Surgical Cut Research Articles

Percutaneous Transaxillary versus Surgically-Assisted Transsubclavian TAVR: A Single Center Experience

ABSTRACT Background: Transfemoral access is the standard approach for transcatheter aortic valve replacement (TAVR). However, an important proportion of TAVR patients may not be considered for transfemoral access because of anatomic reasons – for these patients, an alternative access route must be considered. The objective of this study was to assess the safety and efficacy of percutaneous transaxillary TAVR as compared to surgically assisted transsubclavian TAVR and to report the feasibility of next-day discharge following this percutaneous approach. Methods: Since January 2019, all transaxillary TAVR at our institution were performed using a standardized percutaneous approach – this was compared to our prior experience with transsubclavian TAVR via surgical cut down. Results: Sixty-four patients underwent transsubclavian/axillary TAVR since 2014: 40 surgically assisted transsubclavian (2014–2018) and 24 fully percutaneous transaxillary TAVR (2019–2020). Both groups had similar baseline characteristics. In the surgically assisted TAVR group, six major vascular complications were encountered and six patients were rehospitalized within 30 days after TAVR vs. no patients with a major vascular complication and one patient rehospitalized within 30 days in the percutaneous transaxillary group. Hospitalization was significantly shorter for patients treated by percutaneous vs. surgical approach (1.2 vs. 4.4 days; p <0.001). Twenty out of 24 percutaneous transaxillary TAVR patients (83%) were discharged the day after TAVR. Conclusion: Percutaneous transaxillary TAVR is a safe and effective treatment option for patients not suitable for transfemoral TAVR. Significant reduction in hospital length-of-stay was noted in percutaneous transaxillary vs. surgically assisted transsubclavian TAVR. Abbreviations: CABG: coronary artery bypass graft; ECG: electrocardiogram; LAD: left anterior descending; LIMA: left internal mammary artery; STS: Society of Thoracic Surgeons; TAVR: transcatheter aortic valve replacement; OAC: oral anticoagulation; PTA: percutaneous transluminal angioplasty; VARC: Valve Academic Research Consortium

Transarterial Embolization via Surgical Cut Down of the Occipital Artery for the Treatment of Dural Arteriovenous Fistula of the Superior Sagittal Sinus: Case Report

Transarterial Embolization via Surgical Cut Down of the Occipital Artery for the Treatment of Dural Arteriovenous Fistula of the Superior Sagittal Sinus: Case Report

Effect of gallic acid on liver injury during obstructive cholestasis after bile duct ligation in rat

Aim: To investigate the hepatoprotective, anti-inflammatory and antioxidant effects of gallic acid (GA) against obstructive cholestasis (OC) -induced liver damage in rats. Methods: Thirty female Sprague-Dawley rats were divided into three groups. Group 1 (n=10) was the sham-operated group. In group 2 and group 3, hepatoduodenal ligament dissection was performed after laparotomy. Once the common bile duct was made apparent, it was ligated with 4/0 silk surgical suture and cut between both sutures. Group 2 (n=10) was the control group. Group 3 (n=10) was the GA group. GA (50 mg/kg) was administered by oral gavage daily for 10 days. At the end of the experiment on day 10, the rats were anesthetized. Fibrosis, inflammation, ductal proliferation and necrosis were evaluated histopathologically. Serum levels of AST, ALT, TBIL, DBIL, LDH and GGT levels were determined. In the serum and liver, TAS, TOS, MDA, TNF-α, IL-1, IL-6, and IL 10 levels were evaluated. Results: When group 2 and group 3 were compared histopathologically, fibrosis and inflammation were significantly lower in group 3. In group 3, all LFTs (except DBIL), liver and serum IL-6, IL-1, TOS, MDA, and TNF-α levels were significantly lower than group 2, whereas IL-10 and TAS values were increased. Conclusion: Findings of this research indicate that GA may be effective against OC-induced liver damage in a rat model. We presume that the beneficial effects of GA are closely associated with its antioxidant and anti-inflammatory activities. Therefore, we think that using GA can save us time before resorting to the surgical method.

