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

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.