Introduction:. In an attempt to reduce stress shielding in the proximal femur multiple new shorter stem design have become available. We investigated the load to fracture of a new polished tapered cemented short stem in comparison to the conventional polished tapered Exeter stem. Method:. A total of forty-two stems, twenty-one short stems and twenty-one conventional stems both with three different offsets were cemented in a composite sawbone model and loaded to fracture. Results:. study showed that femurs will break at a significantly lower load to failure with a shorter compared to conventional length Exeter stem. Conclusion:. This Both standard and short stem design are safe to use as the torque to failure is 7–10 times as much as the torques seen in activities of daily living

Introduction. Up to 60% of total hip arthroplasties (THA) in Asian populations arise from avascular necrosis (AVN), a bone disease that can lead to femoral head collapse. Current diagnostic methods to classify AVN have poor reproducibility and are not reliable in assessing the fracture risk. Femoral heads with an immediate fracture risk should be treated with a THA, conservative treatments are only successful in some cases and cause unnecessary patient suffering if used inappropriately. There is potential to improve the assessment of the fracture risk by using a combination of density-calibrated computed tomographic (QCT) imaging and engineering beam theory. The aim of this study was to validate the novel fracture prediction method against in-vitro compression tests on a series of six human femur specimens. Methods. Six femoral heads from six subjects were tested, a subset (n=3) included a hole drilled into the subchondral area of the femoral head via the femoral neck (University of Leeds, ethical approval MEEC13-002). The simulated lesions provided a method to validate the fracture prediction model with respect of AVN. The femoral heads were then modelled by a beam loaded with a single joint contact load. Material properties were assigned to the beam model from QCT-scans by using a density-modulus relationship. The maximum joint loading at which each bone cross-section was likely to fracture was calculated using a strain based failure criterion. Based on the predicted fracture loads, all six femoral heads (validation set) were classified into two groups, high fracture risk and low fracture risk (Figure 1). Beam theory did not allow for an accurate fracture load to be found because of the geometry of the femoral head. Therefore the predicted fracture loads of each of the six femoral heads was compared to the mean fracture load from twelve previously analysed human femoral heads (reference set) without lesions. The six cemented femurs were compression tested until failure. The subjects with a higher fracture risk were identified using both the experimental and beam tool outputs. Results. The computational tool correctly identified all femoral head samples which fractured at a significantly low load in-vitro (Figure 2). Both samples with a low experimental fracture load had an induced lesion in the subchondral area (Figure 3). Discussion. This study confirmed findings of a previous verification study on a disease models made from porcine femoral heads (Preutenborbeck et al. I-CORS2016). It demonstrated that fracture prediction based on beam theory is a viable tool to predict fracture. The tests confirmed that samples with a lesion in the weight bearing area were more likely to fracture at a low load however not all samples with a lesion fractured with a low load experimentally, indicating that a lesion alone is not a sufficient factor to predict fracture. The developed tool takes both structural and material properties into account when predicting the fracture risk. Therefore it might be superior to current diagnostic methods in this respect and it has the added advantage of being largely automated and therefore removing the majority of user bias. For any figures or tables, please contact the authors directly

INTRODUCTION. Ceramic hip components are known for their superior material properties and longevity. In comparison to other materials commonly used, ceramics have a very low friction coefficient and a high fracture load. However, even though in-vivo fractures of ceramic ball heads are a relatively rare occurrence compared to other reasons for revision, they are of concern to the surgeon using ceramic components. The goal of this work was to evaluate the most probable causes for fracture and to quantify the influence of the metal taper contamination and shell deformation, respectively. METHODS. An experimental set-up imitating the in-vivo loading situation was used to analyze different scenarios that may lead to the fracture of the ball heads, such as dynamic loading, edge loading and the metal taper contamination. 58 ceramic ball heads made of pure alumina were loaded until fracture under various conditions. Parameters under investigation were the inclination of the insert, the loading velocity, and the contamination of the interface between taper and ball head. RESULTS. The behavior of the ball heads for the different scenarios showed a large variation. If the inclination of the insert equaled 45°, it is not possible to break the ceramic ball head prior to the failure of the metal taper due to high plastic deformation. In case of edge loading, due to the reduction of load transfer area, the load required to fracture dropped significantly. The loading rate had no measurable influence on this value. The largest effect on the fracture load had a contamination with osseous tissue and a damage of the metal taper. The fracture load decreases to approximately 20% compared to the value measured without the contamination. DISCUSSION. Contamination of the interface with osseous tissue or damages on the metal taper lead to a minimum fracture load in the range of the maximum forces ever measured in vivo. According to these findings, diligence is recommended during the implantation of the ceramic hip components in order to avoid disturbances or contamination of this interface. Because the reduction of the friction and the damage or contamination of the ceramic/metal interface results in a reduction of the fracture load, the presence of any material on the component tapers should be avoided

