The initial fixation of the press-fit acetabular shell - clinical observation and experimental study

Inoue, Yoshihisa; Yanagihara, Yasuho; Uta, Souichi; Mogami, Atsuhiko; Iwase, Hideaki

doi:10.1007/s004020050473

Cited by 10 publications

(14 citation statements)

References 4 publications

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“…Underreaming by 2 mm increased this torsion to failure to approximately 28 Nm. Others have reported similar results [4]. Based on these calculations, depending on the patient's weight, activity level, component positioning, and amount of offset used, the torsional forces applied to the component could very well exceed that required to result in failure of initial fixation.…”

Section: Discussionmentioning

confidence: 79%

Acetabular Loosening Using an Extended Offset Polyethylene Liner

Archibeck

Cummins²,

Junick³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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The use of extended offset femoral components and acetabular liners helps restore preoperative offset during hip arthroplasty. We report a relatively high acetabular component aseptic loosening rate with the use of offset polyethylene liners. We reviewed 1919 primary and 346 revision total hip arthroplasties (THAs). A 7-mm offset acetabular liner was used in 120 of the primary and 100 of the revision THAs. The aseptic loosening rate in the primary THA group was 0.12% in the standard offset and 4.2% in the extended offset groups at a minimum of 2 years (mean, 3.6 years; range, 2-9 years) followup. The aseptic loosening rate in the revision group was 1.7% in the standard and 7% in the extended offset groups at a mean of 4 years (range, 2-9 years) followup. Although extended offset acetabular liners help restore hip offset, torsional force applied to the implant-bone interface may have a detrimental effect on fixation. We found a relatively high failure rate in our primary and revision acetabular components used with an offset liner. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 79%

Acetabular Loosening Using an Extended Offset Polyethylene Liner

Archibeck

Cummins²,

Junick³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…Regarding the press-fit technique in cementless THA, Kaneko et al [2] reported good clinical results and roentgenogram evaluations for 30 uncemented acetabular cups with 2-mm under-reaming, as well as good stability on biomechanical compression load and twist testing. Ng et al [4] reported the 2- to 6-year results of 74 THAs using a cementless acetabular component without holes for supplemental screw fixation and the immediate full-weight-bearing walking allowed postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning both fixation techniques, some reports place emphasis on press-fit fixation [2–6], while others note that bone screws are very helpful aids in cup fixation [7–10]. However, those studies reported the benefits and limitations of press-fit and screw fixation independently.…”

Section: Introductionmentioning

confidence: 99%

Initial stability of cementless acetabular cups: press-fit and screw fixation interaction—an in vitro biomechanical study

Tabata

Kaku

Hara

et al. 2014

Eur J Orthop Surg Traumatol

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Background Press-fit and screw fixation are important technical factors to achieve initial stability of a cementless acetabular cup for good clinical results of total hip arthroplasty. However, how these factors affect one another in initial cup fixation remains unclear. Therefore, this study aimed to evaluate the mutual influence between press-fit and screw fixation on initial cup stability.MethodsFoam bone was subjected to exact hemispherical-shape machining to diameters of 48, 48.5 and 49 mm. A compressive force was applied to ensure seating of a 48-mm-diameter acetabular cup in the foam bone prior to testing. Screws were inserted in six different conditions and tightened in a radial direction at the same torque strength. Then, the socket was rotated with a twist-testing machine, and the torque value at the start of axial rotation between the socket and the foam bone was measured under each screw condition.ResultsThe torque values for the 48-mm-diameter reaming were >20 N m higher than those for the 48.5- and 49-mm-diameter reaming in each screw condition, indicating that press-fit fixation is stronger than screw fixation. Meanwhile, torque values for the 48.5- and 49-mm-diameter reaming tended to increase with increasing the number of screws.ConclusionsAccording to our experiment, press-fit fixation of a cementless acetabular cup achieved rigid stability. Although the supplemental screws increased stability of the implant under good press-fit conditions, they showed little impact on whole-cup stability. In the case of insufficient press-fit fixation, cup stability depends on screw stability and increasing the number of additional screws increases cup stability.

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“…in the case of osteoporotic bone or a dysplastic acetabulum. The use of additional screws when implanting cementless cups in primary hip arthroplasty continues to be the subject of considerable debate in the literature [7][8][9][10][11][12][13]. In their investigations in 2015, Tabata et al showed that the additional use of screws increased the primary stability of the cup [10].…”

Section: Introductionmentioning

confidence: 99%

The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up

Brodt

Bischoff

Schulze

et al. 2021

International Orthopaedics (SICOT)

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Purpose The cementless implantation of hip replacement cups may be performed with and without the additional use of acetabular screws. If the surgeon uses screws or not depends on variable factors. In general, the use of screws is intended to increase the primary stability of the cup. Whether screws increase the initial stability of the cup construct, or even reduce it in part, is the subject of considerable debate in the literature. It is also unclear whether the additional screws lead to increased wear or increased periacetabular osteolysis over the long-term course. Methods Two hundred eleven patients from a previous study with a minimum follow-up of 10.7 years were included. Of these, 68 patients with 82 total hip arthroplasties (THA) were given clinical and radiological follow-up examinations. Of these, 52 had been fitted without screws and 30 with screws. On the basis of radiographs, annual wear and osteolysis were quantified. The clinical results were recorded by means of VAS, HHS, and WOMAC scores. Results Significantly more periacetabular osteolysis was found if additive acetabular screws had been used. No difference was found in relation to the volumetric wear per year. Likewise, no difference was found with regard to the clinical scores. Conclusions The use of additive acetabular screws leads to increased osteolysis in the periacetabular bone stock. Insofar as the primary stability of the cementless cup construct allows it, no additional acetabular screws should be used.

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The initial fixation of the press-fit acetabular shell - clinical observation and experimental study

Cited by 10 publications

References 4 publications

Acetabular Loosening Using an Extended Offset Polyethylene Liner

Acetabular Loosening Using an Extended Offset Polyethylene Liner

Initial stability of cementless acetabular cups: press-fit and screw fixation interaction—an in vitro biomechanical study

The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up

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