Retrieval analysis of neck fracture on uni-modular total hip arthroplasty stems: The contributions of material processing and stem design

2021 ◽  
pp. 095441192110495
Author(s):  
Patricia O Cubillos ◽  
Vinícius O dos Santos ◽  
Daniel A Fernandes ◽  
Ari DO Moré ◽  
Edison da Rosa ◽  
...  
Keyword(s):  
Material Processing ◽  
Grain Size ◽  
Total Hip Arthroplasty ◽  
Mechanical Stress ◽  
Hip Arthroplasty ◽  
Coarse Grain ◽  
Lateral Side ◽  
Stem Design ◽  
Total Hip ◽  
Stem Fracture

Total hip arthroplasty stem fracture is an important contributor to morbidity rate and increases the cost of revision surgery. Failure is usually caused by issues related to overload, inadequate stem support, inappropriate stem design or dimensions and material processing. In this study, the role of the relationship between material characterization and biomechanical performance in the fracture of retrieved stems was explored. The stems were manufactured with forged stainless steel, had the same length, 12/14 trunnion, and 28-mm head. These stems were evaluated by macroscopic and microscopic examination to identify the causes of premature failure. Each stem was sectioned into four regions, and the cross-sections were used for the microhardness and grain size analysis. Finite element analysis (FEA) was carried out, considering the stem positioned at the femur, a musculoskeletal model, and biomechanical loading. All stems had fractured through a fatigue mechanism, mainly a unidirectional bending loading condition, with crack nucleation on the lateral side and propagation on the medial side. The numerical analysis revealed maximum mechanical stress on the lateral side of the stem neck, but this was below the yield stress calculated via the hardness. The use of a shorter head neck length could reduce the maximum mechanical stress at the neck. At a cross-section near the plane of the stem fracture, the hardness was lower than that normally reported by the ASM, and there were heterogonous and coarse grain sizes on the lateral side. The main cause of failure of the two stems analyzed was a combination of low hardness and coarse grain size, due to inappropriate materials processing, worsen by a high level of stress on the lateral side of the neck due to the large stem-head offset selected by the orthopedic surgeon.

scholarly journals Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Georg Hauer ◽  
Maria Smolle ◽  
Sabrina Zaussinger ◽  
Joerg Friesenbichler ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Sick Leave ◽  
Return To Work ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Multivariate Linear Regression Analysis ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Significant Difference

AbstractReturn to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

An analysis of femoral component stem design in total hip arthroplasty.

1980 ◽  
Vol 62 (1) ◽  
pp. 68-78 ◽  
Author(s):  
R D Crowninshield ◽  
R A Brand ◽  
R C Johnston ◽  
J C Milroy
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Stem Design ◽  
Total Hip

Displacement of Femoral Stem during Closed Reduction of Total Hip Arthroplasty

1997 ◽  
Vol 7 (3) ◽  
pp. 125-127
Author(s):  
J. Cordes ◽  
K. Sperling ◽  
M. Kramhøft
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Closed Reduction ◽  
Femoral Stem ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Image Intensification

In the literature, only one case of displacement of a cemented femoral stem from its cement bed during closed reduction of a dislocation has been reported. In that case, it was suggested that the stem design may in part be the explanation for the displacement. Another case with a cemented Müller straight stem is now presented, emphasizing the use of image intensification if reduction proves difficult.

scholarly journals An evaluation of proximal femur bone density in young, active patients undergoing total hip arthroplasty at one year postoperatively

2018 ◽  
Vol 29 (1) ◽  
pp. 51-57
Author(s):  
Denis Nam ◽  
Rondek Salih ◽  
Robert L Barrack ◽  
Ryan M Nunley
Keyword(s):  
Bone Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Mineral Density ◽  
Stem Design ◽  
Ucla Activity Score ◽  
Total Hip ◽  
The Mean ◽  
Active Patients

