Reconstruction of type II+III pelvic resection with a modular hemipelvic endoprosthesis: a finite element analysis study.

Objective: To conduct a biomechanical study of the whole reconstructed pelvic ring using a modular hemipelvic endoprosthesis.

Methods: A subject-specific finite-element (FE) model of the whole pelvic ring, including the pelvis, sacrum and main ligaments, was constructed. Type II+III pelvic resection was simulated on the FE model. Then a three-dimensional model of a reconstructed pelvic ring with a modular hemipelvic endoprosthesis was developed, and FE analysis performed to compare the stresses along the bilateral arcuate lines of the reconstructed and normal pelvis in the bipedal standing position. Comparison between bilateral stress distributions along the sciatic notch was also performed. The characteristics of load transmission within the endoprosthesis were also studied.

Results: No significant difference in the stresses along the bilateral arcuate lines was observed between the reconstructed and normal pelvis. The stress distribution on the prosthesis along the sciatic notch paths was significantly greater than that on the unaffected side in the same position. The peak stress of the implant on the S1 vertebral body was 182.9 MPa under a load of 600N. Study of load transfer on the implant showed that the posterior side of the column between the point of iliac fixation and the acetabulum was subject to the greatest stress.

Conclusion: This FE study showed that a modular hemipelvic endoprosthesis can restore load transfer between the sacrum and acetabulum on simple standing. Future implant design should aim to decrease the stress concentration and make the biomechanical performance more balanced.