Mock-up in hip arthroplasty pre-operative planning.

Elisabetta M Zanetti, Cristina Bignardi

The correct estimation of stem boundary conditions in hip arthroplasty cannot be performed simply by subtracting the prosthesis volume from the bone volume: the stem implant path needs to be taken into account. Digital mock-up is a technique commonly applied in the automotive field which can be used for this aim. Given a certain femur, a stem, and an implantation path, the volume of the removed bone stock can be evaluated, as well as the final contact area between the bone and the stem, and, section by section, the residual cortical bone thickness. The technique proved to be useful: if the stem implant path is not considered, the removed bone stock volume can be underestimated up to 6%, while the contact area extension can be overestimated up to 28%. On the whole, a new methodology has been set up and tested, which can be usefully employed to accurately establish stem boundary conditions in the pre-operative planning stage, and in order to perform a reliable structural stress analysis. The methodology implemented here by experienced researchers can be made available to surgeons, setting up an apposite software suite.