• International Journal of Technology (IJTech)
  • Vol 11, No 5 (2020)

Risk of Bone Fracture in Resurfacing Hip Arthroplasty at Varus and Valgus Implant Placements

Risk of Bone Fracture in Resurfacing Hip Arthroplasty at Varus and Valgus Implant Placements

Title: Risk of Bone Fracture in Resurfacing Hip Arthroplasty at Varus and Valgus Implant Placements
Nor Aiman Nor Izmin, Fatin Hazwani, Abdul Halim Abdullah, Mitsugu Todo

Corresponding email:


Cite this article as:
Nor Izmin, N.A., Hazwani, F., Todo, M., Abdullah, A.H., 2020. Risk of Bone Fracture in Resurfacing Hip Arthroplasty at Varus and Valgus Implant Placements. International Journal of Technology. Volume 11(5), pp. 1025-1035

39
Downloads
Nor Aiman Nor Izmin Faculty of Mechanical Engineering, Universiti Teknologi MARA (UiTM), 40450 Shah Alam, Selangor, Malaysia
Fatin Hazwani Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-koen, Kasuga 816- 8580, Japan
Abdul Halim Abdullah Faculty of Mechanical Engineering, Universiti Teknologi MARA (UiTM), 40450 Shah Alam, Selangor, Malaysia
Mitsugu Todo Research Institute for Applied Mechanics, Kyushu University, 6-1 Kasuga-koen, Kasuga 816-8580, Japan
Email to Corresponding Author

Abstract
Risk of Bone Fracture in Resurfacing Hip Arthroplasty at Varus and Valgus Implant Placements

It is possible to have a varus or valgus placement of resurfacing hip implants after resurfacing hip arthroplasty based on clinical reports. The likelihood of accidents such as sideways falls during the recovery process after arthroplasty is higher for the patient due to gait adaptation and weaker lower body condition. Hence, a computational study has been conducted to predict the risk of bone fracture with different implant placements during sideways fall accidents. A CT image of a young adult with hip osteoarthritis was imported into biomechanical software to develop the 3D inhomogeneous femoral bone model. A model of the Birmingham Hip Resurfacing implant with the properties of cobalt-chromium alloy was inserted into the femur during the reconstruction of the arthroplasty, which mimics the procedure of clinical practice. The loading and boundary conditions were implemented to simulate the sideways fall accident, and the prediction of bone fracture was based on the formation of failure elements. The loading magnitude was applied based on the patient’s body weight, ranging from the patient’s body weight (1 BW) to five times the patient’s body weight (5 BW). The fracture location was predicted to occur at the neck and trochanteric area of the femur, with the greatest damage occurring to the bone model implanted with varus placement. Our finding concludes that the varus placement of the resurfacing hip implant should be avoided whenever possible in clinical practice to sustain bone survivability.

Bone fracture; Damage formation criterion; Resurfacing hip arthroplasty; Sideways fall; Varus and valgus placement

Introduction

    Resurfacing hip arthroplasty (RHA) is a hip replacement method applied to young adults with end-stage hip osteoarthritis (OA) disease (Isaac et al., 2006; Quesada et al., 2008; Amanatullah et al., 2010; Wagner et al., 2012). Previous studies have discussed the positive surgical outcomes of young adults with hip OA who have undergone RHA (Vail et al., 2006; Mont et al., 2007; Lavigne et al., 2008; Shimmin et al., 2008). Despite that, complications after RHA still exist and have been reported by clinical institutions. Based on the clinical reports, the greatest complication that happens to patients who undergo RHA is bone fracture (Freeman, 1978; Freeman et al., 1978; Shimmin and Back, 2005). Other factors  might  contribute  to  the  failure,  including  patient,  post-operative,  and  surgical factors, which have been discussed previously (Shimmin and Back, 2005; Sershon et al., 2016).

However, it is believed that the placement of the RHA implant inserted into the femur during the surgical procedure might have a huge impact on the bone condition. Biomechanical factors, such as stress shielding, might also lead to implant loosening and be oriented toward improper placement during the recovery process (Goshulak et al., 2016). Improper placement of the implant might increase the tendency of early bone fracture after arthroplasty.

Since there is a possibility of improper implant placement occurring in RHA, the prediction of bone fracture in emergency cases such as sideways falls might further the understanding of bone failure after RHA. Patients who underwent hip arthroplasty had a higher risk of falling during the recovery process due to gait adaptation and instability (Beaulieu et al., 2010) and might face some difficulties in avoiding environmental hazards (Brunner et al., 2003). The extreme loading exerted on the hip area during a sideways fall can initiate a sudden impact on the area and might lead to the greatest failure, which is bone fracture. Although many CT-FEA studies have discussed the effects of different implant placements after RHA, no study to date has discussed its consequences in the case of an accident. Thus, the current study aims to predict the bone fracture mechanism of intact femurs and femurs that are associated with different RHA implant placements during sideways fall accidents.

