{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:53:10Z","timestamp":1787863990914,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"3Spine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The goal of this study was to assess elevated spinal loading conditions and their effect on the polyethylene stresses of a lumbar total joint replacement (L-TJR). A previously validated lumbar spine finite element model was virtually implanted with an L-TJR at L4\u2013L5 and exposed to three elevated loading conditions: (1) 95th-percentile male body weight while bending forward, (2) combined \u00b17.5 Nm axial torsion and lateral bending, and (3) ASTM F2423 aggressive loading (1850 N plus 10\u201312 Nm bending). Combined torsion and lateral bending were considered because these loads and moments may be coupled in demanding real-world scenarios. Across all conditions, contact at the bearing remained confined to the intended spherical surfaces, consistent with Mode I in vitro wear tests, with no evidence of impingement. Contact stresses and von Mises stresses were considered acceptable based on the simulated results of Mode IV impingement tests. Only in one scenario\u201495th-percentile male body weight with multiaxial torsion\u2014did von Mises stress in the polyethylene slightly exceed the stresses associated with impingement (&lt;5%). These findings are useful in establishing the upper biomechanical loading limits for the L-TJR design beyond the 50th-percentile loading levels employed by standard in vitro tests. Future validation efforts such as a comparison with retrieval analyses or clinical data will further strengthen the model\u2019s applicability to current and future questions of interest and contexts of use. Additional work may expand the modeling framework to incorporate patient-specific anatomy, variable implant positioning conditions, and a broader range of physiological load scenarios.<\/jats:p>","DOI":"10.3390\/bioengineering13010066","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:34:21Z","timestamp":1767789261000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Polyethylene Stresses in Lumbar Total Joint Replacement Under Elevated Loading: Insights from an Anatomic Finite Element Model"],"prefix":"10.3390","volume":"13","author":[{"given":"Steven A.","family":"Rundell","sequence":"first","affiliation":[{"name":"Explico Inc., Novi, MI 48375, USA"},{"name":"School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Spece","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA"},{"name":"Gyroid LLC., Haddonfield, NJ 08033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald V.","family":"Yarbrough","sequence":"additional","affiliation":[{"name":"3Spine Inc., Chattanooga, TN 37402, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-500X","authenticated-orcid":false,"given":"Steven M.","family":"Kurtz","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA"},{"name":"Gyroid LLC., Haddonfield, NJ 08033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s11916-019-0821-x","article-title":"Treatment of Discogenic Low Back Pain: Current Treatment Strategies and Future Options-a Literature Review","volume":"23","author":"Zhao","year":"2019","journal-title":"Curr. Pain. Headache Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/S0034-8910.2015049005874","article-title":"Prevalence of chronic low back pain: Systematic review","volume":"49","author":"Meucci","year":"2015","journal-title":"Rev. Saude Publica"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1002\/art.34347","article-title":"A systematic review of the global prevalence of low back pain","volume":"64","author":"Hoy","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1097\/01.brs.0000166503.37969.8a","article-title":"United States trends in lumbar fusion surgery for degenerative conditions","volume":"30","author":"Deyo","year":"2005","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3892\/mmr.2024.13398","article-title":"Risk factors and treatment strategies for adjacent segment disease following spinal fusion (Review)","volume":"31","author":"Huang","year":"2025","journal-title":"Mol. Med. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.spinee.2021.12.002","article-title":"Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: A systematic review and meta-analysis","volume":"22","author":"Mesregah","year":"2022","journal-title":"Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/BSD.0000000000000328","article-title":"Adjacent Segment Degeneration Versus Disease After Lumbar Spine Fusion for Degenerative Pathology: A Systematic Review With Meta-Analysis of the Literature","volume":"29","author":"Zhang","year":"2016","journal-title":"Clin. Spine Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.nec.2021.05.009","article-title":"Adjacent-Segment Disease Following Spinal Arthroplasty","volume":"32","author":"Parish","year":"2021","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S245","DOI":"10.1007\/s00590-014-1445-9","article-title":"Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: A meta-analysis","volume":"24","author":"Ren","year":"2014","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.14444\/8746","article-title":"Total Joint Replacement of the Lumbar Spine: The Future of Motion Preservation","volume":"19","author":"Goldstein","year":"2025","journal-title":"Int. J. Spine Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.spinee.2020.12.001","article-title":"A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: A comparative analysis of patient-reported outcomes at one year","volume":"21","author":"Sielatycki","year":"2021","journal-title":"Spine J."},{"key":"ref_12","unstructured":"(2025, November 21). MOTUS Total Joint Replacement Investigational Device Exemption Study. ClinicalTrials.gov, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05438719."},{"key":"ref_13","unstructured":"Yarbrough, R., Spece, H., Kurtz, S.M., Breno, A.J., and Maislin, D. (2025). An Interventional, Multi-Center Investigation of a Novel Lumbar Total Joint Replacement: Propensity Matched Study Design and Protocol. BMJ Open Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.26502\/fjsrs0078","article-title":"The Decline of Lumbar Artificial Disc Replacement","volume":"6","author":"Eskandar","year":"2024","journal-title":"J. Spine Res. