A CT-based high-order finite element analysis of the human proximal femur compared to in-vitro experiments

The prediction of patient-specific proximal femur mechanical response to various load conditions is of major clinical importance in orthopaedics. This paper presents a novel, empirically validated high-order finite element method (FEM) for simulating the bone response to loads. A model of the bone geometry was constructed from a quantitative computerized tomography (QCT) scan using smooth surfaces for both the cortical and trabecular regions. Inhomogeneous isotropic elastic properties were assigned to the finite element model using distinct continuous spatial fields for each region. The Young's modulus was represented as a continuous function computed by a least mean squares method. p-FEMs were used to bound the simulation numerical error and to quantify the modeling assumptions. We validated the FE results with in-vitro experiments on a fresh-frozen femur loaded by a quasi-static force of up to 1500 N at four different angles. We measured the vertical displacement and strains at various locations and investigated the sensitivity of the simulation. Good agreement was found for the displacements, and a fair agreement found in the measured strain in some of the locations. The presented study is a first step toward a reliable p-FEM simulation of human femurs based on QCT data for clinical computer aided decision making.