Finite Element Analysis of Tibial Implants - Effect of Fixation Design and Friction Model

A three dimensional nonlinear finite element model was developed to investigate tibial fixation designs and friction models (Coulomb's vs nonlinear) in total knee arthroplasty in the immediate postoperative period with no biological attachment. Bi-directional measurement-based nonlinear friction constitutive equations were used for the bone-porous coated implant interface. Friction properties between the polyethylene and femoral components were measured for this study. Linear elastic isotropic but heterogeneous mechanical properties taken from literature were considered for the bone. The Tensile behaviour of polyethylene was measured and subsequently modeled by an elasto-plastic model. Based on the earlier finite element and experimental pull-out studies, pegs and screws were also realistically modeled. The geometry of every component was obtained through measurement. The PCA tibial baseplate with three different configurations was considered; one with three screws, one with one screw and two short inclined porous-coated pegs, and a third one with no fixation for the sake of comparison. The axial load of 2000N was applied through the femoral component on the medial plateau of articular insert. It was found that Coulomb's friction significantly underestimates the relative micromotion at the bone-implant interface. The lowest micromotion and lift-off were found for the design with screws. Relative micromotion and stress transfer at the bone-implant interface depended significantly on the friction model and on the baseplate anchorage configuration. Cortical and cancellous bones carried, respectively, 10-13% and 65-86% of the axial load depending on the fixation configuration used. The remaining portion was transmitted as shear force by screws and pegs. Normal and Mises stresses as well as contact area in the polyethylene insert were nearly independent of the baseplate fixation design. The Maximum Mises stress in the polyethylene exceeded yield and was found 1-2 mm below the contact surface for all designs.     

Finite Element Analysis of Tibial Implants — Effect of Fixation Design and Friction Model

Abstract

A three dimensional nonlinear finite element model was developed to investigate tibial fixation designs and friction models (Coulomb's vs nonlinear) in total knee arthroplasty in the immediate postoperative period with no biological attachment. Bi-directional measurement-based nonlinear friction constitutive equations were used for the bone-porous coated implant interface. Friction properties between the polyethylene and femoral components were measured for this study. Linear elastic isotropic but heterogeneous mechanical properties taken from literature were considered for the bone. The Tensile behaviour of polyethylene was measured and subsequently modeled by an elasto-plastic model. Based on the earlier finite element and experimental pull-out studies, pegs and screws were also realistically modeled. The geometry of every component was obtained through measurement. The PCA tibial baseplate with three different configurations was considered; one with three screws, one with one screw and two short inclined porous-coated pegs, and a third one with no fixation for the sake of comparison. The axial load of 2000N was applied through the femoral component on the medial plateau of articular insert. It was found that Coulomb's friction significantly underestimates the relative micromotion at the bone-implant interface. The lowest micromotion and lift-off were found for the design with screws. Relative micromotion and stress transfer at the bone-implant interface depended significantly on the friction model and on the baseplate anchorage configuration. Cortical and cancellous bones carried, respectively, 10–13% and 65–86% of the axial load depending on the fixation configuration used. The remaining portion was transmitted as shear force by screws and pegs. Normal and Mises stresses as well as contact area in the polyethylene insert were nearly independent of the baseplate fixation design. The Maximum Mises stress in the polyethylene exceeded yield and was found 1–2 mm below the contact surface for all designs.     

An efficient and accurate prediction of the stability of percutaneous fixation of acetabular fractures with finite element simulation

Posterior wall fracture is one of the most common fracture types of the acetabulum and a conventional approach is to perform open reduction and internal fixation with a plate and screws. Percutaneous screw fixations, on the other hand, have recently gained attention due to their benefits such as less exposure and minimization of blood loss. However their biomechanical stability, especially in terms interfragmentary movement, has not been investigated thoroughly. The aims of this study are twofold: (1) to measure the interfragmentary movements in the conventional open approach with plate fixations and the percutaneous screw fixations in the acetabular fractures and compare them; and (2) to develop and validate a fast and efficient way of predicting the interfragmentary movement in percutaneous fixation of posterior wall fractures of the acetabulum using a 3D finite element (FE) model of the pelvis. Our results indicate that in single fragment fractures of the posterior wall of the acetabulum, plate fixations give superior stability to screw fixations. However screw fixations also give reasonable stability as the average gap between fragment and the bone remained less than 1 mm when the maximum load was applied. Our finite element model predicted the stability of screw fixation with good accuracy. Moreover, when the screw positions were optimized, the stability predicted by our FE model was comparable to the stability obtained by plate fixations. Our study has shown that FE modeling can be useful in examining biomechanical stability of osteosynthesis and can potentially be used in surgical planning of osteosynthesis.     

