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Prediction of femoral head collapse in osteonecrosis
OSTEONECROSIS is the death of bone that results in the collapse of the bony structure, leading to joint pain, bone destruction, and loss of function. Destruction of the bone frequently is severe enough to require joint replacement surgery. Osteonecrosis is a common disorder and accounts for 10% or more of the 500,000 total joint replacement procedures performed annually in the United States. Approximately 75% of patients with osteonecrosis are between 30 and 60 years of age.
From the point of view of mechanics, osteonecrosis means deterioration of mechanical properties of the bone. Decrease of the magnitude of the elastic modulus of the bone leads to its inability to bear the external load and culminates in bone damage and fracturing. For a couple of decades the engineers were trying to estimate the critical stress-strain state of the femoral head using the available data on the osteonecrotic bone properties, finite element analysis based on 3D elasticity, and Von Mises stress as a criticality condition. The fact that the cortical shell of the femoral head is significantly stiffer than the underlying cancellous bone did not attract much attention yet. However, from the solid mechanics point of view the difference in the stiffness of the cortical and cancellous parts of the femoral head under both normal and necrotic conditions is important. This difference allows for considering the femoral head as an elastic cortical shell on an elastic cancellous foundation. This, in its turn, suggests the buckling of the cortical shell as a possible starting point of the overall head collapse. The purpose of the study, described here, was to assess the cortical shell buckling scenario as a possible mechanism of the femoral head collapse at the various stages of osteonecrosis.