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Liu Y, Zheng L, Li S, Zhang Z, Lin Z, Ma W. Finite element study on the micromechanics of cement-augmented proximal femoral nail anti-rotation (PFNA) for intertrochanteric fracture treatment. Sci Rep 2024; 14:10322. [PMID: 38710745 DOI: 10.1038/s41598-024-61122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
Blade cut-out is a common complication when using proximal femoral nail anti-rotation (PFNA) for the treatment of intertrochanteric fractures. Although cement augmentation has been introduced to overcome the cut-out effect, the micromechanics of this approach remain to be clarified. While previous studies have developed finite element (FE) models based on lab-prepared or cadaveric samples to study the cement-trabeculae interface, their demanding nature and inherent disadvantages limit their application. The aim of this study was to develop a novel 'one-step forming' method for creating a cement-trabeculae interface FE model to investigate its micromechanics in relation to PFNA with cement augmentation. A human femoral head was scanned using micro-computed tomography, and four volume of interest (VOI) trabeculae were segmented. The VOI trabeculae were enclosed within a box to represent the encapsulated region of bone cement using ANSYS software. Tetrahedral meshing was performed with Hypermesh software based on Boolean operation. Finally, four cement-trabeculae interface FE models comprising four interdigitated depths and five FE models comprising different volume fraction were established after element removal. The effects of friction contact, frictionless contact, and bond contact properties between the bone and cement were identified. The maximum micromotion and stress in the interdigitated and loading bones were quantified and compared between the pre- and post-augmentation situations. The differences in micromotion and stress with the three contact methods were minimal. Micromotion and stress decreased as the interdigitation depth increased. Stress in the proximal interdigitated bone showed a correlation with the bone volume fraction (R2 = 0.70); both micromotion (R2 = 0.61) and stress (R2 = 0.93) at the most proximal loading region exhibited a similar correlation tendency. When comparing the post- and pre-augmentation situations, micromotion reduction in the interdigitated bone was more effective than stress reduction, particularly near the cement border. The cementation resulted in a significant reduction in micromotion within the loading bone, while the decrease in stress was minimal. Noticeable gradients of displacement and stress reduction can be observed in models with lower bone volume fraction (BV/TV). In summary, cement augmentation is more effective at reducing micromotion rather than stress. Furthermore, the reinforcing impact of bone cement is particularly prominent in cases with a low BV/TV. The utilization of bone cement may contribute to the stabilization of trabecular bone and PFNA primarily by constraining micromotion and partially shielding stress.
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Affiliation(s)
- Yurui Liu
- Department of Anesthesiology, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Liqin Zheng
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaobin Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhengze Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziling Lin
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Phull SS, Yazdi AR, Ghert M, Towler MR. Bone cement as a local chemotherapeutic drug delivery carrier in orthopedic oncology: A review. J Bone Oncol 2021; 26:100345. [PMID: 33552885 PMCID: PMC7856326 DOI: 10.1016/j.jbo.2020.100345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Metastatic bone lesions are common among patients with advanced cancers. While chemotherapy and radiotherapy may be prescribed immediately after diagnosis, the majority of severe metastatic bone lesions are treated by reconstructive surgery, which, in some cases, is followed by postoperative radiotherapy or chemotherapy. However, despite recent advancements in orthopedic surgery, patients undergoing reconstruction still have the risk of developing severe complications such as tumor recurrence and reconstruction failure. This has led to the introduction and evaluation of poly (methyl methacrylate) and inorganic bone cements as local carriers for chemotherapeutic drugs (usually, antineoplastic drugs (ANPDs)). The present work is a critical review of the literature on the potential use of these cements in orthopedic oncology. While several studies have demonstrated the benefits of providing high local drug concentrations while minimizing systemic side effects, only six studies have been conducted to assess the local toxic effect of these drug-loaded cements and they all reported negative effects on healthy bone structure. These findings do not close the door on chemotherapeutic bone cements; rather, they should assist in materials selection when designing future materials for the treatment of metastatic bone disease.
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Affiliation(s)
- Sunjeev S. Phull
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
| | - Alireza Rahimnejad Yazdi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton L8V 5C2, Ontario, Canada
| | - Mark R. Towler
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
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Ghouchani A, Rouhi G, Ebrahimzadeh MH. Investigation on distal femoral strength and reconstruction failure following curettage and cementation: In-vitro tests with finite element analyses. Comput Biol Med 2019; 112:103360. [PMID: 31330318 DOI: 10.1016/j.compbiomed.2019.103360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
Cement augmentation following benign bone tumor surgery, i.e. curettage and cementation, is recommended in patients at high risk of fracture. Nonetheless, identifying appropriate cases and devices for augmentation remains debatable. Our goal was to develop a validated biomechanical tool to: predict the post-surgery strength of a femoral bone, assess the precision and accuracy of the predicted strength, and discover the mechanisms of reconstruction failure, with the aim of finding a safe biomechanical fixation. Tumor surgery was mimicked in quantitative-CT (QCT) scanned cadaveric human distal femora, and subsequently tested in compression to measure bone strength (FExp). Finite element (FE) models considering bone material non-homogeneity and non-linearity were constructed to predict bone strength (FFE). Analyses of contact, damage, and crack initiation at the bone-cement interface (BCI) were completed to investigate critical failure locations. Results of paired t-tests did not show a significant difference between FExp and FFE (P > 0.05); linear regression analysis resulted in good correlation between FExp and FFE (R2 = 0.94). Evaluation of the models precision using linear regression analysis yielded R2 = 0.89, with the slope = 1.08 and intercept = -324.16 N. FE analyses showed the initiation of damage and crack and a larger cement debonding area at the proximal end and most interior part of BCI, respectively. Therefore, we speculated that devices that reinforce critical failure locations offer the most biomechanical advantage. The QCT-based FE method proved to be a reliable tool to predict distal femoral strength, identify some causes of reconstruction failure, and assist in a safer selection of fixation devices to reduce post-operative fracture risk.
