Experimental and computational studies on the femoral fracture risk for advanced core decompression

Tran, Thanh Ngoc; Warwas, Sebastian; Haversath, Marcel; Claßen, Tim; Hohn, H.P.; Jäger, Markus; Kowalczyk, Wojciech; Landgraeber, Stefan

doi:10.1016/j.clinbiomech.2014.02.001

Cited by 18 publications

(18 citation statements)

References 23 publications

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“…Previous studies have demonstrated that the incidence of intertrochanteric and subtrochanteric fractures of patients treated with core decompression combined with bone grafting is 2%-5% [36,37]. This is due to the destruction of the weight-bearing support structure in the intertrochanteric region [38]. By elevating the surgical site to the head-neck junction, the light bulb procedure, in theory, causes minimal damage to the weight-bearing support structure in the intertrochanteric region, thus reducing fracture risk of the femur.…”

Section: Discussionmentioning

confidence: 99%

Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

Wang

Yang

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

Wang

Yang

et al. 2020

The Journal of Arthroplasty

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“…The ultimate tensile stress of the cortical bone reported in the literature varies from 78 MPa to 151 MPa [18,[25][26][27]. In this study, a limit tensile strength of 110 MPa is chosen as a reference [2,9,18].…”

Section: Discussionmentioning

confidence: 99%

“…The element numbers for final meshes are displayed in Table 1. For material properties of the femur, a linear, elastic and isotropic bone with 3 mm uniform thickness of the cortical bone layer [18] and internal cancellous bone [2,18,20,21].…”

Section: Finite Element Simulationmentioning

confidence: 99%

A Biomechanical Study on the Use of Curved Drilling Technique for Treatment of Osteonecrosis of Femoral Head

Bakhtiarinejad

Alambeigi

Chamani

et al. 2019

Computational Biomechanics for Medicine

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Osteonecrosis occurs due to the loss of blood supply to the bone, leading to spontaneous death of the trabecular bone. Delayed treatment of the involved patients results in collapse of the femoral head, which leads to a need for total hip arthroplasty surgery. Core decompression, as the most popular technique for treatment of the osteonecrosis, includes removal of the lesion area by drilling a straight tunnel to the lesion, debriding the dead bone and replacing it with bone substitutes. However, there are two drawbacks for this treatment method. First, due to the rigidity of the instruments currently used during core decompression, lesions cannot be completely removed and/or excessive healthy bone may also be removed with the lesion. Second, the use of bone substitutes, despite its biocompatibility and osteoconductivity, may not provide sufficient mechanical strength and support for the bone. To address these shortcomings, a novel robot-assisted curved core decompression (CCD) technique is introduced to provide surgeons with direct access to the lesions causing minimal damage to the healthy bone. In this study, with the aid of finite element (FE) simulations, we investigate biomechanical performance of core decompression using the curved drilling technique in the presence of normal gait loading. In this regard, we compare the result of the CCD using bone substitutes and flexible implants with other conventional core decompression techniques. The study finding shows that the maximum principal stress occurring at the superior domain of the neck is smaller in the CCD techniques (i.e. 52.847 MPa) compared to the other core decompression methods; furthermore, the peak value of normal stress at the interface for the CCD model is substantiallyAccepted for 2018 MICCAI Workshop on Computational Biomechanics for Medicine XIII 2 smaller than traditional and advanced core decompression techniques (89% and 76%, respectively). FE results demonstrate the superior performance of CCD compared to the other approaches without any compromise to patient's safety and markedly reducing the risk of femoral fracture in the postoperative phase for normal gait loading.

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“…All the models were then imported into the multi-platform CAD software Catia Ò V5 (Dassault Systèmes S.A., France) for geometric analysis. The entrance point of the drill hole was supposed at the inferior border of the greater trochanter in the subtrochanteric lateral cortex as the position of the supposed standard entrance point [23], and a line connecting this point and the centroid of the necrosis volume was created. A drill hole of 9 mm diameter was created based on the above line penetrating to the necrotic domain in the femoral head.…”

Section: Methodsmentioning

confidence: 99%

“…Second, the entrance point of the drill hole was adjusted so that the removable volume of necrosis is maximized without increasing the risk of femur fracture. As recommended, the entrance point was located around its standard position with a maximum deviation to the distal direction of 20 mm [4,[20][21][22][23].…”

Section: Methodsmentioning

confidence: 99%

Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head

Landgraeber

Tran

Claßen

et al. 2015

Arch Orthop Trauma Surg

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"Advanced core decompression" (ACD) is a treatment option for osteonecrosis of the femoral head (ONFH) that aims at complete removal of the necrotic tissue using a percutaneous expandable reamer and refilling of the head with an osteoconductive bone-graft substitute. The objective of this study was to evaluate if the success of ACD depends on the amount of necrotic tissue remaining after the procedure and how efficiently the necrotic tissue can be removed with the current reamer. Three-dimensional models of proximal femora including ONFH were generated from the preoperative MRIs of 50 patients who underwent ACD. Best-case removal was calculated by geometrical analysis. In 28 of 50 cases, postoperative MRI was used to determine how much necrotic tissue had been removed. Prognostic values and correlations were evaluated in order to assess success or failure of the treatment. The amount of preoperative and remaining necrosis correlates significantly with treatment failure. The larger both volumes are, the more likely it is that treatment will fail. In patients with remaining necrosis of less than 1000 mm(3), no treatment failure was observed. The amount of necrosis actually removed differed significantly from the amount calculated as the best possible result. Simulation of the removal procedure showed that complete removal is not possible. These results led to the conclusion that the success of ACD depends on the amount of necrotic tissue remaining in the femoral head after the procedure. Modifications to the instrument are necessary to increase the amount of necrotic tissue that can be removed.

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Experimental and computational studies on the femoral fracture risk for advanced core decompression

Cited by 18 publications

References 23 publications

Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

A Biomechanical Study on the Use of Curved Drilling Technique for Treatment of Osteonecrosis of Femoral Head

Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head

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