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Favre P, Bischoff J. Identifying the patient harms to include in an in silico clinical trial. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107735. [PMID: 37544163 DOI: 10.1016/j.cmpb.2023.107735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Clinical trials represent a crucial step in the development and approval of medical devices. These trials involve evaluating the safety and efficacy of the device in a controlled setting with human subjects. However, traditional clinical trials can be expensive, time-consuming, and ethically challenging. Augmenting clinical trials with data from computer simulations, so called in silico clinical trials (ISCT), has the potential to address these challenges while satisfying regulatory requirements. However, determination of the patient harms in scope of an ISCT is necessary to ensure all harms are sufficiently addressed while maximizing the utility of the ISCT. This topic is currently lacking guidance. The objective of this work is to propose a general method to determine which patient harms should be included in an ISCT for a regulatory submission. METHODS The proposed method considers the risk associated with the harm, the impact of the device on the likelihood of occurrence of the harm and the technical feasibility of evaluating the harm via ISCT. Consideration of the risk associated with the harm provides maximum clinical impact of the ISCT, in terms of focusing on those failure modes which are most relevant to the patient population. Consideration of the impact of the device on a particular harm, and the technical feasibility of modeling a particular harm supports that the technical effort is devoted to a problem that (1) is relevant to the device in question, and (2) can be solved with contemporary modeling techniques. RESULTS AND CONCLUSIONS As a case study, the proposed method is applied to a total shoulder replacement humeral system. With this framework, it is hoped that a consistent approach to scoping an ISCT can be adopted, supporting investment in ISCT by the industry, enabling consistent review of the ISCT approach across device disciplines by regulators, and providing maximum impact of modeling technologies in support of devices to improve patient outcomes.
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Affiliation(s)
| | - Jeff Bischoff
- Zimmer Biomet, 1800 West Center Street, Warsaw, IN 46580, USA
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Maeda T, Nakano M, Nakamura Y, Momose T, Sobajima A, Takahashi J, Nakata K, Nawata M. Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty. J Clin Med 2023; 12:jcm12093138. [PMID: 37176578 PMCID: PMC10179674 DOI: 10.3390/jcm12093138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Although tapered-wedge short stem has been widely employed with its availability for minimally invasive surgeries in total hip arthroplasty (THA), post-operative stress shielding matter remains unresolved in cementless procedures. This study aimed to clarify the most optimal femoral canal contact regions of the stem design taking stress shielding incidence into consideration. This investigation included 60 joints from 60 patients (mean age at operation: 65.9 years), of which follow-up duration after primary THA had been more than 2 years. Frequencies of spot welds, subsidence, and stress shielding were examined 2 years after surgery. The most suitable femoral canal contact regions were evaluated by plain radiograph (2D) and 3D-computed tomography analyses according to Nakata's division for fitting manners. Spot welds were observed in 38 cases (63.3%), and no subsidence case was seen. Respective number of stress shielding cases, based on Engh's classification, categorized as degree 0, 1, and 2, were 2 (3.3%), 31 (51.7%), and 27 (45.0%), while no cases for degree 3 or 4 were found. When assessed by 3D fitting analysis, 27 cases of stress shielding degree 2 were constituted by 13/42 cases of mediolateral (ML) fit, 2/4 cases of flare fit, and 12/14 cases of multi point fit. In 42 cases of ML fitting, stem contact rate of the most proximedial region in stress shielding degree 0 and 1 was significantly higher compared to stress shielding degree 2 cases. Meanwhile, the rates of distal regions were significantly lower or absent in stress shielding degree 0 and 1 cases. The initial fixation of this stem design was very good in our cohort regardless of fitting manners. This study successfully revealed that ML fitting with femoral component, especially the most proximedial calcar site restricted fitting, would be optimal for reducing stress shielding occurrence in cementless short, tapered-wedge stem THA. Thus, the ideal stem contact region should be considered during THA procedures in light of the reduction of stress shielding development.
