Modares Mechanical Engineering

Modares Mechanical Engineering

Biomechanical Effects of Different Fillers on Bone Defect Reconstruction: A Comparative Finite Element Analysis

Document Type : Original Article

Authors
Marjan Pourgholami 1
Farzaneh Safshekan 1
Ahmad Bagheri 2
Azadeh Ghouchani 3
1 Department of Mechanical Engineering, Ahrar Institute of Technology and Higher Education, Rasht, Iran
2 Department of Mechanical Engineering, University of Guilan, Rasht, Iran
3 Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
10.48311/mme.2026.120241.83010
Abstract
Benign bone tumors occur mainly in the epi-metaphyseal region of long bones, and surgery is the most effective treatment. Tumor recurrence and fractures are complications of following surgery. To reduce the risk of these complications, preoperative surgical simulation is recommended. This study uses FEA to investigate the mechanical effect of reconstructed models with different fillers. The simulations are considered for two defects of different sizes in the medial femoral condyle. The small defect simulates tumor curettage and the large defect simulates tumor curettage with some border texture. The fillers include several polymers, ceramics, and bioglasses. The mechanical performance of each filler in the reconstruction of defects under single-leg standing loading is evaluated by examining the maximum principal and von Mises stresses compared to the healthy model. In the epi-metaphyseal region of the healthy model, the maximum principal stress was 5.15 MPa and the maximum von Mises stress was 7.63 MPa. Among the materials tested, polyether ether ketone (PEEK) exhibits stress values very close to healthy bone. (with the values of the principal and von Mises stresses was 5.14 MPa and 7.66 MPa in the small defect and 5.16 MPa and 7.7 MPa in the large defect, respectively). However, Hydroxyapatite (HA), Beta-tricalcium phosphate and bioglasses showed the least mechanical compliance, which increased with increasing defect size. Comparison of the results obtained shows that the choice of filler depends on the size of the defect. These findings highlight the role of FEA in predicting surgical outcomes and postoperative bone strength.
Keywords
Finite element analysis
Femur
Filler
Bone tumor
Subjects
[1] D. N. Hakim, T. Pelly, M. Kulendran, and J. A. Caris, “Benign tumours of the bone: A review,” J. Bone Oncol., vol. 4, no. 2, pp. 37–41, 2015, doi:10.1016/j.jbo.2015.02.001.
[2] H. Fritzsche, K. D. Schaser, and C. Hofbauer, “Benigne Tumoren und tumorähnliche Läsionen des Knochens: Allgemeine Behandlungsprinzipien,” Orthopade, vol. 46, no. 6, pp. 484–497, 2017, doi:10.1007/s00132-017-3429-z
[3] H. Sugiyama et al., “Characteristics of Benign and Malignant Bone,” JBJS Open Access, vol. 3, no. 2, pp. 1–11, 2018.
[4] P. Behrendt, T. Grunow, F. K-H, M. Krause, H. Fahlbusch, and M. Priemel, “Correction to: Not every knee tumour is a ganglion - retrospective analysis of benign and malign tumour entities around the knee (Archives of Orthopaedic and Trauma Surgery, (2024), 10.1007/s00402-024-05401-7),” Arch. Orthop. Trauma Surg., pp. 3227–3234, 2024, doi:10.1007/s00402-024-05494-0.
[5] I. T. Badr, M. M. Moawad, A. O. Elgebery, B. A. Hakim, and B. Z. Hasan, “Filling of the resultant cavity after curettage of benign bone tumours is still controversial,” Med. J. Malaysia, vol. 78, no. 2, pp. 163–170, 2023.
[6] A. Ghouchani and G. Rouhi, “The Great Need of a Biomechanical-Based Approach for Surgical Methods of Giant Cell Tumor: A Critical Review,” Journal of Medical and Biological Engineering, vol. 37, no. 4. Springer Berlin Heidelberg, pp. 454–467, Aug. 01, 2017. doi:10.1007/s40846-017-0278-5.
[7] Y. Wang, Q. Tian, C. Wu, H. Li, J. Li, and Y. Feng, “Management of the Cavity After Removal of Giant Cell Tumor of the Bone,” Front. Surg., vol. 8, no. July, pp. 1–13, 2021, doi:10.3389/fsurg.2021.626272.
