Numerical simulations on periprosthetic bone remodeling: a systematic review

Background and objective: The aim of the present study was to review the literature concerning the analysis of periprosthetic bone remodeling through finite element (FE) simulation. Methods: A systematic review was conducted on 9 databases, taking into account a ten-year time period (from 2009 until 2020). The inclusion criteria were: articles published in English, publication date after 2009, full text articles, articles containing the keywords both in the abstract and in the title. The arti- cles were classified through the following parameters: dimensionality of the simulation, modelling of the bone-prosthesis interface, output parameters, type of simulated prosthesis, bone remodeling algorithm. Results: Sixty-seven articles were included in the study. Femur and tooth were the most evaluated bone segment (respectively 41.8% and 29.9%). The 55.2% of the evaluated articles used a bonded bone- prosthesis interface, 73% used 3D simulations, 67.2% of the articles (45 articles) evaluate the bone remod- eling by the bone density variation. At last, 59.7% of the articles employed algorithms based on a specific remodeling function. Conclusions: Increasing interest in the bone remodeling FE analysis in different bone segments emerged from the review, and heterogeneous solutions were adopted. An optimal balance between computa- tional cost and accuracy is needed to accurately simulate the bone remodeling phenomenon in the post- operative period.