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Related Experiment Video

Updated: Jan 9, 2026

Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
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Design of Surgical Impaction Instruments Matters.

Peter J Schlieker1, Frank Lampe2,3, Johann Zwirner4,5

  • 1Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany.

Arthroplasty Today
|December 1, 2025
PubMed
Summary

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Impactor design significantly affects force transmission during total hip arthroplasty femoral stem impaction. Only 24-47% of mallet force reaches the implant, highlighting the need for surgeon awareness of instrument influence.

Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Medical Device Design

Background:

  • Femoral stem impaction in total hip arthroplasty (THA) relies on mallet blows.
  • Impactor design (mass, stiffness) influences force transmission, but this is poorly understood.
  • Patient and surgeon factors also affect impaction outcomes.

Purpose of the Study:

  • To investigate force transmission through different impactor designs during THA.
  • To analyze the proportion of mallet force reaching the femoral stem implant.
  • To evaluate the influence of patient-specific femur-tissue systems.

Main Methods:

  • Measured mallet and impactor forces during 9 blows on femoral stems in 4 cadavers.
  • Utilized 2 surgical approaches and 2 different impactor designs.
Keywords:
Cadaveric studyForce transmissionImpactionNumerical simulationTotal hip arthroplasty

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  • Calculated mallet-implant force transmission using a phenomenological model.

    • Main Results:

    • Impactor force was 65-75% of mallet peak force, independent of approach or cadaver.
    • Force measurements distant from the tip overestimated transferred force.
    • Only 24-47% of mallet peak force reached the implant, dependent on impactor design.

    Conclusions:

    • Force transmission during THA stem impaction is primarily determined by impactor design.
    • Patient and approach factors have minimal influence on overcritical mallet blows.
    • Surgeons should exercise caution with novel instruments to prevent complications.