Effect of Sclerosis Bands in Femoral Head Necrosis on Non-Vascularized Fibular Grafting—A Finite Element Study

Abstract

Objective: Femoral head necrosis is a challenging condition in orthopaedics, and the occurrence of collapse is an important factor affecting the prognosis of femoral head necrosis. Sclerosis bands are known to influence the collapse of the femoral head, yet there is a lack of research on the biomechanical role of sclerosis bands in non-vascularized fibular grafting surgery. This study aims to evaluate the biomechanical impact of sclerosis bands in femoral head necrosis and their role in non-vascularized fibular grafting surgery (NVFG) using finite element analysis.

Methods: We constructed 11 finite element models based on CT scan data of a normal hip joint, simulating different sclerosis band thicknesses and defect scenarios. The models were analyzed for changes in femoral head displacement and von Mises stress. We constructed a hip joint model based on CT data from a normal hip joint, and after reconstruction, assembly, and optimization using 3-matic. We created five groups consisting of 11 finite element analysis models of the hip joint. Mesh partitioning and mechanical parameter settings were performed in ANSYS. The changes and differences in femoral head displacement and von Mises stress of these models were analyzed.

Results: Increasing sclerosis band thickness led to reduced peak displacement of the femoral head by 28.6%, 42.9%, and 47.6%, and increased surface von Mises stress by 28.3%, 13.8%, and 13.0%, respectively. Post-surgery, peak displacement decreased in all groups compared to pre-surgery levels. Increasing sclerosis band thickness post-surgery resulted in decreased maximum von Mises stress of the femoral head by 13.9%, 3.0%, and 8.1%. Defect volume in the defect groups correlated with increased peak displacement of the femoral head by 10.0%, 30.0%, and 100.0%, and increased surface maximum von Mises stress of the femoral head by 9.3%, 14.0%, and 15.1%.

Conclusion: Sclerosis band formation exacerbates von Mises stress concentration on the femoral head surface. However, thicker sclerosis bands improve post-NVFG stability and mechanical performance. Larger anterior lateral sclerosis band defects significantly compromise postoperative stability, increasing the risk of collapse. Protecting the anterior lateral sclerosis band during NVFG surgery is crucial.

Keywords

Finite Element Analysis / Hip Preservation / Non-Vascularized Fibular Grafting / Femoral Head Osteonecrosis / Sclerosis Band

References

[1] Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Transl. 2020; 21: 100–110.

[2] Hines JT, Jo WL, Cui Q, Mont MA, Koo KH, Cheng EY, et al. Osteonecrosis of the femoral head: an updated review of ARCO on pathogenesis, staging and treatment. J Korean Med Sci. 2021; 36(24): e177.

[3] Changjun C, Donghai L, Xin Z, Liyile C, Qiuru W, Pengde K. Mid-to long-term results of modified non-vascularized allogeneic fibula grafting combined with core decompression and bone grafting for early femoral head necrosis. J Orthop Surg Res. 2020; 15(1): 116.

[4] Yuan P, Liu X, Du B, et al. Mid-to long-term results of modified avascular fibular grafting for ONFH. J Hip Preserv Surg. 2021; 8(3): 274–281.

[5] Lou P, Zhou G, Wei B, et al. Sclerotic zone in femoral head necrosis: from pathophysiology to therapeutic implications. EFORT Open Rev. 2023; 8(6): 451–458.

[6] Huang Y, Gu C, Xi H, et al. Sclerosis rim volume ratio and Japanese investigation committee classification as predictive factors for femoral head collapse progression after non-vascularized fibular grafting in osteonecrosis patients. Asian J Surg. 2024; 47(1): 250–255.

[7] Yu T, Xie L, Zhang Z, Ke X, Liu Y. Erratum to: prediction of osteonecrosis collapse of the femoral head based on the proportion of the proximal sclerotic rim. Int Orthop. 2015; 39(3): 615.

[8] Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty. 2020; 35(4): 933–940.

[9] Yu T, Xie L, Chu F. A sclerotic rim provides mechanical support for the femoral head in osteonecrosis. Orthopedics. 2015; 38(5): e374–e379.

[10] Zhou GQ, Pang ZH, Chen QQ, He W, Chen ZQ, Chen LL, et al. Reconstruction of the biomechanical transfer path of femoral head necrosis: a subject-specific finite element investigation. Comput Biol Med. 2014; 52: 96–101.

[11] Wen PF, Guo WS, Zhang QD, Gao FQ, Yue JA, Liu ZH, et al. Significance of lateral pillar in osteonecrosis of femoral head: a finite element analysis. Chin Med J. 2017; 130(21): 2569–2574.

[12] Xiong B, Yang P, Lin T, Xu J, Xie Y, Guo Y, et al. Changes in hip joint contact stress during a gait cycle based on the individualized modeling method of “gait-musculoskeletal system-finite element”. J Orthop Surg Res. 2022; 17: 267.

[13] Shi J, Chen J, Wu J, Chen F, Huang G, Wang Z, et al. Evaluation of the 3D finite element method using a tantalum rod for osteonecrosis of the femoral head. Med Sci Monit. 2014; 20: 2556–2564.

[14] Bunn A, Colwell CW, D’lima DD. Effect of head diameter on passive and active dynamic hip dislocation. J Orthop Res. 2014; 32(11): 1525–1531.

[15] Komistek RD, Stiehl JB, Dennis DA, Paxson RD, Soutas-Little RW. Mathematical model of the lower extremity joint reaction forces using Kane’s method of dynamics. J Biomech. 1998; 31(2): 185–189.

[16] Chen Z, Xu Y, Qi Z, Zho JS. The formation and function of the sclerosis rim in the femoral head: a biomechanical point of view. Med Eng Phys. 2015; 37(12): 1125–1132.

[17] Li TX, Huang ZQ, Li Y, Xue ZP, Sun JG, Gao HH, et al. Prediction of collapse using patient-specific finite element analysis of osteonecrosis of the femoral head. Orthop Surg. 2019; 11(5): 794–800.

[18] Skedros JG, Baucom SL. Mathematical analysis of trabecular ‘trajectories’ in apparent trajectorial structures: the unfortunate historical emphasis on the human proximal femur. J Theor Biol. 2007; 244(1): 15–45.

[19] Yang JW, Koo KH, Lee MC, Yang P, Noh M, Kim SY, et al. Mechanics of femoral head osteonecrosis using three-dimensional finite element method. Arch Orthop Trauma Surg. 2002; 122(2): 88–92.

[20] Brown TD, Mutschler TA, Ferguson AB. A non-linear finite element analysis of some early collapse processes in femoral head osteonecrosis. J Biomech. 1982; 15(9): 705–715.

[21] Motomura G, Yamamoto T, Yamaguchi R, Ikemura S, Nakashima Y, Mawatari T, et al. Morphological analysis of collapsed regions in osteonecrosis of the femoral head. J Bone Jt Surg Br. 2011; 93(2): 184–187.

[22] Xu J, Zhan S, Ling M, Jiang D, Hu H, Sheng J, et al. Biomechanical analysis of fibular graft techniques for nontraumatic osteonecrosis of the femoral head: a finite element analysis. J Orthop Surg Res. 2020; 15(1): 335.

[23] Chen XT, Zhu YJ, Liu YW, Chen K, Xu WW, Zhang LL, et al. Metal trabecular bone reconstruction system better improves clinical efficacy and biomechanical repair of osteonecrosis of the femoral head than free vascularized fibular graft: a case-control study. J Cell Physiol. 2019; 234(11): 20957–20968.

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.