• Korean Journal of Computational Design and Engineering
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• v.21 no.4
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• pp.426-432
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• 2016

Designing a morphologically well-fitted hip implant to a patient anatomy is desirable to improve surgical outcomes since a commercial ready-made hip implant may not well conform to the patient joint. In this study, biomechanical stability of patient-specific hip implants with two different stem lengths was compared and discussed using a 3D finite element analysis (FEA). The FEA results in this study showed that an increase in stem length brings about more the peaked von-Mises stress (PVMS) in the prosthesis and less in the femur. However the decrease in von-Mises stress in the femur causes stress shielding phenomenon that usually leads to considerable bone resorption. Although, in biomechanical stability point of view, this work recommends the use of smaller stems, the length of stem must be determined by considering both the von-Mises stress and the stress-shielding phenomenon.

• Hip & pelvis
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• v.34 no.4
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• pp.211-218
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• 2022

Purpose: We report on the 10-year clinical hip function and radiologic outcomes of patients who underwent hip arthroplasty using a COREN stem. Materials and Methods: A consecutive series of 224 primary cementless hip arthroplasty implantations were performed using a COREN stem between 2009 and 2011; among these, evaluation of 128 hips was performed during a minimum follow-up period of 10 years. The mean age of patients was 65.4 years (range, 40-82 years) and the mean duration of follow-up was 10.8 years (range, 10-12 years). Evaluation of clinical hip function and radiologic implant outcomes was performed according to clinical score, thigh pain, and radiologic analysis. Results: Dramatic improvement of the mean Harris hip score (HHS) from 59.4 preoperatively to 93.5 was observed at the final follow-up (P≤0.01). Stable fixation was demonstrated for all implants with no change in position except for one case of Vancouver type B2 periprosthetic femur fracture. A radiolucent line (RLL) was observed in 16 hips (12.5%). Thigh pain was observed in only two hips (1.6%) at the final follow-up. There were no cases of osteolysis around the stem. The survival rate for the COREN stem was 97.7%. Conclusion: Good long-term survival with excellent clinical and radiological outcomes can be achieved using the COREN femoral stem regardless of Dorr type.

• Journal of Yeungnam Medical Science
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• v.37 no.1
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• pp.40-46
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• 2020

Background: Postoperative pain occurring after hip arthroplasty has become common since the expanded use of cementless femoral stems. The characteristic pain develop in the anterolateral thigh area. This study aimed to predict anterior thigh pain based on the measurements of postoperative anteroposterior (AP) and lateral (Lat) radiographs of the hip joint. Methods: The present study included 26 patients (29 hips) who underwent total hip replacement or bipolar hemiarthroplasty between March 2010 and May 2016, whose complete clinical information was available. AP and Lat radiographs of the affected hip were taken on the day of surgery and 1 and 6 months postoperatively. Patients with improper radiographs were excluded. The distance from the femoral stem to the nearest cortical bone in the distal region of the stem was measured. The patient group with a visual analog scale (VAS) score of ≥6 points was designated as patients with anterior thigh pain. Results: Sex, age, weight, height, body mass index, and bone mineral density in the lumbar spine and femur did not have a significant effect on postoperative VAS scores (p>0.05). Presence of contact between the femoral stem and cortical bone was associated with postoperative anterior thigh pain. Conclusion: Hip AP and Lat radiographs are usually taken to confirm fixation and alignment of the femoral stem after hip arthroplasty. The measurement method introduced in this study can be utilized for predicting anterior thigh pain after hip arthroplasty.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.05
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• pp.245-248
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• 1997

Excessive stress on the bone-stem interface may cause local micromotion that could produce midthigh pain, interface bone resorption and prevent bony ingrowth. It is important for clinician and prosthetic designer to develop an understanding of the load transfer mechanism, its associated stress pattern and its relationships with the particular mechanical characteristics of the femoral stem designs. Finite element method (FEM) is preeminently suited to provide information in this respect. The authors developed 3-dimensional numerical finite element models implanted with the straight stem which is composed of total 1170 elements of 8 nodes and with the curved stem which is composed of total 885 elements of 8 node, and analysed the relative micromotions between the straight stem and the curved stem in immediate postoperative stage of an uncemented total hip replacement in load simulating the single leg stance. The results showed that the rotational displacement was occupied over 90% of total micromotion in both types of stem and was peak at the proximal medial portion of the stem, but markedly less distally. The curved stem was more stable especially in terms of rotational stability. It is recommended that surgeons do not allow the patient weight bearing until bony ingrowth was achieved. In the future more attention should be drawn to increase initial rotational stability of the two types of femoral stem to prevent loosening from excessive micromotion.

