Relation between subject-specific hip joint loading, stress distribution in the proximal femur and bone mineral density changes after total hip replacement

In the prediction of bone remodelling processes after total hip replacement (THR), modelling of the subject-specific geometry is now state-of-the-art. In this study, we demonstrate that inclusion of subject-specific loading conditions drastically influences the calculated stress distribution, and hence influences the correlation between calculated stress distributions and changes in bone mineral density (BMD) after THR.For two patients who received cementless THR, personalized finite element (FE) models of the proximal femur were generated representing the pre- and post-operative geometry. FE analyses were performed by imposing subject-specific three-dimensional hip joint contact forces as well as muscle forces calculated based on gait analysis data. Average values of the von Mises stress were calculated for relevant zones of the proximal femur. Subsequently, the load cases were interchanged and the effect on the stress distribution was evaluated. Finally, the subject-specific stress distribution was correlated to the changes in BMD at 3 and 6 months after THR.We found subject-specific differences in the stress distribution induced by specific loading conditions, as interchanging of the loading also interchanged the patterns of the stress distribution. The correlation between the calculated stress distribution and the changes in BMD were affected by the two-dimensional nature of the BMD measurement.Our results confirm the hypothesis that inclusion of subject-specific hip contact forces and muscle forces drastically influences the stress distribution in the proximal femur. In addition to patient-specific geometry, inclusion of patient-specific loading is, therefore, essential to obtain accurate input for the analysis of stress distribution after THR.     

A novel formulation for scratch-based wear modelling in total hip arthroplasty

Damage to the femoral head in total hip arthroplasty often takes the form of discrete scratches, which can lead to dramatic wear acceleration of the polyethylene (PE) liner. Here, a novel formulation is reported for finite element (FE) analysis of wear acceleration due to scratch damage. A diffused-light photography technique was used to globally locate areas of damage, providing guidance for usage of high-magnification optical profilometry to determine individual scratch morphology. This multiscale image combination allowed comprehensive input of scratch-based damage patterns to an FE Archard wear model, to determine the wear acceleration associated with specific retrieval femoral heads. The wear algorithm imposed correspondingly elevated wear factors on areas of PE incrementally overpassed by individual scratches. Physical validation was provided by agreement with experimental data for custom-ruled scratch patterns. Illustrative wear acceleration results are presented for four retrieval femoral heads.     

Quantification of soft tissue balance in total knee arthroplasty using finite element analysis

Unbalanced contact force on the tibial component has been considered a factor leading to loosening of the implant and increased wear of the bearing surface in total knee arthroplasty. Because it has been reported that good alignment cannot guarantee successful clinical outcomes, the soft tissue balance should be checked together with the alignment. Finite element models of patients' lower extremities were developed to analyse the medial and lateral contact force distribution on the tibial insert. The distributions for four out of five patients were not balanced equally, even though the alignment angles were within a clinically acceptable range. Moreover, the distribution was improved by changing soft tissue release and ligament tightening for the specific case. Integration of the biomechanical modelling, image matching and finite element analysis techniques with the patient-specific properties and various dynamic loading would suggest a clinically relevant pre-operative planning for soft tissue balancing.     

The effect of implant design of linked total elbow arthroplasty on stability and stress: a finite element analysis

Several linked total elbow arthroplasty designs exist, which function similar to a loose hinge joint. Constraint behaviour is an important design consideration, as it affects joint stability, or how much secondary [e.g. varus–valgus (VV)] motion is permitted. Implant durability is also a concern, as bearing failures have been reported. This finite element analysis investigates the constraint characteristics and ultra high molecular weight polyethylene bearing stresses of three linked elbow design concepts [cylindrical (CY), hourglass (HG) and concave cylinder (CC)]. The bearing of the CY design was subjected to elevated Von Mises stresses (2.1–5.4 times higher than the HG and CC designs) due to edge loading. The HG design maintained low stresses, but was unable to provide consistent VV stability. The CC design also maintained low stresses while providing consistent VV stability. These results suggest that CC designs may provide better stability characteristics and durability in vivo, compared to the other two designs.     

