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Orthopedic Biomechanics > Functions > Flashcards

Functions Flashcards

1
Q

Bone (6)

A 
Supports load
Protects organs
Provide muscle attachments
Store calcium
Produce Cells 
Enable hearing
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2
Q

Osteoblasts (3)

A

Deposit calcium, phosphate and apatite to form bone matrix crystals.
Make collagen fibres and PG.
Can be turned into osteocytes.

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3
Q

Osteoclasts (2)

A

Secrete H+ to dissolve minerals in bone.

Secrete collagenase to clear protein.

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4
Q

Factors affecting bone mechanics (4)

A

Loading rate.
Orientation.
Creep.
Age.

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5
Q

Factors affecting trabecular bone adaptation (4)

A

Number.
Thickness.
Spacing.
Orientation.

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6
Q

Risk of osteoporosis (5)

A 
Age.
Genetic (partially).
Low peak bone mass.
Diet. 
Physical inactivity.
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7
Q

Treatments for osteoporosis (4)

A

Calcium supplements.
Bisphosphonates.
Oestrogen replacement therapy.
Exercise.

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8
Q

Internal treatment for fracture (4)

A

Screws.
Compression plate.
Wires.
Tension banding.

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9
Q

Complications in fracture (4)

A

Non-union.
Unequal limb length.
Compartment syndrome.
Infection.

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10
Q

Types of cartilage (3)

A

Hyaline / Articular - in joint surface, thought to be inert.
Elastic - in throat, lots of elastin.
Fibrocartilage - in intervertebral disc / meniscus, can replace articular cartilage in pathological situations

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11
Q

Contents of hyaline cartilage

A

Collage Type II.
Water.
Proteoglycans.
Aggrecans.

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12
Q

Roles of chondrocytes (4)

A

Synthesis, modification, assembly and organisation of PG’s.
Synthesis and secretion of collagen.
Degradation and turnover of the matrix.
Balancing anabolic and catabolic activities.

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13
Q

Function of cartilage (3)

A

Absorbs shock.
Spreads load.
Friction, lubrication and wear resistance.

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14
Q

Factors affecting cartilage mechanical properties (6)

A 
Compression.
Tension.
Shear.
Time-scale (viscoelastic).
Permeability. 
Pressure.
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15
Q

Mechanical testing of cartilage (3)

A

Indentation.
Unconfined compression.
Confined compression.

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16
Q

Viscoelastic Constitutive Models (3)

A

Maxwell - spring and dashpot in series, good for relaxation bad for creep.
Kelvin-Voight Body - spring and dashpot in parallel, good for creep bad for relaxation.
Standard Linear Model - combination of above, good for creep and stress relaxation but can’t describe interstitial fluid.

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17
Q

Mechanobiology of cartilage (5)

A
  1. Physiochemical Effects.
  2. Cell deformation.
  3. Hydrostatic pressure.
  4. Fluid transport.
  5. Electrochemical transduction.
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18
Q

Issues with cartilage repair (2)

A

Low blood supply - no haemorrhage or inflammatory cells.

Lack of cells - limited synthesis of matrix for large damage.

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19
Q

Types of OA (2)

A

Primary - spontaneous and no known cause.

Secondary - post traumatic from joint injury / obesity / developmental factors.

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20
Q

Risk factors of OA (3)

A

Genetic - endochondral ossification genes.
Environmental - age/gender/obesity/high bone density.
Biomechanical - injury.

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21
Q

Treatment of OA (5)

A 
Weight loss.
Moderate exercise and stretching. 
Drugs (Analgesics and Non-steroid anti inflammatory)
Nutritional supplements.
Surgery.
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22
Q

Types of joint (9)

A

Fibrous - fibrous connective tissue.
Cartilaginous - bones connected by cartilage.
Synovial - Bones connected by fluid filled cavity.

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23
Q

Factors affecting stability of joint (3)

A
  1. Bones
  2. Ligaments
  3. Muscles
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24
Q

Function of synovial joint (3)

A

Secretes synovial fluid.
Packing changes shape while moving.
Maintain volume of synovial.

