title: The biomechanical effect of notch size, notch location, and femur orientation on hip resurfacing failure.
abstract: For hip resurfacing, this is the first biomechanical study to assess anterior and posterior femoral neck notching and femur flexion and extension. Forty-seven artificial femurs were implanted with the Birmingham hip resurfacing (BHR) using a range of notch sizes (0, 2, and 5 mm), notch locations (superior, anterior, and posterior), and femur orientations (neutral stance, flexion, and extension). Implant preparation was done using imageless computer navigation, and mechanical tests measured stiffness and strength. For notch size and location, in neutral stance the unnotched group had 1.9 times greater strength than the 5-mm superior notch group (4539 N versus 2423 N, p=0.047), and the 5-mm anterior notch group had 1.6 times greater strength than the 5-mm superior notch group, yielding a borderline statistical difference (3988 N versus 2423 N, p = 0.056). For femur orientation, in the presence of a 5-mm anterior notch, femurs in neutral stance had 2.2 times greater stiffness than femurs in 25° flexion (1542 N/mm versus 696 N/mm, p = 0.000). Similarly, in the presence of a 5-mm posterior notch, femurs in neutral stance had 2.8 times greater stiffness than femurs in 25° extension (1637 N/mm versus 575 N/mm, p = 0.000). No other statistical differences were noted. All femurs failed through the neck. The results have implications for BHR surgical techniques and recommended patient activities.
authors.affiliation: Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada. zmori086@gmail.com
authors.forename: Zachary
authors.initials: Z
authors.lastname: Morison
authors.forename: Michael
authors.initials: M
authors.lastname: Olsen
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Higgins
authors.forename: Rad
authors.initials: R
authors.lastname: Zdero
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods*; D019245:Compressive Strength; D055119:Elastic Modulus; D019544:Equipment Failure Analysis; D005269:Femur / Q000503:physiopathology* / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses; D011474:Prosthesis Design; D013314:Stress, Mechanical; D013718:Tensile Strength