Biomechanical analysis of the Universal 2 implant in total wrist arthroplasty: a finite element study

Little is known about the mechanics of in vivo loading on total wrist prostheses where many studies have looked at the mechanics of other types of arthroplasty such as for the hip and the knee which has contributed to the overall success of these types of procedures. Currently surgeons would prefer to carry out arthrodesis on the wrist rather than consider arthroplasty as clinical data have shown that the outcome of total wrist arthroplasty is poorer than compared to the hip and knee. More research is needed on the loading mechanisms of the implants in order to enhance the design of future generation implants. This study looks at the load transfer characteristics of the Universal 2 implant using a finite element model of a virtually implanted prosthesis during gripping. The results showed that the loading on the implant is higher on the dorsal and ulnar aspect than on the volar and radial aspect of the implant. The whole load is transmitted through the radius and none through the ulna.     

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Isolated patellofemoral (PF) arthritis of the knee is a common cause of anterior knee pain and disability. Patellofemoral arthroplasty (PFA) is a bone conserving solution for patients with PF degeneration. Failure mechanisms of PFA include growing tibiofemoral arthritis and loosening of components. The implant loosening can be associated with bone resorption or fatigue-failure of bone by overload. This research work aims at determining the structural effects of the implantation of PF prosthesis Journey PFJ (Smith & Nephew, Inc., Memphis, TN, USA) on femoral cancellous bone. For this purpose, the finite element method is considered to perform computational simulations for different conditions, such as well-fixed and loosening scenarios. From the global results obtained, in the well-fixed scenario, a decrease in strain on cancellous bone was noticed, which can be related to bone resorption. In the loosening scenario, when the cement layer becomes inefficient, a significant increase in cancellous bone strain was observed, which can be associated with bone fatigue-failure.These strain changes suggest a weakness of the femur after PFA.     

Influence of anisotropic bone properties on the biomechanical behavior of the acetabular cup implant: a multiscale finite element study

Although the biomechanical behavior of the acetabular cup (AC) implant is determinant for the surgical success, it remains difficult to be assessed due to the multiscale and anisotropic nature of bone tissue. The aim of the present study was to investigate the influence of the anisotropic properties of peri-implant trabecular bone tissue on the biomechanical behavior of the AC implant at the macroscopic scale. Thirteen bovine trabecular bone samples were imaged using micro-computed tomography (μCT) with a resolution of 18 μm. The anisotropic biomechanical properties of each sample were determined at the scale of the centimeter based on a dedicated method using asymptotic homogenization. The material properties obtained with this multiscale approach were used as input data in a 3D finite element model to simulate the macroscopic mechanical behavior of the AC implant under different loading conditions. The largest stress and strain magnitudes were found around the equatorial rim and in the polar area of the AC implant. All macroscopic stiffness quantities were significantly correlated (R² > 0.85, p < 6.5 e-6) with BV/TV (bone volume/total volume). Moreover, the maximum value of the von Mises stress field was significantly correlated with BV/TV (R² > 0.61, p < 1.6 e-3) and was always found at the bone-implant interface. However, the mean value of the microscopic stress (at the scale of the trabeculae) decrease as a function of BV/TV for vertical and torsional loading and do not depend on BV/TV for horizontal loading. These results highlight the importance of the anisotropic properties of bone tissue.     

Subject-specific musculoskeletal modelling in patients before and after total hip arthroplasty*

The goal of this study was to define the effect on hip contact forces of including subject-specific moment generating capacity in the musculoskeletal model by scaling isometric muscle strength and by including geometrical information in control subjects, hip osteoarthritis and total hip arthroplasty patients. Scaling based on dynamometer measurements decreased the strength of all flexor and abductor muscles. This resulted in a model that lacked the capacity to generate joint moments required during functional activities. Scaling muscle forces based on functional activities and inclusion of MRI-based geometrical detail did not compromise the model strength and resulted in hip contact forces comparable to previously reported measured contact forces.     

