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Woo S, Lee Y, Sun D. A Pilot Experiment to Measure the Initial Mechanical Stability of the Femoral Head Implant in a Cadaveric Model of Osteonecrosis of Femoral Head Involving up to 50% of the Remaining Femoral Head. Medicina (B Aires) 2023; 59:medicina59030508. [PMID: 36984509 PMCID: PMC10051982 DOI: 10.3390/medicina59030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Background and Objectives: Currently, only patients with osteonecrosis of the femoral head (ONFH), who had bone defects involving 30–33.3% of the remaining femoral head, are indicated in hip resurfacing arthroplasty (HRA). In an experimental cadaver model of ONFH involving up to 50% of the remaining femoral head, the initial stability of the femoral head implant (FHI) at the interface between the implant and the remaining femoral head was measured. Materials and Methods: The ten specimens and the remaining ten served as the experimental group and the control group, respectively. We examined the degree of the displacement of the FHI, the bonding strength between the FHI and the retained bone and that at the interface between the FHI and bone cement. Results: Changes in the degree of displacement at the final phase from the initial phase were calculated as 0.089 ± 0.036 mm in the experimental group and 0.083 ± 0.056 mm in the control group. However, this difference reached no statistical significance (p = 0.7789). Overall, there was an increase in the degree of displacement due to the loading stress, with increased loading cycles in both groups. In cycles of up to 6000 times, there was a steep increase. After cycles of 8000 times, however, there was a gradual increase. Moreover, in cycles of up to 8000 times, there was an increase in the difference in the degree of displacement due to the loading stress between the two groups. After cycles of 8000 times, however, such difference remained almost unchanged. Conclusions: In conclusion, orthopedic surgeons could consider performing the HRA in patients with ONFH where the bone defects involved up to 50% of the remaining femoral head, without involving the femoral head–neck junction in the anterior and superior area of the femoral head. However, more evidence-based studies are warranted to justify our results.
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Affiliation(s)
| | | | - Doohoon Sun
- Correspondence: ; Tel.: +82-422-208-460; Fax: +82-422-208-464
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Cho YJ, Rhyu KH, Chun YS, Gwak HG. Hip Resurfacing Arthroplasty after Failure of Tantalum Rod Insertion in Patients with Osteonecrosis of the Femoral Head. Hip Pelvis 2022; 34:219-226. [PMID: 36601613 PMCID: PMC9763834 DOI: 10.5371/hp.2022.34.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose The purpose of this study was to examine the clinical outcomes and efficacy of hip resurfacing arthroplasty (HRA) in patients with osteonecrosis of the femoral head after the failure of porous tantalum rod insertion without rod removal. Materials and Methods Conversion to hip resurfacing arthroplasty was performed in 10 patients (11 hips) with a mean period of 14.9 months after the primary surgery. The mean follow-up period was 73.7 months. Analysis of pre and postoperative range of motion (ROM), University of California at Los Angeles (UCLA) activity score, modified Harris hip score, and visual analog scale (VAS) pain score was performed. Radiographic analysis of component loosening and osteolysis was performed. Results The postoperative ROM showed significant improvement (P<0.05), excluding flexion contracture. The modified Harris hip score showed improvement from 65.82 to 96.18, the UCLA score showed improvement from 4.18 to 8.00, and the VAS pain score was reduced from 6.09 to 1.80. All scores showed statistically significant improvement (P<0.05). No component loosening or osteolysis was detected by radiographic analysis. Conclusion Satisfactory results were obtained from conversion hip resurfacing arthroplasty after failure of porous tantalum rod insertion without rod removal. The findings of this study demonstrate the advantages of HRA, including no risk of trochanteric fracture and no bone loss around the tantalum rod. In addition, the remaining porous tantalum rod provided mechanical support, which reduced the potential risk of femoral neck fracture or loosening. This technique can be regarded as a favorable treatment option.
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Affiliation(s)
- Yoon Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Gon Gwak
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Tran TN, Wolf M, Winter P, Landgraeber S. Hip joint mechanics in patients with osteonecrosis of the femoral head following treatment by advanced core decompression. Clin Biomech (Bristol, Avon) 2022; 94:105635. [PMID: 35367817 DOI: 10.1016/j.clinbiomech.2022.105635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteonecrosis of the femoral head is a serious disease which, if left untreated, leads to destruction of the affected hip joint. For treatment of early stages of this disease, core decompression is the most common procedure. This study investigated the influence of the necrotic lesion and core decompression on the stress pattern in the hip joint using finite element analysis. METHODS Subject-specific models were generated from CT scan data of 5 intact hips. For each intact hip, twelve affected hip models were created by imposing a necrotic lesion in the femoral head, and four treated models were then created from four affected ones with central lesion, respectively. Treated models were created by supposing that the defect zone and the drill canal were filled with a bone substitute. Totally 105 hip models from three groups (intact, affected and treated) were simulated during normal walking activity. FINDINGS Necrotic lesion modified the stress distribution within the femoral head. Peak stress increased significantly up to 186% in mean in hips with a large lesion indicating an increased risk of femoral head collapse. Additionally, the presence of a medium to large necrosis altered significantly stress values (P < 0.05) and pattern in the articular cartilage. Our study revealed that advanced core decompression can recover normal cartilage stress values and pattern in treated joint. INTERPRETATION The presence of a large lesion increased the risk of femoral head collapse. Advanced core decompression with bone grafts can restore normal cartilage mechanics in hip postoperatively.
