Factors influencing initial cup stability in total hip arthroplasty.

BACKGROUND: One of the main goals in total hip replacement is to preserve the integrity of the hip kinematics, by well positioning the cup and to make sure its initial stability is congruent and attained. Achieving the latter is not trivial. METHODS: A finite element model of the cup-bone interface simulating a realistic insertion and analysis of different scenarios of cup penetration, insertion, under-reaming and loading is investigated to determine certain measurable factors sensitivity to stress-strain outcome. The insertion force during hammering and its relation to the cup penetration during implantation is also investigated with the goal of determining the initial stability of the acetabular cup during total hip arthroplasty. The mathematical model was run in various configurations to simulate 1 and 2mm of under-reaming at various imposed insertion distances to mimic hammering and insertion of cup insertion into the pelvis. Surface contact and micromotion at the cup-bone interface were evaluated after simulated cup insertion and post-operative loading conditions. FINDINGS: The results suggest a direct correlation between under-reaming and insertion force used to insert the acetabular cup on the micromotion and fixation at the cup-bone interface. INTERPRETATION: While increased under-reaming and insertion force result in an increase amount of stability at the interface, approximately the same percentage of surface contact and micromotion reduction can be achieved with less insertion force. We need to exercise caution to determine the optimal configuration which achieves a good conformity without approaching the yield strength for bone.

Finite element analysis of resurfacing depth and obliquity on patella stress and stability in TKA.

Patella resurfacing in total knee arthroplasty (TKA) reduces postoperative complications and revisions; however, the optimal cutting depth and angle that minimize patellar strain and fracture remain unclear. We performed three-dimensional finite element analysis (FEA) of resurfacing cutting depth and obliquity to assess the stresses in each component of the knee joint, and fatigue testing to determine cyclic loading conditions over the expected life span of the implant. Maximum stress on the patella increased as cutting depth increased up to 8mm; peak stresses on the idealized button further increased at 10-mm depth. Medial superior obliquities below 3° showed the lowest stress on the patella and button and the highest fatigue life. An oblique cut of 3° with respect to the inferior end increased patellar stress and reduced fatigue life, making this the least successful approach. Taken together, our FEA supports the use of minimal cutting depths at -3° with respect to the superior end for patellar resurfacing in TKA in order to minimize stresses in the structure and improve TKA durability. Future studies will assess the effect of patella button placement to account for real-world practice variations.