Assessment of the fixation

stiffness of some femoral stems of

different designs

Rina Sakai, Nobue Kanai, Moritoshi

Itoman, Kiyoshi Mabuchi
Journal of Clinical Biomechanics (2006) Vol. 21- pages 370378

6/16/15

Contents:
1.
2.
3.
4.
5.
6.

Introduction.
Methods.
Results.
Discussion.
Conclusions.
Critique.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Introduction
Loosening is the most serious complication
occurring after total hip arthroplasty (Gert et al.,
2003; Marshall et al., 2004; Phillips et al., 1991).
Mechanical strength of the fixation site is
important within the initial short period (Engh
and Hopper, 2002; Sakai et al., 2001, 2002).
It takes a few months after the total hip
arthroplasty to complete the biological fixation
by bone ingrowth.
6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Methods
In this study three commercial femoral
stems were modeled which are:
1. IMC stem (Intra-Medullary cruciate stem,
Japan).
2. VS stem (VerSys Fiber Metal Taper,
Zimmer, USA).
3. PSV stem (PerFix SV 910 series, Japan
Medical Materials).
6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Methods (FEA)
A three-dimensional model of the contour of
an adult femur was built from the CT data.
A nonlinear structural finite element
analysis program (LS-DYNA Ver. 950) was
used.
The mass density was experimentally
determined as 7820 kg/m3 for the titanium
alloy and 2333 kg/m3 for the cortical bone.
6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Methods (Mesh)
Hexahedral solid elements filled the
contour models.
After automatic mesh generation by a
preprocessor
(Hyper
Mesh,
Altair
Engineering, USA), corrections were
made individually.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Methods (Material Properties)

Stem elements were assumed to be
isotropic titanium alloy with an elastic
modulus of 111 GPa and Poissons ratio of
0.3.
The femur was assumed to be isotropic
material with an elastic modulus of 15.5
GPa and Poissons ratio of 0.29.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Methods (boundary conditions )

1. Rigid contact of the distal end of the
femur with the rigid base.
2. Load of 800 or 1800 N was applied to the
proximal top of the stem.
3. Load of 640 or 1440 N was applied by
the greater trochanter of the femur as a
muscle force.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Methods (Evaluation of stability)

Instability caused by lack of geometric
conformity is generally evaluated according
to displacement.
Displacement changes with the load applied
and the load changes with the body weight or
activity such as walking and climbing stairs.
The fixation stiffness (the hip joint resultant
force divided by displacement) is used to
evaluate stem stability.
6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

Discussion (IMC Stem)

The mean displacement of the IMC stem
in the z-direction was lowest among the
three femoral stems.
These results indicated that sinking of
stems, which is a clinical problem, was
lowest in the IMC stem.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

10

Discussion (VS Stem)

In the VS system, the displacement in the
y-axis direction was very low, and remained
unchanged under different conditions.
This is due to that the VS stem was
designed to increase rotational stability by
digging fins into bone.
As the fins are thin, the fixation stiffness of
the VS stem in the z- direction was low.
6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

11

Discussion (PSV Stem)

In the PSV stem, the displacements in all
directions were high under any condition.
The high displacement induced was
caused
probably
because
the
characteristic
flange
fixed
in
the
proximomedial region did not sufficiently
fix the bone immediately below it.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

12

Discussion (Angle Effect)

In the IMC stem, increases in the
displacement and changes in the fixation
stiffness were observed by changing the
loading angle from 0o to 20o.
However, in the VS and PSV stems, there
were no differences in these parameters
between the loading angles of 0o and 20o.

6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

13

Conclusions
This study indicated the usefulness of fixation
stiffness for the evaluation of stability of
fixation.
The fixation stiffness in the z-direction was
highest in the IMC stem.
In the VS stem, fixation with fins functioned in
the y- direction alone.
It was suggested that the flange in the PSV
stem did not function as a fixation device.
6/16/15

Egypt-Japan University of Science and

Technology (E-Just)

14