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van Dooren B, Peters RM, Visser D, van Steenbergen LN, Bos PK, Zijlstra WP. Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup. Arthroplast Today 2024; 25:101281. [PMID: 38292143 PMCID: PMC10826135 DOI: 10.1016/j.artd.2023.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.
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Affiliation(s)
- Bart van Dooren
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Rinne M. Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Orthopedic surgery, Martini Hospital, Groningen, The Netherlands
| | - David Visser
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - P Koen Bos
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Emara AK, Ng M, Krebs VE, Bloomfield M, Molloy RM, Piuzzi NS. Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a "Lost" Art. Curr Rev Musculoskelet Med 2021; 14:47-59. [PMID: 33453016 PMCID: PMC7930165 DOI: 10.1007/s12178-020-09681-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation. RECENT FINDINGS Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers. As such, maximizing benefit from cemented femoral stem fixation among suitable candidates is contingent upon the meticulous use of modern cementation techniques. In addition to proper patient selection, modern cementation techniques emphasize the use of (1) pulsatile lavage of the femoral canal, (2) utilization of epinephrine-soaked swabs, (3) vacuum cement mixing, (4) retrograde cement introduction, (5) cement pressurization, and (6) the use of stem centralizers. Furthermore, identifying and optimizing the preoperative status of at-risk patients with pre-existing cardiopulmonary compromise, in addition to intraoperative vigilance, are essential for mitigating the risk of developing bone cement implantation syndrome. Further research is required to assess the utility of cemented femoral stem fixation among younger patients.
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Affiliation(s)
- Ahmed K Emara
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Mitchell Ng
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | | | - Robert M Molloy
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA.
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Toro G, Di Fino C, De Cicco A, Toro G, Paoletta M, Toro A, Tarantino U, Iolascon G, Panni AS. Atypical periprosthetic femoral fractures of the hip: characterisation of three cases. Hip Int 2020; 30:77-85. [PMID: 33267685 DOI: 10.1177/1120700020971726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. METHODS Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. RESULTS 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. CONCLUSIONS Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ciro Di Fino
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, "Martiri del Villa Malta" Hospital, Sarno, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Cassar-Gheiti AJ, McColgan R, Kelly M, Cassar-Gheiti TM, Kenny P, Murphy CG. Current concepts and outcomes in cemented femoral stem design and cementation techniques: the argument for a new classification system. EFORT Open Rev 2020; 5:241-252. [PMID: 32377392 PMCID: PMC7202038 DOI: 10.1302/2058-5241.5.190034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cemented implant fixation design principles have evolved since the 1950s, and various femoral stem designs are currently in use to provide a stable construct between the implant–cement and cement–bone interfaces. Cemented stems have classically been classified into two broad categories: taper slip or force closed, and composite beams or shaped closed designs. While these simplifications are acceptable general categories, there are other important surgical details that need to be taken into consideration such as different broaching techniques, cementing techniques and mantle thickness. With the evolution of cemented implants, the introduction of newer implants which have hybrid properties, and the use of different broaching techniques, the classification of a very heterogenous group of implants into simple binary categories becomes increasingly difficult. A more comprehensive classification system would aid in comparison of results and better understanding of the implants’ biomechanics. We review these differing stem designs, their respective cementing techniques and geometries. We then propose a simple four-part classification system and summarize the long-term outcomes and international registry data for each respective type of cemented prosthesis.
Cite this article: EFORT Open Rev 2020;5:241-252. DOI: 10.1302/2058-5241.5.190034
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Affiliation(s)
| | | | - Martin Kelly
- Connolly Hospital, Orthopaedic Department, Dublin, Ireland
| | | | - Paddy Kenny
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,Connolly Hospital, Orthopaedic Department, Dublin, Ireland
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Scott T, Salvatore A, Woo P, Lee YY, Salvati EA, Gonzalez Della Valle A. Polished, Collarless, Tapered, Cemented Stems for Primary Hip Arthroplasty May Exhibit High Rate of Periprosthetic Fracture at Short-Term Follow-Up. J Arthroplasty 2018; 33:1120-1125. [PMID: 29223405 DOI: 10.1016/j.arth.2017.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/29/2017] [Accepted: 11/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cemented stems are designed to follow 1 of 2 principles of fixation: composite beams or slide taper. Stems in the latter category have a collarless, polished, tapered (CPT) design and subside into the cement mantle, creating hoop stresses. We compared the rate of periprosthetic fracture (PPF) of stem designed with these 2 principles of fixation. In addition, we examined radiographic factors that may predispose to the development of PPF. METHODS We retrospectively reviewed all patients who underwent primary THA by a single surgeon using highly polished cemented stems. PPF rates were compared between CPT stems (follow-up, 21 months; standard deviation [SD], 22) and composite beam stems (follow-up, 21.7 months; SD, 26). Demographic data were compared between patients with and without a PPF. Three preoperative radiographic parameters (canal bone ratio [CBR], canal-calcar ratio, and canal flare index), stem alignment, and cement mantle were compared in match-paired patients with and without a PPF (1:34). RESULTS Seven of 1460 THA patients developed a PPF (0.479%); 4 hips of 185 with a CPT stem (2.2%); and 3 of 1275 hips with a composite beam stem (0.23%; P = .0064). Three of the 4 PPFs in the CPT group and none in the composite beam group were classified as Vancouver B2. The CBR in patients with a PPF was 0.50 (SD, 0.07) and 0.43 (SD, 0.07) in the match cohort of hips without PPF (P = .013). CONCLUSION CPT stems may be associated with a higher risk of PPF that often require reoperation. An increased CBR may be a risk factor for postoperative PPF.
