Cementless femoral stem revision in total hip arthroplasty: The periprosthetic clamshell fracture. A biomechanical investigation.
biomechanics
cementless stem revision
hip arthroplasty
medial wall femur
periprosthetic femoral fracture
Journal
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
revised:
09
06
2022
received:
28
03
2022
accepted:
16
06
2022
pubmed:
24
6
2022
medline:
25
2
2023
entrez:
23
6
2022
Statut:
ppublish
Résumé
To biomechanically evaluate the stability of a diaphyseal anchored, cementless stem in presence of a proximal periprosthetic femoral medial wall defect compared to the stability of the same stem in an intact femur. Twenty-two paired human cadaveric femora were pairwise assigned either to a fracture group, featuring a proximal medial wall defect involving 40% of the stems medial anchorage distance, or a control group with native specimens. The specimens were tested under a monotonically increasing cyclic axial loading protocol. Load, cycles, and multiples of the respective body weight at implant loosening was measured. Mean initial stiffness was 2243.9 ± 467.9 N/mm for the intact group and 2190.1 ± 474.8 N/mm for the fracture group. Mean load to loosening in the intact group was 3210.5 ± 1073.2 N and 2543.6 ± 576.4 N in the fracture group, with statistical significance. Mean cycles to loosening in the intact group were 27104.9 ± 10731.7 and 20431.5 ± 5763.7 in the fracture group, with statistical significance. Mean multiples of the resulting body weight at loosening in the intact group was 548.3 ± 158.5% and 441.4 ± 104% in the fracture group, with statistical significance. A medial wall defect involving 40% of the medial anchorage distance significantly decreases the axial stability of a diaphyseal anchored stem. However, mechanical failure occurred beyond physiological stress. At loosening rates of about 4 multiples of the body weight in the fracture group, a "safe zone" remains of a 0.5-fold body weight for maximum loads and twofold body weights for average loads.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
641-648Informations de copyright
© 2022 Orthopaedic Research Society. Published by Wiley Periodicals LLC.
Références
Abdel MP, Cottino U, Mabry TM. Management of periprosthetic femoral fractures following total hip arthroplasty: a review. Int Orthop. 2015;39:2005-2010.
Khan T, Grindlay D, Ollivere BJ, et al. A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone Joint J. 2017;17-25.
Zhang Z, Zhuo Q, Chai W, Ni M, Li H, Chen J. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: a retrospective study. Medicine (Baltimore). 2016;95:e4751.
Drew JM, Griffin WL, Odum SM, Van Doren B, Weston BT, Stryker LS. Survivorship after periprosthetic femur fracture: factors affecting outcome. J Arthroplasty. 2016;31:1283-1288.
Bellova P, Baecker H, Lotzien S, Brandt M, Schildhauer TA, Gessmann J. Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties. J Orthop Surg Res. 2019;14:432.
Quah C, Porteous M, Stephen A. Principles of managing Vancouver type B periprosthetic fractures around cemented polished tapered femoral stems. Eur J Orthop Surg Traumatol. 2017;27:477-482.
Cohen S, Flecher X, Parratte S, et al. Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision. Orthop Traumatol Surg Res. 2018;104:363-367.
Cottino U, Dettoni F, Caputo G, Bonasia DE, Rossi P, Rossi R. Incidence and pattern of periprosthetic hip fractures around the stem in different stem geometry. Int Orthop. 2020;44:53-59.
Smitham PJ, Carbone TA, Bolam SM, et al. Vancouver B2 peri-prosthetic fractures in cemented femoral implants can be treated with open reduction and internal fixation alone without revision. J Arthroplasty. 2019;34:1430-1434.
Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38:651-654.
Stoffel K, Horn T, Zagra L, Mueller M, Perka C, Eckardt H. Periprosthetic fractures of the proximal femur: beyond the Vancouver classification. EFORT Open Rev. 2020;5:449-456.
Pepke W, Nadorf J, Ewerbeck V, et al. Primary stability of the Fitmore® stem: biomechanical comparison. Int Orthop. 2014;38:483-488.
Ehrnthaller C, Olivier AC, Gebhard F, Dürselen L. The role of lesser trochanter fragment in unstable pertrochanteric A2 proximal femur fractures-is refixation of the lesser trochanter worth the effort? Clin Biomech. 2017;42:31-37.
