Stress shielding and bone resorption of press-fit polyether-ether-ketone (PEEK) hip prosthesis: a sawbone model study

Article


Naghavi, S., Lin, C., Sun, C., Tamaddon, M., Basiouny, M., Garcia-Souto, P., Taylor, S., Hua, J., Li, D., Wang, L. and Liu, C. 2022. Stress shielding and bone resorption of press-fit polyether-ether-ketone (PEEK) hip prosthesis: a sawbone model study. Polymers. 14 (21). https://doi.org/10.3390/polym14214600
TypeArticle
TitleStress shielding and bone resorption of press-fit polyether-ether-ketone (PEEK) hip prosthesis: a sawbone model study
AuthorsNaghavi, S., Lin, C., Sun, C., Tamaddon, M., Basiouny, M., Garcia-Souto, P., Taylor, S., Hua, J., Li, D., Wang, L. and Liu, C.
Abstract

Stress shielding secondary to bone resorption is one of the main causes of aseptic loosening, which limits the lifespan of the hip prostheses and increases the rates of revision surgery. This study proposes a low stiffness polyether-ether-ketone (PEEK) hip prostheses, produced by fused deposition modelling to minimize the stress difference after the hip replacement. The stress shielding effect and the potential bone resorption of the PEEK implant was investigated through both experimental tests and FE simulation. A generic Ti6Al4V implant was incorporated in this study to allow fair comparison as control group. Attributed to the low stiffness, the proposed PEEK implant showed a more natural stress distribution, less stress shielding (by 104%), and loss in bone mass (by 72%) compared with the Ti6Al4V implant. The stiffness of the Ti6Al4V and the PEEK implant were measured through compression tests to be 2.76 kN/mm and 0.276 kN/mm. The factor of safety for the PEEK implant in both static and dynamic loading scenarios were obtained through simulation. Most of the regions in the PEEK implant were tested to be safe (FoS larger than 1) in terms of representing daily activities (2300 N), while the medial neck and distal restriction point of the implant attracts large von Mises stress 82 MPa and 76 MPa, respectively, and, thus, may possibly fail during intensive activities by yield and fatigue. Overall, considering the reduction in stress shielding and bone resorption in cortical bone, PEEK could be a promising material for the patient-specific femoral implants.

KeywordsPEEK; orthopaedic implants; stress shielding; finite element analysis; hip implant; biomechanical behaviors; bone resorption; hip stiffness; additive manufacturing; polyetheretherketone
PublisherMDPI
JournalPolymers
ISSN
Electronic2073-4360
Publication dates
Print29 Oct 2022
Publication process dates
Deposited25 Nov 2022
Submitted26 Sep 2022
Accepted25 Oct 2022
Output statusPublished
Publisher's version
License
File Access Level
Open
Copyright Statement

Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Digital Object Identifier (DOI)https://doi.org/10.3390/polym14214600
Web of Science identifierWOS:000881463700001
LanguageEnglish
Permalink -

https://repository.mdx.ac.uk/item/8q2vq

Download files


Publisher's version
polymers-14-04600.pdf
License: CC BY 4.0
File access level: Open

  • 67
    total views
  • 99
    total downloads
  • 4
    views this month
  • 17
    downloads this month

