The effect of bone properties due to skeletal diseases on stability of cementless hip stems

Abstract

Problem statement: There are two types of implant fixation in hip joint replacement-cemented and cementless. The cemented types are, in general, more popular due to concerns of possible inability of cementless implants achieving maximum primary stability for bone integration. The concern is more significant in cases where there are major losses of cancellous bone stock and thinning of the trabeculae due to osteoporosis. Approach: Three Computed Tomography (CT) images of human hip joints were obtained from a hospital. The first patient showed osteoporotic condition based on DEXA scan of the bone. The second was registered for total hip replacement due to significant deterioration of the cartilage covering the bone ends. The third dataset was from a patient with no reported skeletal diseases and was used as control. Three dimensional models of the femora were reconstructed from the CT images and hip arthroplasty using cementless stem was simulated. Finite element method was used to analyze the stability of the implant through a specialized algorithm to measure micromotion at the bone-implant interface. Bone properties were assigned on an element-by element basis and loads simulating stair climbing were used. Results: Hip stems fixed in the control and osteoarthritic femoral model showed minimum interface micromotion. For the osteoporotic bone there is a progressive reduction in surface area feasible for bone in growth. Conclusion/Recommendations: Bone quality affects the stability of femoral components used in hip replacement and therefore the bone-implant integration potential. Cementless hip stem should not be used in patients with osteoporotic condition as the deterioration of bone tissues lead to an increase in interface micromotion.