Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Finite element analysis of cementless femoral stems based on mid- and long-term radiological evaluation

Authors: Kanehiro Matsuyama, Yasuhiro Ishidou, Yong-Ming Guo, Hironori Kakoi, Takao Setoguchi, Satoshi Nagano, Ichiro Kawamura, Shingo Maeda, Setsuro Komiya

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Femoral bone remodeling in response to stress shielding induces periprosthetic bone loss. Computerized finite element analysis (FEA) is employed to demonstrate differences in initial stress distribution. However, FEA is often performed without considering the precise sites at which the stem was fixed. We determined whether FEA reflects mid-term radiological examination exactly as predicted following long-term stress shielding.

Methods

Femur–stem fixation sites were evaluated radiologically according to the location of spot welds in two anatomical cementless stem designs. Based on mid-term radiological results, four femur–stem bonding site conditions were defined as: (Condition A) no bonding; (Condition B) bonding within the 10 mm area proximal to the distal border of the porous area; (Condition C) bonding of the entire porous area; and (Condition D) bonding of the entire femoral stem, prior to conducting FEA analysis. Furthermore, we radiographically evaluated mid- and long-term stress shielding, and measured bone mineral density of the femur 10 years after total hip arthroplasty.

Results

Spot welds appeared frequently around the border between the porous and smooth areas. FEA showed that, based on mid-term radiological evaluation, von Mises stress was reduced in condition B in the area proximal to the femur–stem bonding sites for both stem designs compared with condition A (no bonding). Conversely, von Mises stress at all areas of the femur–stem bonding sites in conditions C and D was higher than that in condition A. With respect to stress shielding progression, there was no significant difference between the two types of stem designs. However, stress shielding progressed and was significantly higher in the presence of spot welds (p = 0.001). In both stem designs, bone mineral density in zone VII was significantly lower than that in the contralateral hips.

