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Kazemirad S, Yazdi MA. The assessment of implant shape-dependent failure mechanisms in primary total hip arthroplasty using finite element analysis. Comput Methods Biomech Biomed Engin 2024:1-14. [PMID: 38247427 DOI: 10.1080/10255842.2023.2301676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
The three mechanisms known to be responsible for the failure of uncemented femoral stems in primary total hip arthroplasty (THA) are the stress shielding, excessive bone-implant interface stress, and excessive initial micromotion. Since implant designers usually have to sacrifice two mechanisms to improve the other one, the aim of this study was to assess which of them plays a more important role in the failure of uncemented stems. Two hip implant stems which are widely used in the primary THA and their mid-term clinical outcomes are available, were selected. Then, the amount of the three failure mechanisms created by each stem during the normal walking gait cycle was determined for a 70 kg female patient using the finite element method. The results indicated that the stem with better clinical outcome induced an average of 36.6% less stress shielding in the proximal regions of femur bone compared with the other stem. However, the maximum bone-implant interface stress and maximum initial micromotion were, respectively, 30 and 155% higher for the stem with better clinical outcomes. It was therefore concluded that the stress shielding has a more significant impact on the mid-term life of uncemented stems. However, care must be taken to ensure that the other two failure mechanisms do not exceed a certain threshold. It was also observed that the thinner and shorter stem created a smaller amount of stress shielding in the femur bone. The outcomes of this study can be used to design new hip implant stems that can potentially last longer.
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Affiliation(s)
- Siavash Kazemirad
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Ali Yazdi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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Wang XQ, Ren XQ, Qin DA. Thigh pain after total hip arthroplasty. Int J Surg 2023; 109:3236-3237. [PMID: 37410027 PMCID: PMC10583958 DOI: 10.1097/js9.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Xiao-qiang Wang
- Department of Medical Imaging Center, Shanxi Provincial People’s Hospital
| | - Xiao-qiang Ren
- Department of Medical Information Center, Shanxi Provincial People’s Hospital
| | - De-an Qin
- Department of Orthopedics, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
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Messner M, Jacob R, Hagewood J, Broadfoot J, Chandler K, Medawar N, Prahad S, Naranje S. Bone remodeling and cortical thinning distal to the femoral stem: a retrospective review. Arch Orthop Trauma Surg 2023; 143:6461-6467. [PMID: 37055631 DOI: 10.1007/s00402-023-04860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION There is a paucity of information on the bone remodeling that occurs distal to the femoral stem following total hip arthroplasty as most previous studies have focused on proximal changes. In this study, we report the cortical thinning that occur distal to the femoral stem after primary total hip arthroplasty. METHODS A retrospective review was performed at one institution over a 5-year period. 156 primary total hip arthroplasty procedures were included. The Cortical Thickness Index (CTI) was measured on both operative and non-operative hips at 1 cm, 3 cm and 5 cm below the prosthetic stem tip on anteroposterior radiographic images pre-operatively as well as at 6 months, 12 months and 24 months post-operatively. The difference in average CTI was measured using paired t-tests. RESULTS There were statistically significant decreases in CTI distal to the femoral stem at 12 months and 24 months (-1.3% and -2.8%, respectively). Greater losses were seen in female patients, patients older than 75, and patients with BMI less than 35 at 6 months postoperative. There were no differences in CTI at any time point on the non-operative side. CONCLUSION The current study demonstrates that patients undergo bone loss as measured by CTI distal to the stem in the first 2 years following total hip arthroplasty. Comparison to the contralateral non-operative side confirms that this change is greater than expected for the natural aging process. A greater understanding of these changes will help optimize post-operative management and direct future innovations in implant design.
