Sacroiliac joint stability: Finite element analysis of implant number, orientation, and superior implant length

doi:10.5312/wjo.v9.i3.14

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World Journal of Orthopedics

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World J Orthop. Mar 18, 2018; 9(3): 14-23
Published online Mar 18, 2018. doi: 10.5312/wjo.v9.i3.14

Table 1 Sacroiliac joint range of motion for an intact model and 22 configurations of implant orientation, superior implant length, and number of implants

Treatment/orientation	Implant placed			Superior implant ending point	SI joint ROM (°) [Reduction in ROM (%)]
Treatment/orientation	Superior	Middle	Inferior	Superior implant ending point	Flexion-extension	Lateral bending	Axial rotation
Intact	-	-	-	-¹	1.94° (-)	0.66° (-)	1.11° (-)
Inline orientation	X	X	X	Mid-ala	0.7° (64%)	0.45° (32%)	0.41° (63%)
	X	X	X	Mid-sacrum	0.63° (68%)	0.41° (38%)	0.38° (66%)
	X	-	X	Mid-ala	0.82° (58%)	0.47° (29%)	0.44° (60%)
	X	-	X	Mid-sacrum	0.69° (64%)	0.43° (35%)	0.4° (64%)
	X	X	-	Mid-ala	0.97° (50%)	0.5° (24%)	0.49° (56%)
	X	X	-	Mid-sacrum	0.76° (61%)	0.45° (32%)	0.43° (61%)
	-	X	X	-¹	0.91° (53%)	0.53° (20%)	0.55° (50%)
	X	-	-	Mid-ala	1.36° (30%)	0.58° (12%)	0.67° (40%)
	X	-	-	Mid-sacrum	1.21° (38%)	0.58° (12%)	0.61° (45%)
	-	X	-	-¹	1.32° (32%)	0.65° (2%)	0.73° (34%)
	-	-	X	-¹	1.25° (36%)	0.69° (-5%)	0.79° (29%)
Transarticular orientation	X	X	X	Mid-ala	0.59° (70%)	0.41° (38%)	0.34° (69%)
	X	X	X	Mid-sacrum	0.52° (73%)	0.38° (42%)	0.31° (72%)
	X	-	X	Mid-ala	0.69° (64%)	0.42° (36%)	0.36° (68%)
	X	-	X	Mid-sacrum	0.58° (70%)	0.39° (41%)	0.32° (71%)
	X	X	-	Mid-ala	0.81° (58%)	0.45° (32%)	0.4° (64%)
	X	X	-	Mid-sacrum	0.64° (67%)	0.41° (38%)	0.35° (68%)
	-	X	X	-¹	0.76° (61%)	0.47° (29%)	0.46° (59%)
	X	-	-	Mid-ala	1.36° (30%)	0.58° (12%)	0.67° (40%)
	X	-	-	Mid-sacrum	1.21° (38%)	0.58° (12%)	0.61° (45%)
	-	X	-	-¹	1.11° (43%)	0.6° (9%)	0.7° (37%)
	-	-	X	-¹	1.05° (46%)	0.62° (6%)	0.73° (34%)

¹Configuration does not include a superior implant. SI: Sacroiliac; ROM: Range of motion.

Table 2 Reduction in sacroiliac joint range of motion (°) between transarticular and inline orientation groups

Orientation	Implants (positions)	Superior implant ending point	Reduction in SI joint ROM (°) (%)
Orientation	Implants (positions)	Superior implant ending point	Flexion-extension	Lateral bending	Axial rotation
Transarticular vs inline	3 (S, M, I)	Mid-ala	0.11° (16%)	0.04° (9%)	0.07° (17%)
	3 (S, M, I)	Mid-sacrum	0.11° (17%)	0.03° (7%)	0.07° (18%)
	2 (S, -, I)	Mid-ala	0.13° (16%)	0.05° (11%)	0.08° (18%)
	2 (S, -, I)	Mid-sacrum	0.11° (16%)	0.04° (9%)	0.08° (20%)
	2 (S, M, -)	Mid-ala	0.16° (16%)	0.05° (10%)	0.09° (18%)
	2 (S, M, -)	Mid-sacrum	0.12° (16%)	0.04° (9%)	0.08° (19%)
	2 (-, M, I)	-¹	0.15° (16%)	0.06° (11%)	0.09° (16%)
	1 (-, M, -)	-¹	0.21° (16%)	0.05° (8%)	0.03° (4%)
	1 (-, -, I)	-¹	0.20° (16%)	0.07° (10%)	0.06° (8%)
	Median (°) (Range)		0.13° (0.11-0.21)	0.05° (0.03-0.07)	0.08° (0.03-0.09)
	Median (%) (Range)		16% (16-17)	9% (7-11)	18% (4-20)

¹Configuration does not include a superior implant. S: Superior; M: Middle; I: Inferior.

