Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study
Abstract Background Good outcomes have been reported in revision total hip replacement with massive segmental defects using impaction bone grafting with circumferential metal meshes. However, the morphology of defects that require a mesh is poorly defined. The purpose of this study was to evaluate t...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-019-2716-8 |
| _version_ | 1818998302406868992 |
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| author | Tohru Irie Daisuke Takahashi Tsuyoshi Asano Tomohiro Shimizu Ryuta Arai Alaa Muhammad Terkawi Yoichi M. Ito Norimasa Iwasaki |
| author_facet | Tohru Irie Daisuke Takahashi Tsuyoshi Asano Tomohiro Shimizu Ryuta Arai Alaa Muhammad Terkawi Yoichi M. Ito Norimasa Iwasaki |
| author_sort | Tohru Irie |
| collection | DOAJ |
| description | Abstract Background Good outcomes have been reported in revision total hip replacement with massive segmental defects using impaction bone grafting with circumferential metal meshes. However, the morphology of defects that require a mesh is poorly defined. The purpose of this study was to evaluate the effects of a variety of segmental defects on load transmission to the proximal femur under both axial and rotational loads. Methods Initial stability of the Exeter stem was investigated in a composite bone model using three medial bone defect morphologies: Long (length 5 cm × width 2 cm), Short (2.5 cm × 2 cm), Square (3.2 cm × 3.2 cm), Square with mesh (3.2 cm × 3.2 cm defect covered with metal mesh), and with no defect as control. Specimens (5 per group) were axially loaded and internally rotated up to 20° or to failure. Strain distributions of the femora were measured using a strain gauge. Results All Square group specimens failed while rotation was increasing. In the other four groups, failure was not observed in any specimens. Mean torsional stiffness in the Long (4.4 ± 0.3 Nm/deg.) and Square groups (4.3 ± 0.3 Nm/deg.) was significantly smaller than in the Control group (4.8 ± 0.3 Nm/deg.). In the medio-cranial region, the magnitude of the maximum principal strain in the Square group (1176.4 ± 100.9) was significantly the largest (Control, 373.2 ± 129.5, p < 0.001; Long, 883.7 ± 153.3, p = 0.027; Short, 434.5 ± 196.8, p < 0.001; Square with mesh, 256.9 ± 100.8, p < 0.001). Torsional stiffness, and both maximum and minimum principal strains in the Short group showed no difference compared to the Control group in any region. Conclusions Bone defect morphology greatly affected initial stem stability and load transmission. If defect morphology is not wide and the distal end is above the lower end of the lesser trochanter, it may be acceptable to fill the bone defect region with bone cement. However, this procedure is not acceptable for defects extending distally below the lower end of the lesser trochanter or defects 3 cm or more in width. |
| first_indexed | 2024-12-20T21:59:22Z |
| format | Article |
| id | doaj.art-2dc5163188634fc79d0644406232eedd |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-20T21:59:22Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-2dc5163188634fc79d0644406232eedd2022-12-21T19:25:23ZengBMCBMC Musculoskeletal Disorders1471-24742019-08-0120111010.1186/s12891-019-2716-8Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical studyTohru Irie0Daisuke Takahashi1Tsuyoshi Asano2Tomohiro Shimizu3Ryuta Arai4Alaa Muhammad Terkawi5Yoichi M. Ito6Norimasa Iwasaki7Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Biostatistics, Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityAbstract Background Good outcomes have been reported in revision total hip replacement with massive segmental defects using impaction bone grafting with circumferential metal meshes. However, the morphology of defects that require a mesh is poorly defined. The purpose of this study was to evaluate the effects of a variety of segmental defects on load transmission to the proximal femur under both axial and rotational loads. Methods Initial stability of the Exeter stem was investigated in a composite bone model using three medial bone defect morphologies: Long (length 5 cm × width 2 cm), Short (2.5 cm × 2 cm), Square (3.2 cm × 3.2 cm), Square with mesh (3.2 cm × 3.2 cm defect covered with metal mesh), and with no defect as control. Specimens (5 per group) were axially loaded and internally rotated up to 20° or to failure. Strain distributions of the femora were measured using a strain gauge. Results All Square group specimens failed while rotation was increasing. In the other four groups, failure was not observed in any specimens. Mean torsional stiffness in the Long (4.4 ± 0.3 Nm/deg.) and Square groups (4.3 ± 0.3 Nm/deg.) was significantly smaller than in the Control group (4.8 ± 0.3 Nm/deg.). In the medio-cranial region, the magnitude of the maximum principal strain in the Square group (1176.4 ± 100.9) was significantly the largest (Control, 373.2 ± 129.5, p < 0.001; Long, 883.7 ± 153.3, p = 0.027; Short, 434.5 ± 196.8, p < 0.001; Square with mesh, 256.9 ± 100.8, p < 0.001). Torsional stiffness, and both maximum and minimum principal strains in the Short group showed no difference compared to the Control group in any region. Conclusions Bone defect morphology greatly affected initial stem stability and load transmission. If defect morphology is not wide and the distal end is above the lower end of the lesser trochanter, it may be acceptable to fill the bone defect region with bone cement. However, this procedure is not acceptable for defects extending distally below the lower end of the lesser trochanter or defects 3 cm or more in width.http://link.springer.com/article/10.1186/s12891-019-2716-8Revision total hip replacementFemoral bone defectCircumferential metal meshInitial stem stability |
| spellingShingle | Tohru Irie Daisuke Takahashi Tsuyoshi Asano Tomohiro Shimizu Ryuta Arai Alaa Muhammad Terkawi Yoichi M. Ito Norimasa Iwasaki Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study BMC Musculoskeletal Disorders Revision total hip replacement Femoral bone defect Circumferential metal mesh Initial stem stability |
| title | Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study |
| title_full | Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study |
| title_fullStr | Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study |
| title_full_unstemmed | Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study |
| title_short | Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study |
| title_sort | effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model a biomechanical study |
| topic | Revision total hip replacement Femoral bone defect Circumferential metal mesh Initial stem stability |
| url | http://link.springer.com/article/10.1186/s12891-019-2716-8 |
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