Early intervention with levetiracetam prevents the development of cortical hyperexcitability and spontaneous epileptiform activity in two models of neurotrauma in rats

This study examined the antiepileptogenic potential of the antiseizure drug (ASD) levetiracetam (LEV) using the in vitro traumatized-slice and in vivo controlled cortical impact (CCI) models of traumatic brain injury (TBI) in rats when administered early after the injury. For the in vitro model, acute coronal slices (400–450 μm) of rat neocortex (P21–32) were injured via a surgical cut that separated the superficial layers from the deeper regions. Persistent stimulus-evoked epileptiform activity developed within 1–2 h after trauma. In randomly selected slices, LEV (500 μM) was bath-applied for 1 h starting immediately or delayed by 30–80 min after injury. Treated and untreated slices were examined for epileptiform activity via intracellular and extracellular recordings. For the in vivo model, rats (P24–32) were subjected to a non-penetrating, focal, CCI injury targeting the neocortex (5.0 mm diameter; 2.0 mm depth). Immediately after injury, rats were given either a single dose of LEV (60–150 mg/kg, i.p.) or the saline vehicle. At 2–3 weeks after the injury, ex vivo cortical slices were examined for epileptiform activity. The results from the traumatized-slice experiments showed that in vitro treatment with LEV within 60 min of injury significantly reduced (> 50%) the proportion of slices that exhibited stimulus-evoked epileptiform activity. LEV treatment also increased the stimulus intensity required to trigger epileptiform bursts in injured slices by 2–4 fold. Consistent with these findings, LEV treatment of CCI-injured rats (n = 15) significantly reduced the proportion of animals that exhibited spontaneous and stimulus-evoked epileptiform bursts in ex vivo cortical slices compared to saline-treated controls (n = 15 rats), and also significantly increased the stimulus intensity required to evoke epileptiform bursts. These results suggest that early administration of LEV has the potential to prevent or reduce posttraumatic epileptogenesis and that there may be a narrow therapeutic window for successful prophylactic intervention.

TCT CONNECT-79 Is Surgical Cut Down Still an Option in Patients Undergoing Transcatheter Aortic Valve Replacement? A System-Wide Analysis With Second-Generation Valves

TCT CONNECT-79 Is Surgical Cut Down Still an Option in Patients Undergoing Transcatheter Aortic Valve Replacement? A System-Wide Analysis With Second-Generation Valves

New technique of inguinal hernia repair during prostatectomy

Background: Several benefits of inguinal hernia repair concurrent with simple prostatectomy have been proposed recently. For the first time we represent this surgery in the form of retroperitoneal mesh insertion without an additional surgical cut for the inguinal hernia repair. Methods: We selected 19 patients for this trial of a new surgery method. The simple prostatectomy was performed and from the same surgical cut the hernia sac recognized. Two methods of prostatectomy surgery were undertaken: Millin’s and Freyer’s prostatectomy. The retroperitoneal insertion of monofilament polypropylene was undertaken for hernia repair. Results: All patients were prospectively followed for three years for clinical outcomes and hernia recurrence. No complications after surgery, including wound infection, pelvic collections, sepsis and recurrence of the hernia were seen. Conclusions: Our new retroperitoneal mesh insertion technique is safe, effective and simultaneously practical with simple prostatectomy. This new method is strongly recommended to other surgeons, since it has beneficial results with no noteworthy raise in operative duration or further complications.

Comparative study between open and ultrasound-guided central venous access devices

Background and aims Pediatric populations represented a challenge for insertion of central venous access devices (CVADs). Ultrasound guidance seems to provide advantages over the open surgical method. However, there are no enough data to advocate this notion. An additional goal was to compare between ultrasound-guided and open surgical venous cut down for central venous catheter (CVC) placement. Patients and methods The study included 40 patients, divided into two equal groups: group A (open CVAD group) and group B (ultrasound-guided CVAD group). For each group, patient data, procedure success rate, time of the procedure, and any complications were documented and compared in both groups. Results Both groups were comparable regarding patient age, sex, cauterized vein, indication for CVC insertion, success rate, first-attempt success, number of attempts, and complications. Conclusion Ultrasound guidance was confirmed to be effective and safe as an open method for insertion of CVC insertion with preservation of the vein intact.

