October 2004

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Mechano
Mechano
- Bi ol ogi cal
- Bi ol ogi cal
Coupl ed F
Coupl ed F
i el d Anal ysi s
i el d Anal ysi s
Uwe Winter, Kx Simulation Technologies, Inc., presents an iterative finite element method for the simulation of the
adaptive remodeling of bone in response to mechanical influences.
L
iving bone continually reshapes itself as it adapts to
var ying loading conditions. Changes in the stress
and strain distribution in bone tissue are known to
stimulate cell activity, causing bone tissue to increase its
density in response to high load levels, while decreased
load levels will trigger the bone material to resorb
(breakdown). The process whi ch regul at es t hi s
relationship between mechanical stimuli and bone density
is called bone remodeling .
Underst andi ng and bei ng abl e t o predi ct t hi s
phenomenon is of particular interest to the orthopaedic
industr y: whenever an implant is inserted into the body,
existing bone has to be removed for the implant to take its
place. This alters the load path and the strain distribution
for the bone tissue in the vicinity of the implant, causing a
redistribution of bone mass at the implant-bone inter face.
While the deposition of higher density bone material near
the implant is desirable for good fixation, localized bone
resorption may result in the loosening of the device,
resulting in pain for the patient.
Thi s art i cl e i nt roduces BORA (BOne Remodel i ng
Algorithm), a finite element method based program
developed to simulate the mechano-biological coupled
field response of bone remodeling using ANSYS. The
program features discussed here reflect the most recently
completed stage of a multi-phase sof tware development
project commissioned by DePuy Orthopaedics (a Johnson
& Johnson company based in Warsaw, Indiana).
Ul t i mat el y, BORA wi l l be used as an i nt egrat ed
engineering tool allowing design engineers to compare
different prosthesis designs and, given a patient s lifestyle,
medical histor y, and specific bone structure, determine the
ideal implant which leads to a minimal amount of bone
resorption and optimal bone adaptation.
Theoret ical Background
It is assumed that bone material has sensors, which can
detect a mechanical stimulus, and, depending on the
magnitude of the stimulus, cause local bone adaptations,
i.e. a change in density over a specific time increment.
Various mathematical models for relating bone density
distribution to the internal loads in the bone tissue have
been proposed over the years. Furthermore, it has been
shown that there is a relationship between density and the
mechanical properties of bone as discussed below.
Densit y Evolut ion Equat ions
The sof tware is based on the equations presented by
Weinans [ 1] . The objective function implemented into
ANSYS for the rate of change of the apparent density is
shown with equation (1).
(1)
B is an empirical remodeling constant, S is the mechanical
stimulus and k is the reference stimulus, also frequently
referred to as the attractor state.
The mechanical stimulus is defined as the strain energy
density per unit mass (referred to as SED in this article),
and the magnitude and the effect of the stimulus is
determined by comparing the SED distribution in the bone
material to the reference stimulus k. All calculations are
per formed on a per element basis, i.e. there is one sensor
point per element. The mechanical stimulus is readily
obtained from a structural analysis and the corresponding
density increment for each element can be calculated with
a given time increment using equation (1). The adapted
element density is then simply new= + .
As the density changes for the individual elements, the
stiffness of the continuum needs to be updated as well.
The structural properties of bone are related to density
according to the following relationship:
(2)
where E is the modulus of elasticity, the constant c and the
exponent are remodeling constants.
The calculation steps described above represent one
remodeling iteration. In ever y subsequent iteration, the
mechanical stimulus and its proximity to the reference
value will be evaluated for each element, where the overall
structural response of the bone volume is based on the
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bi omechani cal l y adapt ed st i f f ness of t he i ndi vi dual
elements from the previous iteration. This iterative
process continues until all bone mass is in remodeling
equilibrium.
