Small design modifications can improve the primary stability of a fully coated tapered wedge hip stem
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SUBMITTER: Glismann K
PROVIDER: S-EPMC11023602 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Background The use of cementless femoral stems in patients undergoing primary total hip arthroplasty (THA) with Dorr C bone remains controversial for fear of fracture or subsidence. Purpose of this multicenter study was to compare clinical outcomes and complications of THA using a tapered femoral prosthesis in patients with Dorr C bone versus Dorr A/B bone. Methods A total of 1,030 patients underwent primary THA with a tapered wedge femoral stem at a minimum one year follow up. Forty-eight patients with Dorr C bone (mean age 68.7 years) were compared with a matched cohort of patients with Dorr A/B bone (mean age 69.9 years). Mean follow-up was approximately 4 years in both cohorts. There were no differences in sex, age, body mass index (BMI), Harris Hip Score (HHS), complications, and radiographic outcomes including subsidence and aseptic loosening were evaluated. Results Postoperative HHSs were a mean of 82 points in the Dorr C cohort compared to 84 points in the Door A/B cohort (P=0.2653). There was no significant difference in complication or revision rates for any reason (P=0.23). Mean subsidence for the Dorr C and Dorr A/B was 1.4 and 1.2 mm, respectively (P=0.5164), and there was no aseptic loosening of the femoral component found in either group. Conclusions Current generation tapered wedge cementless femoral stems provide stable fixation for patients with Dorr C bone quality without increased complications with respect to fracture or subsidence and can be considered an alternative to cemented stems in patients with compromised bone quality.
| S-EPMC10477656 | biostudies-literature
Project description:Background/objectiveA stem sitting proud (SP) or that above the final rasp position remains in some patients who undergo hip replacement using proximally coated tapered wedge stems. Surgeons may face challenges providing the best fit because of unpredictable SP of proximally coated tapered wedge stems. Zimmer Inc. introduced a new rasp to solve this issue but the clinical results of this rasp have not yet been published. Therefore, our aim was to address the following: (1) What is the stem SP incidence using a proximally coated cementless tapered wedge stem? (2) Does the new rasp system (0-mm rasp) improve seating height? and (3) What are the risk factors of stem SP?MethodsWe performed a retrospective study with 338 hips, in which Tri-Lock Bone Preservation Stem (BPS) was used in 181 hips and M/L Taper stem was used in 157 hips (82 hips before and 75 hips after 0-mm rasp use). A positive stem SP was defined as a stem proud height of >2 mm. We analysed and compared SP incidence in two stems and M/L Taper stems before and after the 0-mm rasp use.ResultsAn incidence of stem SP was 13% in the Tri-Lock BPS and 15% in the M/L Taper stem before the 0-mm rasp use. Stem SP incidence in the M/L Taper stem substantially decreased after the 0-mm rasp use (4%). The significant risk factor for stem SP was use of the high offset option in Tri-Lock BPS.ConclusionThe proximally coated tapered wedge stems present potential problems related to stem SP. The new rasp of the M/L Taper stem showed significant improvement in initial seating height.The translational potential of this articleThis study was conducted to understand "stem sitting proud" in proximally coated tapered wedge stem as one of the most popular designs nowadays in adult hip joint arthroplasty field. In this study, we aimed to address the incidence of stem proud, investigated the risk factor and introduced the effect of new rasp system which improve stem seating height.
| S-EPMC6896482 | biostudies-literature
Project description:In this paper, we evaluated the long-term results of uncemented total hip arthroplasties using tapered fully porous-coated cobalt-chrome stems (Autophor 900S). The average follow-up was 206 months in 127 hips (113 patients). The articulations of the joints were ceramic-on-polyethylene in 43 hips and ceramic-on-ceramic in 84. The survival rate of the stems at 17 years was 94.5%. A stable stem with bony ingrowth was identified in all 120 hips, excluding femoral revision cases (seven hips). The causes of the seven femoral revisions were aseptic loosening in four, infection in two, and stem fracture in one. No surgical intervention was performed for osteolysis or stress shielding. The Autophor 900S tapered fully porous-coated cobalt-chrome femoral stem revealed encouraging radiographic long-term stability.
| S-EPMC2323415 | biostudies-other
Project description: Not available
| S-EPMC11847092 | biostudies-literature
Project description:RNA 5-methyl and 5-propynyl pyrimidine analogs were substituted into short interfering RNAs (siRNAs) to probe major groove steric effects in the active RNA-induced silencing complex (RISC). Synthetic RNA guide strands containing varied combinations of propynyl and methyl substitution revealed that all C-5 substitutions increased the thermal stability of siRNA duplexes containing them. Cellular gene suppression experiments using luciferase targets in HeLa cells showed that the bulky 5-propynyl modification was detrimental to RNA interference activity, despite its stabilization of the helix. Detrimental effects of this substitution were greatest at the 5'-half of the guide strand, suggesting close steric approach of proteins in the RISC complex with that end of the siRNA/mRNA duplex. However, substitutions with the smaller 5-methyl group resulted in gene silencing activities comparable to or better than that of wild-type siRNA. The major groove modifications also increased the serum stability of siRNAs.
