title: Primary cup stability in THA with augmentation of acetabular defect. A comparison of healthy and osteoporotic bone.
abstract: BACKGROUND
  Reconstruction of acetabular defect has been advocated as standard procedure in total hip arthroplasty. The presence of bony defects at the acetabulum is viewed as a cause of instability and acetabular wall augmentation is often used without proper consideration of surrounding bone density. The initial cup-bone stability is, however, a challenge and a number of studies supported by clinical follow-ups of patients suggested that if the structural graft needs supporting more than 50% of the acetabular component, a reconstruction cage device spanning ilium to ischium should be preferred to protect the graft and provide structural stability. This study aims to (1) investigate the relationship between cup motion and bone density and (2) quantify the re-distribution of stress at the defect site after augmentation.
  
  
  OBJECTIVE
  Paprosky type I or II, acetabular defects, when reconstructed with bone screws supported by bioabsorbable calcified triglyceride bone cement are significantly less effective for osteoporotic bone than healthy bone.
  
  
  METHODS
  Acetabular wall defects were reconstructed on six cadaveric subjects with bioabsorbable calcified triglyceride bone cement using a re-bar technique. Data of the specimen with higher bone density was used to validate a Finite Element Model. Values of bone apparent density ranging from healthy to osteoporotic were simulated to evaluate (1) the cup motion, through both displacement and rotation, (2) and the von Mises stress distribution.
  
  
  RESULTS
  Defect reconstruction with bone screws and bioabsorbable calcified triglyceride bone cement results in a re-distribution of stress at the defect site. For a reduction of 65% in bone density, the cup displacement was similar to a healthy bone for loads not exceeding 300 N, as load progressed up to 1500 N, the reconstructed defect showed increase of 99 μm (128%) in displacement and of 0.08° in rotation angle.
  
  
  CONCLUSIONS
  Based on the results, we suggest that an alternative solution to wall defect augmentation with bone screws supported by bioabsorbable calcified triglyceride bone cement, be used for osteoporotic bone.
  
  
  METHODS
  Level IV, experimental and cadaveric study.
authors: Department of orthopaedics, university of Illinois at Chicago, 835, S. Wolcott avenue, 60616 Chicago, Illinois, USA. Electronic address: amirouch@uic.edu.
authors: F
authors: F
authors: Amirouche
authors: Department of orthopaedics, university of Illinois at Chicago, 835, S. Wolcott avenue, 60616 Chicago, Illinois, USA.
authors: G
authors: G
authors: Solitro
authors: Department of orthopaedics, university of Illinois at Chicago, 835, S. Wolcott avenue, 60616 Chicago, Illinois, USA.
authors: S
authors: S
authors: Broviak
authors: Department of orthopaedics, university of Illinois at Chicago, 835, S. Wolcott avenue, 60616 Chicago, Illinois, USA; Illinois bone and joint institute, 9000, Waukegan road, 60053 Morton Grove, Illinois, USA.
authors: W
authors: W
authors: Goldstein
authors: Department of orthopaedics, university of Illinois at Chicago, 835, S. Wolcott avenue, 60616 Chicago, Illinois, USA.
authors: M
authors: M
authors: Gonzalez
authors: Department of orthopaedics, university of Illinois at Chicago, 835, S. Wolcott avenue, 60616 Chicago, Illinois, USA.
authors: R
authors: R
authors: Barmada
mesh_terms: D000077:Acetabulum / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D015519:Bone Density; D001863:Bone Screws; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000150:complications / Q000601:surgery*; D010024:Osteoporosis / Q000150:complications*; D012086:Reoperation
chemical_list: D001843:Bone Cements
keywords: Arthroplasty; Bone cements; Hip prosthesis; Osteoporosis; Replacement