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

TL;DR

This study introduces a novel robot-assisted curved drilling technique for osteonecrosis treatment, demonstrating through finite element simulations that it reduces stress on the femoral neck compared to traditional methods.

Contribution

The paper presents a new curved core decompression method that allows precise lesion access with minimal healthy bone removal, improving biomechanical outcomes.

Findings

Curved technique results in lower maximum principal stress (52.847 MPa) at the femoral neck.

Finite element simulations show biomechanical advantages over conventional methods.

Robot-assisted approach enhances surgical precision and lesion targeting.

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.