.0142 ± 0.0164 mm), the lowest value was found in the femur head region (0.0070 ± 0.0132 mm). The stress of the CT-Breuckmann pair was found close to each other in stress analysis. The deviation values obtained by matching models created by three different methods showed statistically significant results (P < 0.05). Values obtained from the CT-Breuckmann model were lower than those obtained from CT-Metris. In order to lower deviation values, applications such as increasing the resolution of images, using stronger algorithms, meshing methods and enhancing surface form should be implemented.

Computationally-Optimized Bone Mechanical Modeling from High-Resolution Structural Images

Image-based mechanical modeling of the complex micro-structure of human bone has shown promise as a non-invasive method for characterizing bone strength and fracture risk in vivo. In particular, elastic moduli obtained from image-derived micro-finite element (μFE) simulations have been shown to correlate well with results obtained by mechanical testing of cadaveric bone. However, most existing large-scale finite-element simulation programs require significant computing resources, which hamper their use in common laboratory and clinical environments. In this work, we theoretically derive and computationally evaluate the resources needed to perform such simulations (in terms of computer memory and computation time), which are dependent on the number of finite elements in the image-derived bone model. A detailed description of our approach is provided, which is specifically optimized for μFE modeling of the complex three-dimensional architecture of trabecular bone. Our implementation includes domain decomposition for parallel computing, a novel stopping criterion, and a system for speeding up convergence by pre-iterating on coarser grids. The performance of the system is demonstrated on a dual quad-core Xeon 3.16 GHz CPUs equipped with 40 GB of RAM. Models of distal tibia derived from 3D in-vivo MR images in a patient comprising 200,000 elements required less than 30 seconds to converge (and 40 MB RAM). To illustrate the system's potential for large-scale μFE simulations, axial stiffness was estimated from high-resolution micro-CT images of a voxel array of 90 million elements comprising the human proximal femur in seven hours CPU time. In conclusion, the system described should enable image-based finite-element bone simulations in practical computation times on high-end desktop computers with applications to laboratory studies and clinical imaging.

Limited V-shaped cement augmentation of the proximal femur to prevent secondary hip fractures

Patients with a femoral fracture due to osteoporosis are at high risk of sustaining a secondary fracture on the contralateral side. A prophylactic mechanical reinforcement of the contralateral side during operation of the initial fracture could be of interest for such patients. This biomechanical invitro study investigates the potential of a limited V-shaped bone cement augmentation to prevent secondary hip fractures by targeting the areas of the proximal femur with the highest stresses during a fall. Five pairs of human cadaveric proximal femora were tested in a configuration simulating a fall on the greater trochanter. The femoral neck of one specimen of each pair was augmented with 8-14 ml polymethylmethacrylate from the lateral cortex towards inferior and superior, spanning a V-shaped cement pattern. Clinical relevant fractures were generated with a 45 kg mass in controlled free fall. Load-displacement data were recorded and energy to fracture, fracture load, yield load and stiffness were statistically evaluated. Augmented samples absorbed 124% more energy until fracture compared to their controls (p = 0.043). No significant differences were found between the two groups for fracture load (p = 0.5), yield load (p = 0.35) and stiffness (p = 0.5). Biomechanically, a limited V-shaped prophylactic cement augmentation carries potential to prevent secondary hip fractures indicated by increased energy absorption until fracture. Further investigations are necessary to minimize interference with the biology and to maximize the mechanical benefit of prophylactic augmentation.