| S-EPMC2632910 | biostudies-literature
Project description: Not available
| S-EPMC6458012 | biostudies-literature
Project description:AimTo evaluate the correlation between insertion torque (IT) and implant stability quotient (ISQ) in tapered implants with knife-edge threads.MethodsSeventy-five identical implants (Anyridge, Megagen) were inserted by using a surgical drilling unit with torque control and an integrated resonance frequency analysis module (Implantmed, W&H). IT (N/cm) and ISQ were recorded and implants were divided into three groups (n = 25) according to the IT: low (<30), medium (30 < IT < 50), and high torque (>50). ISQ difference among groups was assessed by Kruskal-Wallis test, followed by Bonferroni-corrected Mann-Whitney U-test for pairwise comparisons. The strength of the association between IT and ISQ was assessed by Spearman Rho correlation coefficient (α = 0.05).ResultsAt the pairwise comparisons, a significant difference of ISQ values was demonstrated only between low torque and high torque groups. The strength of the association between IT and ISQ value was significant for both the entire sample and the medium torque group, while it was not significant in low and high torque groups.ConclusionsFor the investigated implant, ISQ and IT showed a positive correlation up to values around 50 N/cm: higher torques subject the bone-implant system to unnecessary biological and mechanical stress without additional benefits in terms of implant stability. This trial is registered with NCT03222219.
| S-EPMC5976959 | biostudies-literature
Project description:BackgroundImmediate function has become an accepted treatment modality for fixed restorations in completely edentulous jaws. It is known that implant microtopography (surface) may enhance osseointegration, while implant macrotopography (macrodesign) plays an important role in primary stability in the patient requiring an immediate loading. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of the edentulous subjects treated with narrow and/or regular diameter, which placed and loaded immediately.MethodsForty-two consecutive patients received 171 implants, including regular and narrow diameter implants (NDIs). Each jaw, 19 mandibles and 24 maxillae, was treated with a fixed-full arch prosthesis according to the Straumann® Pro Arch concept. The majority (95%) of the restorations were supported by four implants, of which the posterior two implants were tilted. A provisional functional acrylic prosthesis was delivered on the day of surgery. All patients were followed up to 55 months. Cumulative survival rate was determined using Kaplan-Meier analysis. Radiological measurement of marginal bone level was performed.ResultsThe overall follow-up time for survival rate was up to 55 months. Four implants (3 implants in maxilla, 1 implant in mandible) were lost, resulting in an overall cumulative implant survival rate of 97.7%. Implant survival rate in the axial and tilted implants was not statistically significant. The mean of interproximal marginal bone loss was 0.15 mm after 24 months. Good soft tissue health was observed in almost 99% of patients. The final prosthesis survival rate was 100%.ConclusionsThe results of this retrospective pilot study indicated that total edentulous patients requiring an immediate implant placement and loading can be successfully treated with this implant design. The improved mechanical properties of these implants might give a more conservative treatment option for the jaws showing a severe horizontal alveolar bone resorption.
| S-EPMC7680819 | biostudies-literature
Project description:Although tapered-wedge short stem has been widely employed with its availability for minimally invasive surgeries in total hip arthroplasty (THA), post-operative stress shielding matter remains unresolved in cementless procedures. This study aimed to clarify the most optimal femoral canal contact regions of the stem design taking stress shielding incidence into consideration. This investigation included 60 joints from 60 patients (mean age at operation: 65.9 years), of which follow-up duration after primary THA had been more than 2 years. Frequencies of spot welds, subsidence, and stress shielding were examined 2 years after surgery. The most suitable femoral canal contact regions were evaluated by plain radiograph (2D) and 3D-computed tomography analyses according to Nakata's division for fitting manners. Spot welds were observed in 38 cases (63.3%), and no subsidence case was seen. Respective number of stress shielding cases, based on Engh's classification, categorized as degree 0, 1, and 2, were 2 (3.3%), 31 (51.7%), and 27 (45.0%), while no cases for degree 3 or 4 were found. When assessed by 3D fitting analysis, 27 cases of stress shielding degree 2 were constituted by 13/42 cases of mediolateral (ML) fit, 2/4 cases of flare fit, and 12/14 cases of multi point fit. In 42 cases of ML fitting, stem contact rate of the most proximedial region in stress shielding degree 0 and 1 was significantly higher compared to stress shielding degree 2 cases. Meanwhile, the rates of distal regions were significantly lower or absent in stress shielding degree 0 and 1 cases. The initial fixation of this stem design was very good in our cohort regardless of fitting manners. This study successfully revealed that ML fitting with femoral component, especially the most proximedial calcar site restricted fitting, would be optimal for reducing stress shielding occurrence in cementless short, tapered-wedge stem THA. Thus, the ideal stem contact region should be considered during THA procedures in light of the reduction of stress shielding development.
| S-EPMC10179674 | biostudies-literature
Project description:Crystals and fibers doped with rare-earth (RE) ions provide the basis for most of today's solid-state optical systems, from lasers and telecom devices to emerging potential quantum applications such as quantum memories and optical to microwave conversion. The two platforms, doped crystals and doped fibers, seem mutually exclusive, each having its own strengths and limitations, the former providing high homogeneity and coherence and the latter offering the advantages of robust optical waveguides. Here we present a hybrid platform that does not rely on doping but rather on coating the waveguide-a tapered silica optical fiber-with a monolayer of complexes, each containing a single RE ion. The complexes offer an identical, tailored environment to each ion, thus minimizing inhomogeneity and allowing tuning of their properties to the desired application. Specifically, we use highly luminescent Yb3+[Zn(II)MC (QXA)] complexes, which isolate the RE ion from the environment and suppress nonradiative decay channels. We demonstrate that the beneficial optical transitions of the Yb3+ are retained after deposition on the tapered fiber and observe an excited-state lifetime of over 0.9 ms, on par with state-of-the-art Yb-doped inorganic crystals.
| S-EPMC9390790 | biostudies-literature