Conclusions

These results indicate that FEA based on mid-term radiological evaluation may be helpful to predict the influence of long-term stress shielding more precisely.
Appendix
Available only for authorised users
Literature
1.
Capello WN, D’Antonio JA, Jaffe WL, Geesink RG, Manley MT, Feinberg JR. Hydroxyapatite-coated femoral components: 15-year minimum followup. Clin Orthop Relat Res. 2006;453:75–80.CrossRefPubMed
2.
Epinette JA, Manley MT. Uncemented stems in hip replacement–hydroxyapatite or plain porous: does it matter? Based on a prospective study of HA Omnifit stems at 15-years minimum follow-up. Hip Int. 2008;18(2):69–74.CrossRefPubMed
3.
Goosen JH, Kums AJ, Kollen BJ, Verheyen CC. Porous-coated femoral components with or without hydroxyapatite in primary uncemented total hip arthroplasty: a systematic review of randomized controlled trials. Arch Orthop Trauma Surg. 2009;129(9):1165–9.CrossRefPubMed
4.
Yamada H, Yoshihara Y, Henmi O, Morita M, Shiromoto Y, Kawano T, et al. Cementless total hip replacement: past, present, and future. J Orthop Sci. 2009;14:228–41.CrossRefPubMedPubMedCentral
5.
Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011;93(5):500–9.CrossRefPubMed
6.
Huiskes R, Weinans H, Grootenboer HJ, Dalstra M, Fudala B, Slooff TJ. Adaptive bone-remodeling theory applied to prosthetic-design analysis. J Biomech. 1987;20(11–12):1135–50.CrossRefPubMed
7.
Sumner DR. Long-term implant fixation and stress-shielding in total hip replacement. J Biomech. 2015;48(5):797–800.CrossRefPubMed
8.
Wilkinson JM, Hamer AJ, Rogers A, Stockley I, Eastell R. Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty. J Orthop Res. 2003;21(4):691–6.CrossRefPubMed
9.
Rosenbaum Chou TG, Child JR, Naughtin RJ, Rigdon RR, Schumann C, Bloebaum RD. The relationship between femoral periprosthetic cortical bone geometry and porosity after total hip arthroplasty. J Biomed Mater Res A. 2008;87(1):107–15.CrossRefPubMed
10.
Engh Jr CA, Young AM, Engh Sr CA, Hopper Jr RH. Clinical consequences of stress shielding after porous-coated total hip arthroplasty. Clin Orthop Relat Res. 2003;417:157–63.
11.
Watanabe Y, Shiba N, Matsuo S, Higuchi F, Tagawa Y, Inoue A. Biomechanical study of the resurfacing hip arthroplasty: finite element analysis of the femoral component. J Arthroplasty. 2000;15(4):505–11.CrossRefPubMed
12.
Abdul-Kadir MR, Hansen U, Klabunde R, Lucas D, Amis A. Finite element modelling of primary hip stem stability: the effect of interference fit. J Biomech. 2008;41:587–94.CrossRefPubMed
13.
Ong KL, Day JS, Manley MT, Kurtz SM, Geesink R. Biomechanical comparison of 2 proximally coated femoral stems: effects of stem length and surface finish. J Arthroplasty. 2009;24(5):819–24.CrossRefPubMed
14.
Hirata Y, Inaba Y, Kobayashi N, Ike H, Fujimaki H, Saito T. Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis. J Arthroplasty. 2013;28(10):1731–5.CrossRefPubMed
15.
ten Broeke RH, Tarala M, Arts JJ, Janssen DW, Verdonschot N, Geesink RG. Improving peri-prosthetic bone adaptation around cementless hip stems: a clinical and finite element study. Med Eng Phys. 2014;36(3):345–53.CrossRefPubMed
16.
Kerner J, Huiskes R, van Lenthe GH, Weinans H, van Rietbergen B, Engh CA, et al. Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling. J Biomech. 1999;32(7):695–703.CrossRefPubMed
17.
Scannell PT, Prendergast PJ. Cortical and interfacial bone changes around a non-cemented hip implant: simulations using a combined strain/damage remodelling algorithm. Med Eng Phys. 2009;31(4):477–88.CrossRefPubMed
18.
Turner AW, Gillies RM, Sekel R, Morris P, Bruce W, Walsh WR. Computational bone remodelling simulations and comparisons with DEXA results. J Orthop Res. 2005;23(4):705–12.CrossRefPubMed
19.
Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257:107–28.
20.
Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.
21.
Hobatho MC, Rho JY, Ashman RB. Anatomical variation of human cancellous bone mechanical properties in vitro. Stud Health Technol Inform. 1997;40:157–73.PubMed
22.
Burstein AH, Reilly DT, Martens M. Aging of bone tissue: mechanical properties. J Bone Joint Surg Am. 1976;58(1):82–6.CrossRefPubMed
