Radiological factors influencing femoral and acetabular failure in cemented Charnley total hip arthroplasties

Ma, Ritter; Zhou, Haibin; Keating, C. M.; Keating, E. Michael; Faris, Philip M.; Meding, John B.; Berend, Michael E.

doi:10.1302/0301-620x.81b6.0810982

Cited by 60 publications

(40 citation statements)

References 14 publications

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“…Thin or incomplete cement mantles have been reported to be responsible for irregular stress distribution, mantle fracture, stem debonding, osteolysis, and loosening [1][2][3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Tight Fit Technique in Primary Hybrid Total Hip Arthroplasty for Patients with Hip Dysplasia

Ito

Hirayama

Tanino

et al. 2007

The Journal of Arthroplasty

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This paper presents the mid-term results of hybrid total hip arthroplasty for patients with hip dysplasia using a tight fit technique for the femoral component. We followed 113 hips in 99 patients for a mean of 11 years. All final femoral rasps used in this study over-rasped by 0.5 -1.0 mm for stem insertion, resulting in relatively thin cement mantles. Both components of one hip were removed due to infection. The other 5 acetabular components were revised for osteolysis, recurrent dislocation, or dislodgement of the polyethylene liner.No femoral component was revised for aseptic loosening. We conclude that the tight fit technique using a canal-filling stem may produce good long-term results for patient with hip dysplasia.

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Section: Discussionmentioning

confidence: 99%

“…Many studies have reported that a thin or incomplete cement mantle should be avoided [1][2][3][4][5][6][7][8]25]. However, Brown and Bargar [28] showed that 1.6 mm thin specimens demonstrated an increase in stress failure of 14% and an increase in strain failure of 30% compared with 3.2 mm thicker specimens.…”

Section: Discussionmentioning

confidence: 99%

Tight Fit Technique in Primary Hybrid Total Hip Arthroplasty for Patients with Hip Dysplasia

Ito

Hirayama

Tanino

et al. 2007

The Journal of Arthroplasty

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“…18 These findings include radiolucent lines, osteolytic lesions and demineralization of bone, which are generally considered as predictors of aseptic loosening of the implant. 18 Finite element analyses of periacetabular stress distribution after cemented cups have postulated a stress redistribution to cancellous bone cranial to the cup and the medial wall of the ilium compared to the postulated high cancellous BD loss after implantation of a rigid spherical press-fit cup. [19][20][21] Consistent with this notion, we have shown in a previous study with a smaller cohort (n ¼ 15) of cemented cups and a less precise three region of interest evaluation, that a significant cancellous BD decrease is detectable solely ventral to the cemented cup, but not dorsal or cranial to the implant.…”

mentioning

confidence: 99%

“…13 For cemented cup fixation, it is well known that excellent clinical results are often in discrepancy to the radiographical findings. 18 These findings include radiolucent lines, osteolytic lesions and demineralization of bone, which are generally considered as predictors of aseptic loosening of the implant. 18 Finite element analyses of periacetabular stress distribution after cemented cups have postulated a stress redistribution to cancellous bone cranial to the cup and the medial wall of the ilium compared to the postulated high cancellous BD loss after implantation of a rigid spherical press-fit cup.…”