Prediction of the mechanical response of the femur with uncertain elastic properties

A mandatory requirement for any reliable prediction of the mechanical response of bones, based on quantitative computer tomography, is an accurate relationship between material properties (usually Young's modulus E) and bone density ρ. Many such E–ρ relationships are available based on different experiments on femur specimens with a large spread due to uncertainties. The first goal of this study is to pool and analyze the relevant available experimental data and develop a stochasticE–ρ relationship. This analysis highlights that there is no experimental data available to cover the entire density range of the human femur and that some “popular” E–ρ relationships are based on data that contains extreme scatter, while others are based on a very limited amount of information.The second goal is to use the newly developed stochastic E–ρ relationship in high-order finite element analyses (FEAs) for the computation of strains and displacements in two human proximal femurs, mimicking in vitro experiments. When compared with the experimental observations, the FEA predictions using the median of the stochastic E–ρ relationship follow the underlying distribution of the stochastic E–ρ relationship. Thus, most deviations of the FEA predictions from experimental observations can possibly be explained by uncertain elastic properties of the femur.

Periosteal Sharpey’s fibers: a novel bone matrix regulatory system?

Sharpey’s “perforating” fibers (SF) are well known skeletally in tooth anchorage. Elsewhere they provide anchorage for the periosteum and are less well documented. Immunohistochemistry has transformed their potential significance by identifying their collagen type III (CIII) content and enabling their mapping in domains as permeating arrays of fibers (5–25 μ thick), protected from osteoclastic resorption by their poor mineralization. As periosteal extensions they are crucial in early skeletal development and central to intramembranous bone healing, providing unique microanatomical avenues for musculoskeletal exchange, their composition (e.g., collagen type VI, elastin, tenascin) combined with a multiaxial pattern of insertion suggesting a role more complex than attachment alone would justify. A proportion permeate the cortex to the endosteum (and beyond), fusing into a CIII-rich osteoid layer (<2 μ thick) encompassing all resting surfaces, and with which they apparently integrate into a PERIOSTEAL-SHARPEY FIBER-ENDOSTEUM (PSE) structural continuum. This intraosseous system behaves in favor of bone loss or gain depending upon extraneous stimuli (i.e., like Frost’s hypothetical “mechanostat”). Thus, the birefringent fibers are sensitive to humoral factors (e.g., estrogen causes retraction, rat femur model), physical activity (e.g., running causes expansion, rat model), aging (e.g., causes fragmentation, pig mandible model), and pathology (e.g., atrophied in osteoporosis, hypertrophied in osteoarthritis, human proximal femur), and with encroaching mineral particles hardening the usually soft parts. In this way the unobtrusive periosteal SF network may regulate bone status, perhaps even contributing to predictable “hotspots” of trabecular disconnection, particularly at sites of tension prone to fatigue, and with the network deteriorating significantly before bone matrix loss.

The Information Imperative: Is It Time for an Informed Consent Process Explaining the Risks of Medical Radiation?

We believe that the radiology community should take the initiative to adopt guidelines and require that all imaging facilities use some form of active information process describing the risks of medical radiation.

IMPROVED FEMORAL NECK FRACTURE PREDICTIONS USING ANISOTROPIC FAILURE CRITERIA MODELS

Finite element models are widely used to assess long bone strength, implant stability and other clinical problems. In most of the models presented so far in the literature, the bone is taken to be isotropic, and the occurrence of failure is predicted by defining a threshold von Mises stress. However, human bone is found to show orthotropic behavior. Studies so far have focused only on the use of anisotropic criteria in orthotropic models designed to predict the occurrence of human femur failure. The aim of this study was therefore to investigate how specific finite element models for human femora combined with composite failure theories could be used to improve failure predictions in vitro. For this purpose, nine human proximal femora were tested mechanically up to failure under the loading conditions present during the one-leg stance phase in walking. Specific finite element models using various materials to represent the bone were generated for each femur. First, the bone material was modeled in the form of an isotropic brittle material, and the von Mises criterion was used to predict the occurrence of fracture. Second, the bone was modeled as a transversely isotropic brittle material with asymmetric strength characteristics, and the occurrence of fracture was predicted using the Hill and the Tsai–Wu criteria. The results obtained here show that the transversely isotropic model combined with Tsai–Wu and Hill criteria accurately predicted the fracture load (values of R2 = 0.94 and SEE = 10.3% were obtained with the Tsai–Wu criteria and R2 = 0.82 and SEE = 22.9% were obtained with the Hill criteria), while the isotropic model combined with the von Mises criterion overestimated the fracture load, although a good correlation was generally observed with the experimental results (R2 = 0.77, SEE = 30.6%).

