The restoration of the anatomical hip rotation center (HRC) has a major influence on the longevity of hip prostheses. Deviations from the HRC of the anatomical joint after total hip arthroplasty (THA) can lead to increased hip joint forces, early wear or loosening of the implant. The contact conditions of acetabular press-fit cups after implantation, including the degree of press-fit, the existence of a polar gap and cup orientation, may affect the HRC restoration, and therefore implant stability. The aim of this study was to determine the influence of acetabular press-fit, polar gap and cup orientation on HRC restoration during THA. THAs were performed by an experienced orthopaedic surgeon in full cadaveric models simulating real patient surgery (n=7). Acetabular cups with a Porocoat™ (n=3) and Gription™ surface coating (n=4) were implanted (DePuy Synthes, Leeds, UK). Computed tomography (CT) scans prior to surgery, as well as after reaming and implantation of press-fit cups were used to calculate the HRC displacement. After aligning the pelves in the anterior pelvic plane, 3D reconstruction of the HRC at each stage was performed by fitting spheres to the femoral head, the reamed cavity and the inserted cup. 3D surface models of the cups were generated using a laser scanner and were registered to the CT images. The effective press-fit was calculated using the diameters of spheres, fitted to the cavity prior to cup insertion and to the outer cup coating. The polar gap was defined as the difference between the outer cup surface and the subchondral bone at the cup pole. Anteversion and abduction angles were calculated as difference between the cup planes and the sagittal and transverse plane, respectively.INTRODUCTION
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Loosening is a major cause for revision in uncemented hip prostheses due to insufficient primary stability. Primary stability after surgery is achieved through press-fit in an undersized cavity. Cavity preparation is performed either by extraction (removing bone) or compaction (crushing bone) broaching. Densification of trabecular bone has been shown to enhance primary stability in human femora; however, the effect of clinically used compaction and extraction broaches on human bone with varying bone mineral density (BMD) has not yet been quantified. The purpose of this study was to determine the influence of the broach design and BMD on the level of densification at the bone-cavity interface, stem seating, the bone-implant contact area and the press-fit achieved. Paired human femora (m/f=11/12, age=60±18 y) were scanned with quantitative computed tomography (QCT, Philips Brilliance 16) before broaching, with the final broach, after its removal and after stem implantation. Compaction broaching (n=4) was compared in an INTRODUCTION
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