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Pareatumbee P, Zainul-Abidin S, Yew A, Chou SM, Howe TS, Koh JSB, Tan MH. Effect of implant length variations on stress shielding in proximal humeral replacement after tumor excision under torsion: Finite element study. J Orthop Res 2022; 41:1139-1147. [PMID: 36200541 DOI: 10.1002/jor.25456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 02/04/2023]
Abstract
The proximal humerus is the most common site of occurrence of primary bone tumors in the upper limb. Endoprosthetic replacement is deemed as the preferred reconstructive option following primary resection of bone tumors. However, it has been also associated with complications such as stress shielding and aseptic loosening compromising prosthetic survival. Our objective was to conduct a finite element (FE) study to investigate the effect of varying endoprosthesis length on bone stresses as well as to quantify the extent of stress shielding across the bone length (BL) in a humerus-prosthesis assembly for proximal humeral replacement after tumor excision thereby allowing us to identify the optimal implant length with best biomechanical performance. FE models of the intact humerus and humerus-prosthesis assemblies were established where they were loaded at the elbow joint under torsion with the glenohumeral joint fixed to represent twisting. After dividing the bone into individual slices consisting of 5% BL, the maximum cortical and cancellous principal, von Mises and shear bone stresses were calculated. To measure the level of stress shielding, the percentage stress change from the intact state was evaluated across each slice. Similar stress patterns were observed between the intact state and shorter endoprosthesis compared to the longer endoprostheses. Our findings illustrated the possibility of stress shielding occurring under torsional forces with its effect increasing with implant lengthening. To conclude, we believe that using a shorter prosthesis may substantially diminish the risk of potential implant failure due to stress shielding.
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Affiliation(s)
- Pivatidevi Pareatumbee
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore
| | - Suraya Zainul-Abidin
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Andy Yew
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Siaw M Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Tet Sen Howe
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Joyce S B Koh
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Mann Hong Tan
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
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