How does the stem design affect the degree of freedom of the stem version and position? A computer simulation study

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-07-21 DOI:10.1016/j.clinbiomech.2025.106628

Shotaro Kawamura , Daisuke Hara , Satoshi Hamai , Goro Motomura , Shinya Kawahara , Taishi Sato , Ryosuke Yamaguchi , Takeshi Utsunomiya , Yasuharu Nakashima

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引用次数: 0

Abstract

Background

Controlling stem anteversion is crucial in total hip arthroplasty to prevent prosthetic impingement. The degree of freedom in stem version varies depending on the stem design. However, few studies have quantified the version freedom across different stem designs. This study aimed to quantify the differences in the version freedom and position according to stem version changes between tapered-wedge and fit-and-fill stems.

Methods

Fifty-one hips were examined using preoperative CT. Three-dimensional templating was performed using tapered-wedge and fit-and-fill stems. The difference between the maximum and minimum stem anteversions was defined as the version freedom. Stem alignment changes in the coronal and sagittal planes and stem depth changes according to the changes in stem version were examined. Changes in the version with respect to the native femoral version were also compared.

Findings

The mean version freedom for the tapered-wedge stem (21.7°) was significantly greater than that for the fit-and-fill stem (9.8°, P < 0.0001). The stem alignment changes of the tapered-wedge stem in the coronal and sagittal planes were significantly greater than those of the fit-and-fill stem, with no significant difference in the stem depth change. The version freedom significantly correlated with stem alignment changes. Both stem designs more easily increased stem anteversion but were more limited in decreasing it relative to the native femoral anteversion.

Interpretation

Stem design affects the version freedom. Increased adjustability of the tapered-wedge stem may improve implant positioning. Meticulous surgical planning and precise intraoperative control remain crucial to achieving target anteversion and ensuring optimal long-term outcomes.

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阀杆设计如何影响阀杆版本和位置的自由度？计算机模拟研究

背景在全髋关节置换术中控制假体前倾是防止假体撞击的关键。阀杆版本的自由度取决于阀杆设计。然而，很少有研究量化不同系统设计的版本自由度。本研究旨在量化锥形楔型和配合填充型阀杆在阀杆形态变化过程中自由度和位置的差异。方法术前CT检查51例髋关节。三维模板使用锥形楔形和配合填充茎。最大和最小杆前倾之差被定义为自由度。研究了茎在冠状面和矢状面的排列变化以及茎深度随茎型变化的变化。还比较了相对于本地股骨版本的版本变化。发现锥形楔杆（21.7°）的平均自由度显著大于配合填充杆（9.8°，P < 0.0001）。锥形楔型茎在冠状面和矢状面排列方向的变化显著大于充填型茎，而茎深变化无显著差异。版本自由度与杆向变化显著相关。两种股骨前倾设计都更容易增加股骨前倾，但在减少股骨前倾方面更有限。系统设计影响版本自由。锥形楔柄的可调节性增加可以改善种植体的定位。细致的手术计划和精确的术中控制对于实现目标前倾和确保最佳的长期预后至关重要。

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.