Biomedical subjects

H Weinans

Publications and source records attributed to H Weinans.

At least 55 records · Page 3Linked to original sources

PubMed1998

Is osteoporosis a matter of over-adaptation?

The stiffness and strength of cancellous bone depends on the amount of bone mineral (BMD) and on the three-dimensional distribution of the mineral (architecture). The relationship between mechanical properties and architecture, excluding confounding effects due to BMD can be studied using computer models of cancellous bone. It was shown that adaptation to mechanical deformation energy leads to an architecture which is an optimal or semi-optimal configuration with respect to maximal stiffness and minimal mass. Thus, the stiffness of the cancellous bone relative to the amount of bone (the bone density) can be considered as an optimality criterion. Based on these findings we assumed that the status of osteoporosis - or better fracture risk - could be related to how close this optimality criterion was met. In other words, we assumed that a higher fracture risk is simply related to a less optimal structure. This was tested for cancellous bone samples taken from post mortem vertebral bodies from two groups of subjects: one group with high fracture incidence during their lives and one group of "healthy" controls. It was found that the specimen from the high fracture incidence group had an architecture leading to a slightly stiffer structure relative to the BMD value. The conclusion is therefore that vertebral bone specimen from subjects with high fracture incidence are better optimized which was contradictory to what we expected. This finding indicates that bone specimen from the "healthy" control subjects had bone matrix at locations which are relatively unloaded. This tissue can be considered as not mechanically efficient or functional. A possible explanation of the present findings is that bone from subjects with increased fracture incidence is better adapted to mechanical stress, because it needs all bone material to carry the load. This stronger adaptation might be related to a compromised safety factor against bone loss, or diminished intrinsic matrix properties (e.g., microdamage).

Adaptation, Physiological↗

PubMed1997

Nondestructive measurements of implant-bone interface shear modulus and effects of implant geometry in pull-out tests.

Push-out and pull-out tests are used for destructive evaluation of implant-bone interface strength. Because nondestructive mechanical tests would allow maintenance of an intact interface for subsequent morphological study, we developed such a test to determine the shear modulus of the interface by measuring the shear deformation of a thin layer adjacent to the implant. A polyurethane foam model was used to test the experimental setup on a group of nine cylindrical implants with three different lengths (15-48 mm) and three different diameters (5-9.7 mm). The shear modulus of the interface, as calculated from the pull-out test, was validated against the shear modulus of the foam derived from tensile tests. The two values of shear modulus were well correlated (R2 = 0.8, p < 0.001), thus encouraging further application of the setup for tests of implant-bone interface mechanics. In addition, we also examined the effects of implant length and diameter. The length of the implants had a significant influence on the interface shear modulus (p < 0.05), indicating that comparisons of the variable should only be made of implants with the same length. The length and diameter of the implants were not critical parameters for the ultimate fixation strength.

Biocompatible Materials↗

PubMed1997

Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat.

We hypothesized that reduced stem stiffness of orthopaedic implants contributes to a high risk of loosening, since interface stresses and relative motions may exceed a tolerable range. To study this hypothesis, three types of load-bearing implant with different stiffnesses were inserted into the tibia of the goat. Histological analysis was performed of bone repair after insertion of the implant, bone ingrowth, interface disruption and loosening. A finite element model of the configuration provided the quantitative range of interface stresses and relative motions for the present experiment. The implants were made out of stainless steel, hollow titanium and a thin titanium core covered with a polyacetal coating. The stiffness ratios of these implants were approximately 10:4:1, respectively. All implants were coated with a layer of hydroxyapatite (HA) in order to minimize the possible biological effects of the different implant materials. Irrespective of the type of implant, there was a repair phase that lasted 6-12 weeks. The stiff implants functioned well. Large areas of bone bonding to the HA layer were found after the repair phase at 12 weeks postoperatively. After 24 weeks, some signs of loosening were observed. More loosening occurred with the hollow titanium and polyacetal implants, mainly during the repair phase. Three hollow titanium and three polyacetal coated implants survived this period, and were killed after 24 weeks. The integrity of the HA layer at the bone-implant interface of the titanium implants was good. In the polyacetal implants, the repair reaction of the cortical bone was incomplete. Bone ingrowth into HA was largely lacking. In conclusion, we found significant differences in the repair and interface reactions around implants of different stiffness. Stiff implants showed favourable initial interface conditions for bone ingrowth. Intermediate and flexible implants provoked unfavourable interface conditions for initial bone ingrowth. The finite element study showed that the flexible stems produce larger micromotions and higher interface stresses at the bone-prosthesis interface than the stiff stems, indicating an explanation for the histological findings.

