Performance of the resurfaced hip. Part 2: The influence of prosthesis stem design on remodelling and fracture of the femoral neck

Dickinson, Alexander; Taylor, Andrew; Jeffers, Jonathan R.T.; Browne, Martin

doi:10.1243/09544119jeim680

Cited by 7 publications

(7 citation statements)

References 45 publications

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“…Most commonly, these studies produced a static FE model of the intact and resurfaced joints and used the comparative mechanical strain or strain energy density (SED) in the two situations to predict the immediately post-operative remodelling stimulus (Watanabe et al 2000;Ong et al 2006Ong et al , 2009Taylor 2006;Taylor 2007a, 2007b;Dickinson et al 2010aDickinson et al , 2010b. These studies have presented predictions of stress shielded bone within the femoral head and the superior femoral neck, with bone densification around the prosthesis stem.…”

Section: Introductionmentioning

confidence: 99%

“…These studies have presented predictions of stress shielded bone within the femoral head and the superior femoral neck, with bone densification around the prosthesis stem. They allow the comparative performance of different surgical and implant design variables to be predicted, such as prosthesis position (Radcliffe and Taylor 2007a;Ong et al 2009;Dickinson et al 2010a) and sizing (Dickinson et al 2010a), fixation methods (Ong et al 2006;Radcliffe and Taylor 2007b), stem diameter (Taylor 2006), stem length (Dickinson et al 2010b) and the extent of stem -bone contact (Taylor 2006;Ong et al 2009). However, these results only represent the driving force for bone remodelling at one instant and do not predict the progression or end point of the nonlinear process.…”

Section: Introductionmentioning

confidence: 99%

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Implant–bone interface healing and adaptation in resurfacing hip replacement

Dickinson

Taylor²,

Browne

2012

Computer Methods in Biomechanics and Biomedical Engineering

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Hip resurfacing demonstrates good survivorship as a treatment for young patients with osteoarthritis, but occasional implant loosening failures occur. On the femoral side there is radiographic evidence suggesting that the implant stem bears load, which is thought to lead to proximal stress shielding and adaptive bone remodelling. Previous attempts aimed at reproducing clinically observed bone adaptations in response to the implant have not recreated the full set of common radiographic changes, so a modified bone adaptation algorithm was developed in an attempt to replicate more closely the effects of the prosthesis on the host bone. The algorithm features combined implant-bone interface healing and continuum bone remodelling. It was observed that remodelling simulations that accounted for progressive gap filling at the implant-bone interface predicted the closest periprosthetic bone density changes to clinical X-rays and DEXA data. This model may contribute to improved understanding of clinical failure mechanisms with traditional hip resurfacing designs and enable more detailed pre-clinical analysis of new designs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implant–bone interface healing and adaptation in resurfacing hip replacement

Dickinson

Taylor²,

Browne

2012

Computer Methods in Biomechanics and Biomedical Engineering

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“…A shorter stem was also shown to offer improved tolerance toward misalignment and bone remodeling stimulus in a previous study. 30 Besides of a shortened stem, an increase of its thickness and the transitional radius were shown to increase the tolerated bending moment. However, it has to be noted that the femoral head preparation for a thicker stem could weaken the mechanical strength of the native femoral head, which may lead to early resorption or collapse of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

Mechanical and numerical characterization of ceramic femoral components for hip resurfacing arthroplasty