单端固定式下颌骨修复体的应力分析

目的：针对包括一侧髁状突的下颌骨缺损,通过有限元应力分析,了解单端固定式下颌骨修复体在功能运动时的受力与变形规律,以期寻求更加合理的修复体的设计和固定方式。方法：建立下颌骨断端和修复体的简易三维模型,模拟咀嚼运动,施加垂直方向载荷,进行有限元法应力分析,计算出该模型各组成部分的应力分布和受力变形。结果：在该模型加载时,延伸板基部和近断端处上部的螺钉颈部是应力集中的部位,近断端处下部的螺钉颈部和修复体的远端舌侧为形变最大的部位。结论：单端固定式下颌骨修复体在加载时,延伸板的基部和靠近断端的固定螺钉是应力集中的部位,修复体远离固定的一侧是变形最大的部位,提示我们应将延伸板形态设计为尽可能加宽,并应增加下颌骨下缘处的固定,使修复体与下颌骨断端受力更加合理,变形也尽可能缩小。     

单端固定式下颌骨修复体的应力分析

目的:针对包括一侧髁状突的下颌骨缺损,通过有限元应力分析,了解单端固定式下颌骨修复体在功能运动时的受力与变形规律,以期寻求更加合理的修复体的设计和固定方式。方法:建立下颌骨断端和修复体的简易三维模型,模拟咀嚼运动,施加垂直方向载荷,进行有限元法应力分析,计算出该模型各组成部分的应力分布和受力变形。结果:在该模型加载时,延伸板基部和近断端处上部的螺钉颈部是应力集中的部位,近断端处下部的螺钉颈部和修复体的远端舌侧为形变最大的部位。结论:单端固定式下颌骨修复体在加载时,延伸板的基部和靠近断端的固定螺钉是应力集中的部位,修复体远离固定的一侧是变形最大的部位,提示我们应将延伸板形态设计为尽可能加宽,并应增加下颌骨下缘处的固定,使修复体与下颌骨断端受力更加合理,变形也尽可能缩小。     

Stress analysis of a centrally fractured rib fixated by an intramedullary screw

The stress on an intramedullary screw rib fixation device holding together a centrally fractured human rib under in vivo force loadings was studied using finite element analysis (FEA). Validation of the FEA modelling using pullout from porcine ribs proved FEA to be suitable for assessing the structural integrity of screw/bone systems such as rib fixated by a screw. In the human rib fixation investigation, it was found that intramedullary bioresorbable Bioretec screws can fixate centrally fractured human ribs under normal breathing conditions. However, under coughing conditions, simulation showed Bioretec fixating screws to bend substantially. High stresses in the screw are mainly the result of flexion induced by the force loading, and are restricted to thin regions on the outside of the screw shaft. Stiffer screws result in less locally intense stress concentrations in bone, indicating that bone failure in the bone/screw contact regions can be averted with improvements in screw stiffness.     

Cortical bone viscoelasticity and fixation strength of press-fit femoral stems: finite element model

Many cementless implant designs rely upon a diaphyseal press-fit in conjunction with a porous coated implant surface to achieve primary or short term fixation, thereby constraining interface micromotion to such a level that bone ingrowth and consequent secondary or long-term fixation, i.e., osseointegration, can occur. Bone viscoelasticity, however, has been found to affect stem primary stability by reducing push-out load. In this investigation, an axisymmetric finite element model of a cylindrical stem and diaphyseal cortical bone section was created in order to parametrically evaluate the effect of bone viscoelasticity on stem push-out while controlling coefficient of friction (mu = 0.15, 0.40, and 1.00) and stem-bone diametral interference (delta = 0.01, 0.05, 0.10, and 0.50 mm). Based on results from a previous study, it was hypothesized that stem-bone interference (i.e., press-fit) would elicit a bone viscoelastic response which would reduce the initial fixation of the stem as measured by push-out load. Results indicate that for all examined combinations of mu and delta, bone viscoelastic behavior reduced the push-out load by a range of 2.6-82.6% due to stress relaxation of the bone. It was found that the push-out load increased with mu for each value of delta, but minimal increases in the push-out load (2.9-4.9%) were observed as delta was increased beyond 0.10 mm. Within the range of variables reported for this study, it was concluded that bone viscoelastic behavior, namely stress relaxation, has an asymptotic affect on stem contact pressure, which reduces stem push-out load. It was also found that higher levels of coefficient of friction are beneficial to primary fixation, and that an interference "threshold" exists beyond which no additional gains in push-out load are achieved.     

