Aims The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical in vitro model. Materials and Methods A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom National Joint Registry (NJR) were included in a multivariable survival and regression analysis to identify the adjusted hazard of revision for periprosthetic fracture following primary THA using a cementless stem. The effect of a collar in cementless THA on this risk was evaluated in an in vitro model using paired fresh frozen cadaveric femora. Results The prevalence of early revision for periprosthetic fracture was 0.34% (1180/337 647) and 44.0% (520/1180) occurred within 90 days of surgery. Implant risk factors included: collarless stem, non-grit-blasted finish, and triple-tapered design. In the in vitro model, a medial calcar collar consistently improved the stability and resistance to fracture. Conclusion Analysis of features of stem design in registry data is a useful method of identifying implant characteristics that affect the risk of early periprosthetic fracture around a cementless femoral stem. A collar on the calcar reduced the risk of an early periprosthetic fracture and this was confirmed by biomechanical testing. This approach may be useful in the analysis of other uncommon modes of failure after THA. Cite this article: Bone Joint J 2019;101-B:779–786.

Implant loosening and periprosthetic fracture are two major revision causes for uncemented hip stems. The chosen method of cavity preparation could play a key role for both failure mechanisms. The aim of this study was to determine the dependence of the broach type as well as patient bone mineral density (BMD) on densification and contact conditions at the bone-implant interface. Hip stems were implanted into cadaveric femora using compaction, blunt extraction or sharp extraction broaches with computed tomography scans performed prior to broaching, after broaching and after stem implantation. Proximal periprosthetic bone densification as well as press-fit, contact area and stem seating relative to the last broach were determined. Median bone densification was higher with the compaction and blunt extraction broaches compared to sharp extraction broaches (181% and 177%, respectively, p ¼ 0.002). The bone densification of femora prepared with compaction broaching increased with higher BMD (R 2 ¼ 0.183, p ¼ 0.037), while stem seating decreased with higher BMD for all broach types (R 2 ¼ 0.259, p ¼ 0.001). Incomplete seated prostheses were associated with smaller press-fit and bone-implant contact area (R 2 ¼ 0.249, p ¼ 0.001; R 2 ¼ 0.287, p < 0.001). Clinical Significance: The results suggest that compaction broaching maximizes bone densification in patients with higher bone density.However, there appears to be an increased risk of insufficient stem seating in high-density bone that could limit the benefits for primary stability. For lower quality bone, the broach type appears to play a lesser role, but care must be taken to limit extensive stem seating which might increase periprosthetic fracture risk. ß

Background: Deformation of acetabular cups when press-fitted into an undersized cavity is inevitable due to the inhomogeneous stiffness of acetabular bone. Thinner cups or screw holes might increase the risk of high cup deformation. The aim of this study was to examine the influence of cup design and liner assembly on the deformation response during cup implantation. Methods: Acetabular cups with different designs were implanted into polyurethane foam models simulating the anatomical situation with nominal press-fits of 1mm and without nominal press-fits (line-toline). Deformations were determined using a tactile coordinate measuring machine. A 3D laser scanner was used to determine the contact conditions at the cup-cavity interface. Polyethylene and ceramic liners were assembled to the implanted cups and the influence of the insertion on the deformation response evaluated. Fixation strength of the cups was determined by push-out testing. Findings: Cup deformation increased with smaller wall thickness (P<0.037) and screw holes (P<0.001). Insertion of ceramic liners reduced the deformation (P<0.001), whereas polyethylene liners adapted to the deformation of the implanted cups (P>0.999). Thin-walled cups exhibited a higher fixation strength for similar implantation forces (P=0.011). Interpretation: Thin-walled cups achieved higher fixation strengths and might be more bone-preserving. However, in combination with screw holes and high press-fit levels, wall thickness should be considered carefully to avoid excessive cup deformations leading to potential complications during liner assembly. Line-to-line insertion of thin-walled cups should be accompanied with a rough surface coating to minimize the loss of fixation strength due to the low press-fit fixation.

Tailoring a material's properties for low friction and little wear in a strategic fashion is a long-standing goal of materials tribology. Plastic deformation plays a major role when metals are employed in a sliding contact; therefore, the effects of stacking fault energy and mode of dislocation glide need to be elucidated. Here, we investigated how a decrease in the stacking fault energy affects friction, wear, and the ensuing sub-surface microstructure evolution. Brass samples with increasing zinc concentrations of 5, 15, and 36 wt% were tested in non-lubricated sphere-on-plate contacts with a reciprocating linear tribometer against Si 3 N 4 spheres. Increasing the sliding distance from 0.5 (single trace) to 5,000 reciprocating cycles covered different stages in the lifetime of a sliding contact. Comparing the results among the three alloys revealed a profound effect of the zinc concentration on the tribological behavior. CuZn15 and CuZn36 showed similar friction and wear results, whereas CuZn5 had a roughly 60% higher friction coefficient (COF) than the other two alloys. CuZn15 and CuZn36 had a much smaller wear rate than CuZn5. Wavy dislocation motion in CuZn5 and CuZn15 allowed for dislocation self-organization into a horizontal line about 150 nm beneath the contact after a single trace of the sphere. This feature was absent in CuZn36 where owing to planar dislocation slip band-like features under a 45° angle to the surface were identified. These results hold the promise to help guide the future development of alloys tailored for specific tribological applications.