Bidyut Pal

A numerical study of failure mechanisms in the cemented resurfaced femur:effects of interface characteristics and bone remodelling

Abstract Failure mechanisms of the resurfaced femoral head include femoral neck fracture in the short term and stress shielding and implant loosening in the long term. In this study, finite element simulations of the resurfaced femur considering a debonded implant—cement interface, variable stem—bone interface conditions, and bone remodelling were used to study load transfer within the resurfaced femur and to investigate its relationship with known failure mechanisms. Realistic three-dimensional finite element models of an intact and resurfaced femur were used. Various conditions at the interface between the stem of the prosthesis and the bone were considered. Loading conditions included normal walking and stair climbing. For all stem—bone contact conditions, the tensile stresses in the cement mantle varied between 1 MPa and 5.4 MPa, except near the distal rim of the resurfacing component where they reached 5.4—7 MPa. In the case of full stem—bone contact, high von Mises stresses (114—121 MPa) were generated in the implant at the stem—cup junction. These stresses were considerably reduced (maximum von Mises stress, 76 MPa) where a gap was present at the stem—bone interface. Resurfacing led to strain shielding of the bone of the femoral head (20—75 per cent strain reductions) and periprosthetic bone resorption (50—80 per cent bone density reductions) for all interface stem—bone contact conditions. In the lateral femoral head and the proximal femoral shaft around the trochantric region, bone density reductions varied between 10 per cent and 50 per cent. Bone apposition was observed in the inferior—medial part of the femoral head and proximal femoral neck region. For full stem—bone contact, more load was transferred through the stem to the surrounding bone, exacerbating strain shielding. Although femoral hip resurfacing conserves bone stock at the primary operation, strain shielding and periprosthetic bone resorption might lead to eventual loosening over time. Post-operatively, the resurfacing procedure generated elevated strains (0.50—0.75 per cent strain) in the proximal femoral neck—component junction irrespective of the variation in interface conditions, indicating an initial risk of femoral neck fracture. Subsequent to bone remodelling, this strain concentration was considerably reduced (0.35—0.50 per cent strain), lowering the risk of neck fracture. In order to reduce the potential risk of neck fracture, patients should avoid activities which might induce high loading of the hip during the early post-operative period to allow the bone around the proximal femoral neck to remodel and heal.

Finite element analysis of a hemi-pelvis: the effect of inclusion of cartilage layer on acetabular stresses and strain.

An appropriate method of application of the hip-joint force and stress analysis of the pelvic bone, in particular the acetabulum, is necessary to investigate the changes in load transfer due to implantation and to calculate the reference stimulus for bone remodelling simulations. The purpose of the study is to develop a realistic 3D finite element (FE) model of the hemi-pelvis and to assess stress and strain distribution during a gait cycle. The FE modelling approach of the pelvic bone was based on CT scan data and image segmentation of cortical and cancellous bone boundaries. Application of hip-joint force through an anatomical femoral head having a cartilage layer was found to be more appropriate than a perfectly spherical head, thereby leading to more accurate stress–strain distribution in the acetabulum. Within the acetabulum, equivalent strains varied between 0.1% and 0.7% strain in the cancellous bone. High compressive (15–30 MPa) and low tensile (0–5 MPa) stresses were generated within the acetabulum. The hip-joint force is predominantly transferred from the acetabulum through the lateral cortex to the sacroiliac joint and the pubic symphysis. The study is useful to understand the load transfer within the acetabulum and for further investigations on acetabular prosthesis.

Strain and micromotion in intact and resurfaced composite femurs: Experimental and numerical investigations

Understanding the load transfer within a resurfaced femur is necessary to determine the influence of mechanical factors on potential failure mechanisms such as early femoral neck fractures and stress shielding. In this study, an attempt has been made to measure the stem-bone micromotion and implant cup-bone relative displacements (along medial-lateral and anterior-posterior direction), in addition to surface strains at different locations and orientations on the proximal femur and to compare these measurements with those predicted by equivalent FE models. The loading and the support conditions of the experiment were closely replicated in the FE models. A new experimental set-up has been developed, with specially designed fixtures and load application mechanism, which can effectively impose bending and deflection of the tested femurs, almost in any direction. High correlation coefficient (0.92-0.95), low standard error of the estimate (170-379 muepsilon) and low percentage error in regression slope (12.8-17.5%), suggested good agreement between the numerical and measured strains. The effect of strain shielding was observed in two (out of eight) strain gauges located on the posterior side. A pronounced strain increase occurred in strain gauges located on the anterior head and neck regions after implantation. Experimentally measured stem-bone micromotion and implant cup-bone relative displacements (0-13.7 microm) were small and similar in trends predicted by the FE models (0-25 microm). Despite quantitative deviations in the measured and numerical results, it appears that the FE model can be used as a valid predictor of the actual strain and stem-bone micromotion.

Influence of the change in stem length on the load transfer and bone remodelling for a cemented resurfaced femur.

The effect of a short-stem femoral resurfacing component on load transfer and potential failure mechanisms has rarely been studied. The stem length has been reduced by approximately 50% as compared to the current long-stem design. Using 3-D FE models of natural and resurfaced femurs, the study is aimed at investigating the influence of a short-stem resurfacing component on load transfer and bone remodelling. Applied loading conditions include normal walking and stair climbing. The mechanical role of the stem along with implant-cement and stem-bone contact conditions was observed to be crucial. Shortening the stem length to half of the current length (long-stem) led to several favourable effects, even though the stress distributions in the implant and the cement were similar in both the cases. The short-stem implant led not only to a more physiological stress distribution but also to bone apposition (increase of 20-70% bone density) in the superior resurfaced head, when the stem-bone contact prevailed. This also led to a reduction in strain concentration in the cancellous bone around the femoral neck-component junction. The normalised peak strain in this region was lower for the short-stem design as compared to that of the long-stem one, thereby reducing the initial risk of neck fracture. The effect of strain shielding (50-75% reduction) was restricted to a small bone volume underlying the cement, which was approximately half of that of the long-stem design. Consequently, bone resorption was considerably less for the short-stem design. The short-stem design offers better prospects than the long-stem resurfacing component.

