Análisis de micromovilidad en vástagos femorales mediante ensayo dinámico de oscilaciones libres

La artroplastia de cadera se considera uno de los mayores avances quirúrgicos de la Medicina. La aplicación de esta técnica de Traumatología se ha incrementado notablemente en los últimos anos, a causa principalmente del progresivo incremento de la esperanza de vida. En efecto, con la edad aumentan los problemas de artrosis y osteoporosis, enfermedades típicas de las articulaciones y de los huesos que requieren en muchos casos la sustitución protésica total o parcial de la articulación. El buen comportamiento funcional de una prótesis depende en gran medida de la estabilidad primaria, es decir, el correcto anclaje de la prótesis en el momento de su implantación. Las prótesis no cementadas basan su éxito a largo plazo en la osteointegración que tiene lugar entre el material protésico y el tejido óseo, y para lograrla es imprescindible conseguir unas buenas condiciones de estabilidad primaria. El aflojamiento aséptico es la principal causa de fallo de artroplastia total de cadera. Este es un fenómeno en el que, debido a complejas interacciones de factores mecánicos y biológicos, se producen movimientos relativos que comprometen la funcionalidad del implante. La minimización de los correspondientes danos depende en gran medida de la detección precoz del aflojamiento. Para lograr la detección temprana del aflojamiento aséptico del vástago femoral se han ensayado diferentes técnicas, tanto in vivo como in vitro: análisis numéricos y técnicas experimentales basadas en sensores de movimientos provocados por cargas transmitidas natural o artificialmente, tales como impactos o vibraciones de distintas frecuencias. Los montajes y procedimientos aplicados son heterogéneos y, en muchas ocasiones, complejos y costosos, no existiendo acuerdo sobre una técnica simple y eficaz de aplicación general. Asimismo, en la normativa vigente que regula las condiciones que debe cumplir una prótesis previamente a su comercialización, no hay ningún apartado referido específicamente a la evaluación de la bondad del diseño del vástago femoral con respecto a la estabilidad primaria. El objetivo de esta tesis es desarrollar una metodología para el análisis, in vitro, de la estabilidad de un vástago femoral implantado, a fin de poder evaluar las técnicas de implantación y los diferentes diseños de prótesis previamente a su oferta en el mercado. Además se plantea como requisito fundamental que el método desarrollado sea sencillo, reversible, repetible, no destructivo, con control riguroso de parámetros (condiciones de contorno de cargas y desplazamientos) y con un sistema de registro e interpretación de resultados rápido, fiable y asequible. Como paso previo, se ha realizado un análisis cualitativo del problema de contacto en la interfaz hueso-vástago aplicando una técnica optomecánica del campo continuo (fotoelasticidad). Para ello se han fabricado tres modelos en 2D del conjunto hueso-vástago, simulando tres tipos de contactos en la interfaz: contacto sin adherencia y con holgura, contacto sin adherencia y sin holgura, y contacto con adherencia y homogéneo. Aplicando la misma carga a cada modelo, y empleando la técnica de congelación de tensiones, se han visualizado los correspondientes estados tensionales, siendo estos más severos en el modelo de unión sin adherencia, como cabía esperar. En todo caso, los resultados son ilustrativos de la complejidad del problema de contacto y confirman la conveniencia y necesidad de la vía experimental para el estudio del problema. Seguidamente se ha planteado un ensayo dinámico de oscilaciones libres con instrumentación de sensores resistivos tipo galga extensométrica. Las muestras de ensayo han sido huesos fémur en todas sus posibles variantes: modelos simplificados, hueso sintético normalizado y hueso de cadáver, seco y fresco. Se ha diseñado un sistema de empotramiento del extremo distal de la muestra (fémur) con control riguroso de las condiciones de anclaje. La oscilación libre de la muestra se ha obtenido mediante la liberación instantánea de una carga estética determinada y aplicada previamente, bien con una maquina de ensayo o bien por gravedad. Cada muestra se ha instrumentado con galgas extensométricas convencionales cuya señal se ha registrado con un equipo dinámico comercial. Se ha aplicado un procedimiento de tratamiento de señal para acotar, filtrar y presentar las respuestas de los sensores en el dominio del tiempo y de la frecuencia. La interpretación de resultados es de tipo comparativo: se aplica el ensayo a una muestra de fémur Intacto que se toma de referencia, y a continuación se repite el ensayo sobre la misma muestra con una prótesis implantada; la comparación de resultados permite establecer conclusiones inmediatas sobre los efectos de la implantación de la prótesis. La implantación ha sido realizada por un cirujano traumatólogo utilizando las mismas técnicas e instrumental empleadas en el quirófano durante la práctica clínica real, y se ha trabajado con tres vástagos femorales comerciales. Con los resultados en el dominio del tiempo y de la frecuencia de las distintas aplicaciones se han establecido conclusiones sobre los siguientes aspectos: Viabilidad de los distintos tipos de muestras sintéticas: modelos simplificados y fémur sintético normalizado. Repetibilidad, linealidad y reversibilidad del ensayo. Congruencia de resultados con los valores teóricos deducidos de la teoría de oscilaciones libres de barras. Efectos de la implantación de tallos femorales en la amplitud de las oscilaciones, amortiguamiento y frecuencias de oscilación. Detección de armónicos asociados a la micromovilidad. La