1
|
Cho CH, Pijls BG, Abrahams JM, Roerink A, Katembwe R, Baker A, Solomon LB, Callary SA. Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies. Acta Orthop 2023; 94:626-634. [PMID: 38157007 PMCID: PMC10757199 DOI: 10.2340/17453674.2023.24580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND PURPOSE We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time. METHODS We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup migration following primary total hip replacement (THR). Proximal migration at 3 and 6 months, 1, 2, 5, and 10 years were considered for analysis. Implant factors investigated included fixation type, head size, bearing surface, uncemented coating design, and the decade of RSA introduction. RESULTS 47 studies reported the proximal migration of 83 cohorts (2,328 cups). Besides 1 threaded cup design, no implant factor investigated was found to significantly influence proximal migration. The mean pooled 2-year proximal migration of cemented cups (0.14 mm, 95% confidence interval [CI] 0.08-0.20) was not significantly different from uncemented cups (0.12 mm, CI 0.04-0.19). The mean pooled proximal migration at 6 months was 0.11 mm (CI 0.06-0.16) and there was no significant increase between 6 months and 2 years (0.015 mm, CI 0.000-0.030). 27 of 75 cohorts (36%) reported mean proximal migration greater than 0.2 mm at 2 years, which has previously been identified as a predictor of implants at risk of long-term loosening. CONCLUSION Our meta-analysis demonstrated that the majority of cup migration occurs within the first 6 months. With one exception, no implant factors influenced the 2-year proximal migration of acetabular cups. 36% of studies with 2-year migration were considered at risk of long-term loosening. Further investigation and comparison against long-term survivorship data would validate 6-month and/or 1-year proximal migration measurements as an earlier predictor of long-term loosening than the current 2-year threshold.
Collapse
Affiliation(s)
- Chan Hee Cho
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne Roerink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Raissa Katembwe
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Baker
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
2
|
Antoniadis A, Wegrzyn J. Direct Cementation of Dual Mobility Cups Into the Bony Acetabulum in Primary Total Hip Arthroplasty: Clinical and Radiographic Outcomes at a Minimum 5-Year Follow-Up. J Arthroplasty 2022; 38:1120-1125. [PMID: 36566998 DOI: 10.1016/j.arth.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cemented dual mobility cups (DMCs) are commonly used in combination with acetabular reinforcement devices. Indeed, according to literature, direct cementation of metal-backed acetabular components into the bony acetabulum remains controversial as this technique is potentially associated with increased rates of aseptic loosening. Therefore, this study aimed to evaluate the clinical and radiographic outcomes of DMC cemented into the bony acetabulum in primary total hip arthroplasty (THA). METHODS A total of 49 THA (48 patients, mean age 78 years [range, 51 to 91]) performed with direct cementation of a DMC into the bony acetabulum were prospectively included in our total joint registry and retrospectively reviewed. The clinical outcome was assessed using the Harris hip score (HHS). The radiographic outcome included measurement of component positioning and occurrence and progression of demarcation around the cemented DMC. Complications were reported with a particular attention to cemented fixation failure and aseptic loosening. RESULTS At a 7-year mean follow-up (range, 5 to 8), the pre-to postoperative HHS improved from 47 (range, 30 to 58) to 92 points (range, 80 to 98) (P < .01). Nonprogressive and focalized demarcations were observed in 7 THA (14%). Importantly, no progressive demarcation or DMC aseptic loosening was observed. CONCLUSION Direct cementation of DMC into the bony acetabulum ensured a stable fixation with no progressive demarcation or aseptic loosening at midterm follow-up. Therefore, this technique can be selectively considered in primary THA, especially in elderly or frail patients to avoid potential mechanical failure of press-fit fixation due to altered bone quality or additional morbidity related to the use of acetabular reinforcement devices.
