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Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study

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Title: Effects of femoral bone defect morphology on initial polished tapered stem stability in massive defect model: a biomechanical study
Authors: Irie, Tohru Browse this author →KAKEN DB
Takahashi, Daisuke Browse this author →KAKEN DB
Asano, Tsuyoshi Browse this author →KAKEN DB
Shimizu, Tomohiro Browse this author →KAKEN DB
Arai, Ryuta Browse this author →KAKEN DB
Terkawi, Alaa Muhammad Browse this author
Ito, Yoichi M. Browse this author →KAKEN DB
Iwasaki, Norimasa Browse this author →KAKEN DB
Keywords: Revision total hip replacement
Femoral bone defect
Circumferential metal mesh
Initial stem stability
Issue Date: 1-Aug-2019
Publisher: BioMed Central
Journal Title: BMC musculoskeletal disorders
Volume: 20
Start Page: 355
Publisher DOI: 10.1186/s12891-019-2716-8
PMID: 31370807
Abstract: BackgroundGood outcomes have been reported in revision total hip replacement with massive segmental defects using impaction bone grafting with circumferential metal meshes. However, the morphology of defects that require a mesh is poorly defined. The purpose of this study was to evaluate the effects of a variety of segmental defects on load transmission to the proximal femur under both axial and rotational loads.MethodsInitial stability of the Exeter stem was investigated in a composite bone model using three medial bone defect morphologies: Long (length 5cmxwidth 2cm), Short (2.5cmx2cm), Square (3.2cmx3.2cm), Square with mesh (3.2cmx3.2cm defect covered with metal mesh), and with no defect as control. Specimens (5 per group) were axially loaded and internally rotated up to 20 degrees or to failure. Strain distributions of the femora were measured using a strain gauge.ResultsAll Square group specimens failed while rotation was increasing. In the other four groups, failure was not observed in any specimens. Mean torsional stiffness in the Long (4.40.3Nm/deg.) and Square groups (4.3 +/- 0.3Nm/deg.) was significantly smaller than in the Control group (4.8 +/- 0.3Nm/deg.). In the medio-cranial region, the magnitude of the maximum principal strain in the Square group (1176.4 +/- 100.9) was significantly the largest (Control, 373.2 +/- 129.5, p<0.001; Long, 883.7 +/- 153.3, p=0.027; Short, 434.5 +/- 196.8, p<0.001; Square with mesh, 256.9 +/- 100.8, p<0.001). Torsional stiffness, and both maximum and minimum principal strains in the Short group showed no difference compared to the Control group in any region.Conclusions Bone defect morphology greatly affected initial stem stability and load transmission. If defect morphology is not wide and the distal end is above the lower end of the lesser trochanter, it may be acceptable to fill the bone defect region with bone cement. However, this procedure is not acceptable for defects extending distally below the lower end of the lesser trochanter or defects 3cm or more in width.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
国際連携研究教育局 : GI-CoRE (Global Institution for Collaborative Research and Education : GI-CoRE) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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