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Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur

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Abstract

Bone morphology and density changes are commonly observed following joint replacement, may contribute to the risks of implant loosening and periprosthetic fracture and reduce the available bone stock for revision surgery. This study was presented in the ‘Bone and Cartilage Mechanobiology across the scales’ WCCM symposium to review the development of remodelling prediction methods and to demonstrate simulation of adaptive bone remodelling around hip replacement femoral components, incorporating intrinsic (prosthesis) and extrinsic (activity and loading) factors. An iterative bone remodelling process was applied to finite element models of a femur implanted with a cementless total hip replacement (THR) and a hip resurfacing implant. Previously developed for a cemented THR implant, this modified process enabled the influence of pre- to post-operative changes in patient activity and joint loading to be evaluated. A control algorithm used identical pre- and post-operative conditions, and the predicted extents and temporal trends of remodelling were measured by generating virtual X-rays and DXA scans. The modified process improved qualitative and quantitative remodelling predictions for both the cementless THR and resurfacing implants, but demonstrated the sensitivity to DXA scan region definition and appropriate implant–bone position and sizing. Predicted remodelling in the intact femur in response to changed activity and loading demonstrated that in this simplified model, although the influence of the extrinsic effects were important, the mechanics of implantation were dominant. This study supports the application of predictive bone remodelling as one element in the range of physical and computational studies, which should be conducted in the preclinical evaluation of new prostheses.

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References

  • Abadie P, Lebel B, Pineau V, Burdin G, Vielpeau C (2010) Cemented total hip stem design influence on adaptative cortical thickness and femoral morphology. Orthop Traumatol Surg Res 96:104–110

    Article  Google Scholar 

  • Adachi T, Tomita Y, Sakaue H, Tanaka M (1997) Simulation of trabecular surface remodeling based on local stress nonuniformity. JSME Int J Ser C 40(4):782–792

    Article  Google Scholar 

  • Ajemian S, Thorn D, Clare P, Kaul L, Zernicke RF, Loitz-Ramage B (2004) Cane-assisted gait biomechanics and electromyography after total hip arthroplasty. Arch Phys Med Rehabil 85:1966–1971

    Article  Google Scholar 

  • Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA (2004) Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg [Am] 86:28–39

    Google Scholar 

  • Amstutz HC, Campbell PA, Le Duff MJ (2004) Fracture of the neck of the femur after surface arthroplasty of the hip. J Bone Joint Surg [Am] 86:1874–1877

    Google Scholar 

  • Bah MT, Nair PB, Taylor M, Browne M (2011) Efficient computational method for assessing the effects of implant positioning in cementless total hip replacements. J Biomech 44:1417–1422

    Article  Google Scholar 

  • Bitsakos C, Kerner J, Fisher I, Amis A (2005) The effect of muscle loading on the simulation of bone remodelling in the proximal femur. J Biomech 38:133–139

    Article  Google Scholar 

  • Bobyn JD, Mortimer ES, Glassman AH, Engh CA, Miller JE, Brooks CE (1992) Producing and avoiding stress shielding: laboratory and clinical observations of noncemented total hip arthroplasty. Clin Orthop Relat Res 274:79–96

    Google Scholar 

  • Bonnin MP, Archbold PHA, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22:371–378

    Article  Google Scholar 

  • Boyle C, Yong Kim I (2011) Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization. J Biomech 44:1722–1728

    Article  Google Scholar 

  • Brand RA, Crowninshield RD (1980) The effect of cane use on hip contact force. Clin Orthop 147:181–184

    Google Scholar 

  • Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, Kainberger F, Gottsauner-Wolf F (2004) Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty. J Bone Joint Surg [Br] 86–B:20–26

    Google Scholar 

  • Caouette C, Bureau MN, Lavigne M, Venditolli P-A, Nuno N (2013) A new interface element with progressive damage and osseointegration for modeling of interfaces in hip resurfacing. Proc IMechE Part H J Eng Med 227:209–220

    Article  Google Scholar 

  • Caouette C, Bureau MN, Venditolli P-A, Lavigne M, Nuno N (2012) Anisotropic bone remodeling of a biomimetic metal-on-metal hip resurfacing implant. Med Eng Phys 34:559–565

