Abstract
For total hip arthroplasty or revision surgery using acetabular reinforcement cross-plates, choosing between bulk and morselized bone grafts for filling acetabular defects is challenging. We used finite element model (FEM) analysis to clarify various stresses on the cross-plate based on bone defect size, bone graft type, and presence or absence of hook fixation to the bone. We constructed 12-pattern FEMs and calculated the maximum stress generated on the Kerboull-type (KT) plate and screw. Bone defects were classified into four patterns according to the volume. Regarding the bone graft type, bulk bone grafts were considered as cortical bone, and morselized bone grafts were considered to consist of cancellous bone. Models were compared based on whether hook fixation was used and whether a gap was present behind the plate. The upper surface of the host bone was fixed, and a 1,000-N load was imposed on the horizontal axis at 71°. Larger bone defects increased the stress on the KT plate and screws. This stress increased when no bone was grafted; it was lower when bulk cortical bone grafts were used for filling than when morselized cancellous bone grafts were used. For cortical bone grafts, the increased stress on the KT plate and screws was lowered with hook removal. Attaching the hook to the bone and filling the gap behind the KT plate with an adequate bone graft reduced the stress on the KT plate and screws, particularly for large bone defects filled by bulk bone grafting.
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References
Lee JM, Nam HT (2011) Acetabular revision total hip arthroplasty using an impacted morselized allograft and a cementless cup: minimum 10-year follow-up. J Arthroplasty 26:1057–1060
Buttaro MA, Comba F, Pusso R, Piccaluga F (2008) Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res 466:2482–2490
Jones L, Grammatopoulos G, Singer G (2012) The Burch-Schneider cage: 9-year survival in Paprosky type 3 acetabular defects. Clinical and radiological follow-up. Hip Int 22:28–34
Mibe J, Imakiire A, Watanabe T, Fujie T (2005) Results of total hip arthroplasty with bone graft and support ring for protrusioacetabuli in rheumatoid arthritis. J Orthop Sci 10:8–14
Uchiyama K, Takahira N, Fukushima K, Yamamoto T, Moriya M, Itoman M (2010) Radiological evaluation of allograft reconstruction in acetabulum with Ganz reinforcement ring in revision total hip replacement. J Orthop Sci 15:764–771
Kerboull M, Hamadouche M, Kerboull L (2000) The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res 378:155–168
Tanaka C, Shikata J, Ikenaga M, Takahashi M (2003) Acetabular reconstruction using a Kerboull-type acetabular reinforcement device and hydroxyapatite granules: a 3- to 8-year follow-up study. J Arthroplasty 18:719–725
Kawai T, Tanaka C, Ikenaga M, Kanoe H, Okudaira S (2010) Total hip arthroplasty using Kerboull-type acetabular reinforcement device for rapidly destructive coxarthrosis. J Arthroplasty 25:432–436
Wegrzyn J, Pibarot V, Jacquel A, Carret JP, Béjui-Hugues J, Guyen O (2014) Acetabular reconstruction using a Kerboull cross-plate, structural allograft and cemented dual-mobility cup in revision THA at a minimum 5-year follow-up. J Arthroplasty 29:432–437
Lunn JV, Kearns SS, Quinlan W, Murray P, Byrne JO (2005) Impaction allografting and the Kerboull acetabular reinforcement device: 35 hips followed for 3–7 years. Acta Orthop 76:296–302
Kawanabe K, Akiyama H, Onishi E, Nakamura T (2007) Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years. J Bone Joint Surg Br 89:26–31
Okano K, Miyata N, Enomoto H, Osaki M, Shindo H (2010) Revision with impacted bone allografts and the Kerboull cross plate for massive bone defect of the acetabulum. J Arthroplasty 25:594–599
Akiyama H, Yamamoto K, Tsukanaka M, Kawanabe K, Otsuka H, So K, Goto K, Nakamura T (2011) Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device with bone allograft: minimum 4.5-year follow-up results and mechanical analysis. J Bone Joint Surg Br 93:1194–1200
Crowninshield RD, Maloney WJ, Wentz DH, Humphrey SM, Blanchard CR (2004) Biomechanics of large femoral heads: what they do and don’t do. Clin Orthop Relat Res 429:102–107
Williams M, Lissner HR (1963) Biomechanical analysis of knee function. J Am Phys Ther Assoc 43:93–99
Kawanabe K, Akiyama H, Goto K, Maeno S, Nakamura T (2011) Load dispersion effects of acetabular reinforcement devices used in revision total hip arthroplasty: a simulation study using finite element analysis. J Arthroplasty 26:1061–1066
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Each author certifies that he or she, or a member of their immediate family, has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.
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This work was performed in the Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
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Kaku, N., Hara, K., Tabata, T. et al. Influence of the volume of bone defect, bone grafting methods, and hook fixation on stress on the Kerboull-type plate and screw in total hip arthroplasty: three-dimensional finite element analysis. Eur J Orthop Surg Traumatol 25, 321–329 (2015). https://doi.org/10.1007/s00590-014-1497-x
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DOI: https://doi.org/10.1007/s00590-014-1497-x