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Affiliation(s)
- Takashi Maeda
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, Japan
| | - Masaki Nakano
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Takashige Momose
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, Japan
| | - Atsushi Sobajima
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Katsuya Nakata
- Department of Orthopaedic Surgery, JCHO Osaka Hospital, Fukushima-ku, Osaka 553-0003, Japan
| | - Masashi Nawata
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto 390-8601, Japan
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Shao X, Dou M, Yang Q, Li J, Zhang A, Yao Y, Chu Q, Li K, Li Z. Reconstruction of massive bone defects after femoral tumor resection using two new-designed 3D-printed intercalary prostheses: a clinical analytic study with the cooperative utilization of multiple technologies. BMC Musculoskelet Disord 2023; 24:67. [PMID: 36698116 PMCID: PMC9875495 DOI: 10.1186/s12891-023-06171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To reconstruct massive bone defects of the femoral diaphysis and proximal end with limited bilateral cortical bone after joint-preserving musculoskeletal tumor resections, two novel 3D-printed customized intercalary femoral prostheses were applied. METHODS A series of nine patients with malignancies who received these novel 3D-printed prostheses were retrospectively studied between July 2018 and November 2021. The proximal and diaphyseal femur was divided into three regions of interest (ROIs) according to anatomic landmarks, and anatomic measurements were conducted on 50 computed tomography images showing normal femurs. Based on the individual implant-involved ROIs, osteotomy level, and anatomical and biomechanical features, two alternative 3D-printed prostheses were designed. In each patient, Hounsfield Unit (HU) value thresholding and finite element analysis were conducted to identify the bone trabecula and calcar femorale and to determine the stress distribution, respectively. We described the characteristics of each prosthesis and surgical procedure and recorded the intraoperative data. All patients underwent regular postoperative follow-up, in which the clinical, functional and radiographical outcomes were evaluated. RESULTS With the ROI division and radiographic measurements, insufficient bilateral cortical bones for anchoring the traditional stem were verified in the normal proximal femur. Therefore, two 3D-printed intercalary endoprostheses, a Type A prosthesis with a proximal curved stem and a Type B prosthesis with a proximal anchorage-slot and corresponding locking screws, were designed. Based on HU value thresholding and finite element analysis, the 3D-printed proximal stems in all prostheses maximally preserved the trabecular bone and calcar femorale and optimized the biomechanical distribution, as did the proximal screws. With the 3D-printed osteotomy guide plates and reaming guide plates, all patients underwent the operation uneventfully with a satisfactory duration (325.00 ± 62.60 min) and bleeding volume (922.22 ± 222.36 ml). In the follow-up, Harris Hip and Musculoskeletal Tumor Society scores were ameliorated after surgery (P < 0.001 and P < 0.001, respectively), reliable bone ingrowth was observed, and no major complications occurred. CONCLUSIONS Two novel 3D-printed femoral intercalary prostheses, which achieved acceptable overall postoperative outcomes, were used as appropriate alternatives for oncologic patients with massive bone defects and limited residual bone and increased the opportunities for joint-preserving tumor resection. Several scientific methodologies utilized in this study may promote the clinical design proposals of 3D-printed implants.
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Affiliation(s)
- Xianhao Shao
- grid.460018.b0000 0004 1769 9639Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Mengmeng Dou
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.417024.40000 0004 0605 6814Department of Biomedical Engineering, Tianjin First Central Hospital, Tianjin, 300070 China
| | - Qiang Yang
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Jianmin Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Ailin Zhang
- grid.417021.10000 0004 0627 7561Physiotherapy department, Acute Neurosciences, the Wesley Hospital, 451 Coronation Drive, Auchenflower, QLD 4066 Australia
| | - Yuan Yao
- Department of Radiography, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Qing Chu
- grid.415105.40000 0004 9430 5605State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China ,grid.415105.40000 0004 9430 5605Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037 China
| | - Ka Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Zhenfeng Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
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New method to apply the lumbar lordosis of standing radiographs to supine CT-based virtual 3D lumbar spine models. Sci Rep 2022; 12:20382. [PMID: 36437349 PMCID: PMC9701766 DOI: 10.1038/s41598-022-24570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
Standing radiographs play an important role in the characterization of spinal sagittal alignment, as they depict the spine under physiologic loading conditions. However, there is no commonly available method to apply the lumbar lordosis of standing radiographs to supine CT-based virtual 3D models of the lumbar spine. We aimed to develop a method for the sagittal rigid-body registration of vertebrae to standing radiographs, using the exact geometry reconstructed from CT-data. In a cohort of 50 patients with monosegmental spinal degeneration, segmentation and registration of the lumbar vertebrae and sacrum were performed by two independent investigators. Intersegmental angles and lumbar lordosis were measured both in CT scans and radiographs. Vertebrae were registered using the X-ray module of Materialise Mimics software. Postregistrational midsagittal sections were constructed of the sagittal midplane sections of the registered 3D lumbar spine geometries. Mean Hausdorff distance was measured between corresponding registered vertebral geometries. The registration process minimized the difference between the X-rays' and postregistrational midsagittal sections' lordoses. Intra- and inter-rater reliability was excellent based on angle and mean Hausdorff distance measurements. We propose an accessible, accurate, and reproducible method for creating patient-specific 3D geometries of the lumbar spine that accurately represent spinal sagittal alignment in the standing position.