Table 3 Reduction in sacroiliac joint range of motion (°) between mid-sacrum and mid-ala placement groups

			Reduction in SI joint ROM (°) (%)
Superior implant ending point	Orientation	Implants (position)	Flexion-extension	Lateral bending	Axial rotation
Mid-sacrum vs mid-ala	Inline	3 (S, M, I)	0.07° (10%)	0.04° (9%)	0.03° (7%)
		2 (S, -, I)	0.13° (16%)	0.04° (9%)	0.04° (9%)
		2 (S, M, -)	0.21° (22%)	0.05° (10%)	0.06° (12%)
		1 (S, -, -)	0.15° (11%)	0.00° (0%)	0.06° (9%)
	Trans-articular	3 (S, M, I)	0.07° (12%)	0.03° (7%)	0.03° (9%)
		2 (S, -, I)	0.11° (16%)	0.03° (7%)	0.04° (11%)
		2 (S, M, -)	0.17° (21%)	0.04° (9%)	0.05° (13%)
		1 (S, -, -)	0.15° (11%)	0.00° (0%)	0.06° (9%)
	Median (°) (Range)		0.14° (0.07-0.21)	0.035° (0.00-0.05)	0.045° (0.03-0.06)
	Median (%) (Range)		14% (10-22)	8% (0-10)	9% (7-13)

The reduction in range of motion (%) was calculated in comparison to the to the mid-ala superior implant length. S: Superior; M: Middle; I: Inferior.

Table 4 Change in sacroiliac joint flexion-extension range of motion (°) as a result of reducing the number of implants

Treatment	Implants (positions)	Superior implant ending point	Range of motion (°)	Motion increase (°)	% 3 Implant motion
Intact	-	-¹	1.94	-	-
Inline	3 (S, M, I)	Mid-ala	0.7	Reference configuration
Inline	2 (S, M, -)	Mid-ala	0.97	0.27	39
Inline	2 (S, -, I)	Mid-ala	0.82	0.12	17
Inline	2 (-, M, I)	-¹	0.91	0.21	30
Inline	1 (S, -, -)	Mid-ala	1.36	0.66	94
Inline	1 (-, M, -)	-¹	1.32	0.62	89
Inline	1 (-, -, I)	-¹	1.25	0.55	79
Inline	3 (S, M, I)	Mid-sacrum	0.63	Reference configuration
Inline	2 (S, M, -)	Mid-sacrum	0.76	0.13	21
Inline	2 (S, -, I)	Mid-sacrum	0.69	0.06	10
Inline	1 (S, -, -)	Mid-sacrum	1.21	0.58	92
Transarticular	3 (S, M, I)	Mid-ala	0.59	Reference configuration
Transarticular	2 (S, M, -)	Mid-ala	0.81	0.22	37
Transarticular	2 (S, -, I)	Mid-ala	0.69	0.1	17
Transarticular	2 (-, M, I)	-¹	0.76	0.17	29
Transarticular	1 (S, -, -)	Mid-ala	1.36	0.77	131
Transarticular	1 (-, M, -)	-¹	1.11	0.52	88
Transarticular	1 (-, -, I)	-¹	1.05	0.46	78
Transarticular	3 (S, M, I)	Mid-sacrum	0.52	Reference configuration
Transarticular	2 (S, M, -)	Mid-sacrum	0.64	0.12	23
Transarticular	2 (S, -, I)	Mid-sacrum	0.58	0.06	12
Transarticular	1 (S, -, -)	Mid-sacrum	1.21	0.69	133
Treatment	Implants (positions)	Superior implant ending point	% 3 Implant motion	Implants (positions)	Median (%) [range]
Inline	2 (S, -, I)	Mid-ala	17	2 (S, -, I)	14.5% (10-17)
Inline	2 (S, -, I)	Mid-sacrum	10
Transarticular	2 (S, -, I)	Mid-ala	17
Transarticular	2 (S, -, I)	Mid-sacrum	12
Inline	2 (S, M, -)	Mid-ala	39	2 (S, M, -)	30% (21-39)
Inline	2 (S, M, -)	Mid-sacrum	21
Transarticular	2 (S, M, -)	Mid-ala	37
Transarticular	2 (S, M, -)	Mid-sacrum	23
Inline	2 (-, M, I)	-¹	30	2 (-, M, I)	29.5% (29-30)
Transarticular	2 (-, M, I)	-¹	29	2 (-, M, I)	29.5% (29-30)
Inline	1 (S, -, -)	Mid-ala	94	1 (S, -, -)	112.5% (92-133)
Inline	1 (S, -, -)	Mid-sacrum	92
Transarticular	1 (S, -, -)	Mid-ala	131
Transarticular	1 (S, -, -)	Mid-sacrum	133
Inline	1 (-, M, -)	-¹	89	1 (-, M, -)	88.5% (88-89)
Transarticular	1 (-, M, -)	-¹	88	1 (-, M, -)	88.5% (88-89)
Inline	1 (-, -, I)	-¹	79	1 (-, -, I)	78.5% (78-79)
Transarticular	1 (-, -, I)	-¹	78	1 (-, -, I)	78.5% (78-79)