    Article  Google Scholar 

  • Carter DR (1984) Mechanical loading histories and cortical bone remodelling. Calcif Tissue Int 36:S19–S24

    Article  Google Scholar 

  • Chandran P, Azzabi M, Andrews M, Bradley JG (2012) Periprosthetic bone remodeling after 12 years differs in cemented and uncemented hip arthroplasties. Clin Orthop Relat Res 470:1431– 1435

    Article  Google Scholar 

  • Claes LE, Heigele CA (1999) Magnitudes of local stress and strain along bony surfaces predict the course and type of fracture healing. J Biomech 32:255–266

    Article  Google Scholar 

  • Cohen B, Rushton N (1995) Bone remodelling in the proximal femur after charnley total hip arthroplasty. J Bone Joint Surg [Br] 77–B:815–819

    Google Scholar 

  • Daniel JT, Kamali A, Li C, Hussain A, Pamu J, Counsell L, Zaiee H, McMinn DWJ (2009) Step activity monitoring of Birmingham hip resurfacing patients at different stages following operation. Trans ORS 55:366

    Google Scholar 

  • de Groot IB, Bussmann HJ, Stam HJ, Verhaar JA (2008) Small increase of actual physical activity 6 months after total hip or knee arthroplasty. Clin Orthop Relat Res 466:2201–2208

    Article  Google Scholar 

  • Della Valle CJ, Paprosky WG (2004) The femur in revision total hip arthroplasty: evaluation and classification. Clin Orthop Relat Res 420:55–62

    Article  Google Scholar 

  • Dickinson AS (2010) Development of computational biomechanical tools to assess the performance of the resurfaced hip joint. PhD Thesis. Bioengineering Science Research Group. Southampton, University of Southampton

  • Dickinson AS (2014) Activity and loading influence the predicted bone remodeling around cemented hip replacements. J Biomech Eng 136(4)

  • Dickinson AS, Taylor AC, Browne M (2012) Implant-bone interface healing and adaptation in resurfacing hip replacement. CMBBE 15:935–947

    Google Scholar 

  • Doblaré M, Garcia JM (2001) 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 34:1157–1170

    Article  Google Scholar 

  • Fernandez J, Sartori M, Lloyd D, Munro J, Shim V (2013) Bone remodelling in the natural acetabulum is influenced by muscle force-induced bone stress. Int J Numer Meth Biomed Eng (online)

  • Garcia JM, Martinez MA, Doblaré M (2001) An anisotropic internal-external bone adaptation model based on a combination of CAO and continuum damage mechanics technologies. Comput Meth Biomech Biomed Eng 4:355–377

    Article  Google Scholar 

  • Gerhardt DMJM, Smolders JMH, Rijnders TAJM, Hol A, van Susante, JLC (2015) Changes in bone mineral density and femoral neck narrowing in the proximal femur three to five years after hip resurfacing versus conventional total hip arthroplasty. J Arthoplasty 30(2):308–314

  • Ghosh R, Mukherjee K, Gupta S (2013) Bone remodelling around uncemented metallic and ceramic acetabular components. Proc IMechE Part H J Eng Med 227:490–502

    Article  Google Scholar 

  • Gruen TA, McNeice GM, Amstutz HC (1979) Modes of failure of cemented stem-type femoral components. Clin Orthop Relat Res 141:17–27

    Google Scholar 

  • Gupta S, New AMR, Taylor M (2006) Bone remodelling inside a cemented resurfaced femoral head. Clin Biomech 21:594–602

    Article  Google Scholar 

  • Häkkinen A, Borg H, Hauklinen M, Jurvelin J, Anttila E, Parvaiainen T, Kiviranta I (2011) Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study. BMC Musculoskelet Disord 12:100

    Article  Google Scholar 

  • Heller MO, Bergmann G, Kassi J-P, Claes L, Haas NP, Duda GN (2005) Determination of muscle loading at the hip joint for use in pre-clinical testing. J Biomech 38:1155–1163

