Finite element analysis of intraosseous distal radioulnar joint prosthesis

doi:10.21203/rs.3.rs-1653078/v1

Download PDF

Research Article

Finite element analysis of intraosseous distal radioulnar joint prosthesis

https://doi.org/10.21203/rs.3.rs-1653078/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

Joint replacement is one of the options to retrieve the DRUJ function. Interosseous DRUJ prosthesis has recently been introduced clinically to treat DRUJ instability. The stability and biomechanical behavior of the prosthesis during different loadings have been analyzed by the finite element method in this article.

Methods

CT images of a healthy 33 years old man were used to construct the three-dimensional geometry of the forearm bone. Then two models, which include a healthy foreman (Model A) and a damaged model with an inserted interosseous prosthesis (Model B) constructed to analyze and compare the foreman's stability and biomechanical behavior under different loading conditions using the finite element method. Both models were examined during pronation and supination movements with 500, 1000, 2000, and 5000 N.mm values. Also, both models were subjected to volar and dorsal loads with values of 10, 30, and 50 N and traction force with 100, 150, and 200 N.

Results

Maximum and minimum principal stress in all conditions performed during movements was extracted for the bones, and Von Mises stress was considered for the prosthesis and its fixing screws. In supination, the maximum stress in Model A is significantly higher than the Model B. The maximum principal stress of both models is similar during volar and dorsal loading. In traction force, in Model A, the maximum principal stress is about 68 MPa, while in Model B, it is about 850 MPa. In Model B, the absolute value of minimum principal stress is in pronation, and supination is higher than Model A. the prostheses and screws are subjected to higher stresses during pronation than supination. Also, the amount of stress created in prostheses and screws during volar and dorsal loading is almost equal. In traction loading, screws are subjected to very high stresses.

Conclusion

In conclusion, our study indicated that the interosseous DRUJ prosthesis looks stable. This prosthesis provides the ability to function similarly to a normal hand. Differences from the normal state can be eliminated, if necessary, with minor modifications in the prosthesis geometry.

distal radioulnar prosthesis

biomechanics study

Kapandji procedure

Finite element analysis

The distal radioulnar joint (DRUJ) is a complex joint involved in both forearm axial and wrist movements and the transmission of forces across the wrist to forearm [1]. Disorders of the distal DRUJ, such as osteoarthritis, distal radius, ulna fractures, inflammatory arthritis, ligament injuries, and congenital diseases, are associated with wrist ulnar side pain, weakness, instability, and loss of forearm rotation [2, 3].

Different treatment methods have been proposed to treat osteoarthritis and DRUJ instabilities [4–7]. One of the options to retrieve the DRUJ function is joint replacement [8, 9]; however, Joint replacement in this area is challenging due to its biomechanical complexity. However, studies with long-term follow-up to evaluate the effect of these techniques showed that they cannot restore normal anatomy and kinematics and have not been entirely successful in reducing forearm pain and instability [10, 11].

So far, various designs for distal radiofrequency prostheses have been introduced [12–14]. Recently a new category of DRUJ prosthesis by the name of “interosseous DRUJ prosthesis” is introduced clinically based on the “Kapandji technique” [15]: In the Kapandji technique, a false joint is created distal region of the ulna by removing a segment of the bone, and the DRUJ itself is arthrodesis [9]. To evaluate the function of this prosthesis in the body, another study was performed on the cadaver by Moradi et al [16]. Based on the results of that study, the intraosseous DRUJ prosthesis did not have a significant effect on the wrist range of motions and showed efficacy in restoring function. Unlike significant prosthesis stability in longitudinal traction, the rotational force has inherent instability. On another short-term clinical study, one of the five patients with Moradi DRUJ prosthesis was dislocated in a two-year follow-up [15].

However, two fundamental questions are still unclear about Moradi's prosthesis: Since the prosthesis is not located in its anatomic place, it may affect the wrist and axial forearm range of motions and concerns about the stability of the prosthesis. According to two previous articles, the latter issue is more concerned. Using the finite element method, this prosthesis and forearm bone's stability and biomechanical behavior under different loading conditions were evaluated and compared with a healthy forearm.

CT images of a healthy 33 years old man were used to compare forearm bone's stability and biomechanical behavior of Moradi's interosseous prosthesis(model B) with the healthy forearm(model A) under different loading conditions using the finite element method.

