Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups
Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups
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DOI：
10.1002/jor.24418
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发表时间：
2019-08-02
影响因子：
2.8
通讯作者：
Jeffers, Jonathan R. T.
中科院分区：
文献类型：
--
作者：
Doyle, Ruben;van Arkel, Richard J.;Jeffers, Jonathan R. T.
通过打入固定非骨水泥型髋臼杯是一种平衡行为;必须获得良好的髋臼杯固定，以确保充分的骨长入和髋臼杯贴壁，同时必须避免髋臼骨折。良好的打入技术是髋关节置换术成功的关键。然而，在文献中几乎没有指导，以告知外科医生“如何努力”打击。使用跌落装置和合成骨模型来改变低密度和高密度合成骨中的撞击撞击能量，同时测量关键参数，如动态应变（量化骨折风险）、植入物固定和极间隙。对于低密度合成骨中的高能量撞击（15 J），在撞击期间观察到的峰值拉伸应变高达撞击后应变的3.4倍，表明骨折风险较高。随着能量的增加，观察到推出固定的回报率逐渐减少。使用7.5 J撞击能量实现了使用15 J撞击实现的推出固定的85%。同样，在高撞击能量下，极隙仅最小程度地减小。因此，建议较高能量的击打会增加骨折风险，但不会对固定或植入物-骨贴壁提供较大改善。外科医生可能很难准确地输送特定的打入能量，这表明手术工具有管理植入物就位的余地。(c)2019年，任作家。Journal of Orthopathy Research（R），Wiley Periodicals，Inc.出版。代表骨科研究学会J Orthop Res
Seating a cementless acetabular cup via impaction is a balancing act; good cup fixation must be obtained to ensure adequate bone in-growth and cup apposition, while acetabular fracture must be avoided. Good impaction technique is essential to the success of hip arthroplasty. Yet little guidance exists in the literature to inform surgeons on "how hard" to hit. A drop rig and synthetic bone model were used to vary the energy of impaction strikes in low and high-density synthetic bone, while key parameters such as dynamic strain (quantifying fracture risk), implant fixation, and polar gap were measured. For high energy impaction (15 J) in low-density synthetic bone, a peak tensile strain was observed during impaction that was up to 3.4x as large as post-strike strain, indicating a high fracture risk. Diminishing returns were observed for pushout fixation with increasing energy. Eighty-five percent of the pushout fixation achieved using a 15 J impaction strike was attained by using a 7.5 J strike energy. Similarly, polar gap was only minimally reduced at high impaction energies. Therefore it is suggested that higher energy strikes increase fracture risk, but do not offer large improvements to fixation or implant-bone apposition. It may difficult be for surgeons to accurately deliver specific impaction energies, suggesting there is scope for operative tools to manage implant seating. (c) 2019 The Authors. Journal of Orthopaedic Research (R) published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res