Influence of size and CCD-angle of a short stem hip arthroplasty on strain patterns of the proximal femur : an experimental study

Purpose: The number of primary total hip arthroplasties (THA) is steadily increasing. Over the last decade numerous so-called short stem hip arthroplasties were introduced on the market. The aim of these implants with a predominantly metaphyseal anchorage is to reduce stress shielding and thereby the risk of aseptic loosening. One of the short stem arthroplasties with predominant metaphyseal fixation is the METHA® short stem (Aesculap, Tuttlingen, Germany). In order to reconstruct the biomechanics the METHA stem is available in different sizes with different centrum-collum-diaphysis-angles (CCD-angle). In this study, we want to address the research question of how the size of the implant and different CCD-angles influence the strain patterns of the proximal femur. Methods: Three different stem sizes (size 2, 3 and 4 – CCD-angle 130°) and three stems with different CCD-angles (size 3 – 120°, 130° and 135° CCD-angle) were successively implanted in a synthetic femur. Eight strain gauges monitored the corresponding strain patterns of the proximal femur. Results: Independent of stem size and CCD-angle only small changes in the strains were recorded around the distal part of the METHA stem when compared to the intact femur. However, all stems increased the strains in the region of the calcar. This was most pronounced by smaller CCD-angles and major sizes. Conclusion: The stem size and CCD-angle primarily influence the region of the calcar. Greater sizes and smaller CCD-angles lead to increased strains at the calcar. The other regions are hardly influenced by the stem size and CCDangle of the femoral component

αBSM failed as a carrier of rhBMP-2 to enhance bone consolidation in a sheep model of distraction osteogenesis

One of the problems associated with callus distraction is a long time period needed for consolidation of the newly formed bone. The goal of this study was to determine whether percutaneous injections of rhBMP 2 in BSM would enhance bone consolidation. Methods: A unilateral tibial osteotomy combined with external stabilization was performed in 20 adult sheep. After a latency of four days, distraction was conducted for 20 days. Sheep were divided into three groups: group 1 received rhBMP-2/αBSM injections at day 23 and 30, group 2 buffer/BSM injections at day 23 and 30 and group 3 did not receive any injection. The radiographs and in-vivo torsional stiffness measurements were obtained weekly during the following 50 days. Post-mortem bone densitometry (DXA) and mechanical testing were performed. Results: In-vivo stiffness assessments, DXA values and the maximum torsional moment of the sheep tibia treated with two rhBMP-2 injections were not significantly greater than those of both control groups. Conclusions: Presented application of rhBMP-2 in BSM failed to enhance bone consolidation in distraction osteogenesis