Biomechanical evaluation of bispherical augments in acetabular defect reconstruction and comparative study of different fixation methods.

BACKGROUND

Novel bispherical augments developed for acetabular defect reconstruction, which combined with acetabular components, have shown excellent results in clinical follow-up. This study aims to evaluate the primary stability of them in severe acetabular defect reconstruction and biomechanical effect using different combine methods in the component-augment interface, and to further explain their value in clinical applications.

METHODS

Nine composite hemipelvis specimens were prepared with a Paprosky II defect. A porous titanium acetabular shell and bispherical augment were combined and implanted for acetabular defect reconstruction. The augment was fixed to the hemipelvis using screws, while three specimens per groups of three groups were varied by different fixation techniques between the augments and acetabular components: (1) screw fixation only, (2) cement fixation only, and (3) screw and cement fixation. The combined components and hemi pelvic specimens were cyclically loaded (500 cycles) with three different levels of loads (maximum 0.5 kN, 0.9 kN, and 1.8 kN).

RESULTS

All constructs had micromotions of less than 99 μm, and bony ingrowth could be achieved between the prostheses and the bone in 3-30% and 5-50% loads. The cement groups showed the maximum relative movement in the interface between the bone and combined prosthesis, especially when the load was increased to 1.8 kN (100%), while in which the hybrid groups had the minimum value.

CONCLUSION

The study indicates that acetabular defect reconstruction utilizing the bispherical augments can achieve excellent primary stability, which provides the mechanical condition of bone ingrowth for prostheses and augments. The hybrid fixation is the most reliable of them, even under full loads.