Displaying publications 1 - 20 of 63 in total

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  1. A finite element study: Finding the best configuration between unilateral, hybrid, and ilizarov in terms of biomechanical point of view
    Abd Aziz AU, Abdul Wahab AH, Abdul Rahim RA, Abdul Kadir MR, Ramlee MH
    Injury, 2020 Nov;51(11):2474-2478.
    PMID: 32798038 DOI: 10.1016/j.injury.2020.08.001
    In an open fracture, the external fixator is one of the definitive treatment options as it could provide the initial stabilisation of the fractured bone. Limited literature discussing on the biomechanical stability between unilateral, hybrid and Ilizarov configurations, principally in treating a femoral fracture. Thus, this study aims to analyse the biomechanical stability of different external fixators via the finite element method (FEM). The present study portrays that different configurations of fixators possess different biomechanical stability, hence leading to different healing rates and complication risks. For the methodology, three-dimensional models of three different external fixators were reconstructed where axial loads were applied on the proximal end of the femur, simulating the stance phase. From the results, the unilateral configuration provides better stability compared to the hybrid and Ilizarov, where it displaced the least with an average percentage difference of 50% for the fixator's frame and 23% for the bone. The unilateral configuration also produced the least interfragmentary movement (0.48 mm) as compared to hybrid (0.62 mm) and Ilizarov (0.61 mm) configurations. Besides, the strain and stress of the unilateral configuration were superior in terms of stability compared to the other two configurations. As a conclusion, the unilateral configuration had the best biomechanical stability as it was able to assist the bone healing process as well as minimising the risk of pin tract infection while treating a femoral fracture.
  2. Fulltext Unilateral external fixator and its biomechanical effects in treating different types of femoral fracture: A finite element study with experimental validated model
    Abd Aziz AU, Ammarullah MI, Ng BW, Gan HS, Abdul Kadir MR, Ramlee MH
    Heliyon, 2024 Feb 29;10(4):e26660.
    PMID: 38404809 DOI: 10.1016/j.heliyon.2024.e26660
    Previous works had successfully demonstrated the clinical effectiveness of unilateral external fixator in treating various types of fracture, ranging from the simple type, such as oblique and transverse fractures, to complex fractures. However, literature that investigated its biomechanical analyses to further justify its efficacy is limited. Therefore, this paper aimed to analyse the stability of unilateral external fixator for treating different types of fracture, including the simple oblique, AO32C3 comminuted, and 20 mm gap transverse fracture. These fractures were reconstructed at the distal diaphysis of the femoral bone and computationally analysed through the finite element method under the stance phase condition. Findings showed a decrease in the fixation stiffness in large gap fracture (645.2 Nmm-1 for oblique and comminuted, while 23.4 Nmm-1 for the gap fracture), which resulted in higher displacement, IFM and stress distribution at the pin bone interface. These unfavourable conditions could consequently increase the risk of delayed union, pin loosening and infection, as well as implant failure. Nevertheless, the stress observed on the fracture surfaces was relatively low and in controlled amount, indicating that bone unity is still allowable in all models. Briefly, the unilateral fixation may provide desirable results in smaller fracture gap, but its usage in larger gap fracture might be alarming. These findings could serve as a guide and insight for surgeons and researchers, especially on the biomechanical stability of fixation in different fracture types and how will it affect bone unity.
  3. Biomechanical evaluation of three different configurations of external fixators for treating distal third tibia fracture: Finite element analysis in axial, bending and torsion load
    Abdul Wahab AH, Wui NB, Abdul Kadir MR, Ramlee MH
    Comput Biol Med, 2020 12;127:104062.
