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Open Access 01-12-2019 | Hip-TEP | Study protocol

Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis

Authors: I. Tatani, A. Panagopoulos, I. Diamantakos, G. Sakellaropoulos, Sp Pantelakis, P. Megas

Published in: Trials | Issue 1/2019

Abstract

Background

Total hip replacement has recently followed a progressive evolution towards principles of bone- and soft-tissue-sparing surgery. Regarding femoral implants, different stem designs have been developed as an alternative to conventional stems, and there is a renewed interest towards short versions of uncemented femoral implants. Based on both experimental testing and finite element modeling, the proposed study has been designed to compare the biomechanical properties and clinical performance of the newly introduced short-stem Minima S, for which clinical data are lacking with an older generation stem, the Trilock Bone Preservation Stem with an established performance record in short to midterm follow-up.

Methods/design

In the experimental study, the transmission of forces as measured by cortical surface-strain distribution in the proximal femur will be evaluated using digital image correlation (DIC), first on the non-implanted femur and then on the implanted stems. Finite element parametric models of the bone, the stem and their interface will be also developed. Finite element predictions of surface strains in implanted composite femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the stems by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. Finally, a prospective randomized comparative clinical study between these two stems will be also conducted to determine (1) their clinical performance up to 2 years’ follow-up using clinical scores and gait analysis (2) stem fixation and remodeling using a detailed radiographic analysis and (3) incidence and types of complications.

Discussion

Our study would be the first that compares not only the clinical and radiological outcome but also the biomechanical properties of two differently designed femoral implants that are theoretically classified in the same main category of cervico-metaphyseal-diaphyseal short stems. We can hypothesize that even these subtle variations in geometric design between these two stems may create different loading characteristics and thus dissimilar biomechanical behaviors, which in turn could have an influence to their clinical performance.

Trial registration

International Standard Randomized Controlled Trial Number, ID: ISRCTN10096716. Retrospectively registered on May 8 2018.

Available only for authorised users

Kim YH. Long-term results of the cementless porous-coated anatomic total hip prosthesis. J Bone Joint Surg Br. 2005;87(5):623–7.PubMedCrossRef

Lombardi AV Jr, Berend KR, Mallory TH. Hydroxyapatite-coated titanium porous plasma spray tapered stem: experience at 15 to 18 years. Clin Orthop Relat Res. 2006;453:81–5.PubMedCrossRef

Marshall AD, Mokris JG, Reitman RD, Dandar A, Mauerhan DR. Cementless titanium tapered-wedge femoral stem: 10- to 15-year follow-up. J Arthroplast. 2004;19(5):546–52.CrossRef

McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008;90(6):1290–6 doi: 0.2106/JBJS.G.00771.PubMedCrossRef

Burt CF, Garvin KL, Otterberg ET, Jardon OM. A femoral component inserted without cement in total hip arthroplasty. A study of the Tri-Lock component with an average ten-year duration of follow-up. J Bone Joint Surg Am. 1998;80(7):952–60.PubMedCrossRef

Capello WN, D’Antonio JA, Jaffe WL, et al. Hydroxyapatite-coated femoral components: 15-year minimum followup. Clin Orthop Relat Res. 2006;453:75–80.PubMedCrossRef

Meding JB, Galley MR, Ritter MA. High survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone. Clin Orthop Relat Res. 2010;468:441–7.PubMedCrossRef

Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004;86-A(1):92–7.CrossRef

Schmidutz F, Grote S, Pietschmann M, Weber P, Mazoochian F, Fottner A, Jansson V. Sports activity after short-stem hip arthroplasty. Am J Sports Med. 2012;40(2):425–32. https://doi.org/10.1177/0363546511424386.PubMedCrossRef

10.

Eingartner C. Current trends in total hip arthroplasty. Ortop Traumatol Rehabil. 2007;9(1):8–14.PubMed

11.

Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am. 2014;96(20):1742–52. https://doi.org/10.2106/JBJS.M.00780 Review.PubMedCrossRef

12.

Judet J, Judet R. The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg Br. 1950;32-B:166–73.PubMedCrossRef

13.

Fink B, Wessel S, Deuretzbacher G, Protzen M, Ruther W. Midterm results of “thrust plate” prosthesis. J Arthroplast. 2007;22(5):703–10.CrossRef

14.

Fottner A, Schmid M, Birkenmaier C, Mazoochian F, Plitz W, Volkmar J. Biomechanical evaluation of two types of short-stemmed hip prostheses compared to the trust plate prosthesis by three-dimensional measurement of micromotions. Clin Biomech (Bristol, Avon). 2009;24(5):429–34. https://doi.org/10.1016/j.clinbiomech.2009.02.007.PubMedCrossRef

15.

Morrey BF. Short-stemmed uncemented femoral component for primary hip arthroplasty. Clin Orthop Relat Res. 1989;249:169–75.

16.

Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br. 2000;82(7):952–8.PubMedCrossRef

17.

Huo SC, Wang F, Dong LJ, Wei W, Zeng JQ, Huang HX, Han QM, Duan RQ. Short-stem prostheses in primary total hip arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(43):e5215 Review.CrossRef

18.

Castelli CC, Rizzi L. Short stems in total hip replacement: current status and future. Hip Int. 2014;24(Suppl 10):S25–8. https://doi.org/10.5301/hipint.5000169 Review.PubMedCrossRef

19.

Decking R, Puhl W, Simon U, Claes LE. Changes in strain distribution of loaded proximal femora caused by different types of cementless femoral stems. Clin Biomech (Bristol, Avon). 2006;21(5):495–501.CrossRef

20.

Yamako G, Chosa E, Totoribe K, Hanada S, Masahashi N, Yamada N, Itoi E. In-vitro biomechanical evaluation of stress shielding and initial stability of a low-modulus hip stem made of β type Ti-33.6Nb-4Sn alloy. Med Eng Phys. 2014;36(12):1665–71. https://doi.org/10.1016/j.medengphy.2014.09.002.PubMedCrossRef

21.

Gillies RM, Morberg PH, Bruce WJ, Turnbull A, Walsh WR. The influence of design parameters on cortical strain distribution of a cementless titanium femoral stem. Med Eng Phys. 2002;24(2):109–14.PubMedCrossRef

22.

Gronewold J, Berner S, Olender G, Hurschler C, Windhagen H, von Lewinski G, Floerkemeier T. Changes in strain patterns after implantation of a short stem with metaphyseal anchorage compared to a standard stem: an experimental study in synthetic bone. Orthop Rev (Pavia). 2014;6(1):5211. https://doi.org/10.4081/or.2014.5211. CrossRef

23.

Kim YH, Kim JS, Cho SH. Strain distribution in the proximal human femur. An in vitro comparison in the intact femur and after insertion of reference and experimental femoral stems. J Bone Joint Surg Br. 2001;83(2):295–301.PubMedCrossRef

24.

Dickinson AS, Taylor AC, Ozturk H, Browne M. Experimental validation of a finite element model of the proximal femur using digital image correlation and a composite bone model. J Biomech Eng. 2011;133(1):014504. https://doi.org/10.1115/1.4003129.PubMedCrossRef

25.

Sztefek P, Vanleene M, Olsson R, Collinson R, Pitsillides AA, Shefelbine S. Using digital image correlation to determine bone surface strains during loading and after adaptation of the mouse tibia. J Biomech. 2010;43(4):599–605. https://doi.org/10.1016/j.jbiomech.2009.10.042.PubMedCrossRef

26.

Väänänen SP, Amin Yavari S, Weinans H, Zadpoor AA, Jurvelin JS, Isaksson H. Repeatability of digital image correlation for measurement of surface strains in composite long bones. J Biomech. 2013;46(11):1928–32. https://doi.org/10.1016/j.jbiomech.2013.05.021.PubMedCrossRef

27.

