Stem Displacement Research Articles

Biomechanical evaluation of the impact of collared cementless total hip arthroplasty stems on implant subsidence: a cadaveric study in German Shepherd.

With the increasing use of cementless total hip arthroplasty (THA), stem subsidence has emerged as one of the primary complications. Although electron beam melting (EBM)-manufactured stems have been demonstrated to prevent subsidence, there has been limited investigation into the comparative biomechanical impact of collarless and collared EBM cementless stems on stem subsidence in veterinary medicine. This study aimed to compare the stem implant resistance and failure mechanical properties between collarless and collared EBM-manufactured stems. Seven pairs of femurs were harvested from canine cadavers. In each pair of femurs, the left femur was implanted with a collarless, and the right femur with a same-sized collared cementless stem. Specimen constructs were mounted to the loading frame of a testing machine and load was transferred to the femoral stem parallel to the longitudinal axis of the femur until the stem subsided 5 mm. Load and stem displacement data acquired during the tests were used to generate load-displacement curves and obtain stiffness, yield, and failure data for each specimen construct. Yield and failure energies were calculated as the areas under the load-displacement curves to the respective points. The effects of implant type and load during subsidence were analyzed using paired t-tests. The yield and failure loads for the collared stems were approximately 40% greater than for the collarless stems (156.39 ± 43.63 kgf vs. 112.01 ± 59.83 kgf, P<0.05). This study supported the advantages of collared EBM stems, including subsidence prevention and better initial stability for early osteointegration.

Une nouvelle méthode pour améliorer la stabilité de la bille fémorale sur le pivot en peropératoire lors d’une arthroplastie totale de la hanche – une étude de preuve de concept

BackgroundMechanically assisted crevice corrosion (MACC) has been associated with the compromised durability and fixation of modular total hip implants, adverse reaction of local tissue, and other undesirable clinical outcomes in total hip arthroplasty (THA). MACC is primarily caused by the relative motion between the femoral head and stem. To minimize the relative motion the taper connection between the two components must be strong enough. The current study addressed the following questions: (1) Does increasing the mass of the femoral stem improve the taper connection strength intraoperatively? (2) Does increasing the mass of the femoral stem reduce the risk of periprosthetic tissue damage intraoperatively? HypothesisIncreasing the mass of the femoral stem improve the taper connection strength intraoperatively. Materials and methodsDuring the experiment, femoral heads were impacted onto the stem tapers with and without an additional weight attached to the stem. The femoral heads were then pulled off to investigate the strength of the taper connection. The stem displacement and acceleration at impaction were also measured to evaluate the risk of periprosthetic tissue damage. ResultsThe results showed that the pull-off force was increased by 24% (p=0.011, n=6) when an additional weight was attached to the stem. The additional weight also reduced the maximum stem acceleration and maximum stem displacement by 37% (p<0.001, n=6) and 14% (p=0.094, n=6), respectively. DiscussionThese findings suggest that the femoral head and stem taper connection strength can be significantly improved and the risk of periprosthetic tissue damage significantly reduced intraoperatively by attaching an additional weight to the stem to increase its mass. Level of evidenceIII, comparative in vitro mechanical investigation.

Assessment of Effective Wind Loads on Individual Plantation-Grown Forest Trees

Quantifying wind loads acting on forest trees remains a major challenge of wind-tree-interaction research. Under wind loading, trees respond with a complex motion pattern to the external forces that displace them from their rest position. To minimize the transfer of kinetic wind energy, crowns streamline to reduce the area oriented toward the flow. At the same time, the kinetic energy transferred to the trees is dissipated by vibrations of all aerial parts to a different degree. This study proposes a method to estimate the effective wind load acting on plantation-grown Scots pine trees. It evaluates the hypothesis that the effective wind load acting on the sample trees can be estimated using static, non-destructive pulling tests, using measurements of stem tilt under natural wind conditions and static, non-destructive pulling tests. While the analysis of wind-induced stem displacement reconstructs the temporal tree response dynamics to the effective wind load, results from the pulling tests enable the effective wind load quantification. Since wind-induced stem displacement correlates strongly with the sample trees’ diameter at breast height, the effective wind load estimation can be applied to all other trees in the studied stand for which diameter data is available. We think the method is suitable for estimating the effective wind load acting on trees whose wind-induced response is dominated by sway in the fundamental mode.

