Stress analysis of a Burch-Schneider cage in an acetabular bone defect: A case study
Burch-Schneider cages are often used for the treatment of acetabular bone defects. In several clinical studies these cages have shown good mid- to long-term results. However, a higher failure rate has been reported in large Paprosky IIIB defects compared with smaller Paprosky II-IIIA defects. This study aims to investigate the effect of cage support on cage failure by means of finite element analysis. The Von Mises stresses in both the implant and the bone are analyzed for a Burch-Schneider cage used in the following scenarios: (1) a large acetabular bone defect, (2) a small acetabular bone defect and (3) a large acetabular bone defect in combination with a reinforcement plate. The results show that implant and bone stresses are higher in the large defect (99th percentile of 146.6 and 73.5 MPa respectively) than in the small defect (99th percentile of 43.9 and 47.9 MPa respectively). Adding a reinforcement plate to posteriorly support the cage decreases the stresses but not fully compensates for the missing bone support (99th percentile of 93.1 and 55.3 MPa respectively). Since high stresses cause an increased risk for fatigue failure and implant loosening, sufficient implant support is required to reduce the risk of cage failure.
J. Gallo and A. V. Florchutz, “Burch-Schneider cage fracture: a case report,” Biomed. Pap.-PALACKY Univ. OLOMOUC, vol. 149, no. 2, p. 281, 2005.
Y. Kosashvili, O. Safir, D. Backstein, D. Lakstein, and A. E. Gross, “Salvage of Failed Acetabular Cages by Nonbuttressed Trabecular Metal Cups,” Clin. Orthop. Relat. Res., vol. 468, no. 2, pp. 466–471, Feb. 2010.
D. Regis, A. Sandri, and I. Bonetti, “Acetabular Reconstruction with the Burch-Schneider Antiprotrusio Cage and Bulk Allografts: Minimum 10-Year Follow-Up Results,” BioMed Res. Int., vol. 2014, pp. 1–9, 2014.
J. N. Sembrano and E. Y. Cheng, “Acetabular Cage Survival and Analysis of Factors Related to Failure,” Clin. Orthop., vol. 466, no. 7, pp. 1657–65, Jul. 2008.
J. Lamo-Espinosa, J. D. Clemente, P. Díaz-Rada, J. Pons-Villanueva, and J. R. Valentí-Nín, “The Burch-Schneider antiprotrusio cage: medium follow-up results,” Musculoskelet. Surg., vol. 97, no. 1, pp. 31–37, Dec. 2012.
C.-C. Hsu, C.-H. Hsu, S.-H. Yen, and J.-W. Wang, “Use of the Burch–Schneider cage and structural allografts in complex acetabular deficiency: 3- to 10-year follow up,” Kaohsiung J. Med. Sci., 2015.
W. G. Paprosky, P. G. Perona, and J. M. Lawrence, “Acetabular defect classification and surgical reconstruction in revision arthroplasty: A 6-year follow-up evaluation,” J. Arthroplasty, vol. 9, no. 1, pp. 33–44, Feb. 1994.
C. Perka and R. Ludwig, “Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch-Schneider anti-protrusio cage,” J. Arthroplasty, vol. 16, no. 5, pp. 568–574, Aug. 2001.
P. Udomkiat, L. D. Dorr, Y.-Y. Won, D. Longjohn, and Z. Wan, “Technical factors for success with metal ring acetabular reconstruction,” J. Arthroplasty, vol. 16, no. 8, pp. 961–969, Dec. 2001.
W. G. Paprosky, S. S. Sporer, and B. P. Murphy, “Addressing Severe Bone Deficiency: What a Cage Will Not Do,” J. Arthroplasty, vol. 22, no. 4, Supplement, pp. 111–115, Jun. 2007.
D. J. Berry, D. G. Lewallen, A. D. Hanssen, and M. E. Cabanela, “Pelvic Discontinuity in Revision Total Hip Arthroplasty*,” J Bone Jt. Surg Am, vol. 81, no. 12, pp. 1692–1702, Dec. 1999.
J. B. Stiehl, R. Saluja, and T. Diener, “Reconstruction of major column defects and pelvic discontinuity in revision total hip arthroplasty,” J. Arthroplasty, vol. 15, no. 7, pp. 849–857, oktober 2000.
T. J. Mäkinen, S. G. Fichman, E. Watts, P. R. T. Kuzyk, O. A. Safir, and A. E. Gross, “The role of cages in the management of severe acetabular bone defects at revision arthroplasty,” Bone Jt. J, vol. 98-B, no. 1 Supple A, pp. 73–77, Jan. 2016.
S. M. Sporer and W. G. Paprosky, “The Use of a Trabecular Metal Acetabular Component and Trabecular Metal Augment for Severe Acetabular Defects,” J. Arthroplasty, vol. 21, no. 6, Supplement, pp. 83–86, Sep. 2006.
M. Baauw, G. G. van Hellemondt, M. L. van Hooff, and M. Spruit, “The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip,” Bone Jt. J., vol. 97, no. 6, pp. 780–785, 2015.
D. K. DeBoer, M. J. Christie, M. F. Brinson, and J. C. Morrison, “Revision Total Hip Arthroplasty for Pelvic Discontinuity,” J. Bone Jt. Surg., vol. 89, no. 4, pp. 835–840, Apr. 2007.
T. Villa, F. Migliavacca, D. Gastaldi, M. Colombo, and R. Pietrabissa, “Contact stresses and fatigue life in a knee prosthesis: comparison between in vitro measurements and computational simulations,” J. Biomech., vol. 37, no. 1, pp. 45–53, Jan. 2004.
D. Lacroix, A. Chateau, M.-P. Ginebra, and J. A. Planell, “Micro-finite element models of bone tissue-engineering scaffolds,” Biomaterials, vol. 27, no. 30, pp. 5326–5334, Oct. 2006.
