Online citations, reference lists, and bibliographies.

ESB Research Award 1992. The Mechanism Of Bone Remodeling And Resorption Around Press-fitted THA Stems.

B. van Rietbergen, R. Huiskes, H. Weinans, D. R. Sumner, T. Turner, J. Galante
Published 1993 · Engineering, Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
A major problem threatening the long-term integrity of total hip replacement is the loss of proximal bone often found around noncemented stems in the long term. It is generally accepted that 'stress shielding' is the cause for this problem: after implantation of the prosthesis the surrounding bone is partially 'shielding' from load carrying and starts to resorb. One of the proposed answers to this problem is the application of press-fitted stems. These smooth-surfaced implants are thought to provoke higher proximal bone loading, and, hence, less stress shielding than bonded implants, because they are wedged into the femur every time when loaded. However, in a two-year experiment in dogs, similar amounts of resorption of the proximal cortex were found around press-fitted and bonded implants. The question arises how similar resorption patterns can develop under completely different stress conditions, and whether this phenomenon can be explained by adaptive bone remodeling theories based on Wolff's law. In the present study an answer was sought for this question. An advanced iterative computer simulation model was used to analyze the remodeling process in the animal experiment. Three-dimensional finite element models were constructed from the animal experimental configuration, in which smooth, press-fitted stems were applied unilaterally in the canine. The FE model was integrated with iterative remodeling procedures, validated in earlier studies. In the model an appropriate non-linear representation of the loose bone-implant interface was realized, also capable of simulating the proximal interface gap that was found around the uncoated implants. The simulation models predicted similar amounts of proximal bone loss and distal bone densification as found in the animal model. Hence, the cortical bone loss could indeed be predicted by the strain-adaptive bone remodeling theory. By unraveling the simulation process, the question stated above could be answered. Densification of the distal bone bed during the initial remodeling process was found to cause reduced axial stem displacement (elastic subsidence), decreasing the wedging effect of the stem and, hence, decreasing the loading of the proximal bone, resulting in proximal bone loss. Hence, whereas in the case of bonded stems the proximal resorption process develops monotonously to a new equilibrium, the process around smooth, press-fitted stems develops nonmonotonously. This is due primarily to the unbonded interface conditions and the development of a proximal fibrous membrane. The remodeling process then gradually causes the stem to be jammed in the distal diaphyses (proximal 'stress bypass').
This paper references
The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty.
C. Engh (1988)
Comparison of strain patterns in femora implanted with straight and curved stem uncemented prostheses
C. S. Fulghum (1992)
The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty
C. A. Engh (1988)
10.2106/00004623-199274020-00010
Remodeling and ingrowth of bone at two years in a canine cementless total hip-arthroplasty model.
D. R. Sumner (1992)
An overview of cementless hip systems . 37 th ORS , Anaheim , CA , p . 545
R. G. Tronzo (1989)
The effects of geometric feedback in the development of osteoporosis
R. B. Martin (1972)
10.1016/0021-9290(88)90224-2
A nonlinear finite element analysis of interface conditions in porous coated hip endoprostheses.
A. Rohlmann (1988)
10.1097/00003086-199012000-00006
The various stress patterns of press-fit, ingrown, and cemented femoral stems.
R. Huiskes (1990)
The effect of stem stiffness on femoral bone resorption after canine porous coated hip replacement
H. Goto (1990)
A. and a function of stem stiffness and porous coating location in McBeath, A. A
B. J. Kiratli (1991)
10.1016/0021-9290(87)90027-3
Mechanical loading history and skeletal biology.
D. Carter (1987)
The influence of prosthetic stem stiffness and Galante
J. L. Lewis (1984)
10.1007/BF00041724
Bone remodeling I: theory of adaptive elasticity
S. Cowin (1976)
10.1002/jbm.820160615
Mechanical properties of the fibrous tissue found at the bone-cement interface following total joint replacement.
R. Y. Hori (1982)
10.1002/jor.1100060519
Symmetry of the canine femur: Implications for experimental sample size requirements
D. R. Sumner (1988)
Quantification of bone loss of the femur after total hip arthroplasty
G. G. Steinberg (1991)
Bone remodelin? Geesink
J Orth. (1991)
Bone mineral density of the prox - cementless THA
N. McKinley (1991)
The behavior of bone as a two - phase porous structure
W. C. Hayes (1977)
10.3928/0147-7447-19890901-11
Cementless total hip arthroplasty: femoral remodeling and clinical experience.
A. Rosenberg (1989)
The pattern of bone remodeling
(1992)
10.1016/0021-9290(90)90314-S
Trends of mechanical consequences and modeling of a fibrous membrane around femoral hip prostheses.
H. Weinans (1990)
10.1002/jor.1100110405
Adaptive bone remodeling around bonded noncemented total hip arthroplasty: A comparison between animal experiments and computer simulation
H. Weinans (1993)
10.1016/0021-9290(84)90004-6
A comparison of hip joint forces in sheep, dog and man.
G. Bergmann (1984)
The effect of stem
C. E. Brooks (1990)
10.1097/00003086-198912000-00015
Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling.
W. Maloney (1989)
Computer predictions of bone remodeling around Galante
T. E. Orr (1990)
10.3928/0147-7447-19890901-15
Adaptive bone remodeling and biomechanical design considerations for noncemented total hip arthroplasty.
R. Huiskes (1989)
10.3928/0147-7447-19890901-13
Experimental and clinical experience with hydroxyapatite-coated hip implants.
R. Geesink (1989)
10.1302/0301-620X.73B1.1991773
Effect of stem modulus in a total hip arthroplasty model.
G. Maistrelli (1991)
10.1016/0021-9290(87)90035-2
Strains and micromotions of press-fit femoral stem prostheses.
P. Walker (1987)
Bone ingrowth disuse osteoporosis
J. E. Miller (1981)
Biomechanics of artificial-joint fixation
Hwj Rik Huiskes (1991)



