Repair of Periprosthetic Pelvis Defects With Porous Metal Implants: A Finite Element Study

Periacetabular osteolysis is a potentially difficult surgical challenge, which can often drive the choice of reconstruction methods used in revision hip replacement. For smaller defects, impaction of bone grafts may be sufficient, but larger defects can require filler materials that provide structural support in addition to filling a void. This study utilized finite element analysis (FEA) to examine the state of stress in periprosthetic pelvic bone when subjected to a stair-climbing load and in the presence of two simulated defects, to show the effect of implanting a defect repair implant fabricated from Trabecular MetalTM. Even a small medial bone defect showed a local stress elevation of 4X compared with that seen with an acetabular implant supported by intact periacetabular bone. Local bone stress was much greater (8X the baseline level) for a defect case in which the loss of bone superior to the acetabular implant permitted significant migration. FEA results showed that a repair of the small defect with a Trabecular MetalTM restrictor lowered periprosthetic bone stress to a level comparable to that in the case of a primary implant. For the larger defect case, the use of a Trabecular MetalTM augment provides structural stabilization and helps to restore the THR head center. However, stress in the adjacent periprosthetic bone is lower than that observed in the defect-free acetabulum. In the augment case, the load path between the femoral head and the pelvis now passes through the augment as the superior rim of the acetabulum has been replaced. Contact-induced stress in the augment is similar in magnitude to that seen in the superior rim of the baseline case, although the stress pattern in the augment is noticeably different from that in intact bone.