Musculoskeletal loading influences the stresses and strains within the human femur and thereby affects the processes of bone modeling and remodeling. It is essential for implant design and simulations of bone modeling processes to identify locally high or low strain values which may lead to bone resorption and thereby affect the clinical outcome. Using a finite element model the stresses and strains of a femur with all thigh muscle and joint contact forces were calculated for four phases of a gait cycle. Reduced load sets with only a few major muscles were analyzed alternatively. In a completely balanced femur with all thigh muscles the stress and strain patterns are characterized by combined bending and torsion throughout the bone. Similar to in vivo recordings, the model with all thigh muscles showed peak surface strains below 2000 με (45% gait cycle). Under simplified load regimes surface strains reached values close to 3000 με. Within the proximal femur, the simplified load regimes produced differences in strain as high as 26% in comparison to those with all thigh muscles included. This difference is reduced to 5% if the adductors are added to a loading consisting of hip contact, abductors and ilio-tibial band. This study demonstrates the importance of an ensemble of muscle forces to reproduce a physiological strain distribution in the femur. Analytical attempts to simulate bone modeling, remodeling or bone density distributions should therefore rely on fully balanced external load regimes which account for the role of the various soft tissue forces.
Femur model; Muscle forces; Surface strain; Bone remodeling; Finite element analysis