Geometry

CT images of a healthy 33 years old man obtained from Computed Tomography were used to construct 3D geometry, including ulnar, radius, and distal Humerus. After receiving the CT images, MIMICS software (MIMICS 10.1; Materialise NV, Leuven, Belgium) was used to convert the images into STL format, which was finally imported to CATIA (CATIA V5; Dassault Systemes, Ve' Lizy-Villacoublay, France) to construct the final solid models. In this study, both trabecular and cortical bones were modelled with considering 2 mm offset toward bone from the outer surface as trabecular bone. In contrast, the cortical bone's outer surface cannot detect the cartilages as CT images. The filled gap between each bone in joints is considered the related cartilage. The final CAD files were imported into ABAQUS software (ABAQUS 6.11, Dassault Systèmes, Vélizy-Villacoublay, France), and subsequent finite element procedures were performed as the following sections. The final geometry of the model is depicted in Figure1.

A specific defect by subtracting a region from the ulna was created to insert the DRUJ prosthesis, as depicted in Figure 1. The interosseous DRUJ prosthesis is inserted between two sides of osteotomy where the pseudoarthrosis is carried out in the Sauvé-Kapandji procedure to address the drawbacks of different surgical techniques and prostheses [9]. Also, it has two main distal and proximal parts connected with a ball. This ball enables the prosthesis to move freely in each degree of freedom. The proximal part fixes to ulna and radius with two screws. Finally, the distal and proximal stems centered on the sphere can have axial movements and bending.

Material definition

All materials used for cortical and trabecula bone, cartilages, different parts of the prosthesis are considered linear elastic [17]. Also, titanium material properties are assigned to all prosthesis parts except the ball. For the ball, polyurethane [18] linear elastic properties are assigned [15]. Material properties of the bone were defined by using Young’s modulus of 17.5 GPa for the cortical bone and 309.8 GPa for the trabecular bone. The Poisson’s ratio for both the cortical and cancellous bones was 0.3. Cartilage was modelled with Young’s modulus of 12 MPa and Poisson’s ratio of 0.4 [17]. Titanium and Polyurethane were assumed to have Young’s modulus of 110 GPa, and Poisson’s ratio was 0.35 and 0.31, respectively [18, 19].

Seven ligaments stand for tension force between bones modelled with spring elements [17, 20]. To better simulate the function of the ligaments, the number of springs assigned to each of the elbow ligaments; Medial anterior, Medial posterior, Lateral radial, Lateral ulnar, four parallel springs and were assigned stiffnesses of 72.3, 52.2, 15.5, and 57 N/mm respectively, and for the Annular ligament, three parallel springs with the stiffness of 28.5 N/mm assigned. For each distal/proximal interosseous membrane and central interosseous membrane, two springs with the stiffness of 18.9 N/mm and 65 N/mm assigned, respectively, based on the orientation reported in the study, were considered. The position of these ligaments was selected based on the references [17, 20].

Loading and boundary condition

Cortical and trabecular bones bounded together. The interface of the distal and proximal part of the prosthesis is considered bound to the bone, and frictionless contact is defined between the ball and the prosthesis. The bones and ligaments of the wrist were not considered in this study, so the proximal surface of the ulna and radius coupled together eliminated the degrees of freedom [17]. Each ligament bonded to its bone and the frictionless surface to surface contact considered for the ligaments of humerus-radius, humerus-ulna, and radius-ulna.

Five different loading scenarios were considered for both models A and model B. These loading conditions represent different conditions each hand encounters with. These loading conditions include pronation (500, 1000, 2000, and 5000 N.mm), supination (500, 1000, 2000, and 5000 N.mm), dorsal loading (10, 30, and 50 N), volar loading (10, 30, and 50 N), and traction (100, 150, and 200 N). To simulate the supination loading, first the 180 ºrotation is applied to the Ulna and Radius with the origin depicted in Figure 2, then the torque is applied. In all simulations, the proximal surface of Humerus was fixed. All loading conditions are depicted in Figure 2.

Applying torque on the wrist in pronation and supination in the distal radius side is inserted, and the amount of torque in the joint dislocation is recorded.

Finite element analysis

ABAQUS-CAE was used to build the finite element meshes with 4-noded linear tetrahedrons. After simulating the convergence analysis to get sufficient accuracy in the results. All simulations performed with ABAQUS (ABAQUS 6.11, Dassault Systèmes, Vélizy-Villacoublay, France).

