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Background All current total hip arthroplasty (THA) systems are modular in design. Only during the operation femoral head and stem get connected by a Morse taper junction. The junction is realized by hammer blows from the surgeon. Decisive for the junction strength is the maximum force acting once in the direction of the neck axis, which is mainly influenced by the applied impulse and surrounding soft tissues. This leads to large differences in assembly forces between the surgeries. This study aimed to quantify the assembly forces of different surgeons under influence of surrounding soft tissue. Methods First, a measuring system, consisting of a prosthesis and a hammer, was developed. Both components are equipped with a piezoelectric force sensor. Initially, in situ experiments on human cadavers were carried out using this system in order to determine the actual assembly forces and to characterize the influence of human soft tissues. Afterwards, an in vitro model in the form of an artificial femur (Sawbones Europe AB, Malmo, Sweden) with implanted measuring stem embedded in gelatine was developed. The gelatine mixture was chosen in such a way that assembly forces applied to the model corresponded to those in situ. A study involving 31 surgeons was carried out on the aforementioned in vitro model, in which the assembly forces were determined. Results A model was developed, with the influence of human soft tissues being taken into account. The assembly forces measured on the in vitro model were, on average, 2037.2 N ± 724.9 N, ranging from 822.5 N to 3835.2 N. The comparison among the surgeons showed no significant differences in sex (P = 0.09), work experience (P = 0.71) and number of THAs performed per year (P = 0.69). Conclusions All measured assembly forces were below 4 kN, which is recommended in the literature. This could lead to increased corrosion following fretting in the head-neck interface. In addition, there was a very wide range of assembly forces among the surgeons, although other influencing factors such as different implant sizes or materials were not taken into account. To ensure optimal assembly force, the impaction should be standardized, e.g., by using an appropriate surgical instrument.

BackgroundAll current total hip arthroplasty (THA) systems are modular in design. Only during the operation femoral head and stem get connected by a Morse taper junction. The junction is realized by hammer blows from the surgeon. Decisive for the junction strength is the maximum force acting once in direction of the neck axis, which depends both on the applied impulse and the damping of human soft tissues. This leads to large differences in assembly forces between the surgeons. The investigation of assembly forces of different surgeons under influence of soft tissue damping is subject of this study.MethodsFirst, a measuring system, consisting of a prosthesis and a hammer, was developed. Both components are equipped with a piezoelectric force sensor. Initially, in situ experiments on human cadavers were carried out using this system in order to determine the actual assembly forces and to characterize the damping properties of human soft tissue. In addition to these experiments, an in vitro model in form of an artificial femur (Sawbones Europe AB, Malmo, Sweden) with implanted measuring stem embedded in gelatine was developed. The gelatine mixture was chosen in such a way that damping properties of the model correspond to those in situ. A study with 31 surgeons was carried out on the in vitro model mentioned above, in which the assembly forces were determined.ResultsA model has been developed, that represents the physiological damping behaviour of human soft tissue. The assembly forces measured on in vitro model were on average 2037.2 N ± 724.9 N and ranged from 822.5 N to 3835.2 N. The comparison of the surgeons showed no significant differences regarding sex (p=0.09), work experience (p=0.71) and number of THAs per year (p=0.69).ConclusionsAll measured assembly forces were below 4 kN, which is recommended in the literature. This could lead to increased corrosion following fretting in the head-neck interface. In addition, there was a very wide range of assembly forces among the surgeons, although other influencing factors such as different implant sizes or materials were not taken into account. To ensure optimal assembly force, the impaction should be standardized, e.g. by an appropriate surgical instrument.