    PMID: 33096298 DOI: 10.1016/j.compbiomed.2020.104062
    External fixators have been widely used in treating open fractures and have produced excellent outcomes, as they could successfully heal bones. The stability of external fixators lies greatly in their construction. Factors that associated with the stability of the external fixators includes stress, displacement, and relative micromotion. Three-dimensional (3D) models of bone and external fixators were constructed by using 3D modelling software, namely Materialise and SolidWorks, respectively. Three different configurations of external fixators namely Model 1, Model 2, and Model 3 were analysed. Three load cases were simulated to assess the abovementioned factors at the bone, specifically at the fracture site and at the external fixator. Findings showed that the double-cross configuration (Model 3) was the most promising in axial, bending, and torsion load cases as compared to the other two configurations. The no-cross configuration (Model 1) had the highest risk of complication due to high stress, relative micromotion, and displacement in the bending and torsion load cases. On the other hand, the single-cross configuration (Model 2) had the highest risk of complication when applied with axial load. In conclusion, the double-cross locking construct (Model 3) showed the biggest potential to be a new option for medical surgeons in treating patients associated with bone fracture. This new double-cross locking construct showed superior biomechanical stability as compared to single-cross and no-cross configurations in the axial, bending, and torsion load cases.
  4. Effects of conform, non-conform, and hybrid conformity toward stress distribution at the glenoid implant and cement: A finite element study
    Abdul Wahab AH, Mohamad Azmi NA, Abdul Kadir MR, Md Saad AP
    Int J Artif Organs, 2022 Feb;45(2):200-206.
    PMID: 33645338 DOI: 10.1177/0391398821999391
    Glenoid conformity is one of the important aspects that could contribute to implant stability. However, the optimal conformity is still being debated among the researchers. Therefore, this study aims to analyze the stress distribution of the implant and cement in three types of conformity (conform, non-conform, and hybrid) in three load conditions (central, anterior, and posterior). Glenoid implant and cement were reconstructed using Solidwork software and a 3D model of scapula bone was done using MIMICS software. Constant load, 750 N, was applied at the central, anterior, and posterior region of the glenoid implant which represents average load for daily living activities for elder people, including, walking with a stick and standing up from a chair. The results showed that, during center load, an implant with dual conformity (hybrid) showed the best (Max Stress-3.93 MPa) and well-distributed stress as compared to other conformity (Non-conform-7.21 MPa, Conform-9.38 MPa). While, during eccentric load (anterior and posterior), high stress was located at the anterior and posterior region with respect to the load applied. Cement stress for non-conform and hybrid implant recorded less than 5 MPa, which indicates it had a very low risk to have cement microcracks, whilst, conform implant was exposed to microcrack of the cement. In conclusion, hybrid conformity showed a promising result that could compromise between conform and non-conform implant. However, further enhancement is required for hybrid implants when dealing with eccentric load (anterior and posterior).
  5. Biomechanical and bioactivity concepts of polyetheretherketone composites for use in orthopedic implants-a review
    Abdullah MR, Goharian A, Abdul Kadir MR, Wahit MU
    J Biomed Mater Res A, 2015 Nov;103(11):3689-702.
    PMID: 25856801 DOI: 10.1002/jbm.a.35480
    The use of polyetheretherketone (PEEK) composites in the trauma plating system, total replacement implants, and tissue scaffolds has found great interest among researchers. In recent years (2008 afterward), this type of composites has been examined for suitability as substitute material over stainless steel, titanium alloys, ultra high molecular weight polyethylene, or even biodegradable materials in orthopedic implant applications. Biomechanical and bioactivity concepts were contemplated for the development of PEEK orthopedic implants and a few primary clinical studies reported the clinical outcomes of PEEK-based orthopedic implants. This study aims to review and discuss the recent concepts and contribute further concepts in terms of biomechanical and bioactivity challenges for the development of PEEK and PEEK composites in orthopedic implants.
  6. Fulltext Mechanical, rheological, and bioactivity properties of ultra high-molecular-weight polyethylene bioactive composites containing polyethylene glycol and hydroxyapatite
    Ahmad M, Uzir Wahit M, Abdul Kadir MR, Mohd Dahlan KZ
    ScientificWorldJournal, 2012;2012:474851.
