1
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Tjønneland A, Nielsen PT, Jakobsen T. Biomechanics of a collum-fixated short stem in total hip arthroplasty. J Orthop 2024; 52:61-66. [PMID: 38435312 PMCID: PMC10901692 DOI: 10.1016/j.jor.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Biomechanical reconstruction of the hip significantly impacts the clinical outcome and implant survival. Our knowledge is limited of the ability of neck-stabilised prostheses to restore hip biomechanics. We hypothesised that hip biomechanics, specifically leg length and global offset (GO), may be restored to an acceptable range using the Primoris™ stem. Methods and material In this retrospective study, we analysed 152 patients who underwent total hip replacement (THA) using the short collum-fixated stem Primoris™.The primary outcomes were hip parameters measured by x-ray following THA using the Primoris™ stem. After surgery, the biomechanical parameters used were measured at the arthroplasty and the native contralateral side of the same x-ray. The X-rays were taken one year after the patient's surgery.1. GO.2. Leg length discrepancy (LLD).3. Neck shaft angle (NSA). Results We recorded an average GO of -3.4 mm (standard deviation (SD) 7.2) and an average LLD of +3.8 mm (SD 6.4). Furthermore, we registered an average 14-degree NSA increase (SD 7.4). Conclusion The Primoris™ neck-stabilised stem enabled hip anatomy restoration to a favourable range with respect to GO and LLD as the average difference fell within ±5 mm. However, the stem tended to be implanted in valgus.
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Affiliation(s)
- Anders Tjønneland
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Poul Torben Nielsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Thomas Jakobsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
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2
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Kinoshita S, Kinoshita K, Sakamoto T, Seo H, Suzuki M, Yamamoto T. Sequential Intraoperative Evaluation of Rotational Stability of Cementless Stem in Total Hip Arthroplasty: A Broach-Based Study. J Clin Med 2023; 12:5444. [PMID: 37685511 PMCID: PMC10487492 DOI: 10.3390/jcm12175444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
In cementless total hip arthroplasty, the rotational stability of the stem is generally confirmed in a one-time manual evaluation by the surgeon. This study was performed to evaluate the sequential intraoperative changes in rotational stability using a torque wrench. Primary total hip arthroplasty was performed on 52 consecutive hips using a single wedge stem design. Intraoperative evaluation of rotational stability was uniformly performed using a torque wrench. Evaluations were performed immediately after broach insertion and immediately before the final insertion of the stem (after placement of the acetabular cup). Immediately after the insertion of the broach, rotational stability was checked and confirmed to be fully stabilized using a torque wrench in all cases, and the stability was maintained in 17 of 52 (33%) hips immediately before the final insertion of the stem. Among the hips showing instability, 11 of 35 (31%) broaches were upsized, while the remaining 24 hips achieved stabilization through deeper insertion of the broach. In conclusion, the rotational stability achieved immediately after the insertion of the broach was not necessarily maintained during surgery, indicating that rotational stability may need to be checked at multiple time points intraoperatively.
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Affiliation(s)
| | | | | | | | | | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (S.K.); (K.K.); (T.S.); (H.S.); (M.S.)
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3
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Witek L, Parente PEL, Torroni A, Greenberg M, Nayak VV, Hacquebord JH, Coelho PG. Evaluation of instrumentation and pedicle screw design for posterior lumbar fixation: A pre‐clinical
in vivo/ex vivo
ovine model. JOR Spine 2023. [DOI: 10.1002/jsp2.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Lukasz Witek
- Biomaterials Division New York University College of Dentistry New York New York USA
- Department of Biomedical Engineering New York University Tandon School of Engineering Brooklyn New York USA
| | | | - Andrea Torroni
- Hansjörg Wyss Department of Plastic Surgery New York University School of Medicine New York New York USA
| | - Michael Greenberg
- Biomaterials Division New York University College of Dentistry New York New York USA
| | - Vasudev Vivekanand Nayak
- Biomaterials Division New York University College of Dentistry New York New York USA
- Department of Mechanical and Aerospace Engineering New York University Tandon School of Engineering Brooklyn New York USA
| | - Jacques Henri Hacquebord
- Hansjörg Wyss Department of Plastic Surgery New York University School of Medicine New York New York USA
- Department of Orthopedic Surgery New York University School of Medicine New York New York USA
| | - Paulo G. Coelho
- Division of Plastic Surgery, Department of Surgery University of Miami Miller School of Medicine Miami Florida USA
- Department of Biochemistry and Molecular Biology University of Miami Miller School of Medicine Miami Florida USA
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4
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Calkins TE, Goetz DD, Zalewski JT, Jones CA, Gaumer PR, Ford MC, Toy PC, Crockarell JR, Harkess JW, Mihalko WM, Guyton JL. Hip Arthroplasty Femoral Stem Designs and Their Association With Early Postoperative Periprosthetic Femoral Fractures. J Arthroplasty 2022; 38:849-854. [PMID: 36535442 DOI: 10.1016/j.arth.2022.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA), especially those in contact with the diaphyseal stem, carry high morbidity. This study evaluated how stem design influences the risk of early Vancouver B PFF or other PFF requiring operative intervention after THA. METHODS A multicenter, retrospective study of 3,433 primary cementless THAs performed from 2014 to 2021 included 2,302 single-taper (micro M/L [n = 1,169]; M/L [n = 1,133]) and 1,131 double-taper (fit-and-fill [n = 420]; compaction-collared [n = 711]) stems. Mean follow-up was 2.2 years (range, 0.3 to 6.5 years). Primary outcomes were Vancouver B and surgically treated postoperative PFFs among differing femoral stems. Secondary outcomes included rates of intraoperative and postoperative Vancouver A and C PFFs. RESULTS Forty five postoperative PFFs (1.3%) occurred within 8.8 weeks (median), 25 of which were Vancouver B (0.7%) and 20 total PFFs that required operative intervention (0.6%). Compaction-collared stems had a decreased risk of Vancouver B (hazard ratio 0.18, 95% confidence interval: 0.03-0.97 P = .044) and any surgically treated PFF (hazard ratio 0.10, 95% confidence interval: 0.01-0.95; P = .037). Intraoperative PFFs were most common with fit-and-fill stems (3.6%, P < .001) and Vancouver A with compaction-collared stems (1.8%, P < .001). The cohort with PFF had a higher Charlson comorbidity index (P = .004), more women (P = .001), more Dorr A or C femora (P = .013), and more posterior or lateral surgical approaches compared to those without PFF (P ≤ .001). CONCLUSION After controlling for confounding variables, compaction-collared stems had a significantly lower risk of postoperative Vancouver B and PFF requiring operative treatment than single-taper and double-taper stems.
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Affiliation(s)
- Tyler E Calkins
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jacob T Zalewski
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Caleb A Jones
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Marcus C Ford
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Patrick C Toy
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John R Crockarell
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James W Harkess
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James L Guyton
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
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5
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Yang W, Li C, Ji X, Yao M, Hong J, Qu Z, Liu A, Wu H. Synergistic Effect of Reverse Drilling and Bone Dust on Femoral Tendon-Bone Healing After Anterior Cruciate Ligament Reconstruction in a Rabbit Model. Am J Sports Med 2022; 50:3844-3855. [PMID: 36326437 DOI: 10.1177/03635465221129267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries and bone tunnel enlargement (BTE) after ACL reconstruction (ACLR) remain frequent issues. Bone dust (BD) produced by tunnel preparation with osteogenic ability and reverse drilling (RD), an easy compaction technique, make it accessible to enhance tendon-bone healing in the clinic. HYPOTHESIS RD and BD synergistically promote tendon-bone healing by improving peritunnel bone and preventing BTE in femurs. STUDY DESIGN Controlled laboratory study. METHODS In total, 96 New Zealand White rabbits underwent ACLR. The semitendinosus tendon was freed before medial parapatellar arthrotomy. After the native ACL was transected, bone tunnels were prepared through the footprint of the native ACL. All animals were randomly assigned to 1 of 4 groups according to different tunnel preparation methods: group 1 (irrigation after extraction drilling [ED]; control group), group 2 (irrigation after RD), group 3 (no irrigation after ED), and group 4 (no irrigation after RD). BD was harvested by irrigating tunnels and was characterized by morphology and size. The specimens underwent microarchitectural, histological, and biomechanical evaluations at 4, 8, and 12 weeks postoperatively. RESULTS Micro-computed tomography demonstrated more peritunnel bone and less BTE in the femurs of group 4 compared with the other groups. Histologically, BD possessed osteogenic activity in bone tunnels postoperatively. Meanwhile, group 4 regenerated a higher amount of the tendon-bone interface and more peritunnel bone than group 1. Biomechanically, group 4 showed higher failure loads and stiffness than group 1. However, peritunnel bone loss, active osteoclasts, and significant BTE were found in the femurs of group 1 and group 3 at 12 weeks postoperatively, while no strong correlation was found between BTE and inflammatory cytokines. Scanning electron microscopy and particle size analysis suggested that BD produced by ED and RD had no difference in size. CONCLUSION Tendon-bone healing was facilitated by the synergistic effect of RD and BD in femurs. CLINICAL RELEVANCE This study provides a more accessible and effective surgical strategy to promote tendon-bone healing after ACLR by increasing peritunnel bone and preventing BTE in femurs.
