Skip to main content

Advertisement

SpringerLink
Log in

Do short-stemmed-prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs

  • Basic Science
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The causes of periprosthetic fractures of the femur due to the design of the prosthesis and the individual parameters of the patient are unexplored. By different anchorage techniques in cementless total hip arthroplasties, it is assumed that there are various load limits of the implant’s bearing femur.

Materials and methods

In the present study, we compared a standard hip stem (cementless Spotorno®) and a short-stemmed design (Mayo®) by an artificial reproduction of periprosthetic fractures in 20 femur specimens.

Results

The measured fracture loads showed an extensive range, with higher maximum loads in the standard stem group. The bone mineral density and the subsiding pattern of the standard stems showed a significant correlation to the incidence of the periprosthetic fractures. In the experimental setup, a slightly lower fracture resistance was shown for the short-stemmed prosthesis. Additionally, it was shown that donors with a higher body mass index had a significantly increased fracture risk.

Conclusions

Short-stemmed prostheses, especially the Mayo® hip, do not constitute a higher fracture risk. In general, an increased body mass index among patients with a cementless hip stem is associated with an increased fracture risk, particularly at high load values, i.e., resulting from a step during stumbling. Taking into account the ascertained results, the danger of provoking a femoral periprosthetic fracture can be reduced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Aldinger PR, Breusch SJ, Lukoschek M, Mau H, Ewerbeck V, Thomsen M (2003) A ten- to 15-year follow-up of the cementless spotorno stem. J Bone Joint Surg Br 85:209–214. doi:10.1302/0301-620X.85B2.13216

    Article  PubMed  CAS  Google Scholar 

  2. Beals RK, Tower SS (1996) Periprosthetic fractures of the femur: an analysis of 93 fractures. Clin Orthop Relat Res 327:238–246. doi:10.1097/00003086-199606000-00029

    Article  PubMed  Google Scholar 

  3. Bergmann G (1994) In vivo Messung der Belastung von Hüftimplantaten. Habilitation thesis, Free University of Berlin

  4. Bergmann G, Graichen F, Rohlmann A (1993) Hip joint loading during walking and running, measured in two patients. J Biomech 26:969–990. doi:10.1016/0021-9290(93)90058-M

    Article  PubMed  CAS  Google Scholar 

  5. Berry DJ (2003) Periprosthetic fractures associated with osteolysis: a problem on the rise. J Arthroplasty 18:107–111. doi:10.1054/arth.2003.50109

    Article  PubMed  Google Scholar 

  6. Buchholz J, Neumann K, Knopp W, Mollenhoff G, Muhr G (1995) Hip para-articular femoral fracture in total endoprosthesis. Chirurg 66:1120–1125

    PubMed  CAS  Google Scholar 

  7. Carls J, Kohn D, Kirsch L, Carls G (1998) An in vitro model for producing femoral fractures and for the study of primary stability of cerclage. Z Orthop Ihre Grenzgeb 136:126–131

    Article  PubMed  CAS  Google Scholar 

  8. Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304

    PubMed  CAS  Google Scholar 

  9. Gruner A, Hockertz T, Reilmann H (2004) Periprosthetic fractures: classification, management, therapy. Unfallchirurg 107:35–49. doi:10.1007/s00113-003-0698-2

    Article  PubMed  CAS  Google Scholar 

  10. Hube R, Hein W (2002) Die Mayo-Hüfte - Eine neue Phylisophie zur proximalen Femurverankerung. In: Perka C, Zippel H (eds) Trends und Kontroversen in der Endoprothetik des Hüftgelenks. Einhorn-Presse, Reinbek, pp 86–90

    Google Scholar 

  11. Hube R, Zaage M, Hein W, Reichel H (2004) Early functional results with the Mayo-hip, a short stem system with metaphyseal-intertrochanteric fixation. Orthopade 33:1249–1258. doi:10.1007/s00132-004-0711-7

    Article  PubMed  CAS  Google Scholar 

  12. Huiskes R, Snijders H, Vroemen W (1986) Fixation stability of a short cementless hip prosthesis. Transcript 32nd from the Orthopaedic Research Society 11:466–1

  13. Huiskes R, Vroemen W (1986) A standardized finite element model for routine comparative evaluations of femoral hip prostheses. Acta Orthop Belg 52:258–261

