Effect of Femoral Head Size, Subject Weight, and Activity Level on Acetabular Cement Mantle Stress Following Total Hip Arthroplasty

Influence of obesity on load-transfer mechanism, contact mechanics, and longevity of cemented acetabular cup

Objective

This investigation aimed to assess the impact of obesity on the load-transfer mechanism, longevity, and contact mechanics of cemented acetabular cups.

Methods

Three obesity scenarios were considered: obese case-I (100-110 kg), obese case-II (120-130 kg), and obese case-III (140-150 kg). Utilising six finite element models, the effects of different bodyweights on load transfer, contact mechanics, and cup longevity during normal walking conditions were assessed. Muscle forces and hip joint reaction forces were adjusted and linearly calibrated based on obesity cases.

Results

Elevated stresses in cortical and cancellous bones, as well as the cement mantle, were observed in obese cases, suggesting a heightened risk of loosening and failure of the cemented fixation of the acetabular cup. Additionally, increased contact pressure and micromotion between articulating surfaces were noted in obese individuals, with a gradual escalation from obese case-I to obese case-III.

Conclusions

These findings highlight the significant negative impact of obesity on the performance of cemented acetabular cups, emphasizing the importance of considering bodyweight variations in the design and assessment of orthopaedic implants for optimal functionality and durability.

A comparative study of robusticity indices of long bones among hunter-gatherers and early agro-pastoral groups of India

OBJECTIVES

Diaphyseal robusticity and cross-sectional shapes of the bone tissues are influenced by mechanical loading history. It changes according to work demand on the body. It is the objective of this study to identify the shifts in the modes of subsistence, activities and mobility patterns through the comparison of the shape and strength of bone diaphyses among the Mesolithic, Chalcolithic and Harappan populations of India.

MATERIALS AND METHODS

For the analysis, 7 sites including 2 from Mesolithic (8000-4000 bc), 2 from Chalcolithic (2000-700 bc) and 3 from Harappan (3500-1800 bc) contexts are considered. The ratio obtained from the maximum length of the bones to their girth (at 50% or 35% from the distal end) and that from anterior-posterior and medio-lateral diameters were calculated (following Martin and Saller codes, 1957) to understand certain functional adaptations and stress markers on preserved long bones. Independent-sample T-tests and ANOVA were applied to detect mean differences of statistical significance within and between cultures.

RESULTS

The robusticity indices obtained from the humeri increase from the hunting-gathering phase (M/F; 19.39/18.45) to the Chalcolithic phase (M/F; 21.99/19.39) showing a slight drop in the Harappan phase (M/F; 18.58/18.37). The right humeri of Mesolithic females show a directional asymmetry of length (4.08%-5.13%) while that in males reach up to 26.09% indicating right-dominant lateralization. In the Harappan phase, females show a greater value for the right ranging from 0.31% to 3.07%. The femoral robusticity of females increases from 11.42 in hunting-gathering societies to 13.28 in Harappan times while mid-shaft of the Mesolithic population clearly shows greater loading along the anterior-posterior (A-P) plane as the index in most cases exceeds 100. There are significant differences among males and females within each group in terms of the indices but significant differences could be discerned between the Mesolithic, Chalcolithic and Harappan populations in case of tibiae, radii and ulnae only.

CONCLUSION

The occupation patterns certainly changed as humans became a food-producer from a hunter-gatherer. Occupations involving the extensive flexion and extension of upper limbs in the Chalcolithic period increase particularly in the Harappan phase. Sedentism gave rise to roundness of the femur and reduced the magnitude of lateralization. While equal level of mobility can be traced in case of both the sexes before the advent of agriculture, this distinction increases between the males and females in the agro-pastoral phases.

Extended mechanical loads for the analysis of acetabular cages

To analyse the strength and mechanical behaviour of hip implants, it is essential to employ an appropriate loading model. Generating computational models supplemented with muscle forces is a complicated task, especially in the initial phase of implant development. This research aims to expand the possibilities of the simpler acetabular cage model based on joint loads without significantly increasing the demand for computing resources. A Python script covered and grouped the loads from daily activities. The ten calculated major loads were compared with the maximum of the walking and stair climbing loads through the finite element analyses of a custom-made acetabular cage. Sensitivity analyses were performed for the surrounding bones' elastic modulus and the pelvis boundary conditions. The major loads can geometrically cover the entire load spectrum of daily activities. The effect of many high-magnitude force vectors is uncertain in the approach that uses the most common maximum loads. Using these resultant major loads, a new stress concentration area could be detected on the acetabular cage, besides the stress concentration areas induced by the loads reported in the literature. The qualitative correctness of the results is also supported by a control computed tomography scan: a fracture occurred in an extensive, high-stress zone. The results are not sensitive to changes in the elastic modulus of the surrounding bone and the boundary conditions of the model. The presented load vectors and the algorithm make more extensive static analyses possible with little computational overhead. The proposed method can be used for checking the static strength of similar implants.

Biomechanical performance of the cemented acetabular cup with combined effects of bone quality, implant material combinations and bodyweight

The objective of this study is to understand the combined effects of bone quality, implant materials and bodyweight on the biomechanical performance of cemented acetabular cup. Additionally, the performance of the cemented acetabular cup was evaluated for obesity cases or obese people. A total of 84 FE models (based on CT data) were developed based on combinations of three different cancellous bone material distributions to represent bone quality, four different implant material combinations and seven different bodyweights. The biomechanical performance of the acetabular cup was evaluated based on bone stress (both cortical and cancellous bone), cement mantle stress, micromotion and contact pressure between the acetabular cup and femoral head. Cortical bone stress, cancellous bone stress, cement stress, the contact pressure between implants and micromotion between implants are affected by different bone quality, implant material combinations and bodyweights. An increase in bodyweight would increase the cortical bone stress, cancellous bone stress, cement stress, contact pressure between implants and micromotion between implants. However, bodyweight affects the cortical and cancellous bone stress more (stiff rise of the bone stresses; nonlinear relation) as compared to other output parameters (mostly linear relation). Comparing cortical and cancellous bone stress, the stress versus bodyweight curve is much stiffer (stiff rise in the curve) for cortical bone than cancellous bone and that even further increases as bone quality decreases. Especially considering obesity cases or obese people (very high bodyweight), the performance of the cemented acetabular component is poor.

Graphical abstract

[Formula: see text]

Effect of intraoperative treatment options on hip joint stability following total hip arthroplasty

Dislocation remains the leading indication for revision of total hip arthroplasty (THA). The objective of this study was to use a computational model to compare the overall resistance to both anterior and posterior dislocation for the available THA constructs commonly considered by surgeons attempting to produce a stable joint. Patient-specific musculoskeletal models of THA patients performing activities consistent with anterior and posterior dislocation were developed to calculate joint contact forces and joint positions used for simulations of dislocation in a finite element model of the implanted hip that included an experimentally calibrated hip capsule representation. Dislocations were then performed with consideration of offset using +5 and +9 offset, iteratively with three lipped liner variations in jump distance (10°, 15°, and 20° lips), a size 40 head, and a dual-mobility construct. Dislocation resistance was quantified as the moment required to dislocate the hip and the integral of the moment-flexion angle (dislocation energy). Increasing head diameter increased resistive moment on average for anterior and posterior dislocation by 22% relative to a neutral configuration. A lipped liner resulted in increases in the resistive moment to posterior dislocation of 9%, 19%, and 47% for 10°, 15°, and 20° lips, a sensitivity of approximately 2.8 Nm/mm of additional jump distance. A dual-mobility acetabular design resulted in an average 38% increase in resistive moment and 92% increase in dislocation energy for anterior and posterior dislocation. A quantitative understanding of tradeoffs in the dislocation risk inherent to THA construct options is valuable in supporting surgical decision making.

The lateral femoral wall thickness on the risk of post-operative lateral wall fracture in intertrochanteric fracture after DHS fixation: A finite element analysis

BACKGROUND

Patients with a lateral femoral wall (LFW) fracture were reported to have high rates of re-operation and complication. Although the LFW thickness was a reliable predictor of post-operative or intra-operative LFW fracture, there was a paucity of literature evaluating the critical stress distributions on the femur and screws of intertrochanteric fractures treated with dynamic hip screw (DHS). This study aimed to investigate the biomechanical performance of intertrochanteric fractures with different LFW thickness treated with DHS device.

METHODS

A three-dimensional model of the proximal femur was established by computed tomography images. The intertrochanteric fracture model with three different LFW thickness (10 mm, 20.5 mm and 30 mm, respectively) was created, which was fixed by DHS. The von Mises stress on the proximal femur, lateral femoral wall, DHS and the total displacement of the device components were evaluated and compared for three different LFW thickness model.

RESULTS

The maximum von Mises stress in the proximal fragment of the 10 and 20.5 mm model increased by 80.56% and 57.97% when compared with the 30 mm model. The peek von Mises stress around the blade entry point of the 10 mm and 20.5 mm model increased by 89.26% and 66.39% when compared with the 30 mm model. The peek von Mises in the DHS located near the junction of the barrel and side plate of each model and the 30 mm model had the smallest von Mises stress compared with the other two models. Furthermore, the maximum displacement in the 30 mm model was much smaller than that in the10mm model and 20 mm model.

CONCLUSIONS

The intertrochanteric fracture with a thinner LFW tended to have a higher risk of LFW fracture stabilized by a DHS device. Thus, the intertrochanteric fractures with a thinner LFW should not be treated by DHS alone and the intramedullary nail or an addition of trochanteric stabilization plate(TSP) was recommended.

A Two-Experiment Approach to Scaling in Biomechanics

A new approach to scaled experimentation has recently appeared in the open literature where hitherto unknown similitude rules have been discovered. The impact of this discovery on biomechanics is the focus of this paper, where rules for one and two scaled experiments are assessed. Biomechanical experimentation is beset by problems that can hinder its successful implementation. Availability of resources, repeatability and variability of specimens, ethical compliance and cost are the most prominent. Physical modelling involving synthetic composite materials can be used to advantage and circumvent ethical concerns but is presently impeded by cost and the limited scope of standardised geometries. The increased flexibility of the new approach, combined with the application of substantially cheaper 3D printed materials, is investigated here for bone biomechanical experiments consisting of mechanical tests for the validation of finite element models by means of digital image correlation.

The microstructure of the scaled materials is analyzed using a laser confocal microscope followed by the construction and validation of numerical models by means of a Bland-Altman statistical analysis. Good agreement is obtained demonstrated with means under 18 micro-strains (µ ε) and limits of agreement below 83 µ ε. Consequently, numerical results for the new similitude approach shows an average percentage error of 3.1% and 4.8% for the optimized results across all values. The two-scaled experiment approach results in a sevenfold improvement for the average difference values of strain when compared to the single scaled experiment, so demonstrating the potential of the new approach.

Fracture Toughness of Acrylic PMMA Bone Cement: A Mini-Review

BACKGROUND

Acrylic PMMA bone cement is an essential component in cemented implants and formed the cement-bone and cement-implant interfaces. The information on the fracture parameters of PMMA bone cement would be decisive for all doctors, researchers, and orthopaedic surgeons.

PURPOSE

This review aims to indicate the parameters responsible for the variation in the fracture toughness of PMMA bone cement. This mini-review also points out some limitations of the earlier published research article, which can be added in the future analysis and can be helpful to get the more realistic data of the fracture parameters of PMMA bone cement.

CONCLUSION

Different mixing techniques, storage medium, temperature, loading conditions, frequency and environment, cement viscosity, type of specimen, and the ASTM standards (shape, size, and geometry), constituents, loading rate, and cement porosity were the critical parameters to affect the fracture toughness of PMMA bone cement. This study will also be helpful to increase the structural integrity of PMMA bone cement and the cemented implant.

Risk factors for a radiolucent line around the acetabular component with an interface bioactive bone cement technique after primary cemented total hip arthroplasty

Aims

The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.

Methods

A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis.

Results

RLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7).

Conclusion

This study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL.

Cite this article: Bone Joint Open 2021;2(5):278–292.

Three-dimensional finite element analysis of intramedullary nail with different materials in the treatment of intertrochanteric fractures

Intramedullary nails are the common treatment options for femoral intertrochanteric fractures. However, aseptic loosening is considered to be one of the primary forms of failure that can be caused by the stress shielding between the bone and implants. The matching in mechanical properties of implant and bone is a key issue to prevent this failure. Polyetheretherketone (PEEK) and Function-graded (FG) materials are widely used in clinical because of their excellent mechanical properties. In this study, to investigate the biomechanical behaviors of intramedullary nails made of Ti-6Al-4V alloy, Stainless Steel (SS), PEEK and two FG materials, three-dimensional finite element models of intertrochanteric fracture femur with intramedullary nail were constructed with ABAQUS. The maximum von Mises stress on the femoral fracture surface fixed by PEEK intramedullary nail was the largest, followed by FG intramedullary nail, which help stimulate bone growth and subsequently reduce fracture healing time. Compared with traditional metal intramedullary nails, PEEK and FG implants might increase von Mises stress along the same path in the proximal femur. The results showed that PEEK and FG intramedullary nails obviously changed the stress distributions in the bone and reduced stress shielding. This finding indicated that PEEK and FG intramedullary nails have the potential to become alternatives to the conventional metal intramedullary nails.

Zeroth-order finite similitude and scaling of complex geometries in biomechanical experimentation

Scaled experimentation provides an alternative approach to full-scale biomechanical (and biological) testing but is known to suffer from scale effects, where the underlying system behaviour changes with scale. This phenomenon is arguably the overriding principal obstacle to the many advantages that scaled experimentation provides. These include reduced costs, materials and time, along with the eschewal of ethical compliance concerns with the application of substitute artificial materials as opposed to the use of hazardous biological agents. This paper examines the role scale effects play in biomechanical experimentation involving strain measurement and introduces a formulation that overtly captures scale dependencies arising from geometrical change. The basic idea underpinning the new scaling approach is the concept of space scaling, where a biomechanical experiment is scaled by the metaphysical mechanism of space contraction. The scaling approach is verified and validated with finite-element (FE) models and actual physical-trial experimentation using digital image correlation software applied to synthetic composite bone. The experimental design aspect of the approach allows for the selection of three-dimensional printing materials for trial-space analysis in a complex pelvis geometry. This aspect takes advantage of recent advancements in additive manufacturing technologies with the objective of countering behavioural distorting scale effects. Analysis is carried out using a laser confocal microscope to compare the trial and physical space materials and subsequently measured using surface roughness parameters. FE models were constructed for the left hemipelvis and results show similar strain patterns (average percentage error less than 10%) for two of the three trial-space material combinations. A Bland-Altman statistical analysis shows a good agreement between the FE models and physical experimentation and a good agreement between the physical-trial experimentation, providing good supporting evidence of the applicability of the new scaling approach in a wider range of experiments.