[8] A. Ghouchani, M. H. Ebrahimzadeh, and G. Rouhi, “The Most Appropriate Reconstruction Method Following Giant Cell Tumor Curettage: A Biomechanical Approach,” 2018. [Online]. Available: http://abjs.mums.ac.irtheonlineversionofthisarticleabjs.mums.ac.ir.
[9] R. Morrison, “Bone Grafts and Bone Graft Substitutes,” Man. Spine Surg. Second Ed., pp. 77–82, 2023, doi:10.1007/978-3-662-64062-3_12.
[10] J. H. Cho and H. K. Song, “Current concepts and applications of bone graft substitutes in orthopedic surgery,” vol. 38, no. 4, pp. 169–177, 2025. doi:10.12671/jmt.2025.00248.
[11] Z. Wang, I. C. van der Geest, S. C. Leeuwenburgh, and J. J. van den Beucken, “Bifunctional bone substitute materials for bone defect treatment after bone tumor resection,” Mater. Today Bio, vol. 23, no. October, p. 100889, 2023, doi:10.1016/j.mtbio.2023.100889.
[12] L. Gyemi, A. Selznick, B. Petrisor, and M. Ghert, “Time to full weight-bearing with the use of a calcium sulfate-calcium phosphate bone substitute as a bone void filler following extended curettage in the treatment of primary benign bone tumours,” J. Orthop. Surg., vol. 32, no. 2, pp. 1–9, 2024, doi:10.1177/10225536241254200.
[13] S. Sakdejayont, T. Chobpenthai, P. Suksirivecharuk, I. F. Ninatkiattikul, and T. Poosiripinyo, “A Review on Bone Tumor Management: Cutting-Edge Strategies in Bone Grafting, Bone Graft Substitute, and Growth Factors for Defect Reconstruction,” Orthop. Res. Rev., vol. 17, no. May, pp. 175–188, 2025, doi:10.2147/ORR.S521832.
[14] P. Aroonjarattham and M. Chanasakulniyom, “Biomechanical Effect of Filled Biomaterials on Distal Thai Femur by Finite Element Analysis,” 2015.
[15] B. Dou, F. Zhang, M. Ni, Y. Dai, Z. Wang, and T. Qin, “Biomechanical and finite element study of drilling sites for benign lesions in femoral head and neck with curettage , bone-grafting and internal fixation,” vol. 16, no. August, pp. 7808–7828, 2019, doi:10.3934/mbe.2019392.
[16] P. K. Wu, C. W. Lee, W. H. Sun, and C. L. Lin, “Biomechanical analysis and design method for patient-specific reconstructive implants for large bone defects of the distal lateral femur,” Biosensors, vol. 12, no. 1, 2022, doi:10.3390/bios12010004.
[17] A. Ghouchani, G. Rouhi, and M. H. Ebrahimzadeh, “Post-operative fracture risk assessment following tumor curettage in the distal femur: a hybrid in vitro and in silico biomechanical approach,” Sci. Rep., vol. 10, no. 1, pp. 1–13, 2020, doi:10.1038/s41598-020-78188-3.
[18] P. Bazyar, A. Baumgart, H. Altenbach, and A. Usbeck, “An Overview of Selected Material Properties in Finite Element Modeling of the Human Femur,” Biomech., vol. 3, no. 1, pp. 124–135, 2023, doi:10.3390/biomechanics3010012.
[19] T. V. Chirila and Y. Hong, The vitreous humor. 2016. doi:10.1007/978-1-4939-3305-1_12.
[20] Z. Sheikh, S. Najeeb, Z. Khurshid, V. Verma, H. Rashid, and M. Glogauer, “Biodegradable materials for bone repair and tissue engineering applications,” Materials (Basel)., vol. 8, no. 9, pp. 5744–5794, 2015, doi:10.3390/ma8095273.
[21] P. Dec, A. Modrzejewski, and A. Pawlik, “Existing and Novel Biomaterials for Bone Tissue Engineering,” Int. J. Mol. Sci., vol. 24, no. 1, pp. 1–14, 2023, doi:10.3390/ijms24010529.
