Mechanical analysis of total hip replacement with cup of different diameters in patients with developmental dysplasia of hip

doi:10.3969/j.issn.2095-4344.2014.13.001

Abstract

Abstract:

BACKGROUND: The anatomical structure of acetabulum is different for the developmental dysplasia of the hip, which is small and shallow, with abundant callus and scar tissue. It is difficult to determine the diameter of cup and installation of the cup during arthroplasty. Loosening and survival of postoperative prosthesis were influenced by local mechanical changes.
OBJECTIVE: Using the three-dimensional finite element analysis, the stress distribution in acetabular cup-bone interface after implanting cups with different diameters was studied during total hip replacement in treating the dysplasia of hip.
METHODS: Pelvis of developmental dysplasia of the hip patients was selected in this study. Acetabulum in the dysplasia was scanned by spiral CT. The computer simulation technology was applied to reconstruct the three-dimensional model of the pelvic for observing the dysplasia of hip from CT scan picture. Implanting cups with different diameters were simulated. Then the pelvis and acetabular cup model were meshed. The mechanics analysis tool was used to analyze three-dimensional model.
RESULTS AND CONCLUSION: For the developmental dysplasia, we chose cup with small diameter that could lead to better bone bed inclusion of cup during total hip replacement. Small diameter cup induced a small contact area and increased unit area stress. On the other hand, with implanting the larger cup and increasing degree of acetabular grinding, the acetabular wall bone breaks more obvious, so that the stress (compressive stress and shearing force) concentration at the top of the acetabulum and uneven stress in the rest were apparent increasingly. Thus, in clinical practice, under the premise of the bone bed inclusion, a large diameter cup is helpful to good distribution of stress during total hip replacement, but the perforation of acetabular wall induced by enlarged bone bed should be avoided or minimized.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, hip, hip joint, acetabulum, finite element analysis, biomechanics

CLC Number:

R318

Xu Jie, Ma Ruo-fan, Cai Zhi-qing, Li Deng. Mechanical analysis of total hip replacement with cup of different diameters in patients with developmental dysplasia of hip[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(13): 1969-1974.

Figures/Tables 2

试验基于临床发育性髋关节脱位患者的术前三维CT 图像，建立了CroweⅡ型骨盆三维有限元模型。模型较精细，包括410 164个节点，264 187个单元，变形髋臼位置显示清晰。模拟患侧单下肢站立的情况，对骨盆受力情况进行初步分析。 2.1 各模型骨盆位移及应力分布变化在设定了一定的约束之后，骨盆在受到力学加载后可能会出现沿冠状面或矢状面的位移，从而会影响到关节的力学环境。从图1A-D中可以看出各模型的位移情况，在此种载荷条件下骨盆的最大位移在髂骨翼的后部。臼杯使用尺寸的不同，骨盆的位移基本相同。大杯打磨掉更多的骨质使得髋臼处骨质变薄，但就整个骨盆的强度和刚度而言没出现明显下降。而就整个骨盆的应力分布云图所见(图1E-H)，最大应力集中区域为髂骨翼下方接近坐骨大切迹处，随臼杯直径的变化未见明显变化趋势(表2)。 2.2 各模型髋臼Von Mises应力分布变化通过应力云图可以看到，由于髋臼骨床形态学的改变，单腿站立时应力主要集中在髋臼顶部及内侧壁。各模型髋臼上的Von Mises应力比较，从髋臼峰值Von Mises应力的比较看，44 mm臼杯模型最小，随臼杯直径的加大，应力峰值加大。对比整个臼杯的受力情况，40 mm臼杯置入后，除髋臼顶外，髋臼其余部分应力分布较为均匀，这在44 mm臼杯置入模型中同样可见，同时因44 mm直径臼杯较40 mm直径臼杯接触面积更大，单位面积所受应力相对较少。至48 mm直径臼杯置入模型，因髋臼内侧已有部分突破，云图可见髋臼顶应力集中区偏下方处出现应力值较低区，此区域在 52 mm直径臼杯置入模型因骨质突破更为明显而有所扩大，使得除髋臼顶部应力集中区外，其余部分应力分布欠均匀(图2，表2)。"

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