TY - JOUR A1 - Benditz, Achim A1 - Auer, Simon A1 - Spörrer, J.F. A1 - Wolkerstorfer, S. A1 - Grifka, Joachim A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Regarding loads after spinal fusion, every level should be seen separately: a musculoskeletal analysis JF - European Spine Journal N2 - The number of spinal fusion surgeries is steadily increasing and biomechanical consequences are still in debate. The aim of this study is to provide biomechanical insights into the sagittal balance of the spine and to compare spinal load before and after spinal fusion. METHOD: The joint reaction forces of 52 patients were analyzed in proximo-distal and antero-posterior direction from the levels T12-L1 to L5-S1 using musculoskeletal simulations. RESULTS: In 104 simulations, pre-surgical forces were equal to post-surgical. The levels L4-L5 and T12-L1, however, showed increased spinal forces compression forces with higher sagittal displacement. Improved restauration of sagittal balance was accompanied by lower spinal load. AP shear stress, interestingly decreased with sagittal imbalance. CONCLUSION: Imbalanced spines have a risk of increased compression forces at Th12-L1. L4-L5 always has increased spinal loads. These slides can be retrieved under Electronic Supplementary Material. KW - AnyBody Modeling System KW - Musculoskeletal analysis KW - Sagittal balance KW - Spinal fusion KW - Spine biomechanics KW - Biomechanische Analyse KW - Wirbelsäulenversteifung KW - Vergleichende Anatomie Y1 - 2018 U6 - https://doi.org/10.1007/s00586-018-5476-5 VL - 27 IS - 8 SP - 1905 EP - 1910 PB - Springer-Verlag ER - TY - JOUR A1 - Renkawitz, Tobias A1 - Weber, Tim A. A1 - Dullien, Silvia A1 - Woerner, Michael A1 - Dendorfer, Sebastian A1 - Grifka, Joachim A1 - Weber, Markus T1 - Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics JF - Gait & Posture N2 - We aimed to investigate the relationship between postoperative leg length/offset (LL/OS) reconstruction and gait performance after total hip arthroplasty (THA). In the course of a prospective randomized controlled trial, 60 patients with unilateral hip arthrosis received cementless THA through a minimally-invasive anterolateral surgical approach. One year post-operatively, LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs. The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored (within 5 mm) or non-restored (more than 5 mm reduction or more than 5 mm increment). The acetabular component inclination, anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur. 3D gait analysis of the lower extremity and patient related outcome measures (HHS, HOOS, EQ-5D) were obtained pre-operatively, six months and twelve months post-operatively by an observer blinded to radiographic results. Component position of cup and stem was comparable between the restored and non-restored group. Combined LL and OS restoration within 5 mm resulted in higher Froude number (p < 0.001), normalized walking speed (p < 0.001) and hip range-of-motion (ROM) (p = 0.004) during gait twelve months postoperatively, whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations. Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA. In summary, postoperative LL/OS discrepancies larger than 5 mm relate to unphysiological gait kinematics within the first year after THA. DRKS00000739, German Clinical Trials Register. KW - THA KW - Leg length KW - Offset KW - Gait analysis KW - Biomechanics Y1 - 2016 U6 - https://doi.org/10.1016/j.gaitpost.2016.07.011 VL - vol. 49 SP - 196 EP - 201 ER - TY - JOUR A1 - Putzer, Michael A1 - Auer, Stefan A1 - Malpica, William A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - A numerical study to determine the effect of ligament stiffness on kinematics of the lumbar spine during flexion JF - BMC Musculoskeletal Disorders N2 - Background There is a wide range of mechanical properties of spinal ligaments documented in literature. Due to the fact that ligaments contribute in stabilizing the spine by limiting excessive intersegmental motion, those properties are of particular interest for the implementation in musculoskeletal models. The aim of this study was to investigate the effect of varying ligament stiffness on the kinematic behaviour of the lumbar spine. Methods A musculoskeletal model with a detailed lumbar spine was modified according to fluoroscopic recordings and corresponding data files of three different subjects. For flexion, inverse dynamics analysis with a variation of the ligament stiffness matrix were conducted. The influence of several degrees of ligament stiffness on the lumbar spine model were investigated by tracking ligament forces, disc forces and resulting moments generated by the ligaments. Additionally, the kinematics of the motion segments were evaluated. Results An increase of ligament stiffness resulted in an increase of ligament and disc forces, whereas the relative change of disc force increased at a higher rate at the L4/L5 level (19 %) than at the L3/L4 (10 %) level in a fully flexed posture. The same behaviour applied to measured moments with 67 % and 45 %. As a consequence, the motion deflected to the lower levels of the lumbar spine and the