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Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head
Journal article   Peer reviewed

Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head

Thomas D Brown, Douglas R Pedersen, Kelly J Baker and Richard A Brand
Journal of bone and joint surgery. American volume, Vol.75(9), pp.1358-1367
1993
DOI: 10.2106/00004623-199309000-00011
PMID: 8408157

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Abstract

We employed an anatomically realistic three-dimensional finite-element model to explore several biomechanical variables involved in coring or bone-grafting of a segmentally necrotic femoral head. The mechanical efficacy of several variants of these procedures was indexed in terms of their alteration of the stress:strength ratio in at-risk necrotic cancellous bone. For coring alone, the associated structural compromise was generally modest, provided that the tract did not extend near the subchondral plate. Cortical bone-grafting was potentially of great structural benefit for femoral heads in which the graft penetrated deeply into the superocentral or lateral aspect of the lesion, ideally with abutment against the subchondral plate. By contrast, central or lateral grafts that stopped well short of the subchondral plate were contraindicated biomechanically because they caused marked elevations in stress on the necrotic cancellous bone. Calculated levels of stress were relatively insensitive to variations in the diameter of the graft.
 Biological and medical sciences Medical sciences Orthopedic surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases

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