The following results show the stress and displacement distribution in each region of the forearm bone and prosthesis in a healthy forearm (model A), a forearm with a prosthesis (model B), and the prosthesis and screws in different loading conditions.

Figure 3 shows the maximum principal stress distribution in model A and model B with different loading conditions. The results of pronation and supination with 1000 N.mm, volar and dorsal with 30 N and traction with 150 N are depicted in this figure. In supination, the maximum stress in model A is significantly higher than the model B. The maximum principal stress of both models is similar during volar and dorsal loading. However, the amount of stress during the dorsal is about 70 MPa and in the volar is about 31 MPa. There is a significant difference between model A and model B in traction. In this loading condition, in model A, the maximum principal stress is about 68 MPa, while in model B, it is about 850 MPa. Figure 4 shows the distribution of minimum principal stress in each loading condition as depicted for maximum principal stress. In model B the absolute value of minimum principal stress is in pronation, and supination is higher than model A.

Figure 5 shows the distribution of von Mises stress in each loading condition in the prosthesis and the screws. As can be seen, the prostheses and screws are subjected to higher stresses during pronation than supination. Also, the amount of stress created in prostheses and screws during volar and dorsal loading is almost equal. In traction loading, screws are subjected to very high stresses.

The displacement in the bone and prosthesis in model B during the pronation and supination is significantly higher than in model A. Still, no significant difference is observed during volar and dorsal loading between models A and B. While in the loading of the traction force, there is higher displacement in model B. The results obtained in all loading conditions during supination and pronation movements, the forces applied in volar, dorsal and traction loading are reported in Tables 1, 2 and 3, respectively, and the comparison of these results is shown in the following diagrams (Fig. 6,7).

Table 1

Stress and displacement values in all loadings during supination and pronation
Loading condition			500(N/mm)	1000(N/mm)	2000(N/mm)	5000(N/mm)
	model A	Maximum principal stress (MPa)	35.00	70.30	140.8	351.9
		Minimum principal stress (MPa)	-28.88	-57.71	-115.2	-286.2
		Displacement (mm)	2.35	4.38	8.80	22.27
Supination	model B	Maximum principal stress (MPa)	80.70	152.1	294.1	722.2
		Minimum principal stress (MPa)	-115.3	-603.0	-1166	-2863
		Displacement (mm)	7.02	14.83	28.23	65.90
	prosthesis	von Mises stress (MPa)	10.3	20.5	41.36	61.4
	screws	von Mises stress (MPa)	50.12	80.3	110.0	200.1
	model A	Maximum principal stress (MPa)	32.83	65.0	128.9	320.1
		Minimum principal stress (MPa)	-37.59	-74.92	-149.2	-370.3
		Displacement (mm)	1.47	2.66	5.20	13.10
Pronation	model B	Maximum principal stress (MPa)	40.76	79.25	276.3	384.6
		Minimum principal stress (MPa)	-68.97	-132.1	-195.2	-637.2
		Displacement (mm)	20.92	42.0	83.0	140.2
	prosthesis	von Mises stress (MPa)	110.2	220.13	380.7	800.1
	screws	von Mises stress (MPa)	90.4	180.3	360.6	800.0

Table 2

Stress and displacement values in volar and dorsal loads
			10(N)	30(N)	50(N)
	model A	Maximum principal stress (MPa)	12.89	37.26	62.12
		Minimum principal stress (MPa)	-28.24	-81.49	-135.9
		Displacement (mm)	1.02	2.99	4.98
Volar	model B	Maximum principal stress (MPa)	80.70	152.1	294.1
		Minimum principal stress (MPa)	-115.3	-603.0	-1166
		Displacement (mm)	0.90	2.45	4.08
	prosthesis	von Mises stress (MPa)	25.1	74.9	131.4
	screws	von Mises stress (MPa)	9.5	18.6	28.7
	model A	Maximum principal stress (MPa)	23.42	72.18	120.0
		Minimum principal stress (MPa)	-14.01	-36.03	-58.27
		Displacement (mm)	0.89	2.71	4.52
Dorsal	model B	Maximum principal stress (MPa)	22.81	70.17	118.0
		Minimum principal stress (MPa)	-8.03	-24.55	-41.18
		Displacement (mm)	1.08	2.99	4.92
	prosthesis	von Mises stress (MPa)	25.3	75.6	130.2
	screws	von Mises stress (MPa)	3.5	8.4	15.4

