Primary Stability Assessment of Patient-Specific Transfemoral Osseointegrated Implants During Static Load-Bearing Exercise: A Comparative Analysis

The long-term effectiveness of osseointegrated implants is heavily dependent on the short-term stability, primarily achieved immediately after surgery through a mechanical connection between the bone and the implant. The most common implant designs nowadays are straight and rely on screw or press-fit fixtures. Despite the promising results achieved by current transfemoral implants, the incidence of early failures and complications is still high. Starting from the hypothesis that a patient-specific approach could lead to better primary stability immediately post-surgery, this study aims to investigate the effect of implant design on primary stability. This was performed by analyzing two patient-specific implants, customized according to the medullary canal morphology, and a simple straight implant as the reference standard. To quantitatively assess the primary stability, a comparative computational analysis was conducted to examine the effective contact area, the relative micromotion, and the stress distribution at the interface between the bone and the implant stem during a static load-bearing exercise. The results showed that implants that follow the curvature of the residual femur provide lower micromotion values and a wider contact area, with a reduction of up to 30.4% and an increase of 10.8%, respectively, compared to the straight design, leading to a more homogeneous load distribution. Patient-specific prosthetic implants allow a more homogenous contact distribution that could lead to higher primary stability by reducing micromotion at the bone-implant interface concerning the straight profile, lowering the risk of loosening related to the short-term stability.