TY - JOUR
T1 - Computational tibial bone remodeling over a population after total knee arthroplasty
T2 - A comparative study
AU - Anijs, Thomas
AU - Eemers, Sanne
AU - Minoda, Yukihide
AU - Wolfson, David
AU - Verdonschot, Nico
AU - Janssen, Dennis
N1 - Funding Information:
This study was funded by DePuy Synthes Joint Reconstruction, Leeds, UK. One of the authors is an employee of DePuy Synthes.
Publisher Copyright:
© 2021 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals LLC.
PY - 2021
Y1 - 2021
N2 - Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to validate computational postoperative bone response using longitudinal clinical DEXA densities. Computational remodeling outcome over a population was obtained by incorporating the strain-adaptive remodeling theory in finite element (FE) simulations of 26 different tibiae. Physiological loading conditions were applied, and bone mineral density (BMD) in three different regions of interest (ROIs) was considered over a postoperative time of 15 years. BMD outcome was compared directly to previously reported clinical BMD data of a comparable TKA cohort. Similar trends between computational and clinical bone remodeling over time were observed in the two proximal ROIs, with most rapid bone loss taking place in the initial months after TKA and BMD starting to level in the following years. The extent of absolute proximal BMD change was underestimated in the FE population compared with the clinical subject group, which might be the result of significantly higher initial clinical baseline BMD values. Large differences in remodeling response were found in the distal ROI, in which resorption was measured clinically, but a large BMD increase was predicted by the FE models. Multiple computational limitations, related to the FE mesh, loading conditions, and strain-adaptive algorithm, likely contributed to the extensive local bone formation. Further research incorporating subject-specific comparisons using follow-up CT scans and more extensive physiological knee loading is recommended to optimize bone remodeling more distal to the tibial baseplate.
AB - Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to validate computational postoperative bone response using longitudinal clinical DEXA densities. Computational remodeling outcome over a population was obtained by incorporating the strain-adaptive remodeling theory in finite element (FE) simulations of 26 different tibiae. Physiological loading conditions were applied, and bone mineral density (BMD) in three different regions of interest (ROIs) was considered over a postoperative time of 15 years. BMD outcome was compared directly to previously reported clinical BMD data of a comparable TKA cohort. Similar trends between computational and clinical bone remodeling over time were observed in the two proximal ROIs, with most rapid bone loss taking place in the initial months after TKA and BMD starting to level in the following years. The extent of absolute proximal BMD change was underestimated in the FE population compared with the clinical subject group, which might be the result of significantly higher initial clinical baseline BMD values. Large differences in remodeling response were found in the distal ROI, in which resorption was measured clinically, but a large BMD increase was predicted by the FE models. Multiple computational limitations, related to the FE mesh, loading conditions, and strain-adaptive algorithm, likely contributed to the extensive local bone formation. Further research incorporating subject-specific comparisons using follow-up CT scans and more extensive physiological knee loading is recommended to optimize bone remodeling more distal to the tibial baseplate.
KW - Bone remodeling
KW - DEXA
KW - Finite element analysis (FEA)
KW - Proximal tibia
KW - Total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85117072619&partnerID=8YFLogxK
U2 - 10.1002/jbm.b.34957
DO - 10.1002/jbm.b.34957
M3 - Article
SN - 1552-4973
JO - Journal of Biomedical Materials Research. Part B: Applied Biomaterials
JF - Journal of Biomedical Materials Research. Part B: Applied Biomaterials
ER -