Abstract 368: A Cardiac Arrest Simulation-Based Feasibility Cadaver Study Investigating Time for Semi Surgical Cut Down Procedure Followed by Insertion of a Novel REBOA Catheter

Aim: Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. The Resuscitative endovascular balloon occlusion of the aorta (REBOA) procedure is currently being discussed as a possible technique to be used during Advanced Life Support (ALS) in humans with Cardiac arrest (CA). The aim of this study was to assess the training of emergency physicians in the procedures related to insertion of a novel REBOA catheter. Methods: We developed a training program using a simulated CA model on human cadavers. CPR was performed using the LUCAS device (Stryker/Jolife AB, Lund, Sweden). All cadavers were hemodynamically monitored. The Neurescue REBOA catheter (Neurescue REBOA device, Neurescue ApS, Copenhagen, Denmark) was inserted using a semi-surgical cut-down and sheath placement technique. Time needed to perform the procedures was measured. The procedures were instructed by 2 experts using video, procedural simulation on manikin and full-scale training on cadavers. Results: Six human cadavers were enrolled and a total of 12 procedures were performed by 2 expert investigators and 10 novice investigators. Eight semi-surgical cut-down producers including placements of the introducer sheath were performed on the first attempt and 4 required a second attempt. The median time required for the semi-surgical cutdown procedure and sheath placement by the novice investigators was: 6 min 48 sec (Min: 3 min 45 sec and Max: 26 min 25 sec). The median time required for the insertion and occlusion of the REBOA catheter by the novice investigators was: 3 min 22 sec (Min: 1 min 22 sec and Max: 7 min 5 sec). The median time required for full insertion for the novice investigators was: 11 min 14 sec (Min: 6 min 49 sec and Max: 28 min 15 sec). The mean aortic pressure during compression was: 31.9 mmHg (±17.0). Conclusions: Semi surgical cut-down and introducer sheath placement were performed in 1 or two 2 attempts for all novice investigators with an insertion time compatible with ALS during refractory CA. Simulation training on cadavers brings clinical realism and could be an important addition to the use of manikin or animal training models.

Surgical procedures performed to improve the prosthetic prognosis in case of maxillary defects: A review of the literature

Aim The purpose of this review is to address the surgical procedures that need to be followed to obtain a maxillary defect that can be suitable to receive a prosthesis. Methods An extensive search of the literature was performed, on the databases of PubMed/Medline and Scopus, in addition to congress proceedings and books, written in English or Italian. Literature search was performed using combinations of the following keywords: (“obturator prognosis” OR “palatal obturator” OR “obturator prosthesis” OR “prosthetic prognosis”) AND (“maxillectomy” OR “maxillary defect”). Results 35 articles, 2 books and 3 congress proceedings were included. After the study of the records included in this review, it was found that surgeon must preserve the anterior maxilla as much as possible, because it is the most suitable site for the placement of implants. Furthermore, if the implant site is involved in post-operative radiotherapy, it is advisable to know the x-ray dose of such an exposition. The surgical cut should preserve mucosa and bone support around the tooth adjacent to the defect, and keratinized mucosa should cover the palatal margin of the defect Equally important is to prepare an adequate access to the defect, because the turbinates and the bands of oral mucosa may prevent the prosthesis from engaging key areas of the defect, impairing function. Conclusion A complete knowledge about the construction techniques and biological/mechanical principles of maxillofacial prosthesis is essential to perform surgical interventions that enhance the prosthetic prognosis.

Outcome of Tubular Aortoaortic Endografts in Infrarenal Aneurysmal Disease and Penetrating Abdominal Aortic Ulcers—a Long-Term Follow-up

