| Autor: |
Patrick J. Denard, Matthias Flury, Werner Anderl, Hans-Kasper Schwyzer, Sven Lichtenberg, Coen A. Wijdicks, Daniel Ritter, Samuel Bachmaier, Laurence D. Higgins |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
Seminars in Arthroplasty: JSES. 31:677-687 |
| ISSN: |
1045-4527 |
| DOI: |
10.1053/j.sart.2021.04.005 |
| Popis: |
Background and Hypothesis Morphologic analysis of the proximal humerus has been performed to provide information about regions of best bone quality for stemless implant fixation. However, implant design-related bone analysis regarding primary fixation strength has not been reported. The purpose of this study was to investigate bone volume fraction (BV/TV) and bone mineral density (BMD) in the spatial vicinity of humeral implant fixation and biomechanical performance following placement of two different stemless RSA designs. It was hypothesized that peripheral expandable implant fixation (PEF) would result in residual peri-implant bone with higher BMD and BV/TV and higher fixation strength compared to a central-hexagonal impaction fixation (CHIF) design. Methods Overall 25 human cadavers were prepped for stemless RSA using either a CHIF (n = 5) or PEF design (n = 20). Micro computed tomography scans were obtained post-preparation to analyze overall BV/TV and BMD in the anchoring region of 2 stemless implant designs. Bone volumes of paired specimens (each group n = 5) were further segmented and divided into three even planar subsections along the implantation direction with four additional radial sectors, each according to their anterior-posterior and medial-lateral direction. Following implantation, biomechanical testing was performed to evaluate ultimate failure load and stiffness of the 2 implants. Results Postpreparation paired humeral bone analysis revealed significantly greater residual peri-implant BMD (P 0.69) with significantly higher bone density for PEF (P= .003). Further division in proximal to distal planar subsections of paired specimens showed overall statistically higher BMD and BV/ TV for PEF (at least P 0.89 with significantly higher primary stability for PEF (P = .046). Conclusion Implant design in stemless RSA affects residual bone quality in the anchoring region and primary fixation strength. Peripheral implant anchoring along the insertion direction provides significantly higher residual peri-implant BMD and BV/TV to achieve improved primary fixation with a radial expandable anchoring implant compared to a central-hexagonal impacted design. Level of Evidence Basic Science Study; Anatomy Study; Imaging; Biomechanics |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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