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Affiliation(s)
- Weinan Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Congsun Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Xiaoxiao Ji
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Minjun Yao
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Zihao Qu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - An Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
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6
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Selecting a Press-fit Stem for Total Hip Arthroplasty: The Rationale and Evolution of the Modern Femoral Prosthesis. J Am Acad Orthop Surg 2022; 30:e1279-e1290. [PMID: 35962989 DOI: 10.5435/jaaos-d-22-00074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Noncemented press-fit femoral stems predominate in total hip arthroplasty for all age groups with generally excellent long-term survivorship. The 2021 American Joint Replacement Registry reports that 96% of all elective primary total hip arthroplasties used noncemented femoral implant fixation. 1 Today, there are many styles of press-fit stems, each with supposed benefits, based on a range of design philosophies. Design aspects to consider when selecting a stem are numerous, including stem geometry, stem length, collared or collarless, material properties, and surface structure. Although most stem designs demonstrate excellent results, the differences in stem designs are intimately linked to additional factors such as ease of use/implantation, percentage of surface osseointegration, overall bone removal versus bone stock preservation, subsequent femoral stress shielding, and consideration of complexity of later revision. A surgeon with a broad understanding and appreciation of femoral stem designs should be prepared to select between the multitude of options to best serve individual patients.
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7
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Densification of cancellous bone with autologous particles can enhance the primary stability of uncemented implants by increasing the interface friction coefficient. J Biomech 2022; 139:111149. [DOI: 10.1016/j.jbiomech.2022.111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
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8
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Okowinski M, Hjorth MH, Mosegaard SB, Jürgens-Lahnstein JH, Storgaard Jakobsen S, Hedevang Christensen P, Kold S, Stilling M. Ten-year comparison of two different techniques for femoral bone cavity preparation-broaching versus compaction in patients with cementless total hip arthroplasty : a randomized radiostereometric study of 30 total hip arthroplasties in 15 patients operated bilaterally. Bone Jt Open 2021; 2:1035-1042. [PMID: 34865512 PMCID: PMC8711659 DOI: 10.1302/2633-1462.212.bjo-2021-0152.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.
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Affiliation(s)
- Maciej Okowinski
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Holm Hjorth
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Breddam Mosegaard
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Kold
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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9
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Li Z, Arioka M, Liu Y, Aghvami M, Tulu S, Brunski JB, Helms JA. Effects of condensation and compressive strain on implant primary stability: A longitudinal, in vivo, multiscale study in mice. Bone Joint Res 2020; 9:60-70. [PMID: 32435456 PMCID: PMC7229305 DOI: 10.1302/2046-3758.92.bjr-2019-0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aims Surgeons and most engineers believe that bone compaction improves implant primary stability without causing undue damage to the bone itself. In this study, we developed a murine distal femoral implant model and tested this dogma. Methods Each mouse received two femoral implants, one placed into a site prepared by drilling and the other into the contralateral site prepared by drilling followed by stepwise condensation. Results Condensation significantly increased peri-implant bone density but it also produced higher strains at the interface between the bone and implant, which led to significantly more bone microdamage. Despite increased peri-implant bone density, condensation did not improve implant primary stability as measured by an in vivo lateral stability test. Ultimately, the condensed bone underwent resorption, which delayed the onset of new bone formation around the implant. Conclusion Collectively, these multiscale analyses demonstrate that condensation does not positively contribute to implant stability or to new peri-implant bone formation. Cite this article:Bone Joint Res. 2020;9(2):60–70.
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Affiliation(s)
- Zhijun Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA; Orthopedic surgeon, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA; Assistant professor, Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yindong Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA; Oral surgeon, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Maziar Aghvami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Serdar Tulu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - John B Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
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10
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Bätz J, Syrigos S, Vorbeck M, Prüch E, Campbell G, Morlock M. The influence of broach design on bone friction and osseodensification in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2020; 73:234-240. [PMID: 32062473 DOI: 10.1016/j.clinbiomech.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The process of cavity preparation by broaching has an impact on the primary stability of uncemented hip stems and on the periprosthetic fracture risk. Osseodensifying broaches may increase primary stability, but have the potential to raise cortex strains and facilitate fracture. The aim of this study was to determine the influence of broach design on the forces acting during broaching, on the microstructure of the broached bone bed and the amount and depth of osseodensification. METHODS Broach models representing compaction, blunt extraction and sharp extraction broaches, were used for quasi-static simulation of femoral cavity preparation on bovine trabecular bone cuboids. Broaching forces were measured and micro-computed tomography scans performed prior and after testing. Friction coefficients during broaching, bone densification parameters and size of the debris particles pushed into the bone were determined. FINDINGS Friction coefficients during sharp extraction exceeded those during compaction and blunt extraction broaching (by 38% and 37%, P < .001). Total bone densification was enhanced for compaction and blunt extraction compared to sharp extraction broaching (increase of 121% and 117%, P = .005), resulting from higher densification depths for compaction (P = .001) and higher maximum densification for blunt extraction broaching (P = .008), with the latter producing fewer large particles than compaction broaching (P = .005). INTERPRETATION Higher friction coefficients indicate a decreased periprosthetic fracture risk with sharp extraction broaches for equal implantation forces. The blunt extraction and compaction designs investigated densified the bone to a similar extent. Blunt extraction broaching may support better osseointegration due to smaller bone debris particles.
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Affiliation(s)
- Johanna Bätz
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany..
| | - Stefan Syrigos
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
| | - Marius Vorbeck
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
| | - Elena Prüch
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
| | - Graeme Campbell
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
| | - Michael Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
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11
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Christiansen JD, Ejaz A, Nielsen PT, Laursen M. An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction. J Bone Joint Surg Am 2020; 102:128-136. [PMID: 31596796 DOI: 10.2106/jbjs.19.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. METHODS Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. RESULTS The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). CONCLUSIONS The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashir Ejaz
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul T Nielsen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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12
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Bonfante EA, Jimbo R, Witek L, Tovar N, Neiva R, Torroni A, Coelho PG. Biomaterial and biomechanical considerations to prevent risks in implant therapy. Periodontol 2000 2019; 81:139-151. [PMID: 31407440 DOI: 10.1111/prd.12288] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This paper is aimed to present a biomaterials perspective in implant therapy that fosters improved bone response and long-term biomechanical competence from surgical instrumentation to final prosthetic rehabilitation. Strategies to develop implant surface texturing will be presented and their role as an ad hoc treatment discussed in light of the interplay between surgical instrumentation and implant macrogeometric configuration. Evidence from human retrieved implants in service for several years and from in vivo studies will be used to show how the interplay between surgical instrumentation and implant macrogeometry design affect osseointegration healing pathways, and bone morphologic and long-term mechanical properties. Also, the planning of implant-supported prosthetic rehabilitations targeted at long-term performance will be appraised from a standpoint where personal preferences (eg, cementing or screwing a prosthesis) can very often fail to deliver the best patient care. Lastly, the acknowledgement that every rehabilitation will have its strength degraded over time once in function will be highlighted, since the potential occurrence of even minor failures is rarely presented to patients prior to treatment.
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Affiliation(s)
- Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo Bauru School of Dentistry, Bauru, Brazil
| | - Ryo Jimbo
- Department of Applied Prosthodontics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Lukasz Witek
- Department of Biomaterials, New York University, New York City, New York, USA
| | - Nick Tovar
- Department of Biomaterials, New York University, New York City, New York, USA
| | - Rodrigo Neiva
- Department of Periodontology, University of Florida at Gainesville, Gainesville, Florida, USA
| | - Andrea Torroni
- Attending Oral and Maxillofacial Surgery, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York City, New York, USA
| | - Paulo G Coelho
- Department of Biomaterials, Hansjörg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, New York City, New York, USA
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13
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Rapagna S, Berahmani S, Wyers CE, van den Bergh JP, Reynolds KJ, Tozzi G, Janssen D, Perilli E. Quantification of human bone microarchitecture damage in press-fit femoral knee implantation using HR-pQCT and digital volume correlation. J Mech Behav Biomed Mater 2019; 97:278-287. [DOI: 10.1016/j.jmbbm.2019.04.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/04/2019] [Accepted: 04/28/2019] [Indexed: 11/27/2022]
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14
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Bätz J, Messer-Hannemann P, Lampe F, Klein A, Püschel K, Morlock MM, Campbell GM. Effect of cavity preparation and bone mineral density on bone-interface densification and bone-implant contact during press-fit implantation of hip stems. J Orthop Res 2019; 37:1580-1589. [PMID: 30908684 DOI: 10.1002/jor.24288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/06/2019] [Indexed: 02/04/2023]
Abstract
Implant loosening and periprosthetic fracture are two major revision causes for uncemented hip stems. The chosen method of cavity preparation could play a key role for both failure mechanisms. The aim of this study was to determine the dependence of the broach type as well as patient bone mineral density (BMD) on densification and contact conditions at the bone-implant interface. Hip stems were implanted into cadaveric femora using compaction, blunt extraction or sharp extraction broaches with computed tomography scans performed prior to broaching, after broaching and after stem implantation. Proximal periprosthetic bone densification as well as press-fit, contact area and stem seating relative to the last broach were determined. Median bone densification was higher with the compaction and blunt extraction broaches compared to sharp extraction broaches (181% and 177%, respectively, p = 0.002). The bone densification of femora prepared with compaction broaching increased with higher BMD (R2 = 0.183, p = 0.037), while stem seating decreased with higher BMD for all broach types (R2 = 0.259, p = 0.001). Incomplete seated prostheses were associated with smaller press-fit and bone-implant contact area (R2 = 0.249, p = 0.001; R2 = 0.287, p < 0.001). Clinical Significance: The results suggest that compaction broaching maximizes bone densification in patients with higher bone density. However, there appears to be an increased risk of insufficient stem seating in high-density bone that could limit the benefits for primary stability. For lower quality bone, the broach type appears to play a lesser role, but care must be taken to limit extensive stem seating which might increase periprosthetic fracture risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1580-1589, 2019.
