X-ray image review of the bone remodeling around an osseointegrated trans-femoral implant and a finite element simulation case study.

The insertion of an implant into a bone leads to stress/strain redistribution, hence bone remodeling occurs adjacent to the implant. The study of the bone remodeling around the osseointegration implants can predict the long-term clinical success of the implant. The clinical medial-lateral X-rays of 11 patients were reviewed. To eliminate geometrical distortion of different X-rays, they were converted into a digital format and geometrical correction was carried out. Furthermore, the finite element (FE) method was used to investigate how the bone remodeling was affected by the stress/strain distribution in the femur. The review of clinical X-rays showed cortical bone growth around the proximal end of the implant and absorbtion at the distal end of the femur. The FE simulation revealed the stress/strain distribution in the femur of a selected patient. This provided a biomechanical interpretation of the bone remodeling. The existing bone remodeling theories such as minimal strain and strain rate theories were unable to offer satisfactory explanation for the cortical bone growth at the implant side of the proximal femur, where the stress/strain level was much lower than the one in the intact side of the femur. The study established the correlation between stress/strain distribution obtained from FE simulations and the bone remodeling of the clinical review. The cortical bone growth was initiated by the stress/strain gradient in the bone. Through the review of clinical X-rays and FE simulations, the study confirmed that the bone remodeling in a femur with an implant was influenced by the stress/strain redistribution. The strain level and stress gradient hypothesis is presented to offer an explanation for the implanted cortical bone remodeling observed in this study.