Finite element analysis of the cervico-trochanteric stemless femoral prosthesis


      Objective. To investigate the biomechanical performance of a newly designed cervico-trochanteric stemless prosthesis by comparing the stress distribution with that of the traditional stem-type porous-coated anatomic prosthesis.
      Design. Three-dimensional finite element models were created for the intact femur, cervico-trochanteric implanted femur and porous-coated anatomic implanted femur. The stress distributions on the femur and the implant were compared. The effects of using two or three screws fixation for the cervico-trochanteric implanted femur were also investigated.
      Background. Local bone loss after implantation of traditional stem-type prostheses remains an unsolved problem during the long-term application of total hip replacement. The stress shielding effect and osteolysis were thought to be the two main factors that result in local bone loss after prosthesis implantation. In order to eliminate the mechanical and the biological causes of bone loss after total hip arthroplasty, a newly designed stemless femoral prosthesis was investigated.
      Methods. Three-dimensional finite element models were created for the intact, cervico-trochanteric (with two or three fixation screws), and porous-coated anatomic implanted femora with the geometry of a standardized composite femur. Analysis was performed for a loading condition simulating the single-legged stance. The von Mises stress distributions of each model were analyzed and compared.
      Results. The results can be summarized as follows: (1) Von Mises stress in the proximal, medial femur for the cervico-trochanteric implanted model was higher than that of the intact model and the porous-coated anatomic implanted model; (2) stress-shielding effect of the cervico-trochanteric models (with two or three fixation screws) were eliminated as compared with the porous-coated anatomic model; (3) no obvious difference in von Mises stress distribution for the cervico-trochanteric implanted model with two or three fixation screws.
      Conclusions. The cervico-trochanteric femoral prosthesis may reduce the stress-shielding effect of the proximal femur and achieve a more physiological stress distribution on the proximal femur than that of the porous-coated anatomic prosthesis.Relevance
      The new concept of cervico-trochanteric stemless prosthesis has proven to possess several advantages based on the current results, and may be an alternative for traditional stem-type prostheses in future clinical applications.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bassett L.W.
        • Gold R.H.
        • Hedley A.K.
        Radiology of failed surface replacement total hip arthroplasty.
        Am. J. Roentgenol. 1982; 139: 1083-1088
        • Buechel F.F.
        • Drucker D.
        • Jasty M.
        • Jiranek W.
        • Harris W.H.
        Osteolysis around uncemented acetabular components of cobalt–chrome surface replacement hip arthroplasty.
        Clin. Orthop. Relat. R. 1994; 298: 202-211
        • Callaghan J.J.
        Total hip arthroplasty: clinical perspective.
        Clin. Orthop. Relat. R. 1992; 276: 33-40
        • Chao E.Y.
        • Coventry M.B.
        Fracture of femoral component after total hip replacement. An analysis of 58 cases.
        J. Bone Joint Surg. Am. 1981; 63A: 1078-1094
        • Cody D.D.
        • Gross G.J.
        • Hou J.H.
        • Spencer H.J.
        • Glodstein S.
        • Fyhrie D.P.
        Femoral strength is better predicted by finite element models than QCT and DXA.
        J. Biomech. 1999; 32: 1013-1020
        • Engh C.A.
        • Bobyn J.D.
        The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty.
        Clin. Orthop. Relat. R. 1988; 231: 7-28
        • Harris W.H.
        Will stress shielding limit the longevity of cemented femoral components of total hip replacement.
        Clin. Orthop. Relat. R. 1984; 274: 120-123
        • Head W.C.
        Wagner surface replacement arthoplasty of the hip.
        J. Bone Joint Surg. Am. 1981; 63A: 420-427
        • Herbeterts P.
        • Lansinger O.
        • Romanus B.
        Surface replacement arthroplasty of the hip.
        Acta. Orthop. Scand. 1983; 54: 884-890
        • Huiskes R.
        • Strens P.
        • Heck J.V.
        • Sloof T.
        Interface stress in the resurfaced hip.
        Acta Orthop. Scand. 1985; 56: 474-478
        • Kroger H.
        • Vanninen E.
        • Overmyer M.
        • Miettinen H.
        • Rushton N.
        • Suomalainen O.
        Periprosthetic bone loss and regional bone turnover in uncemented total hip arthroplasty: a prospective study using high resolution single photon emission tomography and dual-energy X-ray absorptiometry.
        J. Bone Miner. Res. 1997; 12: 487-492
        • Lewis J.L.
        • Askew M.J.
        • Wixson R.L.
        • Kramer G.M.
        • Tarr R.R.
        The influence of prosthetic stem stiffness and of a calcar collar on stresses in the proximal end of the femur with a cemented femoral components.
        J. Bone Joint Surg. Am. 1984; 66A: 280-286
        • Mann K.A.
        • Bartel D.L.
        Coulomb frictional interfaces in modeling cemented total hip replacement: a more realistic model.
        J. Biomech. 1995; 9: 1067-1078
        • Mann K.A.
        • Bartel D.L.
        • Ayers D.C.
        Influence of stem geometry on mechanics of cemented femoral hip components with a proximal bond.
        J. Orthop. Res. 1997; 15: 700-706
        • Marchetti M.E.
        • Steinberg G.G.
        • Greene J.M.
        • Jenis L.G.
        • Baran D.T.
        A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty.
        J. Bone Miner. Res. 1996; 11: 1033-1039
        • McCarthy C.K.
        • Steinberg G.G.
        • Agren M.
        • Leahey D.
        • Wyman E.
        • Baran D.T.
        Quantifying bone loss from the proximal femur after total hip arthroplasty.
        J. Bone Joint Surg. [Br]. 1991; 73B: 774-778
        • McNamara B.P.
        • Cristofolini L.
        • Toni A.
        • Taylor D.
        Relationship between bone-prosthesis bonding and load transfer in total hip reconstruction.
        J. Biomech. 1997; 30: 621-630
        • Munting E.
        • Verhelpen M.
        Fixation and effect on bone strain pattern of a stemless hip prosthesis.
        J. Biomech. 1995; 28: 949-961
        • Murray D.W.
        • Rushton N.
        Mediators of bone resorption around implants.
        Clin. Orthop. Relat. R. 1992; 281: 295-304
        • Shih C.H.
        • Chen W.P.
        • Tai C.L.
        • Kuo R.F.
        • Wu C.C.
        • Chen C.H.
        New concepts-biomechanical studies of a newly design femoral prosthesis (cevico-trochanter prosthesis).
        Clin. Biomech. 1997; 12: 482-490
        • Shih C.H.
        • Wu C.C.
        • Lee Z.L.
        • Yang W.E.
        Localized femoral osteolysis in cementless ceramic total hip arthroplasty.
        Orthop. Rev. 1994; 23: 325-328
        • Testi D.
        • Viceconti M.
        • Brauffaldi F.
        • Cappello A.
        Risk of fracture in elderly patients: a new predictive index based on bone mineral density and finite element analysis.
        Comput. Meth. Prog. Bio. 1999; 60: 23-33
        • Trentani C.
        • Vaccarino F.
        Complications in surface replacement arthroplasty of the hip: experience with the paltrinieri-trentani prosthesis.
        Int. Orthop. (SICOT). 1981; 4: 247-252
        • Whiteside L.A.
        The effect of stem fit on bone hypertrophy and pain relief in cementless total hip arthroplasty.
        Clin. Orthop. Relat. R. 1989; 247: 138-147