Initial stability of an uncemented femoral stem with modular necks. An experimental study in human cadaver femurs

Enoksen, Cathrine H.; Gjerdet, Nils Roar; Klaksvik, Jomar; Arthursson, Astvaldur J.; Schnell-Husby, Otto; Wik, Tina Strømdal

doi:10.1016/j.clinbiomech.2013.12.011

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…We found higher micromotion in torsion (stair climbing) than in compression (walking). This result compares well with results from Enoksen et al (2014) and Kassi et al (2005) obtained with LVDTs or with measurements from postmortem retrieval sections by Mann et al (2012). The patterns of micromotion revealed that for axial compression, micromotion was low proximally and high distally.…”

Section: Discussionsupporting

confidence: 77%

“…Considering the maximum micromotion still allowing osseointegration is around 100 mm, this bias value would represent a relative error of 10%. Current techniques available to measure implant micromotion rely mostly on linear variable differential transformers (LVDTs) (Enoksen et al, 2014;Fottner et al, 2009;Kassi et al, 2005;Monti et al, 1999;Pettersen et al, 2009;Østbyhaug et al, Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jbiomech www.JBiomech.com 2010). Despite their excellent accuracy, they allow only a handful of simultaneous measurement points.…”

Section: Introductionmentioning

confidence: 99%

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Full-field measurement of micromotion around a cementless femoral stem using micro-CT imaging and radiopaque markers

Camine

Rüdiger

Pioletti

et al. 2016

Journal of Biomechanics

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a b s t r a c tA good primary stability of cementless femoral stems is essential for the long-term success of total hip arthroplasty. Experimental measurement of implant micromotion with linear variable differential transformers is commonly used to assess implant primary stability in pre-clinical testing. But these measurements are often limited to a few distinct points at the interface. New techniques based on microcomputed tomography (micro-CT) have recently been introduced, such as Digital Volume Correlation (DVC) or markers-based approaches. DVC is however limited to measurement around non-metallic implants due to metal-induced imaging artifacts, and markers-based techniques are confined to a small portion of the implant. In this paper, we present a technique based on micro-CT imaging and radiopaque markers to provide the first full-field micromotion measurement at the entire bone-implant interface of a cementless femoral stem implanted in a cadaveric femur. Micromotion was measured during compression and torsion. Over 300 simultaneous measurement points were obtained. Micromotion amplitude ranged from 0 to 24 mm in compression and from 0 to 49 mm in torsion. Peak micromotion was distal in compression and proximal in torsion. The technique bias was 5.1 mm and its repeatability standard deviation was 4 mm. The method was thus highly reliable and compared well with results obtained with linear variable differential transformers (LVDTs) reported in the literature. These results indicate that this micro-CT based technique is perfectly relevant to observe local variations in primary stability around metallic implants. Possible applications include pre-clinical testing of implants and validation of patient-specific models for pre-operative planning.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Full-field measurement of micromotion around a cementless femoral stem using micro-CT imaging and radiopaque markers

Camine

Rüdiger

Pioletti

et al. 2016

Journal of Biomechanics

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“…Cooper et al [4] recently studied 12 patients with adverse tissue reactions around the neck-stem junction. Particularly, long varus necks have been associated with high failure rates due to unfavourable mechanical-load distribution at the interface [12][13][14]. In our patient, a long varus neck with retro-angulation was combined with a long head, which further increased the mechanical stress to the neck-stem junction [14].…”