Computational Simulation of Bone Remodeling using Design Space Topology Optimization

AbstractThe law of bone remodeling, commonly referred to as Wolff's Law, asserts that the internal trabecular bone adapts to external loadings, reorienting with the principal stress trajectories to optimize mechanical efficiency creating a naturally optimum structure. The current study utilized an advanced structural optimization algorithm, called design space toptimization (DSO), to perform a three‐dimensional computational bone remodeling simulation on the human proximal femur and analyse the results to determine the validity of Wolff's hypothesis. DSO optimizes the layout of material by iteratively distributing it into the areas of highest loading, while simultaneously changing the design domain to increase computational efficiency. The large‐scale simulation utilized a 175 µm mesh resolution with over 23.3 million elements. The resulting anisotropic trabecular architecture was compared to both Wolff's trajectory hypothesis and natural femur samples from literature using radiography. The results qualitatively showed several anisotropic trabecular regions that were comparable to the natural human femur. The realistic simulated trabecular geometry suggests that the DSO method can accurately predict bone adaptation due to mechanical loading and that the proximal femur is an optimum structure as Wolff hypothesized. (© 2011 Wiley‐VCH Verlag GmbH &amp; Co. KGaA, Weinheim)

Accuracy of finite element predictions in sideways load configurations for the proximal human femur

Subject-specific finite element models have been used to predict stress-state and fracture risk in individual patients. While many studies analysed quasi-axial loading configurations, only few works simulated sideways load configurations, such as those arising in a fall. The majority among these latter directly predicted bone strength, without assessing elastic strain prediction accuracy. The aim of the present work was to evaluate if a subject-specific finite element modelling technique from CT data that accurately predicted strains in quasi-axial loading configurations is suitable to accurately predict strains also when applying low magnitude loads in sideways configurations. To this aim, a combined numerical–experimental study was performed to compare finite element predicted strains with strain-gauge measurements from three cadaver proximal femurs instrumented with sixteen strain rosettes and tested non-destructively under twelve loading configurations, spanning a wide cone (0–30° for both adduction and internal rotation angles) of sideways fall scenarios. The results of the present study evidenced a satisfactory agreement between experimentally measured and predicted strains (R2 greater than 0.9, RMSE% lower than 10%) and displacements. The achieved strain prediction accuracy is comparable to those obtained in state of the art studies in quasi-axial loading configurations. Still, the presence of the highest strain prediction errors (around 30%) in the lateral neck aspect would deserve attention in future studies targeting bone failure.

Real-time X-ray microradiographic imaging and image correlation for local strain mapping in single trabecula under mechanical load

X-ray microradiography was employed to quantify the strains in loaded human trabecula. Samples of isolated trabeculae from human proximal femur were extracted and glued in a loading machine specially designed and manufactured for testing small specimens. The samples were then tested in tension and three-point bending until complete fracture of the specimen occured. To assess the deformation in the very small samples (thickness 100μm, length 1—2mm) a real-time microradiography in conjunction with digital image correlation (DIC) has been employed. Loaded samples were irradiated continuously by X-rays (Hamamatsu L8601-01 with 5μm spot) during the test. Radiographs were acquired using 0.25s exposure time with hybrid single-photon counting silicon pixel detector Medipix2. The distance between the source and detector was kept small to ensure radiographs of good quality for such a short exposure time.Design of the experimental loading device enables for precise control of the applied displacement which is important for the post-yield behavior assessment of trabeculae. Large dynamic range, high sensitivity and high contrast of the Medipix2 enables measuring even very small strains with DIC. Tested experimental setup enables to combine micromechanical testing of the basic building block of trabecular bone with time-lapse X-ray radiography to measure the strains and to assess the mechanical properties of single human trabecula as well as to capture the softening curve with sufficient precision.

