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 Adult Hip Reconstruction Test 2: Revision Total Hip Arthroplasty
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The Journal of Bone and Joint Surgery (American) 85:1100-1110 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

A Biomechanical Analysis of Polyethylene Liner Cementation into a Fixed Metal Acetabular Shell

Geoffrey F. Haft, MD, Anneliese D. Heiner, PhD, Lawrence D. Dorr, MD, Thomas D. Brown, PhD and John J. Callaghan, MD

Investigation performed at the Departments of Orthopaedic Surgery and Biomedical Engineering, University of Iowa, Iowa City, Iowa

Geoffrey F. Haft, MD
Thomas D. Brown, PhD
Department of Biomedical Engineering, University of Iowa, 2181 Westlawn Building, Iowa City, IA 52242. E-mail address for G.F. Haft: geoff-haft{at}uiowa.edu E-mail address for T.D. Brown: tom-brown@uiowa.edu

Anneliese D. Heiner, PhD
John J. Callaghan, MD
Department of Orthopaedic Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan@uiowa.edu. E-mail address for A.D. Heiner: anneliese-heiner@uiowa.edu

Lawrence D. Dorr, MD
The Dorr Arthritis Institute, Centinela Hospital Medical Center, 501 East Hardy Street, Suite 300, Inglewood, CA 90301. E-mail address: centinela.appts@tenethealth.com.

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from DePuy, Warsaw, Indiana. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from commercial entities (DePuy and Howmedica, Rutherford, New Jersey). Also, a commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A common clinical scenario encountered by an orthopaedic surgeon is a patient with a secure cementless acetabular shell and a failed polyethylene liner. One treatment option is to cement a new liner into the fixed shell. The purpose of this study was to evaluate technical variables to improve the mechanical strength of such cemented liner constructs.

Methods: The contributions of shell texturing, liner texturing, and cement mantle thickness (between the liner and the shell) were evaluated by comparing torsional strength (among nine groups of constructs) and lever-out strength (among eight groups of constructs).

Results: Failure almost always occurred at the cement-liner interface. The two exceptions (failure at the shell-cement interface) occurred with a polished, untextured shell with no screw-holes. This finding indicates that if a shell has existing texturing (such as holes), further intraoperative scoring of the shell is unnecessary, but some sort of texturing is necessary to avoid construct failure at the shell-cement interface. Textured liners had significantly (a = 0.05) greater torsional and lever-out strength than untextured liners. The greatest construct strength occurred when liner grooves were oriented so as to oppose the applied loading. A 4-mm-thick cement mantle resulted in slightly greater torsional strength than a 2-mm-thick cement mantle, and a 2-mm-thick cement mantle resulted in considerably greater lever-out strength than a 4-mm-thick cement mantle, but these differences were not significant.

Conclusions: When cementing a liner into a well-fixed shell, a surgeon should ensure that both the shell and the liner are textured, as interdigitation of the cement with the shell and the liner is crucial to the mechanical strength of this construct.



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