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Affiliation(s)
- Trevor Scott
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Anthony Salvatore
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Pauline Woo
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Yuo-Yu Lee
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Eduardo A Salvati
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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Hosein YK, King GJW, Dunning CE. The effect of stem material and surface treatment on the torsional stability at the metal-cement interface of upper limb joint replacement systems. J Biomed Mater Res B Appl Biomater 2014; 102:1217-22. [DOI: 10.1002/jbm.b.33105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 11/08/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Yara K. Hosein
- Biomedical Engineering Graduate Program; Western University; London Ontario Canada N6A 5B9
| | - Graham J. W. King
- Biomedical Engineering Graduate Program; Western University; London Ontario Canada N6A 5B9
- Department of Surgery; Western University; London Ontario Canada N6A 5B9
- Department of Medical Biophysics; Western University; London Ontario Canada N6A 5B9
| | - Cynthia E. Dunning
- Biomedical Engineering Graduate Program; Western University; London Ontario Canada N6A 5B9
- Department of Surgery; Western University; London Ontario Canada N6A 5B9
- Department of Medical Biophysics; Western University; London Ontario Canada N6A 5B9
- Department of Materials & Mechanical Engineering; Western University; London Ontario Canada N6A 5B9
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7
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Hosein YK, King GJW, Dunning CE. The Effect of Stem Circumferential Grooves on the Stability at the Implant-Cement Interface. J Med Device 2013. [DOI: 10.1115/1.4025468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The application of stem surface treatments and finishes are common methods for improving stem-cement interface stability in joint replacement systems; however, success of these surfaces has been variable. As opposed to applying a treatment or finish, altering stem design through changing the surface topography of the base stem material may offer some advantages. This study compared the effect of stem circumferential grooving on the torsional and axial stability of cemented stems. Fifteen metal stems were machined from cobalt chrome to have smooth (n = 5) or circumferential-grooved surfaces, where groove depth and spacing was either 0.6 mm (n = 5) or 1.1 mm (n = 5). Stems were potted in aluminum tubes using bone cement, left 24 h to cure, and placed in a materials testing machine for testing using a cyclic staircase loading protocol at 1.5 Hz. All stems were tested independently in compression and torsion on separate testing days, using the same stems repotted with new cement. Motion of the stem was tracked, and failure was defined either as rapid increase in stem motion, or completion of the loading protocol. Statistical analysis was used to compare interface strength and stem motion prior to failure. Grooved stems demonstrated increased interface strength (p < 0.001) and reduced motion (p < 0.01) compared to smooth stems under compression. In torsion, no significant difference was found in strength among the grooved and smooth stems (p = 0.10); however, grooved 1.1 mm demonstrated greatest interface motion prior to catastrophic failure (p < 0.01). Overall, circumferential-grooved stems offered improved stability under compression, and comparable stability in torsion, relative to the smooth stems.