Export as

Related outputs

On the morphological deviation in additive manufacturing of porous Ti6Al4V scaffold: a design consideration
Naghavi, S., Wang, H., Varma, S., Tamaddon, M., Marghoub, A., Galbraith, R., Galbraith, J., Moazen, M., Hua, J., Xu, W. and Liu, C. 2022. On the morphological deviation in additive manufacturing of porous Ti6Al4V scaffold: a design consideration. Materials. 15 (14). https://doi.org/10.3390/ma15144729
Screen key genes associated with distraction-induced osteogenesis of stem cells using bioinformatics methods
Chen, J., Hua, J. and Song, W. 2021. Screen key genes associated with distraction-induced osteogenesis of stem cells using bioinformatics methods. International Journal of Molecular Sciences. 22 (12). https://doi.org/10.3390/ijms22126505
Long-term dynamic compression enhancement TGF-β3-induced chondrogenesis in bovine stem cells: a gene expression analysis
Chen, J., Chen, L., Hua, J. and Song, W. 2021. Long-term dynamic compression enhancement TGF-β3-induced chondrogenesis in bovine stem cells: a gene expression analysis. BMC Genomic Data. 22 (1), pp. 1-12. https://doi.org/10.1186/s12863-021-00967-2
Biomimetic surface functionalization of clinically relevant metals used as orthopaedic and dental implants
García-Gareta, E., Hua, J., Orera, A., Kohli, N., Knowles, J. and Blunn, G. 2017. Biomimetic surface functionalization of clinically relevant metals used as orthopaedic and dental implants. Biomedical Materials. 13 (1). https://doi.org/10.1088/1748-605X/aa87e6
Calculating the hip centre of rotation using contralateral pelvic anatomy
Durand-Hill, M., Henckel, J., Satchithananda, K., Sabah, S., Hua, J., Hothi, H., Langstaff, R., Skinner, J. and Hart, A. 2016. Calculating the hip centre of rotation using contralateral pelvic anatomy. Journal of Orthopaedic Research. 34 (6), pp. 1077-1083. https://doi.org/10.1002/jor.23118
The effect of a lateral flare feature on uncemented hip stems
Walker, P., Culligan, S., Hua, J., Muirhead-Allwood, S. and Bentley, G. 1999. The effect of a lateral flare feature on uncemented hip stems. Hip international : the journal of clinical and experimental research on hip pathology and therapy. 9 (2), pp. 71-80. https://doi.org/10.1177/112070009900900210
The rationale for CAD-CAM uncemented custom hips: an interim assessment
Hua, J., Walker, P., Muirhead-Allwood, S., Bentley, G. and McCullough, C. 1995. The rationale for CAD-CAM uncemented custom hips: an interim assessment. Hip international : the journal of clinical and experimental research on hip pathology and therapy. 5 (2), pp. 52-62.
The effect of implant stiffness on the osseointegration of titanium alloy
Blunn, G., Hua, J., Hunter, A., Wait, M. and Walker, P. 1992. The effect of implant stiffness on the osseointegration of titanium alloy. in: Doherty, P., Williams, R. and Williams, D. (ed.) Biomaterial-Tissue Interfaces : proceedings of the Ninth European Conference on Biomaterials, Chester, U.K., September 9-11, 1991 Amsterdam Elsevier Science Publishers.
Correlation of stress distribution with bony remodelling in retrieved femora with proximal femoral replacements
Blunn, G., Hua, J., Wait, M. and Walker, P. 1991. Correlation of stress distribution with bony remodelling in retrieved femora with proximal femoral replacements. in: Brown, K. (ed.) Complications of Limb Salvage: Prevention, Management and Outcome: 6th International Symposium, Montreal, September 8 to 11, 1991 Montreal Intl Society of Limb Salvage (ISOLS). pp. 445-450
A comparison of cortical strain following cemented and uncemented proximal and distal femoral replacement
Hua, J. and Walker, P. 1991. A comparison of cortical strain following cemented and uncemented proximal and distal femoral replacement. in: Complications of Limb Salvage: Prevention, Management and Outcome: 6th International Symposium, Montreal, September 8 to 11, 1991 Montreal Intl Society of Limb Salvage (ISOLS). pp. 455-460
Preoperative simulation system for the ZCHW custom hip prosthesis and its usage through the internet
Iguchi, H., Tanaka, N., Yoshida, Y., Kawanishi, T., Taneda, Y., Matsui, N., Hua, J. and Hattori, Y. 2001. Preoperative simulation system for the ZCHW custom hip prosthesis and its usage through the internet. in: Matsui, N., Taneda, Y. and Yoshida, Y. (ed.) Arthroplasty 2000: Recent advances in total joint replacement Springer-Verlag, Tokyo. pp. 91-97
