The Use of DensiProbe (TM) in Hindfoot Arthrodesis. Can Fusion Failure be Predicted by Mechanical Bone Strength Determination?

作者：Klos K^*; Mueckley T; Waehnert D; Zwipp H; Gueorguiev B G; Schwieger K; Hofmann G O; Windolf M

来源：Zeitschrift fur Orthopadie und Unfallchirurgie, 2011, 149(2): 206-211.

DOI：10.1055/s-0030-1250106

• tibiotalocalcaneal arthrodesis
• biomechanics
• hindfoot
• bone strength
• bone quality

Aim: Bone quality is a main factor in implant fixation. After having shown promising results, we have further investigated the use of the DensiProbeTM as an intraoperative measurement tool for evaluation of calcaneal bone quality and prediction of nailed hindfoot arthrodesis failure.
Method: In this add-on study 19 nail arthrodeses were performed using a conventional screw plus a locked blade (n = 6) or plus a locked screw (n = 13) in the calcaneus. A specially devised tool was inserted at the fixation sites of the screws and the cancellous break-away torque was measured. The constructs were then cyclically loaded to failure.
Results: We saw a wide range of BMD (1.9-185.9 mgHA/cm(3), mean 102.4mg/cm(3), SD 53.5). The peak torque was 0.47-1.78 Nm (mean 0.92 Nm, SD 0.46) at the proximal screw site (PSS) and 0.24 and 1.2 Nm (mean 0.63 Nm, SD 0.37) at the distal screw site (DSS), respectively, and 0.42 and 1.52 Nm (mean 1.00 Nm, SD 0.36) in the screw plus blade group (PSS). The number of cycles correlated with peak torque (two screws group PSS: p = 0.002, r(2) = DSS: 0.61 p = 0.001, r(2) = 0.90; screw plus blade group PSS: p = 0.001, r(2) = 0.99). Peak torque also correlated with BMD in both groups (two screws group PSS: p = 0.01, r(2) = 0.71; DSS: p = 0.001; r(2) = 0.83; screw plus blade group PSS: 0.42 and 1.52 Nm, mean 1.00 Nm, SD 0.36).
Conclusion: A mechanical bone measurement tool like the DensiProbeTM seems to be suitable for predicting tibiotalocalcaneal arthrodesis failure in a biomechanical test set-up. As a restriction in clinical practice failure is multifactorial and prediction cannot be based upon these measurements only.

• 出版日期2011-3