Table 3

Stress and displacement values in traction loads
			100(N)	150(N)	200(N)
	model A	Maximum principal stress (MPa)	45.10	67.73	90.39
		Minimum principal stress (MPa)	-12.78	-19.19	-25.5
		Displacement (mm)	5.00	7.46	9.95
Traction	model B	Maximum principal stress (MPa)	568.3	852.5	1137.0
		Minimum principal stress (MPa)	-429.3	-652.2	-876.8
		Displacement (mm)	11.94	18.12	24.27
	prosthesis	von Mises stress (MPa)	130.14	190.05	248.63
	screws	von Mises stress (MPa)	400.21	604.3	816.41

This study compared Moradi interosseous DRUJ prosthesis with a healthy forearm using a finite element analysis method. The only related article to our work was a study on 16 cadavers, evaluating the stability of Moradi DRUJ prosthesis [16]. We hope that the mechanical results of this study will be an experimental guide to the use of this prosthesis in clinical surgeries as well as to improve its design.

According to the cadaver study, the prosthesis is stable during the pronation, but it is slightly unstable in supination, and three out of 16 dislocations were reported. This study examines the distribution of stress in bone and prosthesis. As shown in Fig. 7, the stress created in the forearm bone during the pronation is significantly less than the supination. However, the stress created in the prosthesis and screws during the pronation is more than the stresses created with supination. Also, bone and prosthesis displacement during pronation was greater than supination. By comparing these results, it can be concluded that when the stress on bone are smaller, loosening of the screws and components of the prosthesis is less likely, which can cause the reducing the instability and failure of prosthesis. On the other hand, due to the obtained values, especially in the cases with higher loads, it is necessary to do more research on the design and placement of the prosthesis.

Also, Moradi et al., In a clinical study, analyzed five patients (four men and one woman) with a mean age of 48.8 years and a mean follow-up of 27.6 months who underwent intraosseous DRUJ replacement surgery. This study showed out of five patients, four cases completed the follow-up period with no complications. However, one of the patients faced prosthesis dislocation two weeks after the operation [15].

In the cadaver study of the stability of the prosthesis during traction force loading, the prosthesis showed significant stability by applying traction force of 150 N, and no dislocation was observed in the prosthesis. In the present study, as shown in Fig. 7, the bone in model B is subjected to significant stress during this loading condition. Also, hand and prosthesis displacement with this loading is higher than the displacement in healthy hand. On the other hand, although the amount of stress created in the prosthesis is acceptable, the screws are under relatively high stress. Whether this amount of stress exposes the stability and function of the prosthesis to dislocation and failure requires further investigation.

The cadaver study reported that the prosthesis was very stable during volar loading, and no dislocation was observed during applying this loading, but during dorsal loading, the prosthesis was unstable, and four dislocations out of 16 cadavers were recorded. As can be seen in Fig. 7, in examining the stress distribution in the bone and prosthesis during these loadings, the stresses on model B is significant during the volar loading, while in the dorsal loading, there is not a significant stress difference between Model A and B. Although the stress distribution in the prosthesis is approximately the same during both loadings, but the stresses on screws are almost twice the stresses created with the volar loading. Also, the displacement in both loads is almost equal for both models, which is significant.

Some studies in forearm computational analysis have focused on the kinematic and instability of the DRUJ, and few studies have examined the biomechanical behavior of the joint and DRUJ prosthesis under various loading conditions [2]. Khuyagbaatar et al. evaluated the stability of the DRUJ when using a stabilizer [20]. Bajuri et al. investigated the stress distribution in wrist arthroplasty in rheumatoid arthritis [21]. Austman et al. compared the stresses induced on the bone before and after using a cemented distal ulnar implant [3]. Tan et al. simulated the Monteggia fracture using the finite element method [22]. Zhang et al. evaluated locking plates in head fracture fixation [19]. Although these studies provide valuable information in DRUJ computational analysis, none of them simulated the distal prosthesis under different loading conditions.