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1097\/BRS.0b013e318186b258","article-title":"Total disc replacement positioning affects facet contact forces and vertebral body strains","volume":"33","author":"Rundell","year":"2008","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.nec.2021.05.010","article-title":"Lumbar Total Disc Replacement: Current Usage","volume":"32","author":"Franco","year":"2021","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2607","DOI":"10.1007\/s00586-022-07282-z","article-title":"In which cases do surgeons specializing in total disc replacement perform fusion in patients with symptomatic lumbar disc degeneration?","volume":"31","author":"Zigler","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"343","DOI":"10.21037\/jss-22-4","article-title":"National trends in the utilization of lumbar disc replacement for lumbar degenerative disc disease over a 10-year period, 2010 to 2019","volume":"8","author":"Policht","year":"2022","journal-title":"J. Spine Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.14444\/8809","article-title":"Total Joint Replacement of the Lumbar Spine: 12-Month Pain and Functional Outcomes From an Investigational Device Exemption Clinical Trial","volume":"19","author":"Nunley","year":"2025","journal-title":"Int. J. Spine Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Siskey, R.L., Yarbrough, R.V., Spece, H., Hodges, S.D., Humphreys, S.C., and Kurtz, S.M. (2023). In Vitro Wear of a Novel Vitamin E Crosslinked Polyethylene Lumbar Total Joint Replacement. Bioengineering, 10.","DOI":"10.3390\/bioengineering10101198"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kurtz, S.M., Rundell, S.A., Spece, H., and Yarbrough, R. (J. Orthop. Res., 2025). High Demand Loading Conditions and their Effect on Polyethylene Stresses in Lumbar Total Joint Replacement: Implications for Spine Wear Protocols, J. Orthop. Res., in press.","DOI":"10.1002\/jor.70115"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kurtz, S.M., Rundell, S.A., Spece, H., and Yarbrough, R. (2025). Sensitivity of Lumbar Total Joint Replacement Contact Stresses Under Misalignment Conditions-Finite Element Analysis of a Spine Wear Simulator. Bioengineering, 12.","DOI":"10.3390\/bioengineering12030229"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"635","DOI":"10.14444\/8792","article-title":"Sensitivity of Lumbar Total Joint Replacement to Axial and Coronal Plane Misalignment Using Computational Modeling","volume":"19","author":"Rundell","year":"2025","journal-title":"Int. J. Spine Surg."},{"key":"ref_24","first-page":"76","article-title":"Stresses in polyethylene components of contemporary total knee replacements","volume":"317","author":"Bartel","year":"1995","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1520\/JAI103556","article-title":"Derivation of clinically relevant boundary conditions suitable for evaluation of chronic impingement of lumbar total disk replacement: Application to standard development","volume":"8","author":"Rundell","year":"2011","journal-title":"J. ASTM Int."},{"key":"ref_26","unstructured":"(2018). Assessing Credibility of Computational Modeling Through Verification and Validation: Application to Medical Devices (Standard No. ASME V&V 40-2018)."},{"key":"ref_27","unstructured":"(2025, November 01). Credibility of Computational Modeling and Simulation in Medical Device Submissions: Guidance for Industry and Food and Drug Administration Staff, Available online: https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/assessing-credibility-computational-modeling-and-simulation-medical-device-submissions."},{"key":"ref_28","unstructured":"(2020). Standard Guide for Functional, Kinematic, and Wear Assessment of Total Disc Prostheses (Standard No. ASTM F2423-11(2020))."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1115\/1.3138543","article-title":"The effect of conformity and plastic thickness on contact stresses in metal-backed plastic implants","volume":"107","author":"Bartel","year":"1985","journal-title":"J. Biomech. Eng."},{"key":"ref_30","unstructured":"Bartel, D., Wright, T., and Edwards, D. (1983). The effect of metal backing on stresses in polyethylene acetabular components. The Hip: Proceedings of the 11th Open Scientific Meeting of the Hip Society, CV Mosby."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.2106\/00004623-198668070-00010","article-title":"The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement","volume":"68","author":"Bartel","year":"1986","journal-title":"J. Bone Jt. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/00003086-199612000-00005","article-title":"3-Dimensional Sliding\/Contact Computational Simulation of Total Hip Wear","volume":"333","author":"Maxian","year":"1996","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00003086-199711000-00012","article-title":"Finite element analysis of acetabular wear. Validation, and backing and fixation effects","volume":"344","author":"Maxian","year":"1997","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1097\/00024720-200308000-00014","article-title":"The implications of constraint in lumbar total disc replacement","volume":"16","author":"Huang","year":"2003","journal-title":"J. Spinal Disord. Technol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1080\/00140139308967940","article-title":"Revised NIOSH equation for the design and evaluation of manual lifting tasks","volume":"36","author":"Waters","year":"1993","journal-title":"Ergonomics"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/1\/66\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:47:35Z","timestamp":1767790055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/1\/66"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,7]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["bioengineering13010066"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13010066","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,7]]}}}