Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodelling

Kerner, J.<sup>1</sup>; Huiskes, R.<sup>2</sup>; van Lenthe, G. H.<sup>2</sup>; Weinans, H.<sup>2</sup>; van Rietbergen, B.<sup>2</sup>; Engh, C. A.<sup>3</sup>; Amis, A. A.<sup>1</sup>

Affiliations

¹Biomechanics Section, Mechanical Engineering Department, Imperial College, London, UK

²Orthopaedic Research Laboratory, Institute of Orthopaedics, University of Nijmegen, Netherlands

³Anderson Orthopaedic Research Institute, Arlington, VA, USA

Abstract

Periprosthetic adaptive bone remodelling after total hip arthroplasty can be simulated in computer models, combining bone remodelling theory with finite element analysis. Patient specific three-dimensional finite element models of retrieved bone specimens from an earlier bone densitometry (DEXA) study were constructed and bone remodelling simulations performed. Results of the simulations were analysed both qualitatively and quantitatively. Patterns of predicted bone loss corresponded very well with the DEXA measurements on the retrievals. The amount of predicted bone loss, measured quantitatively by simulating DEXA on finite element models, was found to be inversely correlated with the initial bone mineral content. It was concluded that the same clinically observed correlation can therefore be explained by mechanically induced remodelling. This finding extends the applicability of numerical pre-clinical testing to the analysis of interaction between implant design and initial state of the bone.

Links

DOI: 10.1016/S0021-9290(99)00041-X

PubMed: 10400357

WoS: 000080974200008

History

Received: 1999-01-27

Cited Works (9)

Year	Entry
1993	Weinans H, Huiskes R, Van Rietbergen B, Sumner DR, Turner TM, Galante JO. Adaptive bone remodeling around bonded noncemented total hip arthroplasty: a comparison between animal experiments and computer simulation. J Orthop Res. July 1993;11(4):500-513.
1984	Hart RT, Davy DT, Heiple KG. A computational method for stress analysis of adaptive elastic materials with a view toward applications in strain-induced bone remodeling. J Biomech Eng. November 1984;106(4):342-350.
1992	Huiskes R, Weinans H, Van Rietbergen B. The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop Relat Res. January 1992;274:124-134.
1987	Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg. January 1987;69B(1):45-55.
1989	Huiskes R, Weinans H, Dalstra M. Adaptive bone remodeling and biomechanical design considerations: for noncemented thtal ffip arthroplasty. Orthopedics. September 1989;12(9):1255-1267.
1977	Carter DR, Hayes WC. The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg. 1977;59A(7):954-962.
1987	Huiskes R, Weinans H, Grootenboer HJ, Dalstra M, Fudala B, Slooff TJ. Adaptive bone-remodeling theory applied to prosthetic-design analysis. J Biomech. 1987;20(11-12):1135-1150.
1993	Van Rietbergen B, Huiskes R, Weinans H, Sumner DR, Turner TM, Galante JO. The mechanism of bone remodeling and resorption around press-fitted THA stems. J Biomech. April–May 1993;26(4-5):369-382.
1987	Carter DR, Fyhrie DP, Whalen RT. Trabecular bone density and loading history: regulation of connective tissue biology by mechanical energy. J Biomech. 1987;20(8):785-794.

Cited By (15)

Year	Entry
2021	Martelli S, Giorgi M, Dall'Ara E, Perilli E. Damage tolerance and toughness of elderly human femora. Acta Biomater. March 15, 2021;123:167-177.
2022	Abe S, Kouhia R, Nikander R, Narra N, Hyttinen J, Sievänen H. Effect of fall direction on the lower hip fracture risk in athletes with different loading histories: a finite element modeling study in multiple sideways fall configurations. Bone. May 2022;158:116351.
2001	Garcia JM, Martínez MA, Doblaré M. An anisotropic internal-external bone adaptation model based on a combination of CAO and continuum damage mechanics technologies. Comput Methods Biomech Biomed Eng. 2001;4(4):355-377.
2000	Weinans H, Sumner DR, Igloria R, Natarajan RN. Sensitivity of periprosthetic stress-shielding to load and the bone density–modulus relationship in subject-specific finite element models. J Biomech. July 2000;33(7):809-817.
2001	Doblaré M, Garcia JM. Application of an anisotropic bone-remodelling model based on a damage-repair theory to the analysis of the proximal femur before and after total hip replacement. J Biomech. September 2001;34(9):1157-1170.
2005	Ruimerman R, Hilbers P, van Rietbergen B, Huiskes R. A theoretical framework for strain-related trabecular bone maintenance and adaptation. J Biomech. April 2005;38(4):931-941.
2007	Speirs AD, Heller MO, Duda GN, Taylor WR. Physiologically based boundary conditions in finite element modelling. J Biomech. 2007;40(10):2318-2323.
2010	Santos L, Romeu JC, Canhão H, Fonseca JE, Fernandes PR. A quantitative comparison of a bone remodeling model with dual-energy X-ray absorptiometry and analysis of the inter-individual biological variability of femoral neck T-score. J Biomech. December 1, 2010;43(16):3150-3155.
2014	Martelli S, Kersh ME, Schache AG, Pandy MG. Strain energy in the femoral neck during exercise. J Biomech. June 3, 2014;47(8):1784-1791.
2022	Grace TM, O'Rourke D, Robertson T, Perilli E, Callary S, Taylor M, Atkins GJ, Solomon LB, Thewlis D. A semiautomated method to quantitatively assess osteolytic lesion volume and bone mineral density within acetabular regions of interest from CT. J Orthop Res. February 2022;40(2):396-408.
2007	Scannell PT. Mechanoregulation Algorithms Predicting Peri-Prosthetic Bone Adaptations [PhD thesis]. Trinity College Dublin; 2007.
2005	Ruimerman R. Modeling and Remodeling in Bone Tissue [PhD thesis]. Eindhoven, The Netherlands: Technische Universiteit Eindhoven; 2005.
2003	Nyman JS. Simulations of Bone Adaptation to Total Knee Arthroplasty and Bisphosphonates Through Remodeling Stimulated by Microdamage and Disuse [PhD thesis]. Davis, University of California; 2003.
2007	Rosenbaum TG. Effects of a Femoral Component and Patient Factors on Periprosthetic Cortical Bone [PhD thesis]. University of Utah; May 2007.
2018	Reeves JM. An in-Silico Assessment of Stemless Shoulder Arthroplasty: From CT to Predicted Bone Response [PhD thesis]. London, ON: Western University; 2018.