Topology Optimisation for Compliant Hip Implant Design and Reduced Strain Shielding

Stiff total hip arthroplasty implants can lead to strain shielding, bone loss and complex revision surgery. The aim of this study was to develop topology optimisation techniques for more compliant hip implant design. The Solid Isotropic Material with Penalisation (SIMP) method was adapted, and two hip stems were designed and additive manufactured: (1) a stem based on a stochastic porous structure, and (2) a selectively hollowed approach. Finite element analyses and experimental measurements were conducted to measure stem stiffness and predict the reduction in stress shielding. The selectively hollowed implant increased peri-implanted femur surface strains by up to 25 percentage points compared to a solid implant without compromising predicted strength. Despite the stark differences in design, the experimentally measured stiffness results were near identical for the two optimised stems, with 39% and 40% reductions in the equivalent stiffness for the porous and selectively hollowed implants, respectively, compared to the solid implant. The selectively hollowed implant’s internal structure had a striking resemblance to the trabecular bone structures found in the femur, hinting at intrinsic congruency between nature’s design process and topology optimisation. The developed topology optimisation process enables compliant hip implant design for more natural load transfer, reduced strain shielding and improved implant survivorship.

Short-term success of proximal bone stock preservation in short hip stems: a systematic review of the literature

Total hip arthroplasty is performed more frequently in younger patients nowadays, making long-term bone stock preservation an important topic. A mechanism for late implant failure is periprosthetic bone loss, caused by stress shielding around the hip stem due to different load distribution. Short stems are designed to keep the physical loading in the proximal part of the femur to reduce stress shielding. The aim of this review is to give more insight into how short and anatomic stems behave and whether they succeed in preservation of proximal bone stock. A systematic literature search was performed to find all published studies on bone mineral density in short and anatomic hip stems. Results on periprosthetic femoral bone mineral density, measured with dual-energy X-ray absorptiometry (DEXA), were compiled and analysed per Gruen zone in percentual change. A total of 29 studies were included. In short stems, Gruen 1 showed bone loss of 5% after one year (n = 855) and 5% after two years (n = 266). Gruen 7 showed bone loss of 10% after one year and –11% after two years. In anatomic stems, Gruen 1 showed bone loss of 8% after one year (n = 731) and 11% after two years (n = 227). Gruen 7 showed bone loss of 14% after one year and 15% after two years. Short stems are capable of preserving proximal bone stock and have slightly less proximal bone loss in the first years, compared to anatomic stems. Cite this article: EFORT Open Rev 2021;6:1040-1051. DOI: 10.1302/2058-5241.6.210030

Creation and finite-element analysis of multi-lattice structure design in hip stem implant to reduce the stress-shielding effect

The term stress-shielding is frequently used to mention the reduction in mechanical stimulus in the surrounding bone due to the presence of a biomaterial inert implant whose mechanical properties are superior to bone. As the natural consequence of this, mineral loss occurs in the bone over time and creating subsequent weakness. One of the methods to reduce stress-shielding problem is to develop hip-stem implant designs that will transfer the load more to the bone. Therefore, in this study, multi-lattice designs were developed to reduce the stress-shielding effect in hip implant applications. For this, the proximal part of the hip implant stems has been divided into three parts. Simple cubic, body centered cubic, and face centered cubic lattice structures were created on the upper parts. Inner vertical and inner vertical + inner horizontal beams were added to the lattice structure of the upper part for middle and lower parts, respectively. Due to the multi-lattice designs, the maximum von Mises stress values on the hip implant stem were reduced from 289 to 189 MPa, as well as a weight reduction of up to 25.89%. Stress-shielding signals were obtained by determining the change in strain energy per unit bone mass caused by the presence of the femoral hip implant stem and its ratio to intact bone. In the case of using hip-stems having multi-lattice designs, there is a significant increase (max. 150.47%) in stress-shielding signals from different zones of the femur.

Numerical Simulation of Electric Field Distribution around an Instrumented Total Hip Stem

Presently, total joint replacement (TJR) is a standard procedure in orthopedic surgery. Adequate osseointegration of the implant components still remains a clinical issue. However, active stimulation of bone tissue to enhance bone ongrowth at the implant surfaces has not been widely investigated so far. For the last several years, invasive electromagnetically induced osseotherapy has been employed in clinical practice, e.g., for the treatment of avascular necrosis, femoral neck fractures, and pseudarthrosis. In the present study, the approach of exploiting the electric stimulation effect was transferred to the field of TJR. Therefore, a commercially available total hip stem was instrumented with an electrode on its surface in order to generate an electric field supporting the regeneration of the surrounding bone tissue. The objective was to conduct numerical simulations validated by experimental investigations as a proof of concept for an instrumented electro-stimulative total hip stem. The results revealed that the calculated electric field around a total hip stem fulfills the requirements to stimulate adjacent bone tissue when using clinically applied electric voltages. The derived numerical and experimental data of electric potentials and corresponding electric fields are encouraging for the implementation of active electrical stimulation in uncemented total hip stems to enhance their osseointegration.

