Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2024 Feb;39(2):507-513.e1. doi: 10.1016/j.arth.2023.08.049. Epub 2023 Aug 19.
There is no standard method for assembling the femoral head onto the femoral stem during total hip arthroplasty (THA). This study aimed to measure and record dynamic 3-dimensional (3D) THA head-neck assembly loads from residents, fellows, and attending surgeons, for metal and ceramic femoral heads.
An instrumented apparatus measured dynamic 3D forces applied through the femoral stem taper in vitro for 31 surgeons (11 attendings, 14 residents, 6 fellows) using their preferred technique (ie, number of hits or mallet strikes). Outcome variables included peak axial force, peak resultant force, impulse of the resultant force, loading rate of the resultant force, and off-axis angle. They were compared between femoral head material, surgeon experience level, and the number of hits per trial.
Average peak axial force was 6.92 ± 2.11kN for all surgeons. No significant differences were found between femoral head material. Attendings applied forces more "on-axis" as compared to both residents and fellows. Nine surgeons assembled the head with 1 hit, 3 with 2 hits, 14 with 3 hits, 2 with 4 hits, and 3 with ≥5 hits. The first hit of multihit trials was significantly lower than single-hit trials for all outcome measures except the off-axis angle. The last hit of multihit trials had a significantly lower impulse of resultant force than single-hit trials.
Differences in applied 3D force-time curve dynamic characteristics were found between surgeon experience level and single and multihit trials. No significant differences were found between femoral head material.
在全髋关节置换术（THA）中，将股骨头装配到股骨柄上没有标准方法。本研究旨在测量并记录住院医师、研究员和主治医生使用金属和陶瓷股骨头时，对动态三维（3D）THA 头-颈装配力的影响。
一种仪器化设备在体外通过股骨柄锥度测量了 31 名外科医生（11 名主治医生、14 名住院医师、6 名研究员）使用其首选技术（即敲击次数或敲击次数）时施加的动态 3D 力。结果变量包括轴向力峰值、合力峰值、合力冲量、合力加载率和偏轴角度。比较了股骨头材料、外科医生经验水平和每次试验的敲击次数之间的差异。
所有外科医生的平均轴向力峰值为 6.92±2.11kN。股骨头材料之间没有显著差异。主治医生的施力比住院医师和研究员更“在轴上”。9 名外科医生用 1 次敲击装配头，3 名用 2 次敲击，14 名用 3 次敲击，2 名用 4 次敲击，3 名用≥5 次敲击。多击试验的第一次敲击在所有结果测量中均显著低于单次敲击，除偏轴角度外。多击试验的最后一次敲击的合力冲量明显低于单次敲击。
在外科医生经验水平和单次及多次敲击试验之间，发现了施加的 3D 力-时曲线动态特征的差异。股骨头材料之间没有显著差异。
