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Publisher DOI: 10.1016/j.artd.2021.10.005
Title: Variability in femoral preparation and implantation between surgeons using manual and powered impaction in total hip arthroplasty
Language: English
Authors: Konow, Tobias 
Bätz, Johanna 
Beverland, David E. 
Board, Tim N. 
Lampe, Frank 
Püschel, Klaus 
Morlock, Michael 
Keywords: Implant-position; Implant-size; Periprosthetic fracture; Surgical experience; Surgical process variability; Templating
Issue Date: 20-Jan-2022
Publisher: Elsevier
Source: Arthroplasty Today 14: 14-21 (2022-04-01)
Abstract (english): 
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.
DOI: 10.15480/882.4130
ISSN: 2352-3441
Journal: Arthroplasty today 
Institute: Biomechanik M-3 
Document Type: Article
More Funding information: Publishing fees were supported by Funding Program “Open Access Publishing” of Hamburg University of Technology (TUHH).
License: CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives) CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
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