{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:03:24Z","timestamp":1777637004181,"version":"3.51.4"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"\n Background<\/jats:title>\n Multiple small diameter fan-shaped and parallel core decompression are the surgical procedure used to treat the early osteonecrosis of the femoral head. However, It is not known which method is more appropriate from biomechanical perspective. Therefore, we aimed to analyze the mechanical stability of different distribution parameters of the two drilling methods using finite element analysis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Ten finite element models were established, including different drilling number (three-hole, four-hole, five-hole, seven-hole and nine-hole) based on fan-shaped and parallel core decompression. The stress and strain of the proximal femur was calculated to evaluate the biomechanical stability.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Results showed that maximum equivalent stress in the entire structure, greater trochanter\u2019s lateral wall, and bone tunnels increased with more drill holes in both groups, following the order: three-hole &lt; four-hole &lt; five-hole &lt; seven-hole &lt; nine-hole. At the same hole count, fan-shaped core decompression had higher maximum equivalent stress in the greater trochanter\u2019s lateral wall, cortical bone tunnel, cancellous bone tunnel, and bone tunnel in the osteonecrosis area compared to parallel core decompression, with notable percentage increases in the cancellous bone tunnel (21.18%\u2013585.71%). Additionally, fan-shaped drilling exhibited higher average stress and local strain, especially in the cancellous bone tunnel, whereas parallel drilling maintained lower stress and strain levels across most regions.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n From a biomechanical perspective, multiple small-diameter parallel core decompression is superior to fan-shaped decompression, offering better stability and reduced stress concentration in the proximal femur for early femoral head osteonecrosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1773122","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:59:41Z","timestamp":1777442381000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomechanical comparative analysis of multiple small diameter fan-shaped and parallel core decompression for early osteonecrosis of the femoral head"],"prefix":"10.3389","volume":"14","author":[{"given":"Daizhu","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]},{"name":"Department of Orthopedics, Guizhou Hospital, The First Affiliated Hospital of Sun Yat-Sen University","place":["Guiyang, China"]},{"name":"Center for Tissue Engineering and Stem Cells, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianya","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhonghui","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]},{"name":"Center for Tissue Engineering and Stem Cells, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]},{"name":"Department of Orthopedics, Guizhou Hospital, The First Affiliated Hospital of Sun Yat-Sen University","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]},{"name":"Department of Orthopedics, Guizhou Hospital, The First Affiliated Hospital of Sun Yat-Sen University","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]},{"name":"Department of Orthopedics, Guizhou Hospital, The First Affiliated Hospital of Sun Yat-Sen University","place":["Guiyang, China"]},{"name":"Center for Tissue Engineering and Stem Cells, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/s0021-9290(01)00040-9","article-title":"Hip contact forces and gait patterns from routine activities","volume":"34","author":"Bergmann","year":"2001","journal-title":"J. Biomech."},{"key":"B2","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1097\/00003086-198105000-00035","article-title":"Mechanical characteristics of bone in femoral capital aseptic necrosis","volume":"156","author":"Brown","year":"1981","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B3","first-page":"247","article-title":"Multiple small diameter drillings increase femoral neck stability compared with single large diameter femoral head core decompression technique for avascular necrosis of the femoral head","volume":"29","author":"Brown","year":"2016","journal-title":"Surg. Technol. Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.bone.2019.07.015","article-title":"Stress concentrations and bone microdamage: John Currey\u2019s contributions to understanding the initiation and arrest of cracks in bone","volume":"127","author":"Burr","year":"2019","journal-title":"Bone"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1177\/09544119231193879","article-title":"Stress-strain and fatigue life numerical evaluation of two different dental implants considering isotropic and anisotropic human jaw","volume":"237","author":"De Stefano","year":"2023","journal-title":"Proc. Inst. Mech. Eng. H."},{"key":"B6","doi-asserted-by":"publisher","first-page":"103866","DOI":"10.1016\/j.jmbbm.2020.103866","article-title":"Empirical relationships between bone density and ultimate strength: a literature review","volume":"110","author":"Fleps","year":"2020","journal-title":"J. Mech. Behav. Biomed. Mater"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e21.00176","DOI":"10.5435\/JAAOSGlobal-D-21-00176","article-title":"Osteonecrosis of the femoral head","volume":"6","author":"George","year":"2022","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"B8","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1186\/s13018-019-1359-7","article-title":"The efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis","volume":"14","author":"Hua","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.medengphy.2008.09.006","article-title":"Finite element analysis of the spine: towards a framework of verification, validation and sensitivity analysis","volume":"30","author":"Jones","year":"2008","journal-title":"Med. Eng. Phys."},{"key":"B10","doi-asserted-by":"publisher","first-page":"147","DOI":"10.5371\/hp.2023.35.3.147","article-title":"Updating osteonecrosis of the femoral head","volume":"35","author":"Ko","year":"2023","journal-title":"Hip Pelvis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1302\/0301-620X.77B6.7593098","article-title":"Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI","volume":"77","author":"Koo","year":"1995","journal-title":"J. Bone Jt. Surg. Br."