Background: Three-dimensional planning (3DP) in total hip arthroplasty using computed tomography (CT) to analyze bone mineral density (BMD) at the stem-femur interface has a high reported accuracy and excellent mid-term results in the literature. However, 3DP does not take into account the effect of femoral rasping on BMD distribution within the rasped cavity. Characterizing the impact of femoral rasping on BMD may help avoid mechanical failures, but this data is not accurately investigated. Therefore, we set out a cadaveric study to identify if: (1) Femoral rasping modified regional BMD in areas considered critical for bone anchorage of cementless metaphyseally fixed anatomic stems. (2) In areas of bone-implant contact with an initial high BMD, does femoral rasping increase BMD?
Hypothesis: Femoral rasping increases BMD in some zones considered critical for bone anchorage of cementless metaphyseally fixed anatomic stems within the rasped femoral cavity.
Methods: Four cadaveric femurs were selected to undergo a rasping procedure similar to surgical techniques used for metaphyseally fixed anatomic stems. Images of femurs before and after rasping were obtained with a micro-CT scanner (pixel size 35μm). BMD values before and after rasping were compared in a trabecular bone ring of 3mm thickness around the cavity created by the rasps, in a region extending 3cm above and 2cm below the middle of the lesser trochanter.
Results: Average BMD increased significantly after rasping in 3 of the 4 femurs (13% (0.27 to 0.30) (p=0.004)), 12% (0.32 to 0.36 (p=0.034)) and 15% (0.4 to 0.46 (p=0.001)), while there was no significant variation in the last femur (0.32 to 0.32 (p>0.05)). Increases in regional BMD were significantly higher in the lateral and medial areas, as well as in the most distal femoral regions. There were significantly lower variations of BMD in regions with initially higher BMD.
Discussion: Current opinion considers trabecular bone debris from femoral rasping to have an impact on final stem position and outcome. Our study has demonstrated an overall positive effect of femoral rasping on BMD in the rasped cavity. Understanding this in the context of 3DP may help avoid mechanical failures such as, suboptimal implant fit, fill, and stability as well as femoral fractures during stem implantation.
Level Of Evidence: IV, Prospective in vitro study.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.otsr.2019.11.030 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty?
Int Orthop
October 2024
Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France.
Article Synopsis
- Rising healthcare costs have prompted the exploration of single-use ancillaries (SUA) for total hip arthroplasty (THA), with the study aiming to evaluate the accuracy of 2D templating in determining implant sizes.
- The research analyzed 512 primary THA cases, finding that the accuracy of templating was 96.9% for acetabular and 98.5% for femoral implants, with lower accuracy noted in younger and older patients as well as those with a higher BMI.
- The study concludes that using reduced-size SUA can be effective in most THA procedures, supporting the move towards compact, single-use equipment in surgery.
The Accuracy of Digital Preoperative Templating in Primary Total Hip Replacements.
Cureus
August 2023
Trauma and Orthopaedics, University Hospitals Dorset, Bournemouth, GBR.
Background Digital templating is an essential part of preoperative planning in elective total hip replacement (THR) surgery. The goals of templating are to predict femoral and acetabular implant sizes, to assess leg length, offset, and implant positioning. Templating markers such as the KingMark device (Brainlab, Munich, Germany) have been developed to improve the accuracy.
View Article and Find Full Text PDFHemiarthroplasty of the hip using the direct anterior approach.
Oper Orthop Traumatol
August 2021
Department of Orthopedic Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
Objective: Minimally invasive approach in total hip arthroplasty for the treatment of femoral neck fractures with a hemiarthroplasty.
Indications: Femoral neck fractures of patients without hip osteoarthritis where the acetabulum is still intact.
Contraindications: Lesions and infections of the skin in the approach area; hip osteoarthritis; surgeon's lack of experience with the technique.
[Hemiarthroplasty for geriatric femoral neck fractures].
Oper Orthop Traumatol
June 2021
Fachbereich Orthopädie, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Gebäude Ost 10, 20246, Hamburg, Deutschland.
Objective: Restoration of pain-free joint function by implantation of a bipolar hemiarthroplasty via anterolateral approach.
Indications: Elderly multimorbid patients >70 years, age >80 years, low functional demand.
Contraindications: Infection.
The cement-bone bond is weaker than cement-cement bond in cement-in-cement revision arthroplasty. A comparative biomechanical study.
PLoS One
August 2021
Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland.
This study compares the strength of the native bone-cement bond and the old-new cement bond under cyclic loading, using third generation cementing technique, rasping and contamination of the surface of the old cement with biological tissue. The possible advantages of additional drilling of the cement surface is also taken into account. Femoral heads from 21 patients who underwent a total hip arthroplasty performed for hip arthritis were used to prepare bone-cement samples.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!