Effect of elbow implant design parameters on loosening: A finite element analysis

Abstract

Loosening of an implant is the main complication after total elbow arthroplasty. The design parameters of the implant are a factor that contributes to the loosening of the implant. In this study, the correlation of loosening and geometry of the elbow implant component was investigated using the finite element method. Image processing software was used to construct elbow bones. Humeral and ulnar components were modeled with various cross-sections and flanges using modeling computer-aided design software. Modeling of all stems was based on conventional cemented fixation. Axial torsion and Anterior-posterior force were applied to the articular surface. Zero-displacement was applied to the proximal humerus and distal ulna. Bone graft was used between the flange and distal humerus bone. The stress shielding of bones and micro-motion were obtained in cement-implant-bone interfaces. Results showed that humeral and ulnar stems with modified diamond cross-section observed less micro-motion in the cement-bone-implant interfaces and as well as the least stress shielding in the distal humerus and proximal ulna compared to others. Furthermore, the modified flange, concave, transferred the least micro-motion to the bone-cement-implant interface and less stress shielding in distal humerus in comparison with trapezium and rectangular ones. This computational analysis represented a step in quantifying the role of interface micro-motion stress shielding of bone in initiating elbow implant loosening. A reduction of micro-motion and stress shielding through design modifications may improve the clinical outcomes.