J Korean Orthop Assoc.  2010 Dec;45(6):464-472. 10.4055/jkoa.2010.45.6.464.

The Etiology of Residual Symptoms after Hip Arthroscopic Treatment of Femoroacetabular Impingement: Analysis Using Finite Element Modeling

• Lee JB
• Kim WJ
• Hwang DS
• Kang C
• Yeon KW

• KMID: 2185494
• DOI: http://doi.org/10.4055/jkoa.2010.45.6.464

Abstract

PURPOSE
To analyze, using finite element model analysis, the causes of postoperative pain in patients who had arthroscopic treatment for femoroacetabular impingement (FAI).
MATERIALS AND METHODS
Ten patients with FAI treated by arthroscopic surgery between July 2004 and July 2007 were selected. Five cases whose condition improved to a pain score of 3 postoperatively were assigned to comparative group A and 5 cases who had a second operation done due to a pain score of 1 were assigned to experimental group B. Finite element model analysis was done for the impingement test position. Femoral offset and alpha angle were measured to compare with contact pressure or von Mises stress.
RESULTS
Preoperative von Mises stress and contact pressure were all higher in group B than group A. Maximal stress and pressure location was the anterolateral surface of the femoral head and neck, and this location was removed more accurately in group A.
CONCLUSION
Finite element model analysis of FAI indicated that incomplete removal of a bump was the cause of pain, and that accurate location of the lesion and adequate bump removal are the definitive factors in reducing pain.

Keyword

femoroacetabular impingement; arthroscopic treatment; finite element modeling

MeSH Terms

Arthroscopy
Femoracetabular Impingement
Head
Hip
Humans
Neck
Pain, Postoperative

Figure

• 

  Figure 1 Three dimensional reconstructive view of femoral head. The blue colored covering of femoral head shows the contact area when hip joint rotates, and the sequential color table on the left side indicates the degree of contact pressure and von Mises stress.

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  Figure 2 The correlation of motion and pressure was interpreted by the flexion degree (Z axis) and the internal rotation degree (X axis).

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  Figure 3 (A, B) Preoperative finite element model of a patient in group B. A small portion of femoral head neck junction had an increased contact pressure which indicates a clinical "bump". (C, D) Postoperative model shows that the "bump" was not removed sufficiently, and the contact pressure increased. (E) This model shows the removed bump (striped diagram) and portions of concentrated stress (filled diagram). This figure shows that the concentrated stress portion had not been removed successfully.

• 

  Figure 4 (A, B) Preoperative finite element model of a patient in group A. A small portion of femoral head neck junction had an increased contact pressure which indicates a clinical "bump". (C, D) Postoperative model shows that the "bump" was removed sufficiently, and the contact pressure was 0 at the maximal internal rotation degree. (E) This model shows removed bump (striped diagram) and portions of concentrated stress (filled diagram). This figure shows that the concentrated stress portion had been removed successfully.

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