Effect of humeral stem sizing and alignment on stress shielding - a virtual cohort study.

IF 4.4 2区医学 Q2 ENGINEERING, BIOMEDICAL

IEEE Transactions on Biomedical Engineering Pub Date : 2025-05-12 DOI:10.1109/TBME.2025.3568877

Christine Mueri, Ghislain Maquer, Adam Henderson, Jeff Bischoff, Philippe Favre

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引用次数: 0

Abstract

Objective: Develop a population-level modeling approach that can reproduce the effect of relative stem size (RSS) on stress shielding as observed clinically after total shoulder arthroplasty.

Methods: A population-level finite element modeling approach based on 35 bone models was developed accounting for surgical variability. Stress shielding was assessed in four diaphyseal regions following the clinical literature. Surgical variability was introduced for stem sizing and alignment resulting in 188 unique surgical intervention. Patient variability was introduced for bone quality and loading conditions, resulting in around 300 models overall.

Results: Consistent with clinical observations, the virtual cohort predicted the highest stress shielding in the proximal lateral stem region, in agreement with the location of cortical thinning, and the group with stress shielding showed a larger RSS as well as more stress shielding in all four regions compared to the no stress shielding group. Upsizing or tilting the stem in varus increased stress shielding significantly. Including muscle forces increased bone resorption in the lateral proximal aspect, again aligning with the clinical findings. The influence of bone quality on stress shielding was minimal.

Conclusion: This in silico approach enables simulations of stress shielding to enrich clinical trial with virtual data as part of an in silico clinical trial (ISCT).

Significance: ISCT allows to identify surgical conditions or implant designs that could lead to an increased risk of stress shielding.

查看原文本刊更多论文

肱骨柄尺寸和对准对应力屏蔽的影响——一项虚拟队列研究。

目的：建立一种人群水平的建模方法，再现全肩关节置换术后临床观察到的相对椎体大小（RSS）对应力屏蔽的影响。方法：基于35个骨模型的人口水平有限元建模方法，考虑手术变异性。根据临床文献对四个骨干区域的应力屏蔽进行了评估。手术变异性被引入到茎的大小和对准，导致188种独特的手术干预。引入患者的骨质量和负荷条件的可变性，总共产生了大约300个模型。结果：与临床观察一致，虚拟队列预测在近侧干区有最高的应力屏蔽，与皮质变薄的位置一致，与无应力屏蔽组相比，有应力屏蔽组在所有四个区域显示更大的RSS和更多的应力屏蔽。增大或倾斜内翻的阀杆可显著增加应力屏蔽。包括肌肉力量增加了侧近端骨吸收，再次与临床结果一致。骨质量对应力屏蔽的影响很小。结论：这种计算机方法使应力屏蔽模拟能够丰富临床试验，虚拟数据作为计算机临床试验（ISCT）的一部分。意义：ISCT允许识别可能导致应力屏蔽风险增加的手术条件或植入物设计。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IEEE Transactions on Biomedical Engineering 工程技术-工程：生物医学

CiteScore

9.40

自引率

4.30%

发文量

880

审稿时长

2.5 months

期刊介绍： IEEE Transactions on Biomedical Engineering contains basic and applied papers dealing with biomedical engineering. Papers range from engineering development in methods and techniques with biomedical applications to experimental and clinical investigations with engineering contributions.