葛根异黄酮对去卵巢大鼠骨质疏松症的影响

通过对3月龄Wister大鼠,手术切除双侧卵巢后7天,每天灌胃TIP40mg/kg和10mg/kg,并设去卵巢组(OVX)、假手术组(Sham)和尼尔雌醇阳性对照组(OVX-E2),在给药3个月时,测定大鼠股骨骨矿密度(BMD)、骨钙及血清钙水平等,研究葛根异黄酮(TIP)对由雌激素缺乏引起的骨质疏松症的防治作用。结果TIP40mg/kg的BMD比去卵巢组显著提高了18.1%;使胫骨和血清钙含量显著增加;使去卵巢大鼠的脾脏重量系数和胸腺重量系数明显恢复;并可明显控制大鼠的体重。葛根异黄酮可能具有雌激素样活性,并有改善骨质疏松症的生物学活性。     

Influence of ingrowth regions on bone remodelling around a cementless hip resurfacing femoral implant

Hip resurfacing arthroplasty is an alternative to traditional hip replacement that can conserve proximal bone stock and has gained popularity but bone resorption may limit implant survival and remains a clinical concern. The goal of this study was to analyze bone remodelling patterns around an uncemented resurfacing implant and the influence of ingrowth regions on resorption. A computed tomography-derived finite element model of a proximal femur with a virtually implanted resurfacing component was simulated under peak walking loads. Bone ingrowth was simulated by six interface conditions: fully bonded; fully friction; bonded cap with friction stem; a small bonded region at the stem-cup intersection with the remaining surface friction; fully frictional, except for a bonded band along the distal end of the cap and superior half of the cap bonded with the rest frictional. Interface condition had a large influence on remodelling patterns. Bone resorption was minimized when no ingrowth occurred at the bone-implant interface. Bonding only the superior half of the cap increased bone resorption slightly but allowed for a large ingrowth region to improve secondary stability.     

Four-dimensional model of the lower extremity after total hip arthroplasty

We have developed a four-dimensional (4D) model of the lower extremities after total hip arthroplasty in patients. The model can aid in preventing complications such as dislocation and wearing of the sliding surface. The skeletal structure and implant alignment were obtained from CT data. We applied registration method using CAD data to estimate accurate implant alignment from scattered CT data. The reconstructed three-dimensional (3D) skeletal model was combined with motion capture data that were acquired by an optical tracking system. We displayed the patient's skeletal movement and analyzed several parameters that relate to complications. The patient's skeletal model was superimposed onto video footage that was taken by a synchronized and calibrated digital video camera. For validation of the measurement error in this system, we used open MRI to evaluate the relative movement between skin markers and bones. This system visually represents not only the 3D anatomical structure, but also 4D dynamic functions that include the time sequential transitions of components and their positions. The open MRI results indicated that the average error in hip angle was within 5° for each static posture. This system enables clinicians to analyze patient's motions on the basis of individual differences. We found that our system was an effective tool in providing precise guidance of daily postoperative motions that was individualized for each patient. This system will be applicable for surgical planning, assessment of postoperative activities, and the development of new surgical techniques, materials, and prosthetic designs.     

