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      Biomechanical behaviour of a French femoral component with thin cement mantle: The 'French paradox' may not be a paradox after all.

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          Abstract

          Cement thickness of at least 2 mm is generally associated with more favorable results for the femoral component in cemented hip arthroplasty. However, French-designed stems have shown favorable outcomes even with thin cement mantle. The biomechanical behaviors of a French stem, Charnley-Marcel-Kerboull (CMK) and cement were researched in this study.

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          Most cited references22

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          Assessing activity in joint replacement patients.

          Outcome evaluations of lower extremity joint reconstructions should include an assessment of patient activity. In vivo wear assessments of total joint prostheses should be based on a measure of use, not time in situ or a proxy such as age or gender; however, clinicians lack a simple method to reliably assess the activity of patients with joint replacement. The modern pedometer can be a satisfactory means of quantifying the use of lower extremity joints. The pedometer, however, requires special effort on the part of the physician or evaluator and the patient. Therefore, we compared the quantitative assessment of walking activity of 100 total joint replacement patients, as measured with a pedometer, to the UCLA activity score and a simple visual analog scale that can easily be employed during a routine office evaluation. Both the UCLA activity rating (P = .002) and the visual analog scale rating of the investigator (P = .00001) had a strong correlation with the average steps per day as recorded by the pedometer. There was, however, up to a 15-fold difference in the average steps per day for individual patients with the same UCLA score. The visual analog scale as rated by the patients of their own activity did not have as strong a correlation with the pedometer data (P = .08) as did patient age (P = .049). For practical reasons, the pedometer is probably best reserved for the evaluation of extreme cases of activity (or inactivity). This study indicates that both the UCLA activity rating and the investigator visual analog scale are valid for routine activity assessment in a clinical setting. Adjustments of the UCLA activity score for the frequency and intensity of activity, as can be done with the investigator visual analog scale, increase the accuracy of the activity rating.
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            Hip joint loading during walking and running, measured in two patients.

            The resultant hip joint force, its orientation and the moments were measured in two patients during walking and running using telemetering total hip prostheses. One patient underwent bilateral joint replacement and a second patient, additionally suffering from a neuropathic disease and atactic gait patterns, received one instrumented hip implant. The joint loading was observed over the first 30 and 18 months, respectively, following implantation. In the first patient the median peak forces increased with the walking speed from about 280% of the patient's body weight (BW) at 1 km h-1 to approximately 480% BW at 5 km h-1. Jogging and very fast walking both raised the forces to about 550% BW; stumbling on one occasion caused magnitudes of 720% BW. In the second patient median forces at 3 km h-1 were about 410% BW and a force of 870% BW was observed during stumbling. During all types of activities, the direction of the peak force in the frontal plane changed only slightly when the force magnitude was high. Perpendicular to the long femoral axis, the peak force acted predominantly from medial to lateral. The component from ventral to dorsal increased at higher force magnitudes. In one hip in the first patient and in the second patient the direction of large forces approximated the average anteversion of the natural femur. The torsional moments around the stem of the implant were 40.3 N m in the first patient and 24 N m in the second.
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              Structural properties of fourth-generation composite femurs and tibias.

              The purpose of this study was to measure the structural properties of the latest design (fourth-generation) of composite femurs and tibias from Pacific Research Laboratories, Inc. Fourth-generation composite bones have the same geometries as the third-generation bones, but the cortical bone analogue material was changed to one with increased fracture and fatigue resistance, tensile and compressive properties, thermal stability, and moisture resistance. The stiffnesses of the femurs and tibias were tested under bending, axial, and torsional loading, and the longitudinal strain distribution along the proximal-medial diaphysis of the femur was also determined. The fourth-generation composite bones had average stiffnesses and strains that were for the most part closer to corresponding values measured for natural bones, than was the case for third-generation composite bones; all measurements were taken by the same investigator in separate studies using identical methodology. For the stiffness tests, variability between the specimens was less than 10% for all cases, and setup variability was less than 6%.
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                Author and article information

                Journal
                Bone Joint Res
                Bone & joint research
                British Editorial Society of Bone & Joint Surgery
                2046-3758
                2046-3758
                Jul 2018
                : 7
                : 7
                Affiliations
                [1 ] Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa, Japan.
                [2 ] Marcel Kerboull Institute, Paris, France.
                Article
                10.1302_2046-3758.77.BJR-2017-0288.R2
                10.1302/2046-3758.77.BJR-2017-0288.R2
                6076357
                30123498
                f9f4998c-e06b-45a1-ad91-0e28b82578bb
                History

                Bone cement,French stem,Total hip arthroplasty
                Bone cement, French stem, Total hip arthroplasty

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