Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty

Arthroplasty Today

Johanna Bätz, Dr-Ing¹  Tim Board, MD²  Michael M. Morlock, PhD³  David Beverland, MD⁴  Tobias Konow, MSc⁴  Klaus Püschel, MD⁵  Frank Lampe, MD⁶ 

[1] Corresponding author. TUHH Hamburg University of Technology, Institute of Biomechanics, Denickestraße 15, Hamburg 21073, Germany. Tel.: [phone].;Belfast Arthroplasty Research Trust, Belfast, UK;Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany;Schön Klinik Hamburg Eilbek, Hamburg, Germany;Wrightington Hospital, Lancashire, UK;

关键词: Periprosthetic fracture;    Implant-size;    Implant-position;    Templating;    Surgical process variability;    Surgical experience;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: The influence of the surgical process on implant loosening and periprosthetic fractures (PPF) as major complications in uncemented total hip arthroplasty (THA) has rarely been studied because of the difficulty in quantification. Meanwhile, registry analyses have clearly shown a decrease in complications with increasing experience. The goal of this study was to determine the extent of variability in THA stem implantation between highly experienced surgeons with respect to implant size, position, press-fit, contact area, primary stability, and the effect of using a powered impaction tool. Methods: Primary hip stems were implanted in 16 cadaveric femur pairs by three experienced surgeons using manual and powered impaction. Quantitative CTs were taken before and after each process step, and stem tilt, canal-fill-ratio, press-fit, and contact determined. Eleven femur pairs were additionally tested for primary stability under cyclic loading conditions. Results: Manual impactions led to higher variations in press-fit and contact area between the surgeons than powered impactions. Stem tilt and implant sizing varied between surgeons but not between impaction methods. Larger stems exhibited less micromotion than smaller stems. Conclusions: Larger implants may increase PPF risk, while smaller implants reduce primary stability. The reduced variation for powered impactions indicates that appropriate measures may promote a more standardized process. The variations between these experienced surgeons may represent an acceptable range for this specific stem design. Variability in the implantation process warrants further investigations since certain deviations, for example, a stem tilt toward varus, might increase bone stresses and PPF risk.

【 授权许可】

Unknown