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Li G, Zhang X, Chen M, Luo Z, Ji X, Pan C, Li H, Shang XF. Bispherical metal augment improved biomechanical stability in severe acetabular deficiency reconstruction: a comparative finite element analysis. BMC Musculoskelet Disord 2024; 25:691. [PMID: 39217319 PMCID: PMC11365125 DOI: 10.1186/s12891-024-07816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study used finite element analysis (FEA) to compare the biomechanical stability of bispherical metal augment (BA) and wedge-shaped trabecular-metal augment (TA) in different acetabular defect reconstruction models, thereby explaining the application value of this novel bispherical augment in complex hip revision. METHODS Three different acetabular defect pelvis models originating from three representative patients with different types of severe acetabular defects (Paprosky IIC, IIIA, and IIIB) were constructed and reconstruction with BA and TA technique was simulated. Based on the FEA models, the displacement of reconstruction implants, relative displacement of bone implants, and hemi-pelvic von Mises stress were investigated under static loads. RESULTS BA acquired smaller reconstruction system displacement, less relative displacement of bone implants, and lower pelvic von Mises stress than TA in all Paprosky IIC, IIIA, and IIIB defect reconstructions. CONCLUSION The FEA results show that BA could acquire favourable biomechanical stability in severe acetabular defect reconstruction. This technique is a reliable method in complex hip revision.
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Affiliation(s)
- Guoyuan Li
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Xiaoqi Zhang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Min Chen
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Zhengliang Luo
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Xiaofeng Ji
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Chunang Pan
- Beijing Engineering and Technology Research Center for Medical Endoplant, Beijing, 100000, People's Republic of China
- Beijing Naton Medical Technology Holdings Co. Ltd, Beijing, 100000, People's Republic of China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplant, Beijing, 100000, People's Republic of China
- Beijing Naton Medical Technology Holdings Co. Ltd, Beijing, 100000, People's Republic of China
| | - Xi-Fu Shang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China.
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Hopkins D, Callary SA, Solomon LB, Woodford SC, Lee PVS, Ackland DC. Computational modeling of revision total hip arthroplasty involving acetabular defects: A systematic review. J Orthop Res 2024. [PMID: 38850264 DOI: 10.1002/jor.25902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 06/10/2024]
Abstract
Revision total hip arthroplasty (rTHA) involving acetabular defects is a complex procedure associated with lower rates of success than primary THA. Computational modeling has played a key role in surgical planning and prediction of postoperative outcomes following primary THA, but modeling applications in rTHA for acetabular defects remain poorly understood. This study aimed to systematically review the use of computational modeling in acetabular defect classification, implant selection and placement, implant design, and postoperative joint functional performance evaluation following rTHA involving acetabular defects. The databases of Web of Science, Scopus, Medline, Embase, Global Health and Central were searched. Fifty-three relevant articles met the inclusion criteria, and their quality were evaluated using a modified Downs and Black evaluation criteria framework. Manual image segmentation from computed tomography scans, which is time consuming, remains the primary method used to generate 3D models of hip bone; however, statistical shape models, once developed, can be used to estimate pre-defect anatomy rapidly. Finite element modeling, which has been used to estimate bone stresses and strains, and implant micromotion postoperatively, has played a key role in custom and off-the-shelf implant design, mitigation of stress shielding, and prediction of bone remodeling and implant stability. However, model validation is challenging and requires rigorous evaluation and comparison with respect to mid- to long-term clinical outcomes. Development of fast, accurate methods to model acetabular defects, including statistical shape models and artificial neural networks, may ultimately improve uptake of and expand applications in modeling and simulation of rTHA for the research setting and clinic.
