Effect of press-fit femoral stems on strains in the femur. A photoelastic coating study.

A photoelastic coating method was used to study the strain patterns on the surface of the femur, before and after insertion of femoral stems. The anatomically shaped stems were press-fit without a collar, press-fit with a collar, and press-fit with proximal cementing to approximate a bone ingrowth situation. The strain patterns of the intact femurs were consistent with bending. The pattern changed considerably after stem insertion, probably due to the stiffening effect of the stems. Nevertheless, the collarless press-fit stem preserved 64% of the magnitude of the proximal medial strain. The collar restored the average to normal, but the surface strains varied because of the localized regions of contact between the collar and the bone. Proximal cementing gave results similar to those of the collarless press-fit. The press-fit stems often showed local patches of high strain, probably reflecting local endosteal contact points. Local high stresses at the level of the distal tip were seen in only a few instances.