Loss in mechanical contact of cementless acetabular prostheses due to post-operative weight bearing: a biomechanical model

The primary stability of cementless acetabular components is a prerequisite for their clinical success. The target of the present study was to analyse possible effects of post-operative joint loading on the initial mechanical stability of a press-fitted acetabular prosthesis. For this purpose, a three-dimensional finite element model of the pelvic bone with acetabular reconstruction was set-up. The analysis included two steps: (1) simulation of the prosthesis press-fit implantation and (2) simulation of the instant of peak resultant hip loading during the one-legged stance. The difference between the contact pressures at the bone/implant interface, at the end of the second step and those at the end of the first step was calculated and assumed as an index of variation in mechanical contact due to post-operative weight bearing. The results show that, due to hip loading, contact pressures given by press-fit increase in the postero-superior acetabular region but decrease in the antero-inferior acetabular region. The calculated area in which the contact pressures decrease extend to about 30% of the total contact surface. These results imply that post-operative joint loading significantly reduces the mechanical stability given by press-fit. The decrease in contact pressures at the bone/implant interface may result in a lack of osteointegration, possibly hindering the implant secondary stability. It may also create a route for wear debris, possibly favouring periprosthetic osteolysis, which may lead to further loss in contact and clinical failure of the implant due to loosening.     

Toward a method to simulate the process of bone ingrowth in cementless THA using finite element method

In cementless total hip arthroplasty, long-term implant stability is achieved by bone ingrowth. The strength of the new bond gradually increases in time, due to bone maturation and progression of ingrowth.In finite element simulations, osseointegration generally is implemented as an instant change in the mechanical behavior of the implant–bone interface, although this is a simplified interpretation of the bone ingrowth process. The aim of the present study was to build on previous bone ingrowth simulations and propose a new methodology to simulate bone ingrowth as a time-dependent process.We developed an algorithm to calculate the strength of the local implant–bone bond based of the magnitude of interface micromotions and gaps in time. Our algorithm was subsequently tested in multiple hip reconstructions in which the bone quality and implant–bone contact area were varied.The results of the simulations showed that in the ideal situation (good bone quality and no interface gaps), 91% of implant area could achieve ingrowth, while in the worst case only 17% of implant area showed ingrowth. The initial contact area had a significant effect on ingrowth, overruling the effect of variations in bone quality. The progression of ingrowth had a stabilizing effect on adjacent regions, especially in the high contact area cases.Further development and validation of the presented algorithm requires more information on the nature of the relation between the ingrowth rate and the magnitude of micromotions and gap.     

The potential application of a Cobalt Chrome Molybdenum femoral stem with functionally graded orthotropic structures manufactured using Laser Melting technologies

The cementless fixation of porous coated femoral stems is a common technique employed for Total Hip Arthroplasty (THA). With the rate of revision surgery appearing to rise and younger more active patients requiring primary surgery it can be thought that alternative methods for increasing implant longevity need to be considered. The stress shielding of periprosthetic bone still remains a contributing factor to implant loosening, caused through a mismatch in stiffness between the implant and the bone. However, the ability to achieve stiffness matching characteristics is being realised through the use of Additive Layer Manufacturing (ALM) technologies and Functionally Graded Materials (FGM). This paper proposes an alternative design methodology for a monoblock Cobalt Chrome Molybdenum (CoCrMo) femoral stem. It hypothesises that a femoral stem suitable for cementless fixation can be manufactured using Laser Melting (LM) technology offering orthotropic functionally graded porous structures with similar mechanical properties to human bone. The structure and mechanical properties of the natural femur have been used as a basis for the design criteria which hypothesises that through a combination of numerical analysis and physical testing, an optimal design can be proposed to provide a lightweight, customised femoral stem that can reduce the risk of implant loosening through stress shielding whilst maintaining bone-implant interface stability.     