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Affiliation(s)
- Yara K. Hosein
- Biomedical Engineering Graduate Program, Western University, London, ON N6A 5B9, Canada
| | - Graham J. W. King
- Department of Surgery, Western University, London, ON N6A 5B9, Canada
| | - Cynthia E. Dunning
- Biomedical Engineering Graduate Program, Department of Surgery, and Department of Materials & Mechanical Engineering, Western University, London, ON N6A 5B9, Canada e-mail:
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8
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Norman T, Shultz T, Noble G, Gruen T, Blaha J. Bone creep and short and long term subsidence after cemented stem total hip arthroplasty (THA). J Biomech 2013; 46:949-55. [DOI: 10.1016/j.jbiomech.2012.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 11/07/2012] [Accepted: 12/12/2012] [Indexed: 11/24/2022]
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Ellison P, Hallan G, Høl PJ, Gjerdet NR, Havelin LI. Coordinating retrieval and register studies improves postmarket surveillance. Clin Orthop Relat Res 2012; 470:2995-3002. [PMID: 22723244 PMCID: PMC3462873 DOI: 10.1007/s11999-012-2430-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The relative risk of revision of the Titan(®) femoral stem due to aseptic loosening increased after 2000; however, the reasons for this have not been established. A retrieval analysis was initiated with the aim of delineating the failure mechanism. QUESTIONS/PURPOSES We asked whether aseptic loosening in stems after 2000 was associated with (1) appearance of osteolytic lesions, (2) wear particle exposure, (3) stem damage, or (4) changes to the implant or surgical instrumentation. METHODS Femoral stems, cement, tissue, and radiographs were collected from 28 patients. We assessed the development of osteolytic lesions in 17 patients. Exposure to wear particles was quantified in 18 patients. Stem damage was assessed in 15 patients. We observed differences in the implants by examination of 24 retrieved stems. Information concerning changes to instrumentation was requested from the manufacturer. RESULTS We found osteolysis in all patients receiving implants after 2000, which was associated with a median dose of cement and stem particles of 14,726/mm(2). Abrasion covered 59% of the surface of stems implanted from 1999. We identified geometric changes to the stem, the percent weight of aluminum in the stem's oxide layer decreased from 25% to 14% after 1997 and the rasp used to prepare the femoral cavity changed to a broach in 1999. CONCLUSIONS Stems implanted from 2000 failed through osteolysis induced by particles released from the cement and implant. Changes to implant geometry, surface oxide layer, and surgical tools occurred in the same time frame as the reduction in survivorship.
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Affiliation(s)
- Peter Ellison
- Biomaterials, Department of Surgical Sciences, University of Bergen, Bergen, Hordaland 5021 Norway
| | - Geir Hallan
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Biomaterials, Department of Surgical Sciences, University of Bergen, Bergen, Hordaland 5021 Norway
| | - Nils Roar Gjerdet
- Biomaterials, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Leif I. Havelin
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Austman RL, King GJW, Dunning CE. Bone stresses before and after insertion of two commercially available distal ulnar implants using finite element analysis. J Orthop Res 2011; 29:1418-23. [PMID: 21416502 DOI: 10.1002/jor.21360] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 12/17/2010] [Indexed: 02/04/2023]
Abstract
Distal ulnar arthroplasty is becoming a popular treatment option for disorders of the distal radioulnar joint; however, few studies have investigated how load transfer in the ulna is altered after insertion of an implant. The purpose of our study was to compare bone stresses before and after insertion of two commercially available cemented distal ulnar implants: an implant with a titanium stem and an implant with a cobalt chrome stem. Appropriately sized implants of both types were inserted into eight previously validated subject-specific finite element models, which were created by using information derived from computed tomography scans. The von Mises stresses were compared at eight different regions pre- and post-implantation. The bone stresses with the titanium stem were consistently closer to the pre-implantation stresses than with the cobalt chrome stem. For the loading situation and parameters investigated, results of these models show that insertion of the E-Centrix® ulnar Head may result in less stress shielding than the SBI uHead™ stem. Future studies are required to investigate other implant design parameters and loading conditions that may affect the predicted amount of stress shielding.
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Affiliation(s)
- Rebecca L Austman
- Jack McBain Biomechanical Testing Laboratory, Department of Mechanical and Materials Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B9, Canada
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Mixed-mode failure strength of implant-cement interface specimens with varying surface roughness. J Biomech 2010; 44:780-3. [PMID: 21074772 DOI: 10.1016/j.jbiomech.2010.10.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 10/06/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022]
Abstract
Aseptic loosening at the implant-cement interface is a well-documented cause of failure in joint arthroplasty. Traditionally, the strength of the implant-cement interface is determined using uni-axial normal and shear loading tests. However, during functional loading, the implant fixation sites are loaded under more complex stress conditions. For this purpose, the strength of the implant-cement interface under mixed-mode tensile and shear loading conditions was determined in this study using interface specimens with varying interface roughness. For the lowest roughness value analyzed (R(a)=0.89 μm), the interface strength was 0.40-1.95 MPa at loading angles varying between pure tension and shear, whereas this was 4.90-9.90 MPa for the highest roughness value (R(a)=2.76 μm). The interface strength during pure shear (1.95-9.90 MPa) was substantially higher than during pure tension (0.58-6.67 MPa). Polynomial regression was used to fit a second-order interpolation function through the experimental interface strength data (R²=0.85; p<0.001), relating the interface strength (S [MPa]) to the interface loading angle (α [degrees]) and interface roughness (R(a) [μm]): S(α,R(a))=0.891R²(a)+0.001α²-0.189R(a)-0.064α-0.060. Finally, an interface failure criterion was derived from the interface strength measurements, describing the risk of failure at the implant-cement interface when subjected to a certain tensile and shear stress using only the interface strength in pure tensile and shear direction. The findings presented in this paper can be used in numerical models to simulate loosening at the implant-cement interface.
