Subrata Pal Design of Artificial Human Joints & Organs Springer Contents 1 Overview of Human System and Its Artificial Replacement 1 1.1 Human Body's Superficial Anatomy 1 1.2 Human Body Features 1 1.3 Body Size, Type, and Proportion 2 1.4 A Brief Outline of the Organization of the Human System 3 1.4.1 Tissue+Tissue=Organ (Different Tissues Together Form an Organ) 3 1.4.2 Organ + Organ=Organ System 4 1.5 Major Organ Systems 4 1.5.1 Integumentary System 5 1.5.2 Muscular System 5 1.5.3 Skeletal System 5 1.5.4 Cardiovascular System 7 1.5.5 Respiratory System 7 1.5.6 Urinary System 7 1.5.7 Reproductive System 9 1.5.8 Nervous System 11 1.5.9 Digestive System 11 1.5.10 Lymphatic System 12 1.5.11 Immune System 12 1.6 Common Names of Internal Organs (in Alphabetical Order) 14 1.7 Brief Idea of Artificial Organs 14 1.7.1 Different Types of Organs 15 1.7.2 Brain 15 1.7.3 Cardia 16 1.7.4 Corpora Cavernosa 16 1.7.5 Ear 16 1.7.6 Eye 16 1.7.7 Heart 17 1.7.8 Limbs 17 1.7.9 Liver 17 vii viii Contents 1.7.10 Lungs 18 1.7.11 Pancreas 18 1.7.12 Bladder 18 1.7.13 Ovaries 18 1.7.14 Beyond Restoration 19 1.7.15 Timeline of Successful Transplants 19 References 20 Exercises 20 2 Mechanical Properties of Biological Materials 23 2.1 Introduction 23 2.2 Structural Versus Material Properties 23 2.2.1 Anisotropy and Nonhomogeneity 24 2.2.2 Viscoelastic Properties 24 2.2.3 Viscosity 25 2.3 Testing Procedures 25 2.4 Bones 26 2.4.1 Composition 26 2.4.2 Structure 27 2.5 Material Properties and Related Behavior 29 2.6 Cartilage , 32 2.6.1 Composition 32 2.7 Material Properties and Related Behavior 33 2.8 Ligaments 34 2.8.1 Composition 34 2.9 Material Properties and Related Behavior 36 2.9.1 Ligaments Have Characteristics of Strain-Rate Sensitivity, Stress-Relaxation, Creep, and Hysteresis 36 2.10 Correlation Between Structure and Function 37 2.10.1 Ligament-Bone/Tendon-Bone Insertions 38 Reading List 39 Problems 39 3 Basics of Design Process 41 3.1 Introduction 41 3.2 Adoptive and Adaptive Design 41 3.2.1 Introduction 41 3.3 Introduction to Machine Design 42 3.4 Principle of Science or Mechanism to Be Used 43 3.5 Safety of Products 47 3.6 Manufacturability 47 3.7 Standardization 48 3.8 Customization 48 For Further Details, the Following Books May Be Consulted 49 Exercises 49 Contents ix 4 Biomaterials and Its Characterization 51 4.1 Introduction 51 4.2 Biomineralization 52 4.3 Abalone Shell 54 4.4 Self-Assembly 55 4.5 Structural Hierarchy 56 4.6 Applications 56 4.7 Compatibility 57 For Further Reading, These Papers May Be Consulted 58 4.8 Biopolymers 59 4.8.1 Applications 60 4.8.2 Sources 60 4.8.3 Applications 60 4.8.4 Sources 60 4.8.5 Applications 61 4.8.6 Benefits 61 4.9 Polymers for Healthcare 62 4.9.1 Sterilization 62 4.9.2 Compatibility with Sterilization Method of Various Industrial Biopolymers (Solviva) 62 4.9.3 Polyether Ether Ketone (PEEK) 63 4.9.4 Applications 64 4.10 Bioceramics 64 4.10.1 History 64 4.10.2 Current Status 65 4.10.3 Future Trends 65 4.11 Bioceramic Materials 65 4.11.1 Bioinert 65 4.11.2 Bioactive 66 4.12 Hydroxyapatite: Medical Uses 66 4.13 Bioactive Glass 67 4.13.1 Compositions 67 4.13.2 Mechanism of Bioactivity 67 4.13.3 Applications 68 For Further Study Consult the Reading List (Ceramics and Glass) 68 4.14 Metals as Biomaterials 69 4.15 Signs of Inferior Tissue Response 71 4.16 Stress-Shielding Phenomena 71 4.17 Shape-Memory Alloy 72 Problems 73 5 Dental Implants: Their Design and Manufacture 75 5.1 Introduction 75 5.1.1 Success Criteria 75 5.2 Anatomy of Human Jawbones 77 5.3 Dental Implants 78 x Contents 5.4 Components of Dental Implant 81 5.5 Types of Implants in Use 81 5.5.1 Subperiosteal Implants 81 5.5.2 Transosteal Implants 82 5.5.3 Endosteal Implants 83 5.5.4 Biocompatibility and Implant Design 84 5.6 Biting Force 86 5.7 Implant Shape 87 5.8 Surface Characteristics 87 5.9 Bone Factors 88 5.10 Loading Conditions 89 5.10.1 Prosthetic Considerations 90 5.10.2 The Type of Prosthetic Reconstruction 90 5.10.3 The Occlusal Scheme 90 5.11 The Number, Distribution, Orientation, and Design of Implants 90 5.12 Placement of Implants into Extraction Sites 91 5.13 Clinical and Biomechanical Considerations for Fixed Tooth Replacement 92 5.13.1 Bone Tissue Factors 92 5.13.2 Soft Tissue Factors 92 5.13.3 Number of Implants 93 5.13.4 Crown-to-Root Ratio 93 5.13.5 Implant Orientation 