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      Titanium Acetabular Component Deformation under Cyclic Loading

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          Abstract

          Acetabular cup deformation may affect liner/cup congruency, clearance and/or osseointegration. It is unclear, whether deformation of the acetabular components occurs during load and to what extent. To evaluate this, revision multi-hole cups were implanted into six cadaver hemipelvises in two scenarios: without acetabular defect (ND); with a large acetabular defect (LD) that was treated with an augment. In the LD scenario, the cup and augment were attached to the bone and each other with screws. Subsequently, the implanted hemipelvises were loaded under a physiologic partial-weight-bearing modality. The deformation of the acetabular components was determined using a best-fit algorithm. The statistical evaluation involved repeated-measures ANOVA. The mean elastic distension of the ND cup was 292.9 µm (SD 12.2 µm); in the LD scenario, 43.7 µm (SD 11.2 µm); the mean maximal augment distension was 79.6 µm (SD 21.6 µm). A significant difference between the maximal distension of the cups in both scenarios was noted (F(1, 10) = 11.404; p = 0.007). No significant difference was noted between the compression of the ND and LD cups, nor between LD cups and LD augments. The LD cup displayed significantly lower elastic distension than the ND cup, most likely due to increased stiffness from the affixed augment and screw fixation.

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          Most cited references41

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          Hip joint loading during walking and running, measured in two patients.

          The resultant hip joint force, its orientation and the moments were measured in two patients during walking and running using telemetering total hip prostheses. One patient underwent bilateral joint replacement and a second patient, additionally suffering from a neuropathic disease and atactic gait patterns, received one instrumented hip implant. The joint loading was observed over the first 30 and 18 months, respectively, following implantation. In the first patient the median peak forces increased with the walking speed from about 280% of the patient's body weight (BW) at 1 km h-1 to approximately 480% BW at 5 km h-1. Jogging and very fast walking both raised the forces to about 550% BW; stumbling on one occasion caused magnitudes of 720% BW. In the second patient median forces at 3 km h-1 were about 410% BW and a force of 870% BW was observed during stumbling. During all types of activities, the direction of the peak force in the frontal plane changed only slightly when the force magnitude was high. Perpendicular to the long femoral axis, the peak force acted predominantly from medial to lateral. The component from ventral to dorsal increased at higher force magnitudes. In one hip in the first patient and in the second patient the direction of large forces approximated the average anteversion of the natural femur. The torsional moments around the stem of the implant were 40.3 N m in the first patient and 24 N m in the second.
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            Observations on the effect of movement on bone ingrowth into porous-surfaced implants.

            Although porous-surfaced orthopedic implants have been designed for fixation by bone ingrowth, there is clinical evidence that this does not always occur. Initial implant movement relative to host bone can result in attachment by a nonmineralized fibrous connective tissue layer. The ranges of movement that result in either bone or fibrous connective tissue fixation are observed in dogs in two independent studies. Experimentally, bone ingrowth can occur in the presence of some movement, albeit very small (up to 28 mu), while excess movement (150 mu or more) can result in attachment by mature connective tissue ingrowth.
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              Total hip arthroplasties: what are the reasons for revision?

              Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total hip arthroplasty failure can direct efforts aimed at reducing revision rates. This study was conducted to evaluate the indications for revision hip arthroplasty and relate these to the time after the index primary hip arthroplasty. A review of all revision hip arthroplasties at two centres over a 6-year time period identified 225 patients who underwent 237 revisions. The overall mean time to revision was 83 months (range: 0-360 months). The cause of failure was aseptic loosening in 123 hips (51.9%), instability in 40 hips (16.9%) and infection in 37 hips (5.5%). When stratified into two groups (less than 5 years, more than 5 years after the index primary hip arthroplasty), 118 of 237 (50%) revisions occurred in less than 5 years, with 33% due to instability and 24% resulting from infection. The majority of the causes of failure within 5 years in these early revisions were instability and deep infection. The success of hip arthroplasty is likely to be compromized if technical aspects of the surgery for appropriate component positioning and critical protocols to minimise complications such as infection are not given the proper attention.
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                Author and article information

                Journal
                Materials (Basel)
                Materials (Basel)
                materials
                Materials
                MDPI
                1996-1944
                20 December 2019
                January 2020
                : 13
                : 1
                : 52
                Affiliations
                [1 ]Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany
                [2 ]Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
                [3 ]National Joint Center, ATOS Clinics, 69115 Heidelberg, Germany; rudi.bitsch@ 123456atos.de
                [4 ]Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; Therese.Bormann@ 123456med.uni-heidelberg.de (T.B.); Steffen.Braun@ 123456med.uni-heidelberg.de (S.B.); Sebastian.Jaeger@ 123456med.uni-heidelberg.de (S.J.)
                Author notes
                Article
                materials-13-00052
                10.3390/ma13010052
                6981461
                31861893
                03350ac0-a531-4a35-8f95-2ecb187fe14f
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 November 2019
                : 17 December 2019
                Categories
                Article

                total hip arthroplasty,implant deformation,acetabulum

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