A novel method to improve femoral head and stem taper stability intraoperatively in total hip arthroplasty – a proof of concept study

BackgroundMechanically assisted crevice corrosion (MACC) has been associated with the compromised durability and fixation of modular total hip implants, adverse reaction of local tissue, and other undesirable clinical outcomes in total hip arthroplasty (THA). MACC is primarily caused by the relative motion between the femoral head and stem. To minimize the relative motion the taper connection between the two components must be strong enough. The current study addressed the following questions: (1) Does increasing the mass of the femoral stem improve the taper connection strength intraoperatively? (2) Does increasing the mass of the femoral stem reduce the risk of periprosthetic tissue damage intraoperatively? HypothesisIncreasing the mass of the femoral stem improve the taper connection strength intraoperatively. Materials and methodsDuring the experiment, femoral heads were impacted onto the stem tapers with and without an additional weight attached to the stem. The femoral heads were then pulled off to investigate the strength of the taper connection. The stem displacement and acceleration at impaction were also measured to evaluate the risk of periprosthetic tissue damage. ResultsThe results showed that the pull-off force was increased by 24% (p=0.011, n=6) when an additional weight was attached to the stem. The additional weight also reduced the maximum stem acceleration and maximum stem displacement by 37% (p<0.001, n=6) and 14% (p=0.094, n=6), respectively. DiscussionThese findings suggest that the femoral head and stem taper connection strength can be significantly improved and the risk of periprosthetic tissue damage significantly reduced intraoperatively by attaching an additional weight to the stem to increase its mass. Level of evidenceIII, comparative in vitro mechanical investigation.

Motion and its Effects on the Cement Mantle – A Biomechanical Analysis of Femoral Stem Displacement during Implant Cementation

Background: It is a common notion that motion of a femoral component during cementation should be avoided as it may weaken the cement mantle. We created an in vitro model of cemented femoral components and subjected them to varying rotational motion during the cement curing process, to measure the effect on the pullout strength of the stem. Methods: 21 sawbones femurs were separated into four groups. The first group served as control and was cemented in a standard fashion. The remainder of the stems were divided into groups and subjected to angular rotational displacement within the cement mantle during curing . Anteroposterior and lateral radiographs were obtained of each model to evaluate for cement defects. Pullout strength testing was performed. Results: Despite rotational displacement, no cement defects were noted on imaging. The control stems showed an average pullout strength of 3735.79N. The experimental groups showed a trend for lower failure loads but it was not statistically significant (P=0.063). Of the 21 stems tested, three encountered cement mantle failure and associated stem pullout and the remainder failed by peripros-thetic fracture. Conclusion: Despite conventional thinking that rotational displacement during the cementing process leading to disruption of the cement mantle integrity, this was not borne out in our study. This should give surgeons confidence that in the set-ting of unintended rotational displacement of a femoral stem, returning the stem to its original position does not significantly compromise the integrity of the cement mantle or the pullout strength of the femoral implant. Small displacement of the femoral stem with prompt correction during cement curing does not cause evident cement mantle defects or a loss of femoral stem pullout strength.

Non-oscillatory response to wind loading dominates movement of Scots pine trees

The response of four trees in a Scots pine (Pinus sylvestris L.) plantation to wind loading was studied using time series decomposition methods. For this purpose, wind speed and stem displacement time series recorded on a windy day were divided into intervals adjusted according to stem displacement. The real wind load acting on the sample trees during the intervals was estimated by the momentum flux at canopy top. To identify components in wind-induced stem displacement that are correlated with the wind, wavelet coherence was calculated. Results from these calculations indicate that the trees mainly responded to wind components with periods longer than their damped fundamental sway periods. Therefore, stem displacement data were decomposed into non-oscillatory and oscillatory components as well as noise using singular spectrum analysis. Results from singular spectrum analysis demonstrate that with increasing momentum flux, the importance of oscillatory components in the stem displacement time series decreases whereas the importance of non-oscillatory displacement components increases. The decreasing importance of the oscillatory components suggests that wind loading in the range of the damped fundamental sway period of the trees is inefficient and insignificant for total tree movement under non-destructive wind conditions. Consequently, there was no evidence of the occurrence of resonance effects between wind and tree response.