lower discs had to resist an increase in loading. Conclusions Higher values of ligament stiffness over all lumbar levels could lead to a shift of the loading and the motion between segments to the lower lumbar levels. This could lead to an increased risk for the lower lumbar parts. KW - Lumbar spine KW - Ligament stiffness KW - Musculoskeletal Modeling KW - Biomechanics Y1 - 2016 U6 - https://doi.org/10.1186/s12891-016-0942-x VL - 17 IS - 95 ER - TY - JOUR A1 - Weber, Tim A. A1 - Dendorfer, Sebastian A1 - Bulstra, Sjoerd K. A1 - Grifka, Joachim A1 - Verkerke, Gijsbertus Jacob A1 - Renkawitz, Tobias T1 - Gait six month and one-year after computer assisted Femur First THR vs. conventional THR. Results of a patient- and observer- blinded randomized controlled trial JF - Gait & Posture N2 - A prospective randomized controlled trial is presented that is used to compare gait performance between the computer assisted Femur First (CAS FF) operation method and conventional THR (CON). 60 patients underwent a 3D gait analysis of the lower extremity at pre-operative, 6 months post-operative and twelve months post-operative. Detailed verification experiments were facilitated to ensure the quality of data as well as to avoid over-interpreting of the data. The results confirm a similar data-quality as reported in the literature. Walking speed, range of motion and symmetry thereof improved over the follow-up period, without significant differences between the groups. While all parameters do significantly increase over the follow-up period for both groups, there were no significant differences between them at any given time-point. Patients undergoing CAS FF showed a trend to improved hip flexion angle indicating a possible long-term benefit. KW - Biomechanics KW - Combined anteversion KW - Computer-assisted surgery KW - Femur first KW - Gait analysis Y1 - 2016 U6 - https://doi.org/10.1016/j.gaitpost.2016.06.035 VL - vol. 49 SP - 418 EP - 425 ER - TY - JOUR A1 - Ignasiak, Dominika A1 - Dendorfer, Sebastian A1 - Ferguson, Stephen J. T1 - Thoracolumbar spine model with articulated ribcage for the prediction of dynamic spinal loading JF - Journal of Biomechanics N2 - Musculoskeletal modeling offers an invaluable insight into the spine biomechanics. A better understanding of thoracic spine kinetics is essential for understanding disease processes and developing new prevention and treatment methods. Current models of the thoracic region are not designed for segmental load estimation, or do not include the complex construct of the ribcage, despite its potentially important role in load transmission. In this paper, we describe a numerical musculoskeletal model of the thoracolumbar spine with articulated ribcage, modeled as a system of individual vertebral segments, elastic elements and thoracic muscles, based on a previously established lumbar spine model and data from the literature. The inverse dynamics simulations of the model allow the prediction of spinal loading as well as costal joints kinetics and kinematics. The intradiscal pressure predicted by the model correlated well (R2=0.89) with reported intradiscal pressure measurements, providing a first validation of the model. The inclusion of the ribcage did not affect segmental force predictions when the thoracic spine did not perform motion. During thoracic motion tasks, the ribcage had an important influence on the predicted compressive forces and muscle activation patterns. The compressive forces were reduced by up to 32%, or distributed more evenly between thoracic vertebrae, when compared to the predictions of the model without ribcage, for mild thoracic flexion and hyperextension tasks, respectively. The presented musculoskeletal model provides a tool for investigating thoracic spine loading and load sharing between vertebral column and ribcage during dynamic activities. Further validation for specific applications is still necessary. KW - Inverse dynamics KW - Musculoskeletal model KW - Thoracolumbar spine KW - Brustwirbelsäule KW - Brustkorb KW - Biomechanik KW - Mechanische Belastung KW - Prognose Y1 - 2016 U6 - https://doi.org/10.1016/j.jbiomech.2015.10.010 VL - vol. 49 IS - 6 SP - 959 EP - 966 PB - Elsevier Science ER - TY - JOUR A1 - Weber, Tim A. A1 - Dendorfer, Sebastian A1 - Grifka, Joachim A1 - Verkerke, Gijsbertus Jacob A1 - Renkawitz, Tobias ED - Takagi, Michiaki T1 - Does Computer-Assisted Femur First THR Improve Musculoskeletal Loading Conditions? JF - BioMed Research International N2 - We have developed a novel, computer-assisted operation method for minimal-invasive total hip replacement (THR) following the concept of “femur first/combined anteversion,” which incorporates various aspects of performing a functional optimization of the prosthetic stem and cup position (CAS FF). The purpose of this study is to assess whether the hip joint reaction forces and patient’s gait parameters are being improved by CAS FF in relation to conventional THR (CON). We enrolled 60 patients (28 CAS FF/32 CON) and invited them for gait analysis at three time points (preoperatively, postop six months, and postop 12 months). Data retrieved from gait analysis was processed using