    Article  Google Scholar 

  • Herrera A, Panisello JJ, Ibarz E, Cegonino J, Puertolas JA, Gracia L (2007) Long-term study of bone remodelling after femoral stem: a comparison between dexa and finite element simulation. J Biomech 40:3615–3625

    Article  Google Scholar 

  • Herrera A, Rebollo S, Ibarz E, Mateo J, Gabarre S, Gracia L (2014) Mid-term study of bone remodeling after femoral cemented stem implantation: comparison between DXA and finite element simulation. J Arthroplasty 29:90–100

    Article  Google Scholar 

  • Hing CB, Young DA, Dalziel RE, Bailey M, Back DL, Shimmin AJ (2007) Narrowing of the neck in resurfacing arthroplasty of the hip. J Bone Joint Surg [Br] 89–B:1019–1024

    Article  Google Scholar 

  • Huang Q, Shen B, Yang J, Zhou Z, Kang P, Pei F (2013) Changes in bone mineral density of the acetabulum and proximal femur after total hip resurfacing arthroplasty. J Arthoplasty 28:1811–1815

    Article  Google Scholar 

  • Huiskes R, Weinans H, Grootenboer HJ, Dalstra M, Fudala B, Slooff TJ (1987) Adaptive bone remodelling theory applied to prosthetic design analysis. J Biomech 20:1135–1150

    Article  Google Scholar 

  • Jang IG, Kim IY (2010) Computational simulation of simultaneous cortical and trabecular bone change in human proximal femur during bone remodeling. J Biomech 43:294–301

    Article  Google Scholar 

  • Jayasuriya RL, Buckley SC, Hamer AJ, Kerry RM, Stockley I, Tomouk MW, Wilkinson JM (2013) Effect of sliding-taper compared with composite-beam cemented femoral prosthesis loading regime on proximal femoral bone remodeling. J Bone Joint Surg [Am] 95:19–27

    Article  Google Scholar 

  • Johnston R, Brand RA, Crowninshield RD (1979) Reconstruction of the hip: a mathematical approach to determine optimum geometric relationships. J Bone Joint Surg [Am] 61:639–652

    Google Scholar 

  • Jonkers I, Sauwen N, Lenaerts G, Mulier M, Van der Perre G, Jaecques S (2008) Relation between subject-specific hip joint loading, stress distribution in the proximal femur and bone mineral density changes after total hip replacement. J Biomech 41:3405–3413

  • Kerner J, Huiskes R, van Lenthe GH, Weinans H, van Rietbergen B, Engh CA, Amis AA (1999) Correlation between pre-operative and post-operative bone loss in THA can be explained by strain-adaptive remodelling. J Biomech 32:695–703

    Article  Google Scholar 

  • Kim Y-H, Yoon S-H, Kim J-S (2007) Changes in the bone mineral density in the acetabulum and proximal femur after cementless total hip replacement. J Bone Joint Surg [Br] 89–B:174–179

    Article  Google Scholar 

  • Kinkel S, Wollmerstedt N, Kleinhaus JA, Hendrich C, Heisel C (2009) Patient activity after total hip arthroplasty declines with advancing age. Clin Orthop Relat Res 467:2053–2058

    Article  Google Scholar 

  • Kishida Y, Sugano N, Nishii T, Miki H, Yamaguchi K, Yoshikawa H (2004) Preservation of the bone mineral density of the femur after surface replacement of the hip. J Bone Joint Surg [Br] 86–B:185–189

    Article  Google Scholar 

  • Kuhn M, Harris-Hayes M, Steger-May K, Pashos G, Clohisy JC (2013) Total hip arthroplasty in patients 50 years of less. do we improve activity profiles? J Arthoplasty 28:872–876

    Article  Google Scholar 

  • Leichtle UG, Leichtle CI, Schmidt B, Martini F (2005) Peri-prosthetic bone density after implantation of a custom-made femoral component. J Bone Joint Surg [Br] 88–B:467–471

    Google Scholar 

  • Lian Y, Pei F, Yoo M, Cheng J, Fatou C (2008) Changes of bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head. J Orthop Res 26:453–459

    Article  Google Scholar 

  • Machado MM, Fernandes PR, Cardadeiro G, Baptista F (2013) Femoral neck bone adaptation to weight-bearing physical activity by computational analysis. J Biomech 46:2179–2185