mentioning

confidence: 99%

Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

Mueller

Schmidt

Ehrmann

et al. 2008

Journal Orthopaedic Research

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Stress-shielding and periprosthetic bone loss after total hip arthroplasty (THA) may be clinically relevant for high-demand patients. Analysis of cortical and cancellous bone density (BD) changes in vivo after THA is of interest to basic science researchers and joint reconstruction surgeons. An insufficient periprosthetic bone stock may predispose to migration, early mechanical failure, and major problems in revision surgery. We used computed tomography (CT)-assisted osteodensitometry in two prospectively analyzed cohorts after cemented (n ¼ 21) versus noncemented (n ¼ 23) cup fixation. Periacetabular BD (mgCaHa/mL) was determined in five CT scans cranial and five CT scans at the level of the cup 10 days and 26 months postoperatively. For press-fit cups BD decreased significantly in all CT cans except in four out of the five scans of cortical bone cranial to the cup. The decrease was highest for cancellous bone ventral to the cup (À45 to À53%). After cemented cup fixation, significant cortical BD decrease was seen ventral to the cup (À11 to À20%). Cancellous BD decrased only ventral (À21 to À31%) and in two scans cranial (À11 and À12%) to the cup. The modes of load transfer between cemented and uncemented cups differ fundamentally. Cemented cups especially prevent the loss of cancellous bone of the acetabulum while also cortical BD loss was significantly lower in most CT scans surrounding the cemented cup compared to the press-fit component. Long-term results are required to prove whether third-generation cementing technique protects periprosthetic BD and thereby improve implant survival. Keywords: osteodensitometry; computed tomography; total hip arthroplasty; acetabulum; load transfer Bone is a highly organized tissue that reacts to mechanical load in a typical stress related pattern according to Wolff's law. 1 In the last century increasing knowledge of load transfer mechanisms and stress distribution patterns after total hip replacements was provided. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of these studies have focussed on stress shielding mechanisms after femoral stem implantation. [2][3][4][5][6]10 The most common technique to study bone density (BD) changes is dual X-ray absorptiometry (DXA), which is a reproducible two-dimensional measurement technique. [2][3][4][5][6][7]11,[15][16][17] To allow a differentiated three-dimensional analysis of cortical and cancellous bone structures after THA in vivo we have introduced a novel method of CT-assisted osteodensitometry. 9,10,13,14 In a previous study we have provided clear evidences for the reproducibility and validity of our method. 9 Opposed to DXA CT-assisted osteodensitometry allows the separate analysis of cortical and cancellous BD surrounding the prosthesis, which might be a potential advantage in studying mechanical load transfer mechanisms to the ilium after total hip arthroplasty. 13,14 A DXA based study by Sabo et al. 11 showed a decrease of periacetabular BD 24 months after implantation of a rigid press fit cup. T...

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“…It also is known a radiolucent line at the biologic interface of the cup is an important prognostic sign for later loosening [12,16,26]. The presence of a radiolucent line around the periphery of the cup implies there is inadequate penetration of bone by cement and in these cases, there may be easier ingress of pressure and debris around the implant to erode bone and compromise fixation.…”

Section: Discussionmentioning

confidence: 99%

The Influence of a Suction Device on Fixation of a Cemented Cup using RSA

Timperley

Whitehouse

Hourigan

2009

Clinical Orthopaedics &Amp; Related Research

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The quality of technique used at the time of socket cementation is crucial in ensuring a durable longterm result of the implant. We asked whether a new instrument, an aspirator retractor introduced into the wing of the ilium before socket preparation and cementation, would enhance cement fixation as defined by RSA and radiographic examination. We randomized 38 patients into two groups. The surgical technique was identical between the groups with the exception of the use of the aspirator retractor. Patients were followed clinically and with radiostereometry at a minimum of 2 years. We compared gross radiographic appearances, including the depth of penetration of cement and the incidence of postoperative and 2-year radiolucent lines. There was no difference in proximal migration between the two groups. No improvement of fixation was proven from the measured translations and rotations of the socket in the suction group. We found no difference in the number or extent of radiolucent lines or the depth of cement penetration when the iliac suction device was used in conjunction with contemporary cementing techniques. Although the data suggest no shortterm advantage in this small study, we will continue to follow these patients presuming there will be improved outcomes in the longer term and since the device provides an easier method of obtaining adequate fixation, especially if technical difficulties are encountered during the pressurization procedure.

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Radiological factors influencing femoral and acetabular failure in cemented Charnley total hip arthroplasties

Cited by 60 publications

References 14 publications

Tight Fit Technique in Primary Hybrid Total Hip Arthroplasty for Patients with Hip Dysplasia

Tight Fit Technique in Primary Hybrid Total Hip Arthroplasty for Patients with Hip Dysplasia

Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: A prospective study using computed tomography‐assisted osteodensitometry

The Influence of a Suction Device on Fixation of a Cemented Cup using RSA

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