C. Boyle and I. Y. Kim, “Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization,” J. Biomech., vol. 44, no. 9, pp. 1722–1728, Jun. 2011.
F. Schmidutz, Y. Agarwal, P. E. Müller, B. Gueorguiev, R. G. Richards, and C. M. Sprecher, “Stress-shielding induced bone remodeling in cementless shoulder resurfacing arthroplasty: a finite element analysis and in vivo results,” J. Biomech., vol. 47, no. 14, pp. 3509–3516, Nov. 2014.
J. H. Kuiper and R. Huiskes, “The predictive value of stress shielding for quantification of adaptive bone resorption around hip replacements,” J. Biomech. Eng., vol. 119, no. 3, pp. 228–231, 1997.
M. Rabbani and H. Saidpour, “Stress Analysis of a Total Hip Replacement Subjected to Realistic Loading Conditions,” J Robot Mech Eng Resr, vol. 1, no. 1, pp. 18–23, 2015.
Y. Hirata, Y. Inaba, N. Kobayashi, H. Ike, H. Fujimaki, and T. Saito, “Comparison of Mechanical Stress and Change in Bone Mineral Density Between Two Types of Femoral Implant Using Finite Element Analysis,” J. Arthroplasty, vol. 28, no. 10, pp. 1731–1735, Dec. 2013.
J. M. F. K. Takahashi, A. C. Dayrell, R. L. X. Consani, M. A. de A. Nóbilo, G. E. P. Henriques, and M. F. Mesquita, “Stress Evaluation of Implant-Abutment Connections Under Different Loading Conditions: A 3D Finite Element Study,” J. Oral Implantol., vol. 41, no. 2, pp. 133–137, 2015.
I. Ilyas, H. A. Alrumaih, S. Kashif, S. A. Rabbani, and A. H. Faqihi, “Revision of Type III and Type IVB Acetabular Defects With Burch–Schneider Anti-Protrusio Cages,” J. Arthroplasty, vol. 30, no. 2, pp. 259–264, Feb. 2015.
F. Gelaude, T. Clijmans, and H. Delport, “Quantitative Computerized Assessment of the Degree of Acetabular Bone Deficiency: Total radial Acetabular Bone Loss (TrABL),” Adv. Orthop., vol. 2011, p. e494382, Oct. 2011.
F. Gelaude, T. Clijmans, P. L. Broos, B. Lauwers, and J. V. Sloten, “Computer-aided planning of reconstructive surgery of the innominate bone: Automated correction proposals,” Comput. Aided Surg., vol. 12, no. 5, pp. 286–294, Jan. 2007.
A. E. Anderson, C. L. Peters, B. D. Tuttle, and J. A. Weiss, “Subject-Specific Finite Element Model of the Pelvis: Development, Validation and Sensitivity Studies,” J. Biomech. Eng., vol. 127, no. 3, pp. 364–373, Feb. 2005.
M. Dalstra and R. Huiskes, “Load transfer across the pelvic bone,” J. Biomech., vol. 28, no. 6, pp. 715–724, Jun. 1995.
A. T. M. Phillips, P. Pankaj, C. R. Howie, A. S. Usmani, and A. H. R. W. Simpson, “Finite element modelling of the pelvis: Inclusion of muscular and ligamentous boundary conditions,” Med. Eng. Phys., vol. 29, no. 7, pp. 739–748, Sep. 2007.
Y. Zhou, L. Min, Y. Liu, R. Shi, W. Zhang, H. Zhang, H. Duan, and C. Tu, “Finite element analysis of the pelvis after modular hemipelvic endoprosthesis reconstruction,” Int. Orthop., vol. 37, no. 4, pp. 653–658, Jan. 2013.
N. Kaku, H. Tsumura, H. Taira, T. Sawatari, and T. Torisu, “Biomechanical study of load transfer of the pubic ramus due to pelvic inclination after hip joint surgery using a three-dimensional finite element model,” J. Orthop. Sci., vol. 9, no. 3, pp. 264–269, May 2004.
F. Bachtar, X. Chen, and T. Hisada, “Finite element contact analysis of the hip joint,” Med. Biol. Eng. Comput., vol. 44, no. 8, pp. 643–651, Aug. 2006.
G. Bergmann, G. Deuretzbacher, M. Heller, F. Graichen, A. Rohlmann, J. Strauss, and G. Duda, Eds., “Hip contact forces and gait patterns from routine activities,” 2001.
S. Bauer, P. Schmuki, K. von der Mark, and J. Park, “Engineering biocompatible implant surfaces,” Prog. Mater. Sci., vol. 58, no. 3, pp. 261–326, Apr. 2013.
L. Pazos, P. Corengia, and H. Svoboda, “Effect of surface treatments on the fatigue life of titanium for biomedical applications,” J. Mech. Behav. Biomed. Mater., vol. 3, no. 6, pp. 416–424, Aug. 2010.
I. P. Semenova, G. K. Salimgareeva, V. V. Latysh, T. Lowe, and R. Z. Valiev, “Enhanced fatigue strength of commercially pure Ti processed by severe plastic deformation,” Mater. Sci. Eng. A, vol. 503, no. 1–2, pp. 92–95, Mar. 2009.
R. B. Figueiredo, E. R. de C. Barbosa, X. Zhao, X. Yang, X. Liu, P. R. Cetlin, and T. G. Langdon, “Improving the fatigue behavior of dental implants through processing commercial purity titanium by equal-channel angular pressing,” Mater. Sci. Eng. A, vol. 619, pp. 312–318, Dec. 2014.
Copyright (c) 2016 Katrien Plessers, Hans Mau
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.