SpringerBriefs in Applied Sciences and Technology Computational Mechanics Series Editors Andreas Öchsner Holm Altenbach Lucas F. M. da Silva For further volumes: http://www.springer.com/series/8886 Mohd Nazri Bajuri Mohammed Rafiq Abdul Kadir Computational Biomechanics of the Wrist Joint 123 Mohd Nazri Bajuri Mohammed Rafiq Abdul Kadir Department of Biomechanics and Department of Biomechanics and Biomedical Materials Biomedical Materials Universiti Teknologi Malaysia Universiti Teknologi Malaysia Johor Johor Malaysia Malaysia ISSN 2191-5342 ISSN 2191-5350 (electronic) ISBN 978-3-642-31905-1 ISBN 978-3-642-31906-8 (eBook) DOI 10.1007/978-3-642-31906-8 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2012943372 Ó Springer-Verlag Berlin Heidelberg 2013 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface The wrist joint is engaged in virtually every human functional activity and as such, exposed to high number of traumatic injuries, primary osteoarthritis, and sec- ondary degenerative disease. One of the most common skeletal diseases associated with the wrist joint is rheumatoid arthritis (RA). The disease affects mostly synovial joints, resulting in considerable pain, loss of function, and eventual deformity. It is a life-long condition, and the disease activity might change over time. As compared to the hip and knee joints, this disease was identified to easily affect the wrist joint. There are three main symptoms of wrist with RA—cartilage destruction, synovial proliferation, and ligamentous laxity. Cartilage destruction caused by thinning occurs due to cytochemical effects resulting in degradation and inhibition of new cartilage. Additionally, bone erosion due to the synovial proliferation may cause sharp bony edges which might lead to tendon rupture. The laxity of the ligaments caused by the synovial expansion led to unphysiological bone transla- tion and displacement. The pathological process of the RA starts with synovial inflammation primarily at the ulnar side of the wrist. It then spreads to the adjacent area including the radiocarpal joint, known as a critical region for the load transfer and joint motion. The adjacent cartilages, ligaments, and tendons degenerate accordingly. In severe cases, tendon rupture occurs with a consequence of kine- matic changes of the wrist resulting in periarticular bones disruption at the artic- ular surface. All the mentioned symptoms lead to the degeneration of both soft and hard tissues, and ultimately cause instability and mutilation of the joint. For severe cases of RA, arthroplasty as an alternative to bone fusion treatment (arthrodesis) has an advantage in preserving the joint motion. It is, however, reported in numerous literature that this procedure is the most unsuccessful arthroplasty as compared to the knee and the hip arthroplasty. Two main causes were addressed, the implant loosening and metacarpal perforation. It is noteworthy to mention that to date, however, there are designs reported to obtain good clinical outcome for a short-term evaluation. Follow up procedures are still running assuring the reliability of the implant for long-term clinical application. v vi Preface As one of established methods for prediction, finite element method was chosen to reaffirm those facts. Considering the inconsistent information on the reliability of the existing implant design, series of finite element analyses were performed to investigate the following aspects: 1. The biomechanical behaviours of the rheumatic wrist. 2. The biomechanical performance of the TWA procedure. This monograph is devoted to emphasize and analyse these two main concerns in supporting better clinical treatment for patients with RA. The information is rec- ommended for biomedical engineers and researchers interested in computational works, medical practitioners dealing with the determination of understanding the RA disease as well as its treatment, from both clinical and engineering perspectives. Skudai, May 2012 Mohd Nazri Bajuri Mohammed Rafiq Abdul Kadir Contents 1 The Wrist Joint ...................................... 