[22] I. Ajaxon et al., “Elastic properties and strain-to-crack-initiation of calcium phosphate bone cements: Revelations of a high-resolution measurement technique,” J. Mech. Behav. Biomed. Mater., vol. 74, no. June, pp. 428–437, 2017, doi:10.1016/j.jmbbm.2017.06.023.
[23] I. Ayadi and F. Ben Ayed, “Mechanical optimization of the composite biomaterial based on the tricalcium phosphate, titania and magnesium fluoride,” J. Mech. Behav. Biomed. Mater., vol. 60, pp. 568–580, 2016, doi:10.1016/j.jmbbm.2016.03.020.
[24] I. Koh, A. López, B. Helgason, and S. J. Ferguson, “The compressive modulus and strength of saturated calcium sulphate dihydrate cements: Implications for testing standards,” J. Mech. Behav. Biomed. Mater., vol. 34, pp. 187–198, 2014, doi:10.1016/j.jmbbm.2014.01.018.
[25] L. C. Gerhardt and A. R. Boccaccini, “Bioactive glass and glass-ceramic scaffolds for bone tissue engineering,” Materials (Basel)., vol. 3, no. 7, pp. 3867–3910, 2010, doi:10.3390/ma3073867.
[26] H. A. Bai et al., “Biomechanical evaluation of three implants for treating unstable femoral intertrochanteric fractures: finite element analysis in axial, bending and torsion loads,” Front. Bioeng. Biotechnol., vol. 11, no. November, pp. 1–10, 2023, doi:10.3389/fbioe.2023.1279067.
[27] R. A. Moga, C. D. Olteanu, B. M. Daniel, and S. M. Buru, “Finite Elements Analysis of Tooth — A Comparative Analysis of Multiple Failure Criteria,” 2023. doi:0.3390/ijerph20054133.
[28] H. Yang, X. Ma, and T. Guo, “Some factors that affect the comparison between isotropic and orthotropic inhomogeneous finite element material models of femur,” Med. Eng. Phys., vol. 32, no. 6, pp. 553–560, 2010, doi:10.1016/j.medengphy.2010.01.004.
[29] A. Gujar, R., Warhatkar, H., & Kale, “Finite element analysis (FEA) of femur to predict biomechanical properties and its validation.,” J. Mech. Eng. Sci., vol. 238, no. 5, pp. 1173–1181, 2024, doi:doi:10.1177/09544062231185508.
[30] S. Van Den Munckhof and A. A. Zadpoor, “How accurately can we predict the fracture load of the proximal femur using finite element models?,” Clin. Biomech., vol. 29, no. 4, pp. 373–380, 2014, doi: 10.1016/j.clinbiomech.2013.12.018.
[31] Senra, M. R., & Marques, M. d. F. V. (2020). Synthetic Polymeric Materials for Bone Replacement. Journal of Composites Science, 4(4), 191. doi:10.3390/jcs4040191.
[32] S. Dallal, B. Eslami, and S. Tiari, “Recent Advances in PEEK for Biomedical Applications: A Comprehensive Review of Material Properties, Processing, and Additive Manufacturing,” Polymers (Basel)., vol. 17, no. 14, pp. 1–26, 2025, doi:10.3390/polym17141968.
[33] W. Zhang, “Personalised 3D-printed bioactive peek bone plate scaffold for treating femoral defects,” pp. 5060–5072, 2025, doi:10.1039/d4ra07573k.
[34] X. Zhang et al., “Polymer-Ceramic Spiral Structured Scaffolds for Bone Tissue Engineering : Effect of Hydroxyapatite Composition on Human Fetal Osteoblasts,” vol. 9, no. 1, pp. 2–11, 2014, doi:10.1371/journal.pone.0085871.
[35] R. Agrawal, A. Kumar, M. K. A. Mohammed, and S. Singh, “Biomaterial types, properties, medical applications, and other factors: a recent review,” J. Zhejiang Univ. Sci. A, vol. 24, no. 11, pp. 1027–1042, 2023, doi:10.1631/jzus.A2200403.
[36] J.-T. Lee et al., “Optimized 3D-Printed Polylactic Acid/Graphene Oxide Scaffolds for Enhanced Bone Regeneration,” Bioengineering, vol. 12, no. 11, p. 1192, 2025, doi:10.3390/bioengineering12111192.