A finite element analysis of the vibrational behaviour of the intra-operatively manufactured prosthesis–femur system

In total hip replacement (THR) a good initial stability of the prosthetic stem in the femur, which corresponds to a good overall initial contact, will help assure a good long-term result. During the insertion the implant stability increases and, as a consequence, the resonance frequencies increase, allowing the assessment of the implant fixation by vibration analysis. The influence of changing contact conditions on the resonance frequencies was however not yet quantitatively understood and therefore a finite element analysis (FEA) was set up.Modal analyses on the hip stem–femur system were performed in various contact situations. By modelling the contact changes by means of the contact tolerance options in the finite element software, contact could be varied over the entire hip stem surface or only in specific zones (proximal, central, distal) while keeping other system parameters constant.The results are in agreement with previous observations: contact increase causes positive resonance frequency shifts and the dynamic behaviour is most influenced by contact changes in the proximal zone.Although the finite element analysis did not establish a monotonous relationship between the vibrational mode number and the magnitude of the resonance frequency shift, in general the higher modes are more sensitive to the contact change.     

The potential application of a Cobalt Chrome Molybdenum femoral stem with functionally graded orthotropic structures manufactured using Laser Melting technologies

The cementless fixation of porous coated femoral stems is a common technique employed for Total Hip Arthroplasty (THA). With the rate of revision surgery appearing to rise and younger more active patients requiring primary surgery it can be thought that alternative methods for increasing implant longevity need to be considered. The stress shielding of periprosthetic bone still remains a contributing factor to implant loosening, caused through a mismatch in stiffness between the implant and the bone. However, the ability to achieve stiffness matching characteristics is being realised through the use of Additive Layer Manufacturing (ALM) technologies and Functionally Graded Materials (FGM). This paper proposes an alternative design methodology for a monoblock Cobalt Chrome Molybdenum (CoCrMo) femoral stem. It hypothesises that a femoral stem suitable for cementless fixation can be manufactured using Laser Melting (LM) technology offering orthotropic functionally graded porous structures with similar mechanical properties to human bone. The structure and mechanical properties of the natural femur have been used as a basis for the design criteria which hypothesises that through a combination of numerical analysis and physical testing, an optimal design can be proposed to provide a lightweight, customised femoral stem that can reduce the risk of implant loosening through stress shielding whilst maintaining bone-implant interface stability.     

Balancing incompatible endoprosthetic design goals: a combined ingrowth and bone remodeling simulation

In order to design a good cementless femoral implant many requirements need to be fulfilled. For instance, the range of micromotions at the bone-implant interface should not exceed a certain threshold and a good ratio between implant-bone stiffness that does not cause bone resorption, needs to be ensured. Stiff implants are known to evoke lower interface micromotions but at the same time they may cause extensive resorption of the surrounding bone. Composite stems with reduced stiffness give good remodeling results but implant flexibility is likely to evoke high micromotions proximally. Finding a good balance between these incompatible design goals is very challenging. The current study proposes a finite element methodology that employs subsequent ingrowth and remodeling simulations and can be of assistance when designing new implants. The results of our simulations for the Epoch stem were in a good agreement with the clinical data. The proposed implant design made of porous tantalum with an inner CoCrMo core performed slightly better with respect to the Epoch stem and considerably better with respect to a Ti alloy stem. Our combined ingrowth and remodeling simulation can be a useful tool when designing a new implant that well balances mentioned incompatible design goals.     

Biomechanical simulation of various surface roughnesses and geometric designs on an immediately loaded dental implant

Experiment with rapid prototyping technique and validation finite element model was performed to evaluate the biomechanical behavior of an immediately loaded mandibular implant. Also, 18 finite element models of six implant designs and three surface roughnesses with anisotropic bone material properties were analyzed to compare the bone stresses and the sliding at the bone-implant interface under a vertical or lateral force of 130 N. The results show that bone stress (strain) of an immediately loaded implant is heavily dependent on the implant design and surface roughness. Improving the initial interfacial interlocking using a threaded implant has a higher priority than using cylindrical or step designs with a rough surface for an immediately loaded implant.     