The effect of primary stability on load transfer and bone remodelling within the uncemented resurfaced femur

One of the major causes of aseptic loosening in an uncemented implant is the lack of any attachment between the implant and the bone. The implant’s stability depends on a combination of primary stability (mechanical stability) and secondary stability (biological stability). The primary stability may affect the implant–bone interface condition and thus influence the load transfer and mechanical stimuli for bone remodelling in the resurfaced femur. This paper reports the results of a study into the affect of primary stability on load transfer and bone adaptation for an uncemented resurfaced femur. Three-dimensional finite element models were used to simulate the intact and resurfaced femurs and the bone remodelling. As a first step towards assessing the immediate post-operative condition, a debonded interfacial contact condition with varying levels of the friction coefficient (0.4, 0.5, and 0.6) was simulated at the implant–bone interface. Then, using a threshold value of micromotion of 50 µm, the implant–bone interfacial condition was varied along the implant–bone boundary to mechanically represent non-osseointegrated or osseointegrated regions of the interface. The considered applied loading conditions included normal walking and stair climbing. Resurfacing leads to strain shielding in the femoral head (20–75 per cent strain reductions). In immediate post-operative conditions, there was no occurrence of elevated strains in the cancellous bone around the proximal femoral neck–component junction resulting in a lower risk of neck fracture. Predominantly, the micromotions were observed to remain below 50 µm at the implant–bone interface, which represents 97–99 per cent of the interfacial surface area. The predicted micromotions at the implant–bone interface strongly suggest the likelihood of bone ingrowth onto the coated surface of the implant, thereby enhancing implant fixation. For the osseointegrated implant–bone interface, the effect of strain shielding was observed in a considerably greater bone volume in the femoral head as compared to the initial debonded interfacial condition. A 50–80 per cent periprosthetic bone density reduction was predicted as compared to the value of the intact femur, indicating bone resorption within the superior resurfaced head. Although primary fixation of the resurfacing component may be achieved, the presence of high strain shielding and peri-prosthetic bone resorption are a major concern.

Design considerations for ceramic resurfaced femoral head: effect of interface characteristics on failure mechanisms

Ceramic hip resurfacing may offer improved wear resistance compared to metallic components. The study is aimed at investigating the effects of stiffer ceramic components on the stress/strain-related failure mechanisms in the resurfaced femur, using three-dimensional finite element models of intact and resurfaced femurs with varying stem–bone interface conditions. Tensile stresses in the cement varied between 1 and 5 MPa. Postoperatively, 20–85% strain shielding was observed inside the resurfaced head. The variability in stem–bone interface condition strongly influenced the stresses and strains generated within the resurfaced femoral head. For full stem–bone contact, high tensile (151–158 MPa) stresses were generated at the cup–stem junction, indicating risk of fracture. Moreover, there was risk of femoral neck fracture due to elevated bone strains (0.60–0.80% strain) in the proximal femoral neck region. Stresses in the ceramic component are reduced if a frictionless gap condition exists at the stem–bone interface. High stresses, coupled with increased strain shielding in the ceramic resurfaced femur, appear to be major concerns regarding its use as an alternative material.

Reduced tibial strain-shielding with extraosseous total knee arthroplasty revision system

Highlights • A novel extracortical support system for revision of failed knee prostheses.• Shown to reduce metaphyseal stress-shielding versus intramedullary stem fixation.• Reduces bone loss and enables bone grafting of defects after implant loosening.• Enables use of conventional prosthesis in a revision scenario.

Femoral fracture type can be predicted from femoral structure: A finite element study validated by digital volume correlation experiments

Proximal femoral fractures can be categorized into two main types: Neck and intertrochanteric fractures accounting for 53% and 43% of all proximal femoral fractures, respectively. The possibility to predict the type of fracture a specific patient is predisposed to would allow drug and exercise therapies, hip protector design, and prophylactic surgery to be better targeted for this patient rendering fracture preventing strategies more effective. This study hypothesized that the type of fracture is closely related to the patient‐specific femoral structure and predictable by finite element (FE) methods. Fourteen femora were DXA scanned, CT scanned, and mechanically tested to fracture. FE‐predicted fracture patterns were compared to experimentally observed fracture patterns. Measurements of strain patterns to explain neck and intertrochanteric fracture patterns were performed using a digital volume correlation (DVC) technique and compared to FE‐predicted strains and experimentally observed fracture patterns. Although loaded identically, the femora exhibited different fracture types (six neck and eight intertrochanteric fractures). CT‐based FE models matched the experimental observations well (86%) demonstrating that the fracture type can be predicted. DVC‐measured and FE‐predicted strains showed obvious consistency. Neither DXA‐based BMD nor any morphologic characteristics such as neck diameter, femoral neck length, or neck shaft angle were associated with fracture type. In conclusion, patient‐specific femoral structure correlates with fracture type and FE analyses were able to predict these fracture types. Also, the demonstration of FE and DVC as metrics of the strains in bones may be of substantial clinical value, informing treatment strategies and device selection and design.