Effect of different motor tasks on hip cup primary stability and on the strains in the periacetabular bone: An in vitro study. (December 2019) - Morosato, Federico
Abstract: Background: Excessive prosthesis/bone motions and the bone strains around the acetabulum may prevent osteointegration and lead to cup loosening. These two factors depend on post-operative joint loading. We investigated how Walking (which is often simulated) and Standing-Up from seated (possibly more critical) influence the cup primary stability and periacetabular strains. Methods: Twelve composite hemipelvises were used in two test campaigns. Simplified loading conditions were adopted to simulate Walking and Standing-Up . For each motor task, a single-direction force was applied in load packages of increasing amplitude. Stable and unstable uncemented cups were implanted. Digital image correlation was used to measure implant/bone motions (three-dimensional translations and rotations, both permanent and inducible), and the strain distribution around the acetabulum. Findings: When stable implants were tested, higher permanent cranial translations were found during Walking (however the resultant migrations were comparable with Standing-Up ); higher rotations were found for Standing-Up . When unstable implants were tested, motions were 1–2 order of magnitude higher. Strains increased significantly from stable to unstable implants. The peak strains were in the superior aspect of the acetabulum during Walking and in the superior-posterior aspect of the acetabulum and at the bottom of the posterior column during Standing-Up . Interpretation: Different cup migration trends were caused by simulated Walking and Standing-Up, both similar to those observed clinically. The cup mobilization pattern depended on the different simulated motor tasks. Pre-clinical testing of new uncemented cups could include simulation of both motor tasks. Our study could also translate to indication of what tasks should be avoided. Highlights: We measured 3D implant migration/micromotions and bone deformation with digital image correlation. Simulation of different motor task induced different patterns of cup migration. Walking induces larger cup cranial translation, standing up larger rotations. Periacetabular strain peaks were larger in standing up especially around unstable implants. The motor task influenced significantly the strain distribution of the principal strain peaks.