{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T12:03:00Z","timestamp":1773403380357,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,4,26]],"date-time":"2020-04-26T00:00:00Z","timestamp":1587859200000},"content-version":"vor","delay-in-days":116,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,4,26]],"date-time":"2020-04-26T00:00:00Z","timestamp":1587859200000},"content-version":"vor","delay-in-days":116,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Although metaphyseal sleeves are usually used with stems, little is known about the exact contribution\/need of the stem for the initial sleeve\u2010bone interface stability, particularly in the femur, if the intramedullary canal is deformed or bowed. The aim of the present study is (1) to determine the contribution of the diaphyseal\u2010stem on sleeve\u2010femur interface stability and (2) to determine experimentally the strain shielding effect on the metaphyseal femur with and without diaphyseal\u2010stem. It is hypothesised that diaphyseal\u2010stem addition increases the sleeve\u2010femur interface stability and the strain\u2010shielding effect on the metaphyseal femur relatively to the stemless condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>The study was developed through a combined experimental and finite\u2010element analysis approach. Five synthetic femurs were used to measure cortex strain (triaxial\u2010rosette\u2010gages) behaviour and implant cortex micromotions (Digital Image Correlation) for three techniques: only femoral\u2010component, stemless\u2010sleeve and stemmed\u2010sleeve. Paired t\u2010tests were performed to evaluate the statistical significance of the difference of cortex strains and micromotions. Finite\u2010element models were developed to assess the cancellous bone strain behaviour and sleeve\u2010bone interface micromotions; these models were validated against the measurements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cortex strains are significantly reduced (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) on the stemmed\u2010sleeve with a 150 \u03bcstrain mean reduction at the medial and lateral distal sides which compares with a 60 \u03bcstrain mean reduction (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05) on the stemless condition. Both techniques presented a mean cancellous bone strain reduction of 700 \u03bcstrain (50%) at the distal region and a mean increase of 2500 \u03bcstrain (4x) at the sleeve proximal region relative to the model only with the femoral component. Both techniques presented sleeve\u2010bone micromotions amplitude below 50\u2010150\u2009\u03bcm, suitable for bone ingrowth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The use of a supplemental diaphyseal\u2010stem potentiates the risk of cortex bone resorption as compared to the stemless\u2010sleeve condition; however, the stem is not essential for the enhancement of the initial sleeve\u2010bone stability and has minor effect on the cancellous bone strain behaviour. Based on a purely structural point view, it appears that the use of a diaphyseal\u2010femoral\u2010stem with the metaphyseal sleeve is not mandatory in the revision TKA, which is particularly relevant in cases where the use of stems is impracticable.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40634-020-00242-w","type":"journal-article","created":{"date-parts":[[2020,4,26]],"date-time":"2020-04-26T09:02:17Z","timestamp":1587891737000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Femoral revision knee Arthroplasty with Metaphyseal sleeves: the use of a stem is not mandatory of a structural point of view"],"prefix":"10.1002","volume":"7","author":[{"given":"F.","family":"Fonseca","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery Department Coimbra University Hospitals Coimbra Portugal"}]},{"given":"A.","family":"Sousa","sequence":"additional","affiliation":[{"name":"Mechanical Engineering 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