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Calcar femorale variation in extant and fossil hominids: Implications for identifying bipedal locomotion in fossil hominins. J Hum Evol 2022; 167:103183. [DOI: 10.1016/j.jhevol.2022.103183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022]
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Jyoti, Mondal S, Ghosh R. Biomechanical analysis of three popular tibial designs for TAR with different implant-bone interfacial conditions and bone qualities: A finite element study. Med Eng Phys 2022; 104:103812. [DOI: 10.1016/j.medengphy.2022.103812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
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Youssefian S, Bressner JA, Osanov M, Guest JK, Zbijewski WB, Levin AS. Sensitivity of the stress field of the proximal femur predicted by CT-based FE analysis to modeling uncertainties. J Orthop Res 2022; 40:1163-1173. [PMID: 34191377 PMCID: PMC8716646 DOI: 10.1002/jor.25138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/25/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Proximal femur anatomy and bone mineral density vary widely among individuals, precluding the use of one predefined finite element (FE) model to determine the stress field for all proximal femurs. This variability poses a challenge in current prosthetic hip design approach. Given the numerous options for generating computed tomography (CT)-based FE models, selecting the best methods for defining the mechanical behavior of the proximal femur is difficult. In this study, a combination of computational and experimental approaches was used to explore the susceptibility of the predicted stress field of the proximal femur to different combinations of density-elasticity relationships, element type, element size, and calibration error. Our results suggest that FE models with first-order voxelized elements generated by the Keyak and Falkinstein density-elasticity relationship or quadratic tetrahedral elements generated by the Morgan density-elasticity relationship lead to accurate estimations of the mechanical behavior of human femurs. Other combinations of element size, element type, and mathematical relationships produce less accurate results, especially in the cortical bone of the femoral neck and calcar region. The voxelized model was more susceptible to variation of element size and density-elasticity relationships than FE models with quadratic tetrahedral elements. Regardless of element type, the stress fields predicted by the Keyak and Falkinstein and the Morgan relationships were the most robust to calibration error when deriving material density from CT-generated Hounsfield data. These results provide insight into the implementation of a robust platform for designing patient-specific implants capable of maintaining or modifying the stress in bones.
