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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study

Katherine Wang1, Eustathios Kenanidis2, Khurram Suleman1

  • 1Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK.

SICOT-J
|November 11, 2022
PubMed
Summary

Choosing between a nominal or oversized uncemented femoral stem impacts biomechanical loading. Oversized stems offer potential early stability but may increase long-term risks like stress shielding and thigh pain.

Keywords:
BiomechanicsExperimentalStem sizeStiffnessStrainTotal hip arthroplasty (THA)Uncemented

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Area of Science:

  • Orthopedic biomechanics
  • Biomaterials engineering
  • Surgical implant technology

Background:

  • Incorrect sizing of uncemented femoral stems can lead to early failure and postoperative complications.
  • Surgeons face dilemmas regarding stem size selection, balancing stability with potential adverse effects.
  • The biomechanical consequences of suboptimal femoral stem sizing remain incompletely understood.

Purpose of the Study:

  • To investigate the mechanical behavior of two sequentially sized uncemented femoral stems.
  • To compare the biomechanical effects of nominal versus oversized stem implantation in synthetic femora.

Main Methods:

  • Six synthetic non-osteoporotic femora were used in laboratory models.
  • Femora were implanted with either nominal or oversized uncemented hydroxyapatite-coated titanium stems.
  • Stiffness, uniaxial strain, and strain distribution were measured under a one-legged stance model.

Main Results:

  • Oversized stems showed higher overall stiffness, though not statistically significant.
  • Nominal stems exhibited greater strain in the femoral neck and proximal medial diaphysis.
  • Oversized stems displayed increased strain around the distal implant tip.

Conclusions:

  • Larger stems may enhance primary stability for earlier patient mobility.
  • Increased stiffness from oversized stems could lead to stress shielding, bone loss, and thigh pain.
  • Elevated distal strains may increase periprosthetic fracture risk, particularly in osteoporotic bone.