Finite element analysis for predicting osteonecrosis of the femoral head collapse based on the preserved angles_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Shun ¹ , LIN Tianye ^2,3 , HE Mincong ^2,3 , HE Xiaoming ^2,3 , HE Xianshun ¹ , TIAN Jiaqing ¹ , WEI Tengfei ¹ , ZHAN Zhiwei ¹ , LIN Kun ¹ ,  WEI Qiushi ^2,3

1. Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China;
3. Joint Center, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510378, P. R. China;

Corresponding author：

WEI Qiushi, Email: weiqshi@126.com

Keywords：

Osteonecrosis of the femoral head; anterior preserved angle; lateral preserved angle; femoral head collapse; biomechanical analysis

DOI：

10.7507/1002-1892.202308072

Video：

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Objective To establish finite element models of different preserved angles of osteonecrosis of the femoral head (ONFH) for the biomechanical analysis, and to provide mechanical evidence for predicting the risk of ONFH collapse with anterior preserved angle (APA) and lateral preserved angle (LPA). Methods A healthy adult was selected as the study object, and the CT data of the left femoral head was acquired and imported into Mimics 21.0 software to reconstruct a complete proximal femur model and construct 3 models of necrotic area with equal volume and different morphology, all models were imported into Solidworks 2022 software to construct 21 finite element models of ONFH with LPA of 45°, 50°, 55°, 60°, 65°, 70°, and 75° when APA was 45°, respectively, and 21 finite element models of ONFH with APA of 45°, 50°, 55°, 60°, 65°, 70°, 75° when LPA was 45°, respectively. According to the physiological load condition of the femoral head, the distal femur was completely fixed, and a force with an angle of 25°, downward direction, and a magnitude of 3.5 times the subject’s body mass was applied to the weight-bearing area of the femoral head surface. The maximum Von Mises stress of the surface of the femoral head and the necrotic area and the maximum displacement of the weight-bearing area of the femoral head were calculated and observed by Abaqus 2021 software. Results The finite element models of ONFH were basically consistent with biomechanics of ONFH. Under the same loading condition, there was stress concentration around the necrotic area in the 42 ONFH models with different preserved angles composed of 3 necrotic areas with equal volume and different morphology. When APA was 60°, the maximum Von Mises stress of the surface of the femoral head and the necrotic area and the maximum displacement of the weight-bearing area of the femoral head of the ONFH models with LPA<60° were significantly higher than those of the models with LPA≥60° (P<0.05); there was no significant difference in each index among the ONFH models with LPA≥60° (P>0.05). When LPA was 60°, each index of the ONFH models with APA<60° were significantly higher than those of the models with APA≥60° (P<0.05); there was no significant difference in each index among the ONFH models with APA≥60° (P>0.05). Conclusion From the perspective of biomechanics, when a preserved angle of ONFH is less than its critical value, the stress concentration phenomenon in the femoral head is more pronounced, suggesting that the necrotic femoral head may have a higher risk of collapse in this state.

Citation： LU Shun, LIN Tianye, HE Mincong, HE Xiaoming, HE Xianshun, TIAN Jiaqing, WEI Tengfei, ZHAN Zhiwei, LIN Kun, WEI Qiushi. Finite element analysis for predicting osteonecrosis of the femoral head collapse based on the preserved angles. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1394-1402. doi: 10.7507/1002-1892.202308072 Copy