    PMID: 22666129 DOI: 10.1100/2012/474851
    Ultrahigh-molecular-weight polyethylene/high-density polyethylene (UHMWPE/HDPE) blends prepared using polyethylene glycol PEG as the processing aid and hydroxyapatite (HA) as the reinforcing filler were found to be highly processable using conventional melt blending technique. It was demonstrated that PEG reduced the melt viscosity of UHMWPE/HDPE blend significantly, thus improving the extrudability. The mechanical and bioactive properties were improved with incorporation of HA. Inclusion of HA from 10 to 50 phr resulted in a progressive increase in flexural strength and modulus of the composites. The strength increment is due to the improvement on surface contact between the irregular shape of HA and polymer matrix by formation of mechanical interlock. The HA particles were homogenously distributed even at higher percentage showed improvement in wetting ability between the polymer matrix and HA. The inclusion of HA enhanced the bioactivity properties of the composite by the formation of calcium phosphate (Ca-P) precipitates on the composite surface as proven from SEM and XRD analysis.
  7. Fulltext The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis
    Alizadeh M, Kadir MR, Fadhli MM, Fallahiarezoodar A, Azmi B, Murali MR, et al.
    J Orthop Res, 2013 Sep;31(9):1447-54.
    PMID: 23640802 DOI: 10.1002/jor.22376
    Posterior instrumentation is a common fixation method used to treat thoracolumbar burst fractures. However, the role of different cross-link configurations in improving fixation stability in these fractures has not been established. A 3D finite element model of T11-L3 was used to investigate the biomechanical behavior of short (2 level) and long (4 level) segmental spine pedicle screw fixation with various cross-links to treat a hypothetical L1 vertebra burst fracture. Three types of cross-link configurations with an applied moment of 7.5 Nm and 200 N axial force were evaluated. The long construct was stiffer than the short construct irrespective of whether the cross-links were used (p < 0.05). The short constructs showed no significant differences between the cross-link configurations. The XL cross-link provided the highest stiffness and was 14.9% stiffer than the one without a cross-link. The long construct resulted in reduced stress to the adjacent vertebral bodies and screw necks, with 66.7% reduction in bending stress on L2 when the XL cross-link was used. Thus, the stability for L1 burst fracture fixation was best achieved by using long segmental posterior instrumentation constructs and an XL cross-link configuration. Cross-links did not improved stability when a short structure was used.
  8. Fulltext Preparation Methods for Improving PEEK's Bioactivity for Orthopedic and Dental Application: A Review
    Almasi D, Iqbal N, Sadeghi M, Sudin I, Abdul Kadir MR, Kamarul T
    Int J Biomater, 2016;2016:8202653.
    PMID: 27127513 DOI: 10.1155/2016/8202653
    There is an increased interest in the use of polyether ether ketone (PEEK) for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods.
  9. Fulltext In vitro evaluation of bioactivity of chemically deposited hydroxyapatite on polyether ether ketone
    Almasi D, Izman S, Sadeghi M, Iqbal N, Roozbahani F, Krishnamurithy G, et al.
    Int J Biomater, 2015;2015:475435.
    PMID: 25838826 DOI: 10.1155/2015/475435
    Polyether ether ketone (PEEK) is considered the best alternative material for titanium for spinal fusion cage implants due to its low elasticity modulus and radiolucent property. The main problem of PEEK is its bioinert properties. Coating with hydroxyapatite (HA) showed very good improvement in bioactivity of the PEEK implants. However the existing methods for deposition of HA have some disadvantages and damage the PEEK substrate. In our previous study a new method for deposition of HA on PEEK was presented. In this study cell proliferation of mesenchymal stem cell and apatite formation in simulated body fluid (SBF) tests were conducted to probe the effect of this new method in improvement of the bioactivity of PEEK. The mesenchymal stem cell proliferation result showed better cells proliferation on the treated layer in comparison with untreated PEEK. The apatite formation results showed the growth of the HA on the treated PEEK but there was not any sight of the growth of HA on the untreated PEEK even after 2 weeks. The results showed the new method of the HA deposition improved the bioactivity of the treated PEEK in comparison with the bare PEEK.
  10. Arabinoxylan/graphene-oxide/nHAp-NPs/PVA bionano composite scaffolds for fractured bone healing
    Aslam Khan MU, Haider A, Abd Razak SI, Abdul Kadir MR, Haider S, Shah SA, et al.