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Affiliation(s)
- Johanna Bätz
- Institute of Biomechanics, TUHH Hamburg University of Technology, Germany
| | | | - Frank Lampe
- Department of Life Sciences, Hamburg University of Applied Sciences, Germany
| | - Anke Klein
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Germany
| | - Graeme M Campbell
- Institute of Biomechanics, TUHH Hamburg University of Technology, Germany
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15
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Voumard B, Maquer G, Heuberger P, Zysset PK, Wolfram U. "Peroperative estimation of bone quality and primary dental implant stability". J Mech Behav Biomed Mater 2018; 92:24-32. [PMID: 30654217 DOI: 10.1016/j.jmbbm.2018.12.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/22/2018] [Accepted: 12/24/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Dental implants are widely used to restore function and appearance. It may be essential to choose the appropriate drilling protocol and implant design in order to optimise primary stability. This could be achieved based on an assessment of the implantation site with respect to bone quality and objective biomechanical descriptors such as stiffness and strength of the bone-implant system. The aim of this ex vivo study is to relate these descriptors with bone quality, with a pre-implantation indicator of implant stability: pilot-hole drilling force (Fdrilling), and with two post-implantation indicators: maximal implantation torque (Timplantation) and resonance frequency analysis (RFA). METHODS Eighty trabecular bone specimens were cored from human vertebrae and bovine tibiae. Bone volume fraction (BV/TV), a representative for bone quality, was obtained through micro-computed tomography scans. Implants were kept in controlled laboratory conditions following standard surgical procedures. Forces and torques were recorded and RFA was assessed after implantation. Off-axis compression tests were conducted on the implants until failure. Implant stability was identified by stiffness and ultimate force (Fultimate). The relationships between BV/TV, Stiffness, Fultimate and Fdrilling, Timplantation, RFA were established. RESULTS Fdrilling correlated well with BV/TV of the implantation site (r2 = 0.81), stiffness (r2 = 0.75) and Fultimate (r2 = 0.80). Timplantation correlated better with stiffness (r2 = 0.86) and Fultimate (r2 = 0.94) than RFA (r2 = 0.77 and r2 = 0.74, respectively). CONCLUSION Our results indicate that BV/TV and bone-implant stability can be directly estimated by the force needed for the pilot drilling that occurs during the site preparation before implantation. Moreover, implantation torque outperforms RFA for evaluating the mechanical competence of the bone-implant system.
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Affiliation(s)
- Benjamin Voumard
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Ghislain Maquer
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Peter Heuberger
- Biomechanics Research, Nobel Biocare Services AG, Balsberg Balz Zimmermann-Strasse 7, 8302 Kloten, Switzerland
| | - Philippe K Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014 Bern, Switzerland.
| | - Uwe Wolfram
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014 Bern, Switzerland; Institute for Mechanical, Process and Energy Engineering, Heriot-Watt University, UK EH14 4AS, Edinburgh, United Kingdom
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16
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17
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Podaropoulos L. Increasing the Stability of Dental Implants: the Concept of Osseodensification. BALKAN JOURNAL OF DENTAL MEDICINE 2017. [DOI: 10.1515/bjdm-2017-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Summary
One of the most important factors that affect osseointegration is the primary stability of the implant. Dental implants inserted at the posterior region of the maxilla exhibit the lowest success rates as the low density bone in this area often jeopardize rigid fixation of the implant. Many surgical techniques have been developed to increase the primary stability of an implant placed in low density bone, such as bicortical fixation of the implant, undersized preparation of the implant bed and bone condensation by the use of osteotomes. A new promising technique, named osseodensification, has been recently developed that creates an autograft layer of condensed bone at the periphery of the implant bed by the aid of specially designed burs rotating in a clockwise and anti-clockwise direction. The purpose of this review is to emphasize that implant primary stability is strongly influenced by the surgical technique, to quote and briefly analyse the various surgical procedures laying weight to osseodensification procedure.
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Affiliation(s)
- Leonidas Podaropoulos
- Department of Oral and Maxillofacial Surgery, Dental School, National and Kapodistrian, University of Athens , Greece
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18
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Xu H, Zheng R, Ying J. Bone Tunnel Impaction Reduced the Tibial Tunnel Enlargement. Open Med (Wars) 2017; 12:99-106. [PMID: 28730168 PMCID: PMC5444407 DOI: 10.1515/med-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/06/2017] [Indexed: 01/12/2023] Open
Abstract
The purpose of this study was to investigate whether the bone tunnel impaction technique performed by dilators could dwindle the tibial tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site. Thirty-one consecutive patients undergoing primary ACL reconstruction with the hamstring autograft were enrolled in this research. Patients were randomly allotted to group A (bone tunnel impaction technique using dilators) or group B (regular extraction bone tunnel drilling). RESULTS The average follow-up was 16.2 months. The mean femoral tunnel widening was 1.05 mm and 1.02 mm respectively in group A and B. The mean tibial tunnel widening was 0.61 mm and 1.08 mm respectively in group A and B. There was no statistical difference for tunnel enlargement between the two groups at the femoral site (P = 0.62) but significant difference at the tibial site (P < 0.0001). CONCLUSION Bone tunnel impaction technique leaded to a reduction of tibial bone tunnel enlargement after ACL reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site.
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Affiliation(s)
- Huan Xu
- Department of Joint SurgeryLishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical CollegeLishuiZhejiang 323000, P.R. China
| | - Rongzong Zheng
- Department of Joint SurgeryLishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical CollegeLishuiZhejiang 323000, P.R. China
| | - Jinhe Ying
- Department of Joint SurgeryLishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical CollegeLishuiZhejiang 323000, P.R. China
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Abstract
Total hip replacement is a salvage procedure that is done to alleviate discomfort secondary to osteoarthritis in the hip, which is most often a result of hip dysplasia. Commercially available total hip replacement implants for small animal patients are classified as cemented or cementless. The INNOPLANT Total Hip Replacement system includes modular, screw-in cementless components that were developed to improve implant stability by maintaining as much normal anatomic structure, and by extension biomechanics of the coxofemoral joint, as possible. As a newer system, there are few data and no long-term studies available in the veterinary literature.
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Affiliation(s)
- Tisha A M Harper
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
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20
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Hjorth MH, Kold S, Søballe K, Langdahl BL, Nielsen PT, Christensen PH, Stilling M. Preparation of the Femoral Bone Cavity for Cementless Stems: Broaching vs Compaction. A Five-Year Randomized Radiostereometric Analysis and Dual Energy X-Ray Absorption Study. J Arthroplasty 2017; 32:1894-1901. [PMID: 28111123 DOI: 10.1016/j.arth.2016.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/24/2016] [Accepted: 12/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Short-term experimental and animal studies have confirmed superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. METHODS Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded at mean 7 years (5-8.8) after surgery. RESULTS Absolute migrations of medio/lateral translations between the broaching group and the compaction group of mean 0.14 mm (standard deviation [SD] 0.10) vs mean 0.30 mm (SD 0.27) (P = .01) at 1 year, and of mean 0.13 mm (SD 0.10) vs 0.34 mm (0.31) (P = .01) at 5 years were different. Absolute valgus/varus rotations of mean 0.12° (SD 0.13°) in the broaching group were less than mean 0.35° (0.45°) in the compaction group (P < .01) at 1 year, but at 5 years no difference was observed (P = .19). Subsidence and retroversion were similar between groups at all follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout the period and clinical outcome measures of Harris Hip Score were similar at 7 years (5-8.8) after surgery. CONCLUSION We found increased migration when preparing the bone with compaction compared with broaching in cementless femoral stems.
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Affiliation(s)
- Mette H Hjorth
- Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Kjeld Søballe
- Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark
| | - Bente L Langdahl
- Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, Aarhus, Denmark
| | - Poul T Nielsen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Poul H Christensen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, THG, Aarhus University Hospital, Aarhus, Denmark
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21
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Damm NB, Morlock MM, Bishop NE. Influence of trabecular bone quality and implantation direction on press-fit mechanics. J Orthop Res 2017; 35:224-233. [PMID: 27061728 DOI: 10.1002/jor.23257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
Achieving primary stability of uncemented press-fit prostheses in patients with poor quality bone can involve axial implantation forces large enough to cause bone fracture. Radial implantation eliminates intraoperative impaction forces and could prevent this damage. Platens of two commercial implant surfaces ("Beaded" and "Flaked") were implanted onto trabecular bone specimens of varying quality in a press-fit simulator. Samples were implanted with varying interference, either axially (shear) or radially (normal). Push-in and pull-out forces were measured to assess stability. Microstructural changes in the bone were determined from μCT analysis. For force-defined implantation analysis, push-in and pull-out forces both increased proportionally with increasing radial force, independent of implantation direction, bone quality or implant surface. For position-defined implantation analysis, pull-out forces were generally found to increase with interference and to be greater for radial than axial implantation direction, and to be lower for poor quality bone. Bone density increased locally at the tested interface due to implantation, in particular for the Beaded surface under axial implantation. If a safe radial stress can be determined for cortical bone in a particular patient, the associated implantation force, and pull-out force which represents primary stability, can be directly derived, regardless of implantation direction, bone quality or implant surface. Radial implantation delivers primary stability that is no worse than that for axial implantation and may eliminate potentially damaging impaction forces. Development of implant designs based on this principal might improve implant fixation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:224-233, 2017.
