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Investigation On Distal Femoral Strength And Reconstruction Failure Following Curettage And Cementation: In-vitro Tests With Finite Element Analyses

A. Ghouchani, G. Rouhi, M. Ebrahimzadeh
Published 2019 · Materials Science, Computer Science, Medicine

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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.
This paper references
10.1016/j.jmbbm.2015.10.029
Biomechanical evaluation of intramedullary nail and bone plate for the fixation of distal metaphyseal fractures.
Jalil Nourisa (2016)
10.1302/0301-620X.73B4.2071634
The initiation of failure in cemented femoral components of hip arthroplasties.
M. Jasty (1991)
10.1002/JOR.1100090507
Evaluation of orthogonal mechanical properties and density of human trabecular bone from the major metaphyseal regions with materials testing and computed tomography
M. Ciarelli (1991)
10.1097/00003086-200402000-00038
Biomechanical Study of Pins in Cementing of Contained Proximal Tibia Defect
M. Weiner (2004)
10.1097/00003086-200403000-00035
Contained Femoral Defects: Biomechanical Analysis of Pin Augmentation in Cement
Patrick J. Murray (2004)
10.1038/35015116
Effects of mechanical forces on maintenance and adaptation of form in trabecular bone
R. Huiskes (2000)
10.1016/J.JBIOMECH.2007.09.009
Subject-specific finite element models implementing a maximum principal strain criterion are able to estimate failure risk and fracture location on human femurs tested in vitro.
E. Schileo (2008)
10.1186/s12891-018-1953-6
Biomechanical effects of metastasis in the osteoporotic lumbar spine: A Finite Element Analysis
G. Salvatore (2018)
10.1080/10255842.2012.675057
Micro-mechanical damage of trabecular bone–cement interface under selected loading conditions: a finite element study
Q. Zhang (2014)
10.1007/S40846-015-0066-Z
Prediction of Stress Shielding Around Orthopedic Screws: Time-Dependent Bone Remodeling Analysis Using Finite Element Approach
G. Rouhi (2015)
10.1007/S40846-017-0330-5
Alteration of Strain Distribution in Distal Tibia After Triple Arthrodesis: Experimental and Finite Element Investigations
Ahmad Chitsazan (2018)
10.1097/01.blo.0000164400.37905.22
Predicting Proximal Femoral Strength Using Structural Engineering Models
J. Keyak (2005)
10.22038/ABJS.2016.4701
Giant Cell Tumor of Bone - An Overview.
Anshul Sobti (2016)
Extended Finite Element Method: Theory and Applications
Amir R. Khoei (2015)
10.7480/CGC.6.2155
Numerical Modelling of Adhesive Connections Including Cohesive Damage
Chiara Bedon (2018)
10.1158/0008-5472.CAN-13-2652
An integrated computational model of the bone microenvironment in bone-metastatic prostate cancer.
Arturo Araujo (2014)
Aggressive treatment of giant cell tumour with multiple local adjuvants.
Onder Ofluoğlu (2008)
10.1007/s40846-015-0085-9
Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations
S. Samsami (2015)
10.3311/PPME.11851
Damage of the Bone-Cement Interface in Finite Element Analyses of Cemented Orthopaedic Implants
Toufik Bousnane (2018)
10.1016/j.rcl.2011.07.002
Benign bone tumors.
K. Motamedi (2011)
10.1302/2046-3758.76.BJR-2017-0325.R2
Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?
F. Eggermont (2018)
10.2106/JBJS.D.02313
Reconstruction of noncontained distal femoral defects with polymethylmethacrylate and crossed-screw augmentation: a biomechanical study.
Patrick C. Toy (2006)
10.1016/j.jbiomech.2016.02.032
How accurately can subject-specific finite element models predict strains and strength of human femora? Investigation using full-field measurements.
L. Grassi (2016)
10.1016/J.COMPOSITESB.2017.12.062
A multiscale XFEM approach to investigate the fracture behavior of bio-inspired composite materials
Andre E. Vellwock (2018)
10.1007/S007760200033
Complications associated with bone cementing for the treatment of giant cell tumors of bone
T. Wada (2002)
10.1002/(SICI)1097-4636(199607)31:3<373::AID-JBM11>3.0.CO;2-K
Postfailure compressive behavior of tibial trabecular bone in three anatomic directions.
J. Keyak (1996)
10.1016/J.COMMATSCI.2011.01.021
Micro-scale modelling of bovine cortical bone fracture: Analysis of crack propagation and microstructure using X-FEM
