Areas of Contact and Extent of Gaps With Implantation of Oversized Acetabular Components in Total Hip Arthroplasty

Mackenzie, James; Callaghan, John J.; Pedersen, Douglas R.; Brown, Thomas

doi:10.1097/00003086-199401000-00018

Cited by 96 publications

(80 citation statements)

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“…Variations in surface preparation result from the anisotropic quality of bone and have been described previously. [23][24][25] The sphericity of the reamed acetabular surface may deviate by as much as 4 mm, 26 whereas the overall geometry may be overreamed by 0.6 mm. 24 These reaming variations may affect the initial amount of bone-implant apposition, which will in turn affect the amount of pinching deformation.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] The sphericity of the reamed acetabular surface may deviate by as much as 4 mm, 26 whereas the overall geometry may be overreamed by 0.6 mm. 24 These reaming variations may affect the initial amount of bone-implant apposition, which will in turn affect the amount of pinching deformation. Aside from the surface preparation variations, cup designs also affect the bony support behind the cup [27][28][29] and the overall deformation of the cup.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ong

Rundell

Liepins

et al. 2009

Journal Orthopaedic Research

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Press-fit implantation may result in acetabular component deformation between the ischial-ilial columns (''pinching''). The biomechanical and clinical consequences of liner pinching due to press-fit implantation have not been well studied. We compared the effects of pinching on the polyethylene fracture risk, potential wear rate, and stresses for two different thickness liners using computational methods. Line-to-line (''no pinch'') reaming and 2 mm underreaming press fit (''pinch'') conditions were examined for Trident cups with X3 TM polyethylene liner wall thicknesses of 5.9 mm (36E) and 3.8 mm (40E). Press-fit cup deformations were measured from a foam block configuration. A hybrid material model, calibrated to experimentally determined stress-strain behavior of sequentially annealed polyethylene, was applied to the computational model. Molecular chain stretch did not exceed the fracture threshold in any cases. Nominal shell pinch of 0.28 mm was estimated to increase the volumetric wear rate by 70% for both cups and peak contact stresses by 140 and 170% for the 5.9 and 3.8 mm-thick liners, respectively. Although pinching increases liner stresses, polyethylene fracture is highly unlikely, and the volumetric wear rates are likely to be low compared to conventional polyethylene. ß

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ong

Rundell

Liepins

et al. 2009

Journal Orthopaedic Research

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“…The absence of a central introducer hole reduces intraoperative feedback about component seating, potentially increasing the incidence of interference gaps. Concerns exist about incomplete component seating because it may lead to inadequate fixation, reduced bony ingrowth, and acetabular failure [12]. We therefore (1) assessed the incidence and natural history of postoperative interference gaps in hip resurfacing arthroplasty and (2) determined whether a reduction of the acetabular underream from 2 mm to 1 mm reduced the incidence of periacetabular interference gaps.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, porous-coated press-fit acetabula have demonstrated similar survivorship at a mean followup of 5 to 10 years with their use in hip resurfacing arthroplasty [2,7,9,19,23]. However, underreaming the acetabulum for fixation of an oversized press-fit component has been associated with acetabular fractures [3,10] and incomplete component seating [2,6,12]. Concerns exist about incomplete seating leading to reduced bony ingrowth and acetabular failure [12].…”

Section: Introductionmentioning

confidence: 99%

“…However, underreaming the acetabulum for fixation of an oversized press-fit component has been associated with acetabular fractures [3,10] and incomplete component seating [2,6,12]. Concerns exist about incomplete seating leading to reduced bony ingrowth and acetabular failure [12]. Recommendations for the size of underream in acetabular press-fit fixation range from 1 to 3 mm [1,3,15,16,24].…”

Section: Introductionmentioning

confidence: 99%

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Should We Worry About Periacetabular Interference Gaps in Hip Resurfacing?

Gomes

Olsen

Donnelly

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Press-fit acetabular component seating in hip resurfacing can be challenging as a strong interference fit is required. It has not been established whether reducing the acetabular underream minimizes incomplete component seating or leads to increased acetabular loosening. Questions/purposes We examined (1) the incidence and natural history of postoperative interference gaps in hip resurfacing and (2) whether reduction of the acetabular underream from 2 mm to 1 mm reduces the incidence of periacetabular interference gaps.

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Effects of bone morphogenetic protein‐2 and hyaluronic acid on the osseointegration of hydroxyapatite‐coated implants: An experimental study in sheep

Aebli

Stich

Schawalder

et al. 2005

J Biomedical Materials Res

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Research efforts aim at enhancing early osseointegration of cementless implants to improve early fixation and, thus, reduce the risk of loosening. The aim of the present study was to investigate whether bone morphogenetic protein (BMP) 2 had a positive effect on the osseointegration of hydroxyapatite-coated implants. Hydroxyapatite (HA) implants (perforated hollow cylinders and solid rods) were coated with BMP-2 and hyaluronic acid (HY) as the carrier or with HY alone. Uncoated HA implants served as controls. The osseointegration of the implants was evaluated either by light microscopy or by pullout tests after 1, 2, and 4 weeks of unloaded implantation in the cancellous bone of 24 sheep. The BMP-2 coating significantly increased bone growth into the implant perforations compared with HA-coated implants at 2 and 4 weeks. Bone-implant contact and interface shear strength of BMP-2 implants were lower than HA implants at 2 weeks. At 4 weeks, there was no significant difference in bone-implant contact and shear strength between BMP-2 and HA-coated implants. The BMP-2 coating enhanced gap healing but had no positive or even an inhibitory effect (at 2 weeks) on bone-implant contact and interface shear strength. In the clinical situation, a perfect press-fit implantation cannot be achieved, and BMP-2 may be beneficial for enhancing bone growth into gaps around cementless implants.

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Areas of Contact and Extent of Gaps With Implantation of Oversized Acetabular Components in Total Hip Arthroplasty

Cited by 96 publications

References 0 publications

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Should We Worry About Periacetabular Interference Gaps in Hip Resurfacing?

Effects of bone morphogenetic protein‐2 and hyaluronic acid on the osseointegration of hydroxyapatite‐coated implants: An experimental study in sheep

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