    J Tissue Eng Regen Med, 2021 04;15(4):322-335.
    PMID: 33432773 DOI: 10.1002/term.3168
    The importance of bone scaffolds has increased many folds in the last few years; however, during bone implantation, bacterial infections compromise the implantation and tissue regeneration. This work is focused on this issue while not compromising on the properties of a scaffold for bone regeneration. Biocomposite scaffolds (BS) were fabricated via the freeze-drying technique. The samples were characterized for structural changes, surface morphology, porosity, and mechanical properties through spectroscopic (Fourier transform-infrared [FT-IR]), microscopic (scanning electron microscope [SEM]), X-ray (powder X-ray diffraction and energy-dispersive X-ray), and other analytical (Brunauer-Emmett-Teller, universal testing machine Instron) techniques. Antibacterial, cellular, and hemocompatibility assays were performed using standard protocols. FT-IR confirmed the interactions of all the components. SEM illustrated porous and interconnected porous morphology. The percentage porosity was in the range of 49.75%-67.28%, and the pore size was 215.65-470.87 µm. The pore size was perfect for cellular penetration. Thus, cells showed significant proliferation onto these scaffolds. X-ray studies confirmed the presence of nanohydroxyapatite and graphene oxide (GO). The cell viability was 85%-98% (BS1-BS3), which shows no significant toxicity of the biocomposite. Furthermore, the biocomposites exhibited better antibacterial activity, no effect on the blood clotting (normal in vitro blood clotting), and less than 5% hemolysis. The ultimate compression strength for the biocomposites increased from 4.05 to 7.94 with an increase in the GO content. These exciting results revealed that this material has the potential for possible application in bone tissue engineering.
  11. Biomechanical analysis of the wrist arthroplasty in rheumatoid arthritis: a finite element analysis
    Bajuri MN, Abdul Kadir MR, Murali MR, Kamarul T
    Med Biol Eng Comput, 2013 Feb;51(1-2):175-86.
    PMID: 23124814 DOI: 10.1007/s11517-012-0982-9
    The total replacement of wrists affected by rheumatoid arthritis (RA) has had mixed outcomes in terms of failure rates. This study was therefore conducted to analyse the biomechanics of wrist arthroplasty using recently reported implants that have shown encouraging results with the aim of providing some insights for the future development of wrist implants. A model of a healthy wrist was developed using computed tomography images from a healthy volunteer. An RA model was simulated based on all ten general characteristics of the disease. The ReMotion ™ total wrist system was then modelled to simulate total wrist arthroplasty (TWA). Finite element analysis was performed with loads simulating the static hand grip action. The results show that the RA model produced distorted patterns of stress distribution with tenfold higher contact pressure than the healthy model. For the TWA model, contact pressure was found to be approximately fivefold lower than the RA model. Compared to the healthy model, significant improvements were observed for the TWA model with minor variations in the stress distribution. In conclusion, the modelled TWA reduced contact pressure between bones but did not restore the stress distribution to the normal healthy condition.
  12. Biomechanical analysis of rheumatoid arthritis of the wrist joint
    Bajuri MN, Kadir MR, Amin IM, Ochsner A
    Proc Inst Mech Eng H, 2012 Jul;226(7):510-20.
    PMID: 22913098 DOI: 10.1177/0954411912445846
    The wrist is the most complex joint for virtual three-dimensional simulations, and the complexity is even more pronounced when dealing with skeletal disorders of the joint such, as rheumatoid arthritis (RA). In order to analyse the biomechanical difference between healthy and diseased joints, three-dimensional models of these two wrist conditions were developed from computed tomography images. These images consist of eight carpal bones, five metacarpal bones, the distal radius and ulna. The cartilages were developed based on the shape of the available articulations and ligaments were simulated via mechanical links. The RA model was developed accurately by simulating all ten common criteria of the disease related to the wrist. Results from the finite element (FE) analyses showed that the RA model produced three times higher contact pressure at the articulations compared to the healthy model. Normal physiological load transfer also changed from predominantly through the radial side to an increased load transfer approximately 5% towards the ulnar. Based on an extensive literature search, this is the first ever reported work that simulates the pathological conditions of the rheumatoid arthritis of the wrist joint.