Tayton E, Evans S, O'Doherty D. Mapping the strain distribution on the proximal femur with titanium and flexible-stemmed implants using digital image correlation. J Bone Joint Surg Br. 2010;92(8):1176–81. https://doi.org/10.1302/0301-620X.92B8.23553.PubMedCrossRef

28.

Abdul-Kadir MR, Hansen U, Klabunde R, Lucas D, Amis A. Finite element modelling of primary hip stem stability: the effect of interference fit. J Biomech. 2008;41(3):587–94.PubMedCrossRef

29.

Monea AG, Pastrav LC, Mulier M, Van der Perre G, Jaecques SV. Numerical simulation of the insertion process of an uncemented hip prosthesis in order to evaluate the influence of residual stress and contact distribution on the stem initial stability. Comput Methods Biomech Biomed Engin. 2014;17(3):263–76. https://doi.org/10.1080/10255842.2012.681644.PubMedCrossRef

30.

Grassi L, Väänänen SP, Amin Yavari S, Weinans H, Jurvelin JS, Zadpoor AA, Isaksson H. Experimental validation of finite element model for proximal composite femur using optical measurements. J Mech Behav Biomed Mater. 2013;21:86–94. https://doi.org/10.1016/j.jmbbm.2013.02.006.PubMedCrossRef

31.

Jetté B, Brailovski V, Simoneau C, Dumas M, Terriault P. Development and in vitro validation of a simplified numerical model for the design of a biomimetic femoral stem. J Mech Behav Biomed Mater. 2018;77:539–50. https://doi.org/10.1016/j.jmbbm.2017.10.019.PubMedCrossRef

32.

Umeda N, Saito M, Sugano N, Ohzono K, Nishii T, Sakai T, Yoshikawa H, Ikeda D, Murakami A. Correlation between femoral neck version and strain on the femur after insertion of femoral prosthesis. J Orthop Sci. 2003;8(3):381–6.PubMedCrossRef

33.

Waide V, Cristofolini L, Stolk J, Verdonschot N, Toni A. Experimental investigation of bone remodelling using composite femurs. Clin Biomech (Bristol, Avon). 2003;18(6):523–36.PubMedCrossRef

34.

Ganapathi M, Evans S, Roberts P. Strain pattern following surface replacement of the hip. Proc Inst Mech Eng H. 2008;222(1):13–8.PubMedCrossRef

35.

Hnat WP, Conway JS, Malkani AL, Yakkanti MR, Voor MJ. The effect of modular tapered fluted stems on proximal stress shielding in the human femur. J Arthroplast. 2009;24(6):957–62. https://doi.org/10.1016/j.arth.2008.07.013.CrossRef

36.

Tai CL, Lee MS, Chen WP, Hsieh PH, Lee PC, Shih CH. Biomechanical comparison of newly designed stemless prosthesis and conventional hip prosthesis—an experimental study. Biomed Mater Eng. 2005;15(3):239–49.PubMed

37.

Cristofolini L, Viceconti M, Cappello A, Toni A. Mechanical validation of whole bone composite femur models. J Biomech. 1996;29(4):525–35 Review.PubMedCrossRef

38.

Ruff CB, Hayes WC. Cross-sectional geometry of Pecos Pueblo femora and tibiae—a biomechanical investigation: I. Method and general patterns of variation. Am J Phys Anthropol. 1983;60(3):359–81.PubMedCrossRef

39.

Cristofolini L, Viceconti M. Towards the standardization of in vitro load transfer investigations of hip prostheses. J Strain Anal Eng Des. 1999;34:1–15.CrossRef

40.

Bergmann G, Graichen F, Rohlmann A. Hip joint loading during walking and running, measured in two patients. J Biomech. 1993;26(8):969–90 Review.PubMedCrossRef

41.