metodología se ha demostrado apta para ser incorporada a la normativa de prótesis, es de aplicación universal y abre vías para el análisis de la detección y caracterización de la micromovilidad de una prótesis frente a las cargas de servicio. ABSTRACT Total hip arthroplasty is considered as one of the greatest surgical advances in medicine. The application of this technique on Traumatology has increased significantly in recent years, mainly due to the progressive increase in life expectancy. In fact, advanced age increases osteoarthritis and osteoporosis problems, which are typical diseases of joints and bones, and in many cases require full or partial prosthetic replacement on the joint. Right functional behavior of prosthesis is highly dependent on the primary stability; this means it depends on the correct anchoring of the prosthesis at the time of implantation. Uncemented prosthesis base their long-term success on the quality of osseointegration that takes place between the prosthetic material and bone tissue, and to achieve this good primary stability conditions is mandatory. Aseptic loosening is the main cause of failure in total hip arthroplasty. This is a phenomenon in which relative movements occur, due to complex interactions of mechanical and biological factors, and these micromovements put the implant functionality at risk. To minimize possible damage, it greatly depends on the early detection of loosening. For this purpose, various techniques have been tested both in vivo and in vitro: numerical analysis and experimental techniques based on sensors for movements caused by naturally or artificially transmitted loads, such as impacts or vibrations at different frequencies. The assemblies and methods applied are heterogeneous and, in many cases, they are complex and expensive, with no agreement on the use of a simple and effective technique for general purposes. Likewise, in current regulations for governing the conditions to be fulfilled by the prosthesis before going to market, there is no specific section related to the evaluation of the femoral stem design in relation to primary stability. The aim of this thesis is to develop a in vitro methodology for analyzing the stability of an implanted femoral stem, in order to assess the implantation techniques and the different prosthesis designs prior to its offer in the market. We also propose as a fundamental requirement that the developed testing method should be simple, reversible, repeatable, non-destructive, with close monitoring of parameters (boundary conditions of loads and displacements) and with the availability of a register system to record and interpret results in a fast, reliable and affordable manner. As a preliminary step, we have performed a qualitative analysis of the contact problems in the bone-stem interface, through the application of a continuous field optomechanical technique (photoelasticity). For this proposal three 2D models of bone–stem set, has been built simulating three interface contact types: loosened an unbounded contact, unbounded and fixed contact, and bounded homogeneous contact. By means of applying the same load to each model, and using the stress freezing technique, it has displayed the corresponding stress states, being more severe as expected, in the unbounded union model. In any case, the results clearly show the complexity of the interface contact problem, and they confirm the need for experimental studies about this problem. Afterward a free oscillation dynamic test has been done using resistive strain gauge sensors. Test samples have been femur bones in all possible variants: simplified models, standardized synthetic bone, and dry and cool cadaveric bones. An embedding system at the distal end of the sample with strong control of the anchoring conditions has been designed. The free oscillation of the sample has been obtained by the instantaneous release of a static load, which was previously determined and applied to the sample through a testing machine or using the gravity force. Each sample was equipped with conventional strain gauges whose signal is registered with a marketed dynamic equipment. Then, it has applied a signal processing procedure to delimit, filter and present the time and frequency response signals from the sensors. Results are interpreted by comparing different trials: the test is applied to an intact femur sample which is taken as a reference, and then this test is repeated over the same sample with an implanted prosthesis. From comparison between results, immediate conclusions about the effects of the implantation of the prosthesis can be obtained. It must be said that the implementation has been made by an expert orthopedic surgeon using the same techniques and instruments as those used in clinical surgery. He has worked with three commercial femoral stems. From the results obtained in the time and frequency domains for the different applications the following conclusions have been established: Feasibility of the different types of synthetic samples: simplified models and standardized synthetic femur. Repeatability, linearity and reversibility of the testing method. Consistency of results with theoretical values deduced from the bars free oscillations theory. Effects of introduction of femoral stems in the amplitude, damping and frequencies of oscillations Detection of micromobility associated harmonics. This methodology has been proved suitable to be included in the standardization process of arthroplasty prosthesis, it is universally applicable and it allows establishing new methods for the analysis, detection and characterization of prosthesis micromobility due to functional loads.

