Application of finite element analysis in pre-operative planning for deformity correction of abnormal hip joints – a case series

Kh, Rhyu; Yh, Kim; Wm, Park; K, Kim; Tj, Cho; Ih, Choi

doi:10.1177/0954411911407247

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…Joint contact stress is most commonly assessed in living patients using non-invasive computational modeling techniques such as finite element analysis (FEA) (Harris et al, 2012; Henak et al, 2014a; Rhyu et al, 2011). Unfortunately, the technical burden required to develop and run patient-specific FE models is substantial, with mesh generation and establishment of numerically stable contact conditions requiring many days or weeks of effort, and model runtimes that range from hours to days depending on model complexity.…”

Section: Introductionmentioning

confidence: 99%

Discrete element analysis is a valid method for computing joint contact stress in the hip before and after acetabular fracture

Townsend

Thomas-Aitken

Rudert

et al. 2018

Journal of Biomechanics

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Evaluation of abnormalities in joint contact stress that develop after inaccurate reduction of an acetabular fracture may provide a potential means for predicting the risk of developing post-traumatic osteoarthritis. Discrete element analysis (DEA) is a computational technique for calculating intra-articular contact stress distributions in a fraction of the time required to obtain the same information using the more commonly employed finite element analysis technique. The goal of this work was to validate the accuracy of DEA-computed contact stress against physical measurements of contact stress made in cadaveric hips using Tekscan sensors. Four static loading tests in a variety of poses from heel-strike to toe-off were performed in two different cadaveric hip specimens with the acetabulum intact and again with an intentionally malreduced posterior wall acetabular fracture. DEA-computed contact stress was compared on a point-by-point basis to stress measured from the physical experiments. There was good agreement between computed and measured contact stress over the entire contact area (correlation coefficients ranged from 0.88 to 0.99). DEA-computed peak contact stress was within an average of 0.5 MPa (range 0.2-0.8 MPa) of the Tekscan peak stress for intact hips, and within an average of 0.6 MPa (range 0-1.6 MPa) for fractured cases. DEA-computed contact areas were within an average of 33% of the Tekscan-measured areas (range: 1.4-60%). These results indicate that the DEA methodology is a valid method for accurately estimating contact stress in both intact and fractured hips.

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Section: Introductionmentioning

confidence: 99%

Discrete element analysis is a valid method for computing joint contact stress in the hip before and after acetabular fracture

Townsend

Thomas-Aitken

Rudert

et al. 2018

Journal of Biomechanics

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“…To date, most analyses of the hip investigated normal joints 14–19. Rhyu et al20 simulated surgical outcomes of osteotomies for the treatment of slipped capital femoral epiphyses. Armiger et al21 used a discrete element analysis algorithm to assess contact pressure on the cartilage before and after PAO, ignoring the underlying bone stress.…”

