ArticleJournal of clinical medicine2023
Relationship between Stress Shielding and Optimal Femoral Canal Contact Regions for Short, Tapered-Wedge Stem Analyzed by 2D and 3D Systems in Total Hip Arthroplasty.
Article in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 7 citations in OpenAlex.
- Is the use of primary cementless stem in revision total hip arthroplasty a reliable option? A systematic review.Musculoskeletal surgery · 2026Review
- Short-term Clinical Outcomes of Primary Total Hip Arthroplasty with the CoreHip Stem.Journal of orthopaedic case reports · 2026Article
- Long-term results of the metaphyseal-loading anterolaterally flared anatomic femoral stem for total hip arthroplasty.International orthopaedics · 2025Article
- Biomechanical analysis of a short femoral stem used in revision total hip replacement of a standard femoral stem.Scientific reports · 2025Article
- Radiographic Evaluation and Changes in Bone Density of the Humeral Side after Reverse Total Shoulder Arthroplasty.Journal of clinical medicine · 2023Article
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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