Bergmann G, Kniggendorf H, Graichen F, Rohlmann A. Influence of shoes and heel strike on the loading of the hip joint. J Biomech. 1995;28(7):817–27.PubMedCrossRef

42.

Cristofolini L, Viceconti M, Toni A, Giunti A. Influence of thigh muscles on the axial strains in a proximal femur during early stance in gait. J Biomech. 1995;28(5):617–24.PubMedCrossRef

43.

Cristofolini L, Viceconti M. Strain measurements in femurs implemented with hip prostheses. In: XIV IMECO World Congress Book of Abstracts, Halttunen J, editor, Finnish Society of Automation Publ., Helsinki, Vol.7,1997c,249-254

44.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.PubMed

45.

Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 Health Survey Questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.PubMedPubMedCentralCrossRef

46.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737–55.PubMedCrossRef

47.

Mahomed N, Gandhi R, Daltroy L, Katz JN. The self-administered patient satisfaction scale for primary hip and knee arthroplasty. Arthritis. 2011;2011:591253. https://doi.org/10.1155/2011/591253.PubMedPubMedCentralCrossRef

48.

Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29(6):1273–9.PubMed

49.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef

50.

Kim YH, Kim JS, Joo JH, Park JW. A prospective short-term outcome study of a short metaphyseal fitting total hip arthroplasty. J Arthroplast. 2012;27(1):88–94. https://doi.org/10.1016/j.arth.2011.02.008.CrossRef

51.

Kim YH, Kim JS, Oh SH, Kim JM. Comparison of porous-coated titanium femoral stems with and without hydroxyapatite coating. J Bone Joint Surg Am. 2003;85-A(9):1682–8.CrossRef

52.

Min BW, Song KS, Bae KC, Cho CH, Kang CH, Kim SY. The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplast. 2008;23(3):418–23. https://doi.org/10.1016/j.arth.2007.04.002.CrossRef

53.

Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;(257):107–28 Erratum in: Clin Orthop 1992;284:310–2.

54.

Kim YH, Park JW, Kim JS. Cementless metaphyseal fitting anatomic total hip arthroplasty with a ceramic-on-ceramic bearing in patients thirty years of age or younger. J Bone Joint Surg Am. 2012;94(17):1570–5.PubMedCrossRef

55.

Barreca S, Ciriaco L, Ferlazzo M, Rosa MA. Mechanical and biological results of short-stem hip implants: consideration on a series of 74 cases. Musculoskelet Surg. 2015;99(1):55–9. https://doi.org/10.1007/s12306-014-0334-z.PubMedCrossRef

56.

Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg Am. 1997;79(2):177–84.PubMedCrossRef

57.

Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

58.

Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629–32.PubMedCrossRef

59.

Bugané F, Benedetti MG, Casadio G, Attala S, Biagi F, Manca M, Leardini A. Estimation of spatial-temporal gait parameters in level walking base on a single accelerometer: validation on normal subjects by standard gait analysis. Comput Methods Prog Biomed. 2012;108(1):29–37. https://doi.org/10.1016/j.cmpb.2012.02.003.CrossRef

60.

Buganè F, Benedetti MG, D'Angeli V, Leardini A. Estimation of pelvis kinematics in level walking based on a single inertial sensor positioned close to the sacrum: validation on healthy subjects with stereophotogrammetric system. Biomed Eng Online. 2014;13:146. https://doi.org/10.1186/1475-925X-13-146.PubMedPubMedCentralCrossRef

61.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.PubMedCrossRef

62.

Stulberg SD, Dolan M. The short stem: a thinking man’s alternative to surface replacement. Orthopedics. 2008;31(9):885–6.PubMedCrossRef

63.

Chen HH, Morrey BF, An KN, Luo ZP. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplast. 2009;24(6):945–50. https://doi.org/10.1016/j.arth.2008.07.014.CrossRef

64.