Foreign Peer Effects and STEM Major Choice

Since the 1980s the United States has faced growing disinterest and high attrition from STEM majors. Over the same period, foreign-born enrollment in U.S. higher education has increased steadily. This paper examines whether foreign-born peers affect the likelihood American college students graduate with a STEM major. Using administrative student records from a large public university in California, we exploit idiosyncratic variation in the share of foreign peers across introductory math courses taught by the same professor over time. Results indicate that a 1 standard deviation increase in foreign peers reduces the likelihood native-born students graduate with STEM majors by 3 percentage points – equivalent to 3.7 native students displaced for 9 additional foreign students in an average course. STEM displacement is offset by an increased likelihood of choosing Social Science majors. However, the earnings prospects of displaced students are minimally affected as they appear to be choosing Social Science majors with equally high earning power. We demonstrate that comparative advantage and linguistic dissonance may operate as underlying mechanisms.

Bridge Pile Response to Lateral Soil Movement Induced by Installation of Controlled Modulus Columns

Controlled modulus columns (CMC) for ground improvement are installed using a hollow stem displacement auger to induce lateral soil displacement effect, followed by grout injection. While the method reduces spoils, the excessive lateral soil displacement may damage adjacent structures. Although there has been growing interest in quantifying such effects, only a handful of studies have been attempted. This paper presents the results of a numerical investigation on the CMC installation effect on an existing bridge pile using the three-dimensional finite difference software package FLAC3D. It has been found that when the CMC is long and the existing bridge pile is slender, the pile bending moment and pile lateral movement, induced by the CMC installation effect, can be significant.

An Integrated Approach for Process Control Valves Diagnosis Using Fuzzy Logic

Control valves are widely used in industry to control fluid flow in several applications. In nuclear power systems they are crucial for the safe operation of plants. Therefore, the necessity of improvements in monitoring and diagnosis methods started to be of extreme relevance, establishing as main goal of the reliability and readiness of the system components. The main focus of this work is to study the development of a model of non-intrusive monitoring and diagnosis applied to process control valves using artificial intelligence by fuzzy logic technique, contributing to the development of predictive methodologies identifying faults in incipient state. Specially in nuclear power plants, the predictive maintenance contributes to the security factor in order to diagnose in advance the occurrence of a possible failure, preventing severs situations. The control valve analyzed belongs to a steam plant which simulates the secondary circuit of a PWR—Pressurized Water Reactor. The maintenance programs are being implemented based on the ability to diagnose modes of degradation and to take measures to prevent incipient failures, improving plant reliability and reducing maintenance costs. The approach described in this paper represents an alternative departure from the conventional qualitative techniques of system analysis. The methodology used in this project is based on signatures analysis, considering the pressure (psi) in the actuator and the stem displacement (mm) of the valve. Once the measurements baseline of the control valve is taken, it is possible to detect long-term deviations during valve lifetime, detecting in advance valve failures. This study makes use of MATLAB language through the “fuzzy logic toolbox” which uses the method of inference “Mamdani”, acting by fuzzy conjunction, through Triangular Norms (t-norm) and Triangular Conorms (t-conorm). The main goal is to obtain more detailed information contained in the measured data, correlating them to failure situations in the incipient stage.

Compression wood and stem horizontal displacement in black spruce and Jack pine plantations in the boreal forest

Black spruce and Jack pine are the tree species most often planted in the boreal forest of the province of Quebec. Higher radial growth is expected from these stands in comparison with naturally regenerated forests. The fast growth response of these tree species in plantation has been associated with stem displacement and compression wood formation. This study aims to examine these parameters and to relate them with dendrometric variables. Analysis were conducted in 10 black spruce and 10 Jack pine plantations over 20years old. Stem horizontal displacement was evaluated at stand level within plots of at least 50 stems. A sub-dataset of five dominant trees per plantation was then sampled in order to quantify the occurrences of compression wood. Stem horizontal displacement was mostly sparse for black spruce. In agreement with this observation, compression wood ratio (0.6% of total tree volume) can be considered low for this species. For Jack pine, the measurements of compression wood (5.0% of total tree volume) were higher than black spruce. Compression wood ratio was negatively correlated to stem height and positively to maximum stem horizontal displacement and tree crown cover ratio. We think that the capacity of Jack pine to grow faster, in given conditions, than black spruce is the main reason for the higher occurrence of sinuosity and compression wood in Jack pine plantations.

