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Open Access Research article

The effects of necrotic lesion size and orientation of the femoral component on stress alterations in the proximal femur in hip resurfacing - a finite element simulation

Ching-Lung Tai1, Yung-Chou Chen1 and Pang-Hsin Hsieh2*

Author Affiliations

1 Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan

2 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

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BMC Musculoskeletal Disorders 2014, 15:262  doi:10.1186/1471-2474-15-262

Published: 5 August 2014

Abstract

Background

Due to the advantages of its bone-conserving nature, hip resurface arthroplasty (HRA) has recently gained the interest of orthopedic surgeons for the treatment of young and active patients who have osteonerosis of the femoral head. However, in long-term follow-up studies after HRA, narrowing of the femoral neck has often been found, which may lead to fracture. This phenomenon has been attributed to the stress alteration (stress shielding). Studies addressing the effects of necrotic size and the orientation of the implant on stress alterations are lacking.

Methods

Computed tomography images of a standard composite femur were used to create a three-dimensional finite-element (FE) intact femur model. Based on the intact model, FE models simulating four different levels of necrotic regions (0°, 60°, 100°, 115°) and three different implant insertion angles (varus 10°, neutral, valgus 10°) were created. The von Mises stress distributions and the displacement of the stem tip of each model were analyzed and compared for loading conditions that simulated a single-legged stance.

Results

Stress shielding occurred at the femoral neck after HRA. More severe stress shielding and an increased displacement of the stem tip were found for femoral heads that had a wider necrotic lesion. From a biomechanics perspective, the results were consistent with clinical evidence of femoral neck narrowing after HRA. In addition, a varus orientation of the implant resulted in a larger displacement of the stem tip, which could lead to an increased risk of implant loosening.

Conclusions

A femoral head with a wide necrotic lesion combined with a varus orientation of the prosthesis increases the risk of femoral neck narrowing and implant loosening following HRA.

Keywords:
Hip resurfacing; Femoral head necrosis; Stress shielding; Finite element analysis