Effects of stemmed and nonstemmed hip replacement on stress distribution of proximal femur and implant

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• 作者：Chun-Ming Chen (1)
  Wen-Chi Tsai (2) (3)
  Shang-Chih Lin (4)
  Ching-Shiow Tseng (1)
  
  1. Department of Mechanical Engineering ; National Central University ; Taoyuan ; Taiwan
  2. BoneCare Orthopedic Centers ; Han-Chiung Clinics ; Taipei ; Taiwan
  3. Department of Orthopedic Surgery ; National Taiwan University Hospital ; Taipei ; Taiwan
  4. Graduate Institute of Biomedical Engineering ; National Taiwan University of Science and Technology ; No. 43 ; Sec. 4 ; Keelung Rd ; Taipei ; 106 ; Taiwan
  
• 关键词：Hip ; Stemmed ; Nonstemmed ; Stress ; shielding ; Finite ; element
• 刊名：BMC Musculoskeletal Disorders
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：15
• 期：1
• 全文大小：1,405 KB
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  38. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/15/312/prepub
  
• 刊物主题：Orthopedics; Rehabilitation; Rheumatology; Sports Medicine; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2474

文摘

Background Despite improvements in shape, material, and coating for hip stem, both stress shielding and aseptic loosening have been the major drawbacks of stemmed hip arthroplasty. Some nonstemmed systems were developed to avoid rasping off the intramedullary canal and evacuating the bone marrow due to stem insertion. Methods In this study, the finite-element models of one intact, one stemmed, and two nonstemmed femora with minimal removal of the healthy neck were investigated to evaluate their biomechanical effects. The resurfacing (ball-shaped) and fitting (neck-shaped) systems were respectively selected as the representative of the ready- and custom-made nonstemmed implants. The stress distribution and interface micromotion were selected as the comparison indices. Results The results showed that stress distributions of the two nonstemmed femora are consistently more similar to the intact femur than the stemmed one. Around the proximal femur, the stem definitely induces the stress-shielding phenomenon of its counterparts. The fitting system with the anatomy-shaped cup can make intimate contact with the neck cortex and reduce the bone-cup micromotion and the implant stress. Comparatively, the reamed femoral head provides weaker support to the resurfacing cup causing higher interfacial micromotion. Conclusions The reserved femoral neck could act as the load-transferring medium from the acetabular cup, femoral neck, to the diaphysial bone, thus depressing the stress-shielding effect below the neck region. If the hip-cup construct can be definitely stabilized, the nonstemmed design could be an alternative of hip arthroplasty for the younger or the specific patients with the disease limited only to the femoral head.