E.J. Cheal

Fracture prediction for the proximal femur using finite element models: Part I--Linear analysis

Over 90 percent of the more than 250,000 hip fractures that occur annually in the United States are the result of falls from standing height. Despite this, the stresses associated with femoral fracture from a fall have not been investigated previously. Our objectives were to use three-dimensional finite element models of the proximal femur (with geometries and material properties based directly on quantitative computed tomography) to compare predicted stress distributions for one-legged stance and for a fall to the lateral greater trochanter. We also wished to test the correspondence between model predictions and in vitro strain gage data and failure loads for cadaveric femora subjected to these loading conditions. An additional goal was to use the model predictions to compare the sensitivity of several imaging sites in the proximal femur which are used for the in vivo prediction of hip fracture risk. In this first of two parts, linear finite element models of two unpaired human cadaveric femora were generated. In Part II, the models were extended to include nonlinear material properties for the cortical and trabecular bone. While there was poor correspondence between strain gage data and model predictions, there was excellent agreement between the in vitro failure data and the linear model, especially using a von Mises effective strain failure criterion. Both the onset of structural yielding (within 22 and 4 percent) and the load at fracture (within 8 and 5 percent) were predicted accurately for the two femora tested. For the simulation of one-legged stance, the peak stresses occurred in the primary compressive trabeculae of the subcapital region.(ABSTRACT TRUNCATED AT 250 WORDS)

Trabecular bone remodeling around smooth and porous implants in an equine patellar model

The objective of this investigation was to examine the stress-morphology relationships for trabecular bone around implants with different surface characteristics. Stainless steel spheres with either a polished surface or a sintered-bead porous coating were implanted unilaterally into equine patellae and maintained for a 6 month period. Stereological methods were used to quantify the trabecular bone morphology and finite element analyses were performed to predict the trabecular bone stresses. In general, the remodeling response around the smooth implants was greater than that around those porous implants that exhibited bone ingrowth. In accordance with these differences, the finite element models predicted greater changes in the stresses adjacent to the smooth implants due to the nonlinear boundary conditions. However, it did not appear that the trajectorial theory, in its simplest form, was applicable to the remodeling induced by the implants. A linear relationship between the change in bone areal density and the change in von Mises effective stress provides support for the hypothesis that the architecture of trabecular bone corresponds to an optimal structure. The results also demonstrated that, under certain circumstances, small changes in the stress state may result in large changes in the principal material orientation.

A nonlinear finite element analysis of interface conditions in porous coated hip endoprostheses

We used a geometrically simplified finite element model to investigate load transfer between a porous coated hip endoprosthesis and a femur. Assuming both rigidly bonded and nonlinear interfaces, we analyzed fully and partially coated stems that had coatings of different elastic moduli. Our results indicate that maximum values for relative motion in the interface between bone and implant occur for implants with the same elastic modulus as compact bone. By comparison, interface motion is reduced by about half for Co-Cr-Mo alloy stems. We also showed that the elastic modulus of the porous coating had only a small influence on bone stresses.

Stress analysis of compression plate fixation and its effects on long bone remodeling

A three-dimensional finite element model is generated for an intact plexiglass tube with an attached six-hole stainless steel compression plate. The results for a wide range of loads, including cyclic external loads and static tensile preloads in the plate and screws, are examined as specifically related to plate-induced osteopenia. The model demonstrates that disuse osteopenia, resulting from a reduction in magnitude of cyclic axial stress, should be limited to the central region between the inner screws. Also, the addition of a static preload negates any reduced axial stress levels in this region, thus raising questions on the relative importance of static and cyclic stresses for the internal remodeling of bone.

Three-Dimensional Strain Fields in a Uniform Osteotomy Gap

Stable internal fixation usually results in a unique histological healing pattern which involves direct cortical reconstruction and an absence of periosteal bridging callus. While it has been suggested that longitudinal interfragmentary strain levels control this healing pattern, the complex, multiaxial strain fields in the interfragmentary region are not well understood. Based on an in-vivo study of gap healing in the sheep tibia by Mansmann et al., we used several finite element models of simplified geometry to: explore modeling assumptions on material linearity and deformation kinematics, and examine the strain distribution in a healing fracture gap subjected to known levels of interfragmentary strain. We found that a general nonlinear material, nonlinear geometric analysis is necessary to model an osteotomy gap subjected to a maximum longitudinal strain of 100 percent. The large displacement, large strain conditions which were used in the in-vivo study result in complex, multiaxial strain fields in the gap. Restricting the maximum longitudinal strain to 10 percent allows use of a linear geometric formulation without compromising the numerical results. At this reduced strain level a linear material model can be used to examine the extent of material yielding within a homogeneous osteotomy gap. Severe local strain variations occurred both through the thickness of the gap and radially from the endosteal to periosteal gap surfaces. The bone/gap interface represented a critical plane of high distortional and volumetric change and principal strain magnitudes exceeded the maximum longitudinal strains.

