Bone stresses before and after insertion of two commercially available distal ulnar implants using finite element analysis

Austman, Rebecca L.; King, Graham J.W.; Dunning, Cynthia E.

doi:10.1002/jor.21360

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…Metaphyseal fixed implants should minimize this phenomenon. The effect of reducing stem length has been investigated for implants at other joints, including the distal ulna and hip [2,20,30]. Reduced stem lengths have been shown to closely mimic the intact state.…”

Section: Discussionmentioning

confidence: 99%

Short-stem anatomical shoulder replacement—a systematic review

Schnetzke

Loew²,

Raiss³

et al. 2019

Obere Extremität

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Section: Discussionmentioning

confidence: 99%

Short-stem anatomical shoulder replacement—a systematic review

Schnetzke

Loew²,

Raiss³

et al. 2019

Obere Extremität

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“…2,3 The triangular fibrocartilage complex (TFCC) and the distal part of the forearm interosseous ligament (DIOL) are the main ligamentous stabilizers because both maintain the articular surface stable within the sigmoid notch. 4e8 Ulnar head replacements and total DRUJ replacements are gaining favor 9 in the treatment of severe, painful DRUJ dysfunction, including arthritis and instability. An ulnar head replacement may provide a less invasive and a potentially more reproducible method of joint reconstruction than a total DRUJ replacement, but historically, they have been associated with instability.…”

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confidence: 99%

Effect of Ulnar Head Offset on Distal Radioulnar Joint Stability

Orbay

Vernon

Poirier

et al. 2021

The Journal of Hand Surgery

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Purpose A complete ulnar head replacement may be indicated in cases of distal radial ulnar joint (DRUJ) dysfunction to address bony pathology in lieu of using a constrained total DRUJ prosthesis. Complete ulnar head implants are simple, but they may be unstable if soft tissue tension is not adequately restored. We hypothesized that incorporating an increased offset in the complete ulnar head replacement would lead to increased tension on the distal oblique interosseous ligament, increased contact force at the DRUJ, and improved joint stability.Methods Using a specially designed jig, we measured instability by comparing displacement under load (stiffness) of the DRUJ in 10 cadaveric specimens under 4 different conditions: (1) intact, (2) native head after excision of the triangular fibrocartilage complex, (3) replacement of the ulnar head with a standard offset ulnar head, and (4) replacement of the ulnar head with an increased offset ulnar head. No soft tissue repair was done. We measured anteroposterior displacement under load with maximum translation of 10 mm or maximum loads of 50 N. We tested all specimens with the forearm positioned in neutral, supination, and pronation.Results Excising the triangular fibrocartilage complex decreased the average stiffness of the DRUJ to 46% of the intact state, creating a simulated state of DRUJ instability. Replacing the ulnar head with the standard offset head increased average stiffness to 54% of the intact state. Increasing the ulnar head offset with the simulated total ulnar head replacement increased average stiffness to 77% of the intact state.Conclusions An increased offset ulnar head replacement improves DRUJ stability compared with a standard anatomic offset ulnar head replacement.Clinical relevance Understanding DRUJ morphology and offset is important in the treatment of DRUJ arthritis and instability.

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“…Previous FE investigations of load transfer and stress shielding in the distal ulna have employed models of commercially available implants; 4 however, these models did not consider a temporal component, and as the remodeling process is nonlinear, 2 statically determined stress shielding patterns do not necessarily project the extent or progression of realized bone loss. Strain-based adaptive material models of bone offer a means to include temporal effects; however, variation in loading and biological factors (e.g.…”

Section: Discussion Of Resultsmentioning

confidence: 99%

“…One examined the relationship between stem length and material properties on load transfer from implant to bone, 3 and the other used a finite element (FE) analysis to compare the degree of stress reduction in cortical bone resulting from the implantation of two commercially available prosthetics. 4 These studies were limited by the fact that only one time point was considered. Since remodeling due to stress shielding occurs over time, a more insightful evaluation of implant design should incorporate a temporal component.…”

Section: Introductionmentioning

confidence: 99%

Determination of remodeling parameters for a strain-adaptive finite element model of the distal ulna

Neuert

Dunning

2013

Proc Inst Mech Eng H

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Strain energy-based adaptive material models are used to predict bone resorption resulting from stress shielding induced by prosthetic joint implants. Generally, such models are governed by two key parameters: a homeostatic strain-energy state (K) and a threshold deviation from this state required to initiate bone reformation (s). A refinement procedure has been performed to estimate these parameters in the femur and glenoid; this study investigates the specific influences of these parameters on resulting density distributions in the distal ulna. A finite element model of a human ulna was created using micro-computed tomography (µCT) data, initialized to a homogeneous density distribution, and subjected to approximate in vivo loading. Values for K and s were tested, and the resulting steady-state density distribution compared with values derived from µCT images. The sensitivity of these parameters to initial conditions was examined by altering the initial homogeneous density value. The refined model parameters selected were then applied to six additional human ulnae to determine their performance across individuals. Model accuracy using the refined parameters was found to be comparable with that found in previous studies of the glenoid and femur, and gross bone structures, such as the cortical shell and medullary canal, were reproduced. The model was found to be insensitive to initial conditions; however, a fair degree of variation was observed between the six specimens. This work represents an important contribution to the study of changes in load transfer in the distal ulna following the implementation of commercial orthopedic implants.

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Bone stresses before and after insertion of two commercially available distal ulnar implants using finite element analysis

Cited by 10 publications

References 26 publications

Short-stem anatomical shoulder replacement—a systematic review

Short-stem anatomical shoulder replacement—a systematic review

Effect of Ulnar Head Offset on Distal Radioulnar Joint Stability

Determination of remodeling parameters for a strain-adaptive finite element model of the distal ulna

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