This paper is referenced by
Animal models relevant to cementless joint replacement.
D. R. Sumner (2001)
10.1016/S0021-9290(02)00022-2
Determination of orthotropic bone elastic constants using FEA and modal analysis.
W. R. Taylor (2002)
10.1007/978-0-85729-166-0_4
Multifunctional Polymer Based Structures for Human Tissues Reconstruction
Paolo Antonio Netti (2011)
10.1007/978-4-431-56514-7_14
Trabecular Structural Changes in a Vertebral Body with a Fixation Screw
Y Kameo (2018)
10.1138/20050187
Use of finite element analysis to assess bone strength
E. Morgan (2005)
10.1016/S0883-5403(97)90192-3
Effect of a stemless femoral implant for total hip arthroplasty on the bone mineral density of the proximal femur. A prospective longitudinal study.
E. Munting (1997)
10.1016/S0162-0134(99)00228-7
Polymer-based composite hip prostheses.
R. De Santis (2000)
10.1533/9781845697372.2.178
7 – Composite materials for spinal implants
A. Gloria (2010)
10.1007/s10237-015-0678-9
Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur
Alexander S Dickinson (2016)
10.1016/j.medengphy.2014.09.002
In-vitro biomechanical evaluation of stress shielding and initial stability of a low-modulus hip stem made of β type Ti-33.6Nb-4Sn alloy.
Go Yamako (2014)
10.1054/ARTH.2001.28369
Load transfer and stress shielding of the hydroxyapatite-ABG hip: a study of stem length and proximal fixation.
B. van Rietbergen (2001)
A methodological study with dual-energy X-ray absorptiometry in 16 patients
B. Bøe (2011)
10.1016/1350-4533(95)00033-X
Sensitivity of femoral strain pattern analyses to resultant and muscle forces at the hip joint.
M. Lengsfeld (1996)
10.1016/j.jbiomech.2017.08.017
Improving stress shielding following total hip arthroplasty by using a femoral stem made of β type Ti-33.6Nb-4Sn with a Young's modulus gradation.
Go Yamako (2017)
10.1080/10255842.2011.567269
Implant–bone interface healing and adaptation in resurfacing hip replacement
Alexander S Dickinson (2012)
10.1533/9781845696610.2.252
Composite biomaterials for bone repair
R. Santis (2009)
The susceptibility of smooth implant surfaces to periimplant fibrosis and migration of polyethylene wear debris.
J. Bobyn (1995)
10.3109/17453670209178027
Stemmed femoral knee prostheses
G. H. van Lenthe (2002)
10.1016/S0021-9290(00)00140-8
Large-sliding contact elements accurately predict levels of bone-implant micromotion relevant to osseointegration.
M. Viceconti (2000)
10.1067/MSE.2003.22
Stress shielding and bone resorption in shoulder arthroplasty.
J. Nagels (2003)
10.1177/0954411918793448
The effect of cement mantle thickness on strain energy density distribution and prediction of bone density changes around cemented acetabular component
Devismita Sanjay (2018)
10.1186/s13728-016-0047-z
Moving in extreme environments: extreme loading; carriage versus distance
Samuel J. E. Lucas (2016)
10.1007/S40846-018-0435-5
The Effects of Implant Orientations and Implant–Bone Interfacial Conditions on Potential Causes of Failure of Tibial Component Due to Total Ankle Replacement
Subrata Mondal (2019)
10.1016/j.jbiomech.2014.12.019
Four decades of finite element analysis of orthopaedic devices: where are we now and what are the opportunities?
M. Taylor (2015)
10.1016/j.medengphy.2016.08.008
Numerical prediction of peri-implant bone adaptation: Comparison of mechanical stimuli and sensitivity to modeling parameters.
M. Piccinini (2016)
10.1016/J.JBIOMECH.2004.03.005
The effect of muscle loading on the simulation of bone remodelling in the proximal femur.
C. Bitsakos (2005)
10.1007/s11999-008-0190-y
Small Stem Total Hip Arthroplasty in Hypoplasia of the Femur
F. R. D. De Man (2008)
10.1371/journal.pone.0036231
Generic Rules of Mechano-Regulation Combined with Subject Specific Loading Conditions Can Explain Bone Adaptation after THA
T. Szwedowski (2012)
10.1016/S1350-4533(97)00031-3
Mechanobiological adaptation of subchondral bone as a function of joint incongruity and loading.
F. Eckstein (1997)
10.1098/rsta.2000.0546
Mechanics in skeletal development, adaptation and disease
M. Meulen (2000)
10.1097/00003086-199510000-00007
Preclinical testing of total hip stems. The effects of coating placement.
R. Huiskes (1995)
10.3109/17453679508995559
Bone loss from the proximal femur after arthroplasty with an isoelastic femoral stem. BMD measurements in 25 patients after 9 years.
T. Niinimäki (1995)
See more
Semantic Scholar Logo Some data provided by SemanticScholar