Should thorough Debridement be used in Fibular Allograft with impaction bone grafting to treat Femoral Head Necrosis: a biomechanical evaluation

Abstract

BackgroundFibular allograft with impaction bone grafting (FAIBG) is an effective hip-preservation method for avoiding total hip arthroplasty in the early stage of femoral head necrosis. However, whether thorough debridement should be used with FAIBG is controversial. This study compared the mechanical performance between FAIBG with and without thorough debridement, which provides a biomechanical basis for selecting the proper treatment in clinical settings.MethodsEighteen computational models were constructed and used to simulate two subtypes of femoral head collapse with seven debridement radii. The initial model was validated using the bony density distribution from X-ray images and a photograph of the cadaver bone cross-section. The stress of the anterolateral column and the debridement efficiency were computed and analyzed.Results(1) The peak stress of the anterolateral column in all conditions could return to the physiological level, and in two cases, the decrement/increment of stress was almost less than 0.1 % when the debridement radius increased. (2) The load share ratio (LSR) of the cortical and cancellous bone was markedly decreased in the untreated condition and increases with an increase in the debridement radius. (3) A debridement radius greater than 1/2r yields a LSR value larger than that obtained in the normal condition.ConclusionsThe simulation results provide specific biomechanical evidence to support the finding that FAIBG with a debridement region of 3/8 -1/2 appears to be a better choice for resisting femoral head collapse (FHC). Furthermore, FAIBG without thorough debridement, which requires relatively simple surgical devices and reduces artificial damage, appears to be a better method for resisting FHC than FAIBG with thorough debridement.

Biomechanical Analysis of Fibular Graft Techniques for Nontraumatic Osteonecrosis of Femoral Head: A Finite Element Analysis

“…Researchers on hip joint preservation surgeries of NONFH have tried to use nite element analysis to investigate the biomechanical performance of core decompression 24 , rod implantation 27,28 and CTT 19 . However, there has been no such investigations of LBT.…”

“…A bone tunnel was made along the axis of the femoral neck from window deep into the necrosis lesion in the femoral head 10,13 . The debridement region removed with the burr was the 1/2 radius of the necrotic domain 19 . The grafted bular dimensions (length as in the Table 1 and tting radius as 6.8 mm) were obtained from the volunteer's CT images.…”

“…The bula, necrotic bone and cancellous bone were assigned to different material properties which obtained from other studies 19,22,23 . In these models, each part was assumed to be linear elastic, homogeneous and isotropic.…”

Study on Role of Corticocancellous Graft in Bone Defects Caused by Fractures

“…The advantage of this hip-preservation method is that it provides both repaired materials and biomechanical structural support during the healing of the necrosis region. (6) Fracture gaps which are seen on radiographs and intraoperatively require fixation to give stability as well as closure of the gap. When creating a freshened edge of the fracture it self-causes a defect; the graft should be able to fill the defect and also give the stability during the manipulation and fixation.…”

The effect of the necrotic area on the biomechanics of the femoral head - a finite element study

“…Cortical bone, cancellous bone, cartilage, and necrotic area were considered to be isotropic linear elastic materials. The material parameters in each structure were taken from following previous studies (Table 1) [23][24][25][26]. The mesh division of the bone structure of the hip joint was established using 10-node modified tetrahedron unit, and where cartilage was established using the hexahedron unit.…”