¹Configuration does not include a superior implant. S: Superior; M: Middle; I: Inferior.

Table 5 Change in sacroiliac joint lateral bending range of motion (°) as a result of reducing the number of implants

Treatment	Implants (positions)	Superior implant ending point	Range of motion (°)	Motion increase (°)	% 3 implant motion
Intact	-	-¹	0.66	-	-
Inline	3 (S, M, I)	Mid-ala	0.45	Reference configuration
Inline	2 (S, M, -)	Mid-ala	0.5	0.05	11
Inline	2 (S, -, I)	Mid-ala	0.47	0.02	4
Inline	2 (-, M, I)	-¹	0.53	0.08	18
Inline	1 (S, -, -)	Mid-ala	0.58	0.13	29
Inline	1 (-, M, -)	-¹	0.65	0.2	44
Inline	1 (-, -, I)	-¹	0.69	0.24	53
Inline	3 (S, M, I)	Mid-sacrum	0.41	Reference configuration
Inline	2 (S, M, -)	Mid-sacrum	0.45	0.04	10
Inline	2 (S, -, I)	Mid-sacrum	0.43	0.02	5
Inline	1 (S, -, -)	Mid-sacrum	0.58	0.17	41
Transarticular	3 (S, M, I)	Mid-ala	0.41	Reference configuration
Transarticular	2 (S, M, -)	Mid-ala	0.45	0.04	10
Transarticular	2 (S, -, I)	Mid-ala	0.42	0.01	2
Transarticular	2 (-, M, I)	-¹	0.47	0.06	15
Transarticular	1 (S, -, -)	Mid-ala	0.58	0.17	41
Transarticular	1 (-, M, -)	-¹	0.6	0.19	46
Transarticular	1 (-, -, I)	-¹	0.62	0.21	51
Transarticular	3 (S, M, I)	Mid-sacrum	0.38	Reference configuration
Transarticular	2 (S, M, -)	Mid-sacrum	0.41	0.03	8
Transarticular	2 (S, -, I)	Mid-sacrum	0.39	0.01	3
Transarticular	1 (S, -, -)	Mid-sacrum	0.58	0.2	53
Treatment	Implants (positions)	Superior implant ending point	% 3 Implant motion	Implants (positions)	Median (%) [range]
Inline	2 (S, -, I)	Mid-ala	4	2 (S, -, I)	3.5% (2-5)
Inline	2 (S, -, I)	Mid-sacrum	5
Transarticular	2 (S, -, I)	Mid-ala	2
Transarticular	2 (S, -, I)	Mid-sacrum	3
Inline	2 (S, M, -)	Mid-ala	11	2 (S, M, -)	10% (8-11)
Inline	2 (S, M, -)	Mid-sacrum	10
Transarticular	2 (S, M, -)	Mid-ala	10
Transarticular	2 (S, M, -)	Mid-sacrum	8
Inline	2 (-, M, I)	-¹	18	2 (-, M, I)	16.5% (15-18)
Transarticular	2 (-, M, I)	-¹	15	2 (-, M, I)	16.5% (15-18)
Inline	1 (S, -, -)	Mid-ala	29	1 (S, -, -)	41% (29-53)
Inline	1 (S, -, -)	Mid-sacrum	41
Transarticular	1 (S, -, -)	Mid-ala	41
Transarticular	1 (S, -, -)	Mid-sacrum	53
Inline	1 (-, M, -)	-¹	44	1 (-, M, -)	45% (44-46)
Transarticular	1 (-, M, -)	-¹	46	1 (-, M, -)	45% (44-46)
Inline	1 (-, -, I)	-¹	53	1 (-, -, I)	52% (51-53)
Transarticular	1 (-, -, I)	-¹	51	1 (-, -, I)	52% (51-53)

¹Configuration does not include a superior implant. S: Superior; M: Middle; I: Inferior.