Analysis and simulation of dynamic response behavior of Scots pine trees to wind loading

This paper presents an empirical approach for the decomposition, simulation, and reconstruction of wind-induced stem displacement of plantation-grown Scots pine trees. Results from singular spectrum analysis (SSA) allow a low-dimensional characterization of the complex and complicated tree motion patterns in response to non-destructive wind excitation. Since motion of the sample trees was dominated by sway in the first mode, the application of SSA on time series of sample trees' stem displacement yielded characteristic and distinguishable non-oscillatory trend components, quasi-oscillatory sway, and noise, of which only the non-oscillatory components were correlated directly with wind characteristics. Although sway in the range of the dominant damped fundamental frequency dominated the measured stem displacement signals, it was almost decoupled from near-surface airflow. The ability to discriminate SSA-components is demonstrated based on correlation and spectral analysis. These SSA-components, as well as wind speed measured in the canopy space of the Scots pine forest, were used to train neural networks, which could then reasonably simulate tree response to wind excitation.

Vibration behavior of plantation-grown Scots pine trees in response to wind excitation

This paper deals with the dynamic responses of three plantation-grown Scots pine trees to turbulent wind loading. Although individual tree movement was complicated and irregular in the analyzed wind speed range (hourly mean wind speeds at canopy top below 4 m s −1), results from the cross-wavelet transform and wavelet coherence calculations demonstrate that wind-induced tree displacement strongly covaried with wind loads exerted on the trees by coherent structures. These wind loads caused largest tree displacements in the along wind direction as well as in the across wind direction. The absorption of energy available from wind loads in the range of the damped natural sway frequencies of the sample trees’ stems was of minor importance for tree displacement. The application of the bi-orthogonal decomposition provided insight into the resulting modal deformations of the sample trees’ stems. Based on measured stem displacement data, the mean mode shapes for the first eight stem vibration modes (four mean mode shapes in along wind direction and four mean mode shapes in across wind direction) could be identified. The shapes of these modes were quite similar to the normal mode shapes of a clamped-free beam. For the analyzed wind speed range it is shown that most of the energy absorbed by the trees from the wind is dissipated by tree sway in the first mode. Higher vibration modes localized on the sample trees’ stems were only of minor importance for the trees’ responses to wind.

Femoral Stem Displacement During Closed Reduction of a Dislocated Bipolar Hemiarthroplasty of the Hip

This article describes a case of femoral stem displacement during closed reduction of a redislocated bipolar hemiarthroplasty of the hip in a 72-year-old woman who had undergone bipolar hemiarthroplasty using a polished, tapered cemented femoral stem. The polished, tapered cemented femoral stem is vulnerable to displacement when exposed to traction forces. Six days after bipolar hemiarthroplasty, the patient experienced her first dislocation, and immediate reduction of the dislocated hip was easily achieved. However, on the ninth postoperative day, redislocation occurred, and this time, reduction was not achieved. Subsequent radiographs revealed an unreduced state with posterosuperior dislocation of the hip and dissociation of the femoral stem at the cement-stem interface with proximal migration. Open reduction was then performed, and it was noted that the bipolar prosthesis had dislocated posterosuperiorly, the neck of the femoral stem was incarcerated between the short external rotators, and the femoral stem had migrated proximally by approximately 8 cm. The femoral stem was repositioned by freeing it from the short external rotators and gently tapping it into the cement mantle. Our surgical solution is questionable, because the stability of the stem is likely to be inadequate. According to the established study, no difference in stuffiness was observed before extraction and after reinsertion, which supports the surgical solution we chose. Pre-reduction analysis should be conducted to determine the cause and status of a dislocation, and open reduction should be performed if closed reduction fails when treating dislocated bipolar hemiarthroplasty patients.

Polished Tapered Femoral Stem Displacement during the Closed Reduction of a Redislocated Cemented Bipolar Hemiarthroplasty of the Hip - A Case Report -

Redislocation of bipolar hemiarthroplasty is not a simple complication. When redislocation of bipolar hemiarthroplasty occurs, open reduction must be considered. Displacement of the polished tapered femoral stem could occur through the unwanted traction force during the reduction of the dislocated cemented hip arthroplasty as a complication. We experienced displacement of the polished tapered femoral stem during closed reduction of a redislocated cemented bipolar hemiarthroplasty. We suggest that preoperative analysis for the cause and status of the dislocation is essential and open reduction should be considered if closed reduction is not thought to be suitable for a polished femoral stem.

