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Posterior release is indicated to improve extension, while a 1- to 2-cm proximal transfer of the tibial tuberosity increases knee flexion and raises the patella with a minimal loss of quadriceps strength.
Another minor complication was premature fibular consolidation and valgus angulation which was treated with osteoclasis of the fibular osteotomy site and proximal transfer of the fibula with additional fibular half pin insertion.
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An uncemented, anatomic, proximally fixed femoral short stem that follows the concept of proximal load transfer through a prominent lateral flare has therefore been developed by an international team of surgeons.
The conical shape promotes primary stability and proximal force transfer.
Proximal load transfer is considered one major advantage compared to conventional stems, which typically produce clinically relevant stress shielding.
Short-stemmed femoral implants were designed to achieve proximal load transfer in the femoral metaphysis in order to prevent stress shielding and preserve metaphyseal bone.
Studies examining strain distribution after implantation of short-stemmed femoral prostheses have yielded conflicting results regarding the achievement of selectively proximal load transfer [5, 6, 12, 13].
To overcome this problem and improve proximal load transfer to the femur, a continuous triple-tapered stem the C stem was designed.
In summary, our study results confirm the conclusions of other investigators who postulated a significant and clinically relevant proximal load transfer for both the Metha™ and Nanos™ stems [3, 6].
We found a small to moderate decrease of BMD in Gruen zone 1 for the Metha™ (minus ~9%%) as well as for the Nanos™ stem (minus ~14%%) which supports the conclusion that proximal load transfer occurs for both implants.
Therefore, proximal load transfer to the trochanteric region should probably be aimed in modern implant designs.
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