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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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Autores principales: Gaillard-Campbell, Dani M., Gross, Thomas P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637712/
https://www.ncbi.nlm.nih.gov/pubmed/31355007
http://dx.doi.org/10.1155/2019/9315104
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author Gaillard-Campbell, Dani M.
Gross, Thomas P.
author_facet Gaillard-Campbell, Dani M.
Gross, Thomas P.
author_sort Gaillard-Campbell, Dani M.
collection PubMed
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.
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spelling pubmed-66377122019-07-28 Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method Gaillard-Campbell, Dani M. Gross, Thomas P. Adv Orthop Research Article 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. Hindawi 2019-07-04 /pmc/articles/PMC6637712/ /pubmed/31355007 http://dx.doi.org/10.1155/2019/9315104 Text en Copyright © 2019 Dani M. Gaillard-Campbell and Thomas P. Gross. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Gaillard-Campbell, Dani M.
Gross, Thomas P.
Optimizing Acetabular Component Bone Ingrowth: The Wedge-Fit Bone Preparation Method
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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637712/
https://www.ncbi.nlm.nih.gov/pubmed/31355007
http://dx.doi.org/10.1155/2019/9315104
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