Evaluation of Graft Harvesting Operations from Anterior and Posterior Iliac Donor Sites by Finite Element Analysis

Abstract

When the graft donor areas are evaluated in terms of bone reserve and functional aspects, it can be said that the iliac site has outstanding properties. However, complications of graft harvesting operations performed from various iliac donor sites have been reported by many researchers. Numerous studies have been carried out in the literature to reduce these complications, and to increase the success of the operation. However, biomechanical comparison of anterior and posterior iliac graft harvesting operations is one of the gaps in the literature. This study aims to assess both biomechanical behavior and bone graft reserve comparison of the two surgical operation alternatives. According to the FEA results of the study, posterior iliac graft harvesting provides 264% more trabecular bone reserve than anterior operation. However, this rate is 132% for cortical bone. When the models are compared, anterior osteotomy model has a 8.6% higher von Mises strain compared to the posterior osteotomy model. Results of the present study has shown that the region with the highest stress value in the cortical bone is the sacroiliac joint for both models. While posterior graft harvesting operation offers advantages in terms of morbidity rate, joint fracture risk and graft reserve, anterior operation can be preferred in terms of operational ease and the sacroiliac joint stability. However, since results obtained may be affected by the factors such as the amount of graft harvested, the patient's bone quality, anatomical differences, age and gender, it has been evaluated that the success of the operation may be enhanced by carrying out a patient-specific approach for modeling and analysis steps.