Chang S-M, Zhang Y-Q, Ma Z, Li Q, Dargel J, Eysel P. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg. 2015;135:811-818.
Nie B, Chen X, Li J, Wu D, Liu Q. The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study. J Orthop Surg Res. 2017;12:197.
Cho MR, Lee JH, Kwon JB, Do JS, Chae SB, Choi WK. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg. 2018;10:292-298.
Van Houwelingen AP, Duncan CP. The pseudo A(LT) periprosthetic fracture: it's really a B2. Orthopedics. 2011;34:e479-e481.
Capello WN, D'Antonio JA, Naughton M. Periprosthetic fractures around a cementless hydroxyapatite-coated implant: a new fracture pattern is described. Clin Orthop Relat Res. 2014;472:604-610.
Huang JF, Jiang XJ, Shen JJ, Zhong Y, Tong PJ, Fan XH. Modification of the Unified Classification System for periprosthetic femoral fractures after hip arthroplasty. J Orthop Sci. 2018;23:982-986.
Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;713-716.
Moazen M, Jones AC, Jin Z, Wilcox RK, Tsiridis E. Periprosthetic fracture fixation of the femur following total hip arthroplasty: a review of biomechanical testing. Clin Biomech. 2011;26:13-22.
Andriamananaivo T, Odri G-A, Ollivier M, et al. Contribution of the remaining attachment index in the management of Vancouver B1 periprosthetic hip fracture. Orthop Traumatol Surg Res. 2020;106:1413-1417.
Bergmann G, Graichen F, Rohlmann A, et al. Realistic loads for testing hip implants. Biomed Mater Eng. 2010;20:65-75.
Bergmann G, Bender A, Dymke J, Duda G, Damm P. Standardized loads acting in hip implants. PLoS One. 2016;11:e0155612.
Gueorguiev B, Ockert B, Schwieger K, et al. Angular stability potentially permits fewer locking screws compared with conventional locking in intramedullary nailed distal tibia fractures: a biomechanical study. J Orthop Trauma. 2011;25:340-346.
Windolf M, Muths R, Braunstein V, Gueorguiev B, Hänni M, Schwieger K. Quantification of cancellous bone-compaction due to DHS® blade insertion and influence upon cut-out resistance. Clin Biomech. 2009;24:53-58.
Bergmann G, Deuretzbacher G, Heller M, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859-871.
Baum C, Leimbacher M, Kriechling P, Platz A, Cadosch D. Treatment of periprosthetic femoral fractures Vancouver type B2: revision arthroplasty versus open reduction and internal fixation with locking compression plate. Geriatr Orthop Surg Rehabil. 2019;10:2151459319876859.
Cohen S, Flecher X, Parratte S, Ollivier M, Argenson JN. Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision. Orthop Traumatol Surg Res. 2018;104:363-367.
Cassidy JT, Kenny P, Keogh P. Failed osteosynthesis of cemented B1 periprosthetic fractures. Injury. 2018;49:1927-1930.
Stoffel K, Blauth M, Joeris A, Blumenthal A, Rometsch E. Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. Arch Orthop Trauma Surg. 2020;140:1381-1394.
Gulsen M. The biomechanical assessment of fixation methods in periprosthetic femur fractures. Acta Orthop Traumatol Turc. 2011;45:266-269.
Sarıyılmaz K. Comparison of fixation techniques in Vancouver type AG periprosthetic femoral fracture: a biomechanical study. Acta Orthop Traumatol Turc. 2015.
Demos HA, Briones MS, White PH, Hogan KA, Barfield WR. A biomechanical comparison of periprosthetic femoral fracture fixation in normal and osteoporotic cadaveric bone. the. J Arthroplasty. 2012;27:783-788.
Johnson AJ, Desai S, Zhang C, et al. A calcar collar is protective against early Torsional/Spiral periprosthetic femoral fracture: a paired cadaveric biomechanical analysis. J Bone Joint Surg Am. 2020;102:1427-1433.
Waligora AC, Owen JR, Wayne JS, Hess SR, Golladay GJ, Jiranek WA. The effect of prophylactic cerclage wires in primary total hip arthroplasty: a biomechanical study. J Arthroplasty. 2017;32:2023-2027.