The Effect of Load Direction on the Structure Capacity of Human Proximal Femur during Falling

The annual occurrence of hip fracture increases very rapidly, which cause a heavy public health burden. From a biomechanical perspective, hip fractures are thought to be caused by different directions of load. Fifteen different load conditions were studied here to simulate various falling configurations, the directions of which were defined by angle γ, δ. The purpose of the current study was to clarify the influence of load direction on strength and fracture site of the proximal femur using FE method to determine the load direction under which the proximal femur is most vulnerable to fracture.

Biographical Sketch: Georg Hermann von Meyer (1815-1892)

This biographical sketch on Georg Hermann von Meyer highlights the interactions in the 1860s that von Meyer, a famous anatomist, had with Karl Culmann, a famous structural engineer and mathematician. The published papers from this interaction caught the attention of Julius Wolff and stimulated his development of the trajectorial hypothesis of bone adaptation--now called "Wolff's Law." The corresponding translations are provided: (1) von Meyer's 1867 paper that highlights the regularity of arched trabecular patterns in various human bones, and his discussions with Culmann about their possible mechanical relevance; and (2) Wolff's 1869 paper that first mentions the correspondence of stress trajectories in a solid, crane-like structure to the arched trabecular patterns in the proximal human femur. This biographical sketch on Georg Hermann von Meyer corresponds to the historic texts, The Classic: The Architecture of the Trabecular bone (by von Meyer), and The Classic: On the Significance of the Architecture of the Spongy Substance for the Question of Bone Growth. A preliminary publication (by Wolff) available at DOIs 10.1007/s11999-011-2041-5 , 10.1007/s11999-011-2042-4 .

The Combination of Structural Parameters and Areal Bone Mineral Density Improves Relation to Proximal Femur Strength: An In Vitro Study with High-Resolution Peripheral Quantitative Computed Tomography

The aim of this study was to assess structural indices from high-resolution peripheral quantitative computed tomography (HR-pQCT) images of the human proximal femur along with areal bone mineral density (aBMD) and compare the relationship of these parameters to bone strength in vitro. Thirty-one human proximal femur specimens (8 men and 23 women, median age 74years, range 50-89) were examined with HR-pQCT at four regions of interest (femoral head, neck, major and minor trochanter) with 82μm and in a subgroup (n=17) with 41μm resolution. Separate analyses of cortical and trabecular geometry, volumetric BMD (vBMD), and microarchitectural parameters were obtained. In addition, aBMD by dual-energy X-ray absorptiometry (DXA) was performed at conventional hip regions and maximal compressive strength (MCS) was determined in a side-impact biomechanical test. Twelve cervical and 19 trochanteric fractures were confirmed. Geometry, vBMD, microarchitecture, and aBMD correlated significantly with MCS, with Spearman's correlation coefficients up to 0.77, 0.89, 0.90, and 0.85 (P<0.001), respectively. No differences in these correlations were found using 41μm compared to 82μm resolution. In multiple regression analysis of MCS, a combined model (age- and sex-adjusted) with aBMD and structural parameters significantly increased R (2) values (up to 0.90) compared to a model holding aBMD alone (R (2) up to 0.78) (P<0.05). Structural parameters and aBMD are equally related to MCS, and both cortical and trabecular structural parameters obtained from HR-pQCT images hold information on bone strength complementary to that of aBMD.

