Seating of Ceramic Liners in the Uncemented Trident® Acetabular Shell: Is There Really a Problem?

Howcroft, D.W.J.; Qureshi, Amir; Graham, N.

doi:10.1007/s11999-009-0974-8

Cited by 20 publications

(14 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The maximum determined peak tensile stress of the ceramic liner (129.9 MPa), arising during load-controlled liner insertion, was nowhere near a critical value in terms of ceramic fracture as well [54]. However, under unfavorable conditions, such as an increased press-fit, a decreased wall thickness of the shell, a high bone mineral density, or increased loads, the radial deformation of the shell would increase, leading to increased liner deformation, increased stresses and a further decrease of the clearance, especially in the case of the UHMWPE liners [12][13][14]17,18,42,44,[55][56][57]. Decreased clearances are known to increase the wear rates [15] and frictional torques at the articulating surfaces and therefore, might hamper the initial fixation of acetabular cups [16].…”

Section: Discussionmentioning

confidence: 99%

“…Excessive liner deformations can lead to a reduced clearance between the liner and femoral ball head and subsequently to increased frictional torques and increased wear rates [13][14][15][16]. Moreover, the seating of the liner might be jeopardized by strong shell deformations [17,18], which might lead to increased peak stresses within ceramic liners and, therefore, an increased risk of fracture [19][20][21]. Thus, shells made of PEEK without carbon fiber reinforcement do not seem to be a suitable alternative, whereas the suitability of shells made of CFR-PEEK needs to be further evaluated.Hence, the aim of this computational study was to evaluate whether acetabular shells made of CFR-PEEK can serve as suitable alternatives to shells made of titanium in terms of strain distribution in the adjacent bone and whether the stiffness of such shells is sufficient to withstand adverse shell and liner deformations when they are pushed into an under-reamed bone cavity.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Influence of the Acetabular Cup Material on the Shell Deformation and Strain Distribution in the Adjacent Bone—A Finite Element Analysis

et al. 2020

View full text Add to dashboard Cite

In total hip arthroplasty, excessive acetabular cup deformations and altered strain distribution in the adjacent bone are potential risk factors for implant loosening. Materials with reduced stiffness might alter the strain distribution less, whereas shell and liner deformations might increase. The purpose of our current computational study was to evaluate whether carbon fiber-reinforced poly-ether-ether-ketones with a Young´s modulus of 15 GPa (CFR-PEEK-15) and 23 GPa (CFR-PEEK-23) might be an alternative shell material compared to titanium in terms of shell and liner deformation, as well as strain distribution in the adjacent bone. Using a finite element analysis, the press-fit implantation of modular acetabular cups with shells made of titanium, CFR-PEEK-15 and CFR-PEEK-23 in a human hemi-pelvis model was simulated. Liners made of ceramic and polyethylene were simulated. Radial shell and liner deformations as well as strain distributions were analyzed. The shells made of CFR-PEEK-15 were deformed most (266.7 µm), followed by CFR-PEEK-23 (136.5 µm) and titanium (54.0 µm). Subsequently, the ceramic liners were radially deformed by up to 4.4 µm and the polyethylene liners up to 184.7 µm. The shell materials slightly influenced the strain distribution in the adjacent bone with CFR-PEEK, resulting in less strain in critical regions (<400 µm/m or >3000 µm/m) and more strain in bone building or sustaining regions (400 to 3000 µm/m), while the liner material only had a minor impact. The superior biomechanical properties of the acetabular shells made of CFR-PEEK could not be determined in our present study.Materials 2020, 13, 1372 2 of 16 ceramic and UHMWPE liners combined with structurally identical metallic shells were compared [6]. Therefore, the shell material of modular acetabular cups might have a stronger influence on the strain distribution than the liner material and shells made of polymers might have a lower influence on strain distribution.Besides UHMWPE, poly-ether-ether-ketone (PEEK), often applied with carbon fibers for reinforcement (CFR-PEEK), is a biocompatible polymer that has been introduced as a material for monolithic cups and liners, but not as a material for acetabular shells [7][8][9][10][11].However, PEEK and CFR-PEEK might be suitable alternatives to metal shells in modular acetabular cups as well, in order to avoid adverse effects on stress and strain distribution within the bone stock. However, it was shown that the reduced stiffness of shells made of PEEK and CFR-PEEK leads to increased shell deformations in the case of press-fit fixation in a finite element analysis (FEA) [12]. In particular, shells made of pure PEEK without reinforcement were deformed excessively, resulting in strong deformations of the liners, which might cause further problems in vivo. Excessive liner deformations can lead to a reduced clearance between the liner and femoral ball head and subsequently to increased frictional torques and increased wear rates [13][14][15][16]. Moreover, the seating of the liner might be j...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Influence of the Acetabular Cup Material on the Shell Deformation and Strain Distribution in the Adjacent Bone—A Finite Element Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The MDM metal liner engages the Trident shell with appropriate orientation of locking tabs and impaction into a tapered shell [8] . Although there are no reports of incomplete seating of the MDM metal liner there are multiple reports of incomplete seating related to the Trident ceramic metal backed liner 1 , 2 , 5 , 7 . The tapered locking mechanism of the MDM metal liner is similar to that of the metal backed Trident ceramic liner ( Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Initially reported in conjunction with Trident metal backed ceramic liners, the impaction of the acetabular component during press fit technique is hypothesized to result in deformation of the metal acetabular shell 1 , 2 , 3 , 4 , 5 , 6 , 7 , 12 . This could potentially cause mal-alignment of the cup and liner locking mechanism resulting in improper liner seating.…”

