Does total hip arthroplasty with high hip centre in dysplasia compromise acetabular bone stock?

Background: The placement of uncemented acetabular components during total hip arthroplasty (THA) in Crowe II and Crowe III dysplasia can be at the anatomic or high hip centre position. Purposes: Using computerised tomography data, we simulated acetabular cup placement at the anatomic hip centre and the high hip centre positions to assess whether there is a difference between the 2 in terms of bone loss from acetabular reaming and in acetabular coverage by host bone. Methods: The study population included a consecutive cohort of 19 patients (22 hips) with Crowe II or III dysplasia. 3-dimensional models of the pelvis were created for each patient and digital templating was used to determine the anatomic and high hip centre positions. The coordinates of the digitally templated cup positions were fed into an image processing software to estimate the amount of bone reamed, the cup coverage by host bone and the elevation from tear drop. Results: The mean volume of bone reamed was greater in the high hip centre position as compared to the anatomic position (27.3 ± 11. 4 cm3 vs. 19.4 ± 12.2 cm3, p < 0.0001). The coverage of the acetabular cup by host bone was greater in the high hip centre position (87.3 ± 5.9% vs. 68.3 ± 10%). The mean elevation in the high hip centre group was 13 mm with 3 hips having a breach of the medial wall. Conclusions: In Crowe II and III dysplasia, placement of acetabular cups at the anatomic hip centre better preserves bone stock as compared to high hip centre placement and should be preferred in young patients requiring THA.

Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) as Desired Polymer Material for Biomedical

It is very important that any materials used as implant material work in harmony with the body. There will be drawback with every material. No matter how good, as nothing can be 100% identical as the natural human tissue. The body operates in an environment at a constant temperature of 37°C and pH of 7.25, so choice of materials will have to withstand these conditions. Incorrect use of material can cause rejection by the body, infection and even cancer, leading to more pain and discomfort by the patient. In turn the possibility of even further damage to the joint. The implant must work in the same way as the body part it is replacing- clear understanding of how the joint works is needed. Ultrahigh molecular weight polyethylene is considered as the standard material for Artificial joints to decrease the total weight and the wear rate to make it more flexible. This is what makes Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) such an appropriate polymer. It is very widely used in total hip and knee joint replacements having the highest known impact strength of any thermoplastic presently made, can highly withstand abrasion, and has a very low coefficient of friction. Therefore, these properties, connected with extremely low moisture absorption, make UHMWPE especial material for the medical industry due to good industrial impact and wear resistance sliding applications. For moving joints, the friction would be damaging without the natural lubrication. In implant components this does not exist, however UHMWPE is self-lubricating, making it ideal for component such as an acetabular cup, which would wrap around a metallic femoral head in a hip joint. Also, UHMWPE has high impact strength, high toughness, and low elastic modulus, but it has disadvantages such as low tensile, transverse and compressive strengths with high creep rate. This review article deals with the history of UHMWPE, its material properties that make it an ideal candidate for total joints, implant-component fabrication procedures and provides insights as to why some of the implants eventually fail.

Modeling of the Influence of Input AM Parameters on Dimensional Error and Form Errors in PLA Parts Printed with FFF Technology

As is widely known, additive manufacturing (AM) allows very complex parts to be manufactured with porous structures at a relatively low cost and in relatively low manufacturing times. However, it is necessary to determine in a precise way the input values that allow better results to be obtained in terms of microgeometry, form errors, and dimensional error. In an earlier work, the influence of the process parameters on surface roughness obtained in fused filament fabrication (FFF) processes was analyzed. This present study focuses on form errors as well as on dimensional error of hemispherical cups, with a similar shape to that of the acetabular cup of hip prostheses. The specimens were 3D printed in polylactic acid (PLA). Process variables are nozzle diameter, temperature, layer height, print speed, and extrusion multiplier. Their influence on roundness, concentricity, and dimensional error is considered. To do this, adaptive neuro-fuzzy inference systems (ANFIS) models were used. It was observed that dimensional error, roundness, and concentricity depend mainly on the nozzle diameter and on layer height. Moreover, high nozzle diameter of 0.6 mm and high layer height of 0.3 mm are not recommended. A desirability function was employed along with the ANFIS models in order to determine the optimal manufacturing conditions. The main aim of the multi-objective optimization study was to minimize average surface roughness (Ra) and roundness, while dimensional error was kept within the interval Dimensional Error≤0.01. When the simultaneous optimization of both the internal and the external surface of the parts is performed, it is recommended that a nozzle diameter of 0.4 mm be used, to have a temperature of 197 °C, a layer height of 0.1 mm, a print speed of 42 mm/s, and extrusion multiplier of 94.8%. This study will help to determine the influence of the process parameters on the quality of the manufactured parts.

