Three-dimensional analysis of the cortical contact state of short and conventional stems in different stem positions in total hip arthroplasty. (March 2021)

• Record Type: Journal Article
• Authors: Shoji, Takeshi; Saka, Hideki; Inoue, Tadashi; Kato, Yuichi; Fujiwara, Yusuke; Yamasaki, Takuma; Yasunaga, Yuji; Adachi, Nobuo
• Is Part Of: Clinical biomechanics. Volume 83(2021)
• Publication Date: 2021-03
• Subjects: Total hip arthroplasty -- Cementless short stem -- Cortical contact state -- 3-dimensinal analysis; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2021.105297
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software. Methods: We reviewed 153 hips in 153 patients, grouped according to femoral canal type—normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete Microplasty Ⓡ stem. Findings: The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem. Interpretation: We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions. Highlights: Short stems achieve the same cortical contact as conventional stems in any types of femoral canal. The extended/flexed stem positions increase distal contact in conventional stems. The distal contact may increase in patients with high femoral anteversion.