Kim YH, Park JW, Kim JS, Kang JS. Long-term results and bone remodeling after THA with a short, metaphyseal-fitting anatomic cementless stem. Clin Orthop Relat Res. 2014;472(3):943–50. https://doi.org/10.1007/s11999-013-3354-3.PubMedCrossRef

65.

Patel RM, Stulberg SD. The rationale for short uncemented stems in total hip arthroplasty. Orthop Clin North Am. 2014;45(1):19–31. https://doi.org/10.1016/j.ocl.2013.08.007.PubMedCrossRef

66.

Stulberg SD, Patel RM. The short stem: promises and pitfalls. Bone Joint J. 2013;95-B(11 Suppl A):57–62. https://doi.org/10.1302/0301-620X.95B11.32936.PubMedCrossRef

67.

Patel RM, Lo WM, Cayo MA, Dolan MM, Stulberg SD. Stable, dependable fixation of short-stem femoral implants at 5 years. Orthopedics. 2013;36(3):e301–7. https://doi.org/10.3928/01477447-20130222-18.PubMedCrossRef

68.

Falez F, Casella F, Panegrossi G, Favetti F, Barresi C. Perspectives on metaphyseal conservative stems. J Orthop Traumatol. 2008;9(1):49–54. https://doi.org/10.1007/s10195-008-0105-4.PubMedPubMedCentralCrossRef

69.

Falez F, Casella F, Papalia M. Current concepts, classification, and results in short stem hip arthroplasty. Orthopedics. 2015;38(3 Suppl):S6–13. https://doi.org/10.3928/01477447-20150215-50 Review.PubMedCrossRef

70.

McTighe T. Total hip stem classification system. Joint Implant Surg Res Found. 2014;4:24–28. www.jisrf.org.

71.

Gómez-García F, Fernández-Fairen M, Espinosa-Mendoza RL. A proposal for the study of cementless short-stem hip prostheses. Acta Ortop Mex. 2016;30(4):204–15 Review.PubMed

72.

Ulivi M, Orlandini LC, Meroni V, Lombardo MDM, Peretti GM. Clinical performance, patient reported outcome, and radiological results of a short, tapered, porous, proximally coated cementless femoral stem: results up to seven years of follow-up. J Arthroplasty. 2017;2. https://doi.org/10.1016/j.arth.2017.11.046.PubMedCrossRef

73.

Amendola RL, Goetz DD, Liu SS, Callaghan JJ. Two- to 4-year followup of a short stem THA construct: excellent fixation, thigh pain a concern. Clin Orthop Relat Res. 2017;475(2):375–83. https://doi.org/10.1007/s11999-016-4974-1.PubMedCrossRef

74.

Albers A, Aoude AA, Zukor DJ, Huk OL, Antoniou J, Tanzer M. Favorable results of a short, tapered, highly porous, proximally coated cementless femoral stem at a minimum 4-year follow-up. J Arthroplast. 2016;31(4):824–9. https://doi.org/10.1016/j.arth.2015.08.020.CrossRef

75.

Wang L, Zhang Z, McArdle JJ, Salthouse TA. Investigating ceiling effects in longitudinal data analysis. Multivariate Behav Res. 2009;43(3):476–96.PubMedPubMedCentralCrossRef

76.

Seel T, Raisch J, Schauer T. IMU-based joint angle measurement for gait analysis. Sensors (Basel). 2014;14(4):6891–909. https://doi.org/10.3390/s140406891.CrossRef

77.

Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69(1):45–55.PubMedCrossRef

78.

Itami Y, Akamatsu N, Tomita Y, Nagai M, Nakajima I. A clinical study of the results of cementless total hip replacement. Arch Orthop Trauma Surg. 1983;102(1):1–10.PubMedCrossRef

79.

Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg Br. 1993;75(1):6–13.PubMedCrossRef

80.