Acetals↗

PubMed1997

Prospects of computer models for the prediction of osteoporotic bone fracture risk.

Bone fractures are major problems for osteoporosis patients. To avoid such fractures, more information is needed about the factors that determine the bone fracture risk. In this chapter, it is discussed how recently developed finite element computer models that can represent the trabecular architecture in full detail can provide such information. It is concluded that a computer modeling approach to this problem is feasible, required and promising. It is expected that, eventually, such models can be used as a basis for an accurate diagnosis of the bone fracture risk.

Biomechanical Phenomena↗

PubMed1997

Finite Element analyses to study periprosthetic bone adaptation.

Periprosthetic bone adaptation around orthopaedic implants can be studied with Finite Element models. It requires a comparison between the mechanical status of the bone in the operated (unnatural) situation and the natural situation. The difference between these two situations is the alteration in mechanical condition of the bone, which is assumed to be the driving force of the adaptation process. The time dependent bone adaptation process can be simulated with a computer algorithm by an iterative (time stepping) procedure. This study reviews some clinical and experimental issues, it addresses the value of computer models of periprosthetic bone adaptation and discusses a new development of voxel based models directly converted from CT scans.

Algorithms↗

PubMed1996

Tissue adaptation as a dynamical process far from equilibrium.

It is well established that tissue growth, maintenance, and degeneration are biochemically regulated processes influenced by mechanical function. Biomechanical models have been developed to predict adaptive processes; for example, computer simulation of bone remodeling around orthopaedic implants can accurately predict the effect of certain implant design variables. However, the same success remains to be achieved with other adaptive processes such as joint morphogenesis or osteoporosis. We propose that, to become capable of stimulating such adaptive processes, biomechanical models should capture the inherently irreversible nature of tissue adaptation and therefore should not rely on the assumption of a "homeostatic" equilibrium. In this article, it is proposed that tissue adaptation is an unstable process of moving between tissue states that are far from the equilibrium state--and that to simulate it, independent sensors and positive feedback stimuli should be employed.

Adaptation, Physiological↗

PubMed1995

Reconstruction of bone loading conditions from in vivo strain measurements.

A method is described whereby bone loading conditions can be reconstructed from in vivo strain measurements. The method uses ex vivo calibration measurements to find the relationship between the strain data and the loads applied to the bone. Using singular value decomposition, a transformation matrix is determined which provides the best linear relationship available between the measured strain data and the measured loading components in the calibration measurements. The transformation matrix can then be used to calculate the loads which correspond best with any given strain data set made with that specific bone and strain gages. In this manner, the applied loads of earlier performed in vivo strain measurements can be reconstructed. The method was tested for the reconstruction of the loads on a tibia of a goat. After determining the transformation matrix from a set of calibration measurements, the transformation matrix was used to reconstruct all loading components (three forces and three moments) of a set of test measurements whereby the applied loads were measured. It was found that the axial force and the torsional moment on the bone could be reproduced very accurately, showing a root mean square error (RMSE) of only 2% of the maximal load in the test. The reconstruction of the bending moments was slightly worse, showing a RMSE of 5-8% of the maximal moments. The reconstruction of the transverse force components proved less accurate and a RMSE up to 24% of the maximum was found. Accuracy can be improved by using weight factors for the loading conditions and a more accurate measurement of the location of the loads during the calibration measurements.

Algorithms↗

PubMed1995

A new method to determine trabecular bone elastic properties and loading using micromechanical finite-element models.

