Coupling Musculoskeletal Dynamics and Subject-Specific Finite Element Analysis of Femoral Cortical Bone Failure after Endoprosthetic Knee Replacement.

Background And Objective: A common reconstruction procedure after a wide resection of bone tumors around the knee is endoprosthetic knee replacement. The aim of this study was to investigate the characteristics of bone injury of the patient after endoprosthetic knee replacement during walking.

Methods: A subject-specific finite element model of the femur-prosthesis-tibia complex was established via CT scans. To obtain its physiologically realistic loading environments, the musculoskeletal inverse dynamic analysis was implemented. The extracted muscle forces and ground forces were then applied to the finite element model to investigate bone stress distribution at various stages of the gait cycle.

Results: The maximum femur stress of each stage varied from 33.14 MPa to 70.61 MPa in the gait cycle. The stress concentration position with a distance of 267.2 mm to the tibial plateau showed a good agreement with the patient injury data.

Conclusions: Overall results indicated the reasonability of the simulation method to determine loading environments and injury characteristics which the patient experienced with knee endoprosthesis during walking.