THR: Cemented Acetabular Component

---

 
- See: Total Hip Replacement Menu:
           - cementless components:
           - cement technique
           - acetabular component revision:
           - operative considerations for hip dyplasia
           - protrusio

- Discussion:
    - technical considerations:
    - in the report by BM Crites et al (CORR 2000), the effect of porosity reduction
           cementing techniques with respect to radiolucent lines in Zone 1 and failure in acetabular components was studied
           in 2237 consecutive cemented acetabular components done between 1970 and 1998.
           - porosity reduction techniques did not reduce the incidence of Zone 1 radiolucencies;
           - factors that were considered essential included:
                  - reaming through the subchondral bone to achieve a good cancellous bone bed;
                  - perforation and removal of peripheral sclerotic areas;
                  - dry cancellous bone bed
                  - pressurization of the entire cement mantle in the socket at one time;
                  - complete burying of the acetabular component within the boundary of the bony acetabulum;
           - ref: Technical Considerations of Cemented Acetabular Components A 30-Year Eval  BM. Crites COOR 2000 December;2000(381):114-119
    - special situations:
           - cement resurfacing for fracture: 
                   - Secondary total hip replacement after fractures of the femoral neck.
                   - Bone impaction grafting and a cemented cup after acetabular fracture at 3-18 years.
                   - The chronic central fracture dislocation of the hip
           - impaction bone grafting: (bone grafting for THR)
                   - Reconstruction of acetabular defect with wire mesh and impacted bonegraft in cemented acetabular revision
                   - Acetabular Reconstruction with Impaction Bone-Grafting and a Cemented Cup in Patients Younger Than Fifty Years Old.
                   - Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with RA: 3-14-year follow-up.
                   - Acetabular revision with morsellised allogenic bone graft and a cemented metal-backed component.
                   - Acetabular reconstruction with impacted bone allografts and cemented acetabular components: a 2-13-yr f/u of 142 aseptic revisions.
                   - Acetabular reconstruction w/ impacted morsellised cancellous bone graft and cement. A 10-15-yr f/u of 60 revision arthroplasties.
                   - Particle size of bone graft and method of impaction affect initial stability of cemented cups: human cadaveric and synthetic pelvic specimen studies.
                   - Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup. A 15- to 20-year follow-up.
                   - Reconstruction of the Acetabulum with Structured Bone Graft in Press-Fit Technique.  

---

- Technique:
           - acetabular exposure, estabilishment of acetabular floor, and reaming are carried out in the usual manner;
                   - need to ream through the subchondral bone to achieve a good cancellous bone bed;
                   - perforation and removal of peripheral sclerotic areas;
                   - references:
                           - Is removal of subchondral bone plate advantageous in cemented cup fixation? A randomized RSA study
             - drill holes:
                   - multiple (five to eight) 5-mm-diameter countersink holes were placed throughout the acetabulum;
                           - Fixation of the acetabular cup in cemented THR: improving the anchorage hole profile using finite element method.
                           - Optimizing the configuration of cement keyholes for acetabular fixation in THR using Taguchi experimental design.
                           - Configuration of anchorage holes affects cemented fixation of the acetabular component in THR - An in vitro study.
           - bone grafting for acetabular defects;
                   - cancellous bone chips with a diameter of 0.7 to 1.0 cm were created
                   - segmental defects in the medial wall or peripheral defects of the acetabulum are closed with a slice of corticocancellous bone or with metal mesh;
                   - a trial acetabular prosthesis (w/ mallet) are impacted against the bone grafts.
                   - need to restore the original center of rotation of the hip, (use transverse ligament as a reference);
                   - consider directly cementing the graft at the reconstruction site;
                   - references:
                           - Particle size of bone graft and method of impaction affect initial stability of cemented cups: human cadaveric and synthetic pelvic specimen studies.
           - cement technique:
                   - achieve a dry cancellous bone bed (hypotensive anesthesia);
                   - pressurization of the entire cement mantle in the socket at one time;
                           - Acetabular cement compactor. An experimental study of pressurization of cement in the acetabulum in THA
                           - In Vitro Pressurization of the Acetabular Cement Mantle.  The Effect of a Flange
                           - Migration of the acetabular component: effect of cement pressurization and significance of early radiolucency: a randomized 5-year study using radiostereometry.

---

    - complications:
         - note that exothermic reaction (and ensuing heat) that occurs during cement hardening may injure soft tissue structures opposite of acetabulum (especially
                  when the acetabulum is thin);
         - component loosening:
                  - patients may or may not show symptoms from cemented cup loosening;
                  - radiographic demarcation of the bone cement interface on immediate postoperative x-rays is a strong risk factor for early component loosening;
                       - as noted by Garcia-Cimbrello et al 1997, 13 of 18 cups with a complete radiolucent line on initial radiographs migrated;
                - as noted by Kavanaugh and Fitzgerald 1987, 70% of cemented acetabular revisions developed progressive radiolucencies;  
                       - these authors noted a 10% failure rate at 2 years;
                - references:  
                       - The mechanism of loosening of cemented acetabular components in total hip arthroplasty. Analysis of specimens retrieved at autopsy.
                       - Progression of radiolucent lines adjacent to acetabular component and factors influencing migration after Charnley low friction THA.
                                  E Garcia-Cimbrelo MD et al.  JBJS Vol 79-A. No 9. Sep 1997. p 1373.
                       - Failure of the Mecring screw-ring acetabular component in total hip arthroplasty. A three to seven-year follow-up study.
                       - Loosening of the cemented hip prosthesis. The importance of heat injury.
                       - Early migration of acetabular components revised with cement. A roentgen stereophotogrammetric study.


                 

---

Current status of acetabular fixation in primary total hip arthroplasty.

The role of cemented sockets in 2004: is there one?

Fixation of the acetabular component. The case for cement

Primary total hip arthroplasty with a flanged, cemented all-polyethylene acetabular component: evaluation at a minimum of 20 years.

Cemented cup revisions.

Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years' experience.

Total Hip Arthroplasty with Cement and Use of a Collared Matte-Finish Femoral Component

Multiple revision for failed total hip arthroplasty not associated with infection. Kavanaugh, BK and Ritzgerald, RH.  JBJS. Vol 69-A. 1987. p 1144-1149.