Biomechanical evaluation of the docking nail concept in periprosthetic fracture fixation around a stemmed total knee arthroplasty
| Autor: | Boyko Gueorguiev, Peter Varga, Dominic Mischler, Lena Anna Kasper, Karl Stoffel, Yves P. Acklin, Kajetan Klos, Mark Lenz, Ivan Zderic, Dominic Gehweiler |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
Materials science medicine.medical_treatment 0206 medical engineering Biomedical Engineering Biophysics Periprosthetic 02 engineering and technology Osteotomy Prosthesis law.invention Intramedullary rod 03 medical and health sciences Fracture Fixation Internal 0302 clinical medicine law Fracture fixation medicine Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee Orthodontics Rehabilitation Biomechanics Femoral fracture musculoskeletal system medicine.disease 020601 biomedical engineering Biomechanical Phenomena Fracture Fixation Intramedullary Implant Periprosthetic Fractures Bone Plates Femoral Fractures 030217 neurology & neurosurgery |
| Zdroj: | Journal of biomechanics. 115 |
| ISSN: | 1873-2380 |
| Popis: | Intramedullary femoral nails provide an ideal mechanical axis for periprosthetic fracture fixation. Slotted nails allow a connection to a total knee arthroplasty (TKA) stem. This study aims to compare implant and construct stiffness, interfragmentary movement and cycles to failure between an antegrade slotted femoral nail construct docked to a TKA stem and a distal femoral locking plate in a human periprosthetic femoral fracture model. In eight pairs of fresh-frozen human femora with stalked TKA, a 10 mm transverse osteotomy gap was set simulating a Rorabeck type II, Su type I fracture. The femora were pairwise instrumented with either an antegrade slotted nail coupled to the prosthesis stem, or a locking plate. Cyclic testing with a progressively increasing physiologic loading profile was performed at 2 Hz until catastrophic construct failure. Relative movement at the osteotomy site was monitored by means of optical motion tracking. In addition, four-point bending implant stiffness, torsional implant stiffness and frictional fit of the stem-nail connection were investigated via separate non-destructive tests. Intramedullary nails exhibited significantly higher four-point bending and significantly lower torsional implant stiffness than plates, P 0.01. Increasing difference between nail and stem diameters decreased frictional fit at the stem-nail junction. Nail constructs provided significantly higher initial axial bending stiffness and cycles to failure (200 ± 83 N/mm; 16'871 ± 5'227) compared to plate constructs (93 ± 35 N/mm; 7'562 ± 1'064), P = 0.01. Relative axial translation at osteotomy level after 2'500 cycles was significantly smaller for nail fixation (0.14 ± 0.11 mm) compared with plate fixation (0.99 ± 0.20 mm), P 0.01. From a biomechanical perspective, the docking nail concept offers higher initial and secondary stability under dynamic axial loading versus plating in TKA periprosthetic fracture fixation. |
| Databáze: | OpenAIRE |
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