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Affiliation(s)
- Sina Youssefian
- Department of Civil and Systems Engineering The Johns Hopkins University Baltimore Maryland USA
| | - Jarred A. Bressner
- Department of Orthopaedic Surgery The Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Mikhail Osanov
- Department of Civil and Systems Engineering The Johns Hopkins University Baltimore Maryland USA
| | - James K. Guest
- Department of Civil and Systems Engineering The Johns Hopkins University Baltimore Maryland USA
| | - Wojciech B. Zbijewski
- Department of Biomedical Engineering The Johns Hopkins University Baltimore Maryland USA
| | - Adam S. Levin
- Department of Orthopaedic Surgery The Johns Hopkins University School of Medicine Baltimore Maryland USA
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Azari F, Sas A, Kutzner KP, Klockow A, Scheerlinck T, van Lenthe GH. Cemented short-stem total hip arthroplasty: Characteristics of line-to-line versus undersized cementing techniques using a validated CT-based finite element analysis. J Orthop Res 2021; 39:1681-1690. [PMID: 33095461 DOI: 10.1002/jor.24887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Short stems are becoming increasingly popular in total hip arthroplasty as they preserve the bone stock and simplify the implantation process. Short stems are advised mainly for patients with good bone stock. The clinical use of short stems could be enlarged to patients with poor bone stock if a cemented alternative would be available. Therefore, this study aimed to quantify the mechanical performance of a cemented short stem and to compare the "undersized" cementing strategy (stem one size smaller than the rasp) with the "line-to-line" technique (stem and rasp with identical size). A prototype cemented short stem was implanted in eight pairs of human cadaveric femora using the two cementing strategies. Four pairs were experimentally tested in a single-legged stance condition; stiffness, strength, and bone surface displacements were measured. Subject-specific nonlinear finite element models of all the implanted femora were developed, validated against the experimental data, and used to evaluate the behavior of cemented short stems under physiological loading conditions resembling level walking. The two cementing techniques resulted in nonsignificant differences in stiffness and strength. Strength and stiffness as calculated from finite element were 8.7 ± 16% and 9.9 ± 15.0% higher than experimentally measured. Displacements as calculated from finite element analyses corresponded strongly (R 2 ≥ .97) with those measured by digital image correlation. Stresses during level walking were far below the fatigue limit for bone and bone cement. The present study suggests that cemented short stems are a promising solution in osteoporotic bone, and that the line-to-line and undersized cementing techniques provide similar outcomes.
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Affiliation(s)
| | - Amelie Sas
- Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Karl P Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
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Scheerlinck T, De Winter E, Sas A, Kolk S, Van Gompel G, Vandemeulebroucke J. Hip implants can restore anatomical and medialized rotation centres in most cases : a 3D templating study comparing four implantation strategies. Bone Jt Open 2021; 2:476-485. [PMID: 34236237 PMCID: PMC8325978 DOI: 10.1302/2633-1462.27.bjo-2021-0065.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aims Hip arthroplasty does not always restore normal anatomy. This is due to inaccurate surgery or lack of stem sizes. We evaluated the aptitude of four total hip arthroplasty systems to restore an anatomical and medialized hip rotation centre. Methods Using 3D templating software in 49 CT scans of non-deformed femora, we virtually implanted: 1) small uncemented calcar-guided stems with two offset options (Optimys, Mathys), 2) uncemented straight stems with two offset options (Summit, DePuy Synthes), 3) cemented undersized stems (Exeter philosophy) with three offset options (CPT, ZimmerBiomet), and 4) cemented line-to-line stems (Kerboul philosophy) with proportional offsets (Centris, Mathys). We measured the distance between the templated and the anatomical and 5 mm medialized hip rotation centre. Results Both rotation centres could be restored within 5 mm in 94% and 92% of cases, respectively. The cemented undersized stem performed best, combining freedom of stem positioning and a large offset range. The uncemented straight stem performed well because of its large and well-chosen offset range, and despite the need for cortical bone contact limiting stem positioning. The cemented line-to-line stem performed less well due to a small range of sizes and offsets. The uncemented calcar-guided stem performed worst, despite 24 sizes and a large and well-chosen offset range. This was attributed to the calcar curvature restricting the stem insertion depth along the femoral axis. Conclusion In the majority of non-deformed femora, leg length, offset, and anteversion can be restored accurately with non-modular stems during 3D templating. Failure to restore hip biomechanics is mostly due to surgical inaccuracy. Small calcar guided stems offer no advantage to restore hip biomechanics compared to more traditional designs. Cite this article: Bone Jt Open 2021;2(7):476–485.