The human proximal femur behaves linearly elastic up to failure under physiological loading conditions

It has not been demonstrated whether the human proximal femur behaves linearly elastic when loaded to failure. In the present study we tested to failure 12 cadaveric femurs. Strain was measured (at 5000Hz) on the bone surface with triaxial strain gages (up to 18 on each femur). High-speed videos (up to 18,000frames/s) were taken during the destructive test. To assess the effect of tissue preservation, both fresh-frozen and formalin-fixed specimens were tested. Tests were carried out at two strain-rates covering the physiological range experienced during daily motor tasks. All specimens were broken in only two pieces, with a single fracture surface. The high-speed videos showed that failure occurred as a single abrupt event in less than 0.25ms. In all specimens, fracture started on the lateral side of the neck (tensile stress). The fractured specimens did not show any sign of permanent deformation. The force–displacement curves were highly linear (R2>0.98) up to 99% of the fracture force. When the last 1% of the force–displacement curve was included, linearity slightly decreased (minimum R2=0.96). Similarly, all force–strain curves were highly linear (R2>0.98 up to 99% of the fracture force). The slope of the first part of the force–displacement curve (up to 70% fracture force) differed from the last part of the curve (from 70% to 100% of the fracture force) by less than 17%. Such a difference was comparable to the fluctuations observed between different parts of the curve. Therefore, it can be concluded that the proximal femur has a linear-elastic behavior up to fracture, for physiological strain-rates.

E-modulus mapping at bone packet level: Combination of scanning acoustic microscopy in time of flight mode and back scattered electron imaging

E-modulus mapping at bone packet level: Combination of scanning acoustic microscopy in time of flight mode and back scattered electron imaging

Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization

Since the late 1980s, computational analysis of total hip arthroplasty (THA) prosthesis components has been completed using macro-level bone remodeling algorithms. The utilization of macro-sized elements requires apparent bone densities to predict cancellous bone strength, thereby, preventing visualization and analysis of realistic trabecular architecture. In this study, we utilized a recently developed structural optimization algorithm, design space optimization (DSO), to perform a micro-level three-dimensional finite element bone remodeling simulation on the human proximal femur pre- and post-THA. The computational simulation facilitated direct performance comparison between two commercially available prosthetic implant stems from Zimmer Inc.: the Alloclassic and the Mayo conservative. The novel micro-level approach allowed the unique ability to visualize the trabecular bone adaption post-operation and to quantify the changes in bone mineral content by region. Stress-shielding and strain energy distribution were also quantified for the immediate post-operation and the stably fixated, post-remodeling conditions. Stress-shielding was highest in the proximal region and remained unchanged post-remodeling; conversely, the mid and distal portions show large increases in stress, suggesting a distal shift in the loadpath. The Mayo design conserves bone mass, while simultaneously reducing the incidence of stress-shielding compared to the Alloclassic, revealing a key benefit of the distinctive geometry. Several important factors for stable fixation, determined in clinical evaluations from the literature, were evident in both designs: high levels of proximal bone loss and distal bone densification. The results suggest this novel computational framework can be utilized for comparative hip prosthesis shape, uniquely considering the post-operation bone remodeling as a design criterion.

Numerical procedure for multiscale bone adaptation prediction based on neural networks and finite element simulation

A human femur is composed of cortical and trabecular bone organized in a hierarchical way. In this paper, a multiscale procedure based on finite element simulation and neural network computation was developed to link mesoscopic and macroscopic scales to simulate trabecular bone adaptation process. The finite element calculation is performed at macroscopic level and trained neural networks are employed as numerical devices for substituting the finite element computation needed for the mesoscale prediction. Based on a set of mesoscale simulations of representative volume element of bone, a neural network is trained to approximate the responses. The input data for the artificial neural network are boundary conditions and the applied stress. The output data are some averaged bone properties. A macroscale constitutive model is obtained by homogenization of the mesoscale responses. The proposed approach is able to predict in rapid way some relevant outputs related to bone adaptation process such as trabecular bone density, elastic modulus and accumulation of apparent fatigue damage of 3D trabecular bone architecture at a given bone site. The proposed rapid multiscale method was able to predict final proximal femur trabecular bone adaption similar to the patterns observed in a human proximal femur.