Conclusion

    The present study demonstrates the risk of femoral bone fracture in the case of a sideways fall accidents. As hip arthroplasty is needed for late-stage hip OA patients, the placement of the implant has a huge impact on the survivability of the femoral bone. Although all femurs are predicted to fracture at the highest load applied (5 BW), the femur implanted in valgus placement shows the lowest fracture formation when compared to the varus and straight placements. The result shows that the valgus placement of the RHA implant might have a preventive effect against fracture where the possibility of fracture is reduced by 44% and 34% compared to the varus and straight placement conditions. The increase of failure elements as the implant is oriented from valgus to varus suggests that the risk of bone fracture is higher when the implant is positioned in the varus placement zone.

Acknowledgement

This research was supported by Universiti Teknologi MARA, UiTM under Grant No. 600- IRMI/PERDANA 5/3 BESTARI (103/2018). We thank and acknowledge the Ministry of Education, Malaysia, and our colleagues from the Faculty of Medicine, UiTM, who provided insight and expertise that greatly assisted the research.

References

Abdullah, A.H., Todo, M., Nakashima, Y., Iwamoto, Y., 2014. Risk of Femoral Bone Fractures in Hip Arthroplasties during Sideway Falls. International Journal of Applied Physics and Mathematics, Volume 4(4), pp. 286–289

Abdullah, A.H., Todo, M., Nakashima, Y., 2017. Prediction of Damage Formation in Hip Arthroplasties by Finite Element Analysis using Computed Tomography Images. Medical Engineering and Physics, Volume 44, pp. 8–15

Amanatullah, D.F., Cheung, Y., Di Cesare, P.E., 2010. Hip Resurfacing Arthroplasty: A Review of the Evidence for Surgical Technique, Outcome, and Complications. Orthopedic Clinics of North America, Volume 41(2), pp. 263–272

Beaulieu, M.L., Lamontagne, M., Beaulé, P.E., 2010. Lower Limb Biomechanics during Gait Do Not Return to Normal Following Total Hip Arthroplasty. Gait and Posture, Volume 32(2), pp. 269–273

Bessho, M., Ohnishi, I., Matsumoto, T., Ohashi, S., Matsuyama, J., Tobita, K., Kaneko, M., Nakamura, K., 2009. Prediction of Proximal Femur Strength using a CT-based Nonlinear Finite Element Method: Differences in Predicted Fracture Load and Site with Changing Load and Boundary Conditions. Bone, Volume 45(2), pp. 226–231

Brunner, L.C., Eshilian-Oates, L., Kuo, T.Y., 2003. Hip Fractures in Adults. American Family Physician, Volume 67(3), pp. 537–542

Elfani, M., Putra, N.K., 2013. Biomedical Engineering and Its Potential for Employment in Indonesia. International Journal of Technology, Volume 4(1), pp. 34–44

Fraile Gamarra, I., Jiménez Viseu Pinheiro, J.F., Cano Gala, C., Blanco Blanco, J.F., 2019. Birmingham Mid-head Resection Periprosthetic Fractures: Case Report. International Journal of Surgery Case Reports, Volume 64, pp. 174–176

Freeman, M.A., 1978. Some Anatomical and Mechanical Considerations Relevant to the Surface Replacement of the Femoral Head. Clinical Orthopaedics and Related Research, Volume 134, pp. 19–24

Freeman, M.A.R., Cameron, H.U., Brown, G.C., 1978. Cemented Double Cup Arthroplasty of the Hip: A Five Year Experience with the ICLH Prosthesis. Clinical Orthopaedics and Related Research, No. 134, pp. 45–52

Goshulak, P., Samiezadeh, S., Aziz, M.S.R., Bougherara, H., Zdero, R., Schemitsch, E.H., 2016. The Biomechanical Effect of Anteversion and Modular Neck Offset on Stress Shielding for Short-Stem versus Conventional Long-Stem Hip Implants. Medical Engineering and Physics, Volume 38(3), pp. 232–240

Isaac, G.H., Siebel, T., Schmalzried, T.P., Cobb, A.G., O’Sullivan, T., Oakeshott, R.D., Flett, M., Vail, T.P., 2006. Development Rationale for an Articular Surface Replacement: A Science-based Evolution. In: Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Volume 220(2), pp. 253–268

Kaneko, T.S., Pejcic, M.R., Tehranzadeh, J., Keyak, J.H., 2003. Relationships between Material Properties and CT Scan Data of Cortical Bone with and without Metastatic Lesions. Medical Engineering and Physics, Volume 25(6), pp. 445–454

Keaveny, T.M., Wachtel, E.F., Ford, C.M., Hayes, W.C., 1994. Differences between the Tensile and Compressive Strengths of Bovine Tibial Trabecular Bone Depend on Modulus. Journal of Biomechanics, Volume 27(9), pp. 1137–1146