In this study, as in other similar studies, there are some limitations that should be considered in the future. Simulation of the wrist area was not performed due to simplification. Considering this area can be effective in the better application of boundary conditions. The applied loads are concentrated, while for more realistic results, it is better to use the loads through the reaction of the muscles [23]. The mechanical properties of ligaments and cartilages were considered linearly elastic, while ligaments and cartridges exhibit time-dependent nonlinear behavior [24]. Applying a viscoelastic model to the ligament can be beneficial in achieving better results. Although in this study, the two cortical and trabecular parts of the bone were completely identified, the mechanical properties of the bone have a heterogeneous distribution and change based on osteoblasts and osteoclasts interaction due to the well-known bone remodeling procedure [25, 26]. Considering bone remodeling and the effects of bone damage due to overloading of the functions that the prosthesis may cause can be important in better studying the behavior of the prosthesis. The constructed geometry in this study was based on CT images related to a 33 years old healthy man, so the assigned material properties were chosen accordingly based on data available for healthy bone. As we know, in the presence of disease like osteoarthritis, the stability and function of the prosthesis are greatly affected. Considering patients with such disease and assigning the related properties can open a new perspective in studying the DRUJ prosthesis. Finally, a case study on this type of prosthesis recipient and applying mechanical properties and boundary conditions according to the patient's characteristics can provide helpful information and effective future clinical decisions.

In conclusion, our study indicated that Moradi interosseous DRUJ prosthesis looks stable. It should be noted that initially the screws are subjected to more stress during the pronation movement, and it is important to know where the union will form. But in supination, the most stressed part is the prosthesis, which may lead to its failure. Therefore, until the bone and prosthesis are welded, our main concern is in the pronation and on the screws, and there is a possibility of dislocation after welding during the supination movement.

Consent for publication: Not applicable

Competing interests: The authors declare that they have no competing interests.

Acknowledgements: Not applicable

Funding: This work was supported by Mashhad University of Medical Sciences [Research Project No: 970506].

Ethics approval and consent to participate: Ethics approval and consent to participate: This study was approved by the Research Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran (approval number: IR.MUMS.REC.1396.334). This research was conducted in full compliance with the codes of ethical conduct from the Declaration of Helsinki. Written informed consent were obtained from the patients before they were enrolled in the study.

Statement of the location: This work was performed in Mashhad university of medical sciences and Sahand University of Technology.

data availability statement: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Authors' contributions:

AM: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

FG: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

MA: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

All authors read and approved the final manuscript.

