Stress analysis of cemented glenoid prostheses in Total Shoulder Arthroplasty

Gupta, Sanjay; Helm, F.C.T. van der; Keulen, Fred van

doi:10.1016/j.jbiomech.2004.02.001

Cited by 55 publications

(24 citation statements)

References 33 publications

(37 reference statements)

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“…In all tests, the crack initiated from the rim of the glenoid fixation, consistent with some finite element predictions 5,6,8 From there, it progressed towards and subsequently around the keel. At the end of the test (70,000 cycles), all but one sample exhibited fracture in the superior and inferior fixation, while regions around the keel remained partly intact (Table 2).…”

Section: Discussionsupporting

confidence: 86%

“…[5][6][7][8][9][10][11] Such studies provide stress information in the fixation area, but without supporting experimental studies, FEA predictions are tentative.…”

mentioning

confidence: 99%

“…Several FEA studies assumed the weakest link in fixation is the bulk cement, 6,9 while many clinical studies indicated that the bone-cement interface is the most critical. [12][13][14] This latter conclusion is based on radiolucent lines at the bone-cement interface.…”

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confidence: 99%

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Glenoid loosening after total shoulder arthroplasty: An in vitro CT‐scan study

Grégory

Hansen

Taillieu

et al. 2009

Journal Orthopaedic Research

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Glenoid fixation failure has only been grossly characterized. This lack of information hinders attempts to improve fixation because of a lack of methodologies for detecting and monitoring fixation failure. Our goal was twofold: to collect detailed data of glenoid fixation fracture, and to investigate computed tomography (CT)-scanning as a tool for investigations of fixation failure. Six cadaver scapulas and six bone-substitute specimens were cyclically loaded and CT-scanned at clinical settings after 0, 1,000, 5,000, 10,000, 30,000, 50,000 and 70,000 load cycles. The fixation status was evaluated by inspection of the scans. After 70,000 cycles, the specimens were sectioned, and the fixation inspected by microscopy. The results of the microscopy analysis were compared to the CT-scan analysis. Fracture of the glenoid fixation initiated at the edge of the glenoid rim and propagated towards and around the keel of the implant. The entire process from initiation to complete fracture took place at the polyethylene implant-cement interface, while the cement, the adjacent bone, and the cement-bone interface remained intact. Thus, strengthening the polyethylene-cement interface should improve glenoid fixation. Microscopy results validated the CT methodology, suggesting that the CT technique is reliable. ß

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Section: Discussionsupporting

confidence: 86%

“…[5][6][7][8][9][10][11] Such studies provide stress information in the fixation area, but without supporting experimental studies, FEA predictions are tentative.…”

mentioning

confidence: 99%

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Glenoid loosening after total shoulder arthroplasty: An in vitro CT‐scan study

Grégory

Hansen

Taillieu

et al. 2009

Journal Orthopaedic Research

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“…The predicted values for cement stress were within the same range of other similar FE studies: 6 MPa (Lacroix et al, 2000), 1.3-1.4 MPa (Couteau et al, 2001), 4-6 MPa (Murphy et al, 2001), 1-10 MPa (Gupta et al, 2004). However, the observed cement stress decrease as cement thickness increase was contrary to the only study that discussed this effect (Couteau et al, 2001), by doubling the cement thickness from 2-4 to 4-8 mm, which is quite high.…”

Section: Discussionsupporting

confidence: 81%

“…More specifically, pull-out strength measurements of glenoid component pegs (Nyffeler et al, 2003) provides a rough estimate of 3 MPa for the shear strength of the bone-cement interface. Based on a Hoffman criterion, Gupta et al (2004) used the Hoffman number (Huiskes and van Rietbergen, 1995) to analyse the failure of the fully bonded bone-cement interface of a keeled glenoid implant. They derived a shear strength between 3.8 and 6.9 MPa, a tensile strength between 2.4 and 4.4 MPa, and a compressive strength between 4.6 and 8.9 MPa.…”

Section: Discussionmentioning

confidence: 99%

Bone–cement interface of the glenoid component: Stress analysis for varying cement thickness

Terrier

Büchler

Farron

2005

Clinical Biomechanics

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Background. Although shoulder arthroplasty is an accepted treatment for osteoarthritis, loosening of the glenoid component, which mainly occurs at the bone-cement interface, remains a major concern. Presently, the mechanical effect of the cement mantel thickness on the bone-cement interface is still unclear.Methods. Finite element analysis of a prosthetic scapula was used to evaluate the effect of cement thickness on stresses and micromotions at the bone-cement interface. The glenoid component was all-polyethylene, keeled and flat back. Cement mantel thickness was gradually increased from 0.5 to 2.0 mm. Two glenohumeral contact forces were applied: concentric and eccentric. Two extreme cases were considered for the bone-cement interface: bonded and debonded.Findings. Within cement, stress increased as cement thickness decreased, reaching the fatigue limit below 1.0 mm. Bone stress was below its ultimate strength and was minimum between 1.0 and 1.5 mm. Interface stress was close to the interface strength, and also minimum between 1.0 and 1.5 mm. Both the decentring of the load and the debonding of the interface increased the stress.Interpretation. A cement thinning weakens the cement, but also the bone-cement interface, along the back-keel edges. Conversely, a cement thickening rigidifies the cemented implant, consequently increasing interfacial stresses and micromotions. To avoid both excessive cement fatigue and interface failure, an ideal cement thickness has been identified between 1.0 and 1.5 mm.

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