Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts

Journal of Orthopaedic Surgery and Research

Seung-Chan Kim¹  Soon-Yong Kwon²  Ji Hoon Bahk²  Woo-Lam Jo²  Young Wook Lim² 

[1] Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea;Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, 222, Banpodae-ro, Seocho-gu, 06591, Seoul, South Korea;

关键词: Finite element analysis;    Osteonecrosis of the femoral head;    Lateral pillar;    Femoral head collapse;    Propensity-matched score;   

DOI  :  10.1186/s13018-021-02875-8

来源: Springer

【 摘 要 】

BackgroundThis study was designed as a cohort study using propensity-score matching to age, gender, and body mass index (BMI) for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapsed hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion.MethodsA total of 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over a one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 N of load was applied to 1000 mm2 area at the top of iliac crest to analyze the models in terms of equivalents for yield stress.ResultsAge, sex, and BMI had no significant differences between the two groups, while location (p = 0.015) was lateral, and size (p = 0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p = 0.001).ConclusionThrough FEM analysis, stress concentration to the lateral pillar and the primary compression trabeculae can be used to predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.

【 授权许可】

CC BY