Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Clin Biomech (Bristol). 2021 Mar;83:105297. doi: 10.1016/j.clinbiomech.2021.105297. Epub 2021 Feb 20.
Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software.
We reviewed 153 hips in 153 patients, grouped according to femoral canal type-normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete Microplasty stem.
The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem.
We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions.
尽管在全髋关节置换术中越来越多地使用短的非骨水泥柄，但它们的潜在益处尚未得到证实。我们使用基于 CT 的三维模板软件评估了不同股骨管类型和柄位置的短柄和常规柄的皮质接触状态。
我们回顾了 153 例 153 髋患者的资料，根据股骨管类型（正常 68 髋、香槟酒杯形 41 髋和烟囱形 44 髋）进行分组。我们通过评估三种柄前倾角（原始前倾角、+5°前倾角和+5°后倾角）、三种柄位置（中性+2°伸展位和+2°屈曲位），研究了柄位置对接触状态的影响。我们使用 Taperloc Complete Microplasty 柄。
两种柄在所有管型的所有区域的接触值均无显著差异。在 5°后倾和前倾、2°伸展和屈曲位置时，两种柄在所有区域的接触值与中立位相比均无显著差异。然而，在 2°伸展和屈曲位置时，两种柄的区域 3、4 和 5 的接触值均明显大于中立位；在所有管型中，常规柄的接触值也明显更大。
我们证明了短柄和常规柄在任何股骨管中都可以达到相同的近侧皮质接触，而与柄位置无关。然而，伸展和屈曲的柄位置会增加远端接触，尤其是在常规柄中。此外，后倾柄插入会增加远端接触。
