NDLI: Influence of a metaphyseal sleeve on the stress-strain state of a bone-tumor implant system in the distal femur: an experimental and finite element analysis

Content Provider	Springer Nature : BioMed Central
Author	Li, Jian-jun Tian, Dong-mu Yang, Li Zhang, Jing-yu Hu, Yong-cheng
Abstract	Background Aseptic loosening of distal femoral tumor implants significantly correlates with the resection length. We designed a new “sleeve” that is specially engaged in the metaphysis at least 5 cm proximal to the knee joint line to preserve as much bone stock as possible. This study investigates the influence of a metaphyseal sleeve on the stress-strain state of a bone tumor implant system in the distal femur. Methods Cortex strains in intact and implanted femurs were predicted with finite element (FE) models. Moreover strains were experimentally measured in a cadaveric femur with and without a sleeve and stem under an axial compressive load of 1000 N. The FE models, which were validated by linear regression, were used to investigate the maximal von Mises stress and the implanted-to-intact (ITI) ratios of strain in the femur with single-legged stance loading under immediate postoperative and osseointegration conditions. Results Good agreement was noted between the experimental measurements and numerical predictions of the femoral strains (coefficient of determination (R2) ≥ 0.95; root-mean-square error (RMSE%) ≈ 10%). The ITI ratios for the metaphysis were between 13 and 28% and between 10 and 21% under the immediate postoperative and osseointegration conditions, respectively, while the ITI ratios for the posterior and lateral cortices around the tip of the stem were 110% and 119% under the immediate-postoperative condition, respectively, and 114% and 101% under the osseointegration condition, respectively. The maximal von Mises stresses for the implanted femur were 113.8 MPa and 43.41 MPa under the immediate postoperative and osseointegration conditions, which were 284% and 47% higher than those in the intact femur (29.6 MPa), respectively. Conclusions This study reveals that a metaphyseal sleeve may cause stress shielding relative to the intact femur, especially in the distal metaphysis. Stress concentrations might mainly occur in the posterior cortex around the tip of the stem. However, stress concentrations may not be accompanied by periprosthetic fracture under the single-legged stance condition.
Related Links	https://josr-online.biomedcentral.com/counter/pdf/10.1186/s13018-020-02025-6.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s13018-020-02025-6
Journal	Journal of Orthopaedic Surgery and Research
Issue Number	1
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2020-12-09
Access Restriction	Open
Subject Keyword	Orthopedics Surgical Orthopedics Distal femur Sleeve Finite-element analysis Strain gauge Stress shielding
Content Type	Text
Resource Type	Article
Subject	Surgery Orthopedics and Sports Medicine
Journal Impact Factor	2.8/2023
5-Year Journal Impact Factor	3/2023

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