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25
Q

Types of synovial joint (6)

A 
Pivot - C1&C2 vertebra.
Hinge - elbow. 
Saddle - base of thumb. 
Ball & Socket - hip.
Condyloid - proximal wrist. 
Plane - tarsal bones.
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26
Q

Lubricating components of the synovial joint (2).

A

Hyaluronic acid and lubricin.

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27
Q

Maintenance components of the synovial joint (2).

A

Proteinases and collagenases.

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28
Q

Function of fluid in the synovial joint (3)

A

Lubricate.
Absorb shock.
Supply nutrients and remove waste.

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29
Q

Factors of joint’s low friction surface (2).

A
  1. Adhesion of one surface to another.

2. Viscosity of sheared lubricant film between surface.

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30
Q

Lubrication methods (5).

A

Fluid-film lubrication - low load high velocity.
Mixed boundary lubrication - high load, slow velocity.
Boosted lubrication.
Adsorbed molecules.
Biphasic lubrication.

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31
Q

Requirements for successful implants (7)

A 
Biocompatible. 
Load-bearing.
Long-lasting. 
Reliable. 
Revisable.
Restore pain function. 
Relieve pain.
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32
Q

Metals used for joint replacement (3)

A

Stainless steel.
Cobalt chrome alloys.
Titanium alloys.

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33
Q

Types of joint replacement failure (6)

A 
Wear. 
Fracture from repeated load. 
Stress shielding.
Failed bonding.
Dislocation. 
Infection.
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34
Q

Advantages of cemented joint replacement (3)

A

Suitable for osteoporotic patients.
Antibiotics can be added to cement.
Drys quickly.

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35
Q

Disadvantages of cemented joint replacement (2)

A

Breakdown leads to loosening.

Debris can cause inflammation and enter bloodstream.

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36
Q

Advantages of uncemented joint replacements (2).

A

No breakdown of cement.

Potentially better long term bond.

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37
Q

Disadvantages of uncemented joint replacements (2)

A

Needs good quality bone.

Extended recovery of the bone.

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38
Q

Factors affecting performance of joint replacement - Implant (3)

A

Design details.
Production technology.
Surgical guidelines.

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39
Q

Factors affecting performance of joint replacement - Surgeon (5)

A 
Point at which they operate.
Which joint they pick. 
Pre-planning that occurs. 
Reeming procedure.
Experience in doing surgery.
40
Q

Factors affecting performance of joint replacement - Patient (5)

A 
Weight and dimensions. 
Age. 
Activity level. 
Musculoskeletal condition. 
Health condition.
41
Q

Types of UHMWPE wear (3)

A

Adhesive
Abrasive
Fatigue

42
Q

Testing methods of joint replacements (3)

A

Experimental - cadaveric specimens.
Computer models.
Animal models

43
Q

Issues with anatomical approach (2)

A

Complex geometry is tricky to manufacture.

Difficult surgery.

44
Q

Congruent surface

A

+ low contact stress so low wear

- high constraint force because restricted movement

45
Q

Non-congruent surface

A

+ free movement so less constraint force

- high contact stress so high wear

46
Q

Contact stress results in…

A

bone resorption

47
Q

Constraint force results in…

A

loosening

48
Q

Issues with mobile-bearings (2)

A

More likely to dislocate.

Don’t last as long.

49
Q

Types of shoulder arthroplasty (4)

A

Total joint - metal ball and socket.
Hemiarthroplasty - use normal socket.
Resurfacing arthroplasty.
Reverse total arthroplasty.

50
Q

Types of elbow arthroplasty (3)

A

Linked.
Unlinked.
Linkable - revision surgery can link or unlink.

51
Q

Where is the meniscus found? (4)

A

Temporomandibular joint.
Sternoclavicular joint.
Acromioclavicular joint.
Knee Tibiofemoral joint.