Unconformity-bounded stratigraphic units (UBSUs) in an italian alluvial-plain area: recognizing and dating

We studied the coastal zone of the Tavoliere di Puglia plain, (Puglia region, southern Italy) with the aim to recognize the main unconformities, and therefore, the unconformity-bounded stratigraphic units (UBSUs; Salvador 1987, 1994) forming its Quaternary sedimentary fill. Recognizing unconformities is particularly problematic in an alluvial plain, due to the difficulties in distinguishing the unconformities that bound the UBSUs. So far, the recognition of UBSUs in buried successions has been made mostly by using seismic profiles. Instead, in our case, the unavailability of the latter has prompted us to address the problem by developing a methodological protocol consisting of the following steps: I) geological survey in the field; II) draft of a preliminary geological setting based on the field-survey results; III) dating of 102 samples coming from a large number of boreholes and some outcropping sections by means of the amino acid racemization (AAR) method applied to ostracod shells and 14C dating, filtering of the ages and the selection of valid ages; IV) correction of the preliminary geological setting in the light of the numerical ages; definition of the final geological setting with UBSUs; identification of a ‘‘hypothetical’’ or ‘‘attributed time range’’ (HTR or ATR) for each UBSU, the former very wide and subject to a subsequent modification, the latter definitive; V) cross-checking between the numerical ages and/or other characteristics of the sedimentary bodies and/or the sea-level curves (with their effects on the sedimentary processes) in order to restrict also the hypothetical time ranges in the attributed time ranges. The successful application of AAR geochronology to ostracod shells relies on the fact that the ability of ostracods to colonize almost all environments constitutes a tool for correlation, and also allow the inclusion in the same unit of coeval sediments that differ lithologically and paleoenvironmentally. The treatment of the numerical ages obtained using the AAR method required special attention. The first filtering step was made by the laboratory (rejection criteria a and b). Then, the second filtering step was made by testing in the field the remaining ages. Among these, in fact, we never compared an age with a single preceding and/or following age; instead, we identified homogeneous groups of numerical ages consistent with their reciprocal stratigraphic position. This operation led to the rejection of further numerical ages that deviate erratically from a larger, homogeneous age population which fits well with its stratigraphic position (rejection criterion c). After all of the filtering steps, the valid ages that remained were used for the subdivision of the sedimentary sequences into UBSUs together with the lithological and paleoenvironmental criteria. The numerical ages allowed us, in the first instance, to recognize all of the age gaps between two consecutive samples. Next, we identified the level, in the sedimentary thickness that is between these two samples, that may represent the most suitable UBSU boundary based on its lithology and/or the paleoenvironment. The recognized units are: I) Coppa Nevigata sands (NEA), HTR: MIS 20–14, ATR: MIS 17–16; II) Argille subappennine (ASP), HTR: MIS 15–11, ATR: MIS 15–13; III) Coppa Nevigata synthem (NVI), HTR: MIS 13–8, ATR: MIS 12–11; IV) Sabbie di Torre Quarto (STQ), HTR: MIS 13–9.1, ATR: MIS 11; V) Amendola subsynthem (MLM1), HTR: MIS 12–10, ATR: MIS 11; VI) Undifferentiated continental unit (UCI), HTR: MIS 11–6.2, ATR: MIS 9.3–7.1; VII) Foggia synthem (TGF), ATR: MIS 6; VIII) Masseria Finamondo synthem (TPF), ATR: Upper Pleistocene; IX) Carapelle and Cervaro streams synthem (RPL), subdivided into: IXa) Incoronata subsynthem (RPL1), HTR: MIS 6–3; ATR: MIS 5–3; IXb) Marane La Pidocchiosa–Castello subsynthem (RPL3), ATR: Holocene; X) Masseria Inacquata synthem (NAQ), ATR: Holocene. The possibility of recognizing and dating Quaternary units in an alluvial plain to the scale of a marine isotope stage constitutes a clear step forward compared with similar studies regarding other alluvial-plain areas, where Quaternary units were dated almost exclusively using their stratigraphic position. As a result, they were generically associated with a geological sub-epoch. Instead, our method allowed a higher detail in the timing of the sedimentary processes: for example, MIS 11 and MIS 5.5 deposits have been recognized and characterized for the first time in the study area, highlighting their importance as phases of sedimentation.