Radiographic and Biomechanical Assessment of Three Implant Designs for Canine Cementless Total Hip ReplacementFunding None.
Objective The aim of this study was to evaluate the relationship between radiographic fit/fill measurements and biomechanical performance of three canine cementless total hip implant designs using an in vitro biomechanical testing protocol that replicates compression and torsion.
Study Design Eighteen (six/group) canine cadaveric femurs were implanted with one of three cementless total hip implant designs: (1) collarless, (2) collared or (3) lateral bolt stems. Femoral length, canal flare index (CFI), canal fill, stem fit, stem level and stem angle were measured as independent variables. Biomechanical performance was tested using physiological, non-destructive gait loading (loading protocols) and destructive testing (failure protocols).
Results During loading protocols, compressive stiffness was influenced by stem level (p < 0.05) and torsional stiffness was influenced by stem level and CFI for collarless stems (p < 0.05). During failure protocols, peak load was influenced by mediolateral (ML) stem angle (p < 0.05) and CFI (p < 0.01) for collarless stems and CFI for lateral bolt stems (p < 0.05). Peak torque was influenced by ML stem angle, craniocaudal stem angle and CFI for collarless stems (p < 0.05) and average ML fill for collared stems (p < 0.05).
Conclusion Biomechanical performance of collarless stems in cementless hip arthroplasty is more impacted by radiographic fit/fill than lateral bolt and collared stems. As a result, collarless stems may be more dependent on preoperative fit and intraoperative precision.
N.J.W. and K.J.A. contributed to conception of study, study design, data acquisition, data analysis, interpretation of results and drafting of the submitted manuscript. N.R.O. and M.A.M. contributed to conception of study, study design and the acquisition, analysis and interpretation of biomechanical data. K.A.M. contributed to the conception, design and analysis and interpretation of data for biomechanical testing. G.M.V. and R.H. contributed to conception of study and implantation of stems. K.J.A. contributed to implantation of stems. D.M.V. contributed to study design and interpretation of data. M.K. contributed to analysis and interpretation of data. K.H. contributed to conception of study, study design and interpretation of data. All authors revised and approved the submitted manuscript.
Eingereicht: 07. November 2019
Angenommen: 23. Juni 2020
24. September 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
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- 1 Kalis RH, Liska WD, Jankovits DA. Total hip replacement as a treatment option for capital physeal fractures in dogs and cats. Vet Surg 2012; 41 (01) 148-155
- 2 Jankovits DA, Liska WD, Kalis RH. Treatment of avascular necrosis of the femoral head in small dogs with micro total hip replacement. Vet Surg 2012; 41 (01) 143-147
- 3 Lascelles BD, Freire M, Roe SC, DePuy V, Smith E, Marcellin-Little DJ. Evaluation of functional outcome after BFX total hip replacement using a pressure sensitive walkway. Vet Surg 2010; 39 (01) 71-77
- 4 Peck JN, Liska WD, DeYoung DJ, Marcellin-Little DJ. Clinical application of total hip replacement. In: Peck JN, Marcellin-Little DJ. , eds. Advances in small animal total joint replacement. Ames: Wiley-Blackwell; 2013. :69–107
- 5 Scherrer W, Holsworth I, Goossens M, Schulz K. Coxofemoral arthroscopy and total hip arthroplasty for management of intermediate grade fibrosarcoma in a dog. Vet Surg 2005; 34 (01) 43-46
- 6 Trostel CD, Peck JN, deHaan JJ. Spontaneous bilateral coxofemoral luxation in four dogs. J Am Anim Hosp Assoc 2000; 36 (03) 268-276
- 7 Mitchell EP, Marcellin-Little DM. Radiographic assessment of short term stability of uncemented femoral stems. Vet Surg 2005; 34: E20 (abstr)
- 8 Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. J Biomed Mater Res 1998; 43 (02) 192-203
- 9 Brunski JB. Biomaterials and biomechanics in dental implant design. Int J Oral Maxillofac Implants 1988; 3 (02) 85-97
- 10 Rashmir-Raven AM, DeYoung DJ, Abrams Jr CF, Aberman HA, Richardson DC. Subsidence of an uncemented canine femoral stem. Vet Surg 1992; 21 (05) 327-331
