Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty
Although tapered-wedge short stem has been widely employed with its availability for minimally invasive surgeries in total hip arthroplasty (THA), post-operative stress shielding matter remains unresolved in cementless procedures. This study aimed to clarify the most optimal femoral canal contact re...
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/9/3138 |
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| author | Takashi Maeda Masaki Nakano Yukio Nakamura Takashige Momose Atsushi Sobajima Jun Takahashi Katsuya Nakata Masashi Nawata |
| author_facet | Takashi Maeda Masaki Nakano Yukio Nakamura Takashige Momose Atsushi Sobajima Jun Takahashi Katsuya Nakata Masashi Nawata |
| author_sort | Takashi Maeda |
| collection | DOAJ |
| description | Although tapered-wedge short stem has been widely employed with its availability for minimally invasive surgeries in total hip arthroplasty (THA), post-operative stress shielding matter remains unresolved in cementless procedures. This study aimed to clarify the most optimal femoral canal contact regions of the stem design taking stress shielding incidence into consideration. This investigation included 60 joints from 60 patients (mean age at operation: 65.9 years), of which follow-up duration after primary THA had been more than 2 years. Frequencies of spot welds, subsidence, and stress shielding were examined 2 years after surgery. The most suitable femoral canal contact regions were evaluated by plain radiograph (2D) and 3D-computed tomography analyses according to Nakata’s division for fitting manners. Spot welds were observed in 38 cases (63.3%), and no subsidence case was seen. Respective number of stress shielding cases, based on Engh’s classification, categorized as degree 0, 1, and 2, were 2 (3.3%), 31 (51.7%), and 27 (45.0%), while no cases for degree 3 or 4 were found. When assessed by 3D fitting analysis, 27 cases of stress shielding degree 2 were constituted by 13/42 cases of mediolateral (ML) fit, 2/4 cases of flare fit, and 12/14 cases of multi point fit. In 42 cases of ML fitting, stem contact rate of the most proximedial region in stress shielding degree 0 and 1 was significantly higher compared to stress shielding degree 2 cases. Meanwhile, the rates of distal regions were significantly lower or absent in stress shielding degree 0 and 1 cases. The initial fixation of this stem design was very good in our cohort regardless of fitting manners. This study successfully revealed that ML fitting with femoral component, especially the most proximedial calcar site restricted fitting, would be optimal for reducing stress shielding occurrence in cementless short, tapered-wedge stem THA. Thus, the ideal stem contact region should be considered during THA procedures in light of the reduction of stress shielding development. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:15:36Z |
| publishDate | 2023-04-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d93c953d61754255a10fb9652307a8202023-11-17T23:11:13ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01129313810.3390/jcm12093138Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip ArthroplastyTakashi Maeda0Masaki Nakano1Yukio Nakamura2Takashige Momose3Atsushi Sobajima4Jun Takahashi5Katsuya Nakata6Masashi Nawata7Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, JapanDepartment of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, JapanDepartment of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, JapanDepartment of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, JapanDepartment of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, JapanDepartment of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, JapanDepartment of Orthopaedic Surgery, JCHO Osaka Hospital, Fukushima-ku, Osaka 553-0003, JapanDepartment of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, JapanAlthough tapered-wedge short stem has been widely employed with its availability for minimally invasive surgeries in total hip arthroplasty (THA), post-operative stress shielding matter remains unresolved in cementless procedures. This study aimed to clarify the most optimal femoral canal contact regions of the stem design taking stress shielding incidence into consideration. This investigation included 60 joints from 60 patients (mean age at operation: 65.9 years), of which follow-up duration after primary THA had been more than 2 years. Frequencies of spot welds, subsidence, and stress shielding were examined 2 years after surgery. The most suitable femoral canal contact regions were evaluated by plain radiograph (2D) and 3D-computed tomography analyses according to Nakata’s division for fitting manners. Spot welds were observed in 38 cases (63.3%), and no subsidence case was seen. Respective number of stress shielding cases, based on Engh’s classification, categorized as degree 0, 1, and 2, were 2 (3.3%), 31 (51.7%), and 27 (45.0%), while no cases for degree 3 or 4 were found. When assessed by 3D fitting analysis, 27 cases of stress shielding degree 2 were constituted by 13/42 cases of mediolateral (ML) fit, 2/4 cases of flare fit, and 12/14 cases of multi point fit. In 42 cases of ML fitting, stem contact rate of the most proximedial region in stress shielding degree 0 and 1 was significantly higher compared to stress shielding degree 2 cases. Meanwhile, the rates of distal regions were significantly lower or absent in stress shielding degree 0 and 1 cases. The initial fixation of this stem design was very good in our cohort regardless of fitting manners. This study successfully revealed that ML fitting with femoral component, especially the most proximedial calcar site restricted fitting, would be optimal for reducing stress shielding occurrence in cementless short, tapered-wedge stem THA. Thus, the ideal stem contact region should be considered during THA procedures in light of the reduction of stress shielding development.https://www.mdpi.com/2077-0383/12/9/3138anterolateral supine approachstress shieldingtapered-wedge short stemthree-dimensional analysistotal hip arthroplasty |
| spellingShingle | Takashi Maeda Masaki Nakano Yukio Nakamura Takashige Momose Atsushi Sobajima Jun Takahashi Katsuya Nakata Masashi Nawata Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty Journal of Clinical Medicine anterolateral supine approach stress shielding tapered-wedge short stem three-dimensional analysis total hip arthroplasty |
| title | Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty |
| title_full | Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty |
| title_fullStr | Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty |
| title_full_unstemmed | Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty |
| title_short | Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty |
| title_sort | relationship between stress shielding and optimal femoral canal contact regions for short tapered wedge stem analyzed by 2d and 3d systems in total hip arthroplasty |
| topic | anterolateral supine approach stress shielding tapered-wedge short stem three-dimensional analysis total hip arthroplasty |
| url | https://www.mdpi.com/2077-0383/12/9/3138 |
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