Innovative hip implants should be designed in accordance with biomechanical models of the proximal femur and take into account both body weight and muscle action in order to improve usability and biomimetic performance. This article proposes a finite element analysis of the proximal femur using both cortical and trabecular regions and employing transverse isotropic properties with standardized loads taken from active and young patients. Maximum principal stresses are plotted to show the mechanical behavior of the femur and grouped to evaluate stress shielding. Tsai–Wu and the maximum principal stress fields are useful for finding the areas more prone to failure and analyzing the influence of the stems on femoral mechanics. Other parameters, such as the stem material, absence of neck and osteotomy level, are explained. This paper is expected to provide a guide for designers and surgeons of femoral stems for assessing qualitatively and quantitatively the risks of stress shielding.

The biomechanical performance of hip prostheses is often suboptimal, which leads to problems such as strain shielding, bone resorption and implant loosening, affecting the long-term viability of these implants for articular repair. Different studies have highlighted the interest of short stems for preserving bone stock and minimizing shielding, hence providing an alternative to conventional hip prostheses with long stems. Such short stems are especially valuable for younger patients, as they may require additional surgical interventions and replacements in the future, for which the preservation of bone stock is fundamental. Arguably, enhanced results may be achieved by combining the benefits of short stems with the possibilities of personalization, which are now empowered by a wise combination of medical images, computer-aided design and engineering resources and automated manufacturing tools. In this study, an innovative design methodology for custom-made short femoral stems is presented. The design process is enhanced through a novel app employing elliptical adjustment for the quasi-automated CAD modeling of personalized short femoral stems. The proposed methodology is validated by completely developing two personalized short femoral stems, which are evaluated by combining in silico studies (finite element method (FEM) simulations), for quantifying their biomechanical performance, and rapid prototyping, for evaluating implantability.

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