Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling

Kerner, J; Huiskes, R.; Lenthe, G. Harry van; Weinans, Harrie; Rietbergen, Bert van; Engh, C. Anderson; Amis, Andrew A.

doi:10.1016/s0021-9290(99)00041-x

Cited by 209 publications

(138 citation statements)

References 22 publications

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“…These simulations are difficult to validate, particularly in humans, due to the ethical problems of collecting pre-operative CT and postoperative DEXA images. As a consequence, there has only been limited corroboration between FE predictions from single, representative models and clinical measures of bone adaptation (Lerch et al, 2012;Herrera et al, 2009;Turner et al, 2005;Kerner et al, 1999). Huiskes's early work on bone remodelling later resulted in many papers looking more fundamentally at remodelling at the tissue level as a self-organizational process with Huiskes (1997) being a paper describing his thinking when moving from the subject of remodelling around implants to an algorithm to describe bone remodelling at the tissue level.…”

Section: Time Dependent/adaptive Modelling Techniquesmentioning

confidence: 99%

“…If FE models are to be trusted and accepted, there is a need to demonstrate that they are capable of predicting in vivo performance. To date, only a few studies have attempted to correlate their findings with clinical data (Lennon et al, 2007;Lerch et al, 2012;Herrera et al, 2009;Turner et al, 2005;Kerner et al, 1999;Perillo-Marcone et al, 2004). Historically, this has been limited by the availability of pre-and/or post-op CT scans, as these were not required as part of the routine Fig.…”

Section: Validation and Verificationmentioning

confidence: 99%

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Four decades of finite element analysis of orthopaedic devices: Where are we now and what are the opportunities?

Taylor

Prendergast

2015

Journal of Biomechanics

140

106

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a b s t r a c tFinite element has been used for more than four decades to study and evaluate the mechanical behaviour total joint replacements. In Huiskes seminal paper "Failed innovation in total hip replacement: diagnosis and proposals for a cure", finite element modelling was one of the potential cures to avoid poorly performing designs reaching the market place. The size and sophistication of models has increased significantly since that paper and a range of techniques are available from predicting the initial mechanical environment through to advanced adaptive simulations including bone adaptation, tissue differentiation, damage accumulation and wear. However, are we any closer to FE becoming an effective screening tool for new devices? This review contains a critical analysis of currently available finite element modelling techniques including (i) development of the basic model, the application of appropriate material properties, loading and boundary conditions, (ii) describing the initial mechanical environment of the bone-implant system, (iii) capturing the time dependent behaviour in adaptive simulations, (iv) the design and implementation of computer based experiments and (v) determining suitable performance metrics.The development of the underlying tools and techniques appears to have plateaued and further advances appear to be limited either by a lack of data to populate the models or the need to better understand the fundamentals of the mechanical and biological processes. There has been progress in the design of computer based experiments. Historically, FE has been used in a similar way to in vitro tests, by running only a limited set of analyses, typically of a single bone segment or joint under idealised conditions. The power of finite element is the ability to run multiple simulations and explore the performance of a device under a variety of conditions. There has been increasing usage of design of experiments, probabilistic techniques and more recently population based modelling to account for patient and surgical variability. In order to have effective screening methods, we need to continue to develop these approaches to examine the behaviour and performance of total joint replacements and benchmark them for devices with known clinical performance.Finite element will increasingly be used in the design, development and pre-clinical testing of total joint replacements. However, simulations must include holistic, closely corroborated, multi-domain analyses which account for real world variability.

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Section: Time Dependent/adaptive Modelling Techniquesmentioning

confidence: 99%

Section: Validation and Verificationmentioning

confidence: 99%

Four decades of finite element analysis of orthopaedic devices: Where are we now and what are the opportunities?

Taylor

Prendergast

2015

Journal of Biomechanics

140

106

View full text Add to dashboard Cite

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“…On the other hand the TMZF alloy which is used on the ABG-II stem has a Young's modulus of 74-85 GPa, according to the manufacturer information, using a mean value of 79.5 GPa in the different analyses. Taking various studies as reference (Kerner et al, 1999;Turner et al, 2005), a linear relationship between the bone mass values, which come from the medical study collected in Panisello (Panisello, 2009a), and the apparent density was established in addition to a cubic relationship between the latter and the elastic modulus, using a maximal Young's modulus of 20 GPa, thereby obtaining the cortical bone modulus of elasticity values for each one of the 7 Gruen zones. To carry out the analysis of the results, the cortical bone of each model is divided into seven zones which coincide with the Gruen zones.…”

Section: Fig 8 Gruen Zonesmentioning

confidence: 99%

Simulation by Finite Elements of Bone Remodeling After Implantation of Femoral Stems

Gracia¹,

Ibarz²,

Cegoñino³

et al. 2012

Finite Element Analysis - From Biomedical Applications to Industrial Developments

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“…A mechanostat principle was applied, based upon the strain history stimulus required to produce a bone volume change (Carter 1984), and implemented using Euler forward integration to calculate iterative changes in the thickness of cortex elements (external remodelling), or the heterogeneous density-and hence the Young's modulus-of trabecular elements (internal remodelling). This method has been applied to femoral implants in THR (Kerner et al 1999;Turner et al 2005), RHR (Gupta et al 2006;Pal et al 2009;Rothstock et al 2011;Dickinson et al 2012;Perez et al 2014), to acetabular cups (Ghosh et al 2013), and in other joints (van Lenthe et al 1997). Advanced approaches have combined strain adaptive bone remodelling with other associated mechanobiological processes, including cementless implant ingrowth (Tarala et al 2011) and periprosthetic defect healing (Dickinson et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

Dickinson

2015

Biomech Model Mechanobiol

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Bone morphology and density changes are commonly observed following joint replacement, and may contribute to the risks of implant loosening and periprosthetic fracture, and reduce the available bone stock for revision surgery. This study was presented in the "Bone and Cartilage Mechanobiology across the scales" WCCM symposium to review the development of remodelling prediction methods and to demonstrate simulation of adaptive bone remodelling around hip replacement femoral components, incorporating intrinsic (prosthesis) and extrinsic (activity and loading) factors.An iterative bone remodelling process was applied to finite element models of a femur implanted with a cementless THR (total hip replacement) and a hip resurfacing implant. Previously developed for a cemented THR implant, this modified process enabled the influence of pre-to postoperative changes in patient activity and joint loading to be evaluated. A control algorithm used identical pre-and postoperative conditions, and the predicted extents and temporal trends of remodelling were measured by generating virtual x-rays and DXA scans.The modified process improved qualitative and quantitative remodelling predictions for both the cementless THR and resurfacing implants, but demonstrated the sensitivity to DXA scan region definition and appropriate implant-bone position and sizing. Predicted remodelling in the intact femur in response to changed activity and loading demonstrated that in this simplified model, although the influence of the extrinsic effects were important, the mechanics of implantation were dominant. This study supports the application of predictive bone remodelling as one element in the range of physical and computational studies, which should be conducted in the pre-clinical evaluation of new prostheses.

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Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling

Cited by 209 publications

References 22 publications

Four decades of finite element analysis of orthopaedic devices: Where are we now and what are the opportunities?

Four decades of finite element analysis of orthopaedic devices: Where are we now and what are the opportunities?

Simulation by Finite Elements of Bone Remodeling After Implantation of Femoral Stems

Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

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