23.
Wirtz DC, Schiffers N, Pandorf T, Radermacher K, Weichert D, Forst R. Critical evaluation of known bone material properties to realize anisotropic FE-simulation of the proximal femur. J Biomech. 2000;33(10):1325–30.CrossRefPubMed
24.
Pettersen SH, Wik TS, Skallerud B. Subject specific finite element analysis of implant stability for a cementless femoral stem. Clin Biomech (Bristol, Avon). 2009;24(6):480–7.CrossRef
25.
Spears IR, Morlock MM, Pfleiderer M, Schneider E, Hille E. The influence of friction and interference on the seating of a hemispherical press-fit cup: a finite element investigation. J Biomech. 1999;32(11):1183–9.CrossRefPubMed
26.
Heller MO, Bergmann G, Deuretzbacher G, Dürselen L, Pohl M, Claes L, et al. Musculo-skeletal loading conditions at the hip during walking and stair climbing. J Biomech. 2001;34(7):883–93.CrossRefPubMed
27.
Heller MO, Bergmann G, Kassi JP, Claes L, Haas NP, Duda GN. Determination of muscle loading at the hip joint for use in pre-clinical testing. J Biomech. 2005;38(5):1155–63.CrossRefPubMed
28.
Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br). 1987;69(1):45–55.
29.
Engh Jr CA, McAuley JP, Sychterz CJ, Sacco ME, Engh Sr CA. The accuracy and reproducibility of radiographic assessment of stress-shielding. A postmortem analysis. J Bone Joint Surg Am. 2000;82-A(10):1414–20.CrossRefPubMed
30.
Van Rietbergen B, Huiskes R, Weinans H, Sumner DR, Turner TM, Galante JO. ESB Research Award 1992. The mechanism of bone remodeling and resorption around press-fitted THA stems. J Biomech. 1993;26(4–5):369–82.CrossRefPubMed
31.
Huiskes R, Weinans H, Dalstra M. Adaptive bone remodeling and biomechanical design considerations for noncemented total hip arthroplasty. Orthopedics. 1989;12(9):1255–67.PubMed
32.
Huiskes R. The various stress patterns of press-fit, ingrown, and cemented femoral stems. Clin Orthop Relat Res. 1990;261:27–38.
33.
Weinans H, Huiskes R, Grootenboer HJ. Effects of fit and bonding characteristics of femoral stems on adaptive bone remodeling. J Biomech Eng. 1994;116(4):393–400.CrossRefPubMed
34.
Skinner HB, Kim AS, Keyak JH, Mote Jr CD. Femoral prosthesis implantation induces changes in bone stress that depend on the extent of porous coating. J Orthop Res. 1994;12(4):553–63.CrossRefPubMed
35.
Yamaguchi K, Masuhara K, Ohzono K, Sugano N, Nishii T, Ochi T. Evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. The influence of the extent of porous coating. J Bone Joint Surg Am. 2000;82-A(10):1426–31.CrossRefPubMed
36.
McAuley JP, Sychterz CJ, Engh Sr CA. Influence of porous coating level on proximal femoral remodeling. A postmortem analysis. Clin Orthop Relat Res. 2000;371:146–53.CrossRef
37.
Nishino T, Mishima H, Kawamura H, Shimizu Y, Miyakawa S, Ochiai N. Follow-up results of 10–12 years after total hip arthroplasty using cementless tapered stem – frequency of severe stress shielding with synergy stem in Japanese patients. J Arthroplasty. 2013;28(10):1736–40.CrossRefPubMed
38.
Danesh-Clough T, Bourne RB, Rorabeck CH, McCalden R. The mid-term results of a dual offset uncemented stem for total hip arthroplasty. J Arthroplasty. 2007;22(2):195–203.CrossRefPubMed
39.
Smart RC, Barbagallo S, Slater GL, Kuo RS, Butler SP, Drummond RP, Sekel R. Measurement of periprosthetic bone density in hip arthroplasty using dual-energy x-ray absorptiometry. Reproducibility of measurements. J Arthroplasty. 1996;11(4):445–52.CrossRefPubMed
40.
Rahmy AI, Gosens T, Blake GM, Tonino A, Fogelman I. Periprosthetic bone remodelling of two types of uncemented femoral implant with proximal hydroxyapatite coating: a 3-year follow-up study addressing the influence of prosthesis design and preoperative bone density on periprosthetic bone loss. Osteoporos Int. 2004;15(4):281–9.CrossRefPubMed
41.
Bobyn JD, Mortimer ES, Glassman AH, Engh CA, Miller JE, Brooks CE. Producing and avoiding stress shielding. Laboratory and clinical observations of noncemented total hip arthroplasty. Clin Orthop Relat Res. 1992;274:79–96.
42.
Sumner DR, Turner TM, Urban RM, Galante JO. Experimental studies of bone remodeling in total hip arthroplasty. Clin Orthop Relat Res. 1992;276:83–90.
