{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T11:28:47Z","timestamp":1793964527969,"version":"4.8.0"},"reference-count":59,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Distal femoral replacement (DFR) is commonly used not only for metastatic bone tumours but also for complex revision surgery and treatment of periprosthetic fractures, serving as a limb\u2010salvage procedure or a solution to restore knee function, as a valid alternative to amputation. The success and longevity of DFR depend on proper implant positioning and fixation at the bone\u2013implant interface to ensure physiological load transfer. Clinically, both cemented and press\u2010fit fixations are used; however, there is no consensus biomechanical guideline to determine the optimal fixation strategy. This study provides a biomechanical comparison of different fixation methods to inform surgical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Finite element models of a standard femur implanted with a DFR system\u2014including femoral component, stem, collar and shaft\u2014were used to evaluate bone stress distribution and implant micromotion under physiologically relevant loading conditions (0\u00b0 and 90\u00b0 of flexion, simulating walking and chair\u2010rise). Four fixation configurations were analysed: fully cemented, press\u2010fit with full contact, press\u2010fit with proximal contact only, and press\u2010fit with distal contact only, the latter two simulating implant positioning errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Each fixation technique and load condition influences stress distribution and stability differently. Cemented fixation generally reduced bone stress and therefore fracture risk, but exhibiting higher micromotion though within safe limits for long\u2010term stability. Press\u2010fit fixation offered comparable bone stress and, when properly positioned, higher implant stability. However, inadequate stem or collar contact increased bone stress and micromotion, potentially compromising stability. These findings highlight the importance of precise surgical technique across tumour surgery, complex revision procedures and periprosthetic fracture treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both fixation methods have trade\u2010offs: cemented implants minimise bone stress, while press\u2010fit configurations enhance stability if properly positioned. These findings underline the importance of precise surgical technique to minimise implant errors to optimise outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>NA, preclinical biomechanical computational study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70143","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T13:23:04Z","timestamp":1761657784000},"page":"2504-2514","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cemented fixation improves bone stress and stability in distal femoral replacement"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8992-8865","authenticated-orcid":false,"given":"Bernardo","family":"Innocenti","sequence":"first","affiliation":[{"name":"BEAMS Department Universit\u00e9 Libre 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