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Traina F, Tassinari E, Pilla F, De Fine M, Biondi F, Cristofolini L, Toni A. Outcome of hybrid stem fixation in osteoporotic female patients. A minimum five-year follow-up study. INTERNATIONAL ORTHOPAEDICS 2008; 33:1489-94. [PMID: 18712386 DOI: 10.1007/s00264-008-0645-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/09/2008] [Accepted: 07/09/2008] [Indexed: 11/24/2022]
Abstract
In osteoporotic patients cemented stems are usually used to achieve a good primary stability. However, when patients are obese or active the long-term survival of cemented prostheses is questioned. In these patients, a partially-cemented stem with a hybrid fixation could be advantageous. A hybrid stem was retrospectively evaluated at a minimum follow-up of 60 months (mean, 75 months) in 58 osteoporotic women: seventeen with a body mass index (BMI) >30 (obese), 41 with a BMI between 25 and 29.9 (overweight), and an UCLA score for activity level >6. At the latest follow up, the Harris hip score improved from 33.5 points preoperatively to 81.6 points, and the WOMAC score improved significantly. Three stems (4.9%) had an asymptomatic subsidence of less than 2.5 mm; no stem was revised. These results support the use of partially-cemented stems in heavy or active osteoporotic women.
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Affiliation(s)
- Francesco Traina
- 1st Department of Orthopaedic Surgery, Laboratory of Medical Technology (LTM), Istituti Ortopedici Rizzoli, Via G. Pupilli 1, 40136, Bologna, Italy.
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13
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Austman RL, Beaton BJB, Quenneville CE, King GJW, Gordon KD, Dunning CE. The effect of distal ulnar implant stem material and length on bone strains. J Hand Surg Am 2007; 32:848-54. [PMID: 17606065 DOI: 10.1016/j.jhsa.2007.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/27/2007] [Accepted: 03/19/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Implant design parameters can greatly affect load transfer from the implant stem to the bone. We have investigated the effect of length or material of distal ulnar implant stems on the surrounding bone strains. METHODS Eight cadaveric ulnas were instrumented with 12 strain gauges and secured in a customized jig. Strain data were collected while loads (5-30 N) were applied to the medial surface of the native ulnar head. The native ulnar head was removed, and a stainless steel implant with an 8-cm-long finely threaded stem was cemented into the canal. After the cement had cured, the 8-cm stem was removed, leaving a threaded cement mantle in the canal that could accept shorter threaded stems of interest. The loading protocol was then repeated for stainless steel stems that were 7, 5, and 3 cm in length, as well as for a 5-cm-long titanium alloy (TiAl(6)V(4)) stem. Other stainless steel stem lengths between 3 and 7 cm were tested at intervals of 0.5 cm, with only a 20 N load applied. RESULTS No stem length tested matched the native strains at all gauge locations. No significant differences were found between any stem length and the native bone at the 5th and 6th strain gauge positions. Strains were consistently closer to the native bone strains with the titanium stem than the stainless steel stem for each gauge pair that was positioned on the bone overlying the stem. The 3-cm stem results were closer to the native strains than the 7-cm stem for all loads at gauges locations that were on top of the stem. CONCLUSIONS The results from this study suggest that the optimal stem characteristics for distal ulnar implants from a load transfer point of view are possessed by shorter (approximately 3 to 4 cm) titanium stems.
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Affiliation(s)
- Rebecca L Austman
- Biomechanical Testing Laboratory, Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada
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14
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Cristofolini L, Baleani M, Toni A. Analysis of 16 retrieved proximal cemented femoral stems. J Arthroplasty 2006; 21:464-5; author reply 465-7. [PMID: 16627161 DOI: 10.1016/j.arth.2006.02.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 02/02/2006] [Indexed: 02/01/2023] Open
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