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    Experiments meet simulations : understanding skeletal muscle mechanics to address clinical problems
    (2024) Ateş, Filiz; Röhrle, Oliver
    This article aims to present some novel experimental approaches and computational methods providing detailed insights into the mechanical behavior of skeletal muscles relevant to clinical problems associated with managing and treating musculoskeletal diseases. The mechanical characterization of skeletal muscles in vivo is crucial for better understanding of, prevention of, or intervention in movement alterations due to exercise, aging, or pathologies related to neuromuscular diseases. To achieve this, we suggest an intraoperative experimental method including direct measurements of human muscle forces supported by computational methodologies. A set of intraoperative experiments indicated the major role of extracellular matrix (ECM) in spastic cerebral palsy. The force data linked to joint function are invaluable and irreplaceable for evaluating individual muscles however, they are not feasible in many situations. Three‐dimensional, continuum‐mechanical models provide a way to predict the exerted muscle forces. To obtain, however, realistic predictions, it is important to investigate the muscle not by itself, but embedded within the respective musculoskeletal system, for example, a 6‐muscle upper arm model, and the ability to obtain non‐invasively, or at least, minimally invasively material parameters for continuum‐mechanical skeletal muscle models, for example, by presently proposed homogenization methodologies. Botulinum toxin administration as a treatment option for spasticity is exemplified by combining experiments with modeling to find out the mechanical outcomes of altered ECM and the controversial effects of the toxin. The potentials and limitations of both experimental and modeling approaches and how they need each other are discussed.
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    Analysing the bone cement flow in the injection apparatus during vertebroplasty
    (2023) Trivedi, Zubin; Gehweiler, Dominic; Wychowaniec, Jacek K.; Ricken, Tim; Gueorguiev-Rüegg, Boyko; Wagner, Arndt; Röhrle, Oliver
    Vertebroplasty, a medical procedure for treating vertebral fractures, requires medical practitioners to inject bone cement inside the vertebra using a cannula attached to a syringe. The required injection force must be small enough for the practitioner to apply it by hand while remaining stable for a controlled injection. Several factors could make the injection force unintuitive for the practitioners, one of them being the non‐Newtonian nature of the bone cement. The viscosity of the bone cement varies as it flows through the different parts of the injection apparatus and the porous cancellous interior of the vertebra. Therefore, it is important to study the flow of bone cement through these parts. This work is a preliminary study on the flow of bone cement through the injection apparatus. Firstly, we obtained the rheological parameters for the power law model of bone cement using experiments using standard clinical equipment. These parameters were then used to obtain the shear rate, viscosity, and velocity profiles of the bone cement flow through the cannula. Lastly, an analysis was carried out to understand the influence of various geometrical parameters of the injection apparatus, in which the radius of the cannula was found to be the most influential parameter.
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    About the applicability of the theory of porous media for the modelling of non‐isothermal material injection into porous structures
    (2023) Völter, Jan-Sören L.; Ricken, Tim; Röhrle, Oliver
    In this contribution we investigate the relevance of the theory of porous media for the non-isothermal modelling of material injection into porous structures. In particular, we provide a model describing the injection of cement during percutaneous vertebroplasty, which is derived by consistently following the theory of porous media. We demonstrate numerically that this model elicits unphysical behaviour under local thermal non-equilibrium conditions. No distinct unphysical behaviour is observed under local thermal equilibrium conditions. We conclude that heuristic modifications of the model equations are necessary and suspect the unphysical behaviour to be caused by contradictory modelling assumptions.
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    A continuum mechanical porous media model for vertebroplasty : numerical simulations and experimental validation
    (2023) Trivedi, Zubin; Gehweiler, Dominic; Wychowaniec, Jacek K.; Ricken, Tim; Gueorguiev, Boyko; Wagner, Arndt; Röhrle, Oliver
    The outcome of vertebroplasty is hard to predict due to its dependence on complex factors like bone cement and marrow rheologies. Cement leakage could occur if the procedure is done incorrectly, potentially causing adverse complications. A reliable simulation could predict the patient-specific outcome preoperatively and avoid the risk of cement leakage. Therefore, the aim of this work was to introduce a computationally feasible and experimentally validated model for simulating vertebroplasty. The developed model is a multiphase continuum-mechanical macro-scale model based on the Theory of Porous Media. The related governing equations were discretized using a combined finite element-finite volume approach by the so-called Box discretization. Three different rheological upscaling methods were used to compare and determine the most suitable approach for this application. For validation, a benchmark experiment was set up and simulated using the model. The influence of bone marrow and parameters like permeability, porosity, etc., was investigated to study the effect of varying conditions on vertebroplasty. The presented model could realistically simulate the injection of bone cement in porous materials when used with the correct rheological upscaling models, of which the semi-analytical averaging of the viscosity gave the best results. The marrow viscosity is identified as the crucial reference to categorize bone cements as ‘high- ’or ‘low-’ viscosity in the context of vertebroplasty. It is confirmed that a cement with higher viscosity than the marrow ensures stable development of the injection and a proper cement interdigitation inside the vertebra.