Bischel Oliver E, Seeger Jörn B, Jung Matthias K, Dörfler Stefan, Höppchen Arnold J, Jahnke Alexander, Jakubowitz Eike
BG Trauma Center, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
Kurpark-Klinik, Kurstr. 41-45, 61231 Bad Nauheim, Germany.
Bioengineering (Basel). 2025 Sep 16;12(9):984. doi: 10.3390/bioengineering12090984.
The use of tapered fluted revision stems has been shown to be reliable and safe. Primary stability is mandatory for a long-lasting fixation between bone and a prosthesis. Nevertheless, aseptic loosening due to insufficient primary stability occurs and may be related to technically improper preparation of the femoral canal. Instructions of manufacturers are heterogeneous regarding preparation of implant beds. Does speed or the design of the reamer influence the accuracy of the implant bed and, consecutively, primary stability? A test foam with an elastic moduli and pressure resistance similar to that of cancellous bone was used. The medullary canal was prepared with the use of reamers of two different straight and tapered femoral revision devices. Three different rotational speeds were used for preparation. After preparation, primary stability was measured and fixating characteristics were derived. Sufficient primary stability was achievable by all three preparation methods but fixating characteristics were different. Significantly higher micro-motions were detected near the tip of the prosthesis compared to those at all more proximal measuring points. Reaming with high velocity resulted in significantly higher micro-motions compared to that with mid- or low-speed burring. Different preparation methods may be one explanation for the range of reported survivorship data of the two devices with aseptic loosening as the end point. The precision of the implant bed and fixating characteristics were best after reaming with lower velocity. Superior but not significantly better fixation characteristics were achieved with the monobloc stem compared to those with the modular device.
锥形带槽翻修柄的使用已被证明是可靠且安全的。骨与假体之间持久固定的首要条件是初始稳定性。然而，由于初始稳定性不足导致的无菌性松动仍会发生，这可能与股骨髓腔准备技术不当有关。制造商关于植入床准备的说明各不相同。扩孔钻的速度或设计会影响植入床的精度，进而影响初始稳定性吗？使用了一种弹性模量和耐压性与松质骨相似的测试泡沫。使用两种不同的直柄和锥形股骨翻修器械的扩孔钻来准备髓腔。准备过程中使用了三种不同的转速。准备完成后，测量初始稳定性并得出固定特性。所有三种准备方法都能实现足够的初始稳定性，但固定特性有所不同。与所有更近端的测量点相比，在假体尖端附近检测到的微动明显更高。与中速或低速扩孔相比，高速扩孔导致的微动明显更高。不同的准备方法可能是两种器械以无菌性松动为终点的报告生存率数据范围的一个解释。低速扩孔后植入床的精度和固定特性最佳。与模块化器械相比，整体柄实现了更好但无显著差异的固定特性。
