Long-term response of femoral density to hip implant and bone fracture plate: Computational study using a mechano-biochemical model

•Long-term response of femoral density to a hip implant and bone plate was predicted.•A mechano-biochemical bone remodeling model was employed in this study.•Regions directly beneath the plate experienced severe bone loss (up to ∼ –70%).•Average bone loss in anterior plated femur was the same as that in lateral one (–24%).•With respect to bone remodeling, anterior plating was not superior to lateral plating.

Although bone fracture plates can provide appropriate stability at the fracture site and lead to early patient mobilization, they significantly change the loading pattern in the bone after union (Stress shielding). This phenomenon results in a bone density decrease, which may cause premature failure of the implant. This paper presents the first study that quantifies the long-term response of femoral density to hip implantation and plating (lateral and anterior plating) using a mechano-biochemical model which considers the coupling effect between mechanical loading and biochemical affinities as stimuli for bone remodeling. The results showed that the regions directly beneath the plate experienced severe bone loss (i.e. up to ∼ –70%). However, some level of bone formation was observed in the vicinity of the most proximal and distal screw holes in both lateral and anterior plated femurs (i.e. up to ∼ +110%). The bone under the plate was divided into six zones. With respect to bone remodeling response, the findings revealed that anterior plating was not superior to lateral plating since the maximum and average bone losses among the zones in the anterior plated femur (i.e. –36% and –24%, respectively) were approximately the same as their corresponding values in the lateral plated femur (i.e. –38% and –24%, respectively).