The disadvantage of removing a well-fixed femoral stem are multiple (operating time, risk of fracture, bone and blood loss, recovery time and post-op complications. Ceramic heads with titanium adapter sleeves (e.g. BIOLOX®OPTION, Ceramtec) are a possibility for putting a new ceramic head on slightly damaged used tapers. ‘Intolerable’ taper damages even for this solution are qualitatively specified by the manufacturers. The aim of this study was to determine the fracture strength of ceramic heads with adapter sleeves on stem tapers with such defined damage patterns. Pristine stem tapers (Ti-6Al-4V, 12/14) were damaged to represent the four major stem taper damage patterns specified by the manufacturers: . -. ‘Truncated’: Removal of 12.5% of the circumference along the entire length of the stem taper at a uniform depth of 0.5mm parallel to the taper slope. -. ‘Slanted’: Removal of 33.3% of the proximal diameter perimeter with decreasing damage down to 3.7mm from the proximal taper end. -. ‘Cut’: Removal of the proximal 25% (4mm) of the stem taper. -. ‘Scratched’: Stem tapers from a previous ceramic fracture test study with a variety of scratches and crushing around the upper taper edge from multiple ceramic head fractures. -. The ‘Control’ group consisted of three pristine tapers left undamaged. BIOLOX®OPTION heads (Ø 32mm, length M) with Ti adapter sleeves were assembled to the damaged stem tapers and subjected to ISO7206-10 ultimate compression strength testing. The forces required to fracture the head were high and caused complete destruction of the ceramic heads in all cases. The ‘Truncated’ group showed the lowest values (136kN ± 4.37kN; Fig. 3). Forces were higher and similar for the ‘Cut’ (170kN ± 8.89kN), ‘Control’ (171.8 ± 16.5kN) and ‘Slanted’ (173kN ± 21.9kN) groups, the ‘Scratched’ group showed slightly higher values (193kN ± 11.9kN). The Ti adapter sleeves were plastically deformed but did not fail catastrophically. The present study suggests that manufacturer's recommendations for removal of a well fixed femoral stem could be narrowed down to the ‘Truncated’ condition. Even this might not be necessary since the fracture load is still substantially higher than the ASTM standard requires. Surgeons should consider to keep stems with larger taper damages as previously thought and spare the patient from stem revision. The greatest reservation regarding adapter sleeves is the introduction of the new metal-on-metal interface between stem and sleeve, which could possibly facilitate fretting-corrosion, which is presently one of the major concerns for modular junctions (3). Clinically such problems have not been reported yet. Ongoing FE-simulations are performed to investigate whether micromotions between stem and head taper are altered by the investigated damages

Introduction. Periprosthetic medial tibial plateau fractures (TPF) are rare but represent a serious complication in unicompartmental knee arthroplasty (UKA). Most common treatment of these fractures is osteosynthesis with canulated screws or plates. Aim. The aim of this study was to evaluate these two different treatment options of periprosthetic fractures. The hypothesis was that osteosynthetic treatment with plates show significantly higher maximum fracture loads than fixation with cannulated screws. Materials and Methods. 12 matched paired fresh frozen tibias with periprosthetic tibial plateau fractures were used for this study. In group A osteosyntheses with angle-stable plates were performed, whereas in group B cannulated screws were utilized to fixate the periprosthetic fractures. DEXA bone density measurement and standard X-rays (ap and lateral) were accomplished before loading the tibias under standardised conditions with a maximum load of up to 10.0kN. Results. In the plate group all tibias fractured with a median load of Fmax=2.64 (0.45–5.68) kN, whereas in the group with cannulated screws fractures occurred at a mean load of Fmax=1.50 (0.27–3.51) kN. The difference was statistically significant with p<0.05. Discussion. Angle-stable plates showed significantly higher fracture load resistance than fixation with cannulated screws. Therefore osteosynthesis with angle-stable plates in periprosthetic tibial plateau fractures should be recommended. MULTIPLE DISCLOSURES

