Bone preserving level of osteotomy in short-stem total hip arthroplasty does not influence stress shielding dimensions - a comparing finite elements analysis

被引：18

作者：

Burchard, Rene ^{[1
,2
]}

Braas, Sabrina ^{[2
,3
]}

Soost, Christian ^{[4
]}

Graw, Jan Adriaan ^{[5
,6
]}

Schmitt, Jan ^{[3
,7
]}

机构：

[1] Witten Herdecke Univ, Dept Hlth, Witten, Germany

[2] Kreisklinikum Siegen, Dept Trauma & Orthopaed Surg, Siegen, Germany

[3] Univ Marburg, Dept Orthopaed & Rheumatol, Marburg, Germany

[4] Univ Siegen, Dept Stat Econometr, Siegen, Germany

[5] Humboldt Univ, Freie Univ Berlin, Charite Univ Med Berlin, Dept Anesthesiol & Operat Intens Care Med CCM CVK, Campus Virchow Klinikum, Berlin, Germany

[6] Berlin Inst Hlth, Campus Virchow Klinikum, Berlin, Germany

[7] Lahn Dill Kliniken Wetzlar, Dept Orthopaed & Trauma Surg, Wetzlar, Germany

来源：

BMC MUSCULOSKELETAL DISORDERS | 2017年 / 18卷

关键词：

Stress shielding; Short-stem; THA; Hip; Bone remodelling; Osteotomy level; X-RAY ABSORPTIOMETRY; METHA SHORT STEM; MECHANICAL-PROPERTIES; COMPUTED-TOMOGRAPHY; FEMORAL COMPONENT; STRAIN PATTERN; MUSCLE FORCES; PROSTHESIS; REPLACEMENT; FEMUR;

D O I：

10.1186/s12891-017-1702-2

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background: The main objective of every new development in total hip arthroplasty (THA) is the longest possible survival of the implant. Periprosthetic stress shielding is a scientifically proven phenomenon which leads to inadvertent bone loss. So far, many studies have analysed whether implanting different hip stem prostheses result in significant preservation of bone stock. The aim of this preclinical study was to investigate design-depended differences of the stress shielding effect after implantation of a selection of short-stem THA-prostheses that are currently available. Methods: Based on computerised tomography (CT), a finite elements (FE) model was generated and a virtual THA was performed with different stem designs of the implant. Stems were chosen by osteotomy level at the femoral neck (collum, partial collum, trochanter sparing, trochanter harming). Analyses were performed with previously validated FE models to identify changes in the strain energy density (SED). Results: In the trochanteric region, only the collum-type stem demonstrated a biomechanical behaviour similar to the native femur. In contrast, no difference in biomechanical behaviour was found between partial collum, trochanter harming and trochanter sparing models. All of the short stem-prostheses showed lower stress-shielding than a standard stem. Conclusion: Based on the results of this study, we cannot confirm that the design of current short stem THA-implants leads to a different stress shielding effect with regard to the level of osteotomy. Somehow unexpected, we found a bone stock protection in metadiaphyseal bone by simulating a more distal approach for osteotomy. Further clinical and biomechanical research including long-term results is needed to understand the influence of short-stem THA on bone remodelling and to find the optimal stem-design for a reduction of the stress shielding effect.

引用

页数：7