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Abstract. A comparison study was conducted between titan and cobalt alloy,
shoulder prosthesis, with hydroxyapatite coating. We simulated the internal and
external rotation of the shoulder in order to compare the deformation, equivalent
strain and equivalent mechanical stress appeared for different types of prosthesis
covering layers. The results show that the maximum mechanical solicitations appear in similar humeral positions and the minimal solicitations were obtained for
cobalt alloy prosthesis with composite coatings. This study is innovative due to
the fact that it considers all muscle groups involved in shoulder movement and we
obtain a realistic estimate of the mechanical solicitations appeared into the humerus, and gives an estimate of the optimal material to be used for prosthesis cementing. Possible fracture risk can be determined and prevented in case a prosthesis is
implanted.
Keywords: Modeling, Finite element, Prosthesis, Shoulder, Collagen, Solicitations.
Introduction
Orthopedic implants are intended to support forces and must thereby be firmly attached to the rest of the skeleton [1]. Orthopedic implant devices are intended to
restore the function of load-bearing joints which are subjected to high level of
mechanical stresses, wear, and fatigue in the course of normal activity [2]. The
implant is placed in the body either with an acrylic cement that gradually fails as
regeneration of connecting bone tissue is proceeding, or without cement using an
implant with an interface designed to provide the necessary attachment. However,
a device fabricated from a single material usually cannot meet all physical requirements for successful implantation and function. Therefore, implants and
prostheses usually consist of composites and mixtures or alloys [3].
The problem of the prosthesis material to be used still remains open. There is a
need for high bonding inorganic surfaces to organic ones, and the development of
I. Dumitrache (Ed.): Adv. in Intelligent Control Systems & Computer Science, AISC 187, pp. 191205.
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Springer-Verlag Berlin Heidelberg 2013
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the major and minor humeral tubercles generated by muscle tendons in the rotator
cuff muscles during abduction. Internal and external rotations of the shoulders
were achieved by a displacement of the muscle active during the specific rotation
(subscapularis for internal and infrapinatus for external rotation [11].
Most models concentrate on force estimation and stability of the glenohumeral
joint; there are few models that measure the mechanical solicitation on the humerus during the shoulder movement. It is important to determine the deformation,
stress and strain into the humerus, in shoulder motion, by considering all muscle
groups involved, in order to prevent possible fractures in case there is a prosthesis
implanted. It is also important to determine the optimal material to be used in
prosthesis construction.
The purpose of this work was to develop a 3D digital model of prosthetic humerus and the rotator cuff muscles, and to investigate shoulder movement effect
on humerus and prosthesis. It was considered that for each movement, the muscles
involved act with a specified force on the humerus along its insertion area. There
were considered two types of prosthesis: one built from a Ti-6A1-4V alloy and the
other from CoCrMo alloy. For each type of prosthesis there were simulated the internal and external rotation, for three types of biomaterials used to cover it, respectively: hydroxyapatite layers, hydroxyapatite and collagen layers and composite
material hydroxyapatite and collagen. We studied and compared the mechanical
solicitation obtained for both types of prosthesis. The motivations were to assist in
prosthesis development, to determine the regions where the bone fracture is
more likely to appear and to determine which type of prosthesis coating is more
preferable to be used.
It is well known that the bone is not an isotropic material; therefore the development of a model is not an easy task. We can obtain a handy model of the humerus
by 3D scan and digital reconstruction. By using the finite element modeling approach one can analyze the deformation, strain and stress appeared into the bone
when external forces are applied. . Figure 1 shows the steps in achieving the finite
element model of the humerus. A prosthesis developed by Solar [12] is used to
analyze the mechanical behavior of the glenohumeral-prosthesis assembly.
In order to achieve the bone-prosthesis interface and to establish a contact between the interior surface of the bone and the prosthesis, it is necessary to cut up
the bone such that the prosthesis shape is respected. For an accurate analysis, concentricity and concurrency between the contact surfaces were established. The
bone prosthesis interface along with its covering layers were imported in Ansys
Workbench. Six contact surfaces between the assembly components were considered: prosthesis-bone, prosthesis-first covering layer, first covering layer
second covering layer, second covering layer-bone, prosthesis prosthetic
humeral layer and prosthesis-second covering layer.
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There were used two types of prosthesis: a Ti-6A1-4V alloy and a CoCrMo alloy prosthesis. For the titan alloy prosthesis were considered the following types
of covering layers:
Hydroxyapatite 2 mm covering layer;
Hydroxyapatite 1 mm and Collagen 1 mm covering layers;
Composite material Hydroxyapatite and Collagen 2 mm covering layers
For the cobalt alloy prosthesis were considered the following types of covering
layers:
Hydroxyapatite 1 mm and Collagen 1 mm covering layers
Composite material Hydroxyapatite and Collagen 2 mm covering layers
Simulation
We simulated two types of movement for the healthy and prosthetic shoulder: external and internal rotation. In order to simulate the muscle activity the insertion of
each muscle was drawn on the finite element model of the humerus and humerusprosthesis assembly according to Gray Anatomy [13].
