Is It Time to Rethink Using the Mallet in THA?

    When Charles DeCook, MD, talks about broaching the femur in total hip arthroplasty, he likes to refer to finding the “sweet spot” on the stress/strain curve – that narrow range between delivering too little and too much compacting force on the bone via the mallet.

    It’s a delicate balance: Too little force and the bone will be inadequately prepared, leading to implant instability; too much force and the bone could be weakened, putting the patient at risk for intraoperative or early postoperative fracture.

    And both are problems that can trigger the need for a revision procedure.

    At ICJR’s Pan Pacific Orthopaedic Congress, Dr. DeCook, from Arthritis & Total Joint Specialists in Cumming, Georgia, told attendees that the issue may be with the tool they’re using to broach the femur: Hammers are one of the earliest and most useful tools created by humans, but in the OR, the mallet might also be the most antiquated tool at the surgeon’s disposal, he said.

    Dr. DeCook believes surgeons need a new tool that eliminates the variability in speed and force inherent in manually striking the broach with a mallet.

    Click the image above to watch Dr. DeCook’s presentation, in which he shares his thoughts on the drawbacks of the mallet, illustrates the forces on the stress/strain curve during broaching, and demonstrates a new tool that could improve the consistency of the energy delivered to the bone during broaching to reduce the risk of fractures and unstable implants.