FE stress analysis of the interface between the bone and an osseointegrated implant for amputees - implications to refine the rehabilitation program

BACKGROUND: The direct anchorage of lower-limb prosthesis to the bone has been shown to be an excellent alternative for amputees experiencing complications in using a conventional prosthetic socket. During rehabilitation phase, amputees are asked to apply static loading on the abutment perpendicular to a weigh scale to prepare the bone to tolerate the forces likely to be developed during walking. The weigh scale measures only the vertical force. A different loading protocol can affect the bone-implant interface stresses and the outcome of the rehabilitation. METHODS: This study developed a Finite Element model to study the stresses in the bone adjacent to the implant. Three loading conditions were applied based on the experimentally measured load: (1) vertical force applied along the long axis of the limb, corresponding to the load clinically prescribed in the weight bearing exercise; (2) loads applied on the three axes, corresponding to the true load measured simultaneously by a tri-axial load transducer during the same exercise; and (3) loads experienced during independent walking. FINDINGS: The model revealed that the weigh scale might in fact be applying much higher and less uniform stresses on the bone than expected. During walking, high stress occurred at various locations of the implanted region, which was different from the patterns of stress distribution during weight bearing exercises. INTERPRETATIONS: The difference in stress among three loading conditions implies that tri-axial load should be monitored during the weight bearing exercises and carefully prescribed