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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2017

01-10-2017 | Hip Arthroplasty

Influence of undersized cementless hip stems on primary stability and strain distribution

Authors: Andreas Fottner, Matthias Woiczinski, Manuel Kistler, Christian Schröder, Tobias F. Schmidutz, Volkmar Jansson, Florian Schmidutz

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2017

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Abstract

Introduction

Undersizing of cementless hip stems is a risk factor for aseptic loosening and early subsidence. The purpose of this study was to evaluate the effects of undersized stems and determine whether a biomechanical study can predict the clinical results.

Materials and methods

Three consecutive sizes of a clinically proven stem (CLS Spotorno) were implanted into six composite femora (size large, Sawbones®), respectively. According to the Canal Fill Index (CFI), two stems (size 11.25 and 12.5) were undersized (CFI < 80%) and one stem (size 13.75) had an appropriate size (CFI > 80%). The primary stability was evaluated by measurement of 3-dimensional (3D)-micromotions under physiological adapted load and surface strains were recorded before and after implantation to detect stress-shielding processes.

Results

Both undersized stems revealed significantly higher micromotions in all regions compared to the appropriate stem. The highest micromotions were registered at the distal tip of the three stem sizes. The changes in surface strain did not show a significant difference between the three stem sizes, but the highest strain reduction was observed proximally indicating a tendency for stress shielding.

Conclusions

This study confirms the clinical assumption that undersized stem result in a significantly reduced primary stability. Furthermore, in vitro studies allow to determine the effects of undersizing and stress shielding processes.
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Metadata
Title
Influence of undersized cementless hip stems on primary stability and strain distribution
Authors
Andreas Fottner
Matthias Woiczinski
Manuel Kistler
Christian Schröder
Tobias F. Schmidutz
Volkmar Jansson
Florian Schmidutz
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-017-2784-x

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