Altered Load Transfer in the Pelvis in the Presence of Periprosthetic Osteolysis

Abstract

Periprosthetic osteolysis in the retroacetabular region with cancellous bone loss is a recognized phenomenon in the long-term follow-up of total hip replacement. The effects on load transfer in the presence of defects are less well known. A validated, patient-specific, 3D finite element (FE) model of the pelvis was used to assess changes in load transfer associated with periprosthetic osteolysis adjacent to a cementless total hip arthroplasty (THA) component. The presence of a cancellous defect significantly increased (p < 0.05) von Mises stress in the cortical bone of the pelvis during walking and a fall onto the side. At loads consistent with single leg stance, this was still less than the predicted yield stress for cortical bone. During higher loads associated with a fall onto the side, highest stress concentrations occurred in the superior and inferior pubic rami and in the anterior column of the acetabulum with larger cancellous defects.

Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

“…According to the Paprosky classification system, the superior aspect of the acetabulum comprises an important part of the bone defect pattern. Biomechanical studies have revealed that the superior bone serves as the major support structure for acetabular cups and an essential component in the process of transmitting load from the hip to the sacroiliac joint [12,19,23], and superior and lateral migration of the COR significantly increases joint reaction force, risk of loosening, and decreased range of motion [4,17,18,21,24,35,37]. In knee revision procedures, Haddad et al proposed the concept of zone fixation in the metaphysis and diaphysis, while preserving the knee joint line level [12,22].…”

Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

“…According to the Paprosky classification system, the superior aspect of the acetabulum comprises an important part of the bone defect pattern. Biomechanical studies have revealed that the superior bone serves as the major support structure for acetabular cups and an essential component in the process of transmitting load from the hip to the sacroiliac joint [31][32][33], and superior and lateral migration of the COR significantly increases joint reaction force, risk of loosening, and decreased range of motion [14][15][16][17][18][19][20]. In knee revision procedures, Haddad et al proposed the concept of zone fixation in the metaphysis and diaphysis, while preserving the knee joint line level [32,34].…”

Biomechanics of the Osseous Pelvis and Its Implication for Consolidative Treatments in Interventional Oncology

“…3). Large osseous defects not only increase risk of local mechanical failure but also increase the risk of distant fractures due to the redistribution of the loads within the pelvis [22].…”