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Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications
Background: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femora...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
EDP Sciences
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9651064/ https://www.ncbi.nlm.nih.gov/pubmed/36367405 http://dx.doi.org/10.1051/sicotj/2022043 |
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author | Wang, Katherine Kenanidis, Eustathios Suleman, Khurram Miodownik, Mark Avadi, Mahsa Horne, David Thompson, Jonathan Tsiridis, Eleftherios Moazen, Mehran |
author_facet | Wang, Katherine Kenanidis, Eustathios Suleman, Khurram Miodownik, Mark Avadi, Mahsa Horne, David Thompson, Jonathan Tsiridis, Eleftherios Moazen, Mehran |
author_sort | Wang, Katherine |
collection | PubMed |
description | Background: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femoral cancellous bone is adequate. The biomechanical effect of sub-optimal stem sizing in the femur remains unclear. This study investigated the mechanical behaviour of two sequential sized uncemented stems of the same type. Methods: Six laboratory models of synthetic non-osteoporotic femora were randomly divided into two groups and implanted with either a nominal or oversized uncemented hydroxyapatite-coated nonporous titanium collarless stem. Stiffness, uniaxial strain, and pattern of strain distribution were measured under an anatomical one-legged stance. Results: Oversized stems demonstrated a higher overall stiffness compared to nominal; however, this was not statistically significant. The nominal stem showed a higher strain in the neck and the proximal medial diaphyseal region. The oversized stem showed higher strains in the distal region around the implant tip. Conclusion: Opting to use a larger stem may potentially increase primary stability, thus allowing safer early mobility. However, higher stiffness may lead to stress shielding, bone loss, and thigh pain in the long term. In addition, strains in the diaphysis and the tip of the stem may predispose to periprosthetic fractures, especially in osteoporotic bones, making this a relatable aspect for users and biomechanical loading. Given the wide range of complex factors that need to be considered when choosing stem size in uncemented THA surgery, this study’s results should be interpreted cautiously. |
format | Online Article Text |
id | pubmed-9651064 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | EDP Sciences |
record_format | MEDLINE/PubMed |
spelling | pubmed-96510642022-11-16 Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications Wang, Katherine Kenanidis, Eustathios Suleman, Khurram Miodownik, Mark Avadi, Mahsa Horne, David Thompson, Jonathan Tsiridis, Eleftherios Moazen, Mehran SICOT J Original Article Background: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femoral cancellous bone is adequate. The biomechanical effect of sub-optimal stem sizing in the femur remains unclear. This study investigated the mechanical behaviour of two sequential sized uncemented stems of the same type. Methods: Six laboratory models of synthetic non-osteoporotic femora were randomly divided into two groups and implanted with either a nominal or oversized uncemented hydroxyapatite-coated nonporous titanium collarless stem. Stiffness, uniaxial strain, and pattern of strain distribution were measured under an anatomical one-legged stance. Results: Oversized stems demonstrated a higher overall stiffness compared to nominal; however, this was not statistically significant. The nominal stem showed a higher strain in the neck and the proximal medial diaphyseal region. The oversized stem showed higher strains in the distal region around the implant tip. Conclusion: Opting to use a larger stem may potentially increase primary stability, thus allowing safer early mobility. However, higher stiffness may lead to stress shielding, bone loss, and thigh pain in the long term. In addition, strains in the diaphysis and the tip of the stem may predispose to periprosthetic fractures, especially in osteoporotic bones, making this a relatable aspect for users and biomechanical loading. Given the wide range of complex factors that need to be considered when choosing stem size in uncemented THA surgery, this study’s results should be interpreted cautiously. EDP Sciences 2022-11-11 /pmc/articles/PMC9651064/ /pubmed/36367405 http://dx.doi.org/10.1051/sicotj/2022043 Text en © The Authors, published by EDP Sciences, 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Wang, Katherine Kenanidis, Eustathios Suleman, Khurram Miodownik, Mark Avadi, Mahsa Horne, David Thompson, Jonathan Tsiridis, Eleftherios Moazen, Mehran Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
title | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
title_full | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
title_fullStr | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
title_full_unstemmed | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
title_short | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
title_sort | differences between two sequential uncemented stem sizes in total hip arthroplasty: a comparative biomechanical study and potential clinical implications |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9651064/ https://www.ncbi.nlm.nih.gov/pubmed/36367405 http://dx.doi.org/10.1051/sicotj/2022043 |
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