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Femoral stem design

Sonika Patel, Carl T Talmo, Sumon Nandi
BACKGROUND: Taper corrosion at the modular junctions of total hip arthroplasty (THA) femoral stems are known to cause locally destructive adverse local tissue reaction (ALTR). However, the implants at risk remain to be fully elucidated. CASE REVIEW: We report the case of a 76-year-old woman with hip pain, abductor weakness, and sciatic nerve symptoms 2 years following metal-on-polyethylene THA. Serum cobalt levels were elevated, while chromium levels were normal...
October 15, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Chelsea N Koch, Laura Serrano Mateo, Stephen Kayiaros, Kevin A Cassidy, Seth A Jerabek, Alejandro Gonzalez Della Valle
BACKGROUND: Femoral stem fracture following total hip arthroplasty is an uncommon event that requires immediate revision surgery. QUESTIONS/PURPOSES: We report on four patients who experienced stem fractures of one design and a review of the US Food and Drug Administration adverse event reports on this design. METHODS: Fracture surfaces of four EMPERION™ (Smith & Nephew, Memphis, TN) femoral stems were analyzed under optical and scanning electron microscopy...
October 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
J Palan, M C Smith, P Gregg, S Mellon, A Kulkarni, K Tucker, A W Blom, D W Murray, H Pandit
AIMS: Periprosthetic fracture (PF) after primary total hip arthroplasty (THA) is an uncommon but potentially devastating complication. This study aims to investigate the influence of cemented stem designs on the risk of needing a revision for a PF. PATIENTS AND METHODS: We analysed data on 257 202 primary THAs with cemented stems and 390 linked first revisions for PF recorded in the National Joint Registry (NJR) of England, Wales and Northern Ireland to determine if a cemented femoral stem brand was associated with the risk of having revision for a PF after primary THA...
October 2016: Bone & Joint Journal
Dia Eldean Giebaly, Haider Twaij, Mazin Ibrahim, Fares S Haddad
INTRODUCTION: Total hip replacement is a successful procedure with long survival records compared to other joint arthroplasties. Cemented implants have been available for many years, however the complications associated with loosening and, ultimately, failure over time has led to the development of cementless stems and implants.The ideal prosthesis should recreate a biomechanically normal hip joint, allow pain-free function and last the patient's life span without requiring revision. Optimal results with uncemented femoral stems rely on obtaining initial stability, osseointegration, biological fixation, and uniform stress transfer to the proximal bone...
September 29, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Nemandra A Sandiford, Donald S Garbuz, Bassam A Masri, Clive P Duncan
BACKGROUND: The ideal femoral component for revision THA is undecided. Cylindrical nonmodular stems have been associated with stress shielding, whereas junctional fractures have been reported with tapered fluted modular titanium stems. We have used a tapered fluted nonmodular titanium femoral component (Wagner Self-locking [SL] femoral stem) to mitigate this risk. This component has been used extensively in Europe by its designer surgeons, but to our knowledge, it has not been studied in North America...
September 26, 2016: Clinical Orthopaedics and related Research
Sajad Arabnejad, Burnett Johnston, Michael Tanzer, Damiano Pasini
Current hip replacement femoral implants are made of fully solid materials which all have stiffness considerably higher than that of bone. This mechanical mismatch can cause significant bone resorption secondary to stress shielding, which can lead to serious complications such as peri-prosthetic fracture during or after revision surgery. In this work, a high strength fully porous material with tunable mechanical properties is introduced for use in hip replacement design. The implant macro geometry is based off of a short stem taper-wedge implant compatible with minimally invasive hip replacement surgery...
September 24, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Jan F A Somers, Catherine Van Der Straeten, Luc De Coninck
AIM: We report the short-term clinical, radiographic and ion level data of the Conserve Plus metal-on-metal (MoM) big femoral head (BFH) total hip arthroplasty (THA), used with a cemented cobalt-chrome (Co-Cr) Profemur Xm stem and a titanium (Ti) modular neck. RESULTS: In a consecutive series of 40 hips, survivorship at 3 years was 92.5% with revision for any reason. Average Harris Hip Score was 91.3. There were no implant loosenings. No osteolysis was observed...
September 3, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Kanehiro Matsuyama, Yasuhiro Ishidou, Yong-Ming Guo, Hironori Kakoi, Takao Setoguchi, Satoshi Nagano, Ichiro Kawamura, Shingo Maeda, Setsuro Komiya
BACKGROUND: Femoral bone remodeling in response to stress shielding induces periprosthetic bone loss. Computerized finite element analysis (FEA) is employed to demonstrate differences in initial stress distribution. However, FEA is often performed without considering the precise sites at which the stem was fixed. We determined whether FEA reflects mid-term radiological examination exactly as predicted following long-term stress shielding. METHODS: Femur-stem fixation sites were evaluated radiologically according to the location of spot welds in two anatomical cementless stem designs...
2016: BMC Musculoskeletal Disorders
Xiaojun Weng, Hailin Yang, Jian Xu, Xiaosheng Li, Qiande Liao, Jing Wang
The aim of the present study was to observe the performance of Ti-25Nb alloys with various porosities as femoral stem prostheses in a rabbit model, thus providing basic experimental evidence for the development of porous prostheses. The porous Ti-25Nb alloy prostheses were designed according to the morphology of the medullary cavity. These prostheses were placed into the femoral medullary cavities in 36 New Zealand white rabbits. Postoperative X-ray films, scanning electron microscopy (SEM) of the implant interface, energy-dispersive spectroscopy (EDS) analysis of the implant surface, pulling-out test and general observations were conducted...
September 2016: Experimental and Therapeutic Medicine
M Oba, Y Inaba, N Kobayashi, H Ike, T Tezuka, T Saito
OBJECTIVES: In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. PATIENTS AND METHODS: We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution...
September 2016: Bone & Joint Research
Scott R Small, Sarah E Hensley, Paige L Cook, Rebecca A Stevens, Renee D Rogge, John B Meding, Michael E Berend
BACKGROUND: Short-stemmed femoral components facilitate reduced exposure surgical techniques while preserving native bone. A clinically successful stem should ideally reduce risk for stress shielding while maintaining adequate primary stability for biological fixation. We asked (1) how stem-length changes cortical strain distribution in the proximal femur in a fit-and-fill geometry and (2) if short-stemmed components exhibit primary stability on par with clinically successful designs...
August 10, 2016: Journal of Arthroplasty
Zhendong Zhang, Qi Zhuo, Wei Chai, Ming Ni, Heng Li, Jiying Chen
Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty...
August 2016: Medicine (Baltimore)
Ashleen R Knutsen, Nicole Lau, Donald B Longjohn, Edward Ebramzadeh, Sophia N Sangiorgio
INTRODUCTION: Periprosthetic bone loss may lead to major complications in total hip arthroplasty (THA), including loosening, migration, and even fracture. This study analysed the influence of femoral implant designs on periprosthetic bone mineral density (BMD) after THA. METHODS: The results of all previous published studies reporting periprosthetic femoral BMD following THA were compiled. Using these results, we compared percent changes in bone loss as a function of: femoral stem fixation, material, and geometry...
August 3, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Harry S Hothi, Antti P Eskelinen, Reshid Berber, Olli S Lainiala, Teemu P S Moilanen, John A Skinner, Alister J Hart
BACKGROUND: Trunnionosis of the tapered head-stem junction of total hip arthroplasties, either through corrosion or mechanical wear, has been implicated in early implant failure. Retrieval analysis of large numbers of failed implants can help us better understand the factors that influence damage at this interface. METHODS: In this study, we examined 120 retrieved total hip arthroplasties of one bearing design, the 36-mm diameter metal-on-metal, DePuy Pinnacle, that had been paired with 3 different stems...
June 29, 2016: Journal of Arthroplasty
Shannon R Moore, CĂ©line Heu, Nicole Y C Yu, Renee M Whan, Ulf R Knothe, Stefan Milz, Melissa L Knothe Tate
: : An abundance of surgical studies during the past 2 centuries provide empirical evidence of periosteum's regenerative power for reconstructing tissues as diverse as trachea and bone. This study aimed to develop quantitative, efficacy-based measures, thereby providing translational guidelines for the use of periosteum to harness the body's own healing potential and generate target tissues. The current study quantitatively and qualitatively demonstrated tissue generation modulated by a periosteum substitute membrane that replicates the structural constituents of native periosteum (elastin, collagen, progenitor cells) and its barrier, extracellular, and cellular properties...
July 27, 2016: Stem Cells Translational Medicine
Young-Min Kwon, Valentin Antoci, Eric Eisemon, Tsung-Yuan Tsai, Yu Yan, Ming Han Lincoln Liow
BACKGROUND: Contemporary "dual-taper" modular femoral neck-stem designs have been associated with taper corrosion-related adverse local tissue reaction (ALTR) requiring revision surgery and stem removal. Extended trochanteric osteotomy is recognized as the workhorse procedure for revision hip surgery. The aim of our study is to describe our "top-out" stem removal surgical technique and identify preoperative radiographic risk factors associated with periprosthetic fractures when using this technique...
June 17, 2016: Journal of Arthroplasty
David Clinton McNabb, Jason M Jennings, Douglas A Dennis
INTRODUCTION: Physiologic strain patterns of the femur are altered by the bending stiffness of the implant as well as the loading pattern of the implant itself. The Savish Range of Motion (S-ROM) femoral stem has been designed with flutes (to decrease distal material) and with a coronal slot (to decrease stiffness). MATERIALS: The purpose of this case report is to briefly discuss design characteristics of femoral stems and their relationship to thigh pain as well as to describe the only report in the literature of a fracture of the anterior spline of a S-ROM prosthesis at the coronal slot...
2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Munnan Al-Najjim, Usman Khattak, Juluis Sim, Iain Chambers
INTRODUCTION: Measurement of early subsidence of uncemented femoral stems can be used to evaluate the likelihood of long term stem component loosening and therefore clinical failure. Our aim was to evaluate the factors associated with subsidence in collared and uncollared versions of the Corail femoral stem. METHODS: 121 hips in 113 consecutive patients were studied, operated on by two surgeons in our hospital differing in their choice of Corail stem. This gave two groups of patients with 66 hips having collared stems and 55 hips having uncollared...
December 2016: Journal of Orthopaedics
Robert D Russell, Michael H Huo, Danieli C Rodrigues, Victor Kosmopoulos
BACKGROUND: Stable femoral fixation during uncemented total hip arthroplasty is critical to allow for subsequent osseointegration of the prosthesis. Varying stem designs provide surgeons with multiple options to gain femoral fixation. OBJECTIVE: The purpose of this study was to compare the initial fixation stability of cylindrical and tapered stem implants using two different underreaming techniques (press-fit conditions) for revision total hip arthroplasty (THA)...
July 8, 2016: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
Richard L Amendola, Devon D Goetz, Steve S Liu, John J Callaghan
BACKGROUND: Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series. QUESTIONS/PURPOSES: (1) What is the proportion of patients treated with a short stem cementless THA femoral component that develop thigh pain and what are the hip scores of this population? (2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design? METHODS: Two hundred sixty-one primary THAs were performed in 238 patients by one surgeon between November 2010 and August 2012...
July 14, 2016: Clinical Orthopaedics and related Research
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