Journal article
Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Vol.236(9), pp.1297-1308
09/01/2022
DOI: 10.1177/09544119221109740
Abstract
Metastatic bone disease (MBD) is often managed by non-specialized orthopedic surgeons who rely on Mirels’ criteria to predict pathologic fracture risk. However, low specificity of Mirels’ criteria implies many lesions are scored at high fracture risk when the actual mechanical fracture risk is minimal. Our goal was to retrospectively compare mechanical fracture risk in MBD patients to Mirels’ score and clinical treatment received. Using a CT-based finite element (FE) model of the proximal femur affected by MBD, femur strength and load-to-strength ratio (LSR) were determined for 52 femurs from 48 patients. Associations of femur strength with pain and Mirels’ scores (Pearson r/Spearman ρ correlations), and the decision to operate (percentile analysis), and associations of LSR with pain and Mirels’ scores (Spearman correlations) were determined. Nineteen of 52 femurs (37%) had a very low computed mechanical fracture risk (LSR < 0.4); 5 of those 19 underwent prophylactic stabilization, suggesting that clinical decision-making in MBD is substantially influenced by non-mechanical factors that likely overestimate pathologic fracture risk. Of the 30 femurs managed non-operatively, 24 had a low computed mechanical fracture risk (LSR ≤ 0.5), none of which (0%) experienced a fracture within 9 months. Patient-reported pain did not correlate with femur strength (r = −0.05, p = 0.748) nor with LSR (ρ = 0.07, p = 0.632). Mirels’ score correlated weakly with femur strength (ρ = −0.32, p = 0.019) and with LSR (ρ = 0.29, p = 0.034). Computational mechanical tools like this FE model could be used as a clinical decision aid when considering non-surgical management in appropriate patients, potentially alleviating nonessential surgical treatment in some patients with femur MBD.
Details
- Title: Subtitle
- Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease
- Creators
- Joshua Johnson - Roy J. and Lucille A. Carver College of MedicineJessica Goetz - University of IowaMarc Brouillette - Roy J. and Lucille A. Carver College of MedicineBenjamin Miller - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Vol.236(9), pp.1297-1308
- Publisher
- SAGE PUBLICATIONS, INC
- DOI
- 10.1177/09544119221109740
- ISSN
- 0954-4119
- eISSN
- 2041-3033
- Language
- English
- Date published
- 09/01/2022
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation
- Record Identifier
- 9984303982202771
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