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The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 839 - 844
1 Jul 2018
Ollivier M Laumonerie P LiArno S Faizan A Cavaignac E Argenson J

Aims

In patients where the proximal femur shows gross deformity due to degenerative changes or fracture, the contralateral femur is often used to perform preoperative templating for hip arthroplasty. However, femurs may not be symmetrical: the aim of this study was to determine the degree of variation between hips in healthy individuals and to determine whether it is affected by demographic parameters.

Materials and Methods

CT-scan based modelling was used to examine the pelvis and bilateral femurs of 345 patients (211 males, 134 women; mean age 62 years (standard deviation (sd) 17), mean body mass index 27 kg/m2 (sd 5)) representing a range of ethnicities. The femoral neck-shaft angle (NSA), femoral offset (FO), femoral neck version (FNV), femoral length (FL), femoral canal flare index (fCFI), and femoral head radius (FHr) were then determined for each patient. All measurements were constructed using algorithm-calculated landmarks, resulting in reproducible and consistent constructs for each specimen. We then analyzed femoral symmetry based on absolute differences (AD) and percentage asymmetry (%AS) following a previously validated method.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 142 - 142
1 Feb 2017
LiArno S Gopalakrishnan A Schmidig G Schmidt W Racanelli J
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INTRODUCTION

During activities of daily living (ADL), varus moments are experienced in the knee, which can result in frontal plane rotation, or liftoff, of the lateral femoral condyle with respect to the tibial plateau. An understanding of this rotation is valuable as it could potentially lead to contact between the femoral component and polyethylene post of a total knee replacement (TKR). Therefore, the purpose of this study was 1) to assess how much frontal plane rotation was achieved due to varus moments imposed on a total stabilized (TS) TKR from the stair ascent activity, and 2) to determine whether a TS TKR could withstand the contact stresses imposed by the varus loading for 1 million cycles without the post fracturing or plastically deforming.

METHODS

A PS femoral component paired with a TS polyethylene insert and baseplate (Triathlon, Stryker, Mahwah, NJ) were aligned on a multi-axis testing system (MTS Systems Corp, Eden Prairie, MN) (Figure 1). Size 1 components were used as they represented the worst-case size for testing. The femoral component was fixed at 60 degrees of flexion, representing an angle of peak varus moment during stair ascent [1]. The peak varus moment used in this study was determined by scaling the data from Orthoload.com for a 136 kg patient body weight (3 SD above average TKR patient body weight) [1, 2].

In order to evaluate the frontal plane rotation achieved due to the varus moment with minimal influence from other loads, an FEA model of the physical test setup was used to determine the lowest joint compressive load that would allow testing to be stable. Given this, testing was completed with a constant joint compressive load of 1500 N (33% of that reported by Orthoload.com) while sinusoidally applying a varus moment from 5Nm to 54.5Nm [1, 2]. The loads were applied to three samples for 1 million cycles to represent the number of stair ascent cycles experienced over 20 years [3].

Lastly, a validation test was run on a component with the polyethylene post notched at the medial distal aspect. The post fractured during testing indicating that the test could induce the clinical failure mode of interest.