title: Prediction of Hip Failure Load: In Vitro Study of 80 Femurs Using Three Imaging Methods and Finite Element Models-The European Fracture Study (EFFECT).
abstract: Purpose To evaluate the performance of three imaging methods (radiography, dual-energy x-ray absorptiometry [DXA], and quantitative computed tomography [CT]) and that of a numerical analysis with finite element modeling (FEM) in the prediction of failure load of the proximal femur and to identify the best densitometric or geometric predictors of hip failure load. Materials and Methods Institutional review board approval was obtained. A total of 40 pairs of excised cadaver femurs (mean patient age at time of death, 82 years ± 12 [standard deviation]) were examined with (a) radiography to measure geometric parameters (lengths, angles, and cortical thicknesses), (b) DXA (reference standard) to determine areal bone mineral densities (BMDs), and (c) quantitative CT with dedicated three-dimensional analysis software to determine volumetric BMDs and geometric parameters (neck axis length, cortical thicknesses, volumes, and moments of inertia), and (d) quantitative CT-based FEM to calculate a numerical value of failure load. The 80 femurs were fractured via mechanical testing, with random assignment of one femur from each pair to the single-limb stance configuration (hereafter, stance configuration) and assignment of the paired femur to the sideways fall configuration (hereafter, side configuration). Descriptive statistics, univariate correlations, and stepwise regression models were obtained for each imaging method and for FEM to enable us to predict failure load in both configurations. Results Statistics reported are for stance and side configurations, respectively. For radiography, the strongest correlation with mechanical failure load was obtained by using a geometric parameter combined with a cortical thickness (r(2) = 0.66, P < .001; r(2) = 0.65, P < .001). For DXA, the strongest correlation with mechanical failure load was obtained by using total BMD (r(2) = 0.73, P < .001) and trochanteric BMD (r(2) = 0.80, P < .001). For quantitative CT, in both configurations, the best model combined volumetric BMD and a moment of inertia (r(2) = 0.78, P < .001; r(2) = 0.85, P < .001). FEM explained 87% (P < .001) and 83% (P < .001) of bone strength, respectively. By combining (a) radiography and DXA and (b) quantitative CT and DXA, correlations with mechanical failure load increased to 0.82 (P < .001) and 0.84 (P < .001), respectively, for radiography and DXA and to 0.80 (P < .001) and 0.86 (P < .001) , respectively, for quantitative CT and DXA. Conclusion Quantitative CT-based FEM was the best method with which to predict the experimental failure load; however, combining quantitative CT and DXA yielded a performance as good as that attained with FEM. The quantitative CT DXA combination may be easier to use in fracture prediction, provided standardized software is developed. These findings also highlight the major influence on femoral failure load, particularly in the trochanteric region, of a densitometric parameter combined with a geometric parameter. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottecher
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Klaus
authors.initials: K
authors.lastname: Engelke
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Laure
authors.initials: L
authors.lastname: Duchemin
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Oleg
authors.initials: O
authors.lastname: Museyko
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Moser
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: David
authors.initials: D
authors.lastname: Mitton
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Judith
authors.initials: J
authors.lastname: Adams
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Wafa
authors.initials: W
authors.lastname: Skalli
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Jean Denis
authors.initials: JD
authors.lastname: Laredo
authors.affiliation: From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.).
authors.forename: Valérie
authors.initials: V
authors.lastname: Bousson
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002102:Cadaver; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging*; D020342:Finite Element Analysis; D006620:Hip Fractures / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D013314:Stress, Mechanical; D014057:Tomography, X-Ray Computed / Q000379:methods