Assessment of Head Displacement and Disassembly Force With Increasing Assembly Load at the Head/Trunnion Junction of a Total Hip Arthroplasty Prosthesis.

BACKGROUND: Most femoral components used now for total hip arthroplasty are modular, requiring a strong connection at assembly. The aim of this study was to assess the effect of assembly force on the strength of head-trunnion interface and to measure the initial displacement of the head on the trunnion with different assembly forces. METHODS: Three assembly load levels were assessed (A: 2 kN, B: 4 kN, C: 6 kN) with 4 implants in each group. The stems were mounted in a custom rig and the respective assembly loads were applied to the head at a constant rate of 0.05 kN/s (ISO7260-10:2003). Load levels were recorded during assembly. Head displacement was measured with a laser sensor. The disassembly force was determined by a standard pull-off test. RESULTS: The maximum head displacement on the trunnion was significantly different between the 2 kN group and the other 2 groups (4 kN, 6 kN, P = .029), but not between the 4 kN and 6 kN groups (P = .89). The disassembly forces between the 3 groups were significantly different (mean ± standard deviation, A: 1316 ± 223 kN; B: 2224 ± 151 kN; C: 3965 ± 344 kN; P = .007), with increasing assembly load leading to a higher pull-off force. For the 4 kN and 6 kN groups, a first peak of approximately 2.5 kN was observed on the load recordings during assembly before the required assembly load was eventually reached corresponding to sudden increase in head displacement to approximately 150 µm. CONCLUSION: An assembly force of 2 kN may be too low to overcome the frictional forces needed to engage the head and achieve maximum displacement on the trunnion and thus an assembly load of greater than 2.5 kN is recommended.

The effect of dynamic hip motion on the micromotion of press-fit acetabular cups in six degrees of freedom.

The hip joint is subjected to cyclic loading and motion during activities of daily living and this can induce micromotions at the bone-implant interface of cementless total hip replacements. Initial stability has been identified as a crucial factor to achieve osseointegration and long-term survival. Whilst fixation of femoral stems achieves good clinical results, the fixation of acetabular components remains a challenge. In vitro methods assessing cup stability keep the hip joint in a fixed position, overlooking the effect of hip motion. The effect of hip motion on cup micromotion using a hip motion simulator replicating hip flexion-extension and a six degrees of freedom measurement system was investigated. The results show an increase in cup micromotion under dynamic hip motion compared to Static Flexion. This highlights the need to incorporate hip motion and measure all degrees of freedom when assessing cup micromotion. In addition, comparison of two press-fit acetabular cups with different surface coatings suggested similar stability between the two cups. This new method provides a basis for a more representative protocol for future pre-clinical evaluation of different cup designs.

A novel method to assess primary stability of press-fit acetabular cups.

Initial stability is an essential prerequisite to achieve osseointegration of press-fit acetabular cups in total hip replacements. Most in vitro methods that assess cup stability do not reproduce physiological loading conditions and use simplified acetabular models with a spherical cavity. The aim of this study was to investigate the effect of bone density and acetabular geometry on cup stability using a novel method for measuring acetabular cup micromotion. A press-fit cup was inserted into Sawbones(®) foam blocks having different densities to simulate normal and osteoporotic bone variations and different acetabular geometries. The stability of the cup was assessed in two ways: (a) measurement of micromotion of the cup in 6 degrees of freedom under physiological loading and (b) uniaxial push-out tests. The results indicate that changes in bone substrate density and acetabular geometry affect the stability of press-fit acetabular cups. They also suggest that cups implanted into weaker, for example, osteoporotic, bone are subjected to higher levels of micromotion and are therefore more prone to loosening. The decrease in stability of the cup in the physiological model suggests that using simplified spherical cavities to model the acetabulum over-estimates the initial stability of press-fit cups. This novel testing method should provide the basis for a more representative protocol for future pre-clinical evaluation of new acetabular cup designs.