Metal-metal Hip Resurfacing: Solution to a Nonexistent Problem

Berend, Michael E.; Bertrand, Todd

doi:10.3928/01477447-20070901-17

Cited by 6 publications

(3 citation statements)

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“…Stress shielding is only one potential cause of narrowing of the femoral neck. Other previously suggested causes include inflammatory response to wear particles, impingement, and bone necrosis, possibly caused by exothermic bone cement polymerization or disruption of the blood supply to the femoral head, specifically the retinacular vessels [11,13,15,51]. Considering its high reported incidence and the extreme biomechanical conditions that this modelling study suggests are required for it to occur, it is probable that a combination of these factors is required if narrowing of the femoral neck is to be observed.…”

Section: Discussionmentioning

confidence: 82%

Performance of the resurfaced hip. Part 1: The influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck

Dickinson

Taylor²,

Browne

2009

Proc Inst Mech Eng H

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Abstract:Hip Resurfacing is an established treatment for osteoarthritis in young, active patients. Failure modes include femoral neck fracture and prosthesis loosening, which may be associated with medium term bone adaptation, including femoral neck narrowing and densification around the prosthesis stem.Finite Element modelling was used to indicate the effects of prosthesis sizing and positioning on bone remodelling and fracture strength under a range of normal and traumatic loads, aiming to understand these failure modes better.The simulations predicted increased superior femoral neck stress shielding in young patients with small prostheses, which required shortening of the femoral neck to give an acceptable implant-bone interface.However with a larger prosthesis, natural femoral head centre recreation in the implanted state was possible, so stress shielding was restricted to the prosthesis interior, and its extent was less sensitive to prosthesis orientation. With valgus orientation, the implanted neck strength was, at worst, within 3% of its intact strength.The study suggests that femoral neck narrowing may be linked to a reduction in horizontal femoral offset, occurring if the prosthesis is excessively undersized. As such, hip resurfacing should aim to reproduce the natural femoral head centre, and for valgus prosthesis orientation to avoid femoral neck fracture.

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Section: Discussionmentioning

confidence: 82%

Performance of the resurfaced hip. Part 1: The influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck

Dickinson

Taylor²,

Browne

2009

Proc Inst Mech Eng H

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“…As reported in Part 1 of this study, there are several additional potential causes of radiographic changes around resurfacing head prostheses and their loosening. Other previously suggested causes include inflammatory response to wear particles, impingement, and bone necrosis, possibly caused by exothermic bone cement polymerization or disruption of the blood supply to the femoral head [6,[10][11][12]. The progressive nature of the radiographic changes observed around hip resurfacing prostheses, which may stabilise with time [10,11], may be indicative that bone remodelling plays a considerable part, but the high incidence of radiographic changes implies that some combination of these effects is responsible.…”

Section: Discussionmentioning

confidence: 99%

“…email: alex.dickinson@soton.ac.uk 90 per cent [11]. Narrowing of the femoral neck may be explained by disruption to the femoral head blood supply, inflammatory response to wear particles, and impingement [6,[10][11][12]. However, it is reported to take place substantially during the first two to three years post-operatively, after which it stabilizes up to seven years [10,11], which, in common with its high incidence, would be consistent with stabilizing bone adaptation.…”

Section: Introductionmentioning

confidence: 98%

Performance of the resurfaced hip. Part 2: The influence of prosthesis stem design on remodelling and fracture of the femoral neck

Dickinson

Taylor²,

Jeffers³

et al. 2009

Proc Inst Mech Eng H

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Hip Resurfacing is a popular treatment for osteoarthritis in young, active patients. Previous studies have shown that occasional failures-femoral neck fracture and implant loosening, possibly associated with bone adaptation-are affected by prosthesis sizing and positioning, in addition to patient and surgical factors.Aiming to improve tolerance to surgical variation, Finite Element modelling was used to indicate the effects of prosthesis metaphyseal stem design on bone remodelling and femoral neck fracture, with a range of implant orientations.The analysis suggested that the intact femoral neck strength in trauma could be maintained across a wider range of varus-valgus orientations for short-stemmed and stemless prostheses. Furthermore, the extent of periprosthetic bone remodelling was lower for the short-stemmed implant, with slightly reduced stress shielding and considerably reduced densification around the stem, potentially preventing further progressive proximal stress shielding.The study suggests that a short-stemmed resurfacing head offers improved tolerance to misalignment and remodelling stimulus over traditional designs. Whilst femoral neck fracture and implant loosening are multifactorial, biomechanical factors are of clear importance to the clinical outcome so this may reduce the risk for patients at the edge of the indications for hip resurfacing, or shorten the surgical learning curve.

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Role of Surgical Position on Interface Stress and Initial Bone Remodeling Stimulus around Hip Resurfacing Arthroplasty

Ong

Day

Kurtz

et al. 2009

The Journal of Arthroplasty

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Metal-metal Hip Resurfacing: Solution to a Nonexistent Problem

Cited by 6 publications

References 0 publications

Performance of the resurfaced hip. Part 1: The influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck

Performance of the resurfaced hip. Part 1: The influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck

Performance of the resurfaced hip. Part 2: The influence of prosthesis stem design on remodelling and fracture of the femoral neck

Role of Surgical Position on Interface Stress and Initial Bone Remodeling Stimulus around Hip Resurfacing Arthroplasty

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