    Article  Google Scholar 

  • Martin RB (1984) Porosity and specific surface of bone. CRC Crit Rev Biomed Eng 10:179–222

    Google Scholar 

  • McMinn D, Treacy R, Lyn K, Pynsent P (1996) Metal-on-metal surface replacement of the hip. Clin Orthop Relat Res 329S:S89–S98

    Article  Google Scholar 

  • Morgan EF, Bayraktar HH, Keaveny TM (2003) Trabecular bone modulus–density relationships depend on anatomic site. J Biomech 36:897–904

    Article  Google Scholar 

  • Morlock MM, Schneider E, Bluhm A, Vollmer M, Bergmann G, Muller V, Honl M (2001) Duration and frequency of every day activities in total hip patients. J Biomech 34:873–881

    Article  Google Scholar 

  • Pal B, Gupta S, New AM (2009) A numerical study of failure mechanisms in the cemented resurfaced femur: effects of interface characteristics and bone remodelling. Proc IMechE Part H J Eng Med 223:471–484

    Article  Google Scholar 

  • Penny JO, Brixen K, Varmarken JE, Ovesen O, Overgaard S (2012) Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement. J Bone Joint Surg [Br] 94–B:1036–1044

    Article  Google Scholar 

  • Perez MA, Venditolli P-A, Lavigne M, Nuno N (2014) Bone remodeling in the resurfaced femoral head: effect of cement mantle thickness and interface characteristics. Med Eng Phys 36:185–195

    Article  Google Scholar 

  • Pollard TCB, Baker RP, Eastaugh-Waring SJ, Bannister GC (2006) Treatment of the young active patient with osteoarthritis of the hip: a five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacing. J Bone Joint Surg [Br] 88–B:592–600

    Article  Google Scholar 

  • Rancourt D, Shirazi-Adl A, Drouin G, Paiement G (1990) Friction properties of the interface between porous-surfaced metals and tibial cancellous bone. J Biomed Mater Res 24:1503–1519

    Article  Google Scholar 

  • Rothstock S, Uhlenbrock A, Bishop N, Laird L, Nassutt R, Morlock M (2011) Influence of interface condition and implant design on bone remodelling and failure risk for the resurfaced femoral head. J Biomech 44:1646–1653

    Article  Google Scholar 

  • Sandiford N, Doctor C, Rajaratnam SS, Ahmed S, East DJ, Miles K, Butler-Manuel A, Shepperd JAN (2013) Primary total hip replacement with a Furlong fully hydroxyapatite-coated titanium alloy femoral component, results at a minimum follow-up of 20 years. Bone Joint J 95–B:467–471

    Article  Google Scholar 

  • Scannell PT, Prendergast PJ (2009) Cortical and interfacial bone changes around a non-cemented hip implant: simulations using a combined strain/damage algorithm. Med Eng Phys 31:477– 488

    Article  Google Scholar 

  • Shimmin AJ, Back D (2005) Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg [Br] 87–B:463–464

    Article  Google Scholar 

  • Singh S, Trikha SP, Edge AJ (2004) Hydroxyapatite ceramic-coated femoral stems in young patients, a prospective ten-year study. J Bone Joint Surg [Br] 86–B:1118–1123

    Article  Google Scholar 

  • Skinner HB, Kilgus DJ, Keyak J, Shimaoka EE, Kim AS, Tipton JS (1994) Correlation of computed finite element stresses to bone density after remodelling around cementless femoral implants. Clin Orthop Relat Res 305:178–189

    Article  Google Scholar 

  • Slack R, Tindall A, Shetty AA, James KD, Rand C (2006) 15-year follow-up results of the hydroxyapatite ceramic-coated femoral stem. J Orthop Surg 14(2):151–154

    Google Scholar 

  • Spencer S, Carter R, Murray H, Meek RMD (2008) Femoral neck narrowing after metal-on-metal hip resurfacing. J Arthroplasty 23:1105–1109

    Article  Google Scholar 

  • Steffen RT, Pandit HP, Palan J, Beard DJ, Gundle R, McLardy-Smith P, Murray DW, Gill HS (2008) The five-year results of the Birmingham hip resurfacing. J Bone Joint Surg [Br] 90–B:436–441

