Can Patient-specific Finite Element Models Enter Clinical Practice as a Decision Support System?

Document Type : EDITORIAL

Authors

1 Department of Biomedical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran

2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

The finite element method (FEM) is an engineering tool to assess the mechanical behavior of a structure under applied loads. This method was first applied for stress analysis of mechanical structures in the late 1950s. Later on, this new method got the application in biomedical engineering by analyzing the mechanical behavior of human femora. With the advent of faster computers, more advanced imaging modalities, and better FE software resulting in increased sophistication in 3D modeling, FE models have been greatly improved and the possibility of creating a FE model that can closely mimic the geometry and material properties of bones of an individual patient, so-called a patient-specific model, is accessible. The objective of this editorial is to try to elucidate the advancements in and applications of patient-specific finite element modeling and discuss whether such models can give promising results in predicting the outcome of orthopedic surgeries and enter clinical practice as a decision support system.

Keywords


1. Huiskes R, Chao E. A survey of finite element analysis
in orthopedic biomechanics: the first decade. J.
Biomech. 1983;16(6):385-409.
2. Brekelmans W, Poort H, Slooff T. A new method to
analyse the mechanical behaviour of skeletal parts.
Acta Orthop. Scand. 1972;43(5):301-17.
3. Poelert S, Valstar E, Weinans H, Zadpoor AA. Patientspecific
finite element modeling of bones. Proc Inst
Mech Eng H. 2013;227(4):464-78.
4. Keyak J, Lee I, Skinner H. Correlations between
orthogonal mechanical properties and density of
trabecular bone: use of different densitometric
measures. J. Biomed. Mater. Res. A. 1994;28(11):
1329-36.
5. Keyak JH, Rossi SA, Jones KA, Skinner HB. Prediction of
femoral fracture load using automated finite element
modeling. J. Biomech. 1997;31(2):125-33.
6. Sas A, Ohs N, Tanck E, van Lenthe GH. Nonlinear voxelbased
finite element model for strength assessment
of healthy and metastatic proximal femurs. Bone Rep.
2020:100263.
7. Benca E, Synek A, Amini M, Kainberger F, Hirtler
L, Windhager R, et al. QCT-based finite element
prediction of pathologic fractures in proximal femora
with metastatic lesions. Sci. Rep. 2019;9(1):1-9.
8. Mirzaei M, Keshavarzian M, Alavi F, Amiri P,
Samiezadeh S. QCT-based failure analysis of proximal
femurs under various loading orientations. Med Biol
Eng Comput. 2015;53(6):477-86.
9. Keyak J, Kaneko T, Tehranzadeh J, Skinner H.
Predicting proximal femoral strength using structural 
engineering models. Clin. Orthop. Relat. Res. 2005;
437:219-28.
10. Costa M, Eltes P, Lazary A, Varga P, Viceconti M, Dall’Ara
E. Biomechanical assessment of vertebrae with
lytic metastases with subject-specific finite element
models. J Mech Behav Biomed. 2019;98:268-90.
11. Dall’Ara E, Pahr D, Varga P, Kainberger F, Zysset P. QCTbased
finite element models predict human vertebral
strength in vitro significantly better than simulated
DEXA. Osteoporos. Int. 2012;23(2):563-72.
12. Mosleh H, Rouhi G, Ghouchani A, Bagheri N. Prediction
of fracture risk of a distal femur reconstructed with
bone cement: QCSRA, FEA, and in-vitro cadaver tests.
Phys Eng Sci Med. 2020;43(1):269-77.
13. Ghouchani A, Rouhi G, Ebrahimzadeh MH. Investigation
on distal femoral strength and reconstruction failure
following curettage and cementation: In-vitro tests
with finite element analyses. Comput. Biol. Med.
2019:103360.
14. Derikx LC, van Aken JB, Janssen D, Snyers A, van der
Linden YM, Verdonschot N, et al. The assessment of
the risk of fracture in femora with metastatic lesions:
comparing case-specific finite element analyses with
predictions by clinical experts. J Bone Joint Surg Br.
2012;94(8):1135-42.
15. Sternheim A, Giladi O, Gortzak Y, Drexler M, Salai M,
Trabelsi N, et al. Pathological fracture risk assessment
in patients with femoral metastases using CT-based
finite element methods. A retrospective clinical study.
Bone. 2018;110:215-20.
16. Ghouchani A, Rouhi G, Ebrahimzadeh MH. Post 
operative fracture risk assessment following tumor
curettage in the distal femur: a hybrid in vitro
and in silico biomechanical approach. Sci. Rep.
2020;10(1):1-13.
17. Hirn M, de Silva U, Sidharthan S, Grimer RJ, Abudu A,
Tillman RM, et al. Bone defects following curettage do
not necessarily need augmentation: A retrospective
study of 146 patients. Acta Orthop. 2009;80(1):4-8.
18. Mirzaei M, Keshavarzian M, Naeini V. Analysis of
strength and failure pattern of human proximal femur
using quantitative computed tomography (QCT)-
based finite element method. Bone. 2014;64:108-14.