The simulation performed using the following assumptions:
The muscles involved in the external rotation are: Infraspinatus, Teres minor,
Deltoidus and Supraspinatus.
The muscles that participate in the internal rotation are: Subscapularis, Latissimus Dorsi, Teres major, Pectoralis major, Deltoidus and Brahialis.
In each insertion point on the humerus a force of 22N was applied.
For each individual muscle, the force direction was chosen according to its insertion angle on the humerus
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Results
Total deformation, equivalent strain and the equivalent mechanical stress are investigated and analyzed for both shoulder rotation movements, for all types of
prosthesis. Due to the fact that in many cases, the mechanical solicitations appear
in similar humeral positions, there are presented only the representative cases.
4.1
4.2
If the internal rotation is simulated for the prosthetic glenohumeral joint, figure 5
shows that the total deformation appears close to the center of the diaphysis and decreases along the bone. The equivalent strain, (fig. 6 and 7), is not the same for all
types of prosthesis. For the Ti-6A1-4V alloy prosthesis with: Hydroxyapatite 2 mm;
composite material Hydroxyapatite and Collagen 2 mm covering layer and CoCrMo
alloy with composite material Hydroxyapatite and Collagen 2 mm covering layer,
the equivalent strain is distributed along the bone and reaches a maximum at the distal part of the epiphysis. For the Ti-6A1-4V alloy with: Hydroxyapatite and Collagen 2 mm covering layers and CoCrMo alloy Hydroxyapatite and Collagen 2 mm
covering layers, the equivalent strain appears in the proximal part of the humerus, at
the junction with the prosthesis. The equivalent stress is distributed along the prosthesis and has a maximum in the distal part of the prosthesis (fig. 8).
Discussion
Analyzing the simulation results one could see that for the external rotation, maximum mechanical solicitations appeared in similar humeral positions. In terms of
materials used for prosthesis construction, the lowest total value was obtained for
cobalt alloy prosthesis with composite coatings composed of hydroxyapatite and
collagen, and the highest value is obtained for the titanium prosthesis coated with
hydroxyapatite 1 mm and collagen 1 mm (fig 9). The titan alloy prosthesis
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Fig. 2. Total deformation during external rotation for all types of prostheses
Fig. 3. Equivalent strain during external rotation for all types of prostheses
Fig. 4. Equivalent mechanical stress during external rotation for all types of prostheses
Fig. 5. Total deformation during internal rotation for all types of prostheses
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Fig. 6. Equivalent strain during internal rotation for: a Ti-6A1-4V alloy with: Hydroxyapatite 2 mm; composite material Hydroxyapatite and Collagen 2 mm covering layer and
CoCrMo alloy with composite material Hydroxyapatite and Collagen 2 mm covering layer
Fig. 7. Equivalent strain during internal rotation for: a Ti-6A1-4V alloy with: Hydroxyapatite and Collagen 2 mm covering layers and CoCrMo alloy Hydroxyapatite and Collagen 2
mm covering layers
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Fig. 8. Equivalent mechanical stress during external rotation for all types of prostheses
with hydroxyapatite 2 mm covering layer, also has a big value compared to the
other types of prosthesis used. The minimum equivalent strain was obtained for
implants with titanium and cobalt composite coatings composed of hydroxyapatite
and collagen, and the maximum values for the prostheses of titanium or cobalt alloy coated with hydroxyapatite 1 mm and collagen 1 mm (fig 10). By analyzing
the results from figure (10), one can see that there were obtained very small numerical values of the equivalent strain, for the titan alloy prosthesis with hydroxyapatite 2 mm covering layer. It can be seen that the difference between the values
obtained for the prostheses of titanium or cobalt alloy coated with hydroxyapatite
1 mm and collagen 1 mm and the other three types of prosthesis used is very large.
Mechanical stress had its minimum for titan alloy prosthesis with hydroxyapatite 2
mm coating and the maximum mechanical stress for the cobalt alloy prosthesis
coated with hydroxyapatite 1 mm and collagen 1 mm (fig 11). It can be seen that
the difference between the minimal and maximal value is large, and also the value
of the strain for the titan alloy prosthesis with hydroxyapatite 2 mm coating is
much smaller than the values obtained for all the other prosthesis.