Bone Tissue Terminology
There are two main types of bone tissue: cancellous
( spongy ) and cortical ( compact ) bone, as illustrated in
Figure 1 showing a section through a tibia. Cancellous
bone is less dense and consists of trabeculae (plates and
bars) forming an irregular network of cavities. The
t rabecul ae are of part i cul ar i nt erest t o t he bone
remodel i ng si mul at i on because of t hei r abi l i t y t o
rearrange themselves in response to changing loading
conditions.
Figure 1: Cross-section through tibia showing morphological features of bone
Implement at ion
Densit y as a DOF in a Nonlinear Syst em
Simulating bone remodeling requires that density is not a
fixed material property but acts as an additional degree of
freedom [ DOF] for the mechano-biological coupled field
solution. Density is also the main result quantity of interest
and it dictates the structural response of the finite element
model because of its relationship with the modulus of
elasticity. Additionally, the density DOF has an imposed
upper and lower bound.
Convergence Checking
A remodeling solution is converged when all elements
have reached one of three states:
The element density has reached the minimum
value, i.e. all bone tissue has fully resorbed and a
void has formed at the element location.
The element has reached the maximum density
value, i.e. the element has turned into cortical
bone.
The elemental strain energy density per unit mass is
equal to the reference stimulus.
To allow the solution to continue until one of these three
conditions is met for ALL elements is desirable but
computationally an unrealistic expectation. Similar to
other nonlinear and iterative solution methods, BORA
provides convergence tolerance settings which are specific
to bone remodeling.
The user may specif y a tolerance for the reference
stimulus, in effect defining the width of a proximity band
around the attractor state. Elements with SED values in
the specified range will be treated as if they had reached
the attractor state, i.e. they are considered converged.
Addi t i onal set t i ngs al l ow t he user t o cont rol t he
percentage of elements expected to meet either of the
three converged states.
However, as with any nonlinear iterative solution, a
converged solution does not necessarily imply an accurate
solution. The user still needs to establish that the
predicted bone morphology reflects an adequate and
realistic density distribution.
Adapt ive Time St epping
An adaptive time stepping algorithm is used to adjust the
time increment to suit the goal of solution efficiency such
t hat a desi rabl e densi t y i ncrement i s mai nt ai ned
throughout the solution for a representative group of over-
and under-stimulated elements. The algorithm adapts
itself to the convergence histor y of the model and switches
to more conser vative time step calculations as more and
more elements reach a converged state.
Program-Suggest ed Ref erence St imulus
As illustrated with equation (1) the reference stimulus k
dictates whether an element experiences a positive or a
negative density increment for a given SED state (over-
stimulated elements will lead to an increase in bone mass,
under-stimulated elements are driven towards becoming a
void). The correct value for the reference stimulus k is
rarely known and highly dependent on the structure and
t he l oad envi ronment , and real i st i c bone mat eri al
architecture will be produced for only a ver y specific range
of values.
For those cases when k is not known, BORA calculates a
suggested reference stimulus to provide the remodeling
simulation with a reasonable starting value and to
eliminate frustrating guesswork.
Solut ion Monit oring
There are several ways in which the sof tware provides the
user wi t h f eedback about t he progress and t he
convergence behavior of a remodeling simulation.
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Figure 2: Convergence histor y plot for a well-behaved BORA simulation
A set of convergence metrics is graphed throughout the
run and updated with each iteration (see Figure 2)
providing the user with vital information about the
remodeling progress:
e_minmax tracks how many elements have reached
either the minimum density (fully resorbed) or
maximum density (cortical bone) relative to all bone
elements in the model.
e_cnvrg displays the ratio of converged elements (at
the specified reference stimulus proximity) to all
active elements (elements which are NOT at either
density extreme).
e_remodl shows the percentage of elements that
are remodeling for each iteration.
sat_levl indicates the average normalized element
density level, the bone density saturation level of the
model.
Whenever a significant change in the convergence histor y
occurs, an entr y is added to a convergence histor y file.
