Biomechanical Evaluation of Periprosthetic Femoral Fracture Fixation

Zdero, Rad; Walker, Richard; Waddell, James P.; Schemitsch, Emil H.

doi:10.2106/jbjs.f.01561

Cited by 188 publications

(226 citation statements)

References 26 publications

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“…This simulated the single-legged stance phase of walking, as done in previous studies. [18][19][20][21][22][23][24] Distally, the cement pot was secured in an industrial vice. Proximally, the femur heads were inserted into a smooth cup cut out of a stainless steel block, which was oriented with no anteversion with respect to the femoral neck.…”

Section: Axial Stiffness Testsmentioning

confidence: 99%

“…More physiological orientation ranges from 7°to 25°of adduction during walking. [18][19][20][21][22][23][25][26][27]37 However, two previous studies used vertical femur alignment. 24,44 Moreover, the vertical force was parallel to the long axis of the femur-stem interface, thereby minimizing interfacial resistance to vertical compression.…”

Section: Potential Limitationsmentioning

confidence: 99%

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A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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Few biomechanical studies exist on femoral cementless press-fit stems for revision total knee replacement (TKR) surgeries. The aim of this study was to compare the mechanical quality of the femur–stem interface for a series of commercially available press-fit stems, because this interface may be a ‘weak link’ which could fail earlier than the femur–TKR bond itself. Also, the femur–stem interface may become particularly critical if distal femur bone degeneration, which may necessitate or follow revision TKR, ever weakens the femur–TKR bond itself. The authors implanted five synthetic femurs each with a Sigma Short Stem (SSS), Sigma Long Stem (SLS), Genesis II Short Stem (GSS), or Genesis II Long Stem (GLS). Axial stiffness, lateral stiffness, ‘offset load’ torsional stiffness, and ‘offset load’ torsional strength were measured with a mechanical testing system using displacement control. Axial (range = 1047–1461 N/mm, p = 0.106), lateral (range = 415–462 N/mm, p = 0.297), and torsional (range = 115–139 N/mm, p > 0.055) stiffnesses were not different between groups. The SSS had higher torsional strength (863 N) than the other stems (range = 167–197 N, p < 0.001). Torsional failure occurred by femoral ‘spin’ around the stem’s long axis. There was poor linear correlation between the femur–stem interface area versus axial stiffness (R = 0.38) and torsional stiffness (R = 0.38), and there was a moderate linear correlation versus torsional strength (R = 0.55). Yet, there was a high inverse linear correlation between interfacial surface area versus lateral stiffness (R = 0.79), although this did not result in a statistical difference between stem groups (p = 0.297). These press-fit stems provide equivalent stability, except that the SSS has greater torsional strength.

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Section: Axial Stiffness Testsmentioning

confidence: 99%

Section: Potential Limitationsmentioning

confidence: 99%

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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“…Authors have reported good results after treatment of Type B1 fractures with lateral plates without bone grafting [1,5,20], whereas others advocate the routine use of cortical strut allografts with or without plates [6,12], especially in the presence of medial cortex comminution [8]. Biomechanical analyses investigating optimal construct stiffness have led to varying recommendations of ideal constructs including: nonlocking cable plate and allograft [23], allograft-plate [22], and plate with proximal unicortical screws with or without cables and distal bicortical screws [9].…”

Section: Discussionmentioning

confidence: 99%

“…The trend is toward indirect reduction methods with use of percutaneous plating for truly stable implants, but never at the expense of obtaining an anatomic fracture reduction. Augmentation with cortical strut allografts has a role in select cases to enhance healing from biologic and mechanical standpoints in periprosthetic fractures [6,8,12,22,23].…”

Section: Discussionmentioning

confidence: 99%

In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures

Gaski

Scully

2011

Clinical Orthopaedics &Amp; Related Research

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“…In general, fractures with a well-fixed stem occurring around (type B) or below (type C) the femoral stem are treated by open reduction and internal fixation using plates with proximal monocortical screws, proximal cables, and distal bicortical screws [2][3][4][5]. In cases of periprosthetic fractures with osteoporotic bone combined with a thin cortex and/or bulky revision stems in situ, placement of screws might not be feasible (Fig.…”

Section: Introductionmentioning

confidence: 99%

Extracortical plate fixation with new plate inserts and cerclage wires for the treatment of periprosthetic hip fractures

Bastian

Butscher

Bigolin

et al. 2013

International Orthopaedics (SICOT)

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Purpose Fixation of periprosthetic hip fractures with intracortical anchorage might not be feasible in cases with bulky implants and/or poor bone stock. Methods Rotational stability of new plate inserts with extracortical anchorage for cerclage fixation was measured and compared to the stability found using a standard technique in a biomechanical setup using a torsion testing machine. In a synthetic PUR bone model, transverse fractures were fixed distally using screws and proximally by wire cerclages attached to the plates using "new" (extracortical anchorage) or "standard" (intracortical anchorage) plate inserts. Time to fracture consolidation and complications were assessed in a consecutive series of 18 patients (18 female; mean age 81 years, range 55-92) with periprosthetic hip fractures (ten type B1, eight type CVancouver) treated with the new device between July 2003 and July 2010. Results The "new" device showed a higher rotational stability than the "standard" technique (p <0.001). Fractures showed radiographic consolidation after 14±5 weeks (mean ± SD) postoperatively in patients. Revision surgery was necessary in four patients, unrelated to the new technique. Conclusion In periprosthetic hip fractures in which fixation with intracortical anchorage using conventional means might be difficult due to bulky revision stems and/or poor bone stock, the new device may be an addition to the range of existing implants.

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Biomechanical Evaluation of Periprosthetic Femoral Fracture Fixation

Abstract: A combination of a nonlocking plate with an allograft strut (construct D) resulted in the highest stiffness of the constructs examined for treating a periprosthetic fracture around a stable femoral component of a total hip replacement.

Cited by 188 publications

References 26 publications

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures

Extracortical plate fixation with new plate inserts and cerclage wires for the treatment of periprosthetic hip fractures

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