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Affiliation(s)
- Mitchell Messner
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roshan Jacob
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Hagewood
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jackson Broadfoot
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Chandler
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nick Medawar
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sri Prahad
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sameer Naranje
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Michel B, Augat P, Berninger MT, Keppler L, Simon G, von Rüden C, Birkenmaier C, Schipp R, Becker J. Influence of different CCD angles on osseointegration and radiological changes after total hip arthroplasty of a triple wedge shape cementless femoral stem: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05776-z. [PMID: 36973427 DOI: 10.1007/s00264-023-05776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/11/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the osseointegration and radiological outcomes in patients after total hip arthroplasty, hypothesizing different load patterns with one cementless stem design and different CCD angles (CLS Spotorno femoral stem 125° vs 135°). METHODS All cases of degenerative hip osteoarthritis fulfilling strict inclusion criteria were treated with cementless hip arthroplasty between 2008 and 2017. Ninety-two out of one hundred six cases were clinically and radiologically examined three and 12 months after implantation. Two groups with each 46 patients were rendered prospectively and compared in clinical (Harris Hip Score) and radiological outcome. RESULTS At final follow-up, no significant difference regarding Harris Hip Score was detected between the two groups (mean 99.2 ± 3.7 vs. 99.3 ± 2.5; p = 0.73). Cortical hypertrophy was found in none of the patients. Stress shielding was seen in a total of 52 hips (n = 27 vs. n = 25; 57% of the 92 hips). No significant difference regarding stress shielding was detected when comparing both groups (p = 0.67). Significant bone density loss was detected in Gruen zone one and two in the 125° group. The 135° group showed significant radiolucency in Gruen zone seven. No overall radiological loosening or subsidence of the femoral component was observed. CONCLUSION According to our results, the use of a femoral component with a 125° CCD angle versus a 135° CCD did not result in a different osseointegration and load transfer with a clinically relevant significance.
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Affiliation(s)
- Björn Michel
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Peter Augat
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - Markus T Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Keppler
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Gerhard Simon
- Klinikum Garmisch-Partenkirchen, Department of Radiology & Nuclear Medicine, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Christian von Rüden
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Christof Birkenmaier
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, Ludwig-Maximilians Universität Munich, Munich, Germany
- Artemed Klinikum München Süd, Am Isarkanal 30, 81379, Munich, Germany
| | - Rolf Schipp
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Johannes Becker
- Klinikum Garmisch-Partenkirchen, Endogap, Joint Replacement Institute, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany.
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.
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Aubert T, Auberger G, Gerard P, Lhotellier L, Marmor S, Graff W. Risk Factors Associated With Femorotomy or Fracture During Cementless Stem Removal and Generation of an Individual Predictive Risk Score. J Arthroplasty 2023; 38:341-346.e2. [PMID: 36116687 DOI: 10.1016/j.arth.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Femorotomy is a commonly used technique during cementless stem removal but should be preferred in selective revision cases to prevent intraoperative femoral fracture associated with deteriorated clinical outcome. Our aim was to assess the risk factors for fracture or femorotomy and develop a predictive risk stratification score. METHODS A monocentric retrospective cohort including 202 patients was analyzed. Thirty six candidate prognostic factors were assessed. RESULTS The following independent predictors of fracture or femorotomy were identified: presence of a "bracket sign" (Odds Ratio [OR]: 10.857; 95% Confidence interval [CI]: 2.613-45.115; P = .001) defined as a distal spot weld between the surface of the implant and closest endosteum, bone contact in zone 2 (OR: 4.700; 95% CI: 1.827-12.089; P = .001), 6 (OR: 4.966; 95% CI: 1.823-13.530; P = .002), 12 (OR: 9.660; 95% CI: 3.715-25.116; P < .0001), 13 (OR: 2.958; 95% CI: 1.009-8.021; P = .033), and global hypertrophy (OR: 0.170; 95% CI: 0.036-0.806; P = .026). The prognostic score, named Femorotomy INcidence Numeric scoring system, had good performance and discriminability; the area under the curve of the model was 0.924 (95% CI: 0.878-0.969). CONCLUSION The only independent risk factors were those assessed on X-ray (eg, bracket sign, bone contact in zones 2, 6, 12, and 13), while global hypertrophy was protective. We noticed the importance of differentiating pedestals and "bracket signs"; the latter is an indicator of fixation of the stem. We developed a risk prediction score (Femorotomy INcidence Numeric score) of fracture or femorotomy that can be used as a companion tool to assess the risk for doing an early osteotomy of the femur.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Auberger
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Luc Lhotellier
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Simon Marmor
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Wilfrid Graff
