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Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

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Abstract

Purpose

In total hip arthroplasty fixation of revision stems can be demanding due to femoral bone loss. Strut grafts are often used for bone augmentation and stabilization of the newly inserted prosthesis. The aim of this study was to assess the effect of strut grafts on primary stability under various stem fixation conditions.

Methods

Two different revision stems (cylindrical and conical shape) were implanted into synthetic femora. Following a semicircular transfemoral osteotomy, three deficient femoral bearings were simulated (bony lid reattached with cable wires; weakened lid reattached with cable wires; strut grafts placed to the weakened lid with cable wires). Relative micro-movements were measured between prostheses and bones due to an axial moment applied to the stems.

Results

Relative movements correlated to the stem shape. The cylindrical stem showed higher movements increasing significantly with a weakened bony lid and portrayed a slight decrease of movements with strut graft application. No unequivocal influence of the weakened lid could be detected for the conical implant. Strut graft application did not show an additional stabilizing effect.

Conclusions

The primary stability of the cylindrical fixation concept decreases with impaired fixation conditions of the femur. A clear restabilizing effect with strut grafts could not be proven. A decrease of primary stability due to the impaired bone could not be observed for the conical stem shape. Additionally, strut grafts do not enhance fixation for this stem shape. We conclude that surgeons should not rely on a stabilizing effect of strut grafts in revision hip surgery.

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Acknowledgments

The present study was funded by the Ministry of Art and Science of Baden-Wuerttemberg (Germany). The authors declare that they have no conflict of interest directly related to this study.

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Author notes

  1. Eike Jakubowitz

    Present address: Laboratory of Biomechanics, Department of Orthopaedics, Justus Liebig University, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany

Authors and Affiliations

  1. Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Traumatology and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Stefan Kinkel, Marc N. Thomsen, Jan Nadorf, Christian Heisel, Michael C. Tanner & Eike Jakubowitz

  2. Department of Orthopaedics, German Red Cross (DRK) Clinic Baden-Baden, Lilienmattstrasse 5, 76530, Baden-Baden, Germany

    Marc N. Thomsen

  3. Orthopädie Kurpfalz, Bahnhofstrasse 51, 67346, Speyer, Germany

    Christian Heisel

Authors
  1. Stefan Kinkel
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  2. Marc N. Thomsen
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  3. Jan Nadorf
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  4. Christian Heisel
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  5. Michael C. Tanner
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Correspondence to Eike Jakubowitz.

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Kinkel, S., Thomsen, M.N., Nadorf, J. et al. Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis. International Orthopaedics (SICOT) 38, 1147–1153 (2014). https://doi.org/10.1007/s00264-013-2257-y

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  • DOI: https://doi.org/10.1007/s00264-013-2257-y

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