Prediction accuracy of femoral and tibial stress and strain using statistical shape and density model-based finite element models in paediatrics

Computed tomography (CT)-based finite element (FE) models can non-invasively assess bone mechanical properties, but their clinical application in paediatrics is limited due to fewer datasets and models. Statistical Shape-Density Model (SSDM)-based FE models using statistically inferred shape and density have application to predict bone stress and strains; however, their accuracy in children remains unexplored. This study assessed the accuracy of stress-strain distributions estimated from SSDM-based FE models of paediatric femora and tibiae. CT-based FE models used geometry and densities derived from 330 CT scans from children aged 4-18 years. Paediatric SSDMs of the femur and tibia were used to predict bone geometries and densities from participants' demographics and linear bone measurements. Forces during single-leg standing were estimated and applied to each bone. Stress and strain distributions were compared between the SSDM-based FE models and CT-based FE models, which served as the gold standard. The average normalized root-mean-square error (NRMSE) for Von Mises stress was 6% for the femur and 8% for the tibia across all cases. Principal strains NRMSE ranged from 1.2% to 5.5%. High correlations between the SSDM-based and CT-based FE models were observed, with determination coefficients ranging from 0.80 to 0.96. These results illustrate the potential of SSDM-based FE models for paediatric application, such as personalized implant design and surgical planning.