Abstract
Aseptic loosening remains a major problem for uncemented femoral components in primary total hip arthroplasty (THA). Ideally, bone adaptation after THA manifests minimally and local bone density reduction is widely avoided. Different design features may help to approximate initial, post-THA bone strain to levels pre-THA. Strain-shielding effects of different SP-CL stem design features are systematically analyzed and compared to CLS Spotorno and CORAIL using finite element models and physiological musculoskeletal loading conditions. All designs show substantial proximal strain-shielding: 50% reduced medial surface strain, 40–50% reduction at lateral surface, >120 µm/m root mean square error (RMSE) compared to intact bone in Gruen zone 1 and >60 µm/m RMSE in Gruen zones 2, 6, and 7. Geometrical changes (ribs, grooves, cross sections, stem length, anatomic curvature) have a considerable effect on strain-shielding; up to 20%. Combinations of reduced stem stiffness with larger proximal contact area (anatomically curved, grooves) lead to less strain-shielding compared to clinically established implant designs. We found that only the combination of a structurally flexible stem with anatomical curvature and grooves improves strain-shielding compared to other designs. The clinical implications in vivo of this initial strain-shielding difference are currently under evaluation in an ongoing clinical analysis.
Highlights
Aseptic loosening remains a major problem for uncemented femoral components in primary total hip arthroplasty (THA)
All stem designs generally showed similar qualitative proximal strain-shielding at the bone surface, between 40–50% laterally and in parts higher than 50% medially
The differences of strain-shielding for different stem designs are mostly moderate compared to the deviation to intact (Figs 3–6)
Summary
Aseptic loosening remains a major problem for uncemented femoral components in primary total hip arthroplasty (THA). Combinations of reduced stem stiffness with larger proximal contact area (anatomically curved, grooves) lead to less strain-shielding compared to clinically established implant designs. THA causes proximal bone unloading (stress- or strain-shielding, which represents the bypass transfer of load or deformation from bone to the implant) which often leads to a bone adaptation response, leading to reduced bone density in the proximal femur. This issue impacts especially young patients[3]. Correspondence and requests for materials should be addressed to M.H.
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