A long-lasting bisphosphonate partially protects periprosthetic bone,but does not enhance initial stability of uncemented femoral stems: A randomized placebo-controlled trial of women undergoing total hip arthroplasty

Low bone quality may compromise the success of cementless total hip arthroplasty in high-risk patients such as elderly women. Zoledronic acid is a long-lasting antiresorptive agent, which is known to reduce short-term periprosthetic bone loss. However, its effect on femoral stem stability is not well known. Forty-nine female patients with a mean age of 68 years (range, 51–85 years) scheduled to undergo cementless total hip arthroplasty due to osteoarthritis were randomized in this double-blind, placebo-controlled trial to receive a single postoperative infusion of zoledronic acid or placebo. Patients were evaluated for up to four years postoperatively for femoral stem migration measured by radiostereometric analysis, bone mineral density (BMD) measured by dual X-ray absorptiometry, functional recovery, and patient-reported outcome scores. Implant survival was determined at nine years postoperatively. Zoledronic acid did not reduce the femoral stem migration that occurred predominantly during the settling period of the first 3–6 months. Subsequently, all femoral stems were radiographically osseointegrated. Zoledronic acid maintained periprosthetic BMD, while the expected loss of periprosthetic bone during the first 12 months was found in controls. Thereafter, periprosthetic BMD of Gruen zone 7 decreased even in the zoledronic acid group but remained 14.6% higher than that in the placebo group at four years postoperatively. Functional recovery was comparable across the groups. At nine years postoperatively, no revision arthroplasty had been performed. In conclusion, in women at high-risk for low BMD, zoledronic acid had a long-lasting, partially protective effect on periprosthetic bone loss, but the treatment did not enhance the initial femoral stem stability.     

Circulating serum vitamin D levels and total body bone mineral density: A Mendelian randomization study

Until recently, randomized controlled trials have not demonstrated convincing evidence that vitamin D, or vitamin D in combination with calcium supplementation could improve bone mineral density (BMD), osteoporosis and fracture. It remains unclear whether vitamin D levels are causally associated with total body BMD. Here, we performed a Mendelian randomization study to investigate the association of vitamin D levels with total body BMD using a large‐scale vitamin D genome‐wide association study (GWAS) dataset (including 79 366 individuals) and a large‐scale total body BMD GWAS dataset (including 66,628 individuals). We selected three Mendelian randomization methods including inverse‐variance weighted meta‐analysis (IVW), weighted median regression and MR‐Egger regression. All these three methods did not show statistically significant association of genetically increased vitamin D levels with total body BMD. Importantly, our findings are consistent with recent randomized clinical trials and Mendelian randomization study. In summary, we provide genetic evidence that increased vitamin D levels could not improve BMD in the general population. Hence, vitamin D supplementation alone may not be associated with reduced fracture incidence among community‐dwelling adults without known vitamin D deficiency, osteoporosis, or prior fracture.     

Mechanical significance of femoral head trabecular bone structure in Loris and Galago evaluated using micromechanical finite element models

Work on the interspecific and intraspecific variation of trabecular bone in the proximal femur of primates demonstrates important architectural variation between animals with different locomotor behaviors. This variation is thought to be related to the processes of bone adaptation whereby bone structure is optimized to the mechanical environment. Micromechanical finite element models were created for the proximal femur of the leaping Galago senegalensis and the climbing and quadrupedal Loris tardigradus by converting bone voxels from high-resolution X-ray computed tomography scans of the femoral head to eight-noded brick elements. The resulting models had approximately 1.8 million elements each. Loading conditions representing takeoff phase of a leap and more generalized load orientations were applied to the models, and the models were solved using the iterative "row-by-row" matrix-vector multiplication algorithm. The principal strain and Von Mises stress results for the leaping model were similar for both species at each load orientation. Similar hip joint reaction forces in the range of 4.9 x to 12 x body weight were calculated for both species under each loading condition, but the hip reaction values estimated for Loris were higher than predicted based on locomotor behavior. These results suggest that functional adaptation to hip joint loading may not fully explain the differences in femoral head trabecular bone structure in Galago and Loris. The finite element method represents a unique and useful tool for analyzing the functional adaptation of trabecular bone in a diversity of animals and for reconstructing locomotor behavior in extinct taxa.     