Keyak, J.H., Rossi, S.A., Jones, K.A., Skinner, H.B., 1997. Prediction of Femoral Fracture Load using Automated Finite Element Modeling. Journal of Biomechanics, Volume 31(2), pp. 125–133

Keyak, J.H., Skinner, H.B., Fleming, J.A., 2001. Effect of Force Direction on Femoral Fracture Load for Two Types of Loading Conditions. Journal of Orthopaedic Research, Volume 19(4), pp. 539–544

Kim, S.C., Jung, H.M., 2013. A Study on Performance of Low-dose Medical Radiation Shielding Fiber (RSF) in CT Scans. International Journal of Technology, Volume 4(2), pp. 178–187

Kurdi, O., Rahman, R.A., 2010. Finite Element Analysis of Road Roughness Effect on Stress Distribution of Heavy Duty Truck Chassis. International Journal of Technology, Volume 1(1), pp. 57–64

Lavigne, M., Vendittoli, P.A., Nantel, J., 2008. Gait Analysis in Three Types of Hip Replacement. In: The 75th Annual Proceedings of American Academy of Orthopaedic Surgeons, Symposium, p. 431

Mont, M.A., Seyler, T.M., Ulrich, S.D., Beaule, P.E., Boyd, H.S., Grecula, M.J., Goldberg, V.M., Kennedy, W.R., Marker, D.R., Schmalzried, T.P., Sparling, E.A., Vail, T.P., Amstutz, H.C., 2007. Effect of Changing Indications and Techniques on Total Hip Resurfacing. Clinical Orthopaedics and Related Research, Volume 465, pp. 63–70

Izmin, N.A.N., Hazwani, F., Todo, M., Abdullah, A.H., 2020. Development of Inhomogeneous Femoral Bone Model for CT-based Finite Element Analysis. Journal of Scientific and Engineering Research, Volume 7(6), pp. 98–103

Nicayenzi, B., Shah, S., Schemitsch, E.H., Bougherara, H., Zdero, R., 2011. The Biomechanical Effect of Changes in Cancellous Bone Density on Synthetic Femur Behaviour. In: Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Volume 225(11), pp. 1050–1060

Quesada, M.J., Marker, D.R., Mont, M.A., 2008. Metal-on-Metal Hip Resurfacing. Advantages and Disadvantages. Journal of Arthroplasty, Volume 23, pp. 69–73

Røhl, L., Larsen, E., Linde, F., Odgaard, A., Jørgensen, J., 1991. Tensile and Compressive Properties of Cancellous Bone. Journal of Biomechanics, Volume 24(12), pp. 1143–1149

Sershon, R., Balkissoon, R., Valle, C.J.D., 2016. Current Indications for Hip Resurfacing Arthroplasty in 2016. Current Reviews in Musculoskeletal Medicine, Volume 9(1), pp. 84–92

Shimmin, A.J., Back, D., 2005. Femoral Neck Fractures Following Birmingham Hip Resurfacing: A National Review of 50 Cases. Journal of Bone and Joint Surgery - British Volume, Volume 87(4), pp. 463–464

Shimmin, A.J., Bennell, K., Wrigley, T., 2008. Gait Analysis Comparison of the Functional Outcome of Hip Resurfacing and Total Hip Replacement. In: The 75th Annual Proceedings of American Academy of Orthopaedic Surgeons, Symposium, p. 382

Simões, J.A., Vaz, M.A., Blatcher, S., Taylor, M., 2000. Influence of Head Constraint and Muscle Forces on the Strain Distribution within the Intact Femur. Medical Engineering and Physics, Volume 22(7), pp. 453–459

Tawara, D., Sakamoto, J., Murakami, H., Kawahara, N., Oda, J., Tomita, K., 2010. Mechanical Therapeutic Effects in Osteoporotic L1-Vertebrae Evaluated by Nonlinear Patient-Specific Finite Element Analysis. Journal of Biomechanical Science and Engineering, Volume 5(5), pp. 499–514

Todo, M., 2018. Biomechanical Analysis of Hip Joint Arthroplasties using CT-Image Based Finite Element Method. Journal of Surgery and Research, Volume 01, pp. 34–41

Vail, T.P., Mina, C.A., Yergler, J.D., Pietrobon, R., 2006. Metal-On-Metal Hip Resurfacing Compares Favorably with THA at 2 Years Follow up. Clinical Orthopaedics and Related Research, Volume 453, pp. 123–131

Wagner, P., Olsson, H., Ranstam, J., Robertsson, O., Zheng, M.H., Lidgren, L., 2012. Metal-On-Metal Joint Bearings and Hematopoetic Malignancy: A Review. Acta Orthopaedica, Volume 83(6), pp. 553–558