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Traditional Medicine Research  2018, Vol. 3 Issue (5): 230-236    DOI: 10.12032/TMR201813081
Ethnic and Regional Medicine     
Can hip abduction reduce the risk of femoral head necrosis deteriorated into osteoarthritis? A 3D finite element analysis
Guang-Quan Zhou1, Hong-Lai Zhang2,*()
1 The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
2 School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Highlights

The present computational biomechanical analysis suggest that enhanced lower extremity abduction motion can effectively reduce collapse risk and interrupt the disease pathway of femoral head necrosis deteriorated into osteoarthritis.

Editor’s Summary

Femoral head necrosis is called Gushi, which was first recorded in Huangdineijing published on Xihan Dynasty of China (the third century B.C.). This study provided an unique biomechanical insight into the beneficial effects of lower extremity abduction motion in the treatment of femoral head necrosis.

Abstract

Objective: The purpose of this study was to investigate biomechanical behavior changes of femoral head necrosis (FHN) by increasing lower extremity abduction (LEA) angle, offering scientific basis on choosing the LEA procedure for the exact classifications. Methods: Thirty computational models were constructed and used to simulate six different abducent angles with five different progresses of FHN. The initial model was validated by the bony density distribution in X-rays images and the photograph of the cadaver bone in cross-section. The stress transfer path (STP) of each model was analyzed and the contact stresses were assessed. Results: During the midstance phase, STP of type A showed strong similarities with the healthy level; STP distribution was from the top of the femoral head to the calcar; the damage area of STP of type B was approximately 25% of the healthy. While STPs in both type C1 and C2 were broken off. As the increase of the abduction angle, STP of type B transformed into type A, STP of type C1 transformed into type B. STP of type C2 transformed into type C1. There was no significant difference in contact stress between the four settings of FHN and normal femoral head. Conclusions: We found computational biomechanical technique to be a sensitive and useful method for distinguishing the biomechanical difference of FHN during abduction gait. These results showed that LEA motion could effectively reduce collapse risk and interrupt the disease pathway of FHN deteriorated into osteoarthritis. Furthermore, our findings indicated that the LEA procedure was suitable for type A, B and C1, while type C2 of FHN involved surgical intervention might get a better clinical outcome.



Key wordsLower extremity abduction      Contact stress      Femoral head necrosis      Stress transfer path      Osteoarthritis      Computational biomechanics     
Published: 04 September 2018
Fund:  The authors received grants from Natural Science Foundation of Guangdong Province (2014A030310214), Science and Technology Project of Guangdong Province (2014A020221041), and the Medical Science and Technology Foundation of Guangdong Province (A2015039).
Corresponding Authors: Zhang Hong-Lai     E-mail: zhltmrsci@163.com
Cite this article:

Guang-Quan Zhou, Hong-Lai Zhang. Can hip abduction reduce the risk of femoral head necrosis deteriorated into osteoarthritis? A 3D finite element analysis. Traditional Medicine Research, 2018, 3(5): 230-236. doi: 10.12032/TMR201813081

URL:

https://www.tmrjournals.com/tmr/EN/10.12032/TMR201813081     OR     https://www.tmrjournals.com/tmr/EN/Y2018/V3/I5/230

Figure 1 JIC classification of FHN [18]
JIC, Japanese Investigation Committee; FHN, Femoral head necrosis.
Figure 2 Lower extremity abducent angle
A: Abducent angle β = 0°, B: Abducent angle β = 10°, C: Abducent angle β = 15°, D: Abducent angle β = 20°, E: Abducent angle β = 25°, F: Abducent angle β = 30°.
Figure 3 Photograph, radiograph and computational results of human proximal femur
A: Photograph; B: Radiograph [27-29]; C: Computational results. The color region represents the high stress distribution area in the femoral head, and the white region is the low stress distribution area.
Figure 4 Stress transfer path
The color region represents the high stress distribution area in the femoral head, and the white region is the low stress distribution area. Compared with the color region, the stress conduction in the white region is very small, so the color region is the distribution of the principal stress conduction path of the femoral head. The higher the degree of femoral head necrosis is, the more obvious the area of color area decreases, while the area of color area increases with the increase of abduction angle. A: Healthy condition; B: Type A; C: Type B; D: Type C1; E: Type C2; A - E: Abducent angle β = 0°; A1 - E1: Abducent angle β = 10°; A2 - E2: Abducent angle β = 15°; A3 - E3: Abducent angle β = 20°; A4 - E4: Abducent angle β = 25°; A5 - E5: Abducent angle β = 30°.
Figure 5 The contact stress of articular cartilage
A: Peak values of contact stress of articular cartilage; B: Average contact stress of cartilage. JIC, Japanese Investigation Committee.
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