LUO Guifeng 1 , YANG Fan 1 , HAN Mingli 1 , TIAN Long 1 , LU Shun 1 , LIN Kun 1 , HAN Longfei 1 , WEI Qiushi 1,2
  • 1. Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
  • 2. Department of Orthopedic Surgery, Shenzhen Pingle Orthopedic Hospital (Pingshan District Hospital of Traditional Chinese Medicine, Shenzhen), Shenzhen Guangdong, 518118, P. R. China;
WEI Qiushi, Email: weiqshi@126.com
Osteonecrosis of the femoral head; Japanese Investigation Committee classification; lateral classification; femoral head collapse; biomechanical analysis
10.7507/1002-1892.202604112
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Objective  To investigate the biomechanical characteristics of the CT-based lateral classification of Japanese Investigation Committee (JIC) type C1 osteonecrosis of the femoral head (ONFH) under different necrotic extents using finite element analysis, and to evaluate the validity of the CT-based lateral classification for assessing the risk of femoral head collapse. Methods A finite element model of the hip joint was established based on CT data from a healthy 35-year-old male volunteer. According to the JIC C1 classification criteria, three necrotic extents were defined in the coronal plane: M1 (30%), M2 (50%), and M3 (70%). According to the sagittal location of the necrotic lesion, the femoral head was equally divided into anterior, middle, and posterior regions, and five types of the CT-based lateral classification were defined: type 1, involvement of the anterior region only; type 2, involvement of the anterior and middle regions; type 3, involvement of the anterior, middle, and posterior regions; type 4, involvement of the middle and posterior regions; and type 5, involvement of the posterior region only. A total of 15 finite element models were constructed by combining the three necrotic extents with the five CT-based lateral classification types. Bilateral standing loading was simulated, and the maximum von Mises stress and maximum displacement of the femoral head surface and necrotic region were recorded. Results  Stress concentration was mainly located in the superolateral region of the femoral head directly above the necrotic lesion, consistent with previous studies. Within the same CT-based lateral classification type, increases in necrotic extent from M1 to M3 were associated with significant increases in the maximum von Mises stress and maximum displacement of the femoral head surface, as well as the maximum displacement of the necrotic region. No significant difference was found in the maximum von Mises stress in the necrotic region among M1, M2, and M3 groups (P>0.05). Except for the differences in the maximum von Mises stress on the femoral head surface between groups M2 and M3, and the differences in the maximum displacement in the necrosis region between groups M1 and M2 (P>0.05), there were significant differences in the maximum von Mises stress on the femoral head surface, the maximum displacement on the femoral head surface, and the maximum displacement in the necrosis region between other groups (P<0.05). At the same necrotic extent, the maximum von Mises stress and maximum displacement on the femoral head surface and in the necrosis region were significantly higher in type 3 than in other types; followed by type 2>type 1>type 4>type 5. Among them, there was no significant difference in the maximum von Mises stress on the femoral head surface between types 1 and 4, types 2 and 3, and the maximum displacement on the femoral head surface between types 1 and 2, types 2 and 3, types 4 and 5, as well as the maximum von Mises stress in the necrosis region between types 4 and 5, and the maximum displacement in the necrosis region between types 1 and 2, types 4 and 5, types 2 and 3, and types 4 and 5 (P>0.05); all other comparisons between different types showed significant differences (P<0.05). Conclusion Both the location and extent of osteonecrosis affect the biomechanical stability of the femoral head, with lesion location, particularly involvement of the anterior weight-bearing region, exerting a greater influence on stress distribution. The CT-based lateral classification can effectively distinguish biomechanical differences associated with different necrotic locations and may provide a useful reference for evaluating the risk of femoral head collapse and guiding individualized treatment in patients with JIC type C1 ONFH.

Citation： LUO Guifeng, YANG Fan, HAN Mingli, TIAN Long, LU Shun, LIN Kun, HAN Longfei, WEI Qiushi. Finite element analysis of CT-based lateral classification of Japanese Investigation Committee type C1 osteonecrosis of femoral head and its prognostic value. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1378-1386. doi: 10.7507/1002-1892.202604112 Copy

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