Collapse
Affiliation(s)
- Alexander Antoniadis
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Wegrzyn
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
3
|
Miyamoto S, Iida S, Suzuki C, Nakatani T, Kawarai Y, Nakamura J, Orita S, Ohtori S. Risk factors for a radiolucent line around the acetabular component with an interface bioactive bone cement technique after primary cemented total hip arthroplasty. Bone Jt Open 2021; 2:278-292. [PMID: 33940938 PMCID: PMC8168551 DOI: 10.1302/2633-1462.25.bjo-2021-0010.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA. Methods A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis. Results RLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7). Conclusion This study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL. Cite this article: Bone Joint Open 2021;2(5):278–292.
Collapse
Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Satoshi Iida
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Chiho Suzuki
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan.,Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
4
|
Minimum 5 year follow-up of clinical and radiographic results of cemented acetabular components with an interface bioactive bone cement technique in primary cemented total hip arthroplasty. Arch Orthop Trauma Surg 2021; 141:139-147. [PMID: 33123811 DOI: 10.1007/s00402-020-03638-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A well-fixed cement-bone interface is a crucial factor for acetabular and femoral components in cemented total hip arthroplasty (THA). The aim of the present study was to evaluate the middle-term clinical and radiological results of fixing the acetabular component with an interface bioactive bone cement (IBBC) technique in primary cemented THA. MATERIALS AND METHODS We undertook a retrospective review was undertaken of 193 primary cemented THAs in 174 patients using acetabular components cemented with an IBBC technique and followed for a minimum of 5 years (mean 8.3 years; range 5-17 years). Baseline data, clinical and radiological outcomes were evaluated. RESULTS Japanese Orthopedic Association hip score and modified Harris hip scores demonstrated significant clinical improvement in all patients (p < 0.001). Radiolucent lines were detected in 15 hips (7.8%) at the first year and 24 hips (12.4%) at the final post-operative follow-up. The Kaplan-Meier survivorship with radiographic loosening as the end point was 97.8% [95% confidence interval (CI) 95.2-100]. With revision of the acetabular component for aseptic loosening as the end point, component survival was 99.0% (95% CI 97.5-100). With revision of the acetabular component for any reason as the end point, component survival was 97.0% (95% CI 93.9-100). CONCLUSIONS Clinical and radiological results of the acetabular component with the IBBC technique in primary cemented THA were excellent.
Collapse
|
5
|
Rahman L, Ibrahim MS, Somerville L, Teeter MG, Naudie DD, McCalden RW. Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis. Bone Jt Open 2020; 1:653-662. [PMID: 33215098 PMCID: PMC7659663 DOI: 10.1302/2633-1462.110.bjo-2020-0118.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). Methods This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained. Results In all, 15 hips were available at ten years. There was no statistically significant difference in PROMS between the two groups; PROMs were improved at ten years compared to preoperative scores. Conventional radiological assessment revealed well-fixed components. There was minimal movement for both porous surfaces in translation (X, Y, Z, 3D translation in mm (median and interquartile range (IQR)), StikTite (Smith and Nephew, Memphis, Tennessee, USA): 0.03 (1.08), 0.12 (0.7), 0.003 (2.3), 0.37 (0.30), and Roughcoat (Smith and Nephew): -0.6 (0.59),–0.1 (0.49), 0.1 (1.12), 0.48 (0.38)), and rotation (X, Y, Z rotation in degrees (median and IQR), (Stiktite: -0.4 (3), 0.28 (2), -0.2 (1), and Roughcoat: - 0.4 (1),–0.1 (1), 0.2 (2)). There was no statistically significant difference between the two cohorts (p-value for X, Y, Z, 3D translation - 0.54, 0.46, 0.87, 0.55 and for X, Y, Z rotation - 0.41, 0.23, 0.23 respectively) at ten years. There was significant correlation between two years and ten years 3D translation for all components (r = 0.81(p =< 0.001)). Conclusion Both porous ingrowth surfaces demonstrated excellent fixation on plain radiographs and with RSA at ten years. Short-term RSA data are good predictors for long-term migration data.