Biomechanical comparison of conventional and anatomical calcaneal plates for the treatment of intraarticular calcaneal fractures – a finite element study

Initial stability is essential for open reduction internal fixation of intraarticular calcaneal fractures. Geometrical feature of a calcaneal plate is influential to its endurance under physiological load. It is unclear if conventional and pre-contoured anatomical calcaneal plates may exhibit differently in biomechanical perspective. A Sanders’ Type II-B intraarticular calcaneal fracture model was reconstructed to evaluate the effectiveness of calcaneal plates using finite element methods. Incremental vertical joint loads up to 450 N were exerted on the subtalar joint to evaluate the stability and safety of the calcaneal plates and bony structure. Results revealed that the anatomical calcaneal plate model had greater average structural stiffness (585.7 N/mm) and lower von Mises stress on the plate (774.5 MPa) compared to those observed in the conventional calcaneal plate model (stiffness: 430.9 N/mm; stress on plate: 867.1 MPa). Although both maximal compressive and maximal tensile stress and strain were lower in the anatomical calcaneal plate group, greater loads on fixation screws were found (average 172.7 MPa compared to 82.18 MPa in the conventional calcaneal plate). It was noted that high magnitude stress concentrations would occur where the bone plate bridges the fracture line on the lateral side of the calcaneus bone. Sufficient fixation strength at the posterolateral calcaneus bone is important for maintaining subtalar joint load after reduction and fixation of a Sanders’ Type II-B calcaneal fracture. In addition, geometrical design of a calcaneal plate should worth considering for the mechanical safety in practical usage.     

人工半骨盆假体置换联合腰椎椎弓根螺钉固定术后生物力学的有限元分析

目的:建立人工半骨盆假体置换与联合腰椎椎弓根螺钉固定后的三维有限元模型,评价腰骶段生物力学改变后半骨盆假体力学结构的特点。方法:采用CT薄层扫描采集原始数据,分别建立正常骨盆、半骨盆假体置换术后以及半骨盆假体置换联合腰椎椎弓根螺钉固定术后骨盆的三维有限元模型,分别在第4腰椎上终板平面施以500 N的垂直纵向载荷,分析不同骨盆模型的应力分布特点。结果:与正常骨盆有限元模型相比,半骨盆假体置换术后健侧骨盆应力分布以骶髂关节、髋臼窝及耻骨为主,置换侧半骨盆假体以耻骨连接棒、髋臼杯及髂骨座为主,最大应力出现在耻骨连接棒,应力峰值为65.62 MPa。联合腰椎椎弓根螺钉固定后健侧应力相对减小,置换侧髂骨固定座与骶骨固定处应力相对减小,应力分布以腰椎椎弓根钉棒、耻骨连接棒及髋臼杯为主,最大应力出现在椎弓根螺钉,应力峰值为107 MPa。结论:半骨盆假体置换联合腰椎椎弓根螺钉固定后钉棒分担了半骨盆置换后健侧骨盆及置换侧髂骨固定座与骶骨固定处附近的部分应力,缓解应力集中现象,降低术后骨盆破坏风险,一定程度上增加了半骨盆置换后骨盆的稳定性。     

Effect of screw position on load transfer in lumbar pedicle screws: a non-idealized finite element analysis

Angled screw insertion has been advocated to enhance fixation strength during posterior spine fixation. Stresses on a pedicle screw and surrounding vertebral bone with different screw angles were studied by finite element analysis during simulated multidirectional loading. Correlations between screw-specific vertebral geometric parameters and stresses were studied. Angulations in both the sagittal and axial planes affected stresses on the cortical and cancellous bones and the screw. Pedicle screws pointing laterally (vs. straight or medially) in the axial plane during superior screw angulation may be advantageous in terms of reducing the risk of both screw loosening and screw breakage.     

Influence of bicortical techniques in internal connection placed in premaxillary area by 3D finite element analysis

The aim of study was to evaluate the stress distribution in implant-supported prostheses and peri-implant bone using internal hexagon (IH) implants in the premaxillary area, varying surgical techniques (conventional, bicortical and bicortical in association with nasal floor elevation), and loading directions (0°, 30° and 60°) by three-dimensional (3D) finite element analysis. Three models were designed with Invesalius, Rhinoceros 3D and Solidworks software. Each model contained a bone block of the premaxillary area including an implant (IH, Ø4 × 10 mm) supporting a metal-ceramic crown. 178 N was applied in different inclinations (0°, 30°, 60°). The results were analyzed by von Mises, maximum principal stress, microstrain and displacement maps including ANOVA statistical test for some situations. Von Mises maps of implant, screws and abutment showed increase of stress concentration as increased loading inclination. Bicortical techniques showed reduction in implant apical area and in the head of fixation screws. Bicortical techniques showed slight increase stress in cortical bone in the maximum principal stress and microstrain maps under 60° loading. No differences in bone tissue regarding surgical techniques were observed. As conclusion, non-axial loads increased stress concentration in all maps. Bicortical techniques showed lower stress for implant and screw; however, there was slightly higher stress on cortical bone only under loads of higher inclinations (60°).     