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Affiliation(s)
- Thanh Ngoc Tran
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany.
| | - Milan Wolf
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany
| | - Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, D-66421 Homburg, Germany
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Pascart T, Paccou J, Colard T, Norberciak L, Girard J, Delattre J, Marchandise P, Legrand J, Penel G, Coursier R, Putman S, Cortet B, Kerckhofs G, Budzik JF. T1-weighted MRI images accurately represent the volume and surface of architectural mineral damage of osteonecrosis of the femoral head: Comparison with high-resolution computed tomography. Bone 2020; 130:115099. [PMID: 31654780 DOI: 10.1016/j.bone.2019.115099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022]
Abstract
The potency of magnetic resonance imaging (MRI) to measure the exact extent of osteonecrosis of the femoral head (ONFH) remains uncertain. The objective of this study was to determine if the volume of necrosis assessed with MRI accurately reflects the volume of architectural mineral alterations in osteonecrosis of the femoral head by comparison with high-resolution microfocus X-ray computed tomography (HR-μCT). Fourteen male patients aged 53 years [46.2;59.0] suffering from ONFH were prospectively enrolled to undergo preoperative MRI and ex vivo analysis using HR-μCT. The necrotic zone on T1-weighted MRI scans was defined as total necrosis (delimited by the low-signal peripheral band) or dark necrosis (low-signal lesions only). The HR-μCT scans delimited outer necrosis and inner necrosis by including or excluding the sclerotic zone. The intra-class correlation coefficient (ICC) was calculated to compare the agreement of surface areas and volumes of necrosis measurements with the two techniques. There was an overall excellent agreement between MRI dark necrosis volume and HR-μCT outer necrosis volume (ICC=0.91[0.54;0.98]) while the MRI total necrosis volume showed poor agreement with both HR-μCT delimitations of necrosis volume. For surface area, agreement between MRI dark necrosis and HR-μCT delimitations was good for inner necrosis (ICC=0.70[0.21;0.9]) and moderate for outer necrosis (ICC=0.58[0.07;0.85]). This study demonstrates that measurement of the MRI lesions provides a reliable assessment of the extent of ONFH-related architectural damage.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France; EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France.
| | - Julien Paccou
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France; Department of Rheumatology, Hopital Salengro, Centre Hospitalier Universitaire de Lille, University of Lille, F-59000, Lille, France
| | - Thomas Colard
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Julien Girard
- Department of Orthopaedic Surgery, Hopital Salengro, Centre Hospitalier Universitaire de Lille, F-59037, Lille, France
| | - Jerôme Delattre
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France
| | - Pierre Marchandise
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France
| | - Julie Legrand
- Department of Radiology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
| | - Guillaume Penel
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France
| | - Raphaël Coursier
- Department of Orthopaedic Surgery, Lille Catholic Hospitals, University of Lille, F-59160 Lomme, France
| | - Sophie Putman
- Department of Orthopaedic Surgery, Hopital Salengro, Centre Hospitalier Universitaire de Lille, F-59037, Lille, France
| | - Bernard Cortet
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France; Department of Rheumatology, Hopital Salengro, Centre Hospitalier Universitaire de Lille, University of Lille, F-59000, Lille, France
| | - Greet Kerckhofs
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Prometheus - Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium; Biomechanics lab, Institute of Mechanics, Materials, and Civil Engineering, UC Louvain, Louvain-la-Neuve, Belgium
| | - Jean-François Budzik
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, F-59000, Lille, France; Department of Radiology, Lille Catholic Hospitals, University of Lille, F-59160, Lomme, France
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Cilla M, Checa S, Duda GN. Strain shielding inspired re-design of proximal femoral stems for total hip arthroplasty. J Orthop Res 2017; 35:2534-2544. [PMID: 28176355 DOI: 10.1002/jor.23540] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/27/2017] [Indexed: 02/04/2023]
Abstract
A large number of hip prosthesis with different designs have been developed. However, the influence of hip implant design changes on the strains induced in the bone remains unclear. The purpose of this study is to better understand the mechanics of short stem total hip arthroplasty. Specifically, it investigates whether strain shielding can be avoided by changing implant shape and/or material properties. It is hypothesized that the re-design of existing implant designs can result in further reduction of strain shielding and thus keep bone loss minimal following total hip replacement. Finite element methods were used to compare healthy and implanted models. The local mechanics strains/stresses in the intact and implanted femurs were determined under patient-specific muscle and joint contact forces. Results suggest that small changes in implant geometry and material properties have no major effect on strain shielding. Furthermore, it was found that improvement depends on a dramatic re-design of the original implant design. Whereas the benefit of this strategy of modification of the original geometry of a given short-stemmed hip consists in reduced bone remodeling, care should be taken with regard to long-term bone anchorage and implant fatigue strength. It is also shown that geometrical and material changes have a limited potential in avoiding strain shielding even in short-stemmed implants. Finally, it is suggested that an understanding of the influence of these changes on the strain distribution within the bone can guide in the process of optimizing the current stem designs toward minimal strain shielding effects. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2534-2544, 2017.
