Influence of femoral bowing on stress distribution of the proximal femur: a three-dimensional finite element analysis

BACKGROUND: Whether femoral bowing or its direction has a mechanical effect on the proximal femur is unclear. This study aimed to define the changes in stress distribution in the proximal femur associated with femoral bowing using finite element analysis. METHODS: We created four femoral models: original, entire lateral bowing, entire anterior bowing, and the middle of both (50% anterolateral bowing) from computed tomography data of women with standard bowing. Each model’s stress distribution was compared by two-layering the stress distribution under loading conditions during walking. We also evaluated displacement vectors. RESULTS: In all directions of femoral bowing, the stress increased in the femoral neck and the femoral trochanter in the 50% anterolateral bowing. The direction of deformation of the vector for the femoral head increased anteroinferiorly in the 50% anterolateral bowing. CONCLUSIONS: This study showed that the stress distribution at the proximal femur shifted laterally. The high-stress area increased at the femoral neck or trochanter due to increasing femoral bowing. Femoral bowing also increases the anteroinferior vector in the femoral head. This study provides valuable insights into the mechanism of proximal femoral fractures in older adults. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13018-023-03559-1.