  13. Mechanical and functional assessment of the wrist affected by rheumatoid arthritis: A finite element analysis
    Bajuri MN, Kadir MR, Raman MM, Kamarul T
    Med Eng Phys, 2012 Nov;34(9):1294-302.
    PMID: 22277308 DOI: 10.1016/j.medengphy.2011.12.020
    Understanding the pathomechanics involved in rheumatoid arthritis (RA) of the wrist provides valuable information, which will invariably allow various therapeutic possibilities to be explored. The computational modelling of this disease permits the appropriate simulation to be conducted seamlessly. A study that underpins the fundamental concept that produces the biomechanical changes in a rheumatoid wrist was thus conducted through the use of finite element method. The RA model was constructed from computed tomography datasets, taking into account three major characteristics: synovial proliferation, cartilage destruction and ligamentous laxity. As control, a healthy wrist joint model was developed in parallel and compared. Cartilage was modelled based on the shape of the articulation while the ligaments were modelled with linear spring elements. A load-controlled analysis was performed simulating physiological hand grip loading conditions. The results demonstrated that the diseased model produced abnormal wrist extension and stress distribution as compared to the healthy wrist model. Due to the weakening of the ligaments, destruction of the cartilage and lower bone density, the altered biomechanical stresses were particularly evident at the radioscaphoid and capitolunate articulations which correlate to clinical findings. These results demonstrate the robust finding of the developed RA wrist model, which accurately predicted the pathological process.
  14. Deposition of nanostructured fluorine-doped hydroxyapatite-polycaprolactone duplex coating to enhance the mechanical properties and corrosion resistance of Mg alloy for biomedical applications
    Bakhsheshi-Rad HR, Hamzah E, Kasiri-Asgarani M, Jabbarzare S, Iqbal N, Abdul Kadir MR
    Mater Sci Eng C Mater Biol Appl, 2016 Mar;60:526-537.
    PMID: 26706560 DOI: 10.1016/j.msec.2015.11.057
    The present study addressed the synthesis of a bi-layered nanostructured fluorine-doped hydroxyapatite (nFHA)/polycaprolactone (PCL) coating on Mg-2Zn-3Ce alloy via a combination of electrodeposition (ED) and dip-coating methods. The nFHA/PCL composite coating is composed of a thick (70-80 μm) and porous layer of PCL that uniformly covered the thin nFHA film (8-10 μm) with nanoneedle-like microstructure and crystallite size of around 70-90 nm. Electrochemical measurements showed that the nFHA/PCL composite coating presented a high corrosion resistance (R(p)=2.9×10(3) kΩ cm(2)) and provided sufficient protection for a Mg substrate against galvanic corrosion. The mechanical integrity of the nFHA/PCL composite coatings immersed in SBF for 10 days showed higher compressive strength (34% higher) compared with the uncoated samples, indicating that composite coatings can delay the loss of compressive strength of the Mg alloy. The nFHA/PCL coating indicted better bonding strength (6.9 MPa) compared to PCL coating (2.2 MPa). Immersion tests showed that nFHA/PCL composite-coated alloy experienced much milder corrosion attack and more nucleation sites for apatite compared with the PCL coated and uncoated samples. The bi-layered nFHA/PCL coating can be a good alternative method for the control of corrosion degradation of biodegradable Mg alloy for implant applications.
  15. Age estimation based on bone length using 12 regression models of left hand X-ray images for Asian children below 19 years old
    Darmawan MF, Yusuf SM, Abdul Kadir MR, Haron H
    Leg Med (Tokyo), 2015 Mar;17(2):71-8.