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Affiliation(s)
- Myriam Cilla
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Campus - Virchow Klinikum, Augustenburger Platz 1, Institutsgebäude Süd,13353 Berlin, Germany.,Centro Universitario de la Defensa, Academia General Militar, Ctra. Huesca s/n, 50090 Zaragoza, Spain.,Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Sara Checa
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Campus - Virchow Klinikum, Augustenburger Platz 1, Institutsgebäude Süd,13353 Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Campus - Virchow Klinikum, Augustenburger Platz 1, Institutsgebäude Süd,13353 Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hip joint geometry effects on cartilage contact stresses during a gait cycle. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:6038-6041. [PMID: 28269629 DOI: 10.1109/embc.2016.7592105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The cartilage surface geometry of natural human hip joint is commonly regarded as sphere. It has been widely applied in computational simulation and hip joint prosthesis design. Some new geometry models have been developed and the sphere assumption has been questioned recently. The objective of this study was to analyze joint geometry effects on cartilage contact stress distribution and investigate contact patterns during a whole gait cycle. Hip surface was reconstructed from CT data of a healthy volunteer. Three finite element (FE) models of hip joint were developed from different cartilage geometries: natural geometry, sphere and rotational ellipsoid. Loads at ten instants of gait cycle were applied to these models based on published in-vivo data. FE predictions of peak contact pressure during gait of natural hip were compared with sphere and rotational ellipsoid replaced hip joint. Contact occurs mainly in upper anterior region of both acetabulum and femur distributing along sagittal plane of human body. It moves towards inferolateral aspect as the resultant joint reaction force changes during walking for natural hip. Peak pressures at the instant with maximum contact force were 7.48 MPa, 14.97 MPa and 13.12 MPa for models with natural hip surface, sphere replaced and rotational ellipsoid replaced surface respectively. During the whole gait cycle, contact pressure of natural hip ranked lowest in most of the instants, followed by rotational ellipsoid replaced and sphere replaced hip. The results indicate that rotational ellipsoid is more consistent with natural hip cartilage geometry than sphere during normal walking. This means rotational ellipsoid prosthesis could give a better description of physiological structure compared with standard sphere prosthesis. Therefore, rotational ellipsoid would be a better choice for prosthesis design.
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Abstract
Hip resurfacing arthroplasty (HRA) is an alternative to conventional, stemmed total hip arthroplasty (THA). The best reported results are young, active patients with good bone stock and a diagnosis of osteoarthritis. Since the 1990s, metal-on-metal (MoM) HRA has achieved excellent outcomes when used in the appropriate patient population. Concerns regarding the metal-on-metal bearing surface including adverse local tissue reaction (ALTR) to metal debris have recently lead to a decline in the use of this construct. The current paper aims to provide an updated review on HRA, including a critical review of the most recent literature on HRA.
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Affiliation(s)
- Robert Sershon
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA.
| | - Rishi Balkissoon
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA.
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL, 60612, USA.
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Karasuyama K, Yamamoto T, Motomura G, Sonoda K, Kubo Y, Iwamoto Y. The role of sclerotic changes in the starting mechanisms of collapse: A histomorphometric and FEM study on the femoral head of osteonecrosis. Bone 2015; 81:644-648. [PMID: 26408039 DOI: 10.1016/j.bone.2015.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the distributions of stress, strain, and fractured areas using a finite element model (FEM), and examine the osteoclastic activity histopathologically in osteonecrosis of the femoral head. METHODS Three femoral heads were obtained during hip arthroplasty for femoral head osteonecrosis. One sample with a normal area, two samples with a non-sclerotic boundary without collapse (Type 1), two samples with a non-collapsed sclerotic boundary (Type 2), and two samples with a collapsed sclerotic boundary (Type 3) were collected from each femoral head for the FEM and histopathological analyses. FEM was performed using CT data, and the distributions of von Mises equivalent stress, octahedral shear stress, octahedral shear strain, and simulated fractured area were evaluated. Furthermore, the osteoclast count at the boundary was compared for each type. RESULTS In normal and Type 1 samples, the distributions of von Mises equivalent stress, octahedral shear stress, octahedral shear strain, and the fractured area were equally concentrated along the whole analytical range; however, in the Type 2 and 3 samples, they were concentrated along the thickened bone trabeculae at the boundary, which corresponded to the fractured area. Histopathologically, a significantly increased osteoclast number was observed only at the collapsed sclerotic boundary. CONCLUSION These results demonstrated that both shear stress and shear strain tend to be concentrated on thickened bone trabeculae at the boundary. Fracture analyses revealed that the boundary of sclerotic changes, which results from the repair process, may be the starting point of the fracture. Additionally, the osteoclastic activity increases after collapse.
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Affiliation(s)
- Kazuyuki Karasuyama
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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