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Computational Biomechanics for Medicine pp 87–97Cite as

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

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Abstract

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 substantially 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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Acknowledgments

The research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01EB016703 and R01EB023939. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Laboratory for Computational Sensing and Robotics, Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Mahsan Bakhtiarinejad, Farshid Alambeigi, Alireza Chamani & Mehran Armand

  2. Laboratory for Computational Sensing and Robotics, Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA

    Mathias Unberath

  3. Department of Orthopedic Surgery, Johns Hopkins Medical School, Baltimore, MD, USA

    Harpal Khanuja & Mehran Armand

  4. Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA

    Mehran Armand

Authors
  1. Mahsan Bakhtiarinejad
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  2. Farshid Alambeigi
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  3. Alireza Chamani
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  4. Mathias Unberath
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  5. Harpal Khanuja
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  6. Mehran Armand
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Corresponding author

Correspondence to Mahsan Bakhtiarinejad .

Editor information

Editors and Affiliations

  1. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand

    Martyn P. Nash

  2. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand

    Poul M.F. Nielsen

  3. Intelligent Systems for Medicine Laboratory, Department of Mechanical Engineering, The University of Western Australia, Perth, WA, Australia

    Adam Wittek

  4. Intelligent Systems for Medicine Laboratory, Department of Mechanical Engineering, The University of Western Australia, Perth, WA, Australia

    Karol Miller

  5. Intelligent Systems for Medicine Laboratory, Department of Mechanical Engineering, The University of Western Australia, Perth, WA, Australia

    Grand R. Joldes

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Bakhtiarinejad, M., Alambeigi, F., Chamani, A., Unberath, M., Khanuja, H., Armand, M. (2020). A Biomechanical Study on the Use of Curved Drilling Technique for Treatment of Osteonecrosis of Femoral Head. In: Nash, M., Nielsen, P., Wittek, A., Miller, K., Joldes, G. (eds) Computational Biomechanics for Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-15923-8_7

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  • DOI: https://doi.org/10.1007/978-3-030-15923-8_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15922-1

  • Online ISBN: 978-3-030-15923-8

  • eBook Packages: EngineeringEngineering (R0)

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