Fuchs N, Meier L, Giesen T, Calcagni M, Reissner L: Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications. Hand Surgery and Rehabilitation 2020, 39(3):186–192.
Thomas BP, Sreekanth R: Distal radioulnar joint injuries. Indian journal of orthopaedics 2012, 46(5):493–504.
Austman RL, King GJ, Dunning CE: Bone stresses before and after insertion of two commercially available distal ulnar implants using finite element analysis. Journal of Orthopaedic Research 2011, 29(9):1418–1423.
DARRACH W: Partial Excision of Lower Shaft of Ulna for Deformity Following Colles's Fracture. Clinical Orthopaedics and Related Research (1976–2007) 1992, 275:3–4.
Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD: Failed distal ulna resections. The Journal of hand surgery 1988, 13(2):193–200.
Field J, Majkowski R, Leslie I: Poor results of Darrach's procedure after wrist injuries. The Journal of bone and joint surgery British volume 1993, 75(1):53–57.
Minami A, Iwasaki N, Ishikawa J-i, Suenaga N, Yasuda K, Kato H: Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. Hand Surgery 2005, 10(02n03):243–248.
Bowers WH: Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. The Journal of hand surgery 1985, 10(2):169–178.
Kapandji I: The Kapandji-Sauvé operation. Its techniques and indications in non rheumatoid diseases. Annales de chirurgie de la main: organe officiel des societes de chirurgie de la main 1986, 5(3):181–193.
Lees V, Scheker L: The radiological demonstration of dynamic ulnar impingement. Journal of Hand Surgery 1997, 22(4):448–450.
Hagert C-G: The distal radioulnar joint in relation to the whole forearm. Clinical orthopaedics and related research 1992(275):56–64.
Laurentin-Pérez L, Goodwin A, Babb B, Scheker L: A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis. Journal of Hand Surgery (European Volume) 2008, 33(1):18–28.
Moradi A, Binava R, Vahedi E, Ebrahimzadeh MH, Jesse B J: Distal Radioulnar Joint Prosthesis. The Archives of Bone and Joint Surgery 2021, 9(1):22–32.
van Schoonhoven J, Fernandez DL, Bowers WH, Herbert TJ: Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. The Journal of hand surgery 2000, 25(3):438–446.
Moradi A, Binava R, Hasanabadi SE, Vahedi E, Ebrahimzadeh MH: Introduction and Early Outcomes of Intraosseous Distal Radioulnar Joint Prosthesis: A Pilot Study and a Technique on a New Design of the Sauvé-Kapandji Procedure. Archives of Bone and Joint Surgery 2020, 8(6):703.
Moradi A, Binava R, Hedjazi A, Hasanabadi SE, Chaharjouy NT, Ebrahimzadeh MH: Biomechanical Evaluation of Intraosseous Distal Radioulnar Joint Prosthesis: A Prosthesis Designed Based on Sauvé-Kapandji Procedure. Orthopaedics & Traumatology: Surgery & Research 2021:102975.
Miguel-Andres I, Alonso-Rasgado T, Walmsley A, Watts AC: Effect of anconeus muscle blocking on elbow kinematics: electromyographic, inertial sensors and finite element study. Annals of biomedical engineering 2017, 45(3):775–788.
Rezende CEE, Chase-Diaz M, Costa MD, Albarracin ML, Paschoeto G, Sousa EAC, Rubo JH, Borges AFS: Stress distribution in single dental implant system: three-dimensional finite element analysis based on an in vitro experimental model. Journal of Craniofacial Surgery 2015, 26(7):2196–2200.
Zhang Y, Shao Q, Yang C, Ai C, Zhou D, Yu Y, Sun G: Finite element analysis of different locking plate fixation methods for the treatment of ulnar head fracture. Journal of Orthopaedic Surgery and Research 2021, 16(1):1–13.
Khuyagbaatar B, Lee S-J, Cheon M, Batbayar T, Ganbat D, Kim YH: Effect of wrist-wearing distal radioulnar joint stabilizer on distal radioulnar joint instability using a forearm finite element model. Journal of Mechanical Science & Technology 2019, 33(5).
Bajuri M, Kadir MRA, Murali MR, Kamarul T: Biomechanical analysis of the wrist arthroplasty in rheumatoid arthritis: a finite element analysis. Medical & biological engineering & computing 2013, 51(1):175–186.
Tan J, Mu M, Liao G, Zhao Y, Li J: Biomechanical analysis of the annular ligament in Monteggia fractures using finite element models. Journal of orthopaedic surgery and research 2015, 10(1):1–6.
Ashrafi M, Ghalichi F, Mirzakouchaki B, Doblare M: On the effect of antiresorptive drugs on the bone remodeling of the mandible after dental implantation: a mathematical model. Scientific Reports 2021, 11(1):1–20.
Ashrafi M, Ghalichi F, Mirzakouchaki B, Zoljanahi Oskui I: Numerical simulation of hydro-mechanical coupling of periodontal ligament. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2020, 234(2):171–178.
Ashrafi M, Gubaua JE, Pereira JT, Gahlichi F, Doblaré M: A mechano-chemo-biological model for bone remodeling with a new mechano-chemo-transduction approach. Biomechanics and Modeling in Mechanobiology 2020, 19(6):2499–2523.
Ashrafi M, Ghalichi F, Mirzakouchaki B, Arruga A, Doblare M: Finite element comparison of the effect of absorbers' design in the surrounding bone of dental implants. International journal for numerical methods in biomedical engineering 2020, 36(1):e3270.

No competing interests reported.

Download PDF

Editorial decision: Major revision
12 Jul, 2022
Reviews received at journal
10 Jul, 2022
Reviewers agreed at journal
07 Jul, 2022
Reviews received at journal
01 Jul, 2022
Reviewers agreed at journal
30 Jun, 2022
Reviewers agreed at journal
30 May, 2022
Reviewers invited by journal
27 May, 2022
Editor assigned by journal
27 May, 2022
Editor invited by journal
27 May, 2022
Submission checks completed at journal
27 May, 2022
First submitted to journal
13 May, 2022

You are reading this latest preprint version

Finite element analysis of intraosseous distal radioulnar joint prosthesis

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

Introduction

Materials And Methods

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1