Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization

Boyle, Christopher; Kim, Il Yong

doi:10.1016/j.jbiomech.2011.03.038

Cited by 81 publications

(55 citation statements)

References 53 publications

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“…In a future study, detailed simulations of implant stability [74][75][76][77] and bone remodeling process [60,[77][78][79][80] can be performed to assess both the short and long term performance of the implant.…”

Section: Resultsmentioning

confidence: 99%

Multiscale Design and Multiobjective Optimization of Orthopedic Hip Implants with Functionally Graded Cellular Material

Khanoki

Pasini

2012

Journal of Biomechanical Engineering

129

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Revision surgeries of total hip arthroplasty are often caused by a deficient structural compatibility of the implant. Two main culprits, among others, are bone-implant interface instability and bone resorption. To address these issues, in this paper we propose a novel type of implant, which, in contrast to current hip replacement implants made of either a fully solid or a foam material, consists of a lattice microstructure with nonhomogeneous distribution of material properties. A methodology based on multiscale mechanics and design optimization is introduced to synthesize a graded cellular implant that can minimize concurrently bone resorption and implant interface failure. The procedure is applied to the design of a 2D left implanted femur with optimized gradients of relative density. To assess the manufacturability of the graded cellular microstructure, a proof-of-concept is fabricated by using rapid prototyping. The results from the analysis are used to compare the optimized cellular implant with a fully dense titanium implant and a homogeneous foam implant with a relative density of 50%. The bone resorption and the maximum value of interface stress of the cellular implant are found to be over 70% and 50% less than the titanium implant while being 53% and 65% less than the foam implant.

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Section: Resultsmentioning

confidence: 99%

Multiscale Design and Multiobjective Optimization of Orthopedic Hip Implants with Functionally Graded Cellular Material

Khanoki

Pasini

2012

Journal of Biomechanical Engineering

129

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“…The possible mechanisms of bone loss after large joint replacement surgeries can be summarized as 1) a foreign body reaction of the implant with bone; 2) wear debris effect of the artificial prosthesis; 3) micromotion or micromovement effects at the bone-prosthesis interfaces; and 4) stress shielding effects. 2,5,8,9 The mechanical causes of bone loss were the micromovement effects and stress shielding effects of the implants. The micromotion of the artificial joint into the bone may continuously induce mechanical damage to the bone around the prosthesis and subsequently bone loss occurs around the prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Bone loss of vertebral bodies at the operative segment after cervical arthroplasty: a potential complication?

Heo

Lee

et al. 2017

FOC

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OBJECTIVE Bony overgrowth and spontaneous fusion are complications of cervical arthroplasty. In contrast, bone loss or bone remodeling of vertebral bodies at the operation segment after cervical arthroplasty has also been observed. The purpose of this study is to investigate a potential complication—bone loss of the anterior portion of the vertebral bodies at the surgically treated segment after cervical total disc replacement (TDR)—and discuss the clinical significance. METHODS All enrolled patients underwent follow-up for more than 24 months after cervical arthroplasty using the Baguera C disc. Clinical evaluations included recording demographic data and measuring the visual analog scale and Neck Disability Index scores. Radiographic evaluations included measurements of the functional spinal unit's range of motion and changes such as bone loss and bone remodeling. The grading of the bone loss of the operative segment was classified as follows: Grade 1, disappearance of the anterior osteophyte or small minor bone loss; Grade 2, bone loss of the anterior portion of the vertebral bodies at the operation segment without exposure of the artificial disc; or Grade 3, significant bone loss with exposure of the anterior portion of the artificial disc. RESULTS Forty-eight patients were enrolled in this study. Among them, bone loss developed in 29 patients (Grade 1 in 15 patients, Grade 2 in 6 patients, and Grade 3 in 8 patients). Grade 3 bone loss was significantly associated with postoperative neck pain (p < 0.05). Bone loss was related to the motion preservation effect of the operative segment after cervical arthroplasty in contrast to heterotopic ossification. CONCLUSIONS Bone loss may be a potential complication of cervical TDR and affect early postoperative neck pain. However, it did not affect mid- to long-term clinical outcomes or prosthetic failure at the last follow-up. Also, this phenomenon may result in the motion preservation effect in the operative segment after cervical TDR.

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“…More representative computational predictions may be achieved with mechanistic or multiscaled topographic optimization based models, in which there are on-going research efforts [52][53][54][55]. This study employed a cemented THR as its case study to limit the effects of mechanobiological processes that will compete with remodeling, such as bone ingrowth and damage healing, and demonstrates the continuing value of this simpler approach.…”

Section: Journai Of Biomechanical Engineeringmentioning

confidence: 98%

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

Dickinson

2014

Journal of Biomechanical Engineering

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Periprosthetic bone remodeling is frequently observed after total hip replacement. Reduced bone density increases the implant and bone fracture risk, and a gross loss of bone density challenges fixation in subsequent revision surgery. Computational approaches allow bone remodeling to be predicted in agreement with the general clinical observations of proximal resorption and distal hypertrophy. However, these models do not reproduce other clinically observed bone density trends, including faster stabilizing mid-stem density losses, and loss-recovery trends around the distal stem. These may resemble trends in postoperative joint loading and activity, during recovery and rehabilitation, but the established remodeling prediction approach is often used with identical pre- and postoperative load and activity assumptions. Therefore, this study aimed to evaluate the influence of pre- to postoperative changes in activity and loading upon the predicted progression of remodeling. A strain-adaptive finite element model of a femur implanted with a cemented Charnley stem was generated, to predict 60 months of periprosthetic remodeling. A control set of model input data assumed identical pre- and postoperative loading and activity, and was compared to the results obtained from another set of inputs with three varying activity and load profiles. These represented activity changes during rehabilitation for weak, intermediate and strong recoveries, and pre- to postoperative joint force changes due to hip center translation and the use of walking aids. Predicted temporal bone density change trends were analyzed, and absolute bone density changes and the time to homeostasis were inspected, alongside virtual X-rays. The predicted periprosthetic bone density changes obtained using modified loading inputs demonstrated closer agreement with clinical measurements than the control. The modified inputs also predicted the clinically observed temporal density change trends, but still under-estimated density loss during the first three postoperative months. This suggests that other mechanobiological factors have an influence, including the repair of surgical micro-fractures, thermal damage and vascular interruption. This study demonstrates the importance of accounting for pre- to postoperative changes in joint loading and patient activity when predicting periprosthetic bone remodeling. The study's main weakness is the use of an individual patient model; computational expense is a limitation of all previously reported iterative remodeling analysis studies. However, this model showed sufficient computational efficiency for application in probabilistic analysis, and is an easily implemented modification of a well-established technique.

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Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization

Cited by 81 publications

References 53 publications

Multiscale Design and Multiobjective Optimization of Orthopedic Hip Implants with Functionally Graded Cellular Material

Multiscale Design and Multiobjective Optimization of Orthopedic Hip Implants with Functionally Graded Cellular Material

Bone loss of vertebral bodies at the operative segment after cervical arthroplasty: a potential complication?

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

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