Kovanda M, Havlícek V, Hudec J
Ortopedická klinika FN u sv. Anny, Brno.
Acta Chir Orthop Traumatol Cech. 2009 Apr;76(2):110-5.
PURPOSE OF THE STUDY The mid-term longevity of femoral components varies considerably, with some showing failure due to early aseptic loosening. Since the hip joint is subject to heavy mechanical loads, it can be assumed that the mechanical interaction of the implant, bone cement and femur will play a key role in the resultant reliability of an arthroplasty. This study was designed to examine this mechanical interaction in four femoral components different in construction (Poldi-Cech, CF-30, MS-30 and PFC) using mathematical simulation. MATERIAL AND METHODS Four stem/cement/femur 3-D mathematical models, comparable in quality, infolving the Poldi-Cech, CF-30, MS-30 and PFC stems, respectively, were constructed. A 3-D model for each stem was created according to its real, middle-size femoral component. Each 3-D model of the cement mantle corresponded in shape to the mantle of the appropriate real stem, with its thickness based on the recommended values of 4-7 mm in the proximal and 1-3 mm in the distal part, and with the cement mantle reaching as far as 10 mm distal to the femoral stem tip. For simplicitys sake the outer surface of the cement mantle was simulated as smooth. A 3-D model involving the proximal epiphysis and the metaphysis of a femur was reconstructed, based on a series of CT cross-sections obtained periodically at 10.5-mm and 2.5-mm distances. The sten/cement/femur model with the MS-30 stem also included a centraliser. The mechanical interaction of the stem, bone cement and bone tissue was examined by means of mathematical stimulation using ANSYS 5.7 software based on finite element analysis. RESULTS For the sake of simplicity, only two key parameters are presented, namely, contact stress at the stem-cement interface and equivalent deformation in the stem/cement/femur system. The least satisfactory stress loading was in the CF-30 stem whose sharp edges showed the values of contact stress about six-times higher than on the mid-medial portion of the stem, with the sharp edges behaving as stress concentrators. A satisfactory stress loading was found in Poldi-Cech, MS-30 and PFC stems, in which contact stress was evenly distributed along the whole lenght of the stem and the values at the edges and on the midmedial portion did not differ much. DISCUSSION The distribution of contact stress is one of the most important factors for the long-term longevity of implants. It was found least satisfactory in the CF-30 stem whose sharp edges act as stress condenser adversely affecting not only the stemcement interface, but also the resultant stress distribution within the femur. The most satisfactory results of stress distribution were recorded in the Poldi-Cech and MS-30 stems. The PFC stem also responded satisfactorily to the simulated stress loading. However, on loading whose substantial part would be torsion, the stems circular or oval cross-section could interfere with rotation stability of the implant; but this was impossible to detect by the mathematical simulation used in this study. CONCLUSIONS The results presented here show that, in the Poldi-Cech, CF-30, MS-30 and PFC femoral stems, a good agreement was achieved between the results of their clinical application and those of mathematical modelling of their mechanical properties. It can be concluded that mechanical interaction among the femoral stem, cement mantle and bone tissue plays the key role in the long-term longevity of such an implant. Key words: Poldi-Cech, CF-30, MS-30, PFC, mechanical interaction, contact stress.
研究目的 股骨假体的中期使用寿命差异很大,有些因早期无菌性松动而失效。由于髋关节承受巨大的机械负荷,可以认为植入物、骨水泥和股骨之间的机械相互作用将对关节置换术的最终可靠性起关键作用。本研究旨在通过数学模拟来研究四种结构不同的股骨假体(Poldi-Cech、CF-30、MS-30和PFC)中的这种机械相互作用。材料与方法 构建了四个质量相当的假体/骨水泥/股骨三维数学模型,分别涉及Poldi-Cech、CF-30、MS-30和PFC假体柄。根据其实际的中等尺寸股骨假体创建每个假体柄的三维模型。骨水泥套的每个三维模型在形状上与相应实际假体柄的套对应,其厚度基于近端4 - 7毫米和远端1 - 3毫米的推荐值,并且骨水泥套延伸至股骨假体柄尖端远端10毫米处。为简化起见,骨水泥套的外表面模拟为光滑的。基于以10.5毫米和2.5毫米间距定期获得的一系列CT横截面,重建了一个涉及股骨近端骨骺和干骺端的三维模型。带有MS-30假体柄的假体/骨水泥/股骨模型还包括一个中心化器。基于有限元分析,使用ANSYS 5.7软件通过数学模拟研究假体柄、骨水泥和骨组织之间的机械相互作用。结果 为简化起见,仅给出两个关键参数,即假体柄 - 骨水泥界面处的接触应力和假体/骨水泥/股骨系统中的等效变形。CF-30假体柄的应力加载最不理想,其尖锐边缘处的接触应力值比柄的中内侧部分高出约六倍,尖锐边缘起到了应力集中器的作用。在Poldi-Cech、MS-30和PFC假体柄中发现了令人满意的应力加载情况,其中接触应力沿柄的整个长度均匀分布,边缘处和中内侧部分的值相差不大。讨论 接触应力的分布是影响植入物长期使用寿命的最重要因素之一。在CF-30假体柄中发现其最不理想,其尖锐边缘起到了应力集中器的作用,不仅对假体柄 - 骨水泥界面产生不利影响,而且对股骨内的应力分布也有影响。应力分布最令人满意的结果出现在Poldi-Cech和MS-30假体柄中。PFC假体柄对模拟应力加载的响应也令人满意。然而,在大部分负荷为扭转的情况下,假体柄的圆形或椭圆形横截面可能会干扰植入物的旋转稳定性;但这无法通过本研究中使用的数学模拟检测到。结论 此处给出的结果表明,在Poldi-Cech、CF-30、MS-30和PFC股骨假体柄中,它们的临床应用结果与机械性能数学建模结果之间取得了良好的一致性。可以得出结论,股骨假体柄、骨水泥套和骨组织之间的机械相互作用对这种植入物的长期使用寿命起关键作用。关键词:Poldi-Cech、CF-30、MS-30、PFC、机械相互作用、接触应力