Acetabular Cup Design Influences Deformational Response in Total Hip Arthroplasty

Background Press-fit acetabular components are susceptible to deformation in an underreamed socket, with excessive deformation of metal-on-metal (MOM) components potentially leading to increased torsional friction and micromotion. Specifically, however, it remains unclear how cup diameter, design, and time from implantation affect shell deformation.

Questions/purposes We asked whether (1) changes in component geometry and material altered maximum shell deformation and (2) time-dependent deformational relaxation processes occurred.

Methods Diametral deformation was quantified after press-fit implantation of metal shells into a previously validated polyurethane model. Experimental groups (n = 6-8) consisted of 48-, 54-, 60-, and 66-mm MOM cups of 6-mm wall thickness, 58-mm cups of 10-mm wall thickness, and CoCrMo and Ti6Al4V 58-mm modular cups.

Results Greater cup diameter, thinner wall construction, and Ti6Al4V modular designs generated conditions for maximum shell deformation ranging from 0.047 to 0.267 mm. Relaxation (18%-32%) was observed 120 hours postimplantation in thin-walled and modular designs.

Conclusions Our findings demonstrate a reduction of shell deformation over time and suggest, under physiologic loading, early component deformation varies with design.

Clinical Relevance Component deformation should be a design consideration regardless of bearing surface. Designs neglecting to adequately address deformational changes in vivo could be susceptible to diminished cup survival, increased wear, and premature revision.