We describe the long-term follow-up of patients treated for infrarenal abdominal aortic aneurysms and penetrating ulcers by placement of tubular aortic endografts at our institution from 2010 to present. This is a retrospective study using clinical data of patients treated from 2010 to present by placement of either a single aortic tubular endograft or by two overlapping endografts, using the "trombone technique." Aortic dimensions were measured from the preoperative computed tomography scans using three-dimensional reconstruction. The primary outcome was aortic reintervention. Secondary outcomes were aorta-related mortality, endoleaks, and postoperative complications. Twenty-eight patients were identified. Nine patients were treated for saccular aneurysms, and nineteen patients presented with penetrating aortic ulcers. The median follow-up was 31months (range: 4-99). Twenty patients were treated with a single tubular device, while eight patients were treated using two overlapping devices. Aortic reintervention occurred in four patients (14.3%), all were treated initially with a single device. No aortic mortality occurred during follow-up. No aneurysm ruptures occurred. Four patients died during follow-up of unrelated causes. Endoleaks occurred in ten patients (35%). Five endoleaks were of type I (17.8%), of which three were of distal type (10.7%). Five endoleaks were of type II (17.8%). Shorter distal landing zones than 20mm were present in two of the cases with a distal typeI endoleak (P=0.0232). Postoperative complications occurred in three (10.7%) patients including one myocardial infarction and two wound complications from a surgical cut down in the groin. The technique shows an acceptable postoperative complication rate but is characterized by high rate of occurrence of type I endoleaks and aortic reintervention in our series. Endovascular techniques using tubular endografts should be limited to cases with long proximal and distal sealing zones. The trombone technique seems preferable.

Vascular access and closure for cardiovascular intervention

### Learning objectives Selective coronary angiography initially required surgical cut down to access the brachial artery.1 Subsequently, in 1967 Melvin Judkins described a direct percutaneous approach via the femoral artery,2...

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

ObjectiveThe Valiant Navion stent graft system (Medtronic, Santa Rosa, Calif) is a new iteration of a thoracic endograft for the treatment of descending thoracic aortic aneurysms. Herein, the 30-day primary safety and efficacy outcomes and secondary end points are presented. MethodsThe Valiant EVO global clinical trial is a prospective, nonrandomized, single-arm trial. Patient enrollment occurred from April 2016 to October 2017. The primary end point was defined as access and/or deployment failure and/or a major device effect (MDE), including device-related secondary procedures, device-related mortality, conversion to open surgery, or thoracic aortic aneurysm rupture within 30 days of the index procedure. Other measures of stent graft performance including procedural data, rates of secondary procedures, and frequency of endoleaks are also reported. ResultsOf the 87 consecutive patients undergoing thoracic endovascular aneurysm repair who were enrolled, 33 (37.9%) were female with 61 (70.9%) presenting with severe access artery tortuosity and 66 (85.7%) with high thoracic aortic tortuosity per core laboratory evaluation. The mean procedure duration was 88.7 ± 53.4 minutes and geographical differences existed such as percutaneous access (37/52 [71.2%]) in the United States and surgical cut down in the outside of the U.S. sites (28/35 [80.0%]). There were no access or deployment failures and only 2.3% of the patients (2/87; P < .0001; performance goal of 16%) experienced a MDE within 30 days of the index procedure. Two secondary procedures (n = 1 retrograde type A dissection; n = 1 aortic arch rupture) were required, and in the first 30 days, two patients died leading to a freedom from all-cause mortality of 97.7%. Endoleaks at 1 month were reported in 2.5% of patients (n = 1 type Ia; n = 1 type II). ConclusionsAccess/deployment failures, MDEs, and endoleaks were rare in the first 30 days of the Valiant Evo clinical trial. The Valiant Navion thoracic stent graft system has shown encouraging 30-day results in this challenging cohort and trial patients will continue to be followed through 5 years.

Influence of different orientations and rates of bidirectional distraction osteogenesis of the mandibular corpus: a three-dimensional study.

Objective: The objective of this study was to evaluate the biomechanical effect of mandibular corpus distraction osteogenesis with different orientations and rates. Materials and Methods: A three-dimensional model of the mandible was created. The vertical surgical cut was made, the force was applied horizontally in a bidirectional manner within two orientations: parallel to the occlusal plane and parallel to the inferior border of the mandible with three rates (0.5mm, 1mm and 1.5mm). Results: The maximum values for von Mises stress when the force was applied parallel to the inferior border of the mandible with all three rates were smaller than those with force direction parallel to the occlusal plane. The displacement in all three directions x, y, and z were not parallel and prominent in the anterior part of the mandible, while the movement at the posterior part is negligible, x and z displacement were bigger when force was applied parallel to the inferior border of the mandible, z displacement was more prominent than x and y displacement, both directions produced upward rotation of the mandible, this rotation was more noticeable when the force was applied parallel to the inferior border of the mandible. Conclusions: A vertical cut can be used in the patient with a long anterior face. This site of distraction achieves more lengthening of mandible than expansion.

