The Influence of Geometry of Implants for Direct Skeletal Attachment of Limb Prosthesis on Rehabilitation Program and Stress-Shielding Intensity

摘要

The purpose of the research was to evaluate the influence of selected parameters of the implants for bone anchored prostheses on possibility of conducting static load bearing exercises and stress-shielding intensity. A press-fit implant, a threaded implant, and the proposed design were compared using the finite element method. For the analyses two features were examined: diameter (19.0 – 21.0 mm) and length (75.0 – 130.0 mm). To define the possibility of conducting rehabilitation exercises the micromotion of implants while axial loading with a force up to 1000 N was examined to evaluate the changes at implant-bone interface. The stress-shielding intensity was estimated by bone mass loss over 60 months. The results suggest that, in terms of micromotion generated during rehabilitation exercises, the threaded (max. micromotion of 16.00 μm) and the proposed (max. micromotion of 45.43 μm) implants ensure low and appropriate micromotion. In the case of the press-fit solution the load values should be selected with care, as there is a risk of losing primary stabilisation. The allowed forces (that do not stimulate the organism to generate fibrous tissue) were approx. 140 N in the case of the length of 75 mm, increasing up to 560 N, while using the length of 130 mm. Moreover, obtained stress-shielding intensities suggest that the proposed implant should provide appropriate secondary stability, similar to the threaded solution, due to the low bone mass loss during long-term use (improving at the same time more bone remodelling in distal Gruen zones, by providing lower bone mass loss by approx. 13% to 20% in dependency of the length and diameter used). On this basis it can be concluded that the proposed design can be an appropriate alternative to commercially used implants.