Dynamic response of soft tissue can be disregarded during femoral stem impaction

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-04-20 DOI:10.1016/j.clinbiomech.2025.106530

Peter J. Schlieker , Frank Lampe , Johann Zwirner , Benjamin Ondruschka , Michael M. Morlock , Gerd Huber

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引用次数: 0

Abstract

Background

In cementless total hip arthroplasty stems are inserted into the bone by mallet blows. Surgeons are not instructed to adjust the force of their blows to differences among patients especially with regard to weight. Whether this is linked to complications is yet unknown. This study investigated factors that could affect the mechanical behavior of the femur-tissue system.

Methods

Four cadavers were subject to two total hip arthroplasties by the same surgeon – one side via a lateral approach and the contralateral side via a direct anterior approach. A mass-spring-damper model was used to replicate the mechanical response of the femur-tissue system of the cadavers and make them comparable.

Findings

The mechanical response in terms of mass-spring-damper parameters differed between the approaches (lateral: 16.5 kg, 29.7 N/mm, 467.1 Ns/m; direct anterior: 11.5 kg, 41.7 N/mm, 553.0 Ns/m).

Interpretation

Common metal-on-metal mallet blows in surgery are very short and mostly excite high frequencies that are clearly above the natural frequency of the femur-tissue system. Those overcritical force impulses make the stem slide into the femur before the bone can even start moving. Hence, the individual mechanical behavior of the femur-tissue system can be disregarded provided that the force is applied with very short blows. This needs to be considered for any attempt to replace the mallet in the operation theater (e.g. automated surgical impaction tools) or to modify the mallet (e.g. alternative tip material). Furthermore, it may provide guidance on the fixation of femurs in in vitro testing to mimic surgical reality.

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在股骨干嵌塞过程中，软组织的动态响应可以忽略不计

背景：在无骨水泥全髋关节置换术中，骨柄是通过锤击插入骨内的。外科医生没有被要求根据病人的不同来调整他们的打击力度，特别是在体重方面。这是否与并发症有关尚不清楚。本研究探讨了可能影响股骨-组织系统力学行为的因素。方法对4具尸体行2例全髋关节置换术，一侧经外侧入路，对侧经直接前路。采用质量-弹簧-阻尼器模型来模拟尸体股骨组织系统的力学响应，并使其具有可比性。以质量-弹簧-阻尼器参数表示的力学响应在两种方法之间存在差异(横向：16.5 kg, 29.7 N/mm, 467.1 Ns/m；直接前部：11.5 kg, 41.7 N/mm, 553.0 Ns/m)。在外科手术中，常见的金属对金属锤击是很短的，并且大多激发高频率，明显高于股骨组织系统的固有频率。这些过度的力脉冲使骨柄在骨头开始移动之前就滑入股骨。因此，如果施加的力很短，则可以忽略股骨组织系统的个体力学行为。在手术室中更换锤头（例如自动手术嵌塞工具）或修改锤头（例如替代尖端材料）的任何尝试都需要考虑到这一点。此外，它可以为股骨的固定在体外测试中提供指导，以模拟手术现实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.