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Effect of a collar on subsidence and local micromotion of cementless femoral stems: in vitro comparative study based on micro-computerised tomography

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Abstract

Purpose

The aim of this study is to quantitatively compare the difference in primary stability between collarless and collared versions of the same femoral stem. Specifically, we tested differences in subsidence and micromotion.

Methods

Collarless and collared versions of the same cementless femoral stem were implanted in two groups of six fresh-frozen cadaveric femurs. Each implanted femur was then subsequently tested for axial compressive and torsional loadings. A micro-CT based technique was applied to quantify implant subsidence and compute the map of local micromotion around the femoral stems. Micromotion of collarless and collared stems was compared in each Gruen zone.

Results

Subsidence was higher but not significantly (p = 0.352) with collarless (41.0 ± 29.9 μm) than with collared stems (37.0 ± 44.6 μm). In compression, micromotion was lower (p = 0.257) with collarless (19.5 ± 5 μm) than with collared stems (43.3 ± 33.1 μm). In torsion, micromotion was also lower (p = 0.476) with collarless (96.9 ± 59.8 μm) than collared stems (118.7 ± 45.0 μm). Micromotion was only significantly lower (p = 0.001) in Gruen zone 1 and for compression with collarless (7.0 ± 0.6 μm) than with collared stems (22.6 ± 25.5 μm).

Conclusions

Primary stability was achieved for both stem designs, with a mean micromotion below the osseointegration threshold. Under loading conditions similar to those observed in normal daily activity and with good press-fit, the collar had no influence on subsidence or micromotion. Further studies are required to test the potential advantage of collar with higher loads, undersized stems, or osteoporotic femurs.

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Authors and Affiliations

  1. Laboratory of Biomechanical Orthopaedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015, Lausanne, Switzerland

    Valérie Malfroy Camine, Dominique P. Pioletti & Alexandre Terrier

  2. Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland

    Hannes A. Rüdiger

  3. Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland

    Hannes A. Rüdiger

Authors
  1. Valérie Malfroy Camine
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  2. Hannes A. Rüdiger
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  3. Dominique P. Pioletti
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  4. Alexandre Terrier
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Corresponding author

Correspondence to Alexandre Terrier.

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Conflict of interest

This study was founded by the Swiss National Science Foundation (#141152) and by the SwissLife Jubiläumstiftung. The funding source did not play a role in the investigation. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical review committee statement

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. The local ethical committee approval is not required for biomechanical test on human cadaveric bones.

This work was performed at the Ecole Polytechnique Fédérale de Lausanne and the Lausanne University Hospital, Lausanne, Switzerland.

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Malfroy Camine, V., Rüdiger, H.A., Pioletti, D.P. et al. Effect of a collar on subsidence and local micromotion of cementless femoral stems: in vitro comparative study based on micro-computerised tomography. International Orthopaedics (SICOT) 42, 49–57 (2018). https://doi.org/10.1007/s00264-017-3524-0

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  • DOI: https://doi.org/10.1007/s00264-017-3524-0

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