Table 6 Change in sacroiliac joint axial rotation range of motion (°) as a result of reducing the number of implants

Treatment	Implants (positions)	Superior implant ending point	Range of motion	Motion increase (°)	% 3 implant motion
Intact	-	¹	1.11	-	-
Inline	3 (S, M, I)	Mid-ala	0.41	Reference configuration
Inline	2 (S, M, -)	Mid-ala	0.49	0.08	20
Inline	2 (S, -, I)	Mid-ala	0.44	0.03	7
Inline	2 (-, M, I)	¹	0.55	0.14	34
Inline	1 (S, -, -)	Mid-ala	0.67	0.26	63
Inline	1 (-, M, -)	¹	0.73	0.32	78
Inline	1 (-, -, I)	¹	0.79	0.38	93
Inline	3 (S, M, I)	Mid-sacrum	0.38	Reference configuration
Inline	2 (S, M, -)	Mid-sacrum	0.43	0.05	13
Inline	2 (S, -, I)	Mid-sacrum	0.4	0.02	5
Inline	1 (S, -, -)	Mid-sacrum	0.61	0.23	61
Transarticular	3 (S, M, I)	Mid-ala	0.34	Reference configuration
Transarticular	2 (S, M, -)	Mid-ala	0.4	0.06	18
Transarticular	2 (S, -, I)	Mid-ala	0.36	0.02	6
Transarticular	2 (-, M, I)	¹	0.46	0.12	35
Transarticular	1 (S, -, -)	Mid-ala	0.67	0.33	97
Transarticular	1 (-, M, -)	¹	0.7	0.36	106
Transarticular	1 (-, -, I)	¹	0.73	0.39	115
Transarticular	3 (S, M, I)	Mid-sacrum	0.31	Reference configuration
Transarticular	2 (S, M, -)	Mid-sacrum	0.35	0.04	13
Transarticular	2 (S, -, I)	Mid-sacrum	0.32	0.01	3
Transarticular	1 (S, -, -)	Mid-sacrum	0.61	0.3	97
Treatment	Implants (positions)	Superior implant ending point	% 3 Implant motion	Implants (positions)	Median (%) [range]
Inline	2 (S, -, I)	Mid-ala	7	2 (S, -, I)	5.5% (3-7)
Inline	2 (S, -, I)	Mid-sacrum	5
Transarticular	2 (S, -, I)	Mid-ala	6
Transarticular	2 (S, -, I)	Mid-sacrum	3
Inline	2 (S, M, -)	Mid-ala	20	2 (S, M, -)	15.5% (13-20)
Inline	2 (S, M, -)	Mid-sacrum	13
Transarticular	2 (S, M, -)	Mid-ala	18
Transarticular	2 (S, M, -)	Mid-sacrum	13
Inline	2 (-, M, I)	¹	34	2 (-, M, I)	34.5% (34-35)
Transarticular	2 (-, M, I)	¹	35	2 (-, M, I)	34.5% (34-35)
Inline	1 (S, -, -)	Mid-ala	63	1 (S, -, -)	80% (61-97)
Inline	1 (S, -, -)	Mid-sacrum	61
Transarticular	1 (S, -, -)	Mid-ala	97
Transarticular	1 (S, -, -)	Mid-sacrum	97
Inline	1 (-, M, -)	¹	78	1 (-, M, -)	92% (78-106)
Transarticular	1 (-, M, -)	¹	106	1 (-, M, -)	92% (78-106)
Inline	1 (-, -, I)	¹	93	1 (-, -, I)	104% (93-115)
Transarticular	1 (-, -, I)	¹	115	1 (-, -, I)	104% (93-115)

¹Configuration does not include a superior implant. S: Superior; M: Middle; I: Inferior.

Citation: Lindsey DP, Kiapour A, Yerby SA, Goel VK. Sacroiliac joint stability: Finite element analysis of implant number, orientation, and superior implant length. World J Orthop 2018; 9(3): 14-23
URL: https://www.wjgnet.com/2218-5836/full/v9/i3/14.htm
DOI: https://dx.doi.org/10.5312/wjo.v9.i3.14