1.

Geometric Modeling (ABAQUS)

The modeling of the bone and the implant was made using a finite element model in the software
ABAQUS. The implementation sequence was as follows: initially the parts were created, and the
properties of the materials were defined. Subsequently, the assembly of the pieces was carried out
and the steps (gait cycle and stair climbing) were created. Following this, the types of interactions
and restrictions, as well as the loads associated with the parts were determined. Next, the mesh was
defined, and the job was simulated. Finally, the model was implemented using MATLAB and the
results obtained were visualized.

In Figure # are shown the 2D models of an intact femur, a cemented prosthesis, and an uncemented
prosthesis. Considering the 2D assumption, the intact femur model (Figure #) is composed of two
parts: the femur and the side plate. A thickness of 40mm was assumed for the femur [a]. For bone
material, Young's Modulus is density dependent for densities between ρ = 0.01g/cm3 and ρ =
1.64g/cm3, following the equation E = 3790ρ3. For this, a predefined field "temperature" was
applied to the bone, which allows density changes to be made in the model. Additionally, for the
bone densities throughout the bone, the mathematical model implemented in MATLAB was used in
ABAQUS, the iterations were repeated until the variation of the average density is minimal.

The side plate is considered to be made of cortical bone and has three sections with thickness of
1mm, 3mm and 5mm as seen in Figure #. To connect the side plate to the femur, a "tie" constraint
was used to simulate this three-dimensional connectivity. On the other hand, for the model of the
implanted bone (Figure #), 3 parts were considered: the femur, the side plate, and the prosthesis
(cemented and uncemented). The cemented bone is made of polymethyl methacrylate (PMMA).
Similarly, the prosthesis is attached to the femur by a "tie" constraint and is made of cobalt-
chromium (Co-Cr). The Young's Modulus and Poisson's ratio properties for each material are
shown in Table #.

In all models, the lower nodes were fixed in all directions. Additionally, to simulate the two load
cases (related to the gait cycle and stairs climbing movements), two forces (F a and Fh) were applied.
The values of the forces used are presented in Table #.

E(GPa) v Forces Fx(N) Fy(N)

Cortical Bone 17 0.3 Fh -224 -2246
Prosthesis 230 0.3 Fa 768 1210
Bone Cement 2.2 0.3 Fh 457 -1707
Fa 383 547

2. Side Plate

Since the femur and the prosthesis were simulated using a 2D model, two arrangements were made
to approximate to the real 3D shape of the bone. First, the assignment of thickness to the model,
which corresponds to 40mm. Second, in the diaphysis of the femur is formed a tubular cortical
structure, therefore, to consider the interaction between the right and left sides of this structure, the
side-plate was implemented. This arrangement also makes it possible to simulate the propagation of
forces between the cortical bone of the diaphysis. The thickness of the side-plate was defined
according to literature [a]. Finally, to imitate the changing of thickness of the cortical layer between
the diaphysis and the metaphysis, the thickness of the side-plate is reduced in the distal direction of
the femur.

[a] C. Jacobs, M. Levenston, G. Beaupré, J. Simo and D. Carter, "Numerical instabilities in bone
remodeling simulations: The advantages of a node-based finite element approach", Journal of
Biomechanics, vol. 28, no. 4, pp. 449-459, 1995. Available: 10.1016/0021-9290(94)00087-k
[Accessed 4 April 2022].

MATLAB implementation of Huiskes’ model for bone remodeling

MATLAB was used as a tool to implement the Huiskes model for bone remodeling. The code is
presented in Appendix #. In the developed algorithm, the following initial parameters were defined:
number of maximum iterations, the number of nodes and the initial density. Similarly, other
variables were defined, such as: the weight associated with the two steps ‘w1’ and ‘w2’, the name of
the instance to be analyzed, the parameters for the Huiskes model (the metabolic cost of bone
formation ‘k’, a value for ‘s’ and a step size), the matrix of initial bone densities ‘dens0’ and the
matrix where new densities are stored at each iteration ‘dens1’.

Subsequently, the input file ‘.inp’ for the finite element model in ABAQUS is modified by the file
‘.txt’ to include the density of each node in the entire instance. Then, using a Python script, the
energy densities of each node are extracted to ‘sener(i).txt’ files. It should be noted that two output
files will be produced (because there are two steps in the model, gait cycle and stair climbing).
Following that, the information in these files is then converted into ‘U(i)’ matrices using the
‘strain_energy’ function. The average of the strain energy densities for each step allows the
calculation of the new densities using the Huiskes model, which is then used to examinate if the
convergence criterion is achieved. This criterion is based on the maximum node density difference
after each iteration. If this maximum difference is less than 0.005 g/cm3, the simulation is
considered convergent and the simulation stops. If this does not happen, the simulation runs again
until the maximum number of iterations is reached. At each iteration, an ‘.odb’ file is generated and
updated until the end of the simulation, when it is opened to view the results.
En esta sección se discutirá la comparación de la distribución de densidades del fémur con un
implante no cementado (sección previa) y un implante cementado. Las prótesis cementada se
encuentran diseñadas para tener una capa de cemento óseo, generalmente se trata de un polímero
acrílico llamado polimetilmetacrilato (PMMA) [2L]. Este cemento óseo actúa como un relleno y se
utiliza entre el hueso natural del paciente y el componente del implante mediante una interconexión
mecánica entre ambas superficies [3L]. The primary function of bone cement is to transfer forces
from bone to prosthesis [4L]. De igual manera, otro parámetro importante a considerar es el módulo
de Young del cemento, pues es necesario que sea similar al del hueso, para que se inhiba la atrofia
ósea y se de una buena remodelación ósea [5L].