The Effects of Interfacial Conditions and Stem Length on Potential Failure Mechanisms in the Uncemented Resurfaced Femur

It is hypothesized that changes in stem length and implant–bone interfacial conditions would affect the mechanical environment within the uncemented resurfaced femur, thereby influencing potential short- and long-term failure mechanisms. This study is aimed at investigating the influence of changes in implant–bone interfacial conditions and stem length on eventual failure, using 3D FE models integrated with bone remodeling simulations. Musculoskeletal forces corresponding to normal walking and stair climbing were used as applied loading conditions. Sliding micromotions of 26–72 μm at the implant–bone interfaces for both the stem designs suggest bone ingrowth on the coated surface of the implant was likely. The initial risk of femoral neck fracture was less for the uncemented designs as compared to the cemented designs, irrespective of interfacial conditions and variation in stem length. For the uncemented variety, shortening the stem length provided only slight advantages (5%) with regard to strain shielding and bone remodeling. However, bone resorption was considerably higher when fully bonded interfaces were simulated. It may, therefore, be concluded that cementless fixation seems to be a viable alternative to cemented fixation, provided sufficient initial fixation and secondary stability through bone ingrowth into the coated surface of the implant can be achieved.     

Initial stability of a new hybrid fixation hip stem: experimental measurement of implant-bone micromotion under torsional load in comparison with cemented and cementless stems

A new hybrid fixation stem, named cemented-locked uncemented (CLU), for total hip arthroplasty was developed to achieve good initial stability. Primary stability is guaranteed by the cement which is injected into two pockets in the lateral area. This leaves a large surface available for long-term biologic fixation (direct bone attachment on implant). This study evaluates in vitro the initial stability of the CLU prototype under torsional load, in comparison with cemented and cementless stems. The results show that the CLU stem is very stable in simulated stair climbing. Its micromotions are comparable to those of a cemented prosthesis, and significantly less (80-90% lower) than those for a cementless stem. These findings confirm the optimal initial stability expected from the CLU prototype. This new design, which employs hybrid fixation, should improve bone formation on the implant and reduce the risk of stem loosening.     

A parametric axisymmetric model study on the interface motions in porous-surfaced tibial implants

The effects of a number of variables on the interface relative motions in poroussurfaced tibial implants are investigated using a simplified axisymmetric finite element model. The parameters considered are contact or link spacing, height of the central metal stem, presence of a circumferential metal flange, presence of a UHMWP articular plate resting freely on or fixed to the metal base, resting of the prosthesis edge on the cortical shell, and type of the metal alloy. In order to represent the immediate post-surgical situation with no bone ingrowth, the interface between the bone and porous-surfaced metal is modelled by frictionless rigid links oriented normal to the interface. Cases are also studied in which the horizontal interface is assumed to be fixed while the vertical interface remains frictionless. The magnitudes of the interface motion are negligibly affected by the variation in the link spacing from 0.3 mm to about 3.0 mm. The interface relative motion is predicted to decrease in cases with a shorter central metal stem, with the addition of a circumferential metal flange, with the use of more rigid prosthesis, and with the addition of a UHMWP articular plate.     

植入性下肢骨植入体周围骨应力分布的三维有限元分析

基于CT扫描数据,针对低、中和高位下肢截肢步行最大生理载荷情况下,建立植入性下肢骨植入体及人体股骨三维有限元分析模型,计算结果表明：假肢的最大应力位于骨植入体外力传递杆靠近残肢残端,是假肢周期性载荷的疲劳破坏点;随截肢部位上移,股骨内应力最大值迅速增大;在植入体与股骨接触部位,存在严重的应力屏蔽,应力集中的两个区域分布在植入体末端和股骨四分之三处,可能导致骨质废用性和病理性吸收,影响假肢中长期使用寿命。本研究还表明,股骨的自然曲率对骨内应力分布有较大的影响,是不能忽略的因素。本文所获结果可为植入假肢的设计研究提供依据。     