The apparent mechanical behavior of trabecular bone depends on properties at the tissue or trabecular level. Many investigators have attempted to determine trabecular tissue properties and loading. However, accuracy and applicability of all methods reported are limited. The small size of the trabeculae and a possible size effect are complicating factors when using traditional testing methods on single trabeculae. Other methods reported, using models that describe the trabecular structure, are of limited value because they consider bone as a repetitive structure in order to describe a reasonably large region of bone. The present study introduces a new finite-element method strategy that enables analysis of reasonably large regions of trabecular bone in full detail. The method uses three-dimensional serial reconstruction techniques to construct a large-scale FE model, by directly converting voxels to elements. A 5 mm cube of trabecular bone was modeled in this way, resulting in a FE model that consists of 296,679 elements. Special strategies were developed to solve the set of equations that results from the FE approach. Using this model in combination with experimental apparent data taken from the literature, the upper and lower boundaries for the tissue modulus were calculated to be 10.1 and 2.23 GPa, respectively. From the local stress and strain distributions it was concluded that the deformation mode of the trabeculae in the present cube was predominantly in bending. It was concluded that the method developed offers new perspectives for the study of trabecular bone.

Algorithms↗

PubMed1994

A physiological approach to the simulation of bone remodeling as a self-organizational control process.

Although the capacity of bone to adapt to functional mechanical requirements has been known for more than a century, it is still unclear how the bone adaptation processes are regulated. We hypothesize that osteocytes are sensitive to mechanical loading and control the regulation of bone mass in their environment. Recently, simulation models of such a process were developed, using the finite element method. It was discovered that these models produce discontinuous structures, not unlike trabecular bone. However, it was also found that severe discontinuities violate the continuum assumption underlying the finite element method and that the solutions were element mesh dependent. We have developed a simulation model (which is physiologically and mechanically more consistent) which maintains the self-organizational characteristics but does not produce these discontinuities. This was accomplished by separating the sensor density and range of action from the mesh. The results clearly show that predicted trabecular morphology, i.e. sizes and branching of struts, depend on the actual relationship between local load, sensor density and range of influence. We believe that the model is suitable to study the relationship between trabecular morphology and load and can also explain adaptation of morphology, in the sense of 'Wolff's law'.

Adaptation, Physiological↗

PubMed1994

Effects of fit and bonding characteristics of femoral stems on adaptive bone remodeling.

Bone atrophy caused by stress-shielding may cause serious complications for the long-term fixation of hip stems. In particular, uncemented total hip arthroplasty is threatened by this problem, because the stems are usually larger and, as a consequence, stiffer than those of cemented implants. In the present study, the effects of fit and bonding characteristics of femoral hip stems were investigated, using the (nonlinear) finite element method in combination with adaptive bone remodeling theory to predict the bone density distribution in a bone or bone/implant configuration. Unknown parameters used in the theory, such as a reference equilibrium loading stimulus and a threshold (dead) zone of this stimulus, were established (triggered) by using the method to predict the density distributions in the natural femur and around fully coated uncemented implants. The computer simulation method can provide long term predictions of remodeling patterns around various implant configurations. Several cases were analyzed, whereby the coating conditions (fully, partly, or noncoated) and the fit characteristics (press fitted or overreamed) were varied. The computer predictions showed that partly coating can only significantly reduce bone atrophy relative to fully coated stems, when the coating is applied at a small region at the utmost proximal part of the stem. For smooth press-fit stems the predicted amount of bone loss (35 percent in the proximal medial region) was less than for a one-third proximally coated or a fully coated stem (50 to 54 percent predicted bone loss in the proximal medial region).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

PubMed1993

Adaptive bone remodeling around bonded noncemented total hip arthroplasty: a comparison between animal experiments and computer simulation.

Severe loss of bone related to stress-shielding is one problem threatening the long-term integrity of noncemented total hip arthroplasty. It is widely accepted that this phenomenon is caused by adaptive bone remodeling according to Wolff's law. Recently, quantitative bone-remodeling theories have been proposed, suitable for use in computer-simulation models in combination with finite-element codes, which can be applied to simulate the long-term effect of the remodeling process. In the present paper, the results of such a computer simulation are compared with those in an animal experiment. A three-dimensional finite-element model was constructed from an animal experimental configuration concerning the implantation of a fully coated femoral hip prosthesis in dogs. The simulation results of the adaptive bone-remodeling process (geometric adaptations at the periosteal surface and density adaptations within the cancellous bone) were compared with cross-sectional measurements of the canine femurs after 2 years of follow-up. The detailed comparison showed that long-term changes in the morphology of bone around femoral components of total hip replacements can be fully explained with the present quantitative adaptive bone-remodeling theory.

