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. 2023 Jun 3;18(1):405.
doi: 10.1186/s13018-023-03894-3.

Effect of bone cement augmentation with different configurations of the dual locking plate for femoral allograft fixation: finite element analysis and biomechanical study

Taweechok Wisanuyotin  1 , Permsak Paholpak  2 , Winai Sirichativapee  2 , Wilasinee Sirichativapee  2 , Weerachai Kosuwon  2
Affiliations

Effect of bone cement augmentation with different configurations of the dual locking plate for femoral allograft fixation: finite element analysis and biomechanical study

Taweechok Wisanuyotin et al. J Orthop Surg Res. .

Abstract

Aims: Implant failure in allograft reconstruction is one of the most common problems after treating a large bone defect for a primary bone tumor. The study aimed to investigate the effect of bone cement augmentation with different configurations of dual locking plates used for femoral allograft fixation.

Methods: Four finite element (FE) models of the femur with a 1-mm bone gap were developed at the midshaft with different configurations of the 10-hole fixation dual locking plate (LP) with and without intramedullary bone cement augmentation. Model 1 was the dual LP at the lateral and medial aspect of the femur. Model 2 was Model 1 with bone cement augmentation. Model 3 was the dual LP at the anterior and lateral aspect of the femur. Finally, Model 4 was Model 3 with bone cement augmentation. All models were tested for stiffness under axial compression as well as torsional, lateral-medial, and anterior-posterior bending. In addition, the FE analyses were validated using biomechanical testing on a cadaveric femur.

Results: Model 2 had the greatest axial compression stiffness, followed by Models 1, 4, and 3. Bone cement augmentation in Models 2 and 4 had 3.5% and 2.4% greater axial stiffness than the non-augmentation Models 1 and 3, respectively. In the bone cement augmentation models, Model 2 had 11.9% greater axial compression stiffness than Model 4.

Conclusion: The effect of bone cement augmentation increases construct stiffness less than the effect of the dual LP configuration. A dual lateral-medial LP with bone cement augmentation provides the strongest fixation of the femur in terms of axial compression and lateral bending stiffness.

Keywords: Allograft; Biomechanical study; Bone cement; Femur; Finite element analysis; Fixation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
FE models of femurs with 10-hole dual LP configurations (P = posterior, L = lateral)
Fig. 2
Fig. 2
FE model of the 10-hole dual LP during (A) the axial compression and torsional test and (B) the LM bending test
Fig. 3
Fig. 3
Biomechanical testing for axial compression and torsional testing with the femur at 15 degrees of adduction in the coronal plane aligned vertically in the sagittal plane. The femoral head and condyle were secured to the Instron ElectroPuls ™ E10000 Linear-Torsion with custom, multiple, adjustable jigs
Fig. 4
Fig. 4
FE analysis of dual LP (A) axial compression stiffness (B) bending stiffness (C) torsional stiffness
Fig. 4
Fig. 4
FE analysis of dual LP (A) axial compression stiffness (B) bending stiffness (C) torsional stiffness
Fig. 5
Fig. 5
Validation of the FE strains and experimental strains
See this image and copyright information in PMC

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