Ramamurti B S, Orr T E, Bragdon C R, Lowenstein J D, Jasty M, Harris W H
Orthopaedic Biomechanics Laboratory, Massachusetts General Hospital, Boston 02114, USA.
J Biomed Mater Res. 1997 Aug;36(2):274-80. doi: 10.1002/(sici)1097-4636(199708)36:2<274::aid-jbm17>3.0.co;2-g.
Several factors contribute to the success of stable bony ingrowth into the porous coated surfaces of orthopaedic implants used in hip arthroplasty. Despite having good bony apposition, bony ingrowth might not occur if the relative motion between bone and implant is large. Therefore, determining the limiting micromotion value that inhibits stable bony ingrowth is important. From a previous canine in vivo micromotion study performed at our laboratory, this limiting value was found to be 20 microns. Initially, cementless orthopaedic implants are stabilized only by frictional forces at the bone-implant interface. Therefore, other parameters such as the coefficient of friction and the compressive force normal to the interface should be considered as important factors which stabilize the interface along with micromotion. The purpose of this analytical study was to elucidate how the stability at the bone-implant interface is influenced by various factors, namely, motion of the implant, the coefficient of friction, the degree of pres fit, and the modulus of the surrounding cancellous bone in determining the stability of the bone-implant interface. Nonlinear and linear finite element models which simulated the immediate postsurgical condition and the end point of the canine in vivo micromotion experiment, respectively, were used to this end. From the results of the finite element models it was possible to identify the displacement magnitude for which the implant slipped relative to the bone as the motion of the implant was increased incrementally. This was done for combinations of the coefficient of friction, press fit, and Young's modulus of cancellous bone. This was used as an indicator of the limiting implant motion value beyond which bony ingrowth will be inhibited. The stress distribution in the surrounding cancellous bone bed was also obtained from the results of the finite element analyses for different press-fit conditions. The results of the study indicated that under slight press-fit conditions, the implant slipped relative to bone for implant motions as low as 20 microns. For higher degrees of press fit and reasonable values for the coefficient of friction, no slip occurred for implant motions as much as 100 microns. Although higher degrees of press fit were theoretically conducive to better implant stability, the concomitant high stresses in the adjacent cancellous bone will tend to compromise the integrity of the press fit. This was also evident when the results of an analytical model with a lower degree of press fit correlated well with those of the canine in vivo experiment in which a higher press fit was used, suggesting a possibility of achieving a less than desired press fit during the process of implantation. Through this study the importance of factors other than implant motion was emphasized. The results of the study suggest that the limiting value of implant motion that inhibits bone ingrowth might vary with the degree of press fit for reasonable coefficients of friction.
有几个因素有助于在髋关节置换术中使用的骨科植入物的多孔涂层表面实现稳定的骨长入。尽管骨贴合良好,但如果骨与植入物之间的相对运动较大,可能不会发生骨长入。因此,确定抑制稳定骨长入的极限微动值很重要。根据我们实验室之前进行的一项犬类体内微动研究,发现这个极限值为20微米。最初,非骨水泥型骨科植入物仅通过骨 - 植入物界面处的摩擦力来稳定。因此,诸如摩擦系数和垂直于界面的压缩力等其他参数应被视为与微动一起稳定界面的重要因素。这项分析研究的目的是阐明在确定骨 - 植入物界面的稳定性时,各种因素如何影响骨 - 植入物界面的稳定性,这些因素包括植入物的运动、摩擦系数、预紧度以及周围松质骨的模量。为此分别使用了模拟犬类体内微动实验的术后即刻情况和终点的非线性和线性有限元模型。从有限元模型的结果中,可以确定随着植入物运动逐渐增加,植入物相对于骨发生滑动时的位移大小。针对摩擦系数、压配和松质骨杨氏模量的组合进行了此项操作。这被用作极限植入物运动值的指标,超过该值骨长入将受到抑制。对于不同的压配条件,还从有限元分析结果中获得了周围松质骨床中的应力分布。研究结果表明,在轻微压配条件下,植入物运动低至20微米时就会相对于骨发生滑动。对于更高的压配度和合理的摩擦系数值,植入物运动高达100微米时都不会发生滑动。虽然理论上更高的压配度有利于更好的植入物稳定性,但相邻松质骨中随之产生的高应力往往会损害压配的完整性。当较低压配度的分析模型结果与使用较高压配度的犬类体内实验结果相关性良好时,这一点也很明显,这表明在植入过程中可能会出现低于预期的压配情况。通过这项研究,强调了植入物运动以外的因素的重要性。研究结果表明,对于合理的摩擦系数,抑制骨长入的植入物运动极限值可能会随压配度而变化。