1 1.1 Anatomy of the Wrist Joint . 1 1.2 Bone Structure . 3 1.3 Cartilage Structure. 4 1.4 Ligament Structure . 7 1.5 Kinematics . 8 References . 11 2 Biomechanical Properties and Behaviours of the Wrist Joint..... 13 2.1 Contact Surfaces and Load Transmission . 13 2.2 Biomechanical Consideration of the Cartilage Structure . 14 2.3 Biomechanical Consideration of the Ligamentous Structure . 15 2.4 Current Trends in Biomechanical Modelling. 17 2.4.1 Rigid Body Spring Method . 17 2.4.2 Finite Element Method . 17 References . 22 3 The Wrist Joint Affected by Rheumatoid Arthritis ............ 25 3.1 Pathology . 25 3.2 Rheumatoid Arthritis . 26 3.3 Treatment . 30 References . 31 4 Finite Element Modelling of the Healthy Wrist Joint .......... 33 4.1 Bone Model Reconstruction . 33 4.2 Modelling of Cartilages . 39 4.3 Modelling of Ligaments . 39 References . 40 vii viii Contents 5 Finite Element Analysis of the Wrist Joint Affected by Rheumatoid Arthritis ............................... 41 5.1 Finite Element Model Construction of the Rheumatic Wrist . 41 5.1.1 Simulation of Cartilage Destruction. 42 5.1.2 Simulation of Loss of Carpal Height . 43 5.1.3 Simulation of Dislocation of the Carpus in the Ulnar Direction . 43 5.1.4 Simulation of Dislocation of the Proximal Carpal Row in the Palmar and Ulnar Directions . 43 5.1.5 Simulation of Scapholunate Dissociation and Scapholunate Advanced Collapse . 45 5.1.6 Simulation of Dislocation of the Scaphoid in the Palmar Direction . 46 5.1.7 Simulation of Hand Scoliosis . 46 5.1.8 Simulation of Reduction of Contact Between the Lunate and the Radius . 47 5.1.9 Simulation of Bone Erosion . 47 5.2 Finite Element Analysis: Pre-Processing Procedures . 48 5.3 Biomechanical Behaviours of the Rheumatic Wrist Joint . 50 5.3.1 Comparative Analysis . 50 5.3.2 The Biomechanical Effect of Symptoms and Pathophysiological Characteristics. 52 References . 56 6 Finite Element Analysis of the Wrist Arthroplasty in Rheumatoid Arthritis................................ 59 6.1 Total Wrist Arthroplasty. 59 6.2 Finite Element Modelling of the Total Wrist Arthroplasty . 60 6.3 Finite Element Analysis: Pre-Processing Procedures . 60 6.4 Finite Element Analysis . 65 6.4.1 Mechanical Stress Distribution Within the Bones . 66 6.4.2 Mechanical Contact Pressure Within the Bones . 67 6.4.3 Biomechanical Analysis of Different Moduli of Bone Graft . 67 6.4.4 Biomechanical Assessment of the Total Wrist Arthroplasty Procedure . 67 References . 68 Summary ............................................. 71 Index ................................................ 73 Abbreviations BRM Biologic response modifier C Capitate CD Compact disc CT Computed tomography CTS Carpal tunnel syndrome DMARD Disease-modifying anti-rheumatic drug exp Exponential FE Finite element FEM Finite element method GPa Giga pascal H Hamate HC Hamitocapitate HTq Hamitotriquetral L Lunate LTq Lunotriquetral max. Maximum MC Metacarpal min Minute mm Millimeter MPa Mega pascal MR Magnetic resonance MRI Magnetic resonance imaging N Newton NMR Nuclear magnetic resonance No. Number NSAID Non-steroidal anti-inflammatory drug P Pisiform PRC Proximal row carpectomy RA Rheumatoid arthritis RBSM Rigid body spring method RC Radiocapitate ix x Abbreviations RT Radiotriquetrum S Scaphoid sec Second SL Scapholunate SLAC Scapholunate advanced collapse SLD Scapholunate dissociation STd Scaphotrapezoid STm Scaphotrapezium STq Scaphotriquetrum TCL Transverse carpal ligament TFCC Triangular fibrocartilage complex THA Total hip arthroplasty TKA Total knee arthroplasty TNF Tumor necrosis factor TP Trapezium TWA Total wrist arthroplasty TZ Trapezoid Notations Variable Explanation