Adaptation, Physiological↗

PubMed1993

Quantitative analysis of bone reactions to relative motions at implant-bone interfaces.

Connective soft tissues at the interface between implants and bone, such as in human joint replacements, can endanger the stability of the implant fixation. The potential of an implant to generate interface bone resorption and form soft tissue depends on many variables, including mechanical ones. These mechanical factors can be expressed in terms of relative motions between bone and implant at the interface or deformation of the interfacial material. The purpose of this investigation was to determine if interface debonding and subsequent relative interface motions can be responsible for interface degradation and soft tissue interposition as seen in experiments and clinical results. A finite element computer program was augmented with a mathematical description of interface debonding, dependent on interface stress criteria, and soft tissue interface interposition, dependent on relative interface motions. Three simplified models of orthopaedic implants were constructed: a cortical bone screw for fracture fixation plates, a femoral resurfacing prosthesis and a straight stem model, cemented in a bone. The predicted computer configurations were compared with clinical observations. The computer results showed how interface disruption and fibrous tissue interposition interrelate and possibly enhance each other, whereby a progressive development of the soft tissue layer can occur. Around the cortical bone screw, the predicted resorption patterns were relatively large directly under the screw head and showed a pivot point in the opposite cortex. The resurfacing cup model predicted some fibrous tissue formation under the medial and lateral cup rim, whereby the medial layer developed first because of higher initial interface stresses. The straight stem model predicted initial interface failure at the proximal parts. After proximal resorption and fibrous tissue interposition, the medial interface was completely disrupted and developed an interface layer. The distal and mid lateral side maintained within the strength criterion. Although the applied models were relatively simple, the results showed reasonable qualitative agreement with resorption patterns found in clinical studies concerning bone screws and the resurfacing cup. The hypothesis that interface debonding and subsequent relative (micro)motions could be responsible for bone resorption and fibrous tissue propagation is thereby sustained by the results.

Biomechanical Phenomena↗

PubMed1993

In vivo measurements of the loading conditions on the tibia of the goat.

In vivo strain measurements at 8 locations on the tibia of the goat were performed. Successive in vitro calibrations were used to determine the assumed linear relationship between the measured strain signals and the external loads (3 forces and 3 moments) at the tibia. For the reconstruction of the in vivo external loads from the strain data, a transformation matrix was created from the calibration experiments, using 'singular-value decomposition'. The method is a reliable technique for measuring in vivo loads during functional gait and gives reproducible results.

Animals↗

PubMed1992

Effects of material properties of femoral hip components on bone remodeling.

Bone loss around femoral hip stems is one of the problems threatening the long-term fixation of uncemented stems. Many believe that this phenomenon is caused by reduced stresses in the bone (stress shielding). In the present study the mechanical consequences of different femoral stem materials were investigated using adaptive bone remodeling theory in combination with the finite element method. Bone-remodeling in the femur around the implant and interface stresses between bone and implant were investigated for fully bonded femoral stems. Cemented stems (cobalt-chrome or titanium alloy) caused less bone resorption and lower interface stresses than uncemented stems made from the same materials. The range of the bone resorption predicted in the simulation models was from 23% in the proximal medial cortex surrounding the cemented titanium alloy stem to 76% in the proximal medial cortex around the uncemented cobalt-chrome stem. Very little bone resorption was predicted around a flexible, uncemented "iso-elastic" stem, but the proximal interface stresses increased drastically relative to the stiffer uncemented stems composed of cobalt-chrome or titanium alloy. However, the proximal interface stress peak was reduced and shifted during the adaptive remodeling process. The latter was found particularly in the stiffer uncemented cobalt-chrome-molybdenum implant and less for the flexible iso-elastic implant.

Alloys↗

PubMed1992

The behavior of adaptive bone-remodeling simulation models.

