title: Primary rotational stability of various megaprostheses in a biomechanical sawbone model with proximal femoral defects extending to the isthmus.
abstract: OBJECTIVE
  Fixation of proximal femoral megaprostheses is achieved in the diaphyseal isthmus. We hypothesized that after extended bone resection including the proximal part of the isthmus a reduced length of fixation will affect the stability and fixation characteristics of these megaprostheses. The aim of this study was to analyze in a validated sawbone model with extended proximal femoral defects which types of implants have sufficient primary stability to allow osteointegration and to describe their fixation characteristics.
  
  
  METHODS
  Four different cementless megaprostheses were implanted into 16 Sawbones with an AAOS type III defect after resection 11 cm below the lesser trochanter involving the proximal isthmus. To determine the primary implant stability relative micromotions between bone and implant were measured in relation to a cyclic torque of 7Nm applied on the longitudinal axis of the implant. We determined the fixation characteristics of the different implant designs by comparing these relative micromotions along the longitudinal stem axis.
  
  
  RESULTS
  In the tested sawbones all studied implants showed sufficient primary stability to admit bone integration with relative micromotions below 150 µm after adapting our results to physiologic hip joint loadings. Different fixation characteristics of the megaprostheses were determined, which could be explained by their differing design and fixation concepts.
  
  
  CONCLUSIONS
  Cementless megaprostheses of different designs seem to provide sufficient primary stability to bridge proximal femoral defects if the diaphyseal isthmus is partially preserved. In our sawbone model the different implant fixation patterns can be related to their stem designs. No evidence can be provided to favor one of the studied implants in this setting. However, femoral morphology is variable and in different isthmus configurations specific implant designs might be appropriate to achieve the most favorable primary stability, which enables bone integration and consequently long term implant stability.
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kinkel
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Nadorf
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jan Dennis
authors.initials: JD
authors.lastname: Graage
authors.affiliation: Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Jakubowitz
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jan Philippe
authors.initials: JP
authors.lastname: Kretzer
mesh_terms: D001696:Biomechanical Phenomena; D005265:Femoral Neck Fractures / Q000503:physiopathology* / Q000601:surgery*; D050723:Fractures, Bone / Q000503:physiopathology* / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008954:Models, Biological; D011474:Prosthesis Design; D012399:Rotation