Professional Documents
Culture Documents
January 4, 2017
THA Implants
The cementless stem obtains initial stability via “press-fit” allowing "bone
ingrowth" of the porous-coating by six weeks post-op.
1. RIGIDITY IS THE SHORT-TERM GOAL.
The technique to prepare the femoral canal for the stem implant utilizes
broaching ن سوراخ به كار مىرود
ى كه براى ايجاد يا گشاد كرد
)زبانه يا تيغهى دستگاه
alone for the metaphyseal fitting stems, and utilizes reaming for the meta-
diaphysial and diaphysial fitting stems. Broaching prepares the
metaphysis, while reaming prepares the diaphysis.
The stem is designed so that it is slightly larger than the femoral canal that
was prepared through sequential broaching, and by wedging in a slightly
"oversized" stem, the hoop stress
prevent motion.
The goal is for bone to incorporate into the implant. Therefore, the
implants are typically titanium alloy so the implant modulus of elasticity is
the closest match to bone. There is either bony ingrowth or bony
ongrowth. Bone growth is circumferential to prevent communication
between the joint space and the distal aspect of the component (which is
called a large "effective joint space" and can occur when there is
incomplete proximal coating).
Bone ingrowth occurs with porous coating, achieved by heating the metal
(which can decrease the fatigue strength). The optimal pore size is
between 50 - 150 μm), the deeper the pores, the better the ingrowth, and
overall porosity 40 - 50%.
note: bone ongrowth can also occur with stems containing splines
(longitudinal grooves that travel along the diaphyseal portion of the stem)
Uneven stress causes “stress shielding” the areas that do not experience
stress. Stress shielding is the resorption of bone over time because the
bone is not functioning in its normal capacity, and thus answers in the
affirmative to the question: “is it true that if you don’t use it, you lose it?”
In contrast, areas that experience excess stress are painful and prevent
bone ingrowth. Titanium alloy is preferred because its lower modulus of
elasticity is most compatible with cortical bone (shares the stress) thus
decreasing thigh pain (yet one study [26] compared identical design stem
in titanium and cobalt-chrome and showed all thigh pain and stress shield
was only related to larger stem size because the radius is such a powerful
determinant of rigidity, remember its r4).
GEOMETRY OF STEMS
Multiple designs attempt to achieve the aforementioned 3 Goals of
uncemented hip arthroplasty.
Every implant company makes a stem with this design. Smith &
Nephew: Anthology, DePuy: Tri-lock , Stryker: Accolade II ,
Biomet: Taperlock, Zimmer: M/L Taper.
These designs are usually made for cementless and cemented option.
Every implant company makes a stem with this design. Smith & Nephew
– Synergy; DePuy – Summit;Stryker - Secur-Fit, Biomet - Integral,
Zimmer - Versys.
Most implant companies make a stem with this design. Smith & Nephew
- Echelon, DePuy – AML, Solution , Stryker - Secur-Fit Max, Biomet –
Mallory-Head, Zimmer - Epoch
Most implant companies makes a stem with this design. Smith & Nephew
- Redapt, DePuy - Reclaim, Stryker - Restoration, Biomet - Arcos ,
Zimmer - ZMR or Wagner SL.