Key Takeaways & Executive Findings
- •• Core decompression with ceramic rod implantation significantly reduces stress in the weight-bearing and necrotic areas of the femoral head during single-leg stance and walking push-off phase. • The procedure decreases femoral head collapse (displacement) compared to preoperative values, indicating effective support against further collapse. • Stress distribution is improved, with partial load transfer to the femoral calcar, alleviating local stress concentration. • Finite element analysis provides quantitative biomechanical evidence supporting the clinical use of ceramic rods in peri-collapse stage osteonecrosis.
Abstract
BACKGROUND: The elastic modulus of β-tricalcium phosphate bioceramic rods is close to that of normal bone tissue, and it exhibits excellent biocompatibility and mechanical properties. It can be used as a supporting material inside the femoral head after core decompression. However, there are few biomechanical studies on osteonecrosis of the femoral head and the changes in stress and displacement of the femoral head after ceramic rod implantation. OBJECTIVE: To explore the biomechanical effects of core decompression with ceramic rod implantation in the treatment of osteonecrosis of the femoral head during the peri-collapse stage. METHODS: A total of 21 hips were selected from 19 patients with osteonecrosis of the femoral head implanted with ceramic rods at the peri-collapse stage. Preoperative and postoperative imaging data were obtained, and relevant CT images were loaded in Mimics 21.0 software to construct a three-dimensional model of the femoral head. A global model of the proximal femur that includes cortical and cancellous bone, as well as a model of the proximal cancellous bone of the femur were created. The preoperative MRI image data of the patients were imported, and the necrotic lesion model was made by using the graphic matching technology, which was saved in .stl format. They were transferred to Geomagic 2012 software for smoothing and precise surface processing. Subsequently, the ceramic rod was designed and modeled in SolidWorks 2021 software, and the relevant models were imported for assembly and Boolean operations. After ensuring no interference, ANSYS 2021 software was used to calculate and observe the stress and displacement of the weight-bearing area and necrotic area of the femoral head during single-leg stance and the push-off phase of walking. RESULTS AND CONCLUSION: (1) The area of maximum stress on the femoral head was located in the anterolateral superior part of the necrotic area. During single-leg stance, the stress values in the weight-bearing area and necrotic area were significantly lower postoperatively than preoperatively (P < 0.05), and the femoral head collapse value (displacement of the weight-bearing area) was lower than preoperatively (P < 0.05). (2) During the push-off phase of walking, with the increase in load, the stress values in the weight-bearing area and necrotic area and the femoral head collapse value (displacement of the weight-bearing area) increased, but they were still lower than preoperatively (P < 0.05). (3) It is suggested that core decompression combined with ceramic rod implantation helps to reduce the load on the weight-bearing area of the femoral head, effectively disperse the stress in the weight-bearing area, partially transfer the load to the femoral calcar, improve the local stress concentration, and effectively support the femoral head to prevent further collapse.
1. Introduction
Osteonecrosis of the femoral head is a severe bone and joint disease, in which the death of bone marrow cells in the necrotic area leads to changes in the shape and structure of the femoral head, and even the possibility of collapse [1-2]. Patients with osteonecrosis of the femoral head experience hip pain that seriously affects daily life. The Association Research Circulation Osseus (ARCO) has proposed that for stages III C-IV, total hip arthroplasty is usually adopted [3-6]; while for ARCO II-III B, hip-preserving surgery can effectively limit the progression of necrosis [7].
In hip-preserving surgery, although core decompression can remove necrotic bone tissue and promote blood circulation, it fails to provide sufficient support to the subchondral bone plate. Moreover, core decompression may lead to stress concentration, thereby accelerating the collapse of the femoral head and increasing the risk of femoral neck fracture [8-10]. Therefore, how to provide effective internal support to the femoral head after decompression surgery has become a core issue to be solved in clinical and biomechanical research [11-12]. The elastic modulus of β-tricalcium phosphate bioceramic rods is close to that of normal bone tissue, and they exhibit excellent biocompatibility and mechanical properties [13-15], making them suitable as supporting materials inside the femoral head after core decompression. In addition, minimally invasive porous bioceramic rod treatment for osteonecrosis of the femoral head is simple, with short operation time, low blood loss, less trauma, and rapid postoperative recovery, showing outstanding short-term clinical results [16]. However, there are few biomechanical studies on the changes in stress and displacement of the femoral head after ceramic rod implantation. Therefore, in the treatment of peri-collapse stage osteonecrosis of the femoral head, timely treatment is crucial to reduce the risk of collapse, and accurate assessment of collapse risk is particularly important [17-19]. This study focuses on the biomechanical effects of core decompression with ceramic rod implantation in the peri-collapse stage.
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Liang Yingjie, Yuan Lingli, Geng Chunhui, Zhang Zhongchuan, Zheng Wenming, Hu Tengfei, Tang Haoxu, Zhang Kunkun (2026). Finite element analysis of core decompression with ceramic rod implantation in osteonecrosis of the femoral head during the peri-collapse stage. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21393
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Frequently Asked Questions
What is the peri-collapse stage of osteonecrosis of the femoral head?
The peri-collapse stage refers to the transitional phase from a stable state to collapse, including pre-collapse and early collapse, corresponding to ARCO stage II/Ficat stage II, with the necrotic area involving the anterolateral wall of the femoral head, up to ARCO stage IIIB/Ficat stage III (collapse ≤4 mm, without obvious sclerosis band); and clinical hip pain duration is generally less than 6 months.
How does core decompression with ceramic rod implantation affect femoral head biomechanics?
Finite element analysis shows that core decompression with ceramic rod implantation significantly reduces stress in the weight-bearing and necrotic areas of the femoral head during single-leg stance and walking push-off phase, and decreases femoral head collapse (displacement), thereby improving stress distribution and providing effective support to prevent further collapse.
What are the advantages of β-tricalcium phosphate bioceramic rods?
β-tricalcium phosphate bioceramic rods have an elastic modulus close to that of normal bone tissue, excellent biocompatibility and mechanical properties, and can serve as supporting materials inside the femoral head after core decompression. They also offer advantages such as minimally invasive surgery, short operation time, low blood loss, less trauma, and rapid recovery.
What is the clinical significance of this finite element analysis study?
This study provides quantitative biomechanical evidence supporting the use of ceramic rods in the treatment of peri-collapse stage osteonecrosis of the femoral head, helping clinicians assess the risk of collapse and optimize surgical planning to improve patient outcomes.
What are the limitations of this study?
The study is based on finite element analysis, which relies on simplified models and assumptions. The sample size is relatively small, and the follow-up period is short. Further clinical studies with larger cohorts and long-term follow-up are needed to confirm the biomechanical findings and clinical efficacy.
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