    Article  Google Scholar 

  • Stucinskas J, Clauss M, Tarasevicius S, Wingstrand H, Ilchmann T (2012) Long-term femoral bone remodelling after cemented hip arthroplasty with the Muller straight stem in the operated and nonoperated femora. J Arthroplasty 27:927–933

    Article  Google Scholar 

  • Stulberg BN, Fitts SM, Bowen AR, Zadzilka JD (2010) Early return to function after hip resurfacing: is it better than contemporary total hip arthroplasty. J Arthoplasty 25:748–753

    Article  Google Scholar 

  • Sun S-S, Ma H-L, Liu C-L, Huang C-H, Cheng C-K, Wei H-W (2008) Difference in femoral head and neck material properties between osteoarthritis and osteoporosis. Clin Biomech 23:S39–S47

    Article  Google Scholar 

  • Tarala M, Janssen D, Verdonschot N (2011) Balancing incompatible endoprosthetic design goals: a combined ingrowth and bone remodeling simulation. Med Eng Phys 33:374–380

    Article  Google Scholar 

  • Tarala M, Janssen D, Verdonschot N (2013) Toward a method to simulate the process of bone ingrowth in cementless THA using finite element method. Med Eng Phys 35:543–548

    Article  Google Scholar 

  • ten Broeke RHM, Tarala M, Arts JJ, Janssen DW, Vedonschot N, Geesink RGT (2014) Improving peri-prosthetic bone adaptation around cementless hip stems: a clinical and finite element study. Med Eng Phys 36:345–353

    Article  Google Scholar 

  • Turner AWL, Gillies RM, Sekel R, Morris P, Bruce W, Walsh WR (2005) Computational bone remodelling simulations and comparisons with DEXA results. J Orthop Res 23:705–712

    Article  Google Scholar 

  • van Lenthe GH, de Waal Malefijt MC, Huiskes R (1997) Stress shielding after total knee replacement may cause bone resorption in the distal femur. J Bone Joint Surg [Br] 79–B:117–122

    Article  Google Scholar 

  • van Rietbergen B, Huiskes R, Weinans H, Sumner DR, Turner TM, Galante JO (1993) The mechanism of bone remodelling and resorption around press-fitted THA stems. J Biomech 26:369–382

    Article  Google Scholar 

  • Weinans H, Huiskes R, van Rietbergen B, Sumner DR, Turner TM, Galante JO (1993) Adaptive bone remodelling around a bonded noncemented total hip arthroplasty: a comparison between animal experiments and computer simulation. J Orthop Res 11:500–513

    Article  Google Scholar 

  • Weinans H, Huiskes R, Verdonschot N, van Rietbergen B (1991) The effect of adaptive bone remodelling threshold levels on resorption around noncemented hip stems. Adv Bioeng 20:303–306

    Google Scholar 

  • Wilkinson JM, Peel NFA, Elson RA, Stockley I, Eastell R (2001) Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg [Br] 83–B:238–288

    Google Scholar 

  • Wolff J (1892) Das Gesetz der Transformation Der Knochen. Hirschwald, Berlin

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Acknowledgments

This study was funded by the New Frontiers Fellowship scheme at the University of Southampton’s Faculty of Engineering and the Environment. Geometry of the Furlong implant was provided by Prof E Draper of JRI Ltd, Sheffield, UK.

Conflict of interest

The author has performed paid consultancy for JRI Ltd on unrelated work to that presented in this paper.

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  1. Bioengineering Science Research Group, University of Southampton, Mailpoint M7, Highfield, Southampton, SO17 1BJ, UK

    A. S. Dickinson

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Correspondence to A. S. Dickinson.

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The majority of the work in this manuscript was presented at the 11th World Congress of Computational Mechanics (July 2014, Barcelona, Spain), in the ‘Bone and Cartilage Mechanobiology: experimental and computational assessment across the scales’ symposium.

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Dickinson, A.S. Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur. Biomech Model Mechanobiol 15, 181–194 (2016). https://doi.org/10.1007/s10237-015-0678-9

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