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Affiliation(s)
- Daniel Hopkins
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - L B Solomon
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sarah C Woodford
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Wang B, Sun P, Yao H, Tu J, Xie X, Ouyang J, Shen J. Modular hemipelvic endoprosthesis with a sacral hook: a finite element study. J Orthop Surg Res 2019; 14:309. [PMID: 31511034 PMCID: PMC6739965 DOI: 10.1186/s13018-019-1338-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
Background A novel hemipelvic endoprosthesis with a sacral hook was introduced previously, and its clinical outcome with midterm follow-up showed decreased prosthesis-related complications, especially decreased rate of aseptic loosening. The aim of present study was to evaluate the role of a sacral hook in prosthesis stability and the biomechanical properties of this hemipelvic endoprosthesis. Methods A three-dimensional model of the postoperative pelvis was developed using computed tomography (CT) images. A force of 500 N was applied, and the distribution of stress and displacement was evaluated. Comparisons were performed to explore the role of the sacral hook in prosthesis stability. Prosthesis improvement was simulated to reduce unexpected breakage of the pubic connection plate. Results In the reconstructed hemipelvis, stress distributions were concentrated on the superior area of the acetabulum, sacral connection component, and sacral hook. A maximum stress of 250 MPa was observed at the root of the sacral connection component. The sacral hook reduced the maximum stress and displacement by 14.1% and 32.5%, respectively, when the prosthesis was well fixed and by 10.0% and 42.1%, respectively, when aseptic loosening occurred. Increasing the thickness of the pubic connection plate from 2 to 3.5 mm reduced the maximum stress by 32.0% and 15.8%, respectively. Conclusion A hemipelvic endoprosthesis with a sacral hook fulfills the biomechanical demands of the hemipelvis and is safe under static conditions. The sacral hook is important for prosthesis stability. Increasing the thickness of the pubic connection plate can reduce the maximum stress and risk of fatigue breakage.
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Affiliation(s)
- Bo Wang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Peidong Sun
- Medical Biomechanical Key Laboratory of Guangdong Province, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, 510515, Guangdong, China
| | - Hao Yao
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Jian Tu
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Jun Ouyang
- Medical Biomechanical Key Laboratory of Guangdong Province, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, 510515, Guangdong, China.
| | - Jingnan Shen
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China.
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Reconstruction of Severe Acetabular Bone Defect with 3D Printed Ti6Al4V Augment: A Finite Element Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6367203. [PMID: 30539016 PMCID: PMC6261073 DOI: 10.1155/2018/6367203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect reconstructed by 3D printed Ti6Al4V augment and TM augment and further to analyze the stress distribution and clinical safety of augments, screws, and bones. Methods The FEA model of acetabular bone defect reconstructed by 3D printed Ti6Al4V augment was established by the CT data of a patient with Paprosky IIIA defect. The von Mises stresses of augments, screws, and bones were analyzed by a single-legged stance loading applied in 3 increments (500 N, 2000 N, and 3000 N). Results The peak von Mises stresses under the maximal loading in the 3D printed augments, screws, and cortical bone were less than the yield strength of the corresponding component. However, the peak stress in the bone was greater than the yield strength of cancellous bone under walking or jogging loading. And under the same loading, the peak compressive and shear stresses in bone contact with TM augment were larger than these with 3D printed augment. Conclusions The FEA results show that all the components will be intact under single-legged standing. However, partial cancellous bone contacted with 3D printed augment and screws will lose efficacy under walking or jogging load. So we recommend that patients can stand under full bearing, but can not walk or jog immediately after surgery.
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Luo W, Huang L, Liu H, Qu W, Zhao X, Wang C, Li C, Yu T, Han Q, Wang J, Qin Y. Customized Knee Prosthesis in Treatment of Giant Cell Tumors of the Proximal Tibia: Application of 3-Dimensional Printing Technology in Surgical Design. Med Sci Monit 2017; 23:1691-1700. [PMID: 28388595 PMCID: PMC5391808 DOI: 10.12659/msm.901436] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We explored the application of 3-dimensional (3D) printing technology in treating giant cell tumors (GCT) of the proximal tibia. A tibia block was designed and produced through 3D printing technology. We expected that this 3D-printed block would fill the bone defect after en-bloc resection. Importantly, the block, combined with a standard knee joint prosthesis, provided attachments for collateral ligaments of the knee, which can maintain knee stability. MATERIAL AND METHODS A computed tomography (CT) scan was taken of both knee joints in 4 patients with GCT of the proximal tibia. We developed a novel technique - the real-size 3D-printed proximal tibia model - to design preoperative treatment plans. Hence, with the application of 3D printing technology, a customized proximal tibia block could be designed for each patient individually, which fixed the bone defect, combined with standard knee prosthesis. RESULTS In all 4 cases, the 3D-printed block fitted the bone defect precisely. The motion range of the affected knee was 90 degrees on average, and the soft tissue balance and stability of the knee were good. After an average 7-month follow-up, the MSTS score was 19 on average. No sign of prosthesis fracture, loosening, or other relevant complications were detected. CONCLUSIONS This technique can be used to treat GCT of the proximal tibia when it is hard to achieve soft tissue balance after tumor resection. 3D printing technology simplified the design and manufacturing progress of custom-made orthopedic medical instruments. This new surgical technique could be much more widely applied because of 3D printing technology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jincheng Wang
