Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method
We investigate the efficacy of a modified acetabular bone-preparation technique in reducing the incidence of two clinical problems identified in hip resurfacing arthroplasty. The first issue is failure due to lack of bone ingrowth into the acetabular component. The second is a newly recognized pheno...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Advances in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2019/9315104 |
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| author | Dani M. Gaillard-Campbell Thomas P. Gross |
| author_facet | Dani M. Gaillard-Campbell Thomas P. Gross |
| author_sort | Dani M. Gaillard-Campbell |
| collection | DOAJ |
| description | We investigate the efficacy of a modified acetabular bone-preparation technique in reducing the incidence of two clinical problems identified in hip resurfacing arthroplasty. The first issue is failure due to lack of bone ingrowth into the acetabular component. The second is a newly recognized phenomenon of early cup shift. We hypothesize that these issues might be resolved by using a “wedge-fit method”, in which the component wedges into the peripheral acetabular bone rather than bottoming out and potentially toggling on the apex of the cup. Prior to November 2011, all acetabula were reamed 1 mm under and prepared with a press-fit of the porous coated acetabular component. After November 2011, we adjusted reaming by bone density. In “soft bone” (T-score <-1.0), we underreamed acetabula by 1 mm less than the outer diameter of the cup, as was previously done in all cases. For T-scores greater than -1.0, we reamed line-to-line. Additionally, we began performing an “apex relief” starting June 2012 in all cases by removing 2 mm of apex bone with a small reamer after using the largest reamer. Failure of acetabular ingrowth occurred in 0.5% of cases before the wedge-fit method and <0.1% after. Rate of cup shift was reduced from 1.1% to 0.4%. The rate of unexplained pain between 2 and 4 years postoperatively also declined significantly from 2.6% to 1.3%. Our evidence suggests that wedge-fit acetabular preparation improves initial implant stability, leading to fewer cases of early cup shift, unexplained pain, and acetabular ingrowth failure. |
| format | Article |
| id | doaj-art-fa4de36ea44a4c57b722c96f8922377b |
| institution | Kabale University |
| issn | 2090-3464 2090-3472 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Orthopedics |
| spelling | doaj-art-fa4de36ea44a4c57b722c96f8922377b2025-02-03T06:11:22ZengWileyAdvances in Orthopedics2090-34642090-34722019-01-01201910.1155/2019/93151049315104Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation MethodDani M. Gaillard-Campbell0Thomas P. Gross1Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC 29201, USAMidlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC 29201, USAWe investigate the efficacy of a modified acetabular bone-preparation technique in reducing the incidence of two clinical problems identified in hip resurfacing arthroplasty. The first issue is failure due to lack of bone ingrowth into the acetabular component. The second is a newly recognized phenomenon of early cup shift. We hypothesize that these issues might be resolved by using a “wedge-fit method”, in which the component wedges into the peripheral acetabular bone rather than bottoming out and potentially toggling on the apex of the cup. Prior to November 2011, all acetabula were reamed 1 mm under and prepared with a press-fit of the porous coated acetabular component. After November 2011, we adjusted reaming by bone density. In “soft bone” (T-score <-1.0), we underreamed acetabula by 1 mm less than the outer diameter of the cup, as was previously done in all cases. For T-scores greater than -1.0, we reamed line-to-line. Additionally, we began performing an “apex relief” starting June 2012 in all cases by removing 2 mm of apex bone with a small reamer after using the largest reamer. Failure of acetabular ingrowth occurred in 0.5% of cases before the wedge-fit method and <0.1% after. Rate of cup shift was reduced from 1.1% to 0.4%. The rate of unexplained pain between 2 and 4 years postoperatively also declined significantly from 2.6% to 1.3%. Our evidence suggests that wedge-fit acetabular preparation improves initial implant stability, leading to fewer cases of early cup shift, unexplained pain, and acetabular ingrowth failure.http://dx.doi.org/10.1155/2019/9315104 |
| spellingShingle | Dani M. Gaillard-Campbell Thomas P. Gross Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method Advances in Orthopedics |
| title | Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method |
| title_full | Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method |
| title_fullStr | Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method |
| title_full_unstemmed | Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method |
| title_short | Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method |
| title_sort | optimizing acetabular component bone ingrowth the wedge fit bone preparation method |
| url | http://dx.doi.org/10.1155/2019/9315104 |
| work_keys_str_mv | AT danimgaillardcampbell optimizingacetabularcomponentboneingrowththewedgefitbonepreparationmethod AT thomaspgross optimizingacetabularcomponentboneingrowththewedgefitbonepreparationmethod |