• Biomaterials and Biomechanics in Bioengineering
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• v.3 no.2
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• pp.85-104
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• 2016

Stability and loosening of implanted femoral stems in Total Hip Replacement have been well established as barriers to the primary concerns of osseointegration and long term implant survival. In-vitro experiments and finite element modeling have for years been used as a primary tool to assess the bone stem interface with variable methodologies leading to a wide range of micromotion, interference fit and stress shielding values in the literature. The current study aims to provide a comprehensive review of currently utilized methodologies for in-vitro mechanical testing as well as finite element modeling of both micromotion and interference of implanted femoral stems. A total of 12 studies detailed in 33 articles were selected for inclusion. Experimental values of micromotion ranged from 12 to $182{\mu}m$ while finite element analysis reported a wider range from 2.74 to $1,277{\mu}m$. Only two studies were found that modeled bone/implant contact with consideration for interference fit. In studies evaluating stem micromotion in THA, the reference surface at the bone/stem interface should be well defined. Additionally, the amount of penetration considered should be disclosed and associated with bone density and roughness.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.93-106
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• 2023

Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.

• Journal of Biomedical Engineering Research
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• v.17 no.1
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• pp.61-70
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• 1996

In cementless total hip arthroplasty(THA), an initial stability of the femoral component is mandatory to achieve bony inyowth and secondary long term fixation. Primary stability of the femoral component can be obtained by minimizing the magnitude of relative micromotions at bone stem interface. An accurate evaluation of interf'ace micromotion and stress/strain fields in the bone-implant system may be relevant for better understanding of clinical situations and improving THA design. Recently finite element method(FEM) was introduced in'orthopaedic research field due to its unique capacity to evaluate stress in structure of complex shape, loading and material behavior. The authors developed the 3-dimensional finite element model of proximal femur with $Multilock^{TM}$ stem of 1179 blick elements to analyse the micromotions and mechanical behaviors at the bone-stem inteface in early post-operative period for the load simulating single leg stance. The results indicates that the values of relative motion for this well fit stem were $150{\mu}m$ in maximum $82{\mu}m$ in minimum and the largest relative motion was developed in medial region of Proximal femur and in anterior-posterior direction. The motion in the proximal bone was much greater than in the distal bone and the stress pattern showed high stress concentration on the cortex near the tip of the stem. These findings indicate that the loading on the hip joint in the early postoperative situation before achieving bony ingrowth could produce large micromotion of $150{\mu}m$ and clinicaly non-cemented THA patient should not be allowed weight bearing strictly early in the postoperative period.

• Journal of Biomedical Engineering Research
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• v.23 no.2
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• pp.119-130
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• 2002

The nonlinear finite element program has been developed to analyze the design performance of an artificial hip prosthesis and long term behavior of a treated femur with stems made of composite material after cementless total hip arthroplasty(THA). The authors developed the three dimentional FEM models of femoral bone with designed composite stem which was taken with elliptic cross section of 816 brick elements under hip contact load and muscle farce in simulating single leg stand. Using the program, density changes, stress distributions and micromotions of the material femoral bone were evaluated by changing fiber orientation of stems for selected manufacturing method such as plate cut and bend mold. The results showed that the composite materials such as AS4/PEEK and T300/976 gave less bone resorption than the metallic material such as cobalt chrome alloy, titanium alloy and stainless steal. It was found that increasing the long term stability of the prosthesis in the femur could be obtained by selecting the appropriate ply orientation and stacking sequence of composite.

• Proceedings of the KSME Conference
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• 2001.06c
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• pp.482-484
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• 2001

In orthopedics, hip arthroplasty is the operation that replaces damaged hip joint to artificial joint. In hip arthroplasty, quite better result can be achieved if robot is applied to machine cavity in bone, especially when cementless stem is used. So several kinds of robots were introduced for hip arthroplasty, but they used MRI, CT Scan, vision analysis and real time tracking of bone position for registration of robot. To overcome shortage of conventional robot surgery, gauge based registration method was proposed and small robot was designed. In this method, small robot is mounted on femur, and its position is determined by gauge registration method. Operation procedure was performed on model femur and result was analyzed. This robotic hip surgery system is expected to more adaptable in operation room.

• Proceedings of the KOSOMBE Conference
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• v.1994 no.12
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• pp.75-78
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• 1994

Clinically, proximal bone resorption in the femur is frequently seen postoperatively on the follow up X-rays after total hip replacement(THR). We developed the finite element model of cementless THR. The model is two dimensional side plate model, whereby the three dimensional structural integrity of the bone can be accounted for by a separate two dimensional mesh, a side plate. The subject of this article is the development and application of this two dimensional side plate FEM to study the reverse effect of the various degree of bone resorption of femur after THR. The results of this study indicates that two dimensional side plate model is good and simple alternative to complex three dimensional model and the severity of the proximal bone resorption has the effect of more increasing stress on the cortex at the level of femoral stem tip.