A comparison of cortical strain after cemented and press-fit proximal and distal femoral replacement
Hua, J. and Walker, P. 1992. A comparison of cortical strain after cemented and press-fit proximal and distal femoral replacement. Journal of Orthopaedic Research. 10 (5), pp. 739-744. https://doi.org/10.1002/jor.1100100516
Relative motion of hip stems under load. An in vitro study of symmetrical, asymmetrical, and custom asymmetrical designs
Hua, J. and Walker, P. 1994. Relative motion of hip stems under load. An in vitro study of symmetrical, asymmetrical, and custom asymmetrical designs. The Journal of Bone and Joint Surgery. American Volume. 76 (1), pp. 95-103. https://doi.org/10.2106/00004623-199401000-00012
Prediction of clinical outcome of THR from migration measurements on standard radiographs. A study of cemented Charnley and Stanmore femoral stems
Walker, P., Mai, S., Cobb, A., Bentley, G. and Hua, J. 1995. Prediction of clinical outcome of THR from migration measurements on standard radiographs. A study of cemented Charnley and Stanmore femoral stems. Journal of Bone and Joint Surgery, British Volume. 77-B (5), pp. 705-714. https://doi.org/10.1302/0301-620X.77B5.7559694
Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion
Zadeh, H., Hua, J., Walker, P. and Muirhead-Allwood, S. 1999. Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion. The Journal of Arthroplasty. 14 (6), pp. 682-688. https://doi.org/10.1016/S0883-5403(99)90223-1
Closeness of fit of uncemented stems improves the strain distribution in the femur
Hua, J. and Walker, P. 1995. Closeness of fit of uncemented stems improves the strain distribution in the femur. Journal of Orthopaedic Research. 13 (3), pp. 339-346. https://doi.org/10.1002/jor.1100130307
Accuracy of using radiographs for custom hip stem design
Iguchi, H., Hua, J. and Walker, P. 1996. Accuracy of using radiographs for custom hip stem design. The Journal of Arthroplasty. 11 (3), pp. 312-321. https://doi.org/10.1016/S0883-5403(96)80084-2
Migration of the uncemented CLS acetabular component
Davies, M., Parker, B., Ward, D., Hern, E., Hua, J. and Walker, P. 1999. Migration of the uncemented CLS acetabular component. Orthopedics. 22 (2), pp. 219-222. https://doi.org/10.3928/0147-7447-19990201-11
Migration of the uncemented CLS femoral component
Davies, M., Parker, B., Ward, D., Hua, J. and Walker, P. 1999. Migration of the uncemented CLS femoral component. Orthopedics. 22 (2), pp. 225-228. https://doi.org/10.3928/0147-7447-19990201-12
Stability and bone preservation in custom designed revision hip stems
Walker, P., Culligan, S., Hua, J., Muirhead-Allwood, S. and Bentley, G. 2000. Stability and bone preservation in custom designed revision hip stems. Clinical Orthopaedics and Related Research. 373, pp. 164-173. https://doi.org/10.1097/00003086-200004000-00020
Can mesenchymal stem cells survive under normal impaction force in revision total hip replacements?
Korda, M., Blunn, G., Phipps, K., Rust, P., Di Silvio, L., Coathup, M., Goodship, A. and Hua, J. 2006. Can mesenchymal stem cells survive under normal impaction force in revision total hip replacements? Tissue engineering. 12 (3), pp. 625-630. https://doi.org/10.1089/ten.2006.12.625
Correlation of radiographic and telemetric data from massive implant fixations
Shah, A., Taylor, S. and Hua, J. 2006. Correlation of radiographic and telemetric data from massive implant fixations. Journal of Biomechanics. 39 (7), pp. 1304-1314. https://doi.org/10.1016/j.jbiomech.2005.03.023
Use of mesenchymal stem cells to enhance bone formation around revision hip replacements
Korda, M., Blunn, G., Goodship, A. and Hua, J. 2008. Use of mesenchymal stem cells to enhance bone formation around revision hip replacements. Journal of Orthopaedic Research. 26 (6), pp. 880-885. https://doi.org/10.1002/jor.20598
Custom uncemented revision stems based on a femoral classification
Hua, J., Walker, P., Muirhead-Allwood, S., Engelhardt, F. and Bentley, G. 2010. Custom uncemented revision stems based on a femoral classification. Hip international : the journal of clinical and experimental research on hip pathology and therapy. 20 (1), pp. 18-25. https://doi.org/10.1177/112070001002000103
Comparison of mesenchymal stem cell proliferation and differentiation between biomimetic and electrochemical coatings on different topographic surfaces
