Abstract

BackgroundThis study was performed to investigate the mid-term results of Ti-Nb-Sn (TNS) alloy stem with a low Young’s modulus.MethodsThis study was a multicenter prospective cohort study. A total of 40 primary total hip arthroplasties performed between April 2016 and September 2017 was enrolled in this study. With the unique functional gradient properties by heating treatment, the strength of the proximal portion was enhanced, while the distal portion maintained a low Young’s modulus. The surgeries were performed through the posterolateral approach using the TNS alloy stems. Radiographs were taken from immediately after surgeries until 3 years, and stress shielding and subsidence of the stems were evaluated. The incidences of the stem breakage were also assessed. Clinical assessments were performed using Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores.ResultsAmong the 40 enrolled patients, 36 patients were female and 4 were male. At 3 years after surgery, there were no radiologic signs of loosening, subsidence, or breakage of the stem. Stress shielding was observed in 26 hips (65%). Of 26 hips, 16 hips (40%) were grade 1 and 10 hips (25%) were grade 2. There was no advanced stress shielding. The JOA and JHEQ scores significantly improved compared with the preoperative scores.ConclusionThe current study using a new TNS alloy femoral stem showed good clinical outcomes at 3-year follow-up. Radiologically, there was no loosening or subsidence of the stem. The mild stress shielding was observed in 65% of patients.Trial registrationCurrent Controlled Trials ISRCTN21241251.The date of registration was October 26, 2021.Retrospectively registered.

Highlights

  • This study was performed to investigate the mid-term results of Ti-Nb-Sn (TNS) alloy stem with a low Young’s modulus

  • The mild stress shielding was observed in 65% of patients

  • Stress shielding refers to the bone atrophy and loss of bone density as results of load stress being removed from the bone by the femoral stem [8, 9]

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Summary

Introduction

This study was performed to investigate the mid-term results of Ti-Nb-Sn (TNS) alloy stem with a low Young’s modulus. The good long-term results of total hip arthroplasty (THA) have been reported in patients with hip osteoarthritis. The bone atrophy and loss of bone mineral density by the stress shielding increase the risk of periprosthetic fracture [10, 11]. As the number of THA performed in elderly patients with osteoporosis has been increasing, the prevention of periprosthetic fracture is a very important issue. The Young’s modulus of the human cortical bone ranges between 10 GPa and 30 GPa [13] This mismatch of elasticities between the femoral stem and the cortical bone is considered one of the major causes of stress shielding

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