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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | 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

Authors: Ching-Lung Tai, Yung-Chou Chen, Pang-Hsin Hsieh

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

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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.
Appendix
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Literature
1.
Mont MA, Ragland PS, Etienne G, Seyler TM, Schmalzried TP: Hip resurfacing arthroplasty. J Am Acad Orthop Surg. 2006, 14 (8): 454-463. ReviewCrossRefPubMed
2.
Grigoris P, Roberts P, Panousis K, Bosch H: The evolution of hip resurfacing arthroplasty. Orthop Clin North Am. 2005, 36 (2): 125-134. vii. ReviewCrossRefPubMed
3.
Girard J, Lavigne M, Vendittoli PA, Migaud H: Hip resurfacing: current state of knowledge. Rev Chir Orthop Reparatrice Appar Mot. 2008, 94 (8): 715-730.CrossRefPubMed
4.
Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, GruEN TA: Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004, 86 (1): 28-39.PubMed
5.
Howie DW, Cornish BL, Vernon-Roberts B: The viability of the femoral head after resurfacing hip arthroplasty in humans. Clin Orthop. 1993, 291: 171-184.PubMed
6.
Grecula MJ: Resurfacing arthroplasty in osteonecrosis of the hip. Orthop Clin North Am. 2005, 36 (2): 231-242.CrossRefPubMed
7.
Amstutz HC, Campbell PA, Le Duff MJ: Fracture of the neck of the femur after surface arthroplasty of the hip. J Bone Joint Surg Am. 2004, 86 (9): 1874-1877.PubMed
8.
Ritter MA, Lutgring JD, Berend ME, Pierson JL: Failure mechanisms of total hip resurfacing: implications for the present. Clin Orthop Relat Res. 2006, 453: 110-114.CrossRefPubMed
9.
Spencer S, Carter R, Murray H, Meek RM: Femoral neck narrowing after metal-on-metal hip resurfacing. J Arthroplasty. 2008, 23 (8): 1105-1109.CrossRefPubMed
10.
Wang W, Geller JA, Hasija R, Choi JK, Patrick DA, Macaulay W: Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing. World J Orthop. 2013, 4 (2): 75-79.CrossRefPubMedPubMedCentral
11.
Deuel CR, Jamali AA, Stover SM, Hazelwood SJ: Alterations in femoral strain following hip resurfacing and total hip replacement. J Bone Joint Surg (Br). 2009, 91 (1): 124-130.CrossRef
12.
Radcliffe IA, Taylor M: Investigation into the effect of varus-valgus orientation on load transfer in the resurfaced femoral head: a multi-femur finite element analysis. Clin Biomech. 2007, 22 (7): 780-786.CrossRef
13.
Koo KH, Kim R: Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg (Br). 1995, 77 (6): 875-880.
14.
Taylor M: Finite element analysis of the resurfaced femoral head. Proc Inst Mech Eng H. 2006, 220 (2): 289-297.CrossRefPubMed
15.
Mann KA, Bartel DL, Wright TM, Burstein AH: Coulomb frictional interfaces in modeling cemented total hip replacements: a more realistic model. J Biomech. 1995, 28 (9): 1067-1078.CrossRefPubMed
16.
Watanabe Y, Shiba N, Matsuo S, Higuchi F, Tagawa Y, Inoue A: Biomechanical study of the resurfacing hip arthroplasty: finite element analysis of the femoral component. J Arthroplasty. 2000, 15 (4): 505-511.CrossRefPubMed
17.
Liu WG, Wang SJ, Yin QF, Liu SH, Guan YJ: Biomechanical supporting effect of tantalum rods for the femoral head with various sized lesions: a finite-element analysis. Chin Med J (Engl). 2012, 125 (22): 4061-4065.
18.
Tran TN, Warwas S, Haversath M, Classen T, Hohn HP, Jäger M, Kowalczyk W, Landgraeber S: Experimental and computational studies on the femoral fracture risk for advanced core decompression. Clin Biomech. 2014, 29 (4): 412-417.CrossRef
19.
Ong KL, Kurtz SM, Manley MT, Rushton N, Mohammed NA, Field RE: Biomechanics of the Birmingham hip resurfacing arthroplasty. J Bone Joint Surg (Br). 2006, 88 (8): 1110-1115.CrossRef
20.
De Smet KA: Belgium experience with metal-on-metal surface arthroplasty. Orthop Clin North Am. 2005, 36 (2): 203-213. ixCrossRefPubMed
21.
Lian YY, Pei FX, Yoo MC, Cheng JQ, Fatou CY: Changes of the bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head. J Orthop Res. 2008, 26 (4): 453-459.CrossRefPubMed
22.
Amstutz HC, Le Duff MJ: Hip resurfacing results for osteonecrosis are as good as for other etiologies at 2 to 12 years. Clin Orthop Relat Res. 2010, 468 (2): 375-381.CrossRefPubMed
23.
Duijsens AW, Keizer S, Vliet-Vlieland T, Nelissen RG: Resurfacing hip prostheses revisited: failure analysis during a 16-year follow-up. Int Orthop. 2005, 29 (4): 224-228.CrossRefPubMedPubMedCentral
24.
Costi K, Howie DW, Campbell DG, McGee MA, Cornish BL: Long-term survival and reason for revision of Wagner resurfacing hip arthroplasty. J Arthroplasty. 2010, 25 (4): 522-528.CrossRefPubMed
25.
Hing CB, Back DL, Bailey M, Young DA, Dalziel RE, Shimmin AJ: The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips. J Bone Joint Surg (Br). 2007, 89 (11): 1431-1438.CrossRef
26.
Mont MA, Rajadhyaksha AD, Hungerford DS: Outcomes of limited femoral resurfacing arthroplasty compared with total hip arthroplasty for osteonecrosis of the femoral head. J Arthroplasty. 2001, 16 (8 Suppl 1): 134-139.CrossRefPubMed
27.
George LL, Francis WC, Elizabeth AF: A Primer of Biomechanics. 1999, New York: Springer-Verlag, Inc
28.
Morlock MM, Bishop N, Ruther W, Delling G, Hahn M: Biomechanical, morphological and histological analysis of early failures in hip resurfacing arthroplasty. Proc Inst Mech Eng H. 2006, 220 (2): 333-344.CrossRefPubMed
Metadata
Title
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
Authors
Ching-Lung Tai
Yung-Chou Chen
Pang-Hsin Hsieh
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-262

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