ArticleJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology2026
From bench to bedside: a novel suture-augmented prosthesis for greater trochanteric fixation in osteoporotic hip arthroplasty.
Article in Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStable fixation of the greater trochanter during hip arthroplasty for unstable osteoporotic intertrochanteric fractures remains a significant challenge. Conventional techniques depend on securing the bone-implant interface, which is particularly compromised in osteoporotic bone. Here, we propose a novel conceptual approach that establishes a direct mechanical bridge from the abductor tendon to the prosthesis, thereby reducing reliance on the fragile bone-implant interface.
methodsIn this two-stage translational study, we progressed from biomechanical validation to clinical application. First, using a decalcified caprine femoral model simulating osteoporosis, three fixation constructs were compared: locking plate (LP), suture-augmented locking plate (LPSA), and Kirschner-wire tension band (KWTB). Ultimate load and construct stability were evaluated. Biomechanical testing confirmed the principle of suture-mediated load sharing and highlighted the intrinsic weakness of screw fixation in osteoporotic bone. Guided by these results, we designed a novel femoral prosthesis that eliminates screw fixation, employs sutures as the primary load-bearing element, and incorporates integrated suture anchor tunnels. This prosthesis was then assessed in a retrospective series of 15 consecutive elderly patients with osteoporotic intertrochanteric fractures. Clinical outcomes were evaluated using the Harris Hip Score (HHS).
resultsBiomechanically, the LPSA construct sustained a significantly higher ultimate load than the LP construct in decalcified bone (P < 0.001) and exhibited a greater load at 2-mm displacement than the KWTB construct (P < 0.001). Clinically, all patients achieved fracture union without prosthesis-related complications. The mean HHS at final follow-up was 88.27 ± 6.60, and 80% of patients regained independent ambulation.
conclusionsA prosthesis-anchored, suture-mediated "tendon-to-prosthesis" load pathway provides reliable stabilization of the greater trochanter in osteoporotic bone. Biomechanical validation and favorable early clinical outcomes support the potential of this novel fixation strategy.
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