Ahora bien, en la Figura # es posible observar que en la parte superior de la diáfisis del fémur
(cerca a la metáfisis), así como en la epífisis, la distribución de densidades ósea es muy similar a la
presentada en el caso no cementado (Figura #). Sin embargo, en el caso de la próstesis cementada,
en la parte inferior de la diáfisis del fémur se evidencia un mayor aumento de la densidad. Esta
diferencia indicaría mejores resultados al tener una prótesis cementada que una no cementada.

Sin embargo, en ambos del fémur implantado, se observa una notable reducción de la densidad ósea
en el hueso. Esto se puede presentar debido al efecto de protección contra la tensión entre el hueso y
la capa de cemento. La protección contra el estrés se encuentra relacionada con la Ley de Wolf y se
refiere a la disminución de la densidad ósea a causa de la eliminación del estrés del hueso por medio
del implante. Al introducir la prótesis en el fémur, se cambia la distribución normal de las tensiones
del fémur proximal, por lo que, la protección contra la tensión del fémur proximal es la causa
mecánica de la pérdida de densidad ósea [6L]. Lo anterior, debido a que, si la carga sobre un hueso
disminuye, el hueso se volverá menos denso y más débil porque no hay estímulo para la
remodelación continua que se requiere para mantener la masa ósea. Esto es observado en los
resultados obtenidos en las Figuras # y #.

Respecto a las limitaciones, está la malla utilizada, pues como se observa en la Figura # y
comparando con la malla del fémur intacto, en el caso del fémur con la prótesis se evidencian más
elementos distorsionados. Por un lado, debido a los cambios en la geometría del modelo 2D, pues se
introdujeron dos componentes adicionales (implante y el cemento), cuyos nodos y particiones
utilizadas en el modelo afectarán los elementos de la malla. Por otro lado, esto también ocurre por
la malla del cemento, pues como se mencionó en la metodología, para este componente se utilizaron
tri-elementos en vez de quad-elementos.

[2L]https://www.arthritis-health.com/surgery/shoulder-surgery/cemented-vs-cementless-
alternatives-joint-replacement
[3L] https://pubmed.ncbi.nlm.nih.gov/26403875/
[4L] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631954/
[5L] https://www.hindawi.com/journals/ijbm/2011/836587/
[6L] https://josr-online.biomedcentral.com/articles/10.1186/s13018-014-0071-x
El fémur es el hueso más largo, pesado y fuerte del cuerpo humano. El fémur tiene un papel
importante en la biomecánica y movimientos de los miembros inferiores y es fundamental para
soportar las cargas circundantes. Sin embargo, una fuerza de impacto elevada puede fracturar el
fémur. En ese sentido, la artroplastia de cadera se ha convertido en un tratamiento eficaz para las
fracturas que se producen en fémur proximal. La inserción de una prótesis da como resultado una
remodelación ósea que conduce a cambios en la densidad del hueso. El objetivo de este trabajo fue
estudiar el proceso de remodelación ósea del fémur tras la inserción de una prótesis. Para esto, se
desarrollaron modelos computacionales 2D basados en el modelo de Huiskes y se realizó una
simulación de elementos finitos reiterativos utilizando los softwares de ABAQUS y MATLAB. Se
realizó una comparación de los resultados obtenidos del fémur antes y después de una artroplastia
de cadera con dos casos de carga (walking and climbing) y para dos condiciones diferentes (prótesis
no cementada y cementada). Los parámetros del modelo de Huiskes elegidos fueron k = 0.0025, s =
0 y tamaño de paso = 40. Este modelo permitió desarrollar una buena representación de la
remodelación ósea del fémur. De igual forma, a partir de los resultados obtenidos, se observó una
pérdida de densidad ósea en los modelo del fémur con un implante, lo cual se debe a la presencia
del efecto de protección contra el estrés.

The femur is the longest, heaviest, and strongest bone in the human body. The femur plays an
important role in the biomechanics and movements of the lower limbs and is essential to support
surrounding loads. However, a high impact force can fracture the femur. In this sense, hip
arthroplasty has become an effective treatment for fractures that occur in the proximal femur. The
insertion of a prosthesis results in bone remodeling leading to changes in bone density. The
objective of this work was to study the bone remodeling process of the femur after the insertion of a
prosthesis. To achieve this, 2D computational models based on the Huiskes model were developed
and an iterative finite element simulation was performed using ABAQUS and MATLAB softwares.
Additionally, was made a comparison of the results obtained from the femur before and after hip
arthroplasty with two load cases (gait cycle and stair climbing) and for two different conditions
(uncemented and cemented prosthesis). The Huiskes model parameters chosen were k = 0.0025, s =
0 and step size = 40. This model allowed to develop a good representation of bone remodeling of
the femur. Similarly, from the results obtained, a loss of bone density was observed in the models of
the femur with an implant, which is due to stress shielding.

In this section, the results obtained by adding the implant to the femur model will be discussed. It is
important to highlight that in order to carry out the simulations, were kept the same parameters in
the Huiskes model determined in the previous section. This with the purpose of...

Also, with the addition of the prosthesis, a denser element is being included in the bone. The later,
along with the features of the implant (i.e., Young's Modulus, shape, among others), will affect
bone remodeling in various ways, and therefore the density distribution in the bone. This will be
explained in the following sections.

- intro
- explain why we keep the same parameters ("metabolism" analogy)
- with the addition of the implant we are including denser element in the bone and this affects the
bone remodelling in various ways as it will be explained in the following sections.
- depending on the implant features, the bone remodelling will be different. therefore, the density
distribution will change/be affected accordingly.