Influence of different orientations and rates of bidirectional distraction osteogenesis of the mandibular corpus: a three-dimensional study

Objective: The objective of this study was to evaluate the biomechanical effect of mandibular corpus distraction osteogenesis with different orientations and rates. Materials and Methods: A three-dimensional model of the mandible was created. The vertical surgical cut was made, the force was applied horizontally in a bidirectional manner within two orientations: parallel to the occlusal plane and parallel to the inferior border of the mandible with three rates (0.5mm, 1mm and 1.5mm). Results: The maximum values for von Mises stress when the force was applied parallel to the inferior border of the mandible with all three rates were smaller than those with force direction parallel to the occlusal plane. The displacement in all three directions x, y, and z were not parallel and prominent in the anterior part of the mandible, while the movement at the posterior part is negligible, x and z displacement were bigger when force was applied parallel to the inferior border of the mandible, z displacement was more prominent than x and y displacement, both directions produced upward rotation of the mandible, this rotation was more noticeable when the force was applied parallel to the inferior border of the mandible. Conclusions: A vertical cut can be used in the patient with a long anterior face. This site of distraction achieves more lengthening of mandible than expansion.

Role of Field Staining in the Cytological Assessment of Intraoperative Surgical Specimens

Objective: To study the role of Field staining in scrape smears for intraoperative cytological (IOC) diagnosis. Specimens were assessed for categorizing among benign and malignant lesions, lymph node status, and adequacy of surgical cut margins as per specimen. Technique, adequacy, and quality were assessed along with comparison of cytological diagnosis with final histopathological diagnosis obtained on routine hematoxylin and eosin-stained slides. Study Design: A prospective observational study was conducted over a period of 1 year from November 2016 to October 2017 in the Department of Pathology of our Institute. Results: 50 cases were studied, and scrape smears were stained with Field stain. Results were satisfactory in terms of adequacy and attaining the objectives of the study. A diagnostic accuracy of 98% was observed with an average turnaround time of 5 min. A single case of low-grade glioma was found to be discordant. Conclusions: Use of Field staining for intraoper­ative cytological assessment of surgical specimens has 98% concordance with the final histopathological diagnosis and achieved the aim of the study. With its low costs, easy availability, short turnaround time, and simple technique, it will be helpful in IOC as an alternative to present techniques especially in financially constrained settings.

Establishment of an in vivo turkey model for the study of flexor tendon repair.

Flexor tendon injuries are common and pose a clinical challenge for functional restoration. The purpose of our study was to assess the adequacy of the turkey as a large animal model for flexor tendon injuries in vivo. Twenty-four male turkeys underwent surgical flexor tendon cut and repair. Turkeys were allocated to five groups postoperatively: (1) foot casted in extension and sacrificed after 3 weeks; (2) foot casted in extension and sacrificed after 6 weeks; (3) foot casted in flexion and sacrificed after 3 weeks; (4) foot casted in flexion and sacrificed after 6 weeks; and (5) foot casted in flexion for 6 weeks and then free roaming allowed for an additional 3 weeks before sacrifice. After sacrifice, digits were collected and analyzed for adhesion formation, healing at the macrolevel and histologically, and biomechanical properties-including friction, work of flexion, stiffness, and strength of repair. All turkeys survived anesthesia and surgery. Tendon rupture occurred in all extension casts and in 11% of those casted in flexion. Friction and work of flexion were significantly higher in the repaired digit than the control digit. There was a correlation between duration of immobilization and repair strength. Histologically, the tendon healed with tenocytes migrating into the gap and producing collagen fibers. We have, for the first time, studied flexor tendon injury and repair using turkeys in terms of anesthesia, surgical procedures, postoperative care, and animal husbandry. The findings regarding functional and histological results from this novel avian model were comparable to the most commonly used mammal model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2497-2505, 2018.