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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Fukunishi S, Takeda Y, Fukui T, Nishio S, Tachibana T, Fujihara Y. Long term results of the Bicontact D stem in dysplastic osteoarthritis: a 10-15 year follow-up study. Arch Orthop Trauma Surg 2022; 142:3987-3993. [PMID: 34817670 DOI: 10.1007/s00402-021-04262-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the present study was to investigate the results of total hip arthroplasty (THA) using the Bicontact D stem with a minimum 10 year follow-up that focused on patients with developmental dysplasia of the hip (DDH). METHODS One hundred five patients with osteoarthritis due to DDH who underwent primary THA were included in this study. The mean final follow-up period was 12.7 ± 1.2 years (range 10-15 years). All cases were evaluated both clinically and radiographically, and Kaplan-Meier survivorship was determined as stem revision for any reason as the end point. RESULTS Modified Harris hip score averaged 89.0 ± 1.1 (range 60-98) at the final follow-up. The survivorship was 99.0% (95% confidence interval 93.4-99.9%) at 15.0 years, and only one hip with a well-fixed stem required stem revision due to recurrent dislocations. Cortical hypertrophy (CH) was observed in 40 of 105 hips (38.1%), and stress shielding (SS) progressed to grade 3 or 4 in six hips (6 of 105 hips: 5.7%) during the study period. Among the six hips with progressed SS, Dorr type C proximal femoral geometry was seen in five hips. CONCLUSION This study of 105 THAs using the Bicontact D stem that focused on DDH patients with a minimum 10 year follow-up period achieved satisfactory clinical and radiological outcomes. Dorr type C proximal femoral geometry could be considered a risk factor for progressed SS.
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Affiliation(s)
- Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya, Hyogo, 662-0957, Japan.
| | - Yu Takeda
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya, Hyogo, 662-0957, Japan
| | - Tomokazu Fukui
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shoji Nishio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Morita A, Kobayashi N, Choe H, Tezuka T, Misumi T, Inaba Y. Effect of implant composition on periprosthetic bone mineral density after total hip arthroplasty. Arch Orthop Trauma Surg 2022; 143:2763-2771. [PMID: 35857120 DOI: 10.1007/s00402-022-04537-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The severity of bone mineral density (BMD) loss after total hip arthroplasty (THA) depends on both implant- and patient-related factors. While implant fixation type is an important factor, but few studies have considered the effect of material composition on the same implant fixation type. In particular, differences in mechanical stiffness due to material composition are of great interest. Here, we compared changes in periprosthetic BMD after THA using proximal fixation concept stems comprising different titanium alloys, i.e., β titanium alloys stem and α + β titanium alloys stem. METHODS This retrospective cohort included 122 patients (β titanium alloys stem, 61 cases; α + β titanium alloys stem, 61 cases) who underwent primary THA between January 2009 and December 2019. The primary outcome was the change in periprosthetic BMD from base line. Age, body mass index, diagnosis, stem size, canal flare index, surgical approach, pre-operative lumbar BMD, and pre-operative activity scores were reviewed and changes in periprosthetic BMD between the two groups were compared using analysis of covariance. The secondary outcome was radiographic response after THA. RESULTS There was significant difference in periprosthetic BMD in zone 6 and 7 at 2 years (p < 0.05) between the two groups. There was no significant difference in other zones. A significant difference in radiographic response was noted only for the Engh classification. CONCLUSION α + β titanium alloys stem resulted in a significantly higher rate of BMD loss in zones 6 and 7 compared with the β titanium alloys stem. These results may be due to differences in mechanical stiffness due to the different titanium alloy composition of the prosthetics.
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Affiliation(s)
- Akira Morita
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
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Personalized Artificial Tibia Bone Structure Design and Processing Based on Laser Powder Bed Fusion. MACHINES 2022. [DOI: 10.3390/machines10030205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bone defects caused by bone diseases and bone trauma need to be implanted or replaced by surgery. Therefore, it is of great significance to design and prepare a tibial implant with good biocompatibility and excellent comprehensive mechanical properties. In this paper, with 316L stainless steel powder as the main material, a personalized artificial tibia design and processing method based on laser powder bed fusion is proposed. Firstly, the personalized model of the damaged part of the patient is reconstructed. Then, the porous structure of human tibia is manufactured by selective laser melting technology. To research the factors affecting the quality of selective laser melting porous structure, a laser heat source model, heat transfer model and molten pool model of laser powder bed fusion process were constructed; then, by changing the laser process parameters (laser power, laser beam diameter, scanning speed, powder layer thickness, etc.) to conduct multiple sets of simulation experiments, it is obtained that when the “laser power is 180 W, the laser scanning speed is 1000 mm/s, the laser beam diameter is 80 μm, the powder layer thickness is 50 μm”, the porous stainless steel parts with better quality can be obtained. Finally, the porous structure was fabricated by selective laser processing, and its properties were tested and analyzed. The experimental results show that the cell side length of cube is 1.2 mm, the elastic modulus of octahedral porous structure with pillar diameter of 0.35 mm is about 17.88 GPa, which match well with tibial bone tissue.