Section: Discussionmentioning

confidence: 99%

“…Issues with incomplete seating of ceramic acetabular shell liners with the Stryker Trident (Kalamazoo, MI) acetabular system have been described in multiple case reports and retrospective reviews 1 , 2 , 3 , 4 , 5 , 6 , 7 . Previous authors have hypothesized that there may be technical aspects that complicate the impaction of the liner or that the Trident shell may deform with impaction, preventing complete seating [4] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Canted seating of the Stryker Modular Dual Mobility liner within a Trident hemispherical acetabular shell

2016

View full text Add to dashboard Cite

A 75-year-old woman who suffered a left femoral neck fracture underwent a left total hip arthroplasty using a Stryker Trident (Kalamazoo, MI) hemispherical acetabular shell and Modular Dual Mobility (MDM) metal liner. Post-operative radiographs demonstrated canted seating of the liner. The patient was taken immediately back to the operating room where the acetabular liner appeared well seated superiorly but was in a canted position inferiorly. Removal and replacement was performed and post-operative radiographs demonstrated complete seating. Subsequent follow up at 6 months demonstrated good clinical function with no adverse radiographic findings. Canted seating is a potential complication of the MDM metal liner. Providers should be aware of potential incomplete seating inferiorly despite the superior portion of the liner being well seated.

show abstract

Using intraoperative radiography to detect incomplete seating of Trident acetabular system ceramic liners

Iwai

Kabata

Maeda

et al. 2012

Eur Orthop Traumatol

View full text Add to dashboard Cite

Seating of Ceramic Liners in the Uncemented Trident® Acetabular Shell: Is There Really a Problem?

Abstract: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 20 publications

References 4 publications

Influence of the Acetabular Cup Material on the Shell Deformation and Strain Distribution in the Adjacent Bone—A Finite Element Analysis

Influence of the Acetabular Cup Material on the Shell Deformation and Strain Distribution in the Adjacent Bone—A Finite Element Analysis

Canted seating of the Stryker Modular Dual Mobility liner within a Trident hemispherical acetabular shell

Using intraoperative radiography to detect incomplete seating of Trident acetabular system ceramic liners

Contact Info

Product

Resources

About