Background: Prior investigations have shown a decrease in periprosthetic bone mineral density (BMD) of the calcar following total hip arthroplasty (THA). The purpose of this investigation was to study proximal femur BMD in a cohort of young, active patients following THA at 1 year postoperatively using a recently introduced stem design. Methods: This was a prospective, IRB-approved investigation of patients with an age <65 years, BMI <35 kg/m2, and presymptomatic UCLA score of >6 undergoing a primary THA for a diagnosis of osteoarthritis. All patients received a titanium, proximally coated, tapered cementless femoral stem (ACCOLADE II, Stryker Inc, Mahwah, NJ, USA). Dual energy X-ray absorptiometry scans were performed at 6 weeks, 6 months, and 1 year postoperatively. Bone density was analyzed for 7 traditional Gruen zones with BMD ratios calculated for change in BMD compared with the baseline. Results: 31 patients (mean age of 52.6 + 6.5 years, BMI of 27.9 + 3.9 kg/m2, and UCLA activity score of 7.3 + 1.9) were included. The mean BMD ratio decreased at the 6 months and 1 year interval in zones 1 and 2. However, the mean BMD ratio was maintained in Gruen zones 3 thru 7 with zone 7 (medial calcar) demonstrating 100% maintenance of the baseline BMD at 1 year. Conclusion: This study demonstrates the maintenance of medial calcar bone density at 1 year postoperatively in young, active patients undergoing THA. Further longitudinal analysis of this stem design is necessary to elucidate the significance of this finding.

scholarly journals Impact of stem design and cementation on postoperative femoral antetorsion in 227 patients with total hip arthroplasty (THA)

2020 ◽  
Vol 49 (12) ◽  
pp. 2001-2009
Author(s):  
Tim Fischer ◽  
Christoph Stern ◽  
Benjamin Fritz ◽  
Patrick O. Zingg ◽  
Christian W. A. Pfirrmann ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Prosthesis ◽  
Femoral Stem ◽  
Stem Design ◽  
Femoral Antetorsion ◽  
Total Hip ◽  
Posterior Condylar ◽  
Lower Variability

Abstract Objective In total hip arthroplasty (THA), surgeons attempt to achieve a physiological antetorsion. However, postoperative antetorsion of the femoral stem is known to show large variabilities. The purpose of this study was to assess whether postoperative antetorsion is influenced by stem design or cementation. Materials and methods This retrospective study included 227 patients with a hip prosthesis with five different stem designs (S1: short curved, S2 and S3: standard straight, S4: standard straight collared, S5: cemented straight), who had metal suppressed 1.5T-MRI of the hip between February 2015 and October 2019. Measurement of femoral antetorsion was done independently by two fellowship-trained radiologists on axial images by measuring the angle between the long axis of the femoral neck and the posterior condylar tangent of the knee. Measured angles in the different groups were compared using the t test for independent samples. Results The cementless collared stem S4 showed the highest antetorsion with 18.1° (± 10.5°; range –10°–45°), which was significantly higher than the antetorsion of the collarless S3 with 13.3° (± 8.4°; − 4°–29°) and the cemented S5 with 12.7° (± 7.7°; − 3°–27°) with p = 0.012 and p = 0.007, respectively. S1 and S2 showed an antetorsion of 14.8° (± 10.0°; 1°–37°) and 14.1° (± 12.2°; − 20°–41°). The torsional variability of the cementless stems (S1–4) was significantly higher compared with that of the cemented S5 with a combined standard deviation of 10.5° and 7.7° (p = 0.019). Conclusion Prosthesis design impacts the postoperative femoral antetorsion, with the cementless collared stem showing the highest antetorsion. Cemented stems demonstrated significantly lower variability, suggesting the lowest rate of inadvertent malrotation.

