Modelling changes in modular taper micromechanics due to surgeon assembly technique in total hip arthroplasty

Aims The aim of this study was to develop a novel computational model for estimating head/stem taper mechanics during different simulated assembly conditions. Methods Finite element models of generic cobalt-chromium (CoCr) heads on a titanium stem taper were developed and driven using dynamic assembly loads collected from clinicians. To verify contact mechanics at the taper interface, comparisons of deformed microgroove characteristics (height and width of microgrooves) were made between model estimates with those measured from five retrieved implants. Additionally, these models were used to assess the role of assembly technique—one-hit versus three-hits—on the taper interlock mechanical behaviour. Results The model compared well to deformed microgrooves from the retrieved implants, predicting changes in microgroove height (mean 1.1 μm (0.2 to 1.3)) and width (mean 7.5 μm (1.0 to 18.5)) within the range of measured changes in height (mean 1.4 μm (0.4 to 2.3); p = 0.109) and width (mean 12.0 μm (1.5 to 25.4); p = 0.470). Consistent with benchtop studies, our model found that increasing assembly load magnitude led to increased taper engagement, contact pressure, and permanent deformation of the stem taper microgrooves. Interestingly, our model found assemblies using three hits at low loads (4 kN) led to decreased taper engagement, contact pressures and microgroove deformations throughout the stem taper compared with tapers assembled with one hit at the same magnitude. Conclusion These findings suggest additional assembly hits at low loads lead to inferior taper interlock strength compared with one firm hit, which may be influenced by loading rate or material strain hardening. These unique models can estimate microgroove deformations representative of real contact mechanics seen on retrievals, which will enable us to better understand how both surgeon assembly techniques and implant design affect taper interlock strength. Cite this article: Bone Joint J 2020;102-B(7 Supple B):33–40.

Hemiarthroplasty in Complex Proximal Humeral Fractures Is uncemented methaphyseal corundum blasted titanium humeral stem an efficent alternative?

The aim of this experimental study is to reveal the design and characteristics of unipolar shoulder prosthesis type Arrow (Groupe FH�, France) as well as to evaluate the outcome of the proximal humerus fracture treated with this implant. 8 patients with a mean age of 62.5 years were operated with immediate passive rehabilitation and active exercises initiated around day 45. All patients had good results with minimal pain, a mean Constant - Murley score of 74 and an acceptable shoulder amplitude. The clinical success was assured by the anatomic union of the tuberosities around the implant. The Arrow metaphyseal corundum blasted humeral titanium stem assures a perfect osseointegration with optimal stability and is an efficient alternative for shoulder hemiarthroplasty.