García-Gareta, E., Hua, J., Knowles, J. and Blunn, G. 2013. Comparison of mesenchymal stem cell proliferation and differentiation between biomimetic and electrochemical coatings on different topographic surfaces. Journal of Materials Science: Materials in Medicine. 24 (1), pp. 199-210. https://doi.org/10.1007/s10856-012-4789-x
The effect of temperature on the viability of human mesenchymal stem cells
Reissis, Y., García-Gareta, E., Korda, M., Blunn, G. and Hua, J. 2013. The effect of temperature on the viability of human mesenchymal stem cells. Stem Cell Research & Therapy. 4 (6), p. 139. https://doi.org/10.1186/scrt350
Enhanced wear and corrosion in modular tapers in total hip replacement is associated with the contact area and surface topography
Panagiotidou, A., Meswania, J., Hua, J., Muirhead-Allwood, S., Hart, A. and Blunn, G. 2013. Enhanced wear and corrosion in modular tapers in total hip replacement is associated with the contact area and surface topography. Journal of Orthopaedic Research. 31 (12), pp. 2032-2039. https://doi.org/10.1002/jor.22461
Muscle atrophy and metal-on-metal hip implants
Berber, R., Khoo, M., Cook, E., Guppy, A., Hua, J., Miles, J., Carrington, R., Skinner, J. and Hart, A. 2015. Muscle atrophy and metal-on-metal hip implants. Acta Orthopaedica. 86 (3), pp. 351-357. https://doi.org/10.3109/17453674.2015.1006981
Clinical usefulness of SPECT–CT in patients with an unexplained pain in metal on metal (MOM) total hip arthroplasty
Berber, R., Henckel, J., Khoo, M., Wan, S., Hua, J., Skinner, J. and Hart, A. 2015. Clinical usefulness of SPECT–CT in patients with an unexplained pain in metal on metal (MOM) total hip arthroplasty. The Journal of Arthroplasty. 30 (4), pp. 687-694. https://doi.org/10.1016/j.arth.2014.11.019
Osseointegration of acellular and cellularized osteoconductive scaffolds: is tissue engineering using mesenchymal stem cells necessary for implant fixation?
García-Gareta, E., Hua, J. and Blunn, G. 2015. Osseointegration of acellular and cellularized osteoconductive scaffolds: is tissue engineering using mesenchymal stem cells necessary for implant fixation? Journal of Biomedical Materials Research Part A. 103 (3), pp. 1067-1076. https://doi.org/10.1002/jbm.a.35256
Mesenchymal stem cells with increased stromal cell-derived factor 1 expression enhanced fracture healing
Ho, C., Sanghani, A., Hua, J., Coathup, M., Kalia, P. and Blunn, G. 2015. Mesenchymal stem cells with increased stromal cell-derived factor 1 expression enhanced fracture healing. Tissue Engineering Part A. 21 (3-4), pp. 594-602. https://doi.org/10.1089/ten.tea.2013.0762
Stem cell engineered bone with calcium-phosphate coated porous titanium scaffold or silicon hydroxyapatite granules for revision total joint arthroplasty
García-Gareta, E., Hua, J., Rayan, F. and Blunn, G. 2014. Stem cell engineered bone with calcium-phosphate coated porous titanium scaffold or silicon hydroxyapatite granules for revision total joint arthroplasty. Journal of Materials Science: Materials in Medicine. 25 (6), pp. 1553-1562. https://doi.org/10.1007/s10856-014-5170-z
The effect of mesenchymal stromal cells on the osseoinduction of impaction grafts
Korda, M., Hua, J., Little, N., Heidari, N. and Blunn, G. 2010. The effect of mesenchymal stromal cells on the osseoinduction of impaction grafts. Tissue Engineering Part A. 16 (2), pp. 675-683. https://doi.org/10.1089/ten.TEA.2008.0643
Uncemented computer-assisted design-computer-assisted manufacture femoral components in revision total hip replacement: a minimum follow up of ten years
Muirhead-Allwood, S., Sandiford, N., Skinner, J., Hua, J., Muirhead, W., Kabir, C. and Walker, P. 2010. Uncemented computer-assisted design-computer-assisted manufacture femoral components in revision total hip replacement: a minimum follow up of ten years. Journal of Bone and Joint Surgery, British Volume. 92-B (10), pp. 1370-1375. https://doi.org/10.1302/0301-620X.92B10.23124
The use of hydroxyapatite-coated CAD-CAM femoral components in adolescents and young adults with inflammatory polyarthropathy: ten-year results
McCullough, C., Remedios, D., Tytherleigh-Strong, G., Hua, J. and Walker, P. 2006. The use of hydroxyapatite-coated CAD-CAM femoral components in adolescents and young adults with inflammatory polyarthropathy: ten-year results. Journal of Bone and Joint Surgery, British Volume. 88-B (7), pp. 860-864. https://doi.org/10.1302/0301-620x.88b7.17046