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confidence: 99%

Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis

Zou

Chávez-Arreola

Mandal

et al. 2012

Journal Orthopaedic Research

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Periacetabular osteotomy (PAO) is a surgical procedure to correct acetabular orientation in developmental dysplasia of the hip (DDH). It changes the position of the acetabulum to increase femoral head coverage and distribute the contact pressure over the cartilage surface. The success of PAO depends significantly on the surgeon's experience. Using computed tomography data from patients with DDH, we developed a 3D finite element (FE) model to investigate the optimal position of the acetabulum following PAO. A virtual PAO was performed with the acetabulum rotated in increments from the original center edge (CE) angle. Contact area, contact pressure, and Von Mises stress in the femoral and pelvic cartilage were analyzed. Five dysplastic hips from four patients were modeled. Contact area, contact pressure, and Von Mises stress in the cartilage all varied according to the change of CE angle through virtual PAO. An optimal position could be achieved for the acetabulum that maximizes the contact area while minimizing the contact pressure and von Mises stress in the pelvic and femoral cartilage. The optimal position of the acetabulum was patient dependent and did not always correspond to what would be considered a ''normal'' CE angle. We demonstrated for the first time the interrelation of correction angle, contact area, and contact pressure between the pelvic and femoral cartilage in PAO surgery. Keywords: developmental dysplasia of the hip; periacetabular osteotomy; finite element Developmental dysplasia of the hip (DDH) is an abnormal development of the acetabulum, the femoral head or both. It affects between 1% and 3% of newborn babies and was shown to be the cause of 29% of hip replacements in people under the age of 60. 1 Apart from the pain and discomfort associated with DDH, lack of treatment may lead to osteoarthritis and significant disability. In childhood, early diagnosis and treatment may allow appropriate bony development and avoid complicated and hazardous surgical procedures. However in adults, osteotomy is often the most appropriate treatment. The success largely depends on the surgeon's experience. [2][3][4][5][6][7][8] The diagnosis of DDH is based on the center edge (CE) angle formed by a vertical line passing through the center of the femoral head and a line from the center of the head to the edge of the acetabulum (Fig. 1). The CE angle in a normal hip is >258. A hip with a CE angle <208 may be diagnosed as DDH. 9,10 The periacetabular osteotomy (PAO) to correct DDH depends on the clinical condition of the patient and the severity of the disease. 8 Bernese PAO is a type of pelvic osteotomy described by Ganz et al. 11 that changes the position of the acetabulum to increase coverage of the head, stabilizing the joint and reducing contact pressure. [4][5][6][7][8][9][10]12 The advantages of the Ganz PAO over other pelvic osteotomies are: the cuts are reproducible and can be performed with one incision; post-operatively the posterior column is intact and patients do not need a cast or brace;...

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“…Based on previous studies, von Mises stress is a good representation of stress distribution for evaluating different osteotomy methods and fixation techniques due to its impeccable prediction of injury or failure of bone tissues [6,27,35,36]. As shown in Figure 3, high stresses emerge at the osteotomized regions surrounding the screw holes in both pelvic and acetabular fragments, with peak values of 58.0 MPa and 70.11 MPa (Table 3) at the osteotomized pelvic fragments in the vicinity of the hole surface of the most medial fixation screw (third screw starting from the ASIS) in IS and transverse screw in IT configurations, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…To obtain the optimal method for stabilizing the acetabular fragment, various fixation techniques have been introduced, and their biomechanical strength have been compared through in vitro experiments [16,17,20]. Use of FEA has been proven to be effective in orthopedics applications [7,26,27,33,[35][36][37]; however, the biomechanical comparison of different fixation techniques of PAO with the use of FEA is missing in the literature. In this paper, we assess the biomechanical performance of two popular fixation techniques: iliac and transverse screw configurations, with the aid of FE analysis.…”

Section: Discussionmentioning

confidence: 99%

Comparative Biomechanical Study of Screw Fixation Techniques in Periacetabular Osteotomy

et al. 2021

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Periacetabular osteotomy (PAO) is a common surgical treatment for developmental dysplasia of the hip. To obtain the optimal method of fixation during PAO, different screw fixation techniques have been proposed for stabilizing the acetabular fragment. This study assesses the biomechanical performance of two popular 3-screw fixation techniques: iliac (IS) and transverse (IT) configurations, through finite element simulations. Additionally, different 2-screw combinations are simulated to investigate the biomechanical significance of each screw of the fixation configurations. The study findings show that yield load of the pelvic bone subject to gait loading for IT configuration is on average 7% higher compared to that of the IS. Although the yield load of the IT is predicted to be slightly higher, no significant difference in bone stiffness and displacement of the acetabular fragment are found between two configurations. Simulation results, therefore, do not demonstrate a significant biomechanical advantage of the IT configuration over the IS. Furthermore, the biomechanical comparison between the 2-screw combinations of IS and IT fixations demonstrates that the most anterior screw in IS, located at the iliac crest, and the most medial screw in the IT are the most critical elements in providing sufficient stability and support for acetabular fragment.

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Application of finite element analysis in pre-operative planning for deformity correction of abnormal hip joints – a case series

Cited by 8 publications

References 27 publications

Discrete element analysis is a valid method for computing joint contact stress in the hip before and after acetabular fracture

Discrete element analysis is a valid method for computing joint contact stress in the hip before and after acetabular fracture

Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis

Comparative Biomechanical Study of Screw Fixation Techniques in Periacetabular Osteotomy

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