52
Q

Meniscus tear types (8)

A 
Partial/Complete.
Longitudinal. 
Flap - can't be sutured.
Degenerative.
Radial - can't be sutured. 
Horizontal. 
Bucket Handle Tear.
Pedunculated Tag.
53
Q

Zones of the meniscus (2)

A

Red zone - periphery of the meniscus.

White zone - nourishment comes from synovial fluid.

54
Q

Meniscal Replacement (4)

A

Allograft transplantation.
Artificial.
Collagen Meniscal Implant.
Polycarbonate-Urethane Elastomer.

55
Q

Role of menisci (5)

A 
Protect cartilage and subchondral bone from excessive loading. 
Increase the stability of the joint. 
Joint lubrication. 
Nutrition from articular cartilage. 
Assist with prioception.
56
Q

Causes of menisci tears (4)

A

Younger patients of a flexed loaded knee.
Squatting.
Associated with an injury.
Degenerative process in older patients.

57
Q

Symptoms of menisci tears (6)

A 
Pain.
Swelling. 
Clicking.
Catching. 
Giving-way. 
Locking.
58
Q

Sections of the spinal column (5)

A 
Cervical C1-C7 - supports head. 
Thoracic T11-T12 - midback/dorsal region.
Lumbar L1-L5 - the lower back.
Sacrum - Base of spine.
Coccyx - a few small bones.
59
Q

Parts of the intervertebral disc

A

Nucleus Pulposus - gelatinous inner region.
Annulus Fibrous - firm and banded outer region.
Cartilage Endplates - between vertebral body and disc.

60
Q

Forces acting on the spine (5)

A 
Bodyweight. 
Tension of spinal ligament. 
Tension in the surrounding muscle. 
Intra-abdominal pressure. 
External loads.
61
Q

COM is ______ to the spinal column when standing

A

Anterior

62
Q

Affect of disc degeneration on macroscopic behaviour (3).

A

Pressure and flexibility affected.
Shear modulus increases 8X with degeneration.
Annulus fibrosis undergoes an increase in compressive and shear moduli.

63
Q

The hierarchical structure of tendons and ligaments.

A

Fibrils - Fibres - Subfasicles - Fasciles - Tendon/Ligament

64
Q

Regions in ligament stress strain curve (3)

A

Toe Region.
Linear Region.
Yield.

65
Q

Challenges of mechanical testing ligaments (2)

A

Short segments.

Slippage.

66
Q

Cross-sectional measurement techniques for tendons (2)

A

Contact - callipers, moulding methods.

Non-contact - laser micrometre.

67
Q

Factors affecting the biomechanics of ligaments (6)

A 
Components.
Orientation. 
Location.
Hydration. 
Temperature. 
Strain rate.
68
Q

Effects of ageing on tendons (4)

A

Stiffness and elastic modulus increase.
No and quality of cross-links increase.
Collagen fibril diameter increase.
Decrease in ultimate load.

69
Q

Challenges to repair ligaments (4)

A

Difficult to restore normal function.
Relatively avascular.
Healed tissue needs to be able to glide for active motion - scar tissue leads to adherence.
Other pathology decreases repair ability.

70
Q

Structure of muscles

A

Hierarchical. Sarcomere - Myofibril - Fibres - Fascicles - Muscles.
Regular structure to provide consistent force.

71
Q

Factors affecting force production (3)

A

Amount of stimulation.
Length of muscle.
The velocity of muscle shortening.

72
Q

What impacts the greatest force of a muscle contraction (4)

A

Contraction time
Cross-bridging
Tension in elastic components
Elastic energy stored in actin-myosin cross-bridges

73
Q

Factors affecting muscle excursion (2)

A

Length of fibres composing the muscles - fibres shorten around 30% of its length.
Muscles moment arm - smaller moment arm, great excursion.

74
Q

Muscle fibre types (3)

A

Type I - slow oxidative. Slow contraction, difficult to fatigue.
Type IIA - fast oxidative. Moderately fast contraction, long-term anaerobic.
Type IIB - glycolytic. Fast contraction, rapidly fatigued.