    PMID: 25456051 DOI: 10.1016/j.legalmed.2014.09.006
    Age estimation was used in forensic anthropology to help in the identification of individual remains and living person. However, the estimation methods tend to be unique and applicable only to a certain population. This paper analyzed age estimation using twelve regression models carried out on X-ray images of the left hand taken from an Asian data set for subjects under the age of 19. All the nineteen bones of the left hand were measured using free image software and the statistical analysis were performed using SPSS. There are two methods to determine age in this study which are single bone method and all bones method. For single bone method, S-curve regression model was found to have the highest R-square value using second metacarpal for males, and third proximal phalanx for females. For age estimation using single bone, fifth metacarpal from males and fifth proximal phalanx from females can be used due to the lowest mean square error (MSE) value. To conclude, multiple linear regressions is the best techniques for age estimation in cases where all bones are available, but if not, S-curve regression can be used using single bone method.
  16. Comparison on three classification techniques for sex estimation from the bone length of Asian children below 19 years old: an analysis using different group of ages
    Darmawan MF, Yusuf SM, Kadir MR, Haron H
    Forensic Sci Int, 2015 Feb;247:130.e1-11.
    PMID: 25540897 DOI: 10.1016/j.forsciint.2014.11.007
    Sex estimation is used in forensic anthropology to assist the identification of individual remains. However, the estimation techniques tend to be unique and applicable only to a certain population. This paper analyzed sex estimation on living individual child below 19 years old using the length of 19 bones of left hand applied for three classification techniques, which were Discriminant Function Analysis (DFA), Support Vector Machine (SVM) and Artificial Neural Network (ANN) multilayer perceptron. These techniques were carried out on X-ray images of the left hand taken from an Asian population data set. All the 19 bones of the left hand were measured using Free Image software, and all the techniques were performed using MATLAB. The group of age "16-19" years old and "7-9" years old were the groups that could be used for sex estimation with as their average of accuracy percentage was above 80%. ANN model was the best classification technique with the highest average of accuracy percentage in the two groups of age compared to other classification techniques. The results show that each classification technique has the best accuracy percentage on each different group of age.
  17. Three-dimensional morphometric study of the trapezium shape of the trochlea tali
    Daud R, Abdul Kadir MR, Izman S, Md Saad AP, Lee MH, Che Ahmad A
    J Foot Ankle Surg, 2013 Jul-Aug;52(4):426-31.
    PMID: 23623302 DOI: 10.1053/j.jfas.2013.03.007
    The trapezium shape of the talar dome limits the use of 2-dimensional plain radiography for morphometric assessment because only 2 of the 4 required parameters can be measured. We used computed tomography data to measure the 4 morphologic parameters of the trochlea tali: anterior width, posterior width, trochlea tali length, and angle of trapezium shape. A total of 99 subjects underwent computed tomography scanning, and the left and right talus bones were both virtually modeled in 3 dimensions. The 4 morphologic parameters were measured 3 times each to obtain the intraclass correlation, and analysis of variance was used to check for any significant differences between the repeated measurements. The average intraclass correlation coefficient for the measurements for 2 to 3 trials was 0.94 ± 0.04. Statistical analyses were performed on the data from all 198 talus bones using SAS software, comparing male and female and left and right bones. All 4 morphometric values were greater in the male group. No significant differences were found between the left and right talus bones. A strong positive correlation was observed between the trochlea tali length and the anterior width. The angle of trapezium shape showed no correlation with the other 3 parameters. The measurements were compared with the dimensions of the current talar components of 4 total ankle arthroplasty implants. However, most of them did not perfectly match the trapezium shape of the talus from our population. We successfully analyzed the trapezium shape of the trochlea tali using reliable virtual 3-dimensional measurements. Compared with other published reports, our study showed a relatively smaller dimension of the trochlea tali than the European counterparts.
  18. Geometric variable designs of cam/post mechanisms influence the kinematics of knee implants
    Fallahiarezoodar A, Abdul Kadir MR, Alizadeh M, Naveen SV, Kamarul T
    Knee Surg Sports Traumatol Arthrosc, 2014 Dec;22(12):3019-27.
    PMID: 25149643 DOI: 10.1007/s00167-014-3227-7
    PURPOSE: Reproducing the femoral rollback through specially designed mechanism in knee implants is required to achieve full knee function in total knee arthroplasty. Most contemporary implants use cam/post mechanism to replace the function of Posterior Cruciate Ligament. This study was aimed to determine the most appropriate cam and post designs to produce normal femoral rollback of the knee.