Introduction Multiple camera systems are widely used for 3D-motion analysis. Due to increasing accuracies these camera systems gained interest in biomechanical research areas, where high precision measurements are desirable. In the current study different measurement systems were compared regarding their measurement accuracy. Materials and methods Translational and rotational accuracy measurements as well as the zero offset measurements of seven different measurement systems were performed using two reference devices and two different evaluation algorithms. All measurements were performed in the same room with constant temperature at the same laboratory. Equal positions were measured with the systems according to a standardized protocol. Measurement errors were determined and compared. Results The highest measurement errors were seen for a measurement system using active ultrasonic markers, followed by another active marker measurement system (infrared) having measurement errors up to several hundred micrometers. The highest accuracies were achieved by three stereo camera systems, using passive 2D marker points having errors typically below 20 μm. Conclusions This study can help to better assess the results obtained with different measurement systems. With the focus on the measurement accuracy, only one aspect in the selection of a system was considered. Depending on the requirements of the user, other factors like measurement frequency, the maximum analyzable volume, the marker type or the costs are important factors as well.

The goal of this study is to compare the construct stability of long segmental dorsal stabilization in unstable midthoracic osteoporotic fractures with complete pedicle screw cement augmentation (ComPSCA) versus restricted pedicle screw cement augmentation (ResPSCA) of the most cranial and caudal pedicle screws under cyclic loading. Twelve fresh frozen human cadaveric specimens (Th4–Th10) from individuals aged 65 years and older were tested in a biomechanical cadaver study. All specimens received a DEXA scan and computer tomography (CT) scan prior to testing. All specimens were matched into pairs. These pairs were randomized into the ComPSCA group and ResPSCA group. An unstable Th7 fracture was simulated. Periodic bending in flexion direction with a torque of 2.5 Nm and 25,000 cycles was applied. Markers were applied to the vertebral bodies to measure segmental movement. After testing, a CT scan of all specimens was performed. The mean age of the specimens was 87.8 years (range 74–101). The mean T-score was − 3.6 (range − 1.2 to − 5.3). Implant failure was visible in three specimens, two of the ComPSCA group and one of the ResPSCA group, affecting only one pedicle screw in each case. Slightly higher segmental movement could be evaluated in these three specimens. No further statistically significant differences were observed between the study groups. The construct stability under cyclic loading in flexion direction of long segmental posterior stabilization of an unstable osteoporotic midthoracic fracture using ResPSCA seems to be comparable to ComPSCA.

The lumbo-pelvic complex is a highly complex structural system. The current investigation aims to identify the kinematics between interacting bone segments under different loading conditions. A specimen of the lumbo-pelvic complex was obtained from a human body donor and tested in a self-developed test rig. The experimental setup was designed to imitate extension, flexion, right and left lateral bending and axial rotation to the left and to the right, respectively. The vertebra L3 was firmly embedded and load was introduced via hip joints. Using a digital image correlation (DIC) system, the 3D motions of 15 markers at different landmarks were measured for each loadcase under cyclic loading. For each loadcase, the kinematics were analyzed in terms of three-dimensional relative movements between L3 and the sacrum. The usefulness of the experimental technique was demonstrated. It may serve for further biomechanical investigations of relative motion of sacroiliac and vertebral joints and deformation of bony structures.

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Intraoperative proximal femoral fractures (IPFF) represent a rare but challenging complication of total hip arthroplasties. They usually occur as a longitudinal split. This pilot trial aimed to compare the biomechanical primary stability of different fixation techniques for IPFF. Standardised longitudinal medial split fractures of the proximal femur (type II, Modified Mallory Classification) were created in artificial osteoporotic and non-osteoporotic composite femora after implantation of a cementless femoral stem. Five different fixation techniques were compared: cerclage band, cerclage wiring with one or two wires, and lag screw fixation with one or two lag screws. A quasi-static loading protocol was applied and failure loads were evaluated. The observed median failure loads were 4192N (3982N – 5189N) for one cerclage band, 4450N (3577N – 4927N) for one cerclage wire, 5016N (4175N – 5685N) for two cerclage wires, 6085N (5000N – 8907N) for one lag screw, and 4774N (4509N – 8502N) for two lag screws. Due to the wide range of failure loads within the experimental groups, there were no observable differences between the groups. All fixation techniques provided sufficient primary stability in osteoporotic and non-osteoporotic composite bones. Further cadaveric studies with larger sample sizes may be needed to confirm the results presented here.