A Novel Dynamic Bone Stress Evaluation Method of Postoperative Proximal Femur During Gait by Using Elastic Multi Body Analysis Based on Finite Element Analysis

A proximal femur fracture due to osteoporosis is one of serious health care problems in aging societies. Osteosynthesis with pin or screw type of implants, such as Hansson pin (HP), Dual SC Screw (DSCS), is widely used for femoral neck fracture treatment in Japan. Unfortunately, some complications such as secondary fractures, especially peri-prosthetic fractures, may occur during postoperative rehabilitation period. In order to reveal the potential cause of the postoperative fracture from the viewpoint of the biomechanics, authors had already performed the dynamic stress analysis of the treated proximal femur based on finite element (FE) analysis. The final goal of our project is to establish the reliable postoperative bone fracture risk assessment method in response to the daily activity including mainly walking. The aim of this study is to propose a novel elastic multi body analysis method based on FE analysis for proximal femur biomechanics. Patient-specific 3D left hip joint FE model was constructed from an elderly female volunteer’s CT images. The model consists of the pelvis, proximal femur, cartilage and DSCS, as multi bodies. The dynamic loading and boundary conditions were applied to the model for simulating a gait motion. Direction and magnitude of the loads varies in response to the gait motion. The time dependent loading forces; hip contact, gluteus medius, gluteus maximus, tensor fasciae latae and adductor, acting around the hip joint was obtained by inverse dynamic analysis of a human gait using in-house lower-limb musculoskeletal model. These loading and boundary conditions for simulating the gait motion are the major technical advantages of the proposed multi body analysis comparing with the conventional static FE analysis. Time varying stress distribution during the gait was evaluated by using dynamic explicit method via ABAQUS. In order to visually demonstrate dynamic stress distribution, we examined the time varying von Mises stresses at the representative points located on the cortical surface of the proximal femur; femoral head, fracture surface and around the lateral insertion holes. The results indicate significant increase of the stresses around the proximal lateral insertion holes for DSCS treatment. Maximum stress values are good agreement with the previous static FE analysis, on the other hand, these biomechanical discussions based on the stress time histories are only obtained from the proposed method. It is indicated that the proposed method is feasible to support the better pre- and postoperative clinical decisions, which is the main contribution of this study.