Biomechanical evaluation of the docking nail concept in periprosthetic fracture fixation around a stemmed total knee arthroplasty

Mark Lenz; Yves Pascal Acklin; Lena Anna Kasper; Dominic Mischler; Peter Varga; Ivan Zderic; Dominic Gehweiler; Kajetan Klos; Boyko Gueorguiev; Karl Stoffel

doi:10.1016/j.jbiomech.2020.110109

Biomechanical evaluation of the docking nail concept in periprosthetic fracture fixation around a stemmed total knee arthroplasty

J Biomech. 2021 Jan 22:115:110109. doi: 10.1016/j.jbiomech.2020.110109. Epub 2020 Nov 18.

Authors

Affiliations

¹ AO Research Institute Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany. Electronic address: lenzmar@web.de.
² University Hospital Basel, Switzerland. Electronic address: yvespascal.acklin@gmail.com.
³ AO Research Institute Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany. Electronic address: lena@kasper-schramberg.de.
⁴ AO Research Institute Davos, Switzerland. Electronic address: dominic.mischler@aofoundation.org.
⁵ AO Research Institute Davos, Switzerland. Electronic address: peter.varga@aofoundation.org.
⁶ AO Research Institute Davos, Switzerland. Electronic address: ivan.zderic@aofoundation.org.
⁷ AO Research Institute Davos, Switzerland. Electronic address: dominic.gehweiler@aofoundation.org.
⁸ Gelenkzentrum Rhein-Main, Hochheim (Main), Germany. Electronic address: kajetan.klos@freenet.de.
⁹ AO Research Institute Davos, Switzerland. Electronic address: boyko.gueorguiev@aofoundation.org.
¹⁰ University Hospital Basel, Switzerland. Electronic address: nkstoffel@hotmail.com.

PMID: 33257010
DOI: 10.1016/j.jbiomech.2020.110109

Abstract

Intramedullary femoral nails provide an ideal mechanical axis for periprosthetic fracture fixation. Slotted nails allow a connection to a total knee arthroplasty (TKA) stem. This study aims to compare implant and construct stiffness, interfragmentary movement and cycles to failure between an antegrade slotted femoral nail construct docked to a TKA stem and a distal femoral locking plate in a human periprosthetic femoral fracture model. In eight pairs of fresh-frozen human femora with stalked TKA, a 10 mm transverse osteotomy gap was set simulating a Rorabeck type II, Su type I fracture. The femora were pairwise instrumented with either an antegrade slotted nail coupled to the prosthesis stem, or a locking plate. Cyclic testing with a progressively increasing physiologic loading profile was performed at 2 Hz until catastrophic construct failure. Relative movement at the osteotomy site was monitored by means of optical motion tracking. In addition, four-point bending implant stiffness, torsional implant stiffness and frictional fit of the stem-nail connection were investigated via separate non-destructive tests. Intramedullary nails exhibited significantly higher four-point bending and significantly lower torsional implant stiffness than plates, P < 0.01. Increasing difference between nail and stem diameters decreased frictional fit at the stem-nail junction. Nail constructs provided significantly higher initial axial bending stiffness and cycles to failure (200 ± 83 N/mm; 16'871 ± 5'227) compared to plate constructs (93 ± 35 N/mm; 7'562 ± 1'064), P = 0.01. Relative axial translation at osteotomy level after 2'500 cycles was significantly smaller for nail fixation (0.14 ± 0.11 mm) compared with plate fixation (0.99 ± 0.20 mm), P < 0.01. From a biomechanical perspective, the docking nail concept offers higher initial and secondary stability under dynamic axial loading versus plating in TKA periprosthetic fracture fixation.

Keywords: Biomechanics; Intramedullary nail; Knee arthroplasty; Periprosthetic fracture; Plate.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Knee*
Biomechanical Phenomena
Bone Plates
Femoral Fractures* / surgery
Fracture Fixation, Internal
Fracture Fixation, Intramedullary*
Humans
Periprosthetic Fractures* / surgery