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Tim Board
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Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components.
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Medical management of osteonecrosis of the hip: a review
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New Research Published:Navigated lower limb axis measurements: Influence of mechanical weight-bearing simulation.

Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hüfner T. Navigated lower limb axis measurements: Influence of mechanical weight-bearing simulation.

J Orthop Res. 2008 Apr;26(4):553-61.

link to full text article

Abstract
Wrightington Hospital, Wigan, Lancashire, UK
Trauma Department, Hannover Medical School, Carl Neubergstr. 1, 30625 Hannover, Germany.

Successful outcomes following high tibial osteotomy (HTO) require precise realignment of the mechanical axis of the lower extremity. The inability to accurately assess the weight-bearing axis intraoperatively may account for inappropriate degrees of correction with the osteotomy. We tested the hypothesis that axial loading of the limb affects alignment during an HTO procedure. A custom mechanical load apparatus was developed to simulate weight-bearing conditions intraoperatively. Fixation to the trunk was achieved by supraacetabular pins and an external fixation device, which allowed the pelvis to be rigidly fixed relative to the apparatus while axial load was applied to the foot. Ten fresh cadavers were used for testing. The baseline mechanical axis was determined by a navigation system. HTO was then performed, and varying degrees of valgus correction were obtained and stabilized. For each correction, one quarter, one half, or full body weight was applied axially to the foot, and the axis deviation was measured. Subsequently, the MCL was sequentially released to determine the effect of ligament incompetence. Prior to osteotomy, load application did not produce significant axis deviations. Following osteotomy, the mechanical axis deviation shifted significantly in all trials, increasing as load magnitude and degree of correction increased. With complete sectioning of the MCL, a further significant shift in the axis occurred. Deviations of mechanical axis occur on weight bearing in lower limbs following HTO. These shifts must be considered and possibly quantified to achieve the desired axis correction and maximize the chance at a successful long term outcome.

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