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All bones comprise an outer layer of compact bone, and an interior made up of spongy bone tissue, also called cancellous or trabecular bone. In long bones, spongy bone tissue is mainly found in the interior of the epiphyses (broad ends of the bone).
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Strain shielding in trabecular bone at the tibial cement-bone interface.

Priyanka Srinivasan1, Mark A Miller2, Nico Verdonschot3

  • 1Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.

Journal of the Mechanical Behavior of Biomedical Materials
|November 28, 2016
PubMed
Summary

Aseptic loosening in total knee arthroplasty (TKA) is often due to poor cement-bone fixation. Deeper bone-cement interdigitation reduces micromotion and strain shielding, potentially improving implant longevity.

Keywords:
Aseptic looseningBone-cement interfaceFinite element analysisMicromotionStrain shielding

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Area of Science:

  • Biomedical Engineering
  • Orthopedic Surgery
  • Materials Science

Background:

  • Aseptic loosening of the tibial component is the primary reason for revision in total knee arthroplasty (TKA).
  • Loosening at the cement-trabecular interface in cemented TKA is often attributed to stress shielding caused by the implant's stiffness relative to bone.
  • Understanding the micromechanics of cement-bone interlock is crucial for developing strategies to enhance fixation and implant survival rates.

Purpose of the Study:

  • To investigate the micromechanics of the interlock between cement and trabecular bone in cemented TKA.
  • To analyze the relationship between interdigitation geometry, micromotion, and bone strain at the cement-trabecular interface.
  • To compare the mechanical environment in immediate post-operative and pre-operative simulated situations.

Main Methods:

  • Utilized finite element models based on micro-CT images of lab-prepared tibial cement-trabeculae interface specimens (n=4).
  • Simulated micromotion between cement and trabeculae and analyzed bone strain in interdigitated regions and distal to the interface.
  • Compared models representing immediate post-operative (with cement) and pre-operative (cement removed) conditions.

Main Results:

  • Increased interdigitation depth led to decreased micromotion and bone strain.
  • Micromotion and bone strain at the distal interdigitated region were dependent on bone volume fraction.
  • Trabeculae deeply embedded in cement exhibited the highest strain shielding (35-61% reduction in compressive strains).

Conclusions:

  • Deeper bone-cement interdigitation enhances fixation by reducing micromotion and strain shielding.
  • Strain shielding of interdigitated bone is a significant factor, potentially leading to bone resorption.
  • Strain-adaptive remodeling may be a key mechanism contributing to the loss of interdigitated bone and subsequent aseptic loosening.