A Biomechanical Analysis of Polyethylene Liner Cementation Into a Fixed Metal Acetabular Shell

Haft, Geoffrey F.; Heiner, Anneliese D.; Dorr, Lawrence D.; Brown, Thomas; Callaghan, John J.

doi:10.2106/00004623-200306000-00019

Cited by 67 publications

(45 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10,12 This technique has been described intra-operatively to increase cement interdigitation and fixation strength, particularly when the shell has a smooth inner surface without holes. 10,12,13,16 The cementation technique was performed to mimic the surgeon's experience intra-operatively. Before cementing, the shell inner surface was carefully cleaned with moist gauze.…”

Section: Methodsmentioning

confidence: 99%

“…A 2-3 mm cement mantle provides greater fixation strength than a standard locking liner. 10,12 Cement was allowed to cure at !6 hr before testing.…”

Section: Methodsmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16] This technique, referred to as the double-socket technique, provided fixation strength higher than the standard locking mechanism and allowed a slight reorientation of the acetabular component. [6][7][8][9][10][11][12][13][14][15][16] However, even if the indication of this technique is limited to well-positioned acetabular components within acceptable limits, and in the presence of a preserved abductor mechanism, dislocation may occur after 22-55% of these procedures, especially when the indication for revision is instability. 4,6 Therefore, cementation of a constrained tripolar acetabular component into a well-fixed metal shell has been advocated for patients with THA instability history for treating and/or preventing dislocation recurrence.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Wegrzyn

Thoreson

Guyen

et al. 2013

Journal Orthopaedic Research

View full text Add to dashboard Cite

Cementation of polyethylene (PE) liners into well-fixed metal shells has become a popular option during revision total hip arthroplasty (THA) particularly for older and frail patients. Although dramatic results were reported with dual-mobility acetabular components to manage hip instability during revision THA, no study evaluated the fixation strength of the cementation of dual-mobility components into well-fixed metal shells. Eight dual-mobility and eight all-PE components were cemented into a metal shell with a uniform 2-to 3-mm cement mantle. The cemented fixation strength was evaluated using lever-out and torsion testing. The interface at which failure occurred was determined. Lever-out testing showed that dual-mobility components failed at significantly higher maximum moment than the all-PE components. No direct comparison could be performed with torsion testing due to early failure of the all-PE component itself before failure of the cement fixation. However, the maximum moments measured were dramatically higher than the in vivo frictional moments classically reported in THA. In addition, failure was always observed at the metal shell/cement interface whenever it did occur. In conclusion, a dual-mobility acetabular component cemented into a well-fixed metal shell could constitute a biomechanically acceptable alternative to acetabular shell removal or PE liner cementation while simultaneously preventing instability of the THA revision. Clinical studies are warranted. Keywords: revision total hip arthroplasty; dual-mobility acetabular component; cement; fixation strength; instability Despite continuous improvements in surgical technique and implant design, the rate of revision total hip arthroplasty (THA) did not decrease over the past few decades.1 Furthermore, with increased life expectancy of THA patients and a trend toward surgical indication at younger ages, demand for THA revisions is projected to double by 2026, and case complexity is likely to increase dramatically.2 Instability constitutes the major indication for THA revision, is the most common reason for failure after revision, and represents the most common reason for isolated acetabular revision and modular component exchange.1,3 Modular component exchange has been proposed in an attempt to manage THA instability while minimizing potential morbidity due to extensive bone loss, intra-operative bleeding, and prolonged operative time accompanying formal revision procedures, particularly for older and frail patients. 4,5 Beside instability management, modular component exchange could be required in cases of wear or mechanical failure of the liner. However, liner replacement may be impossible or impractical due to damaged locking mechanisms compromising liner fixation, incompatibility of the available components, non-modularity of the metal shell, or sub-optimal positioning of the acetabular component requiring reorientation. Previous biomechanical and short-term follow-up clinical studies reported the cementation of polyethylene (PE) line...

show abstract

Section: Methodsmentioning

confidence: 99%

“…A 2-3 mm cement mantle provides greater fixation strength than a standard locking liner. 10,12 Cement was allowed to cure at !6 hr before testing.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Wegrzyn

