Can the metaphyseal anchored Metha short stem safely be revised with a standard CLS stem? A biomechanical analysis.

PURPOSE: Short stem total hip arthroplasty (SHA) has gained increasing popularity as it conserves bone stock and is supposed to allow revision with a conventional stem. However, no study has evaluated whether the revision of a SHA with a standard total hip arthroplasty (THA) stem provides sufficient primary stability to allow osseous integration. METHODS: A neck preserving SHA (Metha) and a standard THA (CLS) stem were implanted into six composite femurs respectively and dynamically loaded (300-1700 N, 1 Hz). Primary stability was evaluated by three dimensional-micromotions (3D micro motion) at five points of the interface. Then, a revision scenario was created by removing the SHA and using the same CLS stem as a revision implant (CLS-revision group), with subsequent evaluation of the 3D micro motion according to the primary CLS stem. RESULTS: The 3D micro motion pattern significantly differed in the primary situation between the short and the standard stem. The highest 3D micro motion were registered proximally for the Metha and distally for the CLS stem. Revising the Metha with a CLS stem revealed a bony defect at the calcar. However, the 3D micro motion of the CLS-revision group were not significant higher compared to those of the primary CLS stem. CONCLUSION: Our results show, that SHA (Metha) and standard THA (CLS) provide a good primary stability, however with different pattern of anchorage. The CLS stem reached a similar stability in this revision scenario as the CLS in the primary situation, wherefore it can be assumed that in uncomplicated revisions the Metha short stem can safely be revised with a CLS standard stem.

Influence of undersized cementless hip stems on primary stability and strain distribution.

INTRODUCTION: Undersizing of cementless hip stems is a risk factor for aseptic loosening and early subsidence. The purpose of this study was to evaluate the effects of undersized stems and determine whether a biomechanical study can predict the clinical results. MATERIALS AND METHODS: Three consecutive sizes of a clinically proven stem (CLS Spotorno) were implanted into six composite femora (size large, Sawbones®), respectively. According to the Canal Fill Index (CFI), two stems (size 11.25 and 12.5) were undersized (CFI < 80%) and one stem (size 13.75) had an appropriate size (CFI > 80%). The primary stability was evaluated by measurement of 3-dimensional (3D)-micromotions under physiological adapted load and surface strains were recorded before and after implantation to detect stress-shielding processes. RESULTS: Both undersized stems revealed significantly higher micromotions in all regions compared to the appropriate stem. The highest micromotions were registered at the distal tip of the three stem sizes. The changes in surface strain did not show a significant difference between the three stem sizes, but the highest strain reduction was observed proximally indicating a tendency for stress shielding. CONCLUSIONS: This study confirms the clinical assumption that undersized stem result in a significantly reduced primary stability. Furthermore, in vitro studies allow to determine the effects of undersizing and stress shielding processes.

Quantum Joule-Thomson effect in a saturated homogeneous Bose gas.

We study the thermodynamics of Bose-Einstein condensation in a weakly interacting quasihomogeneous atomic gas, prepared in an optical-box trap. We characterize the critical point for condensation and observe saturation of the thermal component in a partially condensed cloud, in agreement with Einstein's textbook picture of a purely statistical phase transition. Finally, we observe the quantum Joule-Thomson effect, namely isoenthalpic cooling of an (essentially) ideal gas. In our experiments this cooling occurs spontaneously, due to energy-independent collisions with the background gas in the vacuum chamber. We extract a Joule-Thomson coefficient µJT>10(9) K/bar, about 10 orders of magnitude larger than observed in classical gases.

Bose-Einstein condensation of atoms in a uniform potential.

We have observed the Bose-Einstein condensation of an atomic gas in the (quasi)uniform three-dimensional potential of an optical box trap. Condensation is seen in the bimodal momentum distribution and the anisotropic time-of-flight expansion of the condensate. The critical temperature agrees with the theoretical prediction for a uniform Bose gas. The momentum distribution of a noncondensed quantum-degenerate gas is also clearly distinct from the conventional case of a harmonically trapped sample and close to the expected distribution in a uniform system. We confirm the coherence of our condensate in a matter-wave interference experiment. Our experiments open many new possibilities for fundamental studies of many-body physics.

Influence of different anteversion alignments of a cementless hip stem on primary stability and strain distribution.

BACKGROUND: Stem anteversion in total hip arthroplasty is well known to have a high impact on dislocation, but empirical data regarding the clinical and biomechanical influence is lacking. Therefore, we evaluated the impact of different anteversion alignments on the primary stability and strain distribution of a cementless stem. METHODS: The cementless CLS Spotorno stem was implanted in 3 different groups (each group n = 6, total n = 21) with different anteversion alignments: reference anteversion (8°), +15° torsion in anteversion (+23°), -15° torsion in retroversion (-7°) using composite femurs (Sawbones). Primary stability was determined by 3-dimensional micromotions using a dynamic loading procedure simulating walking on level ground. Additionally, surface strains were registered before and after stem insertion in the 3 different groups, using one composite femur for each group (total n = 3). FINDINGS: The micromotion measurements did not show a significant difference between the 3 evaluated alignments. Moreover, determination of the strain distribution did also not reveal an obvious difference. INTERPRETATION: This biomechanical study simulating walking on level ground indicates that there is no considerable influence of stem ante-/retroversion variation (±15°) on the initial stability and strain distribution when evaluating the cementless CLS Spotorno in composite femora.

Varus malalignment of cementless hip stems provides sufficient primary stability but highly increases distal strain distribution.

BACKGROUND: Varus position of cementless stems is a common malalignment in total hip arthroplasty. Clinical studies have reported a low rate of aseptic loosening but an increased risk for thigh pain. This in vitro study aimed to evaluate these clinical observations from a biomechanical perspective. METHODS: A conventional cementless stem (CLS Spotorno) was implanted in a regular, straight (size 13.75) as well as in a varus position (size 11.25) in 6 composite femora (Sawbones), respectively. Primary stability was assessed by recording 3-dimensional micromotions under dynamic load bearing conditions and stress shielding was evaluated by registering the surface strain before and after stem insertion. FINDINGS: Primary stability for stems in varus malposition revealed significantly lower micromotions (p < 0.05) for most regions compared to stems in neutral position. The greatest difference was observed at the tip of the stem where the straight aligned implants exceeded the critical upper limit for osseous integration of 150 µm. The surface strains for the varus aligned stems revealed a higher load transmission to the femur, resulting in a clearly altered strain distribution. INTERPRETATION: This biomechanical study confirms the clinical findings of a good primary stability of cementless stems in a varus malposition, but impressively demonstrates the altered load transmission with the risk for postoperative thigh pain.