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Affiliation(s)
- Niklas B Damm
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, D-21073, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, D-21073, Hamburg, Germany
| | - Nicholas E Bishop
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, D-21073, Hamburg, Germany.,Department of Life Sciences, Hamburg University of Applied Sciences, Ulmenliet 20, D-21033, Hamburg, Germany
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22
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Hjorth MH, Stilling M, Søballe K, Nielsen PT, Christensen PH, Kold S. Preparation of the femoral bone cavity in cementless stems: broaching versus compaction. Acta Orthop 2016; 87:575-582. [PMID: 27759486 PMCID: PMC5119439 DOI: 10.1080/17453674.2016.1244958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Short-term experimental studies have confirmed that there is superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. Patients and methods - 1-stage, bilateral primary THA was performed in 28 patients between May 2001 and September 2007. The patients were randomized to femoral bone preparation with broaching on 1 side and compaction on the other side. 8 patients declined to attend the postoperative follow-up, leaving 20 patients (13 male) with a mean age of 58 (36-70) years for evaluation. The patients were followed with radiostereometric analysis (RSA) at baseline, at 6 and 12 weeks, and at 1, 2, and 5 years, and measurements of periprosthetic bone mineral density (BMD) at baseline and at 1, 2, and 5 years. The subjective part of the Harris hip score (HHS) and details of complications throughout the observation period were obtained at a mean interval of 6.3 (3.0-9.5) years after surgery. Results - Femoral stems in the compaction group had a higher degree of medio-lateral migration (0.21 mm, 95% CI: 0.03-0.40) than femoral stems in the broaching group at 5 years (p = 0.02). No other significant differences in translations or rotations were found between the 2 surgical techniques at 2 years (p > 0.4) and 5 years (p > 0.7) postoperatively. There were no individual stems with continuous migration. Periprosthetic BMD in the 7 Gruen zones was similar at 2 years and at 5 years. Intraoperative femoral fractures occurred in 2 of 20 compacted hips, but there were none in the 20 broached hips. The HHS and dislocations were similar in the 2 groups at 6.3 (3.0-9.5) years after surgery. Interpretation - Bone compaction as a surgical technique with the Bi-Metric stem did not show the superior outcomes expected compared to conventional broaching. Furthermore, 2 periprosthetic fractures occurred using the compaction technique, so we cannot recommend compaction for insertion of the cementless Bi-Metric stem.
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Affiliation(s)
- Mette H Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Aarhus;,Correspondence:
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | | | - Poul H Christensen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
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23
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Ercan A, Sokkar SM, Schmid G, Filler TJ, Abdelkafy A, Jerosch J. Periprosthetic bone density changes after MiniHip TM cementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study. SICOT J 2016; 2:40. [PMID: 27855776 PMCID: PMC5115060 DOI: 10.1051/sicotj/2016033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction: The purpose of the current study was to investigate the reaction of the femur to the implantation of the MiniHipTM in terms of: (1) bone density change during one year; (2) correlations between stem length, CCD (caput-collum-diaphyseal), femoral offset, T-value, and bone density; (3) other co-variables that influence the change of bone density. Patients and methods: MiniHipTM implant was performed for 62 patients. The age range of the patients who underwent treatment was 25–78 years. Periprothestic bone density was determined within two weeks postoperatively, after three, six, and twelve months utilizing the DEXA scan. Results: The highest change was observed in the first three months post-implantation, while significant decrease in density was recorded at proximal Gruen zones 1, 2, and 7, and at distal Gruen zone 4. The decrease in density reached a plateau between the third and sixth months after operation. Afterwards, bone density recovered up to the 12th postoperative month. The correlation analysis showed significant difference between Gruen zone 1 and stem size and CCD. The same significant trend was not reached for Gruen zone 7. Femoral offset showed no correlation. Covariance analysis was unable to establish connection of the results with diagnosis, pairings, or gender. Discussion: MiniHipTM densitometric results are promising and comparable to good results of the other representatives of the femoral neck partially-sustaining short stem prostheses with a lower proximal bone density reduction. Periprosthetic bone resorption is a multifactorial process where stem size, CCD angle, and patient-specific variables such as T-value have an impact on the periprosthetic bone remodeling. In particular, this applies to Gruen zone 1.
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Affiliation(s)
- Ahmet Ercan
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, AM Hasenberg 46, 41462 Neuss, Germany
| | - Sherif M Sokkar
- Orthopaedic Surgery and Traumatology Department, Suez Canal University, Circular Road, 41522 Ismailia, Egypt
| | - Gebhard Schmid
- Department of Diagnostic Radiology, Johanna Etienne Hospital, AM Hasenberg 46, 41462 Neuss, Germany
| | - Timm J Filler
- Department of Anatomy, Heinrich-Heine University of Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
| | - Ashraf Abdelkafy
- Orthopaedic Surgery and Traumatology Department, Suez Canal University, Circular Road, 41522 Ismailia, Egypt
| | - Joerg Jerosch
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, AM Hasenberg 46, 41462 Neuss, Germany
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Hélin M, Pelissier A, Boyer P, Delory T, Estellat C, Massin P. Does the PFNA™ nail limit impaction in unstable intertrochanteric femoral fracture? A 115 case-control series. Orthop Traumatol Surg Res 2015; 101:45-9. [PMID: 25583237 DOI: 10.1016/j.otsr.2014.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 10/19/2014] [Accepted: 11/04/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral neck shortening after dynamic fixation of extra-capsular fracture may impair functional results, but is rarely assessed. The present study measured impaction in stable and unstable fractures (on the Ender classification) treated by PFNA™ nail. The objectives were: 1) to validate the Ender classification to assess fracture stability; 2) to determine whether neck shortening and head purchase quality varied with stability; and 3) to determine the functional impact of femoral neck shortening. HYPOTHESIS The study hypothesis was that the PFNA™ nail stabilizes unstable as well as stable fractures. MATERIALS AND METHODS One hundred and fifteen consecutive patients, aged over 70 years, operated on for intertrochanteric fracture using the PFNA™ nail were followed up prospectively for 6 months. Multivariate analysis, including age, gender, assembly quality and body-mass index, was applied to assess the predictive power of the Ender classification with respect to femoral neck shortening. Secondly, patients were grouped according to stable versus unstable fracture (n=70 and 45, respectively), and impaction and femoral head purchase were assessed on a dedicated radiographic protocol. Functional results were assessed on Parker score. RESULTS In the unstable fracture group, 3 assembly failures required revision by total hip replacement. Ender grade>2 was significantly predictive of>5mm neck shortening. Neck shortening was greater in unstable fracture: 8.1 ± 8.4mm (range, 4-32 mm), versus 2.5 ± 3.7 mm (range, 3-14 mm) (P=0.0004). Mean blade cut-through was 1.2 ± 2.9 mm (range, 1-12 mm) in unstable fracture, versus 0.3 ± 1.3 mm (range, 1-6mm) (P=0.02). Mean cut-out was 2.3 ± 6 mm (range, 2-21 mm) in unstable fracture, versus 0.5 ± 2.6 mm (range, 1-8mm) (P=0.03). Parker scores diminished comparably in the two groups, without significant difference at follow-up: 3.9 ± 2.6 (range, 0-9) in stable and 3.1 ± 1.9 (range, 0-8) in unstable fracture; reduction in Parker score showed no correlation with femoral neck shortening (r=0.013, P=0.88). DISCUSSION The PFNA™ nail provides poorer stabilization of unstable compared to stable fracture. Femoral neck shortening should be taken into account in assessing internal fixation hardware perfomances. LEVEL OF EVIDENCE Level III. Prospective case-control study.
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Affiliation(s)
- M Hélin
- Département de chirurgie orthopédique, hôpitaux universitaires Paris Nord Val-de-Seine, site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, EA REMES, 75010 Paris, France
| | - A Pelissier
- Département de chirurgie orthopédique, hôpitaux universitaires Paris Nord Val-de-Seine, site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, EA REMES, 75010 Paris, France
| | - P Boyer
- Département de chirurgie orthopédique, hôpitaux universitaires Paris Nord Val-de-Seine, site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, EA REMES, 75010 Paris, France
| | - T Delory
- Département de biostatistiques, hôpitaux universitaires Paris Nord Val-de-Seine, site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - C Estellat
- Département de biostatistiques, hôpitaux universitaires Paris Nord Val-de-Seine, site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - P Massin
- Département de chirurgie orthopédique, hôpitaux universitaires Paris Nord Val-de-Seine, site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, EA REMES, 75010 Paris, France.