75
Q

What affects strength (6)

A 
Stretch of muscle. 
Contraction velocity. 
Level of fibre recruitment. 
Muscle size - PCSA. 
Fibre type. 
Muscle moment arm.
76
Q

Effects of disuse on muscles (4)

A

Decrease in PCSA.
Muscle shortening (fewer sarcomeres in series)
Changes ratio of Type I and Type II.
Dependent on muscle.

77
Q

Making a in-silco muscle model determinant (4)

A

Reduce muscles considered.
Only consider agonist muscle
No co-contraction.
Add equations.

78
Q

Pitfalls of muscle models (5)

A

Muscle moment arms change over a range of motion.
Muscle force depends on length and velocity.
Pathological motions may not be optimised.
Datasets vary person-person.
Models are done for convenience.

79
Q

Factors affecting EMG signal (4)

A

Cross-talk between muscles.
Changes in geometry between muscles and electrodes.
The impedance of the tissue.
External noise.

80
Q

Types of ossification (2)

A

Intramembrane ossification

Endochondral ossification

81
Q

Functional requirements of the foot and ankle

A 
MUST: 
Transfer load from lower extremity
Withstand high loads
Be durable
Provide traction for movement
IDEALLY
Adjust to various terrain
Performs at a range of speeds
Contributes to propulsion
Augments awareness of body and joint position
82
Q

Risk factors of hallux valgus (8)

A 
Genetics.
Age.
Sex.
Ligament laxity. 
Congenital abnormalities.
Neuromuscular disorders.
Excessive loading. 
Footwear.
83
Q

Treatment of hallux valgus (5)

A 
Shoe modification.
Physiotherapy.
Padding / splinters / toe spacers.
Insoles. 
Painkillers.
84
Q

Surgical treatment of hallux valgus (5)

A 
Exostectomy
McBride soft tissue
Osteomy
Arthrodesis
Resection Arthroplasty.
85
Q

Symptoms of gout (4)

A

Sudden and severe joint pain.
Joint swelling.
Joint stiffness.
Mild fever.

86
Q

Risk factors of gout (7)

A 
Age.
Sex. 
Genetics. 
Meat / Seafood / Alcohol. 
Drugs
Obesity and diabetes. 
Chronic kidney disease.
87
Q

Joint fusion treats… (4)

A

Pain.
Disability.
Decrease function & range of motion.
Instability.

88
Q

Joint fusion is a result of… (5)

A 
Fractures.
Osteoarthritis.
Rhuematoid arthiritis
Joint Instability
Infection
89
Q

Biomechanical effects of joint fusion in hand (4)

A

Change in carpal position.
Reduced wrist motion.
Altered force transmission.
Reduced grip strength.

90
Q

Types of spinal fusion (2)

A

Posterolateral - Bone graft placed between transverse processes.
Interbody - intervertebral disc removed.

91
Q

Biomechanical impacts of fusing the spine (2)

A

Alters load transmission.

Adjacent segment compensate for decreased range of motion.

92
Q

Categories of disc replacement (8)

A 
Composite. 
Mechanical.
Elastic. 
Nucleus.
Constrained. 
Semi-Constrained. 
Unonstrained. 
Deformable.
93
Q

Complications of disc replacement (6)

A 
Heterotopic ossification.
Migration, loosening and subsidence.
Implant of vetebral body fractures. 
Wear. 
Adjacent segment degeneration. 
Osteolysis.
94
Q

What can cause high strain on Anteromedial Bundle? (4)

A

Anterior shear forces on proximal tibia.
Knee valgus moments.
Reduced flexion angle.
Strong quads.

95
Q

Surgical repairs for ACL and a + & - (3)

A 
Allograft:
\+ No donor site
- High cost, longer incorporation time, properties reduced by sterilisation
Autograft:
\+ native complex
- donor site instability
Synthetic Grafts: 
\+ can control material properties, High UTS, no associated donor site. 
- difficult to mimick properties.
96
Q

Locations for ACL autograph (3)

A

Quadriceps tendon
Patella tendon
Hamstring tendon

Orthopedic Biomechanics (3 decks)

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