Purpose. Twelve case reports of distal femur fractures as post-operative complications after anterior cruciate ligament (ACL) reconstruction have been described in the literature. The femoral tunnel has been suggested as a potential stress riser for fracture formation. The recent increase in double bundle ACL reconstructions may compound this risk. This is the first biomechanical study to examine the stress riser effect of the femoral tunnel(s) after ACL reconstruction. The hypotheses tested in this study are that the femoral tunnel acts as a stress riser to fracture and that this effect increases with the size of the tunnel (8mm versus 10mm) and with the number of tunnels (one versus two). Method. Femoral tunnels simulating single bundle (SB) hamstring graft (8 mm), bone-patellar tendon-bone graft (10 mm), and double bundle (DB) ACL reconstruction (7mm, 6 mm) were drilled in fourth generation saw bones. These three experimental groups and a control group consisting of native saw bones without tunnels, were loaded to failure. Result. All fractures occurred through the tunnels in the double tunnel group whereas fractures did not consistently occur through the tunnels in the single tunnel groups. The mean fracture load was 6145 N 471 N in the native group, 5691 N 198 N in the 8 mm single tunnel group, 5702 N 282 N in the 10 mm single tunnel group, and 4744 N 418 N in the double tunnel group. The mean fracture load for the double tunnel group was significantly different when compared to native, 8 mm single bundle, and 10 mm single bundle groups independently (p value = 0.0016, 0.0060, and 0.0038 respectively). No other statistically significant differences were identified. Conclusion. An anatomically placed femoral tunnel in single bundle ACL reconstruction in our experimental model was not a stress riser to fracture, whereas the two femoral tunnels in double bundle ACL reconstruction significantly decreased load to failure. The results support the sparcity of reported peri-ACL reconstruction femur fractures in single femoral tunnel techniques. However, the increased fracture risk in double bundle ACL reconstruction is a cause for concern and may impact patient selection

Since artificial joints are expected to operate for more than decades in human body, animal and clinical studies are not suitable for evaluation of their durability. Instead, in-vitro mechanical tests have been employed, but they cannot fully reproduce complex in-vivo mechanical and biochemical environment. For instance, lipids in synovial fluid have been known to be absorbed in ultra-high molecular weight polyethylene (UHMWPE) components of artificial joints in vivo, and recently it was found that absorbed lipids have potential to degrade UHMWPE. In order to assure clinical relevance of the in-vitro mechanical tests, understanding of the effect of the in-vivo environment on mechanical properties is indispensable. However, well-developed mechanical tests cannot be applied to retrieved components, because they require large specimens. In this study, we attempted to develop methods to evaluate mechanical properties of retrieved UHMWPE components. We prepared five kinds of UHMWPE. Those are molded UHMWPE made from GUR 1020 resin without any further treatment, remelted highly crosslinked UHMWPE, annealed highly crosslinked UHMWPE, squalene absorbed UHMWPE which was prepared by immersing in squalene at 80°C for 7 days (SQ) and squalene absorbed and artificially aged UHMWPE which was prepared by artificially aging SQ at 80°C for 21 days in air (SQA). SQ and SQA were employed in this study to mimic lipid absorption and lipid induced degradation. These materials were tested by two well-established mechanical tests, namely, tensile tests and compression tests, and two proposed mechanical tests that can be applied to retrieved components, namely, tensile punch tests and micro indentation tests. It was possible to clearly identify the difference between materials by any of test methods used in this study. Stiffness obtained from tensile punch tests and elastic modulus obtained from micro indentation tests were shown to be highly correlated with elastic modulus obtained from compression tests except for SQA, which was inhomogeneous due to degradation at the surfaces. The results showed that the elastic modulus of the local surface could be evaluated by micro indentation tests, while the average of that of the entire specimen could be evaluated by compression tests. ield load, fracture load and maximum load obtained from tensile punch tests showed little correlation with yield stress, fracture stress and maximum stress obtained from tensile tests, respectively. These differences were considered to be attributed to the differences in a stress condition between these two test methods. It is multi-axial tension in tensile punch tests, while it is uniaxial in tensile tests. Although some of the parameters obtained by tensile punch tests showed no or limited correlation with those obtained by tensile tests, it was possible to clearly identify the difference between materials by these proposed test methods. In particular, micro indentation tests could evaluate the mechanical properties very locally. These proposed test methods have the potential to provide useful information on mechanical properties of retrieved UHMWPE components