patient-specific musculoskeletal models. The target parameters were hip reaction force magnitude (hrf), symmetries, and orientation with respect to the cup. Hrf in the CAS FF group were closer to a young healthy normal. Phase-shift symmetry showed an increase in the CAS FF group. Hrf orientation in the CAS FF group was closer to optimum, though no edge or rim-loading occurred in the CON group as well. The CAS FF group showed an improved hrf orientation in an early stage and a trend to an improved long-term outcome. KW - Hüftgelenkprothese KW - Operationstechnik KW - Computerunterstütztes Verfahren KW - Bewegungsapparat KW - Mechanische Belastung Y1 - 2015 U6 - https://doi.org/10.1155/2015/625317 VL - 2015 SP - ID 625317 ER - TY - JOUR A1 - Weber, Tim A1 - Al-Munajjed, Amir Andreas A1 - Verkerke, Gijsbertus Jacob A1 - Dendorfer, Sebastian A1 - Renkawitz, Tobias T1 - Influence of minimally invasive total hip replacement on hip reaction forces and their orientations JF - Journal of Orthopaedic Research N2 - Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a biomechanical comparison between surgical standard and MIS approaches for THR during the early recovery of patients. A validated, parameterized musculoskeletal model was set to perform a squat of a 50th percentile healthy European male. A bilateral motion was chosen to investigate effects on the contralateral side. Surgical approaches were simulated by excluding the incised muscles from the computations. Resulting hip reaction forces and their symmetry and orientation were analyzed. MIS THR seemed less influential on the symmetry index of hip reaction forces between the operated and nonoperated leg when compared to the standard lateral approach. Hip reaction forces at peak loads of the standard transgluteal approach were 24% higher on the contralateral side when compared to MIS approaches. Our results suggest that MIS THR contributes to a greater symmetry of hip reaction forces in absolute value as well as force-orientation following THR. KW - THA KW - THR KW - Biomechanics KW - Conventional surgery KW - Early recovery KW - Hüftgelenkprothese KW - Minimal-invasive Chirurgie KW - Biomechanik Y1 - 2014 U6 - https://doi.org/10.1002/jor.22710 VL - 32 IS - 12 SP - 1680 EP - 1687 ER - TY - JOUR A1 - Putzer, Michael A1 - Ehrlich, Ingo A1 - Rasmussen, John A1 - Gebbeken, Norbert A1 - Dendorfer, Sebastian T1 - Sensitivity of lumbar spine loading to anatomical parameters JF - Journal of Biomechanics N2 - Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential. These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised. KW - Musculoskeletal simulation KW - Lumbar spine KW - Parameter study KW - Vertebra KW - Wirbelsäule KW - Belastung KW - Simulation Y1 - 2015 U6 - https://doi.org/10.1016/j.jbiomech.2015.11.003 VL - 49 IS - 6 SP - 953 EP - 958 PB - Elsevier Science ER - TY - JOUR A1 - Dendorfer, Sebastian A1 - Weber, Tim A1 - Kennedy, O. T1 - Musculoskeletal modeling for hip replacement outcome analyses and other applications JF - The Journal of the American Academy of Orthopaedic Surgeons KW - Hüftgelenkprothese KW - Bewegungsapparat KW - Simulation Y1 - 2014 U6 - https://doi.org/10.5435/JAAOS-22-04-268 VL - 22 IS - 4 SP - 268 EP - 269 ER - TY - JOUR A1 - Lenich, Andreas A1 - Bachmeier, S. A1 - Dendorfer, Sebastian A1 - Mayr, E. A1 - Nerlich, Michael A1 - Füchtmeier, Bernd T1 - Development of a test system to analyze different hip fracture osteosyntheses under simulated walking JF - Biomedizinische Technik. Biomedical engineering N2 - The mechanical complications of osteosyntheses after hip fractures are previously investigated by mostly static or dynamic uniaxial loading test systems. However, the physiologic loading of the hip joint during a normal gait is a multiplanar, dynamic movement. Therefore, we constructed a system to test osteosyntheses for hip fractures under physiologic multiplanar loading representative of normal gait. To evaluate the testing system, 12 femora pairs were tested under 25,000 cycles with two standard osteosyntheses (Proximal Femoral Nail Antirotation/Gamma3 Nail). For angular movement, the varus collapse to cut out (∝CO) (∝CO=4.8°±2.1° for blade and ∝CO=7.8°±3.8° for screw) was the dominant failure mode, and only slight rotational angle shifts (∝Rot) (∝Rot=1.7°±0.4° for blade and ∝Rot=2.4°±0.3° for screw) of the femoral head around the implant axis were observed. Angular displacements in varus direction and rotation were higher in specimens reinforced with screws. Hence, the cut out model and the migration directions showed a distinction between helical blade and hip screw. However, there were no significant differences between the different implants. The new setup is able to create clinical failures and allows to give evidence about the anchorage stability of different implant types under dynamic gait motion pattern. KW - biomechanical implant test KW - dynamic multiplanar loading KW - hip fractureg KW - implant migration KW - patient specific loading KW - Hüftgelenk KW - Knochenbruch KW - Osteosynthese KW - Bewegungsanalyse KW - Simulation Y1 - 2012 U6 - https://doi.org/10.1515/bmt-2011-0999 VL - 57 IS - 2 SP - 113 EP - 119 ER -