In Silico Model for Aseptic Loosening Prediction in Cementless Hip Stems: A Design of Experiments.

Abstract

Hip arthroplasty is a common orthopaedic surgery. Cementless hip prostheses are currently more common, especially in young and active patients. The number of procedures and revisions is expected to increase with life expectancy. Aseptic loosening (AL) is the main cause of failure. Osteoinductive coatings improve long-term implant stability by enhancing osseointegration. This study aimed to develop a computational framework for predicting AL, considering both the biomechanical factors involved in the osseointegration process and the biological response to osteoinductive materials. A Finite Element model of a human femur implanted with a cementless hip stem was coupled with a Finite State Machine to simulate osseointegration and tissue fibrotisation. The osteoinductive coating was modelled by adjusting the maximum gap at the bone-implant interface that can be bridged by newly formed bone, as well as the bone growth rate. To explore population variability, a total of 27 cases were simulated, including three diff.