If the internal rotation was simulated the maximum total deformation occurred
in the diaphysis closer to the proximal epiphysis. The maximum equivalent strain
was obtained in the distal part of the prosthesis at the junction between bone and
prosthesis and distal epiphysis. The minimum total deformation for internal rotation was obtained when we used cobalt alloy prosthesis with composite coatings
composed of hydroxyapatite and collagen, and the maximum for titanium alloy
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Fig. 10. Comparison between equivalent strain values for external rotation
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Fig. 11. Comparison between equivalent mechanical stress values for external rotation
prosthesis coated with hydroxyapatite 1 mm and collagen 1 mm (fig. 12). By analyzing figure (12), one can see that the numerical values obtained for the deformation have similar range. Equivalent strain was minimum for cobalt alloy prosthesis
with composite coating and maximum if we used titanium alloy prosthesis with
hydroxyapatite 1 mm and collagen 1 mm covering layers (fig. 13). It can be seen
that, similar to the external rotation case, the difference between the values obtained for the prostheses of titanium or cobalt alloy coated with hydroxyapatite 1
mm and collagen 1 mm and the other three types of prosthesis used is very large.
The minimum mechanical stress was obtained when we used a titanium alloy
prosthesis coated with hydroxyapatite 2 mm and a maximum for cobalt alloy prosthesis with composite covering layers (fig. 14). It can be seen that the numerical
values are very large for the rest of prosthesis if we compare to the numerical values obtained for the titanium alloy prosthesis coated with hydroxyapatite 2 mm.
Analyzing the data we can see that we obtain a maximum total deformation titanium alloy prosthesis coated with of hydroxyapatite 1 mm and collagen 1 mm,
for both movements. For both rotational movements to obtain minimum values,
cobalt alloy prosthesis with composite coatings, had to be used. One can say that
in terms of total deformation it is preferable to use cobalt alloy prosthesis with
composite coating. If we analyze the strain we can see that we obtain a maximum
for titanium alloy prosthesis coated with of hydroxyapatite 1 mm and collagen 1
mm for both movements and we obtain a minimum value for titanium alloy prosthesis with composite material coating. If we look at the values obtained for the
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Fig. 14. Comparison between mechanical stress values for internal rotation
mechanical stress it be seen that the maximum value obtained for the external rotation is for the titanium alloy prosthesis with hydroxyapatite 1 mm coatings and
cobalt 1mm and for the internal rotation for the cobalt alloy prosthesis with composite covering layers. Minimum value for the stress is obtained for titanium alloy
prosthesis with hydroxyapatite 2 mm coatings for external rotation. For the internal rotation we obtain a minimum using titanium alloy prosthesis with hydroxyapatite 2 mm covering layers. By analyzing these data we can see that there are materials for which the deformation is minimal but the equivalent strain and stress
are maximum. Although the mechanical stress gives us more data on fracture risk
the total deformation and equivalent strain can not be ignored. It can be concluded
that it is preferable to use cobalt alloy prosthesis with composite material coatings.
Conclusions
This study analyzed the load, stress and strain equivalent distribution for titan and
cobalt alloy prosthesis covered with different types of biomaterials, during external and internal rotation of the shoulder.
3D models for the humerus, the prosthesis and the humerus-prosthesis assembly were obtained and the external rotation and internal rotations were simulated.
In order to simulate the muscle activity the insertion area of each muscle was
drawn on the finite element model of the humerus and humerus-prosthesis. In each
insertion point on the humerus a force of 22N was applied.
The simulation results showed that for all the movements the maximum mechanical solicitation appeared in similar areas for all types of prosthesis used.
Analyzing the data obtained it can be concluded that none of the materials used
for the simulations did behave better than the rest materials, those who had low
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strain and deformation, had higher values for mechanical stress, but none of the
analyzed cases exceeded the maximum limits, which would destroy the materials.
It can be concluded that it is preferable to use cemented cobalt alloy prosthesis
with composite coatings. By considering this one has to take in consideration other properties of the material used: elasticity, yield stress, ductility, toughness, wear
resistance, bonding to the bone. Also a real estimate of the muscle forces has to be
obtained, by using EMG (electromyography) based methods [14].
Using this type of modeling one can study the material characteristics used to
construct the prostheses and to perform complete analyses, due to the fact that
there are other physical properties that can be studied. By incorporating the muscle insertions into the model, the maximum humeral fracture risk can be determined, for all shoulder movements. Due to the fact that the prosthesis material can
be changed, one can say that these models are versatile and can be further used to
test cemented prosthesis, and different cement materials, in order to determine
their biomechanical behavior.
Although there are many models that analyze muscle action developed during
certain movements; there are few models that measure the mechanical solicitation
on the humerus during the shoulder movement. Only muscles inserted around the
humeral rotator cuff are used in previous studies. This study is innovative due to
the fact that it considers all muscle groups involved shoulder movement and it obtains a realistic estimate of the mechanical solicitations appeared into the humerus
for many types of material used to build the prosthesis. Possible fracture risk can
be determined and prevented in case a prosthesis is implanted.
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