Electrosurgery Induced Femoral Stem Fracture in Total Hip Arthroplasty

2019 ◽  
Vol 9 (4) ◽  
pp. e0418-e0418
Author(s):  
Martin Aepli ◽  
Christoph Meier ◽  
Peter Wahl
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Total Hip ◽  
Stem Fracture

scholarly journals Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA

2020 ◽  
Vol 140 (12) ◽  
pp. 2091-2100
Author(s):  
Yama Afghanyar ◽  
Christoph Danckwardt ◽  
Miriam Schwieger ◽  
Uwe Felmeden ◽  
Philipp Drees ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Migration Pattern ◽  
Short Stem ◽  
Stem Design ◽  
Total Hip ◽  
Migration Analysis ◽  
Short Stems

Abstract Introduction Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. Materials and methods This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. Results At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. Conclusion The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.

Fracture of the Femoral Stem as a Rare Complication of Total Hip Arthroplasty. Cases Report

2018 ◽  
Vol 20 (4) ◽  
pp. 313-326
Author(s):  
Marek Drobniewski ◽  
Andrzej Borowski ◽  
Magdalena Krasińska ◽  
Piotr Kozłowski ◽  
Marek Synder
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Rare Complication ◽  
Femoral Stem ◽  
Femoral Shaft ◽  
Late Complications ◽  
Transfemoral Approach ◽  
Total Hip ◽  
Primary Hip Arthroplasty ◽  
Stem Fracture

The aim of this paper is to present the femoral stem fracture as a rare complication of total hip arthroplasty and describe further management in such cases. We present 5 cases of stem fracture in the Mittelmeier prosthe­sis which occurred from 8 to 29 years after the primary procedure. In three cases, the primary hip arthroplasty was performed due to dysplastic coxarthrosis. The remaining two patients had idiopathic and post-traumatic coxarthrosis. The four female patients underwent revision hip arthroplasty with stem replacement. One patient refused surgical treatment and has been followed up at the outpatient clinic. Annual clinical and radiological examination is an approved method for detecting late complications Hip arthroplasty should be performed at specialised centres where relevant prostheses and instruments are used. A transfemoral approach and the use of revision stems anchored in the femoral shaft is a method of choice for revision procedures performed due to stem fractures.

scholarly journals Proximal cement fixation in total hip arthroplasty—first results with a new stem design

2007 ◽  
Vol 32 (3) ◽  
pp. 295-306 ◽  
Author(s):  
Thomas Einsiedel ◽  
Florian Gebhard ◽  
Ilaria Bregolato ◽  
Anja Hiemeier ◽  
Lothar Kinzl ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Stem Design ◽  
Total Hip ◽  
First Results

scholarly journals Preoperative Factors Predicting the Severity of BMD Loss Around the Implant after Total Hip Arthroplasty

2021 ◽  
Author(s):  
Akira Morita ◽  
Kobayashi Naomi ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Multivariate Regression ◽  
Harris Hip Score ◽  
Lateral Side ◽  
Mineral Density ◽  
Factors Associated ◽  
Total Hip ◽  
Preoperative Factors

Abstract BackgroundStress shielding after total hip arthroplasty (THA) leads to the loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. BMD loss around the implant is likely to occur within 1 year after THA, but its severity depends on patient characteristics. This study evaluated preoperative factors associated with the severity of zone 7 BMD loss after THA.MethodsThis retrospective cohort study included 48 patients who underwent primary THA at our hospital from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index (BMI), Japanese Orthopaedic Association (JOA) score, Harris Hip Score (HHS), Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Factors associated with loss of zone 7 BMD were identified by univariate and multivariate regression analyses.ResultsUnivariate regression analysis showed that CFI (P=0.003) and preoperative lumbar BMD on the frontal (P=0.003) and lateral (P<0.001) sides were significantly correlated with loss of zone 7 BMD. Multivariate regression analysis showed that CFI (P=0.014) and lumbar BMD on the lateral side (P<0.001) were independently correlated with loss of zone 7 BMD.ConclusionLower preoperative lumbar BMD on the lateral side and lower CFI were significantly associated with zone 7 BMD loss after THA. Patients with these characteristics should be carefully monitored for severe BMD loss after THA.

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