A Quest for Reliable Fixation of In-Bone Implanted Prosthesis

Mark Pitkin*

Although much is known about total joint replacement, research has had little success in elucidating the genesis of prosthetic stem loosening. The adopted methods of stem fixation include positioning the stem’s shaft inside the bone’s medullary canal and rely on ossification inside the canal in the inward radial direction. 

His special communication is to note that the medcanal's normal physiology contains obstacles for reliable fixation. The reason is that the ossification of bone walls in the inward radial direction is naturally restricted to protect the needed space for bone marrow. Also, human development and exercise result in a continued increase in the medullary canal’s diameter, which diminishes the reliability of the bond between the canal’s inner walls and the stem with or without cement. 

These observations result in the suggestion to utilize the ossification for stem fixation in a different direction, namely, circularly relative to the bone circumference. Circular ossification is a component of the bone remodelidistraction osteogenesis for bone widening. To induce the circular ossification in the bone walls, we introduce here a stem with new design characteristics to be implanted in specially prepared slots in the bone walls. If verified, this hypothesis could have important implications for orthopaedic surgery. 

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Published on: Jun 4, 2026 Pages: 1-5

Full Text PDF Full Text HTML DOI: 10.17352/aap.000027
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