Evaluation of finite element analysis for prediction of the strength reduction due to metastatic lesions in the femoral neck

Between 30 and 70% of almost one million new cancer patients diagnosed each year will develop osseous metastases. Clinicians are faced with the difficult task of determining which patients require prophylactic stabilization to prevent pathologic fracture. The objective of this study was to test the ability of macroscopic finite element models to predict the fracture strength of the proximal femur with a lesion in the femoral neck. Drill hole defects in human cadaver femora were used to simulate lesions that penetrate one cortex of the femoral neck. Based on the first of two series of in vitro experiments, the fracture strength of a femur with a lesion that penetrates either the inferior-medial or superior-lateral cortex of the neck is approximately 45% less than the fracture strength of the paired intact femur; based on the second series, the fracture strength with the inferior-medial lesion is approximately 20% less than the fracture strength with the superior-lateral lesion. A series of three-dimensional finite element models were used to predict the fracture strength for anterior and posterior lesions, as well as the inferior-medial and posterior-lateral lesions tested in vitro. Based on a direct comparison of the strengths predicted by the finite element models to the measured in vitro fracture strengths, the finite element models performed poorly. In particular, the application of an anisotropic strength criterion to the stresses predicted by the models resulted in a considerable underestimation of the percentage reduction in the in vitro fracture strength. This may reflect a fundamental inability of a linear, macroscopic continuum-based analysis to predict accurately the fracture strength of a bone structure as complex as the proximal femur. However, despite this lack of agreement in absolute fracture strength, the general trends for gait and stair ascent loading for the inferior-medial and superior-lateral lesions were consistent with the in vitro data. The greatest reduction in strength was predicted for the inferior-medial lesion, followed by the anterior lesion and then the superior-lateral lesion, and the least reduction in strength was predicted for the posterior lesion. Most importantly, the predicted strength ratio varied considerably as a function of the applied loads. Any metastatic lesions of the femoral neck may be especially sensitive to some particular activity, making it difficult to determine precisely the risk of fracture.

Stress analysis of a simplified compression plate fixation system for fractured bones

Abstract A three-dimensional finite element model was generated of a plexiglass tube with an attached six-hole stainless steel compression plate to study the mechanics of internal fixation of fractured long bones. To demonstrate the importance of the plate-bone interface, this interface was represented three different ways in the finite element model. A plated tube with a uniform transverse osteotomy gap was also examined to study the mechanics of plated fractured bones. To validate the model, the results for the intact plated tube were compared to composite beam theory and strain gauge data from an instrumented physical model. Applications of the finite element model data included the prediction of screw failure modes, plate-induced osteopenia, and multi-axial strains in an interfragmentary region. The addition of sliding motion between the plate and tube resulted in a deviation from composite beam theory and improved correspondence with strain gage data when compared to a model having the plate and tube securely bonded. Sliding motion resulted in a much smaller region of bone subjected to reduced axial stress levels, which may decrease the extent of plate-induced osteopenia. The complex nature of induced strains in an osteotomy gap was also demonstrated, along with the tendency for failure of the screws nearest the fracture site.

Three-Dimensional Finite Element Analysis of a Simplified Compression Plate Fixation System

A three-dimensional, linear finite element model was generated for an intact plexiglass tube with an attached six-hole stainless steel compression plate. We examined external forces representing axial, off-center axial, and four-point bending, along with superimposed plate and screw pretension. Strain gage experiments were conducted to test model validity and the finite element results were contrasted to a composite beam theory solution. Excellent correspondence was observed between finite element and strain gage data for the most significant strain components. Composite beam theory tended to overestimate the neutral axis shift which results from plate application. The model also demonstrated fracture site distraction due to plate pretension, and the tendency for outer screw failure for the combination of bending-closed with a preload in the plate and screws.

Influence of porous coating thickness and elastic modulus on stress distributions in hip prostheses

Porous coating of femoral component stems has been widely used in an attempt to improve fixation of prosthesis to bone and to allow the use of total hip replacement in younger, more active patients. Several groups have shown that bone tissue grows into the pores of inert porous materials, thus allowing a three-dimensional interlock between implant and bone. Such a fixation has the ability to transfer tensile stresses across the interface between implant and bone.

Three-dimensional strain fields in a uniform osteotomy gap

Stable internal fixation usually results in a unique histological healing pattern which involves direct cortical reconstruction and an absence of periosteal bridging callus. While it has been suggested that longitudinal interfragmentary strain levels control this healing pattern, the complex, multiaxial strain fields in the interfragmentary region are not well understood. Based on an in-vivo study of gap healing in the sheep tibia by Mansmann et al., we used several finite element models of simplified geometry to: explore modeling assumptions on material linearity and deformation kinematics, and examine the strain distribution in a healing fracture gap subjected to known levels of interfragmentary strain. We found that a general nonlinear material, nonlinear geometric analysis is necessary to model an osteotomy gap subjected to a maximum longitudinal strain of 100 percent. The large displacement, large strain conditions which were used in the in-vivo study result in complex, multiaxial strain fields in the gap. Restricting the maximum longitudinal strain to 10 percent allows use of a linear geometric formulation without compromising the numerical results. At this reduced strain level a linear material model can be used to examine the extent of material yielding within a homogeneous osteotomy gap. Severe local strain variations occurred both through the thickness of the gap and radially from the endosteal to periosteal gap surfaces. The bone/gap interface represented a critical plane of high distortional and volumetric change and principal strain magnitudes exceeded the maximum longitudinal strains.