Lateral Pillar is the Key in Supporting Pre-collapse Osteonecrosis of the Femoral Head: A Finite Element Model Analysis of Propensity-Score Matched Cohorts

Abstract Background This study was designed as a cohort study using propensity-score matching to age and gender for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapse hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion. Methods 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 Newtons of load was applied to 1,000mm2 area at the top of iliac crest to analyze equivalents for yield stress. Results Age, sex, and BMI had no significant differences, while location (p=0.015) was lateral, and size (p=0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p=0.001) Conclusion FEM analysis suggests stress concentration to the lateral pillar and the primary compression trabeculae can predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.