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Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma. J Clin Med 2021; 10:jcm10153424. [PMID: 34362209 PMCID: PMC8347309 DOI: 10.3390/jcm10153424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023] Open
Abstract
(1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is periprosthetic osteolysis around the stem, also known as stress shielding. The frequency, potential risk factors, and the effect on implant survival are unknown. (2) Methods: A retrospective single-center study of 65 patients with sarcoma who underwent resection of the proximal humerus and subsequent reconstruction with a modular endoprosthesis. Stress shielding was defined as the development of bone resorption around the prosthesis stem beginning at the bone/prosthesis interface. The extent of stress shielding was measured with a new method quantifying bone resorption in relation to the intramedullary stem length. All patients had a minimum follow-up of 12 months with conventional radiographs available and the median follow-up amounted to 36 months. (3) Results: Stress shielding was observed in 92% of patients (60/65). The median longitudinal extent of stress shielding amounted to 14% at last follow-up. Fifteen percent (10/65) showed bone resorption of greater than 50%. The median time to the first radiographic signs of stress shielding was 6 months (IQR 3–9). Patients who underwent chemotherapy (43/65) showed a greater extent of stress shielding compared to those without chemotherapy. Three percent (2/65) of patients were revised for aseptic loosening, and one patient had a periprosthetic fracture (1/65, 1.5%). All these cases had >20% extent of stress shielding (23–57%). (4) Conclusions: Stress shielding of the proximal humerus after shoulder reconstruction with modular megaprosthesis is common. It occurs within the first year of follow-up and might be self-limiting in many patients; however, about one third of patients shows progression beyond the first year. Still, mechanical complications were rare, but stress shielding might be clinically relevant in individual cases. The extent of stress shielding was increased in patients who underwent perioperative chemotherapy. Stress shielding can be quantified with an easy method using the stem length as a reference.
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Floerkemeier T. Patientenspezifische Planung in der Hüftendoprothetik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Giannicola G, Castagna V, Villani C, Gumina S, Scacchi M. Does shape and size of the stems affect the stress-shielding around press-fit radial head arthroplasty? Bone Joint J 2021; 103-B:530-535. [PMID: 33641422 DOI: 10.1302/0301-620x.103b3.bjj-2020-1421.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS It has been hypothesized that proximal radial neck resorption (PRNR) following press-fit radial head arthroplasty (RHA) is due to stress-shielding. We compared two different press-fit stems by means of radiographs to investigate whether the shape and size of the stems are correlated with the degree of PRNR. METHODS The radiographs of 52 RHAs were analyzed both at 14 days postoperatively and after two years. A cylindrical stem and a conical stem were implanted in 22 patients (group 1) and 30 patients (group 2), respectively. The PRNR was measured in the four quadrants of the radial neck and the degree of stem filling was calculated by analyzing the ratio between the prosthetic stem diameter (PSD) and the medullary canal diameter (MCD) at the proximal portion of the stem (level A), halfway along the stem length (level B), and distally at the stem tip (level C). RESULTS Overall, 50 of the 52 patients displayed PRNR. The mean PRNR observed was 3.9 mm (0 to 7.4). The degree of endomedullary stem filling at levels A, B, and C was 96%, 90%, and 68% in group 1, and 96%, 72%, and 57%, in group 2, with differences being significant at levels B (p < 0.001) and C (p < 0.001). No significant correlations emerged between the severity of PRNR and the three stem/canal ratios either within each group or between the groups. CONCLUSION PRNR in press-fit RHA appears to be independent of the shape and size of the stems. Other causes besides stem design should be investigated to explain completely this phenomenon. Cite this article: Bone Joint J 2021;103-B(3):530-535.
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Affiliation(s)
- Giuseppe Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Valerio Castagna
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Ciro Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Scacchi
- Shoulder and Elbow Unit, Centro Ortopedico Traumatologico A. Alesini, Rome, Italy
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