A comparative analysis of internal bone remodelling concepts in a novel implant for direct skeletal attachment of limb prosthesis evaluation: A finite element analysis

Abstract

Nowadays, numerous internal bone remodelling concepts are under development, in order to estimate long-term functionality of implants by evaluating the intensity of stress-shielding effect. This effect is also analysed for the implants for direct skeletal attachment, considered as a better exoprosthesis fixation method than prosthetic sockets. Most of bone remodelling approaches are based on basic concepts, differing with certain assumptions, which may affect the accuracy of the results. This article compares commonly used internal bone remodelling concepts and evaluates the functionality of the proposed Limb Prosthesis Osseointegrated Fixation System for direct skeletal attachment of limb prosthesis in comparison with two currently available implants: the Intraosseous Transcutaneous Amputation Prosthesis and the Osseointegrated Prostheses for the Rehabilitation of Amputees. Three concepts were chosen: without and with lazy zone and with the use of quadratic formula which considers bone overloading. Therefore, three finite element models were created with identical femur implanted with each of analysed implants. The implants were loaded with loads that refer to two stages of gait cycle (heel strike and toe-off). The analysed concepts have given similar results, allowing to assume that each of them can be successfully used to estimate internal bone remodelling around analysed implants for direct skeletal attachment of limb prosthesis. The results also present higher functionality of the proposed implant for direct skeletal attachment of limb prosthesis due to a significant reduction in stress-shielding in the analysed areas around implant in comparison with the Intraosseous Transcutaneous Amputation Prosthesis and the Osseointegrated Prostheses for the Rehabilitation of Amputees. It suggests that the proposed design is a better alternative to the currently used solutions.

The Influence of Geometry of Implants for Direct Skeletal Attachment of Limb Prosthesis on Rehabilitation Program and Stress-Shielding Intensity

“…The obtained results are presented as changes in bone mass in individual bone areas (Figure 3), which are similar to Gruen zones, distinguished for hip stems [42]. The same bone remodelling algorithm was used in authors' previous paper in order to estimate the bone density changes after 60 months of using each of analysed implants [43]. The number of loops to be used was determined in the above-mentioned paper, on the basis of the OPRA system analyses and comparative analysis with the clinical results obtained by Xu and Robinson [9].…”

Analysis of Bone Loss around Cemented and Biologic Prostheses after Hemiarthroplasty

“…Compared with the use of biological prostheses in this study, the use of cemented prostheses increased surgery time by an average of 18 minutes, but the mean time of hospitalization and the incidence of postoperative related complications did not differ significantly between the two groups. Cemented prostheses have previously been documented to be preferred for the treatment of osteoporotic femoral neck fractures, but no further studies were performed [16]. Through the quantitative measurement of BMD, it is believed that cemented prostheses can provide early stabilization of the prosthesis-bone interface, which is good for functional recovery and reducing periprosthetic bone mass loss.…”

A Comparative Analysis on Adaptation Behavior and Failure Risk of Femurs of Different Qualities Under the Effect of Direct Transfemoral Fixations

“…regulate the rate of bone remodeling, the width of the lazy zone, and the bone remodeling threshold of the femur, respectively (Prochor and Sajewicz 2018;H. Weinans, Huiskes, and Grootenboer 1992).…”

“…In addition, the effect of amputation level (Newcombe et al 2013), fixation type , and bone remodeling (D. H. Xu, Crocombe, and Xu 2016) have been observed on stress/strain redistribution caused by osseointegrated transfemoral fixations. Studies have also proposed innovative methods to reduce the adverse effects of stress shielding either by changing implant geometry or material properties of these prostheses (Tomaszewski, van Diest, et al 2012;Prochor and Sajewicz 2018;Ghaziani, Soheilifard, and Kowsar 2021).…”

“…Experimental analyses of bone adaptation require a large amount of time and data. For this reason, several investigations have used specific algorithms combined with the finite element analysis (FEA) to simulate the physiological changes of bone in the presence of a metal fixation or prosthesis (Rahchamani and Soheilifard 2020;Kowsar and Soheilifard 2020;Prochor and Sajewicz 2018). The majority of studies attempted to develop novel implants or to evaluate the impact of mechanical properties and geometry on the periprosthetic bone remodeling Harrie Weinans, Huiskes, and Grootenboer 1992;Huiskes, Harrie Weinans, and Rietbergen 1991).…”