Application Of A Thermodynamic-Based Model To Investigate Bone Remodeling After Total Hip Arthroplasty Using Different Hip Implants

A new thermodynamic-based model for bone remodeling is introduced. This model is based on chemical kinetics and irreversible thermodynamics in which bone is treated as a self-organizing system capable of exchanging matter, energy and entropy with its surroundings. Unlike the previous works in which mechanical loading is regarded as the only stimulus for bone remodeling, this model establishes a coupling between mechanical loading and the chemical reactions involved in the process of bone remodeling. This model is then incorporated to the finite element software ANSYS in the form of a macro to study bone remodeling after total hip arthroplasty with four different implants: Custom-made titanium, composite, Exceter and Omnifit hip stems. Numerical computations of bone density distribution after total hip arthroplasty indicate that the Omnifit implant with carbon fiber polyamide 12 composite results in minimum resorption in the proximal femur and consequently minimum bone loss due to stress shielding.

A biomechanical study of a novel biomimetic hip implant.

A three dimensional finite element (FE) model of a novel carbon fibre polyamide 12 composite hip stem was used to compare with two commerically available (Exeter and Omnifit) hip stems to minimize stress shielding and bone resorption. A virtual axial load of 3000N was applied to the FE model which replicated the experimental study. Strain and stress distributions were computed and compared with experimental results. Experimentally, three hip stems had their distal portions rigidly mounted and had strain gauges placed along the surface at 3 medial and 3 lateral locations. From the FE analysis, the von mises stress range for the composite hip stem was 200% and 45% lower than that in the Omnifit and Exeter implants, respectively. The aggregate average difference between FE and experimental microstrains for four proximal strain gauge locations were 7.5% (composite), 11.5% (Exeter), 14.6% (Omnifit), and the composite hip stem's stiffness (1982N/mm) was lower than the metallic hip stem stiffnesses (Exter, 2460N/mm; Omnifit, 2543 N/mm). This study showed considerable improvement in stress transfer to bone tissue.

A biomechanical study of a novel biomimetic hip implant.

A three dimensional finite element (FE) model of a novel carbon fibre polyamide 12 composite hip stem was used to compare with two commerically available (Exeter and Omnifit) hip stems to minimize stress shielding and bone resorption. A virtual axial load of 3000N was applied to the FE model which replicated the experimental study. Strain and stress distributions were computed and compared with experimental results. Experimentally, three hip stems had their distal portions rigidly mounted and had strain gauges placed along the surface at 3 medial and 3 lateral locations. From the FE analysis, the von mises stress range for the composite hip stem was 200% and 45% lower than that in the Omnifit and Exeter implants, respectively. The aggregate average difference between FE and experimental microstrains for four proximal strain gauge locations were 7.5% (composite), 11.5% (Exeter), 14.6% (Omnifit), and the composite hip stem's stiffness (1982N/mm) was lower than the metallic hip stem stiffnesses (Exter, 2460N/mm; Omnifit, 2543 N/mm). This study showed considerable improvement in stress transfer to bone tissue.

Application Of A Thermodynamic-Based Model To Investigate Bone Remodeling After Total Hip Arthroplasty Using Different Hip Implants

A new thermodynamic-based model for bone remodeling is introduced. This model is based on chemical kinetics and irreversible thermodynamics in which bone is treated as a self-organizing system capable of exchanging matter, energy and entropy with its surroundings. Unlike the previous works in which mechanical loading is regarded as the only stimulus for bone remodeling, this model establishes a coupling between mechanical loading and the chemical reactions involved in the process of bone remodeling. This model is then incorporated to the finite element software ANSYS in the form of a macro to study bone remodeling after total hip arthroplasty with four different implants: Custom-made titanium, composite, Exceter and Omnifit hip stems. Numerical computations of bone density distribution after total hip arthroplasty indicate that the Omnifit implant with carbon fiber polyamide 12 composite results in minimum resorption in the proximal femur and consequently minimum bone loss due to stress shielding.