Collapse
Affiliation(s)
- Luthfur Rahman
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada.,Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mazin S Ibrahim
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| | - Lyndsay Somerville
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Douglas D Naudie
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| | - Richard W McCalden
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| |
Collapse
|
6
|
Vajapey SP, Morris J, Li D, Greco NG, Li M, Spitzer AI. Outcome Reporting Patterns in Total Hip Arthroplasty. JBJS Rev 2020; 8:e0197. [DOI: 10.2106/jbjs.rvw.19.00197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
7
|
Liu T, Hua X, Yu W, Lin J, Zhao M, Liu J, Zeng X. Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up. J Orthop Surg Res 2019; 14:371. [PMID: 31730476 PMCID: PMC6858652 DOI: 10.1186/s13018-019-1415-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This retrospective analysis compared the long-term outcomes for patients with a femoral neck fracture (AO/OTA type 31B) treated with a primary unilateral total hip arthroplasty with uncemented or cemented femoral components (UTHA or CTHA, respectively). METHODS We conducted a retrospective cohort study using the South China Hip Arthroplasty Database. We identified 422 patients with femoral neck fracture (AO/OTA type 31B) who were previously treated with primary unilateral UTHA or CTHA between 2007 and 2015, with follow-up until 2019. Follow-up occurred 1, 3, 6 and 12 months postoperatively and yearly thereafter. The primary outcome was the Harris hip score (HHS). The secondary outcome was the orthopaedic complication rate. RESULTS In total, 324 patients (UTHA n = 160, mean age 68.61 ± 7.49 years; CTHA n = 164, mean age 68.75 ± 7.04 years) were evaluated for study eligibility. The median follow-up was 73.3 months (range, 11.6-89.2 months). At the final follow-up, HHS was 74.09 ± 6.23 vs 79.01 ± 10.21 (UTHA vs CTHA, p = 0.012). Significant differences were detected in the incidence of prosthetic revision, loosening, and periprosthetic fracture between the UTHA and CTHA groups (7.5% for UTHA vs 1.8% for CTHA, p = 0.015; 17.5% for UTHA vs 8.5% for CTHA, p = 0.016; 11.9% for UTHA vs 4.9% for CTHA, p = 0.021, respectively). CONCLUSION In this setting, CTHA demonstrated superiority to UTHA by improving functional outcomes and decreasing complication rates.
Collapse
Affiliation(s)
- Tiejian Liu
- Department of Neurosurgery, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan avenue west, Tianhe District, Guangzhou, 510630, China
| | - Xiaoxiao Hua
- Department of Anesthesiology, The Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, No. 56, Lingyuan West Road, Guangzhou, 510055, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Jinluan Lin
- Department of Orthopaedics, The Affiliated Hospital of Fujian Medical University, Chazhong Road No. 20, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
| | - Jun Liu
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| |
Collapse
|
8
|
Garala K, Boutefnouchet T, Amblawaner K, Chahal G, Lawrence T. Acetabular Subchondral Bone Decortication and Its Role in the Outcome of Cemented Total Hip Replacement in Young Patients. Hip Pelvis 2018; 30:182-189. [PMID: 30202753 PMCID: PMC6123503 DOI: 10.5371/hp.2018.30.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022] Open
Abstract
Purpose Long-term fixation of cemented acetabular components can be problematic in younger active patients. Our technique is put forward to improve outcomes and maximize implant survivorship in this particular patient population. Materials and Methods We report on a cohort of young adult patients (less than 55 years old) with cemented total hip replacement (THR) using a novel technique in preparing and cementing the acetabulum with a minimum follow-up of 10 years (mean follow-up, 14 years). Retrospectively collected data on clinical and radiological outcomes were reviewed. Results Sixty-five THRs were performed with the minimum study follow-up period. Average age for patients was 44 years old (range, 19–55 years). The mean Hip Disability and Osteoarthritis Outcome Score for patients at final appointment was 92.7. Radiographs taken at an average of 14 years after operation showed 63 of 65 hips showed no evidence of any radiological loosening. Cup survivorship was 100% at the end of the study period. Conclusion Our technique of preparing the acetabulum in combination with cement fixation is reproducible with excellent results in a cohort of patients prone to early aseptic loosening of the acetabular component.
