Contact finite element stress analysis of the hip joint.

Two-dimensional finite element analyses were conducted of the normal hip using contact elements at the joint surface. The models studied were constructed for a slice through the pubis, acetabulum, and ilium. In the analyses the proximal femur was pressed into the acetabulum and intraarticular pressures and principal stresses in the joint region were determined for different load magnitudes and directions and various boundary conditions. Three sets of boundary conditions were examined: (a) deformable pubic symphysis, (b) rigid pubic symphysis, and (c) simulations of experimental studies. In the deformable model the pubic symphysis was free to displace in the sagittal plane and rotate. In the rigid model the pubic symphysis was rigidly fixed. Superoposterior loading resulted in high-contact pressures at the acetabular dome for all sets of boundary conditions. For the deformable model subject to a more medially directed load the acetabulum closed in such a manner as to squeeze the head of the femur creating high-contact pressures superiorly and inferiorly. This resulted in significant compressive stresses in the superior dome cancellous bone and inferior cancellous bone. The cumulative effect of this squeezing action with normal biological remodeling may cause elongation of the femoral head resulting in asphericity and incongruity of the unloaded hip joint articular surfaces. Rigidly fixing the pubic symphysis stiffened the model and resulted in principal stress patterns that did not reflect trabecular density or orientations as well as those of the deformable pubic symphysis model. Finite element simulations of previous experimental studies modeled the close proximity of the fixation to the excised acetabulum. These boundary conditions prevented the squeezing caused by pelvis deformations. The resulting contact areas, pressure distributions, and bone stresses were very different from those of the more anatomic, deformable pubic symphysis model. These findings demonstrate the sensitivity of hip contact pressures and stresses to imposed boundary conditions and indicate that care should be taken to simulate anatomic conditions in experimental and theoretical studies.