1.	Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury, 2016, 47 Suppl 6: S16-S26.
2.	Cui L, Zhuang Q, Lin J, et al. Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China. Int Orthop, 2016, 40(2): 267-276.
3.	何伟. 如何把握股骨头坏死患者的保髋治疗时机. 中国骨与关节杂志, 2016, 5(2): 82-86.
4.	Jo WL, Lee YK, Ha YC, et al. Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis. Int Orthop, 2018, 42(7): 1599-1603.
5.	方斌, 何伟, 展磊, 等. 不同坏死范围下股骨头坏死区应力分布的有限元分析. 中医正骨, 2012, 24(10): 10-15.
6.	Ha YC, Jung WH, Kim JR, et al. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg (Am), 2006, 88 Suppl 3: 35-40.
7.	Nishii T, Sugano N, Ohzono K, et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res, 2002, 20(1): 130-136.
8.	魏腾飞, 何晓铭, 韦雨柔, 等. Piezo1在激素性和酒精性股骨头坏死骨组织中的差异表达. 中国组织工程研究, 2023, 27(2): 270-275.
9.	Wei QS, Hong GJ, Yuan YJ, et al. Huo Xue Tong Luo capsule, a vasoactive herbal formula prevents progression of asymptomatic osteonecrosis of femoral head: A prospective study. J Orthop Translat, 2018, 18: 65-73.
10.	Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg (Am), 2010, 92(12): 2165-2170.
11.	Bahk JH, Jo WL, Kim SC, et al. Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts. J Orthop Surg Res, 2021, 16(1): 728.
12.	Bae JY, Kwak DS, Park KS, et al. Finite element analysis of the multiple drilling technique for early osteonecrosis of the femoral head. Ann Biomed Eng, 2013, 41(12): 2528-2537.
13.	Wei QS, He MC, He XM, et al. Combining frog-leg lateral view may serve as a more sensitive X-ray position in monitoring collapse in osteonecrosis of the femoral head. J Hip Preserv Surg, 2022, 9(1): 10-17.
14.	魏秋实, 何伟, 张庆文, 等. 基于X线片建立股骨头坏死新分型体系的临床意义. 中华关节外科杂志 (电子版), 2018, 12(6): 84-90.
15.	Wei QS, Li ZQ, Hong ZN, et al. Predicting collapse in osteonecrosis of the femoral head using a new method: Preserved angles of anterior and lateral femoral head. J Bone Joint Surg (Am), 2022, 104(Suppl 2): 47-53.
16.	Derikx LC, van Aken JB, Janssen D, et al. The assessment of the risk of fracture in femora with metastatic lesions: comparing case-specific finite element analyses with predictions by clinical experts. J Bone Joint Surg (Br), 2012, 94(8): 1135-1142.
17.	Wen P, Zhang Y, Hao L, et al. The effect of the necrotic area on the biomechanics of the femoral head—a finite element study. BMC Musculoskelet Disord, 2020, 21(1): 211.
18.	Wen MT, Liang XZ, Luo D, et al. The effect of the hip flexion angle in osteonecrosis of the femoral head based on China-Japan Friendship Hospital Classification—A finite element study. Orthop Surg, 2023, 15(10): 2689-2700.
19.	Ko YS, Ha JH, Park JW, et al. Updating osteonecrosis of the femoral head. Hip Pelvis, 2023, 35(3): 147-156.
20.	梁学振, 刘光波, 刘金豹, 等. 基于CT三维重建的激素性股骨头坏死患者股骨头坏死组织分布研究. 中国修复重建外科杂志, 2020, 34(1): 57-62.
21.	颜新昊, 庞凤祥, 钟原, 等. 股骨头前、外侧壁保留角与股骨头坏死塌陷进展的相关性. 中国组织工程研究, 2021, 25(36): 5827-5831.
22.	Zhang Z, Lin T, Zhong Y, et al. Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study. Open Med (Wars), 2022, 17(1): 1282-1291.
23.	Yang P, Lin TY, Xu JL, et al. Finite element modeling of proximal femur with quantifiable weight-bearing area in standing position. J Orthop Surg Res, 2020, 15(1): 384.
24.	Genda E, Iwasaki N, Li G, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech, 2001, 34(7): 895-905.
25.	杨宾宾, 刘耀升, 刘蜀彬, 等. 多种髓芯减压术治疗股骨头坏死的有限元研究. 中华损伤与修复杂志 (电子版), 2017, 12(1): 39-45.
26.	Boontanapibul K, Steere JT, Amanatullah DF, et al. Diagnosis of osteonecrosis of the femoral head: Too little, too late, and independent of etiology. J Arthroplasty, 2020, 35(9): 2342-2349.
27.	Wang P, Wang C, Meng H, et al. The role of structural deterioration and biomechanical changes of the necrotic lesion in collapse mechanism of osteonecrosis of the femoral head. Orthop Surg, 2022, 14(5): 831-839.
28.	Lee MS, Tai CL, Senan V, et al. The effect of necrotic lesion size and rotational degree on the stress reduction in transtrochanteric rotational osteotomy for femoral head osteonecrosis—a three-dimensional finite-element simulation. Clin Biomech (Bristol, Avon), 2006, 21(9): 969-976.
29.	Kubo Y, Motomura G, Ikemura S, et al. Effects of anterior boundary of the necrotic lesion on the progressive collapse after varus osteotomy for osteonecrosis of the femoral head. J Orthop Sci, 2020, 25(1): 145-151.
30.	Yoshida H, Faust A, Wilckens J, et al. Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living. J Biomech, 2006, 39(11): 1996-2004.
31.	Jirman R, Horak Z, Bouda T, et al. Influence of the method of TM joint total replacement implantation on the loading of the joint on the opposite side. Comput Methods Biomech Biomed Engin, 2011, 14(8): 673-681.
32.	何敏聪, 何晓铭, 林天烨, 等. 基于CT坏死区重建的股骨头坏死侧位分型及其临床验证. 中国修复重建外科杂志, 2023, 37(4): 423-430.
33.	Escudier JC, Ollivier M, Donnez M, et al. Superimposition of maximal stress and necrosis areas at the top of the femoral head in hip aseptic osteonecrosis. Orthop Traumatol Surg Res, 2018, 104(3): 353-358.
34.	厉驹, 杨予, 童培建. 多孔钽棒植入股骨头塌陷风险与生物力学支撑效果分析. 中国骨与关节损伤杂志, 2017, 32(2): 129-132.

1. Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury, 2016, 47 Suppl 6: S16-S26.
2. Cui L, Zhuang Q, Lin J, et al. Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China. Int Orthop, 2016, 40(2): 267-276.
3. 何伟. 如何把握股骨头坏死患者的保髋治疗时机. 中国骨与关节杂志, 2016, 5(2): 82-86.
4. Jo WL, Lee YK, Ha YC, et al. Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis. Int Orthop, 2018, 42(7): 1599-1603.
5. 方斌, 何伟, 展磊, 等. 不同坏死范围下股骨头坏死区应力分布的有限元分析. 中医正骨, 2012, 24(10): 10-15.
6. Ha YC, Jung WH, Kim JR, et al. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg (Am), 2006, 88 Suppl 3: 35-40.
7. Nishii T, Sugano N, Ohzono K, et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res, 2002, 20(1): 130-136.
8. 魏腾飞, 何晓铭, 韦雨柔, 等. Piezo1在激素性和酒精性股骨头坏死骨组织中的差异表达. 中国组织工程研究, 2023, 27(2): 270-275.
9. Wei QS, Hong GJ, Yuan YJ, et al. Huo Xue Tong Luo capsule, a vasoactive herbal formula prevents progression of asymptomatic osteonecrosis of femoral head: A prospective study. J Orthop Translat, 2018, 18: 65-73.
10. Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg (Am), 2010, 92(12): 2165-2170.
11. Bahk JH, Jo WL, Kim SC, et al. Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts. J Orthop Surg Res, 2021, 16(1): 728.
12. Bae JY, Kwak DS, Park KS, et al. Finite element analysis of the multiple drilling technique for early osteonecrosis of the femoral head. Ann Biomed Eng, 2013, 41(12): 2528-2537.
13. Wei QS, He MC, He XM, et al. Combining frog-leg lateral view may serve as a more sensitive X-ray position in monitoring collapse in osteonecrosis of the femoral head. J Hip Preserv Surg, 2022, 9(1): 10-17.
14. 魏秋实, 何伟, 张庆文, 等. 基于X线片建立股骨头坏死新分型体系的临床意义. 中华关节外科杂志 (电子版), 2018, 12(6): 84-90.
15. Wei QS, Li ZQ, Hong ZN, et al. Predicting collapse in osteonecrosis of the femoral head using a new method: Preserved angles of anterior and lateral femoral head. J Bone Joint Surg (Am), 2022, 104(Suppl 2): 47-53.
16. Derikx LC, van Aken JB, Janssen D, et al. The assessment of the risk of fracture in femora with metastatic lesions: comparing case-specific finite element analyses with predictions by clinical experts. J Bone Joint Surg (Br), 2012, 94(8): 1135-1142.
17. Wen P, Zhang Y, Hao L, et al. The effect of the necrotic area on the biomechanics of the femoral head—a finite element study. BMC Musculoskelet Disord, 2020, 21(1): 211.
18. Wen MT, Liang XZ, Luo D, et al. The effect of the hip flexion angle in osteonecrosis of the femoral head based on China-Japan Friendship Hospital Classification—A finite element study. Orthop Surg, 2023, 15(10): 2689-2700.