Section: Discussionmentioning

confidence: 87%

Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty

Gkagkalis¹,

Mettraux²,

Omoumi³

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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Complications related to the neck-stem junction of modular stems used for total hip arthroplasty (THA) are generating increasing concern. A 74-year-old male had increasing pain and a cutaneous reaction around the scar 1 year after THA with a modular neck-stem. Imaging revealed osteolysis of the calcar and a pseudo-tumour adjacent to the neck-stem junction. Serum cobalt levels were elevated. Revision surgery to exchange the stem and liner and to resect the pseudo-tumour was performed. Analysis of the stem by scanning electron microscopy and by energy dispersive X-ray and white light interferometry showed fretting corrosion at the neck-stem junction contrasting with minimal changes at the head-neck junction. Thus, despite dry assembly of the neck and stem on the back table at primary THA, full neck-stem contact was not achieved, and the resulting micromotion at the interface led to fretting corrosion. This case highlights the mechanism of fretting corrosion at the neck-stem interface responsible for adverse local tissue reactions. Clinical and radiological follow-up is mandatory in patients with dual-modular stems.

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“…The lateral translation and varus rotation of the stem were greater in varus necks (43%-65% greater). They found that stems with varus retroverted necks had more micromotion compared with other neck types [12]. In another study, Doehring et al [8] found an increase in micromotion with the use of long bimodular necks owing to greater torsional moment and bending forces.…”

Section: Discussionmentioning

confidence: 98%

“…They found that neck type and head diameter did not affect the rate of the subsidence of the stem [14]. Enoksen et al [12] studied the micromotion of the PROFEMUR 1 GLADIATOR 1 stem. This stem is similar in design to the PROFEMUR 1 Z and it is hydroxyapatite coated.…”

Section: Discussionmentioning

confidence: 99%

High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed. Questions/purposes We asked: (1) What is the survivorship of the PROFEMUR 1 bimodular femoral neck stems? (2) What are the modes of failure of this bimodular femoral neck implant? (3) What are the major risk factors for the major modes of failure of this device?Methods Between 2003 and 2009, we used one family of bimodular femoral neck stems for all primary THAs (PRO-FEMUR 1 Z and PROFEMUR 1 E). During this period, 277 THAs (in 242 patients) were performed with these implants. One hundred seventy were done with the bimodular PROFE-MUR 1 E (all are accounted for here), and when that implant was suspected of having a high risk of failure, the bimodular PROFEMUR 1 Z was used instead. One hundred seven THAs were performed using this implant (all are accounted for in this study). All bearing combinations, including metal-on-metal, metal-on-polyethylene, and ceramic-on-ceramic, are included here. Data for the cohort included patient demographics, BMI, implant dimensions, type of articular surface, length of followup, and C-reactive protein serum level. We assessed survivorship of the two stems using Kaplan-Meier curves and determined the frequency of the different modes of stem failure. For each of the major modes of failure, we performed binary logistic regression to identify associated risk factors. Results Survivorship of the stems, using aseptic revision as the endpoint, was 85% for the patients with the PROFE-MUR 1 E stems with a mean followup of 50 months (range, 1-125 months) and 85% for the PROFEMUR 1 Z with a mean followup of 50 months (range, 1-125 months)(95% CI, 74-87 months). The most common modes of failure were loosening (9% for the PROFEMUR 1 E), neck fracture (6% for the PROFEMUR 1 Z and 0.6% for the PROFEMUR 1 E), metallosis (1%), and periprosthetic fracture (1%). Only the bimodular PROFEMUR 1 E was associated with femoral stem loosening (odds ratio [OR] =1.1; 95% CI, 1.04-1.140; p = 0.032). Larger head (OR = 3.2; 95% CI, 0.7-14; p = 0.096), BMI (OR = 1.19; 95% CI, 1-1.4; p = 0.038) and total offset (OR = 1.83; 95% CI, 1.13-2.9; p = 0.039) were associated with neck fracture.

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Initial stability of an uncemented femoral stem with modular necks. An experimental study in human cadaver femurs

Cited by 12 publications

References 30 publications

Full-field measurement of micromotion around a cementless femoral stem using micro-CT imaging and radiopaque markers

Full-field measurement of micromotion around a cementless femoral stem using micro-CT imaging and radiopaque markers

Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty

High Risk of Failure With Bimodular Femoral Components in THA

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