Protrusio After Medial Acetabular Wall Breach in Total Hip Arthroplasty

Christopher T Martin; Anneliese D Heiner; Thomas E Baer; Andrew J Pugely; Nicolas O Noiseux

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Protrusio After Medial Acetabular Wall Breach in Total Hip Arthroplasty

Journal article

Open access

Peer reviewed

Protrusio After Medial Acetabular Wall Breach in Total Hip Arthroplasty

Christopher T Martin, Anneliese D Heiner, Thomas E Baer, Andrew J Pugely and Nicolas O Noiseux

The Iowa orthopaedic journal, Vol.35, pp.99-107

2015

PMCID: PMC4492152

PMID: 26361450

Appears in Diamond Open Access

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492152/View

Published (Version of record) Open Access

Abstract

Medial protrusio is a recognized complication of total hip arthroplasty, but it is not known if a medial wall breach during cup implantation increases the risk. We thus investigated the effect of up to a 2 cm defect in the medial acetabular wall in a cadaveric model. Separately, we investigated the ability of acetabular screws to rescue the construct. Nine human fresh-frozen hemipelves were reamed medially to create the defect, implanted with acetabular cups, and then loaded to failure. The nine contralateral hemipelves were reamed in a standard fashion and served as controls. Separately, nine hemipelves with a medial defect were augmented with two acetabular screws each, then loaded to failure, with the contralateral side as a control. Load-to-failure, stiffness, and energy were recorded. The presence of a medial wall defect decreased the load-to-failure by a mean of 26% (5710 v. 4221 N, p=0.024). The addition of two acetabular screws did not rescue the construct (mean 27% decrease, 4082 v. 2985 N, p=0.024). The majority of specimens failed in a supra-physiologic range of force. Bone density correlated with failure loads (R(2) range of 0.54-0.78), and osteoporotic specimens were more likely to fail at a physiologic range, consistent with forces experienced during minor stumbles or falls. Osteoporotic patients with a medial wall defect after hip arthroplasty may be susceptible to fracture during activities of daily living. Protected weight bearing with an assistive device may be reasonable in order to minimize fall risk until cup ingrowth is achieved.

Acetabulum - surgery

Risk Assessment

Bone Screws

Acetabulum - pathology

Humans

Hip Prosthesis

Male

Arthroplasty, Replacement, Hip - adverse effects

Arthroplasty, Replacement, Hip - methods

Biomechanical Phenomena

Prosthesis Failure

Aged, 80 and over

Female

Aged

Joint Instability - etiology

Joint Instability - physiopathology

Details

Title: Subtitle: Protrusio After Medial Acetabular Wall Breach in Total Hip Arthroplasty
Creators: Christopher T Martin - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, IA , USA
Anneliese D Heiner - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, IA , USA ; Department of Biomedical Engineering, University of Iowa , Iowa City, IA , USA
Thomas E Baer - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, IA , USA
Andrew J Pugely - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, IA , USA
Nicolas O Noiseux - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, IA , USA ; Department of Orthopaedic Surgery, VA Medical Center , Iowa City, IA , USA
Resource Type: Journal article
Publication Details: The Iowa orthopaedic journal, Vol.35, pp.99-107
Publisher: Dept. of Orthopaedics, The University of Iowa; United States
PMID: 26361450
PMCID: PMC4492152
ISSN: 1541-5457
eISSN: 1555-1377
Language: English
Date published: 2015
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984040468402771

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