Financial Impact of PEVAR Compared With Standard Endovascular Repair in Canadian Hospitals

ObjectivesThe percutaneous endovascular abdominal aortic repair (PEVAR) approach is a minimally invasive technique that has demonstrated clinical benefit over traditional surgical cut down associated with standard endovascular abdominal aortic aneurysm (AAA) repair (EVAR). The objective of our study was to evaluate the budget impact to a Canadian hospital of changing the technique for AAA repair from the EVAR approach to the PEVAR approach. MethodsWe examined the budget impact of replacing the EVAR approach with the PEVAR approach in a Canadian hospital that performs 100 endovascular AAA repairs annually. The model incorporates the costs associated with surgery, length of stay, and postoperative complications occurring within 30 days. ResultsThe use of PEVAR in AAA repair is associated with increased access device costs when compared with the EVAR approach (CAD$1000 vs CAD$400). However, AAA repair completed with the PEVAR approach demonstrates reduced operating time (101 minutes vs 133 minutes), length of stay (2.2 days vs 3.5 days), time in the recovery room (174 minutes vs 193 minutes), and postoperative complications (6% vs 30%), which offset the increased device costs. The model establishes that switching to the PEVAR approach in a Canadian hospital performing 100 AAA repairs annually would result in a potential cost avoidance of CAD$245,120. ConclusionsA change in AAA repair technique from EVAR to PEVAR can be a cost-effective solution for Canadian hospitals.

Evaluation of the Gram-Negative bacilli causing Surgical-Site infections and their sensitivity to antibiotics in Al-Mowasat Hospital, Damascus, Syria

A Surgical-Site Infection (SSI) is an infection that occurs at a surgical cut within 30 days of a surgical operation. It is considered a major health issue in hospitals associated with high levels of morbidity and mortality. The infections caused by Gram-Negative Bacilli are main challenges to patients' health, because of high percentage of antibiotics resistance. This study aims to evaluate the incidence of SSIs in emergency surgical operations department, the epidemiology of Gram-Negative Bacilli in SSIs and their sensitivity to antibiotics. A total of 466 swab samples were taken from patients who had undergone surgical operations. Swabs were collected from the surgical incision or around it between December 2015 and March 2016. The results show the majority of bacterial isolates that cause the SSIs were Gram-Negative Bacilli (56%), while the Gram-Positive Cocci formed 44%, the predominant isolate was staphylococcus aureus (26/44) (59%) and the most commonly isolated Gram-Negative Bacilli were pseudomonas aeruginosa (22/56) (39.3%), followed by E.coli (14/56) (25%) and klebsiella (8/56) (14.4%). The most effective drugs were Imipenem and Meropenem followed by Amikacin.

EXTERIORISATION OF INTESTINAL STOMA AS A RESULT OF INTESTINAL CANCER DISEASE

Among diseases of the 21st century, intestinal tumours are frequently mentioned. Colon cancer is a serious and growing health problem not only in Poland, but also in the world. As the most common result of fighting for one's own health and often even life is the consent to the intestinal stoma. Intestinal stoma is made by exteriorisation of the preserved intestinal end by abdominal incision outside the abdominal cavity, the incision of the mucous membrane and suturing it to the skin. The three main groups of indications for exteriorisation of stoma are: (a) inflammatory disease of intestines, (b) colitis, rectal and colonic trauma, (c) colorectal cancer. Properly exteriorised stoma on the large intestine should be located on the smooth surface of the skin away from the navel, hip bone, skin folds, scars and also at least 4 cm away from the main surgical cut. Patients should see the fistula well because it is the basis of proper self-care. Dermatological complications are the most common complication of stoma and occur in nearly 80% of patients. It comes to them as a result of irritation of the skin by the intestinal contents that come out of it and causes inflammation. This is usually the result of incorrect stoma care or improper use of stoma equipment. Despite medical advances towards minimizing invasive procedures and limiting the severity of the disease, the problem of the great stress experienced by every person undergoing surgical treatment is still valid and relevant to the outcome of the whole therapy. Choosing intestinal stoma is one of the most stressful treatments, so in this case, not only medical care but also psychological over the patient seems to be a priority.

Computational modelling of motion at the bone–implant interface after total knee arthroplasty: The role of implant design and surgical fit

BackgroundAseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. MethodsFinite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone–implant interfaces to allow relative motions to be recorded. ResultsThe results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. ConclusionIn conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants.