BACKGROUND:The main objective of every new development in total hip arthroplasty (THA) is the longest possible survival of the implant. Periprosthetic stress shielding is a scientifically proven phenomenon which leads to inadvertent bone loss. So far, many studies have analysed whether implanting different hip stem prostheses result in significant preservation of bone stock. The aim of this preclinical study was to investigate design-depended differences of the stress shielding effect after implantation of a selection of short-stem THA-prostheses that are currently available. METHODS:Based on computerised tomography (CT), a finite elements (FE) model was generated and a virtual THA was performed with different stem designs of the implant. Stems were chosen by osteotomy level at the femoral neck (collum, partial collum, trochanter sparing, trochanter harming). Analyses were performed with previously validated FE models to identify changes in the strain energy density (SED). RESULTS:In the trochanteric region, only the collum-type stem demonstrated a biomechanical behaviour similar to the native femur. In contrast, no difference in biomechanical behaviour was found between partial collum, trochanter harming and trochanter sparing models. All of the short stem-prostheses showed lower stress-shielding than a standard stem. CONCLUSION:Based on the results of this study, we cannot confirm that the design of current short stem THA-implants leads to a different stress shielding effect with regard to the level of osteotomy. Somehow unexpected, we found a bone stock protection in metadiaphyseal bone by simulating a more distal approach for osteotomy. Further clinical and biomechanical research including long-term results is needed to understand the influence of short-stem THA on bone remodelling and to find the optimal stem-design for a reduction of the stress shielding effect.

译文

背景:全髋关节置换术(THA)的每项新进展的主要目的是使植入物的生存期最长。假体周围应力屏蔽是一种经过科学证明的现象,会导致意外的骨质流失。到目前为止,许多研究已经分析了植入不同的髋关节假体是否能显着保留骨储备。这项临床前研究的目的是研究植入目前可用的短柄THA假体后,取决于设计的应力屏蔽效果差异。
方法:基于计算机断层扫描(CT),生成有限元(FE)模型,并使用不同的植入物茎设计进行虚拟THA。通过股骨颈截骨术水平选择茎(胶原蛋白,部分胶原蛋白,转子粗细,转子粗细损伤)。使用先前验证的有限元模型进行分析,以识别应变能密度(SED)的变化。
结果:在股骨转子区,只有collum型茎表现出与天然股骨相似的生物力学行为。相反,在部分肢体,转子损伤和转子节备模型之间,在生物力学行为上没有发现差异。所有的短茎假体均显示出比标准茎更低的应力屏蔽。
结论:基于这项研究的结果,我们不能证实当前的短茎THA植入物的设计在截骨水平方面导致不同的应力屏蔽效果。某种程度上出乎意料的是,我们通过模拟更远侧的截骨方法,发现了meta骨的骨保护。需要进一步的临床和生物力学研究,包括长期结果,以了解短柄THA对骨重塑的影响,并找到降低应力屏蔽效果的最佳茎设计。

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