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Affiliation(s)
- Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Medische Beeldvorming en Fysische Wetenschappen (BEFY), Vrije Universiteit Brussel, Brussels, Belgium
| | - Elien De Winter
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Medische Beeldvorming en Fysische Wetenschappen (BEFY), Vrije Universiteit Brussel, Brussels, Belgium
| | - Amelie Sas
- Department of Mechanical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Gert Van Gompel
- Medische Beeldvorming en Fysische Wetenschappen (BEFY), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussel, Belgium.,iMinds, Department of Medical IT, Gent, Belgium
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Favre P, Maquer G, Henderson A, Hertig D, Ciric D, Bischoff JE. In Silico Clinical Trials in the Orthopedic Device Industry: From Fantasy to Reality? Ann Biomed Eng 2021; 49:3213-3226. [PMID: 33973129 PMCID: PMC8110242 DOI: 10.1007/s10439-021-02787-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/24/2021] [Indexed: 11/24/2022]
Abstract
The orthopedic device industry relies heavily on clinical evaluation to confirm the safety, performance, and clinical benefits of its implants. Limited sample size often prevents these studies from capturing the full spectrum of patient variability and real-life implant use. The device industry is accustomed to simulating benchtop tests with numerical methods and recent developments now enable virtual "in silico clinical trials" (ISCT). In this article, we describe how the advancement of computer modeling has naturally led to ISCT; outline the potential benefits of ISCT to patients, healthcare systems, manufacturers, and regulators; and identify how hurdles associated with ISCT may be overcome. In particular, we highlight a process for defining the relevant patient risks to address with ISCT, the utility of a versatile software pipeline, the necessity to ensure model credibility, and the goal of limiting regulatory uncertainty. By complementing-not replacing-traditional clinical trials with computational evidence, ISCT provides a viable technical and regulatory strategy for characterizing the full spectrum of patients, clinical conditions, and configurations that are embodied in contemporary orthopedic implant systems.
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Affiliation(s)
| | - Ghislain Maquer
- Zimmer Biomet, Sulzerallee 8, 8404 , Winterthur, Switzerland
| | - Adam Henderson
- Zimmer Biomet, Sulzerallee 8, 8404 , Winterthur, Switzerland
| | - Daniel Hertig
- Zimmer Biomet, Sulzerallee 8, 8404 , Winterthur, Switzerland
| | - Daniel Ciric
- Zimmer Biomet, Sulzerallee 8, 8404 , Winterthur, Switzerland
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Zhang Z, Xing Q, Li J, Jiang Z, Pan Y, Hu Y, Wang L. A comparison of short-stem prostheses and conventional stem prostheses in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:231. [PMID: 33708858 PMCID: PMC7940904 DOI: 10.21037/atm-20-4043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background In total hip arthroplasty (THA), short-stem prostheses (SS) were designed to achieve better preservation of proximal femoral bone stock and stability than conventional stem prostheses (CS), however these effects are controversial. We aimed perform a systematic review and meta-analysis to evaluate the effectiveness of SS and CS in primary THA. Methods Relevant randomized controlled trials (RCTs) involving the comparison of SS and CS in primary THA were screened using the electronic databases PubMed, Embase and Web of Science. Data were analyzed with the RevMan 5.3 software program and evaluated with mean difference (MD), risk ratio (RR) and 95% confidence intervals (CIs) by random or fixed-effect models. Results Sixteen RCTs involving 1,233 patients (1,486 hips) were included. Compared with CS, the incidence of thigh pain was significantly reduced with Proxima SS (RR 0.13, 95% CI, 0.03–0.51; P=0.004). Bone mineral density (BMD) with femoral neck-preserved SS [SS (I)] showed less decrease in Gruen zone 1 (MD 14.60, 95% CI, 10.67–18.54; P<0.00001) and Gruen zone 7 (MD 9.72, 95% CI, 5.21–14.23; P<0.0001) than CS. However, the changes of BMD were not significantly different between the SS without femoral neck preservation group [SS (II)] and the CS group. In addition, no significant differences were found in the revision rate, Harris Hip Score (HHS), or maximum total point motion (MTPM) between the SS and CS groups. Conclusions The results of this study showed that compared with CS, Proxima SS decreased the incidence of thigh pain and that SS (I) provided better proximal bone remodeling than CS. But the revision rates, HHS, and MTPM between SS and CS were similar. However, the findings of this meta-analysis require further verification in high-quality RCTs.
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Affiliation(s)
- Zhen Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qiqi Xing
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyi Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zichao Jiang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yixiao Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
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