The stem-bone interface of cementless total hip arthroplasty undergoes an adaptive process of bone ingrowth until the two parts become osseointegrated. Another important phenomenon associated with aseptic loosening of hip stem is stress-shielding induced adverse bone remodelling. The objective of this study was to preclinically assess the relative performances of two distinct designs of hip stems by addressing the combined effect of bone remodelling and osseointegration, based on certain rule-based criteria obtained from the literature. Premised upon non-linear finite element analyses of patient-specific implanted femur models, the study attempts to ascertain in silico outcome of the hip stem designs based on an evolutionary interfacial condition, and to further comment on the efficacy of the rule-based technique on the prediction of peri-prosthetic osseointegration. One of the two hip stem models was a trade-off design obtained from an earlier shape optimization study, and the other was based on TriLock stem (DePuy). Both designs predicted similar long-term osseointegration (∼89% surface), although trade-off stem predicted higher post-operative osseointegration. Proximal bone resorption was found higher for TriLock (by ∼110%) as compared to trade-off model. The rule-based technique predicted clinically coherent osseointegration around both stems and appears to be an alternative to expensive mechanobiology-based schemes.

中文翻译：

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使用结合骨整合和重塑的基于规则的模拟对两种髋关节设计进行比较评估。

非骨水泥型全髋关节置换术的茎骨界面经历了骨骼向内生长的适应性过程，直到两部分骨整合。与髋关节无菌性松动相关的另一个重要现象是应力屏蔽引起的不良骨骼重塑。这项研究的目的是根据文献中某些基于规则的标准，通过解决骨重塑和骨整合的综合影响，来临床前评估髋关节两种不同设计的相对性能。在针对患者特定的植入股骨模型进行非线性有限元分析的前提下，该研究试图根据进化的界面状况确定髋关节柄设计的计算机模拟结果，并进一步评论基于规则的技术在假体周围骨整合预测中的功效。这两个髋关节杆模型之一是从早期的形状优化研究中获得的折衷设计，另一个是基于TriLock杆（DePuy）。两种设计都预测了相似的长期骨整合（约89％的表面），尽管权衡的茎预测了术后骨整合的更高。与权衡模型相比，TriLock的近端骨吸收更高（约110％）。基于规则的技术预测了两个茎周围的临床骨整合，似乎是昂贵的基于机械生物学方法的替代方案。两种设计都预测了相似的长期骨整合（约89％的表面），尽管权衡的茎预测了术后骨整合的更高。与权衡模型相比，TriLock的近端骨吸收更高（约110％）。基于规则的技术预测了两个茎周围的临床骨整合，似乎是昂贵的基于机械生物学方法的替代方案。两种设计都预测了相似的长期骨整合（约89％的表面），尽管权衡的茎预测了更高的术后骨整合。与权衡模型相比，TriLock的近端骨吸收更高（约110％）。基于规则的技术预测了两个茎周围的临床骨整合，似乎是昂贵的基于机械生物学方法的替代方案。