上颌前牙区不同种植修复体在不同咬合受力下的三维有限元分析

文题释义：口腔种植修复体：是一种以植入骨组织内的结构为基础来支持、固位上部牙修复体的缺牙修复方式,它包括种植体、固位螺丝、修复基台及上部修复体,故以上各结构良好的生物力学性能决定着种植修复体的长期稳定性。 三维有限元分析：通过单元格划分将连续的模型划分为有限个单元,后期根据研究的需要赋予其不同的材料性能,模拟生物力学环境,计算其所受应力。自1980年运用于口腔医学研究以来,有限元法已涉口腔种植的各个领域,如通过三维有限元法分析螺纹形态、基台角度、植体类型、颈部设计等因素对种植修复体的影响,目前经过国内外学者的大量研究,三维有限元模型的精确度也已得到了较大提升。 背景：在口腔种植修复治疗中,修复因素与咬合因素影响着植体内部结构及植体-骨界面处应力的分布,植体内部结构及植体-骨界面处应力分布是否平衡决定着种植体的长期寿命与周围骨质水平的稳定性。 目的：探讨与分析二氧化锆全瓷冠与钴铬合金烤瓷冠修复体在3种咬合关系中对植体-骨界面处、种植体、修复基台、固位螺丝及修复体内部应力分布的影响。 方法：参照1例上颌中切牙区行种植体植入修复患者的锥形束CT影像资料,运用Mimics17.0软件建立上颌中切牙种植修复体模型,分别构建二氧化锆全瓷冠与钴铬合金烤瓷冠两种三维有限元模型,模拟对刃合、正常合、深覆合3种咬合状况进行加载,分析在2种修复体与3种加载方式影响下种植体内部各结构与种植体-骨界面的应力分布情况。 结果与结论：①在钴铬合金烤瓷冠组中,当咬合关系由对刃合转变为正常合及深覆合时,修复体咬合位点处应力相应增加,而修复基台、种植体边缘及植体-骨界面处的应力减小;正常咬合关系中固位螺丝处的应力较其他两种咬合方式更为集中,等效应力峰值更高。②在二氧化锆全瓷冠组中,当咬合关系由对刃合转变为正常合及深覆合时,修复基台、种植体及种植体-骨界面的应力峰值呈逐渐下降趋势;正常合时修复体咬合位点及固位螺丝处的应力峰值高于其他两种咬合关系。③对刃合时,钴铬合金烤瓷冠组修复体咬合位点处的等效应力峰值略高于二氧化锆全瓷冠组,修复基台、固位螺丝、种植体与种植体-骨界面的等效应力峰值略低于二氧化锆全瓷冠组;正常合时,钴铬合金烤瓷冠组种植体颈部处的等效应力峰值略高于二氧化锆全瓷冠组,修复体、修复基台、固位螺丝、种植体-骨界面的等效应力峰值略低于二氧化锆全瓷冠组;深覆合时,钴铬合金烤瓷冠组修复体咬合位点处及种植体颈部处的等效应力峰值均高于二氧化锆全瓷冠组,修复基台、固位螺丝、种植体-骨界面的等效应力峰值略低于二氧化锆全瓷冠组。④结果表明,咬合关系与上部修复体的不同影响着应力在种植修复体各结构及植体-骨界面的分布,此结论或许能为种植修复体远期并发症的预测提供参考依据。 ORCID: 0000-0001-8522-5337(安尼卡尔•安尼瓦尔) 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

TM种植体骨界面应力分布的有限元分析

背景：种植体形态是决定种植体骨界面应力分布的重要因素之一。探讨顺应人体正常颌骨解剖形态的TM种植体骨界面的应力分布特征对临床医生选择和设计种植体有指导意义。 目的：观察集中荷载作用下TM种植体及其周围骨组织应力分布的特征。 方法：通过逆向工程技术,将二维下颌骨CT图片转化为三维实体模型,并建立3种包含不同锥度的TM种植体真实下颌骨B/2类骨质的有限元模型,利用有限元技术研究两种加载方式下TM种植体骨界面应力分布特征。 结果与结论：垂直加载时,对于锥度较大的TM种植体周边密质骨承受较小的应力;斜向加载时,对于锥度较大的TM种植体周边密质骨和松质骨承受较大的应力;种植体颈部,密质骨上缘与种植体接触处和种植体底部松质骨出现明显应力集中现象,斜向荷载下种植体骨界面的应力分布显著高于垂直荷载下的应力分布。从1/2长度开始变化的TM种植体骨界面在垂直荷载下表现出较好的应力分布特征。     

Mesh morphing for finite element analysis of implant positioning in cementless total hip replacements

