A hierarchy of computationally derived surgical and patient influences on metal on metal press-fit acetabular cup failure

Corroboration of coupled musculoskeletal model and finite element predictions with in vivo RSA migration of an uncemented acetabular component

While finite element (FE) models have been used extensively in orthopedic studies, validation of their outcome metrics has been limited to comparison against ex vivo testing. The aim of this study was to validate FE model predictions of the initial cup mechanical environment against patient-matched in vivo measurements of acetabular cup migration using radiostereometric analysis (RSA). Tailored musculoskeletal and FE models were developed using a combination of three-dimensional (3D) motion capture data and clinical computerized tomography (CT) scans for a cohort of eight individuals who underwent primary total hip replacement and were prospectively enrolled in an RSA study. FE models were developed to calculate the mean modulus of cancellous bone, composite peak micromotion (CPM), composite peak strain (CPS) and percentage area of bone ingrowth. The RSA cup migration at 3 months was used to corroborate the FE output metrics. Qualitatively, all FE-predicted metrics followed a similar rank order as the in vivo RSA 3D migration data. The two cases with the lowest predicted CPM (<20 µm), lowest CPS (<0.0041), and high bone modulus (>917 MPa) were confirmed to have the lowest in vivo RSA 3D migration (<0.14 mm). The two cases with the largest predicted CPM (>80 µm), larger CPS (>0.0119) and lowest bone modulus (<472 MPa) were confirmed to have the largest in vivo RSA 3D migration (>0.78 mm). This study enabled the first corroboration between tailored musculoskeletal and FE model predictions with in vivo RSA cup migration. Investigation of additional patient-matched CT, gait, and RSA examinations may allow further development and validation of FE models.

Primary stability of a cementless acetabular cup in a cohort of patient-specific finite element models

The primary stability achieved during total hip arthroplasty determines the long-term success of cementless acetabular cups. Pre-clinical finite element testing of cups typically use a model of a single patient and assume the results can be extrapolated to the general population. This study explored the variability in predicted primary stability of a Pinnacle^® cementless acetabular cup in 103 patient-specific finite element models of the hemipelvis and examined the association between patient-related factors and the observed variability. Cups were inserted by displacement-control into the FE models and then a loading configuration simulating a complete level gait cycle was applied. The cohort showed a range of polar gap of 284-1112 μm and 95th percentile composite peak micromotion (CPM) of 18-624 μm. Regression analysis was not conclusive on the relationship between patient-related factors and primary stability. No relationship was found between polar gap and micromotion. However, when the patient-related factors were categorised into quartile groups, trends suggested higher polar gaps occurred in subjects with small and shallow acetabular geometries and cup motion during gait was affected most by low elastic modulus and high bodyweight. The variation in primary stability in the cohort for an acetabular cup with a proven clinical track record may provide benchmark data when evaluating new cup designs. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1012-1023, 2018.

A Computational Efficient Method to Assess the Sensitivity of Finite-Element Models: An Illustration With the Hemipelvis

Assessing the sensitivity of a finite-element (FE) model to uncertainties in geometric parameters and material properties is a fundamental step in understanding the reliability of model predictions. However, the computational cost of individual simulations and the large number of required models limits comprehensive quantification of model sensitivity. To quickly assess the sensitivity of an FE model, we built linear and Kriging surrogate models of an FE model of the intact hemipelvis. The percentage of the total sum of squares (%TSS) was used to determine the most influential input parameters and their possible interactions on the median, 95th percentile and maximum equivalent strains. We assessed the surrogate models by comparing their predictions to those of a full factorial design of FE simulations. The Kriging surrogate model accurately predicted all output metrics based on a training set of 30 analyses (R2 = 0.99). There was good agreement between the Kriging surrogate model and the full factorial design in determining the most influential input parameters and interactions. For the median, 95th percentile and maximum equivalent strain, the bone geometry (60%, 52%, and 76%, respectively) was the most influential input parameter. The interactions between bone geometry and cancellous bone modulus (13%) and bone geometry and cortical bone thickness (7%) were also influential terms on the output metrics. This study demonstrates a method with a low time and computational cost to quantify the sensitivity of an FE model. It can be applied to FE models in computational orthopaedic biomechanics in order to understand the reliability of predictions.

Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction

The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants.

Finite element modelling for assessing effect of acetabular component orientation on the basic stress path above acetabular dome

OBJECTIVE

To investigate the effect of acetabular component orientation on the basic stress path above the acetabular dome in the recommended safe zone.

METHODS

A subject-specific normal hip finite element model was generated and a convergence study carried out to determine the number of material properties for trabecular bone using a normal hip model. Four abduction angles (35°, 40°, 45° and 50°) and four anteversion angles (10°, 15°, 20° and 25°) from the recommended safe zone of acetabular cup orientation were chosen to simulate acetabular reconstruction. The distribution and level of periacetabular stress was assessed using a normal hip model as a control and 16 reconstructed acetabula in simulated single-legged stances.

RESULTS

The error of the average stress between plans four and five (50 and 100 materials for trabecular bone respectively) was 4.8%, which is less than the previously defined 5% error. The effect of acetabular component orientation on stress distribution in trabecular bone was not pronounced. When the acetabular component was at 15° anteversion and the abduction angle was 40° or 45°, the stress level on posterolateral cortical bone above the acetabular dome was as stable as that in the normal hip model.

CONCLUSIONS

Acetabular component orientation affects the basic stress path above the acetabular dome. Thus, orientation should be considered when attempting to restore normal biomechanics in the main load-bearing area.

Four decades of finite element analysis of orthopaedic devices: where are we now and what are the opportunities?

Finite element has been used for more than four decades to study and evaluate the mechanical behaviour total joint replacements. In Huiskes seminal paper "Failed innovation in total hip replacement: diagnosis and proposals for a cure", finite element modelling was one of the potential cures to avoid poorly performing designs reaching the market place. The size and sophistication of models has increased significantly since that paper and a range of techniques are available from predicting the initial mechanical environment through to advanced adaptive simulations including bone adaptation, tissue differentiation, damage accumulation and wear. However, are we any closer to FE becoming an effective screening tool for new devices? This review contains a critical analysis of currently available finite element modelling techniques including (i) development of the basic model, the application of appropriate material properties, loading and boundary conditions, (ii) describing the initial mechanical environment of the bone-implant system, (iii) capturing the time dependent behaviour in adaptive simulations, (iv) the design and implementation of computer based experiments and (v) determining suitable performance metrics. The development of the underlying tools and techniques appears to have plateaued and further advances appear to be limited either by a lack of data to populate the models or the need to better understand the fundamentals of the mechanical and biological processes. There has been progress in the design of computer based experiments. Historically, FE has been used in a similar way to in vitro tests, by running only a limited set of analyses, typically of a single bone segment or joint under idealised conditions. The power of finite element is the ability to run multiple simulations and explore the performance of a device under a variety of conditions. There has been increasing usage of design of experiments, probabilistic techniques and more recently population based modelling to account for patient and surgical variability. In order to have effective screening methods, we need to continue to develop these approaches to examine the behaviour and performance of total joint replacements and benchmark them for devices with known clinical performance. Finite element will increasingly be used in the design, development and pre-clinical testing of total joint replacements. However, simulations must include holistic, closely corroborated, multi-domain analyses which account for real world variability.

Altered load transfer in the pelvis in the presence of periprosthetic osteolysis

Periprosthetic osteolysis in the retroacetabular region with cancellous bone loss is a recognized phenomenon in the long-term follow-up of total hip replacement. The effects on load transfer in the presence of defects are less well known. A validated, patient-specific, 3D finite element (FE) model of the pelvis was used to assess changes in load transfer associated with periprosthetic osteolysis adjacent to a cementless total hip arthroplasty (THA) component. The presence of a cancellous defect significantly increased (p &lt; 0.05) von Mises stress in the cortical bone of the pelvis during walking and a fall onto the side. At loads consistent with single leg stance, this was still less than the predicted yield stress for cortical bone. During higher loads associated with a fall onto the side, highest stress concentrations occurred in the superior and inferior pubic rami and in the anterior column of the acetabulum with larger cancellous defects.