Biomechanical robustness of a new proximal epiphyseal hip replacement to patient variability and surgical uncertainties: A FE study

The biomechanical behaviour of current hip epiphyseal replacements is notably sensitive to the typical variability of conditions following a standard surgery. The aim of the present study was to assess the biomechanical robustness to the variability of post-operative conditions of an innovative Proximal Epiphyseal Replacement (PER) hip device featuring a short, curved and cemented stem. The risk of femoral neck fractures, prosthesis fractures and aseptic loosening were assessed through a validated Finite Element procedure following a systematic approach. Risk changes due to anatomical variations were assessed mimicking extreme conditions in terms of femoral size and level of osteoporosis. Failure risks associated with surgical uncertainties were assessed mimicking extreme conditions in terms of uncertainties on the prosthesis position/alignment, cement-bone interdigitation depth, and friction between the prosthesis and the hosting cavity. The femoral neck strength increased after implantation from 9% to 49% and was most sensitive to changes of the anatomo-physiological variables. The risk of stem fractures was low in all studied configurations. The risk of stem loosening was low and most sensitive to surgical uncertainties. In conclusion, the new device can be considered an effective alternative to current epiphyseal replacements. Care is recommended in a proper seating of the prosthesis in the femur.