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Background <p>Distal femoral reconstruction after tumor resection can be performed using osteoarticular allografts (OCH) or allograft–prosthesis composites (APC). Although both techniques restore bone stock, complications such as nonunion, graft fracture, and hardware failure remain frequent. These events are closely related to the mechanical environment at the host–graft junction, yet direct biomechanical comparison under identical conditions is limited. Therefore, this study aimed to compare the mechanical behavior of OCH and APC reconstructions following distal femoral tumor resection using finite element analysis, focusing on graft strain, hardware stress, and interfragmentary motion (IFM).</p> Methods <p>Two patient-specific finite element models were created from CT data, simulating a 150-mm distal femoral defect reconstructed either with a plate-fixed osteoarticular allograft (OCH) or with a cemented revision rotating-hinge allograft–prosthesis composite (APC). A 400&#xa0;N axial load was applied to represent early postoperative weight bearing. Equivalent strain, von Mises stress, IFM, and sliding distance at the host–graft interface were quantified.</p> Results <p>OCH demonstrated higher peak graft strain (5700 µε vs. 3200 µε) and increased IFM (median 6.5&#xa0;μm vs. 2.5&#xa0;μm) compared with APC. Hardware stress was 77&#xa0;MPa in OCH and 24&#xa0;MPa in APC. Sliding distance was also greater in OCH (3.5&#xa0;μm vs. 0.6&#xa0;μm). APC showed reduced graft strain and micromotion consistent with load redistribution through the prosthetic stem and cement mantle.</p> Conclusion <p>Under identical geometry and early postoperative loading conditions, OCH and APC reconstructions demonstrated distinct load-transfer patterns. OCH was associated with greater graft strain and micromotion, whereas APC demonstrated lower graft strain and greater construct rigidity. Rather than indicating superiority, the findings highlight that each reconstruction is governed by a characteristic mechanical environment that may influence its failure pattern.</p>

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Comparative host–graft biomechanics of osteoarticular allografts and allograft–prosthesis composites after distal femoral tumor resection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Vasileios Apostolopoulos,
  • Petr Boháč,
  • Michal Mahdal,
  • Luboš Nachtnebl,
  • Tomáš Návrat,
  • Tomáš Tomáš

摘要

Background

Distal femoral reconstruction after tumor resection can be performed using osteoarticular allografts (OCH) or allograft–prosthesis composites (APC). Although both techniques restore bone stock, complications such as nonunion, graft fracture, and hardware failure remain frequent. These events are closely related to the mechanical environment at the host–graft junction, yet direct biomechanical comparison under identical conditions is limited. Therefore, this study aimed to compare the mechanical behavior of OCH and APC reconstructions following distal femoral tumor resection using finite element analysis, focusing on graft strain, hardware stress, and interfragmentary motion (IFM).

Methods

Two patient-specific finite element models were created from CT data, simulating a 150-mm distal femoral defect reconstructed either with a plate-fixed osteoarticular allograft (OCH) or with a cemented revision rotating-hinge allograft–prosthesis composite (APC). A 400 N axial load was applied to represent early postoperative weight bearing. Equivalent strain, von Mises stress, IFM, and sliding distance at the host–graft interface were quantified.

Results

OCH demonstrated higher peak graft strain (5700 µε vs. 3200 µε) and increased IFM (median 6.5 μm vs. 2.5 μm) compared with APC. Hardware stress was 77 MPa in OCH and 24 MPa in APC. Sliding distance was also greater in OCH (3.5 μm vs. 0.6 μm). APC showed reduced graft strain and micromotion consistent with load redistribution through the prosthetic stem and cement mantle.

Conclusion

Under identical geometry and early postoperative loading conditions, OCH and APC reconstructions demonstrated distinct load-transfer patterns. OCH was associated with greater graft strain and micromotion, whereas APC demonstrated lower graft strain and greater construct rigidity. Rather than indicating superiority, the findings highlight that each reconstruction is governed by a characteristic mechanical environment that may influence its failure pattern.