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Affiliation(s)
- Azadeh Ghouchani
- Faculty of Biomedical Engineering, Amirkabir University of Technology, 424 Hafez Ave, Tehran, Iran.
| | - Gholamreza Rouhi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, 424 Hafez Ave, Tehran, Iran.
| | - Mohammad Hosein Ebrahimzadeh
- Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Ahmad Abad Street. Ghaem Hospital, Mashhad, Iran.
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Srinivasan P, Miller MA, Verdonschot N, Mann KA, Janssen D. Experimental and computational micromechanics at the tibial cement-trabeculae interface. J Biomech 2016; 49:1641-1648. [PMID: 27079621 DOI: 10.1016/j.jbiomech.2016.03.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 02/05/2023]
Abstract
Aseptic loosening of the tibial component in cemented total knee arthroplasty remains a major concern. We hypothesize that micromotion between the cement and trabeculae leads to increased circulation of interstitial fluid which in turn causes fluid-induced resorption of the trabeculae. Another mechanism for implant loosening is trabecular strain shielding. Using a newly developed experimental setup and digital image correlation (DIC) methods we were able to measure micromotion and strains in lab-prepared cement-trabeculae interface specimens (n=4). Finite element (FE) models of these specimens were developed to determine whether differences in micromotion and strain in morphologically varying specimens could be simulated accurately. Results showed that the measured micromotion and strains correlated well with FE model predictions (r(2)=0.59-0.85; r(2)=0.66-0.90). Global specimen strains measured axially matched well with the FE model strains (r(2)=0.87). FE model cement strains showed an increasing trend with distance from the cement border. The influence of loss of trabecular connectivity at the specimen edges was studied using our FE model results. Micromotion values at the outer edge of the specimens were higher than the specimen interior when considering a very thin outer edge (0.1mm). When the outer edge thickness was increased to about one trabecular length (0.8mm), there was a drop in the median and peak values. Using the experimental and modelling approach outlined in this study, we can further study the mechanisms that lead to loss of interlock between cement and trabeculae at the tibial interface.
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Affiliation(s)
- Priyanka Srinivasan
- Radboud university medical center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, The Netherlands.
| | - Mark A Miller
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Nico Verdonschot
- Radboud university medical center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, The Netherlands; University of Twente, Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, Enschede, The Netherlands
| | - Kenneth A Mann
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Dennis Janssen
- Radboud university medical center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, The Netherlands
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Zhang QH, Cossey A, Tong J. Stress shielding in bone of a bone-cement interface. Med Eng Phys 2016; 38:423-6. [DOI: 10.1016/j.medengphy.2016.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 01/05/2016] [Accepted: 01/31/2016] [Indexed: 11/29/2022]
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Tozzi G, Zhang QH, Tong J. Microdamage assessment of bone-cement interfaces under monotonic and cyclic compression. J Biomech 2014; 47:3466-74. [DOI: 10.1016/j.jbiomech.2014.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/01/2014] [Accepted: 09/14/2014] [Indexed: 11/28/2022]
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Vafaeian B, El-Rich M, El-Bialy T, Adeeb S. The finite element method for micro-scale modeling of ultrasound propagation in cancellous bone. ULTRASONICS 2014; 54:1663-1676. [PMID: 24656933 DOI: 10.1016/j.ultras.2014.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 06/03/2023]
Abstract
Quantitative ultrasound for bone assessment is based on the correlations between ultrasonic parameters and the properties (mechanical and physical) of cancellous bone. To elucidate the correlations, understanding the physics of ultrasound in cancellous bone is demanded. Micro-scale modeling of ultrasound propagation in cancellous bone using the finite-difference time-domain (FDTD) method has been so far utilized as one of the approaches in this regard. However, the FDTD method accompanies two disadvantages: staircase sampling of cancellous bone by finite difference grids leads to generation of wave artifacts at the solid-fluid interface inside the bone; additionally, this method cannot explicitly satisfy the needed perfect-slip conditions at the interface. To overcome these disadvantages, the finite element method (FEM) is proposed in this study. Three-dimensional finite element models of six water-saturated cancellous bone samples with different bone volume were created. The values of speed of sound (SOS) and broadband ultrasound attenuation (BUA) were calculated through the finite element simulations of ultrasound propagation in each sample. Comparing the results with other experimental and simulation studies demonstrated the capabilities of the FEM for micro-scale modeling of ultrasound in water-saturated cancellous bone.
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Affiliation(s)
- B Vafaeian
- Faculty of Engineering, Civil and Environmental Engineering Department, 3-016 Markin/CNRL Natural Resources Engineering Facility, University of Alberta, Edmonton, Alberta T6G 2W2, Canada.
| | - M El-Rich
- Faculty of Engineering, Civil and Environmental Engineering Department, 3-016 Markin/CNRL Natural Resources Engineering Facility, University of Alberta, Edmonton, Alberta T6G 2W2, Canada.
| | - T El-Bialy
- Faculty of Medicine and Dentistry, 7-020D Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - S Adeeb
- Faculty of Engineering, Civil and Environmental Engineering Department, 3-016 Markin/CNRL Natural Resources Engineering Facility, University of Alberta, Edmonton, Alberta T6G 2W2, Canada.
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