19. Ko YS, Ha JH, Park JW, et al. Updating osteonecrosis of the femoral head. Hip Pelvis, 2023, 35(3): 147-156.
20. 梁学振, 刘光波, 刘金豹, 等. 基于CT三维重建的激素性股骨头坏死患者股骨头坏死组织分布研究. 中国修复重建外科杂志, 2020, 34(1): 57-62.
21. 颜新昊, 庞凤祥, 钟原, 等. 股骨头前、外侧壁保留角与股骨头坏死塌陷进展的相关性. 中国组织工程研究, 2021, 25(36): 5827-5831.
22. Zhang Z, Lin T, Zhong Y, et al. Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study. Open Med (Wars), 2022, 17(1): 1282-1291.
23. Yang P, Lin TY, Xu JL, et al. Finite element modeling of proximal femur with quantifiable weight-bearing area in standing position. J Orthop Surg Res, 2020, 15(1): 384.
24. Genda E, Iwasaki N, Li G, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech, 2001, 34(7): 895-905.
25. 杨宾宾, 刘耀升, 刘蜀彬, 等. 多种髓芯减压术治疗股骨头坏死的有限元研究. 中华损伤与修复杂志 (电子版), 2017, 12(1): 39-45.
26. Boontanapibul K, Steere JT, Amanatullah DF, et al. Diagnosis of osteonecrosis of the femoral head: Too little, too late, and independent of etiology. J Arthroplasty, 2020, 35(9): 2342-2349.
27. Wang P, Wang C, Meng H, et al. The role of structural deterioration and biomechanical changes of the necrotic lesion in collapse mechanism of osteonecrosis of the femoral head. Orthop Surg, 2022, 14(5): 831-839.
28. Lee MS, Tai CL, Senan V, et al. The effect of necrotic lesion size and rotational degree on the stress reduction in transtrochanteric rotational osteotomy for femoral head osteonecrosis—a three-dimensional finite-element simulation. Clin Biomech (Bristol, Avon), 2006, 21(9): 969-976.
29. Kubo Y, Motomura G, Ikemura S, et al. Effects of anterior boundary of the necrotic lesion on the progressive collapse after varus osteotomy for osteonecrosis of the femoral head. J Orthop Sci, 2020, 25(1): 145-151.
30. Yoshida H, Faust A, Wilckens J, et al. Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living. J Biomech, 2006, 39(11): 1996-2004.
31. Jirman R, Horak Z, Bouda T, et al. Influence of the method of TM joint total replacement implantation on the loading of the joint on the opposite side. Comput Methods Biomech Biomed Engin, 2011, 14(8): 673-681.
32. 何敏聪, 何晓铭, 林天烨, 等. 基于CT坏死区重建的股骨头坏死侧位分型及其临床验证. 中国修复重建外科杂志, 2023, 37(4): 423-430.
33. Escudier JC, Ollivier M, Donnez M, et al. Superimposition of maximal stress and necrosis areas at the top of the femoral head in hip aseptic osteonecrosis. Orthop Traumatol Surg Res, 2018, 104(3): 353-358.
34. 厉驹, 杨予, 童培建. 多孔钽棒植入股骨头塌陷风险与生物力学支撑效果分析. 中国骨与关节损伤杂志, 2017, 32(2): 129-132.

Chinese Journal of Reparative and Reconstructive Surgery

Finite element analysis for predicting osteonecrosis of the femoral head collapse based on the preserved angles

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