Coupling Musculoskeletal Dynamics and Subject-Specific Finite Element Analysis of Femoral Cortical Bone Failure after Endoprosthetic Knee Replacement

Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing

The optimal treatment strategy for proximal humerus fractures (PHFs) is debatable owing to the relatively high failure rate of locking plates. Optimizing implants may enhance the fixation stability of PHFs and reduce the rate of mechanical failures. We developed a finite element (FE) model to simulate the treatment of PHFs with Proximal Humerus Internal Locking System (PHILOS) plates. The model evaluated the average bone strain around the screw tips under vertical loading (as an alternative to the risk of cyclic screw cutout failure verified through biomechanical testing) to minimize this strain and maximize predicted fixation stability. After determining the optimal screw configuration, further FE analysis and in vitro biomechanical testing were conducted on both standard and optimized PHILOS screw orientation to assess whether the optimized plates have biomechanical advantages over the standard plates. The FE-based optimized configuration exhibited significantly lower bone strain around the implant than the standard PHILOS screw orientation (- 17.24%, p < 0.001). In both FE analysis and in vitro biomechanical testing, the optimized PHILOS plates achieved significantly lower average bone strain around the screws (p < 0.05), more uniform stress distribution, and greater structural stiffness (p < 0.05) than the standard PHILOS screw orientation. Our results show that biomechanical performance of the PHILOS plates can be improved by altering the orientation of the locking screws. This approach may be useful for future patient-specific design optimization of implants for other fractures.

Appropriate sagittal positioning of femoral components in total knee arthroplasty to prevent fracture and loosening

Aims

This study aimed to investigate the optimal sagittal positioning of the uncemented femoral component in total knee arthroplasty to minimize the risk of aseptic loosening and periprosthetic fracture.

Methods

Ten different sagittal placements of the femoral component, ranging from -5 mm (causing anterior notch) to +4 mm (causing anterior gap), were analyzed using finite element analysis. Both gait and squat loading conditions were simulated, and Von Mises stress and interface micromotion were evaluated to assess fracture and loosening risk.

Results

During gait, varied sagittal positioning did not lead to excessive Von Mises stress or micromotion. However, under squat conditions, posterior positioning (-4 and -5 mm) resulted in stress exceeding 150 MPa at the femoral notch, indicating potential fracture risk. Conversely, +1 mm and 0 mm sagittal positions demonstrated minimal interface micromotion.

Conclusion

Slightly anterior sagittal positioning (+1 mm) or neutral positioning (0 mm) effectively reduced stress concentration at the femoral notch and minimized interface micromotion. Thus, these positions are deemed suitable to decrease the risk of aseptic loosening and periprosthetic femoral fracture.

Stem to prevent periprosthetic fracture after notching in total knee arthroplasty

Improper osteotomy during total knee arthroplasty (TKA) can lead to anterior femoral notching, which increases the risk of periprosthetic fractures due to stress concentration. One potential solution is the addition of an intramedullary stem to the femoral component. However, the optimal stem length remains unclear. In this study, we aimed to determine the optimal stem length using finite element models. Finite element models of femurs were developed with unstemmed prostheses and prostheses with stem lengths of 50, 75, and 100 mm. Under squat loading conditions, the von Mises stress at the notch and stress distribution on four transversal sections of the femur were analyzed. Additionally, micromotion of the prosthesis-bone interface was evaluated to assess initial stability. The unstemmed prosthesis exhibited a von Mises stress of 191.8 MPa at the notch, which decreased to 43.1, 8.8, and 23.5 MPa for stem lengths of 50, 75, and 100 mm, respectively. The stress reduction on four selected femoral transversal sections compared with the unstemmed prosthesis was 40.0%, 84.4%, and 67.1% for stem lengths of 50, 75, and 100 mm, respectively. Micromotion analysis showed a maximum of 118.8 μm for the unstemmed prosthesis, which decreased significantly with the application of stems, particularly at the anterior flange. Intramedullary stems effectively reduced stress concentration at the femoral notch. The 50-mm stem length provided the optimal combination of reduced notch stress, minimized stress-shielding effect, and decreased micromotion at the anterior flange.