A. Abdel-Wahab (2012)
10.4103/0019-5413.32039
Treatment of giant cell tumor of bone: Current concepts
A. Puri (2007)
Clinical outcome of en-block resection and reconstruction with nonvascularized fibular autograft for the treatment of giant cell tumor of distal radius
M. Tarazjamshidi (2014)
10.1109/MCSE.2012.130
Computer Simulation Techniques in Giant Cell Tumor Curettage and Defect Reconstruction
Jihui Li (2013)
10.1007/s10195-016-0394-y
Steinmann pin augmentation versus locking plate constructs
J. Ruskin (2016)
10.1016/0021-9290(94)90014-0
The relationship between the structural and orthogonal compressive properties of trabecular bone.
R. Goulet (1994)
10.1016/S0021-9290(96)00164-9
Tensile strength of the cement-bone interface depends on the amount of bone interdigitated with PMMA cement.
K. A. Mann (1997)
10.1007/s40846-017-0278-5
The Great Need of a Biomechanical-Based Approach for Surgical Methods of Giant Cell Tumor: A Critical Review
A. Ghouchani (2017)
10.1016/J.JBIOMECH.2003.12.011
The dependence of transversely isotropic elasticity of human femoral cortical bone on porosity.
X. N. Dong (2004)
Finite Element Prediction and Experimental Verification of the Failure Pattern of Proximal Femur using Quantitative Computed Tomography Images
Majid Mirzaei (2012)
10.1080/17453670710014815
Cement is recommended in intralesional surgery of giant cell tumors: A Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years
A. Kivioja (2008)
10.1007/s00264-006-0215-7
Giant cell tumour of bone: morphological, biological and histogenetical aspects
M. Werner (2006)
10.1016/j.bone.2013.07.028
Effect of finite element model loading condition on fracture risk assessment in men and women: the AGES-Reykjavik study.
J. Keyak (2013)
10.1016/j.jmbbm.2010.03.001
Bone-cement interfacial behaviour under mixed mode loading conditions.
J. Wang (2010)
10.1002/jemt.22899
Assessment of fracture risk in proximal tibia with tumorous bone defects by a finite element method
Yulin Lin (2017)
10.1080/17453670902804604
Curettage of benign bone tumors without grafts gives sufficient bone strength
T. Yanagawa (2009)
10.1016/S0021-9290(99)00152-9
Prediction of femoral fracture load using finite element models: an examination of stress- and strain-based failure theories.
J. Keyak (2000)
10.1016/J.MECHRESCOM.2008.10.004
A model for mechanical adaptation of trabecular bone incorporating cellular accommodation and effects of microdamage and disuse
Ali Vahdati (2009)
10.1142/S021951941550061X
A THREE-DIMENSIONAL COMPUTER MODEL TO SIMULATE SPONGY BONE REMODELING UNDER OVERLOAD USING A SEMI-MECHANISTIC BONE REMODELING THEORY
Gholamreza Rouhi (2015)
10.1016/S0736-0266(00)00046-2
Effect of force direction on femoral fracture load for two types of loading conditions
J. Keyak (2001)
10.1016/j.compbiomed.2013.07.032
Prediction of stress shielding around an orthopedic screw: Using stress and strain energy density as mechanical stimuli
K. Haase (2013)
10.1080/17453670902804505
Bone defects following curettage do not necessarily need augmentation
M. Hirn (2009)
10.1002/cnm.2809
Cortical bone fracture analysis using XFEM - case study.
Ashraf Idkaidek (2017)
10.1016/j.otsr.2009.07.004
Long bones giant cells tumors: treatment by curretage and cavity filling cementation.
N. Fraquet (2009)
Stability of subchondral bone defect reconstruction at distal femur: comparison between polymethylmethacrylate alone and steinmann pin reinforcement of polymethylmethacrylate.
A. Asavamongkolkul (2003)
10.22038/ABJS.2018.30154.1780
The Most Appropriate Reconstruction Method Following Giant Cell Tumor Curettage: A Biomechanical Approach.
A. Ghouchani (2018)
10.1016/j.bone.2014.04.007
Analysis of strength and failure pattern of human proximal femur using quantitative computed tomography (QCT)-based finite element method.
Majid Mirzaei (2014)
10.3928/01477447-20090624-29
Distal femur defects reconstructed with polymethylmethacrylate and internal fixation devices: a biomechanical study.
Anthony D Uglialoro (2009)
10.1016/j.jbiomech.2013.02.025
Proximal femur bone strength estimated by a computationally fast finite element analysis in a sideways fall configuration.
K. Nishiyama (2013)



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