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Optimizing Stem Length in Conversion Total Hip Arthroplasty: An Expanded Finite Element Analysis.

Koshiro Shimasaki1, Tomofumi Nishino1, Tomohiro Yoshizawa1

  • 1Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan.

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|February 26, 2025
PubMed
Summary

Using longer cementless stems (≥150 mm) in conversion total hip arthroplasty (cTHA) can reduce stress around screw holes, potentially lowering fracture risk and improving outcomes.

Keywords:
conversion total hip arthroplasty (cTHA)finite element analysis (FEA)periprosthetic fracturestem lengthstress concentration

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Medical Device Design

Background:

  • Periprosthetic fractures are a risk after conversion total hip arthroplasty (cTHA) due to stress concentration at distal screw-removal holes.
  • Optimizing stem selection in cTHA is crucial for improving clinical results and mitigating risks.

Purpose of the Study:

  • To investigate how different cementless femoral stem lengths affect stress distribution around distal screw-removal holes in cTHA.
  • To provide evidence-based guidelines for stem selection in cTHA procedures.

Main Methods:

  • Finite element analysis using CT scans of patient femurs to create cTHA models.
  • Simulation of screw-removal holes and testing of 130, 140, 150, and 160 mm cementless stems under walking and stair-climbing loads.
  • Calculation of equivalent stress values around distal screw-removal holes.

Main Results:

  • Femoral stems of 150 mm and 160 mm significantly reduced maximum equivalent stress around distal screw-removal holes compared to the 130 mm stem.
  • The 140 mm stem did not show a significant difference in stress reduction compared to other tested lengths.

Conclusions:

  • A cementless stem length of 150 mm or greater is effective in mitigating stress concentration post-cTHA.
  • Longer stems (≥150 mm) represent an optimal choice for balancing efficacy and complication risk, potentially enhancing long-term clinical outcomes.