Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups

Doyle, Ruben; Arkel, Richard J. van; Jeffers, Jonathan R.T.

doi:10.1002/jor.24418

Cited by 16 publications

(34 citation statements)

References 45 publications

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“…Considering the interaction between bone elastic modulus and interference fit, the surgeon may ensure the primary stability of a cup in patients with low bone quality by introducing larger interference fits in these patients. However, the volume of bone experiencing high strain also increased with interference fit, increasing the risk of acetabular fracture as similarly observed in in vitro studies 45,46 . Therefore, there is a balance to strike between interference fit to establish primary stability and increasing fracture risk of the acetabulum in patients with low bone quality.…”

Section: Discussionmentioning

confidence: 76%

Patient and surgical variability in the primary stability of cementless acetabular cups: A finite element study

O’Rourke

Taylor

2020

Journal Orthopaedic Research

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Aseptic loosening is the most common indication for revision of cementless acetabular cups and often depends on the primary stability achieved following surgery. Cup designs must be capable of achieving primary stability for a wide variety of individuals and surgical conditions to be successful. Typically, preclinical finite element (FE) testing of cups involves assessing the performance in a single patient and under a limited set of idealized conditions. The aim of this study was to assess the effect of patient and surgical parameters on the primary stability of an acetabular cup design in a set of subject‐specific FE models. Interference fit was varied in a representative set of 12 patient‐specific models of the implanted hemipelvis. Linear mixed models showed a significant association with micromotion for interference fit (P < .0001), acetabular bone elastic modulus (P < .001), native acetabular diameter (P = .03), and the interference fit‐elastic modulus interaction (P = .01). There were no significant associations between the polar gap and any of the parameters considered. The significant interference fit‐elastic modulus interaction suggests that increasing the interference fit in patients with low bone quality leads to a greater reduction in micromotion than in patients with higher bone quality. However, the significant association between percentage bone yielding and interference fit (P < .0001) suggests a higher periacetabular fracture risk at higher interference fits. This work supports the development of preclinical testing of cup designs for the broad range patients and surgical conditions a cup may face following surgery.

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Section: Discussionmentioning

confidence: 76%

Patient and surgical variability in the primary stability of cementless acetabular cups: A finite element study

O’Rourke

Taylor

2020

Journal Orthopaedic Research

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“…Pilot testing indicated a characteristic pattern to the strain with an increasing number of strikes ( Figure 3 ): initially strain increased strike by strike ( Figure 3a ), which represents an increase in the stability of the implant. 31 This was followed by an inflexion point (peak strain) and a subsequent deterioration of strain with each strike ( Figure 3b ). This deterioration in strain with subsequent strikes was quantified and analyzed as it poses a clinical risk: over-impacting the component may reduce implant stability.…”

Section: Methodsmentioning

confidence: 94%

“…This location has previously been shown to experience the highest strain. 21 , 31 Strain gauge data were acquired for one second following each strike using a USB datalogger (NI9327; National Instruments, Budapest, Hungary) in quarter bridge configuration. Raw data were captured using Labview (National Instruments, 2014) and analyzed using MATLAB (Mathworks, Natick, Massachusetts, USA).…”

Section: Methodsmentioning

confidence: 99%

“…Previous work has investigated the role of impaction energy or implantation force, both of which depend upon mallet mass and velocity, implant stability, and seating. 31 However the effect of number of impaction strikes remains unclear. As it can be difficult for the surgeon to accurately infer when a component is seated, 32 the effect of under- or over-impacting an acetabular component requires investigation.…”

Section: Introductionmentioning

confidence: 99%

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Impaction technique influences implant stability in low-density bone model

Doyle

Arkel

Muirhead-Allwood

et al. 2020

Bone & Joint Research

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Aims Cementless acetabular components rely on press-fit fixation for initial stability. In certain cases, initial stability is more difficult to obtain (such as during revision). No current study evaluates how a surgeon’s impaction technique (mallet mass, mallet velocity, and number of strikes) may affect component fixation. This study seeks to answer the following research questions: 1) how does impaction technique affect a) bone strain generation and deterioration (and hence implant stability) and b) seating in different density bones?; and 2) can an impaction technique be recommended to minimize risk of implant loosening while ensuring seating of the acetabular component? Methods A custom drop tower was used to simulate surgical strikes seating acetabular components into synthetic bone. Strike velocity and drop mass were varied. Synthetic bone strain was measured using strain gauges and stability was assessed via push-out tests. Polar gap was measured using optical trackers. Results A phenomenon of strain deterioration was identified if an excessive number of strikes was used to seat a component. This effect was most pronounced in low-density bone at high strike velocities. Polar gap was reduced with increasing strike mass and velocity. Conclusion A high mallet mass with low strike velocity resulted in satisfactory implant stability and polar gap, while minimizing the risk of losing stability due to over-striking. Extreme caution not to over-strike must be exercised when using high velocity strikes in low-density bone for any mallet mass. Cite this article: Bone Joint Res 2020;9(7):386–393.

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“…It is hard for the surgeon to control the impaction strike precisely. High-energy strikes lead to a marginal increase in the pushout fixation but only a small decrease in the polar gap and thus should be avoided [29].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative complications in total hip arthroplasty using a new cementless femoral implant (SP-CL®)

et al. 2020

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Background: Considering the excellent results already achieved in total hip arthroplasty (THA), new implants must be at least as safe as currently used implants and lead to longer survival. A new cementless femoral stem, SP-CL ® , has been introduced. The aim of this study is to evaluate intraoperative complications and assess the risk factors of THA with the SP-CL ® implant. Materials and methods: All THA patients who were operated on using the SP-CL ® (LINK, Hamburg, Germany) implant between 2015 and 2018 were included in the analysis. Data were collected from medical records from national and hospital electronic databases. Radiological measurements were made from standard pre-and postoperative radiographs. Results: A total of 222 THA were performed using the SP-CL ® implant. The average age of the patients was 56 years (14-77 years). There were 1 transient sciatic nerve injury, 1 acetabular fracture, and 11 (5.0%) intraoperative femoral fractures (IFF), of which 7 were treated with cerclage wire or titanium band during the operation while the other fractures were treated conservatively. None of the IFF patients were revised due to fracture during the follow-up period (one revision due to infection). The radiographic morphology of proximal femur was associated with increased risk of IFF (p = 0.02). Conclusions: The results of the current study demonstrate a 5% incidence of IFF when using the LINK SP-CL ® femoral stem in THA. The radiographic morphology of the proximal femur was an important predictor of IFF and should be assessed when using SP-CL ® .

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Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups

Cited by 16 publications

References 45 publications

Patient and surgical variability in the primary stability of cementless acetabular cups: A finite element study

Patient and surgical variability in the primary stability of cementless acetabular cups: A finite element study

Impaction technique influences implant stability in low-density bone model

Intraoperative complications in total hip arthroplasty using a new cementless femoral implant (SP-CL®)

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