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¿Cómo afecta el diseño del tallo al grado de libertad de la versión y la posición del tallo? Un estudio de simulación

Shotaro Kawamura¹, Daisuke Hara², Satoshi Hamai¹

¹Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

Clinical biomechanics (Bristol, Avon)

|August 21, 2025

Resumen

Los tallos de cuña cónica ofrecen una mayor libertad de versión en la artroplastia total de cadera en comparación con los diseños de ajuste y relleno. Esta mayor ajustabilidad puede mejorar el posicionamiento del implante, pero la planificación quirúrgica cuidadosa sigue siendo esencial.

Área de la Ciencia:

Cirugía ortopédica
Ingeniería biomédica
Diseño del implante

Sus antecedentes:

El control de la anteversión del tallo es crítico en la artroplastia total de cadera (ATC) para evitar el impacto de la prótesis.
El diseño del tronco influye significativamente en el grado de libertad en el control de versiones.
La investigación limitada cuantifica la libertad de versión en diferentes diseños de tallo de THA.

Objetivo del estudio:

Cuantificar y comparar la libertad de versión y los cambios de posición entre los tallos de cuña cónica y de ajuste y relleno en THA.
Analizar cómo los ajustes de la versión del tallo afectan la alineación y la profundidad coronal y sagital.
Evaluar los cambios en la versión del tallo en relación con la versión femoral nativa.

Principales métodos:

Se analizaron tomografías computarizadas preoperatorias de 51 caderas.
La plantilla tridimensional se realizó utilizando tanto cuñas cónicas como tallos de ajuste y relleno.
La libertad de versión se definió como el intervalo entre las anteversiones máximas y mínimas del tallo.

Principales resultados:

Los tallos de cuña cónica demostraron una libertad de versión media significativamente mayor (21,7 °) que los tallos de ajuste y relleno (9,8 °).
Los tallos de cuña cónica mostraron mayores cambios de alineación en los planos coronal y sagital.
La libertad de versión se correlacionó significativamente con los cambios de alineación del tallo; ambos diseños permitieron un aumento más fácil de la anteversión pero una disminución limitada.

Conclusiones:

El diseño del tallo es un determinante clave de la libertad de versión en THA.
La mayor ajustabilidad de los tallos de cuña cónica puede facilitar un mejor posicionamiento del implante.
La planificación quirúrgica precisa y el control intraoperatorio son vitales para lograr resultados óptimos de anteversión y AHT a largo plazo.

Palabras clave:

Simulación por ordenador Talla de ajuste y relleno Versión de origen El tallo de cuña cónica Artroplastia total de la cadera

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