Validation of numerical prediction of bone ingrowth into cementless implants

Master Thesis


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University of Cape Town

Total joint replacement was pioneered by John Charnley in the late 1950's, and has since revolutionised the management of arthritis sufferers. By 1991, an estimated 5 million people had undergone hip replacements. Although relatively successful, the cemented components had some problems, and this led to the development of cementless implants. These implants depend on the ingrowth of bone into a porous coating, to produce a durable method of implant fixation which the normal bone turnover process will maintain. One of the problems with cementless implants is that the type and extent of tissue ingrowth into the porous coating is unpredictable. Movement of the implant relative to the surrounding bone may result in the formation of an interfacial fibrous tissue layer. Hence, numerical modelling has been used to predict tissue ingrowth into such implants. Numerical simulation has the advantage that comprehensive data can be extracted relatively quickly. The finite element method is a powerful tool that has become the preferred method of analysis, and takes into account critical factors such as implant design, bone properties, and loading conditions. However, these models have not been tested extensively. Little attention has been given to comparing numerical models with the actual findings of retrieval studies or radiological imaging studies. This study thus evaluates the potential of one such numerical model. Most numerical models analyse the stress patterns of a particular state of bone ingrowth (i.e. a static case). This model considered the development of the ingrowing material - a dynamic analysis of tissue changes over a period of time. A 2-dimensional, plane stress finite element model was used to predict the ingrowth of bone into the porous coating of the femoral stem of a hip implant. A side plate was incorporated to mimic 3-dimensional characteristics. The evaluation was achieved by comparing the predictions of the numerical model with plane X-ray images of seven patients with Zimmer Anatomic cementless hip implants. The X-rays were scanned at a high resolution, so as to be able to "magnify" the regions to be examined. Several algorithms were developed to analyse the images, and provide a quantitative assessment of the X-ray images. The algorithms were designed to identify regions of bony and fibrous tissue. This involved the identification of the interface between the implant and the surrounding bone, and the extraction of the grayscale values of the X-rays at this interface. Thereafter, various radiographic signs that indicate the presence of fibrous tissue or bony tissue were identified, and these were used to enhance the original grayscale plot. The resulting graph was then modified slightly so as to make its presentation comparable with the numerical model. Plane X-rays proved to be suitable for the task of identifying tissue types. These data were then compared with the predictions of the numerical model. A qualitative correlation was used, as this was deemed to be most appropriate. Several authors in the literature also found a quantitative approach to have limitations. Some agreement between the experimental findings and the numerical simulation was found to exist, although this was limited. The agreement was judged to be less than the "reasonable agreement'' that several studies in the literature concluded. The correlation is better described by "some agreement". Nevertheless, the finite element method was assessed as being a tool with great potential, and modifications to the present model may provide more reliable results. A time study was also undertaken, whereby the tissue density was evaluated at various periods after the operation. The study provided insight into the evolution of the implant-bone interface after surgery, and correlated well with the literature. The phases of repair and remodelling were evident, and it was assessed as being a valuable contribution to this work. The time study may prove to be a more useful method than those used in assessing the "static" images, and could even provide a prognostic tool in assessing implant stability over time.