Three-dimensional micro-level computational study of Wolff's law via trabecular bone remodeling in the human proximal femur using design space topology optimization

The law of bone remodeling, commonly referred to as Wolff's Law, asserts that the internal trabecular bone adapts to external loadings, reorienting with the principal stress trajectories to maximize mechanical efficiency creating a naturally optimum structure. The goal of the current study was to utilize an advanced structural optimization algorithm, called design space optimization (DSO), to perform a micro-level three-dimensional finite element bone remodeling simulation on the human proximal femur and analyse the results to determine the validity of Wolff's hypothesis. DSO optimizes the layout of material by iteratively distributing it into the areas of highest loading, while simultaneously changing the design domain to increase computational efficiency. The result is a “fully stressed” structure with minimized compliance and increased stiffness. The large-scale computational simulation utilized a 175μm mesh resolution and the routine daily loading activities of walking and stair climbing. The resulting anisotropic trabecular architecture was compared to both Wolff's trajectory hypothesis and natural femur samples from literature using a variety of visualization techniques, including radiography and computed tomography (CT). The results qualitatively revealed several anisotropic trabecular regions, that were comparable to the natural human femurs. Quantitatively, the various regional bone volume fractions from the computational results were consistent with quantitative CT analyses. The global strain energy proceeded to become more uniform during optimization; implying increased mechanical efficiency was achieved. The realistic simulated trabecular geometry suggests that the DSO method can accurately predict bone adaptation due to mechanical loading and that the proximal femur is an optimum structure as the Wolff hypothesized.

Variation of trabecular architecture in proximal femur of postmenopausal women

This investigation of microstructure in the human proximal femur probes the relationship between the parameters of the FRAX index of fracture risk and the parameters of bone microstructure. The specificity of fracture sites at the proximal femur raises the question of whether trabecular parameters are site-specific during post-menopause, before occurrence of fragility fracture. The donated proximal femurs of sixteen post-menopausal women in the sixth and seventh decades of life, free of metabolic pathologies and therapeutic interventions that could have altered the bone tissue, constituted the material of the study. We assessed bone mineral density of the proximal femurs by dual energy X-ray absorptiometry and then sectioned the femurs through the center of the femoral head and along the femoral neck axis. For each proximal femur, morphometry of trabeculae was conducted on the plane of the section divided into conventional regions and sub-regions consistent with the previously identified trabecular families that provide regions of relatively homogeneous microstructure. Mean trabecular width and percent bone area were calculated at such sites. Our findings indicate that each of mean trabecular width and percent bone area vary within each proximal femur independently from each other, with dependence on site. Both trabecular parameters show significant differences between pairs of sites. We speculate that a high FRAX index at the hip corresponds to a reduced percent bone area among sites that gives a more homogeneous and less site-specific quality to the proximal femur. This phenomenon may render the local tissue less able to carry out the expected mechanical function.

Does cancellous bone compaction due to insertion of a blade implant influence the cut-out resistance? A biomechanical study

Background For the treatment of hip fractures helically shaped implants, like the Dynamic Hip Screw (DHS) Blade, are often used. One consequence of blade implantation, the compaction of cancellous bone, is still believed to increase cut-out resistance. This in vitro study investigates implant anchorage of Dynamic Hip Screw Blades in femoral heads due to insertion with or without predrilling under cyclic physiological loading conditions. Methods Six pairs of fresh frozen (− 20 °C) human cadaveric proximal femora were instrumented with DHS Blades. Bone pairs were randomly assigned to two study groups: 1) predrilled; 2) non-predrilled. Prior instrumentation, bone mineral density was determined in the center of the femoral head by Xtreme-CT measurement. After instrumentation biomechanical testing was performed under cyclic loading. The bone-implant interface was monitored by means of fluoroscopic imaging throughout the experiment. Paired t-tests were performed to identify differences regarding bone mineral density, stiffness and cycles to failure. Findings No significant differences were found between study groups with regard to axial stiffness ( P = 0.626) and number of cycles to failure ( P = 0.961). Interpretation This in vitro study did not show differences in biomechanical stability of proximal femora instrumented with a helical blade implant with or without predrilling. Clinically, the findings suggest that predrilling may be performed to ease the surgical procedure without compromising the implant anchorage.