Primary Stability and Strain Distribution of Cementless Hip Stems As a Function of Implant Design

Background: Short stem prostheses have been developed to preserve the femoral bone stock. The purpose of this study was to evaluate the stress-shielding effect in the proximal femur as well as the micromotion between bone and implant as a measure of primary stability for a new short stem in comparison to a clinically successful short stem and a straight stem.

Methods: Using paired fresh human femurs, stress shielding was examined by using tri-axial strain gage rosettes. The strain distribution of the proximal femur was measured before and after implantation of three cementless prostheses of different design concepts and stem lengths. Furthermore, interface motion and rotational stability were investigated under dynamic loading (100-1600 N) after 100,000 load cycles using inductive miniature displacement transducers.

Findings: A reduction of longitudinal cortical strains in the proximal femur was displayed for all three implants. The reduction was less pronounced for the shorter stem implants, however. Interface motion was below the critical threshold of 150 μm at almost all measuring points for all three stems, with a tendency for greater rotational stability in the shorter stem implants.

Interpretation: The new short stem prosthesis displayed reduced stress shielding and comparable primary stability to an established short stem and a conventional shaft design. Shortening the stem did not negatively influence primary stability. The clinical implications of these findings remain to be proven.