Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Ginsel, Bastiaan L., Morishima, Takkan, Wilson, Lance J., Whitehouse, Sarah L., & Crawford, Ross W. (2015) Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study. Archives of Orthopaedic and Trauma Surgery, 135(4), pp. 517-522.

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Introduction: The risk for late periprosthetic femoral fractures is higher in patients treated for a neck of femur fracture compared to osteoarthritis. It has been hypothesised that osteopenia and consequent decreased stiffness of the proximal femur are responsible for this. We investigated whether a femoral component with a bigger body would increase the torque to failure in a biaxially loaded composite Sawbone model.

Material and methods: A biomechanical bone analogue was used. Two different body sizes (Exeter 44-1 vs 44-4) of a polished tapered cemented femoral stem were implanted by an experienced surgeon in 7 bone analogues each and internally rotated at 40°/s until failure. Torque to fracture and fracture energy were measured using a biaxial materials testing device (Instron 8874, MI, USA). The data were non-parametric and therefore tested with the Mann-Whitney U-test.

Results: The median torque to fracture was 156.7 Nm (IQR 19.7) for the 44-1 stem and 237.1 Nm (IQR 52.9) for the 44-4 stem (p=0.001). The median fracture energy was 8.5J (IQR 7.3) for the 44-1 stem and 19.5J (IQR 8.8) for the 44-4 stem (p=0.014).

Conclusions: The use of a large body polished tapered cemented stems for neck of femur fractures increases the torque to failure in a biomechanical model and therefore is likely to reduce late periprosthetic fracture risk in this vulnerable cohort.

Impact and interest:

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ID Code: 83209
Item Type: Journal Article
Refereed: Yes
Keywords: bigger body stem, periprosthetic fracture, fracture load, stress shielding, biomechanical study, sawbone model
DOI: 10.1007/s00402-015-2172-3
ISSN: 1434-3916
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Orthopaedics (110314)
Divisions: Current > Schools > School of Chemistry, Physics & Mechanical Engineering
Current > Institutes > Institute of Health and Biomedical Innovation
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Copyright Owner: Copyright 2015 Springer-Verlag Berlin Heidelberg
Copyright Statement: The final publication is available at Springer via
Deposited On: 08 Apr 2015 23:51
Last Modified: 03 Apr 2016 14:52

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