Porous metal block based on topology optimization to treat distal femoral bone defect in total knee revision

Metal block augmentations are common solutions in treating bone defects of total knee revision. However, the stress shielding and poor osteointegration resulted from metal block application could not be neglected in bone defects restoration. In this study, a novel porous metal block was designed with topology optimization to improve biomechanical performance. The biomechanical difference of the topologically optimized block, solid Ti6Al4V block, and porous Ti6Al4V block in treating bone defects of total knee revision was compared by finite element analysis. The inhomogeneous femoral model was created according to the computed tomography data. Combined with porous structures, minimum compliance topology optimization subjected to the volume fraction constraint was utilized for the redesign of the metal block. The region of interest was defined as a 10 mm area of the distal femur beneath the contacting surface. The biomechanical performance of daily motions was investigated. The von Mises stress, the strain energy density of the region of interest, and the von Mises stress of metal blocks were recorded. The results were analyzed in SPSS. In terms of the region of interest, the maximum von Mises stress of the topological optimized group increased obviously, and its average stress was significantly higher than that of the other groups (p < 0.05). Moreover, the topologically optimized block group had the highest maximum strain energy density of the three groups, and the lowest maximum stress of block was also found in this group. In this study, the stress shielding reduction and stress transfer capability were found obviously improved through topology optimization. Therefore, the topological optimized porous block is recommended in treating bone defects of total knee revision. Meanwhile, this study also provided a novel approach for mechanical optimization in block designing.

The optimal size of screw for using cement-screw technique to repair tibial defect in total knee arthroplasty: A finite element analysis

Cement can be reinforced with cancellous screws for repairing tibial defect in total knee arthroplasty (TKA). However, it is still unknown which size (diameter, length) of screws is better, and the purpose of this study was to perform a finite element analysis (FEA) to determine it. Twelve FEA models were set to represent the cement-screw technique with different diameters (3.5 mm, 5 mm and 6.5 mm) and lengths (20 mm, 25 mm, 30 mm and 35 mm). Contact stresses on the surface of cancellous bone in different areas were calculated. Compared to screws with diameter of 3.5 mm, stresses on the surface of bone defect reduced 5.75% of 5 mm and 10.68% of 6.5 mm for the screw length of 20 mm, 4.23% of 5 mm and 9.16% of 6.5 mm for 25 mm, 6.65% of 5 mm and 12.30% of 6.5 mm for 30 mm, and 5.05% of 5 mm and 12.16% of 6.5 mm for 35 mm. Compared to screws with diameter of 5 mm, stresses on the surface of defect reduced 5.24%, 5.15%, 6.05%, and 7.49% of 6.5 mm for the screw length of 20, 25, 30, and 35 mm. However, it did not show any significant difference in other comparisons. For the treatment of tibial defect in TKA with cement-screw technique, longer screw may not achieve better stability, but the thicker screw can reduce more stresses on the surface of tibial defect and achieve better stability. However, the depth of bone defect must be considered when making a choice.

The influence of body weight index on initial stability of uncemented femoral knee protheses: A finite element study

Background and objective

Obesity is one of the risk factors for osteoarthritis. The end-stage treatment for osteoarthritis is total knee arthroplasty (TKA). However, it remains controversial whether a high body mass index (BMI) affects the initial stability of the femoral prosthesis after TKA. Finite element analysis (FEA) was used to investigate this question in this study.

Methods

Four femur models that assembled with TKA femoral components were reconstructed and divided into high BMI group and normal BMI group. The three-dimensional femurs were modeled and assigned inhomogeneous materials based on computed tomography (CT) images. Then each FEA model was applied with gait and deep bend loading conditions to evaluate the maximum principal strain on the distal femur and the relative micromotion between the femur and prosthesis.

Results

The mean strain of the high BMI group increased by 32.7% (936.9 με versus 706.1 με) and 50.9% (2064.5 με versus 1368.2 με) under gait and deep bend loading conditions, respectively, compared to the normal BMI group. Meanwhile, the mean micromotion of the high BMI group increased by 41.6% (2.77 μm versus 1.96 μm) and 58.5% (62.1 μm versus 39.2 μm), respectively. Under gait condition, the maximum micromotion for high BMI group was 33.8 μm and would compromise the initial stability. Under deep bend condition, the maximum strain and micromotion exceeded -7300 με and 28 μm for both groups.

Conclusion

High BMI caused higher strain on the bone and higher micromotion between the prosthesis and the femur. Gait activities could be risky for prosthesis stability in high BMI group while be safe in normal group. Deep bend activities were highly dangerous for both groups with high BMI and normal BMI and should be avoided.

Cause analysis of the liner dissociation of a customized reverse shoulder prosthesis based on finite element analysis

Background: Dissociation of the polyethylene liner after reverse shoulder arthroplasty could cause shoulder dislocation that could not achieve closed reduction. The cause of liner dissociation is currently unclear.

