Short single-wedge stems have higher risk of periprosthetic fracture than other cementless stem designs in Dorr type A femurs: a finite element analysis

Nandi, Sumon; Shah, Anoli; Joukar, Amin; Becker, Kevin; Crutchfield, Cody; Goel, Vijay K.

doi:10.1177/1120700020949185

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…Thanks to the round-the-corner technique, the use of short stems is particularly suitable for minimall-invasive surgery (in reducing both soft tissue trauma and the spread of bone debris in the surgical field. However, given that the use of short stems is relatively recent, studies with long-term follow up are not available and the use of these stems seems to be related to a higher risk of periprosthetic fractures 41 , we do not recommend the use of short stems as a routine choice. Moreover, the risk of HO formation should not influence the surgeon's choice regarding the type of implant to use.…”

Section: Type Of Implantmentioning

confidence: 97%

Heterotopic ossification after total hip arthroplasty: a narrative review of modifiable risk factors

Spolettini,

Ambrosini,

Elena

et al. 2023

Lo Scalpello

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Total hip arthroplasty is a popular procedure for treatment of fractures and degenerative diseases of the hip. It is a highly successful procedure with high satisfaction of patients, although the success rate can be limited by the development of heterotopic ossification around the hip. This narrative review aims to analyse the peri-operative modifiable risk factors for heterotopic ossification formation to help especially young surgeons choose the correct way to prevent this problematic complication. The search was conducted on Pu-bMed and the final set includes 32 articles. Results are grouped in five paragraphs: nonsteroidal anti-inflammatory drugs and radiation therapy, surgical approach, surgical time and use of drainage and type of implant. In light of this narrative review, we suggest the systematic use of NSAIDs as preventive therapy, adoption of minimally invasive surgical approaches aiming to reduce both surgical time and soft tissue damage and discourage the use of drainage and short stems in total hip arthroplasty.

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Section: Type Of Implantmentioning

confidence: 97%

Heterotopic ossification after total hip arthroplasty: a narrative review of modifiable risk factors

Spolettini,

Ambrosini,

Elena

et al. 2023

Lo Scalpello

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“…Finite element (FE) models of femurs based on quantitative computed tomography (QCT) have been extensively used to estimate bone stiffness and strength ( Mann et al, 2008 ; Benca et al, 2017 ; Mosleh et al, 2020 ; Sullivan et al, 2020 ; Varga et al, 2020 ), which has been applied to predict fracture risk in bone diseases and metastases ( Arrington et al, 2006 ; Anez-Bustillos et al, 2014 ; Celik et al, 2019 ; Falcinelli et al, 2019 ; Nandi et al, 2022 ; Verbruggen and McNamara, 2023 ). Theories of bone adaptation that have been developed to predict changes in bone shape and density are based on strain ( Patel et al, 2014 ; Yang et al, 2014 ; Razi et al, 2015 ; Yang et al, 2017 ; Javaheri et al, 2020 ; Katz and Yosibash, 2020 ), stresses ( San Antonio et al, 2012 ; Celik et al, 2019 ; Falcinelli et al, 2019 ; Bruce Ralphin Rose, 2020 ), and strain energy density (SED) ( Cresswell et al, 2018 ; Lu et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Stress reduction through cortical bone thickening improves bone mechanical behavior in adult female Beclin-1+/− mice

Yang,

Pei,

et al. 2024

Front. Bioeng. Biotechnol.

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Fragility fractures, which are more prevalent in women, may be significantly influenced by autophagy due to altered bone turnover. As an essential mediator of autophagy, Beclin-1 modulates bone homeostasis by regulating osteoclast and chondrocyte differentiation, however, the alteration in the local bone mechanical environment in female Beclin-1+/− mice remains unclear. In this study, our aim is to investigate the biomechanical behavior of femurs from seven-month-old female wild-type (WT) and Beclin-1+/− mice under peak physiological load, using finite element analysis on micro-CT images. Micro-CT imaging analyses revealed femoral cortical thickening in Beclin-1+/− female mice compared to WT. Three-point bending test demonstrated a 63.94% increase in whole-bone strength and a 61.18% increase in stiffness for female Beclin-1+/− murine femurs, indicating improved biomechanical integrity. After conducting finite element analysis, Beclin-1+/− mice exhibited a 26.99% reduction in von Mises stress and a 31.62% reduction in maximum principal strain in the femoral midshaft, as well as a 36.64% decrease of von Mises stress in the distal femurs, compared to WT mice. Subsequently, the strength-safety factor was determined using an empirical formula, revealing that Beclin-1+/− mice exhibited significantly higher minimum safety factors in both the midshaft and distal regions compared to WT mice. In summary, considering the increased response of bone adaptation to mechanical loading in female Beclin-1+/− mice, our findings indicate that increasing cortical bone thickness significantly improves bone biomechanical behavior by effectively reducing stress and strain within the femoral shaft.

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“…MessinaFinite element analysis (FEA) is a computerized method that analyzes the effect of forces applied to a structure with a complex shape. By using computed tomography (CT), three-dimensional (3D) models of Dorr Type A femur and five commonly used primary total hip arthroplasty cementless stem designs were developed in [22] and the femoral strain along the implant bone was analyzed with FEA. In addition, the selection of materials [23][24][25], the geometry of the femur stem [26][27][28][29] and the analysis and calculation of stress [30,31] have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Multi-Scale Topology Optimization of Femoral Stem Structure Subject to Stress Shielding Reduce

Xiao

et al. 2023

Materials

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Hip replacement femoral implants are made of substantial materials that all have stiffness considerably higher than that of bone, which can cause significant bone resorption secondary to stress shielding and lead to severe complications. The topology optimization design method based on the uniform distribution of material micro-structure density can form a continuous mechanical transmission route, which can better solve the problem of reducing the stress shielding effect. A multi-scale parallel topology optimization method is proposed in this paper and a topological structure of type B femoral stem is derived. Using the traditional topology optimization method (Solid Isotropic Material with Penalization, SIMP), a topological structure of type A femoral stem is also derived. The sensitivity of the two kinds of femoral stems to the change of load direction is compared with the variation amplitude of the structural flexibility of the femoral stem. Furthermore, the finite element method is used to analyze the stress of type A and type B femoral stem under multiple conditions. Simulation and experimental results show that the average stress of type A and type B femoral stem on the femur are 14.80 MPa, 23.55 MPa, 16.94 MPa and 10.89 MPa, 20.92 MPa, 16.50 MPa, respectively. For type B femoral stem, the average error of strain is −1682με and the average relative error is 20.3% at the test points on the medial side and the mean error of strain is 1281με and the mean relative error is 19.5% at the test points on the outside.

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Short single-wedge stems have higher risk of periprosthetic fracture than other cementless stem designs in Dorr type A femurs: a finite element analysis

Cited by 8 publications

References 28 publications

Heterotopic ossification after total hip arthroplasty: a narrative review of modifiable risk factors

Heterotopic ossification after total hip arthroplasty: a narrative review of modifiable risk factors

Stress reduction through cortical bone thickening improves bone mechanical behavior in adult female Beclin-1+/− mice

Multi-Scale Topology Optimization of Femoral Stem Structure Subject to Stress Shielding Reduce

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