Dynamic contact stress and frictional heat analysis of femoral head-on-acetabular cup interface based on calculation and simulation methods

Purpose The purpose of this paper is to systematically study the dynamic contact stress, frictional heat and temperature field of femoral head-on-acetabular cup contact pairs in a gait cycle. Design/methodology/approach In this paper, four common femoral head-on-acetabular cup contact pairs are used as the research objects, mathematical calculations and finite element simulations are adopted. The contact model of hip joint head and acetabular cup was established by finite element simulation to analyze the stress and temperature distribution of the contact interface. Findings The results show that the contact stress of the head-on-cup interface is inversely proportional to the contact area; high contact stress directly leads to greater frictional heat. However, hip joints with metal-on-polyethylene or ceramic-on-polyethylene paired interfaces have lower frictional heat and show a significant temperature rise in one gait cycle, which may be related to the material properties of the acetabular cup. Originality/value Previous studies about calculating the interface frictional heat always ignore the dynamic change process in the contact load and the contact area. This study considered the dynamic changes of the contact stress and area of the femoral head-on-acetabular cup interface, and four common contact pairs were systematically analyzed.

Use of a New Off-the-shelf 3D-printed Trabecular Titanium Acetabular Cup in Chinese Patients Undergoing Hip Revision Surgery: Short- to Mid-term Clinical and Radiological Outcomes

Background: Revision total hip arthroplasty (THA) has been a challenge for surgeons. The purpose of this study was to explore the short-to mid-term clinical and radiological outcomes of Chinese patients who underwent revision THA using a new off-the-shelf three-dimensional (3D)-printed trabecular titanium (TT) acetabular cup by comparison with a conventional porous coated titanium acetabular cup, to provide a reference for the recommendation of this prostheses.Methods: A retrospective analysis of 57 patients (57 hips) who received revision THA was performed from January 2016 to June 2019. A total of 23 patients received 3D-printed cups (observation group) and 34 patients received non-3D-printed cups (control group). Clinical scores including Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Short Form 36 (SF-36), upward movement of the hip center of rotation（HCOR）and limb-length discrepancy (LLD), stabilization and bone ingrowth of cups were compared between two groups. The multivariate linear regression was used to determine the factors potentially influencing the HHS score. Postoperative complications in the two groups were also recorded. Results: All 57 patients were routinely followed up. The average follow-up durations in the control and observation groups were 43.57 ± 13.68 (24–65) months and 41.82 ± 11.44 (24–64) months, respectively (p = 0.618). The postoperative clinical scores significantly improved in both groups compared to the preoperative scores (p < 0.05). The VAS score did not significantly differ between the groups at 3 or 12 months postoperatively, or at the last follow-up (p > 0.05). The HHS and SF-36 scores did not significantly differ between the groups at 3 months postoperatively (p > 0.05) but differed at 12 months postoperatively and the last follow-up (p < 0.05). Compared with the control group, the postoperative recovery of HCOR and LLD was better in the observation group (p < 0.05). All cups remained stable, with no loosening throughout the follow-up period. But the observation group had a significantly better rate of bone ingrowth compared to the control group (p = 0.037). Multivariate linear regression analysis showed that different cup types, upward movement of the HCOR, and LLD influenced the HHS score at the last follow-up (p < 0.05). None of the patients exhibited severe postoperative complications.Conclusion: The new off-the-shelf 3D-printed TT acetabular cup demonstrated encouraging short-to mid-term clinical outcomes in Chinese patients. It can effectively relieve pain, improve hip function, provide satisfactory biological fixation and high survival rate. But further follow up is necessary to assess its long-term outcomes.

The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips

Background Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is a complex procedure due to associated anatomical abnormalities. We studied the extent to which preoperative digital templating is reliable when performing cementless THA in patients with DDH. Methods We templated and compared the pre- and postoperative sizes of the acetabular and femoral components and the center of rotation (COR), and analysed the postoperative cup coverage, leg length discrepancy (LLD), and stem alignment in 50 patients (56 hips) with DDH treated with THA. Results The implant size exactly matched the template size in 42.9% of cases for the acetabular component and in 38.2% of cases for the femoral component, whereas the templated ±1 size was used in 80.4 and 81.8% of cases for the acetabular and femoral components, respectively. There were no statistically significant differences between templated and used component sizes among different DDH severity levels (acetabular cup: p = 0.30 under the Crowe classification and p = 0.94 under the Hartofilakidis classification; femoral stem: p = 0.98 and p = 0.74, respectively). There were no statistically significant differences between the planned and postoperative COR (p = 0.14 horizontally and p = 0.52 vertically). The median postoperative LLD was 7 (range 0–37) mm. Conclusion Digital preoperative templating is reliable in the planning of cementless THA in patients with DDH.