94 5.14 Advantages of Permanent Tooth Replacement 94 5.15 Manufacture of Implants and Property Enhancement 94 References 95 Problems 96 Glossary of Dental Terminology 96 6 The Design of a Bone Fracture-Fixation Device 101 6.1 Introduction 101 6.2 External Fixation 101 6.2.1 The Ilizarov Apparatus 105 6.3 Internal Fracture Fixation 106 6.3.1 Wires 106 6.3.2 Braided Multifilament Wire 106 6.3.3 Pins 107 6.3.4 Screws 107 6.3.5 Plates 109 6.3.6 Intramedullary Nails Ill 6.3.7 Use of Machine Elements in External Fixators 114 6.4 Other Considerations 114 6.5 Materials Involved in Bone-Plate Design 114 6.6 Composite Materials 115 Contents xi 6.7 Bioactive Fixation Using Bioactive Materials 117 6.8 Compositions 119 6.9 Strong Interfacial Bond with Bone 119 Suggested Study for Fracture Fixation 119 Problems 121 7 The Shoulder Joint and Its Artificial Replacement 123 7.1 Introduction to Joint Replacement 123 7.2 The Shoulder Joint and Its Artificial Replacement 124 7.2.1 Introduction 124 7.2.2 The Different Joints 125 7.2.3 Musculature 126 7.2.4 Ligaments 127 7.2.5 Glenohumeral Joint 127 7.2.6 Glenoid 128 7.2.7 Humerus 128 7.2.8 Kinematics of the Glenohumeral Joint 129 7.2.9 Geometrical Center and Center of Rotation 130 7.3 Humeral Translation Relative to the Scapula 130 7.4 Degrees of Freedom (DOF) 131 7.5 Range of Motion 132 7.6 Total Shoulder Replacement (Glenohumeral Arthroplasty) 134 7.6.1 Reasons for Shoulder Arthroplasty 134 7.7 Types of Shoulder Prostheses 135 7.8 Fully Constrained Type 136 7.9 Nonconstrained Type 138 7.10 Fixation Procedures 143 7.11 Causes of Failure 144 7.11.1 Loosening of the Component 145 7.11.2 Anterior Instability 146 7.11.3 Superior Instability 146 7.11.4 Posterior Instability 146 7.11.5 Inferior Instability 146 7.11.6 Rotator Cuff Tears 146 7.11.7 Intraoperative Fractures 147 7.11.8 Infection 147 7.11.9 Neural Injuries 147 References 147 Problems 148 8 The Elbow Joint and Its Artificial Replacement 149 8.1 Introduction 149 8.1.1 Movements 149 8.2 Muscles, Arteries, and Nerves 151 8.3 Parts of the Joint 151 8.4 Ligaments 152 xii Contents 8.5 Synovial Membrane 152 8.6 Carrying Angle 153 8.7 Diseases of the Elbow 153 8.7.1 Tendonitis 153 8.7.2 Fractures 153 8.7.3 Arthritis 153 8.8 Elbow Replacement 154 8.9 Elbow Replacement Surgery 156 8.10 Life Expectancy of Prosthetic Elbow Joint 156 References 157 Problems 157 9 The Wrist Joint and Its Artificial Replacement 159 9.1 Anatomy 159 9.2 Rheumatoid Arthritis of the Hand and Wrist 159 9.3 Treatment 161 9.3.1 Forces Generated in the Wrist Joint 161 9.4 Implants: Components of a Wrist Arthroplasty 163 9.5 Surgery 164 9.6 Postsurgical Care 165 References 165 Problems 166 10 The Finger Joint and Its Artificial Replacement 167 10.1 Introduction 167 10.2 Diseases of the Finger Joint 168 10.2.1 Symptoms 170 10.2.2 Nonsurgical Treatment 171 10.3 Finger Joint Replacement 171 10.3.1 Introduction 171 Problems 174 References 175 11 The Hip Joint and Its Artificial Replacement 177 11.1 Introduction 177 11.2 Anatomy of the Hip Region 177 11.2.1 Articulation 177 11.2.2 Femoral Neck Angle 178 11.2.3 Capsule 180 11.2.4 Ligaments 180 11.2.5 Blood and Nerve Supply 181 11.2.6 Muscles and Movements 181 11.3 Hip Joint Replacement 182 11.3.1 History 184 11.4 Modern Developments 185 11.5 Costs 186 xiii 11.6 Aseptic Loosening of Hip Prosthesis 186 11.7 Techniques of Surgery 187 11.8 Alternatives to Hip Replacement 187 11.8.1 Apollo Hip System: Simple, Straight-Stem Design for the Low-Demand Patient 188 11.8.2 Dr. K. H. Sancheti's Hip Prosthesis 190 11.9 Design Modification Using Hollow Section 191 11.9.1 Stress Shielding 191 11.9.2 Hollow Design 192 References & Reading List 193 Problems 194 The Knee Joint and Its Artificial Replacement 195 12.1 Anatomy 195 12.1.1 Cruciate Ligaments 195 12.1.2 Anterior Cruciate Ligament 196 12.1.3 Action of Muscles 197 12.1.4 Knee Joint Stabilization 197 12.2 Knee Replacement, or Knee Arthroplasty 199 12.2.1 Introduction 199 12.3 History 200 12.3.1 Technique 201 12.4 Variations in Design 202 12.4.1 Partial Knee Replacement 202 12.5 Risks and Complications 203 12.5.1 Loss of Motion 204 12.5.2 Instability 204 12.5.3 Infection 204 12.6 Developmental Work on a Congruent Tibial Component 205 12.6.1 This Design has Two Advantages 207 12.6.2 Disadvantages 208 12.7 Indian Effort 208 References..