Thoreson

Guyen

et al. 2013

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…The second mechanical concern is the durability of cementation of the second porous shell into the first. Published mechanical studies of cementing a liner or a component into a shell would support the validity of this construct [7,11]. With a 2-mm cement mantle between a cobalt-chromium shell and a titanium alloy shell, the fixation strength exceeded that of commonly used locking mechanisms [7].…”

Section: Discussionmentioning

confidence: 98%

Surgical Technique: A Cup-in-Cup Technique to Restore Offset in Severe Protrusio Acetabular Defects

Blumenfeld

Bargar

2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Severe medial and/or superior defects encountered in revision THA are currently managed with jumbo (C 66 mm) acetabular components and modular augments, with reconstruction cages, or with the cup-cage technique. Preoperative planning can indicate when these techniques may not restore vertical and horizontal offset. Failure to restore offset can lead to impingement, leg length inequality, abductor weakness, and dislocation. Surgical Technique We developed a ''cup-in-cup'' technique in which a porous tantalum acetabular shell was impacted into supportive medial host bone. A second tantalum shell was then cemented in, and this shell's diameter could be selected based on preoperative planning to achieve restoration of horizontal and vertical offset. Patients and Methods We implanted porous tantalum hemispheric shells in seven patients undergoing eight revision THAs. The average age was 73 years at the time of the procedure. Preoperative defects per the classification of Paprosky et al. were three IIC, four IIIA, and one IIIB. All patients were followed clinically and radiographically for a minimum of 12 months (average, 28 months; range, 12-50 months).

show abstract

“…A number of factors have been proposed to be associated with an increased risk of constrained liner failure and recurrent dislocation, including a history of recurrent dislocation prior to constrained liner implantation [3,9], placing a constrained liner into a well-fixed previously implanted acetabular shell without careful scrutiny of component alignment [3,4,9], inadequate cementing and/ or seating of the constrained liner within the acetabular cup [5,7,14], and failure to fill bone defects and use multiple screw fixation in otherwise well-fixed acetabular cups [12,16]. The results of our study suggest that one or more previous revision surgeries may additionally predispose to failure of constrained acetabular liners.…”

Section: Discussionmentioning

confidence: 99%

Are abductor muscle quality and previous revision surgery predictors of constrained liner failure in hip arthroplasty?

Zywiel

Mustafa

Bonutti

et al. 2010

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Dislocation is one of the most common complications of total hip arthroplasty. The use of constrained liners is an option for the management of chronic hip instability, typically used after other methods have failed. The purposes of this study were to evaluate the overall clinical outcomes and failure rates of a tripolar constrained liner design, to assess the radiographic outcomes of its use, and to examine whether various factors such as abductor mechanism quality and history of previous revision surgeries were associated with an increased risk of failure. Forty-three hips in 39 patients who had a mean follow-up of 51 months (range, 24-110 months) were reviewed. Ninety-one percent of the hips (39 of 43 hips) did not need any revisions over the study period. A new liner was implanted in all four failed hips with concurrent revision of the acetabular cup in three cases. No further dislocations occurred in this group. The mean hip score for surviving hips was 82 points (range, 38-100 points) at final followup. Radiographic evaluation revealed stable, well-fixed acetabular components in all surviving hips without progressive radiolucencies. No association was found between abductor muscle quality and the incidence of failure, but patients who experienced a constrained liner failure were more likely to have undergone at least one previous hip revision operation. Tripolar constrained acetabular liners can provide successful outcomes in patients with hip instability, although it is important not to rely on the use of a constrained liner alone in an attempt to compensate for other correctable factors such as component positioning.

show abstract

A Biomechanical Analysis of Polyethylene Liner Cementation Into a Fixed Metal Acetabular Shell

Cited by 67 publications

References 20 publications

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Surgical Technique: A Cup-in-Cup Technique to Restore Offset in Severe Protrusio Acetabular Defects

Are abductor muscle quality and previous revision surgery predictors of constrained liner failure in hip arthroplasty?

Contact Info

Product

Resources

About