Simulated lesions representative of metastatic disease predict proximal femur failure strength more accurately than idealized lesions

Johnson, Joshua E.; Brouillette, Marc J.; Permeswaran, Palani; Miller, Benjamin J.; Goetz, Jessica E.

doi:10.1016/j.jbiomech.2020.109825

Cited by 5 publications

(16 citation statements)

References 41 publications

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“…Artificial mechanical lesions were induced to simulate what happens in case of a vertebra with lytic metastatic lesions. The lesions were reproduced in the mid-transverse plane of the middle vertebra of each segment, as holes involving the trabecular bone and cortical shell [5,14,[25][26][27].…”

Section: Sample Preparation and Preparation Of The Artificial Focal Lesionmentioning

confidence: 99%

A novel approach to evaluate the effects of artificial bone focal lesion on the three-dimensional strain distributions within the vertebral body

2021

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The spine is the first site for incidence of bone metastasis. Thus, the vertebrae have a high potential risk of being weakened by metastatic tissues. The evaluation of strength of the bone affected by the presence of metastases is fundamental to assess the fracture risk. This work proposes a robust method to evaluate the variations of strain distributions due to artificial lesions within the vertebral body, based on in situ mechanical testing and digital volume correlation. Five porcine vertebrae were tested in compression up to 6500N inside a micro computed tomography scanner. For each specimen, images were acquired before and after the application of the load, before and after the introduction of the artificial lesions. Principal strains were computed within the bone by means of digital volume correlation (DVC). All intact specimens showed a consistent strain distribution, with peak minimum principal strain in the range -1.8% to -0.7% in the middle of the vertebra, demonstrating the robustness of the method. Similar distributions of strains were found for the intact vertebrae in the different regions. The artificial lesion generally doubled the strain in the middle portion of the specimen, probably due to stress concentrations close to the defect. In conclusion, a robust method to evaluate the redistribution of the strain due to artificial lesions within the vertebral body was developed and will be used in the future to improve current clinical assessment of fracture risk in metastatic spines.

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Section: Sample Preparation and Preparation Of The Artificial Focal Lesionmentioning

confidence: 99%

A novel approach to evaluate the effects of artificial bone focal lesion on the three-dimensional strain distributions within the vertebral body

2021

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“…Using reported methodology, 20,23 patient-specific FE models of the femur were created from the whole-femur diagnostic CT scans (Siemens, Forchheim, Germany; 120 kVp, 150 mAs, 0.3906 mm in-plane pixel size, 0.6 mm slice thickness) (Figure 2). FE models generated with this methodology have been validated for accuracy of femur strength calculation using cadaveric femurs incorporating artificial lesions with realistic geometries under torsional loading ( R 2 = 0.88, 12.7% mean error).…”

Section: Methodsmentioning

confidence: 99%

“…Following this approach and using a cadaverically validated, 20 patient-specific, CT-based FE model of the proximal femur, we retrospectively compared the computed mechanical risk of fracture in 48 patients with MBD to the clinical treatment received. We asked (1) can our method identify cases of potentially nonessential surgical treatment (i.e.…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease

Johnson

Goetz

Brouillette

et al. 2022

Proc Inst Mech Eng H

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Metastatic bone disease (MBD) is often managed by non-specialized orthopedic surgeons who rely on Mirels’ criteria to predict pathologic fracture risk. However, low specificity of Mirels’ criteria implies many lesions are scored at high fracture risk when the actual mechanical fracture risk is minimal. Our goal was to retrospectively compare mechanical fracture risk in MBD patients to Mirels’ score and clinical treatment received. Using a CT-based finite element (FE) model of the proximal femur affected by MBD, femur strength and load-to-strength ratio (LSR) were determined for 52 femurs from 48 patients. Associations of femur strength with pain and Mirels’ scores (Pearson r/Spearman ρ correlations), and the decision to operate (percentile analysis), and associations of LSR with pain and Mirels’ scores (Spearman correlations) were determined. Nineteen of 52 femurs (37%) had a very low computed mechanical fracture risk (LSR < 0.4); 5 of those 19 underwent prophylactic stabilization, suggesting that clinical decision-making in MBD is substantially influenced by non-mechanical factors that likely overestimate pathologic fracture risk. Of the 30 femurs managed non-operatively, 24 had a low computed mechanical fracture risk (LSR ≤ 0.5), none of which (0%) experienced a fracture within 9 months. Patient-reported pain did not correlate with femur strength ( r = −0.05, p = 0.748) nor with LSR (ρ = 0.07, p = 0.632). Mirels’ score correlated weakly with femur strength (ρ = −0.32, p = 0.019) and with LSR (ρ = 0.29, p = 0.034). Computational mechanical tools like this FE model could be used as a clinical decision aid when considering non-surgical management in appropriate patients, potentially alleviating nonessential surgical treatment in some patients with femur MBD.

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“…A few studies have attempted to transfer this technology in oncology settings, through the development of FE models of ex vivo femurs with a simulated metastatic lesion [67,68,70,[85][86][87][88][89] and metastatic femurs of patients [71,[90][91][92][93][94][95]. As previously mentioned, FE models and simulations are used to generate detailed distributions of stress and strain in bones and are essential for understanding their mechanical behavior.…”

Section: Femoral Fracture Risk Assessment Using Numerical Simulationmentioning

confidence: 99%

“…Up to now, the accuracy of these models and the ability to implement them in clinical practice was hampered by several limitations. First, except for Johnson et al [89], the available models consider a single-limb stance loading for assessing the risk of fracture related to metastatic disease. Fractures of metastatic femur usually occur spontaneously during daily life activities such as walking, sit to stand, turning, rising; therefore, different loading conditions need to be developed and incorporated into the simulation to predict the fracture risk with higher accuracy.…”

Section: Femoral Fracture Risk Assessment Using Numerical Simulationmentioning

confidence: 99%

Fracture Risk Evaluation of Bone Metastases: A Burning Issue

Confavreux

Follet

Mitton

et al. 2021

Cancers

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Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.

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Simulated lesions representative of metastatic disease predict proximal femur failure strength more accurately than idealized lesions

Cited by 5 publications

References 41 publications

A novel approach to evaluate the effects of artificial bone focal lesion on the three-dimensional strain distributions within the vertebral body

A novel approach to evaluate the effects of artificial bone focal lesion on the three-dimensional strain distributions within the vertebral body

Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease

Fracture Risk Evaluation of Bone Metastases: A Burning Issue

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