Stabilité primaire de la cupule acétabulaire dans les prothèses totales de hanche sur perte de substance cotyloïdienne. Une étude comparative sur os normal et os porotique

Abstract

Background contextReconstruction 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. HyphotesisPaprosky 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. Materials and methodsAcetabular 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. ResultsDefect 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 300N, as load progressed up to 1500N, the reconstructed defect showed increase of 99μm (128%) in displacement and of 0.08° in rotation angle. ConclusionsBased 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. Level of evidenceLevel IV, experimental and cadaveric study.