This feature is intended to help the user better understand
t he model response and t o assi st i n debuggi ng
undesirable remodeling solutions.
Ut ilit ies
Frequently per formed tasks such as generating a density
saturation level plot and a remodeling status plot are
accessed through the toolbar. Other post-processing
options available from the toolbar include the graphing of
the histor y for various remodeling metrics such as the
change in total bone mass, the change in the overall
stiffness, the maximum and average density increment per
element, and the average proximity to the reference
stimulus. The convergence histor y displayed during
solution may be recalled and displayed as well. BORA
also includes an automatic report generator. This utility
automatically gathers all key model parameters, creates a
set of model and results plots, and generates a summar y
report in HTML format viewable with any browser.
Validat ion of t he Code
A human femur was selected as one of the test cases to
validate BORA. The simulation was started with a uniform
density distribution equal to 40% of the cortical bone
density. Static loads representing the stance phase of gait
for a person weighing 80 kg were applied.
If the density evolution equations implemented constitute
an accurat e represent at i on of t he bi omechani cal
phenomenon of bone remodeling, then the initially
uniform density distribution should adapt itself to the load
environment such that the natural formation of a cortical
layer and a trabecular framework is reproduced.
The trabecular architecture of a human femur is shown for
reference in Figure 3, together with the bone density
saturation level predicted for a 2-D femur model
1
. The
similarity between the two images is quite apparent. The
trabecular architecture is captured well and the cortical
layer predicted closely resembles the actual bone section.
(Elements at the maximum density level are shown in dark
gray, green contour bands indicate a saturation level of
40%, pale yellow contour bands correspond to voids in the
bone.)
Three frames from an animation of the remodeling histor y
(see Figure 4) highlight the evolution of the bone density
distribution throughout the simulation.
Figure 3:
Bone densi t y di st ri but i on i n
proximal femur (section through
bone, lef t BORA results and
nodal loads for 2-D model, right)
1
The FE modeling t echniques
employed to simulate the structural
response of a f emur using 2-D
elements are beyond the scope of this
article.
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The saturation level results for the 3-D femur model shown
in Figure 5 are equally encouraging. The simulation
predicts the formation of a hollow femur shaf t with a
realistic cortical layer, and a neck region consisting of the
expected trabecular framework
2
. Resorbed elements are
shown as translucent. Red contour bands correspond to
elements at the maximum density value.
Figure 6 shows the element convergence status at the end
of the solution. The majority of all elements have
converged (shown in green). Elements at either density
extreme are not displayed for clarity, blue elements are
under-stimulated, and red elements have SED values
greater than the reference stimulus.
Conclusions
The basic f ramework f or an ort hopaedic-specif ic
simulation tool has been established.
The biomechanical process of bone remodeling can be
simulated using the BORA program and ANSYS.
While preliminar y simulation results are encouraging,
more confidence in the accuracy of those predictions is
required before any engineering decisions can be
based on the results.
Improved user-f ri endl i ness and bet t er si mul at i on
process aut omat i on are essent i al bef ore t he
integration of BORA into the engineering process can
be considered.
Clinical data for the remodeling of bone around
implants need to be gathered for the validation of
simulations with an implant.
Ref erences
[ 1] Weinans, H., Huiskes, R. and Grootenboer, H. J. (1992) The
behavior of adaptive bone-remodeling simulation models. J.
Biomechanics 25, 1425-1441
Cont act
Uwe Wint er
Kx Simulation Technologies
E uwe.winter@kxinc.com
2
Future studies are expected to show that the excessive element
resorption in the neck region and the disappearance of part of the neck
envelope can be prevented if the tendon and other tissue loads in this
region are modeled more accurately.
Figure 4: Evolution of bone density distribution in proximal femur (from lef t to right: initial state, iteration 3, iteration 9)
Figure 5: Bone density distribution in 3-D femur predicted by BORA
(shown as a section view)
Figure 6: Remodeling status plot for 3-D femur