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Aga C, Rasmussen MT, Smith SD, Jansson KS, LaPrade RF, Engebretsen L, Wijdicks CA. Biomechanical comparison of interference screws and combination screw and sheath devices for soft tissue anterior cruciate ligament reconstruction on the tibial side. Am J Sports Med 2013; 41:841-8. [PMID: 23404085 DOI: 10.1177/0363546512474968] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The tibial fixation site has been reported to be the weakest point in anterior cruciate ligament (ACL) reconstructions. Numerous interference screws and combination screw and sheath devices are available for soft tissue fixation, and a biomechanical comparison of these devices is necessary. HYPOTHESIS Combination screw and sheath devices would provide superior soft tissue fixation properties compared with interference screws in a porcine model. STUDY DESIGN Controlled laboratory study. METHODS Eight different intratunnel tibial soft tissue fixation devices were biomechanically tested in a porcine model with bovine tendons, with 10 specimens per group. The soft tissue fixation devices included 3 interference screws-the Bio-Interference Screw, BIOSURE PK, and RCI Screw-and 5 combination screw and sheath devices (combination devices)-the AperFix II, BIOSURE SYNC, ExoShape, GraftBolt, and INTRAFIX. The specimens were subjected to cyclic (1000 cycles, 50-250 N, 0.5 Hz) and pull-to-failure loading (50 mm/min) with a dynamic tensile testing machine. Ultimate failure load (N), cyclic displacement (mm), pull-out stiffness (N/mm), displacement at failure (mm), load at 3 mm displacement (N), and mechanism of failure were recorded. RESULTS The ultimate failure loads were highest for the GraftBolt (1136 ± 115.6 N), followed by the INTRAFIX (1127 ± 155.0 N), AperFix II (1122 ± 182.9 N), BIOSURE PK (990.8 ± 182.1 N), Bio-Interference Screw (973.3 ± 95.82 N), BIOSURE SYNC (829.5 ± 172.4 N), RCI Screw (817.7 ± 113.9 N), and ExoShape (814.7 ± 178.8 N). The AperFix II, GraftBolt, and INTRAFIX devices were significantly stronger than the BIOSURE SYNC, RCI Screw, and ExoShape. Although the 3 strongest devices were combination screw and sheath devices, no significant differences were observed between the ultimate failure strengths of the screw and combination devices when compared as groups. The least amount of cyclic displacement after 1000 cycles was observed for the GraftBolt (1.38 ± 0.27 mm), followed by the AperFix II (1.58 ± 0.21 mm), Bio-Interference Screw (1.61 ± 0.22 mm), INTRAFIX (1.63 ± 0.15 mm), ExoShape (1.68 ± 0.30 mm), BIOSURE PK (1.72 ± 0.29 mm), BIOSURE SYNC (1.92 ± 0.59 mm), and RCI Screw (1.97 ± 0.39 mm). The GraftBolt allowed significantly less displacement than did the BIOSURE SYNC and RCI Screw. Similarly, no significant differences were observed between the cyclic displacements of the screws and combination devices when compared as groups. CONCLUSION The combination screw and sheath devices did not provide superior soft tissue fixation properties compared with the interference screws alone in a porcine model. Although the highest ultimate failure loads and least amounts of cyclic displacement were observed for combination devices, group comparisons of screw and combination devices did not result in any significant differences for ultimate failure load and cyclic displacement. CLINICAL RELEVANCE It is important to consider that these results represent device performance in an in vitro animal model and are not directly transferrable to an in vivo clinical situation. The combination of a sheath and screw did not consistently result in improved fixation characteristics compared with interference screw fixation.
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Affiliation(s)
- Cathrine Aga
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, CO 81657, USA
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Rodriguez R, Loske AM, Estevez M, Vargas S, Salazar R, Pacheco F, Vazquez-Carpizo J, Gamboa JM. Bio-packaged transponder MEMS implanted in rats. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2012; 24:31-44. [PMID: 22304894 DOI: 10.1163/156856211x621097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A novel hydroxyapatite-based hybrid material with controlled porosity was designed as a bio-package to implant micro-electro-mechanical systems (MEMS) in living organisms. The biomaterial was prepared using synthetic stoichiometric hydroxyapatite powder reacted with a chemical-active, solvent-free, alkyd-based polyurethane. This porous material has interconnected pores with sizes between 100 and 350 μm and a pore volume fraction of 50%, fulfilling the requirements for implants. The biomaterial additionally has high wearing resistance and hydrolytic stability providing high endurance properties. The bio-package was characterized mechanically and morphologically using X-ray diffraction, scanning electron microscopy, densitometry, abrasion and mechanical tests. Twelve packaged micro-electro-mechanical systems were implanted subcutaneously into rats and tested for up to 9 months with good acceptance as revealed by the histological analysis performed on the soft tissue surrounding each implant.
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Affiliation(s)
- R Rodriguez
- Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México.
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Serial dilation reduces graft slippage compared to extraction drilling in anterior cruciate ligament reconstruction: a randomized controlled trial using radiostereometric analysis. Knee Surg Sports Traumatol Arthrosc 2011; 19:347-54. [PMID: 20680245 DOI: 10.1007/s00167-010-1220-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study tested the hypothesis that serial dilation of the tibial tunnel could provide a stronger anchorage of the graft-fixation-device complex compared to traditional extraction drilling. METHODS Forty patients (22 men and 18 women) undergoing ACL reconstruction were randomized to either extraction drilling (group ED) or compaction by serial dilation (group SD) of the tibial tunnel. Tantalum beads were placed in the tibia, femur, and in the hamstring graft. Radiostereometric analysis (RSA) was performed postoperatively and again after 6, 12, and 24 weeks. Migration of graft in the bone tunnels as well as knee laxity was assessed using RSA and a TELOS stress device. RESULTS Six patients (three men and three women) were excluded during follow-up, which resulted in 17 patients in group ED [median age 30 years (range 20-50)] and 17 patients in group SD [median age 32 years (range 20-49)]. The mean migration of the graft in the tibial bone canal after 3 months was 1.3 (SD 0.6) mm in group ED and 0.8 (SD 0.5) mm in group SD (P = 0.02). The overall knee laxity after 3 months was 13.0 (SD 4.0) mm in group ED and 10.9 (SD 3.1) mm in group SD. CONCLUSION This study found less slippage of the hamstring graft in the tibial bone canal in the serial dilated group compared to the extraction drilling group. The clinical relevance of the difference is unknown. No difference in stress radiographic knee laxity was found between the two groups.
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Hapa O, Günay C, Kömürcü E, Cakıcı H, Bozdağ E. Biceps tenodesis with interference screw: cyclic testing of different techniques. Knee Surg Sports Traumatol Arthrosc 2010; 18:1779-84. [PMID: 20549186 DOI: 10.1007/s00167-010-1180-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 05/18/2010] [Indexed: 11/28/2022]
Abstract
Different surgical techniques exist for biceps tenodesis. The most secure fixation technique is with interference screws. The purpose of the study was to compare the biomechanical performance of three different interference screw biceps tenodesis fixation methods, which involve different tunnel preparation methods. Using a sheep shoulder model and metal interference screws, a bone wedge technique was compared to serial tunnel dilation and a control group. After a preload, all repairs were cyclically loaded (20-60 N) for 100 cycles followed by destructive testing. Biceps tenodesis using an interference screw--bone wedge technique showed statistically lower cyclic displacement (8.1 ± 6.4 mm) than serial dilatation with an interference screw (21.3 ± 8.4 mm) or interference screw fixation alone (18.3 ± 8.3 mm) (P = 0.02). There were no statistically significant differences in ultimate failure strength for any of the interference screw biceps tenodesis techniques tested. The tunnel preparation method chosen for interference screw fixed biceps tenodesis can have a positive effect on tenodesis performance. Using the bone wedge technique may allow a more rapid rehabilitation program applicable for the traumatic biceps tendon rupture seen in young, athletic patients with high demands.
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Affiliation(s)
- Onur Hapa
- Çelikkent Sitesi, A-2 No: 6 Çayyolu, Ankara, Turkey.
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Does cancellous bone compaction due to insertion of a blade implant influence the cut-out resistance? A biomechanical study. Clin Biomech (Bristol, Avon) 2010; 25:1053-7. [PMID: 20800326 DOI: 10.1016/j.clinbiomech.2010.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 07/15/2010] [Accepted: 08/05/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the treatment of hip fractures helically shaped implants, like the Dynamic Hip Screw (DHS) Blade, are often used. One consequence of blade implantation, the compaction of cancellous bone, is still believed to increase cut-out resistance. This in vitro study investigates implant anchorage of Dynamic Hip Screw Blades in femoral heads due to insertion with or without predrilling under cyclic physiological loading conditions. METHODS Six pairs of fresh frozen (-20°C) human cadaveric proximal femora were instrumented with DHS Blades. Bone pairs were randomly assigned to two study groups: 1) predrilled; 2) non-predrilled. Prior instrumentation, bone mineral density was determined in the center of the femoral head by Xtreme-CT measurement. After instrumentation biomechanical testing was performed under cyclic loading. The bone-implant interface was monitored by means of fluoroscopic imaging throughout the experiment. Paired t-tests were performed to identify differences regarding bone mineral density, stiffness and cycles to failure. FINDINGS No significant differences were found between study groups with regard to axial stiffness (P=0.626) and number of cycles to failure (P=0.961). INTERPRETATION This in vitro study did not show differences in biomechanical stability of proximal femora instrumented with a helical blade implant with or without predrilling. Clinically, the findings suggest that predrilling may be performed to ease the surgical procedure without compromising the implant anchorage.
