Adaptive glenoid bone remodeling simulation.

Abstract

Glenoid prosthesis loosening is the most common cause for revision total shoulder arthroplasty. Stress-induced bone remodeling may compromise long-term prosthesis fixation and significantly contribute to loosening. Realistic, robust analysis of bone-prosthesis constructs need to look beyond initial post-implantation mechanics provided by static finite element (FE) simulation. Adaptive bone remodeling simulations based on Wolff's law are needed for evaluating long-term glenoid prostheses fixation. The purpose of this study was to take a first step towards this goal and create and validate two-dimensional FE simulations, using the intact glenoid, for computing subject-specific adaptive glenoid remodeling. Two-dimensional glenoid FE models were created from scapulae computed tomography images. Two distinct processes, "element" and "node" simulations, used the forward-Euler method to compute bone remodeling. Initial bone density was homogeneous. Center and offset load combinations were iteratively applied. To validate the simulations we performed location-specific statistical comparisons between predicted and actual bone density, load combinations, and "element" and "node" processes. Visually and quantitatively "element" simulations produced better results (p>0.22), and correlation coefficients ranged 0.51-0.69 (p<0.001). Having met this initial work's goals, we expect subject-specific FE glenoid bone remodeling simulations together with static FE stress analyses to be effective tools for designing and evaluating glenoid prostheses.