The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis

One of the crucial factors for short- and long-term clinical success of total hip arthroplasty cementless implants is primary stability. Indeed, motion at the bone–implant interface above 40 μm leads to partial bone ingrowth, while motion exceeding 150 μm completely inhibits bone ingrowth. The aim of this study was to investigate the effect of two cementless femoral stem designs with different lengths on the primary stability. A finite element model of a composite Sawbones^® fourth generation, implanted with five lengths of the straight prosthesis design and four lengths of the curved prosthesis design, was loaded with hip joint and abductor forces representing two physiological activities: fast walking and stair climbing. We found that reducing the straight stem length from 146 to 54 mm increased the average micromotion from 17 to 52 μm during fast walking, while the peak value increased from 42 to 104 μm. With the curved stem, reducing length from 105 to 54 mm increased the average micromotion from 10 to 29 μm, while the peak value increased from 37 to 101 μm. Similar findings are obtained for stair climbing for both stems. Although the present study showed that femoral stem length as well as stem design directly influences its primary stability, for the two femoral stems tested, length could be reduced substantially without compromising the primary stability. With the aim of minimising surgical invasiveness, newer femoral stem design and currently well performing stems might be used with a reduced length without compromising primary stability and hence, long-term survivorship.     

Age-related changes of bone mineral density in human calcaneus, talus, and scaphoid bone

To examine whether the bone mineral density (BMD) decreases uniformly with aging in any spongy bones, the authors investigated age-related changes of BMD in the calcaneus, talus, and scaphoid bone. After the ordinary dissection by medical students was finished, calcanei, tali, and scaphoid bones were resected from the subjects, and BMDs were measured by dual-energy X-ray absorptiometry. Their BMDs seemed to decrease gradually with aging in the calcanei, tali, and scaphoid bones. It was found that there were statistically significant relationships between age and BMD in the men’s and women’s scaphoid bones, women’s tali, and women’s calcanei, but not in the men’s tali and calcanei. It should be noted that there were significant relationships between age and BMD in both men’s and women’s scaphoid bones. In regard to relationship in BMD between the bones of the upper and lower limbs in individuals, it was found that the relationship between the calcaneus and talus was higher than that between the calcaneus and scaphoid bone. This suggests that there is a higher relationship in BMD between the two tarsal bones compared with that between the tarsal and carpal bones.     

Computational modelling of the natural hip: a review of finite element and multibody simulations

Primary objective: The hip joint suffers from a high prevalence of degenerative conditions. Athough patient's well-being could be improved through early and more effective interventions, without a greater understanding of the mechanics of the hip, these developments cannot be attained. Thus, this review article summarises the current literature on this subject in order to provide a platform for future developments. To illustrate the influence computational simulations have had on the knowledge advancement in hip mechanics, we explored two methodological approaches: finite element (FE) analysis and multibody dynamics (MBD). Main outcomes and results: Notwithstanding the unique capabilities of FE and MBD, the former generally offers the micromechanics of the articulating surfaces whereas the latter the macromechanics of the skeleton, these two methodologies also provide the bulk of the literature regarding computational modelling of the musculoskeletal system. Although FE has provided significant knowledge on contact pressures and the effects of musculoskeletal geometries, in particular cartilage and bone shapes, MBD has afforded a wealth of understanding on the influence of gait patterns and muscle attachment locations on force magnitudes. Conclusions: These two computational techniques have, and will continue to, provide significant contributions towards the development of interventions. It is hoped that this article will help focus ongoing technological developments by highlighting areas of success, but also areas of under development.     

The effects of manufacturing tolerances and assembly force on the volumetric wear at the taper junction in modular total hip arthroplasty

Abstract

Fretting and corrosion at the taper-head interface in total hip arthroplasty has been reported as a potential cause of early failure of the implant system. The finite element (FE) method can be used to study the mechanics at the taper junction that are difficult to assess experimentally. Taper mismatch is one of the factors that can influence the performance of the taper junction. In this study we have assessed the effect of taper mismatch, in combination with assembly force on the volumetric wear. The study showed that higher assembly forces and smaller mismatches result in the least volumetric wear.