Finite Element Analysis of Minimal Invasive Transforaminal Lumbar Interbody Fusion

The purpose of our study is to develop and validate three-dimensional finite element models of transforaminal lumbar interbody fusion, and explore the most appropriate method of fixation and fusion by comparing biomechanical characteristics of different fixation method. We developed four fusion models: bilateral pedicle screws fixation with a single cage insertion model (A), bilateral pedicle screws fixation with two cages insertion model (B), unilateral pedicle screws fixation with a single cage insertion model (C), and unilateral pedicle screws fixation with two cages insertion model (D); the models were subjected to different forces including anterior bending, posterior extension, left bending, right bending, rotation, and axial compressive. The von Mises stress of the fusion segments on the pedicle screw and cages was recorded. Angular variation and stress of pedicle screw and cage were compared. There were differences of Von Mises peak stress among four models, but were within the range of maximum force. The angular variation in A, B, C, and D decreased significantly compared with normal. There was no significant difference of angular variation between A and B, and C and D. Bilateral pedicle screws fixation had more superior biomechanics than unilateral pedicle screws fixation. In conclusion, the lumbar interbody fusion models were established using varying fixation methods, and the results verified that unilateral pedicle screws fixation with a single cage could meet the stability demand in minimal invasive transforaminal interbody fusion.     

Mandibular reconstruction with the titanium hollow screw reconstruction plate (THORP) system: evaluation of 62 cases

The titanium hollow screw reconstruction plate (THORP) system for reconstruction of lower jaw defects provides a functional stable fixation and is used as a long-term or permanent implant in tumor surgery and in traumatology. The rigid fixation of the head of the screw to the plate, avoiding unphysiologic loads to the bone underneath the plate, and the titanium plasma-coated perforated hollow screws, enabling the development of direct bone-titanium contact as well as the ingrowth of bone into the lumen and perforations, are the major advantages of this system compared to conventional systems. The different surgical methods, such as preservation of the condylar process with only two screws, intraoperative freely adjustable condylar prosthesis, lingual application of the plate, and primary bone transplantation, are described. The evaluation of 62 patients reconstructed with the THORP system between 1981 and 1986 revealed no plate loosening, even in irradiated bone, and showed satisfactory aesthetic and functional results.     

A comparison of stress distributions for different surgical procedures, screw dimensions and orientations for a Temporomandibular joint implant

Finite element analysis is a useful analytical tool for the design of biomedical implants. The aim of this study was to investigate the behavior of temporomandibular joint implants with multiple design variables of the screws used for fixation of the implant. A commercially available implant with full mandible was analyzed using a finite element software package. The effects of different design variables such as orientation, diameter and stem length of the screws on the stress distribution in bone for two different surgical procedures were investigated. Considering the microstrain in bone as a principal factor, the acceptable ranges for screw diameter and length were determined. Parallel orientation of the screws performed better from a stress point of view when compared to the zig-zag orientation. Sufficient contact between the implant collar and mandibular condyle was shown to reduce the peak stresses which may lead to long term success. The distance between screw holes in the parallel orientation was much closer when compared to the zig-zag orientation. However, the stresses in bone near the screw hole area for the parallel orientation were within acceptable limits.     

Design and testing of external fixator bone screws

In external fixation, bone screw loosening still presents a major clinical problem. For this study, the design factors influencing the mechanics of the bone-screw interface were analysed and various experimental screws designed with the intention of maximizing the strength and stiffness of the inserted screw. Push-in, pull-out and bending tests were then carried out on the three experimental screws, and on two commercially available screws in both a synthetic material and in cadaveric bone; photoelastic tests on different screw threadforms were also performed. The results of the push-in and pull-out tests indicate that both the screw threadform and cutting head have a significant effect on the holding strength of the screw. The photoelastic tests show that most of the applied load is distributed over the first few threads closest to the load, and that the area between the thread crests is subjected to high shear stresses.     

Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing

The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age) of the animal, the level of the vertebrae (lumbar or thoracic) and the type of screw anchorage (mono- or bi-cortical) on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old) tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level), the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout.     

