This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bonner, K. F.
Right arrow Articles by Mont, M. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bonner, K. F.
Right arrow Articles by Mont, M. A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?
The Journal of Bone and Joint Surgery (American) 84:1587-1593 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Cementation of a Polyethylene Liner into a Metal Shell

Factors Related to Mechanical Stability

Kevin F. Bonner, MD, Ronald E. Delanois, MD, Greg Harbach, MD, Michael Bushelow and Michael A. Mont, MD

Investigation performed at the Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia

Kevin F. Bonner, MD
Jordan-Young Institute, 5501 Greenwich Road, Suite 200, Virginia Beach, VA 23462

Ronald E. Delanois, MD
Greg Harbach, MD
Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Charette Healthcare Center, 27 Effingham Street, Portsmouth, VA 23708

Michael Bushelow
359 Veterans Boulevard, Rutherford, NJ 07070-2584

Michael A. Mont, MD
2411 West Belvedere Avenue, Baltimore, MD 21215
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Various clinical situations may make polyethylene liner exchange desirable in the setting of a well-fixed metal shell. Options have included a simple polyethylene liner exchange or revision of the entire acetabular shell. A recently introduced technique involves cementation of a new liner into a well-fixed metal shell. The purposes of this study were to quantify the mechanical integrity of this method of liner fixation, to evaluate the factors that may influence immediate liner fixation, and to compare this construct with a standard locking mechanism.

Methods: One modular acetabular cup design was evaluated. Variables that may contribute to the mechanical integrity of the construct were evaluated via lever-out and multiaxis dislocation testing methods. The variables included the size of the liner (undersized versus oversized), type of liner (all-polyethylene versus modular design), modification of the modular liner (unmodified versus grooved), and groove configuration (cruciform versus circumferential). Metal shells with and without screw-holes were also tested. The modular locking mechanism was used as the control.

Results: None of the constructs failed at the cement-metal interface. All undersized liners required significantly higher loads to failure than either the controls (p < 0.001) or the oversized liners (p < 0.001). Oversized unmodified liners failed at significantly lower loads than the controls did (p < 0.01). The creation of circumferential grooves in the oversized liners significantly improved the strength of the constructs (p < 0.01), making them comparable with the controls. No significant differences were found among the four undersized groups (p > 0.3). The standard locking construct (control) and the oversized unmodified construct failed at a force of 2000 N in the multiaxis dislocation test. No other construct failed with use of this test mode.

Conclusions: Cementation of a polyethylene liner into a metal shell can be stronger than a conventional locking mechanism if the liner is undersized. Cementation of an oversized liner into a shell should be performed with caution. The long-term durability of this fixation remains unknown.

Clinical Relevance: Cementation of a polyethylene liner in a well-fixed metal shell may provide an alternative option in acetabular revision surgery.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
J. J. Callaghan, J. Parvizi, C. C. Novak, B. Bremner, W. Shrader, D. G. Lewallen, R. C. Johnston, and D. D. Goetz
A Constrained Liner Cemented into a Secure Cementless Acetabular Shell
J. Bone Joint Surg. Am., October 1, 2004; 86(10): 2206 - 2211.
[Abstract] [Full Text] [PDF]