M. Reimeringer

The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis

One of the crucial factors for short- and long-term clinical success of total hip arthroplasty cementless implants is primary stability. Indeed, motion at the bone–implant interface above 40 μm leads to partial bone ingrowth, while motion exceeding 150 μm completely inhibits bone ingrowth. The aim of this study was to investigate the effect of two cementless femoral stem designs with different lengths on the primary stability. A finite element model of a composite Sawbones® fourth generation, implanted with five lengths of the straight prosthesis design and four lengths of the curved prosthesis design, was loaded with hip joint and abductor forces representing two physiological activities: fast walking and stair climbing. We found that reducing the straight stem length from 146 to 54 mm increased the average micromotion from 17 to 52 μm during fast walking, while the peak value increased from 42 to 104 μm. With the curved stem, reducing length from 105 to 54 mm increased the average micromotion from 10 to 29 μm, while the peak value increased from 37 to 101 μm. Similar findings are obtained for stair climbing for both stems. Although the present study showed that femoral stem length as well as stem design directly influences its primary stability, for the two femoral stems tested, length could be reduced substantially without compromising the primary stability. With the aim of minimising surgical invasiveness, newer femoral stem design and currently well performing stems might be used with a reduced length without compromising primary stability and hence, long-term survivorship.

The influence of contact ratio and its location on the primary stability of cementless total hip arthroplasty: A finite element analysis

Cementless hip stems are fixed to the surrounding bone by means of press-fit. To ensure a good press-fit, current surgical technique specifies an under-reaming of the bone cavity using successively larger broaches. Nevertheless, this surgical technique is inaccurate. Several studies show that the contact ratio (percentage of stem interface in contact with bone) achieved after surgery can vary between 20% and 95%. Therefore, this study aimed to investigate the influence of the contact ratio and its location on the primary stability of a cementless total hip arthroplasty using finite element analysis. A straight tapered femoral stem implanted in a composite bone was subjected to stair climbing. Micromotion of 7600 nodes at the stem-bone interface was computed for different configurations of contact ratios between 2% and 98%) along the hip stem. Considering the 15 configurations evaluated, the average micromotion ranges between 27μm and 54μm. The percentage of the porous interface of the stem having micromotion below 40μm that allows bone ingrowth range between 25-57%. The present numerical study shows that full contact (100%) between stem and bone is not necessary to obtain a good primary stability. The stem primary stability is influenced by both the contact ratio and its location. Several configurations with contact ratio lower than 100% and involving either the proximal or the cortical contact provide better primary stability than the full contact configuration. However, with contact ratio lower than 40%, the stem should be in contact with cortical bone to ensure a good primary stability.

On the Two-Dimensional Simplification of Three-Dimensional Cementless Hip Stem Numerical Models

Three-dimensional (3D) finite element (FE) models are commonly used to analyze the mechanical behavior of the bone under different conditions (i.e., before and after arthroplasty). They can provide detailed information but they are numerically expensive and this limits their use in cases where large or numerous simulations are required. On the other hand, 2D models show less computational cost, but the precision of results depends on the approach used for the simplification. Two main questions arise: Are the 3D results adequately represented by a 2D section of the model? Which approach should be used to build a 2D model that provides reliable results compared to the 3D model? In this paper, we first evaluate if the stem symmetry plane used for generating the 2D models of bone-implant systems adequately represents the results of the full 3D model for stair climbing activity. Then, we explore three different approaches that have been used in the past for creating 2D models: (1) without side-plate (WOSP), (2) with variable thickness side-plate and constant cortical thickness (SPCT), and (3) with variable thickness side-plate and variable cortical thickness (SPVT). From the different approaches investigated, a 2D model including a side-plate best represents the results obtained with the full 3D model with much less computational cost. The side-plate needs to have variable thickness, while the cortical bone thickness can be kept constant.