Method: Non-homogeneous model of the bone was constructed and dynamic finite element analysis was utilized to simulate the impingement of the polyethylene liner and scapula during humeral adduction. The stress distribution of the fixation claws, their degree of deformation (DOD), and the stress of the impingement sites in three initial humeral postures (neutral, 30° flexion, and 30° extension) were measured and analyzed. The influence of the liner material stiffness was also investigated.

Result: The impingement stress on the liner and scapula was 100–200 MPa, and different humeral postures caused different locations of impingement points. The fixation claws’ maximum principal stress (MPS) results were below 5 MPa. In the connection area between some fixation claws and the liner, compressive stresses on the inside and tensile stresses on the outside were observed, which showed that the fixation claws were prone to deform toward the center direction. The maximum DOD results of three initial humeral postures (neutral, 30° flexion, and 30° extension) were 3.6%, 2.8%, and 3.5%, respectively. The maximum DOD results of neutral initial humeral posture were 0.51% and 11.4% when the elastic modulus of the liner was increased and decreased by a factor of 10, respectively.

Conclusion: The humeral adduction impingement could lead to the deformation of the claw-shaped liner fixation structure, which might be one of the reasons for the liner dissociation. The increased stiffness of the liner material helped to reduce the deformation of the fixation structure.

Multiscale mechanical responses of young and elderly human femurs: A finite element investigation

BACKGROUND

Bone remodeling in the elderly is no longer balanced. As a result, the morphologies and mechanical properties of bone at different scales will change. These changes would affect the mechanical responses of bone, which might exacerbate the imbalance of bone remodeling and even cause age-related bone diseases.

METHODS

Considering those changes, multiscale finite element (FE) models of bone in the young and the elderly were developed that included macroscale (proximal femur), mesoscale (cortical bone), microscale (Haversian system) and sub-microscale (osteocyte-lacuna-canaliculus-extracellular matrix system, OLCES). The stress and strain distributions at different scales and transmissions among different scales were investigated.

RESULTS

The stresses of the elderly at macroscale, mesoscale and microscale were higher than those in the young by 23.7%, 62.5% and 8.0%, respectively, and the stresses of the elderly and the young at sub-microscale were almost the same. The strain of the elderly at macroscale, mesoscale, microscale and sub-microscale were higher than those in the young by 48.6%, 56.8%, 11.9% and 25.1%, respectively. The stress and strain transmission rates (ησand ηε) from mesoscale to microscale were decreased by 1.8%, and 2.5% than those from macroscale to mesoscale in the elderly, respectively; but increased by 13.8%, and 4.7% in the young, respectively. ηε from microscale to sub-microscale in the elderly was higher than that in the young by 21.3%.

CONCLUSIONS

Degeneration of cortical bone mechanical property in the elderly causes increases in stress and strain at macroscale and mesoscale. The reduction of lacunar number in the elderly is not conducive to the mechanical transmission from mesoscale to microscale. The differences in stress and strain at microscale between the young and the elderly are smaller than those at macroscale or mesoscale. The strain stimulus sensed by osteocyte in the elderly is not weakened compared with that in the young.

Design of Porous Metal Block Augmentation to Treat Tibial Bone Defects in Total Knee Arthroplasty Based on Topology Optimization

Metal block augmentation, which is used for the treatment of tibial bone defects in total knee arthroplasty, with high stiffness will cause significant alteration in stress distribution, and its solid structure is not suitable for osseointegration. This study aimed to design a porous block to reduce weight, promote bone ingrowth, and improve its biomechanical performance. The metal block augmentation technique was applied to finite element models of tibial bone defects. Minimum compliance topology optimization subject to volume fraction combined with the porous architecture was adopted to redesign the block. Biomechanical changes compared with the original block were analyzed by finite element analysis. The stress distribution of the block and proximal tibia was recorded. The strain energy density of the proximal tibia was obtained. The newly designed block realized 40% weight reduction. The maximum stress in the optimized block decreased by 11.6% when compared with the solid one. The maximum stress of the proximal tibia in the optimized group increased by 18.6%. The stress of the anterior, medial, and posterior parts of the proximal medial tibia in the optimized group was significantly greater than that in the original group (all p < 0.05). The optimized block could effectively improve the biomechanical performance between the block and the bone. The presented method might provide a reference for the design of customized three-dimensional printed prostheses.

Is the 0.2%-Strain-Offset Approach Appropriate for Calculating the Yield Stress of Cortical Bone?

The 0.2% strain offset approach is mostly used to calculate the yield stress and serves as an efficient method for cross-lab comparisons of measured material properties. However, it is difficult to accurately determine the yield of the bone. Especially when computational models require accurate material parameters, clarification of the yield point is needed. We tested 24 cortical specimens harvested from six bovine femora in three-point bending mode, and 11 bovine femoral cortical specimens in the tensile mode. The Young's modulus and yield stress for each specimen derived from the specimen-specific finite element (FE) optimization method was regarded as the most ideal constitutive parameter. Then, the strain offset optimization method was used to find the strain offset closest to the ideal yield stress for the 24 specimens. The results showed that the 0 strain offsets underestimated (- 25%) the yield stress in bending and tensile tests, while the 0.2% strain offsets overestimated the yield stress (+ 65%) in three-point bending tests. Instead, the yield stress determined by 0.007 and 0.05% strain offset for bending and tensile loading respectively, can effectively characterize the biomechanical responses of the bone, thereby helping to build an accurate FE model.

Biomechanical comparison between metal block and cement-screw techniques for the treatment of tibial bone defects in total knee arthroplasty based on finite element analysis

BACKGROUND

Managing bone defects is a critical aspect of total knee arthroplasty. In this study, we compared the metal block and cement-screw techniques for the treatment of Anderson Orthopaedic Research Institute type 2A tibial bone defects from the biomechanical standpoint.

METHOD

The metal block and cement-screw techniques were applied to finite element models of 5- and 10-mm tibial bone defects. Biomechanical compatibility was evaluated based on the stress distributions of the proximal tibia and tibial tray. The displacement of the tibial tray and maximum relative micromotion between the tibial stem and tibia were analyzed to assess the stability of the implant.

RESULTS

The maximum stress in both the proximal tibia and tibial tray was greater with the cement-screw technique than with the metal block technique. The stress of the proximal lateral tibia with the cement-screw technique was significantly larger than with the metal block technique (p < 0.05). For the 5-mm bone defect, the maximum relative micromotion was lower than the critical value of 150 μm. For the 10-mm defect, the maximum relative micromotion was 128 μm with the metal block technique and 155 μm with the cement-screw technique, with the latter exceeding the critical value.

CONCLUSIONS

The cement-screw technique showed superior biomechanical compatibility to the metal block technique and is more suitable for 5-mm bone defects. However, as it may reduce the fixation strength in 10-mm bone defects, the metal block technique is more appropriate in this case.

Influence of Gait Cycle Loads on Stress Distribution at The Residual Limb/Socket Interface of Transfemoral Amputees: A Finite Element Analysis

A Finite Element Analysis (FEA) was performed to evaluate the interaction between residual limb and socket when considering the dynamic loads of the gait cycle. Fourteen transfemoral amputees participated in this study, where their residual limbs (i.e., soft tissues and bone), and their sockets were reconstructed. The socket and the femur were defined as elastic materials, while the bulk soft tissues were defined as a hyperelastic material. Each model included the donning, standing, and gait cycle phase, with load and boundary conditions applied accordingly. The influence of adding the dynamic loads related to the gait cycle were compared against the modelling of the static load equivalent to the standing position resulting in changes of 23% ± 19% in the maximum values and in an increase in the size of the regions where they were located. Additionally, the possible correspondence between comfort and the location of peak loadbearing at the residual-limb/socket interface was explored. Consequently, the comfort perceived by the patient could be estimated based on the locations of the maximum stresses (i.e., if they coincide with the pressure tolerant or sensitive regions of the residual limb).

Establishment and Simulation of 3D Geometric Models of Mini-Pig and Sheep Knee Joints Using Finite Element Analysis

Background

Our objective was to establish and compare three-dimensional models of knee joints of mini-pigs and sheep, the 2 most commonly used animal models of osteoarthritis.

Material/Methods

Three-dimensional geometric models of knee joints were used to assess their biomechanical properties by analysis of the three-dimensional finite element stress load for flexion at 30° and 60°.

Results

Analysis of multiple tissues indicated that the sheep knee had greater stress peaks than the mini-pig knee at 30° flexion (range: 12.5 to 30.4 Mpa for sheep vs. 11.1 to 20.2 Mpa for mini-pig) and at 60° flexion (range: 17.9 to 43.5 Mpa for sheep vs. 15.9 to 28.9 Mpa for mini-pig). In addition, there was uneven distribution of stress loads in the surrounding ligaments during flexion.

Conclusions

Our three-dimensional finite element analysis indicated that the mini-pig knee joint had stress values and changes of cartilage, meniscus, and peripheral ligaments that were similar to those of the human knee.