Cementing a Liner into a Stable Cementless Acetabular Shell

Beaulé, Paul E.; Ebramzadeh, Edward; LeDuff, M.; Prasad, Ramjee; Amstutz, Harlan C.

doi:10.2106/00004623-200405000-00007

Cited by 75 publications

(52 citation statements)

References 17 publications

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“…One other study showed a significant improvement in the Harris hip scores following head-liner exchange (from 64.1 points preoperatively to 92.7 points postoperatively), which was comparable with the improvement after acetabular revision (from 66.6 points to 92.1 points) 18 . The Harris hip scores in our study did not improve as impressively as they did in the study by Koh et al 18 , which may be related to our inclusion of femoral revisions, but our clinical outcomes compare favorably with those in studies of different types of revision hip arthroplasty [22][23][24][25][26][27][28][29][30] (see Appendix). Comparison is somewhat limited by differences in procedures and patient populations; however, these data demonstrate that outcomes are not likely limited by retention of the acetabular component [8][9][10] .…”

Section: Discussionsupporting

confidence: 38%

Revision Total Hip Arthroplasty with Retained Acetabular Component

Adelani

Mall²,

Nyazee

et al. 2014

The Journal of Bone and Joint Surgery

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Section: Discussionsupporting

confidence: 38%

Revision Total Hip Arthroplasty with Retained Acetabular Component

Adelani

Mall²,

Nyazee

et al. 2014

The Journal of Bone and Joint Surgery

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“…[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%

“…[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. 6,17 While previous studies of constrained tripolar liners reported mechanical failure rates up to 42.1% at 10-year follow-up, 18,19 the overall survival rate of dualmobility acetabular components has been reported to be as high as 96% at 15-year follow-up with a restoration of hip stability in more than 95% of operated patients.…”

mentioning

confidence: 99%

“…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. 6,17 While previous studies of constrained tripolar liners reported mechanical failure rates up to 42.1% at 10-year follow-up, 18,19 the overall survival rate of dualmobility acetabular components has been reported to be as high as 96% at 15-year follow-up with a restoration of hip stability in more than 95% of operated patients. [20][21][22][23] Despite these encouraging clinical results, no study has reported the cementation of dual-mobility acetabular components into well-fixed metal shells during revision THA.…”

mentioning

confidence: 99%

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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

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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...

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“…At a mean followup of 5.1 years, no liner debonding has occurred [2]. Mechanical testing has confirmed the strength of this construct compared to a conventional locking mechanism [10].…”

Section: Introductionmentioning

confidence: 70%

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

Blumenfeld

Bargar

2012

Clinical Orthopaedics &Amp; Related Research

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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).

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Cementing a Liner into a Stable Cementless Acetabular Shell

Cited by 75 publications

References 17 publications

Revision Total Hip Arthroplasty with Retained Acetabular Component

Revision Total Hip Arthroplasty with Retained Acetabular Component

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

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