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Performance of the resurfaced hip. Part 2: the influence of prosthesis stem design on remodelling and fracture of the femoral neck

By Alexander Dickinson, Andrew Taylor, Jonathan Jeffers and Martin Browne

Abstract

Hip resurfacing is a popular treatment for osteoarthritis in young, active patients. Previous studies have shown that occasional failures – femoral neck fracture and implant loosening, possibly associated with bone adaptation – are affected by prosthesis sizing and positioning, in addition to patient and surgical factors. With the aim of improving tolerance to surgical variation, finite element modelling was used to indicate the effects of prosthesis metaphyseal stem design on bone remodelling and femoral neck fracture, with a range of implant orientations. The analysis suggested that the intact femoral neck strength in trauma could be maintained across a wider range of varus–valgus orientations for short-stemmed and stemless prostheses. Furthermore, the extent of periprosthetic bone remodelling was lower for the short-stemmed implant, with slightly reduced stress shielding and considerably reduced densification around the stem, potentially preventing further progressive proximal stress shielding. The study suggests that a short-stemmed resurfacing head offers improved tolerance to misalignment and remodelling stimulus over traditional designs. While femoral neck fracture and implant loosening are multifactorial, biomechanical factors are of clear importance to the clinical outcome, so this may reduce the risk for patients at the edge of the indications for hip resurfacing, or shorten the surgical learning curve.<br/><br/

Topics: QP, RD, TJ
Year: 2010
OAI identifier: oai:eprints.soton.ac.uk:143433
Provided by: e-Prints Soton

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  1. A clinical, radiological and biomechanical study of the TARA hip prosthesis. doi
  2. (1983). A survey of finite element analysis in orthopedic biomechanics: the first decade. doi
  3. (1993). Adaptive bone remodelling around a bonded noncemented total hip arthroplasty: a comparison between animal experiments and computer doi
  4. (1960). Anchorage of the femoral head prosthesis to the shaft of the femur.
  5. Biomechanical study of the resurfacing hip arthroplasty – finite element analysis of the femoral component. doi
  6. (2006). Biomechanics of the Birmingham hip
  7. (2006). Bone remodelling inside a cemented resurfaced femoral head. doi
  8. (1978). Cemented double cup arthroplasty of the hip. doi
  9. (2007). Changes in femur stress after hip resurfacing arthroplasty: response to physiological loads. doi
  10. (2004). Comparison of the elastic and yield properties of human femoral trabecular and cortical doi
  11. (1995). Effect of femoral offset on range of motion and abductor muscle strength after total hip
  12. (1998). Evolution and future of surface replacement of the hip. doi
  13. (2006). Failure mechanisms of total hip resurfacing: implications for the present. doi
  14. (2008). Femoral neck fracture following
  15. (2005). Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. doi
  16. (2008). Femoral neck narrowing after metal-onmetal hip resurfacing. doi
  17. (2006). Finite element analysis of the resurfaced femoral head. doi
  18. (2004). Fracture of the neck of the femur after surface arthroplasty of the
  19. (1991). Fracture prediction for the proximal femur using finite element models: Part I – Linear analysis. doi
  20. (1991). Fracture prediction for the proximal femur using finite element models: Part II – Nonlinear analysis. doi
  21. Hip resurfacing increases bone strains associated with short-term femoral neck fracture. doi
  22. (2007). Investigation into the effect of cementing techniques on load transfer in the resurfaced femoral head: a multi-femur finite element analysis. doi
  23. Investigation into the effect of varus–valgus orientation on load transfer in the resurfaced femoral head: a multifemur finite element analysis. doi
  24. (2006). Lessons learned from early clinical experience and results of 300 ASR hip resurfacing implantations. doi
  25. (1979). Low friction arthroplasty of the hip: theory and practice, doi
  26. (2007). Metal-metal hip resurfacing: solution to a nonexistent problem. Orthopedics,
  27. (1996). Metal-on-metal surface replacement of the hip. doi
  28. (2004). Metal-onmetal surface arthroplasty with a cemented femoral component: a 7–10 year follow-up study. doi
  29. (2007). Narrowing of the neck in resurfacing arthroplasty of the doi
  30. (2006). Notching of the femoral neck during resurfacing arthroplasty of the hip. A vascular doi
  31. (2004). Orientation of the femoral component in surface arthroplasty of the hip. A biomechanical and clinical
  32. (2005). Osteonecrosis in retrieved femoral heads after failed resurfacing arthroplasty of the
  33. (2010). Performance of the resurfaced hip. Part 1: the influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck. doi
  34. (2005). Performance of the resurfaced hip. Part 2 849 JEIM680
  35. (1998). Prediction of femoral fracture load using automated finite element modelling. doi
  36. (2000). Prediction of femoral fracture load using finite element models: an examination of stress- and strain-based failure theories. doi
  37. (2009). Role of surgical position on interface stress and initial bone remodeling stimulus around hip resurfacing arthroplasty. doi
  38. (2008). Subject-specific finite element models implementing a maximum principal strain criterion are able to estimate failure risk and fracture location on human femurs tested in-vitro. doi
  39. (1978). Surface replacement arthroplasty of the hip. doi
  40. (2006). Surgical variables affect mechanics of a hip resurfacing system. doi
  41. (1986). THARIES resurfacing arthroplasty, evolution and long term results. doi
  42. (2004). The biomechanical results of total hip resurfacing
  43. (1991). The effect of adaptive bone remodelling threshold levels on resorption around noncemented hip stems,
  44. (2008). The five-year results of the Birmingham hip resurfacing arthroplasty. doi
  45. (2009). The influence of femoral head resurfacing on femoral neck strain: a biomechanical study.
  46. (2006). Treatment of the young active patient with osteoarthritis of the hip: a fiveto seven-year comparison of hybrid total hip arthroplasty and metal-on-metal doi
  47. (1990). Wagner resurfacing hip arthroplasty. The results of one hundred consecutive arthroplasties after eight to ten years.

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