Comparative Analysis of the Biomechanical Behaviour of Two Cementless Short Stems for Hip Replacement: Linea Anatomic and Minihip

Gabarre, Sergio; Herrera, Antonio; Ibarz, Elena; Mateo, Jesús; Albarova, Jorge Gil; Gracia, Luis

doi:10.1371/journal.pone.0158411

Cited by 16 publications

(12 citation statements)

References 52 publications

(81 reference statements)

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“…In the case of reduced BMD, extensive micromovements and the risk of increased migration with subsequent loss of optimal implant position can decisively impair osseointegration leading to implant failure [16,17]. In cementless THA, especially the initial stem stability is an essential factor in forming a sufficient fixation between the bone and the prosthesis [18]. Other potential complications of reduced BMD in the context of cementless THA are the increased risk of intraoperative periprosthetic fractures and aseptic loosening [12,19,20].…”

Section: Discussionmentioning

confidence: 99%

High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty

et al. 2021

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We detected a high prevalence of low bone mineral density assessed by DXA in 268 elderly patients with end-stage osteoarthritis scheduled for total hip arthroplasty (18% osteoporosis, 41% osteopenia). Therefore, and due to the identified concomitant undertreatment, routine DXA measurements should be considered in elderly patients prior to surgery. Introduction Bone quality represents a decisive factor for osseointegration, durability, and complications of an implanted prosthesis. Although the risk of osteoporosis increases with age and the assessment of bone mineral density (BMD) prior to total hip arthroplasty (THA) is recommended in elderly patients, a systematic, unbiased analysis of such patients is not available in the literature. Methods In this retrospective study, we examined 268 elderly patients (age ≥70 years) who underwent dual-energy X-ray absorptiometry (DXA) within 3 months prior to primary THA. Demographics, medical history, radiographic OA grade, and stem fixation method (i.e., cemented or cementless) were obtained. Results In total, 153 (57%) cemented and 115 (43%) cementless stem fixations during THA were performed. Forty-nine patients (18%) were diagnosed with osteoporosis (T-score ≤−2.5), 110 patients (41%) with osteopenia (T-score ≤−1.0), and 109 patients (41%) with normal BMD (T-score >−1.0). Importantly, 36/49 patients (73%) with osteoporosis were not diagnosed before, resulting in a relevant undertreatment. Female sex and low body mass index (BMI) were the main factors negatively influencing the bone mineral density (BMD). Conclusions Due to a high incidence of undiagnosed and untreated osteoporosis in elderly patients with potential effects on the success of osseointegration as well as other clinical outcomes, DXA measurements should be included in the clinical routine for these patients prior to THA.

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Section: Discussionmentioning

confidence: 99%

High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty

et al. 2021

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“…Among all the different factors influencing subsidence, press-fit is believed to be one of the key factors [18, 19]. Even though the surgeon is guided by visual, sensory and auditory clues when inserting the femoral stem, finding a good balance between a perfect press-fit level and not fracturing the femur by the stem remains challenging.…”

Section: Discussionmentioning

confidence: 99%

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Schaer

Finsterwald

Holweg

et al. 2019

BMC Musculoskelet Disord

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BackgroundEarly femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems.MethodsIn this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA).ResultsAverage stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures.ConclusionsThe examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.

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“…Ideally, a short-stem implant should provide rigid primary fixation, extensive metaphyseal bone-implant contact for sufficient osseointegration and a more physiological load transfer reproducing a biomechanical behavior more similar to the physiological bone. However, the benefits of short femoral stems remain hypothetical and there is not a clear understanding of the influence of short-stem designs on bone biomechanics [23,24].…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of the biomechanical behavior of two different design metaphyseal-fitting short stems using digital image correlation

et al. 2020

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Background: The progressive evolution in hip replacement research is directed to follow the principles of bone and soft tissue sparing surgery. Regarding hip implants, a renewed interest has been raised towards short uncemented femoral implants. A heterogeneous group of short stems have been designed with the aim to approximate initial, post-implantation bone strain to the preoperative levels in order to minimize the effects of stress shielding. This study aims to investigate the biomechanical properties of two distinctly designed femoral implants, the TRI-LOCK Bone Preservation Stem, a shortened conventional stem and the Minima S Femoral Stem, an even shorter and anatomically shaped stem, based on experiments and numerical simulations. Furthermore, finite element models of implant-bone constructs should be evaluated for their validity against mechanical tests wherever it is possible. In this work, the validation was performed via a direct comparison of the FE calculated strain fields with their experimental equivalents obtained using the digital image correlation technique. Results: Design differences between Trilock BPS and Minima S femoral stems conditioned different strain pattern distributions. A distally shifting load distribution pattern as a result of implant insertion and also an obvious decrease of strain in the medial proximal aspect of the femur was noted for both stems. Strain changes induced after the implantation of the Trilock BPS stem at the lateral surface were greater compared to the non-implanted femur response, as opposed to those exhibited by the Minima S stem. Linear correlation analyses revealed a reasonable agreement between the numerical and experimental data in the majority of cases. Conclusion: The study findings support the use of DIC technique as a preclinical evaluation tool of the biomechanical behavior induced by different implants and also identify its potential for experimental FE model validation. Furthermore, a proximal stress-shielding effect was noted after the implantation of both short-stem designs. Design-specific variations in short stems were sufficient to produce dissimilar biomechanical behaviors, although their clinical implication must be investigated through comparative clinical studies.

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Comparative Analysis of the Biomechanical Behaviour of Two Cementless Short Stems for Hip Replacement: Linea Anatomic and Minihip

Cited by 16 publications

References 52 publications

High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty

High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Comparative analysis of the biomechanical behavior of two different design metaphyseal-fitting short stems using digital image correlation

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