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Numeric simulation of bone remodelling patterns after implantation of a cementless straight stem

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Abstract

Purpose

For further development of better bone-preserving implants in total hip arthroplasty (THA), we need to look back and analyse established and clinically approved implants to find out what made them successful. Finite element analysis can help do this by simulating periprosthetic bone remodelling under different conditions. Our aim was thus to establish a numerical model of the cementless straight stem for which good long-term results have been obtained.

Methods

We performed a numeric simulation of a cementless straight stem, which has been successfully used in its unaltered form since 1986/1987. We have 20 years of experience with this THA system and implanted it 555 times in 2012. We performed qualitative and quantitative validation using bone density data derived from a prospective dual-energy X-ray absorptiometry (DEXA) investigation.

Results

Bone mass loss converged to 9.25 % for the entire femur. No change in bone density was calculated distal to the tip of the prosthesis. Bone mass decreased by 46.2 % around the proximal half of the implant and by 7.6 % in the diaphysis. The numeric model was in excellent agreement with DEXA data except for the calcar region, where deviation was 67.7 %.

Conclusions

The higher deviation in the calcar region is possibly a sign of the complex interactions between the titanium coating on the stem and the surrounding bone. We developed a validated numeric model to simulate bone remodelling for different stem-design modifications. We recommend that new THA implants undergo critical numeric simulation before clinical application.

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Acknowledgments

The study was part of subproject D6 of the Collaborative Research Center 599 “Sustainable degradable and permanent implants out of metallic and ceramic materials”. The authors thank the German Research Foundation for financial support.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries Str. 1-7, 30625, Hannover, Germany

    Matthias Lerch, Henning Windhagen, Christina M. Stukenborg-Colsman & Agnes Kurtz

  2. Institute of Forming Technology and Machines, Leibniz University Hannover, Hannover, Germany

    Bernd A. Behrens, Amer Almohallami & Anas Bouguecha

Authors
  1. Matthias Lerch
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  2. Henning Windhagen
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  3. Christina M. Stukenborg-Colsman
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  4. Agnes Kurtz
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  5. Bernd A. Behrens
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  6. Amer Almohallami
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  7. Anas Bouguecha
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Corresponding author

Correspondence to Matthias Lerch.

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Lerch, M., Windhagen, H., Stukenborg-Colsman, C.M. et al. Numeric simulation of bone remodelling patterns after implantation of a cementless straight stem. International Orthopaedics (SICOT) 37, 2351–2356 (2013). https://doi.org/10.1007/s00264-013-2072-5

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  • DOI: https://doi.org/10.1007/s00264-013-2072-5

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