Abstract
Positioning of the hip resurfacing is crucial for its long term survival and is critical in young patients for some reasons; manly increase the wear in the components and change the load distribution. THR have increased in the last years, mainly in young patients between 45 to 59 years old. The resurfacing solution is indicated for young patients with good bone quality. A long term solution is required for these patients to prevent hip revision. The resurfacing prosthesis Birmingham Hip Resurfacing (BHR) was analyzed in the present study by in vitro experimental studies. This gives indications for surgeons when placing the acetabular cup.
One synthetic left model of composite femur (Sawbones®, model 3403), which replicates the cadaveric femur, and four composite pelvic bones (Sawbones®, model 3405), were used to fix the commercial models of Hip resurfacing (Birmingham model). The resurfacing size was chosen according to the head size of femurs with 48 mm head diameter and a cup with 58 mm. They were introduced by an experimented surgeon with instrumental of prosthesis. The cup is a press fit system and the hip component was cemented using bone cement Simplex, Stryker Corp. The acetabular cup was analyzed in 4 orientations; in anteverion with 15º and 20°; and in inclination 40 and 45°. Combinations of these were also considered
The experimental set-up was applied according to a system previously established by Ramos et al. (2013) in the anatomic position. The femur rotates distally and the Pelvic moves vertically as model changes, such that the same boundary conditions are satisfied. This system allows compensating motions of the acetabular cup orientation. A vertical load of 1700 N was applied on all cases, which have resulted in joint reaction force of 2.4 kN. The femur and iliac bone was instrumented with rosettes. 5 repetitions at each position were conducted.
When the femur was instrumented with three rosettes in medial, anterior and posterior aspect, the maximum strain magnitude was observed in the medial aspect of femur with a minimum principal strain of −2070µε for 45° inclination and 20° of anterversion. The pubic region was found most critical region after instrumenting the Iliac bone with four rosettes, with a minimum principal strain around −2500µε (rosette 1), for the 45° inclination and 20° of anterversion. We have observed the great influence of the inclination on the strain distribution, changing its magnitude from compression to traction in different bone regions.
The minimum principal strain is more critical in medial aspect of the femur and the influence of strain is about 7% when orientation and inclination change. The maximum influence was observed in the anterior aspect, where the anteversion presents a significant influence. The results show the interaction between inclination and anterversion in all aspects, being observed lower values in lower angles.
The orientation of the acetabular cup significantly influences the strain distribution on the iliac surface. Besides, as anterversion increases, more strains are induced, mainly in the region of iliac body (rosette 3).