},{"key":"B12","doi-asserted-by":"publisher","first-page":"112350","DOI":"10.1016\/j.injury.2025.112350","article-title":"Assessment of the effects of core decompression on the patho-biomechanics of the femoral head in avascular necrosis: a biomechanical perspective","volume":"56","author":"Kurup","year":"2025","journal-title":"Injury"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.4103\/0366-6999.207470","article-title":"Long-term outcome of multiple small-diameter core decompression combined with hip arthroscopy versus drilling alone for early avascular necrosis of the femoral head","volume":"130","author":"Li","year":"2017","journal-title":"Chin. Med. J. (Engl)."},{"key":"B14","doi-asserted-by":"publisher","first-page":"12679","DOI":"10.1038\/s41598-023-39879-9","article-title":"The importance of the thickness of femoral lateral wall for treating intertrochanteric fractures: a finite elements analysis","volume":"13","author":"Li","year":"2023","journal-title":"Sci. Rep."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1219835","DOI":"10.3389\/fsurg.2023.1219835","article-title":"Core decompression vs. allogenic non-vascularized bone grafting in patients with osteonecrosis of the femoral head","volume":"10","author":"Mei","year":"2023","journal-title":"Front. Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.surge.2021.12.004","article-title":"Prognostic factors in the management of osteonecrosis of the femoral head: a systematic review","volume":"21","author":"Migliorini","year":"2023","journal-title":"Surgeon"},{"key":"B17","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1589\/jpts.31.935","article-title":"Change in muscle thickness during exercise to stabilize the hip joint against a load in the ventral direction of the femoral head","volume":"31","author":"Miyachi","year":"2019","journal-title":"J. Phys. Ther. Sci."},{"key":"B18","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1097\/01.blo.0000150128.57777.8e","article-title":"Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling","volume":"429","author":"Mont","year":"2004","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1146\/annurev-bioeng-062117-121139","article-title":"Bone mechanical properties in healthy and diseased states","volume":"20","author":"Morgan","year":"2018","journal-title":"Annu. Rev. Biomed. Eng."},{"key":"B20","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s42836-023-00176-5","article-title":"Increasing trend toward joint-preserving procedures for hip osteonecrosis in the United States from 2010 to 2019","volume":"5","author":"Ng","year":"2023","journal-title":"Arthroplasty"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3087071","DOI":"10.1155\/2021\/3087071","article-title":"Consequences of peri-implant bone loss in the occlusal load transfer to the supporting bone in terms of magnitude of stress, strain, and stress distribution: a finite element analysis","volume":"2021","author":"P\u00e9rez-Pevida","year":"2021","journal-title":"Biomed. Res. Int."},{"key":"B22","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1177\/0954411919856138","article-title":"Stability of femoral neck fracture fixation: a finite element analysis","volume":"233","author":"Samsami","year":"2019","journal-title":"Proc. Inst. Mech. Eng. H."},{"key":"B23","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ijsu.2019.06.016","article-title":"Core decompression combined with autologous bone marrow stem cells versus core decompression alone for patients with osteonecrosis of the femoral head: a meta-analysis","volume":"69","author":"Wang","year":"2019","journal-title":"Int. J. Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1097\/BSD.0000000000001050","article-title":"What is finite element analysis?","volume":"33","author":"Welch-Phillips","year":"2020","journal-title":"Clin. Spine Surg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/s0021-9290(00)00069-5","article-title":"Critical evaluation of known bone material properties to realize anisotropic FE-simulation of the proximal femur","volume":"33","author":"Wirtz","year":"2000","journal-title":"J. Biomech."},{"key":"B26","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1186\/s12891-024-07920-1","article-title":"Efficacy study of platelet-rich plasma combined with core decompression and bone grafting in the treatment of early-stage avascular necrosis of the femoral head: a retrospective study","volume":"25","author":"Xu","year":"2024","journal-title":"BMC Musculoskelet. Disord."},{"key":"B27","doi-asserted-by":"publisher","first-page":"106737","DOI":"10.1016\/j.cmpb.2022.106737","article-title":"Biomechanical analysis of the drilling parameters for early osteonecrosis of the femoral head","volume":"219","author":"Yuan","year":"","journal-title":"Comput. Methods Programs Biomed."},{"key":"B28","doi-asserted-by":"publisher","first-page":"3667891","DOI":"10.1155\/2022\/3667891","article-title":"Impact of femoral neck cortical bone defect induced by core decompression on postoperative stability: a finite element analysis","volume":"2022","author":"Yuan","year":"","journal-title":"Biomed. Res. Int."},{"key":"B29","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12891-022-05149-4","article-title":"Preliminary report of the outcomes and indications of single approach, double-channel core decompression with structural bone support and bone grafting for osteonecrosis of the femoral head","volume":"23","author":"Yue","year":"2022","journal-title":"BMC Musculoskelet. Disord."},{"key":"B30","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1111\/os.13985","article-title":"Hip arthroscopy debridement combined with multiple small-diameter fan-shaped low-speed core decompression in the treatment of early and middle stage osteonecrosis of the femoral head: 14 years follow-up","volume":"16","author":"Zhao","year":"2024","journal-title":"Orthop. Surg."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1773122\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:59:43Z","timestamp":1777442383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1773122\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":30,"alternative-id":["10.3389\/fbioe.2026.1773122"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2026.1773122","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"article-number":"1773122"}}