    METHODS: Three different cams (triangle, ellipse, and circle) and three different posts (straight, convex, concave) geometries were considered in this study and were analysed using kinematic analyses. Femoral rollback did not occur until reaching 50° of knee flexion. Beyond this angle, two of the nine combinations demonstrate poor knee flexion and were eliminated from the study.

    RESULTS: The combination of circle cam with concave post, straight post and convex post showed 15.6, 15.9 and 16.1 mm posterior translation of the femur, respectively. The use of ellipse cam with convex post and straight post demonstrated a 15.3 and 14.9 mm femoral rollback, whilst the combination of triangle cam with convex post and straight post showed 16.1 and 15.8 mm femoral rollback, respectively.

    CONCLUSION: The present study demonstrates that the use of circle cam and convex post created the best femoral rollback effect which in turn produces the highest amount of knee flexion. The findings of the study suggest that if the design is applied for knee implants, superior knee flexion may be possible for future patients.

    LEVEL OF EVIDENCE: IV.

  19. Effect of torsional loading on compressive fatigue behaviour of trabecular bone
    Fatihhi SJ, Rabiatul AA, Harun MN, Kadir MR, Kamarul T, Syahrom A
    J Mech Behav Biomed Mater, 2016 Feb;54:21-32.
    PMID: 26410762 DOI: 10.1016/j.jmbbm.2015.09.006
    The present study reports the effects of combined torsional and compressive cyclic loading on trabecular bone in order to mimic true physiological conditions and thereby provides improved data that represents clinical and real life conditions. However, only compressive behaviour is evaluated in most previous studies of bone mechanics. From the monotonic evaluation, it is observed that lower stress is needed for the onset of microcrack in the sample under torsional loading, compared to the stress needed in compression. Trabecular bone samples were subjected to a combination of torsion and compression fatigue at different stress levels during which they were compared to compressive axial fatigue. The stress levels were determined by considering the monotonic strength at 25-50% for both compressive and shear stresses. Significant decrease in fatigue lifetime is observed in between samples of pure compression fatigue and those with superpositioned torsional loading (p<0.05). The reduction in fatigue lifetime became more evident at a high torsional stress level. In this case, the failure of the sample is said to be 'torsional dominant'. Fatigue behaviour of bovine trabecular bone begins with plastic deformation, followed by strain accumulation and modulus reduction. As the strain rate increases, more energy dissipates and the sample finally failed. Further, the analysis of fractograph revealed something on the trabeculae by bending in sample with superpositioned torsional loading. In conclusion, torsional loading decreases the quality of the trabecular properties in terms of stiffness, life and structural integrity. It is hoped that results from this study will improve the understanding of the behaviour of trabecular bone under combined fatigue and help to develop future assessments of trabecular failure.
  20. Uniaxial and Multiaxial Fatigue Life Prediction of the Trabecular Bone Based on Physiological Loading: A Comparative Study
    Fatihhi SJ, Harun MN, Abdul Kadir MR, Abdullah J, Kamarul T, Öchsner A, et al.
    Ann Biomed Eng, 2015 Oct;43(10):2487-502.
    PMID: 25828397 DOI: 10.1007/s10439-015-1305-8
    Fatigue assessment of the trabecular bone has been developed to give a better understanding of bone properties. While most fatigue studies are relying on uniaxial compressive load as the method of assessment, in various cases details are missing, or the uniaxial results are not very realistic. In this paper, the effect of three different load histories from physiological loading applied on the trabecular bone were studied in order to predict the first failure surface and the fatigue lifetime. The fatigue behaviour of the trabecular bone under uniaxial load was compared to that of multiaxial load using a finite element simulation. The plastic strain was found localized at the trabecular structure under multiaxial load. On average, applying multiaxial loads reduced more than five times the fatigue life of the trabecular bone. The results provide evidence that multiaxial loading is dominated in the low cycle fatigue in contrast to the uniaxial one. Both bone volume fraction and structural model index were best predictors of failure (p 
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