Collapse
Affiliation(s)
- Kanai Garala
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Tarek Boutefnouchet
- Department of Trauma of Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | | | - Gurdip Chahal
- Department of Trauma of Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Trevor Lawrence
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
9
|
Iwase T, Morita D, Ito T, Takemoto G, Makida K. Favorable Results of Primary Total Hip Arthroplasty With Acetabular Impaction Bone Grafting for Large Segmental Bone Defects in Dysplastic Hips. J Arthroplasty 2016; 31:2221-6. [PMID: 27133930 DOI: 10.1016/j.arth.2016.03.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of the present study was to assess midterm results after acetabular impaction bone grafting (IBG) in primary total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with large acetabular segmental defect. METHODS Primary THA with IBG for DDH with large acetabular segmental defect was performed in 40 hips of 38 patients. The average age was 61.6 years (range: 33-82 years), and the average follow-up period was 7.5 years (range: 3-10.3 years). The Merle d'Aubigné and Postel hip score and complications were assessed. For radiological assessment, postoperative location of the hip rotation center, the socket inclination angle, and the socket center-edge angle were assessed. Kaplan-Meier survival analysis was performed with the end points of any type of reoperation and aseptic acetabular loosening. RESULTS The mean Merle d'Aubigné and Postel hip score improved from 10.4 points to 16.2 points at the final follow-up. Reoperation was performed in 1 case for acute infection without loosening. In 39 out of 40 hips (97.5%), the center of hip rotation was located beneath the "high hip center." The average socket inclination angle was 39.3° (range: 30°-54°), and the average socket center-edge angle was -11.8° (range: -23° to 9°). Survival rate of acetabular component at 8 years with the end point of any reoperation and of aseptic loosening was 96.6% (95% confidence interval: 89.9%-100%) and 100%, respectively. CONCLUSION Acetabular IBG represents one of the useful options for restoring a normal hip center and acetabular bone stock in primary THA for DDH with large acetabular defect.
Collapse
Affiliation(s)
- Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Daigo Morita
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Tadashi Ito
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Genta Takemoto
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Kazuya Makida
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
10
|
Tanner KE, Svensson I, Samuelsson F, Flivik G. Finite element study of the acetabulum in cemented hip arthroplasty investigating retention or removal of the subchondral bone plate. ACTA ACUST UNITED AC 2016; 61:525-536. [DOI: 10.1515/bmt-2015-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/22/2015] [Indexed: 11/15/2022]
Abstract
AbstractThe importance of the subchondral bone plate of the acetabulum when preparing the pelvis for a cemented acetabular cup during total hip arthroplasty (THA) has been investigated using finite element analysis. The effect of retaining or removing the subchondral bone plate and the use of anchoring holes are compared. Loading was applied via both hip joint contact force and the activity of up to 22 muscles at five stages through the load bearing phase of the gait cycle. Removing the subchondral bone plate leads to decreased stresses in the cancellous bone and slightly increased stresses in the cortical shell superior to the acetabulum. The differences between the two cases are small, nevertheless there are indications that removal of the subchondral bone plate reduces the stresses. Increasing the cement penetration depth leads to a slightly more rigid structure, due to cement penetrating the cancellous bone. Adding anchoring holes moves the position of the highest cancellous bone strains from the bone-cement interface into the cancellous bone. Thus removal of the subchondral bone plate should lead to an increased potential for cement penetration into the cancellous bone which should be beneficial for cup fixation and thus improve long term implant survival.
Collapse
|