Intraoperative Fracture Risk – Standard Versus Compaction Broaching Methods for Total Hip Arthroplasty

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Stockwell, Kevin
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Intraoperative femur fracture is a common complication that arises during cementless total hip arthroplasty (THA) likely due to the strain applied to the bone to achieve a press-fit. These fractures occur with a prevalence of 3-25% [1], threaten the longevity of the prostheses, and increase the likelihood of revision surgery. The two predominant surgical techniques for cementless THAs are compaction broaching and reaming. It is hypothesized that the compaction broaching surgical technique results in less strain experienced by the femoral shaft intra-operatively and improved long term fixation. To investigate this hypothesis an experimental study involving finite element analysis (FEA) of the implantation procedure in-silico will be performed followed by validation testing on four cadaveric femurs. The FEA will consist of two CT scanned cadaveric bones undergoing the reamed technique and two undergoing the compaction broaching technique. The FEA analysis will be validated on the four cadaveric bones with physical testing in a load frame. Areas of high strain on the periosteum will be equipped with strain gauges on the cadaveric femurs to measure strain during the surgical impaction procedure [2]. The validity of the FEA model will be determined by measuring the standard error between and root mean square errors (RMSE) between model (FEA) and experimental (physical) strains at individual and combined strain gauge locations [3]. It is expected that this study will result in a valid FEA model for compaction broaching and reaming surgical techniques and that the femurs undergoing broaching are shown to display reduce intra-operative strain throughout the femur and greater potential for long term fixation. The FEA models produced can serve as powerful explorative tool for investigating the likelihood of success of THA surgery following either implantation technique and can act as a predictive tool for intra-operative fractures and post-operative failure.
total hip arthroplasty (THA)