Abstract
Background and Objective A common reconstruction procedure after a wide resection of bone tumors around the knee is endoprosthetic knee replacement. The aim of this study was to investigate the characteristics of bone injury of the patient after endoprosthetic knee replacement during walking. Methods A subject-specific finite element model of the femur-prosthesis-tibia complex was established via CT scans. To obtain its physiologically realistic loading environments, the musculoskeletal inverse dynamic analysis was implemented. The extracted muscle forces and ground forces were then applied to the finite element model to investigate bone stress distribution at various stages of the gait cycle. Results The maximum femur stress of each stage varied from 33.14 MPa to 70.61 MPa in the gait cycle. The stress concentration position with a distance of 267.2 mm to the tibial plateau showed a good agreement with the patient injury data. Conclusions Overall results indicated the reasonability of the simulation method to determine loading environments and injury characteristics which the patient experienced with knee endoprosthesis during walking.
Highlights
Osteosarcoma is one of the most common primary bone tumors, which mainly happens to children and adolescents [1]
The results indicated that the peaks of the vertical ground reaction forces (GRFs) and fore-aft GRFs of the patient amputee side were significantly smaller than those of healthy subjects and healthy sides of the patients
The maximum stress of 70.6 MPa during the whole gait cycle appeared at the 45% gait stage with the largest ground reaction force
Summary
Osteosarcoma is one of the most common primary bone tumors, which mainly happens to children and adolescents [1]. There are several complications related to endoprostheses, such as infection, loosening, dislocation, and periprosthetic fractures including the anterior cortical perforation of the femur near the stem tip When it comes to insertion of the intramedullary nail for proximal femur fractures, patients short in stature and those with excessive bowing of femurs have higher risks of anterior impingement and cortical perforation [2]. This risk may be applied to patients with endoprosthetic knee replacement after a wide resection of bone tumors. Overall results indicated the reasonability of the simulation method to determine loading environments and injury characteristics which the patient experienced with knee endoprosthesis during walking
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