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A pilot trial comparing the tear-out behavior in screw-sockets and cemented polyethylene acetabular components – a cadaveric study - 20/09/16

Doi : 10.1016/j.otsr.2016.06.007 
R. Möbius a, 1, S. Schleifenbaum b, 1, R. Grunert b, c, S. Löffler a, M. Werner c, T. Prietzel b, 2, N. Hammer d, , 2
a Institute of anatomy, faculty of medicine, university of Leipzig, 13, Liebigstraße, 04103 Leipzig, Germany 
b Department of orthopedics, trauma surgery and plastic surgery, university hospital of Leipzig, 20, Liebigstraße, 04103 Leipzig, Germany 
c Fraunhofer institute for machine tools and forming technology, 44, Nöthnitzer Straße, 01187 Dresden, Germany 
d Department of anatomy, university of Otago, Lindo Ferguson Building, 270, Great King St, 9016 Dunedin, New Zealand 

Corresponding author. Tel.: +64 3 479 7362; fax: +64 3 479 7254.

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Abstract

Background

The removal of well-fixed acetabular components following THA (total hip arthroplasty) is a difficult operation and could be accompanied by the loss of acetabular bone stock. The optimal method for fixation is still under debate. The aim of this pilot study was to compare the tear-out resistance and failure behavior between osseo-integrated and non-integrated screw cups. Furthermore, we examined whether there are differences in the properties mentioned between screw sockets and cemented polyethylene cups.

Hypothesis

Tear-out resistance and related mechanical work required for the tear-out of osseo-integrated screw sockets are higher than in non-integrated screw sockets.

Patients and methods

Ten human coxal bones from six cadavers with osseo-integrated screw sockets (n=4), non-integrated (implanted post-mortem, n=3) screw sockets and cemented polyethylene cups (n=3) were used for tear-out testing. The parameters axial failure load and mechanical work for tear-out were introduced as measures for determining the stability of acetabular components following THA.

Results

The osseo-integrated screw sockets yielded slightly higher tear-out resistance (1.61±0.26kN) and related mechanical work compared to the non-integrated screw sockets (1.23±0.39kN, P=0.4). The cemented polyethylene cups yielded the lowest tear-out resistance with a failure load of 1.18±0.24kN. Compared to the screw cups implanted while alive, they also differ on a non-significant level (P=0.1). Osseous failure patterns differed especially for the screw sockets compared to the cemented polyethylene cups.

Discussion

Osseo-integration did not greatly influence the tear-out stability in cementless screw sockets following axial loading. Furthermore, the strength of the bone-implant-interface of cementless screw sockets appears to be similar to cemented polyethylene cups. However, given the high failure load, high mechanical load and because of the related bone failure patterns, removal should not be performed by means of tear-out but rather by osteotomes or other curved cutting devices to preserve the acetabular bone stock.

Level of evidence

Level III, case-control-study.

Le texte complet de cet article est disponible en PDF.

Keywords : THA, Acetabular component, Acetabular revision, Screw socket, Osseo-integration, Cementless fixation


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Vol 102 - N° 6

P. 723-728 - octobre 2016 Retour au numéro
Article précédent Article précédent
  • Comparison of wear rate and osteolysis between annealed and remelted highly cross-linked polyethylene in total hip arthroplasty. A case control study at 7 to 10 years follow-up
  • R. Takada, T. Jinno, D. Koga, M. Hirao, T. Muneta, A. Okawa
| Article suivant Article suivant
  • Short-term comparison of postural effects of three minimally invasive hip approaches in primary total hip arthroplasty: Direct anterior, posterolateral and Röttinger
  • S. Van Driessche, F. Billuart, L. Martinez, H. Brunel, P. Guiffault, J. Beldame, J. Matsoukis

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