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Aldinger PR, Schneider M, Pritsch M, Kreutzer J, Becker CR, Breusch SJ. Robotic bone preparation does not increase cement penetration into the proximal femur. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/00016470308540840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kold S, Bechtold JE, Ding M, Chareancholvanich K, Rahbek O, Søballe K. Compacted cancellous bone has a spring-back effect. ACTA ACUST UNITED AC 2009; 74:591-5. [PMID: 14620982 DOI: 10.1080/00016470310018018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A new surgical technique, compaction, has been shown to improve implant fixation. It has been speculated that the enhanced implant fixation with compaction could be due to a spring-back effect of compacted bone. However, such an effect has yet to be shown. Therefore we investigated in a canine model whether implant cavities prepared with compaction had spring back. Before killing the animals, we used one of two surgical techniques to make implant cavities of identical dimensions in both lateral femoral condyles of 7 dogs. One side had the implant cavity prepared with compaction, the other side with drilling. The cavities were left empty in vivo for 10 minutes before the dogs were killed. Postoperative micro-CT scanning showed that the diameters of the compacted cavities were significantly smaller than those of the drilled cavities, although they had had identical dimensions initially. Thus we found a spring-back effect of compacted bone, which may be important for increasing implant fixation by reducing initial gaps between the implant and bone.
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Affiliation(s)
- Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Denmark.
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Windolf M, Muths R, Braunstein V, Gueorguiev B, Hänni M, Schwieger K. Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance. Clin Biomech (Bristol, Avon) 2009; 24:53-8. [PMID: 19012997 DOI: 10.1016/j.clinbiomech.2008.09.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 09/08/2008] [Accepted: 09/09/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Compaction of cancellous bone is believed to prevent cut-out. This in vitro study quantified the compaction in the femoral head due to insertion of a dynamic hip screw-blade with and without predrilling and investigated the resulting implant anchorage under cyclic loading. METHODS Eight pairs of human cadaveric femoral heads were instrumented with a dynamic hip screw-blade made of Polyetheretherketon. Pairwise instrumentation was performed either with or without predrilling the specimens. CT scanning was performed before and after implantation, to measure bone-compaction. Subsequently the implant was removed and a third scan was performed to analyze the relaxation of the bone structure. Commercial implants were reinserted and the specimens were cyclically loaded until onset of cut-out occurred. The bone-implant interface was monitored by means of fluoroscopic imaging throughout the experiment. Paired t-tests were performed to identify differences regarding compaction, relaxation and cycles to failure. FINDINGS Bone density in the surrounding of the implant increased about 30% for the non-predrilled and 20% for the predrilled group when inserting the implant. After implant removal the predrilled specimens fully relaxed; the non-predrilled group showed about 10% plastic deformation. No differences were found regarding cycles to failure (P=0.32). INTERPRETATION Significant bone-compaction due to blade insertion was verified. Even though compaction was lower when predrilling the specimens, mainly elastic deformation was present, which is believed to primarily enhance the implant anchorage. Cyclic loading tests confirmed this thesis. The importance of the implantation technique with regard to predrilling is therefore decreased.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/standards
- Benzophenones
- Bone Density/physiology
- Bone Plates
- Bone Regeneration
- Bone Screws
- Equipment Failure Analysis
- Femur Head/anatomy & histology
- Femur Head/chemistry
- Femur Head/surgery
- Fracture Fixation, Intramedullary/adverse effects
- Fracture Fixation, Intramedullary/methods
- Fracture Fixation, Intramedullary/standards
- Hip Fractures/surgery
- Humans
- Internal Fixators
- Ketones
- Polyethylene Glycols
- Polymers
- Prosthesis Failure
- Tomography, X-Ray Computed
- Weight-Bearing
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Affiliation(s)
- Markus Windolf
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, 7270 Davos, Switzerland.
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Windolf M, Braunstein V, Dutoit C, Schwieger K. Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech (Bristol, Avon) 2009; 24:59-64. [PMID: 18977058 DOI: 10.1016/j.clinbiomech.2008.07.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 07/18/2008] [Accepted: 07/20/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Dynamic Hip Screw is well established for the treatment of femoral neck fractures. However, cut-out occurs in 1-6% of all cases. This study compared the biomechanical performance of a helical shaped implant (DHS-Blade) to the Dynamic Hip Screw in an unstable femoral neck fracture model. METHODS Ten pairs of human cadaveric femora were either instrumented with a DHS-Blade or a Dynamic Hip Screw. Osteotomies were created using a custom-made saw-guide. Cyclic loading was performed by introducing in vivo measured load-trajectories to the femoral head. Starting at 1500 N, the load was stepwise increased until failure of the construct. Radiographs were taken in 5000 cycles increments to identify onset of femoral head migration with respect to the implant. A survival analysis was performed on the cycles to onset of migration. A paired t-test was carried out on the displacements of the femoral head relative to the shaft as determined by optical motion tracking. FINDINGS One hundred percent migrations occurred for the Dynamic Hip Screw compared to 50% for the DHS-Blade. The survival probability in terms of implant anchorage was found higher for the blade (P=0.023). However, significant higher deformation of the repair construct was observed for the DHS-Blade (P=0.004). INTERPRETATION The study showed superior implant anchorage of the DHS-Blade compared to the DHS, which might reduce the cut-out risk. Nevertheless, the blade allowed higher deformation of the femur mainly resulting in shortening of the neck, which might be due to a systematic loss of fracture reduction.
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Affiliation(s)
- Markus Windolf
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, 7270 Davos, Switzerland.
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Min BW, Song KS, Bae KC, Cho CH, Kang CH, Kim SY. The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplasty 2008; 23:418-23. [PMID: 18358382 DOI: 10.1016/j.arth.2007.04.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 04/01/2007] [Indexed: 02/01/2023] Open
Abstract
We evaluated the significance of the stem alignment in 98 consecutive primary total hip arthroplasties with a cementless CLS component (Zimmer, Winterthur, Switzerland) after a mean follow-up period of 7.7 years (range, 5-11 years) The patients were divided into 3 groups on the basis of stem alignment: neutral, 62 hips (63%); valgus, 20 hips (21%); and varus, 16 hips (16%). Clinical and radiographic results for the groups were compared. No significant clinical or radiographic differences were found between groups. There was no difference in the Harris hip scores and in the incidence of thigh pain between groups. For all hips, radiographs showed stable osseous fixation of the stem and the cup. A similar pattern of adaptive bone remodeling occurred in all 3 groups. Stem alignment of a tapered-wedge cementless femoral component does not compromise the clinical and radiographic results of total hip arthroplasty at a mean end point of 7.7 years.
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Affiliation(s)
- Byung-Woo Min
- Department of Orthopaedic Surgery, Keimyung University, Dongsan Medical Center, Daegu, South Korea
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Jakobsen T, Kold S, Bechtold JE, Elmengaard B, Søballe K. Local alendronate increases fixation of implants inserted with bone compaction: 12-week canine study. J Orthop Res 2007; 25:432-41. [PMID: 17177297 DOI: 10.1002/jor.20276] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bone compaction has been shown to increase initial implant fixation. Furthermore, bone compaction creates a peri-implant zone of autograft that exerts osteoconductive properties. We have previously shown that locally applied bisphosphonate (alendronate) at 4-week observation can preserve the autograft generated by bone compaction. We now investigate whether the increased amount of autograft, seen at 4 weeks, can increase implant osseointegration and biomechanical fixation. Porous-coated titanium implants were bilaterally inserted with bone compaction into the proximal part of tibia of 10 dogs. On the right side, local bisphosphonate was injected into the bone cavity prior to bone compaction immediately prior to implant insertion. On the left side, saline was used as control. Observation period was 12 weeks. Locally applied bisphosphonate significantly increased biomechanical implant fixation (approximately twofold), bone-to-implant contact (1.2-fold), and peri-implant bone volume fraction (2.3-fold). This study indicates that local alendronate treatment can increase early implant osseointegration and biomechanical fixation of implants inserted by use of bone compaction. Long term effects remain unknown.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Bldg. 1A, DK-8000 Aarhus C, Denmark.
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Dunkin BS, Nyland J, Duffee AR, Brunelli JA, Burden R, Caborn D. Soft tissue tendon graft fixation in serially dilated or extraction-drilled tibial tunnels: a porcine model study using high-resolution quantitative computerized tomography. Am J Sports Med 2007; 35:448-57. [PMID: 17218658 DOI: 10.1177/0363546506294359] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial tunnel preparation may contribute to improved soft tissue graft fixation. HYPOTHESIS Step dilation produces greater tunnel wall bone volume than does extraction drilling and increases fixation strength. Bioabsorbable interference screw divergence decreases fixation strength, regardless of tunnel preparation method. STUDY DESIGN Controlled laboratory study. METHODS Twenty porcine tibias were divided into 2 groups of 10 with matching mean apparent bone mineral density. One group received 9-mm-diameter extraction-drilled tunnels, and the other group received 7-mm-diameter extraction-drilled tunnels followed by step dilation to 9 mm. High-resolution quantitative computerized tomography scans and voxel analysis techniques determined tunnel wall bone volume fraction. Screws secured 8.5-mm-diameter porcine grafts in the tunnels. Repeat scans were used to determine screw divergence. Cyclic loading was performed in a servohydraulic device before load to failure testing. RESULTS The step dilation group had greater tunnel wall bone volume/total volume than did the extraction drilled group; however, a significant increase in fixation strength was not detected. Specimens with screw divergence angles less than 15 degrees had superior fixation and insertion torques compared with specimens with angles 15 degrees or more. Screw divergence correlated more strongly with fixation strength than did mean apparent bone mineral density or screw insertion torque. CONCLUSION Step dilation increased tunnel wall bone volume/total volume, but fixation strength did not improve. Screw divergence >or=15 degrees decreases graft-bone tunnel fixation whether or not step dilation is performed. CLINICAL RELEVANCE Screw alignment plays a greater role in anterior cruciate ligament graft fixation than does extraction drilling or step dilation tunnel preparation methods in healthy bone.
