Modular knee implants are used to manage large bone defects in revision total knee arthroplasty. These implants are confronted with varying fixation characteristics, changes in load transfer or stiffen the bone. In spite of their current clinical use, the influence of modularity on the biomechanical implant-bone behavior (e.g. implant fixation, flexibility, etc.) still is inadequately investigated. Aim of this study is to analyze, if the modularity of a tibial implant could change the biomechanical implant fixation behavior and the implant-bone flexibility. Nine different stem and sleeve combinations of the clinically used tibial revision system Sigma TC3 (DePuy) were compared, each implanted standardized with INTRODUCTION
MATERIAL & METHODS
Good survival rates of cementless hip stems serve as motivation for further development, just like modular implant systems or short stems. New aims are worth striving for, e.g. soft tissue or bone sparing options with similar survival rates in case of short stems. Even minimal design modifications might result in complications, e.g. missing osseointegration, loosening of the implant or painful stem, as shown in the past. One of these developments is the Biomet – GTS™ stem [Fig. 1], a hybrid between conventional cementless straight stem and potentially sparing short stem. Aim of this biomechanical study was to analyze, if the biomechanical behavior of the stem is comparable to a clinically proofed design with respect to the stem fixation in the bone and to the mechanical behavior of the stem itself. That's why the primary stability of the GTS™ stem has been determined and subsequently was compared to the Zimmer – CLS® stem. Four GTS™ stems and four CLS® stems were implanted standardized in eight synthetic femurs. Micromotions of the stem and the bone were measured at different sites. A high precision measuring device was used to apply two different cyclic load situations: 1. Axial torque of +/−7 Nm around the longitudinal stem axis to determine the rotational implant stability. 2. Varus-valgus-torque of +/−3, 5 Nm to determine the bending behavior of the stem. Comparing the motions of the stem and femur at different sites allowed the calculation of relative micromotions at the bone-implant-interface.INTRODUCTION:
MATERIAL & METHODS
Extensive bone defects of the proximal femur e.g. due to aseptic loosening might require the implantation of megaprostheses. In the literature high loosening rates of such megaprostheses have been reported. However, different fixation methods have been developed to achieve adequate implant stability, which is reflected by differing design characteristics of the commonly used implants. Yet, a biomechanical comparison of these designs has not been reported. The aim of our study was to analyse potential differences in the biomechanical behaviour of three megaprostheses with different designs by measuring the primary rotational stability in vitro. Four different stem designs [Group A: Megasystem-C® (Link), Group B: MUTARS®(Implantcast), Group C: GMRS™ (Stryker) and Group D: Segmental System (Zimmer); see Fig. 1] were implanted into 16 Sawbones® after generating a segmental AAOS Typ 2 defect. Using an established method to analyse the rotational stability, a cyclic axial torque of ± 7.0 Nm along the longitudinal stem axis was applied. Micromotions were measured at defined levels of the bone and the implant [Fig. 2]. The calculation of relative micromotions at the bone-implant interface allowed classifying the rotational implant stability.Introduction:
Methods:
Concerning biomechanical research, human specimens are preferred to achieve conditions that are close to the clinical situation. On the other hand, synthetic femurs are used for biomechanical testing instead of fresh-frozen human femurs, to create standardized and comparable conditions. A new generation of synthetic femurs is currently available aiming to substitute the validated traditional one. Structural femoral properties of the new generation have already been validated, yet a biomechanical validation is missing. The aim of our study was to analyse potential differences in the biomechanical behaviour of two different synthetic femoral designs by measuring the primary rotational stability of a cementless femoral hip stem. The cementless SL-PLUS® standard stem (size 6, Smith&Nephew Orthopaedics AG, Rotkreuz, Swizerland) was implanted in two groups of synthetic femurs. Group A consists of three 2nd generation femurs and group B consists of three 4th generation femurs (both: size large, composite bone, Sawbones® Europe, Malmö, Sweden). Using an established method to analyse the rotational stability, a cyclic axial torque of ±7.0 Nm along the longitudinal stem axis was applied. Micromotions were measured at defined levels of the bone and the implant. The calculation of relative micromotions at the bone-implant interface allowed classifying the rotational implant stability.Introduction
Methods
Polyethylene (PE) as a bearing material for total joint replacements (TJR) represents the golden standard for the past forty years. However, over the past decade it becomes apparent that PE wear and the biological response to wear products are the limiting factor for the longevity of TJRs. For this reason research has focused onto PE wear particle analysis. A particle analysis highly depends on the methodological work and results often show discrepancies between different research groups. From there, our hypothesis was, that an often unattended influencing factor is the optical magnification which has been used for particle analyses. In the present study samples of a previous conducted knee wear simulator test were used. Wear particles were isolated from the bovine serum using an established method1. Briefly the serum was digested with hydrochloric acid and a continuous stirring and heating. Particles were filtered onto 20nm alumina filters and analyzed using high resolution field emission gun scanning electron microscopy (FEG-SEM). Filters were analyzed on the same points using three different magnifications: 5000, 15000 and 30000. To describe the size and morphology of the particles the equivalent circle diameter (ECD), aspect ratio (AR), roundness (R) and form factor (FF) were specified according to ASTM F 1877-05. The estimated total number (ETN) of particles was calculated based on the number of particles recovered on the filter, the analyzed area, the dilution, evaporation and the total serum volume.Background
Material and Methods
Tension wires seem to dominate revision surgery and studies only refer to the advantages of cable wires in general. This in-vitro study analyzed the infiuence of both, tension and cable wires on primary stability of cementless revision stems. We aimed to examine the effectivity of wiring a femoral osteotomy, differences achieved with each method, and whether one wire has advantages regarding the fixation concepts of revision stems (meta- and diaphyseal).