- Corresponding Authors: Jincheng Wang, e-mail: , Yanguo Qin, e-mail:
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Girardi BL, Attia T, Backstein D, Safir O, Willett TL, Kuzyk PR. Biomechanical comparison of the human cadaveric pelvis with a fourth generation composite model. J Biomech 2016; 49:537-42. [DOI: 10.1016/j.jbiomech.2015.12.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/18/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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Wang B, Sun P, Xie X, Wu W, Tu J, Ouyang J, Shen J. A novel combined hemipelvic endoprosthesis for peri-acetabular tumours involving sacroiliac joint: a finite element study. INTERNATIONAL ORTHOPAEDICS 2015; 39:2253-9. [PMID: 26183143 DOI: 10.1007/s00264-015-2891-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/12/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Our aim was to introduce a novel combined hemipelvic endoprosthesis for pelvic reconstruction after Enneking type I/II/IV resection and to evaluate the biomechanical properties of the endoprosthesis using finite element analysis. METHODS A three-dimensional finite element model of the postoperative pelvis was developed based on computed tomography (CT) images of the patient with the best post-operative limb function. A force of 400 N was applied along the longitudinal axis of the normal and post-operative pelvis for two positions: standing on two feet and sitting. Stress-distribution analysis was performed in both positions, and results were compared. Prosthesis improvements were simulated by intervertebral fusion and extra screw fixation. RESULTS In the normal pelvis, stress distributions were mostly concentrated on the superior area of the acetabulum, arcuate line, sacroiliac joint and sacral midline in both static conditions, and peak stresses of 1.52 MPa and 4.53 MPa were observed at the superior area of the greater sciatic notch and ischial tuberosity, respectively. For the reconstructed hemipelvis, stress distributions were concentrated on the connecting rods of the acetabular component and the proximal segment of the pedicle rods, and peak stresses of 252 MPa and 213 MPa were observed on the proximal pedicle rods of the fourth lumbar vertebra for standing and sitting, respectively. Interbody fusion of the fourth and fifth lumbar vertebrae and extra screw fixation to the sacrum decreased the peak stresses by 33.0 % and 18.3 % while standing and by 10.8 % and 6.6 % while sitting. CONCLUSION Reconstruction with combined hemipelvic endoprosthesis after types I/II/IV resection of the pelvis fulfilled physiological and biomechanical demands of the hemipelvis and yielded good biomechanical characteristics.
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Affiliation(s)
- Bo Wang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#,Zhongshan Road II, Guangzhou, Guangdong, China, 510080
| | - Peidong Sun
- Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, Guangdong, China, 510515
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#,Zhongshan Road II, Guangzhou, Guangdong, China, 510080
| | - Weidong Wu
- Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, Guangdong, China, 510515
| | - Jian Tu
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#,Zhongshan Road II, Guangzhou, Guangdong, China, 510080
| | - Jun Ouyang
- Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, Guangdong, China, 510515.
| | - Jingnan Shen
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#,Zhongshan Road II, Guangzhou, Guangdong, China, 510080.
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Finite element analysis of the pelvis after modular hemipelvic endoprosthesis reconstruction. INTERNATIONAL ORTHOPAEDICS 2013; 37:653-8. [PMID: 23318936 DOI: 10.1007/s00264-012-1756-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 12/11/2012] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to investigate the biomechanics of the pelvis reconstructed with a modular hemipelvic prosthesis using finite element (FE) analysis. METHODS A three-dimensional FE model of the postoperative pelvis was developed and input into the Abaqus FEA software version 6.7.1. Mesh refinement tests were then performed and a force of 500 N was applied at the lamina terminalis of the fifth lumbar vertebra along the longitudinal axis of the normal pelvis and the postoperative pelvis for three positions: sitting, standing on two feet, and standing on the foot of the affected side. Stress distribution analysis was performed between the normal pelvis and postoperative pelvis at these three static positions. RESULTS In the normal pelvis, stress distribution was concentrated on the superior area of the acetabulum, arcuate line, sacroiliac joint, sacral midline and, in particular, the superior area of the greater sciatic notch. In the affected postoperative hemipelvis, stress distribution was concentrated on the proximal area of the pubic plate, the top of the acetabular cup, the connection between the CS-fixator and acetabular cup and the fixation between the prosthesis and sacroiliac joint. CONCLUSIONS Stress distribution of the postoperative pelvis was similar to the normal pelvis at three different static positions. Reconstruction with a modular hemipelvic prosthesis yielded good biomechanical characteristics.
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