Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications
Background: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femora...
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| Format: | Article |
| Language: | English |
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EDP Sciences
2022-01-01
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| Series: | SICOT-J |
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| Online Access: | https://www.sicot-j.org/articles/sicotj/full_html/2022/01/sicotj220051/sicotj220051.html |
| _version_ | 1811308829951918080 |
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| author | Wang Katherine Kenanidis Eustathios Suleman Khurram Miodownik Mark Avadi Mahsa Horne David Thompson Jonathan Tsiridis Eleftherios Moazen Mehran |
| author_facet | Wang Katherine Kenanidis Eustathios Suleman Khurram Miodownik Mark Avadi Mahsa Horne David Thompson Jonathan Tsiridis Eleftherios Moazen Mehran |
| author_sort | Wang Katherine |
| collection | DOAJ |
| description | Background: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femoral cancellous bone is adequate. The biomechanical effect of sub-optimal stem sizing in the femur remains unclear. This study investigated the mechanical behaviour of two sequential sized uncemented stems of the same type. Methods: Six laboratory models of synthetic non-osteoporotic femora were randomly divided into two groups and implanted with either a nominal or oversized uncemented hydroxyapatite-coated nonporous titanium collarless stem. Stiffness, uniaxial strain, and pattern of strain distribution were measured under an anatomical one-legged stance. Results: Oversized stems demonstrated a higher overall stiffness compared to nominal; however, this was not statistically significant. The nominal stem showed a higher strain in the neck and the proximal medial diaphyseal region. The oversized stem showed higher strains in the distal region around the implant tip. Conclusion: Opting to use a larger stem may potentially increase primary stability, thus allowing safer early mobility. However, higher stiffness may lead to stress shielding, bone loss, and thigh pain in the long term. In addition, strains in the diaphysis and the tip of the stem may predispose to periprosthetic fractures, especially in osteoporotic bones, making this a relatable aspect for users and biomechanical loading. Given the wide range of complex factors that need to be considered when choosing stem size in uncemented THA surgery, this study’s results should be interpreted cautiously. |
| first_indexed | 2024-04-13T09:30:10Z |
| format | Article |
| id | doaj.art-721c6fbafa0e4d4bb672f4ffc601177a |
| institution | Directory Open Access Journal |
| issn | 2426-8887 |
| language | English |
| last_indexed | 2024-04-13T09:30:10Z |
| publishDate | 2022-01-01 |
| publisher | EDP Sciences |
| record_format | Article |
| series | SICOT-J |
| spelling | doaj.art-721c6fbafa0e4d4bb672f4ffc601177a2022-12-22T02:52:16ZengEDP SciencesSICOT-J2426-88872022-01-0184310.1051/sicotj/2022043sicotj220051Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implicationsWang Katherine0https://orcid.org/0000-0002-6900-3213Kenanidis Eustathios1Suleman Khurram2Miodownik Mark3Avadi Mahsa4Horne David5Thompson Jonathan6Tsiridis Eleftherios7Moazen Mehran8Department of Mechanical Engineering, University College LondonDepartment of Mechanical Engineering, University College LondonDepartment of Mechanical Engineering, University College LondonDepartment of Mechanical Engineering, University College LondonDePuy SynthesDePuy SynthesDePuy SynthesDepartment of Mechanical Engineering, University College LondonDepartment of Mechanical Engineering, University College LondonBackground: Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femoral cancellous bone is adequate. The biomechanical effect of sub-optimal stem sizing in the femur remains unclear. This study investigated the mechanical behaviour of two sequential sized uncemented stems of the same type. Methods: Six laboratory models of synthetic non-osteoporotic femora were randomly divided into two groups and implanted with either a nominal or oversized uncemented hydroxyapatite-coated nonporous titanium collarless stem. Stiffness, uniaxial strain, and pattern of strain distribution were measured under an anatomical one-legged stance. Results: Oversized stems demonstrated a higher overall stiffness compared to nominal; however, this was not statistically significant. The nominal stem showed a higher strain in the neck and the proximal medial diaphyseal region. The oversized stem showed higher strains in the distal region around the implant tip. Conclusion: Opting to use a larger stem may potentially increase primary stability, thus allowing safer early mobility. However, higher stiffness may lead to stress shielding, bone loss, and thigh pain in the long term. In addition, strains in the diaphysis and the tip of the stem may predispose to periprosthetic fractures, especially in osteoporotic bones, making this a relatable aspect for users and biomechanical loading. Given the wide range of complex factors that need to be considered when choosing stem size in uncemented THA surgery, this study’s results should be interpreted cautiously.https://www.sicot-j.org/articles/sicotj/full_html/2022/01/sicotj220051/sicotj220051.htmltotal hip arthroplasty (tha)biomechanicsuncementedexperimentalstiffnessstrainstem size |
| spellingShingle | Wang Katherine Kenanidis Eustathios Suleman Khurram Miodownik Mark Avadi Mahsa Horne David Thompson Jonathan Tsiridis Eleftherios Moazen Mehran Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications SICOT-J total hip arthroplasty (tha) biomechanics uncemented experimental stiffness strain stem size |
| title | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
| title_full | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
| title_fullStr | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
| title_full_unstemmed | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
| title_short | Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications |
| title_sort | differences between two sequential uncemented stem sizes in total hip arthroplasty a comparative biomechanical study and potential clinical implications |
| topic | total hip arthroplasty (tha) biomechanics uncemented experimental stiffness strain stem size |
| url | https://www.sicot-j.org/articles/sicotj/full_html/2022/01/sicotj220051/sicotj220051.html |
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