Finite Element Analysis of a New Pedicle Screw-Plate System for Minimally Invasive Transforaminal Lumbar Interbody Fusion

Purpose

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly popular for the surgical treatment of degenerative lumbar disc diseases. The constructs intended for segmental stability are varied in MI-TLIF. We adopted finite element (FE) analysis to compare the stability after different construct fixations using interbody cage with posterior pedicle screw-rod or pedicle screw-plate instrumentation system.

Methods

A L3–S1 FE model was modified to simulate decompression and fusion at L4–L5 segment. Fixation modes included unilateral plate (UP), unilateral rod (UR), bilateral plate (BP), bilateral rod (BR) and UP+UR fixation. The inferior surface of the S1 vertebra remained immobilized throughout the load simulation, and a bending moment of 7.5 Nm with 400N pre-load was applied on the L3 vertebra to recreate flexion, extension, lateral bending, and axial rotation. Range of motion (ROM) and Von Mises stress were evaluated for intact and instrumentation models in all loading planes.

Results

All reconstructive conditions displayed decreased motion at L4–L5. The pedicle screw-plate system offered equal ROM to pedicle screw-rod system in unilateral or bilateral fixation modes respectively. Pedicle screw stresses for plate system were 2.2 times greater than those for rod system in left lateral bending under unilateral fixation. Stresses for plate were 3.1 times greater than those for rod in right axial rotation under bilateral fixation. Stresses on intervertebral graft for plate system were similar to rod system in unilateral and bilateral fixation modes respectively. Increased ROM and posterior instrumentation stresses were observed in all loading modes with unilateral fixation compared with bilateral fixation in both systems.

Conclusions

Transforaminal lumbar interbody fusion augmentation with pedicle screw-plate system fixation increases fusion construct stability equally to the pedicle screw-rod system. Increased posterior instrumentation stresses are observed in all loading modes with plate fixation, and bilateral fixation could reduce stress concentration.     

Calcium phosphate cement augmentation of cancellous bone screws can compensate for the absence of cortical fixation

An obvious means to improve the fixation of a cancellous bone screw is to augment the surrounding bone with cement. Previous studies have shown that bone augmentation with Calcium Phosphate (CaP) cement significantly improves screw fixation. Nevertheless, quantitative data about the optimal distribution of CaP cement is not available. The present study aims to show the effect of cement distribution on the screw fixation strength for various cortical thicknesses and to determine the conditions at which cement augmentation can compensate for the absence of cortical fixation in osteoporotic bone. In this study, artificial bone materials were used to mimic osteoporotic cancellous bone and cortical bone of varying thickness. These bone constructs were used to test the fixation strength of cancellous bone screws in different cortical thicknesses and different cement augmentation depths. The cement distribution was measured with microCT. The maximum pullout force was measured experimentally. The microCT analysis revealed a pseudo-conic shape distribution of the cement around the screws. While the maximum pullout strength of the screws in the artificial bone only was 30±7 N, it could increase up to approximately 1000 N under optimal conditions. Cement augmentation significantly increased pullout force in all cases. The effect of cortical thickness on pullout force was reduced with increased cement augmentation depth. Indeed, cement augmentation without cortical fixation increased pullout forces over that of screws without cement augmentation but with cortical fixation. Since cement augmentation significantly increased pullout force in all cases, we conclude that the loss of cortical fixation can be compensated by cement augmentation.     

Design and experimental evaluation of adjustable bone plates for mandibular fracture fixation

Conventional bone plates are commonly used for surgical mandibular fracture fixation. Improper alignment between bone segments, however, can result in malocclusion. Current methods of fixation require a surgeon to visually align segments of bone and affix a metal plate using bone screws, after which little can be done to adjust alignment. A method of adjusting fracture alignment after plate placement, without screw removal, presents an improvement over costly and risky revision surgery. A modified bone plate has been designed with a deformable section to give surgeons the ability to reduce misalignments at the fracture site. The mechanics of deformation for various adjustment mechanisms was explored analytically, numerically, and experimentally to ensure that the adjustable plate is comparable to conventional bone plates. A static force of 358.8 N is required to deform the adjustable bone plate, compared with predicted values of 351 N using numerical simulation and 362 N using a simple beam theory. Dynamic testing was performed to simulate in vivo loading conditions and evaluate load-capacity in both deformed and un-deformed bone plates. Results indicate that bending stiffness of a rectangular bone plate is 709 N/mm, compared with 174 N/mm for an octagonal plate and 176 N/mm for standard plates. Once deformed, the rectangular and octagonal plates had a stiffness of 323 N/mm and 228 N/mm, respectively. Un-deformed and deformed adjustable bone plates have efficacy in bone segment fixation and healing.