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Affiliation(s)
- Brad S Dunkin
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray Street, Suite 1003, Louisville, KY 40202, USA
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Jakobsen T, Kold S, Bechtold JE, Elmengaard B, Søballe K. Effect of topical alendronate treatment on fixation of implants inserted with bone compaction. Clin Orthop Relat Res 2006; 444:229-34. [PMID: 16523143 DOI: 10.1097/01.blo.0000191273.34786.40] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bone compaction has been shown to enhance the critical initial implant stability that is important for secure long-term fixation. We investigated whether topical bisphosphonate treatment improves fixation of implants inserted with bone compaction. Porous-coated titanium implants were inserted with bone compaction into the knees of eight dogs. In the right knee, topical bisphosphonate treatment was applied before bone compaction. Saline was used as a control in the left knee. The knees were observed for 4 weeks. We found an increase in total bone-to-implant contact and total bone density around the implants in the bisphosphonate-treated group. These were results of increased nonvital bone-to-implant contact and increased nonvital periimplant bone density. No change in biomechanical fixation was found. Studies with a longer followup are needed to investigate whether the preservative effect of alendronate on nonvital bone might enhance implant fixation by osteoconduction.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
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Kold S, Rahbek O, Vestermark M, Overgaard S, Søballe K. Bone compaction enhances fixation of weight-bearing hydroxyapatite-coated implants. J Arthroplasty 2006; 21:263-70. [PMID: 16520217 DOI: 10.1016/j.arth.2005.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Revised: 11/04/2004] [Accepted: 02/20/2005] [Indexed: 02/01/2023] Open
Abstract
The effect of bone compaction vs conventional drilling on the fixation of hydroxyapatite-coated implants was examined in a weight-bearing canine model. In each dog, one knee joint had the implant cavity prepared with drilling, the other with compaction. Eight dogs were euthanized after 2 weeks and 8 dogs after 4 weeks. Femoral condyles from additional 7 dogs represented time 0. Compacted specimens had significantly higher bone implant contact and energy absorption at time 0. Compaction significantly increased ultimate shear strength at 0 and 2 weeks. There was no significant difference in implant fixation after 4 weeks. The results of this study suggest that compaction may be beneficial in optimizing the crucial initial implant stability, even when hydroxyapatite-coated implants with osteoconductive properties are inserted in vivo.
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Affiliation(s)
- Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Kold S, Rahbek O, Zippor B, Søballe K. No adverse effects of bone compaction on implant fixation after resorption of compacted bone in dogs. Acta Orthop 2005; 76:912-9. [PMID: 16470451 DOI: 10.1080/17453670510045589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A new bone preparation technique, compaction, has been shown to enhance initial implant fixation. However, short-term compaction has resulted in more non-vital bone being in contact with the implant. Also, compaction may result in inferior long-term implant fixation as the compacted non-vital bone at the bone-implant interface is resorbed. METHODS We tested the hypothesis that compaction would result in inferior implant fixation after 10 weeks of weight bearing. We compared compaction with the conventional bone removal technique (drilling) for (1) porous coated titanium (Ti) implants inserted exact-fit into medial femoral condyles, and for (2) hydroxy-apatite (HA) porous coated implants inserted press-fit into lateral femoral condyles. In each of 8 dogs, we prepared the implant cavities of one knee joint with drilling, and the other with compaction. Implants were tested mechanically to failure by push-out test, and histomorphometry was done. RESULTS For all specimens, non-vital bone implant contact contributed very little to the total bone implant contact. Inferior mechanical or histological implant fixation with compaction was not found for either Ti implants or HA implants. INTERPRETATION Compaction does not appear to result in inferior implant fixation as the compacted bone at the bone implant interface is resorbed.
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Affiliation(s)
- Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Denmark.
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Wettstein M, Mouhsine E, Argenson JN, Rubin PJ, Aubaniac JM, Leyvraz PF. Three-dimensional computed cementless custom femoral stems in young patients: midterm followup. Clin Orthop Relat Res 2005:169-75. [PMID: 16056046 DOI: 10.1097/01.blo.0000163001.14420.3a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED We prospectively evaluated the results of our custom cementless femoral stems to ascertain whether this technology produced reasonable clinical function, complication rates, and loosening rates at midterm. Fifty-seven consecutive patients had surgery in 62 hips for primary osteoarthritis at a mean age of 57 years using a three-dimensional computed custom cementless stem. Patients were reviewed at a mean followup of 94.9 months. At review, the mean Harris hip score was 98.8 points (range, 84-100) compared with 61.1 (range, 28-78) points preoperatively. No patient complained of thigh pain. No migration or subsidence was observed. All stems were considered stable according to the radiographic criteria defined by Engh et al. There were no dislocations, no infections, and no reoperations. Our results are comparable with published results from clinical and radiologic points of view. Two problems remain unsolved: the price of a custom stem is twice as expensive as a standard stem; and we need longer term results before definitely recommending this technology as a reasonable alternative to current arthroplasties in younger patients. The data support the continued exploration of this technology with controlled clinical followup. LEVEL OF EVIDENCE Therapeutic study, Level II-1 (prospective cohort study). See the Guidelines to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael Wettstein
- Service d'Orthopédie et de Traumatologie, Lausanne University Medical School, Switzerland.
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Abstract
The tapered rectangular press fit femoral component design of Karl Zweymüller remains highly successful since its inception in 1979. The longitudinal taper and rectangular cross-section provide unequaled primary stability, which promotes consistent secondary osseointegration to the grit-blasted titanium surface, even in osteoporotic bone. The "fit without fill" concept provides for bone conservation and preservation of the intraosseous blood supply by compaction, rather than removal, of the metaphyseal cancellous bone. The surgical technique is simple and forgiving, allowing for infinite adjustability in stem height and anteversion. Numerous long-term studies report excellent clinical results with a negligible incidence of loosening, thigh pain, osteolysis, or significant stress shielding and survivorships approaching 100% at 10 years.
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Affiliation(s)
- Todd V Swanson
- Desert Orthopaedic Center, 2800 E. Desert Inn Road, Suite 100, Las Vegas, NV 89121, USA
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Kold S, Rahbek O, Vestermark M, Overgaard S, Søballe K. Bone compaction enhances fixation of weightbearing titanium implants. Clin Orthop Relat Res 2005:138-44. [PMID: 15685067 DOI: 10.1097/01.blo.0000150461.69142.f3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Implant stability is crucial for implant survival. A new surgical technique, compaction, has increased in vitro implant stability and in vivo fixation of nonweightbearing implants. However, the in vivo effects of compaction on weightbearing implants are unknown. As implants inserted clinically are weightbearing, the effects of compaction on weightbearing implants were examined. The hypothesis was that compaction would increase implant fixation compared with conventional drilling. Porous-coated titanium implants were inserted bilaterally into the weightbearing portion of the femoral condyles of dogs. In each dog, one knee had the implant cavity prepared with drilling, and the other knee was prepared with compaction. Eight dogs were euthanized after 2 weeks, and eight dogs were euthanized after 4 weeks. Femoral condyles from an additional eight dogs represented Time 0. Compacted specimens had higher bone-implant contact and periimplant bone density at 0 and 2 weeks, but not at 4 weeks. A biphasic response of compaction was found with a pushout test, as compaction increased ultimate shear strength and energy absorption at 0 and 4 weeks, but not at 2 weeks. This biphasic response indicates that compaction enhances implant fixation by mechanical and biological mechanisms. Therefore, compaction might have potential value in total joint replacement in the future.
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Affiliation(s)
- Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, Bldg., 1A, DK-8000 Aarhus C, Denmark.
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Kold S, Rahbek O, Zippor B, Bechtold JE, Søballe K. Bone compaction enhances fixation of hydroxyapatite-coated implants in a canine gap model. J Biomed Mater Res B Appl Biomater 2005; 75:49-55. [PMID: 16025476 DOI: 10.1002/jbm.b.30289] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Primary cementless joint replacement depends partly on the ability of bone to heal into those areas of an inserted implant where a gap to surrounding bone initially exists. A new bone preparation technique, compaction, has enhanced gap-healing around grit-blasted implants without osteo-conductive properties. However, hydroxyapatite (HA) porous-coated implants with osteo-conductive properties are often inserted clinically to enhance gap healing and implant fixation. It is unknown whether the osteo-conductive properties of HA porous-coated implants might overwhelm the beneficial effects of compaction on gap healing. Therefore, we compared the compaction technique with the conventional bone-removing technique, drilling, using HA porous-coated implants in a canine gap model. HA porous-coated titanium implants were bilaterally inserted into oversized cavities of the proximal humeri of seven dogs. Each dog served as its own control. Thus, one humerus had the implant cavity prepared with compaction, the other with drilling. Two weeks after surgery push-out test and histomorphometry was performed. Compaction significantly increased ultimate shear strength, energy absorption, apparent shear stiffness, bone implant contact, and peri-implant bone density. The results of this study suggest that compaction may enhance gap healing when osteo-conductive HA porous coated implants are inserted in joint replacements.
