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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Densitometric and finite-element analysis of bone remodeling further to implanta...
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Vol. 52. Núm. 5.
Páginas 269-282 (septiembre - octubre 2008)
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Vol. 52. Núm. 5.
Páginas 269-282 (septiembre - octubre 2008)
Original paper
Acceso a texto completo
Densitometric and finite-element analysis of bone remodeling further to implantation of an uncemented anatomical femoral stem
Estudio densitométrico y con elementos finitos de la remodelación ósea tras la implantación de un vástago femoral anatómico no cementado
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1459
A. Herreraa,b,
Autor para correspondencia
aherrera@salud.aragon.es

Corresponding author: Paseo de Isabel la Católica, 1-3. 50009 Zaragoza. Spain.
, J.J. Paniselloa,b, E. Ibarzc, J. Cegoñinoc, J.A. Puértolasd, L. Graciac
a Department of Surgery. University of Zaragoza. Zaragoza. Spain
b Department of Orthopedic and Trauma Surgery. Miguel Servet University Hospital. Zaragoza. Spain
c Department of Mechanical Engineering. University of Zaragoza. Spain
d Department of Materials Science and Technology. University of Zaragoza. Spain
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Abstract
Introduction

Implantation of a femoral stem changes the load transmission dynamics in the hip and gives rise to the so-called adaptive remodeling. The goal pursued by all stems, whether cemented or not, is to achieve a perfect load transmission mechanism in order to avoid the phenomenon of stress-shielding, which may cause proximal bone devitalization.

Materials and methods

In order to quantify bone mass variations in the 7 Gruen zones, a serial DEXA analysis was carried out in 80 patients, with preoperative measurements as well as postoperative measurements at 6 months and 1, 3, 5, 7 and 10 years post implantation.

Results and conclusions

Finite-element (FE) simulations make it possible to characterize the biomechanical changes that occur in the femur further to implantation of a prosthetic stem, as well as the stem's long-term performance. The purpose of our study is to determine whether the results of the simulation can explain the biomechanical changes that may lie behind the evolution of bone density observed through DEXA scanning after implantation of an uncemented anatomical stem.

The results of the FE simulation show an excellent match between the bone loss observed on DEXA scans and the evolution of stress patterns observed in each of the Gruen zones, which confirms that even if the stem implanted was metaphyseal, stress shielding was manifest in the proximal femoral area, giving rise to the devitalization of bone in Gruen zones 1 and 7.

Key words:
bone remodeling
DEXA scan
finite-element analysis
hip prosthesis
Resumen
Introducción

La implantación de un vástago femoral cambia las condiciones de transmisión de carga de la cadera, produciendo el denominado remodelamiento adaptativo. El objetivo de todos los vástagos (cementados y no cementados) ha sido conseguir una perfecta transmisión de cargas que evite los fenómenos de puenteo de fuerzas o stress-shielding, que a su vez producen una desvitalización ósea proximal.

Material y método

Para cuantificar las variaciones de la masa ósea en las 7 zonas de Gruen se ha realizado un estudio seriado a 10 años con DEXA en 80 pacientes, con mediciones en el pre y posoperatorio, 6 meses posperatorio, y a 1, 3, 5, 7 y 10 años tras la implantación de la prótesis.

Resultados y conclusiones

La simulación con elementos finitos (EF) permite caracterizar los cambios biomecánicos que se producen en el fémur tras la implantación de un vástago protésico, así como su comportamiento a largo plazo. El objetivo de nuestro estudio es comprobar si los resultados de la simulación explican los cambios biomecánicos que justifiquen la evolución de la densidad ósea obtenida mediante el estudio con DEXA, tras la implantación de un vástago anatómico no cementado.

Los resultados de la simulación con EF presentan un perfecto paralelismo entre las pérdidas de masa ósea detectadas con la DEXA y la evolución tensional en cada zona de Gruen, lo que confirma que aunque el diseño de la prótesis es de apoyo metafisario, se produce un claro fenómeno de puenteo de fuerzas en la zona proximal del fémur, todo lo cual produce una desvitalización ósea en las zonas 1 y 7 de Gruen.

Palabras clave:
remodelado óseo
estudio con DEXA
elementos finitos
prótesis de cadera
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