{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:29:15Z","timestamp":1786609755175,"version":"build-2736575974"},"reference-count":51,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre","award":["NIHR203331"],"award-info":[{"award-number":["NIHR203331"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIP International"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cemented polished taper-slip (PTS) stems are widely used in total hip arthroplasty but are associated with an increased risk of periprosthetic femoral fracture. Stem centralizers enable surgeons to achieve an even cement mantle and allow for controlled subsidence, which is essential for maintaining fixation, as this relies on the PTS implant\u2019s interaction with the surrounding cement mantle (known as a \u201cforce-closed\u201d mechanism). However, if subsidence exceeds the centralizer\u2019s limit, the implant transitions to a configuration where fixation depends on direct mechanical interlocking with the cement mantle (a \u201cshape-closed\u201d mechanism), potentially increasing stresses within the cement mantle. The aim of this study was to quantify the stress distribution changes within the cement mantle when further subsidence is restricted using finite element analysis (FEA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Three commonly used PTS designs: C-Stem AMT (Johnson &amp; Johnson MedTech, Warsaw, IN, USA), Exeter (Stryker, Kalamazoo, MI), and CPT (Zimmer Biomet, Warsaw, IN), were 3D scanned and modelled, incorporating cement mantle and centralizer gaps per manufacturer guidelines. FEA simulated loading conditions mimicking a stumble (6,900\u2009N) with and without a distal gap to assess von Mises stress and deformation. Variations in stem materials (Stainless steel (SS316L) and Co-Cr alloys) and friction coefficient were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>With subsidence allowance, peak von Mises stresses were concentrated in the medial calcar (Gruen zone 7), with CPT stems showing the highest stress (~45\u2009MPa). When subsidence was restricted, stress shifted to the distal tip (zone 4), increasing by 49\u2013102% depending on stem design and material. Co-Cr stems exhibited higher stress and displacement at the distal tip compared to SS316L stems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Restricting subsidence in PTS stems significantly increases distal cement mantle stress, which may elevate PPF risk. Stem design, material and implant-cement interface friction influence stress distribution and subsidence behavior, potentially affecting long-term implant stability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11207000261454261","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:23:16Z","timestamp":1786339396000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Peak stresses within the cement mantle increase above the yield point of bone cement when the subsidence limit is reached in polished taper stems"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8462-4798","authenticated-orcid":false,"given":"Mohamad","family":"Taufiqurrakhman","sequence":"first","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Jones","sequence":"additional","affiliation":[{"name":"Institute of Medical and Biological Engineering (iMBE), School of Mechanical Engineering, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Halim","family":"Abdullah","sequence":"additional","affiliation":[{"name":"School of Mechanical Engineering, College of Engineering, Universiti Teknologi MARA (UiTM), Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Higgins","sequence":"additional","affiliation":[{"name":"Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin V","family":"Bloch","sequence":"additional","affiliation":[{"name":"Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK"},{"name":"University of Nottingham, School of Medicine, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R J","family":"Manktelow","sequence":"additional","affiliation":[{"name":"Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant G","family":"Pandit","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard H","family":"van Duren","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, UK"},{"name":"Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2019.1582680"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/09544119231225172"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.106B1.BJJ-2023-0587.R1"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2022.02.039"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2019.1624339"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B10.36534"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.11.003"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004462"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.76B3.8175848"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.6.200086"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-016-1247-9"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199810000-00011"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3390\/ma14133702"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016470510030328"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00657"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.101B7.BJJ-2018-1422.R1"},{"key":"e_1_3_2_18_2","first-page":"63","article-title":"Difference of stem subsidence and cement behaviour in the various thicknesses of bone cement: an experimental study using a collarless polished tapered stem","volume":"98","author":"Takahashi E","year":"2016","unstructured":"Takahashi E, Kaneuji A, Hirosaki K, et al. 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