ONFH, deep circumflex iliac artery vascularized iliac bone graft, FEA, Biomechanics, Orthopedic surgery, RD701-811, Diseases of the musculoskeletal system, RC925-935

Abstract Background No appropriate studies have been conducted that compare the biomechanical properties of different fenestration positions in deep circumflex iliac artery (DCIA)-vascularized iliac bone grafts for femoral head necrosis (ONFH) treatment. In this study, we aimed to explore the fenestration locations of DCIA-vascularized iliac grafting in ONFH treatment using FEA and clinical retrospective analysis. Methods We simulated an iliac bone flap transplantation with a vascularized tip by finite element analysis (FEA). Patients were divided into four groups using different femur fenestration positions as follows: center-window group (C-group), superior-window group (S-group), medial-window group (M-group), and inferior-window group (I-group). In this study, we primarily observed the maximum femoral stress at different healing degrees (0, 25, 50, 75, and 100%). We retrospectively analyzed the changes in the postoperative Harris scores (HHS) and the imaging of 16 patients with iliac flaps for ONFH (11 and 5 cases in the center and other-positioned groups, respectively) at the final follow-up visit. Results The FEA results showed that the peak von Mises stresses in the four groups at the time of complete healing were in the following order: group C (20.28 MPa)