Total Hip Acetabular Cup Flange Design and Its Effect on Cement Fixation

Oh, Indong; Sander, Thomas W.; Treharne, R.W.

doi:10.1097/00003086-198505000-00036

Cited by 26 publications

(27 citation statements)

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“…Early in vitro studies confirmed the efficacy of the flange and the authors recommended its use. Oh et al (1985) used a "simulated acetabulum" which allowed the cup flange to be inserted flush with the surface. These authors concluded that a cup with a continuous flange generated significantly higher cement pressures and greater intrusion depths as compared to other cups.…”

Section: Discussionmentioning

confidence: 99%

“…One possibility is that we used paired human acetabula, which, unlike the previous studies (Oh et al 1985, Shelley andWroblewski 1988), do not exclude the possible effects of the irregularities in the acetabular rim, which may have a detrimental effect on the theoretically convincing sealing action of the flange. Secondly, we used a "realistic" insertion force of approximately 80 N and decided against a robotic insertion set-up, as used by Oh et al (1985) and Shelley and Wroblewski (1988). This is because in the operative situation, the surgeon must control the position of the cup as well as the pressurization of the cement to avoid "bottoming-out", which in some circumstances may necessitate reduction of the force applied to the cup.…”

Section: Discussionmentioning

confidence: 99%

“…However, most basic research studies regarding cementing technique are focused on the proximal femur and the femoral component of THA (Bean et al 1988, McDonald et al 1993, Oates et al 1995, Breusch et al 2000, 2001a. There have been few basic research studies addressing the effect of cementing technique on cement pressurization and penetration in the acetabulum (Oh and Harris 1982, Oh et al 1983, 1985, Somville et al 1987, Shelley and Wroblewski 1988. This is in part understandable since many factors, such as improved cement penetration into the cancellous bone following lavage, would be expected to apply equally in the acetabulum and proximal femur.…”

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confidence: 99%

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Acetabular cementing technique in THA—flanged versus unflanged cups, cadaver experiments

Parsch

Diehm

Schneider

et al. 2004

Acta Orthopaedica Scandinavica

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Background There are few studies on the effect of acetabular cup design on cement penetration.Material and methods We evaluated the effects of an acetabular flange on cement pressurization and cement penetration in 12 cadavers. Flanged or unflanged cups were implanted in paired human acetabula with simulated intraosseous bleeding pressure but without cement pressurization before insertion of the cup. Three pressure transducers were used to record intra-acetabular peak and average pressures during cup insertion. Following implantation, the whole specimens were APradiographed and standardized sections through the acetabula were microradiographed to evaluate cement penetration.Results Flanged cups produced greater intraacetabular peak pressures than unflanged cups, but did not increase the average intra-acetabular pressure. Cement penetration did not differ significantly between the two groups.Interpretation Our findings do not support the use of flanged cups as the sole means of cement pressurization in the acetabulum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Acetabular cementing technique in THA—flanged versus unflanged cups, cadaver experiments

Parsch

Diehm

Schneider

et al. 2004

Acta Orthopaedica Scandinavica

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“…The acetabulum was virtually reamed into a hemispherical bed, which is reported to result in a uniform cement mantle, smooth stress distribution and, consequently, a stable reconstruction [27,28]. Three 8-mm deep and 8-mm diameter anchorage holes were then modelled perpendicular to the bed of the acetabulum, one in each of the iliac, pubic and ischial regions, to simulate a good cemented surgical fixation [15].…”

Section: Geometrymentioning

confidence: 99%

Total Hip Replacement: Tensile Stress in Bone Cement is influenced by Cement Mantle Thickness, Acetabular Size, Bone Quality, and Body Mass Index

JMS¹

2014

J Comput Sci Syst Biol

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Background: High stress developed in the cement mantle of a total hip replacement is reported to contribute to premature failure of acetabular components. We postulate that stress level is influenced by cement mantle thickness, acetabular size, bone quality and body mass index. Methods:Finite element models of reconstructed hemi pelves of different sizes and acetabular diameters (46, 52 and 58 mm) were created from CT-Scan data. We investigated the effects of cement mantle thickness (1, 2, 3 and 4 mm), acetabular size, body mass index (BMI = 20, 25 and 30 kg/m 2 ) and bone quality on stress level developed in the cement mantle.Findings: Peak tensile stresses in the cement mantle increased with a decrease in cement mantle thickness, acetabular size and bone quality and an increase in BMI. Interpretation:Our results indicate that a 4-mm-thick cement mantle is required in small reconstructed acetabulae of ≤ 50-mm diameters, while a 1-mm thick cement mantle can be used on larger reconstructed acetabulae of ≥ 58-mm diameter. Patients with poor bone quality require at least a 4-mm-thick cement mantle to reduce the risk failure caused by high stress level in the cement mantle.

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“…A hemispherical cut with dimensions corresponding to the size of the acetabulum being investigated was used to remove excess bone in the acetabular region to simulate the reaming process during surgery. A hemispherical acetabular bed helps achieve an even cement mantle and a smooth stress distribution in the cement mantle and, hence, a more stable reconstruction (Oh et al 1985;Haskess 1998;Lamvohee et al 2003;Lankester et al 2004). Three anchorage holes 8mm deep and 8mm in diameter were modelled perpendicular to the surface of the acetabulum and were located one in each in the three bones of the acetabulum, the pubis, the ishium and the iliac bone, following on results from our previous study (Mootanah et al 2002).…”

Section: Geometrymentioning

confidence: 99%

Stresses in cement mantles of hip replacements: effect of femoral implant sizes, body mass index and bone quality

Lamvohee

Mootanah

Ingle

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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The effects of femoral prosthetic heads of diameters 22 and 28mm were investigated on the stability of reconstructed hemi-pelves with cement mantles of thicknesses 1-4mm and different bone qualities. Materialise medical imaging package and I-Deas finite element (FE) software were used to create accurate geometry of a hemi-pelvis from CT-scan images. Our FE results show an increase in cement mantle stresses associated with the larger femoral head. When a 22mm femoral head is used on acetabulae of diameters 56mm and above, the probability of survivorship can be increased by creating a cement mantle of at least 1mm thick. However, when a 28mm femoral head is used, a cement mantle thickness of at least 4mm is needed. Poor bone quality resulted in an average 45% increase in the tensile stresses of the cement mantles, indicating resulting poor survivorship rate.

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Total Hip Acetabular Cup Flange Design and Its Effect on Cement Fixation

Cited by 26 publications

References 0 publications

Acetabular cementing technique in THA—flanged versus unflanged cups, cadaver experiments

Acetabular cementing technique in THA—flanged versus unflanged cups, cadaver experiments

Total Hip Replacement: Tensile Stress in Bone Cement is influenced by Cement Mantle Thickness, Acetabular Size, Bone Quality, and Body Mass Index

Stresses in cement mantles of hip replacements: effect of femoral implant sizes, body mass index and bone quality

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