Humeral short stem varus–valgus alignment affects bone stress

Author(s):  
Amir Tavakoli ◽  
Gregory Spangenberg ◽  
Jacob M. Reeves ◽  
Kenneth J. Faber ◽  
G. Daniel G. Langohr
2020 ◽  
Vol 29 (4) ◽  
pp. 761-767 ◽  
Author(s):  
G. Daniel G. Langohr ◽  
Jacob Reeves ◽  
Christopher P. Roche ◽  
Kenneth J. Faber ◽  
James A. Johnson

Author(s):  
Vicente Jesús León-Muñoz ◽  
Mirian López-López ◽  
Alonso José Lisón-Almagro ◽  
Francisco Martínez-Martínez ◽  
Fernando Santonja-Medina

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.


2020 ◽  
Vol 46 (3) ◽  
pp. 175-181
Author(s):  
Marcelo Bighetti Toniollo ◽  
Mikaelly dos Santos Sá ◽  
Fernanda Pereira Silva ◽  
Giselle Rodrigues Reis ◽  
Ana Paula Macedo ◽  
...  

Rehabilitation with implant prostheses in posterior areas requires the maximum number of possible implants due to the greater masticatory load of the region. However, the necessary minimum requirements are not always present in full. This project analyzed the minimum principal stresses (TMiP, representative of the compressive stress) to the friable structures, specifically the vestibular face of the cortical bone and the vestibular and internal/lingual face of the medullary bone. The experimental groups were as follows: the regular splinted group (GR), with a conventional infrastructure on 3 regular-length Morse taper implants (4 × 11 mm); and the regular pontic group (GP), with a pontic infrastructure on 2 regular-length Morse taper implants (4 × 11 mm). The results showed that the TMiP of the cortical and medullary bones were greater for the GP in regions surrounding the implants (especially in the cervical and apical areas of the same region) but they did not reach bone damage levels, at least under the loads applied in this study. It was concluded that greater stress observed in the GP demonstrates greater fragility with this modality of rehabilitation; this should draw the professional's attention to possible biomechanical implications. Whenever possible, professionals should give preference to use of a greater number of implants in the rehabilitation system, with a focus on preserving the supporting tissue with the generation of less intense stresses.


2021 ◽  
Vol 11 (2) ◽  
pp. 858
Author(s):  
Mara Terzini ◽  
Andrea Di Pietro ◽  
Alessandro Aprato ◽  
Stefano Artiaco ◽  
Alessandro Massè ◽  
...  

Acetabular fractures have a high impact on patient’s quality of life, and because acetabular fractures are high energy injuries, they often co-occur with other pathologies such as damage to cartilage that could increase related morbidity; thus, it appears of primary importance developing reliable treatments for this disease. This work aims at the evaluation of the biomechanical performances of non-conservative treatments of acetabular fractures through a finite element approach. Two pelvic plates models (the standard suprapectineal plate—SPP, and a suprapectineal quadrilateral surface buttressing plate—SQBP) were analyzed when implanted on transverse or T-shaped fractures. The plates geometries were adapted to the specific hemipelvis, mimicking the bending action that the surgeon performs on the plate intraoperatively. Implemented models were tested in a single leg stance condition. The obtained results show that using the SQBP plate in transverse and T-shaped acetabular fractures generates lower bone stress if compared to the SPP plate. Interfragmentary movement analysis shows that the SQBP plate guarantees greater stability in transverse fractures. In conclusion, the SQBP plate seems worthy of further clinical analysis, having resulted as a promising option in the treatment of transverse and T-shaped acetabular fractures, able to reduce bone stress values and to get performances comparable, and in some cases superior, to traditional fixation.


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