Finite element (FE) analysis of the effect of implant positioning on the performance of cementless total hip replacements (THRs) requires the generation of multiple meshes to account for positioning variability. This process can be labour intensive and time consuming as CAD operations are needed each time a specific orientation is to be analysed. In the present work, a mesh morphing technique is developed to automate the model generation process. The volume mesh of a baseline femur with the implant in a nominal position is deformed as the prosthesis location is varied. A virtual deformation field, obtained by solving a linear elasticity problem with appropriate boundary conditions, is applied. The effectiveness of the technique is evaluated using two metrics: the percentages of morphed elements exceeding an aspect ratio of 20 and an angle of 165° between the adjacent edges of each tetrahedron. Results show that for 100 different implant positions, the first and second metrics never exceed 3% and 3.5%, respectively. To further validate the proposed technique, FE contact analyses are conducted using three selected morphed models to predict the strain distribution in the bone and the implant micromotion under joint and muscle loading. The entire bone strain distribution is well captured and both percentages of bone volume with strain exceeding 0.7% and bone average strains are accurately computed. The results generated from the morphed mesh models correlate well with those for models generated from scratch, increasing confidence in the methodology. This morphing technique forms an accurate and efficient basis for FE based implant orientation and stability analysis of cementless hip replacements.     

Effect of the initial implant fitting on the predicted secondary stability of a cementless stem

A numerical model able to investigate the influence of biomechanical factors on the long-term secondary stability of implants would be extremely useful for the design of new cementless prosthetic devices. A purely biomechanical model of osseo-integration has been developed, formulated as a rule-based adaptation scheme. Due to its complexity, the problem was divided into three steps: preliminary implementation of the model (proof of concept); implementation of the complete model and investigation of the model solution; and model validation. The paper describes the first of these three steps. The model was implemented as a discretestates machine, and the few parameters required were derived from the literature. It was then applied to a real clinical case. The study was conducted using the frictional contact finite element model of a human femur implanted with a cementless anatomical stem. A stable solution was achieved after between three and 15 iterations for all initial positions considered. Similar initial conditions yielded similar final configurations. The model predicted all initial configurations, with the exception of a partial osseo-integration, ranging between 62% (distal fit) and 78% (proximal fit) of the viable interface. This is in good agreement with the values reported in the literature that never exceed 75%, even in the best conditions, and report better clinical results for proximal fit. For the varus configuration, which lacks cortical support, the algorithm predicted a completed loosening.     

Effect of rotator cuff dysfunction on the initial mechanical stability of cementless glenoid components

The functional outcome of shoulder replacement is related to the condition of the rotator cuff. Rotator cuff disease is a common problem in candidates for total shoulder arthroplasty; this study relates the functional status of the rotator cuff to the initial stability of a cementless glenoid implant. A 3D finite element model of a complete scapula was used to quantify the effect of a dysfunctional rotator cuff in terms of bone-implant interface micromotions when the implant is physiologically loaded shortly after surgery. Four rotator cuff conditions (from fully intact to progressively ruptured rotator cuff tendons) as well as two bone qualities were simulated in a model. Micromotions were significantly larger in the worst modeled cuff dysfunction (i.e. the supraspinatus and infraspinatus tendons were fully dysfunctional). Micromotions were also significantly different between conditions with healthy and poor bone quality. The implant’s initial stability was hardly influenced by a dysfunctional supraspinatus alone. However, when the infraspinatus was also affected, the glenohumeral joint force was displaced to the component’s rim resulting in larger micromotions and instability of the implant.     

In vivo stimulation of bone formation by aluminum and oxygen plasma surface-modified magnesium implants

A newly developed magnesium implant is used to stimulate bone formation in vivo. The magnesium implant after undergoing dual aluminum and oxygen plasma implantation is able to suppress rapid corrosion, leaching of magnesium ions, as well as hydrogen gas release from the biodegradable alloy in simulated body fluid (SBF). No released aluminum is detected from the SBF extract and enhanced corrosion resistance properties are confirmed by electrochemical tests. In vitro studies reveal enhanced growth of GFP mouse osteoblasts on the aluminum oxide coated sample, but not on the untreated sample. In addition to that a small amount (50 ppm) of magnesium ions can enhance osteogenic differentiation as reported previously, our present data show a low concentration of hydrogen can give rise to the same effect. To compare the bone volume change between the plasma-treated magnesium implant and untreated control, micro-computed tomography is performed and the plasma-treated implant is found to induce significant new bone formation adjacent to the implant from day 1 until the end of the animal study. On the contrary, bone loss is observed during the first week post-operation from the untreated magnesium sample. Owing to the protection offered by the Al₂O₃ layer, the plasma-treated implant degrades more slowly and the small amount of released magnesium ions stimulate new bone formation locally as revealed by histological analyses. Scanning electron microscopy discloses that the Al₂O₃ layer at the bone-implant interface is still present two months after implantation. In addition, no inflammation or tissue necrosis is observed from both treated and untreated implants. These promising results suggest that the plasma-treated magnesium implant can stimulate bone formation in vivo in a minimal invasive way and without causing post-operative complications.     