Cement mantle fatigue failure in total hip replacement: Experimental and computational testing

One possible loosening mechanism of the femoral component in total hip replacement is fatigue cracking of the cement mantle. A computational method capable of simulating this process may therefore be a useful tool in the preclinical evaluation of prospective implants. In this study, we investigated the ability of a computational method to predict fatigue cracking in experimental models of the implanted femur construct. Experimental specimens were fabricated such that cement mantle visualisation was possible throughout the test. Two different implant surface finishes were considered: grit blasted and polished. Loading was applied to represent level gait for two million cycles. Computational (finite element) models were generated to the same geometry as the experimental specimens, with residual stress and porosity simulated in the cement mantle. Cement fatigue and creep were modelled over a simulated two million cycles. For the polished stem surface finish, the predicted fracture locations in the finite element models closely matched those on the experimental specimens, and the recorded stem displacements were also comparable. For the grit blasted stem surface finish, no cement mantle fractures were predicted by the computational method, which was again in agreement with the experimental results. It was concluded that the computational method was capable of predicting cement mantle fracture and subsequent stem displacement for the structure considered.

Femoral stem displacement as a complication of reduction of a dislocated total hip arthroplasty

Acute displacement at cement-prosthesis interface of a polished femoral component of hip arthroplasty occurring as a consequence of attempted closed manipulation is rare. This complication can be avoided by placing cement over the shoulder of the prosthesis and using fluoroscopic control during closed manipulation if there is a dislocation.

Structural characteristics of impaction allografting for revision total hip arthroplasty

The impaction allografting procedure for treatment of failed hip reconstructions has shown promising but variable results. The objective of this study was to compare the structural characteristics of revision total hip arthroplasty constructs with impaction allografting (cement+morsellized bone) with all-cement and all-morsellized bone constructs. Uniaxial cyclic compression was applied to a simplified uniaxial, parallel, aluminum tube model to simulate normal gait. Applied force and axial stem displacement were recorded to determine stem subsidence and construct stiffness. Introduction of a small amount of cement into the bone graft, as suggested in an impaction allografting procedure previously reported, makes the construct behave structurally more similar to an all-cemented construct than to an all-bone graft construct. The results suggest that the structural properties achieved in an impaction allografting construct are sensitive to the amount of cement in the graft and that care should be taken clinically to achieve consistent constructs.

Relation between brain displacement and local cerebral blood flow in patients with chronic subdural haematoma

OBJECTIVESTo evaluate the relation between brain displacement, clinical signs and symptoms, and local cerebral blood flow (lCBF) in patients with chronic subdural haematoma (CSDH).METHODSForty five patients (age range 58–87 years,...

Stem displacement during reduction of a dislocated cemented total hip arthroplasty with a polished tapered stem

Displacement of the polished stem of a total hip arthroplasty from its cemented mantle occurred as a complication of an attempted closed reduction after luxation. No cement fractures were seen during subsequent reoperation. The complication can be avoided if cement is placed over the shoulder of the prosthesis.

Collarless polished tapered impaction grafting of the femur during revision total hip arthroplasty: Pitfalls of the surgical technique and follow-up in 31 cases

Impacting morcellized allograft bone into the femur during revision total hip arthroplasty is a simple concept with the goal of rebuilding femoral bone stock and providing secure fixation to the femoral stem. Using the collarless polished tapered (CPT, Zimmer, Warsaw, IN) stem impaction grafting system, we became concerned about the discrepancy between the straightforward concept and precise execution of the technique. In this study, we examined 31 consecutive procedures to determining intraoperative difficulties and report on the clinical outcome of 30 cases at an average follow-up of 31 months. Modified Harris Hip Scores averaged 41 points preoperatively and improved to 86 points at follow-up. Nineteen cases were performed on intact femora, whereas 12 cases had disrupted femoral integrity, either extended trochanteric osteotomy or periprosthetic fracture. Successful outcome was seen in all cases with an intact femur, and restoration of femoral integrity was key to successful outcome in cases with compromised femoral integrity. Among cases with disrupted femoral integrity, 3 distal fractures occurred as a result of the rigid CPT cement plug, and 2 complete femoral fractures occurred as a result of bone impaction, for a technique-related fracture rate of 16%. Difficulty packing bone distally occurred in 94% of cases and was associated with varus and valgus stem alignment and medial and lateral stem displacement. Complete cement mantles were seen in 77% of cases. No stem subsidence was seen in 15 of 30 cases (50%). Stem subsidence of <5 mm was seen in 10 of 30, stem subsidence of 6 to 8 mm was seen in 4 of 30, and stem subsidence of >10 mm was seen in 1 patient (4%). Of the patients, 87% thought the procedure improved their function, and 97% would recommend it to a friend with a failed femoral component. Although we hope that the instruments for this procedure can improve, we endorse the concept of impaction grafting with the CPT stem as a successful way of dealing with revision femoral surgery.