The process of adaptive bone remodeling can be described mathematically and simulated in a computer model, integrated with the finite element method. In the model discussed here, cortical and trabecular bone are described as continuous materials with variable density. The remodeling rule applied to simulate the remodeling process in each element individually is, in fact, an objective function for an optimization process, relative to the external load. Its purpose is to obtain a constant, preset value for the strain energy per unit bone mass, by adapting the density. If an element in the structure cannot achieve that, it either turns to its maximal density (cortical bone) or resorbs completely. It is found that the solution obtained in generally a discontinuous patchwork. For a two-dimensional proximal femur model this patchwork shows a good resemblance with the density distribution of a real proximal femur. It is shown that the discontinuous end configuration is dictated by the nature of the differential equations describing the remodeling process. This process can be considered as a nonlinear dynamical system with many degrees of freedom, which behaves divergent relative to the objective, leading to many possible solutions. The precise solution is dependent on the parameters in the remodeling rule, the load and the initial conditions. The feedback mechanism in the process is self-enhancing, denser bone attracts more strain energy, whereby the bone becomes even more dense. It is suggested that this positive feedback of the attractor state (the strain energy field) creates order in the end configuration. In addition, the process ensures that the discontinuous end configuration is a structure with a relatively low mass, perhaps a minimal-mass structure, although this is no explicit objective in the optimization process. It is hypothesized that trabecular bone is a chaotically ordered structure which can be considered as a fractal with characteristics of optimal mechanical resistance and minimal mass, of which the actual morphology depends on the local (internal) loading characteristics, the sensor-cell density and the degree of mineralization.

Bone Density↗

PubMed1992

Intramedullary fixation with screwed, conical stems--unsolicited results from animal experiments.

For the purpose of studying bone remodeling around prostheses, a segmental replacement for the goat tibia was designed, using a conical, screw-threaded, hydroxyapatite-coated stem for fixation. Eight goats were provided with the implant, seven of which loosened within 10 days post-operatively, displaying progressive radiolucency and gross rotational motion. The eighth one also loosened radiographically, but developed a stabilizing callus bridge to prevent motion. A second design of similar shape and coating, but lacking the screw threads, was designed and also applied in eight animals. In this case, no loosening occurred in the first 6 weeks post-operatively. It is concluded that the application of screwed intramedullary stems for prosthetic fixation is not a viable concept, because the threads prevent the stem from subsiding and restabilizing when minor initial interface stress-relaxation and remodeling has occurred.

Animals↗

PubMed1992

The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials.

Bone resorption around hip stems is a disturbing phenomenon, although its clinical significance and its eventual effects on replacement longevity are as yet uncertain. The relationship between implant flexibility and the extent of bone loss, frequently established in clinical patient series and animal experiments, does suggest that the changes in bone morphology are an effect of stress shielding and a subsequent adaptive remodeling process. This relationship was investigated using strain-adaptive bone-remodeling theory in combination with finite element models to simulate the bone remodeling process. The effects of stem material flexibility, bone flexibility, and bone reactivity on the process and its eventual outcome were studied. Stem flexibility was also related to proximal implant/bone interface stresses. The results sustain the hypothesis that the resorptive processes are an effect of bone adaptation to stress shielding. The effects of stem flexibility are confirmed by the simulation analysis. It was also established that individual differences in bone reactivity and mechanical bone quality (density and stiffness) may account for the individual variations found in patients and animal experiments. Flexible stems reduce stress shielding and bone resorption. However, they increase proximal interface stresses. Hence, the cure against bone resorption they represent may develop into increased loosening rates because of interface debonding and micromotion. The methods presented in this paper can be used to establish optimal stem-design characteristics or check the adequacy of designs in preclinical testing procedures.

Biomechanical Phenomena↗

PubMed1990

Trends of mechanical consequences and modeling of a fibrous membrane around femoral hip prostheses.

In the present study, the effects of a fibrous membrane between cement and bone in a femoral total hip replacement were investigated. The study involved the problem of modeling this fibrous membrane in finite-element analyses, and its global consequences for the load-transfer mechanism and its resulting stress patterns. A finite-element model was developed, suitable to describe nonlinear contact conditions in combination with nonlinear material properties of the fibrous membrane. The fibrous tissue layer was described as a highly compliant material with little resistance against tension and shear. The analysis showed that the load transfer mechanism from stem to bone changes drastically when such a membrane is present. These effects are predominantly caused by tensile loosening and slip at the interface, and are enhanced by the nonlinear membrane characteristics. Using parametric analysis, it was shown that these effects on the load-transfer mechanism cannot be described satisfactorily with linear elastic models. Most importantly, the fibrous tissue interposition causes excessive stress concentrations in bone and cement, and relatively high relative displacements between these materials.

Biomechanical Phenomena↗