Does a novel bridging collar in endoprosthetic replacement optimise the mechanical environment for osseointegration? A finite element study

Frontiers in Bioengineering and Biotechnology

Bioengineering and Biotechnology

David Simpson¹  Giulia Fraterrigo²  Fulvia Taddei²  Enrico Schileo²  Ben Kendrick³  Jonathan Stevenson⁴ 

[1] Adler Ortho S.p.A., Cormano, Italy;IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Bioingegneria Computazionale, Bologna, Italy;Nuffield Orthopaedic Centre, Oxford University Hospitals Trust, Oxford, United Kingdom;Nuffield Department of Orthopaedics, Rheumatology and Musculo-skeletal Science, University of Oxford, Oxford, England;Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom;Aston University Medical School, Aston University, Birmingham, United Kingdom;

关键词: limb salvage surgery;    endoprosthetic replacements;    osseointegration;    femur;    collar;    bone resorption;    finite elements;    contact modelling;   

DOI  :  10.3389/fbioe.2023.1120430

 received in 2022-12-09, accepted in 2023-05-09,  发布年份 2023

来源: Frontiers

【 摘 要 】

Introduction: Limb-salvage surgery using endoprosthetic replacements (EPRs) is frequently used to reconstruct segmental bone defects, but the reconstruction longevity is still a major concern. In EPRs, the stem-collar junction is the most critical region for bone resorption. We hypothesised that an in-lay collar would be more likely to promote bone ongrowth in Proximal Femur Reconstruction (PFR), and we tested this hypothesis through validated Finite Element (FE) analyses simulating the maximum load during walking.Methods: We simulated three different femur reconstruction lengths (proximal, mid-diaphyseal, and distal). For each reconstruction length one in-lay and one traditional on-lay collar model was built and compared. All reconstructions were virtually implanted in a population-average femur. Personalised Finite Element models were built from Computed Tomography for the intact case and for all reconstruction cases, including contact interfaces where appropriate. We compared the mechanical environment in the in-lay and on-lay collar configurations, through metrics of reconstruction safety, osseointegration potential, and risk of long-term bone resorption due to stress-shielding.Results: In all models, differences with respect to intact conditions were localized at the inner bone-implant interface, being more marked in the collar-bone interface. In proximal and mid-diaphyseal reconstructions, the in-lay configuration doubled the area in contact at the bone-collar interface with respect to the on-lay configuration, showed less critical values and trends of contact micromotions, and consistently showed higher (roughly double) volume percentages of predicted bone apposition and reduced (up to one-third) percentages of predicted bone resorption. In the most distal reconstruction, results for the in-lay and on-lay configurations were generally similar and showed overall less favourable maps of the bone remodelling tendency.Discussion: In summary, the models corroborate the hypothesis that an in-lay collar, by realising a more uniform load transfer into the bone with a more physiological pattern, creates an advantageous mechanical environment at the bone-collar interface, compared to an on-lay design. Therefore, it could significantly increase the survivorship of endo-prosthetic replacements.

【 授权许可】

Unknown   
Copyright © 2023 Fraterrigo, Schileo, Simpson, Stevenson, Kendrick and Taddei.

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