Abstract
BackgroundSeveral methods are available for the treatment of early-stage osteonecrosis of the femoral head. Core decompression with implantation is a widely-used treatment. However, no single implant is recognized as the most effective way to prevent disease progression. Silk has high strength and resiliency. This study explored the possibility of a strong and resilient silk protein biomaterial as a new alternative implant.MethodsWe investigated the biomechanical properties of the silk protein material by regular compression, torsion, and three-point bending tests. We established three-dimensional finite element models of different degrees of femoral head osteonecrosis following simple core decompression, fibula implantation, porous tantalum rod implantation, and silk protein rod implantation. Finally, we compared the differences in displacement and surface stress under load at the femoral head weight-bearing areas between these models.ResultsThe elastic modulus and shear modulus of the silk protein material was 0.49GPa and 0.66GPa, respectively. Three-dimensional finite element analyses demonstrated less displacement and surface stress at the femoral head weight-bearing areas following silk protein rod implantation compared to simple core decompression (p < 0.05), regardless of the extent of osteonecrosis. No differences were noted in the surface deformation or surface stress of the femoral head weight-bearing areas following silk protein rod, fibula or tantalum rod implantation (p > 0.05).ConclusionsWhen compared with simple core decompression, silk protein rod implantation demonstrated less displacement and surface stress at the femoral head weight-bearing area, but more than fibula or tantalum rod implantation. Similar effects on the surface stress of the femoral head between the silk rod, fibula and tantalum rod implantations, combined with additional modifiable properties support the use of silk protein as a suitable biomaterial in osteonecrosis surgery.
Highlights
Several methods are available for the treatment of early-stage osteonecrosis of the femoral head
The classic surgical treatment of osteonecrosis of the femoral head is core decompression (8 mm/6 mm drill), which can effectively reduce the pressure on the femoral head, improve local blood circulation and relieve hip pain [5,6,7]; this can increase the risk of postoperative fracture and further collapse of the articular surface due to a lack of mechanical support
To the best of our knowledge, this is the first study investigating the clinical application of the silk protein rod design in the treatment of osteonecrosis of the femoral head, with comparisons made between models of silk protein rod implantation, fibula implantation, porous tantalum rod implantation, and simple core decompression
Summary
Several methods are available for the treatment of early-stage osteonecrosis of the femoral head. The classic surgical treatment of osteonecrosis of the femoral head is core decompression (8 mm/6 mm drill), which can effectively reduce the pressure on the femoral head, improve local blood circulation and relieve hip pain [5,6,7]; this can increase the risk of postoperative fracture and further collapse of the articular surface due to a lack of mechanical support. Core decompression combined with bone impaction grafting or implantation is the main operative approach used in Steinberg stage I-II and can increase the strength of the femoral head and reduce the risk of articular surface collapse [8,9,10,11]. The implant design and material, surgical technique, clinical indication and application, and the clinical characteristics of candidates should all be carefully considered and monitored prior to any procedure [13]
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