Biomechanical comparison of oblique and step-cut osteotomies used in total hip arthroplasty with femoral shortening.
BACKGROUND
Various types of shortening osteotomies and prosthesis are used for femoral reconstruction in total hip arthroplasty of the high hip dislocation. This biomechanical study investigates whether step-cut osteotomies result in better stability than oblique osteotomies and cylindrical femoral stems enhance stability of the osteotomy more than conical stems, and which osteotomy and prosthesis type maintain the stability better after cyclical loading.


METHODS
Oblique and step-cut shortening osteotomies were compared under axial and rotational forces, using synthetic femur models and conical or cylindrical femoral prostheses. The models underwent cyclic loading for 10,000 cycles at 3 Hz (100-1000 N axial bending or 0.5-10 Nm torque). After the completion of cyclic loading, the models were loaded until failure. Stiffness values before and after cyclical loading, and failure loads were the outcome parameters. Relative displacements at the osteotomy sites were also measured using 3-Dimensions Digital Imaging Correlation System.


RESULTS
The mean failure load was significantly higher in conical prosthesis groups under axial forces. In torsion tests, the mean stiffness of conical prosthesis groups after cyclical loading was higher in oblique osteotomies. The other parameters were similar between the groups.


CONCLUSIONS
According to the results of the study, although some individual statistically significant parameters were obtained, step-cut osteotomies, which are technically challenging procedures, were not found biomechanically superior to oblique osteotomies, with neither conical nor cylindrical prostheses.
Department of Orthopedics and Traumatology, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey. Electronic address: yildizfatih@hotmail.com.
Fatih
F
Yıldız
Department of Orthopedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey.
Önder I
ÖI
Kılıçoğlu
Department of Orthopedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey.
Göksel
G
Dikmen
Department of Biomechanics, Istanbul Technical University, Istanbul, Turkey.
Ergun
E
Bozdağ
Department of Biomechanics, Istanbul Technical University, Istanbul, Turkey.
Emin
E
Sünbüloğlu
Department of Biomechanics, Istanbul Technical University, Istanbul, Turkey.
Meral
M
Tuna
D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001696:Biomechanical Phenomena; D005270:Femur Head / Q000601:surgery*; D006617:Hip Dislocation / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008953:Models, Anatomic; D010027:Osteotomy / Q000379:methods*; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D016474:Weight-Bearing