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Factors Affecting Modular Acetabular Ceramic Liner Insertion: A Biomechanical Analysis

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Ceramic liner fracture is a concern in THA. However, it is unclear what factors influence the risk of facture. To study these factors under controlled conditions, we created a laboratory model to avoid fractures in vitro.

Questions/purposes

We determined (1) whether misaligned liner insertion, acetabular shell deformation, entrapment of soft tissue within the locking taper area, and damage to the taper during engagement of the ceramic liner on the locking taper influenced fracture at light and medium impaction forces; and (2) whether the number and force of impactions affect the locking taper force between the ceramic liner and acetabular shell and fracture of the ceramic liner.

Methods

Impaction and pushout tests were performed with each of five ceramic inserts in titanium shells per test to simulate clinical intraoperative situations of misaligned inserts (Test 1), deformed shells (Test 2), soft tissue within the locking taper area (Test 3), simulated cup taper damage (Test 4), and a combination of misaligned insert, deformed shells, and simulated taper damage to create an overall worst-case condition (Test 5).

Results

Higher pushout forces occurred with increased impact force and an increased number of strikes. Insert fractures only occurred where inserts were misaligned in the shell. No fractures occurred with deformed shells, soft tissue in the taper, or with simulated taper damage in the absence of misaligned inserts.

Conclusion

The data suggest a misaligned ceramic insert in an acetabular increases the potential for insert fracture. Shell deformation, soft tissue in the taper, or simulated taper damage seemed well tolerated even with very forceful impaction. Forceful and repetitive impaction is favorable for engagement of the taper and improving pullout strength.

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Authors and Affiliations

  1. London Health Sciences Centre, University Hospital, B9 006, 339 Windermere Road, London, ON, N6A 5A5, Canada

    James P. McAuley MD

  2. Colorado Joint Replacement, Denver, CO, USA

    Douglas A. Dennis MD

  3. DePuy Orthopaedics, Inc, Warsaw, IN, USA

    Justin Grostefon

  4. Anderson Orthopaedic Clinic, Alexandria, VA, USA

    William G. Hamilton MD

Authors
  1. James P. McAuley MD
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  2. Douglas A. Dennis MD
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  3. Justin Grostefon
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  4. William G. Hamilton MD
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Corresponding author

Correspondence to James P. McAuley MD.

Additional information

One or more of the authors (JPM, DAD, WGH) are consultants for DePuy (Warsaw, IN, USA) and have a product development agreement with DePuy. One of the authors (JG) is an employee of DePuy Orthopaedics, who funded the material expenses for the study.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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McAuley, J.P., Dennis, D.A., Grostefon, J. et al. Factors Affecting Modular Acetabular Ceramic Liner Insertion: A Biomechanical Analysis. Clin Orthop Relat Res 470, 402–409 (2012). https://doi.org/10.1007/s11999-011-2193-3

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  • DOI: https://doi.org/10.1007/s11999-011-2193-3

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