Stress distribution of cementless stems with unique flanges in a rectangular cross-section: thermoelastic stress imaging study

Objective: In this study, thermoelastic stress analysis was conducted to clarify the surface stress distribution of a femur in which a BiCONTACT E stem was inserted. The contact sites between the stem and femur were examined to investigate the association with the range of stress distribution. Materials and Methods: BiCONTACT E was set up using two synthetic femurs that mimic the morphology and mechanical properties of living bone. Preoperative planning was performed using three-dimensional imaging software. The synthetic bone was placed in a sample holder. After the stem was implanted into the synthetic bone, computed tomography imaging was performed. The contact sites between the stem and the cortical part of the synthetic bone were examined using the imaging software. Subsequently, thermoelastic stress measurements were performed on the sample. Results: The results of thermoelastic stress analysis indicated a minimum change in the sum of principal stresses [Δ (σ(1)+σ(2))] on the medial side and a maximum change in the sum of principal stresses on the lateral side. Thus, no minimum change was observed in the sum of the principal stresses at the maximum proximal part. It is reasonable to assume that the use of a cementless stem can inevitably lead to bone atrophy in the proximal part of the femur. The contact sites between the stem and femur were also investigated, and the results of the study clearly and quantitatively demonstrated the correlation of the contact sites with a range of stress distributions. Conclusion: The surface stress distribution of a femur, in which a BiCONTACT E stem was inserted, was clarified. The contact sites between the stem and femur were also investigated. Furthermore, the correlation between these results and clinical bone response was investigated in this study.