Khalily C, Whiteside LA. Predictive value of early radiographic findings in cementless total hip arthroplasty femoral components: an 8- to 12-year follow-up. J Arthroplast. 1998;13(7):768–73.CrossRef

81.

Kärrholm J. Roentgen stereophotogrammetry. Rev Orthop Appl Acta Orthop Scand. 1989;60(4):491–503 Review.CrossRef

82.

Malchau H, Kärrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty. Digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66(5):418–24.PubMedCrossRef

83.

Cohen B, Rushton N. Accuracy of DEXA measurement of bone mineral density after total hip arthroplasty. J Bone Joint Surg Br. 1995;77(3):479–83.PubMedCrossRef

84.

Engh CA Jr, McAuley JP, Sychterz CJ, Sacco ME, Engh CA Sr. The accuracy and reproducibility of radiographic assessment of stress-shielding. A postmortem analysis. J Bone Joint Surg Am. 2000;82-A(10):1414–20.CrossRef

85.

Grassi L, Isaksson H. Extracting accurate strain measurements in bone mechanics: a critical review of current methods. J Mech Behav Biomed Mater. 2015;50:43–54. https://doi.org/10.1016/j.jmbbm.2015.06.006.PubMedCrossRef

86.

Grassi L, Väänänen SP, Ristinmaa M, Jurvelin JS, Isaksson H. How accurately can subject-specific finite element models predict strains and strength of human femora? Investigation using full-field measurements. J Biomech. 2016;49(5):802–6. https://doi.org/10.1016/j.jbiomech.2016.02.032.PubMedCrossRef

87.

Small SR, Hensley SE, Cook PL, Stevens RA, Rogge RD, Meding JB, Berend ME. Characterization of femoral component initial stability and cortical strain in a reduced stem-length design. J Arthroplast. 2017;32(2):601–9. https://doi.org/10.1016/j.arth.2016.07.033.CrossRef

88.

Hensley S, Christensen M, Small S, Archer D, Lakes E, Rogge R. Digital image correlation techniques for strain measurement in a variety of biomechanical test models. Acta Bioeng Biomech. 2017;19(3):187–95.PubMed

89.

Østbyhaug PO, Klaksvik J, Romundstad P, Aamodt A. An in vitro study of the strain distribution in human femora with anatomical and customised femoral stems. J Bone Joint Surg Br. 2009;91(5):676–82. https://doi.org/10.1302/0301-620X.91B5.21749.PubMedCrossRef

90.

Østbyhaug PO, Klaksvik J, Romundstad P, Aamodt A. Primary stability of custom and anatomical uncemented femoral stems: a method for three-dimensional in vitro measurement of implant stability. Clin Biomech (Bristol, Avon). 2010;25(4):318–24. https://doi.org/10.1016/j.clinbiomech.2009.12.012.PubMedCrossRef

91.

Viceconti M, Affatato S, Baleani M, Bordini B, Cristofolini L, Taddei F. Pre-clinical validation of joint prostheses: a systematic approach. J Mech Behav Biomed Mater. 2009;2(1):120–7. https://doi.org/10.1016/j.jmbbm.2008.02.005.PubMedCrossRef

92.

Cristofolini L, Schileo E, Juszczyk M, Taddei F, Martelli S, Viceconti M. Mechanical testing of bones: the positive synergy of finite-element models and in vitro experiments. Philos Trans A Math Phys Eng Sci. 2010;368(1920):2725–63. https://doi.org/10.1098/rsta.2010.0046 Review.PubMedCrossRef

Title: Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis
Authors: I. Tatani
A. Panagopoulos
I. Diamantakos
G. Sakellaropoulos
Sp Pantelakis
P. Megas
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Hip-TEP
Hip-TEP
Published in: Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-019-3445-x

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Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis

Abstract

Background

Methods/design

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods/design

Discussion

Trial registration

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