    PubMed  CAS  Google Scholar 

  14. Johansson JE, McBroom R, Barrington TW, Hunter GA (1981) Fracture of the ipsilateral femur in patients with total hip replacement. J Bone Joint Surg Am 63:1435–1442

    PubMed  CAS  Google Scholar 

  15. Kavanagh BF (1992) Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 23:249–257

    PubMed  CAS  Google Scholar 

  16. Kelly TL (2007) Bone mineral density reference databases for american men and women. J Bone Miner Res 5:249

    Google Scholar 

  17. Lowenhielm G, Hansson LI, Karrholm J (1989) Fracture of the lower extremity after total hip replacement. Arch Orthop Trauma Surg 108:141–143. doi:10.1007/BF00934256

    Article  PubMed  CAS  Google Scholar 

  18. Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res80–95 doi:10.1097/00003086-200403000-00012

  19. Mont MA, Maar DC (1994) Fractures of the ipsilateral femur after hip arthroplasty: a statistical analysis of outcome based on 487 patients. J Arthroplasty 9:511–519. doi:10.1016/0883-5403(94)90098-1

    Article  PubMed  CAS  Google Scholar 

  20. Mont MA, Maar DC, Krackow KA, Hungerford DS (1992) Hoop-stress fractures of the proximal femur during hip arthroplasty: management and results in 19 cases. J Bone Joint Surg Br 74:257–260

    PubMed  CAS  Google Scholar 

  21. Peicha G, Clement HG, Grechenig W (2000) Periprothetische Frakturen. In: Grechenig W, Szyszkowitz R (eds) Vermeidbare Fehler und Komplikationen bei Osteosynthesen. Sympomed, Munich, pp 333–344

    Google Scholar 

  22. Schwartz JT Jr, Mayer JG, Engh CA (1989) Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am 71:1135–1142

    PubMed  Google Scholar 

  23. Siegmeth A, Menth-Chiari WA, Wozasek GE, Vecsei V (1998) Femur fractures in patients with hip arthroplasty: indications for revision arthroplasty. J South Orthop Assoc 7:251–258

    PubMed  CAS  Google Scholar 

  24. Spitaler R, Reichetseder J, Rappold G, Leixnering M, Hertz H (2003) Periprosthetic fractures of the femur after hip or knee arthroplasty: an operative algorithm. Akt Traumatol 33:272–280. doi:10.1055/s-2003-44656

    Article  Google Scholar 

  25. Szyszkowitz R, Boldin Ch (2001) Die periprothetische Fraktur - Eine Herausforderung für die Unfallchirurgie. Eur J Trauma E-Suppl. 1:139–143

    Google Scholar 

  26. Whittaker RP, Sotos LN, Ralston EL (1974) Fractures of the femur about femoral endoprostheses. J Trauma 14:675–694

    Article  PubMed  CAS  Google Scholar 

  27. Younger AS, Dunwoody I, Duncan CP (1998) Periprosthetic hip and knee fractures: the scope of the problem. Instr Course Lect 47:251–6, 251–256

    Google Scholar 

  28. Zilkens K, Forst R, Ney R (1988) Femoral shaft fractures in ipsilateral total hip endoprostheses :osteosynthesis without the exchange operation? Unfallchirurg 91:351–357

    PubMed  CAS  Google Scholar 

  29. Zuber K, Koch P, Lustenberger A, Ganz R (1990) Femoral fractures following total hip prosthesis. Unfallchirurg 93:467–472

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank the Ministry of Art and Science of Baden-Württemberg (Germany) for supporting this work with research grants; and PD Dr. Sven Schneider (MA) from the Institute of the German Cancer Research Center for expert advice in statistics.

Author information

Authors and Affiliations

  1. Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69151, Heidelberg, Germany

    Eike Jakubowitz, Jörn B. Seeger, Christoph Lee, Christian Heisel & Jan P. Kretzer

  2. Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Jörn B. Seeger, Christoph Lee & Christian Heisel

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

    Marc N. Thomsen

Authors
  1. Eike Jakubowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jörn B. Seeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Heisel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan P. Kretzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc N. Thomsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc N. Thomsen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jakubowitz, E., Seeger, J.B., Lee, C. et al. Do short-stemmed-prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs. Arch Orthop Trauma Surg 129, 849–855 (2009). https://doi.org/10.1007/s00402-008-0676-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-008-0676-9

Keywords

Search

Navigation