The Impact of Coronal Configuration of the Proximal Femur on its Mechanical Properties and the Validation of a New Theoretical Model: Finite Element Analysis and Biomechanical Examination

Objective This study aims to establish the coronal configuration of the proximal femur as an independent factor for its mechanical properties and provide validation for the theoretical model "fulcrum-balance-reconstruction." Methods The digital 3D femur model constructed with the lower extremity high-resolution computed tomography of a senior subject was applied with the axial compression of 2100N under 5 different alpha angles of 10 degrees, 5 degrees, 0 degrees, -5 degrees, -10 degrees. The equivalent stress distribution of the femoral geometric model under each angle were calculated. Under the same five alpha angles, fatigue test was performed on 15 composite artificial left femurs (three specimens in each angle group) to obtain the failure cycle and fracture site. The statistical analysis was accomplished using One-Way ANOVA. Results The maximum stress of the entire femur in physiological angle (alpha = 10 degrees) occurred below femoral neck with a value of 63.91 MPa. When the proximal femur is in extreme abducted angle (alpha = -10 degrees), the maximum stress shift to the lower medial cortex of femoral shaft with a value of 105.2 MPa. As the alpha angle changed from 10 degrees to -10 degrees, the greater trochanteric region had the largest increment in maximum stress (2.78 times for cortex and 1.67 times for cancellous bone) locally at the proximal femur. The failure cycles of the artificial femurs with a variety of abduction angle were averagely 9126 +/- 2453.87 (alpha = -10 degrees), 58,112.33 +/- 1293.84 (alpha = -5 degrees), 92,879.67 +/- 2398.54 (alpha = 0 degrees), 172,045.3 +/- 11011.11 (alpha = 5 degrees), and 264,949.3 +/- 35,067.26 (alpha = 10 degrees), and the statistical analysis revealed that the alpha angle of the group of concern is proportional to the P value of the corresponding group compared to the 10 degrees group(alpha = 5 degrees & alpha = 10 degrees, P = 0.01; alpha = 0 & alpha = 10 degrees, P = 0.001; alpha = -5 degrees, -10 degrees & alpha = 10 degrees, P < 0.001). In fatigue test, the fracture appeared on femoral neck for the alpha angles of 10 degrees (three subcapital), 5 degrees (two basal; one transcervical), and 0 degrees (one transcervical). Fracture sites located at trochanteric region were observed with the more abducted angles including 0 degrees (two subtrochanteric) and -5 degrees (two intertrochanteric; one subtrochanteric). The fracture line was only found on femoral shaft in the -10 degrees group. Conclusion With increasing hip abduction, the proximal femur shows declining mechanical properties, which suggests higher risk of hip fracture and increasement in the fraction of trochanteric fracture subtype. Furthermore, the hypothesis of "fulcrum-balance-reconstruction" was validated by our study to a certain extent.