Biomechanical consequences of progressive marginal bone loss around oral implants: a finite element stress analysis

The purpose of this study was to explore the biomechanical effects of progressive marginal bone loss in the peri-implant bone. Finite element model of a Ø 4.1 × 10 mm Straumann dental implant and a solid abutment was constructed as predefined eight-layers around the implant neck. The implant-abutment complex was embedded in a cylindrical bone model to analyze bone biomechanics regardless of anatomical influences. Angular and circular progressive marginal bone loss was simulated by sequential removal of each layer, resulting crater-like defects and a total of ten finite element models for analysis. Each model was subjected to a vertical and oblique static load of 100 N in separate load cases. Principal stress minimum and maximum, displacement, and equivalent of elastic strain outcomes were compared. Under vertical loading, principal stresses minimum and maximum decreased remarkably as with the increase in bone resorption. Under oblique load simulations, decrease in principal stress maximum and minimum was evident. With progressive bone loss and under oblique load simulations, displacement and equivalent of elastic strain increased considerably in trabecular bone contacting the implant neck. The presence of cortical bone contacting a load-carrying implant, even in a bone defect, improves the biomechanical performance of implants in comparison with only trabecular bone support as a sequel of progressive marginal bone loss.     

Effects of bone morphogenetic protein-2 and hyaluronic acid on the osseointegration of hydroxyapatite-coated implants: an experimental study in sheep

Research efforts aim at enhancing early osseointegration of cementless implants to improve early fixation and, thus, reduce the risk of loosening. The aim of the present study was to investigate whether bone morphogenetic protein (BMP) 2 had a positive effect on the osseointegration of hydroxyapatite-coated implants. Hydroxyapatite (HA) implants (perforated hollow cylinders and solid rods) were coated with BMP-2 and hyaluronic acid (HY) as the carrier or with HY alone. Uncoated HA implants served as controls. The osseointegration of the implants was evaluated either by light microscopy or by pullout tests after 1, 2, and 4 weeks of unloaded implantation in the cancellous bone of 24 sheep. The BMP-2 coating significantly increased bone growth into the implant perforations compared with HA-coated implants at 2 and 4 weeks. Bone-implant contact and interface shear strength of BMP-2 implants were lower than HA implants at 2 weeks. At 4 weeks, there was no significant difference in bone-implant contact and shear strength between BMP-2 and HA-coated implants. The BMP-2 coating enhanced gap healing but had no positive or even an inhibitory effect (at 2 weeks) on bone-implant contact and interface shear strength. In the clinical situation, a perfect press-fit implantation cannot be achieved, and BMP-2 may be beneficial for enhancing bone growth into gaps around cementless implants.     

Variation of the impact duration during the in vitro insertion of acetabular cup implants

The acetabular cup (AC) is an implant impacted into a bone cavity and used for hip prosthesis surgery. Initial stability of the AC is an important factor for long term surgical success. The aim of this study is to determine the variations of the impact duration during AC implant insertion.Twenty-two bone samples taken from bovine femurs were prepared ex vivo for the insertion of an acetabular cup implant, following the surgical procedure used in the clinic. For each bone sample, ten impacts were applied using reproducible mass falls (3.5 kg) in order to insert the AC implant. Each impact duration was recorded using a wide bandwidth force sensor.For all bone samples, the impact duration was shown to first decrease as a function of the impact number, then reaching a stationary value equal in average to 4.2 ± 0.7 ms after an average number of 4.1 ± 1.7 impacts. The impact duration may be related to variations of the bone–implant interface contact rigidity because of an increase the amount of bone tissue in contact with the AC implant.Measurements of impact duration have a good potentiality for clinical application to assist the surgeon during the insertion of the AC implant, providing valuable information on the bone–implant interface contact properties.