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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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Comparative Study for Postoperative Initial Fixation Patterns of Two Different Types of Cementless Short Stem Using

Takuya Nakai1,2, Yu Takeda1, Saori Niitsu3

  • 1Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan.

Clinics in Orthopedic Surgery
|February 2, 2024
PubMed
Summary

The Metha short stem achieves metaphyseal anchoring in total hip arthroplasty (THA) by contacting proximal femur cortical bone, potentially avoiding proximal offloading. This study quantified stem-to-femur contact for Metha and Fitmore stems.

Keywords:
Cementless stemDigital templatingThree-DimensionTotal hip arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Implant Design

Background:

  • Cementless short stems are increasingly used in total hip arthroplasty (THA).
  • The Metha short stem utilizes a unique partial collum-sparing metaphyseal anchorage for initial fixation.
  • Comparative analysis of stem-to-femur contact is crucial for understanding implant performance.

Purpose of the Study:

  • To quantitatively assess the contact state between the Metha short stem and the femur.
  • To compare the stem-to-femur contact points of the Metha stem with the Fitmore curved short stem.

Main Methods:

  • Retrospective review of 42 THA cases with Metha and 41 with Fitmore.
  • Density mapping using a 3D digital template system to evaluate stem-to-femur contact.
  • Quantification of contact based on modified Gruen zones, with cortical contact defined at 543 HU.

Main Results:

  • Metha showed significantly greater cortical contact in Gruen zones 1, 6, and 7 compared to Fitmore.
  • Fitmore demonstrated significantly greater contact in zones 2 and 5.
  • Quantitative data on stem-to-bone contact distribution was obtained for both implant types.

Conclusions:

  • The Metha stem can achieve metaphyseal anchoring via proximal femur cortical bone contact.
  • This fixation mechanism may help prevent proximal offloading, a common issue with some short stems.
  • This study provides novel quantitative data on stem-to-cortical bone contact for curved short stems.