Moreover, given that function is a more distal concept, and that the inclusion/exclusion criteria of the current trial were created to identify subjects with ADHD symptoms and not functional impairment, it is expected that there will be a lesser impact on function in this population.
In an experimental study, Decking et al. (2006) measured strain distribution before and after insertion of 3 different kinds of stems in human cadaveric femora: a conventional straight stem based on a distal anchorage concept, an anatomic stem designed to have proximal loading, and a "stemless" femoral neck prosthesis.
Based on these results, the cementless MRP-TITAN revision stem with its distal diaphyseal fixation concept has proven effective in femoral revision THA [ 17, 25].
Based on published studies, the modular cementless MRP-TITAN revision stem with its distal diaphyseal fixation concept has well-proven short-term effectiveness in femoral revision, especially for large femoral defects (types IIC and III, as described by Paprosky et al. (1990)).
Current concepts of distal humerus fracture treatment dated from 2011 see fair evidence to suggest that the use of a triceps-splitting approach leads to functional outcomes similar to those provided by olecranon osteotomy while potentially avoiding the complications associated with the "Chevron -olecranon osteotomy.
This perpetuated the concept that distal radial fractures could be treated non-operatively with an expected good functional outcome especially in the elderly.
Modular cementless implant systems with a distal diaphyseal press-fit concept provide greater variability in difficult anatomical situations than non-modular revision stems (Berry 2002).
On the other hand, stems that employ the initial distal diaphyseal press fit concept entail a risk of stress shielding in the proximal femur [ 15, 20].
The best strategy to achieve implant stability in revision THA in the presence of extensive metaphyseal defects and with a smooth-walled femoral canal is a distal diaphyseal stem fixation concept [ 27].
Together, these results support the concept that distal nerve fiber injury may occur in patients with diabetes prior to neuropathy symptom onset, and that cutaneous axons can regenerate in response to metabolic improvement.