Vogel

Liebelt

Kalkowsky

et al. 2019

Proc Inst Mech Eng H

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Hip resurfacing arthroplasty may have distinct advantages for young and active patients, but large metal-on-metal bearings can be associated with increased wear, adverse tissue reactions and higher rate of implant loosening. Ceramic wear couples are a commonly used alternative to metals and therefore might be an alternative for hip resurfacing arthroplastys. The aim of this study was to evaluate the mechanical strength of femoral components made of an alumina-toughened zirconia composite by means of experimental testing and finite element analysis. For the mechanical characterization, ceramic femoral components (Ø: 48 mm) were tested under compression loading experimentally until fracture occurred or a maximum load of 85 kN was obtained. The femoral components were either loaded against a ceramic cup or a copper ring (outer diameter Ø: 7.0 mm). In addition, the complex geometry of the ceramic femoral component was simplified, and only the stem was loaded in a cantilever test until fracture. In addition, the fracture tests were numerically simulated to investigate the influence of additional loading conditions and geometric parameters, which were not experimentally tested. The experimental data were used for validation of the finite element analysis. None of the tested ceramic femoral components fractured at a compression load of 85 kN when they were loaded against a ceramic cup at an inclination angle of 45°. When the femoral components were loaded against a copper ring, the femoral components fractured at 29.9 kN at a testing angle of 45°. The fracture load was reduced when an angle of 30° and increased when an angle of 60° was simulated. Using an experimental cantilever test, the stem of the femoral component fractured at 1124.0 N. When the stem length was increased or the diameter was reduced by 10% in the finite element analysis, the fracture load was reduced. Decreasing the length or increasing the diameter led to an increase of the fracture load. The strongest influence was found for the reduction of the transition radius of the stem, with a decrease of the fracture load up to 27.2%. The analyzed femoral components made of alumina-toughened zirconia (ATZ) showed sufficient mechanical capability to withstand high loadings during unfavorable loading conditions. However, further biomechanical and tribological investigations are required before clinical application.

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“…The present analyses and tests were limited to the mechanical fracture strength of the prosthesis and its interface with the cement mantle. Previous research has predicted reduced remodelling stimulus and femoral neck fracture risk for the proposed short-stemmed prosthesis geometry [25, 35, 36], so the behaviour of the supporting bone was not considered in these tests. Contemporary ceramic-on-ceramic bearings in THR also demonstrate excellent in vivo performance with regard to reduced osteolysis [19].…”

Section: Discussionmentioning

confidence: 99%

Pre-clinical evaluation of ceramic femoral head resurfacing prostheses using computational models and mechanical testing

Dickinson

Browne

Wilson³

et al. 2011

Proc Inst Mech Eng H

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Ceramic-on-ceramic hip resurfacing can potentially offer the bone conserving advantages of resurfacing while eliminating metal ion release. Thin-walled ceramic resurfacing heads are conceivable following developments in strength and reliability of ceramic materials, but verification of new designs is required. This study aimed to develop a mechanical pre-clinical analysis verification process for ceramic resurfacing heads, using the DeltaSurf prosthesis design as a case study.Finite element analysis of a range of in-vivo scenarios was used to design a series of physiologically representative mechanical tests, which were conducted to verify the strength of the prosthesis. Tests were designed to simulate ideal and worst-case in-vivo loading and support, or to allow comparison to a clinically successful metallic device.In tests simulating ideal loading and support, the prosthesis sustained a minimum load of 39 kN before fracture, and survived 10, 000, 000 fatigue cycles of (0.534 kN -5.34 kN). In worst-case tests representing a complete lack of superior femoral head bone support or pure cantilever loading of the prosthesis stem, the design demonstrated strength comparable to that of the equivalent metal device.The developed mechanical verification test programme represents an improvement in the state of the art where international test standards refer largely to total hip replacement prostheses. The case study's novel prosthesis design performed with considerable safety margins compared to extreme in-vivo loads, providing evidence that the proposed ceramic resurfacing heads should have sufficient strength to perform safely in-vivo. Similar verification tests should be designed and conducted for novel ceramic prosthesis designs in the future, leading the way to clinical evaluation.3

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Performance of the resurfaced hip. Part 2: The influence of prosthesis stem design on remodelling and fracture of the femoral neck

Cited by 7 publications

References 45 publications

Implant–bone interface healing and adaptation in resurfacing hip replacement

Implant–bone interface healing and adaptation in resurfacing hip replacement

Mechanical and numerical characterization of ceramic femoral components for hip resurfacing arthroplasty

Pre-clinical evaluation of ceramic femoral head resurfacing prostheses using computational models and mechanical testing

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