- 11 Kidd SW, Preston CA, Moore GE. Complications of porous-coated press-fit cementless total hip replacement in dogs. Vet Comp Orthop Traumatol 2016; 29 (05) 402-408
- 12 Buks Y, Wendelburg KL, Stover SM, Garcia-Nolen TC. The effects of interlocking a universal hip cementless stem on implant subsidence and mechanical properties of cadaveric canine femora. Vet Surg 2016; 45 (02) 155-164
- 13 Dosch M, Hayashi K, Garcia TC, Weeren R, Stover SM. Biomechanical evaluation of the helica femoral implant system using traditional and modified techniques. Vet Surg 2013; 42 (07) 867-876
- 14 Liska WD, Doyle ND. Use of an electron beam melting manufactured titanium collared cementless femoral stem to resist subsidence after canine total hip replacement. Vet Surg 2015; 44 (07) 883-894
- 15 Pozzi A, Peck JN, Chao P, Choate CJ, Barousse D, Conrad B. Mechanical evaluation of adjunctive fixation for prevention of periprosthetic femur fracture with the Zurich cementless total hip prosthesis. Vet Surg 2013; 42 (05) 529-534
- 16 Page AE, Allan C, Jasty M, Harrigan TP, Bragdon CR, Harris WH. Determination of loading parameters in the canine hip in vivo. J Biomech 1993; 26 (4-5): 571-579
- 17 Ganz SM, Jackson J, VanEnkevort B. Risk factors for femoral fracture after canine press-fit cementless total hip arthroplasty. Vet Surg 2010; 39 (06) 688-695
- 18 Ordway NR, Ash KJ, Miller MA, Mann KA, Hayashi K. A biomechanical comparison of four hip arthroplasty designs in a canine model. Vet Comp Orthop Traumatol 2019; 32 (05) 369-375
- 19 Liska WD. BFX ® EBM Titanium Collared Femoral Stem: Surgical Technique Details. Houston: Global Veterinary Specialists PLLC. 2017: 4-5 Accessed February 2, 2020 at: https://biomedtrix.com/bfx-ebm-collared-stem/
- 20 BioMedtrix. BFX ® Lateral Bolt System Surgical Technique. Whippany: BioMedtrix:1–9. Accessed June 12, 2020 at: https://biomedtrix.com/bfx-ebm-lateral-bolt-stem/
- 21 Townsend S, Kim SE, Pozzi A. Effect of stem sizing and position on short-term complications with canine press fit cementless total hip arthroplasty. Vet Surg 2017; 46 (06) 803-811
- 22 Issa K, Pivec R, Wuestemann T, Tatevossian T, Nevelos J, Mont MA. Radiographic fit and fill analysis of a new second-generation proximally coated cementless stem compared to its predicate design. J Arthroplasty 2014; 29 (01) 192-198
- 23 Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Vol 1. 2nd ed. Philadelphia, PA: Saunders; 1998: 51-82
- 24 Pernell RT, Gross RS, Milton JL. et al. Femoral strain distribution and subsidence after physiological loading of a cementless canine femoral prosthesis: the effects of implant orientation, canal fill, and implant fit. Vet Surg 1994; 23 (06) 503-518
- 25 Demey G, Fary C, Lustig S, Neyret P, si Selmi TA. Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty? A bilateral comparative cadaver study. J Arthroplasty 2011; 26 (08) 1549-1555
- 26 Ries C, Boese CK, Dietrich F, Miehlke W, Heisel C. Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. Int Orthop 2019; 43 (02) 307-314
- 27 Bergmann G, Graichen F, Rohlmann A. Hip joint contact forces during stumbling. Langenbecks Arch Surg 2004; 389 (01) 53-59
- 28 Townsend KL, Kowaleski MP, Johnson KA. Initial Stability and Femoral Strain Pattern during Axial Loading of Canine Cementless Femoral Prostheses: Effect of Resection Level and Implant Size. In: Proceedings of the 34th Annual Conference of the Veterinary Orthopedic Society; Sun Valley, Idaho; March 3–10, 2007
- 29 McCulloch RS, Roe SC, Marcellin-Little DJ, Mente PL. Resistance to subsidence of an uncemented femoral stem after cerclage wiring of a fissure. Vet Surg 2012; 41 (01) 163-167
- 30 Jehn CT, Manley PA. The effects of femur and implant position on the radiographic assessment of total hip femoral implants in dogs. Vet Surg 2002; 31 (04) 349-357
- 31 Jehn CT, Bergh MS, Manley PA. Orthogonal view analysis for evaluating the femoral component position of total hip implants in dogs using postoperative radiographs. Vet Surg 2003; 32 (02) 134-141
- 32 Husmann O, Rubin PJ, Leyvraz PF, de Roguin B, Argenson JN. Three-dimensional morphology of the proximal femur. J Arthroplasty 1997; 12 (04) 444-450
- 33 de Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for total hip arthroplasty?. Clin Orthop Relat Res 2015; 473 (12) 3860-3866