43.
Kärrholm J, Anderberg C, Snorrason F, Thanner J, Langeland N, Malchau H, Herberts P. Evaluation of a femoral stem with reduced stiffness. A randomized study with use of radiostereometry and bone densitometry. J Bone Joint Surg Am. 2002;84-A(9):1651–8.CrossRefPubMed
44.
Kim YH. Titanium and cobalt-chrome cementless femoral stems of identical shape produce equal results. Clin Orthop Relat Res. 2004;427:148–56.CrossRef
45.
Sano K, Ito K, Yamamoto K. Changes of bone mineral density after cementless total hip arthroplasty with two different stems. Int Orthop. 2008;32(2):167–72.CrossRefPubMed
46.
Albanese CV, Santori FS, Pavan L, Learmonth ID, Passariello R, DXA. Periprosthetic DXA after total hip arthroplasty with short vs. ultra-short custom-made femoral stems: 37 patients followed for 3 years. Acta Orthop. 2009;80(3):291–7.CrossRefPubMedPubMedCentral
47.
Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988;231:7–28.
48.
Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW. Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Joint Surg (Br). 1993;75(2):279–87.
49.
Nishii T, Sugano N, Masuhara K, Shibuya T, Ochi T, Tamura S. Longitudinal evaluation of time related bone remodeling after cementless total hip arthroplasty. Clin Orthop Relat Res. 1997;339:121–31.CrossRef
50.
Sköldenberg OG, Bodén HS, Salemyr MO, Ahl TE, Adolphson PY. Periprosthetic proximal bone loss after uncemented hip arthroplasty is related to stem size: DXA measurements in 138 patients followed for 2–7 years. Acta Orthop. 2006;77(3):386–92.CrossRefPubMed
51.
Engh CA, McGovern TF, Schmidt LM. Roentgenographic densitometry of bone adjacent to a femoral prosthesis. Clin Orthop Relat Res. 1993;292:177–90.
52.
Venesmaa PK, Kröger HP, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM. Monitoring of periprosthetic BMD after uncemented total hip arthroplasty with dual-energy X-ray absorptiometry–a 3-year follow-up study. J Bone Miner Res. 2001;16(6):1056–61.CrossRefPubMed
53.
Sychterz CJ, Engh CA. The influence of clinical factors on periprosthetic bone remodeling. Clin Orthop Relat Res. 1996;322:285–92.CrossRef
54.
Merle C, Streit MR, Volz C, Pritsch M, Gotterbarm T, Aldinger PR. Bone remodeling around stable uncemented titanium stems during the second decade after total hip arthroplasty: a DXA study at 12 and 17 years. Osteoporos Int. 2011;22(11):2879–86.CrossRefPubMed
55.
Cooper HJ, Jacob AP, Rodriguez JA. Distal fixation of proximally coated tapered stems may predispose to a failure of osteointegration. J Arthroplasty. 2011;26(6 Suppl):78–83.CrossRefPubMed
56.
Aro HT, Alm JJ, Moritz N, Mäkinen TJ, Lankinen P. Low BMD affects initial stability and delays stem osseointegration in cementless total hip arthroplasty in women: a 2-year RSA study of 39 patients. Acta Orthop. 2012;83(2):107–14.CrossRefPubMedPubMedCentral
57.
Issa K, Stroh AD, Mont MA, Bonutti PM. Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties. J Orthop Res. 2014;32(9):1214–20.CrossRefPubMed
Metadata
Title
Finite element analysis of cementless femoral stems based on mid- and long-term radiological evaluation
Authors
Kanehiro Matsuyama
Yasuhiro Ishidou
Yong-Ming Guo
Hironori Kakoi
Takao Setoguchi
Satoshi Nagano
Ichiro Kawamura
Shingo Maeda
Setsuro Komiya
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1260-z

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue

Research article

Eye movements in patients with Whiplash Associated Disorders: a systematic review

Study protocol

Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol

Research article

Gender differences in load carriage injuries of Australian army soldiers

Research article

A joint effort over a period of time: factors affecting use of urate-lowering therapy for long-term treatment of gout

Research article

Incidence and prevalence of total joint replacements due to osteoarthritis in the elderly: risk factors and factors associated with late life prevalence in the AGES-Reykjavik Study

Research article

Foot and ankle characteristics associated with falls in adults with established rheumatoid arthritis: a cross-sectional study