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Affiliation(s)
- Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark.
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Kold S, Bechtold JE, Mouzin O, Bourgeault C, Søballe K. Importance of pre-clinical testing exemplified by femoral fractures in vitro with new bone preparation technique. Clin Biomech (Bristol, Avon) 2005; 20:77-82. [PMID: 15567540 DOI: 10.1016/j.clinbiomech.2004.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Accepted: 08/04/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND A new bone preparation technique, using smooth tamps for bone compaction, has increased crucial initial implant stability. However, preparing the femur with bulky smooth tamps, which from size to size increases the same amount in anterior to posterior as in lateral to medial dimensions, has increased the risk of a femoral fracture. This study examined whether compaction also involved an increased femoral fracture risk when using newly developed smooth tamps with a slim anterior to posterior dimension. METHODS One femur in each pair of 10 cadaver femurs was prepared by the compaction technique using cylindrical reamers and smooth tamps. The contralateral femur was conventionally prepared with conical reamers and toothed rasps. The tamps and rasps differed in design as a proximal lateral tip was only present on the smooth tamps. Using a standardized test protocol, the instruments were driven into the femoral canal in controlled manner by a drop tower. FINDINGS At maximum test conditions, five of 10 femurs in the compaction group had fractured, as compared with no fractures in the rasping group. All fractures were longitudinal fissures in the greater trochanter, and these fissures were associated with the extended proximal lateral tip of the tamps. INTERPRETATION Since the lateral fractures in the compaction group were associated with the extended proximal lateral tip of the tamps, it seems that fracture rates are influenced by instrumentation design. Therefore adequate pre-clinical evaluation is warranted prior to the introduction of new implantation techniques.
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Affiliation(s)
- Søren Kold
- Orthopaedic Biomechanics Laboratory, Midwest Orthopaedic and Minneapolis Medical Research Foundations, Minneapolis, MN, USA.
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Kold S, Mouzin O, Bourgeault C, Søballe K, Bechtold JE. Femoral fracture risk in hip arthroplasty: smooth versus toothed instruments. Clin Orthop Relat Res 2003:180-8. [PMID: 12616057 DOI: 10.1097/00003086-200303000-00023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Compaction of cancellous bone with smooth tamps in total hip arthroplasty has been shown to improve initial implant fixation. It is not known, however, whether this improved fixation occurs at the expense of an increased risk of intraoperative femoral fracture. The current authors explore this issue by comparing the risk of fracture in 10 pairs of femurs prepared with either smooth tamps or conventional toothed broaches. Using one pass for each size, smooth tamps were advanced incrementally into one femur of each pair and toothed broaches were advanced incrementally into the contralateral femur. A controlled impulse, representative of a typical impact during surgery, was applied to the instruments by a drop tower (mean starting force, 3017 N). When the instruments no longer advanced distally, the applied force was increased incrementally. Instrument sizes were increased until a femoral fracture was observed or the impact exceeded 8000 N without causing a femoral fracture. At preoperative templated size, significantly more femurs that had tamps had fractured (eight of 10), compared with femurs that had broaches (two of 10). Smooth tamps therefore increased the risk of intraoperative femoral fracture in vitro in this particular implant design developed for cemented fixation of the femoral component.
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Affiliation(s)
- Søren Kold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and Midwest Orthopaedic Research Foundation, Minneapolis, MN, USA.
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Abstract
Varus placement of the femoral component in total hip arthroplasty has been associated with poor outcomes. The purpose of this study was to examine results of total hip arthroplasty with varus alignment of a tapered titanium femoral prosthesis (Alloclassic; Sulzer, Zurich, Switzerland) at a minimum 5-year follow-up. Of a consecutive series of 585 patients, 23 met the inclusion criteria. Harris hip scores averaged 97, and all implants were clinically and radiographically stable at the most recent follow-up. In this series of patients, varus alignment of the prosthesis did not have an adverse effect on outcome. Although malalignment of the femoral prosthesis may compromise the results of some designs, the Alloclassic prosthesis has proved to be reliable and forgiving despite varus malalignment at 5 to 11 years' follow-up.
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Affiliation(s)
- Cyna Khalily
- Wellington Orthopaedic and Sports Medicine, Cincinnati, Ohio 45247, USA.
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Chareancholvanich K, Bourgeault CA, Schmidt AH, Gustilo RB, Lew WD. In vitro stability of cemented and cementless femoral stems with compaction. Clin Orthop Relat Res 2002:290-302. [PMID: 11795746 DOI: 10.1097/00003086-200201000-00034] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rigidity of initial fixation is a key factor contributing to the longevity of cemented and cementless femoral components in total hip arthroplasty. The objective of this study was to measure the initial stability of primary cemented and cementless femoral components under load when 15 pairs of cadaveric femurs were prepared by outward compaction of femoral cancellous bone in situ or by conventional extraction broaching. Three-dimensional micromotion was measured at proximal and distal locations on the femoral components using a device with spherical targets and linear variable differential transformers. External loads simulating the stance phases of level walking and stair ascent were applied to the femoral components by a materials test machine. Bone preparation method significantly affected each of the translation and rotation components of micromotion with cemented and cementless fixation. Micromotion with broaching was consistently greater than with compaction. Compared with compaction, the magnitude of the micromotion translation vector for broaching was an average of 3.9 (standard deviation, 3.1) times greater with cemented fixation, and an average of 2.3 (standard deviation, 1.4) times greater with cementless fixation. The results of this study showed the effectiveness of compaction of femoral cancellous bone in improving the initial stability of cemented and cementless femoral components in primary total hip arthroplasty.
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Affiliation(s)
- Keerati Chareancholvanich
- Orthopaedic Biomechanics Laboratory, Midwest Orthopaedic Research Foundation, Minneapolis, MN 55404, USA
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Zacharias I, Howell SM, Hull ML, Lawhorn KW. In vivo calibration of a femoral fixation device transducer for measuring anterior cruciate ligament graft tension: a study in an ovine model. J Biomech Eng 2001; 123:355-61. [PMID: 11563761 DOI: 10.1115/1.1385842] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Toward developing a transducer for measuring in vivo tension in anterior cruciate ligament grafts in humans, the objectives of this study were to determine the following: (1) whether the calibration of a previously reported femoral fixation device transducer (FDT) (Ventura et al., 1998) is affected by the presence of the graft when implanted in the tibial metaphysis of an ovine model, (2) whether the FDT remains calibrated at 4 weeks postoperatively, and (3) whether the biological incorporation of the graft occurs prior to a change in the FDT calibration. The FDT was implanted in the hind limb of five sheep using an extra-articular procedure. Both the proximal common digital extensor tendon (i.e., graft) and a Teflon-coated wire were looped around the FDT inside a tunnel in the tibial metaphysis. The FDT was calibrated on three occasions using the loop of wire: once intraoperatively before graft insertion, once intraoperatively after graft insertion, and once postoperatively after the animals had been sacrificed at 4 weeks. Following sacrifice, the load transmitted to the FDT by the graft was also determined. The FDT exhibited linear calibration intraoperatively both before and after graft insertion with an average error relative to the calibration before insertion of the graft of -4.6 percent of full-scale load (150 N) and this average relative error was not significantly different from zero (p = 0.183). After 4 weeks of implantation, the average relative percent error was -5.0 percent and was not significantly different from zero (p = 0.434) indicating that the FDT remained calibrated in the in vivo environment. Because only 15 percent of the graft tension was transmitted to the FDT after 4 weeks, biological incorporation of the graft preceded the loss of calibration. In light of these findings, the FDT offers the capability of measuring the intra-articular ACL graft tension in vivo in animal models and possibly humans before the biological bond develops and also of monitoring the formation and maturation of the biological bond between a graft and bone tunnel.
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Affiliation(s)
- I Zacharias
- Department of Mechanical Engineering, University of California, Davis 95616, USA
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Breusch SJ, Norman TL, Revie IC, Lehner B, Caillouette JT, Schneider U, Blaha JD, Lukoschek M. Cement penetration in the proximal femur does not depend on broach surface finish. ACTA ORTHOPAEDICA SCANDINAVICA 2001; 72:29-35. [PMID: 11327410 DOI: 10.1080/000164701753606653] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In a cadaver study, we prepared 29 paired human cadaver femora using 3 different broaches of identical geometry but different surface characteristics. In one group of 20 pairs, preparation with chipped-toothed broaches was compared to diamond-shaped broaches; in the other group of 9 pairs, polished tamps for compaction of cancellous bone were compared with chipped-tooth broaches. Cancellous bone was irrigated with 1 liter pulsed lavage. The specimens were embedded in specially-designed pots. Palacos R and Simplex bone cements were used. After vacuum mixing, the cement was applied in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3,000 N. Radiographs were taken and horizontal sections were obtained at predefined levels using a diamond saw. Microradiographs were taken, digitized and analyzed to assess cement penetration into cancellous bone. In 6 of 9 femora prepared using smooth tamps, femoral fractures occurred despite careful preparation technique. The microradiographic evaluation showed no significant morphometric differences between diamond and chipped-tooth or between polished and chipped-tooth broaches with regard to cement penetration into cancellous bone. Therefore, in the presence of pulsed lavage, one finds no significant effect of broach surface characteristics on cement penetration into cancellous bone of the proximal end of the femur.
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Affiliation(s)
- S J Breusch
- Department of Orthopedic I, University of Heidelberg, Germany.
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