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Experimental investigation of bone remodelling using composite femurs
V Waide1, L Cristofolini, J Stolk
1Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
Objective:
To determine the load transfer patterns of femurs in the intact, immediate post-operative and long-term (remodelled) post-operative implanted conditions for Lubinus SPII and Müller-Curved cemented hip prostheses, and to examine to what extent remodelling may influence the long-term outcome.
Design:
Experimental and finite element (FE) methods were applied to composite femurs under loads representing the heel-strike phase of gait, determining cortical bone and cement strains for the different femur conditions.
Background:
The authors previously developed protocols to measure bone and cement strains, and to produce remodelled femur specimens, yet these have not been applied together to compare strain patterns of different femur conditions. The Lubinus SPII is clinically more successful than the Müller-Curved stem, with failure mainly due to aseptic loosening.
Methods:
Cortical bone strains were determined in intact femurs. Six femurs each were implanted with the two stem types and cortical bone and cement strains were measured. Bone remodelling was recreated using a validated CAD-CAM procedure to remove a layer of proximal cortical bone, replicating a typical scenario found in stable clinical retrievals. Strains were remeasured. FE methods were used to compliment the experiments.
Results:
Stress shielding was reduced with remodelling, though bone strains did not return to their intact values, particularly around the calcar. Cement strains increased with remodelling. Differences occurred between the two stems; the Müller-Curved produced a more severe strain transition.
Conclusions:
Procedures were successfully combined together to investigate in vitro the performance of two cemented stems, in immediate and long-term post-operative conditions. The increase of cement strains with remodelling is a potential indicator for in vivo cement failure.
Relevance:
The consequences of femoral bone remodelling on the long-term success of joint replacements are not well understood, where remodelling may lead to increased bone and cement stresses.