[37] X. Yan, Y. Wei, Y. Luo, Z. Wu, Z. Liu, and H. Liao, “Functionalization of 3D printed PLGA-based scaffolds for bone regeneration,” Regen. Ther., vol. 30, no. May, pp. 884–899, 2025, doi:10.1016/j.reth.2025.10.003.
[38] R. Álvarez-Chimal, L. Pérez-Sánchez, J. Serrano-Bello, F. C. Vázquez-Vázquez, and M. A. Álvarez-Pérez, “3D printing with polylactic acid (PLA) in bone regeneration using animal models: a systematic review,” AIMS Bioeng., vol. 12, no. 4, pp. 453–472, 2025, doi:10.3934/bioeng.2025022.
[39] A. Motameni, A. Z. Alshemary, and Z. Evis, “A review of synthesis methods, properties and use of monetite cements as filler for bone defects,” Ceram. Int., vol. 47, no. 10, pp. 13245–13256, 2021, doi:10.1016/j.ceramint.2021.01.240.
[40] J. Benevenia et al., “Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications,” Clin. Orthop. Relat. Res., vol. 475, no. 3, pp. 776–783, 2017, doi:10.1007/s11999-016-4755-x.
[41] S. Ramanathan, Y. C. Lin, S. Thirumurugan, C. C. Hu, Y. F. Duann, and R. J. Chung, “Poly(methyl methacrylate) in Orthopedics: Strategies, Challenges, and Prospects in Bone Tissue Engineering,” Polymers (Basel)., vol. 16, no. 3, 2024, doi:10.3390/polym16030367.
[42] D. Liu, C. Cui, W. Chen, J. Shi, B. Li, and S. Chen, “Biodegradable Cements for Bone Regeneration,” J. Funct. Biomater., vol. 14, no. 3, 2023, doi:10.3390/jfb14030134.
[43] F. E. Ranjbar et al., “Kaempferol-loaded bioactive glass-based scaffold for bone tissue engineering: in vitro and in vivo evaluation,” Sci. Rep., vol. 13, no. 1, pp. 1–14, 2023, doi:10.1038/s41598-023-39505-8.
[44] M. A. Elnaggar, H. A. Elnoamany, and M. K. Eissa, “Clinical evaluation of 3D PEEK implants for skull bone defects repair: a single center case serious,” Egypt. J. Neurosurg., vol. 40, no. 1, 2025, doi:10.1186/s41984-025-00374-0.
[45] S. Farjaminejad et al., “Advances and Challenges in Polymer-Based Scaffolds for Bone Tissue Engineering: A Path Towards Personalized Regenerative Medicine,” Polymers (Basel)., vol. 16, no. 23, 2024, doi:10.3390/polym16233303.    
[46] R. De Pace, S. Molinari, E. Mazzoni, and G. Perale, “Bone Regeneration : A Review of Current Treatment Strategies,” pp. 1–38, 2025. doi:10.3390/jcm14061838.
[47] H. T. Lu, C. C. Hsu, Q. Q. Jian, and W. T. Chen, “Biomechanical Study of Different Scaffold Designs for Reconstructing a Traumatic Distal Femur Defect Using Patient-Specific Computational Modeling,” C. - Comput. Model. Eng. Sci., vol. 142, no. 2, pp. 1883–1898, 2025, doi:10.32604/cmes.2025.057675.
[48] W. Chen, X., Tang, T., Chen, T., Li, Q., & Zhang, “Mechanical stability of intertrochanteric fracture of femur with different internal fixation systems,” Chinese J. Tissue Eng. Res., vol. 29, no. 9, 2025.
[49] P. A. Motlagh, M. Mirzaei, and V. Naeini, “Failure Prediction of Proximal Femur using quantitative computed tomography based finite element method,” vol. 15, no. 5, pp. 153–158, 2025. https://dor.isc.ac/dor/20.1001.1.10275940.1394.15.5.11.5.
[50] A. Type and A. History, “Biomechanical Analysis of Effect of Inclination Angle on Stress Distribution in the Acetabulum and Acetabularcup after Total Hip Arthroplasty,” vol. 19, no. 3, pp. 559–567, 2019. https://dor.isc.ac/dor/20.1001.1.10275940.1397.19.3.9.3
Modares Mechanical Engineering
Volume 26, Issue 12
December 2026
Pages 989-998