Elsevier

The Journal of Arthroplasty

Volume 25, Issue 8, December 2010, Pages 1282-1289
The Journal of Arthroplasty

A Mechanical Analysis of Femoral Resurfacing Implantation for Osteonecrosis of the Femoral Head

https://doi.org/10.1016/j.arth.2009.09.002Get rights and content

Abstract

Hip resurfacing is becoming a popular procedure for treating osteonecrosis of the femoral head. However, the biomechanical changes that occur after femoral resurfacing have not been fully investigated with respect to the individual extent of the necrosis. In this study, we evaluated biomechanical changes at various extents of necrosis and implant alignments using the finite element analysis method. We established 3 patterns of necrosis by depth from the surface of femoral head and 5 stem angles. For these models, we evaluated biomechanical changes associated with the extent of necrosis and the stem alignment. Our results indicate that stress distribution near the bone-cement interface increased with expansion of the necrosis. The maximum stress on the prosthesis was decreased with stem angles ranging from 130° to140°. The peak stress of cement increased as the stem angle became varus. This study indicates that resurfacing arthroplasty will have adverse biomechanical effects when there is a large extent of osteonecrosis and excessive varus or valgus implantation of the prosthesis.

Section snippets

Materials and Methods

A solid model of a femur was generated from computed tomography (CT) scans (Light Speed Ultra16; GE Medical Systems, Tokyo) of a normal hip from a 28-year-old Japanese woman. For each CT slice, the outer contour of the femur was defined and lofted to form a 3-dimensional solid model of the femur using MECHANICAL FINDER 2.0 (Research Center of Computational Mechanics Inc, Tokyo). We used the proximal 190-mm compartment of the femur. The femur was then virtually implanted with a suitably sized

Result

Expanding the necrosis area, which was replaced by cement, altered the strain distribution within the femoral head. As can be seen Fig. 4, which presents coronal plane sections of each model, strain concentration was not observed in the “type A” femoral head. However, in the “type B” and “type C” femoral heads, we see increased strain near the bone and cement interface corresponding to the expansion of the necrosis replaced by a cement mantle. The strain concentration is particularly evident in

Discussion

Early hip resurfacing implants suffered from poor manufacturing quality of the bearing surface and materials. However, the current generation of metal-on-metal resurfacing arthroplasty, using improved manufacturing techniques, has shown promising results in clinical trials 3, 4, 5. This procedure is regaining its popularity, especially as a treatment option for young and active patients with avascular necrosis of the femoral head, which is difficult to treat with joint preserving surgery (eg,

Conclusions

Finite element analysis of hip resurfacing methods was performed against femoral head necrosis models with various extents of necrosis areas and several implant angles. This study suggests that hip resurfacing for patients in whom osteonecrosis extends widely should be considered very carefully; increased stress concentration near the bone-cement interface may occur when all the necrotic bone is replaced by cement. Further, excessive varus or valgus implantation of the prosthesis has

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    No benefits or funds were received in support of the study.

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